-
hysterectomy nursing care
- routine postop care
- bowel sounds
- bleeding - check pad/inscision q 4 hrs
- foley/encourage voiding when removed
- leg exercises/TEDs
- coughing/deep breathing
- avoid tub baths until bleeding sos
- avoid heavy lifting, douching, tampons, intercourse 4-6 weeks
-
amenorrhea
- absense of a period
- pregnancy, menopause, lactation, hormonal imbalance, anorexia
-
dysmenorrhea
painful menstruation (cramps)
-
menorrhagia
- excessive menstruation
- endocrine/reproductive disorders, anticoagulants
- excessive blood loss, fatigue, anemia, hemorrhage, sexual dysfunction
-
metrorrhagia
- bleeding between periods
- s/s of cervical/uterine cancer
-
PMS
- S/S of hormomal imbalance (estrogen/progesterone)
- pituitary gland effects fluid levels causing bloating & weight gain
- 10 days before/3 days after menses
-
PMS S/S
- irritibility/mood swings
- depression
- breast tenderness
- abd distention
- acne
-
PMS Dx
- made by exclusion
- blood work for hormonal imbalances
-
PMS Rx
- duiretics
- anti-depressants
- analgesics
- anti-anxieties
- diet: low sodium/caffeine, B vitamins, calcium/mag
-
menopause
- no menses for one year
- age 45-55
- ovaries cease to function, atrophy
- uterus returns to prepubescent size
- vagina dries/thins
- breast tissue & body hair decreases
-
menopause S/S
- hot flashes
- night sweats
- vaginal dryness
- emotional changes
-
menopause Dx
symptoms, age, blood work
-
menopause Rx
- hormone replacement therapy - s/e edema, weight gain, phlebitis
- selective estrogen receptor modulators (SERMs)
- aromatherapy
- herbs
- meditation
- vitamins D, E
- soy protein
-
impotence
- inability to achieve an erection
- spinal cord injury, radial prostatectomy, diabetes, COPD, anti-hypertensives, MS
-
impotence Tx
- treat underlying cause
- erectile dysfunction meds: facilitate blood flow in the corpus caverosum
- Viagra, Cialis, Levitra
- can drop B/P w/nitrates
-
infertility
- inability to conceive a child
- inadequate egg production, blockage of fallopian tube, hormonal imbalance, low sperm count/motility, STDs
-
female infections
- disturbance of normal flora of vagina
- vaginitis is most common (caused by e-coli or yeast)
- r/t antibiotics, birth control, improper hygiene, sexual intercourse, poor handwashing, douching
- tx - vaginal suppositories
-
PID
- chronic infection of the cervix, uterus, fallopian tubes, ovaries
- r/t gonorrhea/chlamydia, sex w/infected partners, abortion, irrigation, infection during pregnancy
- scar tissue causes infertility
- can spread to other organs
-
PID S/S
- pelvic pain
- fever
- malaise
- vomiting
- discharge
- dysuria
-
PID Dx
- C&S
- increased WBC
- ultrasound
- laparoscopy
-
PID Tx
- antibiotics
- analgesics
- IV fluids
- surgery - adhesions, TAH-BSO
- treat partner at same time
-
PID nursing
- pt teaching - inform sexual partners, hygiene, abstain during treatment
- monitor VS (temp)
- monitor vaginal drainage
-
TSS
- staph or strep infection
- r/t tampon use, diaphragm, cervical sponge
- change tampon at least every 8 hours
-
TSS S/S
- high fever
- N&V, abd pain, diarrhea
- muscle pain
- sore throat
- HA
- dizziness, low BP
- red rash
- conjunctivitis
- peeling skin on palms/soles
- altered mental status
-
TSS Tx
- antibiotics
- IV fluids to correct eletrolyte imbalance/hypotension
- corticosteroids
-
endometriosis
- benign uterine tissue grows outside uterus
- cause unknown
- women in 20s, 30s, no pregnancies
-
endometriosis S/S
- pain
- menorrhagia/metrorrhagia
- painful intercourse
- HA
- backache
- painful defecation
- infertility
-
-
endometriosis Tx
- hormones to stop ovarian function (BCP)
- Danzol: causes pseudomenopause
- surgery - removal of endometrial tissue, TAH-BSO
-
endometriosis nursing
- post-op surgical care
- pain management
- patient teaching - med side effects
- anemia
-
relaxed pelvic muscle disorders
- uterine prolapse: uterus moves down through vagina
- rectocele: front wall of rectum moves into vagina
- cystocele: bladder falls into vagina
treated surgically - preop kegels
-
fibroids (uterine leiomyomas)
- benign tumors of the uterus
- 20-30% of women over 30, AA, premenopausal
-
fibroids S/S
- menorrhagia/metrorrhagia
- increased pelvic pressure
- constipation
- urinary retention
- weight gain
- enlarged abd
- infertility
- painful intercourse
-
fibroid Dx
adb/transvaginal ultrasound
-
fibroids Tx
- HRT
- uterine artery embolectomy - occludes blood supply to fibroid
- myomectomy - removal of fibroids
- hysterectomy (abd or vaginal)
- endometrial ablation - cauterization of lining of uterus
-
ovarian cysts
- benign tumors of the ovaries
- Dx: palpation, ultrasound
- Tx: laparoscopic removal
-
cervical cancer risk factors
- HPV
- early sexual experience
- multiple partners
- HIV
- unprotected sex
- smoking
- poor diet
-
cervical cancer S/S
- asymptomatic in beginning
- spotting between periods/after sex
