NCM 102: GYNECOLOGY NURSING MANAGEMENT

REPRODUCTIVE SYSTEM  Instruct patient to abstain from

intercourse, douching, and using
FEMALE tampons until advised by physician
5. Cervical biopsy examination: removal of
DIAGNOSTIC TESTS tissue to examine for presence of
malignancy
1. Serum laboratory studies  After procedure, advice patient to rest
 Luteinizing hormone (LH): and avoid strenuous activity for 24
i. Diminished levels may relate to hours
prolonged, heavy menses  Leave packing in place until physician
ii. Elevated levels may result in short, permits removal (usually 12 to 24 hours)
scanty menses  Monitor for vaginal bleeding
 Follicle-stimulating hormone (FSH)  Instruct patient to abstain from
i. Diminished level may relate to intercourse,douching, and use of
bleeding between cycles tampons until advised by physician
ii. Elevated levels may result in  Explained that a malodorous discharge
excessive uterine bleeding that may last three weeks will occur,
 Thyroid function tests daily bath should help control this
i. Diminished thyroid hormone discharge
secretion may result in bleeding 6. Conization
between cycles, irregular menses, or  Removal of cone-shaped tissue of the
absence of menstrual flow cervix for analysis of cancerous cells
 Adrenal function tests  Indicated for removal of diseased
i. Elevated or decreased production of cervical tissue
adrenal cortex hormone secretion  Nursing interventions
may result in a amenorrhea i. Maintained packing 12 to 24 hours
2. Pelvic examination: to inspect and assess ii. Monitor for bleeding
the external genitalia, perineal and anal iii. Instruct patient to abstain from
areas, introitus, vaginal tract & cervix intercourse, douching, and using
 Have patient empty bladder tampons until advised by physician
 Please patient in lithotomy position 7. Schiller’s test
 Flex and abduct patient’s thighs  Application of a dye to the cervix to aid
 Please patients feet in stirrups in detecting cancerous cells
 Extends patients buttocks slightly  Normal vaginal cells will stain a deep
beyond the edge of the examining table brown
3. Laparoscopy: visualization of the pelvic  Abnormal cells will not absorb the dye
structures with a lighted laparoscope  Nursing intervention: recommend to
inserted through the abdominal wall patient that a perineal pad be used to
4. Culdoscopy: visualization of the ovaries, protect clothes from stain
fallopian tubes, and fallopian tubes, and 8. Ultrasonography
uterus with a lighted instrument inserted  A sound frequency that reflects an
through the vaginal tract image of the pelvic structures
 After procedure, position patient on  An aid in confirming ovarian and uterine
abdomen to expel air tumors
 Monitor for vaginal bleeding 9. Culture and sensitivity
 The culture of a specimen and exudate
suspected of infection
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NCM 102: GYNECOLOGY NURSING MANAGEMENT

 The sensitivity of an antibiotic to the

microorganism INFLAMMATORY DISORDERS
10. Dilatation & curettage (D&C)
 A diagnostic and therapeutic procedure Pelvic Inflammatory Disease
 The cervix is dilated to scrape the lining
of the uterine cavity with a curet.  An inflammatory process involving
 Nursing intervention pathogenic invasion of the fallopian tubes
 After procedure, provide sterile perineal or ovaries or both, as well as any vascular or
pads and record amount of drainage supporting structures within the pelvis,
 Encourage avoiding to prevent urinary except the uterus.
retention  Risk factors include multiple sexual
 Instruct patient to abstain from partners, frequent intercourse, IUDs, and
intercourse, douching, and using childbirth.
tampons until advised by physician  Symptoms include low-grade fever, pelvic
11. Mammography: an x-ray examination of the pain, abdominal pain, a “bearing down
breasts to detect tumors; screening test is backache, foul-smelling vaginal discharge,
dunned yearly for women over 40 years of nausea, etc.
age  Future infertility may develop as
12. Thermography: infrared photography used complications.
to detect breast tumors  Diagnostic tests and method: C&S, CBC,
13. Xerography: an x-ray examination of the pelvic examination, laparoscopy
breasts and skin that provides good  Treatment: antibiotic therapy, analgesics
definition of the tissue  Nursing interventions
 Provide nonjudgmental, accepting
MENSTRUAL DISORDER attitude
 Place patients in semi-Fowler’s position
Dysmenorrhea: Painful menstruation to provide dependent pelvic drainage
 Apply heat to abdominal area if ordered
Cause: uterine spasms cause cramping of the lower to improve circulation and provide
abdomen comfort

