NURSING CARE OF CLIENTS WITH GENERAL ○ Pretesticular ■ Drug users or prolonged maintenance of a

DISTURBANCE IN REPRODUCTION AND ■ These are problems or disorders concerning drug that can lead to infertility
SEXUALITY extragonadal endocrine, such as those ○ Diet/Exercise
originating in the hypothalamus, pituitary or ■ Heavy exercises or faulty eating habits can
Slides 1-7 adrenals, in which these affect spermatogenesis also lead to infertility
(production of sperm cells). Pretesticular in other ● Unexplained - 10%
The inability to conceive a child or sustain a pregnancy to words are problems concerning the amount of
birth that affects as many as 14% of couples who desire sperm or low sperm count. Assessment & Evaluation of Infertility:
children. Couples exploring fertility testing come in all ○ Testicular ● Health history and perform physical assessment
different types: many are married couples who are having ■ These are primary defects in the testis. From the ● Nurses often assume the responsibility for initial
trouble conceiving; some are couples who have plans to word primary, this concerns the shape and history taking with a subfertile couple. Because of the
marry and wonder if they will have trouble conceiving; morphology of the sperm. wide variety of factors that may be responsible for
some desire to remain single or partner with someone of ○ Post-testicular subfertility.
their own sex and bear a child, through an assisted fertility ■ These are factors affecting the ability of the ● Most couples assume that subfertility is the woman’s
method; some are gay or lesbian. sperm to travel from the site of production, the problem. Many women, even after careful explanation
testicle, to leave the body in ejaculation. So it is that the problem is their male partner and not theirs,
When a couple first pursues fertility counseling, they more on the problem of sperm motility or the continue to show low self-esteem, as if the fault did rest
usually have fears and anxieties not only about their movement of sperm. Such as those problems with them. For a thorough women’s health history, ask
inability to conceive but also about what this condition will that develop due to autoimmunity which about:
mean to their future lifestyle and family. immobilizes sperms. Another could be problems ○ Current or past reproductive tract problems, such
in the ejaculation or deposition preventing as infections
Infertility (Subfertility) spermatozoa from being placed close enough to ○ Overall health, emphasizing endocrine problems
- Inability to conceive a child or sustain a pregnancy to a woman’s cervix to allow ready penetration and such as galactorrhea (breast nipple secretions) or
birth after at least 1 year of unprotected sex. fertilization. symptoms of thyroid dysfunction
- There are two types of infertility or subfertility: ● Female - 35% ○ Abdominal or pelvic operations that could have
● Primary Subfertility ○ The factors that cause subfertility in women are compromised blood flow to pelvic organs
○ There is no history of conception, which means analogous to those causing subfertility in men: ○ Past history of a childhood cancer treated with
that there has been no previous conception at anovulation (faulty or inadequate production of radiation that might have reduced ovarian function
all. ova), problems of ova transport through the fallopian ○ The use of douches or intravaginal medications or
● Secondary Subfertility tubes to the uterus, uterine factors such as tumors or sprays that could interfere with vaginal pH
○ There has been a previous viable pregnancy poor endometrial development, and cervical and ● Exposure to occupational hazards such as x-rays or
but the couple is unable to conceive at present. vaginal factors that immobilize spermatozoa. toxic substance
 Both - 20% ● Nutrition including an adequate source of folic acid and
Sterility - the inability to conceive because of a known avoidance of trans-fats.
○ Environmental factors
condition, such as the absence of a uterus. ● If she can detect ovulation through such symptoms as
■ Exposure to radiation or chemicals
Causes of Infertility: ○ Drugs breast tenderness, mid cycle “wetness,” or lower
● Male - 35% abdominal pain (mittelschmerz).
● Also obtain a menstrual history including: ● in sexual techniques.
○ Age of menarche Diagnosis: ● In females, monitor and check for the production of
○ Length, regularity, and frequency of menstrual ● To determine and diagnose problems of infertility, the ova. Anovulation (absence of ovulation), the most
periods couple or an individual has to undergo a series of common cause of subfertility in women, may occur
○ Amount of flow diagnostic tests and procedures. from a genetic abnormality such as Turner’s syndrome
○ Any difficulties experienced, such as ● In male infertility, problems in spermatogenesis, or (hypogonadism) in which there are no ovaries to
dysmenorrhea or premenstrual dysphoric disorder inadequate sperm count are determined by the produce ova.
(PDD) diagnostic test semen analysis. ● It may result from a hormonal imbalance caused by a
○ History of contraceptive use ● For a semen analysis, after 2 to 4 days of sexual condition such as hypothyroidism that interferes with
○ History of any previous pregnancies or abortions abstinence, the man ejaculates by masturbation into a hypothalamus-pituitary-ovarian interaction.
● A minimum history for the man should include: clean, dry specimen jar. The number of sperm in the ● Ovarian tumors may also produce anovulation
○ General health specimen are counted and then examined under a because of feedback stimulation on the pituitary, thus
○ Nutrition microscope within 1 hour, then their appearance and ova is not produced.
○ Alcohol, drug, or tobacco use motility are noted. An average ejaculation should ● Chronic or excessive exposure to x-rays or radioactive
○ Congenital health problems such as hypospadias produce 2.5 to 5.0 mL of semen and should contain a substances, general ill health, poor diet, and stress
or cryptorchidism minimum of 20 million spermatozoa per milliliter of fluid may all contribute to poor ovarian function.
○ Illnesses such as mumps orchitis, urinary tract (the average normal sperm count is 50 to 200 million per ● The most frequent cause, however, is naturally
infection, or sexually transmitted diseases milliliter). occurring variations in ovulatory patterns or polycystic
○ Radiation to his testes because of childhood cancer ● In this procedure, the male should be instructed that a ovary syndrome, a condition in which the ovaries
or another cause repeat is done after 2 or 3 months, because produce excess testosterone, lowering FSH and LH
○ Operations such as surgical repair of a hernia, spermatogenesis is an ongoing process, and 30 to 90 levels.
which could have resulted in a blood compromise days is needed for new sperm to reach maturity. ● Ovulation monitoring is the least costly way to
to the testes. Another male infertility factor is ejaculation problem or sperm determine a woman’s ovulation pattern. Patient is
○ Current illnesses, particularly endocrine illnesses or transport disorder, which includes erectile dysfunction or asked to record her basal body temperature (BBT) for
low grade infections impotence (inability to achieve erection). at least 4 months (according sa book; 1 month gi ingon
○ Past and current occupation and work habits ● This condition is primary if the man has never been ni Miss so dili ko sure).
○ Sexual practices such as the frequency of coitus able to achieve erection and ejaculation and secondary To determine this, a woman takes her temperature each
and masturbation, failure to achieve ejaculation, if the man has been able to achieve ejaculation in the morning, before getting out of bed or engaging in any
premature ejaculation, coital positions used, and past but now has difficulty. activity, eating, or drinking, using a special BBT or
use of lubricants ● Solutions to the problem can include psychological or tympanic thermometer.
○ Past contraceptive measures, and existence of any sexual counseling as well as use of a drug such as ● She plots this daily temperature on a monthly graph,
children produced from a previous relationship. sildenafil (Viagra). noticing conditions that might affect her temperature
● Premature ejaculation (ejaculation before (e.g., colds, other infections, sleeplessness).
● For both, nurses have to check into the lifestyle, use penetration) is another factor that may interfere with ● At the time of ovulation, the basal temperature can be
of contraception, STDs, smoking practices, the proper deposition of sperm. . It is another problem seen to dip slightly (about 0.5° F); it then rises to a level
exercises and the type of occupation. often attributed to psychological causes. Adolescents no higher than normal body temperature.
may experience it until they become more experienced ● Towards the end of the cycle, during the 24th day, her
 temperature begins to decline, indicating that ● Endometrial biopsies are done 2 or 3 days before an which is specially developed for treatment of
progesterone levels are falling, and that she did not expected menstrual flow (day 25 or 26 of a typical 28- premature ejaculation. This increases the time
conceive. day menstrual cycle). It will start with the induction of a to ejaculate and can improve the control of
● Another way is through tubal patency. Both ultrasound paracervical block or anesthesia, then a thin probe and ejaculation. It starts to work very quickly so it is
and x-ray imaging can be used to determine the biopsy forceps are introduced through the cervix. A taken when you anticipate having sex, rather
patency of fallopian tubes and assess the depth and woman may experience mild to moderate discomfort than taking it everyday. You have to take it 1-2
consistency of the endometrial lining. from the maneuvering of the instruments. There may be hours before an individual will engage in sexual
● Nurses need to assess the tubal patency to determine a moment of sharp pain as the biopsy specimen is taken activity.
tubal transport problems. Difficulty with tubal transport from the anterior or posterior uterine wall. Possible ○ Hormone Therapy
usually occurs because scarring has developed in the complications include pain, excessive bleeding, ■ For couples who are unable to have children,
fallopian tubes. This typically is caused by chronic infection, and uterine perforation. this treatment can increase the chance of
salpingitis (chronic pelvic inflammatory disease). It can ● This procedure is contraindicated if pregnancy is pregnancy.
result from a ruptured appendix or from abdominal suspected (although the chance that it would interfere ■ In many cases, inability to have children can be
surgery involving infection that spread to the fallopian with a pregnancy is probably less than 10%) or if an attributed to hormonal imbalance. Although
tubes and left adhesion formation in the tubes. infection such as acute PID or cervicitis is present. hormonal imbalance can be present in both
● Sonohysterography is an ultrasound technique Caution a woman that she might notice a small amount men and women, hormone treatment is usually
designed for inspecting the uterus and fallopian tube. of vaginal spotting after the procedure. For follow-up, performed in women.
