Women's Health

Gynecological Cancers

Breast Cancer

Breast cancer is cancer that affects breast tissues. It can start developing at the cells of the ducts, lobules, or other breast tissues. It can be diagnosed using a process known as biopsy where a sample of the affected area is subjected to microscopic analysis. Mammography, screening methods, and other specialized laboratory exams may be required for different types of breast cancer (Friedman, Sutphen, & Steligo, 2012).

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Treatment of breast cancer can entail a combination of different types of therapies, which include chemotherapy, radiation, targeted and hormone therapies, and/or breast surgery if the cancerous cells have spread. Specific treatments and the type of therapies depend on the stage of cancer and the attributes of the tumor.

Prognosis or chances of survival rate depends on the stage of cancer progression. Stage 0/non-invasive cancers and stage I and II/early invasive cancers have better survival rates than later stages III and IV. If cancerous cells have not moved beyond the breast and reached the lymph nodes, there is a better prognosis (Friedman et al., 2012). Metastatic cancer has the poorest prognosis. Nursing implications involve analyzing the feelings of the patient and determining whether they know what they will go through.

Nurses also monitor how the patient is progressing and even talk with her family. Patient education is critical for enabling the patient to understand the stage of her disease and the treatment plans and their effects. This will be instrumental in relieving adverse effects and encouraging the patient to withstand the complications.

Ovarian Cancer

Ovarian cancer is cancer that affects the ovaries and is characterized by cancerous epithelial tumors known as carcinomas which begin to spread. Diagnosis of ovarian cancer may involve a number of steps, which include an internal examination of the vagina, ultrasound scanning, removal of abdominal fluid, CA 125 blood test, risk of malignancy index (RMI), image-guided biopsy, CT scan, and surgery. This type of cancer is treated using chemotherapy and/or surgery, which depends on the stage of the disease, personal considerations, and overall health (Friedman et al., 2012).

34% of women with stage III cancer have a survival rate of at least five years. 3 out of 4 women diagnosed with ovarian cancer live for over one year. 46%, which is almost half the patients who live for over five years. Younger patients below 65 years live longer than aged women.

Nursing interventions involve teaching women about their reproductive system, the risk factors, and the significance of attending regular screening which involves a pelvic exam and Pap smear. This increases the possibility of treating ovarian cancer taking into consideration that the disease is often diagnosed at the latest stages. Nurses are also tasked with teaching the patients about the importance of going through screening (Friedman et al., 2012).

When it is diagnosed, the nurse informs the patient about the treatment procedure and the impacts of chemotherapy and surgery. Encouraging the patient is significant since it motivates them to complete their treatment plans and informs them about their chances of survival.

 

Cervical Cancer

Cervical cancer affects a woman’s cervix and is characterized by abnormal growth and spreading of cancerous cells which also invade other body parts. Diagnosis can be done using Pap smear which involves screening tests although it has a failure rate of almost 50%. The biopsy is the most effective diagnosis procedure where a magnified visual inspection known as colposcopy is done on the cervix with the use of a dilute acetic acid solution so that abnormal cells can be identified. Conization and loop electrical excision procedure are treated as well as diagnostic procedures are used for removing the cervix’s inner lining so that it can be analyzed pathologically (Hilton et al., 2003).

Treatment tends to vary across the world due to the absence of qualified radical pelvic surgery and the presence of “fertility-sparing therapy” in industrialized countries. Hysterectomy (removal of the uterus) is used for treating micro-invasive cancer while cone biopsy can be used to remove the tumor. A trachelectomy is a treatment option that preserves a woman’s fertility.

The survival rate is close to 100% for patients whose cancer is microscopic. For the earliest stage, there is a 95% survival rate for invasive cancer, while for later stages, the survival rate of five years is 72%. The nurse plays numerous roles, like acting as the care provider, patient advocate, and research analyst. She listens and encourages the patient to understand her condition and monitors the complications arising from treatment (Hilton et al., 2003). They educate the patient to monitor her treatment plan, diet, and adverse reactions and inform her about the significance of visiting the oncologist and the gynecologist.

