MDC3 Exam 1 Review - Excessive local growth of smooth muscle tissues

MDC3 Exam 1 Review ABCs A - airway B - breathing C – circulation Uterine Leiomyoma Benign, slow growing solid tumors of the muscle layer of the uterus (fibroids) Excessive local growth of smooth muscle tissues oGrowth may be stimulated by estrogen, progesterone, and growth hormone

Assessment: asymptomatic or symptomatic (heavy prolonged vaginal bleeding)**

Assess pelvic pressure, elimination pattern, abdomen size, dyspareunia, infertility Painful menses Elimination patterns (due to enlarged fibroid pressing on organs) Ask how many pads/tampons used in a day S/S: Heavy periods or periods that last a long time & abd distention, urinary frequency

Psychosocial assessment:

Quality of life from dyspareunia Fear that symptoms could be cancerous Anxiety Significance of loss of uterus for patient and partner if want to conceive

Diagnostic assessment:

CBC – iron deficiency anemia from heavy bleeding WBC would be normal HGB and HCT – low Pregnancy test to rule out uterine enlargement Transvaginal US – able to see if fibroid is protruding into uterine cavity

Biopsy: gold standard

Pelvic exam Planning and Implementation Manage bleeding

o Non-surgical management: oral contraceptive**

o Surgical management:

MRI focused ultrasound-heat to tumor Uterine artery embolization – starves tumor of circulation allowing it to shrink

 Myomectomy- laser removal Hysterectomy

Erectile Dysfunction: causes & treatment

Common as one ages: reduced blood flow to penis

Causes

Medical causes: change in blood pressure

Non-organic: increased stressor, illnesses

Treatment Medications that increase perfusion to penis (PDE- 5 inhibitors) Vacuum pump Pineal implant Managing stress

Education related to treatment for HPV/Cervical Cancer Caused by HPV

s/s of cervical cancer:

oheavy bleeding in later stages obleeding after sex oMost of the time asymptomatic Bleeding between periods

Preventive screening: PAP smear, surgical biopsy (gold standard) to determine

staging

Treatment:

Early- ablation, laser Late- chemotherapy/radiation

Education:

No sticking anything up the vagina (tampons, douches) May have bleeding No sexual intercourse No tub baths Breast cancer- preventative screenings, risk factors, diagnostic tests Preventative screenings Mammography

• Recommended to start screening at 45
• Women over 55 may switch to every 2 years

Breast self-awareness/self-examinations

• >90% detected by patient

Clinical breast clinical

• At least every 3 years for women in their 20s and 30s and every year for

asymptomatic women at least 40 years old Risk Factors Increased age Family history Early menarche, late menopause Lack of breastfeeding Postmenopausal obesity Alcohol consumption Mutations in BRCA1 or BRCA2 Diagnostic tests

Lab assessment: study of breast mass tissue and lymph nodes, liver enzymes,

calcium, and alkaline phosphatase

Imaging assessment:

• Mammogram
• Ultrasound
• MRI
• Chest x-ray, CT for metastasis
• Breast biopsy*

Endometrial cancer- symptoms, risk factors, diagnostic testing Most common gynecologic malignancy Cancer of inner uterine lining Grows slowly but vaginal bleeding usually leads to prompt evaluation and treatment = good prognosis Most commonly associated with prolonged exposure to estrogen without its protective effects of progesterone

Risk Factors:

Women in reproductive years Family History Diabetes Mellitus

HTN

Obesity Uterine polyps Late menopause Nulliparity (no childbirths) Smoking Tamoxifen – given for breast cancer

Symptoms:

Postmenopausal bleeding (how many pads/tampons a day)** Watery, bloody vaginal discharge Low back or abdominal pain Low pelvic impaired comfort (describe exact location and intensity) Pelvic exam may reveal palpable uterine mass**

Diagnostic testing:

oTransvaginal ultrasound* oEndometrial biopsy – gold standard “determine presence of endometrial thickening/cancer”** Interventions oPelvic exam

Hysterectomies- what they are, who gets them, post-operative care, education Total Hysterectomy -The entire uterus, including the cervix, is removed. The procedure may be vaginal or abdominal, with laparoscopic or robotic assistance.Bilateral Salpingo-Oophorectomy (BSO)- Fallopian tubes and ovaries are removed.

Panhysterectomy - Total abdominal hysterectomy and BSO: The uterus,

ovaries, and fallopian tubes are removed.Radical Hysterectomy - The uterus, cervix, adjacent lymph nodes, upper third of the vagina, and surrounding tissues (parametrium) are removed.

Leiomyomas are the most common reason for hysterectomies Postoperative care Assess vaginal bleeding Abdominal bleeding at the incision site (a small amount is normal) Intactness of the incision Urine output per urinary catheter for 24 hours Incisional or abdominal pain Perineal care Deep breathing exercises Education oAvoid sexual intercourse, douching oReport excessive bleeding or changes in discharge oAvoid heavy lifting or strenuous activity- can cause hernias or ruptures of sutures ohydrate