Reproductive System Physiology

Anatomy and Nursing Care in

Cervical Cancer

Group 6 Class 3C:

Ayu Wahyuni
Emmi Lestari
Maulida Akisah
Tsamara Dhila Utami
 Medical Concept

A. Reproductive System Physiology

Anatomy

1. Anatomy of female external organs (Genetalia Eksterna) : mons

pubis, labya mayora, labya minora, clitoris, vestibule, hymen,
perineum, and vulva.
2. Anatomy of the female internal reproductive organs (Genetalia
Interna) : vagina, cervix, uterus, fallopian tubes, ovaries, nerves of
the genitalia, lymphatic flow
3. Physiology of Female Reproduction Based on its function
(Physiology) :
- Sexual function
- Hormonal function
- Reproductive function
Anatomy of the female internal reproductive organs (Genetalia
Interna)
Anatomy of female external organs (GenetaliaEksterna)
 B. Definition of cervical cancer

Cervical cancer (cervix) or uterine cervical

carcinoma is the number two female killer cancer in the
world after breast cancer. In Indonesia, cervical cancer
even ranks first. Cervical cancer that has entered an
advanced stage often causes death in a relatively fast
period of time.Cervical cancer is the most common
malignancy among women. This disease is a process
of changing from a normal epithelium to an invasive
Ca that gives symptoms and is a process that takes
years slowly.
 C. Etiology

HPV (Human Papilloma Virus) is the most common cause.

In addition, cigarette smoking has been found to be a culprit as
well. Female smokers contain concentrated nicotine and cotinins
in their cervix which damage cells. Male smokers also have
concentrations of this substance in their genital secretions, and it
can fill the cervix during intercourse. Deficiencies of some
nutrients can also cause cervical dysplasia. The National Cancer
Institute recommends that women should consume five times
fresh fruit and vegetables every day. If you are unable to do this,
consider taking a daily multivitamin with antioxidants such as
vitamin E or beta carotene.
 D. Clinical symptoms of cervical cancer

• Whitish or watery discharge from the vagina. The

sap that comes out of the vagina will have a foul
odor due to infection and tissue necrosis.
• Bleeding after intercourse (post coital bleeding)
which then continues to be abnormal bleeding.
• The onset of bleeding after menopause.
• In the invasive phase, a yellowish, smelly, and can
be mixed with blood.
• Symptoms of anemia arise when chronic bleeding
occurs.
Next...

• There is pain in the pelvis (pelvis) or in the

lower abdomen if there is inflammation of the
pelvis. If the pain occurs in the lower back area,
hydronephrosis is possible. In addition, pain
may also arise in other places.
• At an advanced stage, the body becomes
emaciated due to malnutrition, leg edema,
irritation of the bladder and lower large intestine
shaft.
 F. Pathophysiology

In early development, cervical cancer does not give signs and

complaints, on examination with speculators, it appears as an
erosive portion (Metaplasia Squamora) which is physiologic or
pathological. Tumors can grow:
1. Exophilic, starting from squamo columnar (SCJ) towards the
vaginal lumen as a proliferative period that experiences
secondary infection and necrosis.
2. Endophilic, starting from SCJ grows into the cervical stroma
and tends to infiltrate into ulcers.
3. Ulcerative, start at SCJ and tend to damage cervical tissue
structures by involving the initial fornless vagina to become a
large ulcer.
 G. Physical examination/support/ diagnostics

1. Cytology/pap smear
Advantage: cheap can check the parts that are not visible.
Weakness: unable to pinpoint localization.
2. Schillentest
Pitel cervical carcinoma does not contain glycogen because it does
not taking iodine, the normal carcinoma epithelium will be brown
old, being affected by carcinoma is colorless.
3. Photoscopy
Advantage: can see clearly the area concerned so easily to do a
biopsy.
Weakness: can only check the visible area, namely portionso,
meanwhile, abnormalities in the squamous columnerjuction and
intracervical were not seen.
 next

4. Colpomicroscopy
View pop smears at a magnification of up to 200 times.
5. Biopsy
With a biopsy can be found or determined the type of
carcinoma.
6. Conization
By removing the tissue containing the mucous membrane
of the cervix andflattened epithelium and gland.
Performed when the results of cytology and on the cervix
no obvious abnormalities.
 G. Management

1. At the clinical level (KIS) electrocoagulation is not allowed,

electrophysization, cryosurgery or laser light, except where otherwise
handle an expert in colposcopy and the sufferer is still young and don't
have children yet. If the sufferer has had enough children and is old
enough performed a simple hysterectomy.
2. At the clinical level, the management is like the KIS
3. At the clinical level Ib, Ib OCC and IIa a medical hysterectomy is
performed with pelvic lymphatenectomy, post-surgery is usually
followed radiation, depending on the presence / absence of tumor cells
in the lymph nodes region appointed.
4. At levels IIb, III and IVb it is not allowed to perform surgery, the
primary action is radiotherapy.
5. At the clinical level IVa and IVb radiation is only palliative,
chemotherapy can be considered.
 Nursing Care in Cervical Cancer
A. Assessment

2.The main
1.Client Identity
complaint

3.Current medical 4. Past medical

history history

6. Psychosocial
5. Family history
history

7. Physical
examination
 B. Nursing Diagnosis in Cervical Cancer

1. Impaired tissue perfusion associated with

bleeding intra cervical.
2. Lack of fluid volume associated with loss of
volume of body fluids actively due to bleeding.
3. Changes in nutrition less than body
requirements associated with nausea and
vomiting.
 C. Intervention

1. Impaired tissue perfusion associated with bleedingintra cervical.

Purpose: After nursing action, it is expected that tissue perfusion will improve.
Result Criteria:
1) Intra-cervical bleeding is reduced.
2) The conjunctiva is not anemic.
3) The lip mucosa is moist and reddish.
4) Extremity warm.
5) Vital signs are within normal limits.
Intervention:
a) Observation of vital signs every 7 hours.
b) Observe bleeding (amount, color, and duration of bleeding).
c) Collaboration :
• Installation of vaginal tampons.
• Therapy to stop bleeding.
• Giving oxygen (if necessary).
• Laboratory tests: Hb.
2. Lack of fluid volume associated with loss of volume of body fluids actively
due to bleeding.
Purpose: After nursing actions, it is expected that an adequate balance of
fluid volume is expected.
Result Criteria:
1) TTV within normal limits.
2) Moist mucous membranes.
3) Improved skin turgor.
4) Normal intake and output.
Intervention:
a. Monitor urine input and output.
b. TTV monitor every 7 hours.
c. Monitor peripheral pulse and capillary refill.
d. Assess skin turgor and mucous membrane moisture.
e. Encourage fluid intake according to client tolerance.
f. Observe for bleeding.
g. Collaboration with doctors for fluid administration as indicated.
h. Collaboration of laboratory examinations.
3. Changes in nutrition less than body requirements associated with
nausea and vomiting.
Purpose: after nursing action, nutritional needs are expected to be
met.
Result Criteria:
1) Weight within normal limits.
2) The conjunctiva is not anemic.
3) The sclera is not icteric.
Intervention:
a. Monitor daily food intake and output.
b. Monitor BB every day.
c. Encourage clients to eat foods high in calories and protein.
d. Identify a pleasant dining atmosphere.
e. Encourage clients to eat little but often.
f. Collaboration with families in providing food.
g. Collaboration with doctors for further treatment.