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Powerpoinr presentation of BSN 3 Richards of FILAMER CHRISTIAN COLLEGE, COLLEGE OF NURSING

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  1. 1. The Reproductive System (DISORDERS) GROUP 5 BSN III RICHARDS
  2. 2. Introduction <ul><li>At its most basic level, reproduction is the process by which a single cell duplicates its genetic material. Reproduction is also the process by which our genetic material is passed on from one generation to the next. </li></ul><ul><li>This process requires a special kind of cellular reproduction that produces special cells, the sperm from the male and the egg from the female. These join in the process of fertilization to produce a fertilized egg or zygote. </li></ul>
  3. 3. The Male Reproductive System <ul><li>The primary sex organs of the male reproductive system are the TESTES or male gonads. These organs produce sperm and the male sex hormones. Other organs also include; </li></ul><ul><li>Scrotum – supports the testes. </li></ul><ul><li>Penis – engorged with blood during arousal. </li></ul><ul><li>Testes – produces sperm cells. </li></ul>
  4. 5. The Female Reproductive System <ul><li>The primary sex organs of the female reproductive system are the ovaries or the female gonads. These organs produce eggs or OVA, as exocrine glands and endocrine glands produce the female sex hormones estrogen and progesterone . Other organs include; </li></ul><ul><li>Fallopian Tube </li></ul><ul><li>Uterus </li></ul><ul><li>Vagina </li></ul><ul><li>External Genitalia </li></ul>
  5. 7. Reproductive Disorders
  6. 8. PHIMOSIS <ul><li>- The abnormal tightness of the foreskin. Occurs when penile foreskin is constricted at the opening, making retraction difficult or impossible. </li></ul><ul><li>It is not usually painful, but it can lead to obstructive uropathy if it is severe enough. </li></ul>
  7. 9. ETIOLOGY <ul><li>Result of inflammation or local trauma. </li></ul><ul><li>Uncircumcised adult male </li></ul><ul><li>Congenital </li></ul>
  8. 11. Diagnostics <ul><li>Pre : </li></ul><ul><li>cleanse the penis thoroughly, retract the foreskin for proper cleaning. </li></ul><ul><li>Intra : </li></ul><ul><li>assist in the procedure such as circumcision. </li></ul><ul><li>Post: </li></ul><ul><li>provide proper dressing for the wound </li></ul>
  9. 12. Complications <ul><li>Painful erection </li></ul><ul><li>Difficulty in urinating </li></ul><ul><li>Balanitis – inflammation of the penis head (glans) </li></ul><ul><li>Paraphimosis - is a condition where there is constriction in the glans penis by a foreskin. </li></ul>
  10. 13. Nursing Diagnosis <ul><li>Pain related to surgery. – a variety of unpleasant sensation that the patient experienced after surgery </li></ul><ul><li>Self-esteem disturbance related to alteration in body image. – patient will have negative feeling of himself due to his illness. </li></ul><ul><li>Knowledge deficit related to alteration in body image. – patient will have questions about what has done to him after surgery. </li></ul><ul><li>Urethral trauma secondary to surgery. – patient will have a difficulty in urinating after his surgery. </li></ul><ul><li>High risk for Fluid volume deficit. – post operative hemorrhage. </li></ul>
  11. 14. Medical and Surgical Interventions <ul><li>Medical: </li></ul><ul><li>Control infection with local treatment of antimicrobial drugs. </li></ul><ul><li>Surgical: </li></ul><ul><li>- Circumcision </li></ul>
  12. 15. Levels of Care <ul><li>Promotive : </li></ul><ul><li>-provide teachings to parents about the disadvantages of being uncircumcised </li></ul><ul><li>Preventive : </li></ul><ul><li>-advise clients for early circumcision </li></ul><ul><li>Rehabilitative : </li></ul><ul><li>-provide proper wound dressing to the circumcised penis </li></ul>