The uterus is filled with sterile saline, introduced she needs to call her primary care FIGURE 8.3 Insertion Hormone treatment, in women, aims to promote
through a narrow catheter inserted into the uterine of dye for a hysterosalpingogram. The contrast dye egg maturation and triggers ovulation. So this
cervix. A transvaginal ultrasound transducer is then outlines the uterus and fallopian tubes on radiographs to increases the likelihood of successful
inserted into the vagina to inspect the uterus for demonstrate patency. If she develops a temperature fertilization. Under hormone therapy we have
abnormalities such as septal deviation or the presence greater than 101° F, has a large amount of bleeding, or Clomiphene citrate or clomid. This is an oral
of a myoma and assess the patency of the fallopian passes clots. medication that is often used to treat certain
tube. Because this is a minimally invasive technique, it ● She also needs to call the health care agency when she types of women infertility. Clomid works by
can be done at any time during the menstrual cycle. has her next menstrual flow. This helps “date” the making the body think that your estrogen levels
Transvaginal Hydrolaparoscopy allows direct visualization endometrium and the accuracy of the analysis. are lower than they are, which causes the
of female peritoneal cavity. A trocar is passed through the Management: pituitary gland to increase secretion of FSH
vagina, into the pouch of douglas, and an optic scope is ● Pharmacologic: (follicle stimulating hormone) and LH (luteinizing
placed through the trocar sleeve, allowing close ○ Sildenafil (Viagra) hormone). High levels of FSH stimulate the
examination to the uterus, ovaries, fallopian tube, and ■ This drug is used to treat male’s sexual function ovary to produce an egg cell or multiple follicles
peritoneum. problems, like impotence or erectile dysfunction that would develop and release during ovulation,
● In this procedure, no abdominal incision is required. disorder. This is in combination with sexual while high levels of LH stimulate ovulation.
The procedure can be accomplished in the office stimulation. It works by increasing the blood ■ Letrozole is a medication that has been used in
setting. flow to the penis, to help a man get and keep an women with breast cancer. It is sold under the
● Uterine endometrial biopsy may be used as a test for erection. trade name femara. Letrozole belongs to a class
ovulation or to reveal an endometrial problem such as ○ Dapoxetine of medication known as aromatase inhibitor.
a luteal phase defect. ■ A selective serotonin reuptake inhibitor (SSRI) Aromatase is an enzyme that is responsible for
 the production of estrogen in the body. It works through the first catheter and then into the Artificial Insemination (Therapeutic Insemination ang
by inhibiting aromatase, thereby suppressing fallopian tube to clear the blockage. nakaput sa ako book)
estrogen production. ● Adhesiolysis
■ Clomiphene citrate on the other hand, blocks ○ Adhesions can form from any type of trauma to The instillation of sperm into the female reproductive
estrogen receptors. In both cases, the result is the abdomen. However, they’re most tract to aid conception. The sperm is instilled into the
that the pituitary gland produces more hormone commonly a side effect of abdominal surgery. cervix (intracervical insemination) or directly into
needed to stimulate the ovaries. In adhesiolysis, this is the removal of the uterus (intrauterine insemination). Either the
■ These hormones, FSH and LH, can cause the adhesions in any part of the abdominal cavity. husband’s sperm (artificial insemination by
development of ovulation in women who are In fertility adhesion can cause female husband) or donor sperm (artificial insemination
anovulatory or increase the number of eggs reproductive organ problems by obstructing by donor or therapeutic donor insemination) can
developing in the ovaries of women who already ovaries or fallopian tubes. They can also be a be used.
ovulates. cause of painful intercourse for some people.
■ Bromocriptine belongs to the group of medicine So if a doctor suspects adhesions are causing Used if the man has an adequate sperm count or a
also known as ergot alkaloids. It blocks the the reproductive issue, they may recommend woman has a vaginal or cervical factor that interferes
release of a hormone called prolactin from the surgery to remove them. As for how it is done, with sperm motility.
pituitary gland. Prolactin affects the menstrual a laparoscope is a long thin tube that contains
cycle and milk production. Bromocriptine is used a camera and light is inserted into an incision Donor insemination can be used if a man has a
to treat certain menstrual problems like which helps the surgeon find the adhesion to known genetic disorder that he does not want
amenorrhea in women and stop milk production remove them. transmitted to children or if a woman has no male
in some men and women who have abnormal partner.
Slides 8-14 It is a useful procedure for men who, feeling their
milk leakage. It is also used to treat infertility in
both men and women that occurs because the family was complete, underwent a vasectomy but
body is making too much prolactin. now wish to have children.
■ Antibiotic therapy is given if underlying cause is
brought about by infection, such as in pelvic In the past, men who underwent chemotherapy or radiation
inflammatory diseases. for testicular cancer had to accept being child free afterward
● Canalization of fallopian tube as they were no longer able to produce sperm.
○ This is a nonsurgical procedure to clear the
blockage in the fallopian tube and this is Today, sperm can be cryopreserved (frozen) in a sperm
performed through a speculum placed in the bank before radiation or chemotherapy and then used for
vagina, and a small plastic tube is inserted insemination afterward (cryopreserved sperm: sperm
into the cervix to the uterus. Then a liquid placed in a sperm bank before radiation or chemotherapy).
contrast agent is injected through a catheter
and examine the uterine cavity on a nearby One disadvantage of using frozen sperm is that it tends to
monitor using an x-ray camera. If blockage is have slower motility than unfrozen specimens/sperm.
determined, and it is located on one or both However, although the rate of conception may be lower
fallopian tubes, thread a small catheter from this source, there appears to be no increase in the
incidence of congenital anomalies in children conceived by ova are inserted into a woman’s uterus, where ideally one hours after fertilization, they will have undergone their first
this method. or more of them will implant and grow. cell division. The fertilized eggs are then examined if it is
normal, it is transferred back to the uterine cavity through
An advantage of cryopreserved sperm is that it can be Most often used for couples who have not been able to the cervix by means of a urinary catheter.
used even after years of storage. conceive because a woman has a blocked or damaged
fallopian tube. It is also used when a man has oligospermia In some instances, progesterone may be given to a woman
To prepare for artificial insemination, a woman must record (very low sperm count). IVF may be useful to help couples if it is believed that she will not produce enough on her own
her Basal Body Temperature (BBT), assess her cervical when an absence of cervical mucus prevents sperm from to support implantation.
mucus, or use an ovulation predictor kit to predict her travelling to or entering the cervix, or antisperm antibodies
likely day or involution. cause immobilization of sperm. In addition, couples who Once a pregnancy has been successfully established, a
have unexplained infertility of long duration may be helped woman’s prenatal care is the same as that for any
On the day after involution, the selected sperm are instilled by IVF. pregnancy.
into the cervix using a device similar to a cervical cap or
diaphragm, or they are injected directly into the uterus A donor ovum, rather than a woman’s own ovum, also can Part of the nursing consideration, we nurses need to supply
using a flexible catheter. be used for a woman who does not ovulate (genetic support and counseling to sustain the couple through this
disorder) or carries a sex linked disease that she does not process. Also couples need emphatic support from the
If therapeutic donor insemination is selected, the donors want to pass on to her children (these are the indications). health care providers through these difficult times.
are volunteers who have no history of disease or no family
history of possible inheritable disorder. The blood type, or Before the procedure, a woman is given an ovulation- Infertility (Subfertility)
at least the Rh factor, can be matched with the woman’s to stimulating agent such as Clomiphene citrate (Clomid). Nursing Management:
prevent incompatibility. Sperm from sperm banks can be Beginning about the 10th day of the menstrual cycle, the ● Educate couples on a variety of tests.
selected according to the desired physical or mental ovaries are examined daily by ultrasound to assess the ○ As we all know couples have to undergo diagnostic
characteristics. number and size of developing ovarian follicles. When a testing procedures in order to determine problems
follicle appears to be mature, a woman is given an injection of infertility. Prior to availing those tests, we need to
Some couples have religious or ethical beliefs that prohibit of HCG, which causes ovulation in 38-42 hours. inform this couple how these procedures are being
them from using artificial insemination. Some states have performed and what is expected of that.
specific laws regarding inheritance, child support, and In the harvesting procedure, a needle is introduced ● Allow couples to express thoughts on subfertility of
responsibility concerning children conceived by artificial intravaginally, guided by ultrasound and the oocyte is sterility.
insemination. Artificial insemination takes an average of 6 aspirated from its follicle. Many oocytes may ripen at once ○ Infertility causes anxiety and emotional stress to
months to achieve conception, it may be a discouraging and perhaps as many as 3 to 12 can be removed. The individuals or couples.
process for couples to have to wait this long to see results. oocytes are incubated for at least 8 hours to ensure ● Listen to them.
viability. In the meantime, the husband or donor supplies ● Express their concerns.
In Vitro Fertilization fresh semen specimens. The sperm cells and oocyte are ● Let them ventilate their feelings and anxiety.
One or more mature oocytes are removed from a woman’s mixed and allowed to incubate in a growth medium. ○ This way it relieves tension and airs out feelings of
ovary by laparoscopy and fertilized by exposure to sperm frustrations and disappointments.
under laboratory conditions outside a woman’s body. About After sterilization of the chosen oocyte occurs, the zygotes ● Reinforce options on alternative childbirth techniques.
