Chapter 24 A Etiology and pathophysiology 1. Slow, malignant change in tissue-forming neck of uterus at squamocolumnar junction b. Sexually transmitted infections c. Exposure to human papillomavirus (HPV), human immunodeficiency virus (HIV), or herpes simplex virus (HSV) d. Erosions of cervix, often resulting from changes in pH that can be precursors of cancer e. Exposure to diethylstilbestrol (DES) in utero, which increases risk for vaginal cancer 3. High cure rate when diagnosed early 4. Tends to spread by direct invasion of surrounding tissues; metastasizes to lungs, bones, liver 1. Prevention: human papillomavirus vaccine (three doses between 11 and 12 years of age) 2. Type of surgical intervention depends on extent of lesion and client’s physical status a. Stage 0—carcinoma in situ, limited to epithelial layer c. Stage II—extends beyond cervix but not to pelvic sidewall d. Stage III—extends to pelvic sidewall and lower vagina 3. Hysterosalpingo-oophorectomy (panhysterectomy): removal of uterus, fallopian tubes, and ovaries; menstruation and ovarian function cease; in advanced lesions parametrial tissue and lymph nodes may be removed 4. Hysterectomy: removal of uterus; menstruation ceases but ovarian function continues 5. Internal or external radiation: reduce the lesion and limit metastasis; used alone or in conjunction with surgery 7. Cryosurgery: destruction of cells by freezing 8. Conization: removal of cone-shaped area of cervix while preserving reproductive functions 10. Chemotherapy (see Chapter 3, Integral Aspects of Nursing Care, Neoplastic Disorders, Related Pharmacology) 1. Assist client and family in coping with diagnosis of cancer 2. Allow and encourage client to express feelings and concerns about change in self image and sexual functioning 3. Support client’s feminine image 4. Provide care for client receiving internal radiation (see Chapter 3, Integral Aspects of Nursing Care, Neoplastic Disorders: Radiation and General Nursing Care of Clients with Neoplastic Disorders, common nursing interventions) a. Instruct client to maintain supine position with head of bed flat or only slightly elevated b. Inspect implant for proper position c. Provide low-residue diet and antidiarrheal agents to prevent bowel movements; insert indwelling urinary catheter to prevent displacement of radioactive substance and irradiation of adjacent tissues d. Explain need for isolation; explain to client and visitors that amount of time they can spend in the room will be limited to avoid overexposure to radiation; pregnant women and children should be restricted from visiting e. Use principles of time, distance, and shielding to minimize staff exposure f. Provide diversional activities for clients undergoing internal radiation 5. Provide care for client receiving chemotherapy (see Chapter 3, Integral Aspects of Nursing Care, Neoplastic Disorders, Related Pharmacology) 6. Provide care following surgery a. Maintain patency of urinary catheter inserted before surgery to decompress bladder and reduce stress on operative site b. Monitor for reestablishment of bowel sounds c. Maintain accurate intake and output d. After removal of urinary catheter, monitor amount of output and pattern of voiding; catheterize for residual urine and whenever necessary for urinary retention if ordered A Etiology and pathophysiology a. Localized overgrowths of endometrial glands and stroma that occur on cervix and in fundus of uterus; usually benign c. Occur more frequently in premenopausal women who are anovulatory 2. Uterine fibroids (e.g., leiomyomas, myomas, fibromas, fibromyomas) a. Benign tumors of uterine muscle b. Occur more frequently in African-American women and women who have not been pregnant 3. Endometrial cancer (e.g., adenocarcinoma, adenoacanthoma, adenosquamous carcinoma) a. Malignant overgrowth of uterine lining b. Risk factors: hormone replacement therapy (HRT), unopposed estrogen therapy, pelvic radiation, obesity, family history c. Most common malignancy of female reproductive system d. Occurs more frequently with hormone imbalance, obesity, nulliparity, late menopause, dysfunctional bleeding, anovulation, uninterrupted estrogen stimulation, diabetes mellitus, early menarche e. Occurs twice as often in Caucasian women than in African-American women f. Spreads by direct extension or metastasis to myometrium, vagina, and paracervical tissue g. Metastasizes to abdominal cavity, liver, lung, brain, bone; progression is slow and metastasis occurs late b. Excessive menstrual bleeding (menorrhagia) c. Signs of pressure from enlarging mass (e.g., low abdominal discomfort, backache, visceral