  13. 16. HYPOSPADIA <ul><li>- a developmental anomaly in which the male urethra opens on the under side of the penis. Midline </li></ul><ul><li>of the urethral folds </li></ul><ul><li>is incomplete so </li></ul><ul><li>that urethral meatus </li></ul><ul><li>opens on the </li></ul><ul><li>urethral side of penis. </li></ul>
  14. 17. Etiology <ul><li>Single-gene defect </li></ul><ul><li>Chromosomal abnormalities </li></ul><ul><li>Maternal progestational drug ingestion in early pregnancy </li></ul>
  15. 19. Diagnosis <ul><li>- Hypospadias is usually diagnosed during the physical examination of a newborn. A test that may be useful if hypospadias is suspected is an excretory urogram. This test uses X-rays to provide pictures of the urinary tract. </li></ul>
  16. 20. Complications <ul><li>complications are more likely to occur in older children and adults. These include: </li></ul><ul><li>Narrowing of the urethra </li></ul><ul><li>Bleeding </li></ul><ul><li>Infection </li></ul><ul><li>Curvature of the penis </li></ul>
  17. 21. Nursing Diagnosis <ul><li>I. Acute pain related to surgery. - a variety of unpleasant sensation that the patient experienced after surgery </li></ul><ul><li>II. Body image disturbance related to alteration in body structure. </li></ul><ul><li>III. Fear related to developmental concerns with body integrity. – patient may experience fear caused by awareness of pain or danger concerning body function. </li></ul><ul><li>IV. Altered patterns of urinary elimination related to surgical repair. – patient may experience incontinent of passing urine due to surgery. </li></ul><ul><li>V. High risk for fluid volume deficit. – post operative hemorhhage. </li></ul>
  18. 22. Medical and Surgical Interventions <ul><li>Hypospadias/epispadias is sometimes treated with surgery to correct the placement of the urethral opening, usually during the first year of life. </li></ul><ul><li>There are several different types of surgery, which may include repositioning of the urethra, correcting the placement of the urethral opening in the head of the penis, and reconstructing the skin of the area around the urethral opening. </li></ul><ul><li>Because the foreskin may be needed for surgical repair, a baby with hypospadia should not be circumcised . </li></ul>
  19. 23. Levels of Care <ul><li>Preventive : </li></ul><ul><li>-advice parents of male child to have their son checked for early detection </li></ul><ul><li>Rehabilitative : </li></ul><ul><li>-assist client in recovery and changes in urination </li></ul>
  20. 24. EPISPADIA <ul><li>- A congenital absence of the uper wall of the urethra, ocuring in both sexes but commonly in males. </li></ul>
  21. 25. Etiology <ul><li>Acro-pectoro-renal field defect - A very rare genetic syndrome characterized by abnormalities of the genital and urinary systems as well as the absence of chest muscles at birth </li></ul><ul><li>Acrofacial dysostosis Catania form - One of a group of disorders characterized by defective limb and facial development. </li></ul><ul><li>BEEC- A rare syndrome characterized by a birth defect where the bladder is inside out and protrudes from the lower abdominal wall. The urethra and genitals are also abnormally formed. </li></ul><ul><li>Chromosome 4 ring syndrome - rare chromosomal disorder where the ends of chromosome 4 have been deleted and the two broken ends have rejoined to form a ring shape resulting in a range of symptoms determined by the size and location of the genetic deletion. </li></ul><ul><li>Exstrophy of the bladder- Exstrophy of the bladder: A rare congenital malformation the bladder is inside out and is protrudes through the wall of the abdomen. </li></ul>
  22. 27. Diagnosis <ul><li>Epispadias is usually diagnosed during the physical examination of a newborn. A test that may be useful if epispadias is suspected is an excretory urogram. This test uses X-rays to provide pictures of the urinary tract. </li></ul>
  23. 28. Complication <ul><li>Urinary tract malformation </li></ul>
  24. 29. Nursing Diagnosis <ul><li>I. Acute pain related to surgery. - a variety of unpleasant sensation that the patient experienced after surgery </li></ul><ul><li>II. Body image disturbance related to alteration in body structure. </li></ul><ul><li>III. Fear related to developmental concerns with body integrity. – patient may experience fear caused by awareness of pain or danger concerning body function. </li></ul><ul><li>IV. Altered patterns of urinary elimination related to surgical repair. – patient may experience incontinent of passing urine due to surgery. </li></ul><ul><li>V. High risk for fluid volume deficit. – post operative hemorhhage. </li></ul>
  25. 30. CRYPTORCHIDISM <ul><li>or undescended testicles. Occurs when one or both of the testicles fail to move down into the scrotal sac. </li></ul>
  26. 31. Etiology <ul><li>Hormonal factors (testosterone deficiency) </li></ul><ul><li>Prenatal exposure to diethylstilbesterol </li></ul><ul><li>Prematurity (premature neonates are most commonly affected because testes normally descend into the scrotum around 28 weeks gestation. </li></ul><ul><li>Mechanical interference with the passage of the testes into the scrotum. </li></ul><ul><li>Deficiency of gonadotropin </li></ul>
  27. 33. Diagnostics <ul><li>Laparoscopy – useful in locating intra-abdominal testes or cord structures entering the inguinal canal </li></ul><ul><li>Ultrasonography </li></ul><ul><li>CT scan </li></ul><ul><li>MRI (magnetic resonance imaging) </li></ul>
  28. 34. Complications <ul><li>Testicular cancer </li></ul><ul><li>Male infertility </li></ul><ul><li>Groin mass </li></ul><ul><li>Testosterone level is low </li></ul>
  29. 35. Nursing Diagnosis <ul><li>Body image disturbance related to perceived body image changes </li></ul><ul><li>Anxiety related to intensive diagnostic and surgical procedures </li></ul><ul><li>Knowledge deficit related to new condition </li></ul><ul><li>Pain related to invasive procedure </li></ul><ul><li>Fear related to anticipation of pain </li></ul>
  30. 36. Medical and Surgical Interventions <ul><li>Orchiopexy - is a surgery to move an undescended testicle into the scrotum and permanently fix it there. It is performed by a pediatric urologist or surgeon on boys with cryptorchidism, typically before they reach the age of two. </li></ul>
  31. 37. Levels of Care <ul><li>Preventive : </li></ul><ul><li>-provide information on causes and the possible effect on reproduction </li></ul><ul><li>Curative : </li></ul><ul><li>-antimicrobial therapy </li></ul><ul><li>-warm moist soaks and used to relieved discomfort and help reduce swelling </li></ul><ul><li>-circumcission </li></ul>
  32. 38. HYDROCELE <ul><li>Collection of fluid between the visceral and parietal layers of the tunica vaginalis of the testicles or along the spermatic cord. </li></ul><ul><li>Most common form of </li></ul><ul><li>scrotal swelling </li></ul>
  33. 39. <ul><li>Two Types of Hydrocele </li></ul><ul><li>Communicating Hydrocele (Infants) </li></ul><ul><li>1. Incomplete obliteration of processus vaginalis </li></ul><ul><li>2. Open communication between peritoneum and tunica </li></ul><ul><li>3. Closes spontaneously in the first year of life </li></ul><ul><li>Non-Communicating Hydrocele (Adults) </li></ul><ul><li>1. Imbalance in secretion vs absorption of tunica </li></ul><ul><li>2. Results from inflammatory reaction </li></ul><ul><li>a. injury </li></ul><ul><li>b. infection </li></ul><ul><li>c. Testicular Tumor </li></ul>
  34. 40. Etiology <ul><li>Congenital malformation </li></ul><ul><li>Trauma of the testes or epididymis </li></ul><ul><li>Infection of the testes </li></ul><ul><li>Testicular tumor </li></ul>
  35. 41. Pathophysiology <ul><li>A communicating hydrocele, a congenital condition, occurs because of patency between the scrotal sac and peritoneal cavity, which allows peritoneal fluids to collect in the scrotum. </li></ul><ul><li>In non-communicating hydrocele, fluids accumulate because of infection, 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. </li></ul>
