Saturday, September 5, 2009

Nursing Care Plans for Endometriosis

. Saturday, September 5, 2009

Nursing Care Plans for Endometriosis. Endometriosis is a hormonal and immune system disease characterized by a benign growth of endometrial tissue that occurs atypically outside of the uterine cavity. When endometrial tissue appears outside the lining of the uterine cavity, endometriosis results. Such ectopic tissue is generally confined to the pelvic area, most commonly around the ovaries, uterovesical peritoneum, uterosacral ligaments, and the cul-de-sac, but it can appear anywhere in the body.
This ectopic endometrial tissue responds to normal stimulation in the same way that the endometrium does. During menstruation, the ectopic tissue bleeds, which causes inflammation of the surrounding tissues. This inflammation causes fibrosis, leading to adhesions, which produce pain and infertility.  Active endometriosis usually occurs between ages 30 and 40. Severe symptoms of endometriosis may have an abrupt onset or may develop over many years. This disorder usually becomes progressively more severe during the menstrual years but tends to subside after menopause.

Causes for Endometriosis
The direct cause is unknown, but the most predominant theory is the retrograde menstruation theory, research focuses on the following possible causes:
  • Transportation (retrograde menstruation). During menstruation, the fallopian tubes expel endometrial fragments that implant outside the uterus.
  • Formation in situ. Inflammamsstion or a hormonal change triggers coelomic metaplasia.
  • Induction. The endometrium chemically induces undifferentiated mesenchyma to form endometrial epithelium. (This is the most likely cause.)
  • Immune system defects. Endometriosis may result from a specific defect in cell mediated immunity.
Complications for Endometriosis
Primary complication
  • Infertility.
Other complications
  • Spontaneous abortion,
  • Anemia due to excessive bleeding.
  • Emotional problems resulting from infertility.
Nursing Assessment Nursing Care Plans for Endometriosis
  • Patient History Elicit a complete history of the woman’s menstrual, obstetric, sexual, and contraceptive practices
  • The patient may complain of cyclic pelvic pain, infertility and, the classic symptom, acquired dysmenorrhea.
  • The patient typically reports pain in the lower abdomen, vagina, posterior pelvis, and back. This pain usually begins from 5 to 7 days before menses, reaches a peak, and lasts for 2 to 3 days.
  • Patient may complain of deep-thrust dyspareunia (ovaries and cul-de-sac);
  • suprapubic pain, dysuria, and hematuria
  • painful defecation, rectal bleeding with menses, and pain in the coccyx or sacrum
  • nausea and vomiting that worsen before menses and abdominal cramps
  • Palpation may disclose multiple tender nodules on uterosacral ligaments or in the rectovaginal septum.
  • Palpation may also uncover ovarian enlargement in the presence of endometrial cysts on the ovaries or thickened, nodular adnexa.
Diagnostic tests for Endometriosis
Scoring and staging system created by the American Society for Reproductive Medicine quantifies endometrial implants according to size, character, and location.
  • Stage I is minimal disease (0 to 5 points);
  • Stage II signifies mild disease (6 to 15 points);
  • Stage III, moderate disease (16 to 40 points); and
  • Stage IV, severe disease (more than 40 points).
Treatment for Endometriosis
The stage of the disease and the patient's age and desire to have children are considered in determining the course of treatment.
  • Conservative therapy for young women who want to bear children with androgens, which produce a temporary remission in Stages I and II.
  • Progestins and hormonal contraceptives also relieve symptoms.
  • Gonadotropin releasing analogues, such as leuprolide, suppress estrogen production.
  • Laparoscopy, used for diagnostic purposes, can also be used therapeutically to lyse adhesions, remove small implants, and cauterize implants. The goal is to remove as much of the ectopic endometrial tissue as possible
  • Laparoscopy also permits laser vaporization of implants. This surgery is usually followed with hormonal therapy to suppress the return of endometrial implants.
  • Surgery may be needed to rule out cancer.
  • Conservative surgery is possible, but the treatment of choice for women who don't want to bear children or for those who have extensive disease (Stages III and IV) is a total abdominal hysterectomy with bilateral salpingo-oophorectomy.
  • Minor gynecologic procedures are contraindicated immediately before and during menstruation.
Nursing diagnosis nursing care plans for endometriosis
Primary nursing diagnosis nursing care plans for endometriosis
Pain, chronic, related to cramping, internal bleeding, swelling, and inflammation during the menstrual cycle
Common nursing diagnosis found on nursing care plans for endometriosis:

  • Anxiety
  • Chronic pain
  • Deficient knowledge (diagnosis and treatment)
  • Disturbed body image
  • Fear
  • Ineffective coping
  • Risk for infection
  • Sexual dysfunction

Key outcomes Nursing Care Plans for Endometriosis

  • Comfort level, Pain control, Depression control, Pain: Disruptive effects, Pain: Psychological response
  • Patient will identify strategies to reduce anxiety.
  • Patient will express feelings of comfort.
  • Patient and her family will express understanding of the disorder and its treatment.
  • Patient will express feelings about self.
  • Patient will discuss fears and concerns.
  • Patient will develop adequate coping behaviors.
  • Patient will remain free from signs and symptoms of infection.
  • Patient will verbalize feelings regarding sexual impairment.

Patient teaching Nursing Care Plans for Endometriosis

  • Ensure that the patient understands the dosage, route, action, and side effects before going home.
  • Explain all procedures and treatment options. Clarify misconceptions about the disorder, associated complications, and fertility.
  • Advise adolescents to use sanitary napkins instead of tampons. This can help prevent retrograde flow in girls with a narrow vagina or small vaginal meatus.
  • Because infertility is a possible complication, counsel the patient who wants children not to postpone childbearing.
  • Advise the patient to have an annual pelvic examination and a Pap test.

Encourage the patient to be alert to her emotions, behavior, physical symptoms, diet, and rest and exercise. Encourage the patient to maintain open communication with her significant other and her family to discuss concerns she may have about the disease process.


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