2.10 Reproductive

Question 1

Erectile Dysfunction aka Impotence

What is it?

Answer 1

Inability to attain or maintain an erection.

Age related changes in sexual function include:

Cellular & tissue changes of penis

Decreased sensory activity

Decreased testosterone levels

Effects of chronic illness & meds to treat the illnesses.
DM, HTN, renal failure are examples.

Skin sensation of penis declines causing increased time to achieve erection

Greying & thinning of pubic hair

Increased drooping of the scrotum & loss of rugae

Question 2

Erectile Dysfunction-

NI

Answer 2

Nursing Considerations:
Obtain med history.
Teach: Do not take ED meds if on nitrate based meds can cause severe hypotension and cardiac s/e.
Assess for risk factors (new meds, new dx).
Detailed assessment of sexual practices.
Encourage discussion with partner.

Question 3

Erectile Dysfunction-

med and treatment

Answer 3

Meds & Treatment:
Sildenafil (Viagra)
Tadalfil (Cialis)

Vacuum-assisted erection device
Surgery to re-vascularize (Vacuum device draws blood into the penis and an o ring is secured at the base of penis to keep blood there during intercourse)

Lifestyle changes – wt. loss, smoking cessation, exercise.

Penile implants

Penile injections- self-inject prostaglandin E1 into shaft of penis.

Wear condom to prevent infection during intercourse.

Question 4

Penile Cancer

what is it

Answer 4

Rare occurrence
Cause unknown- HPV present in 50% of cases.

Penile cancer less common in men who have had circumcisions.

Question 5

Penile Cancer
diagnosis
prognosis

Answer 5

Diagnosis:
Biopsy of lesion and suspicious lymph nodes
Prognosis:
Good if dx early & no lymph involvement.

Question 6

Penile Cancer
s/s
treatment

Answer 6

/S
Foul-smelling discharge
Enlarged inguinal lymph nodes (occasionally)
Treat:
Prevent- HPV vaccine
Penectomy (Man may have continent perineal urethrostomy but the man must void sitting down)
Radiation 
Creams

Question 7

Testicular CA-

what is it

Answer 7

Occurrence 1 in every 250 men
Common age 13-35
Cause unknown- correlation with undescended testicle at birth.

Question 8

Testicular CA
s/s
treatment

Answer 8

S/S
1st sign- slight painless enlargement of one testicle.
Abdominal ache
Heaviness in one testicle 
Treatment:
Chemo- up to 95% cure rate
Radical orchiectomy –(testicle removal)
Radiation 
Considered one of the most curable cancers.

Question 9

Prostate CA- what is it

Answer 9

Common type of cancer 2nd leading cause of CA death in men in US.

Question 10

Prostate CA

risk factors

Answer 10

Risk Factors:
 85% dx after age 65
Family hx
Vasectomy-believed r/t increased levels of free testosterone circulating 
Diet high in animal fat
95-100% cure rate

Question 11

Prostate CA

s/s

Answer 11

S/S
Early stage asymptomatic
Urgency, frequency, hesitancy, nocturia, dysuria, reduced stream. 
Hematuria common late sign.
Fatigue, weight loss.

Question 12

Prostate CA

diagnostics

Answer 12

Diagnostics
Digital rectal exam=nodular prostate
PSA –can be elevated in CA of prostate
Biopsy= definitive diagnosis

Question 13

Prostate CA Treatment

medication

Answer 13

Medication Treatment:
Androgen deprivation therapy.

Many tumors are androgen dependent.

Question 14

Prostate CA

androgen deprivation meds

Answer 14

Androgen deprivation meds:
Leuprolide (Lupron)
Goserelin (Zoladex)
Radiation

Question 15

Prostate CA

surgical

Answer 15

Surgical Treatment
Prostatectomy
Orchiectomy

Question 16

Prostate CA

complications

Answer 16

Complications of Tx:
ED( with open radical prostatectomy)
Urinary incontinence
Diarrhea- radiation tx

Question 17

Menopause

types

Answer 17

Types of Menopause:
Natural/biologic (average age 52)
Surgical
Chemical (chemotherapy/cytotoxic drugs)

Question 18

Menopause

diagnosis

Answer 18

Diagnosis:
No menstruation x 1 full year
Estrogen decreases & FSH & LH remain elevated
Combination of above 2 is diagnostic for menopause.

