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MCN MIDTERM Post Breast
MCN MIDTERM Post Breast
By Pauwy <3
Ø Weigh perineal pads
Ø Turn patient to her side and inspect
the buttocks for pooling of blood.
Ø Monitor vital signs and I&O
SUBINVOLUTION
- Delayed return of the enlarged
uterus to normal size and
function.
Etiology
Subinvolution results from:
• Retained placental fragments and
membranes.
• Endometritis or uterine fibroid tumor
• Treatment depends on the cause.
Pathophysiology
• Uterine atony or placental fragments
prevent the uterus from contracting
effectively.
Assessment Findings
Clinical manifestations include:
1. Prolonged lochial discharge
2. Irregular or excessive bleeding
3. Larger than normal uterus
4. Boggy uterus (occasionally)
Nursing Management
1. Prevent excessive blood loss,
infection, and other complications.
a. Massage uterus, facilitate
voiding, and report blood loss.
b. Monitor blood pressure and pulse
rate.
c. Administer prescribed
medications.
d. Be prepared for possible D&C
2. Assist the client and family to deal
with physical and emotional stresses
of postpartum complications.
By Pauwy <3
PUEPERAL INFECTION Ø Hemorrhage
- Puerperal infection affects the Ø Maternal conditions, such as anemia,
uterus and structures above it with DM, immunosuppression, or
a characteristic fever pattern debilitation from malnutrition
Ø Cesarean birth
Several types of puerperal infection
including: Assessment Findings
• Endometritis – an infection of the Ø fever at least 100.4˚F (38˚C)
uterine lining Ø chills, headache, malaise,
• Myometritis – an infection of the restlessness, and anxiety
uterine muscle Ø pain in the lower abdomen or pelvis
• Parametritis – an infection of the caused by a swollen uterus
areas around the uterus Ø foul-smelling vaginal discharge
Ø loss of appetite increased heart rate
Ø Localized perineal infection
o pain, elevated temperature,
edema, redness, firmness, and
tenderness at the wound site;
o sensation of heat; burning on
urination; discharge from the
wound;
o or separation of the wound
Ø Endometritis
Pathophysiology o heavy, sometimes foul- smelling
• group A, B, or G hemolytic lochia;
streptococcus, gardnerella vaginalis, o tender, enlarged uterus; backache;
Chlamydia trachomatis, and o severe uterine contractions
coagulase-negative staphylococci persisting after childbirth;
• Less common causative agents are: o fever greater than 100.4˚F; chills;
clostridium perfringens, bacteroides o and increased pulse rate
fragilis, klebsiella, proteus mirabilis, Ø Parametritis
pseudomonas, staphylococcus o vaginal tenderness and abdominal
aureus, and Escherichia coli pain and tenderness
By Pauwy <3
Nursing Management
1. Monitor vital signs every 4 hours
2. Place her in a high Fowler’s to semi-
Fowler’s position
3. Assess capillary refill and skin turgor
as well as mucous membranes
4. Assess intake and output
5. Enforce strict bed rest
6. Provide a high-calorie, high protein
diet
7. Provide fluid (3,000 to 4,000ml)
8. Encourage the patient to void Assessment Findings:
frequently 1. Femoral DVT
9. Inspect the perineum often o malaise; chills; and pain, stiffness,
10. Encourage the patient to change or swelling in a leg or in the groin
perineal pads frequently, o calf pain
11. Administer antibiotics and o a positive RIELANDER’S SIGN /
analgesics, antiemetics PAYR’S SIGN
12. Provide sitz baths or warm or cool
compress
13. Change bed linens, perineal pads, and
underpads frequently
THROMBOPHLEBITIS OR DEEP
VEIN THROMBOS 2. Pelvic DVT
- is an inflammation of the lining of o high fever, severe repeated
a blood vessel that occurs in chills, and general malaise
conjunction with clot formation o lower abdominal or flank pain
By Pauwy <3
Nursing Management Risk Factors
Institute measures to prevent DVT: Ø Previous bout of mastitis while
Ø Assess the woman for risk factor that breast-feeding
could predispose her to DVT Ø Sore or cracked nipples — although
Ø Teach her about measures to reduce mastitis can develop without broken
her risk skin
Ø Avoid standing in one place for too Ø Wearing a tightfitting bra or putting
long or sitting with knees bent or legs pressure on your breast when using a
crossed seat belt or carrying a heavy bag,
Ø Avoid using garters or wearing which may restrict milk flow
constrictive clothing Ø Improper nursing technique
Ø Wiggle toes and perform leg lifts Ø Becoming overly tired or stressed
while in bed Ø Poor nutrition
Ø Ambulate as soon as possible after Ø Smoking
delivery
Ø Wear antiembolism or support Signs and Symptoms
stockings as ordered. • Breast tenderness or warmth to the
Ø Bed rest touch
Ø Apply warm compresses • Breast swelling
Ø Give an analgesic as ordered • Thickening of breast tissue, or a
Ø Assess uterine involution and note breast lump
any changes in fundal consistency • Pain or a burning sensation
Ø Administer anticoagulant, antibiotic continuously or while breast- feeding
and antipyretic therapy • Skin redness, often in a wedge-
Ø Mark, measure, and record the shaped pattern
circumference of the affected • Generally feeling ill
extremity at least daily • Fever of 101 F (38.3 C) or greater
Ø Watch for signs and symptoms of
bleeding, such as tarry stools, coffee-
ground vomitus, and ecchymoses.
