Ch 57 Management of Patients With Female Reproductive Disorders
• Cleansing the wound daily • Offering a low-residue diet • Positioning the patient with pillows (The wound is usually cleansed daily with warm, normal saline irrigations or other antiseptic solutions as prescribed, or a transparent dressing may be in place over the wound to minimize exposure to the air and subsequent pain. A low-residue diet prevents straining on defecation and wound contamination. Positioning the patient on her side, with pillows between her legs and against the lumbar region, provides comfort and reduces tension on the surgical wound. After the dressings are removed, a bed cradle may be used to keep the bed linens away from the surgical site. Antibiotic ointment should not be applied to the site.)
(see full question) The nurse is caring for a patient postoperatively who had a simple vulvectomy. What nursing interventions should be provided to this patient? (Select all that apply.)
Toxic shock syndrome (TSS is a type of septic shock that is a life-threatening systemic reaction to the toxin produced by several kinds of bacteria. TSS is associated with the use of superabsorbent tampons that are not changed frequently and internal contraceptive devices that remain in place longer than necessary.)
A 12-year-old adolescent is being seen in the primary care office where you practice nursing. She has just had her first menses, and you are advising her on how to use a tampon. Your instructions include using the least absorbent tampon and to change tampons frequently, at least every 4 to 6 hours. Which of the following conditions are you most likely trying to prevent?
Bladder dysfunction (After a total abdominal hysterectomy and bilateral salpingo-oopherectomy, the client is at risk for several complications, especially bladder dysfunction because the surgical site is close to the bladder. Leukopenia and neurotoxicity are adverse effects of chemotherapy agents such as paclitaxel and carboplatin used to treat ovarian cancer. Deep vein thrombosis, not clotting deficiencies are a potential complication after this type of surgery.)
A client has undergone a total abdominal hysterectomy and bilateral salpingo-oopherectomy as treatment for endometrial cancer. When providing postoperative care to this client the nurse would be alert for signs and symptoms of which of the following?
"My partner will not need any treatment." (Trichomoniasis is treated with metronidazole. Both partners are treated and receive a one-time loading dose or smaller dose three times a day for a week. The client may experience a transient metallic taste when taking the drug. Client are strongly advised to abstain from alcohol when taking metronidazole because of a possible disulfiram-like reaction.)
A client is being treated for trichomoniasis. The client has received instructions about the prescribed drug therapy. The nurse determines that the client needs additional teaching when she states which of the following?
A bowel-cleansing procedure will precede radioactive implantation. (The nurse should tell the client that she'll receive an enema before the procedure because bowel motility during cervical radiation implant therapy can disrupt or dislodge the implants. The client will be in a private room, but activities will be restricted to keep the implants in place. To keep the bladder empty, an indwelling catheter will be used. Positioning in bed shouldn't exceed a 20-degree elevation because sitting up can cause the implants to move from their intended locations. Semi-Fowler's position is 45 degrees.)
A client who has cervical cancer is scheduled to undergo internal radiation. In teaching the client about the procedure, the nurse should tell the client that:
Take sitz baths frequently. (Sitz baths are recommended to relieve the client's itching and burning as well as relieve swelling of the vulva and perineum. Skin protectants containing zinc oxide promote healing. A vinegar (1 to 2 tablespoons) and water (1 pint) douche daily may be used to combat the vaginitis when the client is symptomatic. Taking Lactobacillus acidophilus in capsule form or eating yogurt containing active cultures of lactobacilli can help restore normal vaginal microorganisms.)
A client with vaginitis complains of itching and burning of the perineum. Which suggestion would be most appropriate to relieve the client's symptoms?
Use of corticosteroids (Explanation: A small quantity of the fungus Candida albicans commonly exists in the vagina. Because corticosteroids decrease host defense, they increase the risk of candidiasis. Candidiasis is rare before menarche and after menopause. Using hormonal contraceptives, not spermicidal jelly, and pregnancy, not nulliparity, increase the risk of candidiasis)
A nurse is reviewing a client's medical history. Which factor indicates the client is at risk for candidiasis?
Vulvar pruritus. (Vulvar pruritus is the chief complaint of those diagnosed with candidiasis.)
