Exam 1 Material : Renal Benign Uterine Tumors and Prolapses

Question 1

What are Leiomyomas?

Answer 1

Uterine fibroids

Basically benign smooth muscle tumors of uterus.

Question 2

True or false? Having Leiomyomas increases the risk for developing cancer?

Answer 2

FALSE

Question 3

Most patients with Leiomyomas are asymptomatic but there can be clinical manifestations. What are they?

Answer 3

Pelvic pain, pressure, abnormal uterine bleeding.

Question 4

What is the cause of Leiomyomas?

Answer 4

Unknown but there is a genetic predisposition

Question 5

True or false? Leiomyomas are dependent on estrogen and progesterone?

Answer 5

True. Thats why Leiomyomas grow slowly during reproductive years and then atrophy after menopause

Question 6

What diagnostic tests can be done for Leiomyomas?

Answer 6

Pelvic and/or transvaginal ultrasound

Question 7

What treatments can be done for Leiomyomas?

Answer 7

If asymptomatic = monitor patient

oral contraceptives

If tumor is large, fast growing or patient has heavy mentrual bleeding =

Hysterectomy or myomectomy

Uterine Artery Embolization = Injecting embolic material into the femoral arteries to cut off blood supply to the Leiomyomas and cause them to shrink.

Question 8

A child-bearing aged women has very large leiomyomas. What surgical procedure be done if the patient still want to bear children?

Answer 8

Myomectomy = only removing tumors.

Question 9

What are post-op nursing considerations for Leiomyoma patients?

Answer 9

Monitor femoral site for hematoma, bleeding. Keep them on bed for 3-6 hours post op

Patients post op can have lots of cramps. Consider PCA

Question 10

What is uterine prolapse?

Answer 10

Uterus displaces downward into the vaginal canal.

Question 11

What are the clinical manifestations of Uterine Prolapse?

Answer 11

Dyspareunia (painful intercourse)

Heavy feeling in pelvis

Feeling that there is something there

Lower Backache

Bowel and bladder problems (if rectocele and cystocele present)

Question 12

What care can be done for Uterine Prolapse patients?

Answer 12

Pessary (vaginal device to support uterus)

Surgery- vaginal hysterectomy and vaginal and underlying fascia repair

Kegel exercises = Improve pelvic muscles

Question 13

What is Cystocele and Rectocele?

Answer 13

Cystocele = Weakened support between bladder and vagina

Rectocele = Weakened support between rectum and vagina

Question 14

What are the clinical manifestations for Cystocele?

Answer 14

Incomplete bladder emptying

UTI

Question 15

What are the clinical manifestations for Rectocele?

Answer 15

Incomplete emptying of stool upon defecation

Question 16

What care can be done for Cystocele?

Answer 16

Kegel exercises

Pessary (for cystocele)
If left in for too long, lead to erosion and fistula and vaginal cancer
Should be taken out at least every 2 weeks for cleaning.

Surgery = Anterior colporrhaphy (meant to strengthen vaginal walls)

Pre-op: Douching/Enema and shaving perineal area
Post-op: Prevent wound infection and decrease pressure on the vaginal suture line.

Post op for Anterior: Using a foley cath and good cath care

NO SEXUAL INTERCOURSE after surgery until HCP says so
No heavy lifting, walking and limited sitting until HCP approval

Question 17

What care can be done for Rectocele?

Answer 17

Kegel exercises

Surgery = Posterior colporrhaphy (to strengthen vaginal walls)

Pre-op: Douching/Enema and shaving perineal area

Post-op: Prevent wound infection and decrease pressure on the vaginal suture line.

Post op for Posterior: Preventing constipation so high fiber diet. Use stool softeners.

NO SEXUAL INTERCOURSE after surgery until HCP says so

No heavy lifting, walking and limited sitting until HCP approval