MDC 3 Exam 1 Review

MDC 3 Exam 1 Review. Multidimensional Care.Uterine Leiomyoma  Benign, slow growing solid tumors of the muscle layer of the uterus (fibroids)  Excessive local growth of smooth muscle tissues o Growth may be stimulated by estrogen, progesterone, and growth hormone Assessment: asymptomatic or symptomatic (heavy prolonged vaginal bleeding)**  Assess pelvic pressure, elimination pattern, abdomen size, dyspareunia, infertility  Painful menses  Elimination patterns (due to enlarged fibroid pressing on organs)  Ask how many pads/tampons used in a day S/S: Heavy periods or periods that last a long time & abd distention, urinary frequency Psychosocial assessment:  Quality of life from dyspareunia  Fear that symptoms could be cancerous  Anxiety  Significance of loss of uterus for patient and partner if want to conceive Diagnostic assessment:  CBC – iron deficiency anemia from heavy bleeding  WBC would be normal  HGB and HCT – low  Pregnancy test to rule out uterine enlargement  Transvaginal US – able to see if fibroid is protruding into uterine cavity  Biopsy: gold standard Pelvic exam Planning and Implementation  Manage bleeding o Non-surgical management: oral contraceptive** o Surgical management:  MRI focused ultrasound-heat to tumor  Uterine artery embolization – starves tumor of circulation allowing it to shrink  Myomectomy- laser removal  Hysterectomy Erectile Dysfunction: causes & treatment  Common as one ages: reduced blood flow to penis Causes Medical causes: change in blood pressure Non-organic: increased stressor, illnesses Treatment  Medications that increase perfusion to penis (PDE- 5 inhibitors)  Vacuum pump  Pineal implant  Managing stress Education related to treatment for HPV/Cervical Cancer  Caused by HPV s/s of cervical cancer: o heavy bleeding in later stages o bleeding after sex o Most of the time asymptomatic Bleeding between periods Preventive screening: PAP smear, surgical biopsy (gold standard) to determine staging Treatment:  Early- ablation, laser  Late- chemotherapy/radiation Education:  No sticking anything up the vagina (tampons, douches)  May have bleeding  No sexual intercourse  No tub baths Breast cancer- preventative screenings, risk factors, diagnostic tests Preventative screenings  Mammography o Recommended to start screening at 45 o Women over 55 may switch to every 2 years  Breast self-awareness/self-examinations o 90% detected by patient  Clinical breast clinical o At least every 3 years for women in their 20s and 30s and every year for asymptomatic women at least 40 years old Risk Factors  Increased age  Family history  Early menarche, late menopause  Lack of breastfeeding  Postmenopausal obesity  Alcohol consumption  Mutations in BRCA1 or BRCA2 Diagnostic tests  Lab assessment: study of breast mass tissue and lymph nodes, liver enzymes, calcium, and alkaline phosphatase  Imaging assessment: o Mammogram o Ultrasound o MRI o Chest x-ray, CT for metastasis o Breast biopsy* Endometrial cancer- symptoms, risk factors, diagnostic testing  Most common gynecologic malignancy  Cancer of inner uterine lining  Grows slowly but vaginal bleeding usually leads to prompt evaluation and treatment = good prognosis  Most commonly associated with prolonged exposure to estrogen without its protective effects of progesterone Risk Factors:  Women in reproductive years  Family History  Diabetes Mellitus  HTN  Obesity  Uterine polyps  Late menopause  Nulliparity (no childbirths)  Smoking  Tamoxifen – given for breast cancer Symptoms:  Postmenopausal bleeding (how many pads/tampons a day)**  Watery, bloody vaginal discharge  Low back or abdominal pain  Low pelvic impaired comfort (describe exact location and intensity)  Pelvic exam may reveal palpable uterine mass** Diagnostic testing: o Transvaginal ultrasound* o Endometrial biopsy – gold standard “determine presence of endometrial thickening/cancer”**  Interventions o Pelvic exam Hysterectomies- what they are, who gets them, post-operative care, education  Total Hysterectomy -The entire uterus, including the cervix, is removed. The procedure may be vaginal or abdominal, with laparoscopic or robotic assistance.  Bilateral Salpingo-Oophorectomy (BSO)- Fallopian tubes and ovaries are removed.  Panhysterectomy - Total abdominal hysterectomy and BSO: The uterus, ovaries, and fallopian tubes are removed.  Radical Hysterectomy - The uterus, cervix, adjacent lymph nodes, upper third of the vagina, and surrounding tissues (parametrium) are removed.  Leiomyomas are the most common reason for hysterectomies Postoperative care  Assess vaginal bleeding  Abdominal bleeding at the incision site (a small amount is normal)  Intactness of the incision  Urine output per urinary catheter for 24 hours  Incisional or abdominal pain