displacement, constipation) d. Painful menstruation (dysmenorrhea) e. Problems with pregnancy (e.g., preterm labor, spontaneous abortion, dystocia) 1. Depends on type and extent of lesion or tumor, stage, and client’s physical status 2. Dilation and curettage (D&C) for polyps 3. Myomectomy or hysterectomy for benign neoplasms; hysterectomy results in no menstrual period; when surgery is not advisable, radiation therapy is employed 4. Total hysterectomy with bilateral salpingo-oophorectomy (panhysterectomy) for endometrial neoplasms; results in no menstrual periods and surgical menopause 5. Intracavitary radiation may be done before or after surgery, depending on stage of endometrial cancer 6. Hormonal therapy with progestins for endometrial cancer; HRT after panhysterectomy is controversial 7. Combination chemotherapy with antineoplastic drugs (e.g., cyclophosphamide [Cytoxan], DOXOrubicin, cisplatin [Platinol]) for endometrial neoplasms 1. Encourage healthy lifestyle, weight reduction if overweight, and routine pelvic examinations 2. Monitor fluid and electrolyte balance 3. Maintain patency of urinary catheter; monitor amount and characteristics of urine (blood in urine may indicate incisional tear in bladder; small voidings after catheter removal may indicate retention) 4. Encourage coughing and deep breathing at frequent intervals 5. Check for bowel sounds and gas pains; insert a rectal tube or administer a return flow enema (Harris flush) (see Chapter 8, Nursing Care of Clients with Gastrointestinal System Disorders, Related Procedures, Enemas) if ordered 6. Encourage frequent ambulation and elevation of extremities when sitting to prevent thrombophlebitis; apply antiembolism stockings if ordered 7. Provide emotional support; encourage ventilation of feelings 8. Teach to postpone driving for several weeks and to avoid sexual intercourse, strenuous exercise, and heavy lifting for 6 to 8 weeks 9. Provide care for client receiving chemotherapy or radiation (see Chapter 3, Integral Aspects of Nursing Care, Neoplastic Disorders: Related Pharmacology, Radiation, and General Nursing Care of Clients with Neoplastic Disorders) A Etiology and pathophysiology 1. Histologic cell types influenced by age a. Malignant germ cell tumors more frequent between 20 and 40 years of age b. Epithelial cell tumors more frequent in perimenopausal women 2. More common in Caucasian women than in African-American women; rare in Asian women 3. Incidence influenced by hormonal factors; environmental factors have been implicated but not proven 4. Risk factors: ovarian dysfunction, irregular menses, infertility, genetic predisposition (familial BRCA 1 or BRCA 2 mutations), endometriosis, early menopause, nulliparity 5. Rarely diagnosed early because abdominal cavity can accommodate an enlarging ovary without causing symptoms; poor prognosis because of advanced stage at initial diagnosis, which is usually stage II to IV 1. Subjective: vague, lower abdominal discomfort or pain; feeling of fullness; rapid satiation; dyspepsia; nausea 2. Surgical removal of tumor via oophorectomy, salpingo-oophorectomy, or panhysterectomy and removal of any involved structures; oophorectomy causes surgical menopause 3. Cytoreductive surgery to debulk poorly vascularized large tumors; the smaller the remaining tumor, the better the response to adjuvant therapy 4. Adjuvant therapy after tumor debulking A Etiology and pathophysiology 1. Trichomoniasis: caused by Trichomonas vaginalis, a protozoa 2. Candidiasis (moniliasis): caused by Candida albicans, a fungus; incidence is high in clients with diabetes mellitus and those receiving antibiotic therapy because of decreased bacterial flora 3. Bacterial vaginosis: caused by overgrowth of vaginal flora 4. Atrophic vaginitis: common in postmenopausal period 5. Contributing factors: oral contraceptive use, sexually transmitted infections (e.g., gonorrhea, HIV), allergic reactions 1. Subjective: pruritus, burning, dysuria, dyspareunia (pain with intercourse) (1) Malodorous, thin, yellow discharge (trichomoniasis) (2) White “cheesy” discharge (moniliasis) (3) Grayish-white discharge; malodorous (bacterial vaginosis) b. Vaginal smear may indicate T. vaginalis, C. albicans, or other microorganisms
Nursing Care Related to Major Disorders Affecting Women’s Health
Major Disorders Affecting Women’s Health
Cancer of the Cervix
Data Base
Nursing Care of Clients with Cancer of the Cervix
Planning/Implementation
Uterine Neoplasms
Data Base
Nursing Care of Clients With a Hysterectomy
Planning/Implementation
Cancer of the Ovary
Data Base
Vaginitis
Data Base
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