Question

CASE STUDY II

CERVICAL CANCER

A.G. is a 45 yea-old divorced mother of four children ranging in age from 16-23. She was married at age 18 and had several sexual partners prior to marriage. She has had three sexual partners since her marriage ended. Last year she was treated with cryosurgery for venereal warts. The pap smear taken 2 weeks ago showed atypical cells, and she has come in for repeat test. The pap smear reveals squamous cell carcinoma of the cervix. Laparoscopy shows the disease to be widespread in the pelvic cavity.

Assessment Data

Vitals: Bp 130/80, P 72, R 18, T 99.2 (37.3C). A.G. weight 142, approximately 15% over her ideal body weight. Examination of the cervix reveals a large necrotic lesion at the 7 o’clock position. She complains of back pain radiating down her back for several months and a foul vaginal discharge that increases after intercourse.

A CT scan and lymphangiography are orders. Radiation therapy to pelvic region 5 times/week for 6 weeks. Pain medication ; Percocet 2 tabs po every 4 hours prn for pain and Xanax 5 mg po prn qhs for increase anxiety.

During a home visit, Ms. A.G. tells the nurse that she has been tired since beginning radiation treatments and that all she can do is sit in her chair.

1.             Identify risk factors associated with cervical cancer.

2.             What health promotion activities could decrease the risk of cervical cancer?

3.             Develop a teaching plan to help Mrs. A.G. cope with the effects of radiation.

4.             Explain the purpose of the diagnostic procedures and instructions given to the patient.

5.            Identify 4 Nursing Diagnoses and Expected Outcomes in the approved NANDA listing for Mrs.

Answer 1

# Risk factors associated with cervical cancer are :-

1. Many sexual partners. - The greater your number of sexual partners and the greater your partner's number of sexual partners the greater your chance of acquiring HPV.

2..Early sexual activity - Having sex at an early age increases your risk of HPV.

3. Other sexually transmitted infections (STIs) - Having other STIs such as chlamydia, gonorrhea, syphilis and HIV/AIDS — increases your risk of HPV.

4. A weak immune system - You may be more likely to develop cervical cancer if your immune system is weakened by another health condition and you have HPV.

5. Smoking - Smoking is associated with squamous cell cervical cancer.

# Health promotion activities that could decrease the risk of cervical cancer are : -

- Get vaccinated against HPV. Vaccination is available for girls and women ages 9 to 26. The vaccine is most effective if given to girls before they become sexually active.

- Have routine Pap tests. Pap tests can detect precancerous conditions of the cervix, so they can be monitored or treated in order to prevent cervical cancer. Most medical organizations suggest women begin routine Pap tests at age 21 and repeat them every few years.

- Practice safe sex. Using a condom, having fewer sexual partners and delaying intercourse may reduce your risk of cervical cancer.

- Cessation of smoking

#. Teaching plan to help Mrs. A.G. cope with the effects of radiation are :-

- keep skin clean & dry and protect from trauma/abrasions

- avoid frequent washing to area but maintain hygiene: irradiated skin is fragile, use mild soap & tepid water, soft cloth & gently pat dry; use mild soap (e.g. Ivory or Dove) or plain water

- avoid emollients, lotions, powders, deodorants, perfumes/fragrances, cosmetics, etc

- avoid shaving hair in treatment area (use electric razor if shaving necessary)

- handle area gently (reposition frequently); avoid tape/adhesive bandages to treatment area

- avoid temperature extremes (can precipitate skin breakdown)

- do not massage radiation area; fragile skin is subject to blistering & sloughing

- advise patient to avoid wearing tight-fitting clothing or harsh fabrics (e.g. avoid wool/corduroy) over treatment area; wear loose, light-weight clothing (e.g. cotton is best); don't scratch

- instruct patient to avoid direct sun exposure for at least one year to radiated areas; if have to, use precautions

- avoid swimming in salt water or chlorinated water during treatment

#. The purpose of the diagnostic procedures and instructions given to the patient is to do the diagnostic procedures properly .