PATHOPHYSIOLOGY WK 11 DISCUSSION
Discussion: Disorders of the Reproductive Systems
While the male and female reproductive systems are unique to each sex, they share a common function—reproduction. Disorders of this system range from delayed development to structural and functional abnormalities. Since many reproductive disorders not only result in physiological consequences but also psychological consequences such as embarrassment, guilt, or profound disappointment, patients are often hesitant to seek treatment. Advanced practice nurses need to educate patients on disorders and help relieve associated stigmas. During patient evaluations, patients must feel comfortable answering questions so that you, as a key health care provider, will be able to diagnose and recommend treatment options. As you begin this Discussion, consider reproductive disorders that you would commonly see in the clinical setting.
To Prepare
- Review Chapter 22 and Chapter 23 in the Hammer and McPhee text, as well as Chapter 33 and 34 in the Huether and McCance text.
THE ASSIGNMENT TO COMPLETE. (PLS PROVIDE SUBHEADINGS). THANKS.
In a 1-2-page paper, respond to your colleagues’ postings on “Amniotic Fluid Embolism and Female Sexual Dysfunction” below in the following ways:
- Share insights on how AGE as a factor impacts the pathophysiology of the disorder your colleague selected.
- Offer alternative diagnoses and prescription of treatment options for the disorder of Amniotic Fluid Embolism and Female Sexual Dysfunction
- Validate an idea with your own experience and additional research.
- Support your paper with 1 or more credible outside sources, in addition to 2 course resources within the last 5yrs. (SEE ATTACHED LEARNING RESOURCES).
HERE ARE LINKS THAT WILL BE HELPFUL
COLLEAGUE’S POSTING BY PAMELA
Disorder of Pregnancy: Amniotic Fluid Embolism
The usual events of childbearing can potentially pave the way for many systemic and localized disorders (Hammer & McPhee, 2019). Pregnancy is considered a hypercoagulable state recognized in part by estrogen activation of hepatic coagulation proteins which is associated with hemorrhage (Hammer & McPhee, 2019). One of these hemorrhagic and devastating disorders is an amniotic fluid embolism (AFE).
AFE is a rare and catastrophic complication of pregnancy in which amniotic fluid, fetal cells or other amniotic fetal debris enter the maternal pulmonary circulation causing the collapse of the cardiovascular system (Kaur, et al., 2016). The exact pathophysiology remains unknown (Kaur, et al., 2016). The most prevalent histopathological finding in a 1941 study by Steiner and Luchbaught in postmortem women who succumbed suddenly during childbirth was the existence of amniotic fluid debris in the pulmonary vasculature (Boulden, Bell, Rojas-Saurez, & Tolosa, 2018). Therefore, the thought was that AFE causes pulmonary artery obstruction from amniotic fluid debris (Boulden, Bell, Rojas-Saurez, & Tolosa, 2018).
Another more commonly accepted theory of AFE is that it causes an abnormal response of proinflammatory mediators leading to an immunologic response similar to the systemic inflammatory response syndrome (Boulden, Bell, Rojas-Saurez, & Tolosa, 2018). Amniotic fluid is made up of procoagulant factors that include the following: leukotrienes, platelet-activating factors, cytokines, thromboxane, bradykinin, and arachidonic acid; an acid which facilitates in understanding why disseminated intravascular coagulation (DIC) is seen in greater than 80% of women diagnosed with AFE (Boulden, Bell, Rojas-Saurez, & Tolosa, 2018). In addition to this response, profound hemodynamic changes lead to rapid maternal collapse and death (Boulden, Bell, Rojas-Saurez, & Tolosa, 2018). In the first few minutes, a swift elevation in pulmonary vascular resistance resulting from anaphylactoid/inflammatory vasoconstriction leads to a dysfunction/dilation of the right ventricle chambers with an interventricular septum left shift and a decline of left ventricular filling pressures with resulting hypotension, pulmonary edema, and cardiovascular collapse (Boulden, Bell, Rojas-Saurez, & Tolosa, 2018). An oxygen shunt is produced from severe pulmonary vasoconstriction with severe hypoxia and a mismatch of ventilation-perfusion (Boulden, Bell, Rojas-Saurez, & Tolosa, 2018). It is also speculated that endothelin (maternal plasma) is increased with an entry of amniotic fluid into the systemic vasculature contributing to respiratory and cardiac collapse related to endothelin acting as a bronchoconstrictor in addition to a coronary and pulmonary vasoconstrictor (Kaur, et al., 2016).
