CHAPTER 10 Reproductive Disorders
Section One Gynecologic Disorders
Uterine Fibroids
Collaborative Management
Most fibroids decrease by 40%-60% at menopause, which is the natural end-point to their growth.
Gonadotropin-releasing hormone (GnRH) agonists
Decrease anemia and tumor size before surgery and thus allow use of optimal surgical techniques. Maximum effect is usually seen about 12 wk after start of medication, with an approximately 50% decrease in tumor size. However, regrowth to previous size occurs within 6 mo after discontinuation of these agents. Side effects include those found in hypoestrogenic states (e.g., bone demineralization, hot flashes, mood changes, vaginal dryness).
Nursing Diagnoses And Interventions
Acute pain
Nursing Interventions
♦ Evaluate for incisional pain as well as referred pain to the shoulders from the diaphragm resulting from accumulation of gas used during the procedure.
♦ Provide back rubs, which are especially helpful for patients who were in the lithotomy position during surgery.
Nursing Interventions
♦ Monitor VS q2-4h during first 24 hr. Be alert to indicators of hemorrhage and impending shock: hypotension, increased pulse and respirations, pallor, and diaphoresis.
♦ Assess postoperative bleeding q2-4h by noting amount and quality of drainage on dressings and perineal pads if abdominal approach was used or on perineal pads alone if vaginal approach was used. Normally, postoperative bleeding is minimal. It should be dark in color (or serosanguineous if an abdominal hysterectomy was performed).
♦ Inspect abdomen for distention, and assess patient for presence of severe abdominal pain; both are indicators of internal bleeding.
♦ Review complete blood count (CBC) values for evidence of bleeding: decreases in hemoglobin (Hgb) and hematocrit (Hct). Notify health care provider of significant findings. Optimal values are Hct 37% or greater and Hgb 12 g/dL or greater.
Nursing Interventions
♦ Monitor I&O, and document every shift. Notify health care provider if urinary output falls below 30 mL/hr for 2 hr in the presence of adequate intake. Along with low back pain or costovertebral angle tenderness, this sign can indicate ureteral ligation during surgery.
♦ Administer oral or parenteral fluids as prescribed. Ensure totals of 2-3 L/day in nonrestricted patients.
Nursing Interventions
♦ Anticipate patient’s concern about loss of uterus and “loss of womanhood.” Provide emotional support and an unhurried atmosphere for patient and significant other to ask questions and express concerns, frustrations, and fears.
♦ Recognize covert signs of grief that can accompany self-image disturbances: anger, withdrawal, demanding behavior, or inappropriate affect. Clarify patient’s coping behaviors to significant other as necessary.
Patient-Family Teaching and Discharge Planning
♦ Need to report signs of infection to health care provider: incisional swelling, local warmth around incision, fever, redness, purulent drainage, vaginal bleeding, odorous vaginal discharge, incisional or abdominal pain.
♦ Restriction of activities as directed, such as heavy lifting (more than 10 lb) and sexual intercourse. Advise patient to get maximum amount of rest and avoid fatigue.
♦ If ovaries were removed, risks and benefits of estrogen therapy and types available and management of symptoms such as hot flashes, weight gain, altered mood, and changes in sexual response.
♦ Medications, including drug names, dosage, purpose, schedule, precautions, and potential side effects. Also discuss drug/drug, herb/drug, and food/drug interactions.
♦ Phone numbers to call if questions or concerns arise following hysterectomy. Additional general information can be obtained by contacting the following organization.
Pelvic Organ Prolapse
Collaborative Management
Urinary catheterization
Empties a distended bladder. This is an emergency measure rather than a permanent correction.
Nursing Diagnoses and Interventions
Constipation
Nursing Interventions
♦ Administer stool softeners or mild laxatives as prescribed. Ensure that patient drinks a full 8-10 oz of water with each dose.
♦ Unless otherwise contraindicated, push fluids to at least 2500 mL/day or more. Explain that good hydration softens stool.
♦ Expect the patient to be on a low-residue diet during early postoperative period to minimize potential for disruption of surgical site. Subsequently consult health care provider about introducing high-residue foods to promote bowel movements.
♦ Instruct patient to avoid straining when having a bowel movement because this can disrupt surgical repair.
♦ Advise patient that defecation may be painful and to alert staff as soon as urge to defecate is felt so that patient can be medicated before the bowel movement.
Patient-Family Teaching and Discharge Planning
♦ Medications, including drug names, purpose, dosage, schedule, precautions, potential side effects, and drug/drug, herb/drug, and food/drug interactions.
♦ Activity restrictions during first 6 wk or as directed, including no heavy lifting (more than 10 lb) or strenuous exercises. Explain importance of abstinence from sexual intercourse for 6 wk or as prescribed if vaginal surgery was performed. Discuss alternate methods of sexual expression. Advise patient that initially coitus may be painful.
♦ If discharged with a suprapubic catheter, teach need to monitor postvoid residual (PVR) and how to attach tubing to a drainage bag overnight.
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