A nurse who works in a gynecologist's office frequently cares for patients who are diagnosed with vulvovaginal candidiasis. The nurse should teach the patients how to manage and treat the most common symptom of:
The cancer involves metastases outside the pelvis. (Explanation: *Stage III* ovarian cancer involves one or both ovaries, and one or both of the following are present: (1) cancer has spread beyond the pelvis to the lining of the abdomen; (2) cancer has spread to lymph nodes. *Stage I* ovarian cancer is contained within the ovary (or ovaries). *Stage II* ovarian cancer is in one or both ovaries and has involved other organs (i.e., uterus, fallopian tubes, bladder, the sigmoid colon, or the rectum) within the pelvis. *Stage IV* involves distant metastasis to the liver, lungs, or other organs outside the peritoneal cavity.)
A patient has a diagnosis of stage III ovarian cancer and wants to know what organs are involved. What information should be provided to the patient?
• Avoiding unprotected sexual intercourse • Avoiding multiple partners for sexual intercourse • Avoiding IV drug use (Intravenous drug use and risky sexual behaviors, which include multiple partners and unprotected sex, are factors that can put anybody at risk for HIV. Thus, the correct way to minimize HIV transmission would be to avoid these factors. HIV is not transmitted through simple physical contact. Open lesions related to HPV increase the likelihood that HIV can be transmitted; prevention includes administration of the HPV vaccine.)
A patient has been diagnosed with genital herpes. Knowing patient education is an essential part of nursing care of the patient with a genital herpes infection, the nurse plans to include which of the following methods to minimize HIV transmission? Select all that apply.
See her gynecologist to remove and clean the pessary at regular intervals. (A pessary can be used to avoid surgery (Lone, Thakar, Sultan, et al., 2011). This device is inserted into the vagina and positioned to keep an organ, such as the bladder, uterus, or intestine, properly aligned when a cystocele, rectocele, or prolapse has occurred. Pessaries are usually ring- or doughnut shaped and are made of various materials, such as rubber or plastic (Fig. 57-4). Rubber pessaries must be avoided in women with latex allergy. The size and type of pessary are selected and fitted by a gynecologic health care provider. The patient should have the pessary removed, examined, and cleaned by her health care provider at prescribed intervals)
A patient has had a pessary inserted for long-term treatment of a prolapsed uterus. As part of the teaching plan, what should the nurse advise the patient to do?
It grows within the wall of the uterine muscle.
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?
White blood cell 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.)
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?
A cystocele (Cystocele is a downward displacement of the bladder toward the vaginal orifice (Fig. 57-3) from damage to the anterior vaginal support structures. It usually results from injury and strain during childbirth. Because a cystocele causes the anterior vaginal wall to bulge downward, the patient may report a sense of pelvic pressure and urinary problems such as incontinence, frequency, and urgency. Back pain and pelvic pain may occur as well. The symptoms of rectocele resemble those of cystocele, with one exception: Instead of urinary symptoms, patients may experience rectal pressure. Constipation, uncontrollable gas, and fecal incontinence may occur in patients with complete tears.)
A patient reports to the nurse that she has a sense of pelvic pressure and urinary problems such as incontinence, frequency, and urgency. The problem has gotten much worse since the birth of her third child. What does the nurse suspect the patient is experiencing?
See her gynecologist as soon as possible. (Explanation: All women should be encouraged to have annual checkups, including a gynecologic examination. Any woman who is experiencing irregular bleeding should be evaluated promptly.)
A perimenopausal woman informs the nurse that she is having irregular vaginal bleeding. What should the nurse encourage the patient to do?
Cervical cancer (The patient's symptoms are those of cervical cancer. The symptoms of cervical cancer include abnormal vaginal bleeding and persistent discharge that is yellowish, blood tinged, or foul smelling. Patients may complain of postcoital pain and bleeding, bleeding between menstrual periods, and unusually heavy menstrual periods. If the cancer has progressed into the pelvic wall, the patient may experience pain in the flank regions of the body.)
A woman in her late thirties has been having unusually heavy menstrual periods combined with occasional urine and stool leakage over the last few weeks. On further enquiry, she reveals that she also has postcoital pain and bleeding. To which of the following diagnoses do you think the investigations are most likely to lead?
