Question

Using pg. 88 in your Hawkins text, select 1 of the 7 reasons that women elect to have sterilization scheduled. Then:

Describe this patient.

What other questions would you ask?

What labs should you order preoperatively?

What follow up teaching would be involved?

See Pg 88 in Hawkins below

STERILIZATION

I. DEFINITION

Sterilization in women is the purposeful occlusion of the fallopian tubes by surgical disruption or an occlusion device. Several methods are practiced through closed laparoscopy, open laparoscopy, or suprapubic minilaparotomy. The method of tubal occlusion depends on the surgical route.

These occlusion methods include excision of a portion of each tube and suturing of the ends; excision of the fimbriated end; excision of a portion and then suturing of the proximal end into the muscle of the uterus and of the distal end in the broad ligament; banding with Silastic bands (Falope rings, Yoon band) or clips (Hulka-Clemens clip, Filshie clip); ligation of a loop of the tubes with nonabsorbable suture material; and occlusion by bipolar cautery. Another method is transcervical to place the Essure tubal occlusion device.

II. BACKGROUND FOR ELECTING STERILIZATION

Decision by the woman to seek permanent sterilization through tubal ligation or occlusion as a means of fertility regulation

III. HISTORY

A. What the woman may present with

1. History of use of one or more methods of contraception

2. Dissatisfaction with available methods and/or method failure

3. Experiencing problems with one or more methods and a decision

not to have any more children

4. Medical contraindications for use of one or more methods

5. Psychosocial contraindications for use of one or more methods

6. Desire to have no more children or no children at all; need or desire

for permanent method

7. Premenopause, less than 1 year without a period

B. Additional information to be obtained

1. Knowledge about all family planning methods used

2. Psychosocial and cultural aspects: size of family desired, beliefs

about sterilization, family attitudes

3. Knowledge about the sterilization procedures available and beliefs

4. History of any previous pelvic surgery, partial or total hysterectomy,

oophorectomy, salpingectomy, laparoscopy, assisted reproductive

procedures, or plastic surgery such as tubal reconstruction

5. Medical/surgical history, present use of medications

6. Type of anesthesia for previous surgeries, any untoward effects

7. Gynecologic and obstetric history: pregnancies, live births, abortions,

ectopic pregnancies, endometriosis, uterine anomalies, presence

of adhesions, uterine leiomyomas (fibroids)

8. Menstrual history to the present, last period, premenstrual syndrome

(PMS), character of menses and menstrual cycle

9. Contraceptive use to present and reasons for discontinuation

IV. PHYSICAL EXAMINATION

A. Vital signs

1. BP

2. Pulse

B. General physical exam: lungs, heart, neck, abdomen, breasts, extremities,

thyroid

C. Pelvic examination

1. External: Skene’s glands, Bartholin’s glands, urethra, labia,

fourchette

2. Vaginal examination: walls, discharge, cervix; inspect for cystocele,

rectocele, urethrocele

3. Uterus: masses, tenderness, enlargement, possible pregnancy

4. Adnexa: masses, tenderness, palpable ovaries or tubes, enlargement

V. LABORATORY EXAMINATION (FOR PREOPERATIVE WORKUP

ONLY OR FOR SYMPTOMS OF PROBLEM)

A. Urinalysis, culture if signs of urinary tract infection

B. Complete blood count (CBC)

C. Pregnancy test

D. Gonorrhea culture

E. Chlamydia test

F. Pap smear

VI. DIFFERENTIAL DIAGNOSIS

None

VII. TREATMENT

A. Teaching

1. Methods of sterilization and possible failure

2. Chance of future reversal; choice of method of sterilization related

to this

3. Information on informed consent

4. Risks and benefits

5. Discussion of regret

Answer 1

Answer :

The woman should elect the sterilization procedure because of :

* to stop to get pregnancy

* if she have any pelvic inflammatory diseases

* any infections like salphingitis.

* the whose pregnancy is having a medical risk.

* any tubal tumors.

* it is used like one of the family planning proceedure.

Other questions like :

* where she is willing for surgery?

* is she having any cardiac problems?

* which type of contraceptive methods she used?

* whether she maintained asceptic technique or not?

* whether she undergone the contraceptive procedures by medical and eligible professionals or non eligible persons?

* whether is it legal or illegal methods.

* is there any cancer find out in uterus?

Like this questions we need to ask.

Preoperatively labs for female sterilization :

* Bleeding time

* clotting time.

* complete blood picture

* HIV

* HBSAG

* HCV

* VDRL

these all test must be important before going to do operation.

Follow up teaching :

* use asceptic technique to touch the site.

* adequate rest.

* follow up visit to hospital on 7^th day after the surgery.

* the site should be keep clean, dry and avoiding the running their site.

* we need to explain regarding the side effects of sterilization like bleeding, breathing problems, allergies reactions, damage to surrounding organs and tissues etc.

* if she feels any of above she have to consult doctor immediately.

* there is no need any Food restrictions.

Like this we need to give follow up teaching to the clients.