supporting structures: scrotum, penis </li></ul>External Structures:<br />Penis - comprised of 3 columns of erectile tissues(2 corpus cavernosa on the sides of the shaft; 1 corpus spongiosum around the urethra). <br /> Consists of the Shaft and the Glans Penis.<br />Shaft - contains the urethra which is the passageway for urine and semen <br />Glans - is highly sensitive (well supplied with sensory receptors) and is located at the dismal end of the penis. At the<br />tip of the glans is the opening to the urethra, called urethral meatus. It is covered by a fold of skin, Prepuce/foreskin<br />that is often removed during circumcision.<br />Scrotum - rugated skin-covered muscular pouch/sac suspended from the perineum. It contains the testes, epididymis and the lower portion of the spermatic cord. <br />
Penis <br />a.Conduit for urine form bladder<br /> b. Male organ for sexual intercourse<br />2. Scrotum <br />a.House testes and maintains their temperature at a level cooler than the body thus promoting normal sperm formation<br />3. Testes <br />a.Endocrine glands that secrete the primary male hormone, testosterone<br />4. Seminiferous Tubules <br />a.Location of spermatogenesis (within the testes)<br />5. Epididymis<br /> a. Storage for some spermb. Final sperm maturationc. Where sperm develops the ability to be motile.<br />6. Vas Deferens <br /> a. Storage of spermsb. Conduction of sperm form epididymis to urethra<br />7. Seminal Vesicle, Prostate, Bulbourethral gland <br /> a. Secretion of seminal fluids that carry sperm and provide for:- Nourishment of sperm- Protection of sperm from hostile acidic environment of vagina- Enhancement of motility of sperm- Washing of all sperm from urethra <br />8.Urethra <br />a.hollow tube leading from the base of bladder, passing through the prostate gland, continues to the outside through the shaft and glans penis. <br />9.Cowper’s glands <br />a.They secrete an alkaline fluid that helps counteract the acid secretion of the urethra and ensures safe passage of spermatozoa. <br />
Female organ for coitus; receives male penisc. Passageway for the fetus during birth</li></ul>2. Uterus <br /><ul><li>Houses and nourishes fetus until sufficiently mature to function outside the mother’s body
Uterine muscles propels fetus outside</li></ul>3.Fallopian Tube <br /><ul><li>Provides passageway for ovum as it travels from ovary to uterus.
Site of Fertilization.</li></ul>4.Ovaries <br /><ul><li>Endocrine glands that secrete estrogen and progesterone.
Contain ova within follicles for maturation during the woman’s reproductive life.</li></li></ul><li>
PHIMOSIS<br />There are two entinities, based on age and pathophysiology. Congenital phimosis and acquired phimosis. Both terms imply the inability to retract the distal prepuce over the glans penis. Paraphimosis is the entrapments of a retracted foreskin behind the sukcus. There condition occur in the uncircumcised of incorrectly circumcised penis. , a higher incidence in seen in infancy and adolescence especially those male.<br />CLASSIFICATION OF PHIMOSIS ( according to history)<br />Congenital Phimosis<br /><ul><li>Children with congenital phimosis, may have a history of recent catherization or of parents forcibly retracting the foreskin in an attempt to clean the glands.</li></ul>Acquired Phimosis<br /><ul><li>There is a history of poor hygiene, chronic balanoposthtis, or forceful retraction of a congenital phimosis.
Presence of hematuria or preputial pain is important historical factor and may be an appropriate reason to refer the patient for circumcision.</li></ul>Paraphimosis<br /><ul><li>Pain and edema of the uncircumcised or improperly circumcised penis are characteristics
Adults, especially the elderly population Hx of frequent chatheterization/poor hygiene/chronic balanoposthitisphmosisparaphimosis. </li></ul>CLASSIFICATION OF PHIMOSIS ( according to physical)<br /><ul><li>Congenital and acquired phimosis o foreskin cannot be retracted proximally over the gians penis.
