Introduction to Medical-Surgical Nursing, 6th ed.
49
Lesson Plans for
Female Reproductive Disorders
CHAPTER LESSON PLANS & OBJECTIVES
Lesson 49.1:
2. Describe the nursing interventions for women who are undergoing diagnostic tests and procedures
for reproductive system disorders.
Lesson 49.2:
5. Assist in developing a nursing care plan for patients with common disorders of the female
reproductive system.
Lesson 49.3:
6. Describe the nursing interventions for the patient who is menopausal.
CHAPTER TEACHING FOCUS
• In this chapter, the student will be introduced to topics related to female reproductive disorders,
including the anatomy and physiology of the female reproductive system and the nursing assessment
of this system.
CONCEPTS
The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2013).
Concepts for nursing practice. St. Louis: Elsevier. The specific exemplars chosen and listed below for
each concept have been tailored specifically to correspond to the Linton textbook.
THEME: Homeostasis and Regulation
• Concept: Cellular Regulation
• Exemplar: Breast Cancer, p. 1120
• Cultural Considerations: What Does Culture Have to Do with Breast Cancer? p. 1121
• Table 49-6: Examples of Breast Reconstruction Procedures, p. 1124
THEME: Sexuality and Reproduction
• Concept: Reproduction
2 Chapter 49Female Reproductive Disorders _____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
CHAPTER PRETEST
Have the students answer these questions prior to covering this chapter to understand where they stand
in relation to the content.
1) What is a normal female hormonal cycle?
a) Menstrual phase, secretory phase, proliferative phase, ischemic phase
b) Ischemic phase, menstrual phase, secretory phase, proliferative phase
c) Proliferative phase, menstrual phase, ischemic phase, secretory phase
d) Menstrual phase, proliferative phase, secretory phase, ischemic phase
2) A surgical procedure that uses a small incision in the anterior vagina to identify an ectopic pregnancy
is a __________.
a) culdoscopy
b) colposcopy
c) laparoscopy
d) laparotomy
3) When teaching a patient about vaginal hygiene, the nurse would include which statement?
a) Use a vinegar douche following menstruation.
b) Wear clean nylon panties.
c) Wash the external genitalia at least once a day with soap and water.
d) Wear tight clothing to help keep the perineal area dry.
4) Profuse or prolonged bleeding during menstruation is called __________.
a) metrorrhagia
b) menorrhagia
c) amenorrhea
d) menses
5) Mastitis is an infection that affects the breast tissue in a __________.
a) pregnant woman
b) menopausal woman
c) lactating woman
d) premenstrual woman
6) What should a patient taking danazol (Danocrine) for endometriosis be informed of?
a) She may notice vaginal dryness.
b) Expect some hair loss.
c) Chills may occur.
d) Use warm salt water for throat soreness.
7) The bulging of the bladder through the vaginal wall is a __________.
a) rectocele
b) uterine prolapse
c) fibroid
d) cystocele
8) A retroverted uterus is __________.
a) positioned at a 45-degree angle anterior to the vagina
b) tilted backward with the cervix pointed downward toward the anterior vaginal wall
c) tilted forward with a sharp angle to the vagina
d) bent forward as if folding on itself
9) Which of these women would be more likely to develop cervical cancer?
a) A monogamous married woman of Irish and English descent
b) A Hispanic Catholic nun
c) A Native American who has smoked cigarettes for 20 years
d) A pregnant Polish-American woman taking folic acid
10) The entire process of menopause, from the earliest signs to the complete cessation of menstruation,
usually takes about __________.
a) 6 to 8 months
b) 9 to 12 months
c) 12 to 18 months
d) 2 years
____________________________________________________ Chapter 49Female Reproductive Disorders 3
Introduction to Medical-Surgical Nursing, 6th ed.
Chapter Pretest Answers
CHAPTER BACKGROUND ASSESSMENT
Discuss these questions with your students prior to covering this chapter to understand where they stand
in relation to the content.
