Nursing 211

N211: Health Differences Across the Lifespan I Benign Tumors of the Uterus (Leiomyoma’s, Fibroids, Myomas, Fibromyomas, Fibromas) are more common in African American women than in white women; more common in women who have never been pregnant; tend to disappear after menopause, and rarely become malignant. Nursing Assessment For Leiomyoma’s is hyper menorrhea, which is profuse or prolonged menstrual bleeding, dysmenorrhea (extremely painful menstrual periods), uterine enlargement and low back pain and pelvic pain. Signs may also include anemia and fatigue. Assessment includes vital signs, pelvic examinant to locate and palpate nodules/masses; pain management. Diagnostics Includes CBC with differential count to rule out anemia or infection, PAP test to rule out malignancy, pregnancy test, ultrasound and/or CAT scan to identify size and location, findings of diagnostic laparoscopic examination if endometriosis is suspected. Nursing Diagnosis • Pain related to abnormal cellular growth • Knowledge deficit related to management of symptoms and follow up care Medical Interventions Include dilation and curettage (D&C), endometrial ablation with laser or electrosurgical technique. Myomectomy is the removal of fibroids without removal of the uterus) via laparotomy, laparoscopy, or hysteroscopy. Abdominal or vaginal hysterectomy; hormonal regimens of Gonadotropin-releasing hormone (GnRH), Nafarelin (Synarel), leuprolide (Lupron) to shrink the tumor; cryosurgery and uterine artery embolization (UAE) of the blood vessels supplying the fibroid tumor. Nursing Interventions For GnRH include regrowth will occur after the treatment is stopped; a small loss in bone mass and changes in lipid levels may occur; amenorrhea may occur; adding raloxifene to GnRH administration has been effective in preventing these effects in pre-menopausal women; women who wish to avoid pregnancy should use a non-hormonal barrier method of contraception. Discuss administration of GnRH agonists, subcutaneous and intramuscular injections, intranasal administration, and subcutaneous implantation. Teaching with Uterine artery embolization is to expect cramping during injection of polyvinyl alcohol pellets into selected blood vessels. Postoperatively client may have pelvic pain, fever, malaise and nausea and vomiting caused by acute fibroid degeneration. Pain is controlled with a patient controlled analgesia pump. Check for bleeding, pedal pulses and neurovascular condition of the affected leg post-operatively. Instruct client not to douche or use tampons or have vaginal intercourse for at least four weeks. Instruct client to notify physician if there is bleeding, pain,

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