Faccidity of the penile shaft proximal to the areas of paraphimosis
Ensure the absence of an encircling foreign bodies such as hair, clothing, metallic objects or rubber bands.</li></li></ul><li>
ETIOLOGY<br /><ul><li>Congenital phimosis can be considered physiologic in the young make since the foreskin is always tight, nonretractible, and adherent to the glans at birth.
Acquired phimosis is result of poor hygience or chronic balamoporthitis, which leads to the formation of a (foreign) fibrotic ring of tissue close to the opening of the prepuce. Repetitive extraction by attempting to clean the underlying glans may lead to an acquired phimosis because of scar formation and fibrotic ring of tissue at the prepuce.</li></ul>PATHOPHYSIOLOGY:<br />Foreskin of the penis fits to tighly over the head of the penis and cannot be retracted, can occur congenitally or as result of inflammation and edema-inflammation (balanitis), occur’s if the perceptual area is not cleaned normal secretions accumulate, eventually balanitis lead to adhesions and fibrosis. The thickened secretions become encrusted with urinary salts and calficy, forming calculi in the prepuce. In elderly men, penile carcinoma may develop. <br />Assessment<br /><ul><li>balantitis
Inspect for red, swollen foreskin, irritation and pain upon urination
Position patient in Provide privacy thru draping
Record data accurately</li></ul>Cystoscopy<br /><ul><li>can be used to detect abnormalities of the lower urinary tract or to assist in transurethral surgery.</li></ul>COMPLICATIONS<br /><ul><li>Gangrene of the Glands
Pasthitis Inflammation of the prepuce</li></ul>DIAGNOSIS<br /><ul><li>Risk for infection related to altered urinary drainage.
Fear related to perceived threat of the surgical procedure and separation from support system.
Deficient knowledge of the preoperative aspects of circumcision and post-operative self care.
Impaired renal elimination related to balanitis</li></li></ul><li>INTERVENTIONS<br />Medical Interventions<br /><ul><li>Antibiotics may control the infection hot soaks may help separate foreskin from glans.</li></ul>B. Surgical Interventions<br /><ul><li>Circumcision is generally advised when the inflammation clears. Circumcision is the incision of the foreskin (prepuce) of the glans penis.
Surgeons may perform preputioplasty with the aim of increasing the diameter of the preputial ring but without excising the prepuce (foreskin).
Circumcision is typically performed under gen. anesthesia. Foreskin is pulled back as far as it will go. It slit along its upper surface and then all around so that it can be removed. The raw edges of the inner and outer layers are stitched and a dressing is applied. </li></ul> rings without incision of foreskin<br />
C. Levels of care<br />Promotive<br /><ul><li>Patient education on the prevention of phimosis.
Emphasize the importance of seeking halthcare provider.
Testicular examination for early detector of illness. </li></ul>Preventive<br /><ul><li>Encourage patient to clean his genital specially the preputial area of to remove secretions to prevent non-surginalphimosis.
Advice patient to take a bath everyday for proper hygiene
Discourage patient to retract his foreskin to avoid irritation and infection
Demonstrate/Perform proper hand washing to prevent spread of infection.</li></ul> <br />Curative <br /><ul><li>Apply not soaks, may help to separate the foreskin from glans
Preputioplasty to increase diameter of preputial</li></ul>Rehabilitative<br /><ul><li>Collaborate with dietitians to help paients plan meals that will bw acceptable and meet nutritional requirements
Encourage patient to regain the highest level of function and independence possible.
Ambulate to perform self care activities w/c may restore normal activity of patient and to improve self esteem.</li></li></ul><li>HYPOSPADIA<br />is a birth defect of the urethra in the male that involves an abnormally placed urinary meatus(opening). Instead of opening at the tip of the glans of the penis a hypospadic urethra opens anywhere along a line (the urethral groove) running from the tip along the underside (ventral aspect) of the shaft to the junction of the penis and scrotum or perineum.<br />Kinds of hypospadia<br /><ul><li>Anterior hypospadia - (70% of cases) the meatus is located near the apex of the penis.
