Nursing care of clients with specific health problems related to reproduction and sexuality

Question 1

A urethral defect in which the urethral opening is not at the end of the penis but on the ventral (lower) aspect of the penis.

Answer 1

Hypospadias

Question 2

Denotes a urethral opening on the superior or dorsal (i.e., upper) surface.

Answer 2

Epispadias

Question 3

Urethral defect occurring in approximately 1 in 300 male newborns.

Answer 3

Hypospadias

Question 4

Urethral defect occurring in approximately 1 in 100,000 male newborns.

Answer 4

Epispadias

Question 5

Many newborns with hypospadias have an accompanying short
_______ : a fibrous band that causes the penis to curve
downward (often called a cobra-head appearance).

Answer 5

chordee

Question 6

The opening of the urethra is located somewhere near the head of the penis.

Answer 6

Subcoronal Hypospadias

Question 7

The opening of the urethra is located along the shaft of the penis.

Answer 7

Midshaft Hypospadias

Question 8

The opening of the urethra is located where the penis and scrotum meet.

Answer 8

Penoscrotal Hypospadias

Question 9

Hypospadias
Therapeutic Management
Should not be ___________ :

Answer 9

Circumcised Surgeon may wish to use a portion of the foreskin during repair.

Question 10

A procedure in which the urethra is extended to a usual position—to establish better urinary function.

Answer 10

Meatotomy

Question 11

When the child is older (___ to ___ months), adherent chordee can be released. If the repair will be extensive, all surgery may be delayed until the child is __ to __ years of age. Must be corrected before _______ age if at all possible so the child looks and feels like other males.

Answer 11

12 to 18 months
3 to 4 years of age
school age

Question 12

The child may notice painful bladder spasms as long as the catheter is in place (__ to __ days), so an analgesic such as acetaminophen (Tylenol) and an ____________ medication such as oxybutynin (Ditropan) may be prescribed for pain relief.

Answer 12

3 to 7 days

anticholinergic

Question 13

Meatal opening at an inferior penile site may interfere with
________ because it does not allow sperm to be deposited close to
the female cervix during coitus.

Answer 13

fertility

Question 14

A most common benign tumor of the breast in women of all
ages.

Answer 14

Fibrocystic disease of the breast

Question 15

Fluctuating hormone levels during the menstrual cycle can cause
breast discomfort and areas of lumpy breast tissue that feel
tender, sore and swollen.

Answer 15

Fibrocystic disease of the breast

Question 16

Most common in older adolescents. Can occur as early as puberty, when estrogen rises to adult levels.

Answer 16

Fibrocystic disease of the breast

Question 17

List the how you can Diagnosis Fibrocystic disease of the breast

Answer 17

Mammogram and ultrasound.
BSE (breat self examination)
-Should be performed at monthly intervals, preferably 1 week
after menses.

Question 18

BSE (breat self examination)
-Should be performed at monthly intervals, preferably __ week/s
after menses.

Answer 18

1 week

Question 19

Fibrocystic disease of the breast
Assessment:

Answer 19

Breast tenderness
Round, fluid-filled, and freely movable cysts form in the
connective breast tissue.

Question 20

3 patterns in conducting BSE

Answer 20

Lines
Circles
Wedges

Question 21

Fibrocystic disease of the breast
Medical Management:

Answer 21

-Breast tenderness: Acetaminophen (Tylenol), an NSAID, or warm compresses, avoidance of trauma, and firm bra support.

-Annual breast ultrasound or magnetic resonance imaging (MRI) to efficiently locate and identify that the cysts are benign.

Question 22

Fibrocystic disease
of the breast
Surgical Management:

Answer 22

Aspiration: Reduces the size of
the cyst but also provides fluid
for biopsy.(FNAB)

Question 23

FNAB

Answer 23

Fine needle aspiration biopsy

Question 24

The client frequently finds lumps in her breasts, esp. around
her period. Which info should the nurse teach the client re:
breast self care?
1. This is a benign process that does not need follow up.
2. Eliminate chocolate and caffeine from diet.
3. Practice breast self exam monthly.
4. This is how breast cancer starts and she needs surgery

Answer 24

3. Practice breast self exam monthly.

Question 25

-Benign tumors that consist of both fibrotic and glandular components that occur in response to estrogen stimulation . -They may increase in size during adolescence, during pregnancy and lactation, or when a woman takes an estrogen source such as an oral contraceptive.

Answer 25

Fibroadenoma

Question 26

Fibroadenoma -They may increase in size during adolescence, during pregnancy and lactation, or when a woman takes an _________ source such as an oral contraceptive.

Answer 26

estrogen

Question 27

Where do fibroadenoma usually occur in the breast? a. fat b. muscle c. lobule d. milk duct

Answer 27

C. Lobule

Question 28

Fibroadenoma Assessment: -Feels _______ and well delineated, are ________ and freely movable. -Occasionally, they _______ and feel extremely hard.

Answer 28

round painless calcify

Question 29

Fibroadenoma Surgical management:

Answer 29

Breast mass excision (BME)

Question 30

ADDENDUM: Breast Surgeries – the surgeon removes: • all of the breast tissue • the skin of the breast • the nipple and the areola (the dark area around the nipple)

Answer 30

Simple mastectomy (also called a total mastectomy)

Question 31

Breast Surgeries Surgery to remove the whole breast, all of the lymph nodes under the arm, and the chest wall muscles under the breast

Answer 31

Radical Mastectomy /Halsted Radical mastectomy

Question 32

Breast Surgeries The entire breast is removed, including the skin, areola, nipple, and most axillary lymph nodes, but the pectoralis major muscle is spared.

Answer 32

Modified radical mastectomy

Question 33

Breast Surgeries Removes the cancer while leaving as much normal breast as possible.

Answer 33

Breast-conserving surgery (BCS)

Question 34

Inflammation of the breast due to infection that may occur as early as the 7th postpartal day or not until the baby is weeks or months old.

Answer 34

Mastitis

Question 35

The organism causing the infection usually enters through cracked and fissured nipples. (Bacterial Mastitis)

Answer 35

Mastitis

Question 36

Assessment for Mastitis

Answer 36

Breast feels painful and appears swollen and reddened. Fever accompanies these first symptoms within hours Breast milk becomes scant.

Question 37

Mastitis Therapeutic Management: -Antibiotic against penicillin-resistant staphylococci such as _________ or a _________.

Answer 37

dicloxacillin cephalosporin

Question 38

Provide Therapeutic Management for mastitis

Answer 38

- Antibiotic against penicillin-resistant staphylococci such as dicloxacillin or a cephalosporin. - Breastfeeding should be continued if possible because keeping the breast emptied of milk helps to prevent the growth of bacteria. - Express milk manually from the affected breast until their antibiotic has taken effect and the mastitis has diminished (about 3 days). - Cold or ice compresses and a good supportive bra help with pain relief.

Question 39

Mastitis Measures to prevent nipples from cracking:

Answer 39

-Making certain the baby is positioned correctly and grasps the nipple properly, including both the nipple and areola - Helping a baby release a grasp on the nipple before removing the baby from the breast - Washing hands betweenhandling perineal pads and touching breasts - Exposing nipples to air for at least part of every day - Encouraging women to begin breastfeeding (when the infant sucks most forcefully) on an unaffected nipple (if a woman has one cracked nipple and one well nipple)

Question 40

Prevention of breast engorgement

Answer 40

Regular breastfeeding -Every 1 to 3 hours throughout the day and night. While you should let them breastfeed for as long as they want, aim for at least 20 minutes at each feeding (10 minutes each side)

Question 41

Abnormal growth of extrauterine endometrial cells, often in the cul-desac of the peritoneal cavity or on the uterine ligaments or ovaries, and is one of the main causes of dysmenorrhea in adolescents.

Answer 41

Endometriosis

Question 42

This abnormal tissue results from excessive endometrial production and a reflux of blood and tissue through the fallopian tubes during a menstrual flow

Answer 42

Endometriosis

Question 43

Endometriosis Assessment:

Answer 43

-Dyspareunia (painful coitus): Abnormal tissue in the pelvic cul-desac can cause pressure on the posterior vagina. -Pelvic examination: Uterine displacement due to tender, fixed, palpable nodules. -Pelvic UTZ: Large endometrial tissues; Chocolate cysts (endometrioma)

Question 44

Endometriosis Complications:

Answer 44

Subfertility: Immobilized fallopian tubes blocked by tissue implants or adhesions, preventing peristaltic motion and transport of ova. Adhesions

Question 45

Endometriosis Therapeutic Management: __________/_________ ____ ________ may reduce the amount of extrusion into the peritoneal cavity because the tissue sloughs under the influence of the progesterone. ____________, a synthetic androgen, can be prescribed to help shrink the abnormal tissue. Administration of a GnRH agonist, such as __________ _______ (Lupron), can reduce hormone stimulation to help shrink the abnormal tissue.

