Nursing Management:
Female Reproductive Problems
Chapter 54 Overview
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Infertility
Etiology and Pathophysiology
 Diagnostic Studies

• Ovulatory studies
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Infertility
Fig. 54-1. Basal body temperature chart. A, Typical biphasic temperature curve indicative of ovulation and
normal progesterone effect. B, Irregular monophasic curve characteristic of anovulatory cycles. C, Ovulatory
curve with sustained temperature elevation following conception and the first missed period.
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Infertility

Diagnostic Studies, continued
• Tubal patency studies
• Postcoital studies
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Nursing and Collaborative Management:
Infertility
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Abortion
Spontaneous Abortion
 Induced Abortion

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Problems Related to
Menstruation
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Premenstrual Syndrome
Etiology and Pathophysiology
 Clinical Manifestations
 Diagnostic Studies and
Collaborative Care

• Drug therapy
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Dysmenorrhea
Etiology and Pathophysiology
 Clinical Manifestations
 Collaborative Care

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Nursing Management:
Dysmenorrhea
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Abnormal Vaginal Bleeding

Types of Irregular Bleeding
• Oligomenorrhea and secondary
amenorrhea
• Menorrhagia
• Metrorrhagia

Diagnostic Studies and
Collaborative Care
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Abnormal Vaginal Bleeding
Fig. 54-2. Balloon thermotherapy for treatment of menorrhagia. A, Balloon-tipped catheter is inserted into the
uterus through the vagina and cervix. B, The balloon is inflated with a sterile fluid that expands to fit the size
and shape of the uterus. The fluid is heated to 188° F (87° C) and maintained for 8 minutes while the uterine
lining is treated. C, Fluid is withdrawn from the balloon and the catheter is removed.
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Abnormal Vaginal Bleeding

Diagnostic Studies and
Collaborative Care, continued
• Surgical therapy
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Nursing Management:
Abnormal Vaginal Bleeding
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Ectopic Pregnancy
Fig. 54-3. Ectopic pregnancy occurring in the fallopian tube.
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Ectopic Pregnancy
Etiology and Pathophysiology
 Clinical Manifestations
 Diagnostic Studies

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Nursing and Collaborative Management:
Ectopic Pregnancy
Fig. 54-4. Laparoscopic treatment of ectopic pregnancy in the right fallopian tube.
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Perimenopause and
Postmenopause
Clinical Manifestations
 Collaborative Care

• Drug therapy
• Nonhormonal therapy
• Nutritional therapy
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Culturally Competent Care:
Menopause
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Nursing Management:
Perimenopause and Postmenopause
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Conditions of Vulva, Vagina,
and Cervix
Etiology and Pathophysiology
 Clinical Manifestations
 Collaborative Care

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Nursing Management:
Conditions of Vulva, Vagina, and Cervix
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Pelvic Inflammatory Disease
Fig. 54-5. Pelvic inflammatory disease. Acute infection of the fallopian tubes and ovaries. The tubes and
ovaries have become an inflamed mass attached to the uterus. A tubo-ovarian abscess is also present.
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Pelvic Inflammatory Disease
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Pelvic Inflammatory Disease
Etiology and Pathophysiology
 Clinical Manifestations
 Complications
 Collaborative Care

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Nursing Management:
Pelvic Inflammatory Disease
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Endometriosis
Fig. 54-6. Common sites of endometriosis.
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Endometriosis
Etiology and Pathophysiology
 Clinical Manifestations
 Collaborative Care

• Drug therapy
• Surgical therapy
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Nursing Management:
Endometriosis
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Benign Tumors of Female
Reproductive System
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Leiomyomas

Etiology and Pathophysiology
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Leiomyomas
Fig. 54-7. Leiomyomas. Uterine section showing whorl-like appearance and locations of leiomyomas.
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Leiomyomas
Clinical Manifestations
 Collaborative Care

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Cervical Polyps
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Benign Ovarian Tumors
Fig. 54-8. Large ovarian cyst.
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Benign Ovarian Tumors

Polycystic Ovary Syndrome
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Benign Ovarian Tumors
Fig. 54-9. Polycystic ovary syndrome. Multiple fluid-filled cysts in the ovary.
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Cancer of Female
Reproductive System
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Cervical Cancer
Etiology and Pathophysiology
 Clinical Manifestations

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Cervical Cancer
Fig. 54-10. Cervical cancer. View through a speculum inserted into the vagina.
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Cervical Cancer
Diagnostic Studies
 Collaborative Care

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Endometrial Cancer
Etiology and Pathophysiology
 Clinical Manifestations
 Collaborative Care

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Ovarian Cancer
Etiology and Pathophysiology
 Clinical Manifestations
 Diagnostic Studies
 Collaborative Care

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Vaginal Cancer
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Vulvar Cancer
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Surgical Procedures: Female
Reproductive System
Fig. 54-11. A, Cross section of subtotal hysterectomy. Note that cervical stump, fallopian tubes, and ovaries
remain. B, Cross section of total hysterectomy. Note that fallopian tubes and ovaries remain. C, Cross
section of vaginal hysterectomy. Note that fallopian tubes and ovaries remain. D, Total hysterectomy,
salpingectomy, and oophorectomy. Note that uterus, fallopian tubes, and ovaries are completely removed.
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Radiation Therapy: Cancers of
Female Reproductive System
External Radiation Therapy
 Brachytherapy

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Nursing Management:
Cancers of Female Reproductive System
Nursing Assessment
 Nursing Diagnoses
 Planning

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Nursing Management:
Cancers of Female Reproductive System

Nursing Implementation
• Health promotion
• Acute intervention related to surgery
• Hysterectomy
• Salpingectomy and oophorectomy
• Vulvectomy
• Pelvic exenteration
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Nursing Management:
Cancers of Female Reproductive System
Fig. 54-12. Total exenteration is removal of all pelvic organs with creation of an ileal conduit and a colostomy.
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Nursing Management:
Cancers of Female Reproductive System

Nursing Implementation, continued
• Acute intervention with radiation
therapy

Evaluation
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Problems With Pelvic Support
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Uterine Prolapse
Fig. 54-13. Uterine prolapse. A, First-degree prolapse. B, Second-degree prolapse. C, Third-degree prolapse.
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Cystocele and Rectocele
Fig. 54-14. A, Cystocele. B, Bladder has prolapsed into the vagina, causing a uterine prolapse.
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Cystocele and Rectocele
Fig. 54-15. A, Rectocele. B, Rectum has prolapsed into the vagina.
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Nursing Management:
Problems With Pelvic Support
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Fistula
Fig. 54-16. Common fistulas involving the vagina.
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Nursing Management:
Fistulas
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Sexual Assault

Clinical Manifestations
• Physical
• Psychologic

Collaborative Care
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Nursing Management:
Sexual Assault
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