Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NUR 201 Week 13 > Hysterectomy/Reproductive Disorders > Flashcards

Hysterectomy/Reproductive Disorders Flashcards

1
Q

Uterine Disorders

  • Endometriosis
  • Leiomyomas, or fibroids
  • Cancer
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Endometriosis

  • Is endometrial tissue that plants itself outside the uterine cavity
  • 2 layers - endometrium & myometrium
    > Myometrium - muscle layer (myomectomy = removal of muscle layer)
    > Endometrium - what sheds monthly during menses
A
  • Most common implantation sites are pelvis, ovaries, & posterior rectal vaginal wall
  • Widespread dz
    ! Major concern is scarring, inflammation, & adhesion (affected organs stick together)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Relevant Cues: Clinical Manifestations

  • Pain (peaks right before onset of menstrual flow)
  • Infertility (esp if it affects the fallopian tubes or ovaries)
  • Dyspareunia
  • Menstrual irregularities
  • GI disturbances (like nausea, diarrhea, some pelvic tenderness)
A

Diagnostic

  • Health hx, pelvic exam
  • Laparoscope
  • US (transvaginal; to rule out masses)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Take Action: Treatment

  • NSAIDs (i.e., ibuprofen, naproxen)
  • OCP’s (i.e., low dose estrogen, progesterone [to shrink endometrial tissue])
  • regulate flow
  • decrease endometrium
  • help w/pain
  • Lupron/Synarel
    > can medically induce menopause & thereby suppress ovarian function
A
  • Calcium, magnesium supplements
  • Relaxation techniques
  • yoga, massage, biofeedback
  • Heat
  • Surgery
  • laparoscopically to remove endometrial tissue from areas outside uterine cavity

! decrease the pain; restore sexual or fertility function; alleviate anxiety; educate pts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

?

Are uterine tumors that arise from the myometrium

Are benign, slow growing, solid tumors of the uterine myometrium, the muscle layer of the uterus
- 20-30% women
- vary in size; if you have 1, probably have >1
- are probably stimulated by estrogen & progesterone; get bigger during pregnancy & shrink >menopause
- nulligravidas are @ higher risk but unsure why

A

Leiomyomas, or fibroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Relevant Cues: Clinical Manifestations

  • May be totally asymptomatic or very severe; depends on size of fibroid, location, & how many
  • Bleeding
  • Anemia
  • Dysmenorrhea
A
  • Pelvic pressure/back pain
  • Urinary retention/frequency
  • Infertility
  • Spontaneous abortions, miscarriages
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Diagnosis

  • Health history; pelvic exam
  • U/S (transvag)
  • Laparoscopic exam
  • CBC (to check for anemia d/t bleeding)
A

Take Action: Treatment

  • Hormone Therapy (HT)
  • Laser surgery
  • Myomectomy
  • Uterine artery embolization
  • Hysterectomy

What’s the woman’s desire for future fertility?

! Complications incl perforation, bleeding, & infection
All can be done outpt except for hysterectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which 2 procedures help preserve fertility?

A

laser surgery; myomectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Ovarian Disorders

Cancer
* Leading cause of death from female reproductive cancers
* 5th most common cancer in women
* Sx’s are vague & benign
> Survival rates are very low b/c we don’t detect it until late stage

A

Cysts
* Usually benign
* Lupron
- Rare >menopause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Ovarian Cancer Risk Factors

↠ Nulliparity
↠ H/o infertility
↠ Family hx
↠ Age (>40)
↠ Fertility rx’s (ovulation-stimulating rx’s)
↠ Use of baby talc

A

Relevant Cues: Clinical Manifestations

  • Persistent GI/GU disturbances (tumor enlarging & causing pressure against GI system & bladder)
  • Abd distention w/ascites
  • Inc abd girth
  • Urinary freq/urgency/pain/pressure
  • Malnutrition w/wt loss
  • Pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Take Action: Treatment

↠ Surgery
- remove tumor & ovaries; a hysterectomy may or may not be done
- surgery to dec estrogen
- will be putting the woman into a surgical menopause

A

↠ Chemotherapy
↠ Radiation
↠ Supportive therapies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Uterine (Endometrial) Cancer

  • Endometrial cancer is a reproductive cancer, of which adenocarcinoma is the most common type
    > is very curable if caught early; 80% of all cases of uterine ca
  • The main sx is bleeding:
    premenopausal heavy or irregular bleeding
    postmenopausal bleeding
A
  • Diagnostic assessment incl
    > CA-125 tumor marker
    > Cxr
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Endometrial Cancer Risk Factors