Medium hypospadia -(10% of the cases) the meatus is located on the medium part of the penis, which often has a slight curvature.
Posterior hypospadia - (20% of the cases) these are the most severe types: the meatus is located at the base of the penis or in the scrotum of in the perineal scrotum. The penile curvature is considerable.</li></ul>Hypospadias: pathophysiology and etiologic theories<br />Hypospadias is a congenital defect of the male urethra and phallus. Most boys with hypospadias have no other signs of under-masculinization or congenital malformations. The incidence appears to be increasing in the developed world. Evidence suggests that the etiology of hypospadias is multifactorial and that environmental conditions may have a role in the increasing incidence. <br />
Assessment <br /><ul><li>Urethra is located underside of the penis instead of at the tip
Opening of urethra may be seen near head of penis, midshaft or beneath the scrotum.
Difficulty of urination/voiding while standing.</li></li></ul><li>Diagnostic exam<br /><ul><li>Hypospadia is usually diagnosed during the physical examination of a new born
This test uses X-rays to provide pictures of the urinary tract. It is used to check for other congenital abnormalities of the kidneys or the tubes that carry urine from the kidneys to the bladder (ureters).</li></ul>Pre-procedure<br /><ul><li>Inform patient about the procedure
Advise patient to use a mirror to check inaccessible places, scrotum ventral side of the penis
Tell the patient not to hesitate to seek physician and advice about anything unusual assessment may noted</li></ul>Curative <br /><ul><li>Surgical procedures are performed to correct the defect.</li></ul>Mathieu’s technique<br />Duckett’s technique<br />Snodgrass’s technique<br />Bracka’s technique<br /><ul><li>Frequent inspection of the tip of the penis.
Insert smooth and soft (silicon) catheter to drain urine from the bladder temporarily.</li></ul>Rehabilitative<br />Adequate supplementation of food w/c is rich in protein, carbohydrates, minerals, and vitamins.<br /><ul><li>Advice patient to regularly clean the surgical wound and cover it with clean dressings.
Ambulate to perform self care activities w/c may restore normal activity of patient and to improve self esteem.</li></ul> <br /> <br />
EPISPADIA<br />is a rare congetinal malformation of male urogenital apparatus that consist of a defect of the dorsal wall of the urethra. The extent of defecvt can vary from a child glandural defect to complete defects as are observed in bladder exstrophy, diastasis of the pubic bones, or both occurs more commonly in males than in females. <br /> <br />Etiology<br />Unlike hypospadias, epispadias can be explain by defective migration of the paired primordia of the genital tubercle that fuse on the midline to form the genital tubercle at the fifth week of embryologic development.<br />Pathophysiology<br />In males, epispadias causes impotentiacoeundi, which results from the dorsal curvature of the penile shaft, and in impotentia generandi,which results from the incomplete urethra. Also reported are frequent ascending infections to the prostate r bladder and kidneys and psychological problems related to deformity if epispadia is distal to the bladder neck, urinary continence may be not be present.<br />
Reflux nephrophathy</li></li></ul><li>Diagnosis exam<br /><ul><li>X-ray provide picture for urinary tract
Magnetic resonance image uses strong magnetic field to visualized pelvic structure, including the prostate bladder seminal vesicles and penis.</li></ul>Pre-procedure<br /><ul><li>Inform patient about the procedure
Urethrocutaneous fistula with urinary leakage from the new urethra and urethral stricture.</li></ul> <br />
Interventions <br />Surgical intervention<br /><ul><li>Skin grafting -is a type of medical grafting involving the transplantation of skin.</li></ul>Nursing Care<br />Promotive<br /><ul><li>Health teaching about the disease process and genetic counseling
Advise Px to seek medical assistance if unusual assessment may not after self examination.