Colorectal Cancer

Colorectal cancer begins either in the colon or the rectum and these cancers are usually adenocarcinomas, implying that they affect the cells that produce mucus and different types of fluids. A growth known as polyp develops in the inner lining of the rectum or colon (Labianca et al., 2010). The physical exam is the first diagnosis that can be followed by a number of procedures, which include a physical exam and health history, stool tests, complete blood count (CBC), double-contrast barium enema, blood chemistry tests, colonoscopy, sigmoidoscopy, and biopsy. Treatment procedure can involve surgery to remove the tumor and this can be combined with adjuvant chemotherapy. Another option is the clinical trial. Radiation therapy in combination with chemotherapy can be used to treat rectal cancer after or before surgery followed by adjuvant chemotherapy.

The survival rate for stage I cancer is 93%, stage II is 75 to 85%, while stage III is 44-83%. Prognosis can be improved for stage III cancer with the help of chemotherapy. The poorest prognosis is for stage IV cancer which is approximately 8% within five years (Cleveland Clinic, n.d.). Nursing priorities involve supporting independence and adaptation of the patient, ensuring comfort, preventing complications, providing optimal psychological help, and informing the patient about the conditions/processes of the disease, treatment, and prognosis rates. Patient education is critical to enable the patient to deal realistically with her condition. This will motivate the patient to achieve a recovery that will warrant discharge.

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Endometrial Cancer

Endometrial cancer affects the cells of the inner lining of the womb or uterus which are known as endometrial. The cells begin to grow abnormally and invade other body parts. Diagnosis is established after the physical examination which is then followed by curettage and dilation, where the endometrial tissue is surgically removed. Histological examination is performed on the tissue to determine the attributes of cancer (Colombo et al., 2013).

After finding cancer, the physician performs medical imaging to determine whether cancer has invaded the tissue. Treatment may involve a single or a combination of different procedures, which includes chemotherapy, radiation, and hormone therapies, or surgical removal of the uterus. Just like other cancers, the treatment procedure depends on the overall state of health of a woman, personal preferences, age, and progress of cancer.

Endometrial cancer is usually diagnosed at stage I and II and the survival rate for these stages is 94-98%. Stage IV has the poorest prognosis which is 15-17% within a period of five years (American Cancer Society, 2016). Stage III survival rate is 47-58%. The nurse has several opportunities for improving early diagnosis and detecting this type of cancer. The patients can be consulted informally to provide advice on ways of dealing with the condition and enable the patient to understand the attributes of the disease (Dinkelspiel, Wright, Lewin, & Herzog, 2013). Nurses can also educate women on the treatment plans to reassure the patient that their condition can be effectively controlled or treated.

STI’s and Vaginal Infections

Chlamydia

Chlamydia is a sexually transmitted disease (STD) caused by a bacterium known as Chlamydiatrachomatis. Laboratory tests are used to diagnose Chlamydia to reveal the presence of the bacteria in the organism either by culture or by analyzing the genetic attributes of the bacteria. Urine and swab specimens are also screened to detect infection (Chernesky, 2005). Treatment is carried out using antibiotics such as doxycycline, azithromycin, ofloxacin, or erythromycin. 95% to 100% of patients are completely cured when treated using antibiotics.

However, when left untreated for a long period, it causes infertility, cervicitis, pelvic inflammatory disease (PID), urethritis, epididymitis, and reactive arthritis and ultimately death from complications. Nursing implications involve preserving, promoting, protecting, and maintaining the patient’s health and monitoring her recovery. They also establish counseling programs to educate people on ways of avoiding infection.

Gonorrhea

Gonorrhea is an STD that is infected by a bacterium Neisseria gonorrhoeae which mostly affects the moist body parts such as sexual organs, eyes, anus, and throat. In the past, culture and gram stain were used to diagnose gonorrhea but the current testing techniques include polymerase chain reaction (PCR). Gonorrhea has become resistant to several antibiotics (Unemo, 2015). However, the disease is treated by an intramuscular injection known as ceftriaxone (Rocephin) and an oral dose of azithromycin.

When diagnosed early, 95% to 99% of patients are completely cured when treated with antibiotics. 20-40% of patients will get complications like PID, sterility, meningitis, Chlamydia, and extended complications that can result in death. Nurses are required to take extra precautions when testing and dealing with gonorrhea patients and the most important step is to educate the patient on the significance of adhering to medical treatment to prevent a recurrence.

