____________________________________________________ Chapter 49Female Reproductive Disorders 21
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 49.2
Slide 45
Pelvic Inflammatory Disease (cont.)
• Medical diagnosis
• Culture of the causative organism or organisms; sonography, laparoscopy, and
culdocentesis
• Medical treatment
• Rest; application of heat via warm compresses, a heating pad, or sitz baths; and a
• Interventions
• Acute pain
• Impaired skin integrity
• Deficient knowledge
TALKING POINTS:
• The diagnosis is based on the presenting symptoms (if any) and the pelvic examination.
Slide 46
Endometriosis
• Pathophysiology
• Endometrial cells deposited in the pelvic cavity implant on structures within the cavity
• They continue to respond to menstrual cycle hormonal stimulation
• Result is the periodically painful and potentially destructive condition
Endometriosis (cont.)
• Cause and risk factors
• Believed to occur in 10% of all women of reproductive age
TALKING POINTS:
• Although it is known that almost all women experience retrograde menstruation to some
degree, it is not known why some women develop endometriosis and others do not.
• Why would endometriosis cause infertility?
Slide 48
Endometriosis (cont.)
• Complications
• Constriction of pelvic structures by endometriosis-related adhesions
22 Chapter 49Female Reproductive Disorders _____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 49.2
Slide 49
Endometriosis (cont.)
• Nursing care
• The most significant nursing interventions are validating that the pain is real and
providing information about pain-relief measures
• Patient teaching based on treatment method selected and includes anticipatory
guidance and treatment-specific instructions
Cysts
• A closed saclike structure that is lined with epithelium and that contains fluid, semisolid, or
solid material
TALKING POINTS:
• What should the nursing interventions focus on for the patient with cysts?
Slide 51
Fibroid Tumors
• Pathophysiology
• Benign and common
• Fibroid tumors grow slowly during reproductive years but atrophy after onset of
menopause
TALKING POINTS:
• It is predicted that at least 25% of all women will develop fibroid tumors during their
reproductive period.
• What hormones may promote fibroid tumor growth?
Fibroid Tumors (cont.)
• Signs and symptoms
• May be asymptomatic, but the most common symptoms are menstrual irregularities—
Slide 53
Fibroid Tumors (cont.)
• Medical diagnosis
• On examination, uterus is enlarged and distorted
• Medical treatment
• Many need no treatment; tumors atrophy after menopause
TALKING POINTS:
• What surgical procedures may be performed for the patient with fibroid tumors?
____________________________________________________ Chapter 49Female Reproductive Disorders 23
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 49.2
Slide 54
Cystocele and Rectocele
• Pathophysiology
• Vaginal disorders caused by weakness of supportive structures between the vagina
and bladder (cystocele) or the vagina and rectum (rectocele)
Slide 55
Cystocele and Rectocele (cont.)
• Signs and symptoms
• Dyspareunia, lower back and pelvic discomfort, and recurrent bladder infections
• Medical diagnosis and treatment
TALKING POINTS:
• Why are surgical procedures for a cystocele or rectocele usually not done during
childbearing years?
Slide 56
Cystocele and Rectocele (cont.)
• Assessment
• Problems related to urinary and bowel function
• If surgery planned, assess patient’s understanding of the procedure, the preoperative
and postoperative care, and the patient’s concerns
Slide 57
Cystocele and Rectocele (cont.)
• Interventions
• Urinary stress incontinence
• Constipation
Uterine Prolapse
• Uterus descends into the vagina from its usual position in the pelvis
• First degree: cervix is above vaginal introitus
Slide 59
Uterine Prolapse (cont.)
• Cause and risk factors
• The supporting ligaments may be congenitally weak or become stretched during
pregnancy or injured during childbirth, resulting in weakening of support
• Signs and symptoms
• Dyspareunia, backache, and a feeling of pelvic heaviness and pressure
24 Chapter 49Female Reproductive Disorders _____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 49.2
Uterine Prolapse (cont.)
• Complications
• In second- and third-degree prolapse, protruding uterine portion subject to trauma and
Slide 61
Uterine Prolapse (cont.)
