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Nursing Care of a Family When a Child Has a Reproductive Disorder

DISORDERS CAUSED BY ALTERED REPRODUCTIVE DEVELOPMENT

Genetic sex or biologic
_ (sex chromosomes XX or XY) is determined at conception.
gender
8th week
Reproductive organs and genitalia begin to differentiate in utero by the_, with
growth and refinement occurring over the next several months.
Ambiguous genitalia
_, which is a rare condition with various causes that occurs during fetal
development
Ambiguous Genitalia
ambiguous genitalia
_means that external sexual organs in the child did not follow
the normal course of development, so that, at birth, they are so incompletely
or abnormally formed that it is impossible to clearly determine the childs
gender by simple observation.
congenital
The most common cause of in vitro fertilization of females is_.
adrenocortical
syndrome
congenital
The adrenal gland produces androgen instead of adequate cortisone, causing
adrenocortical
the clitoris to become the size of a typical newborn males penis
syndrome
hermaphrodite
If testosterone was produced in utero but development of the mllerian duct
(female) was not suppressed, a child may be intersexed (formerly termed_),
with both ovaries and testes and either male or female external genitalia.
pseudohermaphrodit Children with ambiguous genitalia are often termed pseudointersexed or_
es
because, as infants, they have some external features of both sexes
Assessment
Karyotyping
_helps to establish whether the child is genetically male or female
Karyotyping
This involves drawing a specimen of blood, allowing the white blood cells to
reach a division
stage, and then examining them.
Laparoscopy
_(introduction of a narrow laparoscope into the abdominal cavity through a
half-inch incision under the umbilicus) or possibly exploratory surgery may be
necessary to determine if ovaries or undescended testes are present.
Intravenous
_can be used to establish whether a male has a complete urinary tract.
pyelography or
ultrasound
Therapeutic Management
reconstructive surgery
Once the childs true chromosomal gender has been documented, the extent
of necessary _is determined in consultation with the parents.
Precocious Puberty
8 years or menses
Although development of breasts or pubic hair before age _years may be just
before age 9
early maturation, such development has traditionally been considered
precocious sexual development
girls than in boys
Precocious puberty occurs more often in _
Precocious puberty
This condition is caused by the early production of gonadotropins by the
pituitary gland
gonadotropins
_stimulate the ovaries or testes to produce sex hormones
oral contraceptive pills
In girls, ingestion of a mothers _can initiate menarche-like changes.
enzyme aromatase
Overstimulation by the _which converts androgens into estrogens by a process
called aromatization may be yet anther cause.
tumor
In children affected by precocious puberty, a _must be ruled out.
Assessment
precocious
With _puberty, children have increased breast and genital development and
accelerated skeletal maturation.
serum analysis
The diagnosis of early puberty is confirmed by _for estrogen or androgen;
these will be at adult levels.
Therapeutic Management
leuprolide acetate
A synthetic analog to GnRH is available as _
leuprolide acetate
Administration of this analog desensitizes GnRH receptors, making stimulation
by GnRH ineffective and halts sexual maturation at the point to which it has
advanced
aromatase inhibitors
Therapy may also include use of_, which are able to block the enzyme
aromatase and therefore decrease signs of estrogen effects
Delayed Puberty
14 years in girls and 15 Secondary sex characteristics normally are present by age _in boys.
years
Delayed puberty
_, as the name implies, is the failure of pubertal changes to occur at the usual

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Nursing Care of a Family When a Child Has a Reproductive Disorder

