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Genital Urinary System
Female Reproductive System
Part 3
Cancer of the Cervix
Pathophysiology
•
Predominantly
Squamous cell
cancer
•
Age 30 – 45
Cancer of the Cervix
• Risk factors
– Multiple sex partners
– Early age at first coitus
– Sex with men whose
partner have had cervical
cancer
– Human papillomavius
virus - HPV
• STD
• Causes warty growths
– Smoking
Cancer of the Cervix
Clinical Manifestations
•
•
Early
– Asymptomatic
Late symptoms
–
Discharge
•
•
•
•
h
Watery
Dark
Foul-smelling
Cancer of the Cervix
Clinical Manifestations
•
Late symptoms
–
–
–
–
–
Irregular bleeding
Leg pain
Dysuria
Rectal bleeding
Edema of
extremities
Cancer of the Cervix
•
Advanced disease should not occur if all
women have access to gynecologic care or
avail themselves of it.
Cancer of the Cervix
Assessment and
diagnostic findings
•
Pap smear
•
x-ray
•
Colposcopy
–
Biopsy
Cancer of the Cervix
Medical management
•
CRYOTHERAPY
•
Surgery
–
–
•
Hysterectomy
recurrence is 35%
Radiation
Cancer of the uterus
Pathophysiology
•
Cancer of the
uterine
endometrium
Cancer of the uterus
Risk factors
•
Age: >55 yrs
•
Postmenopausal
bleeding
•
Obesity
•
Unopposed estrogen
tx
•
Nulliparity /
•
Infertility
Cancer of the uterus
Assessment
•
Irregular bleeding
evaluated promptly
•
Endometrium
aspirations / biopsy
•
Ultrasound
Cancer of the uterus
Medical management
•
Hysterectomy
Cancer of the Ovary
Pathophysiology
•
About 75% detected
in the late stage –
with metastasizes
•
Age 50-59
•
Risk factors
–
–
Nulliparity
Infertility
Cancer of the Ovary
Clinical Manifestations
•
h abdominal girth
•
pelvic pressure
•
bloating
•
flatulence
•
h waist size
•
leg pain
•
VAGUE
Cancer of the Ovary
Assessment and
diagnostic findings
•
Pelvic exams do not
detect ovarian
cancer
•
Pelvic imaging are
not definitive
Cancer of the Ovary
Medical management
•
Surgical removal
•
Chemotherapy
•
Radiations
Hysterectomy
•
•
•
Hysterectomy is the surgical removal of the
uterus
Total hysterectomy: removal of uterus &
cervix
Sub-total hysterectomy: Removal of the
uterus, but not the cervix
• Radical hysterectomy: Removal of uterus,
vagina (upper 1/3) pelvic lymph nodes,
fallopian tubes, & ovaries
– Usually performed d/t malignant conditions
Hysterectomy
Hysterectomy’s why?
•
Cancer
•
Dysfunctional
uterine bleeding
•
Endometriosis
•
Non-malignant
growths
•
Prolapse
Hysterectomy
Variety of approaches
•
Vaginal
•
Abdominal
•
Laproscopically
• Vaginal hysterectomy
Hysterectomy
Pre-op management
•
Shave?
•
Empty bladder
•
Empty bowels
•
Douche
A client has been admitted to the hospital the day
before she is scheduled for an abdominal
hysterectomy. Nursing responsibilities for the
preoperative period would include notifying the
physician if the
A.
B.
C.
D.
Erythrocyte count is 6 million/cu mm.
Urine report indicates ketonuria.
Temperature is 99.6 degrees F orally.
Hemoglobin is 14 gm/100 ml.
Hysterectomy
•
Anxiety related to the diagnosis of cancer,
fear of pain, possible perception of loss of
femininity, and disfigurement
–
–
Educate
Support
Hysterectomy
Disturbed body image r/t alt. fertility & fear
about sexuality & relationships with partner
& family
• Discuss changes
• Orgasm
Which of the following stressors affect selfconcept? (Select all that apply.)
A. Declining mental, physical, or sensory
abilities
B. Relationship concerns
C. Unrealistic ideal self
D. Realistic Role Expectations
Hysterectomy
Acute pain related to surgery and other adjuvant
therapy AMB statement, guarding, grimacing, not
ambulating.
•
Asses pain
•
Administer: analgesics
•
Teach alternatives
–
–
–
Relaxation tx
Early ambulation
Heat
Potential Complications
• Hemorrhage
• Deep Vein Thrombosis
• Bladder disfunction
Hysterectomy
•
Hemorrhage
–
–
–
Assess # pads
Assess Vital Signs
Educate on activity restrictions
Hysterectomy
•
Deep vein thrombosis
–
Prevention
•
•
Elastic compression stockings
Early amb.
Hysterectomy
•
Deep vein thrombosis
–
Assess of DVT’s
•
Phlebitis
–
–
–
–
Leg pain
Red
Warm
edema
Hysterectomy
•
Deep vein thrombosis
–
Assess for PE
•
•
•
Chest pain
h pulse
Dyspnea
Hysterectomy
Bladder dysfunction (urinary retention)
•
I&O
•
Assess Bladder distention
•
Stim. Bladder
–
–
–
–
–
–
•
Cold to abd.
Stoke inner thigh
Running H2O
Privacy
Position
Time
Catheter
True or false. Following a hysterectomy,
ambulation should be discouraged.