Syphilis

Syphilis is a contagious STD that is primarily caused by Treponema pallidum bacterium and can be transmitted from a pregnant mother to the unborn child. During the early stages, a clinical diagnosis can be challenging. However, it can be diagnosed through blood tests and using microscopy to conduct a direct visual inspection, although blood tests are preferred over diagnostic tests since they are easy to conduct and determine the progress of the disease. Early infections are treated using antibiotics like intramuscular benzathine penicillin G, tetracycline, and doxycycline (De Santis et al., 2012).

Late infections are treated with huge doses of intravenous penicillin combined with intramuscular penicillin G. Just like in the case of gonorrhea, 95-95% of patients are cured but lengthy complications can result in death. Nursing intervention for syphilis patients requires a huge amount of keenness to educate the patient on the significance of adhering to the treatment plan and medications. Nurses are also mandated to advance the patient on ways of preventing repeated infections, and the significance of using protection during sexual intercourse.

Human Papillomavirus (HPV)

HPV is a group of several viruses that are sexually transmitted and usually affect the skin and moist regions of the body. HPV may disappear without causing health complications but in other cases, it may cause genital warts and cancer. HPV is not diagnosed using blood tests, but there are useful tests that can be carried out. Pap test involves obtaining and testing sample cells from the genitals. Colposcopy means using a colposcope to place the vinegar solution on the cervix to identify abnormal cells. HPV DNA test analyzes the genetic materials of the virus (Dixit, Bhavsar, & Marfatia, 2011).

HPV does not have a cure but the immune system clears it from the body. Symptoms may be treated using cryosurgery, electrocautery, prescribed cream, and laser therapy. Apart from being cured naturally, some warts can disappear in 6 to 12 months. Complications that result in cancer depend on the efficiency of the treatment plan otherwise it may result in death. Since HPV complications may cause cancer, nurses fulfill the task of determining the progress of the treatment plan. Tumors may also require comprehensive screening, diagnosis, therapy, and treatment program.

Trichomonas

Trichomonas is an STD caused by a protozoan parasite known as Trichomonas vaginalis that affects only women causing the smelly discharge. Trichomoniasis can be diagnosed using three major procedures, which include saline microscopy, culture tests, and nucleic acid amplification tests (NAATs). Both pregnant and non-pregnant women are treated by a single dose of metronidazole (Gulmezoglu, 2007). HIV patients can be cured after being treated for seven days instead of a single dose. 95% to 97% are cured by a single dose of metronidazole.

However, the prognosis of the diseases shows that 4-5% are resistant to this drug which leads to recurrence of the disease but the condition improves with time. Nurses should pay attention to patients who are resistant to medication and pregnant mothers should be specifically advised on important ways of protecting their pregnancy. Education is also crucial to ensure that patients understand the required protective measures.

Herpes Simplex Type 1 and 2

Herpes simplex type 1 and 2, simply referred to as herpes, is an STD caused by two types of viruses, type 1(oral herpes) and type 2 (genital herpes). On most occasions, herpes simplex virus appearance is typical and does not require a diagnosis. However, in case of uncertainties, diagnosis can involve lab tests, PCR, and DNA tests, as well as culture testing (Singh et al., 2005). Herpes does not have any cure but there are medications such as Zovirax, Famvir, and Valtrex that are used to relieve the symptoms, shorten the recovery period, and prevent an outbreak.

Although herpes does not have a cure, people can completely recover so that the virus will remain inactive in the body, and the disease prognosis implies that it can become active in the future which will require retreatment. Nursing implications require close monitoring of the treatment plan to enhance quick recovery and educate the patient on ways of preventing the spread of the infection in the future.

Bacterial Vaginosis

Bacterial vaginosis is a vaginal infection caused by abnormal growth of bacteria found in the vagina leading to smelly discharge. Before the disease can be diagnosed, physicians have to confirm the absence of other diseases like Chlamydia and gonorrhea. Diagnosis involves obtaining a swab from the vagina. When potassium hydroxide is applied a fishy odor confirms the presence of the disease (Kumar et al., 2011).

