Maricar :Maricar Jonathan Mara Mae Pie


UTERINEPROLAPSE :UTERINEPROLAPSE


ASSESSMENT: :ASSESSMENT: A complete pelvic examination is required, including a rectovaginal examination to assess sphincter tone. A Sims speculum or a standard bivalve speculum with the anterior blade removed may facilitate diagnosis. Physical findings may be enhanced by having the patient strain during the examination or by having her stand or walk prior to examination. Standing with an empty bladder may result in a 1-2 stage difference in the degree of prolapse noted on examination when compared to a supine position with a full bladder. Mild uterine prolapse may be recognized only when the patient strains during the bimanual examination. Evaluate all patients for estrogen status. Signs of decreased estrogens Loss of rugae in the vaginal mucosa Decreased secretions Thin perineal skin Easy perineal tearing Physical examination should also be directed toward ruling out serious conditions that may rarely be associated with uterine prolapse, such as infection, urinary outflow obstruction with renal failure, and hemorrhage. If urinary obstruction is present, the patient may exhibit suprapubic tenderness or a tympanitic bladder. If infection is present, purulent cervical discharge may be noted.


SIGNS AND SYMPTOMS :SIGNS AND SYMPTOMS Pelvic heaviness or pressure Protrusion of tissue: A patient who reports of a "bulge" has been found to be a valuable screening tool for the detection of pelvic organ prolapse (81% PPV, 76% NPV). Pelvic pain Sexual dysfunction, including dyspareunia, decreased libido, and difficulty achieving orgasm Lower back pain Constipation Difficulty walking Difficulty urinating Urinary frequency Urinary urgency Urinary incontinence Nausea Purulent discharge (rare) Bleeding (rare) Ulceration (rare)


PATHOPHYSIOLOGY :PATHOPHYSIOLOGY Age Race (Hispanic) Pelvic structure (Anthropoid) Uterine structure Lifestyle (occupation) Multiparus menopause Decreased estrogen level Obstetrical trauma Weakening of the pelvic tissues, muscles, ligaments


Slide 6:Uterine prolapse Stage I (descent to any point of the vagina above the hymenal remnants) Stage II (descent to the hymen) Stage III (descent beyond the hymen) Stage IV (total eversion or procidentia) GI: Dysuria Constipation Urinary frequency Nausea & vomiting Urinary incontinence Urinary urgency Circulatory: Bleeding Musculoskeletal: Pelvic heaviness Pelvic pain Low back pain Reproductive: Sexual dysfunction Decreased libido Integumentary: Protrusion of tissue ulceration


NURSINGDIAGNOSES :NURSINGDIAGNOSES


Pain :Pain Administer analgesic as prescribed. Provide comfort measures such as backrub. Provide diversional activities such as guided imagery and socialization.


Constipation :Constipation Administer stool softeners/laxatives as prescribed. Encourage increase in fluid and fiber intake. Encourage early ambulation.


Urinary Incontinence :Urinary Incontinence Implement bladder training for incontinence management by providing ready acces to bathroom or commode, encouraging adequate fluid intake, and establishing voiding/bladder emptying. Determine if client is aware of incontinence. Developmental issues/ medical conditions that can impair patient’s awareness and sensory perception of voiding. Determine patient’s particular symptoms (e.g. continuous dribbling).


Sexual Dysfunction :Sexual Dysfunction Provide for ways to obtain privacy to allow for sexual expression for individual and/or between partners with out embarrassment and/or objection of others. Establish therapeutic nurse-client relationship to promote treatment and facilitate sharing of sensitive information. Provide factual information about individual condition involved to promote informed decision making.


Risk for infection :Risk for infection Observe for localized signs of infection. Note for signs and symptoms for sepsis. Stress proper hand hygiene.


MEDICALMANAGEMENT :MEDICALMANAGEMENT Lifestyle changes. Exercises to strengthen your pelvic floor muscles (Kegel exercises) may help relieve some symptoms. Avoid heavy lifting or straining Vaginal pessary.


SURGICAL MANAGEMENT :SURGICAL MANAGEMENT Surgery to repair uterine prolapse. Surgical repair of uterine prolapse usually requires vaginal hysterectomy to remove your uterus and excess vaginal tissue. However, in some cases, surgical repair may be possible through a graft of your own tissue, donor tissue or some synthetic material onto weakened pelvic floor structures to support your pelvic organs. Laparoscopic techniques — using smaller abdominal incisions, a lighted camera-type device (laparoscope) to guide the surgeon and specialized surgical instruments — offer a minimally invasive approach to abdominal surgery.


THE END :THE END


ECTOPICPREGNANCY :ECTOPICPREGNANCY


ASSESSMENT :ASSESSMENT Needle insertion through the postraginal fornix into the cul-de-sac under sterile conditions to see whether blood can be aspirated. Laparoscopy/culdoscopy- used to visualize the fallopian tube. Sonography- visualization of the abnormal implantment of the zygote. Cullen’s sign- umbilicus may develop a bluish tinge. Vaginal Examination- tender mass is usually palpable in Douglas cul-de-sac.


SIGNS AND SYMPTOMS :SIGNS AND SYMPTOMS Early signs…. Nausea and Vomiting Sharp stabbing pain in the lower abdominal quadrant Vaginal bleeding Late signs…. Weak thready pulse Decreased BP Rapid respirations


Pathophysiology :Pathophysiology Age(33-45) Female PID Previous ectopic pregnancy Surgery of the fallopian tube 2nd hand smoker in the time of conception Impaired functioning of the fallopian tube Partial or total blockage of the fallopian tube Dysfuntion of the cilia which normally propel the fertilized ovum through the tube into the uterine cavity Disruption or scarring of the fallopian tube Blocks or slows the movement of a fertilized egg through the fallopian tube of the uterus


Slide 22:Fertilized egg attaches to an area outside of the uterus (e.g. ampullary area of the fallopian tube, ovaries, cervix) where it implants and grows Abnormal bleeding of the vagina, usually in scanty amounts or spotting Abdominal ultrasound findings: No intrauterine gestational sac identified Sudden severe abdominal pain CVS: Leukocytosis Acute hemorrhage Rapid pulse Decreased BP GI: Nausea Vomiting Reproductive systems: Vaginal Bleeding Respiratory: Rapid respirations CNS: Light Headedness


NURSINGDIAGNOSES :NURSINGDIAGNOSES


Altered Comfort; Pain :Altered Comfort; Pain Assess Patients Vital Signs Determine or document prescence of possible pathophysiological causes of pain Obtain clients assessment of pain


Anxiety :Anxiety Assess patients viatal signs Miminize environmental factors contributing to increase anxiety Encourage client to acknowledge feelings


Fear :Fear Discuss clients perception/ fearful feelings Provide therapeutic touch/contact to soothe fear Manage environmental factors


Powerlessness :Powerlessness Identify situational circumstances Note behavioral responses Listen to statements that client states


Risk for Deficient Fluid Volume :Risk for Deficient Fluid Volume MIO Assess skin turgor and oral mucous membranes Establish individual fluid needs/ replacement schedule


MEDICAL MANAGEMENT :MEDICAL MANAGEMENT Methotrexate, a folic acid antagonis chemotherapeutic agent, attacks and destroys fast growing cells


SURGICAL MANAGEMENT :SURGICAL MANAGEMENT Hysterosalpingogram