ASSESSMENT AND MANAGEMENT OF FEMALE PHYSIOLOGIC PROCESSES

→ A highly sensitive organ

ROLE OF NURSES IN WOMEN’S HEALTH composed of erectile tissue
• Must be sensitive to health needs and
be knowledgeable about preventive
health care for women
• Encourage women to determine their
own health goals and behaviors • URINARY MEATUS
• Teach about health promotion and → Located between labia minora,
illness prevention below and posterior to clitoris
→ External opening of female
STRATEGIES IN PROMOTING POSITIVE urethra
PRACTICES AND BEHAVIORS R/T REPRO AND → 3cm (less than 1.5 in) long
SEXUAL HEALTH:
• Recommend regular examinations to: • VAGINAL ORIFICE (INTROITUS)
→ promote health → Located below the urinary
→ detect health problems at an meatus which is larger opening
early stage
→ assess problems r/t gynecologic • VESTIBULAR (BARTHOLIN’S) GLAND
& repro function → Located on each side of vaginal
→ discuss questions or concerns orifice
r/t sexual function and sexuality → Bean-shaped structure that
• Providing an open, nonjudgmental empties its mucous secretion
environment –nurses must convey thru small duct
understanding and sensitivity and be → Opening of duct lies w/in labia
alert to cues about unspoken patient minora, external to hymen
concerns
• Recognize s/s of abuse and screening • PERINEUM
all patients in private and safe → Area between vagina and
environment rectum
• Recognize cultural differences and
beliefs and respecting sexual INTERNAL REPRODUCTIVE STRUCTURES
orientation
• VAGINA
ASSESSMENT OF THE FEMALE → Canal lined with mucous
REPRODUCTIVE SYSTEM membrane
→ 7.5-10cm (3-4in) long; extends
ANATOMIC AND PHYSIOLOGIC upward and backward from the
OVERVIEW vulva to the cervix
→ Anterior to the bladder and
ANATOMY OF FEMALE REPRODUCTIVE urethra, posterior to rectum
SYSTEM → Anterior and posterior walls of
vagina touch each other
EXTERNAL GENITALIA (VULVA)
FORNIX
• LABIA MAJORA → Upper part of vagina
→ two thick folds of tissue → Surrounds the CERVIX (inferior
part of the uterus)
• LABIA MINORA
→ Two smaller lips of delicate • UTERUS
tissue → Pear-shaped muscular organ
→ Lie within labia majora → Upper part:
 7.5cm (3in) long
• CLITORIS  5cm (2in)wide
→ Located in upper portions of → Walls:
labia minora  1.25cm (0.5in) thick
 → Size varies, depending on → Oval bodies about 3cm (1.2in)
PARITY (no. of variable births) long
and uterine abnormalities → At birth: contain thousands of
 Nulliparous woman has tiny egg cells or OVA
smaller uterus than → Produces steroid hormones,
multiparous woman predominantly estrogen and
progesterone

→ Lies posterior to bladder ADNEXA

→ Held in position by several → Term for ovaries and fallopian
ligaments: tubes together
1) ROUND LIGAMENTS
→ extend anteriorly
and laterally to the
lateral inguinal ring
and down the
inguinal canal FUNCTION OF THE FEMALE
2) BROAD LIGAMENTS REPRODUCTIVE SYSTEM
→ folds of peritoneum
extending from OVULATION
lateral pelvic walls • Discharge of mature ovum into the
and enveloping peritoneal cavity from the ovary
fallopian tubes • Ova begin to mature and menstrual
3) UTEROSCARAL cycle begins at puberty (usually 12-
LIGAMENTS 14y/o)
→ extend posteriorly • FOLLICULAR PHASE
to the sacrum → Ovum (oocyte) enlarges as type
of cyst called GRAAFIAN
2 PARTS OF UTERUS: FOLLICLE until it reaches
1) CERVIX surface of ovary, where
→ Projects into the vagina transport occurs
2) FUNDUS or BODY • Ovum finds its way into fallopian tube,
→ Larger upper part of where it is carried to uterus
uterus • If penetrated by SPERMATOZOON,