- dark foul discharge
- leukorrhea - white discharge
- leg pain/swelling
- flank pain/pelvic pain
- weight loss
- hematuria
- rectal bleeding
-
cervical cancer Dx
- abnormal pap x2 --> colpopscopy/biopsy
- MRI
- HPV test
-
cervical cancer Tx
- preinvasive - conization (removal of cone shaped section of cervix)
- no metastasis - hysterectomy/intracavity radiation
- metastasis - radical hysterectomy (removal of ovaries, tubes, lymph nodes)
-
intracavity radiation
- supine position/legs extended
- Lovenox/antibiotics prophylactically
- pain management
- nurse must wear doximeter badge/lead apron
- no pregnant women/children under 16
- visitors remain 6 feet away
- if discharged, handle with forceps and place in lead container
-
uterine (endometrial) cancer risk factors
- age (50-70 yrs)
- family history
- diabetes
- obesity
- uterine polyps
- late menopause
- smoking
-
uterine cancer S/S
moderate to large amounts of abnormal bleeding after menopause (usually painless)
-
uterine cancer Dx
- endometrial biospy
- liver & bone scans
- IVP (renal involvement)
- barium enema (rectal involvement)
-
uterine cancer Tx
- surgery - TAH-BSO, lymph nodes
- chemo
- radiation
-
ovarian cancer
- leading cause of death among female cancers
- usually Dx after symptomatic/metastasized (stage 3 or 4)
- less than 20% survival
-
ovarian cancer risk factors
- older age
- early menarche
- late menopause
- infertility
- Clomid tratment
- family Hx of breast/ovarian cancer
-
ovarian cancer S/S
- asymptomatic in beginning
- abd pain/swelling
- indigestion/GI symptoms
- abd mass
- 30% have abnormal pap
-
ovarian cancer S/S
- biospy
- elevated CA-125
- CAT scan
-
ovarian cancer Tx
surgery - TAH-BSO
-
ovarian cancer nursing
- emotional support
- post op care
- pt teaching
- hospice
-
fibrocystic breast disease
- benign tumors of the breast due to increased estrogen
- ages 30-50
- increased risk for breast cancer
-
fibrosystic breast disease Dx
- palpation
- mammogram
- ultrasound
- biopsy
-
fibrosystic breast disease Tx
- reduce caffeine intake
- vitamins C, E, B-complex
- oral contraceptives to suppress estrogen
-
breast cancer
- most common dx malignancy in women (1 in 8)
- 2nd leading cause of cancer deaths
- survival - 97% if localized, 79% if lymph, 23% if other organs
-
breast cancer risk factors
- white females over 50
- family Hx (mom, sister)
- endometrial cancer, fibrocystic breast changes
- early menarche/late menopause
- late births (after 30)
- multiple CXRs
- 2+ alcoholic drinks daily
- obesity
- smoking
- breast trauma
-
infiltrating ductal carcinoma/adenocarcinoma
- 80% of all breast cancers
- originates in mammary ducts
- upper outer quadrant of breast
- 5-9 years of growth before can be palpated
- high cure rate if non-invasive (still in duct)
- most found after invasive (infiltrated other tissues/palpable)
- causes dimpling of breast
-
breast cancer Dx
- phyical exam (mass > 1cm can be palpated)
- mammogram (mass > 0.5cm)
- ultrasound to distinguish between benign (fluid) vs cancerous (solid)
- biopsy to confirm
- MRI/PET scan
-
breast cancer S/S
- palpable mass that is small, irregularly shaped, firm, non-tender, non-mobile
- discoloration of the nipple
- breast/axilla tenderness
-
TNM staging
- T: tumor size
- N: lymph involvement
- M: metastasis
- G1-4: grade of tumor cells
-
simple mastectomy
removal of the breast
-
radical mastectomy
removal of the breast, chest muscles, lymph nodes
-
modified radical mastectomy
removal of the breast, lymph nodes (chest muscles intact)
-
lumpectomy
removal of the tumor/small margin of surrounding tissue
-
mastectomy nursing
- wound care
- emotional support
- CSM of affected arm
- no BP/blood work affected arm
- arm exercises - wall climbs, over head pulley, rope turns, arm swings
- patient teaching
- risk for infection
- pain management
-
epididymitis
- infection of the epididymis (contracts during orgasm/moves sperm)
- Hx of STDs, UTIs
-
epididymitis S/S
- pain
- scrotal swelling
- fever
- malaise
-
epididymitis Dx
- urinalysis
- CBC
- exam
- symptoms
- semen specimen
-
epididymitis Tx
- antibiotics
- ice packs
- scrotal support
-
epididymitis nursing
- bed rest
- patient teaching - antibiotics
- complication - abscess
-
testicular cancer
- age 15-35
- non-aggressive cancer
-
testicular cancer S/S
- scrotal pain
- edema
- palpable lump in scrotum
-
testicular cancer Dx
- ultrasound
- elevated serum alpha fetoprotein (AFP) and HCG
- CXR/CAT scan (metastasis)
-
testicular cancer Tx
- orchiectomy
- chemo
- radiation
-
self testicular exam
- roll testes between thumb and fingers
- after bath/shower, use soap
- monthly exam
-
STDs
- infections transmitted though vaginal or oral intercourse, mother to fetus
- causes infertility, cancer, chronic infection, death
-
STDs nursing
- patient education
- support groups
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