Digiulio M., Keogh J. Medical-Surgical Nursing Demystified
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CHAPTER 14 Women’s Health
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Mastectomy for larger tumors or more than two tumors in the same breast.
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Chemotherapy before surgery to shrink some tumors, or after surgery:
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cyclophosphamide
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methotrexate
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fluorouracil
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doxorubicin
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epirubincin
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vincristine
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paclitaxel
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docetaxel
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Hormonal therapy:
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tamoxifen
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anastrozole
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Radiation therapy.
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Prophylactic bilateral mastectomy for women with BRCA1 or BRCA2 genes.
NURSING DIAGNOSES
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Body image disturbance.
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Anticipatory grieving.
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Altered sexuality patterns.
NURSING INTERVENTIONS
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Allow patient to voice concerns and questions over treatment plans.
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Monitor incision site, dressing, and drainage.
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Check for signs and symptoms of infection.
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Explain to patient:
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Disease.
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Use of affected arm.
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Use of pain medication, timing, and side effects.
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Urge follow-up mammography.
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Discuss low-fat diet.
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Cervical Cancer
The Papanicolaou (Pap) smear has markedly increased early detection of cervical
cancer and thus decreased the mortality.
WHAT WENT WRONG?
Abnormal cells, cervical intraepithelial neoplasia (CIN), are the initial indication
on a Pap smear, and are more common in women with HIV and those infected
with human papillomavirus (HPV), subtypes 16, 18. HPV is more common in
women with multiple sexual partners, those having sex at an early age, and those
with HIV.
PROGNOSIS
Prognosis is dependent upon the stage at which the cancer is discovered. The five-
year survival rate ranges from 60 to 80 percent.
HALLMARK SIGNS AND SYMPTOMS
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Vaginal bleeding due to abnormal cells and ulceration of the cervix
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Postcoital bleeding
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Pelvic pain
INTERPRETING TEST RESULTS
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Pap smear.
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Biopsy to confirm disease and determine staging.
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Cone biopsy which provides a sample of tissue of the lateral margins of the
cervix.
TREATMENT
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Cone biopsy may remove enough of the dysplasia.
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Ablation of the lesion with cryotherapy, which freezes the cells.
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Hysterectomy with lymph node biopsy for women with late-stage cancer or
those with early-stage cancer who have completed childbearing.
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Radiation.
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Chemotherapy:
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cisplatin
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5-fluorouracil
NURSING DIAGNOSES
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Altered sexuality patterns
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Personal identity disturbance
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Disturbance in self-esteem
NURSING INTERVENTIONS
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HPV vaccine.
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Offer pain and antiemetic medications.
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Abdominal assessment—distention, bowel sounds.
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Check vaginal bleeding.
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Assess urinary retention.
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Intake and output.
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Assess vital signs; check for fever.
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Remove vaginal packing when directed.
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Emotional reassurances.
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Explain to the patient:
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Need for Pap tests.
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All procedures.
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Support through cancer treatments.
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Use of pain and antiemetic medications.
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Benefit of early ambulation.
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Safer sex practices.
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Dysmenorrhea
Menstrual pain occurring after ovulation for which no cause can be discerned is
called dysmenorrhea.
WHAT WENT WRONG?
Dysmenorrhea is caused by the changing hormones in the reproductive cycle.
Uterine contractions from prostaglandins and blood vessel constriction in
the uterine lining cause the discomfort as the enriched lining prepares to be
sloughed off.
PROGNOSIS
Dysmenorrhea usually begins one to two years after menarche and becomes
more acute with age. Pregnancy often diminishes the severity of dysmenorrhea,
as does age. Some women are debilitated for several days per month. A large
majority of women experience some degree of discomfort.
HALLMARK SIGNS AND SYMPTOMS
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Cramps from small uterine contractions
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Nausea from fluctuating hormone levels
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Headache from declining hormone levels
INTERPRETING TEST RESULTS
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Pelvic exam is normal.
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Hemoglobin and hematocrit may be slightly declined from excessive blood
loss.
TREATMENTS
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Over-the-counter preparations.
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Hot water bottles.
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Home remedies.
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Nonsteroidal anti-inflammatory drugs (NSAIDs) have antiprostaglandin
activities, which decrease the discomfort:
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ibuprofen
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naproxen
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nabumetone
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Oral contraceptives which inhibit ovulation as well as diminish amount
of menstrual flow and dysmenorrhea.
NURSING DIAGNOSES
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Intolerance for activity
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Pain, discomfort
NURSING INTERVENTIONS
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Explain to the patient:
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The disease.
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Benefit of exercise.
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Medication use, timing, and side effects.
Ectopic Pregnancy
Ectopic pregnancy occurs when the fertilized ovum implants in an area other
than the uterus. Most ectopic pregnancies occur in the fallopian tubes; how-
ever, other possible sites for ectopic pregnancy include the ovary, cervix, and
peritoneum.
WHAT WENT WRONG?
When the fertilized ovum is unable to get to the uterus, it may settle in the fallop-
ian tube. Any blockage, stricture, previous surgery on the tube, infection or inflam-
mation may impede the ovum from its final, proper destination.