40 hours after fertilization, the laboratory grown fertilized formed almost immediately begin to divide and grow. By 40 ○ Surrogate mothers
 ■ Women who agrees to carry a pregnancy to ● With all of the anxiety and stress they are going ● The failure of women to achieve orgasm can be a
term for a infertile couple through, we uplift them, offer genuine result of poor sexual technique, or concentrating
○ Adoption encouragement, reassurance and compassion. too hard on achievement or negative attitude
■ Once a ready alternative for infertile couple 5. Create or refer to support groups. toward sexual relationships. Treatment is aimed to
○ Child-free Living ● Couples with infertility are described to be extremely relieve the underlying cause and it may include
■ An alternative lifestyle available for both fertile isolating. They may feel like they are the only couple instruction and counseling for the couple about
and infertile couple couples who have been going through this. To help them, let them talk to sexual feelings and needs. Like the arousal
through rigors and frustrations of subfertility others who are in similar situation disorder, disorder of orgasm occurs in both men
testing and unsuccessful treatment regimens, 6. Promote a positive self image and women.
child free living may emerge as the option they ● We help them recognize their own assets and 4. Pain disorders
finally wish to pursue. potential while being realistic liabilities and ● Pain during intercourse (dyspareunia)
limitations. Negative self-image focuses on faults, Because the reproductive system has sensitive nerve
Advantages: distorting image and imperfections. A positive self supply when pain occurs in response to sexual activities
● Pursue careers image can boost our physical, mental, social, it can be acute or severe and impairs a person’s ability
● Travel more spiritual well being. to enjoy this segment of life.
● More time for hobbies ● Examples of a condition under pain disorder:
● May continue their education Sexual Dysfunction - This can happen at any phase of ○ Vaginismus
sexual response cycle, and it prevents an individual from ■ Involuntary contraction of muscles at the
Client Education: experiencing satisfaction from sexual activity. outlet of vagina when coitus is attempted.
1. Provide information of the different tests This muscle contraction prohibits penile
and procedures and possible outcomes. 1. Desire disorders penetration. This can occur in women who
2. Self care awareness regarding fertility: ● Lack of sexual desire or interest in sex have been raped and also a result of early
● Avoid douching ● The decrease in the sexual desire can also be the learning pattern in which sexual relations are
○ Can alter the pH of vaginal secretion effect of the medicine or chronic disease such as viewed as bad and sinful. In other sexual
● Promote retention of sperm after coitus peptic ulcer or chronic pulmonary disorder that problems, psychological counseling is
○ Right positioning causes frequent pain and discomfort. This may needed to reduce this response
● Maximize the potential for fertilization interfere with the man and women’s overall ○ Vestibulitis
○ Intervention: Monitoring of ovulation and right wellbeing and interest in sexual activity. ■ Inflammation of the vestibule. This condition
timing of coitus. 2. Arousal disorders occurs due to endometriosis or abnormal
● Avoid anxiety and stress. ● Inability to become physically aroused or excited placement of endometrial tissue, vaginal
● Maintain adequate nutrition. during sexual activity. infection, hormonal changes that occur with
3. Empowering realistic expectations. ● Can be caused by physical or psychological factors menopause and causes vaginal drying.
● Most infertility interventions have advantages and or both. Needs careful assessment to help clarify ■ A psychological condition may be present,
disadvantages and not all of the outcomes favors the cause of the problem. treatment is aimed at the underlying cause,
the couple’s desires. Help them set realistic goals 3. Orgasm disorders encouraging open communication between
to prevent devastations. ● Delay of absence of orgasm the sexual partners is necessary.
4. Provide emotional support.
 ● Lack of sexual desire
INFECTIONS
● Premature Ejaculation ○ Lack of interest into coitus
○ Ejaculation before penile-vaginal contact ● Difficulty in arousal 1. Vaginitis
○ This term is also used to mean ejaculation before ○ Problems like erectile dysfunction or impotence - An inflammation of the vagina that can result in
the sexual partner achieved satisfaction. ● Pain during intercourse discharges, itching and pain.
○ This can be unsatisfactory and frustrating to both - The cause is usually a change in the normal
partners. Management: balance of the vaginal bacteria or an infection.
○ Other reasons suggest: doubt of muscularity and ● Counseling, behavior modification - Reduced estrogen level after menopause and
fear of impregnating the woman, which prevents ● Sildenafil (viagra) some skin disorders can also cause vaginitis.
the men from sustaining an erection. ○ Problems of impotence
○ Sexual counseling to both partners may be helpful ○ It can be prescribed to this individual to correct Etiology:
to reduce stress in alleviating the problem. some sexual dysfunction. ● Yeast infection
● Persistent Sexual Arousal Syndrome ● Mechanical aids ○ This occurs when there is overgrowth of fungal
○ Excessive sexual arousal in the absence of desire. ○ Such as vaginal vacuum, these are mechanical organisms, usually caused by candida albicans in
aids in helping relieve pain during sexual the vagina.
Slides 15-21
intercourse and maybe penile implant. ○ Candida albicans also causes infection in other
Etiology:
● Urologic problem ● Psychotherapy moist areas of the body such as in the mouth in the
● Chronic conditions form of oral thrush, skin folds and nail beds. The
○ Such as pulmonary disease Nursing Considerations: fungus can also cause diaper rash.
○ Peptic ulcer can also lead to sexual dysfunction. ● Educate on preventing sexual dysfunction. ○ Antibiotics, hormone therapy, diabetes
○ For example, pulmonary disease, if an individual ○ How to prevent: We need to understand the ● Bacterial vaginosis - STI
has chronic pulmonary disease he/she has the underlying cause then we can be able to help them ○ The common cause of vaginitis results from a
tendency to cannot perform, maybe the individual abstain or prevent from having sexual dysfunction. change of the normal bacteria found in the vagina.
will experience difficulty in breathing. He/She will be ● Diet modification The overgrowth of one of the several organisms
deprived of air so the individual cannot reach or an ○ Obesity could be a cause in sexual dysfunction. A usually bacteria normally found in the vagina like
individual has a sexual disorder. diabetic individual can also experience sexual lactobacilli are outnumbered by other bacteria such
○ Example: A diabetic individual has decreased libido dysfunction. as anaerobes . If anaerobic bacteria becomes too
because of the hormone and overweight individuals ● Control health if comorbidities are present. numerous they accept the balance causing bacterial
can also be one of the etiology of sexual ○ Health conditions like chronic conditions. We need vaginosis.
dysfunction. to inform them that they need to see a doctor to ○ This type of vaginitis seems to be linked to sexual
● Hormonal imbalance have a maintenance medication so that they may intercourse especially if a person has multiple
● Alcohol and drugs be able to do some of the activities that they wanted sexual partners or a new sex partner. It also occurs
● Nerve damage to do, especially activities for couples. in women who aren’t sexually active.
● Psychological in origin ● Trichomoniasis
○ This common sexually transmitted infection is
Signs and Symptoms: caused by a microscopic one celled parasite called
trichomonas vaginalis.
 ○ Trichonomas vaginalis latex condoms may help you avoid infections spread birth control or any medical procedure that involves
■ This organism spread through sexual by sexual contact. inserting instruments to the uterus.
intercourse with some who have the infection.
In men, the organism usually infects the urinary 2. Pelvic Inflammatory Disease (PID) Risk Factors:
tract that often causes no symptoms. - Infection of the female reproductive organ spreading ● Sexually active, more than one sexual partner
○ In women, trichomoniasis usually infects the vagina from the vagina to the uterus, fallopian tubes or ○ Women younger than 25 years old having multiple
and might cause symptoms also increases a ovaries. sexual partners or being in a sexual relationship
woman’s risk of getting sexually transmitted - This is an ascending infection in the upper genital with a person who has more than one sexual
infection. tract caused by poly microbial organisms. partner.
- This may include infection of any of the following ● Unprotected sex
Atrophic Vaginitis - the thinning of tissues and less anatomical structures: endometrium, oviduct, ovary, ○ Sex without condom
moisture due to menopause uterine wall, uterine serosa, broad ligaments and ● Douching regularly
Signs and Symptoms: the pelvic peritoneum. ○ Which upset the balance of good versus harmful
● Discharges Signs and Symptoms: bacteria in the vagina.
○ Changes in the color, odor and amount of ● Pain in your lower abdomen and pelvis ● History of PID or STD
discharges from the vagina. ● Heavy vaginal discharge with an unpleasant odor
● Redness, swelling, itching, pain during intercourse ● Abnormal uterine bleeding, especially during or after
● Odor intercourse, or between menstrual cycles
● Dysuria ● Pain or bleeding during intercourse
○ Painful urination ● Fever, sometimes with chills
● Light vaginal bleeding or spotting ● Painful or difficult urination
● Pain or bleeding upon sex
Etiology:
Nursing Considerations: ● STDs (gonorrhea and chlamydia)
● Explain the importance of complete course of ○ Many types of bacteria can cause PID but Diagnosis:
antibiotic therapy to prevent resistance to the drug. gonorrhea and chlamydia are the most common ● Pap smear (Papanicolaou smear)
● Avoid douching. one. ● Culture and sensitivity testing
● Avoid irritants. ○ These bacteria are usually acquired during ○ Of vaginal secretion
○ This includes scented tampons, pads, douching, unprotected sex. Less commonly, bacteria can ● UTZ (ultrasound)
scented soap. enter the reproductive tract anytime.
