BENIGN AND MALIGNANT GROWHS IN GYNAECOLOGICAL NURSING

 

BENIGN AND MALIGNANT GROWHS IN GYNAECOLOGICAL NURSING

 

INTRODUCTION:

          Neoplasm refers to the growth of a new tissue, also known as a tumor that serves no physiological function.  These tumor can be either benign or malignant.  Benign tumors usually do not endanger life tend to grow slowly and are not invasive.  Malignant tumors grow rapidly in a disorganized manner and invade surrounding tissues and are invasive.

BENIGN GROWTHS

 

          The benign growths can be seen in different sites of the female reproductive system and they are

1.    Benign lesions of vulva.

2.    Benign lesions of the cervix.

3.    Benign lesions of the uterus.

4.    Benign lesions of the ovary

 

1) Benign lesions of vulva.

Definition:

          Vulval epithelial disorders constitute several lesions in the vulva characterized by epithelial abnormalities which result in either red or white appearance of the skin of the region.

Incidence:

          It accounts for 3-5% of all vulval lesions recorded.

Etiology

i.             Traumatic (Scratching)

ii.           Allergic factors

iii.          Irrigation

iv.          Nutritional deficiency (Vit B12)

v.            Infection (Fungal)

vi.          Immunological or metabolic factors

Clinical Features

·        Pruritis

·        Dyspareunia

·        Dysuria

·        Skin thin and looks white

·        Increased soreness and pain

Diagnosis

·        Biopsy

·        Laboratory investigations are done if necessary

Nursing Management  

·        The patient should avoid the use of deodorants or douches.

·        A non-irritant soap should be used in the area and dried carefully.

·        The patient should use only cotton under garments.

·        The patient should maintain the perineal hygiene.

·        Avoidance of coitus till the infection is cured.

Treatment

·        Testosteroied ointment applied locally 2-3 times per day.

·        Local application of 1% hydrocortisone cream such as clobetasol propionate (0.05%).

·        Antimitotic agent such as fluorouracil for 6-8 weeks.

B.VULVAL ULCERS

Definition

          Vulval ulcers are those occurring predominantly due to sexually transmitted diseases.

Incidence

          It account for 3-5% of all identified cases of vulval disorder.

Etiology

          The cause remains unknown.

Types

a. CROHN’S DISEASE

          Crohn’s disease affecting the intestine may involve the vulva in late stage of the disease in about 25% of cases.  The ulcer looks like knife cuts  in the skin.

b. BEHCET’S DISEASE

          It is a chronic disease characterized by recurrent oral and genital ulcers.  The vulval ulcerations leave behind dense  scar after healing.

TREATMENT

          There is no specific treatment

·        Tropical and systemic corticorteroids are used

·        Oestrogen dominated oral contraceptives

NURSING MANAGEMENT

·        Explain the patient about the disease condition.

·        Avoid infective visitors to the patients unit to prevent cross infection.

·        Continuous monitoring of the vital signs

·        Check the site for any bleeding discharges or drainages tube etc.

·        Administer intravenous fluids to prevent dehydration.

·        In case of heavy bleeding blood transfusion is given.

·        Keep the patient in suitable position (supine) to facilitate breathing and drainges.

·        Intake and output chart should be maintained.

·        Aseptic wound dressing should be done and maintain aseptic techniques in all procedures.

·        Advice complete bed rest as per doctors advice.

 

2) Benign lesions of the cervix.

Cervical Erosion (Ectopy)

Definition

          Cervical erosion is a condition where the squamous cell epithelium which is continuous with the endocervix is replaced by columnar epithelium.

 

Incidence

          The average age for the occurrence is 40-50 years.

Etiology

a. Congenital

          At birth in about one third of cases, the columnar epithelium of endocervix extends beyond the external OS.  This condition persists only for a few days until the level of oestrogen derived from the mother falls.

B. Acquired

Hormonal factors

          When the oestrogen level is high, columnar epithelium extends, into the vaginal portion of the cervix replacing the sqamous epithelium.  This is observed during pregnancy and amongst pill users.

Infection

          Due to infection there is a chance of getting erosion because of the delicate columnar epithelium.

CLINICAL FEATURES

SYMPTOMS

a.    Vaginal discharge: It may be mucopurulent, offensive and irritant in presence of infection, may even blood stained due to premenstrual congestion

b.    Contact bleeding: it is seen during pregnancy and ‘pill use’ either following coitus or associate with defection.

c.    Associated cervicities: It may produce backache, pelvic pain and at times infertility.

