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Genitourinary 3

 
  1. Management
  2. medical:
    1. danazol (Cyclomen) - atrophy of ectopic endometrial tissue
    2. leuprolide acetate (Lupron) - reduction of pain/lesions in endometriosis
    3. progestins - decreases endometriosis
    4. oral contraceptives
  3. surgical:
    1. laparoscopic surgery
    2. CO2 laser laparoscopy
    3. laparotomy
    4. presacral neurectomy
    5. hysterectomy(illustration)
  4. Complications - infertility
  5. Nursing interventions
  6. assess
    1. history of current signs and symptoms
    2. pain level
    3. impact of infertility (especially in child-bearing age group)
  7. reduce pain
  8. increase self-esteem
  9. Cervical cancer
  10. Definition - three types:
    1. dysplasia
    2. carcinoma in situ
    3. invasive carcinoma
  11. Etiology/epidemiology
    1. 35 to 55 years of age is the most common age group
    2. higher incidence in African Americans
    3. higher incidence among low socioeconomic populations
    4. risk factors include:
      1. multiple sexual partners
      2. history of STD's
      3. early sexual activity
  12. Findings
    1. usually asymptomatic in early stages
    2. postcoitalbleeding, irregular vaginal bleeding
    3. spotting between periods
    4. spotting after menopause
    5. evidence of discharge
    6. pain with radiation to buttocks and legs
    7. anemia
    8. weight loss
    9. fever
  13. Diagnostics
    1. Papanicolaou test
    2. staging laparotomy
    3. metastatic evaluation:
      1. IVP
      2. cystoscopy
      3. sigmoidoscopy
  14. Management
    1. radiotherapy
      1. used in all stages
      2. internal - radium via applicator
      3. external - via linear accelerator or cobalt
    2. surgery
      1. hysterectomy(illustration)
        • if childbearing is no longer wanted
        • if carcinoma in situ or invasive carcinoma, combine with radiotherapy
        • complication: impairment of the bladder not uncommon
      2. pelvic exenteration
      3. conization
    3. chemotherapy
      1. used as an adjunct with surgery or radiation if indicated
      2. specific agents are dependent on diagnosis and often used in combination therapy
  15. Complications include metastasis to:
    1. lungs
    2. mediastinum
    3. bones
    4. liver, and subsequent spread to rectum and bladder
  16. Nursing interventions
    1. assessment
      1. history of pap smears, sexual history and past STD's
      2. history of current symptoms
      3. client's understanding of the disease
    2. reduce anxiety
    3. enhance body image
  17. Breast cancer (illustration)
  18. Types of breast cancer
    1. in situ ductal
    2. in situ lobular
    3. invasive ductal
    4. invasive lobular
    5. inflammatory
    6. Paget's Diseaseof the nipple
    7. tubular
    8. medullary
    9. mucinous
    10. papillary
    11. sarcoma
  19. Etiology
    1. in women, begins in lining of milk duct
    2. higher risk if family history 
    3. risk may increase with use of hormones
  20. Findings (illustration)
    1. painless firm lump
    2. painless thickening in breast
    3. enlargement of axillary nodes or supraclavicular nodes
    4. nipple discharge
    5. scaliness or retraction of nipple (seen more in Paget's Disease)
    6. pain, ulceration, edema, orange-peel skin (usually late findings)
  21. Diagnostics
    1. mammography
    2. biopsyor aspiration
    3. tumor cell tests
    4. lab tests to determine metastases
  22. Management
    1. surgical approach (will depend on lymph node biopsies and tumor staging):
      1. lumpectomy
      2. partial mastectomy
      3. modified radical mastectomy
      4. radical mastectomy
      5. simple mastectomy
      6. axillary dissection
    2. radiation therapy
    3. chemotherapy:
      1. cyclophosphamide (Cytoxan)
      2. methotrexate (Mexate)
      3. doxorubicin HCL (Adriamycin)
      4. paclitaxel (Taxol)
    4. endocrine therapy
      1. bone marrow transplant
      2. oophorectomy
      3. adrenalectomy
    5. hormone therapy
      1. use of tamoxifen (Nolvadex)
        • to block the effects of estrogen
        • for post-menopausal women with positive nodes
        • course of treatment a minimum of two years
      2. use of other hormones in advanced disease:
        • estrogens (DES) or ethinyl estradiol (Estinyl) to suppress FSH and LH
        • progestins may decrease estrogen receptors
        • androgens may suppress FSH and estrogen production
        • aminoglutethimide blocks estrogen by blocking adrenal steroids
        • corticosteroids suppress secretion estrogen and progesteronefrom the adrenal glands
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