Advise Px to wash his genital carefully to prevent infection.</li></ul> <br />
CRYPTOCHIDISM<br />Is the absence of one or both testes from the scrotum. This usually represent failure of the test is to move, or “descend”, during fetal development from an abdominal position, through the inguinal canal, into the ipsilateralserotum.<br />Etiology<br /><ul><li>Sporadic
Other generic defects</li></ul>Pathophysiology<br /> <br />A prevalent but still unsubstantiated theory links undescended testes to development of the a fibromuscular band that connects the testes to the scrotal floor this band probably helps pull the testes into the scrotum by shortening as the fetus grow.<br />May result from inadequate testosterone levels or a defect in the testes or the gubernaculum.<br />Because the testes are maintained at a higher temperature by being within the body spermatogenesis is impaired, leading to reduced fertility.<br />
Assessment<br /><ul><li>Misplaced testes hidden in the abdomen.
DAGNOSTIC EXAMS<br /><ul><li>Buccal smear (cells from oral mucosa) analysis determines the genetic sex (a male sex chromatin pattern)
Serum gonadotropin analysis confirms the presence of testes by showing the presence of circulating hormone.</li></ul>Intervention<br />Medical<br /><ul><li>Hormone Therapy (B-HCG or Testosterone)</li></ul>Surgery<br /><ul><li>Orchiopexy – surgical procedure for undescended testicles in which the testicle is brought down into the scrotal sac and stitched in place.</li></li></ul><li>Complications<br /><ul><li>Infertile
Higher risk of developing testicular cancer in both testes</li></ul>Complications of orchiopexy<br /><ul><li>Inadequate testis position occurs in up to 10% of patients and is due to incomplete retroperitoneal dissection.
Testicular atrophy due to devascularization during dissection of the cord occurs in approximately 5% of patients.
Accidental division of the vas deferens occurs in 1-2% of patients.
Scrotal swelling may occur and is usually secondary to edema.</li></li></ul><li>HYDROCELE<br /><ul><li>is an abnormal fluid-filled sac that develops in the scrotum.
Men who have a hydrocele experience swelling of the testicles.
Hydroceles may be a sign of a more serious condition
Hydrocele can be present at birth (congenital)</li></ul>Etiology<br />Hyrdoceles are caused by the accumulation of fluid in the scrotum, surrounding one, or less often both, of the testes. In most cases, the condition is congenital, or present at birth. <br />Pathophysiology<br />The communicating hydrocele, fluids accumulates because of infections, trauma, tumor, an imbalance between the secreting and absorptive capacities of scrotal tissue, or an obstruction of lymphatic or venous drainage in the spermatic cord.<br /><ul><li>Leads to displaced fluid in the scrotum, outside the testes.
Subsequent swelling results, causing reduced blood flow to the testes.</li></li></ul><li>Assessment<br /><ul><li>feels like a small fluid filled balloon inside the scrotum.
painless and harmless</li></ul>large hydroceles causes discomfort because of thier size<br /><ul><li>as the fluid of a hydrocele is transparent, line shone through a hydrocelic region will be visible from the other side.
Scrotal swelling and feeling of heaviness due to fluid accumulation.
Testicular enlargement due to fluid accumulation.
Fluid collection, with either flaccid or tense mass due to patency between the scrotal sac and the peritonial cavity.
Pain due to acute epididymal infection or testicular torsion.
Scrotal tenderness due to severe swelling. </li></li></ul><li>Diagnostic exams<br />A hydrocele is usually diagnosed by examining the scrotum, which may appear enlarged. As part of the examination, your health professional will shine a light behind each testicle (transillumination) to check for solid masses that may be caused by other problems, such as cancer of the testicle. Because hydroceles are filled with fluid, light will shine through them (transillumination). Light will not pass through solid masses that may be caused by other problems, such as cancer of the testicle.<br />An ultrasound may be used to confirm the diagnosis of a hydrocele. <br />Complications<br /><ul><li>An extremely large hydrocele may impinge on the testicular blood supply.
The resulting ischemia can cause testicular atrophy and subsequent impairment of fertility.
Hemorrhage into the hydrocele can result from testicular trauma.