→ Covered posteriorly and union occurs and conception takes
partly anteriorly by place
peritoneum
• Graafian follicle undergo rapid change
after ovulation; they became yellow
EXTERNAL and INTERNAL OS
(CORPUS LUTEUM) and produce
→ Triangular inner portion of
PROGESTERONE (hormone that
fundus narrows to a small canal
prepares uterus for receiving fertilized
in the cervix that has
ovum
constrictions at each end
• Usually occurs 2 weeks prior to next
menstrual period
CORNUA
→ Upper lateral parts of the uterus
MENSTRUAL CYCLE
→ Oviducts or fallopian tube tubes
extend outward, and their • Complex process involving the
lumina are internally continuous reproductive and endocrine systems
with uterine cavity
ESTROGEN
• OVARIES • Responsible for developing and
→ Lie behind the broad ligaments maintaining female repro organs and
and behind and below the 2˚ sex characteristics
fallopian tubes • Play important role in breast
development and in monthly cyclic
changes in uterus
 • Different estrogens are produced by → Causes endometrium to thicken
ovarian follicle, w/c consists of and become more vascular
developing ovum and its surrounding 2) SECRETORY PHASE
cells → Near the middle portion of cycle
(day 14 in a 28-day cycle)
ESTRADIOL –most potent of the → LH output increases, stimulating
ovarian estrogens ovulation
→ Endometrium reaches peak of
PROGESTERONE its thickening and
• Important in regulating changes that vascularization under combined
occur in uterus during menstrual cycle stimulus of estrogen and
• Secreted by corpus luteum, w/c is progesterone
ovarian follicle after the ovum has 3) LUTEAL PHASE
been released → Begins after ovulation
• Most important hormone for → Progesterone is secreted by
conditioning the ENDOMETRIUM corpus luteum
(mucous membrane lining the uterus)
WHAT IF OVUM IS FERTILIZED?
• In pregnancy, its secretion becomes
largely a function of placenta and is • Estrogen and progesterone levels
essential for maintaining a normal remain high, and complex hormonal
pregnancy changes of pregnancy follow
• With estrogen, it prepares breast for
WHAT IF OVUM HAS NOT BEEN FERTILIZED?
producing and secreting milk
ANDROGENS • FSH and LH output diminishes,
estrogen and progesterone secretion
• Produced by ovaries and adrenal
falls, ovum disintegrates, and
glands, but only in small amounts
endometrium becomes hemorrhagic
• Involved in early development of
• Product will be menstrual flow
follicle and also affect the female
consisting of blood, mucus, and
libido
endometrial tissue, w/c is discharged
thru cervix and vagina
2 GONADOTROPIC HORMONES (released by
pituitary gland): • After menstrual flow stops, cycle
1) FOLLICLE STIMULATING begins again; endometrium
Phase MENSTRUA FOLLICULA OVULATIO LUTEAL PREMENSTRU
HORMONE (FSH) L R N AL
→ Responsible for Days 1-5 4-13 12-16 15-25 26-28
stimulating the Ovary Degenerati Growth Ovulation Active CL Degenerating
ng CL; and CL
ovaries to secrete beginning maturatio
estrogen follicular n of
developme follicular
2) LUTEINIZING HORMONE nt cell
(LH) Estrogen Low Increasing High Declining, Decreasing
→ Responsible for production then a
secondary
stimulating rise
progesterone Progesterone None Low Low Increasing Decreasing
production production
FSH Increasing High, then Low Low Increasing
production declining
PHASES OF MENSTRUAL CYCLE: LH Low Low, then High High Decreasing
1) PROLIFERATIVE PHASE production increasing
Endometrium Degenerati Reorganiz Continued Active Vasoconstricti
→ At the beginning of on and ation and growth secretion on of coiled
