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- 1. UNIT IV: Reproductive Disorders Muhammad Yaqoob RN, BScN, MSN Lecturer Institute of Nursing Dow University of Health Sciences May 30, 2022
- 3. Uterine Fibroids (Leiomyomas) • Benign smooth muscle tumors in uterus diagnosed with Hysteroscopy
- 4. Leiomyomas • Signs and Symptoms – Most do NOT have symptoms If they do: – Abnormal uterine bleeding- menorrhagia and metrorrhagia – Pain, pelvic pressure
- 5. Uterine Fibroids (Leiomyomas) • Diagnosis – Enlarged uterus distorted with nodular masses • Treatment and Nursing Care – Myeomectomy, Myeolysis – hysterectomy – Cryosurgery – ExAblate 2000 system
- 6. Answer this! • A 26 y/o woman who wishes to have children is diagnosed with uterine fibroids (leiomyoma). Which of the following is likely to be the treatment of choice? a. A hysterectomy will be necessary to remove the tumor b. A myomectomy may be performed c. Aspirin and NSAID’s will be used to control the pain d. Hormonal therapy will be used to shrink the tumor and maintain sterility
- 7. Chronic endocrine disorder resulting in: Insulin resistance Hyperandrogenism Altered gonadotropin functioning
- 8. Polycystic ovaries LH, FSH No egg released from ovary Small cysts develop in ovaries r/t failure to release egg Diagnosed – Pelvic Ultrasound Estrogen/ testosterone progesterone
- 11. Polycystic Ovaries • Signs and Symptoms – Irregular menstrual periods – infrequent or absent – Hirsutism – Obesity – Acne – No ovulation
- 12. Polycystic ovaries Treatment: a. oral contraceptives – b. spironolactone (Aldactone) - c. leuprolide (Lupron) - d. Metformin (glucophage) - e. clomiphene (Clomid) – Surgery • Oophorectomy
- 13. Additional Treatment Options • Weight management • Exercise • Monitor lipid profile • Monitor glucose levels
- 17. Pap Test
- 18. Colposcopy LUMA Cervical Imaging System
- 19. Conization Loop Electrosurgery Excision Procedure
- 22. Cervical Cancer
- 25. Endometrial Cancer • Major Risk factor – Prolonged exposure to Estrogen • Other Risk factors – Age - >60 – Infertility – Diabetes – Family history, other cancers – Lifestyle – obesity, smoking
- 26. Endometrial Cancer Treatment and Nursing Care • Diagnosed – Endometrial biopsy Treatment: • Surgical Therapy – Hysterectomy – first choice of treatment • Chemotherapy • Radiation - brachytherapy
- 27. Brachytherapy • Internal radiation implantation which delivers a high dose of radiation to a localized area. • The radiation device is placed near the tumor (in vagina) seeds, needles, catheters • Radioisotopes are loaded into the device after correct placement.
- 28. Postop interventions for PanHysterectomy • Analgesia • Ambulation • I & O • Passage of flatus • Heat to abdomen • Psychological support • Teaching for home care
- 29. Ovarian Cancer
- 30. Ovarian Cancer • Greatest risk factor is family history • Other risk factors include – Age – High-fat diet – Greater number of ovulatory cycles – Hormone replacement therapy – Use of infertility drugs • 90% of ovarian cancers are epithelial carcinomas from malignant transformation of surface epithelial cells
- 31. Clinical Manifestations – Increase in abdominal girth – Bowel and bladder dysfunctions – Persistent pelvic or abdominal pain – Menstrual irregularities – Ascites
- 32. Ovarian Cancer Diagnosis • Screening for high risk women should include CA-125, ultrasound, and yearly pelvic examination • CA-125 is positive in 80% of women with ovarian cancer
- 33. Tutorial on ovarian cancer • http://www.nlm.nih.gov/medlineplus/tutorial s/ovariancancer/htm/index.htm • Treatment of Ovarian Cancer – Surgery – most common – Chemotherapy
- 34. Treatment options for all Caners • Surgery – Oophorectomy, Panhysterectomy – Pelvic Exenteration • Chemotherapy • Radiation – External – Brachytherapy
- 36. Uterine Prolapse • Downward displacement of uterus into vagina Stage I Stage II Stage III •Stage I – the uterus is in the upper half of the vagina. •Stage II – the uterus has descended nearly to the opening of the vagina. •Stage III – the uterus protrudes out of the vagina.