Antibiotics such as clindamycin and metronidazole are used to treat the disease. The disease can be cured quickly using antibiotics and this implies that its prognosis is 100% survival rate. Clinical implications require the determination of other vaginal infections so that the condition can be managed quickly. Nurses should also give advice on the importance of personal hygiene even though the actual cause of the disease is unknown.

Vaginal Candidiasis

Vaginal candidiasis, also known as vaginal yeast infection, is an infection caused by the fungus Candida that leads to the extreme growth of yeast in the vagina. Diagnosis involves a pelvic exam that may determine redness and swelling of the skin around the vulva inside the vagina as well as the cervix. The test can also be used to examine white, dry spots inside the walls of the vagina, while the skin around the vulva may have cracks (Storck, 2013). The condition is treated using ointments, creams, vaginal suppositories, or tablets. Other medications include miconazole, tioconazole, clotrimazole, and butoconazole.

Prognosis of the disease is a 100% recovery rate since there are no major complications if medications are used correctly. Nursing implications also involve personal hygiene for the vagina to be kept clean and dry and the use of protection to avoid infections. The nurse can educate women on simple ways of maintaining hygiene and a healthy diet.

GYN Benign Conditions

Dysmenorrhea

Dysmenorrhea is a medical condition that involves painful abdominal cramps that take place during or before menstruation. Diagnosis involves taking a medical history of the woman to determine whether menstrual pain has ever interfered with her normal duties (Jones, 2004). Menstrual symptomatic can also be used to determine the severity of pain. Treatment involves the use of non-steroidal anti-inflammatory drugs (NSAIDs) to relieve pain. COX-2 inhibitor can also be prescribed and alternative medicine may be effective including vitamin E and thiamine. It is estimated that 25% of women are affected by this condition but the use of medications leads to 100% recovery. Nurses can assist patients to manage the discomfort in both primary and secondary dysmenorrhea by determining the recurrence and stage of the condition.

Menorrhagia

Menorrhagia is a condition that involves prolonged and heavy bleeding during the menstruation period. Women suffering from this condition have menstrual bleeding that lasts for over seven days compared to the normal four or five days, and they lose twice the amount of blood. Therefore, diagnosis can involve analyzing the medical past of menstrual cycles. Other tests include a blood test, Pap tests, ultrasound, and endometrial biopsy (CDC, 2015).

Treatment can involve surgery and medications including iron supplements, ibuprofen, birth control pills, hormone therapy, and antifibrinolytic drugs. The right treatment enables women to fully recover implying that the prognosis is 100%. Since one out of every five women may be affected, nursing interventions can involve determining the most effective procedures that can be used to manage the condition.

Dyspareunia

Dyspareunia is a medical condition that is described by painful sexual intercourse which may be caused by psychological concerns or structural problems. Diagnosis involves the description a woman gives about the areas and times she feels pain. The physical examination can be done on the genitals to examine abnormalities of inflammation and a biopsy can also be done (Basson, 2016). Treatment involved determining the cause of pain. Mycogen cream can be prescribed for treating fungal and yeast infection while estrogen treatment is used for vaginal dryness. Surgery can also be a viable option. Prognosis may involve full recovery once the couple determines what causes the pain. Nursing intervention can involve encouraging the couple to plan exciting experiences before having sex.

Menstrual Cycle Disorders

Polycystic ovarian syndrome (PCOS) is a medical condition when women lack or have irregular menstrual periods. It is characterized by the presence of pelvic pain, heavy bleeding, excessive body hair, and problems with getting pregnant. Pelvic ultrasound can be used to diagnose the condition. It is a straightforward process that involves the use of Rotterdam criteria but the syndrome can be related to several other symptoms. The main types of treatment include medication, surgery, and lifestyle changes (Pinkerton, 2016).

Metformin and oral contraceptives enhance female testosterone. This condition puts women at great risk of suffering from severe complications like heart attack, cardiovascular diseases, cancer, diabetes, and high blood pressure. Prognosis, therefore, requires regular medical attention to manage and treat the condition. Clinical attention involves educating women on how to change their lifestyle and effective ways of managing their condition.