age.
If girls have not begun to menstruate by age 17 years and pathology has been
ruled out, menstrual cycles can be initiated by administering_.
REPRODUCTIVE DISORDERS IN MALES
phimosis and
Common reproductive disorders in males include structural alterations in the
cryptorchidism,
penis or testes such as_
inflammation such as
balanoposthitis, and, in
adolescents, testicular
cancer.
Balanitis (Balanoposthitis)
Balanoposthitis
_is inflammation of the glans and prepuce of the penis.
Balanoposthitis
It is usually caused by poor hygiene and may accompany a urethritis or a
regional dermatitis.
Assessment
red and swollen
The prepuce and glans become_; a purulent discharge may be present.
difficulty voiding
The boy may have _because of crusting at the meatal opening and because
acidic urine touching the denuded surface of the glans causes pain
Therapeutic Management
application of heat
Medical treatment involves local_; this can be carried out with warm wet soaks
or warm baths.
Local antibiotic
_may be prescribed.
ointment
circumcision
If phimosis (a tight foreskin) appears to be contributing to the condition, _
may be advocated after the inflammation subsides to prevent the condition
from recurring.
Phimosis and Paraphimosis
Phimosis
_is the inability to retract the foreskin from the glans of the penis.
tight
The foreskin is _at birth and may even be held fast by adhesions so cannot be
retracted in newborns.
Balanoposthitis
If a foreskin is extremely tight it can interfere with voiding. _may develop
because the foreskin cannot be retracted for cleaning.
phimosis
Circumcision of newborns is no longer routinely advised but is used to relieve
_
Paraphimosis
_is the inability to replace the prepuce over the glans once it has been
retracted.
Paraphimosis
This is an emergency situation to address before circulation to the glans is
impaired
Cryptorchidism
Cryptorchidism
_is failure of one or both testes to descend from the abdominal cavity into the
scrotum
months 7 to 9
Normally, the testes descend into the scrotal sac during _of intrauterine life.
6 months
They may descend any time up to _after birth; they rarely descend after that
time
caffeine
The cause of undescended testes is unclear. It may be associated with _intake
during pregnancy
Assessment
inguinal ring (true
An undescended testis may be at the _
undescended testis) or
ectopic (still in the
abdomen).
Laparoscopy
_is effective in identifying undescended testes.
karyotype
If undescended testes and other factors such as ambiguous genitals pose
questions about the childs gender, a _may be done to determine true gender.
Therapeutic Management
6 to 12 months
Because the testes sometimes descend spontaneously during the first year of
life, treatment is usually delayed for_.
chorionic gonadotropin Boys may be given _for about 5 days to stimulate testicular descent,
hormone
Orchiopexy
If necessary, surgery (_) by laparoscopy by 1 year of age corrects the
condition.
Hydrocele
processus vaginalis
When a testis descends into the scrotum in utero, it is preceded by a fold of
tissue, the_.
hydrocele
_(the fluid) can be revealed by prenatal ultrasound.
estrogen

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Nursing Care of a Family When a Child Has a Reproductive Disorder

enlarged
shines or glows
inguinal hernia
sclerotherapy
Varicocele
varicocele
NO
Testicular Torsion
Testicular torsion
sports activity
severe scrotal pain,
nausea and vomiting
within 4 hours
Laparoscopic surgery
Testicular Cancer
Testicular cancer
painless

Human chorionic
gonadotropin (hCG)
and alpha-fetoprotein
(AFP), tumor markers
Gynecomastia

At birth, the collection of fluid makes the scrotum of the newborn appear _
On transillumination (the shining of a light through the scrotal sac), the area is
illuminated by the water and_.
hydrocele may form later in life due to _(abdominal contents extruding into the
scrotum through the inguinal ring, with accompanying fluid).
Injection of a drug to decrease fluid production (_) may also be effective.
A _is abnormal dilation of the veins of the spermatic cord
_treatment is necessary unless fertility becomes a concern, at which time the
varicocele can be surgically removed.
_ (twisting of the spermatic cord) is a surgical emergency.
Testicular torsion usually results from a_.
The boy experiences _and perhaps _from the severity of the pain
If the condition is not recognized promptly (_), irreversible change in the testis
can occur from lack of circulation to the organ.
_, however, is usually necessary to reduce the torsion and re-establish
circulation.
_is rare (only 1% of all malignancies). It usually occurs between ages 15 and
35 years, often in association with cryptorchidism
Symptoms include _testicular enlargement and a feeling of heaviness in the
scrotum. The disease metastasizes rapidly, leading to abdominal and back
pain due to retroperitoneal node extension, weight loss, and general
weakness.
_, can be detected in blood serum.