According to Kaur et al., there are two clinical forms of AFE which are typical and atypical, 2019. Typical is the classic form which includes the following three phases: circulatory and respiratory disorders, coagulation disruption of maternal hemostasis, and acute respiratory distress syndrome (ARDS) with acute renal failure leading to cardiopulmonary collapse (Kaur, et al., 2016). In the atypical form, there is no embolism or cardiopulmonary collapse, however, the initial life-threatening symptom seen is hemorrhage due to DIC (Kaur, et al., 2016). This is noted during a c-section or right after or in cases of a uterine cervix rupture (profound), placenta abruption or with a mid-trimester induced abortion (Kaur, et al., 2016).
The exact incidence of AFE is unknown due to inconsistent reporting of nonfatal cases and inaccurate diagnosis (Kaur, et al., 2016). It is thought to occur in 1 in 8000 to as rare as 1 in 80,000 deliveries (Boulden, Bell, Rojas-Saurez, & Tolosa, 2018). This unpreventable and unpredictable event typically occurs right after cesarean/vaginal deliveries, during labor or during 2nd-trimester DIC procedures (Kaur, et al., 2016). Previous mortality rates were as high as 86% with recent estimates at only 13-26% and a fetal mortality rate of more than 10% if AFE occurs before delivery (Kaur, et al., 2016). This great decrease in the mortality rate may be the result of early diagnosis and better resuscitative care (Kaur, et al., 2016).
This phenomenon may also occur in healthy women up to 48 hours postdelivery, after abdominal trauma, during amnioinfusion, and after an induced abortion with the use of intrauterine injection of hypertonic saline. Risk factors identified include the following: maternal age of >35, diabetes, multiparity, and ethnic minority (Boulden, Bell, Rojas-Saurez, & Tolosa, 2018). Fetal factors include a male fetus, fetal death, and fetal distress (Kaur, et al., 2016).
Symptoms occur abruptly in the pregnant or postpartum woman and have the following clinical presentation upon initial assessment: rapid onset of respiratory distress, hypoxia (rapid decline in pulse ox values/decrease or absence in end-tidal carbon dioxide), vaginal bleeding (DIC), hypotension (hemodynamic compromise), cyanosis (d/t ventilation-perfusion mismatch r/t pulmonary vascular constriction), altered mental status (secondary to hypoxia) and fetal bradycardia (Boulden, Bell, Rojas-Saurez, & Tolosa, 2018).
The initial ABG will show levels related to hypoxia with a decrease in pH and PO2 and an increase in PCO2 and base excess (Kaur, et al., 2016). In addition to drawing the following labs: CBC, type and screen, coagulation studies, arachidonic acid metabolites, and fibrinogen level, a tryptase should be drawn due to its’ usefulness in diagnosing anaphylaxis (Boulden, Bell, Rojas-Saurez, & Tolosa, 2018). Another biomarker identified is zinc coproporphyrin (a component of amniotic fluid identified in maternal serum), which can be elevated in women with AFE (Boulden, Bell, Rojas-Saurez, & Tolosa, 2018).
Management of AFE includes quick recognition, immediate resuscitation, and delivery of the fetus if greater than 23 weeks gestation performed via c-section and simultaneously while resuscitation of the mother is taking place (Boulden, Bell, Rojas-Saurez, & Tolosa, 2018). A rapid infusion of a colloid or isotonic crystalloid should be administered to aid in hypotension to optimize preload (Kaur, et al., 2016). A massive transfusion protocol should be initiated for those with hemorrhage and DIC and a vasopressor as well as inotropic support via a central line should also be considered (Kaur, et al., 2016). Vasopressin, if given in small doses, saves the pulmonary vasculature from vasoconstriction and Methergine which acts directly on the smooth muscle of the uterus, causes a uterotonic sustained tetanic effect that lessens uterine bleeding (Kaur, et al., 2016).
Disorders of the Reproductive Systems: Sexual Dysfunction
As written by Huether & McCance, sexual dysfunction in women is defined as the inadequacy of satisfaction with the function of intercourse resulting from pain or deficiency in sexual arousal, desire, or climax/orgasm and defined in men as any impairment involving emission, erection, and ejaculation caused in both sexes by various emotional, psychological or physiological factors (2017). Slomski defines sexual dysfunction as impotence of the unceasing inability of a male to maintain and achieve an adequate erection for sexual intercourse and penetration and frigidity (a disinterest in sex), mostly applied to women due to inadequate or unpleasurable sensation during intercourse (2019).
Historically, the female disorder has been the lack of desire, whereas, the male disorder is the lack of performance (Slomski, 2019). From the male standpoint, failure to perform is to a certain extent understandable given that it is often treated with sympathy, humor, or indulgence (Slomski, 2019). The same indulgence, however, is not traditionally seen for women when the role expected of her cannot be fulfilled (Slomski, 2019).