Answer 45

-Estrogen/progesterone-based oral contraceptives -Danazol (Danocrine) -leuprolide acetate

Question 46

Endometriosis Surgical Management:

Answer 46

Laparoscopic surgery A laparotomy with excision by laser surgery is the most effective measure. Adhesiolysis Hysterectomy Oophorocystectomy/Ovarian cystectomy

Question 47

Endometriosis Nursing considerations:

Answer 47

Patient Education Complications → Infertility/Subinfertility Don’t postpone childbearing Importance of treatment Check hemoglobin level as ordered. Annual pelvic exam Evaluate disease progression

Question 48

-Bladder prolapse (________) is a chronic condition during which a bladder herniates to the anterior vaginal wall. -Due to weakness of the pelvic floor muscles (Levator ani) and the connective tissue surrounding the bladder and vagina.

Answer 48

Cystocele

Question 49

Cystocele Factors:

Answer 49

-Obesity -Increasing age: Changes in pelvic anatomy. -Multiparity -Increased intra-abdominal pressure: Constipation, chronic cough, and obstructive pulmonary disease -Family history of cystocele -Following pelvic surgery: Damage to the endopelvic fascia and nerves.

Question 50

Cystocele Assessment:

Answer 50

Feeling of pressure or sensation that something is bulging or about to come out of the vagina. Incontinence: Overactive bladder Dyspareunia

Question 51

Cystocele Diagnostics:

Answer 51

Vaginal examination Perineal floor ultrasound cystourethrogram

Question 52

Cystocele Medical and surgical management:

Answer 52

Pessaries: Plastic or silicone devices that are inserted into the apex of the vagina. Kegel exercises (pelvic muscle exercises) can be advised for women with stage 1 or 2 prolapse Anterior colporrhaphy (Cystocele Repair) - Performed trans-vaginally to repair central vaginal wall defects and to lessen the size of the anterior vaginal wall. Sacral Colpopexy This procedure aims to place a permanent mesh to the anterior and posterior walls of the vagina and then attach it to the anterior longitudinal ligament below the sacral promontory. • Benefit : Avoids vaginal incisions and scarring, which results in a lower risk of vaginal shortening or dyspareunia.

Question 53

Sacral Colpopexy

Answer 53

This procedure aims to place a permanent mesh to the anterior and posterior walls of the vagina and then attach it to the anterior longitudinal ligament below the sacral promontory. • Benefit : Avoids vaginal incisions and scarring, which results in a lower risk of vaginal shortening or dyspareunia.

Question 54

Performed trans-vaginally to repair central vaginal wall defects and to lessen the size of the anterior vaginal wall.

Answer 54

Anterior colporrhaphy (Cystocele Repair)

Question 55

Is a variety of pelvic organ prolapse (POP) that involves the herniation of the rectum through the rectovaginal septum into the posterior vaginal lumen.

Answer 55

Rectocele

Question 56

The loss of integrity in the rectovaginal fascia would result in a herniation of the rectal tissue into the vaginal lumen leading to a vaginal bulge along the posterior vaginal wall on examination that would become more pronounced with the Valsalva maneuver.

Answer 56

Rectocele

Question 57

Rectocele Physical assessment:

Answer 57

Pelvic pain/pressure Posterior vaginal bulge Obstructive/Incomplete defecation Constipation Dyspareunia Erosions and bleeding of mucosa if there is tissue exposure to the outside environment

Question 58

Rectocele Diagnostic:

Answer 58

Vaginal/Rectal exam Defecography: Contrast medium is instilled in the vagina, bladder, and rectum. This test can be useful to determine the size of the rectocele.

Question 59

Rectocele Medical and Surgical Management:

Answer 59

 High fiber diet and increased water intake to reduce constipation/defecatory symptoms. Kegel exercises Vaginal pessary: Stabilize the defects in the pelvic floor Rectocele Repair aka Posterior colporrhaphy: Tightens the muscles in the back wall that hold your rectum in place.

Question 60

A type of fistula wherein there is a tunnel-like opening that develops between the vagina and rectum.

Answer 60

Rectovaginal fistula

Question 61

Rectovaginal fistula Factors:

Answer 61

Prolonged vaginal labors Pressure from your baby pushing against your vaginal wall can reduce blood flow, causing tissue death. Vaginal tears Inflammatory bowel diseases (IBD) Colon infections like diverticulitis. Radiation therapy to your pelvic region.

