2211: Unit 11
Nursing management – Female reproductive problems pt. 2
1) External Radiation Therapy
- A source outside the body delivers electromagnetic radiation in the form of waves
2) Internal Radiation Therapy (Brachytherapy)
- High dose radiation is placed near or into the tumour
- The dose decreases sharply as distance from source increases = this causes less damage to surrounding
healthy tissue
- Many forms = wires, capsules, needles, tubes, seeds
- Isotopes used = Radium and cesium
- Used in Cervical and endometrial cancer
(due to accessibility of these body parts and favourable results)
- Preparing the for treatment:
o Nurse gives cleansing enema to prevent straining at stool (bc this cane displace the isotope)
o Indwelling catheter is inserted to prevent distended bladder from contacting radioactive source
o Applicator is inserted into endometrial cavity & vagina in the OR
If the applicator contains the radioactive material it is called preloading
If applicator is implanted in the OR but not loaded with anything, until it is in correct placement
and the pt returns to her room, it is called after loading
Radiation exposure to the staff in the implantation is reduced when afterload technique is used
o Applicator is secured with vaginal packing and left in place 24-72 hrs
- During the treatment:
o Pt placed in a lead-lined private room – absolute bed rest
o She can be turned side to side
o Intrauterine applicator produces uterine contractions that may need analgesics
o Destruction of cells causes foul-smelling vaginal discharge – may need deodorizer
o Nausea, vomiting, diarrhea and malaise – may be a systemic rxn to radiation
- At the end of treatment, the radioactive material and catheter are removed
- Bed rest period ends, and pt is discharged from hospital
- Late complications:
o Fistula = vesico-vaginal or utero-vaginal
o Cystitis
o Phlebitis
o Hemorrhage
o Fibrosis = vaginal wall becomes smaller in diameter and shorter
o Dilation of vagina thru intercourse
- Pt must report unusual symptoms or complaints
, FEMALE REPRODUCTIVE SYSTEM CANCER – NURS MANAGEMENT
Assessment
- Malignant tumours of female reproductive system are found in = cervix, endometrium, ovaries, vagina,
vulva
- Variety of clinical manifestations = leukorrhea, vaginal discharge, irregular vaginal bleeding, abd pain
and pressure, bowel and bladder dysfunction, vulvar itching and burning
Diagnoses
- Anxiety related to threat to current status, threat of death (cancer diagnosis)
- Acute pain related to biological injury agent (enlarging tumour)
- Disturbed body image related to alteration in self-perception (loss of body part, loss of good health)
- Ineffective sexuality pattern related to insufficient knowledge about alternatives related to sexuality
(fatigue, physiological limitations)
- Grieving related to poor prognosis of advanced disease
Planning (goals)
1) Pt will actively participate in treatment decisions
2) Achieve satisfactory pain and symptom management
3) Recognize and report problems promptly
4) Maintain preferred lifestyle as long as possible
5) Continue to practise cancer detection strategies
Implementation
1) Health promotion
- Teach the importance of routine screening for cancers of reproductive system (women)
- Pelvic exams and Pap tests identify lesions on the vulva, uterine or ovarian irregularity, and cervical
cancer
- HPV = Vaccine against cervical cancer (best administered age 9-13)
- Cancer may be prevented if precancerous conditions are revealed
- Can be identified in early stage
- If identified earlier, treatment can be more conservative, and prognosis improves
- Educate about risk factors for cancers of reproductive system
- Limit sexual activity during adolescence, use condoms, fewer sexual partners, don’t smoke = reduces
risk of cervical cancer
- If high risk behaviour is identified, nurses must help with lifestyle changes to decrease risk
2) Acute intervention related to surgery
- Pts can experience anxiety, guilt, anger, annoyed, relieved or embarrassment around gyno surgery
- They may be worried on the effect of surgery on reproductive and sexual functions
- They may be relieved at thought of no longer getting periods or becoming pregnant
- Nurse needs to understand pt’s fears and concerns – listen, provide psych support
