Female Reproductive

Most common diagnosed cancer in women
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LCIS treatmentnoneDCIS treatmentmastectomy with large lesionBreast cancer treatment complications-lymphedema -chemo: premature ovarian failure -radiation: pneumonitis, latent cardiac morbidity and mortalityPost-op considerations with mastectomyreduce lymphedema, address body image and coping, monitor incisions/drains at home, early ambulation, regular dietHow to reduce lymphedema (post-op)-do not take BP or place IV on side of it -elevate affected arm -do not immobilize affected side -encourage arm exercise at home -specialized therapyDifficult perioddysmenorrheaAbd cramping Headache N/VdysmenorrheaNursing management for dysmenorrheaNSAIDS Contraceptives Head, acupuncture, TENS, exercise, omega-3 Menstrual calendarUterine endometrial cells exist and grow outside the uterine cavityendometriosisSymptoms of endometriosisDysmenorrhea Excessive bleeding during menses Painful intercourse InfertilityDiagnosis & treatment of endometriosisDiagnosis: laparoscopy with biopsy Treatment: oral contraceptives, Gonadtropin-releasing hormone (GnRH) (inhibits estrogen production)Surgical management for extreme cases of endometriosishysterectomy and/or oophorectomyWhen ovaries fail and estrogen production declinesmenopauseWhen does menopause occur?after 12 months of amenorrheaBeginning of irregularity to end of 12 months of amenorrheaperimenopauseMenopause nursing management-Hormone therapy (estrogen & progesterone) -SSRI's, Gabapentin, Clonidine -Cooling therapy, naps -teach about HT pros/cons, lubricants/estrogen creams, calcium and vitamin D supplements, weight-bearing exerciseWhat should you know about hormone therapy (HT)?The lowest possible dose should be used. Therapy should not generally exceed beyond 4-5 years. There is increased risk of breast cancer & cardiovascular disease. Vaginal estrogen therapy can be used for genitourinary atrophy with little systemic effect.Benign, slow-growing solid tumors of uterusfibroidsWhat are fibroids stimulated by?estrogen, progesterone, and growth hormoneClinical manifestations of fibroidsasymptomatic, menorrhagia, pelvic pressureTreatment for fibroids-Asymptomatic do not require treatment -HT -Contraceptives -Myomectomy/Hysterectomy -Uterine artery embolization (UAE)Fibroid nursing management-Pain assessment & med -Pad count to determine amount of bleeding -Blood transfusion -HT -Educate about treatment optionsHT for fibroids-Estrogen & progesterone -Tranexamic acid -GnRH agonistsEstrogen/progestin HT for fibroidscontrol bleeding/dysmenorrhea, short term relief, could stimulate fibroid growthTranexamic acid HT for fibroidstaken for 5 days with onset of menses to decrease blood clotsGnRH agonists HT for fibroidsinduce false menopause, reduce size of fibroid & decrease bleeding, causes bone loss-- limit to 6 months of use, used pre-op to reduce size before surgeryLeading cause of death from gynecological malignancyovarian cancerRisk factors for ovarian cancer-long term HT -family historySymptoms of ovarian cancerearly signs are vague and nonspecificStage 1 ovarian cancercancer is confined to one or both ovariesStage 2 ovarian cancercancer spreads within the pelvic regionStage 3 ovarian cancer**average stage of diagnosis** cancer spreads to other body parts within the abdomenStage 4 ovarian cancercancer spreads beyond the abdomen to other body partsDiagnosis and treatments of ovarian cancerDiagnostics: US & CT scan, surgical removal of entire ovary Treatments: chemo, surgeryEducation for ovarian cancerMethods to ease chemo side effects and support groupsMost common gynecological malignancyuterine (endometrial) cancerWho is at highest risk of uterine cancer?postmenopausal women, age 55-65Risk factors of uterine cancerprolonged exposure to estrogen without protective progesterone; gene mutation; obesityDiagnosis for uterine cancer-biopsy -pelvic ultrasound -dilation and curettageClinical manifestations of uterine cancerpostmenopausal vaginal bleedingTreatment for uterine cancer-surgical (hysterectomy, bilateral salpingo-oophorectomy) -radiation (treatment of choice) -chemoEducation on uterine cancer-maintain healthy weight, exercise, if on estrogen therapy, take progesterone as well -chemo comfort measures -support resourcesNearly 100% are positive for Human papillomavirus (HPV)cervical cancerCauses/risks for cervical cancer-early sexual activity -multiple sexual partners -low socioeconomic status -immunosuppresionHealth promotion for cervical cancerHPV vaccineColposcopyswab cervix with acetic solution and look with lighted magnifier, allows visualization of location of tissues for biopsy (cervical cancer)Cervical cancer treatmentSurgical: radial trachelectomy, radial hysterectomy with lymph node dissection, recurrent Chemo and radiationRemoval of cervix only, for those who want to retain fertilityradial trachelectomyRecurrentpossible removal of all pelvic organs, pts left with colostomy, urinary diversionComplication of post-surgical for endometriosiscatamenial pneumothorax- if endometrial tissue implants in the lungs