Signs:

Internal examination reveals

a.        A bright red area surrounding the external OS in the ectocervix.

b.       The lesion may be smooth or having small papillary folds.

c.        On rubbing with a gauze, there may be multiple ooging spots.

DIAGNOSIS

·        Biopsy

·        Colposcopy

·        Smear Examination

MANAGEMENT

·        In Asymptomatic cases: The active treatment is withheld in these case.

·        In symptomatic cases

(i)           Detected during pregnancy and early peurperium, the treatment should be withheld or atleast 12 weeks postpartum.  In pill uses the ‘pill’ should be stopped and barrier method is advised.

(ii)          Persistent erosion with continuous discharge is treated surgically by

                                         i.    Thermal cauterization

                                       ii.    Cryosurgery

                                      iii.    Laser vaporisation

NURSING MANAGEMENT

PRE-OPERATIVE MANGEMENT

·        Explain the procedure to the patient for obtaining self confidence.

·        Obtain the consent from the patient / guardian after explaining the procedure.

·        Obtain the results of routine laboratory investigation.

·        Tell the mother to change the vulval pads.

·        Avoid infective visitors to the patients unit to prevent cross infection.

·        Continuous monitoring of the vital signs.

·        Prepare the part according to the doctors advise.

POST-OPERATIVE MANAGEMENT

·        Receive the patient without disturbing the device attached to the patient.

·        Check the vital sign.

·        Provide foot end elevation.

·        Check the operated site for bleeding, discharges.

·        Administer intraveneous fluids to prevent dehydration.

·        Blood transfusion should be given to maintain blood loss during surgery.

·        Keep the patient in suitable position i.e., in supine position.

·        Intake and output chart should be maintained.

·        Speculum examination should be done to remove the sloughs and the clots from the cervix.

·        Haemostasis is achieved by tight vaginal pack with roller guaze and kept 24-48 hrs.

·        Local and systemic antibiotics are administered.

·        Dietary management consist of providing fluid diet after hearing bowel sound followed by soft diet.

·        Advice complete bed rest as per doctors advice.

 

III. BENIGN LESIONS OF THE UTERUS

IV. BENIGN LESIONS OF THE OVARY

Types

1.    Non neoplastic

2.    Neoplastic (Benign)

2. benign ovarian neoplasm

Definition

          Benign ovarian neoplasms are the neoplastic growth occurring inside the functional unit of ovary.

Incidence

          About 75% of ovarian tumors are considered as bening neoplasms.

Clinical Features

Symptoms

·        Heaviness in lower abdomen.

·        A gradually increasing mass in lower abdomen.

·        Dull aching pain in lower abdomen.

·        Menorrhagia or postmenopausal bleeding

Signs

a. Abdominal Examination

(i) Inspection

·        Bulging of lower abdomen

·        Mass is placed centrally or at one side.

(ii) Palpation

·        Upper and lateral borders are well defined but the lower pole is difficult to reach suggestive of pelvic origin.

·        Surface of the tumor is smooth and usually not tender.

 

(iii) Percussion

·        Percussion note is dull in the center and resonant in the flanks.

(iv) Auscultation

·        A friction rub may be present over the tumor.

b) Pelvic examination

          The bimanual examination reveals.

·        The uterus is separated from the mass.

·        A groove is felt between the uterus and the mass.

·        Movement of mass per abdomen fails to move the cervix.

·        On elevation of mass per abdomen, the cervix remains in stationary position.

·        The lower pole of the cyst can be felt through the fornix.

·        Absence of pulsation of the uterine vessels through the fornixes.

Investigations

·        Sonography

·        Straight X-ray of the abdomen over the tumor

·        Laproscopy

·        Laprotomy

Treatment

·        Only a symptomatic treatment is given such as in pain analgesics are given

Surgical management

·        Ovarian cystectomy

·        Ovaritomy (Salpingo-OOphorectomy).

·        Total hysterectomy with bilateral salpingo ooplurectomy.

Nursing Management

Pre-Operative Management

·        Explain the procedure to the patient for obtaining self confidence.

·        Obtain the consent from the patient / guardian after explaining the procedure.

