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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 - PowerPoint PPT Presentation
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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• Definition
– Discharge of a mature ovum from the ovary
Start
Physiology Review
Ovulation• Follicular Stage
– Ovum enlarges cyst (graafian follicle) – Reaches the surface (of the ovary)
– Ovum is discharged• Ovulation
Physiology ReviewAfter 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 PhaseEstrogen IncreasingProgesterone LowFSH High decreasingLH Low increasingOvaries Growth of follicleEndometrium Proliferation of superficial layerDay(s) 5 - 13
OvulationEstrogen HighProgesterone LowFSH LowLH HighOvaries OvulationEndometrium Continued growthDay(s) 14
Luteal PhaseEstrogen Drops then increasesProgesterone IncreasingFSH LowLH HighOvaries Active corpus luteumEndometrium Highly vascular & thickDay(s) 15 - 25
Premenstrual PhaseEstrogen DecreasingProgesterone DecreasingFSH IncreasingLH DecreasingOvaries Degeneration of corpus luteumEndometrium Vasoconstriction, degenerationDay(s) 26 - 28
Menstrual PhaseEstrogen LowProgesterone NoneFSH IncreasingLH LowOvaries follicular development beginsEndometrium Degeneration and shedding of
superficial layerDay(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–
• Reproductive organs 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– 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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