MASTITIS
- Inflammation of the breast tissue
that is usually caused by infection
or by stasis of milk in the ducts.
Etiology
• Injury to breast - overdistention,
stasis (missed feedings, a bra that is POSTPARTUM MOOD
too tight or impaired infant sucking) DISORDERS
• Staphylococcus aureus derived from 3 PHASES
the infant’s nose and throat 1. Initial/acute period – first 6-12hrs
postpartum
By Pauwy <3
2. Subacute postpartum period – which Comparison of Postpartum Blues,
lasts 2-6 weeks Depression, Psychosis
3. Delayed postpartum period – which
can last up to 6 months
Physiological Changes
1. Taking-In Phase
- 1 to 2 days after delivery.
- within this period, the woman is
passive.
- dependent on with some of the
daily tasks and decision-making.
- talk about her experiences during
labor and birth
- regain her physical strength and
organize her rambling thoughts
2. Taking-Hold Phase
- starts 2 to 4 days after delivery.
- starts to initiate actions on her
own and making decisions
- begins to actively participate in
newborn care.
- woman still needs positive
Assessment Findings
reinforcements
- Allow the woman to settle in
gradually into her new role
3. Letting-Go Phase
- 10 days to 6 weeks
- the woman finally accepts her
new role
- the phase where postpartum
depression may set in.
- Readjustment of relationship
By Pauwy <3
o Maintain the prescribed Etiology for Fibroids
medication schedule. • early menarche
o Keep communication open • use of oral contraception before the
with the health care providers; age of 16 and an increase in body
coordinate social services. mass index.
o Include family participation • use of progestin-only contraceptives
and involvement in plans of multiparity
care.
o Make appropriate referrals. Pathology
• studies indicate that ovarian steroids,
estradiol, and progesterone, promote
REPRODUCTIVE FUNCTION the growth of leiomyomas; and that
DISORDERS the size of fibroids often decline after
menopause
UTERINE DISORDERS
Fibroids
• abnormal growths that develop in or
on a woman’s uterus.
• known as:
* leiomyomas
* myomas
* uterine myomas
* fibromas
By Pauwy <3
Diagnostic Exam for Fibroids Risk Factors
• Ultrasound • Imbalance between estrogen and
• Pelvic MRI progesterone
• obesity
Management • nulliparity
o Gonadotropin-Releasing Hormone • other reproductive cancer
(GnRH) agonists: leuprolide • tamoxifen use for breast cancer
(Lupron), will cause estrogen and • family history of diabetes mellitus,
progesterone levels to drop, will hypertension
eventually stop menstruation and
shrink fibroids.
Surgical Management
• Surgery: Myomectomy
• Laparoscopy
Note:
Fibroids might grow back after surgery.
Signs /Symptoms:
• Bleeding or discharge not related to
periods (menstruation) — over 90
percent of women diagnosed with
endometrial cancer have abnormal
vaginal bleeding.
• Postmenopausal bleeding.
UTERINE CANCER • Difficult or painful urination.
Endometrial cancer : cancer that arises from • Pain during intercourse.
the endometrium (the lining of the uterus or • Pain and/or mass in the pelvic area.
womb).
• result of the abnormal growth of cells
that have the ability to invade or
spread to other parts of the body.
By Pauwy <3
Diagnostic Examination OVARIAN DISORDERS
• examining the pelvis. Incidence
• Using sound waves to create a picture • Inactive ovaries and ovarian cysts .
of uterus. • Incomplete uterine involution,
• Using a scope to examine your endometritis
endometrium: • Major finding of the present study
• Hysteroscopy: inserts a thin, flexible, increased prevalence of polycystic
lighted tube (hysteroscope) through ovaries in patients with borderline
vagina and cervix into uterus. personality disorder
• Removing a sample of tissue for
testing.
Management
• Radiation therapy:
• Radiation from a machine outside the
body.