• Medical treatment
• Vaginal hysterectomy with anterior and posterior colporrhaphy
• Pessaries may be used for women who are poor surgical risks or who refuse surgical
treatment
• Interventions
TALKING POINTS:
• Pessaries are instruments that are inserted into the vagina to apply pressure on the
vaginal wall, thereby supporting the uterus in the pelvis.
• What are two types of pessaries?
Slide 62
Retroversion and Retroflexion, Anteversion and Anteflexion
• Uterus normally at 45-degree angle anterior to the vagina; cervix points downward toward
the posterior vaginal wall
• Retroversion: backward tilt, with the cervix pointed downward toward the anterior vaginal
wall
• Retroflexion: body of uterus bends back on itself
• Anteversion: entire uterus tilts forward at a sharper angle to the vagina
• Anteflexion: uterus bends forward, folding on itself
Retroversion and Retroflexion, Anteversion and Anteflexion (cont.)
• Cause and risk factors
Slide 64
Retroversion and Retroflexion, Anteversion and Anteflexion (cont.)
• Complications
• Difficulty with conception
• Nursing care
TALKING POINTS:
• Most complications are now thought to be associated with an underlying pathology (e.g.,
endometriosis, pelvic inflammatory disease) rather than with displacement itself.
• Which type of uterine displacement is particularly associated with difficult conception?
____________________________________________________ Chapter 49Female Reproductive Disorders 25
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 49.2
Slide 65
Vaginal Fistulas
• Abnormal passageways between the vagina and other pelvic organs
• Vesicovaginal fistula
• Between the vagina and the urinary bladder
• Urethrovaginal fistula
Slide 66
Breast Cancer
• Cause and risk factors
• White non-Hispanic women have highest incidence of breast cancer
• African-American women most likely to die from it
• Family history important; risk rises if one or more first-degree family members has had
breast cancer and if that cancer was premenopausal and bilateral
TALKING POINTS:
• The current prediction is that one of every eight or nine women will develop breast cancer
Slide 67
Breast Cancer (cont.)
• Prognosis
• When cancer is confined to the breast, the 5-year relative survival rate is 96.8%;
cancer spread to surrounding tissue, 5-year rate is 75.9%; disease has metastasized,
the rate is 20.6%
• Signs and symptoms
• Painless breast tissue thickening or lump
• Late symptoms include dimpling of the skin, nipple discharge, nipple or skin retraction,
edema, dilated blood vessels, ulceration, and hemorrhage
TALKING POINTS:
• What is Paget disease?
Breast Cancer (cont.)
• Complications
• Infiltration of adjacent breast and axillary tissue and metastasis to distant sites
26 Chapter 49Female Reproductive Disorders _____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 49.2
Slide 69
Breast Cancer (cont.)
• Medical treatment
• Lumpectomy, simple mastectomy, and radical mastectomy (see Figure 49-14, p.
1065)
• Staging: the tumor-node-metastasis classification
• Critical factor determined—whether the cancer cells are estrogen receptors or
nonreceptors
Breast Cancer (cont.)
• Interventions
• Disturbed body image
Slide 71
Cervical Cancer
• Cause and risk factors
• Research indicates that the risk for cervical cancer is increased in women who have
been infected with the human papillomavirus or HIV
TALKING POINTS:
• In the past, a drug called diethylstilbestrol was used to prevent spontaneous abortion. It
has since become apparent that this therapy increased the risk of reproductive system
cancers in offspring who were exposed to the drug.
Cervical Cancer (cont.)
• Signs and symptoms
____________________________________________________ Chapter 49Female Reproductive Disorders 27
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 49.2
Slide 73
Cervical Cancer (cont.)
• Complications
• Invasion of cervical cancer into adjacent structures
• Medical diagnosis
• Tissue specimens obtained by multiple punch biopsy, endocervical curettage, or
conization
• Medical treatment
TALKING POINTS:
• When is cervical cancer usually first suspected?
• Cervical cancer is staged according to the extent of invasion, with stage 0 signifying
limitation to the cervical epithelium and with stage IVb indicating metastasis to distant
organs.
