Fluent Essays

MDC 3 week 1 Module 01 Content 1. Top of Form Competency Identify multidimensional nursing care strategies for clients with reproductive system disorders. Scenario You work in a gynecological office, and your office has been asked to participate in a women’s health fair. The focus of the fair is health promotion. Preventative screening for female reproductive disorders is vital to identify and treat rapidly to produce the best patient outcomes. Preventative screening includes mammogram and Pap smear and should be performed based on recommended age and associated risk factors. To promote preventative screening, your office will be creating brochures to distribute at the health fair. Instructions Design a women’s health brochure by choosing one of the female reproductive disorders covered in this module. In the brochure, include the following: · Overview of the disease including disease process, signs and symptoms, and risk factors · Preventative screening · Diagnostics tests · Treatment · Multidimensional nursing care interventions Recommended Disorders to be familiar with: · Breast Cancer · Fibrocystic Breast Disorder · Fibroadenoma · Endometrial Cancer · Cervical Cancer · Uterine Leiomyoma · Pelvic Organ Prolapse · Vulvovaginitis · Toxic shock syndrome REFERENCES 1. American Cancer Society. (2020, July 30). What is cervical cancer? https://www.cancer.org/cancer/cervical - cancer/about/what -is- cervical- cancer.html 2. March, P. P., & Holle, M. R. (2017). Cervical cancer: an overview. CINAHL Nursing Guide. https://search.ebscohost.com/login.aspx?direct=true& AuthType=ip,shib&db=nup&AN=T703247&site=eds- live&custid=s9076023 3. Workman, L. M. (2018). Medical-Surgical Nursing (9th ed.). Elsevier. https://ambassadored.vitalsource.com/ books/9780323461580 CERVICAL CANCER SIGNS AND SYMPTOMS • Often asymptomatic (3) • Painless vaginal bleeding is common - spotting between periods, after sex or douching (3) • Unexplained weight loss, painful urination, pelvic pain, bloody urine, rectal bleeding, chest pain • Physical exams may not detect abnormalities in the early stage (3) MULTIDIMENSIONAL CARE A cervical cancer treatment team typically includes a nurse, a gynecologist, a doctor who’s specialized in female reproductive health; a gynecologic oncologist, a doctor who knows about cancers of the female reproductive system; and oncologists, doctors who use radiation, chemotherapy, and other medicines to treat cancer (1). Care may also include a social worker, a mental health clinician, or the patient’s clergyperson (2). NURSING CARE • Assess cultural needs, attitude, and traditions • Assess patient and family for knowledge deficit and anxiety. Share education and encourage dialogue. Provide emotional support. • Monitor vital signs, all physiologic systems; report abnormalities to provider (2) • Frequently assess for pain (2) • Review medications, discharge and home health guidelines with patient and family (2) • Educate on the appropriate care after local cervical ablation therapies: Refrain from sex, avoid tampons and douching, shower rather than tub, avoid lifting heavy objects, report heavy vaginal bleeding, foul-smelling drainage, or fever (3). DISEASE PROCESS • Cervical cancer is the result of abnormal cellular growth. • The progression of cervical cancer “starts in the cells lining the cervix – the lower part of the uterus” ( 1, para. 1). The cervix is comprised of glandular and squamous cells: the transformation zone is the area where the two cell types meet, and is “where most cell abnormalities occur” ( 3, p. 1469). • Most cases are caused by specific strains of HPV , especially strains 16 and 18 (3) 1. Pap: collection of cells from cervix which are then examined in the lab to detect pre cancer or cancer (1) 2. HPV-typing DNA test: detects the presence of HPV, the virus that causes cervical cancer (1). Certain types of HPV, 16 + 18, increase cervical cancer risk (1) 3. Colposcopy: acetic acid solution is applied to the cervix. The provider looks for signs of dysplasia or cancer (2). 4. Biopsies: removal of tissue to test for cancer 5. Endocervical curettage: scraping of the endocervix wall; tissue sample examined in lab for signs of cervical cancer (2) DIAGNOSTIC ASSESSMENT RISK FACTORS PREVENTATIVE SCREENING VACCINES (for females and males) 1. HPV vaccines protect against certain HPV infections a. Ideally, the vaccine is administered before the first sexual contact. This is a means “to receive protection against the highest-risk HPV types that are responsible for most cervical cancers” (3, p. 1469). b. Types: Gardasil and Cevarix c. Who: Females, ages 9-26 (3) i. Males, ages 9-26, to protect against genital warts (3) d. Must receive the vaccine’s entire series - 3 injections over 6 months (3) SCREENINGS (for females only) 1. Pelvic exams a. Start at age 21; part of well women visit (3) 2. Pap tests a. Start at age 21 – may be earlier depending on sexual history (3) b. Ages 21-29: Pap every 3 years (3) c. Ages 30-65: Pap + HPV test every 5 years (3) d. 65 and older: Pap no longer recommended, so long as history of normal results (3) 3. Screening timeline is subject to change. A more frequent follow-up, for example, may be the result of a previous abnormal result (1) Risk factors are things that increase one’s chance of getting a disease like cancer (1) • “Infection by HPV is the most important risk factor for cervical cancer” (1, para. 1). • Becoming sexually active at a young age: < 18 years of age (1) o Many sexual partners; a sexual partner who is high-risk (1) • Smoking o “Women who smoke are about twice as likely as non-smokers to get cervical cancer” (1, para. 2). • HIV: a weakened immune system increases a person’s risk for HPV infections (1). • Long-term use of oral contraceptives (1) o “Research suggests that the risk of cervical cancer goes up the longer a woman