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Ncm [Recovered]
 

Ncm [Recovered]

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    Ncm [Recovered] Ncm [Recovered] Presentation Transcript

    • POWERPOINT PRESENTATION GROUP 4
    • The REPRODUCTIVE SYSTEM
    • Overview of the System
    • THE FEMALE REPRODUCTIVE SYSTEM
    • THE MALE REPRODUCTIVE SYSTEM
    • GYNECOLOGICAL TEST OR DIAGNOSTIC PROCEDURES
    • Basal Body Temperature BBT may be taken orally or rectally. However, the client must use the same method consistently. A special thermometer is used to measure BBT. It measures a smaller range of degrees of temperature and has a larger space between each number, thus increasing the ease of accurately identifying minimum changes in temperature.
    • Cervical mucus examination The maximum effect of estrogen occurs immediately near the time of ovulation. Cervical mucus responses include decreased viscosity, ferning and increased alkalinity. Abundant alkaline, clear, watery, elastic mucus facilitates sperm penetration and survival. Cervical mucus ferning Ferning is caused by the effects of estrogen on the concentration of sodium chloride and other electrolytes in the mucus; high estrogen levels produce more complete arborization. When the mucus is spread on a glass slide and allowed to dry, the pattern it forms resembles a fern leaf. Ferning is absent in anovulatory women.
    • Plasma progesterone Plasma level of progesterone increase significantly after ovulation following formation of the corpus luteum. Serum progesterone assays are drawn between the second day after ovulation and the onset of menses. Pelvic ultrasonography Uine Ultrasonography is a biomedical adaptation of marine sonar technology. Sound wave echos create a picture of the pelvic structures. Abdominal or vaginal ultrasonography may be used to visualized the reproductive structures. Ultrasonography can identify anatomic abnormalities and often used to determine follicular development and maturation in planning for therapeutic interventions, e.g. surgical removal of an ovum for use in in vitro fertilization.
    • Invasive Procedures Endometrial biopsy A curette is gently introduced through the cervical canal to the level of the uterine fundus, and one or two samples of tissue are removed for examination of the pathologist. Endometrial biopsy identifies estrogen/progesterone-induced endometrial changes and is helpful in ruling out a chronic inflammatory condition of the endometrium. Uterine and tubal factor assessment Tubal patency determination [rubin’s test] The patency of the fallopian tubes can be assessed by introducing co2 gas under pressure through the uterine cavity. With the client in lithotomy position, co2 is insufflated transcervically. Characteristic findings accompany passage of the gas through patent fallopian tubes. Although this test was used extensively in the past, it is being replaced by other tests that allow more definitive assessment.
    • Hysterosalphingography Instilling radiopaque dye through a small tube into the uterus permits roentgenographic visualization of the uterus and fallopian tubes. Hysterosalphingography has become the method of choice for evaluating the structure and patency of the uterus and fallopian tubes. Transvertical instillation of 1 to 2ml contrast medium is performed under fluoroscopy; the small amount of radiopaque dye may outline small abnormalities that would be obscured by a larger amount of medium. Larger amounts of medium are then instilled to distend the uterus and they flow upward through the fallopian tubes. Laparoscopy Insertion of an endoscope through a small abdominal incision permits direct visualization of pelvic structures. Laparoscopy is essential in the study of infertile woman when there is no obvious cause for failure to achieve pregnancy. Immediately before the laparoscopy, a cannula is placed at the cervix. A thin solution of methylene blue dye is introduced through the cannula .
    • A. Double puncture technique The double puncture technique allows the surgeon to use a probe to move the ovaries and tubes for optimum visualization, to explore the fimbriated ends of the fallopian tubes, and to view the undersurface of the broad ligaments if the ovaries. Unsuspected pelvic disease, adhesions and endometriosis have been discovered through use of this technique. Cervical factor assessment The sim-huhner (postcoital) test is used to identify the quality of the cervical mucus and its effect is on sperm survival and motility. The test is another component of the initial investigation and into possible infertility. Tomaximize the potential for concurrent achievement of pregnancy, the test usually is timed for 1 or 2 days before expected ovulation. At that time the influence of estrogen increases the cervical mucus hospitality to spermatozoa.
      • How is infertility diagnosed?
      • The following tests are often part of the basic medical workup for infertility.
      • Both partners
      • Medical and sexual history (to evaluate possible causes of infertility and if sexual intercourse has been appropriately timed)
      • Female
      • Physical examination
      • A complete physical examination including a pap smear and testing for infection will be necessary.
