Female GYN Cancer Med Surg

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Peri-menopause is
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decreased level of estrogen -starts at age 35
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Menopause is
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Process is done, post babies -age 45-52 or later
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Endometriosis is
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Inflammation of tissues from inner lining of uterus Sxs: pain, hemorrhage, anemia
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Pelvic Exams
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-Empty bladder before exam -Supine Laparotomy position, Upright Laparotomy, Left Sims Position -should not hurt unless infected or inflamed
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Pap Smear
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Detects cervical cancer/STDs -do not do during period or douching -Atypical squamous cells w/ HPV (do biopsy, pt will have watery discharge) -Atypical cells w/ no HPV (check pt again in a year) -Pain = Pos. Chandler Sign (infection) -Uterine Inspection (1 hand in vj & 1 pushing on abdominal wall) -Cancer looks like califlower, bleeds easily
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Cervix Multipara is
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For pt who had multiple pregnancies, will have lacerations, dilated 2-3 cm
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Cone Biopsy (surgery) & Leep (laser) do what
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-more extensive -packing left in vj -no sex until after healing
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Endometrial Biopsy is
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women with midlife irregular bleeding, will have some pain
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Dilation & Curettage (D&C) is
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diagnostic for cause of bleeding & therapeutic treatment -obtains endometrial tissue
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Laparoscopy & hysteroscopy is
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Direct visual of uterine cavity -Adjacent to D&C -Treats infertility, fibroids, implants IUDs, detects early pregnancy
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Begnin Tumors of the Uterus
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Myomatous or Fibroid Tumors -Can be intracavity (in lining), intramural (in wall), or outside of the uterus -Develop slowly
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Manifestations of begnin tumors of the uterus
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Infertility Meno/Metorraghia Backache Bleeding urinary problems Asymptomatic Pain
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Medical Management for begnin tumors of the uterus
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Disappears after menopause -Myomectomy (removal of large tumors) -Hysteroscopic Resection (resection w/ laser, no overnight stay or incision) -Hysterecctomy (for meno/metorraghia. Sxs- severe chills) -Meds (Lurpine-temp menopause, shrinks size of tumors before surgery)
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Risks for Cervical Cancer
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Early intercourse HPV Unsafe sex Smoking
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Manifestations for Cervical Cancer
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Asymptomatic in beginning Thin watery discharge after sex/douching, irregular bleeding/discharge, pain after sex Advanced: spotting, irregular bleeding between periods, back/leg pain, dysmenorrhea, painful urination, rectal bleeding, edema, dysrua, fever, anemia, abscesses, fistulas
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Assessment for Cervical Cancer
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Screening: Pap Smear -biopsy, x-ray, lab tests Diagnosis: Colposcopy
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Medical Management for Cervical Cancer
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Radical Hysterectomy (large lesion) Radical Trachelectomy (alternative to hysterectomy, for young women who want kids, removes cervix) Pelvic Extenteration (reocurrent cancer, increased risk for surgical complications)
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Types of Endometrial Cancer/Cancer of the Uterus
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Corpus & Fundus
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Risk Factors for Endometrial Cancer/Cancer of the Uterus
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Increased Estrogen Early period & late menopause Afertile, Infertility, Nulliparity Diabetes, HTN, Gallbladder disease, Obesity Hermoxicine (drug for breast cancer)
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Assessment & Diagnosis for Endometrial Cancer/Cancer of the Uterus
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Annual check up, ultrasound, biopsu Diagnostic: Biopsy Aspiration
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Medical Management for Endometrial Cancer/Cancer of the Uterus
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Total hysterectomy, oophorectomy Whole pelvis radiation (temporary) Pre-op radiation (stage 2 cancer) Surgery & radiation (reocurrent cancer) Chemo & hormone therapy (cancer extended beyond vj)
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Risk Factors for Cancer of the Vulva
