en dome trios is case study final

8/9/2019 En Dome Trios Is Case Study Final

http://slidepdf.com/reader/full/en-dome-trios-is-case-study-final 1/23

Endometriosis



Endometriosis, a cause of female infertility, is a condition inwhich endometrial tissue, the tissue that lines the inside of theuterus, grows outside the uterus and attaches to other organs inthe abdominal cavity such as the ovaries and fallopian tubes.Endometriosis is a progressive disease that tends to get worseover time and can reoccur after treatment. Symptoms includepainful menstrual periods, abnormal menstrual bleeding and painduring or after sexual intercourse.

The endometrial tissue outside your uterus responds to your menstrual cycle hormones the same way the tissue inside your uterus responds - it swells and thickens, then sheds to mark the

beginning of the next cycle. The blood that is shed from theendometrial tissue in your abdominal cavity has no place to go,resulting in pools of blood causing an inflammation that forms scar tissue. The scar tissue can block the fallopian tubes or interferewith ovulation. Another result of endometriosis is the formation of ovarian cysts called endometrioma that may also interfere withovulation.

The cause of endometriosis is unknown though there are afew theories that suggest possible causes. One theory suggeststhat during menstruation, some of the menstrual tissue backs upthrough the fallopian tubes into the abdomen where it implantsand grows. Another theory indicates that it is a genetic birthabnormality in which endometrial cells develop outside the uterusduring fetal development.



Most endometriosis is found:

- on or under the ovaries

- behind the uterus- on the tissues that hold the uterus in place

- on the bowels or bladder



What are the symptoms of endometriosis?

Pain is one of the most common symptoms of endometriosis. Usually the pain is in the abdomen, lower

back, and pelvis. The amount of pain a woman feels doesnot depend on how much endometriosis she has. Somewomen have no pain, even though their disease affectslarge areas. Other women with endometriosis have severepain even though they have only a few small growths.Symptoms of endometriosis include:Very painful menstrual cramps

Pain with periods that gets worse over timeChronic pain in the lower back and pelvis

Pain during or after sexIntestinal pain

Painful bowel movements or painful urination during

menstrual periodsHeavy and/or long menstrual periods

Spotting or bleeding between periodsInfertility (not being able to get pregnant)

Fatigue



What causes endometriosis?

No one knows for sure what causes this disease, butscientists have a number of theories.

They know that endometriosis runs in families. If your mother or sister has endometriosis, you are six times more likely to get thedisease than other women. So, one theory suggests thatendometriosis is caused by genes.

Another theory is that during a woman's monthly periods, someendometrial tissue backs up into the abdomen through the fallopian

tubes. This transplanted tissue then grows outside the uterus.Many researchers think a faulty immune system plays a part inendometriosis. In women with the disease, the immune system failsto find and destroy endometrial tissue growing outside of the uterus.

Plus, a recent study shows that immune system disorders (healthproblems in which the body attacks itself) are more common inwomen with endometriosis.

More research in this area may help doctors better understand and treat endometriosis.



The Patient

Name:Mrs. V

Sex: Female

Admitting V/S:

T ± 36.4 Ûc

P - 59

R ± 12

AdmittingMedical Diagnosis:Infertility: for HSSG

Admitting weight: 49 kg



Information Provided: Patient

Age: 32 years oldCitizenship: Filipino

Arrive on Unit: conscious, ambulatory

Admission Date: March 2, 2007

Time: 5:30 pm

Allergies: none



The patient has been into the care of her OB-GYN being worked up for her

infertility for almost 2 years. She gotmarried at age 28 and for 4 years now thecouple still longs for a baby to completetheir family. The couple decided to havethemselves check by a professional andfound out that the wife has the so called³polycystic ovary´ wherein her left ovaryproduces so many follicles and none of thisgets ripe. At first the patient was given

meds to induce fertility. The medicationgiven was clomid (ClomipheneCitrate),taken during day 1 to day 5 of her menses.



Her sugar level and the thyroid were alsochecked but results were normal.

Normal RangeFBS 4.7 mmol/L 3.6 ± 5.0

TSH 2.91 uIU/ml 0.25 ± 5

FT414.83 pmol/L 9 ± 20

Also a regular TVS done; results showed aconsistent polycystic left ovary but right ovaryshowed leading follicles during an ovulation whichwas observed to happen on the later part of the

patients cycle. After such procedures andmonitoring done to the patient her doctor decidedto check on the fallopian tubes for possiblekinks/blocks; thus this confinement.



