Closed-wound drainage system device (eg, Jackson-Pratt, Hemovac)

consists of fenestrated drainage tubing connected to a flexible, vacuum (self-suction) reservoir

unit. The distal end lies within the wound and can be sutured to the skin. It is usually inserted
near the surgical site through a small puncture wound rather than in the surgical incision. The
purpose of the drain is to prevent fluid buildup (eg, blood, serous fluid) in a closed space.
Although it depends on the client and type of surgical procedure, about 80-120 mL of
serosanguineous or sanguineous drainage per hour during the first 24 hours after surgery can be
expected. The priority action is to notify the HCP due to the change in type and amount of
drainage after the first 24 hours following surgery. Excessive bleeding and fluid collection into
the closed space following breast reconstruction can greatly affect the integrity of the surgical
incision, the tissue reconstruction, and wound healing.

Breast self-examination (BSE)

Women with regular menstrual periods should perform BSE after menstruation. Those who are
postmenopausal or have irregular menses should choose the same day of each month. Women
taking oral contraceptives should perform BSE when a new package is initiated.

Fibrocystic breast changes

One of the most common benign breast disorders
correlate to estrogen/progesterone hormone fluctuations during the menstrual cycle. Clients may
report cysts, nodules, or lumps that are more tender, swollen, and/or noticeable prior to
menses. The condition typically resolves after menopause.
The nurse instructs the client on breast self-awareness and emphasizes that any noncyclic breast
changes (ie, not related to the menstrual cycle) may indicate malignancy (ie, cancer) and should
be immediately reported to the health care provider (HCP)

Breast cancer
Unregulated growth of abnormal breast tissue cells and the second most common cause of cancer
deaths among women. When palpated, the breast lump is usually described as hard, irregularly
shaped, non-mobile, and non tender. Mammography usually detects breast cancer.
Non-modifiable breast cancer risk factors include:
 Female sex and age ≥50
 First-degree relative (mother or sister) with history of breast cancer
 BRCA1 and BRCA2 genetic mutations
 Personal history of endometrial or ovarian cancer
 Menarche before age 12 or menopause after age 55
Modifiable breast cancer risk factors include:
 Hormone therapy with estrogen and/or progesterone (increased risk if taken after
menopause)
 Postmenopausal weight gain and obesity as fat cells store estrogen
 History of smoking and alcohol consumption
 Dietary fat intake
 Sedentary lifestyle

inflammatory breast cancer

aggressive form of cancer, breast lymph channels are blocked by cancer cells, creating breast
tissue that becomes red, warm, and has an orange peel (peau d'orange), pitting appearance on the
skin surface. The nurse would be most concerned about this client and make an immediate
referral to the health care provider for examination and evaluation.
Infertility
Inability to conceive after unprotected intercourse (ie, no contraceptive use) for >12 months
Female fertility declines as women age, with the first significant decrease seen after age
35. Hormonal dysfunction (eg, polycystic ovarian syndrome) can cause ovarian cysts
and anovulatory cycles (ie, lack of ovulation during a menstrual cycle), which impair fertility.
Some sexually transmitted infections (eg, chlamydia) may be asymptomatic in females, which
can delay treatment (eg, antibiotics). Untreated or recurrent infections cause inflammation
(eg, pelvic inflammatory disease), scarring, and damage to the reproductive tract, leading to
infertility.
Endometriosis is characterized by endometrial tissue (ie, inner lining of the uterus) depositing
outside the uterus. These endometrial lesions can result in chronic inflammation, pelvic pain,
menstrual cycle abnormalities, and infertility.
Optimal female fertility is achieved at a BMI of 18.5-24.9

Pap testing
allows early detection of cervical dysplasia (ie, abnormal cell growth) that may indicate cervical
cancer.
Human papillomavirus (HPV), one of the most common sexually transmitted infections, causes
almost all cases of cervical cancer. Before age 30, most HPV infections are transient and may
resolve spontaneously. Guidelines for Pap testing vary slightly by professional organization but
are based on the knowledge that overtreating potentially transient HPV infections may
cause more harm than good.
Pap testing is generally started at age 21, regardless of sexual history. Women age 21-29 should
be screened with a Pap test only every 3 years. At age 30, HPV and Pap testing may be done
together every 5 years.
Women who have had their uterus and cervix removed for benign reasons may discontinue
screening.