      • Ovulation evaluation
      • An evaluation of ovulation function using an analysis of body temperatures and ovulation called the basal body temperature chart, or with ovulation prediction methods using urine samples, may be recommended.
    • Hormone testing Hormone testing may be recommended, as certain hormones increase and decrease in production at various times in monthly cycle. Ultrasound Ultrasound can show the presence of follicles (the sacs containing developing eggs) and the thickness of the uterine tissues. Ultrasound can show abnormal conditions such as ovarian cysts or fibroids(benign tumors in the uterus). X-rays A hysterosalphingogram may be recommended. This test uses radio-opaque dye injected into the cervical opening to visualize the inside of the uterus and determine if the fallopian tubes are open.
      • Male
      • Semen analysis
      • A collection of a semen sample obtained by masturbation that is analyzed in the laboratory for the sperm count, sperm motility, sperm shape, quantity and evaluation of the ejaculate liquid may be recommended. A normal ejaculate contains more than 20 million sperm per milliliter of liquid, more than 50 percent of sperm should be moving forward, and more than 30 percent of sperm should have normal shapes.
    • Diagnostic test for cervical cancer The papanicolau smear (pap test) is used to screen for cervical intraepithelial neoplasia (cin) and cervical cancer. It can also be used to assess hormonal status and identify the presence of sexually transmitted diseases, such as human papilloma virus (hiv) infection. With the woman in lithotomy position, a speculum is inserted to visualize the cervix. A plastic or woodenll lsllllatua is used to scrape the cervical os and any suspicious-looking areas, and the material is transferred to a slide for histologic analysis. A cotton-tipped applicator or cytobrush is used to obtain a specimen from the endocervix; this specimen is then transferred to a second slide.
      • Client preparation:
      • 1. Instruct the woman to empty the bladder.
      • 2. Explain that the test should be painless and quick, although slight cramping may be experienced when the endocervical specimen is obtained.
      • Client and family teaching
      • Teach the woman about the recommended frequency of screening every 3 years until age 65 after two successive negative results a year apart or more frequently if the woman has a specific risk factors for cervical cancer.
      • 2. Teach the woman to schedule the pap test for a time when she is not menstruating. Blood interfere with interpretation of the smear.
      • 3. Teach the woman to avoid intercourse, douching or placing of any medication in the vagina for 36 hours prior to the test.
    • Cervical biopsy Cervical biopsy is performed to women whose pap smear findings indicate possible cervical cancer or cervical intraepithelial neoplasia. The biopsy is also used to screen women at high risk for vaginal and cervical cancers due to intrauterine des exposure. With the woman in lithotomy position, the cervix is cleaned with 3% acetic acid, and tissue samples are taken for biopsy.
    • ABORTION
      • Introduction of the Disease
      • ABORTION
      • is the termination of pregnancy before viability of the fetus.
      • is a procedure to end a pregnancy by removing the fetus and placenta from the mother's womb.
      • The most common complication of pregnancy
      • which occurs in an estimated 10-15% of pregnancies
      • categorized as threatened, inevitable, incomplete, complete, or missed.
      • TYPES OF ABORTION
      • Spontaneous abortion or miscarriages
      • Is a type of abortion that occur without medical or other intervention
      • About 25% of all pregnancies result in miscarriages, women older than 35 or younger than 17 years old and couples who have difficulty in achieving pregnancy
      • women who have had at least two miscarriages has a higher chance of experiencing miscarriage. About 90% of miscarriages occur during the first trimester (first three months, or 12 weeks of pregnancy)
      • Some cases of miscarriages happen even before a woman realizes that she is pregnant, and she even may not realize that she has aborted
      • SYMPTOMS
      • (10TH WEEK) very heavy menstrual period
      • several days of bleeding and cramps before the contents of the uterus are removed
      • followed by a short period of bleeding until the lining of the uterus heals
      • 12th week is like a mild version of the labor of during childbirth
      • with strong contractions that dilate the cervix and expel the fetus
      • 13th and 24th weeks (second trimester) are most often caused by faulty attachment of the placenta to the walls of the uterus or from a weak cervix that dilates too soon
    • 2. INDUCED ABORTION -this type of abortion uses drugs or instruments to stop the normal course of pregnancy 3. HABITUAL ABORTION - Successive (3) repeated abortions of unknown cause.