• Radiation placed inside the body:
Internal radiation (brachytherapy)
• Chemotherapy drugs by pill or IV
• Hormone therapy option in advanced
endometrial cancer that has spread
OVARIAN CANCER
Risk Factors
beyond the uterus.
• Nulliparity
• Targeted drug therapy
• History of infertility
• Supportive (palliative) care
• 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
By Pauwy <3
CERVICAL DISORDERS
Cervical Polyps: growths on the cervical
canal, the passage that connects the uterus to
the vagina.
Causes:
• Cervical infections
• Chronic inflammation
• An abnormal response to hormone
estrogen
Signs/Symptoms • Clogged blood vessels near the cervix
• GI disturbances: 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
Management
• Surgery with complete surgical
staging (including dissection of the
pelvic and para- aortic lymph nodes,
omentectomy, peritoneal and
diaphragm biopsies).
• Chemotherapy
By Pauwy <3
CERVICAL CANCER • Laser- direct beam (heat) to remove
Risk Factors diseased tissue
• presence of HPV strains for 16-18, • Hysterectomy
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
Etiology/Risk Factors
• older women 50 years old
Management • vaginal lesions- squamous cell
• Irradiation precancerous changes
• Chemotherapy • VAIN (vaginal intraepithelial
• Cold colonization- cone shaped neoplasia)
biopsy • ingestion DES
• Loop electrocautery excision-lesions • STD or infection with herpes virus or
removed by low voltage diathermy HPV
loop (electrical current causing • smoking
burning) • vaginal irritation
• Cryosurgery – freezing of diseased • cervical cancer
cervical tissue
By Pauwy <3
Conditions of the Female
Reproductive System:
• Female Urogenital Displacement and
Prolapse - occurs when the pelvic
organs relax and descend into the
vagina.
Risk factors:
• Childbearing, decrease levels of
VAGINAL CANCER estrogen during menopause cause
Signs and Symptoms supporting structures lose their
• foul vaginal discharge elasticity and strength.
• painless vaginal bleeding • Multiparity, childbirth trauma,
• vaginal mass or lesion chronic straining, previous pelvic
• frequency and pain upon urination surgeries, or radiation, abdominal
masses, effects of gravity and age.
FEMALE UROGENITAL
DISPLACEMENT AND PROLAPSE
S/S
• Cystocele: descent of bladder into
vagina
• Rectocele: protrusion of rectum into
the vagina
• Vaginal or uterine prolapse descent of
uterus in the vagina.
Diagnostic Exam: • S/S: complete-cervix
• Cytologic examination protrudes into vagina
• Colposcopy and vagina becomes
Management: inverted
• External or intravaginal radiation Management: surgical repair, hysterectomy
therapy
• Chemotherapy Nursing Diagnosis
• Surgical: radical hysterectomy Hysterectomy
• Lymphadenectomy Potential Nursing Diagnosis
• Vaginectomy for Hysterectomy
• Pelvic exenteration in more advanced 1. Situational low, self-esteem
if bladder or rectum is involved. 2. Impaired urinary elimination
3. Impaired urinary retention (acute)
4. Risk for constipation or diarrhea
5. Risk for ineffective tissue perfusion
6. Risk for sexual dysfunction
7. Dysfunctional grieving
8. Knowledge deficient regarding
condition, prognosis, treatment, self-
care, and discharge needs.
By Pauwy <3
BREAST DISORDERS • Referral and biopsy indicated for
Normal Female Breast definitive diagnosis, especially for
first mass.
By Pauwy <3
Breast Cancer Mass (Malignant)
Physical Assessment/Inspection:
• 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
• Unilateral localized increase in
venous pattern associated with
malignant tumors
• Peau d’Orange (edema) associated
with breast cancer
• Caused by interference with
BREAST CANCER lymphatic drainage
Risk Factors • Breast skin has orange peel
• Female gender appeearance
• 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
• Hormonal factors
• 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 Pagets Disease
Physical Assessment/Inspection:
Paget Disease (Malignancy of Mammary
Ducts)
1. Early signs: erythema of nipple and
areola
2. Late signs: thickening, scaling, and
erosion of the nipple and areola
By Pauwy <3
Diagnostic Evaluation
Ø Breast Self-Examination (BSE)
• Done on day 5-7 of menstrual
cycle (some changes in breast
occur due to hormones around
menstruation)
• Breast examination with
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.
Ø Mammography
• Detect nonpalpable lesions
and assist in diagnosing
palpable 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 (i.e..
smaller than 1cm)
Ø Magnetic Resonance Imaging (MRI)
Ø Procedure for Tissue Analysis
• Percutaneous biopsy
• Fine-needle aspiration
• Surgical biopsy
• Excisional biopsy
• Incisional biopsy
By Pauwy <3