Question: What are the major structures of the external female genitalia? What are the major internal
structures of the female reproductive system?
Question: Briefly describe six different types of female reproductive disorders.
Answer: A number of disorders are due to carcinomas: cervical, breast, ovarian, vulvar, and vaginal
4 Chapter 49Female Reproductive Disorders _____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 49.1
Textbook Objectives Covered
1. List data to be collected when assessing the female reproductive system.
3. Identify the nursing interventions associated with douche, cauterization, heat therapy, and
topical medications used to treat disorders of the female reproductive system.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying female reproductive disorders, including:
• Anatomy and physiology and related nursing assessments
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• cystocele (p. 1116)
• dysmenorrhea (p. 1112)
• dyspareunia (p. 1109)
• retroversion (p. 1119)
• salpingo-oophorectomy
(p. 1112)
Student Preparation
Assignments 2 hours
1
READ – Textbook (pp. 1088-1093)
REVIEW
• Figure 49-1: External female genitalia (p. 1089)
• Figure 49-2: Internal female genitalia (p. 1090)
ANSWER – Text
• Review Questions for the NCLEX Examination: 1, 2 (p. 1134)
ANSWER – Study Guide
• Part IA: 10, 12 (p. 329)
____________________________________________________ Chapter 49Female Reproductive Disorders 5
LESSON 49.1
2
READ – Textbook (pp. 1093-1098)
REVIEW
• Figure 49-5: Internal examination of the cervix (p. 1094)
• Figure 49-6: Bimanual palpation (p. 1095)
• Figure 49-7: Laparoscopy (p. 1096)
ANSWER – Text
• Review Questions for the NCLEX Examination: 3, 4 (p. 1134)
ANSWER – Study Guide
• Part IB: 1-11 (p. 330)
• Part IIJ: 2, 3, 26 (p. 333)
3
READ – Textbook (pp. 1098-1103)
REVIEW
• Table 49-2: Drug Therapy: Drugs Used to Treat Disorders of the Female Reproductive
System (pp. 1100-1103)
ANSWER – Text
ANSWER – Study Guide
• Part IF: 1, 2 (p. 331)
• Part IIJ: 4-8, 22, 41, 42 (pp. 333-335)
• Part IIIK: 6 (p. 337)
Lecture Outline 20 minutes
Slide 1
Chapter 49
Female Reproductive Disorders
1
Slide 2
Anatomy and Physiology of the Female Reproductive System
• External genitalia
• Mons pubis
TALKING POINTS:
• What is the function of the Bartholin and Skene glands?
6 Chapter 49Female Reproductive Disorders _____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 49.1
Slide 3
Anatomy and Physiology of the Female Reproductive System (cont.)
• Internal genitalia
• Vagina
TALKING POINTS:
• What is the purpose of the lubricating fluid secreted by the vaginal walls?
• The pathway through the female reproductive tract, intended to serve as a route for
reproduction, also provides a route for infectious organisms to access the pelvic cavity
and its organs.
Slide 4
Anatomy and Physiology of the Female Reproductive System (cont.)
• Menstrual cycle
• Menstruation
• Maturation of ovarian follicle
TALKING POINTS:
• What hormonal changes are associated with each phase of the menstrual cycle?
2
Slide 5
Nursing Assessment of the Female Reproductive System
• Health history
• Chief complaint and history of present illness
• Medical history
TALKING POINTS:
• What are common problems women experience with their periods?
Slide 6
Nursing Assessment of the Female Reproductive System (cont.)
• Obstetric-gynecologic history
• Number of pregnancies, term/preterm births, living children, abortions, multiple
pregnancies
TALKING POINTS:
• Which medical terms are used to describe the number of pregnancies and the number of
births?
____________________________________________________ Chapter 49Female Reproductive Disorders 7
Introduction to Medical-Surgical Nursing, 6th ed.
