Care of a woman with gynaecological conditions Flashcards
What are the chief complaint symptoms?
- Pain ( lower abdomen ( cramps ) during menses )
- Vaginal bleeding :
- During or after intercourse
- In between menses - Vaginal discharge
- Unpleasant / unusual odour
- Unusual colour - Itchiness , burning, swelling, redness or soreness in the vaginal area
- Sore or lumps in the breasts or genital area
- Hot flashes and night sweats
What are the possible conditions?
- Dsymenorrheoa
- Pelvic Inflammatory Disease ( PID )
- Ectopic Pregnancy
- Vagnitis
- Urinary Tract Infection
- Menopause
- Carcinoma
Present health problem
- Onset of the problem : Duration, frequency
- Aggravating and relieving factors
- Associated symptoms
- Treatment, self care, outcome
Menstrual history
menarche, lengths of cycles, length and amount of flow, cramp or pain,
bleeding between periods or after intercourse, bleeding after
menopause
What are the key points to ask?
• Use of Contraception (Type and duration)
• Medical history: chronic illnesses, reproductive health; use of medications
• Surgical history: any operation including removal of structures of the
reproductive system undertaken?
• Obstetric history: number of pregnancies, outcome of pregnancies
• Family history: any genetic disorders
• Personal history (e.g. Smoking)
• Sexual history
What does the physical examination consists of?
• Breast examination
• Pelvic examination: Assessment of external and
internal structures
• Using vaginal speculum: pap smear, high vaginal
swabs, cultures
• Bimanual palpation:
cervix, uterus, fallopian tubes, ovaries.
What are the common diagnostic tests?
- Pregnancy test
- Swabs for culture
- Cervical smear
- Endometrial population
- Ultrasound pelvis
Pap smear
Direct sampling of tissues from the uterine cervix to detect nay malignant cells ( pre-invasive cancerous changes )
Culture and sensitivity
Culture is to detect any micro-organisms ( such as bacteria or a fungus ) that may cause an infection.
Sensitivity test is performed to find out what type of antibiotic could best to treat the infection
Follicle-stimulating hormone (FSH) , Luteinizing hormone ( LH ), Estrogen, Progesterone levels
- to find out of there is inadequate or excessive hormone levels to exclude certain hormones related gynaecological conditions
Thyroid and adrenal function tests
- To exclude any related gynaecological conditions that may cause
Alpha- fetoprotein ( AFP )
- to exclude liver cancer or yolk sac ovarian tumour
Human-chorionic gonadotropin ( hCG )
- for pregnancy or hydatidiform mole, choriocarcinoma
What are the invasive/ surgical procedures?
- Breast biopsy
- Endometrial biopsy
- Cervical biopsy, Conization of the cervix
- Dilation and curettage ( D & C )
- Laparoscopy
- Culdoscopy
- Colposcopy
What is breast biopsy?
It is also called a lumpectomy, an open biopsy.
It is a surgical procedure in which all or part of a lump is removed and treated for malignancy
Biopsy followed by pathological ( microscopic ) analysis is the only definitive way to determine the breast cancer
What is an endometrial biopsy?
- A catheter is inserted into uterus through the vagina to remove cells from uterine lining for examination
- To check for abnormal cells to see whether the hormone levels that affect the endometrium are in balance
What is punch biopsy?
The removal of cervix tissue to examine for presence of malignancy of the cervix
What is cone biopsy ( conization )?
The removal of cone-shaped tissue of the cervix for analysis of cancerous cells, or removal of diseased cervical tissue.
What are the nursing interventions after cervical biopsy?
• leave vaginal packing in place for about 12-24 hours.
• rest and avoid strenuous activity for 24 hours.
• abstain from intercourse, douching, and use of tampons for 2 weeks.
• take antibiotics as prescribed.
• monitor for vaginal bleeding, if heavy?
• monitor for a malodorous discharge which may last for three weeks, daily
shower is helpful.
Dilution and curettage ( D & C )
- Diagnostic and therapeutic.
- The cervix is dilated to scrape the lining of the uterine cavity with a curette.
Nursing intervention:
• Provide sterile perineal pads and record amount of drainage
• Encourage a voiding to prevent urinary retention
• No intercourse, douching and tampon for 2 weeks
What is laparoscopy?
• Visualization of the pelvic structures with a lighted laparoscope inserted
through the abdominal wall.
• Diagnostic use: e.g. pelvic
inflammatory disease (PID).
• Therapeutic uses: removing a damaged or diseased organ.
• a faster recovery time, less pain after the operation, minimal scarring.
What is culdoscopy?
Culdoscopy is a type of vaginal sterilization procedure
• Visualization of the ovaries,
fallopian tubes, and uterus with a lighted instrument inserted through the posterior vaginal
fornix .
• Good for obese patients
• Nursing intervention: after the procedure, position patient on her side or supine to expel air.
What is colposcopy?
- visualization of the cervix with an instrument that magnifies tissue.
What are the other tests?
- Hysterosalpinogram
- Ultrasonography
- Mammography
- Thermography
- CT, MRI
Hysterosalpinogram
Hysterosalpingography (HSG) is an X-ray procedure that is used to view the inside of the uterus and fallopian tubes. It often is used to see if the fallopian tubes are partly or fully blocked. It also can show if the inside of the uterus is of a normal size and shape.
- dye ( called contrast material ) is injected through a tube inserted into the uterus. A series of x ray pictures are taken.
Diagnosis :
- Infertiity
- Internal abnormalities e.g. polyps, fibroids or other tumors
What is ultrasonography?
The sound waves make echoes that form pictures of the tissues and organs on a computer screen (sonogram).
A sound frequency that reflects an image of the breast, pelvic
structures for confirmation of tumours.
Mammography
The sound waves make echoes that form pictures of the tissues and organs on a computer screen (sonogram).