      • ETIOLOGY
      • Abortion is by definition a reproductive failure. The failure can be the result of the mother's lack of access to care, failure of the contraceptive method, failure to use contraceptives, or failure of the normal reproductive process (eg, fetal anomalies, fetal death, maternal illness).
      • FETAL CAUSES
      • Most common cause of early sponatneous abortion is abnormal development of the zygote, embryo and fetus
      • MATERNAL CAUSES
      • Congenital or acquired conditions of the mother and environmental factors that had adversely affected the pregnancy outcome and led to abortion. It includes Diabetes Mellitus, incompetent cervix, exposure to radiation and infection.
      • A missed abortion is a nonviable intrauterine pregnancy that has been retained within the uterus without spontaneous abortion.
      • A septic abortion is a spontaneous or therapeutic/artificial abortion complicated by a pelvic infection.
      • is a completed miscarriage
      • spontaneous expulsion of the products of conception after the fetus had died in the uterus
      • is the partial expulsion of the products of conception before the 20th week of gestation.
      • is defined as bleeding of intrauterine origin with continuous and progressive dilation of the cervix but without expulsion of conception products before the 20th week of gestation.
      • is a condition of pregnancy, occurring before the 20th week of gestation, the patient usually experiences vaginal bleeding with or without some cramps, and the cervix is closed
      MISSED SEPTIC COMPLETE INCOMPLETE INEVITABLE THREATENED TYPES OF SPONTANEOUS ABORTION
    • PATHOPHYSIOLOGY THREATENED - consists of any vaginal bleeding during early pregnancy without cervical dilatation or change in cervical consistency. Usually, no significant pain exists, although mild cramps may occur. More severe cramps may lead to an inevitable abortion INEVITABLE - Genetic anomalies (trisomies); hormonal abnormalities; and infectious, immunologic, and environmental factors usually result in first-trimester loss. Anatomic factors usually are associated with second-trimester loss INCOMPLETE - Genetic anomalies (eg, trisomies); hormonal abnormalities; and infectious, immunologic, and environmental factors usually result in first-trimester pregnancy loss. Anatomic factors usually are associated with second-trimester pregnancy loss.
    • COMPLETE - Typically, a history of vaginal bleeding, abdominal pain, and passage of tissue exists. After the tissue passes, the patient notes that the pain subsides and the vaginal bleeding significantly diminishes. The examination reveals some blood in the vaginal vault; a closed cervical os; and no tenderness of the cervix, uterus, adnexa, or abdomen. The ultrasound demonstrates an empty uterus. SEPTIC - Infection usually begins as endometritis and involves the endometrium and any retained products of conception. If not treated, the infection may spread further into the myometrium and parametrium. Parametritis may progress into peritonitis. The patient may develop bacteremia and sepsis at any stage of septic abortion. Pelvic inflammatory disease (PID) is the most common complication of septic abortion MISSED - Causes include anembryonic gestation (blighted ovum), fetal chromosomal abnormalities, maternal disease, embryonic anomalies, placental abnormalities, and uterine anomalies. Virtually all spontaneous abortions are preceded by missed abortion. A rare exception is expulsion of a normal pregnancy because of a uterine abnormality.
    • Assessment ASSESSING ABORTION Smaller than expected for length of pregnancy Closed No No No Slight MISSED Any of the above with tenderness Usually open; fever present Varies; fever present Varies; fever present Varies; fever present Varies; usually malodorous; fever present SEPTIC Smaller than expected for length of pregnancy Closed Possible Mild Mild Heavy COMPLETE Smaller than expected for length of pregnancy Open with tissue in cervix Possible Yes Severe Slight INCOMPLETE Agrees with length of pregnancy Open No No Moderate Moderate INEVITABLE Agrees with length of pregnancy Closed No No Mild Slight THREATENED SIZE OF UTERUS INTERNAL CERVICAL OS TISSUE IN VAGINA PASSAGE OF TISSUE UTERINE CRAMPING AMOUNT OF BLEEDING TYPE
      • DIAGNOSTICS
      • Laboratory Studies
      • A pregnancy test, blood-type determination , and CBC count are the minimum lab studies required for abortion.
        • A pregnancy test is required because non–pregnancy-related causes of amenorrhea exist
        • Blood-type determination is required so that women who are Rh negative can be identified and treated with RhoGAM to prevent sensitization of subsequent pregnancies
        • A CBC count is recommended to identify patients with significant anemia.
      • Screen for common sexually transmitted diseases (eg, chlamydia, gonorrhea, HIV, hepatitis B) in geographic areas with high prevalence (eg, urban, inner city) and in age groups commonly at risk (women <25 y).