Nursing management – Female reproductive problems pt. 2
1) External Radiation Therapy
- A source outside the body delivers electromagnetic radiation in the form of waves
2) Internal Radiation Therapy (Brachytherapy)
- High dose radiation is placed near or into the tumour
- The dose decreases sharply as distance from source increases = this causes less damage to surrounding
healthy tissue
- Many forms = wires, capsules, needles, tubes, seeds
- Isotopes used = Radium and cesium
- Used in Cervical and endometrial cancer
(due to accessibility of these body parts and favourable results)
- Preparing the for treatment:
o Nurse gives cleansing enema to prevent straining at stool (bc this cane displace the isotope)
o Indwelling catheter is inserted to prevent distended bladder from contacting radioactive source
o Applicator is inserted into endometrial cavity & vagina in the OR
If the applicator contains the radioactive material it is called preloading
If applicator is implanted in the OR but not loaded with anything, until it is in correct placement
and the pt returns to her room, it is called after loading
Radiation exposure to the staff in the implantation is reduced when afterload technique is used
o Applicator is secured with vaginal packing and left in place 24-72 hrs
- During the treatment:
o Pt placed in a lead-lined private room – absolute bed rest
o She can be turned side to side
o Intrauterine applicator produces uterine contractions that may need analgesics
o Destruction of cells causes foul-smelling vaginal discharge – may need deodorizer
o Nausea, vomiting, diarrhea and malaise – may be a systemic rxn to radiation
- At the end of treatment, the radioactive material and catheter are removed
- Bed rest period ends, and pt is discharged from hospital
- Late complications:
o Fistula = vesico-vaginal or utero-vaginal
o Cystitis
o Phlebitis
o Hemorrhage
o Fibrosis = vaginal wall becomes smaller in diameter and shorter
o Dilation of vagina thru intercourse
- Pt must report unusual symptoms or complaints
, FEMALE REPRODUCTIVE SYSTEM CANCER – NURS MANAGEMENT
Assessment
- Malignant tumours of female reproductive system are found in = cervix, endometrium, ovaries, vagina,
vulva
- Variety of clinical manifestations = leukorrhea, vaginal discharge, irregular vaginal bleeding, abd pain
and pressure, bowel and bladder dysfunction, vulvar itching and burning
Diagnoses
- Anxiety related to threat to current status, threat of death (cancer diagnosis)
- Acute pain related to biological injury agent (enlarging tumour)
- Disturbed body image related to alteration in self-perception (loss of body part, loss of good health)
- Ineffective sexuality pattern related to insufficient knowledge about alternatives related to sexuality
(fatigue, physiological limitations)
- Grieving related to poor prognosis of advanced disease
Planning (goals)
1) Pt will actively participate in treatment decisions
2) Achieve satisfactory pain and symptom management
3) Recognize and report problems promptly
4) Maintain preferred lifestyle as long as possible
5) Continue to practise cancer detection strategies
Implementation
1) Health promotion
- Teach the importance of routine screening for cancers of reproductive system (women)
- Pelvic exams and Pap tests identify lesions on the vulva, uterine or ovarian irregularity, and cervical
cancer
- HPV = Vaccine against cervical cancer (best administered age 9-13)
- Cancer may be prevented if precancerous conditions are revealed
- Can be identified in early stage
- If identified earlier, treatment can be more conservative, and prognosis improves
- Educate about risk factors for cancers of reproductive system
- Limit sexual activity during adolescence, use condoms, fewer sexual partners, don’t smoke = reduces
risk of cervical cancer
- If high risk behaviour is identified, nurses must help with lifestyle changes to decrease risk
2) Acute intervention related to surgery
- Pts can experience anxiety, guilt, anger, annoyed, relieved or embarrassment around gyno surgery
- They may be worried on the effect of surgery on reproductive and sexual functions
- They may be relieved at thought of no longer getting periods or becoming pregnant
- Nurse needs to understand pt’s fears and concerns – listen, provide psych support