A. True
B. False
On a follow-up visit after having a vaginal hysterectomy,
a 32-year-old patient has a decreased hematocrit
level. Which of the following complications does this
suggest?
A.
B.
C.
D.
Hematoma
Hypovolemia
Infection
Pulmonary embolus (PE).
• A 36-year-old woman who underwent a hysterectomy 4 days
ago says to the nurse, "I wonder if I'll still feel like a woman."
Which response would most likely encourage the patient to
expand on this and express her concerns in more specific
terms?
A.
B.
C.
D.
"When did you begin to wonder about this?“
"Do you want more children?“
"Feel like a woman...?“
Remaining silent
Breast Cancer - FYI
•
•
•
•
212,000 women/ year
1,700 men/ year
41,000/ year die
Women 1:8 chance of
developing it
Breast Cancer
• Risk Factors
– (No single specific cause)
– Gender
• Women (99%)
– Age
• >50 years
– Personal history
• (Past breast cancer)
• Hormonal factors
– Early menarche
– Nulliparity
– Late menopause
• Obesity
• Alcohol use
• **No evidence that oral
contraceptives increase
risk!
Breast Cancer
• Characteristics
– Can occur anywhere
– Most common
• Upper outer quad
–
–
–
–
Non-tender
Fixed
Hard
Irregular boarders
• Advanced signs
– Skin dimpling
– Nipple retraction
– Skin ulceration
Surgical management
• Modified Radical
Mastectomy
– Removal of
• All breast tissue
• Nipple-areola
• Axillary lymph nodes
– Not removed
• Pectoralis major muscles
• Pectoralis minor muscles
• Total Mastectomy
– Removal of
• Breast
• Nipple-areola
– Nor removed
• Axillary lymph nodes
• Muscles groups
• Breast Conservation Treatment
– AKA:
• Lumpectomy
– Partial or segmental mastectomy
– Remove tumor
– May include axillary lymphs
Mastectomy
Pain:
•
Assess:
•
Administer
–
–
–
Opiod analgesics
Oxycodone &
acetominaphen
(Percocet)
Propoxyphene &
acetominaphen
(Darvocet)
•
Non-Rx
–
–
–
•
Warm showers
Position arm
Distraction technique
Report
–
Excruciating pain
Mastectomy
Impaired skin integrity
• Drainage tubes in place
• Patency of tubes
• Hematoma
• Ice pack
Mastectomy
Risk for infection
•
Drainage tube duration
–
•
Drain 7-10 d
Teach
–
–
–
empty & strip/milk
Incision care
S&S of infection
•
•
•
Foul smell drainage
Temp >100
No lotion/cream until completely healed
Mastectomy
•
Disturbed Body Image
–
SUPPORT!
–
–
–
–
–
–
–
–
–
–
View with them 1st time
Normal feelings
Asses degree of self-esteem disturbance
Arrange for visitor from support group
Provide info about prosthesis
Assist pt. to verbalize feeling
Enc open communication with S/O
Answer questions
Counseling
Community resources
Mastectomy
•
Impaired sensory perception r/t sensation in
arm, breast or side
–
–
–
–
–
(Tightness, pulling burning, tingling in chest
wall, axilla, upper arm)
h with healing  last mo./yr  diminish
Teach “This is normal”
Exercise  i sensation
“Most bothersome part”
Mastectomy
•
Lymphedema
–
Results when lymphatic channels are
inadequate to return flow of lymph fluid
Transient swelling
Happens 10-25% of pt with axillary dissection
Medication:
–
–
–
•
–
Antibiotics
Exercises
• Manual lymph
drainage:
– light massage,
– performed by a
therapist
– assists moving the
fluid to other parts of
the body
Compression bandaging:
• multi-layered
bandages after
massage
• keep the fluid out of
the arm
• Exercise:
• Do not perform
venipuncture
• Do not take BP on
affected arm
• Avoid dependent
arm position
• Compression garment:
– fitted
– helps maintain
decreased swelling
achieved during
treatment
• Do not perform venipuncture or take BP on
affected arm
• Avoid dependent arm position
A client with breast cancer is returned to the room following a
right total mastectomy. The nurse should:
A. Elevate the client's right arm on pillows
B. Place the client's right arm in a dependent sling
C. Keep the client's right arm on the bed beside her
D. Place the client's right arm across her body
Mastectomy
•
Knowledge deficit: prevent complication
from surgery -hematoma formations
–
–
–
–
–
Monitor for excessive swelling, tightness, pain, bruising
Notify MD
Check drainage device
Ace wrap to compress surgical site
Ice Pack f/b warm showers
Which statement indicates the client is accepting of her
body image following a mastectomy?
A. "I haven't looked in the mirror since my
mastectomy."
B. "My husband loves me the way I am, even
after a mastectomy."
C. "I don't care if I had a mastectomy, I'm still
wearing a bikini."
D. "I just want a picture of me from the
shoulders on up since my mastectomy."
A client receiving chemotherapy for breast cancer has
an order for Zofran (ondansetron) 8mg PO to be
given 30 minutes before induction of the
chemotherapy. The purpose of the medication is to:
A. Prevent anemia
B. Promote relaxation
C. Prevent nausea
D. Increase neutrophil counts
The nurse observes a staff member caring for a client with a left
unilateral mastectomy. The nurse would intervene if she
notices the staff member is
A.
B.
C.
D.
Advising client to restrict sodium intake
Taking the blood pressure in the left arm
Elevating her left arm above heart level
Compressing the drainage device