Assessment and Management of Female

Physiologic Processes

Estrogens are responsible for developing and maintaining the female reproductive organs.
Progesterone is the most important hormone for conditioning the endometrium in
preparation for implantation of the fertilized ovum. Androgens, secreted by the ovaries in
small amounts, are involved in the early development of the follicle and affect the female
libido. Follicle-stimulating hormone is responsible for stimulating the ovaries to secrete
estrogen.
An open-ended question related to the patients need for further information should be
included while obtaining a sexual history. None of the other listed questions are openended.
Asking about abuse directly is effective in identifying the presence of abuse and should
be included in the health history of all women. Oblique questions that relate to the
character of the relationship or conflict resolution are less useful clinically. Asking about
making a partner angry is not an appropriate way to screen for family violence because it
does not directly address the problem.
Clinical symptoms of an ectopic pregnancy include delay in menstruation of 1 to 2
weeks, vaginal spotting, and sharp, colicky pain. Trichomonas vaginalis causes a vaginal
infection. Cervical cancer and fibromyalgia do not affect menstruation.
When working with women who have disabilities, it is important that the nurse avoid
equating the woman with her disability; the nurse must make an effort to understand that
the patient and the disability are not synonymous. A chaperone is not necessarily required
and there may or may not be a need to abbreviate the assessment. The nurse should

provide education as needed.

Drainage caused by Candida is typically curd-like and white. Trichomonas infections
usually cause copious, frothy yellowish-green discharge. There is no immediate need for
a Pap smear, as malignancy is an unlikely cause.
In general, the patient is encouraged to increase or initiate an exercise program to help
relieve symptoms of PMS. Fluid intake should be increased. Opioids are not used to treat
PMS. Stress reduction has multiple benefits, but it is not noted to alleviate the symptoms
of PMS.
Amenorrhea refers to absence of menstrual flow, whereas dysmenorrhea is painful
menstruation. Menorrhagia, also called hypermenorrhea, is defined as prolonged or
excessive bleeding at the time of the regular menstrual flow. Metrorrhagia refers to
vaginal bleeding between regular menstrual periods.
The diaphragm may be cleaned with soap and water after use. It must be left in 6 hours
after intercourse and should be used with spermicidal jelly. There are different sizes of
diaphragms and the patient needs to be fitted by the health care practitioner.
If only some of the tissue is passed, the abortion is referred to as incomplete. An
emptying or evacuation procedure (D&C, or dilation and evacuation [D&E]) or
administration of oral misoprostol (Cytotec) is usually required to remove the remaining
tissue. Bed rest will not necessarily result in the passing of all the tissue. Clomiphene and
hydromorphone are of no therapeutic benefit.

Assessment and Management of Female

Physiologic Processes

The use of HRT is contraindicated in women with a history of vascular thrombosis, active
liver disease, some cases of uterine cancer, and undiagnosed vaginal bleeding. HRT is
beneficial in women with a risk for osteoporosis. Vaginal dryness, hot flashes, and night
sweats are symptoms of menopause that may be relieved with HRT.
The test should be performed when the patient is not menstruating. Douching washes
away cellular material. The test detects cervical cancer, and falsenegative Pap smear
results occur mostly from sampling errors or improper technique. For most women, a Pap
smear should be done annually.
Because lubricants may obscure cells on a Pap smear, warm water is the only lubricant
that can be used.
Women who smoke and who are 35 years of age or older should not take oral
contraceptives because of an increased risk for cardiac problems. Previous surgeries,
STIs, and blood sugar instability do not necessarily contraindicate the use of oral
contraceptives.
Tampons should not be used for more than 4 to 6 hours, nor should super-absorbent
tampons be used because of the association with toxic shock syndrome. If used
appropriately, it is acceptable and safe for the patient to use tampons.
For some women, vitamins B6 and E have proven beneficial for the treatment of hot
flashes. Sodium restriction, vegan diet, and massage have not been noted to relieve this
symptom of perimenopause.
If an ectopic pregnancy is suspected, the patient is assessed using ultrasound and hCG
testing. CT and x-rays are contraindicated during pregnancy and estrogen and
progesterone levels are not diagnostic of ectopic pregnancy.
Dysfunctional uterine bleeding can occur at any age, but is most common at opposite
ends of the reproductive life span. It is usually secondary to anovulation (lack of
ovulation) and is common in adolescents. It is not suggestive of vaginitis, an STI, or
ectopic pregnancy.
A sexual assessment includes both subjective and objective data. Health and sexual
histories, physical examination findings, and laboratory results are all part of the
database. A sexual assessment would not normally include the patients interpersonal
skills. It is not likely to necessary to assess an adolescents understanding of menopause.
By initiating an assessment about sexual concerns, the nurse communicates to the patient
that issues about changes or problems in sexual functioning are valid and significant
health issues. The nurse communicates that it is safe to talk about sexual issues and that
changes or challenges in sexual function are not unusual.
The PLISSIT model of sexual assessment begins with permission and subsequently
includes limited information, specific suggestions, and intensive therapy.
The nurses primary roles in light of this disclosure are to provide empathy and to arrange
for appropriate resources and referrals. There is no need to phone 911 and psychotherapy
is beyond the nurses scope of practice. The patients confidentiality will be respected, but
this does not mean that the nurse can promise to keep it a secret.

