Genital Urinary System

1
Genital Urinary System

• Female Reproductive System
• Part 3

2
Cancer of the Cervix

• Pathophysiology
• Predominantly Squamous cell cancer
• Age 30 45

3
Cancer of the Cervix

• Risk factors
• Multiple sex partners
• Early age at first coitus
• Sex with men whose partner have had cervical
  cancer
• Human papillomavius virus - HPV
• STD
• Causes warty growths
• Smoking

4
Cancer of the Cervix Clinical Manifestations

• Early
• Asymptomatic
• Late symptoms
• Discharge
• h
• Watery
• Dark
• Foul-smelling

5
Cancer of the Cervix Clinical Manifestations

• Late symptoms
• Irregular bleeding
• Leg pain
• Dysuria
• Rectal bleeding
• Edema of extremities

6
Cancer of the Cervix

• Advanced disease should not occur if all women
  have access to gynecologic care or avail
  themselves of it.

7
Cancer of the Cervix

• Assessment and diagnostic findings
• Pap smear
• x-ray
• Colposcopy
• Biopsy

8
Cancer of the Cervix

• Medical management
• CRYOTHERAPY
• Surgery
• Hysterectomy
• recurrence is 35
• Radiation

9
Cancer of the uterus

• Pathophysiology
• Cancer of the uterine endometrium

10
Cancer of the uterus

• Risk factors
• Age gt55 yrs
• Postmenopausal bleeding
• Obesity
• Unopposed estrogen tx
• Nulliparity /
• Infertility

11
Cancer of the uterus

• Assessment
• Irregular bleeding evaluated promptly
• Endometrium aspirations / biopsy
• Ultrasound

12
Cancer of the uterus

• Medical management
• Hysterectomy

13
Cancer of the Ovary

• Pathophysiology
• About 75 detected in the late stage with
  metastasizes
• Age 50-59
• Risk factors
• Nulliparity
• Infertility

14
Cancer of the Ovary

• Clinical Manifestations
• h abdominal girth
• pelvic pressure
• bloating
• flatulence
• h waist size
• leg pain
• VAGUE

15
Cancer of the Ovary

• Assessment and diagnostic findings
• Pelvic exams do not detect ovarian cancer
• Pelvic imaging are not definitive

16
Cancer of the Ovary

• Medical management
• Surgical removal
• Chemotherapy
• Radiations

17
Hysterectomy

• Hysterectomy is the surgical removal of the
  uterus
• Total hysterectomy removal of uterus cervix
• Sub-total hysterectomy Removal of the uterus,
  but not the cervix

18

• Radical hysterectomy Removal of uterus, vagina
  (upper 1/3) pelvic lymph nodes, fallopian tubes,
  ovaries
• Usually performed d/t malignant conditions

19
Hysterectomy

• Hysterectomys why?
• Cancer
• Dysfunctional uterine bleeding
• Endometriosis
• Non-malignant growths
• Prolapse

20
Hysterectomy

• Variety of approaches
• Vaginal
• Abdominal
• Laproscopically

• Vaginal hysterectomy

21
Hysterectomy

• Pre-op management
• Shave?
• Empty bladder
• Empty bowels
• Douche

22

• A client has been admitted to the hospital the
  day before she is scheduled for an abdominal
  hysterectomy. Nursing responsibilities for the
  preoperative period would include notifying the
  physician if the
• Erythrocyte count is 6 million/cu mm.
• Urine report indicates ketonuria.
• Temperature is 99.6 degrees F orally.
• Hemoglobin is 14 gm/100 ml.

23
Hysterectomy

• Anxiety related to the diagnosis of cancer, fear
  of pain, possible perception of loss of
  femininity, and disfigurement
• Educate
• Support

24
Hysterectomy

• Disturbed body image r/t alt. fertility fear
  about sexuality relationships with partner
  family
• Discuss changes
• Orgasm

25
Which of the following stressors affect
self-concept? (Select all that apply.)

1. Declining mental, physical, or sensory abilities
2. Relationship concerns
3. Unrealistic ideal self
4. Realistic Role Expectations

26
Hysterectomy

• Acute pain related to surgery and other adjuvant
  therapy AMB statement, guarding, grimacing, not
  ambulating.
• Asses pain
• Administer analgesics
• Teach alternatives
• Relaxation tx
• Early ambulation
• Heat

27
Potential Complications

• Hemorrhage
• Deep Vein Thrombosis
• Bladder disfunction

28
Hysterectomy

• Hemorrhage
• Assess pads
• Assess Vital Signs
• Educate on activity restrictions

29
Hysterectomy

• Deep vein thrombosis
• Prevention
• Elastic compression stockings
• Early amb.

30
Hysterectomy

• Deep vein thrombosis
• Assess of DVTs
• Phlebitis
• Leg pain
• Red
• Warm
• edema

31
Hysterectomy

• Deep vein thrombosis
• Assess for PE
• Chest pain
• h pulse
• Dyspnea

32
Hysterectomy

• Bladder dysfunction (urinary retention)
• IO
• Assess Bladder distention
• Stim. Bladder
• Cold to abd.
• Stoke inner thigh
• Running H2O
• Privacy
• Position
• Time
• Catheter

33

• True or false. Following a hysterectomy,
  ambulation should be discouraged.
• True
• False

34

• On a follow-up visit after having a vaginal
  hysterectomy, a 32-year-old patient has a
  decreased hematocrit level.  Which of the
  following complications does this suggest?
• Hematoma
• Hypovolemia
• Infection
• Pulmonary embolus (PE).

