MDC3 Exam 1 Review
ABCs
A - airway
B - breathing
C – circulation
Uterine Leiomyoma
Benign, slow growing solid tumors of the muscle
... [Show More] layer of the uterus (fibroids)
Excessive local growth of smooth muscle tissues
o Growth may be stimulated by estrogen, progesterone, and growth
hormone
Assessment: asymptomatic or symptomatic (heavy prolonged vaginal bleeding)**
Assess pelvic pressure, elimination pattern, abdomen size, dyspareunia,
infertility
Painful menses
Elimination patterns (due to enlarged fibroid pressing on organs)
Ask how many pads/tampons used in a day
S/S: Heavy periods or periods that last a long time & abd distention, urinary
frequency
Psychosocial assessment:
Quality of life from dyspareunia
Fear that symptoms could be cancerous
Anxiety
Significance of loss of uterus for patient and partner if want to conceive
Diagnostic assessment:
CBC – iron deficiency anemia from heavy bleeding
WBC would be normal
HGB and HCT – low
Pregnancy test to rule out uterine enlargement
Transvaginal US – able to see if fibroid is protruding into uterine cavity
Biopsy: gold standard
Pelvic exam
Planning and Implementation
Manage bleeding
o Non-surgical management: oral contraceptive**
o Surgical management:
MRI focused ultrasound-heat to tumor
Uterine artery embolization – starves tumor of circulation
allowing it to shrink Myomectomy- laser removal
Hysterectomy
Erectile Dysfunction: causes & treatment
Common as one ages: reduced blood flow to penis
Causes
Medical causes: change in blood pressure
Non-organic: increased stressor, illnesses
Treatment
Medications that increase perfusion to penis (PDE- 5 inhibitors)
Vacuum pump
Pineal implant
Managing stress
Education related to treatment for HPV/Cervical Cancer
Caused by HPV
s/s of cervical cancer:
o heavy bleeding in later stages
o bleeding after sex
o Most of the time asymptomatic
Bleeding between periods
Preventive screening: PAP smear, surgical biopsy (gold standard) to determine
staging
Treatment:
Early- ablation, laser
Late- chemotherapy/radiation
Education:
No sticking anything up the vagina (tampons, douches)
May have bleeding
No sexual intercourse
No tub baths
Breast cancer- preventative screenings, risk factors, diagnostic tests
Preventative screenings
Mammography
o Recommended to start screening at 45
o Women over 55 may switch to every 2 years
Breast self-awareness/self-examinations
o >90% detected by patient
Clinical breast clinicalo At least every 3 years for women in their 20s and 30s and every year for
asymptomatic women at least 40 years old
Risk Factors
Increased age
Family history
Early menarche, late menopause
Lack of breastfeeding
Postmenopausal obesity
Alcohol consumption
Mutations in BRCA1 or BRCA2
Diagnostic tests
Lab assessment: study of breast mass tissue and lymph nodes, liver enzymes,
calcium, and alkaline phosphatase
Imaging assessment:
o Mammogram
o Ultrasound
o MRI
o Chest x-ray, CT for metastasis
o Breast biopsy*
Endometrial cancer- symptoms, risk factors, diagnostic testing
Most common gynecologic malignancy
Cancer of inner uterine lining
Grows slowly but vaginal bleeding usually leads to prompt evaluation and
treatment = good prognosis
Most commonly associated with prolonged exposure to estrogen without its
protective effects of progesterone
Risk Factors:
Women in reproductive years
Family History
Diabetes Mellitus
HTN
Obesity
Uterine polyps
Late menopause
Nulliparity (no childbirths)
Smoking
Tamoxifen – given for breast cancer
Symptoms: Postmenopausal bleeding (how many pads/tampons a day)**
Watery, bloody vaginal discharge
Low back or abdominal pain
Low pelvic impaired comfort (describe exact location and intensity)
Pelvic exam may reveal palpable uterine mass**
Diagnostic testing:
o Transvaginal ultrasound*
o Endometrial biopsy – gold standard “determine presence of endometrial
thickening/cancer”**
Interventions
o Pelvic exam
Hysterectomies- what they are, who gets them, post-operative care, education
Total Hysterectomy -The entire uterus, including the cervix, is removed. The
procedure may be vaginal or abdominal, with laparoscopic or robotic assistance.
Bilateral Salpingo-Oophorectomy (BSO)- Fallopian tubes and ovaries are
removed.
Panhysterectomy - Total abdominal hysterectomy and BSO: The uterus,
ovaries, and fallopian tubes are removed.
Radical Hysterectomy - The uterus, cervix, adjacent lymph nodes, upper third
of the vagina, and surrounding tissues (parametrium) are removed.