  36. 43. Diagnostics <ul><li>Transllumination of the scrotum – shining a light through the scrotum for the purpose of visualizing the internal structures. </li></ul><ul><li>Ultrasonography – determine whether the mass is solid or cystic and whether the testicle is normal. </li></ul>
  37. 44. Complications <ul><li>Epididymitis – is a medical condition in which there is inflammation of the epididymis (a curved structure at the back of the testicle in which sperm matures and is stored). </li></ul><ul><li>Testicular Atrophy - is a medical condition in which the male reproductive organs (the testes, which in humans are located in the scrotum) diminish in size and may be accompanied by loss of function. </li></ul>
  38. 45. Nursing Diagnosis <ul><li>I. High risk for dysfunction related to excision of tunica vaginalis.- may lose sexual urges due to surgery. </li></ul><ul><li>II. Pain related to swelling. – pain that is experienced by the patient after surgery. </li></ul><ul><li>III. Impaired skin integrity related to surgery. – incisions made during surgery. </li></ul><ul><li>IV. High risk for infection related to fluid accumulation. – fluid that is collected at the scrotal sac may cause infection. </li></ul><ul><li>V. Anxiety related to intrusive diagnostic and surgical test and procedure. – patient may feel very anxious about the procedures that will be done to him. </li></ul>
  39. 46. Medical and Surgical Interventions <ul><li>Medical: </li></ul><ul><li>usually no treatment for congenital hydrocele, condition commonly resolves spontaneously by age 1. </li></ul><ul><li>Surgical: </li></ul><ul><li>aspiration of fluid and injection of sclerosing drug into the scrotal sac for a tense hydrocele that impedes blood circulation or cause pain. </li></ul>
  40. 47. Levels of Care <ul><li>Promotive: </li></ul><ul><li>-provide health education </li></ul><ul><li>Preventive: </li></ul><ul><li>-thorough physical examination annually </li></ul><ul><li>Rehabilitative: </li></ul><ul><li>-apply ice packs </li></ul>
  41. 48. VARICOCELE <ul><li>- a mass of dilated and tortuous varicose veins in the spermatic cord. Classically </li></ul><ul><li>described as a </li></ul><ul><li>“ Bag of worms” </li></ul>
  42. 49. Etiology <ul><li>Incompetent or congenitally absent valves in the spermatic veins </li></ul><ul><li>Tumor or thrombus obstructing the inferior vena cava (unilateral [left-sided] varicocele) </li></ul>
  43. 50. Pathophysiology <ul><li>Because of a valvular disorder in the spermatic vein, blood pools in the pampiniform plexus of veins that drain each testis rather than flowing into the venous system </li></ul><ul><li>One function of the pampiniform plexus is to keep the testis slightly cooler than body temperature </li></ul><ul><li>Testicular atrophy may also occur because of reduce blood flow </li></ul>
  44. 51. Diagnostics <ul><li>Physical examination allows palpation of the “bag of worms” when the patient is upright </li></ul><ul><li>Real-time ultrasonography </li></ul><ul><li>Radioisotope scanning </li></ul><ul><li>Spermatic venography </li></ul><ul><li>Scrotopenography </li></ul>
  45. 52. Complications <ul><li>Infertility </li></ul><ul><li>Hydrocele </li></ul><ul><li>Metastasis from a renal tumor leading to sudden development of varicocele in an older man (late sign) </li></ul>
  46. 53. Nursing Diagnosis <ul><li>High risk sexual dysfunction related to injury to excision of tunica vaginalis </li></ul><ul><li>Pain related to swelling </li></ul><ul><li>Impaired skin integrity related to surgical repair </li></ul><ul><li>High risk for infection related to fluid accumulation </li></ul><ul><li>Anxiety related to intusive diagnostic surgical test and procedure </li></ul>
  47. 54. Medical and Surgical Interventions <ul><li>Medical: </li></ul><ul><li>Conservative treatment with a scrotal support to relieve discomfort (jockstrap) </li></ul><ul><li>Surgical: </li></ul><ul><li>Surgical ligation or sclerosis using a percutaneous transvenous catheter under flouroscopic guidance </li></ul>