the cycle (just after shedding of proliferatio and arteries;
menstruation) superficial n of glandular beginning
layer. superficial dilation; degeneration
→ FSH output Coiled layer highly
increases, arteries vascular;
dilate, then edematous
stimulating estrogen constrict
secretion again
proliferates and thickens from
 estrogenic stimulation, and ovulation → with menses (DYSMENORRHEA)
recurs → with intercourse (DYSPAREUNIA)
→ pelvic pain
HORMONAL CHANGES DURING THE • Symptoms of vaginitis
MENSTRUAL CYCLE → Odor
→ Itching
• Problems with urinary function
MENOPAUSAL PERIOD → Frequency
• Marks the end of a women’s → Urgency
reproductive capacity → Incontinence
• Usually occurs between 45 and 52 y/o • Bowel problems
but may occur as early as 45 or as late • Sexual history
as 55; median age is 51 • STDs and methods of treatment
• PERIMENOPAUSE precedes and can • Current or previous sexual abuse or
begin as early as 35 y/o physical abuse
• Physical, emotional, and menstrual • Past surgery or other procedures on
changes may occur which offers reproductive tract structures
another opportunity for health • Chronic illness or disability
promotion and disease prevention
• Presence of family history of genetic
teaching and counseling
disorder
MENOPAUSE
SEXUAL HISTORY
• Not a pathologic phenomenon but a
• PURPOSE:
normal part of aging and maturation
→ to obtain information that
• Menstruation ceases, and because provides a picture of a woman’s
ovaries are no longer active, sexuality and sexual practices
reproductive organs become smaller → to promote sexual health
• No more ova mature, therefore, no • PLISSIT (permission, limited info,
ovarian hormones are produced specific suggestions, intensive
• May occur if ovaries are surgically therapy) of sexual assessment and
removed or are destroyed by radiation intervention may be used to provide
or chemotherapy framework for nursing interventions

ASSESSMENT
WHAT TO DO?
HEALTH HISTORY • Introduce topic and ask for permission
to discuss issues related to sexuality
Data should be collected about ff:
• Explain the purpose of obtaining
• Menstrual history sexual history
→ Menarche
• Inquire about present sexual activity
→ Length of cycles
and sexual orientation
→ Duration and amount of flow
• Inquire about possible sexual
→ Presence of cramps and pain
dysfunction
→ Bleeding bet. Periods or after
intercourse • Ask about thoughts on what is causing
→ Bleeding after menopause current problem
• Pregnancies • Introduce sexual function during
→ No. of pregnancies health history
→ Outcomes of pregnancies • Offer specific suggestions for
• Exposure to medications interventions
→ Diethylstilbestrol • For young women: give info about
→ Immunosuppressive agents using tampons, emergency
→ Others contraception, or issues r/t pregnancy
• Pain • For perimenopausal women: give info
about irregular menses
 • For menopausal women: give info • Broad term that includes child abuse,
about vaginal dryness and discomfort elder abuse, and abuse of women and
with intercourse men
• Ask number of sexual partners to • Can be emotional, physical, sexual or
assess risk for STDs economic
• Open-ended question r/t needs should • Involves fear of one partner by
be included another and control by threats,
• Advised that intercourse should never intimidation, and physical abuse
be painful • It is r/t the need to maintain control of
• Encourage to talk openly with their partner and is rooted in sex role
partners inequality

FEMALE GENITAL MUTILATION or CUTTING BATTERING

