Chapter 12

Care of the Patient with a

Reproductive Disorder

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 1
Slide 1

Overview of Anatomy and Physiology

• Male reproductive system

 Testes
 Ductal system
• Epididymis
• Ductus deferens (vas deferens)
• Ejaculatory duct and urethra
 Accessory glands
• Seminal vesicles
• Prostate gland
• Cowper’s glands
 Urethra and penis
 Sperm
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 2
Slide 2

Figure 12-1

(From Thibodeau, G.A., Patton, K.T. [1987]. Anatomy and physiology. St. Louis: Mos by.)

Longitudinal section of the male pelvis showing the location of the

male reproductive organs.
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Figure 12-2

(From Thibodeau, G.A., Patton, K.T. [1987]. Anatomy and physiology. St. Louis: Mos by.)

Male sex cell (spermatozoon) greatly enlarged (left). Female sex cell
(ovum) surrounded by sperm at time of fertilization (right).
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 4
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Overview of Anatomy and Physiology

• Female reproductive system

 Ovaries
 Fallopian tubes
 Uterus
 Vagina
 External genitalia
 Accessory glands
• Skene’s glands
• Bartholin’s glands
 Perineum
 Mammary glands (breasts)

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 5
Slide 5

Figure 12-3

(From Thibodeau, G.A., Patton, K.T. [1987]. Anatomy and physiology. St. Louis: Mos by.)

Longitudinal section of the female pelvis showing the location of the

female reproductive organs.
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Figure 12-4

(From Thibodeau, G.A., Patton, K.T. [2004]. Structure and function of the body. [12th ed.]. St. Louis: Mosby.)

Sectioned view of the uterus showinag relationship to the ovaries and

vagina.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 7
Slide 7

Figure 12-6

(From Thibodeau, G.A., Patton, K.T. [1987]. Anatomy and physiology. St. Louis: Mos by.)

Lateral view of the breast (sagittal section).

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 8
Slide 8

Figure 12-7

(From Thibodeau, G.A., Patton, K.T. [2003]. Anatomy and physiology. [5th ed.]. St. Louis: Mosby.)

Mammalian ovary showing successive stages of ovarian (graafian)

follicle and ovum development.
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 Figure 12-15

(From Seidel, H.M., Ball, J.W., Dains, J.E., Benedict, G.W. [2003]. Mosby ’s guide to physical
examination. [5th ed.]. St. Louis: Mosby.)

A, Lymph nodes of the axilla. B, Lymphatic drainage of the breast.

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 10
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Human Sexuality

• Sexual identity
 The sense of being feminine or masculine
• Influences on sexual health
 Overall wellness includes sexual health, and sexuality
should be part of the health care program
• Illness and sexuality
 Illness may cause changes in a patient’s self-concept
and result in an inability to function sexually

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 11
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Laboratory and Diagnostic Examinations

• Diagnostic tests for the female

 Colposcopy; culdoscopy; laparoscopy
 Papanicolaou (Pap) smear
 Biopsies: breast, cervical, endometrial
 Conization; dilation and curettage
 Cultures and smears
 Schiller’s iodine test
 Hysterograms
 Mammography; pelvic ultrasonography
 Tubal insufflation (Rubin’s test)
 Human chorionic gonadotropin; serum CA-125

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 Laboratory and Diagnostic Examinations

• Diagnostic tests for the male

 Testicular biopsy
 Semen analysis
 Prostatic smears
 Cystoscopy
 Prostate specific antigen (PSA)

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 13
Slide 13

The Reproductive Cycle

• Amenorrhea
 Etiology/pathophysiology
• Absent or suppressed menstrual flow
 Clinical manifestations/assessment
• No menstrual flow for at least 3 months
 Medical management/nursing interventions
• Based on underlying cause
• Hormone replacement may be necessary

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 14
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The Reproductive Cycle

