Deck 70: Care of Patients With Gynecologic Problems

Question 1

A 34-year-old woman is diagnosed with ovarian cancer today. She tells you that she "can't believe this," and that "this must be the wrong diagnosis." She states that she and her husband had planned to get pregnant later this year and that she "cannot lose" her ovaries. However, she is scheduled to have a bilateral salpingooophorectomy and hysterectomy in 2 days. Her oncologist told her that after she recovers from surgery, she may need to have adjuvant chemotherapy to destroy any remaining cancer cells.
What preoperative teaching will you provide for this patient and why?

Answer 1

According to the given case; the client is diagnosed with the ovarian cancer, and she is scheduled for the Bilateral Salpingo-Oopherectomy and Hysterectomy. The client does not believe that, she is diagnosed with ovarian cancer.
On such situation, the nurse should explain the client, about ovarian cancer and the surgical importance. Ovarian cancer is not often detected until its advanced stage; and the survival rate with the ovarian cancer is very les s. In addition, the ovarian cancer condition can affect other organs also ; so, the surgery protects the cancer migration to the other organs.
Generally, the preoperative teaching covers, the description about the surgery; So, the Nurse should explain about the surgical outcome of Hysterectomy and Salpingo-oopherectomy. The Hysterectomy defines the removal of Uterus ; and the Bilateral Salpingo-Oopherectomy refers the removal of both ovaries and fallopian tubes.

Question 2

A client tells the nurse that she has vaginal itching. Which client statement would cause the nurse to further assess for symptoms of vaginitis? Select all that apply.

A) "I always use the same detergent when washing clothes."
B) "All of my immunizations, including Gardasil, are up to date."
C) "I've scratched so hard that it gets raw, but then it feels better for awhile."
D) "My boyfriend and I broke up last month, but we are together again now."
E) "My health care provider prescribed antibiotics for my sinus infection last week."

Answer 2

The inflammation and itching in the vagina is termed as Vaginitis. Vaginal itching can be caused due to the bacterial, fungal and viral infections. In addition, some medicines include antibiotics ; chemical irritants include the detergents, vaginal spray, fabric dyes , and the tampons also cause the vaginal itching.
According to the client's statement, she is using the same detergent for washing her clothes; so there is no evidence for new chemical irritant to cause the itching symptom. In addition, Gardasil (recombinant Human Papillomavirus vaccine) vaccination of the client is up to date. So there is no HPV (Human papilloma virus) related infection.
Hence, the options (A) and (B) are not the exact cause for vaginal itching.
The option (C) representing, that the client feels better during the hard scratching , indicating the possibilities for fungal or bacterial infections. The option (D) representing that, long after the client is together with her boyfriend; so, there may be a possibility for transmission of STD's (sexually transmitted diseases). And, in option (E) the client added the statement; that antibiotics are prescribed the for her sinus problems, indicates the possibility for the medication allergy.
Hence, the correct answer is options (C), (D), (E)

Question 3

A 34-year-old woman is diagnosed with ovarian cancer today. She tells you that she "can't believe this," and that "this must be the wrong diagnosis." She states that she and her husband had planned to get pregnant later this year and that she "cannot lose" her ovaries. However, she is scheduled to have a bilateral salpingooophorectomy and hysterectomy in 2 days. Her oncologist told her that after she recovers from surgery, she may need to have adjuvant chemotherapy to destroy any remaining cancer cells.
How will you address this patient's statements about disbelief of the diagnosis?

Answer 3

The client is does not believed that she is having the ovarian cancer; and she is totally confused. The nurse should prepare the patient, to become calm and normal, before explaining about the ovarian cancer.
Once, the client is at understanding mood, the nurse should explain the client about the ovarian cancer is generally not often detected; they are detected only on the advanced stages. So, the diagnosis is exact and there is no confusion. In addition, the ovarian cancer condition can affect other organs also ; so, the surgery will protect the cancer migration to the other organs.

Question 4

A client returns from surgery after a total vaginal hysterectomy. Upon initial assessment, which finding by the nurse requires immediate intervention?

A) Clean, intact dressing
B) Excessive vaginal bleeding
C) Temperature of 99° F
D) Client statement that pain is "4" on scale of 0-10

Question 5

A 34-year-old woman is diagnosed with ovarian cancer today. She tells you that she "can't believe this," and that "this must be the wrong diagnosis." She states that she and her husband had planned to get pregnant later this year and that she "cannot lose" her ovaries. However, she is scheduled to have a bilateral salpingooophorectomy and hysterectomy in 2 days. Her oncologist told her that after she recovers from surgery, she may need to have adjuvant chemotherapy to destroy any remaining cancer cells.
How will you approach the patient's feelings about getting pregnant later this year?

Question 6

A 34-year-old woman is diagnosed with ovarian cancer today. She tells you that she "can't believe this," and that "this must be the wrong diagnosis." She states that she and her husband had planned to get pregnant later this year and that she "cannot lose" her ovaries. However, she is scheduled to have a bilateral salpingooophorectomy and hysterectomy in 2 days. Her oncologist told her that after she recovers from surgery, she may need to have adjuvant chemotherapy to destroy any remaining cancer cells.
Do you believe that this patient understands the implications of a bilateral salpingo-oophorectomy? If not, what would be your next nursing action?

Question 7

A 34-year-old woman is diagnosed with ovarian cancer today. She tells you that she "can't believe this," and that "this must be the wrong diagnosis." She states that she and her husband had planned to get pregnant later this year and that she "cannot lose" her ovaries. However, she is scheduled to have a bilateral salpingooophorectomy and hysterectomy in 2 days. Her oncologist told her that after she recovers from surgery, she may need to have adjuvant chemotherapy to destroy any remaining cancer cells.
What will you tell her about chemotherapy that may be necessary after surgery?

Question 8

A 34-year-old woman is diagnosed with ovarian cancer today. She tells you that she "can't believe this," and that "this must be the wrong diagnosis." She states that she and her husband had planned to get pregnant later this year and that she "cannot lose" her ovaries. However, she is scheduled to have a bilateral salpingooophorectomy and hysterectomy in 2 days. Her oncologist told her that after she recovers from surgery, she may need to have adjuvant chemotherapy to destroy any remaining cancer cells.
Where would you search for evidence about her expected quality of life and prognosis?

Question 9

A 34-year-old woman is diagnosed with ovarian cancer today. She tells you that she "can't believe this," and that "this must be the wrong diagnosis." She states that she and her husband had planned to get pregnant later this year and that she "cannot lose" her ovaries. However, she is scheduled to have a bilateral salpingooophorectomy and hysterectomy in 2 days. Her oncologist told her that after she recovers from surgery, she may need to have adjuvant chemotherapy to destroy any remaining cancer cells.
To what community resources would you refer this patient after discharge?