female reproductive

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female reproductive
2010-06-29 02:19:46
part 2`

ch. 53
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  1. Uterine Leiomyoma sometimes shorten to myoma
    benign growth consisting of smooth muscle & fibrous CT, most common tumor AKA fibroid tumor

    • P&E-stimulated by Estrogen, different sizes and either single or multiple, growth stops during preg. & shrink during & after menopause, excessive bleeding
    • can occur: subserous(below serous membrane), intramural(w/i wall), submucosal(below mucus membrane)

    • Assess:Menorrhagia, feelin of pressure, dysmenorrhea, anemia, malaise
    • detected durin pelvis exam, sonogram

    • medical & surgical manag.:D&C 2 determine cause or control bleeding
    • myectomy-surgical removal- thru abdominl incision or a laparoscope 4 ppl who want to have children
    • hysterectomy- when symptoms bad, & dont want more kids

    Nurse manag.: help w/ exam, provides info, explanations, help w/ safe recovery
  2. cervical & endometrial cancer
    • cervical- affects lowest portion of uterus
    • endometrial- affects linning of uterus (fudus & corpus), common in postmenopausal woman

    P&E- born 2 mother treated w/ diethylstilbesterol while preg., havin sex young, or never having sex, many sex partners or sex w/ someone dat has many sex partners or penile condyloma, havin genital infection (HPV), havin chronic cervicitis from uterine prolapse, hx of smokin, had pelvic radiation, after 50 y/o, obesity

    • Assess: spotting when intrcourse or douchin, Bleeding, pain, pressure on bladder or bowel, general wasting
    • DX- endocervical aspiration, pap, biopsy

    Medical & surgical manag.- Hysterectomy, external & internal radiation therapy, chemo, uterus removed thru abd. ( radical hysterectomy) & vag.(lowers complications, recovery time, cost)

    Nurse: inform pt bout vaccine, to have exams reg., emotional support, option of tx

    pt teaching- take rx meds, inform if adverse effects, avoid heavy lifting, sex, douch until permited, ambulate w/ assistance, avoid sitting 4 long time, clean site, watch 4 signs of fever, redness, swellin, pain, drainage, vag. d/c & bleedin, odor, pain in chest, abd. legs, drink plenty of fluids to avoid constipation
  3. Ovarian cyst & abd. benign ovarian tumors
    cyst a membrane sac filled cells

    • P&E- unknown, endocrine dysfunction implicated, follicular cyst develope when ripenin ovum fails to b released or when corlus luteum fails to regress after ovulation & keep producing progesteron, can be reason 4 infertility & can become malignant
    • Chocolate cyst from endometrium
    • Assess: pressure of lower abd. backache, menstral irreg. & pain tht could b mistaken 4 appendicities, urethral stones, if influenced w/ hypothalamic, piturity, adrenal hormones could cause hirsutism(growth of facial hair)atrophy of breast, sterility
    • detected by pap, ultrasonography & laparoscopy 2 check size,

    Medical & surgical manag.- no tx, oral contraceptive, if cyst ruptures a oophorectomy(removal of ovary), oophorocystectomy(removal of cystic tissue), salping-oophorectomy(removal of ovary & follopian tube)

    nurse manag.- relieving menstral discomfort, referrals 2 support groups(infertility),surgery prep. assist w/ ambulation, inserting rectal tube, abd. binder, inform bout still risk 4 uterine cancer
  4. cancer of ovary
    from ovarian cyst, hereditary, the more we ovulate in lifetime the higher risk 4 cancer, Hx of other cancers increase risk,

    assess: lower abd. pain, frequent urination & urgency, acites, wt loss, bad pain, GI symptoms, mass felt durin exam, labs, ultrasound & doppler,

    Med. & surg. mang.- recommened to have 2 full-time preg. followed by breast feeding & usin oral contraceptives 4 more than 5 yrs, oooharectomy 4 pt w/ family hx after 35y/o, removal & HRT rx, chemo after surgery or radiation therapy
  5. cancer of vagina
    rare, mostly after 40yrs, bigger risk when HPV & STI, when moms were given DES in preg., upper posterior of vag. most affected

    Assess- bleedin, dyspareunia, confirmed by biopsy, & visual exam

    Med. & surg manag- laser photovaporation but partial or total vaginectomy possible, radiation therapy (complications- fistulas & bleeding)

    nurse manag- keep pt comfortable, change clothes & sheets reg., advise pt to tell daughters to have exam b/c of DES, inform to use lube when havin sex, using foreplay, to take slower pace when havin sex
  6. cancer of vulva
    curable if early DX, HPV & herpes 2 increases risk,happens in clit, labia majora & minora & bartholin glands, slow growing but could spread easily spread to suroundin areas

    Assess- pruritus, genital burnin, bloody d/c, enlarge lymph nodes, swellin, ulcerations, pain, masses

    med & surg manag- vulvectomy w/ or w/o removal of lymph nodes (radical vulvectomy), laser photovaporation if lesion >3mm, when not operable wet dressin & perineal irrigation w/ deoderizor, narcotics