NCM 234

CARE OF MOTHER AT
RISK OR WITH
PROBLEMS (ACUTE AND
CHRONIC)
Reproductive Function
Disorders
Fibroids:
• abnormal growths that
Uterine Disorders
develop in or on a
woman’s uterus.
• known as:
* leiomyomas
* myomas
* uterine myomas
* fibromas
Leiomyomas:
• group of benign smooth
Uterine Disorders
muscle tumors
commonly present in
premenopausal women
• monoclonal origin
which arises from the
smooth muscle of the
uterus
Etiology:
Fibroids
• early menarche
• use of oral
contraception before
the age of 16 and an
increase in body mass
index.
• use of progestin-only
contraceptives
• multiparity
Pathology:
• studies indicate that
Fibroids
ovarian steroids,
estradiol, and
progesterone, promote
the growth of
leiomyomas; and that
the size of fibroids often
decline after menopause
Signs and Symptoms:
• heavy bleeding between or Fibroids
during periods that
includes blood clots
• pain in the pelvis or lower back
• increased menstrual cramping
• increased urination
• pain during intercourse
• menstruation that lasts longer
than usual
• pressure or fullness in lower
abdomen
• swelling or enlargement of the
abdomen
Diagnostic Exam:
• Ultrasound Fibroids
• Pelvic MRI
Management:
• gonadotropin-releasing
hormone (GnRH)
agonists, : leuprolide
(Lupron), will cause
estrogen and
progesterone levels to
drop , will eventually
stop menstruation and
shrink fibroids.
Surgical
Management: Fibroids
• Surgery:
myomectomy.
• Laparoscopy
Note:
Fibroids might grow
back after surgery.
Endometrial cancer :
cancer that arises from Uterine Cancer
the endometrium (the
lining of the uterus or
womb).
• result of the abnormal
growth of cells that
have the ability to
invade or spread to
other parts of the body.
Risk factors:
• Imbalance between Uterine Cancer
estrogen and
progesterone
• obesity
• nulliparity
• other reproductive
cancer
• tamoxifen use for breast
cancer
• family history of
diabetes mellitus,
hypertension
Signs /Symptoms:
• Bleeding or discharge not Uterine Cancer
related to periods
(menstruation) — over 90
percent of women
diagnosed with endometrial
cancer have abnormal
vaginal bleeding.
• Postmenopausal bleeding.
• Difficult or painful urination.
• Pain during intercourse.
• Pain and/or mass in the
pelvic area.
Diagnostic Examination:
• examining the pelvis. Uterine Cancer
• Using sound waves to
create a picture of
uterus.
• Using a scope to
examine your
endometrium:
• Hysteroscopy: inserts a
thin, flexible, lighted tube
(hysteroscope) through
vagina and cervix into
uterus.
• Removing a sample of
tissue for testing.
Management: Uterine Cancer
• Radiation therapy:
• Radiation from a
machine outside the
body.
• Radiation placed
inside the body:
Internal radiation
(brachytherapy)
 Management:
• Chemotherapy drugs Uterine Cancer
by pill or IV
• Hormone therapy
option in advanced
endometrial cancer
that has spread
beyond the uterus.
• Targeted drug
therapy
• Supportive (palliative)
care
Incidence:
• Inactive ovaries and
Ovarian Disorders
ovarian cysts .
• Incomplete uterine
involution, endometritis
• Major finding of the
present study increased
prevalence of
polycystic ovaries in
patients with borderline
personality disorder
Ovarian Disorders:
Type of Cyst Characteristics Management

Follicular ▪ Unruptured follicle at time • Manage presenting

of ovulation symptoms
▪ May grow with hormonal • Weight loss may help obese
stimulation clients

Corpus luteum Corpus luteum fails to regress OCPs used if cyst is small
after ovulation
Polycystic ovary ▪ One or both ovaries are ▪ Surgical excision maybe
syndrome enlarged with multiple follicles, necessary if cyst continues
oligomenorrhea or to grow or is unresponsive
amenorrhea; to treatment
▪ women usually
hyperandrogenic with LH
hypersecretion

Dermoid Asymptomatic,
unilateral ovarian tumors
Teratomas ▪ Germ cell tumor; mature
form benign, immature
form malignant
▪ may contain skin, bone,
hair or teeth

