Digiulio M., Keogh J. Medical-Surgical Nursing Demystified
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CHAPTER 14 Women’s Health
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Risk for altered parenting
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Altered growth and development
NURSING INTERVENTIONS
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Monitor blood pressure.
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Monitor protein in urine.
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Assist during bedrest.
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Explain to the patient:
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The disease.
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Necessity of low-salt diet.
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All tests.
Crucial Diagnostic Tests
Beta Subunit of Human Chorionic
Gonadotropin (
ββ
-hCG)
This test, better known as pregnancy testing, is used to detect early pregnancy and
to diagnose or to monitor trophoblastic disease and other
β
−hCG secreting tumors.
Using a chemilumnescent or florimetric immunoassay, the test measures the level
of
β
−hCG in a blood sample.
Biopsy
Biopsy is removal of tissue from the body for examination to determine if cellu-
lar changes have occurred. It is one of the principal tools used in diagnosing
cancer. Core or incisional biopsy involves removal of only a sample of tissue.
When an entire lump or suspicious area is removed, the procedure used is an exci-
sional biopsy. Needle aspiration biopsy involves the removal of tissue or fluid
with a needle.
After the test—Always monitor the patient for bleeding following a biopsy.
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Medical-Surgical Nursing Demystified
Cancer Antigen 125 (CA 125)
This test measures the amount of the protein, CA 125, in the blood. It is per-
formed to monitor existing endometrial and ovarian cancers. This is not a screen-
ing test.
Hysterosalpingogram (HSG)
This is an x-ray test that examines the inside of the uterus and fallopian tubes and
the surrounding area. It is used to identify abnormalities, reasons for infertility,
tubal pregnancy or infections in the uterus and tubes. A contrast dye is inserted
through the vagina into the cervix and x-ray pictures are taken as the dye flows
through the uterus and fallopian tubes.
Before the test—Explain to patient NPO for 6–8 hours before the procedure and
that it is normal to experience some cramping during and after the test. Obtain
informed consent.
After the test—Monitor the patient after the test for any allergic reaction to the dye.
Monitor for excessive vaginal bleeding.
Hysteroscopy
This test directly examines the lining of the uterus to determine the cause of
abnormal bleeding and infertility. A thin viewing tube called a hysteroscope is
moved through the cervix into the uterus via the vagina. A light and a camera
are hooked to the hysteroscope so that the lining of the uterus can be viewed on
a video screen.
Before the test—Explain to patient that she must be NPO for 6–8 hours before the
procedure. Obtain informed consent.
After the test—Monitor for excessive vaginal bleeding.
Mammogram
A radiological study of the breast tissue in which the breasts are positioned and
compressed within a special device to allow optimal imaging. At least two images
are taken of each breast. This test is used to detect growths within the breast tis-
sue, as part of recommended screening for breast cancer.
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CHAPTER 14 Women’s Health
Before the test—Explain to patient that she must avoid using lotions, powders and
deodorants the day of the tests.
Papanicolaou (Pap) Smear
This test is a screening test for cervical cancer. During the test the doctor takes a
sample of cells from the cervix and sends the sample to a laboratory which then
checks the sample for changes in the cervical cells.
Rhesus (Rh) Factor
This is a serum test used to check for the presence of a protein, Rh D antigen, on
the surface of the red blood cells. It is used to assess for blood compatibility
between mother and fetus. This is a nonfasting test.
Semen Analysis
This test evaluates the male aspect of a couple’s inability to conceive. The patient
must abstain from sex for 2 days and then collect a specimen, which is then micro-
scopically evaluated for volume, sperm motility and count. The specimen must be
delivered to the lab within one hour of collection.
Quiz
1. Which of the following is a definitive sign of pregnancy?
(a) Amenorrhea.
(b) Positive hCG.
(c) Morning sickness.
(d) Fetal heart sounds.
2. The third stage of labor is when:
(a) contractions reach their peak.
(b) the head is visible.
(c) the water breaks.
(d) the placenta is delivered.
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Medical-Surgical Nursing Demystified
3. Your patient is a 25-year-old female just diagnosed with hydatidiform mole.
You would expect:
(a) a positive hCG.
(b) weight loss and wasting as with other malignancies.
(c) Braxton-Hicks contractions.
(d) a cough.
4. The start of the luteal phase of the menstrual cycle is marked by:
(a) menstruation.
(b) pelvic pain.
(c) ovulation.
(d) cramping.
5. Which of the following is a finding that is most often associated with
endometrial cancer?
(a) Thickened endometrial lining on ultrasound.
(b) Irregular periods.
(c) Young age.
(d) Dyspareunia.