Copyright © 2016 by Saunders, an imprint of Elsevier Inc. Linton
LESSON 49.1
Slide 7
Nursing Assessment of the Female Reproductive System (cont.)
• Health history
• Family history
• Review of systems
• Functional assessment
TALKING POINTS:
• What information should be included in the family history? The review of systems? The
functional assessment?
Slide 8
Nursing Assessment of the Female Reproductive System (cont.)
• Physical examination
• General survey, vital signs
3
Slide 9
Diagnostic Tests and Procedures
• Patient instruction, preparation, and support during tests and procedures
• Assisting the examiner
• Provide anticipatory guidance
Diagnostic Tests and Procedures (cont.)
• Pelvic examination, inspection and palpation of reproductive structures to identify
TALKING POINTS:
• How can the nurse and the examiner promote comfort during this examination?
Diagnostic Tests and Procedures (cont.)
Diagnostic Tests and Procedures (cont.)
• Endometrial and cervical biopsies
TALKING POINTS:
• For which reasons is the endometrial biopsy performed?
• How do the nurse and examiner promote comfort during these examinations?
8 Chapter 49Female Reproductive Disorders _____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 49.1
Slide 13
Diagnostic Tests and Procedures (cont.)
• Colposcopy: instrument (colposcope) used to inspect cervix under magnification to
identify abnormal and potentially cancerous tissue prior to cervical biopsy
TALKING POINTS:
• How do the nurse and examiner promote comfort during these examinations?
Diagnostic Tests and Procedures (cont.)
• Laparoscopy performed under local or general anesthesia with laparoscope to visualize
abdominal organs, perform minor surgery such as tubal ligation
TALKING POINTS:
• What is the reason the patient experiences shoulder or rib cage pain after this procedure?
Diagnostic Tests and Procedures (cont.)
• Dilation and curettage: diagnoses uterine cancer, causes of abnormal uterine bleeding
TALKING POINTS:
• How is the patient prepared and positioned?
Diagnostic Tests and Procedures (cont.)
Diagnostic Tests and Procedures (cont.)
• Breast self-examination performed regularly, monthly, starting in the 20s
• Not a substitute for periodic professional breast examinations
TALKING POINTS:
• How does the nurse demonstrate breast self-examination?
Diagnostic Tests and Procedures (cont.)
• Breast biopsy: definitive test for diagnosing breast cancer
____________________________________________________ Chapter 49Female Reproductive Disorders 9
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 49.1
Slide 19
Common Therapeutic Measures
• Douching
• Cauterization
• Application of heat
• Genital hygiene
TALKING POINTS:
Slide 20
Drug Therapy
• Ovarian hormones
• Estrogens
• Progestins
• Selective estrogen receptor modulators (SERMs)
• Androgens
TALKING POINTS:
• What are the uses and possible adverse effects of these drugs?
Drug Therapy (cont.)
• Gonadotropin-releasing hormone agonists (GnRH)
Drug Therapy (cont.)
• Medications for application to the vulva or vagina; tablets, creams, suppositories
underclothing
Slide 23
Surgical Procedures
• Abdominal procedures performed through abdominal incision, vaginally or endoscopically
• Nursing care varies with each approach
• Assess for excessive bleeding, vaginal discharge
Slide 24
Question 1
• Which of the following is not secreted by the ovaries?
A. Androgen
B. Estrogen
C. Prostaglandin
D. Relaxin
TALKING POINTS:
10 Chapter 49Female Reproductive Disorders _____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 49.1
Activities
Classroom Choose from below to make 30 minutes
Online
1
ASSESS BASELINE
• Have the class complete the Pretest. Collect
their work and use the results to guide how
you teach the class.
DISCUSS
• Discuss the progression of the menstrual
cycle. In what ways does the cycle vary?
• Discuss Box 49-1 (p. 1093), and ask
students to offer rationales as to why each
element of the health history could be
important.
