Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Female Reproductive Disorders
Transcript
Premenstrual Syndrome • Why is PMS know as a syndrome and not a disease? a Group of physiological and psychological symptoms Premenstrual Syndrome • What are the symptoms? • Remember – these can vary from month to month? Premenstrual Syndrome Treatment and Nursing Care • Stress Reduction Techniques • Initiation of an Exercise Program • Diet Therapy – – – – Avoid caffeine and alcohol Eat complex carbohydrates, high-fiber Reduce salt intake Increase vitamin B12 , calcium and magnesium Premenstrual Syndrome Treatment and Nursing Care • Drug Therapy – Selective Serotonin reuptake inhibitors • Prozac • Zoloft – Diuretics - spironolactone – Prostaglandin inhibitors - ibuprofen – Antidepressants, antianxiety - Xanax – Oral contraceptives Dysmenorrhea • Discomfort associated with menstruation • Cause - excessive prostaglandins * What is the action of prostaglandins on smooth muscles? • Signs and Symptoms – In addition to Abdominal what will the patient complain of? Dysmenorrhea • Treatment and Nursing Care – Drug Therapy • NSAIDS/ Prostaglandin blockers • Oral Contraceptives – Relaxation Techniques – Heat Therapy – Exercise – Other • Acupuncture • Transcutaneous nerve stimulation Abnormal Vaginal Bleeding • Oligomenorrhea – long interval between menses • Amenorrhea - absence of menses • Menorrhagia – prolonged menstrual bleeding • Metrorrhagia – irregular bleeding Complications of Vaginal Bleeding • Anemia • • • • Order lab work – CBC, Hgb, Hct Assess for excessive fatigue Monitor vital signs Provide for safety with the weak patient • Toxic Shock Syndrome (TSS) • Assess for high fever, vomiting, diarrhea, weakness, myalgia, and sunburn-like rash • Patient teaching – avoid use of superabsorbent tampons and pads; change pads and tampons frequently Abnormal Vaginal Bleeding • Treatment and Nursing Care – Drug Therapy • Oral Contraceptives – Baloon Thermotherapy – Myomectomy Endometrial Ablation • A resectoscope is a special type of telescope inserted inside the uterus. It has a built in wire loop that uses high-frequency electrical energy to cut or coagulate or ablate tissue. • The resectoscope has the advantage of being able to remove polyps and some fibroids at the time of ablation. Menopause Cessation of menses Menopause • Menopause is related to a decrease in the production of _______ and ___________. or Surgically induced Menopause Clinical Manifestations • Cessation of menses • Occasional vasomotor symptoms • Atrophy of genitourinary tissue • Stress incontinence • Osteoporosis • Sleep disturbances Menopause Treatment and Nursing Care • Drug Therapy – NO longer encourage the use of Hormone Replacement Therapy – related to increase in risk for development of breast cancer, stroke, heart disease, DVT, pulmonary emboli – Antidepressants – Selective estrogen receptor modulators • raloxifene (Evista) – Bisphosphonates • Fosamax or Actonel Menopause Treatment and Nursing Care • Non-hormonal Therapy – Cool environment – Loose fitting clothing – Moisturizing soaps and lotions – Healthy diet with vitamin D – Vitamin and mineral supplements – Exercise Review • To prevent or decrease age-related changes that occur after menopause in a patient who chooses not to take HRT, the nurse teaches the patient that the most important self-care measure is a. Maintain sexual activity b. Increase intake of dairy products c. Performing regular aerobic, weightbearing exercise d. Taking vitamin E and B6 supplements Infection of uterus, fallopian tubes, ovaries, and peritoneal cavity Pelvic Inflammatory Disease • Cause – gonorrhea and chlamydial infections spread up the reproductive system into the peritoneal cavity • Manifestation – Abdominal pain – Fever – Vaginal discharge • Diagnosis – Vaginal culture Pelvic Inflammatory Disease • Complications – Septic Shock – Infertility – Ectopic pregnancy • Treatment and Nursing Care – Drug Therapy – Positioning – Force fluids – Heat to abdomen or Sitz bath – Patient teaching – prevention of re-infection Ask Yourself? • The nurse caring for a patient with PID places her in a semi-fowlers position in order to: a. Relieve pain b. Prevent the complication of sterility c. Promote drainage and prevent abscess d. Improve circulation and promote healing Presence of normal Endometrial Tissue outside the uterine cavity Answer this! • What is the big deal about endometrial tissue being outside the uterus? Endometriosis • What is the main symptom of endometriosis? Endometriosis • Clinical Manifestations – – – – Dysmenorrhea, pelvic pain Dyspareunia, dysuria Infertility Chocolate cysts in ovaries • Diagnosis – Laproscopy Endometriosis How do these medications help in treatment? • • • • • Ibuprofen (Advil) Oral contraceptives medroxyprogesterone (Depo-Provera) danazol - Danocrine Gonadotropin-releasing hormone agonists – leuprolide (Lupron) – Nafarelin (Synarel) Endometriosis • Treatment and Nursing Care • Surgical Therapy – Conservative • Laparoscopic laser surgery / laparotomy • Used in women who desire to bear children – Definitive • Hysterectomy • Used in women who no longer desire children Which of these diagnostic measures is used most often to confirm the diagnosis of endometriosis? – – – – – A. CBC with differential C. Pelvic ultrasound D. Exploratory laproscopy E. Biopsy F. Ablation Tutorial on endometriosis • Go to the following website for a tutorial on endometriosis: • http://www.nlm.nih.gov/medlineplus/tutorials /endometriosis/htm/index.htm Leiomyomas Polycystic ovary Uterine Fibroids (Leiomyomas) • Benign smooth muscle tumors in uterus diagnosed with Hysteroscopy • Do they grow fast or slow? • What makes them