Gynecologic Problems PDF

gynecologic problems Professor Marissa Ferrentino, msn rn Student Learning Outcomes  Describe pathophysiologic conditions and signs and symptoms associated with the various types of gynecological disorders  Identify appropriate nursing interventions and rationales for the care of the patient with...

gynecologic problems Professor Marissa Ferrentino, msn rn Student Learning Outcomes  Describe pathophysiologic conditions and signs and symptoms associated with the various types of gynecological disorders  Identify appropriate nursing interventions and rationales for the care of the patient with gynecological disorders  Discuss the various diagnostic testing for the patient with gynecological disorders  Explain the common medical treatments for gynecological disorders  Formulate a nursing care plan for patients with gynecological disorders Pelvic Inflammatory Disease (PID)  Infectious condition of the pelvic cavity  May Involve:  Fallopian Tubes- salpingitis  Ovaries- oophoritis  Pelvic peritoneum- peritonitis  Untreated cervical infection  Women at higher risk should be routinely checked Pelvic Inflammatory Disease (PID)  Clinical Manifestations  Lower abdominal pain  Walking or movement can increase pain  Pain with intercourse  Spotting after intercourse  Purulent cervical or vaginal discharge  Fever and chills  Pelvic (adnexal) tenderness  Positive cervical motion tenderness Pelvic Inflammatory Disease (PID)  Diagnostic tests  Pelvic exam for N. gonorrhoeae and C. trachomatis  Pregnancy test  Vaginal ultrasound  Lab values  Treated on outpatient basis  Antibiotics  No intercourse for 3 weeks  Partner examined and treated  Rest & oral fluids  Reevaluation in 48-72 hours Pelvic Inflammatory Disease (PID)  Acute care hospitalization  Intravenous antibiotics  Corticosteroids  Applications of heat to lower abdomen  Sitz baths  Bed rest-semi-Fowler’s position  Analgesics  Intravenous fluids  Surgery Pelvic Inflammatory Disease (PID)  Nursing management  Teach women about the risks associated with multiple sexual contacts.  Use of a condom  Teach perineal care. Wipe from front to back  Do not douche. Monitor vaginal discharge  Avoid intercourse when symptoms present  Provide psychological support  Proper hand washing when in contact with perineal pads and vaginal discharge  Clean underwear Pelvic Inflammatory Disease (PID)  Complications  Septic shock  Perihepatitis  Tubo-ovarian abscess  Peritonitis  Embolisms  Adhesions and strictures  Ectopic pregnancy  Infertility Practice Question A nurse is caring for a 28-year old female patient diagnosed with pelvic inflammatory disease. The nurse is teaching the patient about potential complications associated with PID. Which statement made by the patient would indicate a need for further education? a. “I know that PID can lead to infertility if left untreated.” b. “I understand that PID can cause chronic pelvic pain.” c. “I am aware that PID can lead to an ectopic pregnancy.” d. “I should avoid sexual activity until only my symptoms resolve completely.” Endometriosis  Presence of normal endometrial tissue in sites outside the endometrial cavity.  Tissue responds to the hormones of the ovarian cycle and undergoes a “minimenstrual cycle” Endometriosis  Etiology and Pathophysiology  Unknown  Retrograde menstrual flow passes through the fallopian tubes carrying viable endometrial tissues into the pelvis. The tissues attach to various sites  Abnormal tissue spread through the lymph system or bloodstream  There is an increased sensitivity and production of prostaglandins, which are released prior to onset of menses.  Genetic predisposition  Diagnostic  History and physical, Pelvic exam-bimanual exam, laparoscopy with biopsy, MRI Endometriosis Endometriosis  Clinical Manifestations  Symptoms vary with the location of endometrial tissue.  Dysmenorrhea  Irregular bleeding  Pelvic pain  Dyspareunia  Infertility Endometriosis Treatment Depends on extent of disease, desire for pregnancy, and presence of symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs) Oral contraceptives GnRH agonist (leuprolide (Lupron) Surgery Assess patient for pregnancy before initiating therapy Monitor for dysrhythmias, palpitations Instruct patient to use nonhormonal contraceptive measures during therapy Endometriosis  Nursing Management  Educate the patient about the disease process.  