• Partial or total removal of external → Involves repeated physical or sexual
female genitalia or other injury to assault in a context of coercive
female organs control, emotional degradation,
• Some cultures (Africa and Middle East) threats and intimidation
accept this as a rite of passage of
womanhood and believe that it MANIFESTATIONS OF ABUSE:
promotes hygiene, protects virginity, • Suicide attempt
etc • Drug and alcohol abuse
• Illegal in U.S. and many health • Frequent emergency department visits
organizations • Vague pelvic pain
• Usually performed between 4 and 10 • Somatic complaints
y/o, but may be performed on • Depression
newborn, adolescent, @time of
marriage, or during 1st pregnanvy INCEST AND CHILDHOOD SEXUAL ABUSE
• Must be considered in sexual history • 1 out of 5 women has experienced
particularly in women from cultures incest or childhood sexual abuse
and countries where it is common • Victims are more reported to
• Nurses must be sensitive, empathetic, experienced:
knowledgeable, culturally competent → Chronic depression
and nonjudgmental → Posttraumatic stress disorder
• The term “cutting” is more acceptable → Morbid obesity
than mutilation → Marital instability
→ GI problems
SHORT TERM COMPLICATIONS: → Headaches
→ Hemorrhage • CHRONIC PELVIC PAIN
→ Cellulitis → Often associated with physical
→ Lacerations violence, emotional neglect,
→ Urinary dysfunctions and sexual abuse in childhood
→ Infection
RAPE AND SEXUAL ASSAULT
LONG TERM COMPLICATIONS: • Oral, anal, and genital tissue is
→ Urinary dysfunction examined for evidence of trauma,
→ Chronic vaginitis semen, or infection
→ Pelvic infections • Saliva, hair, and fingernail is also
→ Inability to undergo pelvic exam collected
→ Painful intercourse • Cultures are obtained for STDs, and
→ Impaired sexual response prophylactic antibiotics are prescribed
→ Anemia → Ceftriaxone (Rocephin)
→ Increased risk of HIV → Metronidazole (Flagyl)
→ Azithromycin (Zithromax)
DOMESTIC VIOLENCE
• HEPA B vaccine may be given if
patient is not already immune
 → Subsequent doses given at 1-2 2) UPRIGHT LITHOTOMY
months and 4-6 months (semisitting)
• HIV testing is offered and repeated in → May also be used
3-6 months 3) SIMS’ POSITION
→ HIV prophylaxis is not → Alternate position if
universally recommended but is patient has illness and
considered when mucosal disability
exposure to contamination has → Patient lies on her left
occurred side with her right leg
bent at 90˚
RAPE TRAUMA SYNDROME
→ Emotional reaction to sexual • EQUIPMENTS:
assault and may consist of → Good light source
shock, sleep disturbances, → Vaginal speculum
nightmares, flashbacks, anxiety, → Clean gloves
anger, mood swings, and → Lubricant
depression → Spatula
→ Cytobrush
HEALTH ISSUES IN WOMEN WITH → Glass slides
DISABILITIES → Fixative solution or spray
• Limit full participation in society → Dx testing supplies
• Stereotyping and increased risk of
abuse INSPECTION
• Others equate them with their • Inspect labia majora and labia minora
disability • Note epidermal tissue of labia majora
• Less primary health care and • Evaluate any type of lesions
preventive health screening • Introitus should be free of lesions
• Nulliparous:
PHYSICAL ASSESSMENT → labia minora come together at
• Explain procedures to be performed the opening of vagina
→ It relaxes and provides • Women who delivered child vaginally:
opportunity for her to ask → labia minora may gape and
questions vaginal tissue may protrude
• Ask to empty bladder before
examination COMPLICATIONS OF CHILD BIRTH
