Repro 1: male and female disorders

Question 1

Her Repro Issues (5)

Answer 1

• mestral disorders; amennorrhea
• infertility
• contraception
• abortion
• menopause: must be naturally occuring for a full yr

Question 2

Her reproductive cycle

Answer 2

• series of chemical secretions and rxns
• produce potential fertility and birth
• menstruation (shedding of the endometrium) marks the beginning of the monthly cycle

Question 3

Pituitary-hypothalamic axis

Answer 3

• Hypothalamus: in response to low estrogen and progesterone, releases pulses of gonadotropin hormone which stimulates anterior pituitary
• Anterior pituitary: first releases follicle stimulating hormone which stimulates graafian primordial follicles to mature
• Anterior pituitary: Then releases lutenizing hormone. this surge selects one follicle, the ovum is released from the follicle, the empty follicle then becomes the corpus luteum

Question 4

Fertilization: major parts controlled by( 4)

Answer 4

• endometrium
• ovaries
• pituitary gland
• hypothalamus

Question 5

Menstruation

Answer 5

Ave age: 12.8 yr
can be btn 8-18 yr
-genetics is an important factor
-Number contributed to and affected by geographic location, nutrition, weight, general health, cultural and social practices, attitude, family environment, and beliefs, stress are important
-puberty begins faster in hot environment
-large portion is genetics, when your mom did
-cultural tribes believe it happens and report at later age if they believe the daughter is “not ready yet”

Question 6

Irregular Menses (6)

Answer 6

Can be associated with:

• irregular ovulation
• polycystic ovarian syndrome
• weather conditions
• stress
• disease
• hormonal imbalances

Question 7

Cycle length

Answer 7

• Cycle length: 21-36 days
• Duration of flow: 3-7 days
• Blood loss/cycle: 1-2.5 oz (1-3 teaspoons)

Question 8

Polycystic ovarian syndrome (pcos)

Answer 8

:imbalance of sex hormone, too much testosterone, ratio of progesterone and estrogen is off

• don’t create eggs, instead cysts develop and ovary becomes enlarged from them,
• if they don’t release eggs, then infertile and irregular ovulation
• could have no periods at all, maybe asymptomatic until pain from inc size of ovary and pain from it

Question 9

Menopause

Answer 9

:Complete cessation of menses for 12 months resulting in loss of high levels of estrogen and progesterone

• loss of estrogen and progesterone results in physiological changes
• around 45-55 yo
• sx: slow metabolism, HA, hot flashes, depression maybe
• some things can put a woman into early menopause

Question 10

Menstrual disorders (4)

Answer 10

• amenorrhea: absence of menses during reproductive yrs, sometimes considered normal (pre-pub, post-partum, pregnancy, post-menopausal)
• dysmenorrhea
• premenstrual syndrome
• endometriosis

Question 11

Etiology for Amenorrhea (12)

Answer 11

• extreme wt loss or gain
• congenital abnormality of reproductive system
• stress from major life event
• excessive exercise
• eating disorder, not correct vit and min
• hypothyroidism: metabolic probs
• turner’s syndrome: chromosomal
• chronic illness: diabetes
• pregnancy
• cystic fibrosis
• ovarian or adrenal tumors
• depression

Question 12

Dysmenorrhea

Answer 12

:painful menstruation

• frequent and very intense
• Primary: (spasmodic) increase prostaglandin production (important hormone for labor and delivery and menstruation)
• Secondary: (congestive) painful menstruation due to pelvic or uterine pathology: mass, tumor, IUD placement, PID, fibroid (fibrous tissue that is non-malignant in uterus)

Question 13

Tx options (4)

Answer 13

• NSAID
• hormonal contraceptives: override the females own cycle
• complementary therapy
• lifestyle change: daily exercise, limit salty foods, vit mineral deficiency, wt loss, smoking cessation, relaxation tech

Question 14

Nursing assessment/management (3)

Answer 14

• health hx and physical exam
• lab and dx test: r/o before reach conclusion for pt
• pt edu (what you are doing and why): explain how the menstrual cycle works, encourage use of correct terms more accurately, provide monthly graphs or charts

Question 15

Premenstrual Syndrome (PMS)

Answer 15

• constellation of recurrent sx during luteal phase or last 1/2 of menstrual cycle and resolve with the onset of menstruation
• sx: craving, pelvic pain, HA, moody

Question 16

PmS s/sx (7)

Answer 16

• days before menses (1 week)
• emotionally labile, irritable
• fatigue, lethargy
• appetite changes
• fluid retention
• HA
• breast tenderness

Question 17

about PMS

Answer 17

• exact cause unknown
• r/t interaction btn hormonal events and neurotransmitter fn, specifically serotonin
• affects millions of women
• 75% report having one or more premenstrual sx
• 10% report debilitating, incapacitating sx

Question 18

(3) Tx options and nursing care for pms (esp 10%)
and meds (7)

Answer 18

• calendar of sx
• vitamin and mineral suppletments (usual ones in defecit are E, MG, K, especially if known deficiency)
• lifestyle change: reduce stress, exercise (3-5xwk), eat balanced diet, decrease caffeine, stop smoking, decr alcohol intake
  meds: NSAID prior to menses (@ least one week), oral contraceptives (low dose), antidepressants (ssri), anxiolytics (during luteal, ex valium), diuretics (remove excess fluids for bloating), GnRH antagonist (stop secretion of FSH and LH), Danazol (androgen hormone inhibits estrogen production)

Question 19

Endometriosis

Answer 19

: endometrial tissue located outside of normal site
-commonly found attached to ovaries, fallopian tubes, outer surface of uterus, area btn vagina and rectum, and pelvic side wall