  48. 55. Levels of care <ul><li>Promotive: </li></ul><ul><li>-provide health education </li></ul><ul><li>Preventive: </li></ul><ul><li>-thorough physical examination annually </li></ul><ul><li>-retograde venogram will confirm the diagnosis </li></ul><ul><li>Curative: </li></ul><ul><li>-scrotal support which relieves any associated discomfort </li></ul><ul><li>- surgery (varicosilectomy) </li></ul>
  49. 56. PROSTATE CANCER <ul><li>Slow-growing, most common neoplasm in men older than age 50 </li></ul><ul><li>Commonly forms as adrenocarcinoma </li></ul><ul><li>Usually originates </li></ul><ul><li>in posterior </li></ul><ul><li>prostate gland </li></ul>
  50. 57. Etiology <ul><li>Exact cause unknown </li></ul><ul><li>Risk factors </li></ul><ul><li>-older than age 40 </li></ul><ul><li>-infection </li></ul><ul><li>-vasectomy </li></ul><ul><li>-Family history </li></ul><ul><li>-heavy metal exposure </li></ul>
  51. 58. PATHOPHYSIOLOGY <ul><li>Difficulty initiating urinary stream, dribbling, urine retention, and unexplained cystitis due to obstruction of urinary tract by tumor </li></ul><ul><li>Hematuria due to infiltration of bladder tumor </li></ul><ul><li>Back pain caused by metastasis </li></ul>
  52. 59. <ul><li>Prostate Cancer </li></ul>
  53. 60. Diagnostics <ul><li>Serum prostate-specific antigen level is elevated </li></ul><ul><li>Transrectal prostatic ultrasonography shows prostate size and presence of abnormal growths </li></ul><ul><li>Bone scan and excretory urography detarmines extent of disease </li></ul><ul><li>MRI and CT scanning define extent of tumor </li></ul><ul><li>Direct rectal examination reveals a small, hard nodule </li></ul><ul><li>Blood testing reveals elevated serum acid phosphatase levels </li></ul><ul><li>Biopsy confirms the cell type </li></ul>
  54. 61. Complications <ul><li>Spinal cord compression </li></ul><ul><li>Deep vein thrombosis </li></ul><ul><li>Pulmonary emboli </li></ul><ul><li>Myelophthisis </li></ul><ul><li>death </li></ul>
  55. 62. Nursing Diagnosis <ul><li>Altered pattern of urinary elimination related to malignant tissue-growth of tissue interferes bladder function </li></ul><ul><li>High risk for fluid volume deficit (risk factor: Post operative hemorrhage) </li></ul><ul><li>Pain related to surgical incision </li></ul><ul><li>High risk for infection (risk factor: Surgical resection, indwelling catheter and underlying malignancy) </li></ul><ul><li>Knowledge deficit related to need for home mangement </li></ul>
  56. 63. Medical and Surgical Interventions <ul><li>Medical </li></ul><ul><li>-hormone manipulation therapy as prescribed </li></ul><ul><li>-administer luteinizing hormone </li></ul><ul><li>-radiation therapy to treat locally invasive lesions </li></ul><ul><li>-administration of chemotherapy incase of hormone resistant tumors </li></ul><ul><li>Surgical </li></ul><ul><li>-Radical prostatectomy to remove prostate gland and tumor </li></ul><ul><li>-TURP to relieve obstruction </li></ul><ul><li>-Orchiectomy to decrease androgen production </li></ul>
  57. 64. Levels of Care <ul><li>Promotive: </li></ul><ul><li>-health teaching concerning; the need for regular physical xamination, certain drugs that may produce further bladder problems </li></ul><ul><li>Preventive: </li></ul><ul><li>-routine physical examinations </li></ul><ul><li>-diagnostic test such as urinalysis and BUN </li></ul><ul><li>Rehabilitative: </li></ul><ul><li>-exercise to avoid prostatectomy urinary incontinence </li></ul><ul><li>-follow-up health care visits and physical examinations </li></ul>
  58. 65. Ovarian Cancer <ul><li>Malignancy arising from the ovary </li></ul><ul><li>Rapidly progressing </li></ul><ul><li>cancer that’s </li></ul><ul><li>difficult to diagnose </li></ul>