→ Ensures comfort and eases the TRAUMA:
examination, it also provide (patient should bear down to check for
urine specimen if urine test is ff:)
needed 1) CYSTOCELE
→ Bulge caused by bladder
POSITIONING protruding into the
• ADVANTAGES OF POSITIONING: submucosa of anterior
→ More comfortable vaginal wall
→ Allows better eye contact 2) RECTOCELE
→ Provide easier to carry out → Bulge caused by rectal
bimanual examination cavity protruding into the
→ Enables to use mirror to posterior vaginal wall
visualize her anatomy (if she 3) UTERINE PROLAPSE
chooses) → Cervix descend under
pressure thru vaginal
• POSITIONS: canal and be seen at
1) SUPINE LITHOTOMY introitus
→ Most common position
→ Patient lies on table with SPECULUM EXAMINATION
her feet on foot rests or • BIVALVE SPECULUM (metal or plastic)
stirrups is used
 o Metal specula are soaked, → Small broomlike device can also
scrubbed, and sterilized be used to obtain specimens
o Plastic specula is one-time use • CULTURE
only → Specimen of any purulent
material appearing at cervical
• Can be warmed with heating pad or os
warm water to make insertion more → Sterile applicator is used, w/c is
comfortable immediately placed in
• Not lubricated because commercial appropriate medium for transfer
lubricants may interfere with cervical in lab
cytology
• Gently inserted into posterior portion
of introitus and slowly advanced to top
of vagina (this should not be painful) INSPECTING VAGINA
• Then slowly open and setscrew of the • Young girls:
thumb rest is tightened to hold → Smooth; thickens after puberty
speculum → Many rugae (folds)
• Menopausal women:
INSPECTING THE CERVIX → Thin; fewer rugae because of
• Nulliparous women: decreased estrogen
→ 2-3cm wide and smooth
• Woman who have borne child: BIMANUAL PALPATION
→ Cervix may have laceration, • Usually STANDING POSITION
usually transverse • Fingers are advanced vertically along
→ “fishmouth” appearance of vaginal canal, vaginal wall is palpated
cervical os • Firm part may represent old scar
• Woman whose mother took DES tissue from childbirth trauma
during pregnancy:
→ “hooded” appearance cervix CERVICAL PALPATION
• NABOTHIAN CYSTS • Palpated and assessed for
→ Small, benign cysts; bluish or consistency, mobility, size and position
white color; may appear on • Normal: uniformly firm but not hard
cervical surface • Early pregnancy: soft cervix
• POLYP of endocervical mucosa • Invasion of neoplasm: hard and
→ May protrude thru os and immobile
usually dark red; can cause • CHANDELIER SIGN
irregular bleeding and rarely → Pain on gentle movement of
malignant cervix
• CARCINOMA → (+CMT) positive cervical motion
→ Cauliflower-like growth that tenderness
bleeds easily when touched → Indicates pelvic infection
• CHADWICK’S SIGN
→ Bluish coloration of cervix; sign UTERINE PALPATION
of early pregnancy • Place opposite hand on abdominal wall
halfway between umbilicus and pubis
OBTAINING PAP SMEARS AND OTHER and press firmly toward vagina
SAMPLES • Uterine size, mobility, and contour can
• PAP SMEAR be estimated
→ Obtained by rotating small • Fixation of uterus: sign of
spatula at os, followed by endometriosis or malignancy
cervical brush rotated in the os • Body of uterus is 2x the dm and length
→ Material obtained is spread on of cervix
glass slide and sprayed
immediately or inserted into ADNEXAL PALPATION
liquid (thin “prep”) • Evaluates fallopian tubes and ovaries
 • Fingers are moved at one side then to • Slide, spatula, and cytobrush or thin
other, while other hand palpating prep kit
abdominal area is moved to either