• Dysmenorrhea
 Etiology/pathophysiology
• Uterine pain with menstruation
 Clinical manifestations/assessment
• Breast tenderness; headache
• Abdominal distention; nausea and vomiting
• Vertigo
• Palpitations
• Excessive perspiration
• Colicky, cyclic pain; dull pain in the lower pelvis

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 The Reproductive Cycle

• Dysmenorrhea (continued)
 Medical management/nursing interventions
• Exercise
• Nutritious foods, high in fiber
• Heat to pelvic area
• Mild analgesics
• Prostaglandin inhibitors

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 16
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The Reproductive Cycle

• Abnormal uterine bleeding

 Menorrhagia
• Excessive bleeding during the regular menstrual flow
• Causes: endocrine disorders; inflammatory
disturbances; uterine tumors
 Metrorrhagia
• Uterine bleeding between regular menstrual periods or
after menopause
• May indicate cancer or benign tumors of the uterus

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 17
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The Reproductive Cycle

• Premenstrual syndrome (PMS)

 Etiology/pathophysiology
• Related to the neuroendocrine events occurring within
the anterior pituitary gland
 Clinical manifestations/assessment
• Irritability, lethargy, and fatigue
• Sleep disturbances; depression
• Headache; backache; breast tenderness
• Vertigo
• Abdominal distention
• Acne

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The Reproductive Cycle

• Premenstrual syndrome (PMS) (continued)

 Medical management/nursing interventions
• Analgesics; diuretics; progesterone
• Diet
 High in complex carbohydrates
 Moderate in protein
 Low in refined sugar and sodium
 Limit caffeine, chocolate, and alcohol
• Reduce or eliminate smoking
• Exercise; adequate rest, sleep, and relaxation

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The Reproductive Cycle

• Menopause
 Etiology/pathophysiology
• The normal decline of ovarian function resulting from
the aging process
• May be induced by irradiation of the ovaries or surgical
removal of both ovaries
• Not considered complete until 1 year after the last
menstrual period

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The Reproductive Cycle

• Menopause
 Clinical manifestations/assessment
• Decrease in frequency, amount, and duration of the
normal menstrual flow
• Shrinkage of vulval structures; shortening of the vagina
• Dryness of the vaginal wall; pelvic relaxation
• Loss of skin turgor and elasticity
• Increased subcutaneous fat; decreased breast tissue;
thinning of hair
• Osteoporosis

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 The Reproductive Cycle

• Menopause (continued)
 Medical management/nursing interventions
• Estrogen therapy
 Premarin
 Provera
• Calcium supplements

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 22
Slide 22

The Reproductive Cycle

• Male climacteric
 Etiology/pathophysiology
• Gradual decrease of testosterone levels and seminal
fluid production; 55-70 years of age
 Clinical manifestations/assessment
• Decreased erections; decreased seminal fluid
• Enlarged prostate gland; decreased muscle tone
• Loss or thinning of hair
 Medical management/nursing interventions
• Emotional support; treatment for impotence

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 23
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The Reproductive Cycle

• Impotence
 Etiology/pathophysiology
• Inability of an adult man to achieve penile erection
• Functional; anatomical; atonic
 Medical management/nursing interventions
• Remove cause if possible
• Treat diseases
• Viagra
• Mechanical devices: penile prosthesis

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 The Reproductive Cycle

• Infertility
 Etiology/pathophysiology
• Inability to conceive after 1 year of sexual intercourse
without birth control
 Medical management/nursing interventions
• Depends on the cause
• Hormone therapy
• Repair occlusion
• Intrauterine insemination
• In vitro fertilization

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 25
Slide 25

Infections of the Female Reproductive

Tract
• Simple vaginitis
 Etiology/pathophysiology
• Common vaginal infection
• Causitive organisms: E. coli; staphylococcal;
streptococcal; T. vaginalis; C. albicans; Gardnerella
 Clinical manifestations/assessment
• Inflammation of the vagina
• Yellow, white, or grayish white, curd-like discharge
• Pruritus and vaginal burning