↠ Early onset of menarche
↠ Late menopause (are exposed to estrogen for a longer period of time)
↠ Obesity
↠ Nulliparity

A

↠ Reproductive cancers (i.e., if you have had ovarian ca)
↠ Tamoxifen use (for breast ca)
↠ Fhx
↠ DM
↠ HTN

! Common sites for metastasis are liver, lungs, & brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Endometrial Ca

  • Stages 1-4
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Stage ___

Cancer has spread beyond the uterus but remains confined to the pelvis, such as in bladder or rectum

A

3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Stage ___

Tumor is confined to the uterine corpus

A

1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Stage ___

Highest lvl of invasiveness b/c ca has spread beyond the pelvis, causing metastatic dz & large masses, like in the liver or lungs

A

4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Stage ___

In addition to the uterine corpus, ca has invaded the cervix

A

2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Relevant Cues: Clinical Manifestations

  • Bleeding (AUB, esp in postmenopausal women)
  • Pelvic pressure
  • Pain

↠ Dx = endometrial biopsy

A

Types of Hysterectomies

↠ Total hysterectomy
↠ Partial hysterectomy
↠ Panhysterectomy aka TAH-BSO
↠ BSO
↠ Radical hysterectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

?

Is the removal of the uterus & cervix; may be either vaginal or abdominal, w/ or w/o a laparoscope

A

Total hysterectomy

21
Q

?

The uterus is removed but the ovaries are retained esp if the woman is young to prevent menopause
- Cervix can be removed or retained
- Pt should receive ed to know what kinds of gyn exams will need yearly
> no pap smear but ovary palpation will be done

A

Partial (or subtotal) hysterectomy

22
Q

?

Is a total abdominal hysterectomy plus BSO (bilateral salpingo-oophorectomy
> fallopian tubes & ovaries

A

Panhysterectomy aka TAH-BSO

23
Q

?

Is a total hysterectomy; the uterus & ligaments (tissue fibers) that hold it in place
- cervix & an inch or 2 of the vagina around the cervix are also removed
- may or may not incl a BSO

A

Radical hysterectomy

24
Q

Potential Complications

A

DVT

> Prevent it w/early ambulation
May be wearing pneumatic boots & stockings to help w/circulation
Leg exercises; SC heparin or Lovenox

25
Q

Hemorrhage

> Assess vaginal bleeding postop
saturates >1 pad/hr ?
if a vaginal hysterectomy may not see a lot of bleeding d/t a lot of packing in place

! overly distended abd; tender to touch
! unstable VS; HTN; tachycardia

A

Infection

> Look @ abd or lap sites for S/S

  • vaginal packing in place for 24 hrs

> Look for infection from urinary catheter
- monitor I&O, temp
- encourage fluids
- check for UTI’s; is bladder emptying completely?
- look for hematuria; inability to void; infections appear ~48-72 hrs in

26
Q

Bladder dysfunction

  • any trauma or dysfunction?
  • inability to void; incomplete emptying of bladder; hematuria
  • Foley cath in for 24 hrs >surgery; urine color
A

Sexual dysfunction

  • d/t scarring, removal of uterus & cervix & poss part of vagina
27
Q

Constipation

  • d/t bowel manipulation
  • monitor bowel sounds, bowel function, & abd distention
  • inc warm fluids to inc peristalsis
  • early ambulation & Colace will help
A

Grief response

  • grief over the loss of a female reproductive organ; loss of womanhood
28
Q

Cervical Cancer

  • Preinvasive or invasive
  • Carcinoma in situ
A
  • is slow growing; if found early, prognosis is very good
29
Q

___ cancer

Has spread to other pelvic structures
- cervical ca is the 13th most common ca in women in the US

A

invasive

30
Q

___ cancer

Is ca just limited to the cervix

A

preinvasive

31
Q

?