Slide 74
Ovarian Cancer
• Cause and risk factors
• Family or personal history of ovarian cancer; a personal history of ovarian dysfunction
or of breast, endometrial, or colorectal cancer; high-fat diet; nulliparity; early
menarche and late menopause
• Signs and symptoms
• Asymptomatic in its early stage
TALKING POINTS:
• Ovarian cancer rarely is found in women who have had children or who have used oral
contraceptives.
• Why are the symptoms of advanced cases of ovarian cancer usually attributed to various
other conditions before ovarian cancer is considered?
Slide 75
Ovarian Cancer (cont.)
• Medical diagnosis
• Pelvic and rectal examinations; abdominal and vaginal ultrasound; exploratory
laparotomy or laparoscopy
• Screening with blood serum for CA-125 (elevated levels can be caused by other
factors in addition to ovarian cancer
• Medical treatment
28 Chapter 49Female Reproductive Disorders _____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 49.2
Slide 76
Vulvar Cancer
• Cause and risk factors
• Cause unknown, but it may be related to STIs, particularly human papillomavirus
• Other factors: diabetes mellitus, hypertension
• Signs and symptoms
TALKING POINTS:
• Cancer of the vulva is the rarest but also the most visible of the cancers of the female
reproductive system.
• What is the most common site of vulvar cancer?
Slide 77
Vulvar Cancer (cont.)
• Complications
• Invades adjacent structures or metastasizes via the lymphatic system
• Medical diagnosis
Slide 78
Vaginal Cancer
• Cause and risk factors
• No definite cause has been identified
• Risk factors: STIs, previous diagnosis of cervical/vulvar cancer, previous radiation
therapy, and intrauterine exposure to diethylstilbestrol
• Signs and symptoms
• In early and most treatable form, usually is asymptomatic
TALKING POINTS:
• Except for young women whose vaginal cancers are associated with intrauterine
exposure to diethylstilbestrol, vaginal cancer most commonly is found in postmenopausal
women.
• What is the prognosis for vaginal malignant melanoma?
____________________________________________________ Chapter 49Female Reproductive Disorders 29
LESSON 49.2
Slide 79
Vaginal Cancer (cont.)
• Medical diagnosis and treatment
• Most cases detected during inspection of vagina and from Pap smears
• Definitive diagnosis made via colposcopy and biopsy of suspicious areas followed by
tissue studies
• Treatment
• In situ (localized) cancer: treated relatively simple with local laser surgery or
cryosurgery
Slide 80
Care of the Patient with Cancer of the Cervix, Ovaries, Vulva, or Vagina
• Assessment
• Signs and symptoms and possible risk factors
• When reviewing the systems, related changes or problems: fatigue, pain, bowel or
bladder dysfunction
Slide 81
Care of the Patient with Cancer of the Cervix, Ovaries, Vulva, or Vagina
(cont.)
• Interventions
• Anxiety and Fear
Slide 82
Infertility
• Cause and risk factors
• Conception depends on a number of factors
• Timing and techniques used for sexual intercourse
• Production and release of a healthy ovum and numerous (200 million/ejaculate)
TALKING POINTS:
• Infertility generally is defined as the inability to conceive within 1 year of regular
unprotected sexual intercourse. Infertility is categorized as primary infertility if the woman
has never conceived or if the man has never impregnated a woman.
• How can faulty timing or technique for sexual intercourse be corrected?
30 Chapter 49Female Reproductive Disorders _____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 49.2
Slide 83
Infertility (cont.)
• Medical diagnosis
• Based on data obtained from exhaustive psychosocial and physical health and sexual
health histories of both partners
Slide 84
Infertility (cont.)
• Medical treatment
• See Table 49-5
• Interventions
• Situational low self-esteem
• Ineffective sexuality pattern
• Ineffective coping
• Deficient knowledge
Slide 85
Question 2
• Infection with which organism is thought to be the most commonly occurring sexually
transmitted disease and the one most often responsible for pelvic inflammatory disease or
PID?
