Female Reproductive Problems Flashcards

Question

Types of hysterectomies

Answer 1

Subtotal hysterectomy Total hysterectomy Total hysterectomy with bilateral or unilateral salpingo-oophorectomy Wertheim’s hysterectomy

Answer 2

In the presence of large tumors when pelvic cavity needs to be explored When tubes and ovaries are to be removed Very large uterus b/c fibroids (vaginal approach is impossible)

Answer 3

When vaginal repair is done in addition to removal of the uterus Fewest complications, shorter hospital stay & fastest recovery Usually in older women where there is prolapse of uterus For treatment of early stage of cervical and uterine cancers

Answer 4

Uterus is usually removed through vagina, but sometimes through incisions for laparoscope if uterus is not too large

Answer 5

Subtotal hysterectomy Total hysterectomy Total hysterectomy with bilateral or unilateral salpingo-oophorectomy Wertheim’s/Radical hysterectomy

Answer 6

Uterus is removed, leaving cervix in place Rarely performed today Less disruption to pelvic floor, less damage to urinary tract, and fewer infections

Answer 7

Both uterus and cervix are removed

Answer 8

Body of uterus, cervix, fallopian tube(s), and ovary(ies) are removed Usually done at the same time as total abdominal hysterectomy Removal of ovaries brings on a sudden menopause d/t loss of ovarian hormones Prevents recurrence of ovarian ca

Answer 9

Removal of uterus, ovaries, Fallopian tubes, adjacent pelvic tissue, lymph ducts, and upper 1/3 of vagina Necessary in case of advanced cervical and endometrial cancer Treatment of choice for low risk Stage 1 disease

Answer 10

ABC IV infusion for 24-48 hours (possible blood transfusion depending on blood loss) Hemovac drain (drain blood from operation site) – to prevent hematoma Foley cath – accurate u/o Maybe a suprapubic catheter via abdomen ⇒ to ↓ post-op UTI Unless heavy oozing from wound, a light dry dressing to cover wound x 48 hrs Women with vaginal hysterectomy ⇒ will have ‘vaginal pack’ (with ribbon gauze) inserted into vagina to stop bleeding from suture point Analgesia: epidural or PCA Control nausea: e.g., Ondansetron, Metoclopramide Early mobilization Sit up on a bedside chair, work with physiotherapist With return of BS, start clear water/full fluids With start of oral fluids, IV rate may needs to be adjusted (e.g., ↓ ) Strict I & O Encourage to empty bladder fully By post-op day 2, should be able to ambulate to BR Splint abdomen (or hold a towel in place if had a vaginal hysterectomy) when coughing With horizontal wound (bikini line) – stitches removed usually 5th day vertical wound - 7 or 10th day Prevent constipation (e.g., Lactulose or supp) Common to feel ‘blue’ on post-op Day 3 or 4 → reassure this is a normal reaction, that it will pass

Answer 11

Important to teach pt AND family: what she can and cannot do Bleeding - May be vaginal discharge for up to 4 wks – will change color from red to pale brown - Seek help if discharge becomes heavier, brighter in color, or offensive smell Important to get sufficient rest first 2 weeks - Common to suddenly feel tired and exhausted Exercise - Advisable to go for short walks, increasing gradually in duration - May resume swimming by 6 weeks post surgery House work - No housework for the first 2 weeks - Light chores can be undertaken after this period - Do not lift heavy objects first 4 weeks; very heavy objects for at least 3 months Work - Varies in individuals; some feel ready to return 6-8 weeks, while other take longer Sexual intercourse - In general, takes approx. 6 weeks to physically and emotionally feel ready to resume sexual intercourse after major gynecological surgery - Important to wait until any vaginal bleeding has stopped, to prevent risk of infection - Partner should be gentle and avoid undue trauma to the area - Hormonal effects of oophorectomy ⇒ loss of libido, vaginal atrophy, ↓vaginal lubrication r/t ↓ estrogen and testosterone - Some report ↓ sexual response after hysterectomy (may be d/t scar tissue at surgical site) She may need to be encouraged to focus on other sensations that will help build her sexual response

Answer 12

Female Gender Advancing age Hormone therapy Weight gain Sedentary lifestyle Smoking Obesity Alcohol intake

Answer 13

Increased risk if family member has had ovarian cancer, was premenopausal at diagnosis, had bilateral breast cancer and is a first degree relative. First degree relative increases likelihood from 1.5 to 3X depending on age. Women with the BRAC1 and BRAC2 ( mutations) have a 85% chance of developing breast cancer in their lifetime and are at a high risk for ovarian

Answer 14

Noninvasive breast cancer (one place) Invasive (infiltrating) ductal carcinoma (most common) - milk ducts to surround tissues Invasive (infiltrating) lobular carcinoma - starts in lobs (producing milk) Inflammatory - develops when cancer cells block lymph vessels, rare and spreads quickly Paget's disease - develops on nipple, unilateral, invasive ductal carcinoma with this cancer Triple negative - no estrogen, progesterone or human epidural growth factor (HER2

Answer 15

Lump or mammographic abnormality Most often in outer upper quadrant of the breast If palpable hard, irregularly shaped, poorly delineated, nonmobile and nontender Nipple d/c in small percentage may be clear or bloody nipple retraction may occur Peau d'orange caused by plugging of the lymphatic vessels infiltration, induration, and dimpling of the skin may occur in large cancers

Answer 16

Most common is recurrence Metastases

Answer 17

Axillary lymph node dissection lymphatic drainage and sentinel lymph node biopsy tumor size estrogen and progesterone status HER2 (increases cell growth) Spreads to liver, bones and brain

Answer 18

Thergical therapy considered the primary tx breast conserving therapy (non-invasive, lumpectomy) ALND (removal of all breast tissue, chest muscles left intact) Modified radical mastectomy

Answer 19

radiation high dose brachytherapy (type of radiation that goes down to the source) Palliative radiation therapy Estrogen receptor blockers aromatase inhibitors

Answer 20

pain corelates to extent of lymph node dissection pts usually d/c home with drains restoring arm function on side of sx is a key nursing goal postop arm and shoulders exercises prevent or reduce lymphedema psychological care

Answer 21

Lymphedema Postmastectomy pain syndrome

Answer 22

An accumulation of lymph in soft tissue as a result of excision or radiation of lymph nodes Can cause, heaviness, pain, impaired motor function, numbness and paresthesia of fingers in the affected arm. Cellulites and progressive fibrosis

Answer 23

chest and upper arm pain, tingling down arm, numbness, shooting or prickling pain, and unbearable itching that persists beyond the normal 3 months healing time. Though to be due to nerve injury tx - NSAIDs, antidepressants, topical lidocaine, gabapentin, local anesthetic

Answer 24

affected arm should never be dependent even in sleep elastic bandages not used in early post op as they inhibit lymphatic drainage protect arm from trauma and sunburn if trauma treat and watch closely decongestive therapy BP, venipuncture and injection should never be done on the affected arm

Female Reproductive Problems Flashcards

(48 cards)