The procedure:

Ten days prior to this confinement the

patient was advised to take Doxycycline

(Doxin) 100mg 2x/day starting from day 3

to day 7 of her cycle, this is due to a

possible Pelvic Inflammatory Disorder that

the procedure may cause the patient.

During the procedure the patient will feel

some discomfort like pain and will return to

her attending physician a week after the

procedure to check on presence of a PID.



Final impression of the procedure

Endometriotic focus on the right

ovary at 1.8 x 1.9cm

- no kinks on the fallopian tubes



The result of the procedure conforms

with the signs and symptoms the patient

has been experiencing for sometime

Very painful menstrual cramps

Chronic pain in the lower back and pelvisPain during sex (but not all the time)

Heavy and/or long menstrual periods

Infertility

Fatigue



Medical Management

The physician presented several options to treat her endometriosis

1. Laparoscopy (can be used to di ag nose and t reat end omet ri osis. Duri ng this surgery, d octors remov e gr owths and scar t issue or dest r oy them w i th i nt ense heat . The g oal is to t reat the end omet ri osis w i thout har mi ng the heal thy t issue ar ound i t . Women recov er f r om l apar oscopy much fast er than f r om major

abd omi nal surgery.) 2. Birth control pills (bl ock the eff ect s of natur al hor mones on

end omet ri al gr owths. So, they prev ent the monthly build-up and break d own of gr owths. This can mak e end omet ri osis less pai nful. Bir th cont r ol pills also can mak e a woman' s peri ods lig ht er and less uncomfor table. Most bir th cont r ol pills contai n two hor mones, est r ogen and pr ogest i n. This t y pe of bir th cont r ol pill is called a

"combi nat i on pill." Onc e a woman stops tak i ng them, the abili t y toget preg nant retur ns, but so may the sy mptoms of end omet ri osis.)

3. DPM A



maslow's hierarchy of needs

Each of us is motivated by needs. Our most basicneeds are inborn, having evolved over tens of thousands of years. AbrahamMaslow's Hierarchy of Needs helps toexplain how these needs motivate us all.

Maslow's Hierarchy of Needs states that we mustsatisfy each need in turn, starting with the first, which dealswith the most obvious needs for survival itself.

Only when the lower order needs of physical andemotional well-being are satisfied are we concerned with the

higher order needs of influence and personal development.

Conversely, if the things that satisfy our lower order needs are swept away, we are no longer concerned aboutthe maintenance of our higher order needs.



1. Biological and Physiological needs -air, food, drink, shelter, warmth, sex,

sleep, etc.2. Safety needs - protection from elements,

security, order, law, limits, stability, etc.

3. Belongingness and Love needs - work

group, family, affection, relationships, etc.4. Esteem needs - self-esteem,

achievement, mastery, independence,status, dominance, prestige, managerial

responsibility, etc.5. Self-Actualization needs - realizingpersonal potential, self-fulfillment, seekingpersonal growth and peak experiences.



Effects of illness to growth and

development



Nursing Diagnosis

P AIN

- during the procedure

- during menstruation

- during sexual intercourse

- during bowel movement

Interventions:

Instruct patient to

- maintain bed rest with position of comfort- maintain relaxing environment to promote calmness

- Encourage diversionary activities

- teach patient some relaxation tecniques, deep breathing



RISK FOR INFECTION

- related to the procedure done

Interventions:

- instruct patient to notify physician for any

elevation of body temp. and chills

- maintain proper perineal care/good hygiene

- comply with all the medications and instructions

given by her physician

- go back for follow up check as scheduled



ANXIETY

- related to fear of losing husband (separation) due

to her infertility.

Interventions:

- Encourage patient to discuss her fears and

feelings.- provide private time for patient and husband to

verbalize feelings

- instruct patient and husband as to all procedures,

tests, medications and care in factual consistentmanner.

- instruct patient in relaxation techniques



As endometriosis can grow below

the surface of the peritoneum, It is

believed that excision of

endometriosis leads to better results

than laser vaporization.

en dome trios is case study final

Documents