PRACTICE
• Have two female students role-play a nurse
and a patient who visits the office for her first
ASSESS BASELINE
• Post the Pretest and the Background
Assessment online and have your class
complete them. Use the results to guide how
you teach the class.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Discuss
common misconceptions regarding the
menstrual cycle. Post comments on how you
would correct the misconceptions. Ask
students to provide constructive comments
on each other’s posts.
____________________________________________________ Chapter 49Female Reproductive Disorders 11
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 49.1
2
DISCUSS
• Discuss patient teaching appropriate for
common diagnostic tests and procedures for
reproductive system disorders.
• Discuss the diagnostic tests and procedures
listed on p. 1098. What postprocedure
nursing care is typical for each test or
procedure?
PRACTICE
• A 38-year-old woman who is having
excessive menstrual bleeding is scheduled
for a dilation and curettage (D&C). Lead a
class discussion on why this might be
necessary, how the procedure is performed,
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Discuss ways
the nurse can promote comfort during pelvic
examinations, especially for the patient’s first
examination. If applicable, provide
comments on your first pelvic examination
and how that experience will affect the way
you teach patients in the future.
• Post the following discussion topic online
and have students comment. Discuss
common myths on mammography and the
ways nurses can dispel these myths. Ask
students to provide constructive comments
on each other’s posts.
3
DISCUSS
• Discuss the Patient Teaching Plan: Genital
Hygiene (p. 1099). What types of
misinformation might need to be addressed?
• Discuss the drugs used to treat disorders of
the female reproductive system and the
rationales for the nursing interventions
related to these drugs.
PRACTICE
• Divide the class into three groups. Have one
group discuss the different types of heat
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Ask students
to search popular websites for three articles
on the controversies associated with use of
estrogen and other hormones. Ask students
how they would comment on the
controversies. Ask students to provide
constructive comments on each other’s
posts.
12 Chapter 49Female Reproductive Disorders _____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 49.1
Critical Thinking Question
An 18-year-old female patient who wants to begin taking birth control pills comes to the
family planning clinic. She is visibly nervous and tells the nurse that she has never had a
gynecologic examination. What can the nurse say to lessen her fears? How should the
nurse assist her during the pelvic examination? What additional information can the nurse
provide?
Discussion Guidelines: The nurse should calm the patient by talking softly and encouraging her
as well as explaining the examination from beginning to end. As part of the examination, the nurse
Instructor Notes/Student Feedback
____________________________________________________ Chapter 49Female Reproductive Disorders 13
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 49.2
Textbook Objectives Covered
4. Explain the pathophysiology, signs and symptoms, complications, diagnostic procedures, and
medical or surgical treatment for selected disorders of the female reproductive system.
5. Assist in developing a nursing care plan for patients with common disorders of the female
reproductive system.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Guest speaker: nurse who works with gynecologic preoperative and postoperative patients
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying female reproductive disorders, including:
• Assemble materials and supplies needed for each lesson as indicated below.
