妇产科护理子宫肌瘤病人的护理VIP免费

Nursingcareforuterinemyoma子宫肌瘤病人的护理Introduction(概述)Leiomyoma,fibromyomaorfibroidsThemostcommonbenign(良性的)tumorsofthefemalegenitaltract（女性生殖系统）Affect1/4ofchild-bearingagewomen30-to50-yearsEtiology(病因)Hormone-dependent(激素依赖性肿瘤)Femalehormones(estrogen,progesterone)女性激素雌激素孕激素Evidencesoccursinreproductiveageincreaseinsizeduringpregnancydecreaseinsizeaftermenopause★Classification(分类)SubserousMyomaIntramuralMyomaSubmucousMyomaMultipleMyomas:Classification(分类)SingleMultiplePathology(病理)VaryinsizeHardPseudocapsule(假包膜）Whorledstructure(螺旋状结构)Secondarychange(变性)hyalinedegeneration玻璃样变cysticdegeneration囊性变reddegeneration红色样变malignantdegeneration肉瘤样变(0.4~0.8%.)★Clinicalmanifestations(临床表现)•Symptoms•SignsDependonitssize,location,thepresenceofdegenerationsornot★Clinicalmanifestations(临床表现)Symptoms•(1)Abnormaluterinebleeding•(2)Abdominallump腹部包块•(3)Pressuresymptoms压迫症状★Clinicalmanifestations(临床表现)⑴abnormaluterinebleedingThetypicalchangeistheheavierflowandprolongationoftheperiods.Mostcausedbyintramuralmyomasandsubmucousmyomas.★Clinicalmanifestations(临床表现)(2)Abdominallump(s)腹部包块Resultfromamyomaofconsiderablesize,mostfrequentlyofthesubserousmyomasStructureoffemalepelvis★Clinicalmanifestations(临床表现)⑸Pressuresymptoms压迫症状PressureonbladderUrinaryfrequency(尿频)Pressureonrectumincompletedefecation(排便不尽)Constipation(便秘)Signs(体征)PelvicsignsUterusfeellargerthannormalAnirregularuterusmasswithoutpainDiagnosticTests(诊疗方法)（1）B-modeUltrasonagraphyB超（2）Hysteroscopy宫腔镜检查（3）MagneticResonanceImaging(RMI)核磁共振Treatments(治疗)TheseverityofsymptomsTheageandgeneralconditionsThetypesoftumorpresentThedesiretobearchildrenThepresenceofsecondarychangesornotTreatments(治疗)Options：Conservativemanagement保守治疗Surgicalmanagement手术治疗Others:HighIntensityFocusedUltrasoun-d，etc(HIFU)海扶刀治疗Treatments(治疗)Conservativemanagement保守治疗Follow-up随访观察Appropriateforthosewhohavesmall,asymptomatic(无症状的)myomas,especiallythosewhoareclosetomenopauseTakeexaminationat3to6monthintervalsMedicalmanagement药物治疗Androgen(雄激素)，GnRHagonist(激动剂)Sideeffects(副作用):weightgain,vaginaldryness,acne(痤疮),etc.Treatments(治疗)Surgicalmanagement手术治疗Myomectomy(肌瘤切除术)Hysterectomy(子宫切除术)totalorsubtotal~全/次全子宫切除术(trans-vaginaorabdomen;throughlaparoscopyorhysteroscopy)腹腔镜宫腔镜HIFUThelatesttreatmentforfibroidsHighlyfocusedultrasonicwaves(聚焦超声波)todestroyfibroi-dsNursingcareNursingAssessment护理评估NursingHistory病史PhysicalHistory身体评估PsychosocialAssessment社会心理评估DiagnosticTestsAssessment诊断检查的评估NursingAssessment护理评估1.Nursinghistory病史Menstruationhistory月经史Deliveryhistory生育史Estrogentaken雌激素服药史Responsetothemedicaltreatment药物治疗的反应NursingAssessment护理评估2.Physicalhistory身体评估Assessmentofsymptoms症状的评估AssessmentofsignsNursingAssessment护理评估3.Psychosocialassessment心理社会评估Assessthewoman’sfeelings,concernsabouthersymptomsandthefaresoftheunknown.Discussthesignificanceofthelossoftheuteruswiththewoman.NursingAssessment护理评估4.DiagnosticTestsAssessmentTheresultofB-modeultrasonography,hystero-scopy,bloodroutinetest,etc.NursingcareNursingdiagnosi...