○ Rinse soap from the outer genital area after a ● Childbirth, miscarriage and abortion Nursing Considerations:
shower and dry the area well to prevent irritation. ○ The normal value created by the cervix is disturbed. ● Encourage to practice safe sex and use of
○ Do not use harsh soaps such as those with ○ This can happen during menstruation and contraception.
deodorant and antibacterial action or bubble bath. childbirth, or miscarriage or abortion. ○ The use of condoms every time an individual
● Avoid tampons. Regularly change sanitary pads. ○ Rarely bacteria can also enter the reproductive engage into sex and the limitation of numbers of
● Practice protected sex. tract during the insertion of IUD, a form of long term partner and ask about potential partner sexual
○ The use of latex condoms. Both male and female history.
 ○ The use of birth control pills do not protect against ● Fever Signs and Symptoms:
the development of PID. ● A swollen, red or warm scrotum
○ Using barrier methods such as condoms helps to Pain is also present in and around the penis, testicles, ● Testicle pain and tenderness
reduce the risk even if you are taking birth control anus, lower back or lower abdomen. There is also ● Dysuria
pills. enlargement or tenderness of the prostate on rectal ○ Pain upon urination
○ The use of condom every time an individual examination. Sexual problem could also be present such ● Discharge from the penis
engage into sex with a new partner protects STI. as erectile dysfunction, pain when ejaculating or pelvic ● Pain or discomfort in the lower abdomen or pelvis
● Avoid douching. pain after sex. And the typical sign of infection such as ● Blood in the semen
○ Douching upsets the balance of bacteria in the fever. These symptoms can have a significant impact on ● Fever
vagina. the quality of life but in most cases they gradually improve ○ Typical sign of infection
every time and with treatment.
Treatment: Etiology:
● Antibiotics (same with partner) ● Current UTI
● Temporary abstinence ○ Less common in men
● STI (chlamydia or gonorrhea)
Prostatitis ○ More likely in younger men under 35-years-old
- This is an inflammation or swelling of the prostate ● Groin injury (epididymitis)
gland. It can be very painful and distressing but will ○ Undergone surgery to the groin, prostate and
often get better eventually. bladder
- Can come at any age but usually between the age 30- Epididymitis
50 years old. - Where a tube or the epididymis at the back of the Treatment:
- Prostate is a small gland that lies between the penis testicle becomes swollen and painful. ● Antibiotic
and the bladder. It produces fluid that mixes with sperm - It is often caused by an infection and is usually Nursing Considerations:
to create semen. treated with antibiotics. ● Lie down with elevated scrotum.
- If the testicles is also affected, if maybe called ● Cold packs over scrotum (hypogastric area) to relieve
Signs and Symptoms: epididymo-orchitis pain and discomfort.
● Dysuria, nocturia, hematuria ● Avoid lifting heavy objects.
○ Pain when peeing ● Abstinence
● Avoid alcohol, caffeine, spicy and acidic foods that
irritate the bladder.
Slides 29-35
● Encourage increase in water intake.
○ There is frequency, urgency or the need to pee
particularly at night or stop-start peeing. INFANTS
● Pain in the abdomen, groin or lower back Phimosis
● Pain in the area between the scrotum and rectum - The inability to retract the foreskin from the glans of
● Pain or discomfort of the penis or testicles the penis.
● Painful ejaculation - Can occur naturally or be the result of scarring.
- Young boys may not need treatment, unless it makes (Left: Phimosis; Right: Normal Retracted Foreskin) Treatment:
urination difficult or causes other symptoms. ● Surgical correction: 6-12 months of age
- Tight foreskin is common in baby boys who are not Hypospadias ● Testosterone (pre-op)
circumcised (usually stops by 3-years-old). - Abnormal ventral placement of urethral opening on the ○ To increase the size of the penis
underside of the penis. ● Goal: To improve the physical appearance, to be able to
Balanitis - Birth defect or congenital condition in which the void in a standing position and sexually adequate organ.
- Inflammation of the phimotic foreskin (glans/head of opening of the urethra is on the underside instead of at
the penis). the tip. Bladder Exstrophy
- Due to infection or other causes. - Urethra: Tube through which urine drains from the - Severe defect involving the musculoskeletal system
- Can be uncomfortable and sometimes painful but is bladder and exit to the body. and urinary, reproductive and intestinal in some cases.
not usually serious. - Common and does not cause difficulty caring for this - Congenital abnormality that occurs whenever the skin
- Relieved with topical medication. infant. over the lower abdomen does not form properly—the
- Surgery usually restores the normal appearance of the bladder is open and exposed on the outside of the
Nursing Considerations: child’s penis. abdomen.
● Encourage proper hygiene. - “Exstrophy” = turned inside out
● Instruct not to forcibly retract the skin. Signs and Symptoms:
○ Paraphimosis may occur. ● Opening of the urethra other than the tip of the penis Epispadias
○ A urologic emergency in which the retracted ● Chordee - Failure of urethra to close; opening at the dorsal of the
foreskin of an uncircumcised male cannot be ○ Downwards curvature of the penis penis.
returned back to its normal anatomical position; ● Hooded appearance of the penis (only the top half of - The urethra does not form properly.
recognize condition promptly, can lead to gangrene the penis is covered by foreskin) - So all boys with bladder exstrophy also
and amputation of the glans penis. ● Normal (spraying?) during urination have epispadias, but it can occur on its own.

Treatment: Nursing Considerations: Nursing Considerations:

● Steroid cream ● No circumcision ● Clamp cord with soft umbilical tape or silk suture.
● Circumcision ● Catheter care (in surgery) ● Parental support
● Urinary diversion
○ Position drainage bag at lower level to facilitate Treatment:
continuous flow of urine. ● Surgery
● Avoid tub baths, straddle toys, sandboxes, swimming
and rough activities.
● Encourage quiet play after the first few weeks of
surgery. Avoid contact sports while the catheter is in
place.
Pharmacological Management:
● Anticholinergic (Oxybutynin)
○ Used to treat bladder spasm
 on its own within the first few months of life. If your - Swelling in scrotum that occurs when fluid collects
(How Bladder Exstrophy looks like with Epispadias: Male) son has undescended testes that doesn’t correct in the thin sheet surrounding the testicle.
itself, then surgery can relocate the testicle into the - Common in newborns and usually disappear
Cryptorchidism scrotum. without treatment by age 1. Other boys and adult
Sign & Symptoms men can develop hydrocele due to inflammation or
- Absence of testes in the scrotum. Testicle formed injury within the scrotum.
in the abdomen during fetal development. During - Is not usually painful or harmful and might not need
the last couple of months of normal fetal any treatment
development, the testicle gradually descends from 2 types of hydrocele
the abdomen through a tube-like passageway in Communicating Hydrocele
the groin or inguinal cavity into the scrotum. - Open process vaginalis
- Acquired undescended testes - Has an opening into the abdominal cavity. The
- Retractile testes on warm baths opening allows abdominal fluid to pass into the
scrotum.
Treatment Noncommunicating
- Spontaneous descend within 6 months of life - Less serious
- Surgery 12-18 months of life - Usually remains the same size or has a very slow
- Orchiopexy (a procedure to move testicle that has growth. No connection with peritoneum or due to
not descended or moved down to its proper place secondary to trauma, infection, torsion.
in the scrotum. Done 6-24 months of life) If the communicating hydrocele does not go away on its
own, and is not treated, it can lead to an inguinal hernia.
Nursing Consideration
- Pain management
- Keep post-op site free from stool and urine. Take Treatment
note of the anatomical position of the site and the Surgery - for communicating hydrocele, this is corrected
possibility of contaminating urine within 1 year
- Avoid rough sports and straddling Nursing Consideration
- Swelling and discoloration are temporary
- Change dressing everyday and bathe after 3 days
- Failure of one or both testes to design through Slides 43-49 ADOLESCENTS
- Avoid straddle toys for 2-4 weeks
the inguinal canal into the scrotum. Another term - Teach child TSE starting puberty
for this is undescended testicle. Usually one
Varicocele
testicle is affected but about 10% of the time, both Hydrocele
testicles are undescended. An undescended - Presence of peritoneal fluid in the scrotum between
testicle is uncommon in general but common the parietal and visceral layers of the tunica
among babies born prematurely. The vaginalis. Most common painless scrotal swelling in
undescended testicle moves into proper position children.
 ○ Also called breast conserving surgery or wide
- Elongation, dilation and tortuosity of the veins of the location incision because only portion of the
spermatic cord or rather this is an enlargement of the breast is removed.
vein within the loose bag of skin that holds the testicle ○ During lumpectomy, a small amount of tissue around
or the scrotum. the lump is taken to help ensure that all cancer or
- Similar to varicose vein that you may seen in the legs other abnormal tissue is removed.
- Common cause of low sperm production and decrease ● Mastectomy
sperm quality which can cause infertility ○ A surgery to remove all breast tissues from a breast
- Can cause testicle to fail to develop normally or shrink - Cancer that forms into the cells of the breast , after skin as a way to treat or prevent breast cancer.
- Most varicocele develop overtime or most varicocele is cancer breast cancer is the most common diagnosis in ○ With those early stages of cancer mastectomy,
easy to diagnose and may not need treatment women. maybe one treatment option.