        • Coagulation studies are indicated in patients with a history of bruising, abnormal bleeding, hemorrhage with previous surgical procedures, or petechiae on physical examination.
        • Liver function tests are indicated in patients with ethyl alcohol abuse, hepatitis, hepatomegaly, or jaundice.
        • Renal function tests are indicated in patients with histories of renal disease or dialysis.
      • Imaging Studies
      • Pelvic ultrasound is indicated prior to surgical abortion under the following circumstances:
        • Dates of conception are uncertain.
        • Uterine sizing by physical examination is inadequate.
        • A discrepancy between the uterine size and date of conception exists.
        • The pregnancy is in the second trimester.
        • Uterine leiomyoma are present.
        • Uterine anomalies are known or suspected.
        • Adnexal or pelvic masses are known or suspected.
        • The patient has vaginal bleeding.
        • The patient has pelvic pain.
        • The patient has had a previous ectopic pregnancy.
      • Chest x-ray films may be indicated by history and physical examination findings.
      • MRI may be indicated to assess location of leiomyomas or other uterine pathology.
      • Other Tests
      • ECG may be indicated based on age, history or physical examination findings, and type of anesthesia requested.
      • PRE-OP
      • Monitor vital signs.
      • Stabilize with IV fluids (eg, normal saline, Ringer lactate).
      • Administer oxygen.
      • Provide detailed counseling about procedure, risks, complication rates, and alternatives. For manual vacuum aspiration, suction curettage, and D&E, obtain the patient's medical history with an emphasis on bleeding disorders and allergies.
      • Obtain the patient's obstetric/gynecologic history with an emphasis on last menstrual period (LMP), fibroids, and uterine anomalies.
      • Perform a pelvic examination to determine uterine size and position and to exclude pelvic mass(es).
      • Lab work is required, including—at minimum—a pregnancy test and an Rh status.
      • Vaginal probe ultrasound can be used as indicated for preoperative confirmation of pregnancy, gestational age, and location of pregnancy, and it can be used postoperatively to confirm termination of the pregnancy.
      • Assess the patient's need for pain relief, and administer pain medication.
    •  
      • POST-OP
      • Observe the patient for a minimum of 20-30 minutes
      • Consider the possibility of retained POC, uterine perforation, cervical laceration, hematometra, or heterotopic pregnancy
      • Activity: You may be referred for ongoing counseling and support after an abortion. You may eat a regular diet and resume normal activity. Avoid heavy activity or lifting for a few days. Do not use tampons, douche , or have sexual intercourse for one week.
      • Medications: You may be given medication for pain, but these are usually not necessary. Your doctor may prescribe medications for painful contractions and cramping of your uterus, but with a first-trimester procedure, none are usually needed. f you have pain, your doctor may suggest acetaminophen (such as Tyleno)l or ibuprofen (such as Advil) and similar pain relievers.
      • FOLLOW-UP
      • For manual vacuum aspiration, suction curettage, D&E, and hysterotomy/hysterectomy, schedule a follow-up visit in 2 weeks (1-2 wk after hospital discharge for hysterotomy) to evaluate the patient for complications, to initiate contraception if not previously initiated, to review culture results if not previously reviewed, and to evaluate the pathology results
      • COMPLICATIONS
      • Heavy Bleeding - Some bleeding after abortion is normal. However, if the cervix is torn  or the uterus is punctured, there is a risk of severe bleeding known as hemorrhaging. When this happens, a blood transfusion may be required.  Severe bleeding is also a risk with the use of RU486.  One in 100 women who use RU486 require surgery to stop the bleeding.
      • Infection – can develop from the insertion of medical instruments into the uterus, or from fetal parts that are mistakenly left inside (known as an incomplete abortion).  A pelvic infection may lead to persistent fever over several days and extended hospitalization.  It can also cause scarring of the pelvic organs.
      • Incomplete Abortion - Some fetal parts may be mistakenly left inside after the abortion. Bleeding and infection may result.
      • Sepsis – A number of RU486 or mifepristone users have died as a result of sepsis (total body infection).
      • Anesthesia – Complications from general anesthesia used during abortion surgery may result in convulsions, heart attack, and in extreme cases, death.  It also increases the risk of other serious complications by two and a half times.
      • Damage to the Cervix - The cervix may be cut, torn, or damaged by abortion instruments.  This can cause excessive bleeding that requires surgical repair.