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PROGNOSIS
Ectopic pregnancy is the greatest cause of maternal death early in the pregnancy
if diagnosis cannot be made. Rupture of the involved organ and excessive bleed-
ing into the peritoneum may occur.
HALLMARK SIGNS AND SYMPTOMS
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Severe, lancinating (stabbing) lower pelvic pain from the growing embryo
stretching the fallopian tube or other structure
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Backache from pressure on these structures
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Vaginal spotting; bleeding; amenorrhea
INTERPRETING TEST RESULTS
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Beta hCG serum levels will be elevated but not as high as during an intra-
uterine pregnancy.
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Ultrasound will show an empty uterus.
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Urine pregnancy test will be positive.
TREATMENTS
Surgery is planned to remove the fertilized egg. Often the egg can be retrieved
laparoscopically if the pregnancy is early. Surgery will involve removal of the egg
and may involve partial or complete removal of the fallopian tube (called salping-
ectomy—partial or complete).
NURSING DIAGNOSES
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Body image disturbance
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Anticipatory grieving
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Pain, discomfort
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NURSING INTERVENTIONS
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Check vaginal bleeding.
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Check incision site.
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Assess abdomen—bowel sounds, distention.
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Assess voiding patterns.
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Administer pain medication.
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Check vital signs, temperature.
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Explain to the patient:
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Use of pain medication.
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Benefit of early ambulation.
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Increased chance of future ectopic pregnancies.
Endometrial Cancer
One of the most common gynecological cancers in women, it is most often diag-
nosed in postmenopausal women.
WHAT WENT WRONG?
Abnormal tissue grows rapidly, affected most often by estrogen. Eventually,
this abnormal tissue, hyperplasia, turns into a cancer. Some causes of elevated
estrogen levels are exogenous estrogen, polycystic ovarian disease, and estrogen-
producing tumors. Risk factors for endometrial cancer include endometrial
hyperplasia, tamoxifen, diabetes type II, nulliparity, obesity (estrogen is stored in
adipose tissue).
PROGNOSIS
Prognosis is dependent upon the stage and grade of the cancer upon diagnosis.
Staging of the tumor (I–IV) can only be done via surgery and grading is based
on the histology of the tumor (GI, GII, GIII). In patients with stage IV, the 5-year
survival rate is 10 percent.
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HALLMARK SIGNS AND SYMPTOMS
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Abnormal bleeding
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Abnormal Pap test (not diagnostic but begs a further work-up)
INTERPRETING TEST RESULTS
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Pap test.
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Endometrial biopsy.
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Endocervical curettage.
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Ca-125.
TREATMENT
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Surgery initially for staging and to remove the tumor—usually hysterectomy,
bilateral salpingo-oophorectomy, biopsy of nodes.
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Radiation.
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Hormone therapy:
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progestins
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Chemotherapy used for cancers that recur outside the pelvis:
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doxorubicin
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cisplatin
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ifosphamide
NURSING DIAGNOSES
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Anticipatory grieving
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Body image disturbance
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Sexual dysfunction
NURSING INTERVENTIONS
•
Check vaginal bleeding.
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•
Check incision site.
•
Assess abdomen for bowel sounds, distention.
•
Check urinary output.
•
Administer pain medication.
•
Check vital signs, temperature.
•
Emotional reassurance.
•
Explain to the patient:
•
Use of pain medication.
•
Benefit of early ambulation.
•
Increased chance of future ectopic pregnancies.
Fibroids (Leiomyomas)
Leiomyomas are smooth muscle tumors of the uterus. Since they are hormone-
receptive, the tumors will change in size with the menses.
WHAT WENT WRONG?
It is unknown what causes the proliferation of these smooth muscle tumors.
Fibroids are more common in African-American women.
PROGNOSIS
Since the tumors are hormone-responsive, they will shrink with menopause.
However, in patients with large tumors, pain, and excessive bleeding, treatment is
necessary.
HALLMARK SIGNS AND SYMPTOMS
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Bleeding, anemia
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Pain, from a large tumor
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Pressure
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INTERPRETING TEST RESULTS
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Labwork will show a declining Hgb and Hct.
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Ultrasound, MRI, CT scan, and hysteroscopy will all show a tumor.
TREATMENTS
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Watchful waiting.
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Surgery—myometomy if childbearing is to be preserved, or hysterectomy if
childbearing is completed.
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Hormones may help to shrink the tumor.
NURSING DIAGNOSES
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Pain, discomfort
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Fatigue
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Disturbed body image
NURSING INTERVENTIONS
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Monitor CBC to check anemia.
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Check vaginal bleeding.
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Check incision site.
•
Administer pain medication.
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Check vital signs, temperature.
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Explain to patient:
•
Use of pain medication.
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Increased chance of future ectopic pregnancies.
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Encourage early ambulation.
Infertility
Infertility is the inability of a reproductive-age couple to conceive after 12 months of
unprotected sexual intercourse. More than 50 percent of the time the reproductive
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