side of abdomen and downward NURSING ACTION:
• Palpated for mass, tenderness and • Do not obtain if woman is
mobility menstruating or has other frank
• Normal ovaries: slightly tender bleeding except if neoplasia is highly
• Informed patient that slight discomfort suspected
is normal → Because blood obscures proper
reading of cells
VAGINAL AND RECTAL PALPATION • Obtain pap smear test first if
• Bimanual palpation and cul-de-sac is performing more than one test
accomplished by placing index finger → Because chance of bloody
in vagina and middle finger in rectum smear is avoided
• Put new gloves to prevent cross- • Label slide or thin-prep Pap bottle with
contamination between vaginal and name using pencil
rectal orifices → Because ink may rub off or blur;
• Patient may sense urge to defecate prevents improper identification
• Put on gloves before inserting
GERONTOLOGIC CONSIDERATIONS unlubricated speculum (but it may be
• PERINEAL PRURITUS moistened with warm water
→ Abnormal and may indicate → Because it provides protection
disease process (diabetes or and warm water prevents
malignancy) discomfort; lubricants may
• VULVAR DYSTROPHY obscure cells
→ Thickened or whitish • Place longer end of Ayre spatula in
discoloration of tissue cervical canal and rotate it in full circle
→ May be visible, and biopsy is to obtain sample form exocervix; then
needed to rule put abnormal spread it on the slide
cells → Because this technique obtains
→ Topical cortisone and hormone sampling of exocervix and
may be prescribed for squamocolumnar junction
symptomatic relief • Insert cytobrush 2cm into cervical
• RELAXING PELVIC MUSCULATURE canal and rotate 180˚. Roll brush onto
→ Uterine prolapse and relaxation slide. (but with thin-prep, brushings
of vaginal walls can occur are not spread, the brush and spatula
→ Surgical repair can provide are placed in fixative and swirled)
relief → Because saline solution
→ PESSARIES (latex device that prevents drying, w/c makes
provide support) are used if interpretation difficult; and
surgery is contraindicated prevents absorption of cells in
→ Assess for allergy in latex cotton, increasing yield on slide
• Immediately spray the slide or if thin-
DIAGNOSTIC EVALUATION prep, swirl brush and spatula in
solution
CYTOLOGIC TEST FOR CANCER (PAP → Because exposure to light or air
SMEAR) causes distortion of cells
→ Used to detect cervical cancer
IMPORTANT CONSIDERATION:
GUIDELINES FOR OBTAINING OPTIMAL PAP • Instruct patient not to douche before
SMEAR having pap smear taken to avoid
washing away cellular material
EQUIPMENT:
• Speculum WHAT If reveals ATYPICAL CELLS:
• Gloves • use LIQUID METHOD w/c allows for
HPV testing
 IF BIOPSY SHOWS PREMALIGNANT CELLS OR
TERMINOLOGIES used to describe findings: CIN, CRYOTHERAPY, LASER THERAPY, OR
• ASCUS (atypical squamous cells of CONE BIOPSY IS REQUIRED.
undetermined significance)
→ Either HPV (+) or (–) CRYOTHERAPY AND LASER THERAPY
• LSIL (low-grade squamous (used in outpatient setting)
intraepithelial lesion)
→ Equivalent to cervical CRYOTHERAPY
intraepithelial neoplasia (CIN; → Freezing cervical tissue with nitrous
grade 1) and to mild changes r/t oxide
exposure to HPV → May result in cramping and occasional
→ Repeat pap smear in 4-6 feelings of faintness (VASOVAGAL
months and perform RESPONSE)
COLPOSCOPY if not resolved → Watery discharge is normal for few
• HGSIL (high-grade squamous weeks after procedure as the cervix
intraepithelial lesion) heals
→ Equates to moderate and
severe dysplasia, carcinoma in CONE BIOPSY AND LOOP