- If it causes symptoms is often can be repaired - Occurs both in men and women, but far more common ● Chemotherapy
surgically in women. ○ Drug treatment that uses powerful chemicals to kill
- Survival rates have increased and the number of fast growing cells in the body.
Signs and Symptoms: deaths associated with this disease is steadily ○ Is most often used to treat cancer, since cancer cells
● Rarely it might cause pain (sharp to dull discomfort). declining. grow and multiply more quickly than most cells in the
There is increased pain when standing or physical - Largely due to factors such as early detection, new body.
exertion over long periods. It worsened over the personalized approach to treatment and better ○ Many different chemotherapeutic drugs are
course of the day and relieved when the person lay understanding of the disease. available, chemotherapy drugs can be used alone
down on his back. This causes impaired infertility. or in combination to treat a wide variety of cancer.
● Physical Appearance: Signs and Symptoms: ● Radiation Therapy
○ Wormlike mass above the testes ● A breast lump or thickening that feels different from the ○ A type of cancer treatment that uses a beam of
○ Decrease testes surrounding tissue intense energy to kill cancer cells.
○ Decrease dihydrotestosterone ● Changes in the size, shape or appearance of a breast ○ Most often used x-rays but proton or other types of
particularly during physical and breast examination energy can be used.
Treatment: ● Changes to the skin over the breast, such as dimpling ○ Most often refers to external beam radiation therapy.
● Varicocelectomy ● A newly inverted nipple ○ Damages cells by destroying genetic material that
○ A surgery performed to remove those enlarged ● Peeling, scaling, crusting or flaking of the pigmented controls how cells grow and divide. While both
veins and it is done to restore proper blood flow to area of the skin surrounding the nipple (areole) or breast health and cancerous cells are damaged by
the reproductive organ. skin radiation therapy.
● Redness or pitting of the skin over your breast like the ○ The goal is to destroy as few normal cells, healthy
ADULT WOMEN skin of an orange cells as possible. Normal cells can often repair
Breast Cancer much of the damage caused by radiation.
Treatment:
● Lumpectomy Nursing Considerations:
○ A surgery to remove cancer or other abnormal tissue ● Chemotherapy support
from the breast. ○ Helps aids in the overall health and well-being of an
 individual. So support from family, friends and Etiology: Treatment
healthcare providers has value to participate as to ● Related to estrogen ● Fine-needle aspiration
deal with the disease and treatment. ● Surgical incision
● Hydration Signs and Symptoms:
○ Providing adequate hydration can counter the effect ● Breast lumps with fluctuation size especially during or Fibroadenoma of the Breast
of dehydration for significant planned visits to nearing menstruation - Solid, non cancerous breast lumps that occur most
cancer clinics, proper hydration of the patient. ● Generalized breast pain or tenderness often in women between the ages of 15 and 35.
● Address body image concerns. ● Green or dark brown nonbloody nipple (secretion is Hormonal in nature.
○ The body image concerns in women have been present) - Cause is unknown
attributed to loss of breast from surgery, this result ● Monthly increase in breast pain or lumpiness from mid - Occurs more often during the reproductive years
scarring, physical changes resulting from adjuvant cycle (ovulation) to menstruation - Becomes bigger during pregnancy or hormone
treatment. therapy
○ All of which have an impact on overall quality of - May shrink after
life particularly body image perception. menopause S/S:
● Firm, smooth, rubbery or hard and has a well-
Fibrocystic Breast defined shaped lump
- Nodular or glandular breast tissue or these are ● Painless, moveable
composed of tissues that feel lumpy or ropelike in ● Complex fibroadenomas - this contains changes
texture. such as an overgrowth of cells or hyperplasia that
- More than half of women experienced fibrocystic can grow rapidly; diagnosed after reviewing the
breast changes at some point of their life. Fibrocystic Breast tissue from a biopsy
- In fact medical professionals have stopped using the Diagnosis: ● Juvenile fibroadenomas - most common; found in
term fibrocystic breast disease and now simply refer ● Detected through: adolescent girls (10-18 y.o.). It can grow large but
to fibrocystic breast. Fibrocystic breast changes ○ Clinical & self-breast exam - the doctor shrinks overtime and some may disappear
because having fibrocystic breast is not really a checks the breast and lump modules by the ● Giant fibroadenomas - can grow larger than 2 in. or
disease. lower neck and underarm areas; if normal 5 cm; might need to remove because they can
- Breast changes categorized as fibrocystic are breast changes = no need for additional tests press on or replace other breast tissue
considered normal. Although many women with ○ Mammogram - 45 yrs & above; to take ● Phyllodes tumor - usually benign; some can
fibrocystic breasts do not have symptoms, some annually. Focuses on a specific area of become cancerous or malignant. Doctors
women experience breast pain, tenderness and concern in the breast. recommend removing the tumor.
lumpiness especially in the upper outer area of the ○ Ultrasound - uses soundwaves to produce
breast. image of the breast and often performed with
- Breast symptoms tend to be most bothersome just mammogram; better use for younger
before menstruation. Simple self-are measures can women; can help the doctor distinguish fluid
relieve discomfort associated with fibrocystic breasts. filled cyst and solid mass
Fine-needle aspiration ○ Can cause frequent and severe menstrual Most girls have a small crescent or donut-shaped opening
cramping for severe and abnormal uterine in their hymen. This opening allows for access to the vagina
contraction and approximately 1 in 1,000 girls are born with what is
● Secondary dysmenorrhea - due to pathologic called imperforate hymen.
condition. Dull pain that radiates to buttocks and
thighs Imperforate hymen is a hymen in which no opening to the
○ Usually starts later in life which may be vagina is present. Many girls will not even be aware that
because of another medical condition such they have an imperforate hymen until they begin their
as PID and endometriosis menstrual period and experience complications due to
blood pooling in the vagina.
Slides 57-62

- May collapse the cyst and resolve the Dysmenorrhea Signs and Symptoms:
Risk Factors: ● Abdominal pain and swelling which often come and go
discomfort Treatment ● Obese, Smoking each month
● Monitoring to detect changes in the size (can ● Drinking alcohol during period tends to prolong ● Back pain
shrink or disappear on their own) menstrual pain ● Lack of a menstrual cycle despite having other signs
● Biopsy - to evaluate the lump ● Early menarche (before the age of 11), nulliparity of sexual maturity (developing breast and pubic hair)
● Surgery - to remove the lump ● Dysuria and unable to void
○ Lumpectomy Nursing Considerations:
○ Cryoablation ● Heating pad or hot baths Diagnosis:
● Massage on lower back to relieve cramping ● Gynecologic exam
Nursing Consideration ● Yoga, acupuncture, aromatherapy ● Vaginal or Pelvic Ultrasound
● Instruct to wear firm support bra ● TENS or transcutaneous electrical nerve stimulation ○ Rule out transverse vaginal septum or mass
● Avoid caffeine and fats ● Diet modifications: low salt and sugar ■ Imperforate hymen diagnosed in girls younger
● Warm pack for discomfort ● NSAIDS or Nonsteroidal Anti-Inflammatory Drugs than 10 years old are often found by chance.
■ In some cases, doctors may suspect an
Dysmenorrhea Imperforated Hymen imperforate hymen following a routine newborn
- Pain at the suprapubic area or lower abdomen Most females are born with hymen. A hymen is a thin check. So if the doctor suspects an imperforate
during or shortly after menstruation membrane that stretches across the vagina. It generally has hymen, they can order vaginal or pelvic
Two Types a ring-like appearance with a small opening. There is no real ultrasound.
● Primary dysmenorrhea - due to prostaglandin medical purpose for the hymen although some think it may ■ Can also be mistaken for other pelvic conditions
release. 8-48 hrs. have evolved over time to help protect vagina from infection. such as transverse vaginal septum. This is a
○ Occurs at menarche and thick mass blocking the vagina and ultrasound
continues throughout life can help confirm the diagnosis.
○ Commonly first 3 to 5 years after
menarche or after ovulation is established
○ Usually life-long
Different Types of Hymen: ● Abdominal bloating Causes:
● Normal ● Pelvic fullness Unknown, but there are some factors that may contribute:
● Imperforate ● Joint muscle pain ● Cyclic change in hormones or hormonal fluctuation
● Microperforate ● Breast tenderness ○ Disappears in pregnancy and menopause
● Cribriform ● Weight gain due to fluid retention ● Chemical change in the brain
● Septate ● Premenstrual cravings or appetite changes ○ Neurotransmitters: serotonin. This is thought to play
● Headache, fatigue a crucial role in mood state. With the fluctuation of
● Constipation, Diarrhea serotonin, this could trigger PMS symptoms.
● Alcohol Intolerance, Acne flares ○ Insufficient amounts of serotonin may contribute to
● Depression, crying spells, irritability, panic attacks, premenstrual depression as well as fatigue, food
anger (mood swings) cravings and sleep problems.
● Insomnia, social withdrawal, change in libido, poor ● Depression
concentration ○ Some women with severe premenstrual syndrome
○ Generally, these will disappear 4 days after the have undiagnosed depression although depression
start of the menstruation. alone does not cause all the symptoms.

Treatment: Premenstrual Dysphoric Disorder (PMDD) - Significant Treatment:

● Hymenotomy physical and behavioral symptoms that interfere with daily ● Advise women to have regular exercise and enough
○ Surgically cut away part of the hymen using a living. sleep
scalpel or laser ● Avoid smoking, limit sugar, salt, alcohol and caffeine.