Materials and Supplies
• computer and PowerPoint
projector
• unlabeled copy of Figure 49-
10
Key Terms
• cystocele (p. 1116)
• dysmenorrhea (p. 1112)
• retroversion (p. 1119)
• salpingo-oophorectomy
14 Chapter 49Female Reproductive Disorders _____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 49.2
Assignments 2 hours
4
READ – Textbook (pp. 1103-1132)
REVIEW
• Table 49-3: Uterine Bleeding Disorders (p. 1104)
• Figure 49-9: Common sites of endometriosis (p. 1111)
• Figure 49-10: Types of genital prolapse (p. 1118)
• Table 49-5: Common Ovarian and Breast Cysts (p. 1115)
• Figure 49-10 Types of genital prolapse (p. 1118)
• Table 49-7: Common Causes of Female Infertility and Related Medical Treatment (p. 1132)
ANSWER – Text
• Review Questions for the NCLEX Examination: 6, 7, 9, 10 (p. 1135)
ANSWER – Study Guide
• Part IA: 1-9, 11, 13 (p. 329)
• Part IC: 1-4 (p. 330)
5
READ – Textbook (pp. 1103-1132)
REVIEW
• Table 49-4: Care of Patients with Reproductive Tract Infections (p. 1106)
• Nursing Care Plan 49-1: Patient with a Hysterectomy (pp. 1113-1114)
• Figure 49-15: Arm exercises for mastectomy patients (p. 1126)
ANSWER – Text
• Review Questions for the NCLEX Examination: 8 (p. 1135)
ANSWER – Study Guide
• Part IIJ: 28 (p. 334)
____________________________________________________ Chapter 49Female Reproductive Disorders 15
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 49.2
50-Minute Lesson Plan
Lecture Outline 20 minutes
4
&
5
Slide 25
Uterine Bleeding Disorders
• Pathophysiology
• Metrorrhagia
• Bleeding or spotting between menstrual periods
• Menorrhagia
TALKING POINTS:
• Normal menstrual patterns vary widely in length of cycles (21 to 40 days), duration of
menstruation (2 to 8 days), and amount of blood lost (40 to 100 mL).
• Deviations from the normal cycles are viewed as uterine bleeding disorders.
• When are bleeding patterns that are irregular in both spacing and amount common?
Slide 26
Uterine Bleeding Disorders (cont.)
• Cause and risk factors
• Symptoms of underlying factors, rather than being specific definable conditions in
themselves
Slide 27
Uterine Bleeding Disorders (cont.)
• Medical diagnosis and treatment
• Colposcopy, biopsy, and cauterization, as well as laboratory analyses of blood
components, hormone levels, and tissue specimens or smears provide diagnostic
information
• Interventions
• Deficient knowledge
• Anxiety
TALKING POINTS:
• Because anemia may result from excessive bleeding, hemoglobin and hematocrit levels
16 Chapter 49Female Reproductive Disorders _____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 49.2
Slide 28
Vulvitis and Vaginitis
• Pathophysiology
• Vulvitis
• Inflammation of the vulva
• Vaginitis
• Local inflammatory response to various factors
• Cause and risk factors
• Two most common causes: Candida albicans (fungus, or yeast infection) and
Trichomonas vaginalis (protozoal infection)
• Signs and symptoms
• Include local swelling, redness, and itching
TALKING POINTS:
• Depending on the causative agent, vulvitis may be viewed as an infection, as a local
Slide 29
Vulvitis and Vaginitis (cont.)
• Complications
• Ascending infection
• Medical diagnosis
• Based on symptoms and on inspection of the vulva and vagina
Slide 30
Vulvitis and Vaginitis (cont.)
• Medical treatment
• Specific to the causative agent
• Topical antifungal creams, oral antiprotozoals or antibiotics, vaginal suppositories
TALKING POINTS:
• Advise the patient not to scratch the itching tissues, which can cause further mechanical
trauma and infection.
• What advice should be given to the patient regarding sexual activity during treatment?
____________________________________________________ Chapter 49Female Reproductive Disorders 17
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 49.2
Slide 31
Bartholin Gland Abscess (Bartholinitis)
• Pathophysiology
• Edema and pus formation due to infectious microorganisms occlude the duct of the
affected gland and form an abscess
• Cause and risk factors
TALKING POINTS:
• Various microorganisms can be transmitted from the anus, vulva, or vagina to the
Bartholin gland duct.
• How are the organisms commonly introduced to the Bartholin gland?
Slide 32
Bartholin Gland Abscess (Bartholinitis) (cont.)
• Signs and symptoms
• Perineal pain, fever, labial edema, chills, malaise, and purulent discharge
• Complications
• Systemic infection
• Medical diagnosis
• Visual inspection; culture and sensitivity
TALKING POINTS:
Slide 33
Bartholin Gland Abscess (Bartholinitis) (cont.)
