A client has been diagnosed with endometriosis. When planning this clients care, the nurse should prioritize what nursing diagnosis?
A.
Anxiety related to risk of transmission.
B.
Acute pain related to misplaced endometrial tissue.
C.
Ineffective tissue perfusion related to hemorrhage.
D.
Excess fluid volume related to abdominal distention.
The Correct Answer and Explanation is:
The correct answer is B. Acute pain related to misplaced endometrial tissue.
Explanation:
Endometriosis is a chronic, often painful condition where endometrial tissue, which normally lines the inside of the uterus, grows outside the uterus. This misplaced tissue can be found on the ovaries, fallopian tubes, outer surface of the uterus, and other organs within the pelvis. One of the primary symptoms of endometriosis is acute pain, which can be cyclic and often correlates with the menstrual cycle. The pain is caused by the endometrial tissue responding to hormonal changes in the same way as the tissue inside the uterus: it thickens, breaks down, and bleeds with each menstrual cycle. Since this tissue is outside the uterus, it has no way to exit the body and leads to inflammation, scar tissue formation, and sometimes adhesions.
Addressing acute pain is a priority in the care of clients with endometriosis due to its significant impact on the client’s quality of life. Pain management is crucial not only for the client’s comfort but also to prevent chronic pain syndromes that can affect physical function and emotional well-being. Effective pain management strategies may include pharmacological approaches like NSAIDs (nonsteroidal anti-inflammatory drugs), hormonal therapies, and possibly surgical interventions. Non-pharmacological approaches, such as physical therapy, acupuncture, or dietary adjustments, may also be considered depending on the client’s specific needs and response to treatment.
The other options, while relevant to general nursing care, are less directly associated with the immediate and most common concerns of endometriosis:
- A. Anxiety related to risk of transmission: Endometriosis is not an infectious disease, so the risk of transmission is not a concern.
- C. Ineffective tissue perfusion related to hemorrhage: While endometriosis can lead to bleeding, it does not typically result in significant hemorrhage affecting tissue perfusion.
- D. Excess fluid volume related to abdominal distention: Abdominal distention can occur, but it is secondary to the acute pain and inflammation rather than a primary concern.
Thus, focusing on acute pain provides a direct approach to managing one of the most debilitating aspects of endometriosis and improving the client’s overall quality of life.