  59. 66. Etiology <ul><li>Exact cause unknown </li></ul><ul><li>Risk factors </li></ul><ul><li>-infertility problems or nulliparity </li></ul><ul><li>-celibacy </li></ul><ul><li>-exposure to asbestos and talc </li></ul><ul><li>-history of breast or uterine cancer </li></ul><ul><li>-family history of ovarian cancer </li></ul><ul><li>-diet high in satured fat </li></ul>
  60. 67. Pathophysiology <ul><li>Ovarian cancer spreads rapidly intraperitoneally by local extension of surface seeding and, occasionally, through the lymphatict and the bloodstream </li></ul><ul><li>Metastasis to the ovary can originate as breast, colon, gastric, and pancreatic cancer </li></ul>
  61. 68. Ovarian cancer
  62. 69. Diagnostics <ul><li>Exploratory laparotomy </li></ul><ul><li>Abdominal ultrasonography </li></ul><ul><li>Mammography </li></ul><ul><li>Aspiration of ascitic fluid reveals atypical cells </li></ul><ul><li>Laboratory tumor marker studies shows abnormaities that may indicate complications </li></ul>
  63. 70. Complications <ul><li>Fluid and electrolyte imbalance </li></ul><ul><li>Leg edema </li></ul><ul><li>Ascites </li></ul><ul><li>Intestinal obstruction </li></ul>
  64. 71. Nursing Diagnosis <ul><li>Pain related to increased abdominal pressure caused by tumor or metastasize to abdominal structures </li></ul><ul><li>High risk for ineffective breathing pattern (risk factor: presence of ascites) </li></ul><ul><li>High risk for altered nutrition (Risk factor: cancer, poor appetite secondary to disease, side effects of therapies) </li></ul><ul><li>High risk for Impaired home management (risk factor: inadequate support system) </li></ul><ul><li>High risk for sexual Dysfunction related to injury to perineal nerves during injury </li></ul>
  65. 72. Medical and Surgical Interventions <ul><li>Medical </li></ul><ul><li>- STAGE I OVARIAN CANCER- irradiation or chemotherapy after surgery or systemic chemotherapy may be administered. </li></ul><ul><li>- STAGE II OR HIGH- typically received the same treatment as those with stage I disease , with the inclusion of pelvic and possibly abdominal radiation. </li></ul><ul><li>Surgical </li></ul><ul><li>-TAH-BSO or partial or compete omentectomy and removal of all visible tumor. </li></ul>
  66. 73. <ul><li>Pre-operatively Nursing care management </li></ul><ul><li>- Evaluate the clients understanding of the proposed procedure and the changes it involves. </li></ul><ul><li>-Clients may be nutritionally compromised and may require nutritional therapy before surgery </li></ul><ul><li>Post-operatively nursing care management </li></ul><ul><li>-Wound care and prevention of infection </li></ul><ul><li>For clients receiving radiation therapy </li></ul><ul><li>-Provide education </li></ul><ul><li>-Minimize side effects </li></ul><ul><li>For clients receiving chemotherapy </li></ul><ul><li>-Careful monitoring for potential adverse reactions and side effects is required during and even after completion of the infusion. </li></ul><ul><li>-Review clients medical history to identify potential risk factors for chemotherapy toxicity; such as impaired cardiac, pulmonary function </li></ul><ul><li>-Careful assess the severity and duration of side effects experienced since the previous cause of therapy. </li></ul><ul><li>-Abnormal laboratory values may indicate organ-specific toxicities of chemotherapeutic agents. </li></ul>
  67. 74. Levels of Care <ul><li>Primary Prevention </li></ul><ul><li>Involves measures to avoid or reduce exposure to carcinogens </li></ul><ul><li>Screening programs help to identify high risk populations and individuals </li></ul><ul><li>Early detection involves finding a precancerous lesion or a cancer at its earliest most treatable stage </li></ul><ul><li>Rehabilitation </li></ul><ul><li>Consist of limitation of disability and rehabilitation </li></ul><ul><li>An important opportunity for rehabilitation may be an exercise program to help a client counteract chemotherapy related fatigue </li></ul>