takes oral contraceptives, but the risk goes back down again after the pills are stopped” (1, para. 19). • Family history of cervical cancer (1) • Economic status: lower-income women lack easy access to adequate healthcare (1) TREATMENT SURGICAL: There are many options: factors to consider include “patient overall health, desire for future childbearing, tumor size and stage, cancer cell type, degree of lymph node involvement, and patient preference” (3, p. 1470). Cervical ablation procedures are the choice for early-stage management and include the following: Laser therapy, which utilizes a laser beam to absorb fluid from the abnormal tissue; cryotherapy, which freezes off the abnormal cells, and the loop electrosurgical excision procedure, or LEEP, in which a thin loop-wire electrode transmits an electrical current to cut away the tissue. A total hysterectomy may be considered if the woman does not want children (3). NONSURGICAL: Radiation therapy is used to treat invasive cervical cancer (3). Depending on extent and location, therapy may involve brachytherapy or external beam radiation (2). Later-stage disease is often treated with a combination of radiation + chemotherapy (3). ENDOMETRIAL CANCER Written By: Emily Geiger The most common gynecologic malignancy (2). Endometrial cancer, also called uterine cancer, is cancer of the inner uterine lining (2). One of the first symptoms is abnormal vaginal bleeding, which leads individuals to seek care, and ultimately leads to early detection of the cancer. As a result, endometrial cancer has a good prognosis and typically spreads slowly (2). OVERVIEW REFERENCES Bernstein, R., M.D., DeJoseph, D., M.D., & Buchanan, E. M., M.D. (2010). When to Stop Screening: A Review of Breast, Gynecologic, and Colorectal Cancer Screening in Women Over Age 65. Care Management Journals, 11(1), 48-57. http://dx.doi.org/10.1891/1521- 0987.11.1.48 Rebar, C., Ignatavicius, D., & Workman, L. (2018). Medical-Surgical Nursing. 9th Edition. Elsevier. Retrieved from https://ambassadored.vitalsource.com/#/bo oks/9780323461580/cfi/6/10!/4/2/6/[email protected]:0 1. 2. NURSING INTERVENTIONS When patients are diagnosed with endometrial cancer, it can cause disbelief, anger, depression, anxiety, or withdrawal feelings and behaviors (2). It is the responsibility of the nurse to help the patient express their concerns and assess the patients support system. The nurse should ask the patient how she copes with stressful events and provide therapeutic coping mechanisms when appropriate. The nurses role is also to be a part of the collaborative team. From initial examination to post treatment, the nurse should provide support to the patient throughout the process and be available to answer questions and/or concerns. For example, if the patient is to receive radiation, such as brachytherapy, the nurse should instruct the patient of the importance of maintaining bedrest during treatment (2). Post treatment education on adverse effects to monitor for and report to the provider should also be part of the nurses role. The wish for the patient is to pass the 5-year survival mark without recurrence of the disease (2). If the tumor recurs and a positive outcome is slim, the patient will need to begin discussing hospice care. The nurses role in that situation is to support the patient and family and be a resource for them. Nursing interventions include encouraging the patient to discuss their feelings, refer support services such as a chaplain, social worker, our counselor, and use therapeutic communication (2). Complete Blood Count (2) Serum Tumor Markers (2) human chorionic gonadotropin (hCG) (2) Transvaginal Ultrasound (2) Endometrial Biopsy (2) CT/MRI of the pelvis (2) Intravenous pyelography (2) Abdominal ultrasound (2) CT/MRI of pelvis (2) liver and bone scans (2) There are currently no standard or routine screenings for endometrial cancer. Cases are often found as a result of abnormal bleeding reported to a physician (1). During a pap smear test, cells on the uterine wall may appear abnormal, requiring further examination (1). If endometrial cancer is suspected, there are a multitude of diagnostic tests available to confirm diagnosis. These include: Other tests to determine the presence of metastasis include: SCREENINGS & DIAGNOSTIC TESTS There are four stages to endometrial cancer. Each stage is based on where the cancer is located and if it has metastasized (2). The stages are as follows: Stage 1: Cancer is defined to endometrium (2). Stage 2: Cancer has spread to cervix as well (2). Stage 3: Cancer has metastasized to include the vagina or lymph nodes (2). Stage 4: The cancer has made its way to the bowel or bladder (2). DISEASE PROCESS SIGNS & SYMPTOMS Postmenopausal bleeding (2) Watery or bloody discharge (2) Lower back or abdominal pain (2) Low pelvic impaired comfort (2) Palpable uterine mass or uterine polyp (2) RISK FACTORS Girls and young women (2) Infection with HPV (2) Multiple births (2) Multiple sex partners (2) History of STIs (2) Obesity or poor diet (2) African American (2) Oral contraceptive use (2) Smoking (2) Younger than 18 years at first intercourse (2) Family history of cervical cancer (2) HIV/AIDS (2) Lower socioeconomic status (2) Endometrial cancer is strongly correlated to conditions that cause prolonged exposure to estrogen without the effects of progesterone. Other risk factors include: TREATMENT Cancer staging and removal of tumor (2) Total hysterectomy (2) Bilateral salpingo oophorectomy (BSO) (2) Radical hysterectomy (2) Radiation (2) Bracytherapy (2) External beam radiation therapy (2) Chemotherapy (2) After being diagnosed with endometrial cancer, an individual will meet with a collaborative team of professionals to discuss the best treatment option, utilizing surgical and non- surgical methods. Surgical Treatment Options: Non-Surgical Treatment Options: