H mole

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H mole

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Presentation Transcript

Slide 1: 

H.MOLE

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Gestational trophoblastic disease is abnormal proliferation and degeneration of the trophoblasitic villi. As the cells degenerate, they become filled with fluid and appear as clear fluid, grape-sized vesicles. With this condition, the embryo fails to develop beyond a primitive start. Hydatidiform Mole

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Pathophysiology

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PATHOPHYSIOLOGY

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MEDICAL MGTs

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LABORATORY TESTS: Serum or urine test of hCG for pregnancy because hCG is produced by trophoblast cells that are overgrowing (positive if 1 to 2 million IU compared with a normal pregnancy level of 400,000 IU) Sonogram – to show defense growth (typically a snowflake pattern) but no fetal growth in the uterus chest x-ray – To check if lungs are affected with the metastatic/cancerous cells from the uterus. Checking hCG levels 6 weeks after childbirth to confirm that no trophoblastic disease has developed. A pelvic exam, to evaluate the size of the uterus and check for abnormalities. A blood test to measure the amount of a pregnancy hormone, called human chorionic gonadotropin (hCG), to see whether the level is abnormally high for the length of the pregnancy. A pelvic ultrasound test. If pelvic exam or hCG level suggests a molar pregnancy, an ultrasound can be used to confirm the diagnosis. Some molar pregnancies are first diagnosed during an ultrasound done for another purpose. LABORATORY TESTS: Serum or urine test of hCG for pregnancy because hCG is produced by trophoblast cells that are overgrowing (positive if 1 to 2 million IU compared with a normal pregnancy level of 400,000 IU) Sonogram – to show defense growth (typically a snowflake pattern) but no fetal growth in the uterus Chest x-ray – To check if lungs are affected with the metastatic/cancerous cells from the uterus. Checking hCG levels 6 weeks after childbirth to confirm that no trophoblastic disease has developed. A pelvic exam, to evaluate the size of the uterus and check for abnormalities. A blood test to measure the amount of a pregnancy hormone, called human chorionic gonadotropin (hCG), to see whether the level is abnormally high for the length of the pregnancy. A pelvic ultrasound test. If pelvic exam or hCG level suggests a molar pregnancy, an ultrasound can be used to confirm the diagnosis. Some molar pregnancies are first diagnosed during an ultrasound done for another purpose.

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MEDICAL ASSESSMENTS: Assessment of vaginal spotting of dark- brown blood or as a profuse fresh flow. As bleeding progresses, maybe accompanied with discharge of clear fluid-filled vesicles. Report any bleeding, excessive vomiting or abdominal pain during pregnancy to your doctor. If you have prolonged vaginal bleeding after childbirth, an abortion or a miscarriage, contact your doctor for an evaluation. For any pregnancy, make sure you have appropriate prenatal care beginning in the first trimester, with regular checkups. Following mole extraction chest x-ray Prophylactic cause of methatrexate – drug choice for choriocarcinoma. But should be weighed carefully because it interfere WBC formation. If you have no future plans to become pregnant, you may consider a hysterectomy, which reduces the chance of developing gestational trophoblastic disease after a molar pregnancy.

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MEDICAL INTERVENTIONS: It is important for women with molar pregnancies to be evaluated periodically after the problem has been treated. Women are advised not to attempt pregnancy for some time in order to be sure that levels of HCG remain at zero and that no further treatment is needed. There is a risk that a molar pregnancy can come back after treatment. If you have Rh-negative blood, you will also have a shot of Rh immune globulin. This prevents a problem called Rh sensitization, which can cause serious problems in a future pregnancy. Preventing pregnancy while hCG levels are being monitored, usually about 6 months. It is very important that you practice highly effective birth control during the entire period of follow-up. For more information on contraception, see the topic Birth Control.

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Close medical supervision if you happen to conceive within 12 months of molar pregnancy treatment. Routine prenatal care and a late first-trimester fetal ultrasound to confirm a healthy pregnancy. Chemotherapy with a single drug — This treatment with medication toxic to the molar tissue is used to treat a molar pregnancy tumor that has features suggesting a good prognosis. Chemotherapy with multiple drugs — Treatment with several medications toxic to the molar tissue usually is needed to treat invasive tumors with poorer prognosis. Radiation treatment — This uses high-strength X-ray beams to destroy cancer cells in the exceedingly rare case when a tumor has spread (metastasized) to the brain.