_ (enlargement of the breasts) may arise because of hCG produced by the

tumor.
orchiectomy
Therapy for testicular malignancy is _(removal of the testis) followed by
radiation or chemotherapy
REPRODUCTIVE DISORDERS IN FEMALES
imperforate hymen, by Other disorders are caused by structural alterations of the reproductive organs
pelvic inflammatory
such as _.
disease (PID), or
infections caused by
STIs
Menstrual Disorders
(a) menstruation that is Menstrual disorders fall into two categories: _
painful or
uncomfortable and (b)
infrequent or toofrequent cycles.
Mittelschmerz
Some women experience abdominal pain during ovulation from the release of
accompanying prostaglandins.
Mittelschmerz
Pain may also be caused by a drop or two of follicular fluid or blood that spills
into the abdominal cavity.
Mittelschmerz
It is typically felt on one side of the abdomen (near an ovary) and may be
accompanied by scant vaginal spotting.
ovulation
An advantage of mittelschmerz is that it clearly marks_.
as nausea, vomiting,
If pain is felt in the right lower quadrant, it can be differentiated from
fever, abdominal
appendicitis by the lack of associated symptoms such_, and rebound
guarding
tenderness as well as by its occurrence in the menstrual cycle.
acetaminophen
It can be relieved by a mild analgesic such as_.
Dysmenorrhea
Dysmenorrhea
_is painful menstruation.
Dysmenorrhea
it is known that the pain is caused by the release of prostaglandins in response
to tissue destruction during the ischemic phase of the menstrual cycle
Dysmenorrhea
_can also be a preliminary symptom of an underlying illness such as PID,
uterine myomas (tumors), or endometriosis (abnormal formation of
endometrial tissue).
anovulatory
During the first year or two of menstruation, dysmenorrhea rarely occurs,

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Nursing Care of a Family When a Child Has a Reproductive Disorder

mild (no interference

with normal activities),
moderate (some
interference), or severe
(interference with the
majority of everyday
activities)
Primary
secondary
bloated
analgesic
prostaglandin inhibitor

irritating
Menorrhagia
endometriosis (see
later discussion), a
systemic disease
(anemia)
PID

von Willebrand disease

oral contraceptive
less than 1 hour
Metrorrhagia
(mittelstaining).
oral contraceptives
Endometriosis
nulliparous
Dysmenorrhea
Do not ovulate or
ovulate
dyspareunia
Dysmenorrhea

tender, fixed, palpable

nodules
extreme dysmenorrhea
or dyspareunia.
surgical
Estrogen/progesteronebased oral
contraceptives
Danazol (Danocrine)
leuprolide acetate
(Lupron)
Laparotomy with
excision by laser
surgery
Amenorrhea

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because early menstrual cycles are usually _(without ovulation).

Dysmenorrhea can be categorized as_.

Dysmenorrhea is _if it occurs in the absence of organic disease;

t is _if it occurs as a result of organic disease.
Symptoms may begin with a _feeling and light cramping 24 hours before
menstrual flow.
Painful symptoms can usually be controlled by an _such as acetylsalicylic acid
(aspirin) or ibuprofen (Advil, Motrin).
Acetylsalicylic acid (aspirin) works well as an analgesic for dysmenorrhea
because it is a
Mild_.
Be certain that girls know not to take these drugs on an empty stomach,
because they can be extremely _to gastric mucosa.
abnormally heavy menstrual flow, usually defined as greater than 80 mL per
menses
A heavy flow can indicate_, blood dyscrasia such as a clotting defect, or a
uterine abnormality such as a myoma (fibroid) tumor.