Is the most advanced, pre-malignant stage

A

carcinoma in situ

32
Q

The earlier cervical dysplasia has no recognizable sx’s & is sometimes not visible even to trained providers

A

Most common sx 1st seen is vaginal bleeding in invasive cervical ca

33
Q

Cervical Cancer Risk Factors

  • HPV (leading cause)
    > Gardasil (3 inj series over 6 mos)
  • Multiple sexual partners
  • Early sexual intercourse
  • H/o STD’s
  • Smoking
  • Immunosuppression
  • Low socioeconomic status
  • Poor access to health care
A

Relevant Cues: Manifestations

  • Often asymptomatic
  • Classic sx - painless vaginal bleeding
  • Watery, blood-tinged vaginal d/c that may become dark & foul-smelling as the dz progresses
  • Unexplained wt loss, pelvic pain, dysuria, hematuria, rectal bleeding, CP, & cough
  • Leg/flank pain
    > leg pain is followed along the sciatic nerve & involves swelling of 1 leg; ca is growing & pressing on the sciatic nerve
    > flank pain is a late sign; is a sx of hydronephrosis, indicating that the ca has adv & is pressing on ureters, backing up urine into the kidneys
34
Q

Diagnostic Assessment

  • Pap smear
  • Colposcopy
  • Endocervical curettage
A
35
Q

?

Is the gold standard
- Done annually for all women during their reproductive yrs
- Should begin within 3 yrs >1st intercourse OR by age 21 & then annually
- Refrain from sex <
- No douching, tampons, or vaginal creams 48 hrs prior
- Not usually done during a menstrual flow; isn’t unusual to see sm amts of vag bleeding the 1st 24 hrs after

A

Pap smear

36
Q

?

The physician applies a thick acid solution to the cervix & then visualizes it w/magnification & a bright light to examine the cervical cells
> may take 1 or more bx’s @ this time
> might expect some dark vag bleeding or d/c 1-2 wks >

A

Colposcopy

37
Q

?

This is a scraping of the endocervical wall for biopsies

A

Endocervical curettage

38
Q

Treatment

  • Local Cervical Ablation (3 types)
    > LEEP
    > Cryosurgery
    > Laser
  • Cone biopsy
  • Hysterectomy
  • Radiation/chemotherapy
A
39
Q

LEEP

Loop electrical or electrocautery procedure
> newest & most common
> performed to excise cervical areas in question; under local anesthesia
> lesions totally removed by low voltage cautery
> rapid healing & less tissue damage

A

Cryosurgery

> uses freezing on affected surgical tissue
minimal s/e but can have vaginal d/c for 2-4wks following

40
Q

Laser

> Uses heat over cold
A laser beam is directed into the area to ablate ca cells

A

Care after a cervical ablation

  • no intercourse, tampons, douching, hot tubs for 2-3 wks after
  • avoid heavy lifting & report foul-smelling d/c, fever, or pain (d/c that lasts longer than a couple of wks might signify infections)
41
Q

Cone biopsy

  • a cone-shaped segment is removed
  • used to preserve reproductive ability
  • can be both diagnostic & treatment
A

Hysterectomy
> If the woman doesn’t desire fertility & it’s in adv stage

Radiation/chemotherapy
> For adv stage; can be done in combo

42
Q

?

Occurs when the pelvic organs relax & descend into the vagina
- involves the urethra, bladder, uterus, bowel, & rectum
- seen in older women
- women that’ve had mult childbirths w/extra large macrosomia infants or had prolonged pushing during childbirth

  • different grades (1-3) described by degree of descent of uterus
A

Urogenital displacement/prolapse; uterine prolapse

43
Q

Sx’s

Backache, pressure in pelvis, bowel, or bladder problems all common

A
44
Q

Grade ___

Uterus bulges farther into the vagina, & then the cervix protrudes through the entrance of the vagina

A

2

45
Q

Grade ___

Uterus bulges into the vagina, but the cervix doesn’t protrude through the entrance of the vagina

A

1

46
Q

Grade ___

Body of the uterus & cervix protrudes through the entrance of the vagina. Vagina actually turns inside out & it’s not uncommon in older women

A

3

47
Q

Cystocele [bladder] / Rectocele [rectum]

  • difficulty emptying bladder
  • urinary freq/urgency
  • UTIs
  • stress urinary incontinence
    > laughing, sneezing, peeing; women who laugh too hard, cough, sneeze loose a little urine, dribble a little urine
A
  • The elderly become dehydrated b/c they don’t drink. Don’t drink b/c they don’t want to pee
48
Q

?

Occurs where the rectum is displaced, causing bulging of the posterior vaginal wall
> constipation & hemorrhoids; fecal impaction
> feeling of rectal or vaginal fullness

A

Rectocele

49
Q

Treatment

  • Pessary
  • Kegel exercises
  • Surgery (anterior posterior repair)
A

NUR 201 Week 13 (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions