Timby/Smith: Introductory Medical-Surgical Nursing, 9/E

Transcription

1 Timby/Smith: Introductory Medical-Surgical Nursing, 9/E Chapter 59: Caring for Female Clients With Disorders of the Pelvic Reproductive Structures Slide 1 A Nurse s Role in All Reproductive Disorders Nurse s Role Providing subjective and objective assessment of the client Assisting with gynecologic examinations Assisting with relief measures Providing perioperative care Evaluating client progress Instructing on self-care including sexual functions Slide 2 Disorders of Menstruation Premenstrual Syndrome (PMS) Physical and emotional symptoms Causes: Excess estrogen, hypothalamicpituitary dysregulation Symptoms: Weight gain, headache, pain, irritability Treatment: Healthful lifestyle changes; hormonal therapy Menstrual diary Slide 3 1

2 Disorders of Menstruation Dysmenorrhea Primary and secondary Symptoms: Low abdominal pain and cramping Treatment Non-narcotic analgesics Applications of heat Knee-chest position Adequate rest and diet Figure 59-2 Knee chest position Slide 4 Disorders of Menstruation Amenorrhea Absence of menstrual flow Primary and secondary Oligomenorrhea Infrequent menses Causes Endocrine imbalances and stress Poor nutrition Associated conditions Polycystic ovarian syndrome Premature ovarian failure Slide 5 Disorders of Menstruation Menorrhagia Menstruation longer than 7 days Causes Endocrine and coagulation disorders Management of Menorrhagia NSAIDs; estrogen and progesterone Endometrial ablation Photodynamic therapy Uterine balloon therapy Slide 6 2

3 Disorders of Menstruation Figure 59-3 Uterine balloon therapy Top: Insertion of the catheter Bottom: Infusion and heating of fluid within the balloon Slide 7 Disorders of Menstruation Metrorrhagia Unexpected and irregular bleeding Intermenstrual or postcoital bleeding Causes Pituitary or ovarian stimulation Uterine malignancies and cervical irritation Breakthrough bleeding with HRT Slide 8 Menopause Introduction Cessation of menstrual cycle Physiologic and surgical menopause Climacteric and postmenopausal period Diminishing ovarian function Reduction in hormones Hypothalamic-pituitary stimulation Menstrual irregularities Vasomotor disturbances Slide 9 3

4 Menopause Medical Management HRT; antidepressants Biphosphonates Symptomatic relief measures Nursing Management Coping strategies Symptomatic relief measures Routine gynecologic and breast examinations Slide 10 Infectious and Inflammatory Disorders Vaginitis Vaginal inflammation Chemical or mechanical irritants Pathogenic microorganisms Predisposing factors Assessment Findings Symptoms: Abnormal vaginal discharge, itching, burning, and redness Examination of vaginal secretions Slide 11 Infectious and Inflammatory Disorders Vaginitis: Medical Management Anti-infective agents Treatment of sexual partner Symptomatic relief measures Nursing Management Vaginal suppositories Regular douching and sitz bath Prevention of recurrence and follow-up Slide 12 4

5 Infectious and Inflammatory Disorders Cervicitis Inflammation of the cervix Trauma of gynecologic procedures Chronic cervicitis may lead to infertility History of spotting or unusual bleeding Dyspareunia; unhealthy vaginal discharge Examination of cervix and vaginal smears Slide 13 Infectious and Inflammatory Disorders Cervicitis: Medical Management Antibiotics; douching Electrocautery; conization Cervicitis: Nursing Management Postelectrocautery instructions Rest Straining or heavy lifting Abstinence from sexual relations Slide 14 Infectious and Inflammatory Disorders Pelvic Inflammatory Disease Infection of pelvic organs except uterus Microorganisms entering through cervix Malodorous vaginal discharge Severe abdominal and pelvic pain Fever, menorrhagia, and dysmenorrhea Diagnosis: MRI, CTS; ultrasonography Slide 15 5

6 Infectious and Inflammatory Disorders Assessment Findings: Medical Management Hospitalization; rest Symptomatic relief measures Emergency surgery for pelvic abscess Nursing Process for the Client With Pelvic Inflammatory Disease: Assessment Symptoms Vaginal smear Douching Slide 16 Infectious and Inflammatory Disorders Diagnosis, Planning, and Interventions Risk Infection; spread of infection Impaired skin integrity Self-care and self-esteem Pain related to inflammation Expected Outcomes Measures to detect, manage, and prevent infection Control of pain and enhancement of client comfort Perineal skin care Slide 17 Infectious and Inflammatory Disorders Evaluation of Expected Outcomes Monitor vital signs and leukocyte count Toxic Shock Syndrome Type of septic shock Unhygienic use of tampons Chemicals produced by bacteria Signs and symptoms Diagnostic findings Slide 18 6

7 Infectious and Inflammatory Disorders Toxic Shock Syndrome Medical management Maintenance of body fluids; adrenergics Aerobic metabolism at cellular level Vital signs; cell count; renal functions First dose of antibiotics Perineal hygiene Slide 19 Structural Abnormalities Endometriosis Adhesions and sterility Dysmenorrhea; chocolate cyst Removal of cysts; panhysterectomy Diagnosis and relief measures Regular gynecologic checkup Slide 20 Structural Abnormalities Vaginal Fistulas Definition and types Surgical injury; cancer therapy Congenital anomaly; ulcerative colitis Leakage of urine or stool through vagina Symptomatic relief measures; surgery Slide 21 7

8 Structural Abnormalities Nursing Process: Assessment Vaginal drainage, meatus, and vault Diagnosis, Planning, and Interventions Repair of fistula; indwelling catheter Postoperative care; maintain self-esteem and skin integrity; promote sexual activity Evaluation of Expected Outcomes Positive self-image; self-confidence Skin integrity Slide 22 Structural Abnormalities Pelvic Organ Prolapse Cystocele; rectocele Weakness in muscles and fascia Urinary and bowel alterations Irritation of protruding cervix : Signs and symptoms Difficulty standing for long or walking Cystocele; uterovaginal prolapse Slide 23 Structural Abnormalities Pelvic Organ Prolapse : Diagnostic findings Pelvic examination; urinary test Pessary; Kegel exercises Transvaginal repairs Knee-chest position Heavy lifting Intermittent catheterization Slide 24 8

9 Structural Abnormalities Uterine Displacement Retroversion; may cause infertility Positional displacement Backache; dysmenorrhea; dyspareunia Pessary; knee-chest position Uterine relocation Slide 25 Tumors of the Female Reproductive Uterine Leiomyoma Sites of occurrence Menorrhagia; dysmenorrhea; anemia D and C; myomectomy; hysterectomy Gynecologic examination Slide 26 Tumors of the Female Reproductive Cervical and Endometrial Cancer Age; history of diethylstilbestrol; sexual activity : Signs and symptoms Bleeding; pain; pressure on bladder Surgery: Hysterectomy; chemotherapy Heavy lifting; sexual activity Exercise; douching Slide 27 9

10 Tumors of the Female Reproductive Cervical and Endometrial Cancer (cont d) Preoperative and postoperative care Client and family teaching Ovarian Cysts and Benign Tumors Types; affects menstruation and fertility Menstrual irregularities, low abdomen discomfort, and backache Slide 28 Tumors of the Female Reproductive Ovarian Cysts and Benign Tumors Diagnosis Pelvic examination; USG; laparoscopy Pain relief measures; gynecologic examinations Cancer of the Ovary Hereditary; nulliparous women Abdominal discomfort; urinary frequency Slide 29 Tumors of the Female Reproductive Cancer of the Ovary Oophorectomy; panhysterectomy Emotional support Preoperative and postoperative care Cancer of the Vagina Age of occurrence HPV infection; diethylstilbestrol Slide 30 10

11 Tumors of the Female Reproductive Cancer of the Vagina Abnormal vaginal bleeding; dyspareunia Vaginal canal examination; biopsy Laser photovaporization treatments Total vaginectomy; radiotherapy Emotional support; physical comfort Slide 31 Tumors of the Female Reproductive Cancer of the Vulva High incidence in HPV and herpes Pruritus and genital burning White raised patches on labia Bloody discharge; enlarged lymph nodes Vulvectomy; laser photovaporization Slide 32 Tumors of the Female Reproductive Nursing Process for the Client With Cancer of the Vulva Undergoing Surgery Assessment Pain; skin integrity Homans sign Diagnosis, Planning, and Interventions Biopsy; surgery Self-care activities Control of thrombophlebitis Prevention of infection Slide 33 11

12 Tumors of the Female Reproductive Diagnosis, Planning, and Interventions Client education Maintain skin integrity and self-esteem Promote sexual intimacy Evaluation of Expected Outcomes Wound healing Reduction of dependent edema Sitz bath Stool softeners Slide 34 General Nutritional Considerations Considerations Large doses of vitamin B 6 can cause sensory neuropathy Clearly defined relationship between nutrients and PMS Soy products may help alleviate menopausal symptoms Slide 35 General Pharmacologic Considerations Estrogen Therapy Side effects; diuretics; thromboembolism Risk of osteoporosis and renal calculi Androgen Therapy Recalcification of bone Initial increased bone pain Alendronate Prevents bone resorption Raloxifene Danger of prolonged antibiotics Slide 36 12

13 General Gerontologic Considerations Pruritus Age of occurrence Cause Pessary usage for prolapse Thorough investigation HRT Slide 37 End of Presentation Slide 38 13