Question

Read the following scenario:

T.C. is a 49-year-old woman who 3 weeks ago underwent a vaginal hysterectomy and right salpingo-oophorectomy for abdominal pain and endometriosis. Postoperatively, she experienced an intra-abdominal hemorrhage, requiring transfusion with 3 units of packed red blood cells (RBCs). After discharge, she continued to have abdominal pain, chills, and fever. She was readmitted twice: first for treatment of postoperative infection and second for evacuation of a pelvic hematoma. Despite treatment, T.C. continued to have abdominal pain, chills, fever, and nausea and vomiting.

T.C. has now been admitted to your unit from the postanesthesia care unit (PACU) after an exploratory laparotomy. Vital signs (VS) are 130/70, 94, 16, 99.7° F (37.6° C). Respirations are shallow and her Spo2 is 93% with oxygen at 2 L by nasal cannula. She is easily aroused and oriented to place and person. She dozes between verbal requests. She has a low-midline abdominal dressing that is dry and intact and a Jackson-Pratt drain that is fully compressed and contains a scant amount of bright red blood. Her Foley to down drain has clear yellow urine. She is receiving an IV of 1000 mL D5.45NS at 100 mL/hr in her left forearm, with no swelling or redness. T.C. is receiving IV morphine sulfate for pain control through a patient-controlled analgesia (PCA) pump. The settings are dose 2 mg, lock-out interval 20 minutes, 4-hour maximum dose of 30 mg. When aroused, she states that her pain is an 8 on a scale of 1 to 10.

Think through the following related to T.C.'s condition:

Etiology and pathophysiology

Risk factors

Signs and symptoms

Diagnostic procedures

Medication and treatment

Nursing interventions, including patient education

Potential complications

Complete a concept map

Show interrelationships of all components.

Prioritize the nursing interventions related to complications.

Include at least three peer-reviewed sources to support your concept map, and an APA-formatted reference page.

Answer 1

Answer :

Endometriosis : A condition resulting from the appearance of endometrial tissue outside the uterus and causing pelvic pain ,especially associated with menstruation .

Causes and risk factors :

The exact causes of endometriosis is not known but some of the risk factors includes :

• Increased age .
• Alcoholic use .
• Early menarche .
• Family history of endometriosis.
• Infertility .
• Sexual intercourse during the menstruation .
• Low body weight .
• Prolonged menstrual flow
• Short menstrual cycle.

Pathophysiology :

There is a combination of failure of immune mechanism associated with stromal cell defect with increased oestrogen and prostaglandins and progesteron resistance lead to endometriosis.

Signs and symptoms :

• Pain : pain in the lower abdomen ,pain at lower back ,pelvis ,rectum .
• Pain circumstances : can occur during the sexual intercourse or while defecation
• Menstrual : abnormal menstruation ,heavy menstruation ,irregular menstruation ,painful menstruation or spotting .
• Gastro intestinal : constipation or nausea .
• Abdominal : abdominal fullness or cramping .

Diagnostic procedures :

• Ultrasound abdomen
• Laparoscopy for both diagnostic and therapuetic purposes .
• MRI : it can reveals the endometriotic deposits in rectovaginal septum .
• CA 125 : may be elevated in severe endometriosis.
• Bimanual pelvic examination : it can reveal the fixed retroverted uterus ,bilateral pelvic tenderness,fixed or enlarged ovaries or painful utero sacral nodules .
• Clinical examination : deep infiltrating nodules are most reliably detected with clinical examination.

Management :

Medical management :

• Medical management for the pain control such as NSAIDS very help full for the pain control .
• Prevention of menstruation and there fore restric progressive ectopic endometrial proliferation ,tab .postan 500 mg tid ,for 5 days .

Surgical intervention :

hysterectomy

Explorative laparotomy

Oopherectomy

Salpingectomy

Total hysterectomy

Nursing interventions :

• As a health care provider ,we need to asses the patient post operative condition such as whether she is conscious or subconscious state .
• Nurse should monitor the vital signs of the client such as temp .,Bp , pulse .,respirations etc .
• Administer the oxygen to maintain the saturation and perfusion of client .
• If the client is in subconscious state ,we need to awake the client to know where she is .
• Nurse should check for the post operative complications such as chills ,hypotension ,bleeding etc .
• Nurse should administer the i.v fluids as per doctor prescription .
• Nurse should position the patient in a food end elevated position .
• Educate the client about her condition
• Instruct the client to make the call light if any abnormality she perceived .
• Allow the client for ventilate her doubts about post operative condition .
• Educate the client to take high iron diet to compensate anemia ,high protein diet for early wound healing and balanced diet .
• Instruct the client to take plenty of oral fluids

Complications :

Post operative bleeding .

Anaemia

Infection or inflammation .

Infertility .

Blockage of tubes .