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UANE&S 2009 1
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Modified Radical
Mastectomy
• Radical surgery
– Entire breast removed
• Highlighted area indicates tissue
removed
• B - axillary lymph nodes: levels I
• C - axillary lymph nodes: levels II
• No muscles are removed
• Who usually gets a modified
radical mastectomy?
– Most people who are diagnosed
with invasive cancer
http://www.breastcancer.org/treatment/surgery/mastectomy/what_is.jsp
UANE&S 2009
Breast Reconstruction
• Skin, muscle & fat are
transferred to reconstruct the
breast
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Breast Reconstruction (cont’d)
• Involves prostheses or tissue from other parts of body to re-build
breast
Complications of Surgery
• Breast pain
• Chest wall pain
• Swelling
• Lymphoedema
• Infection
• Altered perception of body image & appearance
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Premenstrual (PMS) Dysmenorrhoea – Primary &
Secondary
Cyclic occurrence of physical,
behavioural and psychologic
Clinical manifestations:
symptoms during the luteal • Primary – lower abdominal
phase of the menstrual cycle
(Stevinson & Ernst, 2001) and back pain, nausea, fatigue,
• Breast discomfort light headedness
• Peripheral oedema
• Abdominal bloating • Secondary – dyspareunia,
• Binge eating painful defecation, irregular
• Autonomic nervous system bleeding
arousal
• Emotional symptoms (Hickey & Balen, 2003; McEvoy, Chang & Coupey, 2004)
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Disorders of the female reproductive system
• Ovarian cysts
• Polycystic ovarian syndrome (PCOS)
• Ovarian cancer
• Uterine fibroids
• Cervical polyps
• Uterine prolapse
• Endometriosis
• Endometrial cancer
• Pelvic inflammatory disease (PID)
• Salpingitis
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Ovarian Cysts
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Diagnosis and Management
Uterus
•Ultrasound
•Pelvic examination
Ovarian Cyst
•Laboratory tests
•Hysterectomy if malignant
• Counseling
• Palliative care UANE&S 2009 13
(Brown & Edwards, 2005; Chen & Bethan Powell, 2006)
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Pelvic organ
prolapse
• Present in 50% of
parous women
• Recognised risk
factors
– Pregnancy
– Vaginal childbirth
– Menopause
– Chronic rise in IAP
(eg. Obesity, cough)
– Pelvic floor muscle
weakness
www.merck.com/mmhe/sec22/ch249/ch249a.html
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Uterine Prolapse
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Endometriosis
• Generally adenocarcinomas
• Metrorrhagia
• Metastatic symptoms
• Pain (occurs late in disease process)
• Endometrial biopsy
Treatment
• Total hysterectomy
• Progesterone therapy
• Chemotherapy
• Counseling
• Palliative care
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Salpingitis
• Infectious condition
involving fallopian tubes
• Salpingectomy
• Oophorectomy
• Pre & post op care
• Manage same as PID
http://www.macmed.ttuhsc.edu/Graham/gyn2/images/Untitled-50.jpg
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Disorders of Pregnancy
• Spontaneous abortion
(miscarriage)
• Ectopic pregnancy
• Gestational diabetes
• Pregnancy induced
hypertension
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www.positivenation.co.uk/issue117/pics/foetus
Spontaneous Abortion (Miscarriage)
Physical management:
– Surgical – D&C
– Medical – Misoprostol, oxytocin
– Expectant care
Possible complications:
– Haemorrhage
– RPOC
– Infection
– Pain
– Anxiety & depression
(Aleman, Althabe, Belizán, & Bergel, 2006, Shelley, Healy, & Grover, 2005; White & Bouvier, 2005)
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Ectopic Pregnancy
•Zygote implants outside uterine Management:
cavity.
• Serum beta hCG, blood pathology and
•More than 95% in fallopian ultrasound
tubes
• Monitor vital signs / offer emotional support
•Responsible for 9-13% of
maternal mortality in 1st • Administer analgesia as ordered
trimester.
• Report & record PV loss
•Signs & symptoms
•Severe abdomino-pelvic pain • IV fluids & / or blood transfusion as indicated
•Dizziness, nausea & diarrhoea
• Methotrexate if fallopian tube has not ruptured
•+/-Vaginal bleeding & patient haemodynamically stable
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References
Bradley, L. (2005). Abnormal uterine bleeding. The Nurse Practitioner, 30(10), 38-49.
Brown. D., & Edwards, H. (2005). Lewis’s medical – surgical nursing: Assessment and
management of clinical problems. Elsevier. Sydney
Chen, L., & Bethan Powell, C. (2006). Combating ovarian cancer with salpingo-
oophorectomy. Contemporary Obstetrics and Gynaecology, 86-92.
Gould, D. (2003). Endometriosis. Nursing Standard,17(27), 47-53.
Hickey, M., & Balen, A. (2003). Menstrual disorders in adolescence: Investigation and
management. Human Reproduction Update, 9(5), 493-504.
Huntington, A., & Gilmour, J. (2005). A life shaped by pain: Women and
endometriosis. Journal of Clinical Nursing, 14, 1124-1132.
HWHW. (1999). Ovarian disorders. Harvard Women’s Health Watch, 6(12), 4-5.
Kobashi, K., & Leach, G. (2000). Pelvic prolapse. The Journal of Urology, 164, 1879-1890.
Lane, D. (2006). Polycystic ovary syndrome and its differential diagnosis. Obstetrical and
Gynecological Survey, 61(2), 125-135.
McEvoy, M., Chang, J., & Coupey, S. (2004). Common menstrual disorders in
adolescence:Nursing interventions. MCN: The American Journal of Maternal Child
Nursing,29, 41-49.
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Markle, M. (2001). Polycystic ovary syndrome: Implications for advanced practice nursing in
primary care. Journal of the American Academy of Nurse Practitioners 13(4), 160-
163.
Novara, G., & Artibani, W. (2005). Surgery for pelvic organ prolapse: Current status and
future perspectives. Current Opinion in Urology 15, 256-262.
Pregler & DeCherney, (2002). Women’s health: Principles and clinical practice. Philadelphia:
B.C. Decker
Ringold, S., Lynm, C., & Glass, R. (2005). Uterine prolapse. The Journal of the American
Medical Association, 293 (16), 2054.
Royal College of Obstetricians and Gynaecologists (2003). Management of acute pelvic
inflammatory disease. Guideline No. 32.
Stevinson, C., & Ernst, E. (2001). Complementary/alternative therapies for premenstrual
syndrome: A systematic review of randomised controlled trials. American Journal of
Obstetrics and Gynaecology, 185(1), 227-235.
Walker, C., & Stewart, E. (2005). Uterine fibroids: The elephant in the room. Science,
308,1589-1592.
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