21. PATHOPHYSIOLOGY THREATENED - consists of any vaginal bleeding during early pregnancy without cervical dilatation or change in cervical consistency. Usually, no significant pain exists, although mild cramps may occur. More severe cramps may lead to an inevitable abortion INEVITABLE - Genetic anomalies (trisomies); hormonal abnormalities; and infectious, immunologic, and environmental factors usually result in first-trimester loss. Anatomic factors usually are associated with second-trimester loss INCOMPLETE - Genetic anomalies (eg, trisomies); hormonal abnormalities; and infectious, immunologic, and environmental factors usually result in first-trimester pregnancy loss. Anatomic factors usually are associated with second-trimester pregnancy loss. COMPLETE - a history of vaginal bleeding, abdominal pain, and passage of tissue exists. After the tissue passes, the patient notes that the pain subsides and the vaginal bleeding significantly diminishes. The examination reveals some blood in the vaginal vault; a closed cervical os; and no tenderness of the cervix, uterus, adnexa, or abdomen. The ultrasound demonstrates an empty uterus.
22. SEPTIC - Infection usually begins as endometritis and involves the endometrium and any retained products of conception. If not treated, the infection may spread further into the myometrium and parametrium. Parametritis may progress into peritonitis. The patient may develop bacteremia and sepsis at any stage of septic abortion. Pelvic inflammatory disease (PID) is the most common complication of septic abortion MISSED - Causes include anembryonic gestation (blighted ovum), fetal chromosomal abnormalities, maternal disease, embryonic anomalies, placental abnormalities, and uterine anomalies. Virtually all spontaneous abortions are preceded by missed abortion.
23. Assessment ASSESSING ABORTION Smaller than expected for length of pregnancy Closed No No No Slight MISSED Any of the above with tenderness Usually open; fever present Varies; fever present Varies; fever present Varies; fever present Varies; usually malodorous; fever present SEPTIC Smaller than expected for length of pregnancy Closed Possible Mild Mild Heavy COMPLETE Smaller than expected for length of pregnancy Open with tissue in cervix Possible Yes Severe Slight INCOMPLETE Agrees with length of pregnancy Open No No Moderate Moderate INEVITABLE Agrees with length of pregnancy Closed No No Mild Slight THREATENED SIZE OF UTERUS INTERNAL CERVICAL OS TISSUE IN VAGINA PASSAGE OF TISSUE UTERINE CRAMPING AMOUNT OF BLEEDING TYPE
43. BREAST CANCER -Malignant proliferation of epithelial cells lining the ducts or lobules of the breast. -Most common cancer affecting women. May develop anytime after puberty; most common after age 50. ETIOLOGY / CAUSES -Exact cause unknown -possibly estrogen therapy, antihypertensive agents, high fat diet, obesity, fibrocystic breast disease, or heredity PATHOPHYSIO - Breast cancer spreads by the way of lymphatic system.and the bloodstream, through the right side of the heart to the lungs, and to the other breast, chest wall,liver, bone and brain. -If infiltrating, occurs in parenchymal tissue. -If adenocarcinoma, arises from epithelium.
44. ASSESSMENT: -Lump or mass in breast -nipple inversion or discharge -breast tenderness -change in contour -dimpling, puckering, or retraction -change in breast shape DIAGNIOSTIC TEST: -Mammography: presence of tumor that’s too small to palpate. -Utrasonography: Fluid-filled cyst or solid mass. -Fine-needle aspiration and excisional biopsy: procurement of cells for histologic examination to confirm diagnosis. -Blood chemistry reveals distant metastasis. -Chest x-ray can pinpoint metastases in chest. -Magnetic resonance imaging (MRI) can be used to look specifically at the breast. COMPLICATIONS: -distant metastasis -infection -CNS effects -respiratory effects
45. Nursing Diagnosis: -Fear related to procedure and cancer diagnosis -Pain related to postoperative status Rationale: Chronic pain can also be an after-effect of surgery. It may initially begin at the same time as the expected post-operative acute pain, but chronic pain continues beyond the normal time expected for resolution of the problem. Instead, the pain persists and recurs. -Body image disturbance related to loss of breast -Impaired skin integrity related to incision -Anxiety related to sugery Interventions: Treatment -radiation -chemotherapy -hormone therapy
46. Surgical -Depending on the stage of your cancer, you may have a choice of: Surgery to remove just the cancer from the breast (breast-conserving surgery, or lumpectomy ). You will need to have several weeks of radiation after surgery. -Surgery to remove the breast ( mastectomy ). If you choose mastectomy, you can have an operation to make a new breast. This is called breast reconstruction. Nursing Care Pre-op: -Provide pre-operative patient teaching about the disease -Give prescribe drugs -Encourage patient to express fears and concerns Post-op: -Monitor wound site, vital signs, and intake and output. -Instruct patient to exercise hand and arm regularly. -Emotional support; support groups -No restrictive garment, BP measurement or IVs on affected side.
49. Anatomy and Physiology The cervix is one part of your reproductive system.It is the lower part of your womb, also called the uterus.The cervix connects your uterus and vagina.And your vagina leads to the outside of your body and the vulva, which is the skin area where you have pubic hair.These are the other parts of your reproductive system.They are all in the pubis. >Vagina >2 Ovaries >2 Fallopian tubes The cervix has two parts: 1.ECTOCERVIX-the outer part which is closest to the vagina 2.ENDOCERVIX-the inner part which is closest to the uterus.
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51. TRANSFORMATION ZONE -where the ectocervix and endocervix meet where most cervical cancers start. Two types of cells which are on the surface of the cervix: 1.Squamous epithelial cells-line the outer part of the cervix. 2.Columnar epithelial cells-line the inner part of the cervix.
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57. The spread of squamous cell cerervical cancer occurs first by direct extensionto the vaginal mucusa, the lower uterine segment,parametrium, pelvic wall, bladder, and bowel. Distant metastasis occurs mainly through lymphatic spread, with some spread occurring through the circulatory system to the liver, lungs, or bones. The 5 year survival rate for women with cervical cancer is 65% for nonlocalized disease.