      • Scarring of the Uterine Lining – Suction tubing, curettes, and other abortion instruments may cause permanent scarring of the uterine lining. 
      • Perforation of the Uterus - The uterus may be punctured or torn by abortion instruments. The risk of this complication increases with the length of the pregnancy. If this occurs, major surgery may be required, including removal of the uterus (known as a hysterectomy).
      • Damage to Internal Organs - When the uterus is punctured or torn, there is also a risk that damage will occur to nearby organs such as the bowel and bladder.
      • Death - In extreme cases, other physical complications from abortion including excessive bleeding, infection, organ damage from a perforated uterus, and adverse reactions to anesthesia may lead to death. This complication is rare, but is real .
      • Risks of surgical abortion include:
      • Excessive bleeding
      • Infection of the uterus or fallopian tubes
      • Damage to the uterus or cervix
      • Emotional or psychological distress
      • The risks of surgical abortion increase as a woman gets further along in her pregnancy. That's why it's important to make a decision about abortion as early as possible, when the procedure is safest.
      • Risks of medical (non-surgical) abortion include:
      • Prolonged bleeding
      • Fetus not passing completely from body, making surgery necessary
      • Nausea
      • Vomiting
      • Diarrhea
      • Pain
      • The risks for any anesthesia are:
      • Reactions to medications
      • Problems breathing
      • The risks for any surgery are:
      • Bleeding
      • Infection
      • NURSING DIAGNOSIS
      • Risk for Infection
      • Ineffective Individual Coping related to high degree of threat
      • Dysfunctional Griefing related to Actual on perceived object loss
      • Fear related to separation from support system in potentially stressful situation
      • Altered role performance related to health alteration
      • INTERVENTIONS
      • MEDICAL
      • Medical abortion using one of the following regimens:
        • mifepristone plus misoprostol
        • methotrexate plus misoprostol
        • misoprostol alone
        • Anti-D immune globulin as indicated
        • Non-steroidal anti-inflammatory drugs, or narcotics for pain relief when indicated (considered, but not specifically recommended)
      • SURGICAL
      • Manual vacuum aspiration (menstrual extraction) is used at 4-10 weeks of gestation and is 99.2% effective.
      • Suction curettage is used at 6-12 weeks of gestation
      • Sharp curettage is used at 4-12 weeks of gestation but is not currently used because of increased blood loss and retained POC compared to suction
      • Dilation and extraction (D&E) is used at 13-24 weeks of gestation
      • Intact dilation and extraction (D&X) is used at more than 16 weeks' gestation
      • Hysterotomy is used at 12-24 weeks of gestation and is reserved for the rare instances in which all other methods of abortion have failed or are contraindicated
      • Hysterectomy is reserved for rare instances in which other gynecological pathology dictates removal of the uterus.
      • LEVELS OF NURSING CARE
      • PROMOTIVE
      • Prenatal care
      • PREVENTIVE
      • Contraception to prevent unwanted pregnancies
      • Safe and legal abortions
      • Easy access to prenatal care
      • Prompt diagnosis of septic abortion
      • Timely treatment with IV antibiotics
      • Prompt evacuation of retained tissue from the uterus
      • CURATIVE
      • Perform a prompt evacuation of retained products of conception from the uterus.
      • Administer aggressive antibiotic therapy.
      • Monitor temperature, vaginal discharge, and bleeding.
      • REHABILITATIVE
      • Bed rest
    • MASTITIS
    • OVERVIEW OF THE DISEASE -Mastitis means that the breast is inflamed, and there is swelling, redness, tenderness and pain. There may be an infection, so it is wise to consult your health-care provider to determine whether or not an antibiotic is necessary. A breast infection can become a breast abscess that requires surgical draining, but this can almost always be prevented by treating mastitis promptly . - Mastitis is a condition that causes the breast tissue to become inflamed. It usually occurs in women who are breastfeeding, so it is often referred to as lactation mastitis. -Mastitis usually affects only one breast, causing it to become painful, red and swollen. Some women may also experience flu-like symptoms, which can include fever, chills or aches.
      • Symptoms
        • Fatigue
        • Malaise
        • Myalgias
        • Headache
      • Signs
        • Fever
        • Unilateral Breast inflammation
        • Warmth
        • Tenderness
        • Erythema
        • Observe for signs of breast abscess
        • Requires needle aspiration
      • Types of mastitis
      • non-infectious mastitis , which is typically caused by breast milk remaining within the breast tissue (milk stasis), and is due to a blocked milk duct or problems with breastfeeding, and
      • infectious mastitis , which is caused by bacteria.