Question 19

Menopause

physical assessment

Answer 19

Decrease in breast tissue, body hair, skin elasticity, & sub q fat
Ovaries & uterus become smaller
Cervix & vagina decrease in size & become pale in color
Decreased size of labia majora and clitoris
Loss of elasticity of pelvic ligaments & connective tissue.
Greying & thinning of pubic hair

Question 20

Menopause
Perimenopausal Period (lasts several years):
S/S:

Answer 20

Perimenopausal Period (lasts several years):
S/S:
Erratic menstrual cycles
Vaginal PH rises increasing vaginal infection risk.
Decreased vaginal lubrication 
Vasomotor instability
Hot flashes & night sweats
Palpitations, dizziness

Question 21

Menopause

psychogenic s/s

Answer 21

Psychogenic S/S:
Moodiness
Nervousness/anxiety
Insomnia/frequent awakenings
HA
Irritability
Poor concentration/memory
Depression

Question 22

Menopause

effects of long term estrogen deprivation

Answer 22

Effects of long term estrogen deprivation:
Imbalance in bone remodeling (fracture risks)
Osteoporosis- Ca & Vit D supplements & weight bearing activities.
Increased Cardiovascular risks
Atherosclerosis development (r/t LDL:HDL ratio increase)

Question 23

Menopause

treatment

Answer 23

Treatment:
HRT- controversial r/t ? Increased risk of breast & ovarian CA, stroke, MI, DVT. Informed consent.
Antidepressants- SSRI’s- promote use of serotonin to affect heat regulation in body. (off label use)

Question 24

Menopaus

Teaching

Answer 24

each:
Dress in layers
Use vaginal lubricant
Screening: PAP, BSE, bone density testing, lipid profile, wt. control.

Question 25

Breast CA- | risk factors

Answer 25

Risk Factors: Increased age is primary risk factor for men and women. Family history Menstruation before age 12 /menopause after age of 55 yrs. Oral contraceptive use No children or having after age 30 Long term use of HRT Overweight (physical inactivity are higher risk of developing breast cancer) Never breastfed

Question 26

Breast CA- | s/s

Answer 26

``` S/S of Breast CA: Non-tender lump in breast Nipple discharge Rash around nipple Nipple retraction Dimpling of skin Nipple pain may occur Usually painless Some pts. report burning or stinging ```

Question 27

Breast CA | diagnosis

Answer 27

``` Diagnostics Mammogram –detects tumors 2 years before palpable Ultrasound MRI or PET scan Needle biopsy Clinical Breast exam- CBE Breast self exam - BSE ```

Question 28

Breast CA Treatment | radiation

Answer 28

Radiation Typically after surgery (adjuvant), but can shrink large tumors pre-op Can be palliative, treat bone mets Daily, intraoperative hi dose, brachytherapy

Question 29

Breast CA Treatment | chemo

Answer 29

Chemotherapy If axillary nodes + most get chemo Prolong life in metastatic disease Neoadjuvant = pre-op to shrink large tumors Adjuvant = widely used, chemo after surgery

Question 30

Breast CA Treatment | hormone

Answer 30

Hormone Therapy - Estrogen blockers- Tamoxifen (If take for 5 years following surgery it can reduce the risk of cancer reoccurrence by about 50%) - Fareston (treat postmenopausal women with advanced cancers) - Arimidex Immunotherapy agents Herceptin) used to stop growth of tumors.