Signs and Symptoms Endometriosis

 Subjective: Headache, backache, abdominal
pain, chills, nausea  The growth of endometrial tissue, the
 Objective: Fever, vomiting normal lining of the uterus, outside of the
uterus within the pelvic cavity.
Treatment  Most often occurs in women over 30 with
 Analgesics, such as NSAIDs familial history.
 Local application of heat  One cause of female infertility.
 Pelvic exercises  Signs and symptoms
 Subjective
Nursing Intervention:  Discomforts of pelvic area before
 Instruct patient on avoidance of fatigue and menses, becoming worse during
overexertion during menstrual period. menstrual flow, and diminishing as
 Instruct patient on ingestion of warm flow ceases .
beverages before onset of pain to prevent  Dyspareunia
attack  Fatigue
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NCM 102: GYNECOLOGY NURSING MANAGEMENT

 Objective: infertility  Condition occurs during reproductive years

 Diagnostic tests and methods and disappears with menopause
 Laparoscopy culdoscopy  A benign condition affecting 25% of women
 Treatment over 30 years of age
 Hormonal therapy to suppress ovulation  Signs and symptoms
 Surgical intervention: hysterectomy,  Subjective: breast tenderness and pain
oophorectomy, or salpingectomy  Objective: small, round, smooth nodules
 Nursing interventions  Diagnostic tests and methods
 Provide emotional support .  Mammography, thermomastography,
 If patient is young, advised not to delay xerography
having a family because of risk of  Treatment: conservative
sterility .  Aspiration
 Explain that hormonal drugs may cause  Biopsy examination to rule out
pseudo pregnancy and irregular malignancy
bleeding  Nursing intervention
 If patient is middle-aged, advise her that  Explain importance of monthly breast
menopause may stop progression of self-examination
condition  Encourage patient to seek medical
 Follow general post operative nursing evaluation if nodule forms, because
actions, if the patient undergoes cystic disease may interfere with early
surgical procedure diagnosis of breast malignancy
 Observe for vaginal hemorrhage,
malodorous vaginal discharge, or MALIGNANT NEOPLASMS
vaginal discharge, other than
serosanguineous discharge Breast Cancer
 Observe for year-end retention,
burning, frequency, or urgency to  Second major cause of cancer death among
void women. Statistics indicate that 1 in 10 will
 Listen to renewed bowel sounds develop cancer sometime during her life.
 Provide patient teaching on discharge  The key to cure is early detection by
 Heavy lifting, prolonged standing, physical examination, mammography, and
walking, and sitting are breast self-examination.
contraindicated  Signs and symptoms
 Sexual intercourse should be  Subjective: nontender nodule
avoided until approved by physician  Objective:
 Enlarged axillary nodes
 Nipple retraction or elevation
 Skin dimpling
 Nipple discharge
 Diagnostic tests and methods
 Mammography, thermography,
BENIGN NEOPLASM xerography, breast biopsy examination
 Treatment
Fibrocystic Breast Disease(FBD)  Lumpectomy: removal of the lump and
partial breast tissue; indicated for early
 Cause is unknown; possible hormonal detection
imbalance  Mastectomy
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NCM 102: GYNECOLOGY NURSING MANAGEMENT