·        Obtain the results of routine laboratory investigation

·        Avoid infective visitors to the patients unit to prevent cross infection.

·        Continuous monitoring of the vital signs.

·        Nil by mouth for 6-8 hrs before surgery.

·        Bowel and bladder should be emptied.

·        Prepare the part according to the doctors advice.

 

Post Operative management

·        Receive the patient without disturbing the device attached to the patient.

·        Check the vital signs.

·        Provide foot end elevation.

·        Check the operation site for bleeding, discharges or any operation site for bleeding, discharges or any drainage tubes etc.

·        Administer intraveneous fluids to prevent dehydration.

·        Blood transfusion should be given to maintain the blood loss during surgery.

·        Keep the patient in suitable position (supine) to facilitate breathing, drainage and secretion.

·        Intake and output chart should be maintained.

·        Aseptic wound dressing and maintain aseptic  techniques in all procedures.

·        Dietary management consists of fluid diet.

·        Advice complete bed rest as per doctors advice.

 

MALIGNANT GROWTH

INTRODUCTION

          Neoplasm refers to the growth of new tissue.  Malignant tumors grow rapidly in a disorganized manner and invade surrounding tissue.  In the developing countires including India.  Genital malignancy is in the top list.

          This include mainly.

(i)           Vulval carcinoma

(ii)          Vaginal carcinoma

(iii)        Cervical center

(iv)        Endometrial cancer

(v)          Gestational Trophoblastic Neoplasia (GTN)

(vi)        Ovarian Cancer

 

CERVICAL CANCER

Definition

          Cervical cancer is a female genital malignancy, which affect the fibrous and smooth connective tissue in the cervical region.

Incidence

The average age range for the occurrence of cervical cancer is 40-50 years.

 

Etiology

·        Womens who are not sexually active < 18 years.

·        Multiple sexual partners.

·        Poor personal hygiene.

·        Poor socio economic status.

·        Exposure to uncircumcised partners was considered important factor.

·        Smoking, drug abuse including alcohol.

·        Women with STD, HIV infection, herpex simplex virus 2, infection,  humanpapilloma virus.

·        Immunosuppressed individuals.

·        Prolonged use of profesterons pills.

Staging

          Cervical cancer classified on the basis of papanicolour test in 5 categories. 

Class I        No abnormal cells present.

Class II       A typical cells are identified, inflammation must be            ruled out.

Class III     Suspecious abnormal cells present

Class IV     Malignant Cells present

Class V       Malignant cells present carcinoma in situ.

Class IV     Malignant cells present invasive cancer

 

Clinical manifestations

·        Cervical changes

·        Abnormal vaginal discharge

·        Bleeding during coitus or physical examination

·        Spotting in earlier changes.

·        Pain in later stages.

·        Irregular menses

·        Continuous bleeding

·        Haematurea and renal failure from bladder invasion and obstruction.

·        Rectal bleeding and bowel obstruction from rectal invasion.

Diagnosis

·        Biopsy

·        Fractional curettage

·        Ultrasound

·        Speculum examination of cervix and vagina.

·        rectal examination

·        Hysteroscopy

MANAGEMENT

MEDICAL MANAGEMENT

·        Radio therapy: Radiation may be delivered by radium application of the cervix followed by external radiation therapy that includes lymphatic of the pelvic side wall.

·        Cytotherapy and cold coagulation.

·        Tamoxifen, It is a non steroidal agent, 10 mg twice daily.

·        Cytotoxic drugs: They are giving tried either singly or in combination.  The commonly used drugs are adriamycin, cisplatin, carboplastin and cyclophosplamide.

Surgical management

·        Radial hysterectomy

·        Combined therapy: hysterectomy followed by radiation therapy 4-6 weeks after surgery is done to prevent recurrence.

Prevention

·        Identifying ‘high risk’ women or casual factor and eliminating or preventing those from exerting their effect.

·        Identifying ‘high risk’ males i.e.,

o   Multiple sexual partners

o   Previous wife died of cervical cancer

·        Cancer consciousness, propagandas, proper health education of the population, especially amongst the poor socio – economic group.

·        Use of condom during early intercourse.

·        Raising the age of marriage and of first birth.

·        Maintenance of local hygiene

·        Effective therapy of STD.

·        Removal of cervix during hysterectomy

·        Routine screening procedures such as pap’s smear test once in a year for every sexually active womens.