Ovarian cancer
results in more deaths than any other gynecologic cancer. Symptoms are often subtle and may
include abdominal bloating; pelvic pain or pressure; abdominal girth increase; early satiety;
abdominal, back, or leg pain; urinary urgency/frequency; and gastrointestinal disturbances. Due
to the lack of routine screening and reports of vague symptoms, ovarian cancer may not be
diagnosed until an advanced stage.

cervical cancer
Risk Factors: Infection w/ high risk HPV strains, hx of STDs, early onset of sexual activity,
multiple or high risk sexual partners, immunosuppression, oral contraceptive use, low
socioeconomic status, tobacco use

Human papillomavirus (HPV)

one of the most common sexually transmitted infections, is associated with genital warts
and cervical cancer. There are many different strains of HPV, with types 16 and 18 causing
nearly all cases of cervical cancer. HPV infection is often asymptomatic, and genital warts due to
HPV are typically painless. Prevention includes vaccination against HPV before sexual activity
begins and safe sex practices/abstinence. The recommended age for vaccination in both boys and
girls is age 11-12, but the vaccine can be given as early as age 9 and up to age 26.
Clients with HPV and their partners should be educated that the virus can still be spread through
skin-to-skin contact, even with the use of condoms. Safe sex practices decrease the risk of
disease transmission but do not prevent it entirely.
hormonal contraception (ie, estrogen with or without progestin)
places women at a 2- to 4-fold increased risk for developing blood clots due to resulting
hypercoagulability
Clients who are prescribed oral contraceptive pills (OCPs) containing estrogen should be
educated on potential warning signs (eg, chest pain, vision loss, severe leg pain)
clients should be instructed not to smoke while taking combined OCPs due to an increased risk of
blood clots
A- abdominal pain, ischemic bowel
C- chest pain, pulmonary embolism or MI
H- headaches, stroke
E- eye problems, retinal blood vessel ischemia
S- severe leg pain, DVT

Emergency contraception (EC)

prevents pregnancy after unprotected intercourse. EC pills (eg, levonorgestrel [Plan B]) should
be taken within 5 days of intercourse; however, efficacy is reduced after 3 days (72 hours)
The copper intrauterine device (IUD) may be inserted for up to 5 days after intercourse as another
form of EC.
Backup contraception is required for 7 days after starting oral contraceptives, unless initiating on
the first day of menses.

Vaginal candidiasis
causes itching and painful urination due to urine stinging the inflamed areas of the
vulva. Assessment shows a thick, white, curd-like vaginal discharge and reddened vulvar lesions.
Candida albicans (yeast) can colonize and cause infections of the vulvovaginal region.
Miconazole (Monistat), an antifungal cream commonly prescribed to treat vaginal candidiasis,
is inserted high into the vagina using an applicator. It is best applied at bedtime so that it will
remain in the vagina for an extended period. Sexual intercourse is avoided until the inflammation
is resolved, typically for the duration of treatment, approximately 3-7 days. However, sexual
activity is not a significant cause of infection or reinfection of candida, and partner evaluation is
not needed. Trichomoniasis, syphilis, gonorrhea, and HIV are mainly sexually transmitted;
therefore, partners should be evaluated and treated.
Other teaching points for this client should include:
 Ensuring proper hygiene of the perineum - cleansing from anterior to posterior (front to
back) to prevent accidental introduction of fecal organisms
 Wearing loosely fitted cotton underwear and avoiding synthetic undergarments to
promote ventilation, decrease friction, and reduce moisture
 Refraining from douching, which can introduce organisms higher up into the vaginal
canal and cervix

Postmenopausal woman
The average age of menopause in the United States is 50-52. Major health risks of menopause
include osteoporosis and heart disease. Bisphosphonates, such as alendronate (Fosamax),
risedronate (Actonel), or ibandronate (Boniva), decrease bone resorption so that loss of bone
density is minimized. They must be consumed in the morning, on an empty stomach, with at
least 30 minutes before other drugs. The medication is taken with a full glass of water and the
client must remain upright for at least 30 minutes to aid absorption and prevent esophageal
irritation
Adequate sources (both food and supplements) of calcium and vitamin D are required to build
bone mass
HRT can improve bone mass and prevent osteoporosis but is associated with increased risk of
thrombotic complications (deep vein thrombosis, stroke, myocardial infarction) and some cancers
(breast, uterine). Therefore, it is used only in clients who have disabling hot flashes. Unilateral
leg swelling is a classic symptom of venous thromboembolism
Postmenopausal bleeding or abnormal premenopausal bleeding is the most common symptom of
endometrial cancer and requires follow-up.

