Ectopic pregnancy

This is when a fertilized ovum implants outside of the uterine cavity, most commonly in the Fallopian tubes. Decreased tubal peristalsis or tubal blockage can cause the zygote to implant before reaching the uterine cavity. As it continues to grow the Fallopian tubes expand, potentially rupturing. Symptoms manifest typically 6-8 weeks after the last menstrual cycle and include:

  • abdominal pain
  • irregular vaginal bleeding
  • GI upset
  • syncope
  • haemorrhage causing hypovolaemic shock

It is a life threatening condition.

Risk factors for the development of ectopic pregnancy are:

  • pelvic inflammatory disease
  • IUD
  • pelvic/tubal surgery

Surgery is required to treat a ruptured EP if the tube has ruptured, otherwise Methotrexate can be used. Nurses must monitor for signs of shock, increased bleeding, increased pain and offer support and reassurance.

Pelvic inflammatory disease

This is an infectious condition that can cause ovarian abscesses to form. It can involve the Fallopian tubes, ovaries and peritoneum. Sexually transmitted disease such as gonorrhea and chlamydia are the common risk factors for this. Symptoms include:

  • Abdo pain
  • increased pain on mobilizing
  • painful cramping
  • pain during intercourse
  • abnormal discharge

PID can cause the development of septic shock due to bacteria leaked from the abscesses entering into systemic circulation. The bacteria can also spread to the liver resulting in fitz-hugh-curtis syndrome.

PID is treated with antibiotics. If the abscesses do not respond to AB treatment surgical intervention may be required. The nurse should educate the patient on the importance of safe sex and regular STI check ups.

Endometriosis

This is when there is endometrial tissue outside of the endometrial cavity, usually ovaries, uterosacral ligament and peritoneum. Hormones cause the tissue to undergo menstrual cycles causing the formation of cyst like nodules. Upon rupture, the affected area can adhere to other structures. Painful micturation and bowel obstruction can occur. Symptoms:

  • Pelvic pain
  • infertility
  • painful bowel motions
  • irregular bleeding
  • dysmenorrhoea (painful periods)

Treatment requires the removal of endometrial tissue or drugs which inhibit oestrogen production and reduce the size of tissues.

Poly-cystic ovaries

An increased production of luteinising hormone and decreased follicle stimulating hormone results in the failure to release eggs from the ovaries which causes  benign cysts to form. Symptoms:

  • irregular menstrual periods
  • infertility
  • obesity
  • acne
  • hirsutism (increased hair growth)

Treatment may include medication to restore ovulation and increase fertility

Benign prostate hyperplasia

An enlargement of the prostate gland from an increase in epithelial cells and stromal tissue. The excessive growth is caused by the accumulation of dihydrotestosterone. The enlargement can lead to urethra compression resulting in an obstruction. Symptoms include:

  • decreased force of urination
  • difficulty starting urination
  • dribbling after urination
  • bladder pain
  • nocturia
  • incontinence
  • UTI

Treatment involves dietary changes, 5 alpha reducatse inhibitors and resection/ ablation of the prostate.

Erectile dysfunction

The inability to attain or maintain an erection. Medical conditions that damage microvascular networks, diabetes, hypertension, coronary disease, stress and substance abuse can lead to sexual dysfunction. Psychological causes can also result in ED. The main complication with ED is a change in self concept, depression and anger issues.

Treatment can involve hormone replacement, sexual therapy, vacuum constrictive devices, oral drug therapy, and surgical implants.

 

 

References

Martin, M. (2008). Nursing management: Female reproductive problems. In D. Brown & H. Edwards (Eds.), Lewis’s medical-surgical nursing: Assessment and management of clinical problems (2nd ed., pp. 1480–1513). Sydney, Australia: Mosby Elsevier.

Martin, M., & Rolley, J. (2008). Nursing management: Male reproductive problems. In D. Brown & H. Edwards (Eds.), Lewis’s medical-surgical nursing: Assessment and management of clinical problems (2nd ed., pp. 1514–1542). Sydney, Australia: Mosby Elsevier.

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