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 26
Slide 26

Infections of the Female Reproductive

Tract
• Simple vaginitis (continued)
 Medical management/nursing interventions
• Douching
• Vaginal suppositories, ointments, and creams
 Organism-specific
• Sitz baths
• Abstain from sexual intercourse during treatment
• Treat partner if necessary

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 Infections of the Female Reproductive
Tract
• Cervicitis
 Etiology/pathophysiology
• Infection of the cervix
 Clinical manifestations/assessment
• Backache
• Whitish exudate
• Menstrual irregularities
 Medical management/nursing interventions
• Vaginal suppositories, ointments, and creams;
organism-specific

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 28
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Infections of the Female Reproductive

Tract
• Pelvic inflammatory disease (PID)
 Etiology/pathophysiology
• Any acute, subacute, recurrent, or chronic infection of
the cervix, uterus, fallopian tubes, and ovaries that has
extended to the connective tissues
• Most common causative organisms
 Gonorrhea; streptococcus; staphylococcus; Chlamydia;
tubercle bacilli
• High risk: surgical and examination procedures; sexual
intercourse (especially with multiple partners);
pregnancy

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 29
Slide 29

Infections of the Female Reproductive

Tract
• Pelvic inflammatory disease (PID) (continued)
 Clinical manifestations/assessment
• Fever and chills
• Severe abdominal pain
• Malaise
• Nausea and vomiting
• Malodorous purulent vaginal exudate
 Medical management/nursing interventions
• Antibiotics; analgesics
• Bedrest

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 Infections of the Female Reproductive
Tract
• Toxic shock syndrome
 Etiology/pathophysiology
• Acute bacterial infection caused by Staphylococcus
aureus
• Usually occurs in women who are menstruating and
using tampons

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 31
Slide 31

Infections of the Female Reproductive

Tract
• Toxic shock syndrome (continued)
 Clinical manifestations/assessment
• Usually occurs between days 2 and 4 of the menstrual
period
• Flu-like symptoms; sore throat; headache
• Red macular palmar or diffuse rash
• Decreased urinary output; BUN elevated
• Pulmonary edema
 Medical management/nursing interventions
• Antibiotics; IV fluid therapy; oxygen

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 32
Slide 32

Disorders of the Female Reproductive

System
• Endometriosis
 Etiology/pathophysiology
• Endometrial tissue appears outside the uterus
• The tissue responds to the normal stimulation of the
ovaries; bleeds each month
 Clinical manifestations/assessment
• Lower abdominal and pelvic pain
• May radiate to lower back, legs, and groin
 Medical management/nursing interventions
• Antiovulatory medications; pregnancy
• Laparoscopy; total hysterectomy

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 Figure 12-10

(From Herbst, A.L., et al. [1992]. Comprehensive gynecology. [2nd ed.]. St. Louis: Mos by.)

Common sites of endometriosis.

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 34
Slide 34

Disorders of the Female Reproductive

System
• Vaginal fistula
 Etiology/pathophysiology
• Abnormal opening between the vagina and another
organ
 Clinical manifestations/assessment
• Urine and/or feces being expelled from vagina
 Medical management/nursing interventions
• Oral or parenteral antibiotics
• Diet: high protein; increase vitamin C
• Surgery: repair fistula; urinary or fecal diversion

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 35
Slide 35

Figure 12-11

(From Beare, P.G., Myers, J.L. [1998]. Adult health nursing. [3rd ed.]. St. Louis: Mosby.)

Types of fistulas that may develop in the vagina and uterus.

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 Disorders of the Female Reproductive
System
• Displaced uterus
 Etiology/pathophysiology
• Congenital
• Childbirth
• Backward displacement
 Retroversion
 Retroflexion
• Forward displacement
 Anteversion
 Anteflexion

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Slide 37

Disorders of the Female Reproductive

System
• Displaced uterus (continued)
 Clinical manifestations/assessment
• Backache
• Muscle strain
• Leukorrheal discharge
• Heaviness in the pelvic area
 Medical management/nursing interventions
• Pessary
• Uterine suspension

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 38
Slide 38

Disorders of the Female Reproductive

System
• Uterine prolapse
 Etiology/pathophysiology
• Prolapse of the uterus through the pelvic floor and
vaginal opening
 Clinical manifestations/assessment
• Fullness in vaginal area
• Backache
• Bowel or bladder problems
• Protrusion of cervix and vaginal walls in perineal area

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 Figure 12-12

(From Seidel, H.M., Ball, J.W., Dains, J.E., Benedict, G.W. [2003]. Mosby ’s guide to physical
examination. [5th ed.]. St. Louis: Mosby.)