Question 20

etiology and risk factors (7) for endometriosis

Answer 20

• unknown etiology although there are several therapies although none scientifically proven
• Risks include: inc age, fam hx of it in first degree relatives, short menstrual cycle < 28 days, long menstrual flow > 1wk, high dietary fat consumption, young age of menarche < 12yo, few or no pregnancy

Question 21

Nursing assessment and care for endometriosis

Answer 21

• conservative surgery: one area vs inc risk would be all
• definitive surgery: remove all
• NSAIDS
• oral contraceptives
• Gnrh
• -dx through ultrasound, can find mass, cysts, fibrosis

Question 22

HIs reproductive issues

Answer 22

Disorders of the penis: penile foreskin (prepuce) is too tight

• phimosis: cant retract from distal to proximal
• paraphimosis: cant retract from proximal to distal
• urethral stricture: blockage in urethra/urinary retention from trauma,
• sx: dribbling, pain, prostatitis,
• any inflammation can cause stricture

Question 23

Disorders of the urethra

Answer 23

• urethritis: inflammation of urethra usually, but not always caused by STI
• nonsexual origins can be due to urologic procedures, insertion of foreign objects, anatomic abnormalities, or trauma

Question 24

Disorders of the penis (3)

Answer 24

• peyronies: bent nail syndrome
• from aerial view= hourglass
• middle age men 45-65 yo
• painful during sex, not at rest
• 50% gets resolved, but tx for severe pain and cant have sex-surgical removal
• priapism: can be from meds (viagra), condition of prolonged penile erection
• balanitis: inflammation of glans penis, associated with foreskin inflammation

Question 25

Disorders of the scrotum

Answer 25

-variocele: dilation or absence of spermatic cord, (veins inside) -inadequate valves, congestion, causes pain -40% can become infertile, aged men -95% swollen L testicle, bc left ventricle -can be asymptomatic, do nothing, but if severe then need surgery to remove -seen during DRE, transillumination (light over testes, scrotum to see translucent then variocele but if there is a mass then something else -hydrocele: common in neonates, scrotum filled with fluid and enlarged -1/10 newborns -high resolution in baby and adult -actue, acquired later in life, > 40 yo -secretion and reabsorption is off, fluid is stagnant in scrotum -assess for 2 testes in newborn -spermatocele: sperm gets blocked in tube/ductus deferens -non cancerous growth -can be due to inflammation -misdx as epididemitis -fullness in testicle, no other sx 40-60yo -surgery if symptomatic and problematic, but usually asymptomatic

Question 26

disorders of the testes

Answer 26

- cryptorchidism: 1/10 newborns, testes havent descended - report to pediatrician, get ultrasound or xray - absences of one or both testes, usually a defect - <1% have testes descend after 3 mo - ectopic testes - torsion of the testes: twisting, swelling, no blood to testicle then can cause infertility - orchitis

Question 27

disorders of the epidimys

Answer 27

- epididymitis: inflammation, common in sexually active young man, related to STI - sx: pain, swelling, infertility

Question 28

Disorders of the prostate gland (3)

Answer 28

1) benign prostatic hyperplasia : enlargement of prostate - sx associated with urethral compression - relationship to aging - evaluation: DRE, prostate-specific antigen monitoring (below 4.0 is good) - biopsy may be necessary 2) prostatitis: inflammation of prostate, enlarged prostate gland - normal protective barrier: urethral length, micturition, ejaculation - similar sx to BPH - acute, chronic, non-bacterial 3) prostaodynia" chronic painful not r/t bacteria - goes away and comes back

Question 29

Prostate health

Answer 29

- keep healthy wt and exercise regularly - eat more fruits and veg - let doc know if you have fam history of prostate cancer - dont smoke - get PSA and DRE annually start at 50 yo - men at high risk (black) with strong fam hx of prostate cancer should begin test at 45 yo

Question 30

Male sexual dysfunction

Answer 30

- erectile dysfunction: inability to achieve or maintain an erection sufficient for satisfactory sexual fn - NIH proposed term change to impotence (only type of male sexual dysfunction studied and most publicly known)

Question 31

Who does male sexual dysfn affect

Answer 31

- 17-35% of men btn ages 40-70 yrs - most common physiologic causes include: adverse med effects and pathologic conditions - medical conditions most strongly associated with ED: HTN, dyslipidemia, diabetes, disorders of prostate and lower urinary tract

Question 32

Impairment of sperm production and quality (7)

Answer 32

- hormone and growth factors: FSH, LH, testosterone, - androgen-binding protein, inhibin B and other peptides - adequate spermatogenia - sperm count > 20 mill/ml - sperm motility - antisperm antibodies - drugs and toxins in semen

Question 33

Meds ED

Answer 33

mode of action: improves erectile fn by inhibiting breakdown of enyzyme cyclic guanosine monophosphate - relax smooth muscle when male is being sexually stimulated so blood can flow in - take med 1hr before sex and can last for 4 hr - erection wont stay 4 hours just time frame

Question 34

Testes tests (4)

Answer 34

- detailed medical hx and physical exam - rigiscan test: nocturnal penile tumescence test conducted in sleeplab, monitors penile circumference during sleep - penile doppler studies - psych eval

Question 35

circumscision procedure

Answer 35

- methods: plastibel, gomco are both neonatal - nursing considerations: assist in decision making, care during and after procedure, evaluate pain, observe for complications

Question 36

debate

Answer 36

reasons for choosing it: decr uti, inflammation, cancer, STD, religion, culture, phimosis in later life, school reasons for rejecting: painful, risk, irritation to glans, decr sexual pleasure -pain relief: anesthetics, acetomenophin, pacifiers, oral glucose -ban in sf?