Incarceration or strangulation of an associated hernia may occur. </li></ul>Surgical Complications:<br /><ul><li>Accidental injury to the vas deferens can occur during inguinal surgery for hydrocele.
Postoperative wound infections occur in 2% of patients undergoing surgery for hydrocele.
Post-operative hemorrhagic hydrocele is not uncommon, but it usually resolves spontaneously.
Direct injury to the spermatic vessels may occur.</li></li></ul><li>Nursing diagnosis<br /><ul><li>Pain
Altered sexuality patterns </li></ul>Interventions<br />Medical<br />Interventions:<br />Hyroceles are not usually dangerous and are treated only when they cause pain or embarrassment or when they decrease the blood supply to the penis (rare). Treatment is not usually needed if a hydrocele does not change in size or gets smaller as the body reabsorbs the fluid. Hydroceles in men younger than 65 may go away by themselves, but hydroceles in older men do not usually go away.<br />Surgical<br /><ul><li>Hydrocelectomy-t he turniavaginalis is excised, the fluid drained, and the edges of the tunica are sutured to prevent the reaccumulation of fluid.</li></li></ul><li>VARICOCELE<br />A varicocele is on abnormal dilation of the veins of the pompiniform venous plexus in the scrotum (the network of viens from the testes is and the epididymis that constitute part of the spermatic cord).<br />Etiology<br /> <br />Varicoceles usually develop slowly and may not have any symptoms. There are most frequently diagnosed when a patient is 15-25 years of age, and rarely develop after the age of 40.<br />Pathophysiology<br />Because of vavular disorder in the spermatic vein, blood pools in the pampiniform plexus of the veins that each testis rather than flowing into the venous system.<br />
ASSESSMENT<br />Symptoms<br /><ul><li>visible, enlarged, twisted veins in the scrotum
Feeling of heaviness in scrotum.</li></li></ul><li>Diagnostic exam<br /><ul><li>Cystoscopy (Cystourethroscopy)</li></ul>is a procedure usually performed by a urologist that allows the physician to see the inside of the lower urinary tract (urethra, prostate, bladder neck and bladder).<br /><ul><li>Physical examinations
Semen analysis</li></ul>Used to evaluate male fertility a man’s ability to reproduce. This test, which also is called a sperm count.<br />Complications<br /><ul><li>Raised testicular temperature
Metastasis from renal tumor leading in sudden development of a varicocele in an older man.</li></li></ul><li>NURSING DIAGNOSIS<br />Ineffective Coping related to shame and anger.<br />Pain related to abnormal dilation of the vein in the scrotum.<br />Ineffective therapeutic Regimen Management related to denial and lack of understanding of disease. <br />Jesual dysfunction related to surgery.<br />INTERVENTION<br /> <br />Surgery <br /><ul><li>varicocele ligation</li></ul>The procedure is surgical ligation (typing off) of the distended veins.<br /> <br />Levels of care<br />promotive<br /><ul><li>EducaEmphasize seeing healthcare provider
Provide info about disease process prognosis and treatment.
tion on the prevention of varicocele</li></li></ul><li>Preventive<br /><ul><li>Avoid lifting heavy objects.
Varicocele ligation-The procedure is surgical ligation (typing off) of the distended veins.</li></ul>Rehabilitative<br /><ul><li>Establish realistic endpoints based on improvement.