Uterine prolapse.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 40
Slide 40

Disorders of the Female Reproductive

System
• Uterine prolapse (continued)
 Medical management/nursing interventions
• Pessary
• Surgery
 Vaginal hysterectomy
 Anteroposterior colporrhaphy

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 41
Slide 41

Disorders of the Female Reproductive

System
• Cystocele and rectocele
 Etiology/pathophysiology
• Cystocele
 Displacement of the bladder into the vagina
• Rectocele
 Rectum moves toward posterior vaginal wall

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 Figure 12-13

(From Lewis, S.M., Heitkem per, M.M., Dirksen, S.R. [2004]. Medical-surgical nursing: assessment and
management of clinical problems. [6th ed.]. St. Louis: Mosby.)

A, Cystocele. B, Rectocele.
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 43
Slide 43

Disorders of the Female Reproductive

System
• Cystocele and rectocele (continued)
 Clinical manifestations/assessment
• Cystocele
 Urinary urgency, frequency, and incontinence; pelvic
pressure
• Rectocele
 Constipation; rectal pressure; hemorrhoids
 Medical management/nursing interventions
• Surgical repair
 Anteroposterior colporrhaphy; bladder suspension

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 44
Slide 44

Disorders of the Female Reproductive

System
• Leiomyomas of the uterus
 Etiology/pathophysiology
• Arise from the muscle tissue of the uterus
• Stimulated by ovarian hormones
 Clinical manifestations/assessment
• Pelvic pressure; pain; backache
• Dysmenorrhea; menorrhagia
• Constipation; urinary symptoms
 Medical management/nursing interventions
• Surgery: myomectomy; hysterectomy

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 Figure 12-14

(Redrawn from Novak, E. R., Woodruff, J. D., eds. [1967]. Novak ’s gynecologic and obstetric pathology.
[6th ed.]. Philadelphia, Saunders. In McCance, K.L., & Huether, S.E. [2002]. Pathophysiology: the
biologic basis for diseas e in adults and children. [4th ed.]. St. Louis: Mosby.)

Leiomyomas.

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 46
Slide 46

Disorders of the Female Reproductive

System
• Ovarian cysts
 Etiology/pathophysiology
• Benign tumors that arise from dermoid cells of the ovary
 Clinical manifestations/assessment
• May be no symptoms
• Palpable on examination
• Disturbance of menstruation
• Pelvic heaviness; pain
 Medical management/nursing interventions
• Ovarian cystectomy

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 47
Slide 47

Cancer of the Female Reproductive Tract

• Cancer of the cervix

 Etiology/pathophysiology
• Squamous cell carcinoma
• Carcinoma in situ
• If untreated, invades the vagina, pelvic wall, bladder,
rectum, and regional lymph nodes
• High risk
 Sexually active during teens
 Multiple sexual partners
 Multiple births

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 Cancer of the Female Reproductive Tract

• Cancer of the cervix (continued)

 Clinical manifestations/assessment
• Few symptoms in early stages
• Leukorrhea
• Irregular vaginal bleeding; spotting
• Advanced
 Pain in the back, upper thighs, and legs

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 49
Slide 49

Cancer of the Female Reproductive Tract

• Cancer of the cervix (continued)

 Medical management/nursing interventions
• Carcinoma in situ
 Removal of the affected area
• Early carcinoma
 Hysterectomy
 Intracavitary radiation
• Advanced carcinoma
 Radical hysterectomy with pelvic lymph node dissection

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Cancer of the Female Reproductive Tract