It can be a symptom of infection such as _or an indication of early pregnancy

loss that is coincidentally occurring at the time of an expected menstrual
period.
It can occur because of a previously undiagnosed bleeding disorder such as_
It can occur from breakthrough bleeding from an _
If a pad or tampon is saturated in_, the flow is considered heavier than usual.
_is bleeding between menstrual periods
This is normal in some adolescents who have spotting at the time of ovulation
_
It may also occur in teenagers taking _(breakthrough bleeding) during the first
3 or 4 months of use.
_is the abnormal growth of extrauterine endometrial cells, often in the cul-desac of the peritoneal cavity or on the uterine ligaments or ovaries.
The condition tends to occur most often in white _women, but there is also a
familial tendency.
Daughters of women with endometriosis may develop symptoms of _early in
life.
Many women with endometriosis _irregularly.
Abnormal tissue in the pelvic cul-de-sac can cause _(painful coitus) because it
puts pressure on the posterior vagina.
Endometriosis causes _when the abnormal tissue responds to estrogen and
progesterone stimulation by swelling and then sloughing its layers in the same
manner as the uterine lining
Pelvic examination may show that the uterus is displaced by_.
If the condition is moderate or extensive, she may experience _
Treatment for endometriosis can be medical or_, depending on the extent of
the condition.
_may stimulate implant regression as the tissue sloughs under the influence of
the progesterone.
_, a synthetic androgen, can be prescribed to help shrink the abnormal tissue.
Administration of a GnRH agonist, such as_, can reduce hormone stimulation
and cause the same effect
_is the most effective measure, but, because this is a highly invasive
procedure, a course of conservative medical treatment may be tried first.
_, or absence of a menstrual flow

Nursing Care of a Family When a Child Has a Reproductive Disorder

pregnancy

follicle-stimulating
hormone (FSH),
follicular development,
and estrogen secretion.
bromocriptine
(Parlodel),
anorexia nervosa or
bulimia
Premenstrual
dysphoric disorder
(PDD)
anxiety, fatigue,
abdominal bloating,
headache, appetite
disturbance, irritability,
and depression.
buspirone (BuSpar)
Paroxetine (Paxil)

strongly suggests _but is by no means definitive, because it can also result

from tension, anxiety, fatigue, chronic illness, extreme
Competitive swimmers, long-distance runners (50 to 75 miles weekly), and
ballet
dancers notice that intensive training causes their periods to become scant
and irregular.
An elevation in prolactin causes a decrease in GnRH from the hypothalamus,
followed
by declines in _
Adolescents who wish to maintain a normal cycle while training for a sports
event may take _which can reduce high prolactin levels by acting on the
hypothalamus and initiating menstruation each month.
Adolescents with _often develop amenorrhea after approximately 3 months of
excessive dieting or binging and dieting; as in athletes, this is caused by an
increase in prolactin.
_is a condition that occurs in the luteal phase of the menstrual cycle and is
relieved by the onset of menses.
Symptoms that include _

If depression is a major symptom, an antidepressant such as _can be helpful.

_is a selective serotonin reuptake inhibitor that is specifically designed for PDD
therapy in adults.
Additional Reproductive Disorders in Females
Female circumcision
_is incision and removal of the clitoris
Female circumcision
They may have difficulty with childbirth because of vulvar scarring and
contraction.
Imperforate Hymen
hymen
The _is the membranous ring of tissue that partly obstructs the vaginal
opening.
imperforate hymen
An _totally occludes the vagina, preventing the escape of vaginal secretions
and menstrual blood
obstructed
With onset of menstruation, the menstrual flow is_.
surgical incision
The treatment is _or removal of the hymenal tissue.
Toxic shock
_is an infection that usually is caused by toxin-producing strains of
syndrome (TSS)
Staphylococcus aureus organisms.
fever with diarrhea and female who develops _during a menstrual period should suspect TSS.
vomiting
S. aureus
Women or adolescents with suspected TSS need a careful vaginal examination
and removal
of any tampon particles, as well as cervical and vaginal cultures for_.
Iodine douches
_may reduce the number of organisms present vaginally.
dopamine (Intropin)
Intravenous fluid therapy to restore circulating fluid volume and increase blood
pressure, or vasopressors such as ,may be necessary to increase the blood
pressure.
Vulvovaginitis
In_, inflammation of the vulva or vagina is accompanied by pain, odor,
pruritus, and a vaginal discharge
Vaginal bleeding
_may be present
infections
The change to adult pH and the presence of vaginal secretions make the
vagina more
receptive to_.
Pelvic inflammatory
_is infection of the pelvic organs: the uterus, fallopian tubes, ovaries, and their
disease (PID)
supporting structures.
pelvic peritonitis
The infection can extend to cause_.
E. coli or Streptococcus Infections from other causes such as _are beginning to occur more frequently
and may be as severe.
end of a menstrual
It is most likely to occur at the _
period
the lower abdomen
With acute PID, an adolescent notices severe pain in_.
heavy, purulent
She may have an accompanying_.
discharge