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Smoking HPV HIV Immunosuppressant therapy Chronic vulva irritation Early sexual activity
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Manifestations of Cancer of the Vulva
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Long-standing pruritus & soreness Presents as chronic dermatitis/lumps/ulcer/mass Late signs: bleeding, foul-smelling discharge, pain
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Medical Management of Cancer of the Vulva
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Surgical, Chemo, Creams, Cryosurgery Vulvectomy (wide excision of the vulva) -w/ or w/out lymph node dissection -Additional therapy: chemo or radiation -complications (infection, sepsis, DVT, hemorrhage, vj scarring)
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Cancer of the Vagina: Risk Factors & Treatment
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Rare, takes years to develop Risk Factors (previous female cancer, use of vaginal pessaries, DEF drug) Treatment (laser/radical vaginectomy- reconstructive surgery)
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Fallopian Tube Cancer: SxS, Diagnosis, & Treatment
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Rare, least common, any age SxS (abdominal pain, distention, bleeding) Diagnosis (Sonogram) Treatment (Surgery first, than radiation)
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Risk Factors for Ovarian Cancer
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*causes the most death Nulliparity Infertility Talcum powder
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Manifestations of Ovarian Cancer
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*there is no screening tool* Nonspecific, increased abdominal girth, pelvic pressure, bloating, constipation, abdominal pain, flatulence, urinary urgency, indigestion, leg/pelvic pain
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Total Hysterectomy
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Removal of uterus & cervix
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Radical Hysterectomy
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Removal of uterus, surrounding tissues, including lymph nodes
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Subtotal Hysterectomy
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Remove fungus & leave cervix
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Internal Radiation/Intracavity/Brachy Therapy Radiation
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Under anesthesia, applicators placed, x-ray done after, radiologist loads predetermined amount, decreases exposure for others & makes sure its the exact amount. Pt in isolated room or room w/ lead wall, adjacent room must be dislocated
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Nursing Interventions for Internal Radiation/Intracavity/Brachy Therapy Radiation
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Foley Catheter **Bed Rest: 24-72 hours* Diet: low residue Hygiene: don’t clean perineal area No prego visitors or visitors under 18 S/E: fatigue, spasms *Leg exercises for circulation
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Safety Issues with Internal Radiation/Intracavity/Brachy Therapy Radiation
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Staff: wear film badges, decrease time around pt If device becomes dislodged do not touch & call radiation safety Wear: rubber gloves, no latex
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Post treatment for Internal Radiation/Intracavity/Brachy Therapy Radiation
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-progressive ambulation -allowed to shower, no douching -Radiation S/E (fatigue, enteritis (diarrhea & cramping), cystitis (urinary frequency)
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Which of the following patient statements demonstrates an understanding related to Pap smear testing? 1.) I plan to postpone my first Pap test because it is a painful experience.” 2.) I have my Pap test every other year to reduce cost related to this expensive screening.” 3.) Pap tests are not indicated for older women past childbearing age.” 4.) “I need to have my first Pap test when I turn 21 or earlier if I become sexually active.”
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4.) “I need to have my first Pap test when I turn 21 or earlier if I become sexually active.” (Screening should begin within 3 years of the initiation of sexual intercourse or at 21 years of age. Pap smear is a painless and relatively inexpensive method of early detection. Preventive measures for cervical cancer include regular pelvic examinations and Pap tests for all women, especially older women past childbearing age.)
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The nurse is caring for a patient who has just been told that her ovarian cancer is terminal and that no curative options remain. What would be the priority nursing care for this patient at this time? 1.) Teach the patient about the importance of maintaining a positive attitude 2.) Offer to inform the patient’s family of this diagnosis 3.) Provide emotional support to the patient and her family 4.) Implement distraction and relaxation techniques
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3.) Provide emotional support to the patient and her family (Emotional support is an integral part of nursing care at this point in the disease progression. It is not normally appropriate for the nurse to inform the family of the patient’s diagnosis. It may be inappropriate and simplistic to focus on distraction, relaxation, and positive thinking.)
