Hysterectomy/Breast Cancer Flashcards
(33 cards)
1
Q
Indications for Hysterectomy (6)
A
- Gynecological cancer
- Fibroids
- Endometriosis
- Uterine prolapse
- Abnormal vaginal bleeding
- Chronic pelvic pain
2
Q
3 approaches for hysterectomy
A
- abdominal
- vaginal (fastest recovery)
- Laparoscopic
3
Q
Types of Hysterectomy (4)
A
- Subtotal hysterectomy
- Total hysterectomy
- Total hysterectomy with bilateral or unilateral salpingo-oophorectomy
- Werheim’s hysterectomy
4
Q
Abdominal Hysterectomy Indications (4)
A
- 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)
5
Q
Vaginal Hysterectomy Indications (4)
A
- 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
6
Q
Laparoscopic Hysterectomy Indication
A
Uterus is usually removed through vagina, but sometimes through incisions for laparoscope if uterus is not too large
7
Q
Subtotal hysterectomy
A
- uterus is removed, leaving cervix in place
- rarely performed today
- less disruption to pelvic floor less damage to urinary tract, and fewer infection
8
Q
Total hysterectomy
A
both uterus and cervix are removed
9
Q
Total hysterectomy with bilateral or unilateral salpingo-oophorectomy
A
- 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
10
Q
Wertheim’s/Radical hysterectomy
A
- removal of uterus, fallopian tubes, adjacent pelvic tissues, 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
11
Q
Post-Op Care Hysterectomy
A
- ABC
- IV infusion for 24-48 hours (possible blood transfusion depending on blood loss)
- Hemovac darin (drain blood from operation) - to prevent hematoma
- Foley Cath - may be a suprapubic catheter via abdomen to decrease post-op UTI
- Unless heavy oozing from wound, a light dressing to cover for 48hrs
- Woman with vaginal hysterectomy will have vaginal packing inserted into vagina to stop bleeding from suture point
- Analgesia: epidural or PCA
- Control nausea: ondansetron, metoclopramide
- early mobilization
- with return of BS, start clear water/full fluids
- strict I&O
- encourage to empty bladder fully
- by post-op day 2 should be able to ambulate
- SPLINT ABDOMEN (OR HOLD TOWN IN PLACE IF HAD A VAGINAL HYSTERECTOMY) WHEN COUGHING
- with horizontal wound (bikini line) - stitches removed usually 5th day. vertical wound - 7-10th day
- prevent constipation
- common to feel blue on post-op day 3-4. this is a normal reaction
12
Q
Discharge Teaching: Bleeding and Rest
A
- may be vaginal discharge for up to 4 weeks - 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 for first 2 weeks. common to suddenly feel tired and exhausted
13
Q
Discharge Teaching: Exercise
A
- advisable to go for short walks, increasing gradually in duration
- may resume swimming by 6 weeks post surgery
14
Q
Discharge Teaching: House Work and Work
A
- 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
15
Q
Discharge Teaching: sexual intercourse
A
- 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, decreased vaginal lubrication related to decreased estrogen and testosterone
- Some report decreased sexual response after hysterectomy (may be d/t scar tissue at surgical site)
16
Q
Risk Factors for Breast Cancer (8)
A
- Female Gender
- Advancing age
- Hormone therapy
- Weight gain
- Sedentary lifestyle
- Smoking
- Obesity
- Alcohol intake
17
Q
Genetic Factors Breast Cancer
A
- 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 1.5-3x depending on age
- Women with BRAC1 and BRAC2 (mutations) have a 85% chance of developing breast cancer in their lifetime and are at a high risk for ovarian
18
Q
Noninvasive breast cancer
A
Ductal sarcoma insitu
hasnt spread
19
Q
Invasive (infiltrating) ductal carcinoma
A
- most common type of breast cancer - begins in the milk ducts and spreads to the surrounding breast tissues
20
Q
Invasive (infiltrating) lobular carcinoma
A
- starts in the lobules and spreads into surrounding breast tissue
21
Q
Inflammatory Breast Cancer
A
Develops when cancer cells block the lymph vessels in the breast. Swollen and red. More rare and aggressive. Seen in younger women and African American. Very likely it has already spread in their lymph nodes.
22
Q
Paget’s disease
A
Rare type. Develops rash or skin changes on the nipple. Usually have invasive ductal carcinoma also
23
Q
Triple Negative
A
Lack of 3 receptors seen in other types of breast cancer. Estrogen, progesterone, HER2, if the cancer has the receptors it is going to grow faster. it is not a bad thing that they dont have this. can’t use hormonal thearpy
24
Q
Clinical Manifestations of Breast Cancer (7)
A
- lump or mammographic abnormality
- most often in outer upper quadrant of breast
- if palpable, hard, irregularly shaped, poorly delineated, nonmobile, and nontender
- nipple discharge in sometimes
- 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
25
Complications of Breast Cancer
- Most common is recurrence
- Metastases
26
Diagnosis (4)
- Axillary Lymph Node dissection (removes 10-12 lymph nodes and they are examined)
- lymphatic drainage and sentilen lymph node biopsy (sentinel lymph node is the first to drain next to the cancer. use blue die to see which one it is)
- Tumour Size
- Estrogen and progesterone status (receptors on the cancer cells means it will grow more rapidly)
- HER2 (protein that helps the cancer grow fast)
27
Interprofessional Care
- Depends on the clinical stage and biology of the cancer
TNM (tumour, node involvement, metastases) and stage
28
Surgical Therapy of Breast Ca
- surgical therapy considered the primary Tx
- breast conserving therapy (lumpectomy. only done if it is insitu)
- ALND (axillary lymph node dissection)
- Modified Radical Mastectomy (whole breast, leaves chest muscles intact, most of axillary nodes removed)
29
Adjuvant Therapy (6)
- Radiation
- High Dose Brachytherapy (taking radiation and putting it in the exact spot where the cancer was)
- Palliative Radiation Therapy
- Chemotherapy (systemic)
- Estrogen Receptor Blockers
- Aromatase Inhibitors (lower estrogen levels to slow the growth of the cancer)
30
Acute Intervention: Mastectomy
- pain correlates to extent of lymph node dissection
- patients usually d/c home with drains
- restoring arm function on side of surgery is a key nursing goal - PAID MANAGEMENT
- postoperative arm and shoulder exercises
- prevent or reduce lymphedema (elevate the arm)
- psychological care
31
Post-Op Complications: Lymphedema
- 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
32
Post-Op Complications: postmastectomy Pain Syndrome
- chest and upper arm pain, tingling down arm, numbness, shooting or pricking pain, and unbearable itching that persists beyond the normal 3 months healing time. thought to be due to nerve injury
- Tx: NSAIDS, antidepressants, topical lidocaine, gabapentin, local anesthetic
33
Treatment for Lymphedema (6)
- 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, veinpuncture, and injections should never be done on the affected arm