grow? Leiomyomas • Signs and Symptoms – Most do NOT have symptoms If they do: – Abnormal uterine bleeding- menorrhagia and metrorrhagia – Pain, pelvic pressure Uterine Fibroids (Leiomyomas) • Diagnosis – Enlarged uterus distorted with nodular masses • Treatment and Nursing Care – Myeomectomy, Myeolysis – hysterectomy – Cryosurgery – ExAblate 2000 system Answer this! • A 26 y/o woman who wishes to have children is diagnosed with uterine fibroids (leiomyoma). Which of the following is likely to be the treatment of choice? a. A hysterectomy will be necessary to remove the tumor b. A myomectomy may be performed c. Aspirin and NSAID’s will be used to control the pain d. Hormonal therapy will be used to shrink the tumor and maintain sterility Chronic endocrine disorder resulting in: Insulin resistence Hyperandrogenism Altered gonadotropin functioning Polycystic ovaries Estrogen/ testosterone progesterone LH, FSH No egg released from ovary Small cysts develop in ovaries rt failure to release egg Diagnosed – Pelvic Ultrasound Polycystic Ovaries • Signs and Symptoms – – – – – Irregular menstrual periods – infrequent or absent Hirsutism Obesity Acne No ovulation • These manifestations are related to estrogen and high levels of ____________ and no ________________. Polycystic ovaries How do each of these medications assist in treatment? a. oral contraceptives – b. spironolactone (Aldactone) c. leuprolide (Lupron) d. Metformin (glucophage) e. clomiphene (Clomid) – Surgery • Oophorectomy Additional Treatment Options • Weight management • Exercise • Monitor lipid profile • Monitor glucose levels Polycystic Ovaries Diagnostic Testing Pelvic Examination • What are the duties of the nurse in assisting with a pelvic exam? Pap Test Colposcopy LUMA Cervical Imaging System Conization Loop Electrosurgery Excision Procedure Endometrial Biopsy Teach what to “Call the Doctor” for. Cervical Cancer Cervical cancer • What are the risk factors that could lead to cervical cancer? Staging and Treatment Endometrial Cancer Endometrial Cancer • Major Risk factor – Prolonged exposure to Estrogen • Other Risk factors – – – – – Age - >60 Infertility Diabetes Family history, other cancers Lifestyle – obesity, smoking Endometrial Cancer What brings a woman to her doctor? Endometrial Cancer Treatment and Nursing Care • Diagnosed – Endometrial biopsy Treatment: • Surgical Therapy – Hysterectomy – first choice of treatment • Chemotherapy • Radiation - brachytherapy Brachytherapy • Internal radiation implantation which delivers a high dose of radiation to a localized area. • The radiation device is placed near the tumor (in vagina) seeds, needles, catheters • Radioisotopes are loaded into the device after correct placement. Nursing Care for Brachytherapy • What are the special considerations and nursing care related to the woman undergoing brachytherapy for endometrial cancer? Postop interventions for PanHysterectomy • • • • • • • Analgesia Ambulation I&O Passage of flatus Heat to abdomen Psychological support Teaching for home care Ovarian Cancer Ovarian Cancer • Greatest risk factor is family history • Other risk factors include – – – – – Age High-fat diet Greater number of ovulatory cycles Hormone replacement therapy Use of infertility drugs • 90% of ovarian cancers are epithelial carcinomas from malignant transformation of surface epithelial cells Clinical Manifestations • Explain why how these symptoms are related to ovarian cancer. – Increase in abdominal girth – Bowel and bladder dysfunctions – Persistent pelvic or abdominal pain – Menstrual irregularities – Ascites Ovarian Cancer Diagnosis • Screening for high risk women should include CA-125, ultrasound, and yearly pelvic examination • CA-125 is positive in 80% of women with ovarian cancer • What is the only way to confirm the diagnosis of ovarian cancer? Tutorial on ovarian cancer • http://www.nlm.nih.gov/medlineplus/tutorials/o variancancer/htm/index.htm • Treatment of Ovarian Cancer – Surgery – most common – Chemotherapy Vaginal Cancer • Risk Factors – Elderly – Cancer of the cervix or endometrium – Young women - DES exposure • Manifestations – Bleeding not related to menses – Dyspareunia, Dysuria – Vaginal discharge Vulvar Cancer • Risk Factors – 50 plus – Chronic irritation – History of HPV or Herpes 2 • Manifestations – Pruritus – Burning – Enlarged inguinal lymph nodes – Asymmetry – Lesions or mass – Change in color Treatment options for all Caners • Surgery – Oophorectomy, Panhysterectomy – Pelvic Exenteration • Chemotherapy • Radiation – External – Brachytherapy Try This? • Nursing responsibilities related to the patient receiving brachytherapy for endometrial cancer include: a. Maintaining bedrest b. Allowing the patient bathroom privileges only c. Limiting an individual nurses’ contact with the patient to 1 hour per day d. Allow visitors as long as they stay 6 feet away from the bed Problems with Pelvic Support Uterine Prolapse • Downward displacement of uterus into vagina Second degree First degree Third Degree Uterine Prolapse • Signs and symptoms – Stress incontinence – Dyspareunia – Heavy feeling in pelvis • Treatment and Nursing Care – Pessary – Hysterectomy with A&P repair Cystocele and Rectocele • Cystocele – support is lost and bladder protrudes into the vagina • Rectocele – support is lost and rectum protrudes into the vagina Treatment and Nursing Care • Patient teaching – Kegels exercises • Surgery – Anterior or Posterior colporrhaphy – Post-op nursing care • Patient teaching – Prevent straining at Bowel Movement by using a Low residue diet and stool – Restriction of heavy lifting and prolonged standing, walking or sitting – Prevention of urinary retention That’s all folks!