Leiomyomas are the most common reason for hysterectomies
Postoperative care
Assess vaginal bleeding
Abdominal bleeding at the incision site (a small amount is normal)
Intactness of the incision
Urine output per urinary catheter for 24 hours
Incisional or abdominal pain
Perineal care
Deep breathing exercises
Education
o Avoid sexual intercourse, douching
o Report excessive bleeding or changes in discharge
o Avoid heavy lifting or strenuous activity- can cause hernias or ruptures of
sutures
o hydrateVulvovaginitis- s/s, causes, treatment, education
Inflammation of the lower genital tract resulting from a disturbance of the balance
and hormones and flora
Signs/Symptoms
Itching
Change in vaginal discharge, odor, or lesions
Causes
Yeast
Bacterial vaginosis
Changes in normal flora
Education
Teach wearing of cotton underwear
Avoiding tight clothing
Front to back wiping
No douching
Do not have sex if partner infected
Sitz baths, breathable cotton, avoid irritants
Toxic shock syndrome
An infection caused by staph or strep (mainly staph)
Not necessarily from tampons
o tampon is inserted into vaginal and causes micro-abrasions when
inserted – if there for long period of time = more prone to bacterial growth
Education:
Wear pads to bed
Change tampons every 4 hours
Do not use super absorbent tampons
Avoid sprays for hygiene, douching
Treatment:
IVF
Antibiotics
Prostate cancer- risk factors, s/s, lab tests, screening, metastases, post-op education,
interventions, and complications
Prostate cancer screening is recommended to start discussion with provider at
age 50*
Risk Factors: Men over age 65 are at greatest risk & family history
If family history, screening starts at age 40*
Lab tests:
PSA/digital rectal examinationSigns/Symptoms:
Urinary symptoms (dribbling/incontinence)
Unexpected weight loss
Blood in urine
BPH- s/s, treatment, education
Enlarged prostate tissue and compresses urethra
Signs/symptoms
Difficulty urinating (maintaining or starting the stream)
Increased urination
Dribbling
Nocturia
Painful infection = UTI
Treatment
Alpha blocker (doxazosin) – urinary retention and can also help with blood
pressure
Reductase inhibitor (finasteride) – 1st line drug therapy
Education
Holistic care
Multidimensional care pieces: Mental, physical, psychosocial
Collaboration
Caring for the patient as a whole**
People can be scared about cancer MDC CARE
o Address fear and anxiety
Testicular cancer
Most at risk: people who have non-distended testes
Most common age its seen: Younger adults (age 15-30)
Most of time patient is going to recognize lump/bump themselves
Psychosocial assessment is important – anxiety, stress, fear
Treatment/education:
Most common: remove the testes
Chemotherapy
Seeds?
Prior to getting testes removed = sperm banking so they can have kids down the
road
Genital herpes
Two types: 1 & 2
o One= oralo Two = genital
If symptoms are absent- viral shedding can still occur
Latex condoms are best to prevent contamination/transmission
Treatment: Valacyclovir (Valtrex) and Acyclovir
Nursing interventions: ***
o Analgesics = NSAIDs and topical
o Pt education about infection
o Sexual transmission
o Potential for recurrent episodes
o Correct use of therapy
Syphilis- s/s, treatment
STI
Sign/symptoms
Chancre (primary clinical stage) – often goes undiagnosed
Flu-like symptoms (fever, body aches, headache) – 2nd stage
Treatment
Drug of choice: penicillin
Genital warts- risk factors, s/s, treatment
Caused by HPV
Risk factors
Unprotected sex
Signs/symptoms
Bleeding if disrupted
Small, white or flesh-colored papillary growths that may grow into cauliflower-like
masses
Treatment
Goal is to remove the wart
No current therapy eliminated HPV infection
Podofilox 0.5% cream or gel
Cryotherapy
Trichloroacetic acid or bichloroacetic acid may be applied weekly
Chronic renal failure- causes, treatment
Causes
Hypertension**
Diabetes**
Prerenal (cause acute kidney injury/chronic kidney disease) - dehydration, decreased
perfusion to the kidneysIntrarenal - clot in kidneys, glomerulonephritis
Post renal - Urinary retention, prostate cancer, tumors, stones, BPH, bladder cancer
Treatments
Maintain good blood pressure to avoid overuse of kidneys
Maintain blood sugars
Administer diuretics to remove excess fluids
ESKD – dialysis/kidney transplant
Fluid restrictions
o Diet: low/no salt, no protein, renal diet, phosphorus
Prevention
Control hypertension & diabetes with medication & diet
Acute kidney injury- causes, electrolyte imbalances, treatment
Causes: perfusion reduction, kidney damage, urine flow obstruction
Electrolyte imbalances: potassium
Treatment: fluid supplementation, reduce exposure to nephrotoxic agents, diuretics
Types of dialysis and nursing considerations related to dialysis
Hemodialysis
Patient’s blood is removed and passes through an artificial semipermeable
membrane to perform filtration and returned back to patient
Peritoneal dialysis
Catheter is placed in peritoneal cavity due to high amount of capillaries
s/s of complication:
o pain
o increased in weight
o signs of infection at catheter site
fluid returning from dialysis solution removed: cloudy solution indicates
infection
Can depresss respiratory since fluid is compressing on lungs
Nursing considerations
Assessment is nursing intervention-part of nursing process
Before treatment: Evaluate baseline vital signs, weight, laboratory tests
Continually monitor patient for respiratory distress, pain, discomfort
Monitor prescribed dwell time, initiate outflow
Observe outflow amount and pattern of fluid
Chlamydia- s/s, treatment, education
Signs/symp [Show Less]