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Nursing Care of a Family When a Child Has a Reproductive Disorder

cefoxitin (Mefoxin),
doxycycline
(Vibramycin), or
clindamycin (Cleocin)
BREAST DISORDERS
Gynecomastia

Therapy involves administration of analgesia for comfort plus specific broadspectrum antibiotics such as_.

_(enlarged breast tissue) may occur temporarily in preadolescent boys in

response to a rising estrogen level.
Accessory nipples
As the name implies, _are additional breast nipples
Breast hypertrophy
_is abnormal enlargement of breast tissue.
low
Progesterone levels are _until menstruation cycles are fully established
back or shoulders
A girl may feel pain and fatigue in the _from attempting to maintain good
posture despite the weight of heavy breast tissue.
Breast hypoplasia
_is less-than-average breast size.
Breast Tenderness or Fullness
day or two
Many women notice a _of premenstrual breast fullness and tenderness each
month.
Breast tenderness
This is a benign occurrence and is part of the monthly changes that occur from
hormone stimulation.
Fart necrosis
If breast tissue is struck during a fall or other traumatic injury, it can become
tender, painful, inflamed or reddened,and possibly bruised.
Fibrocystic breast
_is the most common benign breast condition in women of all ages.
disease
Fibrocystic breast
It can occur as early as puberty, when estrogen rises to adult levels
disease
H. pylori
It may be caused by_, the bacteria also responsible for peptic ulcers
transmitted during sexual foreplay
feel painful; the breasts Fibrocystic breasts may_ interfering with active sports.
may feel tender and
stretched
acetaminophen
This discomfort can be relieved with a simple analgesic, such as_
(Tylenol), or warm
compresses, avoidance
of trauma, and firm bra
support
methylxanthines
The formation of fibrocystic lesions may be increased in some women with the
use of _found in caffeine, theophylline, and theobromine.
aspirin compound or
Avoiding foods such as coffee, cola drinks, tea, chocolate, some toffee
Excedrin that contain
candy, and
caffeine
medications such as _reduces pain.
Danazol (Danocrine)
_a synthetic androgen, may help reduce the symptoms by suppressing
estrogen formation in the ovaries
Fibroadenomas
_are tumors that consist of both fibrotic and glandular components and occur
in response to estrogen stimulation.
Fibroadenomas
The tumors may increase in size during adolescence, during pregnancy and
lactation, or when a woman takes an estrogen source such as an oral
contraceptive
are round and well
Fibroadenomas_, feeling firmer and more rubbery than fluidfilled cysts.
delineated
Mastitis
_is inflammation or infection of the breast
SEXUALLY TRANSMITTED INFECTIONS
Sexually transmitted _are diseases that are spread through sexual contact with an infected partner.
infections (STIs)
Candidiasis
_is a vaginal infection spread by the fungus Candida, an organism that thrives
on glycogen.
Candidiasis
when high estrogen levels lead to glycogen levels that produce a favorable
environment for fungal growth.
oral contraceptives
Because oral contraceptives produce a pseudopregnancy state, women using
_also have frequent vaginal candidal infections.
white patches
The vagina sometimes shows _on the walls.
thick, cream cheese
A _can usually be observed at the vaginal introitus.
like discharge
above 5.0
A woman inserts a pH wand into her vagina and in a few seconds compares
the color of
the swab to a pH color chart. If the reading is_, it suggests that she may have
a bacterial infection and should see a doctor.