• Cancer of the endometrium

 Etiology/pathophysiology
• Adenocarcinoma of the uterus
 Clinical manifestations/assessment
• Postmenopausal bleeding (50% will have cancer)
• Abdominal pressure; pelvic fullness
 Medical management/nursing interventions
• Surgery: total abdominal hysterectomy with bilateral
salpingo-oophorectomy (TAH-BSO)
• Radiation; chemotherapy

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 Cancer of the Female Reproductive Tract

• Cancer of the ovary

 Etiology/pathophysiology
• Fourth most common cause of cancer death in women
• High risk: infertile; anovulatory; nulliparous; habitual
aborters; high-fat diet; exposure to industrial chemicals

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Slide 52

Cancer of the Female Reproductive Tract

• Cancer of the ovary (continued)

 Clinical manifestations/assessment
• Early
 Vague abdominal discomfort
 Flatulence; mild gastric disturbance
• Advanced
 Enlarged abdominal girth
 Flatulence; constipation
 Urinary frequency
 Nausea and vomiting
 Weight loss

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Cancer of the Female Reproductive Tract

• Cancer of the ovary (continued)

 Medical management/nursing interventions
• Surgery
 TAH-BSO and omentectomy
• Radiation and/or chemotherapy

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 Hysterectomy

• Total hysterectomy
 Removal of the uterus including the cervix
• TAH-BSO
 Removal of the uterus, fallopian tubes, and ovaries
• Radical hysterectomy
 TAH-BSO with removal of the pelvic lymph nodes
• Vaginal hysterectomy
 The uterus is removed through the vagina
• Abdominal hysterectomy
 Abdominal incision is made to perform procedure

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 55
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Disorders of the Female Breast

• Fibrocystic breast condition

 Etiology/pathophysiology
• Hyperplasia and cystic formation in mammary ducts
 Clinical manifestations/assessment
• Cysts are soft, well-differentiated, tender, and freely
moveable; often bilateral and multiple
 Medical management/nursing interventions
• Eliminate methylxanthines
• Danazol (danocrine); vitamin E

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Disorders of the Female Breast

• Acute mastitis
 Etiology/pathophysiology
• Acute bacterial infection of the breast
 Clinical manifestations/assessment
• Breasts are tender, inflamed, and engorged
 Medical management/nursing interventions
• Keep breasts clean
• Application of warm packs
• Support: well-fitting bra
• Systemic antibiotics

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 Disorders of the Female Breast

• Chronic mastitis
 Etiology/pathophysiology
• Fibrosis and cysts in the breast
 Clinical manifestations/assessment
• Tender, painful, and palpable cysts
• Usually unilateral
 Medical management/nursing interventions
• Same as for acute mastitis

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Disorders of the Female Breast

• Breast cancer
 Etiology/pathophysiology
• Unknown cause; usually adenocarcinoma
 Clinical manifestations/assessment
• Small, solitary, irregular-shaped, firm, non-tender, and
non-mobile tumor
• Change in skin color
• Puckering or dimpling of tissue
• Nipple discharge; retraction of nipple
• Axillary tenderness

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Disorders of the Female Breast

• Breast cancer (continued)

 Medical management/nursing interventions
• Depends on the stage
 Radiation
 Chemotherapy
 Surgery
o Lumpectomy

o Mastectomy—partial, subcutaneous, simple, radical

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 Inflammatory Disorders of the Male
Reproductive System
• Prostatitis
 Etiology/pathophysiology
• Acute or chronic infection of the prostate gland
 Clinical manifestations/assessment
• Chills and fever
• Dysuria; urgency and frequency of urination
• Cloudy urine
• Perineal fullness; lower back pain
• Arthralgia; myalgia
• Tenderness, edema, and firmness of the prostate

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Inflammatory Disorders of the Male

Reproductive System
• Prostatitis (continued)
 Medical management/nursing interventions
• Antibiotics
• Digital massage of the prostate
• Sitz baths
• Monitor I&O