      • ETIOLOGY
        • Staphylococcus aureus
        • Escherichia coli
        • Haemophilus Influenzae
        • PATHOPHYSIOLOGY
          • Generally occurs in Lactation several weeks postpartum
          • Bacteria enter through a cracked nipple
    • ASSESSMENT
      • DIAGNOSTICS
      • - MILK CULTURE
      • Indications (not routine)
          • Severe mastitis
          • Refractory despite optimal antibiotics for at least 48 hours
          • Hospital acquired infection
        • Technique
          • Cleanse nipple
          • Hand express small quantity of breast milk and discard
          • Hand express a sample into a sterile container
      • Complications
        • Breast Abscess
          • Obtain bacterial culture
          • Treat with needle aspiration or Incision and Drainage
      • NURSING DIAGNOSIS:
      • Knowledge deficit related to prevention of infection.
      • Acute pain related to breast engorgement.
      • Altered family process related to possible separation from newborn.
      • INTERVENTION
      • MEDICAL
      • Antibiotics
        • Course: 10 to 14 days
        • Coverage: Staphylococcus aureus (or as directed by culture)
        • Antibiotics: Nursing Mothers
          • Amoxacillin-Clavulanate ( Augmentin ) 875 mg orally twice daily
          • Cephalexin ( Keflex ) 500 mg orally four times daily
          • Dicloxacillin 500 mg orally four times daily
          • Clindamycin 300 mg orally four times daily (for MRSA )
          • Ciprofloxacin 500 mg orally twice daily (for MRSA )
        • Antibiotics: Non- Breast Feeding women
          • Trimethoprim-sulfamethoxazole ( Septra ) 160mg/800 mg orally twice daily (for MRSA )
      • SURGICAL
        • If not better in 48 hours examine breast for abscess consider Incision and Drainage
      • NURSING CARE
      • PROMOTIVE
      • Optimal Breast Feeding Technique with good latch-on by infant
      • Breastfeed frequently
      • Avoid sleeping on your stomach or so far over on your side that your breasts are compressed against the mattress
      • PREVENTIVE
      • Relieve engorgement promptly. Milk that doesn't flow gets thicker and clogs the ducts, which is a set-up for mastitis.
      • Breastfeed frequently. Don't restrict the length of feedings.
      • If you feel your breasts getting full, encourage your baby to nurse. You don't have to wait for baby to tell you he's hungry.
      • Avoid sleeping on your stomach or so far over on your side that your breasts are compressed against the mattress.
      • Take care of yourself and get plenty of rest (both of mind and body).
      • CURATIVE
      • Alternate warm and cold compresses on your breasts.
      • Gently massage the area of tenderness.
      • Breastfeed frequently on the affected side.
      • Vary the baby's position at the breast
      • Take analgesics for fever and pain.
      • Drink lots of fluids
      • Boost your immune system with good nutrition
      • Don't quit nursing at this point
      • REHABILITATIVE
      • Rest
      • Sleep without a bra
      • Drink lots of fluids
      • continue analgesics for fever and pain
      • Increase vitamin C intake
      • Breastfeed frequently. Don't restrict the length of feedings
      • Take care of yourself and get plenty of rest (both of mind and body).
    • CERVICAL CANCER
    • Anatomy and Physiology The cervix is one part of your reproductive system.It is the lower part of your womb, also called the uterus.The cervix connects your uterus and vagina.And your vagina leads to the outside of your body and the vulva, which is the skin area where you have pubic hair.These are the other parts of your reproductive system.They are all in the pubis. >Vagina >2 Ovaries >2 Fallopian tubes The cervix has two parts: 1.ECTOCERVIX-the outer part which is closest to the vagina 2.ENDOCERVIX-the inner part which is closest to the uterus.
    •  
    • TRANSFORMATION ZONE -where the ectocervix and endocervix meet where most cervical cancers start. Two types of cells which are on the surface of the cervix: 1.Squamous epithelial cells-line the outer part of the cervix. 2.Columnar epithelial cells-line the inner part of the cervix.
      • INTRODUCTION OF THE DISEASE
      • - Is malignant cancer of the cervical area.
      • Stages of cervical cancer includes:
      • Stage 0 – also called carcinoma in situ or non-invasive cancer, this early cancer is small andconfinedto the surface of the cervix.
      • Stage 1 – cancer is confined to the cervix.