  68. 75. MYOMA <ul><li>Disease characterized </li></ul><ul><li>by fibroid (benign tumors) </li></ul><ul><li>in the uterus </li></ul><ul><li>Most common benign </li></ul><ul><li>tumors in women </li></ul><ul><li>composed of smooth </li></ul><ul><li>cells </li></ul><ul><li>become malignant in </li></ul><ul><li>fewer than 0.1% of patients </li></ul>
  69. 76. Etiology <ul><li>cause is unknown </li></ul><ul><li>their growth seems to be related to estrogen stimulation because the fibroids often enlarged with pregnancy and shrink with menopause </li></ul><ul><li>begins as a simple proliferation of smooth muscle cells </li></ul>
  70. 77. Pathophysiology <ul><li>Fibroids vary greatly in size and usually appear firm, sorrounded by a pseudocapsule composed of compressed but otherwise normal uterine myometrium. </li></ul><ul><li>The uterine cavity may become larger, increasing the endometrial surface area; this can cause increased uterine bleeding </li></ul>
  71. 78. <ul><li>Intramural -found in the uterine wall, surrounded by myometrium. </li></ul><ul><li>Submucosal -located directly under the endometrium, involving the endometrial cavity </li></ul><ul><li>Subserosal -found on the outer surface (under the serosa) of the uterus. </li></ul><ul><li>Wandering or parasitic -a pedunculated leiomyoma that twist on its pedicle, breaks off,then attaches to other tissues, particularly the omentum. </li></ul><ul><li>Intraligamentary - implants on the pelvic ligaments, may displace the uterus or involve the ureters </li></ul><ul><li>Cervical - occur infrequently and may obstruct the cervical canal. </li></ul>
  72. 79. Diagnostics <ul><li>Bimanual examination </li></ul><ul><li>Utrasonography </li></ul><ul><li>MRI </li></ul><ul><li>Endometrial Biopsy </li></ul><ul><li>Laparoscopy </li></ul>
  73. 80. Complications <ul><li>Recurrent spontaneous abortion </li></ul><ul><li>Preterm labor </li></ul><ul><li>Anemia secondary to excessive bleeding </li></ul><ul><li>Bladder compression </li></ul><ul><li>Infection </li></ul><ul><li>Bowel obstruction </li></ul>
  74. 81. Nursing Diagnosis <ul><li>Risk for Dysfunctional Grieving- some women experience grief about their loss of the female reproductive organs </li></ul><ul><li>Risk for Infection- patient has a foley catheter inserted during surgery </li></ul><ul><li>Constipations- because of bowel manipulation during surgery </li></ul>
  75. 82. Medical and Surgical Interventions <ul><li>Medical </li></ul><ul><li>-GnRH agonists </li></ul><ul><li>-NSAIDs </li></ul><ul><li>Surgical </li></ul><ul><li>-Myomectomy </li></ul><ul><li>-Hysterectomy </li></ul>
  76. 83. <ul><li>Pre-operative care </li></ul><ul><li>-reduce pain </li></ul><ul><li>-provide education </li></ul><ul><li>-explain surgery effects on menstruation, menopause, sexual activity and hormonal balance </li></ul><ul><li>Post-operative care </li></ul><ul><li>-Tell patient to report abnormal bleeding or pelvic pain immediately </li></ul>
  77. 84. References <ul><li>Medical-Surgical Nursing Pathophysiological Concepts 2 nd Edition 1991 </li></ul><ul><li>Patrick, Woods, Craven, Rokosky, Bruno </li></ul><ul><li>JB LIPPINCOTT COMPANY </li></ul><ul><li>Medical-Surgical Nursing Vol. 2 10 th Edition 2004 </li></ul><ul><li>Suzanne Smelter, Brenda G. Bane </li></ul><ul><li>LIPPINCOTT WILLIAMS & WILKINS </li></ul><ul><li>Medical-Surgical Nursing 6 th Edition Vol. 1 and 2 Joyce M. Black, Jane Hokanson Hawks, Annabelle M. Keene </li></ul><ul><li>SAUNDERS </li></ul><ul><li>Nursing Care Plans 3 rd Edition </li></ul><ul><li>Gulanick, Klopp, Galanes, Gradishar, Puzas </li></ul><ul><li>MOSBY </li></ul><ul><li>Internet Reference </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul>
  78. 85. GROUP 5 <ul><li>Dula, Cheene Jane </li></ul><ul><li>Forro, Delsheila </li></ul><ul><li>Olivares, Emmily </li></ul><ul><li>Loresto, Mary Ann </li></ul><ul><li>Dela Cruz, John Euxine </li></ul><ul><li>Barros, Cherrie </li></ul><ul><li>THANK YOU and GOD BLESS!! </li></ul>