A. C. trachomatis
B. M. hominis
C. N. gonorrhoeae
D. S. aureus
TALKING POINTS:
____________________________________________________ Chapter 49Female Reproductive Disorders 31
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 49.2
Activities
Classroom Choose from below to make 30 minutes
4
DISCUSS
• Discuss the signs, symptoms, and treatment
methods for mastitis.
• Discuss common complications of
endometriosis and their treatments.
• Discuss Figure 49-10 (p. 1118). What are
the causes and medical treatment of each
type of prolapse?
• Discuss Figure 49-12 (p. 1120). What are
32 Chapter 49Female Reproductive Disorders _____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 49.2
4
PRACTICE
• Divide the class into three groups and
present the following scenario: A 25-year-old
childless married woman is experiencing
metrorrhagia. Have one group identify and
list the signs and symptoms of metrorrhagia.
Have the second identify and list the
• A patient has cervicitis secondary to a
sexually transmitted infection (STI). Using
the same three groups from the previous
activity, have the third group identify and
present the pathophysiology and
complications of cervicitis; the second group
identify and present the signs and symptoms
of cervicitis; and the first group identify and
present the diagnostic procedures and
treatment for the disorder. Have each group
identify the probable disorder, define the
probable cause, and list an intervention.
Have the students present their findings to
the class.
• Provide the following definitions to the class
and have them identify the reproductive
disorder.
treatment for this condition.
____________________________________________________ Chapter 49Female Reproductive Disorders 33
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 49.2
4
• Divide the class into four groups. Assign
each group one of the following scenarios:
• A breastfeeding mother of a week-old
infant comes to the doctor’s office with a
complaint of left breast tenderness and
a low-grade fever.
• A woman is seen in the clinic with dull,
steady, low abdominal pain and dysuria.
• A woman with menorrhagia and severe
dysmenorrhea says that she hasn’t
5
DISCUSS
• Discuss how to help patients with their
anxieties about uterine bleeding disorders.
• Discuss how to help patients with the
psychological effects of contracting
34 Chapter 49Female Reproductive Disorders _____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 49.2
5
PRACTICE
• Divide the class into two groups. Have each
group respond to the findings in the two
preceding class activities. Have one group
discuss a nursing care plan for the woman
experiencing metrorrhagia. Have the second
group discuss the nursing care that is
appropriate for the patient with cervicitis
secondary to an STI. Then have the groups
present their findings to the class.
• Discuss the Patient Teaching Plan on
Mastitis (p. 1108). What is the controversy
concerning breastfeeding?
• Discuss the Patient Teaching Plans on
Pelvic Inflammatory Disease (p. 1110). How
would you address this information during
patient teaching?
• Using the same scenarios listed in the
previous activity, have the groups develop
• Discuss the nursing care of the patient with
breast cancer. What are some important
nursing interventions? What content needs
to be covered in preoperative and
postoperative patient teaching?
• Lead a discussion with the class about
ovarian cancer. What are the symptoms?
How is it diagnosed? What is the prognosis?
• Divide the class into three groups. Assign
one of the following to each group.
• Identify and list resources available to
patients with breast cancer and after a
mastectomy.
____________________________________________________ Chapter 49Female Reproductive Disorders 35
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 49.2
Critical Thinking Question
A 22-year-old Caucasian woman with no children arrives at the family practice clinic
complaining of a swollen, reddened mass on the left side of the opening to her vagina. When
she touches it, it is tender, hot, and painful. She has abstained from sexual relations for the
past year, so she is surprised that she has developed this problem. What does this patient
probably have? What can the nurse tell her about the cause, treatment, and prevention of
her disorder?
Discussion Guidelines: This patient describes symptoms of a Bartholin gland abscess, or
Instructor Notes/Student Feedback
36 Chapter 49Female Reproductive Disorders _____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 49.3
Instructor Preparation
Textbook Objectives Covered
6. Describe the nursing interventions for the patient who is menopausal.
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:
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• cystocele (p. 1116)
• dysmenorrhea (p. 1112)
• mastitis (p. 1107)
• menarche (p. 1092)
• retroversion (p. 1119)
• salpingo-oophorectomy
Student Prep.