 Simple mastectomy: removal of  Measure upper arm and

breast forearm, twice daily, to monitor
 Modified radical mastectomy: edema
removal of breast, pectoralis minor,  Encourage exercises of the
and some of an adjacent lymph affected arm when approved by
nodes a physician; avoid abduction
 Radical mastectomy: removal of the  Patient teaching on discharge
breast, pectoral muscles, pectoral  Exercise to tolerance
fascia, and nodes  Sleep with arm elevated
 Oophorectomy, adrenalectomy,  Elevated arm several times daily
hypophysectomy to remove source of  Avoid injections, vaccinations, IV,
estrogen and the hormones that and taking blood pressure, in
stimulate the breast tissue affected arm
 Radiation therapy to destroy malignant Cervical Cancer
tissue
 Chemotherapeutic agents to shrink,  The most preventable gynecological cancer,
retard, and destroy cancer growth it is detected by Papanicolaou (Pap) smear.
 Corticosteroids, antigens, and anti-  An abnormal Pap smear shows dysplasia, a
estrogens to alter cancer that is change in the size and shape of the cervical
dependent on hormonal environment cells.
 Nursing intervention  Sexual habits constitute a major factor in
 Provide atmosphere of acceptance, the development of cancer of the cervix,
frequent patient contact, and with sexually transmitted disease being a
encouragement in illness particularly significant factor.
adjustment  Five year survival rate is 69%.
 Encourage grooming activities  Signs and symptoms
 Arrange attractive environment  Subjective
 If the patient is receiving radiation  Asymptomatic in early stage
or chemotherapy, explain and assist  Menstrual disturbances
with potential site effects  Postmenopausal bleeding
 If the patient has undergone surgical  Bleeding after intercourse
intervention, follow post operative  Watery discharge
nursing actions  Objective: suspicious Pap test result
 Elevate affected arm above level  Diagnostic tests and methods
of right atrium to prevent edema  Pap smear
 Drawing blood or administering  Cervical biopsy examination
parenteral fluids or taking blood  Colposcopy
pressure on affected arm is  Schiller’s test
contraindicated  Conization
 Monitor dressing for  Treatment
hemorrhage, observed back for  Panhysterectomy
pooling of blood  Radiation in advance case
 Empty Hemovac and measure  Chemotherapy
drainage every 8 hours  Nursing interventions
 Assess circulatory status of  Reassure the patient and family that
affected limb adjustment illness can be slow

PREPARED BY: TJM

NCM 102: GYNECOLOGY NURSING MANAGEMENT

 Acknowledge that the patient must  Panhysterectomy, oophorectomy,

adapt to illness, according to her age, salpingectomy
developmental stage, and past life  Chemotherapy
experiences  Radiation
 If patient is to receive an internal  Nursing interventions: see cancer of the
radium implant: cervix
 Provide isolation
 Instruct a patient to maintain supine
or side-lying position
 Explaine to the patient and visitors
that the amount of time spent with MALE
patients will be limited to avoid
overexposure to radiation Prostatitis
 Provide high-protein, low residue
diet to avoid straining of bowels  An inflammation of the prostate which is a
 Maintain high fluid intake: 2000 to common complication of urethritis caused
3000 mL daily by chlamydia or gonorrhea.
 Insert Foley catheter to prevent  Symptoms include perineal pain,
bladder distention fever,dysuria, and urethral discharge.
 Administer antiemetics as ordered  Nursing Interventions:
 If the patient undergo surgery, followed  Encourage bed rest
general post operative nursing actions  Monitor VS, esp. temp for fever
 Monitor I & O
Endometrial Cancer  Assess pain
 Sitz bath – provide comfort
 Postmenopausal women are at greatest  Provide ice pack to scrotum to decrease
risk, especially if they have taken estrogen swelling
therapy for more than five years.  Elevate or provide scrotal support
 Cancer of the endometrium does not  Medical Interventions:
usually produce symptoms until it becomes  Analgesic
relatively advanced.  Antibiotic
 The five-year survival rate for endometrial  Procaine = anesthetic
cancer is 84%.  Stool softeners
 Signs and symptoms  Digital massage – rectally – release
 Subjective infected fluid
 Postmenopausal bleeding
 Bleeding between cycles Benign Prostatic Hyperplasia
 Bleeding after intercourse  Slow enlargement of the prostate
 Watery vaginal discharge  Men over 40 year (prostate gland
 Objective enlargement begins)
 Uterine enlargement  On the latent phase it will constrict the
 Suspicious Pap test results urethra which interferes in urination
 Diagnostic tests and methods: D & C, tissue
biopsy examination SIGNS/SYMPTOMS
 Treatment  SUBJECTIVE
 Surgical intervention  Frequency
 Urgency
PREPARED BY: TJM
NCM 102: GYNECOLOGY NURSING MANAGEMENT