      • Stage 2 – cancer at the stage includes the cervix and uterus, but hasn”t spread to the pelvic wall or the lower portion of the vagina.
      • Stage 3 – cancer at the stage has moved beyond the cervix and uterus to the pelvic wall or the lower portion of the vagina
      • Stage 4 – at this stage the cancer spread to nearby organs, such as the bladder or rectum, or it has spread to other areas of the body, such as the lungs, live or bones.
    •  
      • ETIOLOGY
      • Commonly various strains of the Human papilloma virus (HPV).
      • The incidence is grater in blacks than whites.
      • The age of the diagnosis is between 50-55 years;however,it begins to appear in woman in thier 20s.
      • Risk Factor:
      • Having sex at an early age
      • Multiple sexual partner
      • Sexual partners who have multiple partners or who participate in high risk sexual activities.
      • Infection by the HPV(the most important risk factors)
      • Other includes:
      • Weakened immune system
      • Poor economic status
      • Poor nutritional status
      • Symptoms:
      • Continuous vaginal discharge which maybe pale ,watery, pink, brown, bloody, or foul-smelling
      • Abnormal vaginal bleeding between periods, after intercourse, or after menopause
      • Periods become heavier and last longer than usual
      • Any bleeding after menopause
      • Symptoms of advanced cervical cancer may include:
      • Loss of appetite
      • Weight loss
      • Fatigue
      • Pelvic pain
      • Back pain
      • Leg pain
      • Single swollen leg
      • Heavy bleeding from the vagina
      • Leaking of urine and feces from the vagina
      • Bone fracture
    • Pathophysiology: Potentially, all women with carcinoma in situ and 90% of women with nonmetastatic disease can be cured. Five to ten years may elapse between the preinvasive and invasive stages of cervical cancer. Most cervical cancers are of the squamous cell type. Squamous cell carcinoma usually begins at the squamocolumnar junction near the external end of thecervix. Some cervical adenocarcinomas occur but are more difficult to diagnose. Adenocarcinoma generally involves the endocervical glands. Cervical dysplasia, theearliest premalignant change noted incervical epithelium, is now further dividedinto several levels of cervical intraepithelial neoplasia (CIN):MILD DYSPLASIA is CIN1, MODERATE DYSPLASIA is CIN 2, SEVERE DYSPLASIA and carcinoma in situ are CIN
    • The spread of squamous cell cerervical cancer occurs first by direct extensionto the vaginal mucusa, the lower uterine segment,parametrium, pelvic wall, bladder, and bowel. Distant metastasis occurs mainly through lymphatic spread, with some spread occurring through the circulatory system to the liver, lungs, or bones. The 5 year survival rate for women with cervical cancer is 65% for nonlocalized disease.
      • Assessment
      • Health history:
      • history of sexually transmitted infections
      • sexual history
      • family history of cervical cancer
      • vaginal bleeding or discharge
      • Smoking history
      • maternal treatment with DES.
      • Physical assessment:
      • pelvic examination
      • abdomen
      • lymph glands
        • Diagnostic Test
        • Papanicolaou smear or PAP test , the primary screening tool for cervical carcinoma is used to screen for cervical intraepithelial neoplasia or CIN and cervical cancer. It can also be used to assess hormonal status and identify the presence of sexually transmitted diseases such as human papilloma virus or HPV or infections.
      • Staging
      • Includes:
      • Imaging test
      • Visual examination of your bladder and rectum
      • Cervical biopsy or colposcopy
      • Loop diathermy technique or Loop electrosurgical excision procedure[ LEEP])
      • MRI or CT of the pelvis, abdomen, or bones may be performed to detect the spread of the tumor.
      • Complications
      • Some type of cervical cancer do not respond well to treatment.
      • The cancer may comeback (reoccur) after treatment
      • Woman who have treatment to save the uterus have a high risk of the cancer coming back
      • Spread to bladder and rectum, metastasis to lungs, mediastinum, bones and liver
      • Complications of intracavitary radiotherapy arcystitis, proctitis, vaginal stenosis, uterine perforation
      • Complications of external radiation are bone marrow depression, bowel obstruction, fistula
      • Nursing Diagnosis
      • Anxiety related to cancer and treatment
      • Disturb body image related to surgical treatment
      • Fear
      • Impaired tissue integrity
      • Interventions
      • Medical
      • Irradiation – primary therapy for early cervical cancer, usually curative but induces menopause
      • Surgical
      • Laser therapy or surgery
      • Cryosurgery
      • Conization
      • Hysterectomy or radical hysterectomy
      • Pelvic exenterization
      • Pre-op
      • (Nursing preparation for a woman for cryosurgery and laser therapy involves:
      • Clarifying that this procedure is not actual surgery and an incision will not be made.