Fibromas ▪ Benign solid tumors; can be

extremely large and may fill
pelvic cavity
Risk factors:
• Nulliparity Ovarian Cancer
• History of infertility
• Family history of ovarian or
breast cancer ( mutations in
BRCA1 or BRCA2 genes have
been observed in families)
• Family history of hereditary
nonpolyposis colorectal
cancer ( HNPCC )
• Estrogen Replacement
Therapy
• Age older than 50 years
Signs/Symptoms:
• GI disturbances: Ovarian Cancer
abdominal distention
with ascites
increasing abdominal
girth
• Urinary frequency
and urgency
• Pain and pressure
caused by growing
tumors or effects of
urinary and bowel
obstruction
Diagnostic Exam:
• History and physical Ovarian Cancer
exam
• Ultrasound
• CT scan
• MRI
• Blood tests
• Barium enema and
chest x-ray to detect
metastasis
Management:
• Surgery with complete
Ovarian Cancer
surgical staging
(including dissection of
the pelvic and para-
aortic lymph nodes,
omentectomy,
peritoneal and
diaphragm biopsies).
• Chemotherapy
Cervical Polyps: growths
on the cervical canal, the Cervical Disorders
passage that connects
the uterus to the vagina.
Causes:
• Cervical infections
• Chronic inflammation
• An abnormal response
to hormone estrogen
• Clogged blood vessels
near the cervix
Signs and Symptoms:
Cervical Polyps
• reddish, purplish,
or grayish in color.
shaped like a
finger, bulb, or thin
stem
hypermenorrhea or
intermenstrual,
postmenopausal
and postcoital
bleeding
Diagnosis: Cervical Polyps
• Pap’s Smear
• Surgery:
surgical removal by
ligation or use of polyp
forceps to gently twist
the growth off the
cervix.
 Risk factors:
• presence of HPV strains Cervical Cancer
for 16-18, intraepithelial
neoplasia (CIN):
• progress to CA and
invasive cervical cancer
• multiple sexual partners
• early sexual intercourse
less than 20yr,
• history of STD
• smoking tobacco
immunosuppression
Signs and Symptoms:
• abnormal vaginal Cervical cancer
bleeding after
intercourse
• Metrorrhagia
• postmenopausal
bleeding
• polymenorrhea
• pressure on bowel and
bladder
• rectal discharge
• anemia,
• heavy aching abdominal
pain
Management:
• Irradiation Cervical Cancer
• Chemotherapy
• Cold colonization-
cone shaped biopsy
• Loop electrocautery
excision-lesions
removed by low
voltage diathermy
loop(electrical
current causing
burning
Management:
Cervical cancer
• Cryosurgery –
freezing of diseased
cervical tissue
• Laser- direct beam
(heat) to remove
diseased tissue
• Hysterectomy
 Vaginal Fistula:
Vaginal Disorders
• an abnormal
opening that
connects the vagina
to another organ,
Imperforate Hymen:
▪ when the hymen
covers the whole
opening of the
vagina.
Etiology/risk Vaginal Cancer
factors:
• older women 50
years old
• vaginal lesions-
squamous cell
precancerous
changes
Risk Factors:
• VAIN (vaginal
Vaginal cancer
intraepithelial
neoplasia)
° ingestion DES
° STD or infection with
herpes virus or HPV
° smoking
• vaginal irritation
• cervical cancer
Signs/Symptoms: Vaginal Cancer
• foul vaginal discharge
• painless vaginal
bleeding
• vaginal mass or lesion
• frequency and pain
upon urination
 Diagnostic Exam:
• Cytologic examination Vaginal Cancer
• Colposcopy
Management:
• External or intravaginal
radiation therapy
• Chemotherapy
• Surgical: radical
hysterectomy
• Lymphadenectomy
• Vaginectomy
• Pelvic exenteration in more
advanced if bladder or
rectum is involved.
 Conditions of the Female
• Risk factors:
• Childbearing, decrease Reproductive System:
levels of estrogen during
menopause cause
supporting structures lose
their elasticity and
strength. • Female Urogenital Displacement
• Multiparity, childbirth and Prolapse - occurs when the
trauma, chronic straining, pelvic organs relax and descend
previous pelvic surgeries,
or radiation, abdominal into the vagina.
masses, effects of gravity
and age.
 Conditions of the Reproductive System
FEMALE UROGENITAL DISPLACEMENT AND PROLAPSE
• S/S:
• 1. Cystocele: descent of bladder into vagina
• 2. Rectocele: protrusion of rectum into the vagina
• 3. Vaginal or uterine prolapse descent of uterus in the vagina.
• S/S: complete-cervix protrudes into vagina and
vagina becomes inverted
▪ Management: surgical repair, hysterectomy
Potential Nursing Diagnosis
for Hysterectomy
1. Situational low, self-esteem Nursing Diagnoses
2. Impaired urinary
elimination
3. Impaired urinary retention
(acute)
4. Risk for constipation or
diarrhea
5. Risk for ineffective tissue
perfusion HYSTERECTOMY
6. Risk for sexual dysfunction
7. Dysfunctional grieving
8. Knowledge deficient
regarding condition,
prognosis, treatment, self-
care, and discharge needs.
 CARE OF MOTHER AT RISK OR
WITH PROBLEMS (ACUTE AND
CHRONIC)

Female Client With

Problems of
Reproductive Please watch the video:
Function https://www.youtube.com/watch?
v=Qe_7c2fFI9E
 NCM 234