Uterine Fibroids

Uterine fibroids are muscle tumors that are benign smooth and affect the uterus. Diagnosis involves a bimanual examination to examine the presence of fibroids of large sizes. Gynecologic ultrasound has also steadily evolved to become the standard tool for the examination of the uterus for fibroids. There are a number of treatment methods, which include medication to manage the symptoms or shrink tumors, the use of ultrasound to destroy fibroids, radiofrequency ablation or myomectomy, and uterine artery embolization (Evans & Brunsell, 2007).

Several medical therapies that are currently being used can shrink the fibroids. However, the condition can also contribute to cancer implying that the clinical rate is essential. Malignancy is <1 in 1000 implying that women can fully recover from the condition. The most appropriate nursing intervention is doing a follow-up to determine the progress of the treatment plan.

Toxic Shock Syndrome

Toxic Shock Syndrome is a life-threatening bacterial toxin that is caused by a retained IUD or tampon. Diagnosis involves a physical examination of the nature of symptoms. Traces of streptococcus or staphylococcus bacteria can also be examined using urine or blood tests. Treatment involves medical emergency and admission in the ICU. Intravenous (IV) antibiotic is prescribed to fight the infection. Appropriate and comprehensive treatment can help patients recover in a period of fewer than two weeks but the condition can also be fatal in a matter of a few hours (Matsuda et al., 2003). Depending on the cause, the clinical intervention involves educating the patient on the importance of hygiene ensuring that tampons are changed every 4 to 8 hours.

Endometriosis

Endometriosis is a medical complication which implies that tissues that should be inside the uterus appear outside. An internal pelvic examination can be used to diagnose the condition. An ultrasound can also be recommended to examine the ovaries for cysts. Laparoscopy is a surgery that can confirm the diagnosis. Hormone medication and painkillers are used to treat the disease (Mandal, 2014). Surgical removal of patches of endometriosis also improves fertility. 70% of women suffer from mild conditions but proper treatment leads to full recovery. Clinical implications involve constant management to avoid recurrence and enhance recovery.

Cystocele

Cystocele or dropped bladder is the budging of the woman’s balder into the vagina that may be caused by childbirth or weakening of supportive tissues and muscles between the vagina and bladder. Physical exam and medical tests on the vagina are used to diagnose the condition. Treatment can involve vaginal pessary, pelvic muscle exercise, or surgery (Lentz, 2012). Kegel exercises can also be used to strengthen the pelvic muscles. If there are no complications, physical exercises and other treatment plans can result in full recovery. Nurse implications involve educating women on the process of doing exercises to tighten pelvic muscles.

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Rectocele

Rectocele takes place when the back wall of the vagina is pushed forward by the rectum leading to a huge bulge into the vagina. Diagnosis involves an examination of the rectum and vagina. It involves speculum and bimanual examination while a special x-ray and digital examination can also be conducted. Treatment is not compulsory but there are surgical and medical options available (Speranza, n.d.). Unless it is a severe case, the condition does not have any complications and it is possible to live with it normally without problems. 75-90% experience significant improvement after treatment. Nursing implication involves advising the patient on the best management procedure to adhere to.

Vulvodynia

Vulvodynia is discomfort or chronic pain in the vulvar region with no identifiable reason. Diagnosis depends on the nature of complaints of the patients while physical examination can be used to determine severity. Treatment includes lifestyle changes, like using lubricants during intercourse and avoiding irritating substances around the area (Feldhaus-Dahir, 2011). There are also used such methods of treatment as counseling, medication, and surgery. Full recovery is possible after going through the treatment procedures. Nurses can help the patient to identify the root cause of the condition in order to enhance recovery.

Vaginismus

Vaginismus is a condition in which a woman is unable to participate in vaginal penetration which includes intercourse, using tampons and even gynecological examinations. Diagnosis involves a physical examination and depends on the problems listed by the patient. Treatment can involve medication if there is an infection (Smith, 2016). Sex and psychological therapy are also recommended. Since there are no severe complications, a woman can recover fully by undergoing the therapy session. Nurses are tasked with helping the patient to relax and think critically to determine the factors that have caused these conditions.

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