Question 31

Breast CA Treatment | surgical

Answer 31

``` Surgical Intervention: Aspiration biopsy Excisional biopsy Lumpectomy Mastectomy ```

Question 32

Breast CA Treatment | surgical complications

Answer 32

Complications of surgery for breast cancer ``` Lymphedema Pain Infection/delayed healing Grieving Affects on sexual intimacy Body image concerns: reconstruction or prosthesis ```

Question 33

Breast CA Treatment | Prophylactic Mastectomy

Answer 33

Prophylactic Mastectomy- in high risk patients | -women who carry a BRCA1 or BRCA2 gene mutation

Question 34

Nursing Care after Mastectomy

Answer 34

Wound and drain care Pain management Restore operative arm function – move affected arm Prevent lymphedema- no b/p, lab draws affected arm Provide psychosocial support- anxious, sad, body image disturbance Counselor or support group

Question 35

Cervical Cancer | risk factors

Answer 35

Risk factors HPV infection- most important risk factor. 1st intercourse before age 16 Multiple sex partners, STI’s Multiple pregnancies Smoking Family history Overweight Long-term use of oral contraceptives.

Question 36

Cervical Cancer | manifestations

Answer 36

Manifestations: Early: None Late: watery vaginal discharge that becomes dark and foul-smelling, bleeding after intercourse, post-menopausal bleeding Later: pressure on bowel and bladder, ureteral obstruction, heavy aching and abdominal /back pain, hematuria, anemia

Question 37

Cervical Cancer | treatment

Answer 37

Treatment Chemotherapy Radiation Surgical intervention Cold conization- removal of cone shaped portion of cervix Cryosurgery- freezing cervix causing necrosis & sloughing Hysterectomy

Question 38

Cervical Cancer | diagnostic

Answer 38

Diagnostic Tests PAP smear Colposcopy-magnifying device used when abnormal PAP results. Tissue samples can be taken. Cervical biopsy

Question 39

Endometrial Cancer | what is it

Answer 39

Most frequent diagnosed reproductive cancer in women cancer of the uterine lining.

Question 40

Endometrial Cancer | risk factors

Answer 40

``` Risk Factors Early menarche or late menopause Use of estrogen after menopause Use of birth control pills. Obesity DMII, polycystic ovarian syndrome. Endometrial hyperplasia. ```

Question 41

Endometrial Cancer | s/s

Answer 41

S/S: Abnormal painless vaginal bleeding in postmenopausal women. Late: pelvic cramping, bleeding after sex, lower abdominal pressure, enlarged uterus.

Question 42

Endometrial Cancer | diagnosis

Answer 42

Diagnosis: Transvaginal ultrasound & Endometrial biopsy provides gold standard for definitive diagnosis. CA-125- identifies markers CT, MRI, PET scans **Any post menopausal bleeding is abnormal and needs evaluation!!!

Question 43

Ovarian Cancer | what is it

Answer 43

Tumors grow rapidly & spread quickly. Spread directly to nearby organs & through blood/lymph circulation.

Question 44

Ovarian Cancer | risk factors

Answer 44

``` Risk factors: Middle to older age. BRCA1 or BRCA2 gene mutations. Infertility/ difficulty getting pregnant. Hx. of endometriosis. ```

Question 45

Ovarian Cancer | diagnosis

Answer 45

Diagnosis: Bimanual pelvic exam performed Biopsy/ CT scan/ Ultrasound CA-125 – tumor marker highly specific to ovarian CA

Question 46

Ovarian Cancer | s/s

Answer 46

Formerly thought to be a “silent” disease where no s/s presented until late progression. Evidence now shows common early s/s include: - Bloating, urinary urgency/frequency - Difficulty eating - Feeling full - Pelvic pain. Caught early is treatable. Bimanual palpation of mass may not be palpable until it reaches a size of 4-6 inches Many do not seek care with the s/s because they are often associated with other things (menopause, constipation, weight gain)

Question 47

Ovarian Cancer – | treatment

Answer 47

Treatment: TAH (Total abdominal hysterectomy) with BSO (bilateral salpingo-oophorectomy) Radiation Chemotherapy Pts. Identified with BRCA1 & BRCA2 may opt for prophylactic BSO.