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SURGICAL MGTs

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Suction dilation and curettage (D and C) — This is a surgical procedure used to remove noncancerous hydatidiform moles. The opening in the cervix is dilated and the inside uterus lining is scraped (curetted) clean using suction and another spoonlike instrument. D & C is commonly used to obtain tissue for microscopic evaluation to rule out cancer. D & C may also be used to diagnose and treat heavy menstrual bleeding, and to diagnose endometrial polyps and uterine fibroids. D & C can also be used as an early abortion technique up to 16 weeks.

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Dilatation/dilation and evacuation (D&E) is a procedure in which the cervix is dilated and tissue is removed from the uterus. D&E is used to describe two different procedures. D&E can also be used to describe a surgical removal of a fetus and placenta between 14-20 weeks of gestation, called also late abortion or second trimester abortion. To accomplish dilatation/dilation and evacuation, a negative pressure/vacuum is used to aspirate tissue from the inside of the uterus. The procedure is thought to be less traumatic to the surface of the uterine cavity than a sharp curettage.

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Removal of the uterus (hysterectomy) — This is used rarely to treat hydatidiform moles but may be chosen, particularly if the woman does not want to become pregnant again. It may be done through the abdomen or the vagina. Other Tumors in the uterus like uterine fibroids or endometrial cancer Cancer of the cervix or severe cervical dysplasia (a precancerous condition of the cervix) Cancer of the ovary Endometriosis, in those cases in which the pain is severe and not responsive to nonsurgical treatments Severe, long-term (chronic) vaginal bleeding that cannot be controlled by medications Prolapse of the uterus Complications during childbirth (like uncontrollable bleeding)

Nu : 

Nu

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Assessment

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Palpate and check the level of the uterus because it tends to expand faster than normally and could reach the symphysis and umbilicus. Could assess fetal heart sounds to verify no variable fetus. Verify and interpret results of the serum test as compared to normal. Note for nausea and vomiting, may be due to increase hCG levels Assess for vaginal discharges as to bleeding, spotting and clear fluid-filled vesicles. Health teaching and possible complications such as malignancy of cells that would lead to choriocarcinoma. Complete assessment consists of patient history, physical examination, and laboratory data. The history should include the patient's sex, age, address, occupation, and place of work; known exposure to illness and recent medications, including antibiotics; and date of disease onset. Detail information about recent hospitalization; blood transfusions; blood donation denial by the Red Cross or other agencies; recent travel or camping trips; exposure to animals; and vaccinations.

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If applicable, ask about possible exposure to sexually transmitted diseases or about drug abuse. Also, try to determine the patient's resistance to infectious disease. Ask about usual dietary patterns, unusual fatigue, and any conditions, such as neoplastic disease or alcoholism, that may predispose him to infection. Notice if the patient is listless or uneasy, lacks concentration, or has any obvious abnormality of mood or affect. In suspected infection, a physical examination must assess the skin, mucous membranes, liver, spleen, and lymph nodes. Check for and make note of the location and type of drainage from any skin lesions. Record skin color, temperature, and turgor; ask if the patient has pruritus. Take his temperature, using the same route consistently, and watch for a fever, which is the best indicator of many infections. Note and record the pattern of temperature change and the effect of antipyretics. Be aware that certain analgesics may contain antipyretics. With a high fever, especially in children, watch for seizures.

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NURSING Diagnosis

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NURSING Diagnosis

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Acute pain r/t disease process Nursing Interventions: Assess reports of pain (PQRST). Evaluate pain and its characteristics Provide comfort measures and diversional activities. Provide relief of pain. Encourage stress management techniques. To cope up with stress and activities .

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Nursing Diagnosis: Hyperthermia r/t increased metabolic rate secondary to illness Nursing Interventions: Apply TSB to decrease core temperature Promote rest to relieve stress and prevent work overload Encourage patient to increase fluid intake to ensure hydration

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Nursing Diagnosis: Impaired Physical Mobility r/t muscle weakness Nursing Interventions: assist on performing ROM exercises passively. Improve muscle strength and joint mobility reposition pt as to turning pt to sides and sitting position. To prevent skin irritation and ulceration through turning pt to her sides schedule activities with adequate rest periods during the day and encourage to do whatever possible activity according to tolerance

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Nursing Diagnosis: Fatigue r/t to poor physical condition Nursing Interventions: assist on performing ROM exercises passively. Improve muscle strength and joint mobility reposition pt as to turning pt to sides and sitting position. To prevent skin irritation and ulceration through turning pt to her sides schedule activities with adequate rest periods during the day and encourage to do whatever possible activity according to tolerance

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Nursing Diagnosis: Nausea r/t hormonal imbalance Nursing Interventions: Encourage pt. to eat small, frequent meals. So stomach does not feel excessively full. Provide frequent oral care. To cleanse mouth and minimize bad tastes Advise client to eat dry foods such as crackers and toast when nausea occurs.