Assessment and Management of Female

Physiologic Processes

Primary amenorrhea (delayed menarche) refers to the situation in which young women
older than 16 years of age have not begun to menstruate but otherwise show evidence of
sexual maturation, or in which young women have not begun to menstruate and have not
begun to show development of secondary sex characteristics by 14 years of age. In
secondary dysmenorrhea, pelvic pathology such as endometriosis, tumor, or pelvic
inflammatory disease (PID) contributes to symptoms. Dyspareunia is painful intercourse
and vaginal atrophy would not contribute to the delayed onset of puberty.
Physiologic symptoms of PMS include headache, breast tenderness, and fluid retention as
well as affective symptoms, such as depression. Loss of appetite is not noted to be among
the most common symptoms.
Pharmacologic remedies for PMS include selective serotonin reuptake inhibitors. MAOIs
are not used for this purpose. Calcium channel blockers and opioids would not lead to
symptom relief.
Menstrual history addresses such factors as the length of cycles, duration and amount of
flow, presence of cramps or pain, and bleeding between periods or after intercourse.
Family members menarche and prior STIs are not likely to affect the patients current
cycles.
Although further assessment is undoubtedly necessary, it is likely that the couple will be
experiencing hopelessness at the news that a potentially promising intervention has
failed. Acute confusion denotes a cognitive deficit, not a sense of despair. Sadness at this
news is not necessarily suggestive of impaired coping. Moral distress is unlikely because
this is not a situation involving morality.
Although HT decreases hot flashes and reduces the risk of osteoporotic fractures as well
as colorectal cancer, studies have shown that it increases the risk of breast cancer, heart
attack, stroke, and blood clots. There is no significant risk of anaphylaxis.
Providing opportunities for the patient to talk and express her emotions is helpful and
also provides clues for the nurse in planning more specific care. The patient may or may
not want to be alone, but the nurse should first determine her wishes. It would be
inappropriate to refer to future pregnancies during this acute time of loss. It would not be
necessary or practical to remove the patient from the unit.
Diagnostic studies performed to determine if ovulation is regular and whether the
progestational endometrium is adequate for implantation may include a serum
progesterone level and an ovulation index. None of the other listed tests is used to
investigate infertility.
Men may be affected by varicoceles, varicose veins around the testicle, which decrease
semen quality by increasing testicular temperature. Low prolactin levels may contribute
to the problem. Genetic factors are not noted to relate to male infertility. Infertility is not
normally linked to sperm that are incompatible with the shape of the egg.
Gamete intrafallopian transfer (GIFT), a variation of IVF, is the treatment of choice for
patients with ovarian failure. In intracytoplasmic sperm injection (ICSI), an ovum is
retrieved as described previously, and a single sperm is injected through the zona
pellucida, through the egg membrane, and into the cytoplasm of the oocyte. The fertilized

Assessment and Management of Female

Physiologic Processes

egg is then transferred back to the donor. ICSI is the treatment of choice in severe male
factor infertility. IVF involves ovarian stimulation, egg retrieval, fertilization, and embryo
transfer. Artificial insemination is the deposit of semen into the female genital tract by
artificial means.
Nursing interventions appropriate when working with couples during infertility
evaluations include referring the couple to appropriate resources when necessary. It
would likely be considered offensive and insensitive to focus the couple on parenting
skills or the benefits of child-free living. Choosing particular reproductive technologies is
beyond the nurses scope of practice.
It is highly likely that the woman diagnosed with an ectopic pregnancy will experience
intense anxiety. Pain and sorrow are also plausible, but are unlikely to become chronic.
Impaired tissue integrity and keloid scarring are atypical.

Women have widely varying views on menopause and the nurse must ascertain these. It is
wrong to presume either a positive or negative view of this transition without first
performing assessment.

HT is effective, but has been associated with serious adverse effects. However, it does not
exacerbate the symptoms of menopause. Nonpharmacologic interventions that address
perimenopausal symptoms have not yet been identified.

Calcium and vitamin D supplementation may be helpful in reducing bone loss and
preventing the morbidity associated with osteoporotic fractures. Phosphorus, potassium,
vitamin B12, vitamin C, and vitamin B6 do not address this risk.
The individual womans evaluation of herself and her worth, now and in the future, is
likely to affect her emotional reaction to menopause. Patient teaching and counseling
regarding healthy lifestyles, health promotion, and health screening are of paramount
importance. This broad goal of fostering healthy lifestyles transcends individual topics
such as drug treatment, support groups, and osteoporosis prevention.
If the patient has severe symptoms of PMS or PMDD, the nurse assesses her for suicidal,
uncontrollable, and violent behavior. The problem can escalate and is not necessarily selflimiting. HT is not a relevant intervention and the nurse should not recommend herbal
supplements without input from the primary care provider.
Menorrhagia is prolonged or excessive bleeding at the time of the regular menstrual flow.
In young women, the cause is usually related to endocrine disturbance; in later life, it
usually results from inflammatory disturbances, tumors of the uterus, or hormonal
imbalance. STIs, pelvic inflammatory disease, and cancer are less likely causes.