      • explain that the procedure is performed with a vaginal speculum in place, as during a routine pelvic examination.
      • During treatment, a few women experienced headache, dizziness, flushing, and some cramping
      • Intra-op
      • During the procedure, provide psychological support by :
      • Staying with the client
      • Informing her of what is to be done
      • Talking with her, listening to her, and facilitating her expression of concern
      • Continuing to acknowledge her presence during the procedure rather than excluding her
      • Allowing her to retain as much self control as possible
      • Assess the woman’s discomfort during the procedure
      • Post-op
      • Meticulous, perennial hygiene minimizes
      • Levels of Prevention
      • Primary
      • Instruct client to avoid or seek early treatment of vaginal or cervical infection
      • Instruct client to limit the number of sexual partners and use condoms and limit the transmission of STD and human papilloma virus
      • Secondary prevention
      • Emphasize that woman should get regular PAP smear per physician recommendations (yearly for high risks woman)
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    • SEXUALLY TRANSMITTED DISEASE
      • Genital warts
      • Genital warts, also known as venereal warts or condylomata acuminata, are one of the most common types of sexually transmitted diseases.
      • Symptoms
      • Small, flesh-colored or gray swellings in your genital area
      • Several warts close together that take on a cauliflower shape
      • Itching or discomfort in your genital area
      • Bleeding with intercourse
      • Often, genital warts cause no symptoms. They may be so small and flat that they can't be seen with the naked eye. Sometimes, however, genital warts may multiply into large clusters .
      • ETIOLOGY
      • Like warts that appear on other areas of your skin, genital warts are caused by a virus — HPV — that infects the top layers of your skin. There are more than 100 different types of HPV, but only a few can cause genital warts. These strains of the virus are highly contagious and spread through sexual contact with an infected person.
      • About two-thirds of people who have sexual contact with someone who has genital warts develop the condition — usually within three months of contact, but in some cases not for years.
      • Risk factors
      • Risk factors of becoming infected with HPV include:
      • Having unprotected sex with multiple partners
      • Having had another sexually transmitted disease
      • Having sex with a partner whose sexual history you don't know
      • Becoming sexually active at a young age
    • BREAST CANCER
      • ANATOMY AND PHYSIOLOGY
      • The breast is a mass of glandular, fatty, and fibrous tissues positioned over the pectoral muscles of the chest wall and attached to the chest wall by fibrous strands called Cooper’s ligaments.
      • The breast is composed of:
      • milk glands (lobules) that produce milk
      • ducts that transport milk from the milk glands (lobules) to the nipple
      • nipple
      • areola (pink or brown pigmented region surrounding the nipple)
      • connective (fibrous) tissue that surrounds the lobules and ducts
      • fat
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    • PATHOPHYSIOLOGY
      • What are the symptoms?
      • Breast cancer can cause:
      • A change in the way the breast feels. The most common symptom is a painless lump or thickening in the breast or underarm.
      • A change in the way the breast looks. The skin on the breast may dimple or look like an orange peel. There may be a change in the size or shape of the breast.
      • A change in the nipple. It may turn in. The skin around it may look scaly.
      • A clear or bloody fluid that comes out of the nipple.
      • See your doctor right away if you notice any of these changes.
      • Many people think that only women get breast cancer. But about 1 in every 100 cases of breast cancer occurs in men. So any man who has a breast lump should be checked.
      • How is breast cancer diagnosed?
      • During a regular physical exam, your doctor can check your breasts to look for lumps or changes. Depending on your age and risk factors, the doctor may advise you to have a mammogram , which is an X-ray of the breast. A mammogram can often find a lump that is too small to be felt. Sometimes a woman finds a lump during a breast self-exam.
      • If you or your doctor finds a lump or other change, the doctor will want to take a sample of the cells in your breast. This is called a biopsy . Sometimes the doctor will put a needle into the lump to take out some fluid or tissue (needle biopsy). In other cases, a surgeon may take out the whole lump through a small cut in your breast. The results of the biopsy help your doctor know if you have cancer and what type of cancer it is.
      • You may have other tests to find out the stage of the cancer. The stage is a way for doctors to describe how far the cancer has spread. Your treatment choices will be based partly on the type and stage of the cancer.
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