Assist patient in performing activities in daily living.</li></li></ul><li>PROSTATE CANCER<br />Prostate cancer is the most common cancer in men. The incidence of prostate cancer increases rapidly after the age of 50 years, and more than 70% of cases occur in men over 65 years.<br />Etiology<br />Factors:<br /><ul><li>Genetic Tendency
Viruses</li></ul>Pathophysiology<br />Prostate tumors are usually adenocaricinomas that begin in the peripehery of the posterior lobe of the gland, whereas BPH occurs centrally and the gland is large by the time it restricts urination. The tumor may appear as normal prostatic tissue, which delays diagnosis. Typically, such lesions grow slowly and remain confined to the prostatic capsule, and if they occur late in life, the client may die of other causes. Sometimes, however, the tumor grows rapidly and metastasis has occurred by the time a diagnosis is made. <br /> <br /> When prostate cancer metastasizes (spreads), it does so mainly through direct extension to the bladder neck and seminal vesibles. Other spread occurs through lymphatic and hematogenous routes. Obturator and iliac nodes are commonly positive. With advanced disease, metastasis to the bone is common, as is spread to the lungs and liver.<br /> <br />
ASSESSMENT<br />Symptoms<br />(Early prostate cancer usually causes no symptoms.)<br /><ul><li>Frequent urination
Painful Urination</li></li></ul><li>DIAGNOSTIC EXAMS<br />1. PROSTATE<br /> If cancer is suspected, a biopsy is offered. During a biopsy a urologist or radiologist obtains tissue samples from the prostate via the rectum.<br />PRE-OP CARE<br /><ul><li>Assess the man’s understanding of the procedure.
impotence (erectile dysfunction)</li></ul>NURSING DIAGNOSIS<br /><ul><li> pain related to obstruction
Urinary Retention related to the obstruction.
Fluid Volume Deficit Due to Postoperative Hemorrhage.
Alteration in comfort:</li></ul>Alteration in Patterns of Urinary Elimination due to Post surgical need for urinary catheter.<br />INTERVENTIONS<br /> Medical<br /><ul><li> High Plasma levels of Vit. D may have a protective effects.
Eastrogens from fermented soybeans and other plant sources (called phytoestrogens) may also help prevent prostate cancer.
TURP (transurethral resection of the prostate)</li></ul>is a surgical procedure performed when the tube from the bladder to the penis (urethra) is blocked by prostate enlargement.<br /><ul><li>Orchiectomy</li></ul>removal of the testicles done to decrease testosterone levels and control cancer growth. <br /><ul><li>Cryosurgery</li></ul>Prostate gland is exposed to freezing temperature mental rods are inserted through the skin of the perineum into the prostate.<br /><ul><li>Radiation therapy(Radiotherapy)</li></ul>Is often used to treat all stages of prostate cancer, or when surgery fails. Radiotherapy uses ionizing radiation to kill prostate cancer cells.<br /> <br />
Levels of care<br />Promotive<br /><ul><li>Educate patient about importance of adequate rest and proper nutrition.
OVARIAN CANCER<br />Ovarian cancer is a cancerous growth arising from an ovary. Most commonly forms in the living of the ovary (resulting in epithelial ovarian cancer) or in the egg cells (resulting in a germ cell tumor). <br />ETIOLOGY<br />Ovarian cancers are histologically diverse. At least 80% originate in the epithelium; 75% of these cancers are serous cystadenocarcinoma, and the rest include mucinous, endometriod, transitional cell, clear cell, unclassified carcinomas, and Brenner tumor. <br />PATHOPHYSIOLOGY<br />Where epithelial ovarian cancer arise from cells derived from the ovarian surface epithelium and/or the peritoneal mesothelium is unclear; however, more than 70% of women present with tumor involving multiple peritoneal surfaces, suggesting the presence of metachronous peritoneal t tumors. In particular, primary peritoneal carcinoma appears to be one of the famililian ovarian cancer phenotypes.<br />
Urinary urgency</li></li></ul><li>DIAGNOSTIC TEST<br />Ultrasound <br /><ul><li>A non-invasive test uses sound waves to create a picture of the uterus and ovaries.
It can help determine whether an ovarian growth is likely to be a cancer or a fluid-filled cyst.</li></ul>Pre, Intra, Post Nursing Care:<br /><ul><li>If indicated, prepare the patient with a special diet, laxative or other medication to cleanse the bowel and decrease gas.
Place the patient on NPO for at least 6 hours.
Position the patient according to the organ to be visualize.
Provide patient with emotional support.</li></ul>Computed Tomography (CT) Scan<br />This is an x-ray technique that provides excellent anatomic definition and is used to detect tumors, cysts, and abscesses.<br />Pre, Intra, Post Procedure nursing Care:<br /><ul><li>Ask the patient if she is pregnant.