Question 62

Rectovaginal fistula Assessment

Answer 62

Foul-smelling vaginal discharge. Gas, pus or stool that leaks out of the vagina. Dyspareunia Recurrent urinary tract infections (UTIs) or vaginitis (vaginal infections). Rectal bleeding or vaginal bleeding. Skin irritation in your vagina, vulva (entrance to the vagina) or perineum.

Question 63

Rectovaginal fistula Diagnostic:

Answer 63

CBC and urinalysis to look for infections. Fistulogram X-ray to determine the number and size of fistulas. Pelvic MRI or CT scan to take images of your vagina and rectum. Flexible sigmoidoscopy to view your rectum and the lower part of your large intestine (colon). Colonoscopy to examine the inside of your rectum and all of your large intestine

Question 64

Rectovaginal fistula Medical/Surgical Managment:

Answer 64

Small rectovaginal fistulas may heal on their own over time. You may need antibiotics for infections or medications for IBD. (3 to 6 months after starting ttt.) Fistulotomy/Fistulectomy If the opening is large, Pt. may need a temporary colostomy. This procedure diverts poop (stool) away from the large intestine and rectum until the fistula heals.

Question 65

Rectovaginal fistula Nursing considerations for post-operative patients

Answer 65

Principles of catheter care post-op No traction;No kinks Increase fluid intake Assess discharges Mobilization Abstinence for at least 3 months CS for future pregnancies

Question 66

The hymen is the membranous ring of tissue that partly obstructs the vaginal opening.

Answer 66

Imperforate hymen

Question 67

Imperforate hymen Assessment:

Answer 67

Lack of a first menstrual cycle Palpation of the abdomen reveals a lower abdominal mass. On vaginal examination, an intact, bulging hymen is evident. Dysuria

Question 68

Imperforate hymen Surgical Managmenet:

Answer 68

Surgical incision (hymenotomy) or removal of the hymenal tissue. The girl may have local pain after the incision, which can be relieved by a mild analgesic and warm baths. Because most girls of early menstrual age have scant knowledge of anatomy, pictures of the reproductive tract can help to explain that this is a local and minor problem. Once relieved, it will not interfere with sexual relations or future childbearing.

Question 69

Imperforate hymen Nursing Consideration:

Answer 69

Supportive environment: Adolescent patients may be highly embarrassed and may feel violated constantly examining and discussing their genitals. Nurse should be vigilant in supporting the patient’s emotional needs

Question 70

Adolescents with the syndrome begin to develop an increased androgen (male hormone) level, which then prevents follicular ovarian cysts from maturing. The androgen increase is usually directly related to obesity and further exacerbates insulin resistance.

Answer 70

Polycystic Ovary Syndrome (PCOS)

Question 71

Polycystic Ovary Syndrome (PCOS) Most frequent cause of ovulation failure seen today. Found in about _____ of women of childbearing age.

Answer 71

10%

Question 72

Polycystic Ovary Syndrome (PCOS) Typical symptoms:

Answer 72

Irregular or missed menstrual cycles Acne Excessive hair growth (hirsutism) Overweight Male pattern baldness Type 2 diabetes Absence of ovulation.

Question 73

Polycystic Ovary Syndrome (PCOS) Assessment:

Answer 73

Irregular periods or infrequent periods Pelvic exam and ovarian UTZ to determine the consistency and size of ovaries. Serum androgen and glucose levels.

Question 74

Polycystic Ovary Syndrome (PCOS) Medical management:

Answer 74

Weight loss by increasing lean meat, fruits, and vegetables and decreasing the amount of concentrated carbohydrates. COC may be prescribed because this changes the ratio of estrogen and testosterone produced, leading to better regulated menstrual cycles. Morbidly obese: Bariatric surgery. Metformin (Glucophage) for to prevent type 2 diabetes from developing Clomiphene (Clomid) to stimulate ovulation. In vitro fertilization (IVF) Ovarian drilling: Reduces the size of the ovaries and limits the amount of testosterone the ovaries are able to produce. To decrease hair growth and reduce acne symptoms: Antiandrogens such as spironolactone (Aldactone) or finasteride (Propecia) can be tried. Caution women that finasteride is teratogenic and so should not be used if they intend to become pregnant, and it should be discontinued during pregnancy

Question 75

Polycystic Ovary Syndrome (PCOS) Nursing Considerations:

Answer 75

Lifestyle modifications are considered the first line of treatment for PCOS. Changes to diet or physical activity should be recommended. Supportive care: Health education Post-operative care