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Nursing Care of a Family When a Child Has a Reproductive Disorder

4.5 plus itching and/or

burning, unusual
discharge, or a yeasty
odor suggests a yeast
infection
miconazole (Monistat)
or clotrimazole
(Lotrimin),

normal pH level of _

Oral fluconazole
(Diflucan)
Antifungal creams
Pregnancy

_can be administered as a one-time oral dose

Trichomoniasis
Trichomonas vaginalis
frothy white or grayishgreen vaginal
discharge.

Therapy for candidal infections includes vaginal suppositories or cream

applications of antifungal preparations such as _ once a day for 3 to 7 days.

_are purchased over-the-counter.

Both miconazole (Monistat) for 7 days or a single dose of oral fluconazole
(Diflucan) are approved for use during_.
_is a single-cell protozoan that is spread by coitus
With a trichomonal infection, females notice vaginal irritation and a _

The infection is diagnosed by microscopic examination of a sample of the

vaginal discharge after it is combined with lactated Ringers or normal saline
solution.
_eradicates trichomonal infections.

Oral metronidazole
(Flagyl)
preterm labor,
Trichomoniasis infections are associated with _
premature rupture of
membranes, and
postcesarean infection
Bacterial Vaginosis
Gardnerella vaginalis
Bacterial vaginosis is the invasion of an organism such as_.
milk-white to gray and
When the infection is present vaginal discharge appears _
has a fishlike odor.
metronidazole
The treatment is oral or vaginal _for 7 days
Chlamydia
_infections have become the most common bacterial cause of STI
trachomatis
infections
grayishwhite discharge Symptoms include a heavy_.
and vulvar itching
1 to 5 weeks
The incubation period is_.
Human
_causes fibrous tissue overgrowth (sometime called genital warts) on the
papillomavirus (HPV)
external vulva, vagina, or cervix (condyloma acuminatum).
Sitz baths and a
_may be soothing during the healing period
lidocaine cream
Trichloroacetic acid
_ applied to the lesions weekly may be effective and can be used during
(TCA) or bichloroacetic
pregnancy.
acid (BCA)
Herpes Genitalis (Herpes Simplex Type 2)
herpesvirus hominis
Genital herpes is caused by _
type 2
3 to 14 days
The incubation period is_.
moist, painful, draining, Within a few days, the vesicles ulcerate and become_.
open lesions
Acyclovir (Zovirax)
_is an example of an antiviral that controls the virus by interfering with
deoxyribonucleic acid reproduction and decreasing symptoms
Gonorrhea
Neisseria gonorrhoeae
Gonorrhea is transmitted by_, a grampositive diplococcus that thrives on
columnar transitional epithelium of the mucous membrane.
a 2- to 7-day
Symptoms begin after _incubation period.
oral cefixime (Suprax)
or intramuscular ceftriaxone (Rocephin) plus oral doxycycline (Vibramycin) for
7 days is the current recommended therapy.
Hepatitis B and Hepatitis C
Group B Streptococcal Infection
ampicillin
A broad-spectrum penicillin such as _is the treatment of choice.
WHAT ARE THE CAUSATIVE AGENTS FOR THESE SYMPTOMS?
Candida
Vulvar reddening and pruritus; thick, white, cheeselike vaginal discharge

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Nursing Care of a Family When a Child Has a Reproductive Disorder

Trichomonas
Herpesvirus type II
Gardnerella
Chlamydia trachomatis
Neisseria gonorrhoeae
Enterobius vermicularis
Treponema pallidum
Streptococcus
Foreign body

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Thin, irritating, frothy, gray-green discharge; strong, putrid odor; itching

Painful pinpoint vesicles on an erythematous base with a watery vaginal
discharge possible; voiding may be irritating and painful
Edema and reddening of vulva, milky gray discharge, fishlike odor
Watery, gray-white vaginal discharge, vulvar itching
Possibly symptomless; may have profuse yellow-green vaginal discharge
Rectal pruritus, especially on rising in the morning
Painless ulcer on vulva or vagina
Vaginitis, vulvar itching; edema and reddening of vulva
Vaginal discharge; odor