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Slide 62

Inflammatory Disorders of the

Male Reproductive System
• Epididymitis
 Etiology/pathophysiology
• Infection of the epididymis
 Clinical manifestations/assessment
• Scrotal pain and edema
• Pyuria; chills and fever
 Medical management/nursing interventions
• Bedrest
• Elevate scrotum; cold compresses
• Antibiotics

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 Disorders of Male Genital Organs

• Phimosis
 Etiology/pathophysiology
• Prepuce is too small to allow retraction of the foreskin
over the glans
• Usually congenital; may be due to inflammation or
disease
 Clinical manifestations/assessment
• Infection of foreskin and glans penis
• Occasionally causes obstruction of urine flow
 Medical management/nursing interventions
• Circumcision

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 64
Slide 64

Disorders of Male Genital Organs

• Hydrocele
 Etiology/pathophysiology
• Accumulation of fluid between the membranes of the
testes
 Clinical manifestations/assessment
• Enlargement of the scrotum; pain
 Medical management/nursing interventions
• Aspiration of fluid
• Surgical removal of testicular sac
• Bedrest; elevate scrotum; cold compresses

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 65
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Disorders of Male Genital Organs

• Varicocele
 Etiology/pathophysiology
• Dilation of scrotal veins causing obstruction and
malfunction of circulation
 Clinical manifestations/assessment
• Engorgement and elongation of the scrotum
• Pulling sensation in scrotum; dull, aching pain
 Medical management/nursing interventions
• Surgery: removal of obstruction
• Bedrest
• Elevate scrotum; cold compresses

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 66
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 Cancer of the Male Reproductive Tract

• Cancer of the testis

 Etiology/pathophysiology
• Cause unknown
 Clinical manifestations/assessment
• Enlarged scrotum; feeling of heaviness
• Firm, painless, smooth mass
 Medical management/nursing interventions
• Radical inguinal orchiectomy
• Radiation and/or chemotherapy
• Teach testicular self-examination

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 67
Slide 67

Cancer of the Male Reproductive Tract

• Cancer of the penis

 Etiology/pathophysiology
• Very rare
 Clinical manifestations/assessment
• Painless, wart-like growth or ulceration, usually on the
glans penis
 Medical management/nursing interventions
• Surgery
 Removal of tissue
 Partial or total amputation of the penis
 Metastasis: radical surgical procedures

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 68
Slide 68

Sexually Transmitted Diseases

• Genital herpes (herpes simplex virus type II)

 Etiology/pathophysiology
• Infectious viral disease; usually acquired sexually
 Clinical manifestations/assessment
• Fluid-filled vesicles
• Eventually rupture and develop shallow, painful ulcers
• Fever; malaise
• Dysuria
• Leukorrhea (female)

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 69
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 Figure 12-20

(From Beare, P.G., Myers, J.L. [1998]. Adult health nursing. [3rd ed.]. St. Louis: Mosby.)

Herpes simplex virus type II in a male and female patient.

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 70
Slide 70

Sexually Transmitted Diseases

• Genital herpes (herpes simplex virus type II)

(continued)
 Medical management/nursing interventions
• No cure; treat symptoms
• Acyclovir (Zovirax)
• Sitz baths
• Local anesthetic; analgesics
• Keep lesions clean and dry
• GOOD handwashing
• No sexual contact while lesions are present
• Encourage use of condoms

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 71
Slide 71

Sexually Transmitted Diseases

• Syphilis
 Etiology/pathophysiology
• Treponema pallidum organism
• Transmission occurs primarily with sexual contact
 Clinical manifestations/assessment
• Incubation period
 No symptoms
• Primary stage
 Chancre; headaches; enlarged lymph nodes

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 72
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 Sexually Transmitted Diseases

• Syphilis (continued)
 Clinical manifestations/assessment
• Secondary stage
 Rash on palms of hands and soles of feet
 Generalized enlargement of lymph nodes
• Latent stage
 No symptoms
• Tertiary or late stage
 Lesions may affect many different systems; may be fatal

