【妇产科护理课件】子宫肌瘤病人的护理

Nursing care for uterine myoma 子宫肌瘤病人的护理 Introduction(概述) through laparoscopy or hysteroscopy) 腹腔镜 宫腔镜 HIFU The latest treatment for fibroids Highly focused ultrasonic waves(聚焦超声波) to destroy fibroi- ds Nursing care Nursing Assessment 护理评估 lNursing History 病史 lPhysical History身体评估 lPsychosocial Assessment 社会心理评估 lDiagnostic Tests Assessment诊断检查的评 估 Nursing Assessment 护理评估 1. Nursing history 病史 l Menstruation history 月经史 l Delivery history 生育史 l Estrogen taken 雌激素服药史 l Response to the medical treatment 药物治疗的反 应 Nursing Assessment 护理评估 2. Physical history身体评估 lAssessment of symptoms 症状的评估 lAssessment of signs Nursing Assessment 护理评估 3. Psychosocial assessment 心理社会评估 l Assess the womans feelings, concerns about her symptoms and the fares of the unknown. l Discuss the significance of the loss of the uterus with the woman. Nursing Assessment 护理评估 4. Diagnostic Tests Assessment The result of B-mode ultrasonography ,hystero- scopy, blood routine test, etc. Nursing care Nursing diagnosis 护理诊断 Knowledge deficit related to the disease , treatment and nursing care Activity intolerance related to anemia High risk for malnutrition related to server anemia, from abnormal uterine bleeding High risk for body image disturbance related to the loss of uterus. Nursing care Expected outcome 护理目标 The patient will understand the growth of myomas, the therapeutic methods and routine nursing care, as eviden-ced by her statements. The patient will maintain activity within limits of ability. Anemia will be corrected. The patient will maintain a positive self-concept. Nursing care Nursing interventions 护理措施 (1) For the woman receiving conservative management (2) Preoperative and postoperative educati -on (3)Postoperative care (4) Care for the symptoms Nursing interventions 护理措施 (1)For the woman receiving conservative management（保守治疗病人的护理） Observational management (followed up every 36 months) Medical treatment The effects of the medication / The way to administer the medicine/The possible side effects of the medicine ( self- limited and abate when discontinued) Nursing interventions 护理措施 Preoperative and postoperative education（术前术后的健康教育） l The difference between myomectomy and hystere-ctomy. l Advantages and disadvantages of myomectomy ve-rsus hysterectomy. l Information as to what to expect postoperatively and how to care for herself. l The influence on sexual intercourse(性交) after surg-ery. Nursing interventions护理措施 Postoperative care（术后护理 ） Similar to that of any woman having abdominal surgery. (Please see the section of Nursing Care of Patients Undergoing Abdominal Surgery) Nursing interventions护理措施 Care for the symptoms (对症 护理) lExcessive bleeding(针对出血多者) lFor ones suffer from pressure effects(针 对压迫症状） Nursing interventions护理措施 Excessive bleeding(针对出血多者) 1) Count the number of pads or tampons used and weigh each before and after use. (观察出血量) 2) Monitor vital signs. 3) Volume expansion by IV therapy ; Blood transfusion ; 4) Help her to identify ways to perform activities and Instru-ct her to take well-balance diet . Nursing interventions护理措施 For ones suffer from pressure effe -cts(针对压迫症状） 1)Catheterization(导尿) 2)Stimulating the peristalsis(肠蠕动) 3)The enema(灌肠) can be performed as ordered Nursing Evaluation护理评价 The patient can state an understanding of the rep-roductive system and the changes that occur after hysterectomy ( without misconceptions). The patient is able to do self-care within activity li-mits The patient demonstrates a positive psychological adjustment to surgery as evidenced by the absenc-e of depression and the presence of a positive self-concept. Case analysis Ann is a 35-year-old married women with 3 children rangin-g from 5 to 11. She was married at age 22. Her menstrual cycle used to be normal since the menarche(初潮) at age 13. But now she complains about prolonged and heavy menstruation. In the recent days, she had incomplete and difficult defecations. She found a mass in her lower ab-domen 2 days ago. So she went to see doctor . Questions : (1) According to her symptoms, what do you think of her p-robable diagnosis? (2) How to do and what to do for a nurse to collect the info-rmation ?(how to make assessment?) Case analysis Questions : (3) What kinds of medical tests will be used to e-stablish the diagnosis ? (4) What treatment options are available for her? (5) What are the probable nursing diagnosis for h-er ? (6) How to take nursing care for her? Summary Introduction Classifications Pathology ( secondary change) Clinical manifestations Diagnostic tests Management Nursing care Questions What is uterine myoma? What are the types of uterine myoma? What are the clinical manifestations of myomas?