According to Heuther & McCance, up to 45% of women live with some form of sexual dysfunction; adequate research continues to be a need in this area for exact numbers (2017). With regard to impotence, it is estimated that there are roughly ten million men in the U.S. who suffer from this disorder with an estimated 50-70% accounting for medical or organic causes estimated in the early 1990s (Slomski, 2019).
Diabetes mellitus is a fairly common disorder accounting for impotence in men with an estimated 50% of those males becoming impotent after 20 years of having DM (Slomski, 2019). DM causes impotence due to the narrowing of the blood vessels related to arteriosclerosis involving those vessels that supply blood to the penis (Slomski, 2019).
Medications such as antihypertensives can also pose problems. SSRIs and SNRIs, a group of antidepressant medication taken by both sexes can also cause sexual dysfunction. Bupropion, an atypical antidepressant, may be effective in nondepressed women for the treatment of dysfunctional intercourse (Slomski, 2019).
Treatment consisting of therapy, surgery or medications is individualized and often age-dependent (Slomski, 2019). Treatment also consists of avoiding certain behaviors such as consuming excessive alcohol and smoking. Oral medications for erectile dysfunction include Viagra, Cialis, Levitra, and Uprima (Slomski, 2019). Addyi was the first medication approved for dysfunctional intercourse for women by the FDA in 2015 and acts primarily on the brain, altering serotonin, dopamine and norepinephrine levels and must be taken daily (Slomski, 2019).
Many causes of decreased libido are not only complex but are diverse in many factors (cultural, regional, medical hx, behavior, medications, abuse, etc.) and apparent etiology; each case must be examined and treatment must be tailored to the individuals’ specific needs.
References
Boulden, N., Bell, J., Rojas-Saurez, J., & Tolosa, J.E. (2019). Amniotic fluid embolism.
doi: 10.5772/intechopen.85726
Hammer, G.D., & McPhee, S.J. (2019). Pathophysiology of Disease: An Introduction to Clinical Medicine (8th ed.). New York, NY: McGraw-Hill Education
Huether, S.E., & McCance, K.L. (2017). Understanding Pathophysiology (6th ed.). St. Louis,
MO: Mosby.
Kaur, K., Bhardwaj, M., Kumar, P., Singhal, S., Singh, I., & Hooda, S. (2016). Amniotic fluid embolism. Journal of Anaesthesiology Clinical Pharmacology, 32(2), 153-159.
doi 10.4103/0970-9185.173356: 10.4103/0970-9185.173356
Slomski, G. P. D. (2019). Sexual dysfunction. Magill’s Medical Guide (Online Edition). Retrieved from
THE RESPONSE GRADING RUBRIC
| Response: Post to colleague’s main post that is reflective and justified with credible sources. | 9 (9%) – 9 (9%)
Response exhibits
critical thinking and application to practice settings responds to questions posed by faculty the use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives | 8.5 (8.5%) – 8.5 (8.5%) Response exhibits critical thinking and application to practice settings | 7.5 (7.5%) – 8 (8%) Response has some depth and may exhibit critical thinking or application to practice setting | 6.5 (6.5%) – 7 (7%) Response is on topic, may have some depth | 0 (0%) – 6 (6%) Response may not be on topic, lacks depth |
| Response: Writing | 6 (6%) – 6 (6%)
Communication is
professional and respectful to colleagues Response to faculty questions are fully answered if posed Provides clear, concise opinions and ideas that are supported by two or more credible sources Response is effectively written in Standard Edited English | 5.5 (5.5%) – 5.5 (5.5%)
Communication is
professional and respectful to colleagues Response to faculty questions are answered if posed Provides clear, concise opinions and ideas that are supported by two or more credible sources Response is effectively written in Standard Edited English | 5 (5%) – 5 (5%)
Communication is
mostly professional and respectful to colleagues Response to faculty questions are mostly answered if posed Provides opinions and ideas that are supported by few credible sources Response is written in Standard Edited English | 4.5 (4.5%) – 4.5 (4.5%)
Responses posted in
the discussion may lack effective professional communication Response to faculty questions are somewhat answered if posed Few or no credible sources are cited | 0 (0%) – 4 (4%)
Responses posted in
the discussion lack effective Response to faculty questions are missing No credible sources are cited |
| Response: Timely and full participation | 5 (5%) – 5 (5%)
Meets requirements
for timely and full participation posts by due date | 0 (0%) – 0 (0%) NA | 0 (0%) – 0 (0%) NA | 0 (0%) – 0 (0%) NA | 0 (0%) – 0 (0%) Does not meet requirement for full participation |