·        Now a days a vaccination had introduced to reduce the risk of cervical cancer, qardaril at is given at the age of 18 years. 3 doses at the gap of 1 month for each dose.

NURSING MANAGEMENT

PRE-OPERATIVE MANAGEMENT

·        Explain the procedure to the patient.

·        Obtain the result of routine investigations.

·        Avoid infective visitors to the patients unit.

·        Before Surgery the general health of the patient should be improved.

·        Attention is to be made to the correct the anemia and malnutrition.

·        Clean the site with aseptic techniques.

·        Bowel and bladder should be emptied.

·        NBM for 6-8 hrs before surgery.

·        Give psychological support to the mother.

POST-OPERATIVE MANAGEMENT

·        Advice for adequate rest.

·        Periodic monitoring of vital signs.

·        A well balanced diet rich in proteins should be given

·        Avoid coitus till the doctor permits.

·        Maintain aseptic techniques in all procedures.

·        Keep perineal area clean and dry, wash perineum with a solution of hydrogen peroxide and water after each elimination.

·        Advice to take all medications as prescribed.

·        Inform the physician if there is any complication.

ENDOMETRIAL CANCER

Definition

        Endometrial cancer is the most common malignancy of the reproductie system.  It mainly affects the laminapropria and surface epithelial tissues of the endometrium.

Incidence:

          Commonly seen in 50-64 years age group.

 

Etiology

·        Oestrogen

·        Age i..e, 60 years

·        Parity more in multiparae

·        Late menopause

·        Corpous cancer syndrome

·        Drugs

·        Family history

·        Fibroids

Clinical features

Symptoms

·        Post menopausal bleeding which may be slight, irregular or continuous.

·        In premenopausal women, there may be irregular and excessive bleeding.

·        Watery offensive discharge due to performetra.

·        Pain may be colicky due to uterine contractions.

SIGNS

·        There may be varying degrees of pallor.

DIAGNOSIS

·        History and clinical examination

·        Endometrial biopsy.

·        Ultra sound

·        Hysteroscopy

·        Fractional curettage

Staging

Stage 1       The carcinoma is confirmed to the corpus

Stage 2       The carcinoma has involved the corpus and the                           cervix but has not extended outside the uterus.

Stage 3       The carcinoma has extended outside the uterus                          but not outside the true petus.

Stage 4       The carcinoma has extended outside the true                     pelvis or has obviously involved the mucosa of the                         bladder or rectum.

MANAGEMENT

MEDICAL MANAGEMENT

·        Profestrogens: The commonly used to 17 dyrony profesterone caproate megester or megesterol acetate is used continuously for 3 months.

·        Jamoxifen: It is a non steroidal agent with antioestrogenic as well as weekly oesterogenic properties.  It is used 10 mg twice douly along with profesterone therapy.

·        Cytotoxic drugs: They are being tried either single or in combination.  The drugs commonly used are adrainycin, cisplatin, carboplatin and cyclophosphamide.

·        Radiation therapy: Based on staging, here whole abdomen is radiated.

SURGICAL MANAGEMENT

·        Total abdominal tungstrectomy.

·        Abdominal lymphodenectomy

NURSING MANAGEMENT

PRE-OPERATIVE MANAGEMENT

·        Explain the procedure to the patient

·        Obtain lab investigation such as blood and urine reports.

·        Obtain pelvic ultrasonography.

·        Continuous monitoring of the vital signs.

·        Clean the site with aseptic techniques.

·        Bowel and bladder should be emptied.

·        NBM for 6-8 hrs before surgery.

·        Give psychological support to the mother.

Post operative management

·        Explain the purpose of treatment and accompanying procedures.

·        Ensure adequate bed rest for maximum 1 month.

·        Women needs to maintain good nutrition’s status.

·        Avoid sexual intercourse.

·        Keep perineal area clean and dry.

·        Avoid tight fitting for 6 weeks and avoid sitting for long period.

·        Blood transfusion of anaemia is present.

·        Advice adequate follow up and continuation of the drugs without failure.

GESTATIONAL TROPHOBLASTIC NEOPLASIA (GTN) OVARIAN CANCER

Definition:

          Ovarian cancer is often referred to as a ‘silent’ cancer, because it lacks deginitive sign or symptoms in its early stages.  It mainly affects the ferminal epithelial buyers of the ovary.

