Med Surge

  1. external structures
    • vulva all external sturctures
    • 1.Mons Pubis- pad of fat centrally located in lower pelvis
    • 2.labia majora & minora- hairless skin folds, when seperated show urethra & vag. openings
    • 3.Cllitoris- very sensitive, skin protrussion
    • Batholin glands- secretes lube when havin sex
    • fourchette- gives evidence 4 rape trails
    • Hymen- ruptured when sex, physical activity, paps, tampons
  2. internal structures
    • 1.vagina- has doderlien bacilli- nonpathogenic bacteria needed to reduce infection
    • 2.uterus- subdivided to corpus (body/central portion), fundus(upper area), cervix (narrow neck)- which releases thick mucus except when ovulating, mucus help with movement of sperm to ovum
    • Uterin has 3 layers- perimetrium outer serous membrane, myometium- smoth muscle layer that contracts when in labor, endometrium- innermost layer sheds q mon.
    • 3.fallpian tubes- gets ovum q monthly, where ovum fertilized, has fimbriae which direct ovum to fallopian tubes
    • 4.ovaries(female gonads)- 2 hormones secreted estrogen & progestoron
  3. process of ovulation
    • release of ovum to ovary, influenced by pituritary hormones
    • Anterior pituitary hormone the follicle- stimulaing hormone(FSH) starts ovulation, & increase estrogen
    • 2nd pituitary hormon- lutenzing hormon (LH)- causes mature follicle to rupure, releasing ovum to ovary, ruptured follicles tranform to corpus luteum(yellow body) which secretes estrogen & progesteron
  4. physilogical changes that lead to period
    • production of progesteron by corpus luteum decreases until changed to white spot on ovary(corpus albicans) & endometrium sheds,
    • starts 2wks after ovulation, last 4-5 days, loss of 30-60ml
  5. data when takin female HX
    • & family HX 2.when started period
    • of LMP, & description 4.STD
    • 5.preg. hx 6.birth control
    • 7.last physical
  6. purpose of cytologic test (pap)
    • cervical cancer screening test takin dead cells & to determine estrogen levels 4 menopause & endocrine abnormalities, get 2 wks after 1st day of LMP\
    • recommended @ 21yr or 3yrs after sex, after 30 & 3 norml results could get them q 2-3 yrs unless high risk of cancer
    • Aslo HPV test should be done the nurse advices
    • 1. no sex for 2 day
    • douching 1 day before
    • vag. meds 48hrs before
  7. dx exam for reproductive system disorders
    • 1.cervical biopsy- when pap +, performed by conization removin lrg section of cervical tissue
    • if permenopausal wait 1 wk after period ended when cervix is least vascular, crampin & spotting may happen after,notify Dr. is severe pain or bleedin
    • 2.Endometrial pap smear & biopsy- Dx cancer od endmetrium by aspiration or biopsy-
    • aspiration- inserting flexible cannula w/ syringe thru cervix to uterine cavity w/o anethesia
    • biopsy-dialating instrument called uterine sound inserted thru cervix, & scaping tissue w/ curette, w/o anesthesia
    • 3.Dialation & curattage- cervix stretched & endometrium scraped, pt under IV anesthesia
    • 4.culdoscopy-allows visualization of uterus, broad ligaments, & fallopian tubes, etopic preg. & masses could be seem, procedure could lead to internal bleeding and shock
    • 5. laproscopy- to see in abdomen, ectopic preg. for tubal ligation, & get ovarian biopsy, incision 1/2in above umbilicus,2/3 Liters of carbon dioxide or nitrgenous gas put in perotoneal cavity to seperate intestines from ograns to see better, pt could get shoulder pain from gas
    • 6.colposcopy-to see cervix & vag., done during pap
    • 7.hysterosalpingogram-radiographic exam to see uterus & fallopian tubes to detect adhesion & fallopian tube patency & congital malformations, cannula inserted & contrast injected, films taken & examined, bowel prep need
    • 8.Sonogram-see soft tissue by sound waves, for tumors & fetal & placenta location, istuctions by nurse are drink quart of water hr before & not to pee until test done (help w/ tranmission of sound & left bowel from other organs), no solid foods for 6-8 hr b/c of gas
    • 9. labs- CBC, hemoglobin, serum electrolytes, C&S if infection
  8. Breast
    • sweat glands AKA mammory glands have 15-20 lobes surrounded by fatty tissue, has areola/nipple,
    • prolactin gives milk
    • they have many blood vessels that distributes cancer to other areas
  9. clinical breast exam vs self exam
    • clinical- palpation of breast before mammogram/ during physical, done q 3yr when 20-39 yrs & yrly 40 & up
    • checkin 4 symmetry, size, & unusual changes( masses, dimpling, flattening, discharge, ulceration, rashes)

    Self- 3 days after period, start in shower & again in bed, with arms raised, move fingers in circles/ rows but follow same tech. feel nipple and armpit also, look @ breast in mirrow for any changes in both, squeez nipple for drainage
  10. advantages of mammogramic exam
    • radiographic exam when cyst or tumors to sm. to palpate, should be done when over 40,
    • needed when family hx of cancer & benignbreast disease, biopsies that may interfere w/ BSE
    • many woman dont like b/c of discomfort
    • Nurse instuctions:
    • avoid deoderant w/ aluminum hydroxide or talc b/c could interfer w/ x-ray, & determines how much they know bout BSE
  11. Tech. for breast biospy( determin if lesion is malignant)
    • 1.incisional- in OR, 1/more section of tissue removed, specimen frozen fast & examined while pt still under anesthesia, if neg. the rest is removed, incision closed, & pt sent to RR, if pos. the DR decides what best chance 4 cure is
    • 2.excisional- prefered by DR., removal of whole lesion, results take longer
    • 3.aspirational- by out-pt, anesthesia injected, and sample removed, sometime done a hospital under mammogramic guidance