Instruct the patient not to eat anything after midnight before the test.
If indicated, prepare the patient with laxative to clean out the intestinal tract.
Ask if there are known allergies to iodine or contrast dye. A contrast medium may be given intravenously to provide better visualization of body parts.
Inform patient that she can go to normal activities after the procedure.</li></li></ul><li>X-ray<br /><ul><li>Light rays of short length which are passed by a n electric generator through a glass vacuum tube. Such rays have special penetrative powers through body tissues.</li></ul>Pre, Intra, Post Procedure Nursing Care: <br /><ul><li>Ask the patient if she pregnant
Ask client to remove any radio opaque objects such as jewelries</li></ul>Instruct patient not to eat anything after midnight before the procedure.<br /><ul><li>Position the patient properly to the x-ray board.
Ensure patient is properly position in front of the x-ray board.
If the image is taken instruct patient to release his/her breath.
Follow up x-ray result.</li></ul>Complications:<br /><ul><li>Spread of the cancer to other organs
Malabsorption related to chemotherapy and radiation theraphy.</li></ul> <br />
Interventions:<br />A. Medical<br /><ul><li>Any ascites encountered during the surgery are submitted for cytology and, if there is no ascetic fluid “washings” are taken by laughing the peritoneal cavity with normal saline and submitting this fluid for analysis.
Pelvis and abdomen tissue is carefully scrutinized, and biopsy is done of any suspicious areas.</li></ul>B. Surgical<br />7 total abdominal hysterectomy bilateral salpingocophorectomy and omentectomy<br />C. Nursing Care<br />* Promotive*<br /><ul><li>Educate the community about cancer risk and assets then to avoid known carcinogens to reduce the rile for cancer.
Counsel the community to participate in cancer prevention programs
Teach the public about healthy lifestyles and practices</li></ul>* Preventive*<br /><ul><li>Teach the patient to increase consumption of fresh vegetables because studies indicates that roughage and vitamin rich foods help to prevent certain kind of cancer.
Advise patient to reduce intake of dietary fat because a high fat diet increases the risk for cancer.
Encourage patient to stop smoking cigarettes if he/she is smoking because cigarettes and cigars are carcinogens.</li></ul> <br />
*Curative*<br /><ul><li>Provide patient with emotional support, comfort measures, and information, plus attentiveness and caring.
Administer intravenous therapy as prescribed to alleviate fluid and electrolyte imbalances in patients with advanced ovarian cancer.
Provide adequate nutrition and pain relief as prescribed.</li></ul>*Rehabilitative*<br /><ul><li>Assess patient for body image changes as a result of disfiguring treatment
Assist the patient in identifying strategies for coping with them.
Collaborate with dietitians to help paients plan meals that will bw acceptable and meet nutritional requirements
Encourage patient to regain the highest level of function and independence possible.</li></li></ul><li>MYOMA<br /><ul><li>Myoma-abenign tumor of smooth muscle in the wall of the uterus. A myoma of the the uterus is commonly called a fibroid.
Uterine fibroids (also referred to as myoma, leiomyoma, leiomyomata, and fibromyoma) are benign (non-cancerous) tumours that grow within the muscle tissue of the uterus.
