Assessment of the Reproductive System

Question 1

Decreased efficiency in age
Graying and thinning of pubic hair
Decreased size of the labia majora and clitoris
Drying, smoothing, and thinning of the vaginal walls
Decreased size of the uterus
Atrophy of the endometrium
Decreased size and marked convolution of the ovaries
Loss of tone and elasticity of the pelvic ligaments and connective tissue
Increased flabbiness and fibrosis of the breasts, which hang lower on the chest wall; decreased erection of nipples

Answer 1

Female - Changes in the reproductive system related to aging

Question 2

Decreased efficiency in age
Graying and thinning of pubic hair
Increased drooping of the scrotum and loss of rugae
Prostate enlargement, with an increased likelihood of urethral obstruction

Answer 2

Male - Changes in the reproductive system related to aging

Question 3

Thorough history
Nutrition
Family history and genetic risk

Answer 3

Patient history - Assessment-history

Question 4

Huge impact on diff types reproductive cancer
High/excessive alcohol intake increases risk of ovarian cancer
Diet high in fat and low in fruits and vegetables increases risk of reproductive cancers - Ex. Prostate cancer (specifically if saturated fats and red meats), ovarian cancer

Answer 4

Nutrition

Question 5

Daughters of women given diethylstilbestrol (DES) to control bleeding during pregnancy are at increased risk for infertility and reproductive tract cancer - child woman who received that during pregnancy then increased risk
Specific BRCA1 and BRCA2 gene mutations increase overall risk for breast and/or ovarian cancer
Men with first-degree relatives (father, brother) -fam history- with prostate cancer are at greater risk

Answer 5

Family history and genetic risk

Question 6

Focused assessment related to specific concerns and needs of the patient
Primary/chief complaint is

Answer 6

Physical assessment

Question 7

Pain - diff times cancer
Bleeding - female areas = cancer; hematuria = prostate cancer
Discharge - unusual discharge out ordinary
Masses - cancer
Reproductive tract cancers for females not notice masses as much since internal

Answer 7

Current health problems - brings people into healthcare

Question 8

Cytologic study effective in detecting precancerous and cancerous cells from the cervix
Annual Pap test starting at age 21; if negative after reproductive years can stretch out testing
Cervical cancer - want detect early so treat more effectively
Full pelvic exam; samples off cervix and test for diff cells; cytology test

Answer 8

Pap smear-F

Question 9

Highly associated with cervical cancer; vaccine against HPV (causes genital warts)
Puts men at higher risk for other cancer
Used to identify many high-risk types of HPV associated with the development of cervical cancer
Cells are collected from the cervix at the same time a Pap test is completed

Answer 9

Human papilloma virus (HPV)-F

Question 10

Big for STDs
Used to detect bacterial, viral, fungal, and parasitic disorders

Answer 10

Vaginal cultures-F

Question 11

Elevated with ovarian cancer

Answer 11

Alpha fetoprotein (AFP)-F

Question 12

Elevated/big with ovarian cancer; long-term monitoring with this; ovarian not caught early because not lot symptoms and symp vague (abd bloating, discomfort) so caught later stages

Answer 12

Cancer antigen 125 (CA 125)-F

Question 13

Drawn lot on men; esp once older
Normally increase with age
BPH increase PSA and prostatitis; not specific so only screening
increases with age
Have prostate cancer - monitor over time; raised for lot diff things: BPH
Indicates prostate probs
Used as a screening lab for prostate cancer because other prostate problems can increase the level
Some variance on the PSA value and how it is affected by age

Answer 13

Prostate-specific antigen (PSA) test-M

Question 14

Diagnostic for prostate cancer - do biopsy tell cancer
Elevations indicative of prostate cancer
EPCA-2 is very sensitive and can detect cancer early

Answer 14

Early prostate cancer antigen (EPCA-2) and Serum acid phosphatase-M

Question 15

Elevations indicative of testicular cancer - hit younger people; looking for masses
Indicative of testicular cancer

Answer 15

Alpha-fetoprotein (AFP), Beta human chorionic gonadotropin (hCG), and Lactate dehydrogenase (LDH)-M

Question 16

Evaluate for metastasis with different reproductive cancers
Evaluate for ovarian cancer
After diagnosed with reproductive cancer to check for metastasis

Answer 16

CT

Question 17

Not tons; very high risk for breast cancer
Better pic
Evaluation for breast cancer for women with high risk factors

Answer 17

MRI

Question 18

For diff types cancer
Get good pics
Transvaginal ultrasound-ovarian and endometrial cancer
Transrectal ultrasound-prostate cancer
Ultrasound-evaluate for testicular masses versus fluid; concerned about testicular cancer because differentiate if fluid mass or tumor
Also used for breast cancer evaluation