Provide information about drug and pain relief measures.  Provide preoperative and postoperative care in association with surgery (Hysterectomy)  Educate about watching menstrual cycle.  Provide Psychological Support Practice Question Which clinical manifestation observed in a patient would typically be associated with endometriosis? a. Hot flashes b. Dysuria c. Excessive bleeding during menses d. Bones loss Practice Question If a young patient with a new diagnosis of endometriosis is provided care in the provider’s office, which treatment would the nurse initially anticipate? a. Aromatose inhibitors b. Oral contraceptive pills c. Immunotherapy d. Gonadotropin-releasing hormone agents Benign Tumors of the Female Reproductive System  Leiomyomas (uterine fibroids)  Ovarian Cysts Leiomyomas (uterine fibroids)  Benign smooth-muscle tumors that occur in the uterus, within the endometrium, within the muscles of the uterus or outside on the surface of the uterus.  Child-bearing years  Clinical Manifestations  None  Abdominal and pelvic pain  Abnormal uterine bleeding  Painful sexual intercourse, pressure or dysuria or frequent urination.  Constipation Leiomyomas (uterine fibroids)  Diagnosis based on pelvic findings and ultrasound results  Treatment- depends on symptoms, patient’s age, desire to bear children, and location and size of tumors Oral contraceptives Surgery-hysterectomy or myomectomy Uterine artery embolization (UAE) Ovarian Cysts  Polycystic Ovary Syndrome (PCOS)  Chronic disorder in which many benign cysts form on the ovaries  Women under 30  Causes infertility  Etiology  Hormonal abnormalities which ovaries produce estrogen and excess testosterone but not progesterone  Fluid-filled cysts develop from mature ovarian follicles-fail to rupture each month. Ovarian Cysts  Clinical Manifestations  Irregular menstrual periods, amenorrhea, hirsutism and obesity  Pelvic ultrasound-enlarged ovaries with multiple small cysts Ovarian Cysts Management  Medications  Oral contraceptives-regulating menstrual cycles  Spironolactone (Aldactone)-hirsutism  Metformin (Glucophage)- reduces hyperinsulinemia, improves hyperandrogenism and restores ovulation  Flutamide and a GnRH agonist (leuprolide)-hyperandrogenism  Clomiphene (Clomid)-induce ovulation  Notify physician if lower abdominal pain occurs or pregnancy is suspected  Surgery  Education  Weight management, exercise, monitor lipid and fasting glucose levels, manage stress Practice Question Which nursing intervention is the highest priority for a patient diagnosed with an ovarian cyst experiencing sudden onset of severe lower abdominal pain and signs of hypovolemic shock? A. Administering analgesics as ordered. B. Providing emotional support to the client and family. C. Assessing vital signs and initiating fluid resuscitation. D. Preparing the client for diagnostic imaging studies. Practice Question A patient with a history of polycystic ovarian syndrome (PCOS) presents to the clinic reporting sudden weight gain, irregular menstrual cycles, and excessive facial hair growth. The nurse understands that these symptoms are most likely associated with which complication of PCOS? A. Ovarian torsion B. Ovarian hyperstimulation syndrome (OHSS) C. Endometriosis D. Hyperandrogenism Cancers of the Female Reproductive System Cervical, Endometrial, Vaginal & Ovarian Cancer Cervical Cancer  Cervix is lower third of the uterus that projects into vagina; lines uterine cavity and endo-cervical canal.  Hispanic women and black women  Risk factors  Diagnosis: Pap Smear & HPV test  Recommended routine pap smear and hpv testing  Colposcopy Cervical Cancer Clinical Manifestations  Asymptomatic  Vaginal discharge  Increases in amount, watery then dark & foul smelling discharge  Irregular intermenstrual bleeding  Spotting initially, then heavier and more frequent bleeding  Pain  Weight loss  Anemia  Cachexia Cervical Cancer Management  Vaccines against HPV  Recommendation for females and males at 11-12 years  Given IM two or three times over a 6-month period  Gynecologic Oncologist  Surgery  Cone biopsy or trachelectomy, hysterectomy, pelvic extenteration  Advanced disease-Bevacizumab, a targeted therapy drug along with Cisplatin-based chemotherapy Endometrial Cancer  Most common GYN cancer  Low mortality rate  Exposure to estrogen  Average age for diagnosis is 60  Risk factors  No