Signs and Symptoms: ● Yoga, acupuncture, hypnosis, massage
Nursing Considerations: ● Irritability or anger that may affect other people ● Stress reduction techniques
● NSAIDS, antibiotics as ordered ● Feeling of sadness or despair ● NSAIDs
● Dilator-application ● Thoughts of suicide, Feeling out of control
Menopausal Syndrome
Slides 63-68
Premenstrual Syndrome - The stage of life after you have not had a period for 12
3 of every 4 menstruating women have experienced ● Feeling of tension or anxiety, panic attacks, mood months or longer.
premenstrual syndrome. Symptoms may occur in swings or crying - This is the time that marks the end of the menstrual
predictable patterns but the physical and emotional ● Often lack of interest in daily activities and relationships cycle.
changes women experience with PMS may vary from just ● Trouble thinking or focusing - It is diagnosed after 12 months without a menstrual
slightly noticeable to all the way to intense. ● Tiredness or low energy period.
● Food craving or binge eating and insomnia - This can happen to women in their 40s or 50s, but the
We do not let this problem control our life. Treatment and ● Bloating, breast tenderness, headache and joint or average age is 51.
lifestyle adjustment can help reduce or manage the signs muscle pain
and symptoms of premenstrual syndrome. Signs and
symptoms could be behavioral, physical, or emotional.
Signs and Symptoms:
- A natural, biological process but the physical ○ Replacement of declined hormones The specific disturbance in adult men includes:
symptoms such as hot flashes, emotional symptoms ● Gabapentin 1. Benign Prostatic Hyperplasia (BPH)
of menopause may disrupt sleep, lower the energy, or ○ For hot flashes - Also called prostate gland enlargement
affect emotional health. ○ Is said to be an anticonvulsant drug but it is used to - Common condition in men as they get older
treat vasomotor symptoms in premenstrual women - An enlarged prostate gland can cause
Etiology: with contraindications to hormonal therapy uncomfortable urinary symptoms such as blocking
● Decline of hormones ● Vitamin D and calcium supplements the flow of urine out of the bladder. So with the
● Hysterectomy ○ Prevent osteoporosis blockage, it causes stasis, urinary tract and kidney
● Chemotherapy and radiation problems.
● Primary ovarian insufficiency Nursing Considerations: (Key focus is more on a ● Risk Factors:
○ Is said to be genetic symptomatic approach) ○ Aging
● Dress lightly ■ 60-years-old and above
Signs and Symptoms: ○ To counter the effects of hot flashes ○ Family history of BPH
● Irregular periods ● Increase cold fluids. Minimize hot beverages, spicy ○ Diabetes and heart diseases
● Vaginal dryness foods, smoking, alcohol, stress, hot weather, and warm ■ Because of the use of beta blockers
● Hot flashes room ○ Obesity
● Chills ● Use water-based vaginal lubricants
● Night sweats ○ For vaginal dryness
● Sleep problems ● Sleep and exercise
● Mood changes ● Kegel exercises
● Weight gain and slowed metabolism ○ For the muscle tone in the lower pelvic area
● Thinning hair and dry skin
● Loss of breast fullness
● Osteoporosis
○ Due to loss of estrogen in the body
○ Will lose up to 25% of our bone density following
menopause up to the age of 60
○ Makes a woman susceptible to bone fractures
particularly in the hips, spine, and wrists
● Cardiovascular diseases
● Obesity
○ Due to slowed metabolism
● Vaginal dryness
● Urinary incontinence

Treatment:
● Hormone therapy
 The size of the prostate doesn’t necessarily determine the ● PSA Test (Prostate Specific Antigen)
This slide will help us compare a normal and enlarged severity of the symptoms. Some men with only slightly ○ Blood test
prostate gland. Prostate gland is located beneath the enlarged prostate can have significant symptoms, while ○ A substance produced in the prostate, an increased
bladder. The tube that transports urine from the bladder other men with very large prostate can only have minor level of which is seen in large prostate. However,
out of the penis and passes through the center of the urinary symptoms. Symptoms usually stabilize or might elevated PSA level can also be due to recent
prostate, that tube is called the urethra. When the even improve over time. procedure, infection, surgery, and prostate cancer.
prostate enlarges, it begins to block the urine flow. Most ● UTZ, Bx (Ultrasound and Biopsy)
men have continued prostate growth throughout life, and Complications: ○ Transrectal ultrasound
with the enlarged prostate, this can cause urinary ● Urinary retention ○ An ultrasound probe is inserted in the rectum to
symptoms or significant blocked urine. ○ Sudden inability to urinate, the need to have a measure and evaluate the prostate.
catheter inserted into the bladder to drain the urine. ○ Prostate biopsy, this is an examination wherein a
The one with the yellow picture is the normal prostate, and ○ In some men with larger prostate, they need tissue sample is taken to help the doctor diagnose
there is no obstruction in the urethra. surgery to relieve the retention. and rule out prostate gland cancer.
● UTI (Urinary Tract Infection) ○ A transrectal ultrasound guides the needle and
On the other hand, the enlarged prostate, it pushes ○ The inability to fully empty the bladder can increase takes tissue samples for biopsy.
through the urethra causing blockage. There is little the risk of infection in the urinary tract. ● Cystoscopy
amount of urine passed through the urethra because of ○ If UTI occurs frequently, the need for surgery to ○ Wherein an instrument called a cystoscope is
the increased size of the prostate. The compressed remove part of the prostate. inserted to the urethra, allowing the doctor to see
urethra, a possibility of stasis of urine in the bladder ● Bladder stones and damage the inside of the urethra and the bladder.
○ Generally caused by inability to empty the bladder. ○ A local anesthesia is given before the test
Complications:
○ Bladder stones can cause infection, bladder
irritation, blood in the urine, and obstruction of urine. Treatment:
The severity of symptoms in people who have prostate ● Damaged bladder For the treatment of BPH, this could either be minimally
gland enlargement varies, but they tend to gradually ○ Is also a complication of BPH. invasive therapy like drug therapy or surgery.
worsen over time. ○ A bladder that hasn’t emptied completely, can stretch
and weaken over time. As a result, the muscular wall For medication or drug therapy, this is the most common
Signs and Symptoms: of the bladder no longer contracts properly and treatment for mild to moderate symptoms of prostate
● Frequent or urgent need to urinate makes it hard to fully empty the bladder. enlargement. This drug includes alpha blockers and 5-
● Increased frequency of urination at night (nocturia) ● Kidney damage alpha reductase inhibitor:
● Difficulty starting urination ○ Pressure in the kidney from urinary retention can ● Alpha-blockers (Tamsulosin, Alfuzosin, Doxazosin)
● Weak urine stream or a stream that stops and starts directly damage the kidneys and allow bladder ○ A medication that relaxes the bladder neck
● Dribbling at the end of urination infection to reach the kidney or ascending infection. muscle and muscle fiber in the prostate making
● Inability to completely empty the bladder urination easier.
Diagnosis: ● 5-alpha reductase inhibitor (Finasteride,
The less common signs or symptoms are urinary tract ● DRE (Direct Rectal Exam) Dutasteride)
infections, inability to urinate, and blood in the urine. ○ This is when the doctor inserts a finger into the ○ This medication shrinks the prostate by
rectum to check the prostate for enlargement. preventing hormonal changes that cause
prostate growth. urine to pass through the urethra. MCN WEEK
● Transurethral Resection of the Prostate 6 NOTES Nursing Considerations:
(TURP) ○ This surgery might be an option if the man has ● Instruct the patient to spread the fluid intake
○ Surgical management a small to moderate enlarged prostate gland, throughout the day.
○ Done using a lighted scope inserted into the especially if the man has health problems that ● Limit beverages at night, caffeine and
urethra, then the surgeon removes all but the make other surgeries too risky. alcohol.
outer part of the prostate. ● Transurethral Microwave Thermotherapy ○ To prevent nocturia
○ Generally relieves the symptoms quickly and (TUMT) ○ This increases the needs to urinate
most men have a strong urine flow soon after ○ The doctor inserts special electrodes through ● Bladder care
the procedure. After TURP catheter is inserted the urethra into the prostate area. The ○ Take plenty of time to urinate and try to relax.
temporarily to drain the bladder microwave energy from the electrodes destroy ○ Read or think of other things while waiting. ○
● Transurethral incision of the prostate (TUIP) the inner portion of the enlarged prostate gland, For dribbling (?) problems, wash penis daily to
○ Same with TURP; a lighted scope into the shrinking it and easing the urine flow. avoid skin irritation and infection.
urethra and the surgeon makes one or two ○ Only partly relieves symptoms and it might ● Healthy diet, minimize obesity.
cuts in the prostate gland, making it easier for take some time before a man notices the result.
MCN WEEK
NURSING 6 NOTES
CARE OF A FAMILY WITH AN ILL CHILD =School age child and adolescent –loss of body parts, loss of life, and PREPARING THE ILL CHILD AND FAMILY FOR
loss of friends HOSPITALIZATION
THE MEANING OF ILLNESS TO CHILDREN
NUTRITIONAL NEEDS Depending on the age of the child (2-7 years old)
Depends on:
According to CDC (2015a) E.g. 2 years old –2 days before hospitalization
○ Cognitive ability
=Children have greater metabolic demand
4 year-old –4 days before hospitalization
=Children breathe in more air per pound of body weight
○ Past experiences Children older than 7 years of age can be told as soon as the parents
=Higher surface to body mass ratio are aware of it.
