Chapter 42 Nursing Care of Women with Reproductive System Disorders

Answers CHAPTER 42 NURSING CARE OF WOMEN WITH REPRODUCTIVE SYSTEM DISORDERS MENSTRUAL DISORDERS 1. (5) 2. (3) 3. (1) 4. (2) 5. (4) AUDIO CASE STUDY Mrs. Franklin and Total Abdominal Hysterectomy MASTECTOMY CARE 1. Pain, constipation, grieving. 2. Michelle provided prune juice, walking assistance, bran cereal, and fluids, including hot tea. If these are not effective, talking to the health care provider (HCP) about a stool softener or laxative might be necessary. 3. Small amounts of serosanguinous drainage are normal. If bleeding is copious, sudden, or becomes purulent, or if Mrs. Franklin develops a fever, swelling, or excessive redness, Michelle should report them to the registered nurse (RN) or HCP. You are assigned to care for Mrs. Joseph, who is 1-day postoperative following a right radical mastectomy. You know that she is not anxious because she had a left mastectomy a year ago and knows everything to expect. You listen to her breath sounds and find them clear, so it is not necessary to have her cough and deep breathe. You encourage her to lie on her right side to prevent bleeding. You use her right arm for blood pressures because both arms are affected and the right one is more convenient. You also encourage her to avoid use of her right arm to prevent injury to the surgical site. You provide a balanced diet and plenty of fluids to aid in her recovery. 1. It is impossible to know if Mrs. Joseph is anxious without assessing her. Most likely she is anxious because a second mastectomy probably was done for a recurrence of cancer. She needs a lot of support. A referral to Reach to Recovery or another appropriate support group would be helpful. 2. Never assume that because a patient has had a procedure before, she knows everything to expect. Assess her knowledge level and teach accordingly. 3. The incision on her chest may hurt when she coughs and deep breathes, increasing her risk of pulmonary complications. She should receive analgesics and encouragement to cough and deep breathe every hour. 4. Lying on her right side may make elevation of her right arm difficult. She should assume a position in which her arm can be elevated on a pillow to decrease swelling. VOCABULARY 1. (3) 2. (4) 3. (2) 4. (10) 5. (5) 6. (7) 7. (1) 8. (6) 9. (8) 10. (9) BREAST SURGERIES 1. (5) 2. (1) 3. (3) 4. (2) 5. (4) Errors are in boldface and the correct nursing care steps are detailed below. 1 2 Chapter 42 Answers 5. Neither arm should be used for blood pressures after mastectomies; consult with the health care provider about the advisability of using the left arm or possibly her legs. 6. She should be taught to exercise her arm using exercises recommended by the institution. CRITICAL THINKING 1. Some factors affecting her frequent yeast overgrowths may include poor nutrition, inadequate blood glucose control, overly restrictive clothing, overheating of the genital area from long periods of sitting, immune system deficiency, a strain of yeast that is resistant to her usual treatment, and antibiotic use (many young people take antibiotics regularly for acne control). 2. Some suggestions to help her prevent this problem in the future might include wearing loose-fitting skirts and light cotton underwear for bus trips, changing positions frequently, sitting with her legs apart under a skirt, and getting out and walking (if this is practical) when the bus stops. She should also mention any antibiotic use and emphasize the recurrent nature of this problem to her physician; assessment for immune system problems should be done if other infections are also frequent. One main area to explore with her is her blood glucose control. Find out why she is not testing often enough and help her to plan strategies to improve testing regularity. If she is financially unable to afford the test materials, find out if there are support options available to her. (The local American Diabetes Association chapter or hospital diabetes clinic may be able to help you find this information.) Emphasize the benefits of adequate blood glucose control for many body systems as well as this disorder. REVIEW QUESTIONS—CONTENT REVIEW The correct answers are in boldface. 1. (3) is correct. A douche may wash away signs of the pathogen. (1) is incorrect. Better visualization is nice, but it does not help identify the pathogen. (2, 4) are not true. 2. (3) is correct. Multiple sexual partners increase the risk of cervical cancer. (1) is incorrect. There is no evidence that tight underwear increases cancer risk. (2) is incorrect. Papanicolaou (Pap) smears detect cancer early. (4) is incorrect. Late onset of sexual activity may reduce risk of some diseases. 3. (2) is correct. Women who eat a high-fat diet have higher rates of breast cancer. (1, 3, 4) are all associated with reduced risk of breast cancer. REVIEW QUESTIONS—TEST PREPARATION The correct answers are in boldface. 4. (1, 2, 3, 5) are correct. Restriction of alcohol, caffeine, nicotine, salt, and simple sugars; participation in regular exercise; and development of stress management skills may help to reduce premenstrual syndrome symptoms. (4) is incorrect. 5. (2) is correct; it is not 100% effective. (1, 3, 4) are all true and do not indicate a need for more teaching. 6. (3, 1, 4, 2) is correct. Breathing pattern takes priority because ineffective respirations can be life-threatening. Ineffective tissue perfusion can be health-threatening and is second. Psychosocial problems, although important, are the last priority. Anxiety comes first because it is actual; coping is a risk in this case and is last. 7. (2) is correct. Elevation of the arm reduces swelling. (1, 3, 4) may worsen swelling. 8. (1) is correct. Her reaction shows anger over her diagnosis, a normal grieving response. (2, 3, 4) may be true, but there is no evidence to support them in the question. 9. (1) is correct. This therapy affects hormone function. (2, 3, 4) do not work by affecting estrogen. 10. (4) is correct. These are signs of infection. Prompt reporting is necessary so a culture can be done and antibiotics ordered. (1, 3) Another day or two allows time for the infection to spread. (2) May cause unnecessary concern in the patient. In addition, if she is receiving home care, it may be difficult for her to get to her physician’s office.