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The nurse documents the following history obtained from a female patient: No known allergies Douching 2 to 3 times per week Use of barrier methods for contraception Recent viral upper respiratory infection Estrogen levels within acceptable parameters Which of the following would the nurse identify as a risk factor for the patient developing a vulvovaginal infection? 1.) Douching 2.) Viral upper respiratory infection 3.) Use of Barrier contraceptive 4.) Estrogen levels
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1.) Douching (Risk factors for vulvovaginal infections include frequent douching, allergies, oral contraceptive use, use of broad-spectrum antibiotics (for bacterial infections), and low estrogen levels)
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A patient is receiving chemotherapy with paclitaxel as treatment for ovarian cancer. The patient arrives at the facility for laboratory testing prior to her next dose of chemotherapy. The results are as follows: Hemoglobin: 12.9 gm/dL White blood cell count: 2,200 /cu mm Platelets: 250,000 /cu mm Red blood cell count: 4,400,00/cu mm Which result would be a cause for concern? 1.) Hemaglobin levels 2.) WBC count 3.) RBC count 4.) Platelets
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2.) WBC count (The patient’s white blood cell count is low, revealing leukopenia and placing the patient at an increased risk for infection. The other results are within normal parameters and would not be a cause for concern)
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Which client has the highest risk of ovarian cancer? 1.) 30-year-old woman taking hormonal contraceptives 2.) 36-year-old woman who had her first child at age 22 3.) 40-year-old woman with three children 4.) 45-year-old woman who has never been pregnant
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4.) 45-year-old woman who has never been pregnant (The incidence of ovarian cancer increases in women who have never been pregnant, are older than age 40, are infertile, or have menstrual irregularities. Other risk factors include a family history of breast, bowel, or endometrial cancer. The risk of ovarian cancer is reduced in women who have taken hormonal contraceptives, have had multiple births, or have had a first child at a young age.)
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Which of the following is a reason why ovarian cancer is largely considered to be a lethal cancer of the female reproductive system? Select all 1.) Tumors present with nonspecific symptoms 2.) There is no effective screening test. 3.) Tumors are typically far advanced and inoperable by the time they are diagnosed 4.) They are the leady cause of gynocological cancer deaths 5.) The tumors are very painful in the early stage
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1.) Tumors present with nonspecific symptoms 2.) There is no effective screening test. 3.) Tumors are typically far advanced and inoperable by the time they are diagnosed 4.) They are the leady cause of gynocological cancer deaths (Although other types of female reproductive system cancers occur with greater incidence, ovarian tumors are the leading cause of death from gynecologic malignancies. Tumors of the ovary have been lethal largely because they present with nonspecific symptoms; there is no effective screening test, and therefore tumors frequently are far advanced and inoperable by the time they are diagnosed. Ovarian tumors are the leading cause of death from gynecologic malignancies partly because they present with nonspecific symptoms. Ovarian tumors are the leading cause of death from gynecologic malignancies partly because there is no effective screening test. Ovarian tumors are the leading cause of death from gynecologic malignancies partly because tumors are typically far advanced and inoperable by the time they are diagnosed.)
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The nurse is reviewing a patients lab work and notes a stage II Pap smear result. What does this indicate for the patient? 1.) cancer insitu 2.) Vaginal invasion 3.) Pelvic wall invasion 4.) Bladder extension
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2.) Vaginal invasion
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A patient is diagnosed with the most common type of uterine fibroid, an intramural fibroid. The nurse includes which of the following information in teaching the patient about this type of fibroid? 1.) It lies underneath the outermost layer of the uterus. 2.) It grows within the wall of the uterine muscle. 3.) It grows below the inner uterine surface. 4.) It arises from inside or outside the surface of the uterine muscle.
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2.) It grows within the wall of the uterine muscle.
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Following a colposcopy, the confirmation of in situ carcinoma of the cervix has been determined. Which comment by the client indicates an appropriate understanding of the diagnosis? 1.) “I will not need any further treatment.” 2.) “The cancer has not spread” 3.) “I will need surgery and chemotherapy to increase my odds for survival.” 4.) “I can wait until I have finished having babies to seek treatment.”
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2.) “The cancer has not spread” (carcinoma in situ means the cancer has not left the original site and therefore has not invaded other tissues. Further treatment is required, which usually consists of cryosurgery or hysterectomy. Surgery with adjuvant chemotherapy is usually reserved for cancers that are more advanced. Even though cervical cancers tend to be slower growing, treatment should not be delayed)
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The nurse is caring for a patient with a diagnosis of vulvar cancer who has returned from the PACU after undergoing a wide excision of the vulva. How should this patient’s analgesic regimen be best managed? 1.)Analgesia should be withheld unless the patient’s pain becomes unbearable. 2.) Scheduled analgesia should be administered around-the-clock to prevent pain. 3.) All analgesics should be given on a PRN, rather than scheduled, basis. 4.) Opioid analgesics should be avoided and NSAIDs exclusively provided
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2.) Scheduled analgesia should be administered around-the-clock to prevent pain (Because of the wide excision, the patient may experience severe pain and discomfort even with minimal movement. Therefore, analgesic agents are administered preventively (i.e., around the clock at designated times) to relieve pain, increase the patient’s comfort level, and allow mobility. Opioids are usually required)

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