routine screening – endometrial biopsy for dx Endometrial Cancer Management  Clinical Manifestations  Asymptomatic  Postmenopausal bleeding  Treatment  Total hysterectomy and bilateral salpingo-oophorectomy with node biopsies and external radiation  If later stages may need chemo and hormone therapy Ovarian Cancer  Malignant tumor of the ovaries  Fifth leading cause of death in women in the United States  Risk factors: family history, BRCA gene, never been pregnant  Diagnosis  Tumor marker CA-125  Ultrasound  Yearly exams Ovarian Cancer Clinical Manifestations  Early signs Vague Pelvic or abdominal pain Bloating Urinary urgency or frequency Difficulty eating or feeling full quickly  Late signs Increased abdominal girth with ascites Unexplained weight loss or gain Menstrual changes Ovarian Cancer Management  Prophylactic removal of ovaries and fallopian tubes  OCP’s  Surgery- total abdominal hysterectomy and bilateral salpingooophoectomy with omentectomy and removal as much tumor as possible  Intraperitoneal and systemic chemotherapy  Targeted therapy  Intraperitoneal instillation of radioisotopes  External abdominal and pelvic radiation therapy Nursing Management for Cancers  Health promotion- Routine screening Pelvic examination and Pap test Teach about risk factors for cancer  Acute intervention related to surgery Assess anxiety, fears, anger, guilt etc Prepare preoperatively Postoperatively  Assess abdominal dressing and perineal pad  Assess for urinary retention  Assess abdominal distention  Prevent DVT- Teach activity restrictions Practice Question A 25-year old patient presents to the clinic for their annual gynecological examination. This clinic does not have access to HPV screening. The patient’s last Pap smear was at the age of 21. What should the patient have done today? a. Breast exam, pelvic exam, pap smear b. Breast exam, pelvic exam, pap smear with HPV testing c. Breast exam, pelvic exam and HPV testing d. Breast exam and pelvic exam Practice Question The nurse recognizes that which virus leads to an increased risk for cervical cancer? a. Cytomegalovirus b. Herpes simplex virus c. Human parvovirus d. Human papillomavirus Practice Question The nurse is most concerned about a 60-year old female patient when they call complaining of which of the following? a. Vaginal itching b. A foul vaginal discharge c. Hot flashes at night d. Vaginal bleeding Problems with Pelvic Support Uterine Prolapse, Cystocele/Rectocele, Fistula Practice Question Which assessment finding would the nurse expect in a patient diagnosed with pelvic organ prolapse? A. Increased urinary frequency and urgency. B. Irregular menstrual cycles. C. Decreased vaginal discharge. D. Hypertension and tachycardia. Uterine Prolapse  Downward displacement of the uterus into the vaginal canal  1st, 2nd or 3rd degree  “feeling of something coming down”  Dyspareunia  Stress incontinence  Backache  Pelvic strengthening exercises  Use of a pessary  Surgery Cystocele/Rectocele  Cystocele  Support between the vagina and bladder is weakened  Emptying the bladder is difficult  Bladder infections  Rectocele  Weakening between the vagina and rectum  Emptying the rectum is difficult  Collaborative Care  Kegel exercises, pessary, surgery Nursing Management for Pelvic Organ Prolapses  Teaching Kegel exercises  Preoperative teaching Cleansing douche in the morning of surgery Cleansing enema (rectocele)  Postoperative Prevent infection-perineal care, hand hygiene Ice pack, Sitz baths Indwelling care for cystocele- 4 days High fiber diet Stool softener for rectocele Avoid heavy lifting, prolonged standing, walking or sitting Avoid sexual intercourse until seen by the physician Fistula  Abnormal opening  Most commonly caused by GYN procedures  Can resolve on its own  Surgery  Perineal hygiene Q 4 hours  Indwelling catheter for 7-10 days  Adequate fluid intake Practice Question Which nursing intervention is most appropriate for a patient experiencing pelvic organ prolapse? A. Encouraging the client to perform Kegel exercises. B. Administering diuretics to decrease urinary frequency. C. Instructing the client to avoid lifting heavy objects. D. Advising the client to increase intake of caffeine-containing beverages. References Lewis, S., Heitkemper, M., Dirksen, S., O’Brien, P., & Bucher, L. (2020). Medical surgical nursing, 11th edition, St. Louis: Mosby/Elsevier.