CARE OF MOTHER AT
RISK OR WITH
PROBLEMS (ACUTE AND
CHRONIC)
Normal Female Breast: Breast Disorders
Assessment: Breast
1. History Assessment/Inspection
2. Inspection:

Retraction Signs:
appear only with position
changes or with breast
palpation
• skin dimpling,
• creasing, or changes in
the contour of the breast
or nipple secondary to
fibrosis or scar tissue
formation in the breast
Physical Assessment/Inspection:
Breast Cyst (Benign Mass)
• Occur as single or multiple lumps
in one or both breasts
• Usually tender (omitting caffeine
reduces tenderness);
• tenderness increases during
premenstrual period
• Round shape, soft or firm, mobile
• Referral and biopsy indicated for
definitive diagnosis, especially for
first mass.
Physical Assessment/Inspection: Fibroadenoma (Benign
• Occurs as a single mass Breast Lump)
in women aged 15–35
years
• Non tender round or
lobular, firm, mobile,
not fixed to breast tissue
or chest wall
• No premenstrual
changes
• Referral and biopsy
indicated for definitive
diagnosis
Benign Breast Problem Definition Presentation Management

Mastalgia breast pain cyclical or persistent based on presentation

focal or generalized *dietary changes reducing
caffeine intake

Fibrocystic breasts common pathologic fluid filled cysts, tender cysts aspiration if painful
problem in female breast nodular breast tissue with *reduce caffeine intake
cyclical variation

Fibroadenoma benign tumor common breast tumor 15- no treatment

30 years old • If large- can be surgically
removed
Hyperplasia and atypical cellular proliferation from • hyperplasia in 20% of No treatment
hyperplasia normal cells to abnormal biopsy specimen • excisional biopsy with
cells • Atypical hyperplasia in 1 chemo
% of biopsy specimen, preventive treatment with
represents risk factors for tamoxifen or raloxifene
breast cancer

Papilloma lesion at terminal portion • occurs in 40 years old • ductogram for nipple
of duct with serous or discharge
serosanguineous nipple • surgery for removal of
discharge ducts as indicated
Duct ectasia disease of ducts in palpable dilated duct; • no risk for cancer,no
subareolar zone sticky nipple discharge; surgical intervention
Burning pain, itching and required
inflammation
Gynecomastia Hypertrophy of one • increased breast • caused by
or both male size in male estrogen, tumors
breasts of thyroid
conditions and
hepatic problems
Risk factors for Breast
Cancer:
• Female gender
Breast Cancer
• Increasing age
• Personal history of breast
cancer
• Family history of breast
cancer
• Genetic mutations (BRCA-
1 and BRCA-2 mutations
are responsible for
majority of inherited
breast cancer cases)
• Late menopause
• Nulliparity
Risk factors for Breast Cancer:

• Hormonal factors
Breast Cancer
• Early menarche
• First child after 30 years of age
• Hormone therapy (HT)
• Exposure to ionizing radiation
during adolescence and early
adulthood
• History of benign proliferative
breast disease
• Obesity
• High-fat diet (controversial)
• Alcohol intake
Physical Assessment/ Breast Cancer Mass
Inspection:
(Malignant)
• occurs as a single mass
(lump) in one breast,
firm, hard, embedded
in surrounding tissue
• Referral and biopsy
indicated for definitive
diagnosis
• Usually non tender
• Irregular shape
Physical Assessment/ Breast Cancer Mass
Inspection:
(Malignant)
• Unilateral localized
increase in venous
pattern associated with
malignant tumors
• Peau d'Orange (Edema)
associated with breast
cancer
• Caused by interference
with lymphatic
drainage
• Breast skin has orange
peel appearance
Physical
Assessment/ Pagets Disease
Inspection:
Paget Disease
(Malignancy of
Mammary Ducts)
Early signs: erythema
of nipple and areola
Late signs: thickening,
scaling, and erosion of
the nipple and areola
 Breast Self-Examination
(BSE)
• Done on day 5-7 of
Diagnostic Evaluation
menstrual cycle (some
changes in breast occur
due to hormones around
menstruation)
• Breast examination with
the woman in a supine
position
• The entire surface of the
breast is palpated from
the outer edge of the
breast to the nipple.
• Alternative palpation
patterns are circular or
clockwise, wedge, and
vertical strip.
• Detect nonpalpable
lesions and assist in Diagnostic Evaluation
diagnosing palpable Mammography
masses
• Recommended to be
done every year
beginning at 40 years
of age (women with
family history, start
at younger age)
• Mammography may
detect a breast
tumor before it is
clinically palpable (ie,
smaller than 1 cm);
• Magnetic
Resonance Imaging Diagnostic Evaluation
• Procedures for
Tissue Analysis:
• Percutaneous
Biopsy
• Fine-Needle
Aspiration
• Surgical Biopsy
• Excisional Biopsy
• Incisional Biopsy
 Breast Disorders

Please watch the link:

https://www.youtube.com/wa
tch?v=hhWmwNjCD4A