○ Level of knowledge
FLUID AND ELECTROLYTE BALANCE ADMITTING THE ILL CHILD AND FAMILY
Assessment on Admission
=Adults: extracellular water represents approximately 23% of total body ○ Chief concern
 Early school age children wt.
=Newborn: extracellular water is closer to 40% ○ Family profile
Generally know quite a bit about the workings of their major body parts ○ Past experience with illness or separation
Able to name the function of heart, lungs, and stomach SYSTEMIC RESPONSE TO ILLNESS ○ Daily routines
Not able to see the body as a system until the age of 10 to 11 years. =Young children tend to respond to disease systemically rather than ○ Developmental survey
 Younger children locally. ○ Special Information
=Systemic reactions can delay diagnosis and therapy and can cause
May think the cause of illness in magical / a consequence of breaking a rule.* increased fluid and nutrient loss. PROMOTING A POSITIVE HOSPITAL STAY
By 4thgrade –generally aware of the role germs play in illness*  Providing continuity of care (primary nursing)
AGE-SPECIFIC DISEASES  Providing adequate play facilities
By 8thgrade –able to voice an understanding that illness can occur from several
causes.* =Most adults have achieved immunity to common infectious diseases ○ Therapeutic play
 Setting limits on behavior
DIFFERENCES IN RESPONSES OF CHILDREN AND =Children are very susceptible to illnesses such as measles, mumps,
and chicken pox. DISCHARGE PLANNING
ADULTS TO ILLNESS
CARE OF THE ILL CHILD AND FAMILY IN THE  Discharge planning is not only an important link between the
=Inability to communicate
hospital and the home, but it is also a final way to create a
=Inability to Monitor Own Care and Manage Fear HOSPITALIN THE satisfying hospital experience
=Nutritional NeedsFluid and Electrolyte Balance
=Systemic Response to illness HOSPITAL
=Age-specific Diseases THE EFFECT OF HOSPITAL SEPARATION AND DEVELOPMENT OF THE ILL CHILD
INABILITY TO COMMUNICATE CHILDREN: DECREASING SEPARATION ANXIETY
Nsg. Dx. : Risk for delayed growth and development related to the
=Infants (5-9 months old) –attached to parents and care giversTo effects of illness
Very young children –do not have the vocabulary to describe symptoms
School age –most can describe symptoms with accuracy* reduce separation anxiety –establish a primary nurse For ill infants –maintain their at-home schedule when posible.
=Toddlers and pre-schoolers –effects of separation become especially
For ill toddler and pre-schooler –promote both autonomy in toddlers and
INABILITY TO MONITOR OWN CARE AND MANAGE intense in young children before they understand time
initiative in pre-schoolers
FEAR =School-age children and adolescent –react better than younger
children to the separation For ill school-age children –need to work on a sense of industry or
Adults –Often ask questions about medications and procedures learning more about how and why things are done
School age and younger children cannot monitor their own care
Children have fears :
=8-9 months –fear of separation
=Toddler and pre-schoolers –fear of separation, the dark, intrusive
procedures, and mutilation of body parts
MCN WEEK 6 NUTRITIONAL
PROMOTING NOTES HEALTH OF THE ILL PROMOTING ADEQUATE SLEEP FOR THE ILL CHILD NURSING CARE OF THE CHILD UNDERGOING
CHILD MEDICATION ADMINISTRATION & INTRAVENOUS
SLEEP PATTERNS
Areas of Concern when planning Nutrition for Ill Children THERAPY
=Meaning of food Influenced by: apprehension level, state of health, habit, medication,
=Opportunity for socialization and environment at the time of sleep.
=Level of stress ➢Variety of routes: orally, intranasally, transdermally, topically, rectally,
Stages:
=Custom and culture and via injection or by inhalation.
=Non-rapid eye movement (NREM) stage I –a feeling of drifting or
=Environment
falling ➢Safe medication administration is a priority in child health nursing
Encourage Fluid Intake =NREM stage II –Sleep deepens. Temp and HR decrease slightly more. .➢Each dose of drug must be calculated individually.
Offer small, full glasses frequently rather than larger half-full glasses =NREM stage III –Sleep deepens still further. Temp and HR decrease
Determine the child’s favoritefluid and then offer it, if appropriate further. Pharmacokinetics in Children
Popsicles and Jell-O count as fluids =NREM stage IV –Approx. 20-30 minsafter beginning to fall asleep
Children can drink more of clear fluid than a thicker fluid* =Rapid eye movement (REM) –Eyes move in rapid, involuntary motions. ➢The four basic processes: Absorption, Distribution, Metabolism, and
Excretion
Suggest soothing beverages such as milk or Pedialytepopsicles for
children with mouth lesions* SLEEP DEPRIVATION ➢The immaturity of body systems in children plays a major role in drug
Ice melts one half its volume. action throughout each of these processes.
-Infants are dependent on sleep to promote brain development .
Encourage breast feeding whenever possible. -If sleep loss is mainly REM deprivation, children show symptoms of
Introduce a game.
Adverse Drug Effects in Children
irritability and difficulty concentrating.
Encourage Food Intake
-If stage IV NREM sleep is lacking, tends to cause apathy, physical ➢Children may experience unique or exaggerated side effects
Calorie counting –record all the foods that a child eats during each 24-
fatigue and depression and can slow recovery. ➢Newborns may suffer from adverse effects from drugs taken by the
hour period-include snacks, candy, or gum mother prenatally or from drugs taken during breast-feeding mother
PROMOTING ADEQUATE STIMULATION FOR THE ILL
-A dietitian then will analyse the list and determine the calorie intake
CHILD Safe Storage of Drugs
PROMOTING SAFETY FOR THE ILL CHILD
=Sensory Deprivation –the condition of being deprived of, or lacking ➢Adolescents can deliberately take extra doses of drugs such as
adequate sensory, social, physical or cognitive stimulation steroids or pain medicine, hoping for an added effect.
>Always be sure of the location of all children in your care.
=Sensory Overload –occurs when children receive more stimulation ➢Children, like adults, may hoard drugs and then use them in a suicide
>Ensure that doors of healthcare facilities have working alarms to
than they can tolerate or process. attempt
prevent children from going out and to prevent strangers from coming
in.
>Be sure windows are covered by screens or guards so children cannot
PROMOTING PLAY FOR THE ILL CHILD ❖In hospitals:
climb up on sills and fall out. ➢Always be certain that medicines are stored in a safe place.
>Assessing child health through play
>Check that the side rails of beds and beds are in good condition, ➢On a children’s unit, leaving a cart in the hallway is inappropriate.
>Providing play in ambulatory settings
raised appropriately, and locked >Providing Play in the hospital ➢Never leave medicine on a bedside table for a child to take
>Test crib rail after it is raised to ensure the lock is caught >Providing play for children on Bed rest
>Push bedside tables or stands away from cribs so as child cannot >Safety with play ❖At home:
>Child support programs
climb over the railing and use the stand as a step down.
>Therapeutic play ➢Medication should be kept in a locked medicine cabinet above the
>Ensure that electrical cord or appliances such as hair dryers are not height their child could reach.
used in bathrooms.
Therapeutic play (3 types) ➢Remind parents that most childhood poisoning occurs when a family
>Be careful of the placement of television/call cords or window blind is under stress.
Energy release –pounding, hitting, running, punching and shouting.
cords so they cannot lead to strangulations
Dramatic play –acting out an anxiety producing situation. ➢Tell parents they should never take medicine in front of children or
>Never leave a child alone in the bathtub. pour or prepare medicine in the dark
>Adhere to all fire precaution measures. Creative Play –e.g. drawing
>Closely follow standard infection precautions.
MCN Administration
Safe WEEK 6 NOTESof Drugs ➢If using spray bottles, let patient stand or sit upright, hold spray bottle ➢suppositories are supplied already lubricated. If not, add a drop of
➢Determine giving the right drug to the right child, in the right dosage upright with the tip just inside the nose, and gently squeeze the spray water-based lubricant to the tip.
and by the right route, at the right time. bottle. ➢Use a glove and insert the suppository gently but quickly beyond the
rectal sphincters.
Oral Administration Ophthalmic Administration
○Approximately ½ inch or as far as the first knuckle of the little
➢Children younger than 9 years old often have difficulty swallowing ➢Eye medications -most often dropped into the conjunctival sac of the finger for infants, and 1 inch or as far as the first knuckle of the index
tablets. eye.
finger for older children)
➢Most oral medication is furnished in liquid form. ➢Infants and preschoolers must be restrained in a mummy restraint
➢Withdraw your finger and press the buttocks together firmly until the
➢In infants: Place the child on the back.
child’s urge to evacuate the suppository passes.
✓Oral medication can be given with a medicine dropper or a unit dose Open the eyes of infants and preschoolers gently by firmly
syringe (without needle). pressing on the lower lid with the thumb and on the upper lid with the Transdermal/ Topical Administration
index finger.
✓Gently restrain the child’s arm and head
➢You may need to rest a hand on the eyelid to keep the eye open long ➢Most children accept this type of application well because the
✓Never give medicine with the child lying completely flat.
enough and allow the eyelid to close after.
➢A crying child is already opening his or her mouth for you; or gently medicine brings most immediate relief.