situ (CIS), CIN grade 2 and 3 ELECTROSURGICAL EXCISION
→ Precursors to invasive PROCEDURE (LEEP)
carcinoma of the cervix that
indicate evaluation and LOOP ELECTROSURGICAL EXCISION
treatment PROCEDURE (LEEP)
→ Require prompt COLPOSCOPY → Uses laser beam; performed with
CONE BIOPSY if endocervical curettage
findings indicate abnormal changes or
if lesion extends into canal
→ Associated with high success rate in
COLPOSCOPY AND CERVICAL BIOPSY removal of abnormal cervical tissue
→ Low incidence of complications; slight
COLPOSCOPY increase in risk of later cervical
→ Performed if Pap smear requires stenosis or premature deliveries
evaluation
NURSING ACTION:
HOW TO PERFORM? • Advise patient to rest for 24 hours
• Use COLPOSCOPE (portable after the procedure and to leave any
microscope; magnification from 10X- vaginal packing until it is removed
25X) w/c allows to visualize cervix and (usually next day)
obtain sample of abnormal tissue for • Instruct to report any excessive
analysis bleeding
• Apply acetic acid to the cervix • Provide guidelines regarding postop
sexual activity, bathing, and other
INDICATIONS FOR CERVICAL BIOPSY: activities
• LEUKOPLAKIA • Caution to avoid intercourse until
→ White plaque visible before healing is complete and verified at
applying acetic acid follow-up
• ACETOWHITE TISSUE
→ White epithelium after applying ENDOMETRIAL (ASPIRATION) BIOPSY
acetic acid → Method of obtaining endometrial
• PUNCTUATION tissue; performed as an outpatient
→ Dilated capillaries occurring in procedure
dotted or stippled pattern → Permits diagnosis of cellular changes
in the endometrium
• MOSAICISM
→ May experience slight discomfort
→ Tile-like pattern
• ATYPICAL VASCULAR PATTERNS
INDICATIONS FOR ENDOMETRIAL BIOPSY:
(while taking hormone therapy or tamoxifen) • Cervical canal is widened with dilator,
• Midlife irregular bleeding and uterine endometrium is scraped
• Postmenopausal bleeding with curette
• Irregular bleeding
NURSING ACTION:
HOW TO PERFORM? • Explain procedure, preparation and
• Apply TENACULUM (clamp-like expectations regarding postop
instrument that stabilizes uterus) after discomfort and bleeding
pelvic exam • Instruct to void before procedure
• Insert thin, hollow, flexible suction • Place in lithotomy position
tube (PIPELLE or SAMPLER) thru cervix • Perineal pad is placed after the
into uterus procedure
• Report excessive bleeding
FINDINGS: • No restrictions on dietary intake
• NORMAL ENDOMETRIAL TISSUE • Mild analgesic provide relief if pelvic
• HYPERPLASIA discomfort or low back pain occurs
o SIMPLE HYPERPLASIA • Advise no vaginal penetration or use
→ Overgrowth of uterine of tampons for 2 weeks to reduce risk
lining of infection and bleeding
→ Usually treated with
progesterone ENDOSCOPIC EXAMINATIONS
o COMPLEX HYPERPLASIA
→ Overgrowth of cells with LAPARASCOPY (PELVIC PERITONEOSCOPY)
abnormal features → Inserts LAPAROSCOPE into peritoneal
→ Risk factor for uterine cavity thru 2cm incision below
cancer umbilicus to allow visualization of
→ Treated with pelvic structures
progesterone and careful → Used for diagnostic purposes or
follow-up treatment
HIGH RISK FOR HYPERPLASIA: → Facilitates many surgical procedures:
 Overweight o Tubal ligation
 45 y/o above o Ovarian biopsy
 History of nulliparity and o Myomectomy
infertility o Hysterectomy
 Family history of colon cancer o Lysis of adhesions (scar tissue
• ENDOMETRIAL CANCER that can cause pelvic
discomfort)
DILATION AND CURETTAGE (D&C)
→ Diagnostic (identifies cause of HOW TO PERFORM?