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 73
Slide 73

Sexually Transmitted Diseases

• Syphilis (continued)
 Medical management/nursing interventions
• Penicillin
• Tetracycline or erythromycin, if allergic to penicillin
• May be treated in any stage; damage will not be
reversed
• Treat all sexual contacts

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 74
Slide 74

Sexually Transmitted Diseases

• Gonorrhea
 Etiology/pathophysiology
• N. gonorrhoeae
• Transmitted by sexual contact
 Clinical manifestations/assessment
• Vaginal (female)
 Urinary frequency and pain
 Yellowish discharge
 Nausea and vomiting

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 75
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Sexually Transmitted Diseases

• Gonorrhea (continued)
 Clinical manifestations/assessment (continued)
• Urethra (male)
 Urethral discomfort; dysuria
 Yellowish discharge containing pus
 Red and swollen meatus
• Rectal (male and female)
 Perineal discomfort; purulent rectal discharge
• Pharyngitis (male and female)
 Sore throat and swallowing discomfort
 Edema of the throat

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 76
Slide 76

Sexually Transmitted Diseases

• Gonorrhea (continued)
 Medical management/nursing interventions
• Penicillin
• Rocephin
• Doxycycline or tetracycline
• TREAT ALL SEXUAL CONTACTS

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 77
Slide 77

Sexually Transmitted Diseases

• Trichomoniasis
 Etiology/pathophysiology
• T. vaginalis protozoan
• Usually sexually transmitted
 Clinical manifestations/assessment
• Most are asymptomatic
• Male: urethritis, dysuria, urinary frequency, pruritus, and
purulent exudate

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 78
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 Sexually Transmitted Diseases

• Trichomoniasis (continued)
 Clinical manifestations/assessment (continued)
• Female
 Frothy, gray, green, or yellow malodorous discharge
 Pruritus
 Edema
 Tenderness of vagina
 Dysuria and urinary frequency
 Spotting; menorrhagia; dysmenorrhea

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 79
Slide 79

Sexually Transmitted Diseases

• Trichomoniasis (continued)
 Medical management/nursing interventions
• Metronidazole (Flagyl)
• TREAT ALL SEXUAL CONTACTS

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 80
Slide 80

Sexually Transmitted Diseases

• Candidiasis
 Etiology/pathophysiology
• C. albicans and C. tropicalis
 Clinical manifestations/assessment
• Mouth: edema; white patches
• Nails: edematous, darkened, erythematous nail base;
purulent exudate
• Vaginal: cheesy, tenacious white discharge; pruritus;
inflammation of the vagina
• Penis: purulent exudate
• Systemic: chills; fever; general malaise

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 81
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 Sexually Transmitted Diseases

• Candidiasis (continued)
 Medical management/nursing interventions
• Treat underlying condition
• Nystatin (Mycostatin)
• Topical amphotericin B

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 82
Slide 82

Sexually Transmitted Diseases

• Chlamydia
 Etiology/pathophysiology
• Chlamydia trachomatis
 Clinical manifestations/assessment
• Usually asymptomatic
• Male
 Scanty white or clear exudate
 Burning or pruritus
 Urinary frequency; mild dysuria

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 83
Slide 83

Sexually Transmitted Diseases

• Chlamydia (continued)
 Clinical manifestations/assessment
• Female
 Vaginal pruritus or burning
 Dull pelvic pain
 Low-grade fever
 Vaginal discharge; irregular bleeding

 Medical management/nursing interventions

• Tetracycline; doxycycline; Zithromax
• TREAT ALL SEXUAL CONTACTS

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 84
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Nursing Process

• Nursing diagnoses  Knowledge, deficient

 Anxiety  Pain, acute and
chronic
 Body image, disturbed
 Self-esteem,
 Coping, ineffective situational low
 Fear  Sexual dysfunction
 Fluid volume, deficient  Skin integrity, impaired
 Health maintenance,  Tissue perfusion,
ineffective ineffective
 Infection, risk for  Urinary elimination,
impaired

Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. Slide 85
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