• Medical treatment
• Oral analgesics and moist heat in the form of frequent sitz baths or hot wet packs
• Surgical incision and drainage of the abscess
• Broad-spectrum antibiotics
• Nursing care
TALKING POINTS:
• What basic hygiene practices should be taught to the patient with bartholinitis?
18 Chapter 49Female Reproductive Disorders _____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 49.2
Slide 34
Cervicitis
• Pathophysiology
• Inflammation of the cervix
• Cause and risk factors
• Infectious organisms, scraping of cells for diagnostic tests, cryosurgery, use of vaginal
tampons or medications, childbirth, decreased estrogen levels after menopause, and
use of oral contraceptives
TALKING POINTS:
• It may be acute or chronic.
• What is cervicitis usually associated with?
Cervicitis (cont.)
• Medical diagnosis and treatment
Slide 36
Mastitis
• Pathophysiology
• Infection-induced inflammation of breast tissue in the lactating woman
• Cause and risk factors
• Staphylococcus aureus, Escherichia coli, streptococci
• Signs and symptoms
• Usually confined to one breast; may be asymptomatic except for tenderness and low-
TALKING POINTS:
• What is mastitis currently associated with?
____________________________________________________ Chapter 49Female Reproductive Disorders 19
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 49.2
Slide 37
Mastitis (cont.)
• Complications
• Abscess formation
• Medical diagnosis and treatment
• Diagnosis based on presenting symptoms
• Culture and sensitivity
TALKING POINTS:
• The question of whether to empty the breast by breastfeeding or by artifical pumping is a
Slide 38
Mastitis (cont.)
• Interventions
• Risk for injury
• Deficient knowledge
Fibrocystic Changes
• Pathophysiology
• An exaggerated response to hormonal influences
mammary ducts, proliferation of mammary ducts, and the formation of cysts
TALKING POINTS:
• Can fibrocystic nodules become cancerous?
Fibrocystic Changes (cont.)
• Cause and risk factors
• Common among women who have never given birth, have had a spontaneous
TALKING POINTS:
• Usually affects both breasts.
• When are symptoms usually most apparent?
20 Chapter 49Female Reproductive Disorders _____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 49.2
Slide 41
Fibrocystic Changes (cont.)
• Medical diagnosis and treatment
• Diagnosis based on the physical exam and health history. A mammogram or
ultrasound may be used
TALKING POINTS:
• Fluid for study may be aspirated from a mass, or the mass may be surgically removed for
examination.
• What side effects may occur with the use of danazol?
Slide 42
Pelvic Inflammatory Disease (PID)
• Pathophysiology
• Infection that may affect any or all structures in pelvic portion of reproductive tract and
peritoneal cavity
• Cause and risk factors
• Most PID cases from sexually transmitted organisms
• N. gonorrhoeae, Chlamydia trachomatis, and M. hominis
• Nonsexually transmitted infection (non-STI) organisms also causative agents
• Staphylococcal, streptococcal, and other organisms
TALKING POINTS:
• Why is pelvic inflammatory disease (PID) called an ascending infection?
• PID is a major female reproductive health problem and a major cause of infertility in the
United States.
• The risk of PID increases as the number of sexual partners increases.
Slide 43
Pelvic Inflammatory Disease (cont.)
• Signs and symptoms
• May be a silent infection with no symptoms
• Symptomatic PID: with either the gradual onset of dull, steady, low abdominal pain or
TALKING POINTS:
• In many instances evidence of PID is first discovered during surgery for ectopic
pregnancy, blocked fallopian tubes, ovarian abscess, or other pelvic disorders.
• Which type of PID is most likely to be diagnosed?
Pelvic Inflammatory Disease (cont.)
• Complications
• Ectopic pregnancy, infertility, and chronic abdominal discomfort