6. Symptoms of an ectopic pregnancy include:
(a) hematuria, pelvic pain, and dizziness.
(b) amenorrhea, pelvic pain, and vaginal spotting.
(c) constipation, nausea, and fainting.
(d) fallopian pain, nausea, and breast enlargement.
7. One risk factor that increases a woman’s chances of getting breast cancer
include:
(a) family history.
(b) young age at first birth.
(c) multiple births.
(d) underwire bras.
8. Symptoms indicative of cervical cancer include:
(a) irregular vaginal bleeding.
(b) bloating.
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CHAPTER 14 Women’s Health
(c) weight gain and nausea.
(d) dyspareunia.
9. The most important lab value to monitor in a patient with heavy bleeding
due to fibroids is:
(a) hemoglobin.
(b) luteinizing hormone.
(c) white blood cell count.
(d) potassium.
10. The main action of luteinizing hormone is:
(a) beginning of menses.
(b) menopause.
(c) ovulation.
(d) pregnancy.
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Pain Management
CHAPTER 15
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Pain
Pain is sensed through nerve endings, which are generously spread throughout the
internal tissues and the skin. The brain is the only structure without pain receptors.
When pain receptors are stimulated, discomfort or pain results, prompting that
action be taken to remove the cause of the pain. The pain impulse travels along
sensory fibers of the spinal nerves to the spinal cord and then to the brain, which
interprets the degree and source of the pain. The brain can then signal nerve fibers
to release chemicals to inhibit pain signals. Some of the chemicals—enkephalins,
serotonin, and endorphins—are able to suppress pain signals and provide endoge-
nous pain control. Visceral pain is pain from an organ secondary to surgery, cramp-
ing, ischemia, stretching, or spasms. Referred pain is the sensation of pain coming
from another part of the body than where it actually originates. It is common for
heart pain to be felt in the arm, jaw, or back. The pain impulses from the heart
travel the same circuit as the receptors in these areas, confusing the interpretation
in the brain.
Key Terms
Adjuvant modalities
Biofeedback
Electomyography
Endorphins
Enkephalins
Likert scale
Neuroleptics
Serotonin
Serum levels
Acute pain
Chronic pain
Peripheral neuropathy
Phantom limb pain
Substance use disorders
Drug addiction
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Learning Objectives
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CHAPTER 15 Pain Management
Various individuals can experience different levels of pain with the same injury.
Researchers have sought to explain this phenomenon. The gate control theory pos-
tulates that there is a “gate” in the spine which controls the impulses from the finger
on the hot stove to the brain. The brain controls this gate to allow total or partial sig-
nals through. However, the interpretation is based on current emotions, memories,
expectations, ideals, and cultural biases. If your mind is busy elsewhere, the pain
may be somehow lessened, for example, the Lamaze experience through labor and
childbirth. This is one of the more popular pain theories, among others.
Emotional pain can produce many symptoms, as varied in their presentation as
the etiology of the pain.
Pain scales are useful tools to assess severity of pain and quality of life. They
will help the patient to accurately assess the pain and the impact it is having. Pain
scales often are measured on a Likert scale, from 0 (no pain) to 10 (the worst pain
ever). The Wong pain scale for children, uses a happy smiling face to a sad, tear-
ful one. Another useful tool is a pain diary, in which the patient records severity,
location, activity at the time, precipitating factors, and what, if anything, relieved
the pain. It is a helpful tool to asses worsening or alleviating pain and also reac-
tions to pain medications.
Just the Facts
Acute Pain
Acute pain usually points to an aberration or an illness. It is differentiated from
chronic pain by the duration, usually less than 4 to 6 months.
WHAT WENT WRONG
Pain nerves are stimulated by pressure, cuts, heat, cold, stabs, surgery, and so on.
Other causes include fractures, burns, and bruises.
PROGNOSIS
Acute pain is usually able to be managed and terminated in less than 4 to 6 months.
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Medical-Surgical Nursing Demystified
HALLMARK SIGNS AND SYMPTOMS
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Intense sharp pain (severe)
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Fleeting, momentary, or ongoing
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Cramping, spasmotic
INTERPRETING TEST RESULTS
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Ultrasound.
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X-rays.
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CT scans.
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MRI.
TREATMENTS
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Surgery.
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Delivery of child.
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Anesthesia.
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Analgesics:
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acetaminophen
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aspirin
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COX-2 inhibitors
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NSAIDs:
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celecoxib
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diclofenac
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flurbiprofen
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ibuprofen
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indomethacin
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ketorolac
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nabumetone
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naproxen
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Opioids:
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codeine
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hydrocodone