Testicular self-examination (TSE)

Testicular cancer is the most common form of cancer in men age 15-35. When diagnosed early,
it is highly curable. Clients at high risk for developing a tumor (eg, history of undescended testis)
are encouraged to perform a monthly TSE. Client instructions for a TSE include:
 Perform TSE monthly on the same day (easy to remember)
 Perform TSE while taking a warm shower or bath as warm temperatures will relax the
scrotal tissue and make the testis hang lower in the scrotum
 Use both hands to feel each testis separately
 Palpate each testicle gently, using the thumb and first 2 fingers
 Check that the testicle is normally egg-shaped and movable with a smooth surface
The clinical findings that should be reported to the health care provider include:
 Painless, hardened lump on testes
 Scrotal swelling or heaviness
 Dull ache in pelvis or scrotum

Prostatitis
inflammation of the prostate gland, usually caused by a bacterial infection.
Symptoms include rectogenital pain, burning, urinary hesitancy, and/or urinary
urgency. Management of prostatitis includes antimicrobial and anti-inflammatory
medications (eg, ibuprofen). Alpha-adrenergic blockers (eg, tamsulosin, alfuzosin) help relax the
bladder and prostate. Suprapubic catheterization may be necessary for urinary retention in severe
cases of acute prostatitis. Urethral catheterization is contraindicated due to the risk of
exacerbating pain and urethral inflammation.
Clients should be instructed to:
 Hydrate with clear liquids (eg, water, fruit juices). Avoid coffee, tea, and
other caffeinated beverages due to diuretic and stimulant properties, which may worsen
symptoms.
 Complete the full course of antibiotics regardless of symptom improvement to ensure
infection resolution.
 Engage in sexual intercourse or masturbation to reduce discomfort related to retained
prostatic fluid. Clients should use a barrier prophylactic method (eg, condoms) when
engaging in sexual activity with a partner to prevent transmission of the causative
organism
 Take stool softeners as prescribed to reduce straining during defecation; tension of the
pubic muscles presses against the prostate, causing pain
 Take sitz baths, in which the hips and buttocks are immersed in warm water, to help
relieve symptoms.

Priapism
a sustained, painful erection (more than 2hrs) often associated with sickle cell anemia, as the
sickling (crescent shaping) of red blood cells can lead to penile vascular occlusion, erectile tissue
hypoxia, and tissue necrosis. Bluish discoloration is of most concern as it can be a sign
of ischemia to the penis.
 Common associated clinical manifestations include discoloration of the penis, intense pain, rigid
penis, difficulty voiding, and anxiety and embarrassment.

Radical prostatectomy
Any rectal interventions such as suppositories or enemas must be avoided to prevent stress on the
suture lines and problems with healing in the surgical area. The client should not strain when
having a bowel movement for these reasons. Therefore, interventions to prevent constipation are
an important part of postoperative care and discharge teaching. Prevention of constipation is
particularly important while the client remains on opioid analgesics, which can cause
constipation

Vasectomy
surgical procedure performed for permanent male sterilization
Following the procedure, it can take several months for the remaining sperm to be ejaculated or
absorbed. Alternative birth control should be used until the health care provider confirms that
semen samples taken at a follow-up appointment are free of sperm; otherwise, pregnancy can
occur

Chlamydia
most common sexually transmitted infection (STI) in the United States and Canada
Many clients are asymptomatic or have minor symptoms but can still transmit the
infection. Appropriate preventive measures are important to reduce the spread of infection. Risk
factors include being female or an adolescent; having multiple sexual partners; a history of or
coexisting STI; and incorrect/inconsistent condom use. Clients should be taught to abstain from
sexual intercourse for 1 week after initiation of drug therapy and until all sexual partners have
completed antibiotic treatment to prevent transmission and recurrence. Drug therapy for a
chlamydial infection may include doxycycline or azithromycin.
General safe sex practices to prevent STI transmission include:
 Remain in a monogamous sexual relationship
 Use a condom during all sexual encounters
 Avoid sex with IV drug users
 Ask sexual partners about their previous sexual history
 Restrict the number of sexual partners
 Avoid sex with potential partners who have visible perineal lesions

** A client recovering from a vaginal hysterectomy should be monitored for excessive vaginal
bleeding, urinary retention, backache, decreased urinary output, and the development of signs and
symptoms of complications such as DVT.