Incidence:

          It constitutes about 15-20% of genital malignancy.  The greatest number of cases are found in the 50 to 59 age group.

RISK FACTORS

·        Age (< 70).

·        Nulliparity

·        Family history of ovarian cancer.

·        User of coffee, tobacco.

STAGING

Stage I        : Growth Limited to the ovaries

Stage II       :Growth involving one or both ovaries with pelvic

                    examination.

Stage III      : Tumor involving one or both ovaries with

                   peritoneal implants outside the pelvis and positive

                   retroperitoneal or inguinal lymphnodes

Stage IV      : Growth involving one or both ovaries with distant

                   metastases.

CLINICAL FEATURES

SYMPTOMS

·        Feeling of abdominal distension.

·        Features of dyspepsia such as flatulence and eructations.

·        Loss of appetite with a sense of blocking after meals

·        2 per existing tumor

o   Appearance of dull acting pain and tenderness once one area.

o   Rapid enlargement of the tumor.

o   Abdominal swelling may be rapid.

o   Respiratory distress.

o   Sudden loss of the weight

o   Menstrual abnormalities

SIGNS

·        Pallor of varying degrees.

·        Jaundice may be evident in late cases.

·        Left supra clinical lymph gland may be enlarge

·        Edema of the leg or vulva.

·        Liver may be enlarged, firm and modular.

·        A mass is felt in the hypogastrium it may be bilateral.

·        The uterus is reported from the mass felt per abdomen.

·        Modules may be felt through the posterior fornix.

Diagnosis

Investigations aims at

1.    To confirm malignancy

-      Cytological examination for detection of malignant cells.

-      Immune marker

2.    To identify the extent of lesion.

-      Barium enemia

-      Cytological examination of ethoracsynthesis fluid.

-      Intravenous pyelography.

-      Diagnostic uterine aurettage

3.    To detect primary site

-      Barium meal X-ray

-      Colonoscopy

-      Mammography

MANAGEMENT

MEDICAL MANAGEMENT

·        Radiotherapy: Total abdomino – pelvic irradiation is employed a dose of 3000 CGY is delivered to the whole area in a weeks and another 2000 CGY in 2 weeks to the pelvis.

·        Chemotherapy: Chemotherapy is widely used following surgery to improve the result in terms of survival.

(i)           Single agents – alkalyting agents (melphelan, cyclophasphamide) are commonly used.

(ii)          Platinum compounds are more effective drugs in ovarian cancer eg., cisplain, caeboplatin.

(iii)        Taxane derivations are found to be vary effective in ovarian cancer eg, Paclitaxel

SURGICAL MANAGEMENT

1.    Surgery: In surgery one or both ovaries may be remove and often the fallopian tubes and uterus are removed and its name is TAH-BSO.

2.    Contained therapy: Drugs acting in different ways with different toxicities are combined eg, combination of pacilitaxel and cisplatin are found more effective.

NURSING MANAGEMENT

PRE-OPERATIVE MANAGEMENT

·        Explain the procedure to the patient.

·        Obtain the result of routine lab investigation.

·        Avoid infective visitors to the patient unit

·        Continuous monitoring of the vital signs.

·        Clean the site with aseptic techniques.

·        Bowel and bladder should be emptied.

·        NMB for 6-8 hrs before surgery.

·        Give psychological support to the mother.

POST-OPERATIVE MANAGEMENT

·        Explain the purpose of treatment and accompanying procedure.

·        Ensure adequate bed rest.

·        Maintain aseptic technique in all procedures to prevent infection.

·        Periodic  monitoring of vital signs.

·        Consumption of well balanced die rich in protein.

·        Take all medication as prescribed.

·        Discuss about the surgical menopause with the patient.

·        For relieving pain sits baths or application of heat to the lower abdomen are helpful.

·        As a nurse should support normal grieving, including temporary denial, if not she may require counseling to help her cope with her loss.

·        Advice to drink 2-4 liters of fluid daily.

·        Early frequent ambulation helps improve gastrointestinal function.

·        Abdominal strengthening exercises are treached to restrengthening of the abdominal muscles.

·        Avoid heavy lighting for about 2 months.

·        Avoid constrictive clothing for several months.

·        Report to the doctor for any complications.

·        Follow – up care should be maintained.

CYSTS

INTRODUCTION

 

          Cysts are nothing lent the swelling which is functional and inflammatory enlargement.  They may be asymptomatic and produce local discomfort.

