Genital Urinary System

1. Genital Urinary System Female Reproductive System Part 3

2. Cancer of the Cervix Pathophysiology • Predominantly Squamous cell cancer • Age 30 – 45

3. Cancer of the Cervix • Risk factors • Multiple sex partners • Early age at first coitus • Sex with men whose partner have had cervical cancer • Human papillomavius virus - HPV • STD • Causes warty growths • Smoking

4. Cancer of the CervixClinical Manifestations • Early • Asymptomatic • Late symptoms • Discharge • h • Watery • Dark • Foul-smelling

5. Cancer of the CervixClinical Manifestations • Late symptoms • Irregular bleeding • Leg pain • Dysuria • Rectal bleeding • Edema of extremities

6. Cancer of the Cervix • Advanced disease should not occur if all women have access to gynecologic care or avail themselves of it.

7. Cancer of the Cervix Assessment and diagnostic findings • Pap smear • x-ray • Colposcopy • Biopsy

8. Cancer of the Cervix Medical management • CRYOTHERAPY • Surgery • Hysterectomy • recurrence is 35% • Radiation

9. Cancer of the uterus Pathophysiology • Cancer of the uterine endometrium

10. Cancer of the uterus Risk factors • Age: >55 yrs • Postmenopausal bleeding • Obesity • Unopposed estrogen tx • Nulliparity / • Infertility

11. Cancer of the uterus Assessment • Irregular bleeding evaluated promptly • Endometrium aspirations / biopsy • Ultrasound

12. Cancer of the uterus Medical management • Hysterectomy

13. Cancer of the Ovary Pathophysiology • About 75% detected in the late stage – with metastasizes • Age 50-59 • Risk factors • Nulliparity • Infertility

14. Cancer of the Ovary Clinical Manifestations • habdominal girth • pelvic pressure • bloating • flatulence • hwaist size • leg pain • VAGUE

15. Cancer of the Ovary Assessment and diagnostic findings • Pelvic exams do not detect ovarian cancer • Pelvic imaging are not definitive

16. Cancer of the Ovary Medical management • Surgical removal • Chemotherapy • Radiations

17. Hysterectomy • Hysterectomy is the surgical removal of the uterus • Total hysterectomy: removal of uterus & cervix • Sub-total hysterectomy: Removal of the uterus, but not the cervix

18. Radical hysterectomy: Removal of uterus, vagina (upper 1/3) pelvic lymph nodes, fallopian tubes, & ovaries • Usually performed d/t malignant conditions

19. Hysterectomy Hysterectomy’s why? • Cancer • Dysfunctional uterine bleeding • Endometriosis • Non-malignant growths • Prolapse

20. Hysterectomy Variety of approaches • Vaginal • Abdominal • Laproscopically • Vaginal hysterectomy

21. Hysterectomy Pre-op management • Shave? • Empty bladder • Empty bowels • Douche

22. A client has been admitted to the hospital the day before she is scheduled for an abdominal hysterectomy. Nursing responsibilities for the preoperative period would include notifying the physician if the • Erythrocyte count is 6 million/cu mm. • Urine report indicates ketonuria. • Temperature is 99.6 degrees F orally. • Hemoglobin is 14 gm/100 ml.

23. Hysterectomy • Anxiety related to the diagnosis of cancer, fear of pain, possible perception of loss of femininity, and disfigurement • Educate • Support

24. Hysterectomy Disturbed body image r/t alt. fertility & fear about sexuality & relationships with partner & family • Discuss changes • Orgasm

25. Which of the following stressors affect self-concept? (Select all that apply.) • Declining mental, physical, or sensory abilities • Relationship concerns • Unrealistic ideal self • Realistic Role Expectations

26. Hysterectomy Acute pain related to surgery and other adjuvant therapy AMB statement, guarding, grimacing, not ambulating. • Asses pain • Administer: analgesics • Teach alternatives • Relaxation tx • Early ambulation • Heat