Answer 18

Ultrasonography

Question 19

Common imaging used to eval reproductive tract in woman
X-ray that uses an injection of a contrast medium to visualize the cervix, uterus, and fallopian tubes
Used to evaluate tubal anatomy and patency and uterine problems such as fibroids, tumors, and fistulas
Do early on in cycle so risk pregnancy lower; first ½ menstrual cycle
Inject dye and tubes patent - dye goes into peritoneal space - good result
Not resulted
Pre: Assess for allergies to contrast dye
Post: Some pelvic and referred shoulder pain - irritate phrenic nerve during procedure

Answer 19

Hysterosalpingography

Question 20

Big one for breast cancer
x-ray of the soft tissue of the breast
Now have 3-D mammograms that allow better visualization of the layers of breast tissue
Annually for women ages 40 and older
Some research recommend every other year over 40 and annually over 50 if no risk factors; lot research recommends annually 40+
Pre: no creams, lotions, powders or deodorant on breast or under arms - interferes with pic
May experience discomfort during procedure - smush breast tissue to get good pic
Post: reinforce continued self breast exams and clinical breast exams (very extensive)
Catch breast cancer early so treat them and better outcomes; less mortality with breast cancer; better survival rate if caught early

Answer 20

Mammography

Question 21

Examination of the cervix and vagina using a colposcope
Allows three-dimensional magnification and intense illumination of epithelium with suspected disease
Locate exact site of precancerous and possible malignant lesions for biopsy
Better pic of lesion/area think cancerous

Answer 21

Colposcopy

Question 22

Direct examination of the pelvic cavity through a endoscope
Performed under anesthesia typ
Pre: NPO prior
Post:
Some pelvic and referred shoulder pain - irritate phrenic nerve
Observe incision sites for infection - redness, swelling, temp; tiny incisions
Can also used during surgical procedures/instead of procedures; less invasive - make little incisions

Answer 22

Laparoscopy

Question 23

Fibroptic camera that is inserted into the vagina
Examines the cervix and uterus
Performed with regional nerve block - numbness post-op and safety is issue
Post: Some pelvic and referred shoulder pain

Answer 23

Hysteroscopy

Question 24

Biopsy gives

Answer 24

definitive diagnosis for cancers regardless of area

Question 25

Cervical tissue is removed for cytologic study Do Early in menstrual cycle so less vascular and less risk of bleeding Pre: Depends on anesthesia used - gen: NPO Address anxiety - not top priority since safety always is but make sure address any concerns from psychosocial standpoint Post: Monitor for bleeding and infections - inform about s/s: temp, increased bleeding, increased pain Nothing in vagina for 2 weeks post biopsy No heavy lifting

Answer 25

Cervical

Question 26

Used to obtain cells directly from the lining of the uterus to assess for cancer of the endometrium Biopsy endometrium of uterus For cancers and check for menstrual abnormalities and if infertile Assess menstrual disturbances and infertility - issues with fertility do endometrial biopsy Post: Some cramping may occur Monitor for bleeding and infections Some Spotting for 1-2 days Nothing in vagina for 1-2 days or as long as have spotting/discharge

Answer 26

Endometrial

Question 27

Tissue aspirated through a large bore needle or through small incision - 2 ways dones local anesthetic Aspirated fluid from benign cysts may appear clear to dark green-brown Bloody fluid suggests cancer - suspicious of cancer Pre: Depends on anesthesia used Address anxiety - psychosocial anxiety experiencing Post: Mild/min pain alleviated/managed with non-opioid analgesics, ice or heat Monitor incision for bleeding and infection Some Numbness may occur around biopsy site - tell pat about this Wear a really supportive bra for at least 1 week - helps pain and discomfort

Answer 27

Breast

Question 28

Definitive diagnostic tool for prostate cancer 2 ways Transurethral biopsy Insert a needle through the area of skin between the anus and scrotum Transrectal biopsy Passing the needle through the wall of the rectum to get to prostate More common one Typ in providers office Pre: Discuss positioning and some discomfort during procedure - side lying and knees toward them Address anxiety - psychosocial issues related to diagnosis; helping through procedure and edu ahead of time No anesthesia - no NPO Post: Educate regarding soreness and possible light rectal bleeding, possibily some blood in urine and stool for a few days since biopsied prostate in addition to rust colored semen for several weeks - let know this Monitor for signs of excessive bleeding (report), infection and urinary retention - signs of any of these report Post biopsy antibiotic - for infection prevention

Answer 28

Prostate