Assignments 2 hours
6
READ – Textbook (pp. 1132-1133)
ANSWER – Study Guide
• Part IG: 1 (p. 331)
• Part IIJ: 30-34, 39 (p. 335)
____________________________________________________ Chapter 49Female Reproductive Disorders 37
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 49.3
50-Minute Lesson Plan
Lecture Outline 20 minutes
6
Slide 86
Menopause
• Cessation of menstruation; end of reproductive capacity
• Natural menopause part of normal aging; surgical menopause from removal of the ovaries
• May begin as early as age 35 but more commonly occurs between ages 40 and 55
• Process from earliest signs to complete cessation of menstruation usually is 2 years or
less
• A woman is said to be menopausal when she has not had a menstrual period for 1 year
TALKING POINTS:
• What is usually the first sign of natural menopause?
• Some women experience a surgical menopause brought on by the surgical removal of the
ovaries.
Slide 87
Menopause (cont.)
• Signs and symptoms
• Hot flashes typically accompanied by perspiration and sometimes faintness
• Also vaginal dryness, insomnia, joint pain, headache, and nausea
Slide 88
Menopause (cont.)
• Medical treatment
• Estrogen therapy
• Drugs used to control hot flashes include clonidine patches, Bellergal-S, venlafaxine,
and paroxetine
TALKING POINTS:
Slide 89
Menopause (cont.)
• Complementary and alternative therapies
• Vitamin E, vitamin B complex, calcium with vitamin D
Menopause (cont.)
• Nursing diagnosis, goal, and outcome criterion
• Nursing diagnosis: Ineffective management of therapeutic regimen related to lack of
38 Chapter 49Female Reproductive Disorders _____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 49.3
Slide 91
Menopause (cont.)
• Interventions
• Patient’s understanding of menopause and how she feels about it
• May need reassurance that her symptoms and responses are normal
• If drug therapy, instruct regarding self-medication
Activities
Classroom Choose from below to make 30 minutes
6
DISCUSS
• Discuss the signs, symptoms, and medical
treatment of menopause. What content
needs to be included in patient teaching
related to menopause?
PRACTICE
• Have a student role-play a nurse in a
gynecologist’s office and another student
role-play a 51-year-old female patient. The
patient should describe the menopause-
related signs and symptoms she is
Critical Thinking Question
Why might some women welcome the onset of menopause and others experience a less
favorable reaction?
Instructor Notes/Student Feedback
____________________________________________________ Chapter 49Female Reproductive Disorders 39
Introduction to Medical-Surgical Nursing, 6th ed.
49
Assessments for
Female Reproductive Disorders
CHAPTER 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
Lesson 49.3:
6. Describe the nursing interventions for the patient who is menopausal.
Assessments by Lesson & Objective
1
Study Guide
• Part IA: 10, 12 (p. 329)
2
Study Guide
• Part IB: 1-11 (p. 330)
Evolve Instructor Resources
• Test Bank: 2, 3, 8, 16, 29
• Open Book Quiz: 1-3
Evolve Student Resources
• NCLEX Review 1, 5, 9
• Prioritization 5
3
Study Guide
• Part IF: 1, 2 (p. 331)
Evolve Instructor Resources
• Test Bank: 1, 4, 10, 14, 21
• Open Book Quiz: 4
40 Chapter 49Female Reproductive Disorders _____________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
Assessments by Lesson & Objective
Lesson 49.2
4
Study Guide
• Part IA: 1-9, 11, 13 (p. 329)
Evolve Instructor Resources
• Test Bank: 5, 7, 9, 11, 12, 15, 18, 19, 22–28
• Open Book Quiz: 5-10
Evolve Student Resources
• NCLEX Review: 3, 4, 8
5
Study Guide
• Part IIJ: 28 (p. 334)
• Part IIIL: 1-4 (pp. 337-338)
Evolve Instructor Resources
• Test Bank: 6, 13, 16, 17, 20
Evolve Student Resources
• NCLEX Review: 7
Lesson 49.3
Instructor’s Notes/Student Feedback