 Difficulty initiating stream  Suprapubic resection – lower abdomen

 Incomplete emptying of the bladder – incision through the bladder –
after urination urethrotomy
 OBJECTIVE  Retropubic – lower abdomen – does not
 Nocturia go through the bladder
 Hematuria
 Weak stream Pharmacologic Management
 Urinary retention
 Biopsy reveals hyperplasia  Alpha blockers – relax the smooth muscles
 Rectal Examination along urinary tract (Hytrin, Cardura) – p.
852
Diagnosis:  S/E: dizziness – orthostatic hypotension
 PSA – prostate specific antigen = high  Belladonna & Opium suppository – reduce
 Rectal examination – most reliable post-op bladder spasm
 Ultrasound  Narcotic analgesic – relieve p-op pain –
 Cystoscopy – visualization of bladder Vicodin, Morphine, Codeine – S/E
 IVP – Intravenous Pyelography – inject a constipation
dye through vein – visualize bladder,  Proscar – androgen hormone inhibitor –
ureters, kidney – allergic to shellfish or may arrest prostate enlargement
iodine?
 BUN – blood, urea, nitrogen – urine, blood – Nursing. Interventions
increase  Increased fluids – monitor I & O
 Serum creatinine – Increased  Maintain gravity drainage of F/C
 Monitor blood clots and color = bright red =
Management bleeding
 Keep irrigation flowing, note clots
 Transurethral Resection of the Prostate  Monitor VS – pain level, temp – orally, NOT
 Continuous irrigation = reduce or prevent rectal
clot formation = clogs urethra = urinary  Avoid straining, provide stool softeners
retention = kidney damage  Teach deep breathing, relaxation technique
 Monitor I & O  Avoid straining
 3-way f/c  Observe bladder distention & spasms = ask
 Monitor fluid overload=water for antispasmodic – stops spasms = pain,
intoxication increase blood clots
 Edema, mental status = agitation,
lethargy Prostate Cancer
 Monitor for distention – bladder
 Stent  The second leading cause of cancer deaths
 Balloon in men.
 Surgical  Risk factors include: advancing age (over
 TULIP – Transurethal Ultrasound-guided 55); first-degree relative with prostate
Laser-induced prostatectomy cancer; African-American heritage; high
 Less invasive level of serum testosterone.
 PROSTATECTOMY  Five-year survival rate is 89%.
 Perineal prostectomy – incision through
perineum SIGNS AND SYMPTOMS

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NCM 102: GYNECOLOGY NURSING MANAGEMENT

 Early tumor – no symptoms  Control pain – terminally ill = hospice,

 Subjective palliative care
 Back pain, same symptoms as BPH –
hesitancy, decrease pressure, INFERTILITY
frequency, dysuria, urinary retention
 Objective  Causes of infertility in males include
 Symptoms from metastasis varicoceles, cryptorchidism, impaired
 Lumps – inguinal sperm, insufficient number of sperm, and
 Enlarged lymph nodes hormonal imbalance.
 Blockage of urethra, and rectal  Tight-fitting underwear and use of hot tubs
dysfunction or saunas may decrease the sperm count.
 In female, may be related to anatomic or
Diagnostic Tests endocrine problems.
 Diagnostic tests may include:
 Rectal examination  Endometrial biopsy to detect tissue
 PSA- prostate specific antigen – elevated responses during both phases of
 Prostatic smear – abnormal cells, dysplasia menstrual cycle.
 Acid phosphatase – prostate – 100x higher  Endocrine imbalance testing.
than normal – PAP – prostatic acid  Laparoscopy to discover conditions such
phosphatase as endometriosis, adhesions, or scar
 Serum alkaline phosphatase – increased if tissue.
bone metastasis  Treatment includes counseling,
 Bone scan – metastasis medications, circulatory aids, and surgery.
 MRI, CT scan

Treatment

 Radiation, chemo, surgical removal

 Radical perineal prostatectomy –
removal of prostate, surrounding
tissues, lymph nodes – inguinal area
 Urethra is anastomosed to the bladder
 Urostomy
 Bilateral orchiectomy (removal of testes)
 TURP
 Estrogen therapy – inhibits serum
testosterone = contradicts
 Agonists of LH – estrogen
 Radioactive seed implant – rectally

Nursing Interventions:

 BPH interventions
 Be supportive – expect feminization, more
emotional, educate
 Gynecomastia – enlargement of the breast

PREPARED BY: TJM