Reproductive issue

• Normal uterus


  Uterus is in the proper position

  
• Prolapsed uterus


  Uterus is descending down into the vagina

  
• Signs and symptoms of uterine prolapse

  • Pain
  • Pelvic pressure or heaviness
  • Urinary frequency
  • Difficulty having bowel movements
  • Painful urination
  • The patient may say "it feels like something is falling out!"
  • The patient may say "it feels like something is falling out my vagina!"
  • Low back pain
  • Feels uncomfortable or painful during sexual intercourse before or after (Dyspareunia)
  • May be relieved by lying down

  
• Causes of uterine prolapse

  • Weak muscles from childbirth
  • Multiparas (women that have multiple children)
  • Age (decreased muscle tone, degeneration, loss of hormones, estrogen)
  • Straining due to chronic constipation
• Grades of uterine prolapse

  • Grade I= the uterus is bulging into the vagina
  • Grade II= the uterus bulges even further; the cervix can protrude into the entrance of the vagina
  • Grade III= the worst, and the uterus can protrude out

  
• Therapeutic management of prolapsed uterus


  • Kegel exercises (toning the muscle)
  • Non-surgical pessary use (toning the muscle)
  • Relaxation
  • Stress management
  • Elimination of bladder irritants from the diet
• Patient instruction for kegel exercises

  1. Tighten (contract) your pelvic floor muscles

  2. Hold the contraction for five seconds, then relax for five seconds

  3. Work up to holding the contractions for 10 seconds at a time

  4. Repeat several sets of 10 repetitions each day

  
• Pessary


  A device that fits inside the vagina and holds the uterus in place

  
• Pessary types


  • Temporary or permanent treatment
  • Come in many shapes and sizes
  • The healthcare provider will fit the woman for the best type
  • The patient is taught how to insert, remove and clean it
  • Some are used more during the day and removed at night, others can be left in for a longer period of time
• You could have 2 children and have a uterine prolapse or have 10 children and not have a uterine prolapse so it depends on multiple factors
• Postpartum we need to support the uterus because the uterus is relaxed due to the hormone relaxin; muscles don't have good tone during this period so we need to place our hand at the symphysis pubis, right at the vagina hair line and cup the uterus when we do uterine massages, if we don't the uterus can prolapse

  
• Therapeutic management for prolapsed uterus - surgical

  • Anterior and posterior colporrhaphy (suturing the pubocervical fascia and perineal muscles)
  • If severe may require a vaginal hysterectomy
  • May combine all of the above

  
• Vaginal hysterectomy


  Concerned about recurring prolapse, cystocele/rectocele, incontinence, psychosocial due to something hanging out

  
• Assessments for vaginal hysterectomy


  • Assess coping skills
  • Assess voiding / urinary and bowel
  • Teach the patient if she feels something hanging out, that this isn't normal, and it needs to be prevented
  • Avoid heavy lifting and strenuous exercises
  • Ambulate and hydrate
  • Kegel exercises
  • No bladder irritants (caffeine, food allergies, spicy foods)
• Post-op care for hysterectomy

  • Watch for bleeding (should not be saturating more than one pad in 4 hours)
  • Less bleeding with robotic or vaginal hysterectomy compared to abdominal
  • No sexual activity
  • No douching
  • No heavy lifting (5 lbs)
  • Watch for fever, pain, urine output, and teach peri care
• It typically takes infection a while to develop so we usually see it after 3 days (72hrs)
• Post-op care summary


  • Prevent infection
  • Prevent pressure on suture lines
  • May have Foley catheter
  • Clean after each void and bowel movement
  • No heavy lifting
  • Stool softeners
  • Avoid sexual intercourse for 6 weeks
• Fistulas


  Abnormal opening between 2 adjacent organs (urethrovaginal, rectovaginal)

  
• Signs and symptoms of female fistulas

  • Leakage, incontinence
  • Irritation or inflammation of vagina, perineum or the skin around anus
  • Odor
  • Wetness of dribbling in vagina
  • Recurrent vaginal or urinary tract infections
  • Foul smelling discharge due to possible stool coming out of vagina
  • Infected fistulas that forms an abscess, can become life-threatening if not treated
  • Fistula recurrence

  
• Nursing care for female fistulas

  • Assist with hygiene (sitz baths, perineal cleaning, douching)
• Structural disorders - male

  • Hydrocele
  • Spermatocele
  • Varicocele
  • Torsion of spermatic cord
  • Cryptorchidism
  • Hypospadias
  • Epispadias
  • Phimosis
  • Circumcision
  • Priapism
• Hydrocele


  Painless build up of fluid in one or more testicles, looks like a water balloon

  
• Interventions for hydrocele


  1. Aspiration (help relief to pressure)

  2. Hydrocelectomy (removal of hydrocele)
• Hydrocelectomy


  An incision is made in the scrotum or lower abdomen to remove the hydrocele

  
• Interventions for male surgery involving scrotum and penis

  • Scrotal support (keeps dressing in place, keeps scrotum elevated, prevents edema, ice immediately after surgery)

  
• Spermatocele


  Sperm-containing cyst that develops on epididymis alongside the testicle

  
• Surgical treatment for spermatocele

  Spermatocelectomy (surgeon makes an incision in the scrotum and separates the spermatocele from the epididymis)

  
• Varicocele


  Cluster of dilated veins posterior to and above the testis, can cause infertility
• Interventions for varicocele


  • Surgery (varicocelectomy)
  • Patient teaching (rolled towel under scrotum, ice, scrotal support)
• Varicocele treatment may not be necessary unless it causes pain, testicular atrophy, or infertility
• Varicocelectomy


  Most commonly performed operation for the treatment of male infertility

  
• Torsion of spermatic cord


  Rotation of the testicle that interrupts its blood supply, causing irreparable testicular damage

  
• Varicocele


  Enlarged veins in the scrotum that drain blood from the testicles
• Varicocele treatment


  1. Surgery to seal off affected veins and redirect blood flow

  2. Patient teaching (rolled towel, ice, scrotal support)
• The purpose of varicocele surgery is to seal off affected veins and to redirect the blood flow into normal veins
• In cases of male infertility, treatment of a varicocele may improve or cure infertility or improve the quality of sperm if techniques such as in-vitro fertilization are to be used
• Varicocelectomy is the most commonly performed operation for the treatment of male infertility
• Testicular torsion


  Rotation of the testicle that interrupts its blood supply, causing irreparable testicular damage
• Testicular torsion is the most common between ages 12 and 16, but it can occur at any age, even before birth
• Testicular torsion treatment


  1. Emergency surgery to untwist the spermatic cord

  2. Stitching one or both testicles to the inside of the scrotum to prevent rotation