27. Potential Complications • Hemorrhage • Deep Vein Thrombosis • Bladder disfunction

28. Hysterectomy • Hemorrhage • Assess # pads • Assess Vital Signs • Educate on activity restrictions

29. Hysterectomy • Deep vein thrombosis • Prevention • Elastic compression stockings • Early amb.

30. Hysterectomy • Deep vein thrombosis • Assess of DVT’s • Phlebitis • Leg pain • Red • Warm • edema

31. Hysterectomy • Deep vein thrombosis • Assess for PE • Chest pain • h pulse • Dyspnea

32. Hysterectomy Bladder dysfunction (urinary retention) • I&O • Assess Bladder distention • Stim. Bladder • Cold to abd. • Stoke inner thigh • Running H2O • Privacy • Position • Time • Catheter

33. True or false. Following a hysterectomy, ambulation should be discouraged. • True • False

34. On a follow-up visit after having a vaginal hysterectomy, a 32-year-old patient has a decreased hematocrit level.  Which of the following complications does this suggest? • Hematoma • Hypovolemia • Infection • Pulmonary embolus (PE).

35. A 36-year-old woman who underwent a hysterectomy 4 days ago says to the nurse, "I wonder if I'll still feel like a woman." Which response would most likely encourage the patient to expand on this and express her concerns in more specific terms? • "When did you begin to wonder about this?“ • "Do you want more children?“ • "Feel like a woman...?“ • Remaining silent

36. Breast Cancer - FYI • 212,000 women/ year • 1,700 men/ year • 41,000/ year die • Women 1:8 chance of developing it

37. Breast Cancer • Risk Factors • (No single specific cause) • Gender • Women (99%) • Age • >50 years • Personal history • (Past breast cancer) • Hormonal factors • Early menarche • Nulliparity • Late menopause • Obesity • Alcohol use • **No evidence that oral contraceptives increase risk!

38. Breast Cancer • Characteristics • Can occur anywhere • Most common • Upper outer quad • Non-tender • Fixed • Hard • Irregular boarders • Advanced signs • Skin dimpling • Nipple retraction • Skin ulceration

39. Surgical management • Modified Radical Mastectomy • Removal of • All breast tissue • Nipple-areola • Axillary lymph nodes • Not removed • Pectoralis major muscles • Pectoralis minor muscles • Total Mastectomy • Removal of • Breast • Nipple-areola • Nor removed • Axillary lymph nodes • Muscles groups

40. Breast Conservation Treatment • AKA: • Lumpectomy • Partial or segmental mastectomy • Remove tumor • May include axillary lymphs

41. Mastectomy Pain: • Assess: • Administer • Opiod analgesics • Oxycodone & acetominaphen (Percocet) • Propoxyphene & acetominaphen (Darvocet) • Non-Rx • Warm showers • Position arm • Distraction technique • Report • Excruciating pain

42. Mastectomy Impaired skin integrity • Drainage tubes in place • Patency of tubes • Hematoma • Ice pack

43. Mastectomy Risk for infection • Drainage tube duration • Drain 7-10 d • Teach • empty & strip/milk • Incision care • S&S of infection • Foul smell drainage • Temp >100 • No lotion/cream until completely healed

44. Mastectomy • Disturbed Body Image • SUPPORT! • View with them 1st time • Normal feelings • Asses degree of self-esteem disturbance • Arrange for visitor from support group • Provide info about prosthesis • Assist pt. to verbalize feeling • Enc open communication with S/O • Answer questions • Counseling • Community resources

45. Mastectomy • Impaired sensory perception r/t sensation in arm, breast or side • (Tightness, pulling burning, tingling in chest wall, axilla, upper arm) • hwith healing  last mo./yr  diminish • Teach “This is normal” • Exercise  i sensation • “Most bothersome part”

46. Mastectomy • Lymphedema • Results when lymphatic channels are inadequate to return flow of lymph fluid • Transient swelling • Happens 10-25% of pt with axillary dissection • Medication: • Antibiotics • Exercises

47. Manual lymph drainage: • light massage, • performed by a therapist • assists moving the fluid to other parts of the body

48. Compression bandaging: • multi-layered bandages after massage • keep the fluid out of the arm

49. Exercise: • Do not perform venipuncture • Do not take BP on affected arm • Avoid dependent arm position

50. Compression garment: • fitted • helps maintain decreased swelling achieved during treatment