35

• A 36-year-old woman who underwent a hysterectomy
  4 days ago says to the nurse, "I wonder if I'll
  still feel like a woman." Which response would
  most likely encourage the patient to expand on
  this and express her concerns in more specific
  terms?
• "When did you begin to wonder about this?
• "Do you want more children?
• "Feel like a woman...?
• Remaining silent

36
Breast Cancer - FYI

• 212,000 women/ year
• 1,700 men/ year
• 41,000/ year die
• Women 18 chance of developing it

37
Breast Cancer

• Risk Factors
• (No single specific cause)
• Gender
• Women (99)
• Age
• gt50 years
• Personal history
• (Past breast cancer)

• Hormonal factors
• Early menarche
• Nulliparity
• Late menopause
• Obesity
• Alcohol use
• No evidence that oral contraceptives increase
  risk!

38
Breast Cancer

• Characteristics
• Can occur anywhere
• Most common
• Upper outer quad
• Non-tender
• Fixed
• Hard
• Irregular boarders

• Advanced signs
• Skin dimpling
• Nipple retraction
• Skin ulceration

39
Surgical management

• Modified Radical Mastectomy
• Removal of
• All breast tissue
• Nipple-areola
• Axillary lymph nodes
• Not removed
• Pectoralis major muscles
• Pectoralis minor muscles

• Total Mastectomy
• Removal of
• Breast
• Nipple-areola
• Nor removed
• Axillary lymph nodes
• Muscles groups

40

• Breast Conservation Treatment
• AKA
• Lumpectomy
• Partial or segmental mastectomy
• Remove tumor
• May include axillary lymphs

41
Mastectomy

• Pain
• Assess
• Administer
• Opiod analgesics
• Oxycodone acetominaphen (Percocet)
• Propoxyphene acetominaphen (Darvocet)

• Non-Rx
• Warm showers
• Position arm
• Distraction technique
• Report
• Excruciating pain

42
Mastectomy

• Impaired skin integrity
• Drainage tubes in place
• Patency of tubes
• Hematoma
• Ice pack

43
Mastectomy

• Risk for infection
• Drainage tube duration
• Drain 7-10 d
• Teach
• empty strip/milk
• Incision care
• SS of infection
• Foul smell drainage
• Temp gt100
• No lotion/cream until completely healed

44
Mastectomy

• Disturbed Body Image
• SUPPORT!
• View with them 1st time
• Normal feelings
• Asses degree of self-esteem disturbance
• Arrange for visitor from support group
• Provide info about prosthesis
• Assist pt. to verbalize feeling
• Enc open communication with S/O
• Answer questions
• Counseling
• Community resources

45
Mastectomy

• Impaired sensory perception r/t sensation in arm,
  breast or side
• (Tightness, pulling burning, tingling in chest
  wall, axilla, upper arm)
• h with healing ? last mo./yr ? diminish
• Teach This is normal
• Exercise ? i sensation
• Most bothersome part

46
Mastectomy

• Lymphedema
• Results when lymphatic channels are inadequate to
  return flow of lymph fluid
• Transient swelling
• Happens 10-25 of pt with axillary dissection
• Medication
• Antibiotics
• Exercises

47

• Manual lymph drainage
• light massage,
• performed by a therapist
• assists moving the fluid to other parts of the
  body

48

• Compression bandaging
• multi-layered bandages after massage
• keep the fluid out of the arm

49

• Exercise
• Do not perform venipuncture
• Do not take BP on affected arm
• Avoid dependent arm position

50

• Compression garment
• fitted
• helps maintain decreased swelling achieved during
  treatment

51

• Do not perform venipuncture or take BP on
  affected arm
• Avoid dependent arm position

52
A client with breast cancer is returned to the
room following a right total mastectomy. The
nurse should

1. Elevate the client's right arm on pillows
2. Place the client's right arm in a dependent sling
3. Keep the client's right arm on the bed beside her
4. Place the client's right arm across her body

53
Mastectomy

• Knowledge deficit prevent complication from
  surgery -hematoma formations
• Monitor for excessive swelling, tightness, pain,
  bruising
• Notify MD
• Check drainage device
• Ace wrap to compress surgical site
• Ice Pack f/b warm showers

54
Which statement indicates the client is accepting
of her body image following a mastectomy?

1. "I haven't looked in the mirror since my
   mastectomy."
2. "My husband loves me the way I am, even after a
   mastectomy."
3. "I don't care if I had a mastectomy, I'm still
   wearing a bikini."
4. "I just want a picture of me from the shoulders
   on up since my mastectomy."

55

• A client receiving chemotherapy for breast cancer
  has an order for Zofran (ondansetron) 8mg PO to
  be given 30 minutes before induction of the
  chemotherapy. The purpose of the medication is
  to
• Prevent anemia
• Promote relaxation
• Prevent nausea
• Increase neutrophil counts

56

• The nurse observes a staff member caring for a
  client with a left unilateral mastectomy. The
  nurse would intervene if she notices the staff
  member is
• Advising client to restrict sodium intake
• Taking the blood pressure in the left arm
• Elevating her left arm above heart level
• Compressing the drainage device