Uterine fibroids are the single most common indication for hysterectomy</li></ul>EPIDEMIOLOGY AND ETIOLOGY<br />It has been estimated that 20% to 25% of women over 30 years of age develop uterine fibroid tumors (myomas). Uterine myomas occur more often in black women and in women who have never been pregnant. They rarely become malignant. Because their growth is stimulated by ovarian hormones, fibroid tumors of the uterus tend to disappear spontaneously with the advent of menopause.<br />PATHOPHYSIOLOGY<br /> <br />The cause of uterine myomas is unknown. They do not appear to be transmitted genetically. Because uterine myomas regress after menopause, it has been suggested that they are stimulated by estrogen. The sizes of myomas are variable. Most are found in the body of the uterus (corporeal), but some occur in the cervix or may involve the broad ligament. Subserous growths may extend outward into the folds of the broad ligament, cresting as intraligamentary tumors that burrow outward to from retroperitoneal masses. Intramural growths may cause in change in the contour of the uterus if they are small. When the growths are larger, they may produce an actual uterine enlargement. Submucous tumors may impinge on the uterine enlargement. Submucous tumors may impinge on the blood vessels of the larger, they may impinge on the opposite uterine wall and distort the cavity of the uterus. In some instances, submucous tumors develop pedicles and may protrude through the vagina or cervix resulting in infection or ulcerations.<br /> <br />
ASSESSMENT <br /><ul><li>Very heavy that and prolonged menstrual periods
Pressure on the bladder which leads to a constant need to urinate, incontinence, or inability to empty the bladder
Pressure on the bowel which can lead to constipation and/or bloating
An enlarge abdomen which may be mistaken for weight gain or pregnancy</li></li></ul><li>Diagnostic test:<br /><ul><li>Hysteroscopy
Visual examination of the uterus by the use of a hysteroscope inserted through the cervix into the uterus. </li></ul>Pre, Intra, Post diagnostic nursing care:<br /><ul><li>Explain the procedure to the patient .
Assess patient for cervical or endometrial carcinoma or acute pelvic inflammation because this procedure is contra-indicated with such condition.
Assist the physician during the procedure</li></ul>Hysterosalpingographyotuterotubography<br />An x-ray study of the uterus and the fallopian tubes after injection of a contrast agent.<br />Pre, Intra, Post diagnostic nursing care: (assess px for allergies to iodine or contresdye<br /><ul><li>Explain the procedure to the patient
Enema and cathartics may be ordered so that gas shadows do not distort the x-ray findings</li></ul> An analgesic agent may be prescribed.<br /><ul><li>Position the patient in lithotomy position
Advise patient to wear a perineal pad for several hours because the radiopaque agent may strain the clothing.</li></li></ul><li>Complications<br /><ul><li>Anemia
Altering the position of the cervix and preventing sperm from reaching the uterus</li></ul>Nursing Diagnosis<br /><ul><li>Disturbed body image related to altered fertility and fears about sexuality and relationships with family.
Anxiety related to fear that will undergo surgery, anxiety are common.
Deficient knowledge of the perioperative aspect of hysterectomy and post- operative elf care.
Fear related to perceived threat of the surgical procedure and separation from support system.</li></li></ul><li>Interventions:<br />Medical<br /><ul><li>Closely monitor for symptoms. (this is called watchful waiting)
Administer medications as prescribed such as leuprolide (Lupron) or other GNRH analogs that induce medical menopause to shrink tunors.</li></ul>Surgical<br /><ul><li>Myomectomy – removal of one or more of the fibroids with open abdominal surgery.
Laparoscopic or HysteroscopicMyomectomy – removal of a fibroids through a laparoscope inserted through a small abdominal incision.
Uterine artery embolization – polyvinyl alcohol beads are injected into the blood vessels that supply the fibroids which block the flow of blood and causing necrosis.
MR guided Focused Ultrasound Surgery – reduce the size of the fibroids.</li></ul>Nursing Care<br />Promotive<br /><ul><li>Educate the community about the possible cause of myoma.
Conduct health teaching on how to avoid myoma.</li></li></ul><li>REFERENCES:<br />MEDICAL SURGICAL NURSING VOL. 1 AND 2 BY SUZANNE C. SMELTZER, BRENDA G. BARE 10TH EDITION.<br />MEDICAL SURGICAL NURSING 4TH EDITION BY PHIPPS, LONG, WOOD, CARSMEYER.<br />http.//www.mayoclinic.com<br />http.//www.wikipedia.org<br />
Group 5 members:<br />Balgos, Cecile<br />Cortel, George Ivan<br />Dasig, Ken Hensley<br />Dela Cruz, Jesce<br />Progio, Genesis<br />