"I will remove and clean it every day." (Pessaries should be removed, cleaned, and replaced periodically (at least every 2 months). If the client is unable to manage the pessary, then follow-up appointments should be made with the practitioner. Ill-fitting pessaries can cause irritation and erosion of tissue resulting in irritation, bleeding, or infection. The placement of the pessary should support the uterus in the pelvis and lessen urinary and pelvic symptoms.)
An elderly client, who can void only while standing and pushing upward on the vagina, is ordered a pessary. Which comment from the client indicates a need for further teaching about this device?
Bulging of the bladder into the vagina Explanation: A cystocele is the bulging of the bladder into the vagina. A rectocele is a herniation of the rectum into the vagina. An enterocele is a protrusion of the intestinal wall into the vagina. An uterovaginal prolapse is the downward displacement of the cervix anywhere from low in the vagina to outside the vagina.
Assessment of a client reveals evidence of a cystocele. The nurse interprets this as which of the following?
"I will track follow-up appointments in my smart phone so she receives all three injections." (Explanation: The Centers for Disease Control and Prevention (CDC) recommends routine vaccination of boys and girls 11-12 years of age, before they become sexually active. The vaccination is administered in three intramuscular doses, with the initial dose followed by a second dose in 2 months and a third dose 6 months after the first dose. Completion of all three doses of the vaccine is important for immunity to develop; it does not replace other strategies important in prevention of HPV. Women still need cervical cancer screening as recommended.)
During a routine sports physical examination, the nurse practitioner recommends HPV vaccination for an 11-year-old girl. Which of the following statements made by the patient's mother demonstrates understanding of HPV vaccinations?
"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.)
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?
Candida albicans (Explanation: Candida albicans presents with a thick, curdy white discharge, accompanied by a strong odor and burning with urination. Trichomonas vaginalis presents with a foamy, yellow-white discharge, accompanied by a foul odor and severe itching. Gardnerella vaginalis presents with a watery, gray-white discharge, accompanied by a fishy odor and more discharge after intercourse.)
Samantha Velasquez, a 24-year-old preschool teacher, is being seen by the physician in the primary care group where you practice nursing. Over the past 2 months, she has been receiving treatment for multiple ear infections and tonsillitis. She reports a curdy white vaginal discharge and burning with urination. What is the most likely cause of her symptoms?
45-year-old woman who has never been pregnant (Explanation: 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.)
Which client has the highest risk of ovarian cancer? a) 36-year-old woman who had her first child at age 22 b) 30-year-old woman taking hormonal contraceptives c) 45-year-old woman who has never been pregnant d) 40-year-old woman with three children
Rectocele (A rectocele is the extrusion of the rectum into the posterior vagina. A cystocele is the herniation of the bladder into the anterior vagina. The descent of the small intestine into the vaginal vault is termed enterocele. A uterine prolapsed is the downward descent of the uterus into the vagina.)
Which of the following is the extrusion of the rectum into the posterior vagina?
Menorrhagia (Uterine leiomyomas or fibroids cause menorrhagia, which in turn causes anemia. A poor dietary intake of iron does not cause anemia but aggravates the problem. Though there can be a feeling of pressure in the pelvic region, this does not cause anemia.)
Which of the following is the main cause of anemia in a patient with active uterine leiomyoma?
Metronidazole (Flagyl) (The most effective treatment for trichomoniasis is Flagyl. Monistat, Cleocin, and Gyne-Lotrimin are not the most effective treatment for trichomoniasis.)
Which of the following is the most effective treatment for trichomoniasis?
It affects women of reproductive age. (Endometriosis affects women of reproductive age. It is a benign lesion or lesions with cells similar to those lining the uterus. Extensive endometriosis causes few symptoms.Causation has been linked to infertility.)
Which of the following is true regarding endometriosis?
"What questions do you have related to your sexual health?" (Therapeutic communication techniques include a nonjudgmental attitude, use of open-ended questions, and allowing the patient to lead the discussion. Educational counseling and role playing may be helpful. "Why" statements immediately place the patient in a defensive position that may block communication.)
Which of the following statements made by the nurse demonstrates effective communication techniques when initiating a discussion about sex with a 25-year-old female patient?
Retroversion (In retroversion the uterus turns posteriorly as a whole unit. In anteversion the uterus tilts forward as a whole unit. In retroflexion, the fundus bends posteriorly. In anteflexion, the uterus bends anteriorly)
Which position occurs when the uterus turns posteriorly as a whole unit?
