内膜异位护理2008普本护理.ppt

ENDOMETRIOSIS,Aims and demands,To master the definition of endometriosis and its typical clinical manifestation.To know well about the main treatments for endometriosis and the main nursing interventions.To understand the pathology of endometriosis.,What is endometriosis?,Definition,Endometriosis is a disorder in which abnormal growths of tissue,histologically resembling the endometrium are present in locations outside the uterine cavity.,Which locations?,The most common location is _.,Figure 7.1 shows the sites at which endometriosis may occur.,It is influnced by the action of oovarion hormones.It is often found in 25-45 reproductive age women and normally not seen before menarche or after menopause.The incidence of it is about 10-15%.,why?,Endometriosis is a benign disease,the cause of it is still uncertain.,Etiology,1.Implantation of viable Endometrial cells theory(1)retrograde menstruation theory(2)implantation from medical infection2.lymphatic and vascular metastasis 3.Coelomic metaplasia theory 4.Immune system morbidity theory,How can we recogniaze Endometriosis?,Pathology,There are two basic features:1.cyclic bleeding in the endometriotic site accompanied by the ovarian cycle.2.surrounded by a zone of fibrosis and contracture or“puckering”.,Microscopic changes:,The classic microscopic picture of endometriosis consists of：endometrial glandsendometrial stroma hemosiderin-laden macrophages surrounding inflammatory cells and fibrosis,diagnose?,history,general data,menstrual history,reproductive history,surgical historycontraception history,abnormal development of reproductive organs,the treatment,the effect and so on.,Clinical manifestation?,Physical assessment,1.Symptoms(1)painPain is the most common symptom.It is mostly characterized by secondary and progressive dysmenorrhea(痛经,cyclic pain in phase with menses).It can also cause dyspareunia(性交痛，pain during or following interourse),chronic pelvic pain(慢性盆腔痛)and low back pain(腰背部痛).an acute abdominal emergency?(2)dysfunctional menstruationAbout 15-30%of patients manifest as excessive menstruation,premenstrual spotting,or prolonged menses.(3)infertilityovarian adhesions may prevent release of the ovum from the follicle pelvic adhesions may prevent the ovum from entering the fallopian tube;(4)other special symptomspainful urination,bloody urine or bloody stools.,2.SignsThese implants usually are nodular,firm,fixed,and discrete and are especially sensitive during menstruation.When we examine,the patient maybe feel tenderness.However,many patients have no abnormal findings on physical examination.,Diagnostic tests?,Special examinations,1.ultrasonic scanning2.CA125 measurement 3.laparoscopy,Methods?,Treatment focus on arresting the progression of the disease,symptom control,and preservation of fertility(if desired).,Treatment,1.Expectant managementIf the patient has no symptom，there is no need to insist on anytreatment,but the patient should be examined periodically.2.Hormonal therapyThe basis of hormonal methods treating endometriosis is the suppressionof cyclical ovarian function and avoiding menstruation.(progestins,androgen-danazol,Gonadotropin-releasing hormone-Diphereline)(1)Pseudopregnancy(2)Pseudomenopause 3.Surgical treatmentAccording to the operation range,it can be divided into conservative surgery and curative surgery.At the same time,medication may be used 2-3 months before or after the operation to improve the therapy effect.,How can we do as a nurse?,Psychosocial assessment,the patients feeling social support of the patient the stress coping style,Nursing diagnosis,Pain related to the abnormal endometrium replantedKnowledge deficit related to ignorance of the disease and its management Sex function disturbance related to the intercourse painSelf-esteem disturbance related to infertilityFear related to the prognosis of endometriosis,Nursing interventions,1.Health education2.Medication nursing 3.Surgery nursing 4.Nursing care of infertility5.Psychological counseling,Thank you!,