bleeding) • Surgical instrument (intrauterine
→ Therapeutic (often temporarily stops sound or cannula) may be positioned
irregular bleeding) inside the uterus to permit
→ PURPOSE: to secure endometrial or manipulation or movement during
endocervical tissue for cytologic exam; laparoscopy w/c gives better
to control abnormal uterine bleeding; visualization
as therapeutic measure for incomplete • Inject carbon dioxide intraperitoneally
abortion to visualize pelvic organs
(INSUFFLATION) –technique that
HOW TO PERFORM? separates intestine from pelvic organs
• Usually in operating room; requires • After laparoscopy is completed, CO2 is
anesthesia supplemented with allowed to escape thru outer cannula
diazepam and midazolam; and • Incision is closed with sutures or clip
surgical asepsis and is covered with adhesive bandage

NURSING ACTION:
 • Monitor patient for several hours to → Alternative to hysterectomy for some
detect untoward signs indicating pt
bleeding, bowel or bladder injury, or → Hemorrhage, perforation or burns can
burns from coagulator occur
• Instruct patient that he may OTHER DIAGNOSTIC PROCEDURES
experience abdominal or shoulder pain (helpful in evaluating pelvic conditions)
r/t use of CO2 • Xrays
• Barium enema
HYSTEROSCOPY • GI series
→ Transcervical intrauterine endoscopy; • IV urography
allows direct visualization of all parts • Cystography
of uterine cavity by LIGHTED OPTICAL • KUB xray
instrument
• Pyelography
→ Best performed after 5 days of
• Angiography
menstruation ceases (ESTROGENIC
PHASE of menstrual cycle) • Radioisotope scanning
→ Few complications; used for evaluating • Hysterosalpingography
endometrial pathology • CT scan
→ Can also be treatment for some
conditions like fibroid tumors HYSTEROSALPINGOGRAPHY or
UTEROTUBOGRAPHY
INDICATIONS: → Xray study of uterus and fallopian
• Andjunct to D&C and laparoscopy in tubes after injection of contrast agent
cases of: → Diagnostic (evaluates infertility or
o Infertility tubal patency and to detect any
o Unexplained bleeding abnormal condition in uterine cavity)
o Retained uterine device → Therapeutic (contrast agent flushes
debris or loosens adhesions)
• Recurrent early pregnancy loss
HOW TO PERFORM?
CONTRAINDICATIONS:
• Expose cervix with bivalved speculum
• Cervical carcinoma
• Insert cannula into cervix
• Endometrial carcinoma
• Insert contrast agent into uterine
• Acute pelvic inflammation
cavity and fallopian tubes
• Xrays are taken to show path and
HOW TO PERFORM?
distribution of contrast agent
• Cleanse vagina and vulva
• Perform paracervical anesthetic block NURSING ACTION:
or lidocaine spray
• BEFORE:
• HYSTEROSCOPE is passed thru o Administer laxative and enema
cervical canal and advanced 1 or 2cm to evacuate intestinal tract so
under direct vision that gas shadows do not distort
• Infuse Uterine-distending fluid (NSS or xray findings
D5W) thru instrument to dilate the o Mild sedative or analgesic agent
uterine cavity and enhance visibility may be prescribed
• DURING:
ENDOMETRIAL ABLATION
o Placed in lithotomy position
→ Destruction of uterine lining
→ Performed with hysteroscope and • AFTER:
resector (cutting loop), roller ball o Advise to wear perineal pad for
(barrel shaped electrode) or laser several hours, because
beam in cases of severe bleeding not radiopaque contrast agent may
responsive to therapies stain clothing
→ Performed in outpatient with genera,
regional or local anesthesia (rapid COMPUTED TOMOGRAPHY
procedure) • ADVANTAGES OVER
ULTRASONOGRAPHY:
 → More effective for obese and for
patients with distended bowel
→ Demonstrate tumor and any
extension into retroperitoneal
lymph nodes and skeletal tissue

• DISADVANTAGES:
→ Involves radiation exposure
→ More costly
→ Limited in diagnosing
gynecologic abnormalities

ULTRASONOGRAPHY
→ Useful adjunct to physical
examination, particular in OB or
patients with abnormal pelvic exam
findings
→ Simple procedure based on sound
wave transmission that uses pulsed
ultrasonic waves @ frequencies
exceeding 20000 Hz by a
TRANSDUCER placed in contact with
abdomen (abdominal scan) or vaginal
probe (vaginal ultrasound)
→ Takes less than 10 minutes
→ Involves no ionizing radiation and no
discomfort other than full bladder
(necessary for good visualization in
abdominal scan)
→ Vaginal UTZ or sonogram do not
require full bladder but vaginal probe
can cause discomfort
→ Saline may be instilled to help
delineate endometrial polyps or
fibriods

MAGNETIC RESONANCE IMAGING

→ Produces patterns that are finer and
more definitive than other imaging
procedures
→ Does not expose patients to radiation
→ It is more costly