    • aspirational could cause redness & soreness in area, notify if drainage/bleeding
    • Incisional & excisional- req. sutures
    • tell pt to wear supported bra & S/S if infection, & meds to be taken
  12. external structures of male reproductive system
    • 1.penis- contains urethral when pee & sperm come out, has nerves for sex stimulation, tip of penis is the glans, when uncircumcised the foreskin(prepuce) covers glans
    • 2.scrotum- skin between testes, cant make sperm when male is cold the scrotal sac regulates temp. the testes are degrees cooler them rest of body, smooth & skeletal muscles raise testes when cold, & relax releasing them when hot
  13. internal male reproductive system
    • 1.testes- responsible for spermatoggenesis & secretion of testosterone
    • 2.seminiferous tubles- spermatocytosis(immature spermatozoa) form, adult make 400million daily, leydig cells in tubals secrete testosteron controlled by LH released by by anterior pituitary gland
    • 3.epididymis- collect spermecytes, & nourishes them till motile, when mature they have a head & 23 chromosones, a midpiece that stores ATP, tail to move to ovum
    • 4.ductus deferens/vas deference- connected to epididymis- has spermatic cord
    • 5.spermatic cords- loops thru inguinal canal & into pelvix cavity before decending to prostate gland
  14. Accessory structures
    • 1.seminal vesicles- pair of glands that produce fluids (1)nourish sperm, (2) helps with sperm motility by liquefing ejaculated semen, (3)stimulates contraction of uterus to help sperm reach ovum, (4) stops sperm distruction b female antibodies, seminal fluid translucent so used for sexual assults
    • 2.prostate glands- encircle & empties, has secratory cells that produce alkaline fluid, which neutralizes acidic waste from released by sperm & counteracts the acid ph in vag. to ensure suvivalof sperm
    • 3.bulbourethral glands (cowpers glands) w/i external urethral sphincters, secretes lube for sex
  15. erection, emission & ejaculation
    • erection- takes place in parasympathic nerve activity, which releases nitric oxide chemical that vasodialating properties
    • emission- movement of sperm & mixture w/ fluid from seminal vesical & prostate glands into urethra
    • ejaculation- d/c of semun, normal volume of semun is 6-8ml containing 60-100 spermatozoa per ml, lower then 20million per mlis infertility
    • Might take men from min. to hrs to come again!!!!! Shit them gurls have to have a 2nd man !!!! ahhhh DANA
  16. Data we should gather during assessment
    • *risk of STI
    • *Birth control used
    • *ability to get & keep erection
    • *pain when having sex
    • *premature ejactlation & other concerns
    • *not being able to conceive(self/partner)
    • *prior tx (drug therapy, DX test or surgery) RT genitourinary system
  17. tech. 4 assessing male reproductive system
    • *Lookin 4 abnorma skin lesions & urethral d/c
    • *palpates testes 4 tumors & examines scrotum
    • *Translumination- shining of light thru scrotum, gives clues for density of scrotal tissue
    • *Digital rectal exam- to assess prostate for size as well as for tumors, DRE recommended older than 40-50 y/o
  18. method 2 DX prostate cancer
    • 1.Transrectal ultrasonography(TRUS)- lubed probe inserted into rectum 2 see prostate gland @ diff. angles, done when prostate enlarged or blood level od prostate-specific antigen is high
    • Nurse managment- inform non painful, administer enema or instruct pt do, tell pt to breath slowly to rduce anxiety, assisst clean lube, & tell pt that he could resume normal activity
    • 2.Cytoscopy- illuminated optical instrument called a cytoscope inserted in urinary meatus to inspect bladder, prostate, & urethra, which evaluates degree of encroachment by the prostate on urethra
    • Nurse managment- explain might feel bladder fullness or may want to void, inform pt that anethesia lube will be instillled, instruct pt to record void pattern, to report bleeding or difficult urinating, inform that prophylactic meds & to take RX as ordered
    • 3.Prostatic biopsy- abtained via perineal/rectal
    • 4.testicular biops- specimen from one or both testes, checks spermatozoa to dx infertility & testicular malignancy
    • Nurse managment- anessthesia given, give enema if rectal way used, inform bout site care, prophlactic meds will b given & to take meds as ordered, inform to do sitz baths, inform to refrain from tub baths until sutures removed
  19. infertility test
    • 1.seman anaysis- 4 sperm count, motiliy, abnormal sperm
    • 2.measuring level of plams LH- necessary for release of testosterone from testes, low LH shows infertility
  20. tumor markers
    • sustance synthesized by tumors that are release in big amounts
    • Prostate-specific antigen (PSA)- detect prostate cancer, High % of free PSA= benign disease, low %of free PSA= malignancy
    • test could be wrong so rarely used b/c pt could get scared for no reason
Card Set
Med Surge
ch 52