➢Avoid placing the drops directly on the cornea. ➢Be certain the child’s skin is dry and intact at the site
open the mouth by pressing on the child’s chin.
➢Do not hold the eyelids apart of any longer than necessary ➢Apply patches over trunk or major muscle, not on distal extremities,
➢The end of the syringe or dropper should rest on the side on the
mouth to prevent aspiration. ➢After the child has blinked two or three times, allow the child to get up. for best absorption.
➢May also be given fluid from a small glass or spoon. ➢Praise the child for his or her cooperation ➢Assess and change the site every time a new patch is applied
➢To instill ophthalmic ointment: ➢Put clothes on the young child immediately so that patch is out of site.
➢Because firm pressure was used to give the medicine to the infant, he
or she may be frightened, so take time to sit and comfort. ➢Be certain patches applied to children wearing diapers are not placed
Apply a fine line of the ointment long the inside rim of the where a leaking diaper could wet the patch.
➢Preschoolers and Early School-age conjunctivalsac, working from the inner to the outer eye
canthus. Intramuscular and Subcutaneous Administration
Responds well to rewardseach time they take their medicine.
➢Older children If the eye is pus-filled, apply from the medial aspect to the
outer one ➢Intramuscular (IM) injections are rarely prescribed for children
Hand them a glass of medicine as if they are expected to take
it Otic Administration ✓For infants the mandatory site is the vastus lateralis muscle of the
Offer a “chaser” if necessary and not contraindicated.
anterior thigh.
➢If a child is having difficult in swallowing tablets, they can be crushed ➢refers to administering medicine into the ear canal. ○Use the lateral aspect rather than the medial portion
and added to a teaspoonful of applesauce or a flavored syrup.
➢Remind the child that ear drops can feel funny ○Using the gluteal muscle in children younger than 1 year is
➢Let the child practice on small bits of ice before teaching them to
➢Ear drops must always be used at room temperature or warmed extremely hazardous
swallow tablets.
slightly.
➢Another technique to help a child swallow pills is to push them into Continuous Subcutaneous Pump Infusion
teaspoonful of ice cream or pudding. ➢Place the child on the back, in a mummy restraint if necessary
The intent is not to hide the pill but to help the child learn to ➢Turn head to one side ➢the constant infusion of a medication into the subcutaneous tissue
swallow medicine ➢A child younger than 3, straighten the ear canal by pulling the pinna using a medication pump.
down and back. ➢The disadvantage: the child must be careful to protect the pump from
Intranasal Administration
➢A child older than 3 years, pull the pinna of the ear up and back. damage.
➢Place the child on his or her back. ➢Site chosen: the abdomen
➢Instill the specified number of drops into the ear canal.
➢Extend the head over the side of the bed ➢Insulin and heparin are two drugs often prescribed for use with
➢Hold the child’s head in the sideways position for at least 1 minute to
➢Preschoolers are too frightened by this strange position. Place a infusion pumps.
pillow under their shoulders instead. ensure that the medication fills the entire ear canal.
➢The syringe is filled with medicine and a small tube with the needle
➢An infant, may need to be restrained in a mummy restrain ➢Praise the child for his or her cooperation after the procedure.
attached at the distal end is attached to hub of the syringe.
➢Instill the appropriate number of drops into one nostril. Rectal Administration ➢The syringe is the clamped into the pump and the skin is cleaned with
➢Turn the child’s head to the sides. alcohol and the needle inserted at 45-degree angle.
➢Ask the child to sniff the medicine. ➢this allows the medication to be absorbed across the mucous ➢The insertion site is change every 1 to 2 days
➢Have the child remain in head flat position for at least 1 minute. membrane of the intestine. ➢If the child is not toilet trained, it is important to keep pump and
➢Give the child high praise ➢Medications are given by rectal suppository or by retention enema.
MCN WEEK
insertion 6 NOTES
site away from an area that can be soiled with urine or stool. ➢“Butterfly” needles or “scalp vein needles” are metal needles with a Determining Rate and Amount of Fluid Administration
➢With small children, cover the pump with clothing flange of plastic added on both sides of the needle hub
➢A length of narrow tubing leads from the needle to the fluid ➢IV fluids must be infused at a slower rate than adults.
administration tubing ➢Automatic rate-flow infusion pumps are useful when giving potent
.This tubing must be flushed with IV solution before the medications. Should be mandatory for small children
Nursing Considerations in Administering Intravenous needle is inserted to avoid air embolus. ➢Fluid chambers -devices that allow only 50 to 100mL of fluid into the
Therapy to Pediatric Clients drip chamber at a time.
Intravenous Therapy ➢Minidropper -device that reduces the size of the drop in the control
chamber to 60 drops per mL.
➢The quickest and most effective means of administering fluid or ➢Keeping a careful record of both rate and amount of fluid
medicine Signs of fluid overload are those of congestive heart failure
➢used to:
(1)maintain fluid and electrolyte balance Intravenous Medication Administration
(2)to produce therapeutic levels of drugs in the body quickly (3)to
provide rehydration and nutritional support ➢Medications may be added to an IV line as a small, one-time
➢IV fluid may be infused into a peripheral vein, a central venous access administration (bolus) or piggyback for longer infusions.
device, or a peripherally inserted central venous catheter. ➢Ensure that the drug to be injected is compatible with an IV fluid being

➢The amount, type and rate of IV fluids for children are prescribed infused.
➢To administer medicine by a bolus technique
carefully ➢Common sites: the veins on the dorsal surface of the hand or on the
Determining Fluid and Caloric Needs of the Child
flexor surface of the wrist For piggyback infusion of medicine:
➢Leg and foot veins may also be used. ✓Clean the medicine port on the IV line, and insert the piggyback
IV fluids administered to children and infants must be isotonic ➢Scalp vein over the temporal area -ultimately causes the least system into the port
discomfort for their child because needles do not infiltrate readily .✓Lower the level of the main infusion bag and adjust the flow rate.
➢Children who have IV infusions for long periods may require the ✓elevate the maintenance bag of fluid again and regulate at proper rate
placement of an Intracath (a slim, pliable catheter threaded into a vein).
Advantage: it cannot be dislodged as easily Using Intermittent Infusion Devices
➢IV infusions must be secured in place with at least a small armboard.
➢Heparin locks -devices that maintain open venous access for
medicine administration while allowing children to be free out of bed.
➢Scalp vein tubing is used and capped at the end with a specially
designed rubber stopper or a commercial trap.
➢The tubing and stopper must be firmly secured to the wrist and an
armboard taped in place to remind the child to protect the site from
trauma.
E.g. of isotonic: Lactated ringer’s and 0.9% normal saline ➢For hospitalized or receiving home care for a long time
E.g. of hypotonic: Normal saline 0.45% ➢Can also be used if frequent venous blood samples are required.
E.g. of hypertonic: Dextrose 10% in 0.9% sodium chloride

Obtaining Venous Access

➢The needle size for IV therapy varies depending on the solution and
the rate at which it will be administered.
➢Commonly used catheter sizes: 22-gauge, 24-gauge, and 25 gauge
(in newborns).
MCN WEEK
Using 6 NOTES
Central Venous Access Catheters and Devices ● Children can also have Peripherally inserted central
catheters (PICC lines)
➢Venous access for long-term IV therapy -obtained using a catheter
inserted into the vena cava just outside the right atrium. ✓Advantage: can remain in place for up to 4 months without being
➢Typical catheters: Broviac, Hickman, Groshong catheters. changed.
○These catheters can be used to administer bolus or continuous ✓These catheters are inserted into an arm vein (usually at the
infusions of medications and fluid antecubital space into the median, cephalic, or basilic vein) and
Advantage: discomfort from further skin punctures is avoided. advanced until the tip rests in the superior vena cava.
Disadvantage: catheter could become snagged on something and
➢All central venous access systems have the potential to cause
accidentally be pulled out.
thromboses because they partially occlude a vein.
Patients are not allowed to swim or take showers to avoid
➢Dressing must be changed using strict aseptic technique to prevent
infection, unless there is a waterproof dressing
infection.

Administering an intraosseousInfusion

➢Infusion of fluid into the bone marrow, usually the distal or proximal
tibia, the distal femur, or the iliac crest.
➢Fluid reaches the blood stream quickly as if it were administered IV
➢is used in an emergency when it is difficult to establish usual IV
access
➢It is a temporary measure until a usual route of administration
Vascular access ports (VAPs) ➢It must be initiated with sterile technique, and if continued for an
extended time, the infusion point is rotated about every 2 to 3 days
✓Are small plastic devices that are implanted under the skin, usually on ➢Tubing must be changed every 48 hours and the dressing over the
the anterior chest just under the clavicle, for long term fluid or site must be changed every 24 hours
medication administration via bolus or continuous administration ➢Assess for a distal pulse and adequate temperature and color of the
✓Common brands: Port-A-Cath, Infus-a-Port, and Groshong Venous leg every hour throughout the infusion
Port.
Administering a Subcutaneous (Hypodermoclysis)
Infusion
➢used for children with blood disorders who receive a medication to
remove stored iron from their body.
➢Sites used for hypodermoclysis generally include the pectoral region,
the back, and the anterolateral aspects of the thigh.

✓After skin cleansing, blood samples can be removed or medication

can be injected by a puncture through the chest / skin into the port.
✓This device requires a skin puncture, but no dressing is required. It
allows a full range of activities like showering and swimming