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Genital Urinary System

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					Genital Urinary System

Female Reproductive System
Brunner and Suddarth’s
  Medical Surgical
  Nursing

Text: Ch. 46-48
                 Behavioral Objectives:
•   Review the anatomy and physiology of the female GU systems
•   Describe the physical assessment of the female GU systems
•   Discuss the application of the nursing process as it relates to patients with
    disorders of the female GU system
•   Describe etiology, pathophysiology, clinical manifestations, nursing management
    and patient education for the following female GU disorders:
     – Vaginitis
     – Pelvic inflammatory disease (PID)
     – Endometriosis
•   Discuss incidence, prevention & tx of the pts with CA of the GU system
•   Discuss the nursing interventions in pre and post-operative care of patients
    undergoing the following surgeries
     – Hysterectomy
     – Mastectomy
         Anatomy Review: Breast
• Female breast
  development
    – 10-16 yrs
• Tail of Spence
    – Into axillary area
•   Cooper’s ligament
•   12-20 lobes
•   Nipple
•   Areola
                      Anatomy Review
         Internal Reproductive Structures

Vagina
   –         Mucus membrane
   –         Posterior to bladder &
             urethra
   –         Anterior to rectum
   –         Anterior & posterior
             walls touch
   –         Upper vagina
             surrounds cervix
         •      Inferior uterus
                      Anatomy Review
         Internal Reproductive Structures

Uterus
•       Pear-shaped
    –      Muscular
•       Size
    –        ?
    –        Variable
         •     # pg
              Anatomy Review
      Internal Reproductive Structures

• Location
  – Posterior to bladder
• Ligaments
                     Uterus
• Two parts of the
  uterus
   – Cervix
      • Projects into the
        Vagina
   – Fundus
      • Body of the uterus
• Endometrium:
   – Lining of the uterus
                   Anatomy Review
          Internal Reproductive Structures

Ovaries
•    Connected to uterus by
     the fallopian tubes
•    Contains
    –     1000’s of ova @ birth
•       Ova / Ovum
    –     Egg cells (immature)
    –     Ova – plural
    –     Ovum - Singular
           Physiology Review
Ovulation




                               Start
•   Definition
   –   Discharge of a
       mature ovum from
       the ovary
                  Physiology Review
Ovulation
•   Follicular Stage
   –       Ovum enlarges  cyst (graafian follicle)
   –       Reaches the surface (of the ovary)
   –       Ovum is discharged
       •      Ovulation
              Physiology Review
                 After Ovulations

•   Ovum
•   Fallopian tube 
•   Uterus
•   IF is meets a
    spermatozoon
    – Union & conception
    – Location of
      fertilization?
                 Physiology Review
                     After ovulation

• Ovum cyst 
   – Corpus luteum
   – Stays in the ovary
• Produces progesterone
• Prepares the uterus for
  the fertilized ovum
           The Menstrual Cycle
•       2 system control
        menstruation
        process
    –     Reproductive
    –     Endocrine
          Hormones
        The Menstrual Cycle

•    Ovaries 
    – Estrogen
    – Progesterone
             The Menstrual Cycle
Pituitary gland
• FSH
    –    Stim. Ovaries
    –    to secrete estrogen
•       LH
    –    Ovulation
    –    Stim. Progesterone
         
           The Menstrual Cycle
•       Cyclic pattern 
    –     Changes in the
          endometrium and
          menstruation
    –     28 day cycle
               Follicular Phase
Estrogen       Increasing
Progesterone Low
FSH            High  decreasing
LH             Low  increasing
Ovaries        Growth of follicle
Endometrium Proliferation of superficial layer
Day(s)         5 - 13
            Ovulation
Estrogen    High
Progesterone Low
FSH         Low
LH          High
Ovaries     Ovulation
Endometrium Continued growth
Day(s)      14
             Luteal Phase
Estrogen     Drops then increases
Progesterone Increasing
FSH          Low
LH           High
Ovaries      Active corpus luteum
Endometrium Highly vascular & thick
Day(s)       15 - 25
             Premenstrual Phase
Estrogen     Decreasing
Progesterone Decreasing
FSH          Increasing
LH           Decreasing
Ovaries      Degeneration of corpus luteum
Endometrium Vasoconstriction, degeneration
Day(s)       26 - 28
             Menstrual Phase
Estrogen     Low
Progesterone None
FSH          Increasing
LH           Low
Ovaries      follicular development begins
Endometrium Degeneration and shedding of
            superficial layer
Day(s)      1-5
            Menopausal Period
•       End of reproductive
        capacity
•       Age 45 – 52 yrs
•       Menstruation ceases
    –     No periods for   >
          1 year
            Menopausal Period
•       Ovaries not active 
    –     _?__ estrogen
    –     i
•       Reproductive organs
        i size
•       No ova mature
            Physical assessment
Health history
•    Menstrual hx
  – Menarche
        •    Beginning of
             menstruation
    –     Length
    –     Amount
    –     Cramps/pain ?
•       Hx of pregnancies
• Medication history
  – Hormone therapy
  – Hormonal
    contraceptives
  – Fertility treatment
                  Assessment:
        History & Clinical Manifestations
•       Pain
    –     Dysmenorrhea
    –     Dyspareunia
•       Hx vaginal discharge
    –     Odor
    –     Itching
•       Hx urinary functions
•       Hx B&B control
                 Assessment:
       History & Clinical Manifestations
•   Sexual history
•   History of sexual or physical abuse
•   History of surgery
•   History of chronic illness or disability
•   History of genetic disorders
• Physical Exam
• Breast
  – Frequency:
     • Monthly
    Breast Exam – Assessment

•   Palpable masses
•   Skin changes
•   Pain
•   Swelling
•   Redness
•   Nipple changes
•   Self exam
       Abnormal breast findings
• Erythema
  – Benign local infection or
  – Superficial neoplasm
• Prominent venous pattern
  – h blood supply required by tumor
• Edema & pitting
  – Neoplasm blocking the lymphatic drainage tubes
• Orange-peel appearance / Peau D’orange
  (edema)
  – Advanced breast cancer
• Nipple inversion
  – If new  requires evaluation
• Signs of dimpling, creasing, changes in contour
• Breast Cancer Mass - palpate
  – Single mass
  – One breast
  – Firm, hard, embedded in surrounding tissue
  – Non-tender
                 Mammography
• Duration
  – 15 minutes
• Recommended
  frequency
  – Annually
  – > age 40
               Physical Assessment
•       Pelvic
    –         Frequency
          •       Annual
    –         Initial
          •       > age 18
          •       sexually active
    –         breast
    –         pelvic
•       Positioning
    –         Supine lithotomy
              position
              Physical Assessment
•       Inspection
    –        Inspects external
             genitilia
    –        Speculum examination
         •     Vaginal canal
         •     Cervix
              Physical Assessment
•       Pap smear
    –        Tissue sample of cervix
             
    –        Purpose:
         •     Dx Cervical Ca
    –        No douche before visit
           Physical Assessment
•       Bimanual palpation
    –     Cervical palpation
    –     Uterine palpation
• Colposcopy
  – Portable microscope
  – Obtain sample

				
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posted:5/8/2013
language:Latin
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