 

DEFINITION:

          An abnormal closed epithelium lined cavity in the body, containing liquid or semisolid material.

 

TYPES OF CYSTS

1.    Vulva cysts

2.    Vagina cyst

3.    Cervical cyst

4.    Ovarian cyst

 

1) Vulva Cyst

Definition

          Vulva cyst is an abnormal closed cavity present in the vulva region containing liquid or semisolid material.

TYPES

1.    Bartholins cyst

2.    Sebaceons cyst

 

Bartholin’s cyst

Definition:

          The Bartholins cyst occurs due to dust closure of the duct or the opening of an acnus.

ETIOLOGY

·        Infection

·        Trauma

·        Lateral or illdirected mediolateral episitomy

CLINICAL FEATURES

·        A small size often remains unnoticed

·        If the cyst becomes large (size of hens egg, there is local discomfort).

·        Dyspareunia.

·        Examination reveals unilateral swelling posterior half of the labium majors.

·        The overlying skin is thin and shiny

·        Cyst fluctuant

·        Cyst is having no tenderness

TREATMENT

·        Marsupialization is a grafting surgery for Batholins cyst.

MANAGEMENT

MEDICAL MANAGEMENT

·        Antibiotics are given to inhibit the infection.

·        Perineal hygiene should be maintained.

SURGICAL MANAGEMENT

Marsupiligation

NURSING MANAGEMENT

PRE-OPERATIVE MANAGEMENT

·        Explain the procedure to the patient.

·        Obtain lab investigations.

·        Avoid infective visitors to the patients unit.

·        The operation is done under local anaesthesia.

POST –OPERATIVE MANAGEMENT

·        Advice adequate bed rest.

·        Advice for regular checkups

·        Check the vital signs

·        Avoid coitus for one week.

·        Provide perineal care by changing the wound dressing.

·        Advice to take regular medical check ups till the wound recover.

SEBACEOUS CYST

          Sebaceous cyst are usually multiple are formed by accumulation of the rebaceous material due to occlusion of the ducts.  There are located in the labia majora.

TREATMENT

·        Antibiotics are given.

·        Surgical drainage

NURSING MANAGEMENT

·        Advice the patient to maintain personnel hygiene especially the perineal hygien.

·        Advice to take the medications.

·        Observe the content of the fluid.

·        Mild analgesics are given in case of pain.

·        Provide suitable position (supine) for comfort.

·        Avoid constrictive clothing.

·        Early ambeulation is done.

 

2. VAGINAL CYSTS

          A cyst present in the vaginal region is known as vaginal cysts.

          It is rare because there is no gland in the mucous coat.

TYPES

1.    Gartners cyst

2.    Inclusion cyst

 

GARTNER’S CYST

          The gartners duct cyst is usually situated in the anterolateral wall of the vagina.

TREATMENT

Surgical Excision

Inclusion cyst

The inclusion cyst is usually located in the lower third of the vagina on the posterior or posterolateral wall.

CAUSES

·        Traumatic injury following child birth.

·        Surgery

NURSING MANAGMENT

·        Advice the patient  to take rest atleast one week.

·        Check the vital signs

·        Avoid sexual activity for 4 to 6 weeks or as physician directs.

·        Advice to have regular checkups.

·        Maintain of personnel hygiene (perineal)

·        Antibiotic are given as doctors advice.

3. CERVICAL CYSTS

A cavity or sac like structure which is present in the cervical region is known as cervical cysts.

TYPES

1.    Nabothian cysts

2.    Endometriotic cysts

 

1. nabothian cysts

          Nabothian cysts are cyst like formations due to occlusion of the lumina of glands in the mucosa of the uterine cervix, causing them to the distented with retained secretion.

DIAGNOSIS

·        Pelvic examination

·        Speculum examination

MANAGEMENT

·        The diseased tissue may the destroyed by electro or diathenuy countersiation.

·        Laser

·        Cryosurgery

·        In unresponsive cases with the patients approaching menopause, lugeterectomy in justified

 

 

2. ENDOMETRIOTIC CYSTS

          Endometriotic Cysts which is present in the endometrium of the portio vaginatis  part of the cervix

CLINICAL MANIFESTATIONS

·        SMALL AND REDDISH

·        Less than lcm in diameter

·        Intermenstrual bleeding

·        Post coital bleeding

·        Deep dyspareunia

·        Dysmenorrhoea

DIAGNOSIS

·        Speculum  examination

·        Pelvic examination

MANAGEMENT

·        Canterisation

·        Rarely excision

NURSING MANAGEMENT

·        Explain about the disease condition to the patient.