- 37. Uterine Prolapse • Signs and symptoms – Stress incontinence – Dyspareunia – Heavy feeling in pelvis • Treatment and Nursing Care – Pessary – Hysterectomy with A&P repair
- 38. Cystocele and Rectocele • Cystocele – support is lost and bladder protrudes into the vagina • Rectocele – support is lost and rectum protrudes into the vagina
- 39. Treatment and Nursing Care • Patient teaching – Kegels exercises • Surgery – Anterior or Posterior colporrhaphy – Post-op nursing care • Patient teaching – Prevent straining at Bowel Movement by using a Low residue diet – Restriction of heavy lifting and prolonged standing, walking or sitting – Prevention of urinary retention
- 40. Infertility • May be related to anatomic or endocrine problems. • Diagnostic tests may include: –Endometrial biopsy to detect tissue responses during both phases of menstrual cycle. –Endocrine imbalance testing. –Laparoscopy to discover conditions such as endometriosis, adhesions, or scar tissue.
- 41. Spontaneous Abortion • Also called miscarriage, and is the expulsion of the conceptus before viability
- 42. Signs and Symptoms • Pink or brown discharge may precede onset of cramping and increased vaginal bleeding • Clotty menstrual flow • Pulse rate increased • Blood pressure is lowered
- 43. Ectopic Pregnancy • Occurs when the fertilized ovum implants and grows somewhere other than the uterine cavity • Most common in fallopian tubes
- 45. Ectopic Pregnancy • Etiology • Scarring or inflammation of the fallopian tubes as result of infection or congenital malformations • Signs and Symptoms • Abdominal pain and tenderness • If life threatening, severe abdominal pain • Treatment • Laparotomy • Transfusions of blood in the event of severe intra- abdominal bleeding or hypovolemic shock
- 46. Hydatidiform mole • Hydatidiform mole, also called molar pregnancy, is a rare mass or growth that forms inside the uterus at the beginning of a pregnancy. It is a type of gestational trophoblastic disease (GTD).
- 47. • Hydatidiform mole, or molar pregnancy, results from over- production of the tissue that is supposed to develop into the placenta. The placenta feeds the fetus during pregnancy. With a molar pregnancy, the tissues develop into an abnormal growth, called a mass. • There are two types: • Partial molar pregnancy: There is an abnormal placenta and some fetal development. • Complete molar pregnancy: There is an abnormal placenta but no fetus. • Both forms are due to problems during fertilization. The exact cause of fertilization problems is unknown. A diet low in protein, animal fat, and vitamin A may play a role.
- 48. Treatment • Dilation and curettage (D&C) • Hysterectomy
- 49. Fistulas • A fistula is a passage or hole that has formed between: Two organs in the body. An organ in the body and skin.
- 50. • Vesicovaginal fistula: between the bladder and the vagina • Cervical fistula: abnormal opening in the cervix • Enterovaginal fistula: between the intestine and the vagina • Rectovaginal: between the rectum and the vagina
- 51. Breast Cancer • Second major cause of cancer death among women. Statistics indicate that 1 in 10 will develop cancer sometime during her life. • The key to cure is early detection by physical examination, mammography, and breast self- examination. • Five year survival rate is 97% for localized cancer, 76% for cancer that has spread regionally, and 21% for cancers having distant metastases.
- 52. Highest At-Risk for Breast Cancer • Had a mother or sibling with breast cancer. • Never had children or had first child after 30. • Never breast fed. • Has a history of fibrocystic breast disease. • Started menstruating before age 10. • Is obese. • Consumes high-fat diet and moderate amount of alcohol. • Smokes. • Experienced a late menopause.
- 53. Thank You