·        Take permission prior to any procedures such as cantesation or cryosurgery.

·        Provide rest to the patient after the procedure has finished.

·        If there is more bleeding confirm to the doctor.

·        Vagina pack with roller guaze is introduced

·        Local and systemic antibiotics are administered.

 

4. OVARIAN CYSTS

Polyps

          Polyps are peduneulated tumors arising from the mucosa and extending into the opening of a body cavity.

TYPES

1.    Mucous polyps

2.    Fibroid polyps

1) MUCOUS POLYPS

          The commonest type of benign uterine polyp is mucous one.  It may arise from the body of the uterus or from the cervix.

CAUSES

·        Hyperoestoinism

·        Chronic irritation by infection

·        Localised vasculae congestion

CLINICAL MANIFESTATIONS

SYMPTOMS

·        Irregular uterine bleeding, ethic pre or post menopausal.

·        Contact bleeding, if the polyp is situated at or outside the cervix.

·        Excessive vaginal discharge which may be offensive.

SIGNS

·         Reddish in color

·        A slender pedicle

·        Small in size

·        Slippery

DIAGNOSIS

·        Speculum examination

·        Pelvic examination

·        Hysteroscopy

MANAGEMENT

·        Uterine aucettage

·        Using ring or ovum forceps the polyps are twisted and removed and base of the pedicle is canterised.

·        Hysterectomy

Routine uterine encetage is done to remove the unhealthy endometrium.

2. fibroid polyp

·        The fibroid polyp may arise from the body of the uterus or from the cervix

CAUSES

·        If mucous polyp is not treated

CLINICAL MANIFESTATIONS

SYMPTOMS

·        Intermenstrual bleeding

·        Colicky pain in the lower abdomen due to uterine contraction in an effort to expel the polyp out of the uterine cavity.

·        Excessive vaginal discharge which may be offensive.

·        Sensation of something concing down when the polyp becomes big distending the vagina.

SIGNS

·        General examination reveals the presence of anaemia.

·        The uterus may be bulky.

·        Polyp is felt outside the external OS.

·        Colour of polyp is pale and haemorrhagic

DIAGNOSIS

·        Sound test

·        Hysterosalpingography

·        Hysteroscopy

MANAGMENT

·        Antibiotics are given

·        Narcotics drugs are prescribed to relive the pain such as morphine.

SURGICAL MANAGEMENT

·        A polyp is removed by twisting by altis or lanes tissue forceps

·        Anterior hysterotomy

·        Hysterectomy

NURSING MANAGEMENT

PRE-OPERATIVE MANAGEMENT

·        Explain the procedure to the patient.

·        Obtain the routine lab investigations.

·        Avoid infective visitors to the patients unit.

·        Continuous monitoring of the vital signs.

·        Clena the site with aseptic technique.

·        Bowel and bladder should be emptied

·        NMB for 6-8 hrs before surgery.

·        Preoperative management is done by providing blood transfusion to prevent anaemia.

·        Give psychological support to the mother.

POST OPERATIVE MANAGEMENT

·        Explain the treatment regime.

·        Ensure adequate bed rest.

·        Maintain aseptic technique in all procedures to prevent infection.

·        Periodic monitoring of vital signs.

·        Consumption of well balanced diet rich in protein.

·        Sponge bath should be given.

·        Sits bath for relieving the pain.

·        Early ambulation helps improve gastro intestinal function.

·        Avoid heavy lifting for about 2 months.

·        Report to the doctor for any complication.

·        Follow up care should be maintained.

CONCLUSION

 

          Thus cancer is a second leading cause for death.  Among 4 people one person is the sufferer, so once in a year health check up must be done for the detection and prevention of the cancerous disease.

 

BIBLIOGRAPHY

 

1.      A Text book of Gynecology writtened by D.C.Dutta, 4^th Edition, Pg.No.242-355.

2.      A Text Book of Gynecology written by Shaw’s 13^th Edition, Page.No.353-405.

3.      A text book of Medical surgical Nursing By joycce.M.black, 4^th Edition, Pg.No.2133-2153.