Académique Documents
Professionnel Documents
Culture Documents
June 2010
Table of Contents
Introduction............................................................................................................2-3
Pathophysiology.....................................................................................................10
Surgical Discussion................................................................................................11-12
Instrumentation......................................................................................................13
Nursing management.............................................................................................14-15
Drug Study…………………………………………………………………………….16-17
Reference...............................................................................................................18
Definition of Terms
Cervix- is the lower, narrow portion of the uterus where it joins with the top end of
the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior
vaginal wall
Fallopian tubes- two very fine tubes lined with ciliatedepithelia, leading from
the ovaries of female mammals into the uterus, via the utero-tubal junction. In non-
mammalian vertebrates, the equivalent structures are the oviducts.
Supracervical hysterectomy- surgical technique that removes the uterus while leaving
the cervix intact, does not have clear benefits over total hysterectomy in women with
non-cancerous disease and should not be recommended as a superior technique
This is the most common type of hysterectomy. During a total abdominal hysterectomy,
the doctor removes the uterus, including the cervix. The scar may be horizontal or
vertical, depending on the reason the procedure is performed, and the size of the area
being treated. Cancer of the ovary(s) and uterus, endometriosis, and large uterine
fibroids are treated with total abdominal hysterectomy. Total abdominal hysterectomy
may also be done in some unusual cases of very severe pelvic pain, after a very
thorough evaluation to identify the cause of the pain, and only after several attempts at
non-surgical treatments. Clearly a woman cannot bear children herself after this
procedure, so it is not performed on women of childbearing age unless there is a serious
condition, such as cancer. Total abdominal hysterectomy allows the whole abdomen and
pelvis to be examined, which is an advantage in women with cancer or investigating
growths of unclear cause.
Anatomy and Physiology of the Uterus and Cervix
Uterus
1. Round ligament
The uterus (from Latin2. Uterus3. "uterus" (womb, belly), plural uteruses or uteri)
or womb is a major female hormone-responsive reproductive sex organUterine
cavity4. of most mammalsIntestinal surface of Uterus5. Versical
surface(towa including humansrd bladder)6. Fundus of uterus7. . One end,
the cervixBody of uterus8. , opens into the vaginaPalmate folds of cervical canal9. ,
while the other is connected to one or both fallopian tubesCervical canal10. , depending
on the species. It is within the uterus that the fetusPosterior lip11. develops during ,
usually developing completely in placental mammalsgestationCervical
os (external)12. such as humans and partially in marsupialsIsthmus of
uterus13. Supravaginal portion of cervix1 such as kangaroos4. and opossumsVaginal
portion of cervix15. . Two uteruses usually form initially in a female fetus, and in
placental mammals they may partially or completely fuse into a single uterus depending
on the species. In many species with two uteruses, only one is functional. Humans and
other higherHYPERLINK "http://en.wikipedia.org/w/index.php?
title=Anterior_lip&action=edit&redlink=1" primatesAnterior lip16. such
as chimpanzeesCervix, along with horses, usually have a single completely fused
uterus, although in some individuals the uteruses may not have completely fused. The
term uterus is used consistently within the medical and related professions, while the
Germanic derived term womb is also common in everyday usage in
theEnglish language.
Most animals that lay eggs, such as birds and reptiles, have an oviduct instead of a
uterus. In monotremes, mammals which lay eggs and include the platypus, either the
term uterus oroviduct is used to describe the same organ, but the egg does not develop
a placenta within the mother and thus does not receive further nourishment after
formation and fertilization. Marsupials have two uteruses, each of which connect to a
lateral vagina and which both use a third, middle "vagina" which functions as the birth
canal. Marsupial embryos form achoriovitelline "placenta" (which can be thought of as
something between a monotreme egg and a "true" placenta), in which the egg's yolk sac
supplies a large part of the embryo's nutrition but also attaches to the uterine wall and
takes nutrients from the mother's bloodstream.
Function
The uterus provides structural integrity and support to the bladder, bowel, pelvic bones
and organs. The uterus helps separate and keep the bladder in its natural position above
the pubic bone and the bowel in its natural configuration behind the uterus. The uterus is
continuous with the cervix, which is continuous with the vagina, much in the way that the
head is continuous with the neck, which is continuous with the shoulders. It is attached
to bundles of nerves, and networks of arteries and veins, and broad bands of ligaments
such as round ligaments, cardinal ligaments, broad ligaments, and uterosacral
[1]
ligaments.
The uterus is essential in sexual response by directing blood flow to the pelvis and to the
external genitalia, including the ovaries, vagina, labia, and clitoris. The uterus is needed
for uterine orgasm to occur.
The reproductive function of the uterus is to accept a fertilized ovum which passes
through the utero-tubal junction from the fallopian tube. It then becomes implanted into
theendometrium, and derives nourishment from blood vessels which develop exclusively
for this purpose. The fertilized ovum becomes an embryo, attaches to a wall of the
uterus, creates a placenta, and develops into a fetus (gestates) until childbirth. Due to
anatomical barriers such as the pelvis, the uterus is pushed partially into the abdomen
due to its expansion during pregnancy. Even during pregnancy the mass of a human
uterus amounts to only about a kilogram (2.2 pounds).
Anatomy
The uterus is located inside the pelvis immediately dorsal (and usually somewhat rostral)
to the urinary bladder and ventral to the rectum. The human uterus is pear-shaped and
about 3 in. (7.6 cm) long. A female's uterus can be divided anatomically into four
segments: The fundus, corpus, cervix and the internal os.
Regions
• Fundus (uterus)
The cervix is the lower most part of the uterus and is made up of strong muscles. It also
provides support to the uterus due to attachment of muscles from the pelvic bone. The
cervix protrudes and opens through a canal into the vagina. The function of the cervix is
to allow flow of menstrual blood from the uterus into the vagina, and direct the sperms
into the uterus during intercourse.
The opening of the cervical canal is normally very narrow. However under the influence
of the body hormones and the pressure from the fetal head, this opening widens to
about 4 inches (10 cm.) during labor, to allow the birth of a baby. If the opening is loose,
as observed in some women, it can lead to miscarriages during pregnancy.
• Endocervical canal
• Ectropion
Transformation Zone
• From True (proximal) to Original (distal) SCJ
• Where premalignant changes and neoplasia occur
• Encompasses Immature and mature squamous metaplasia
•
• True Squamocolumnar junction
• Upper or proximal limit of squamous metaplasia
• Usually not visualized
• Within endocervical canal
• Approximately 3 cm from observed SCJ
• Immature Squamous metaplasia
• Observed Squamocolumnar Junction
•
•
I. Squamous Epithelium Landmarks (Vagina)
• Mature squamous metaplasia
• Nabothian cysts/follicles are in this area
•
• Original Squamocolumnar Junction
• Squamous epithelium
• Ectocervix
PATHOPHYSIOLOGY
pregnant not
pregnant
Abnormal uterine bleeding — Excessive uterine bleeding, called menorrhagia, can lead
to anemia (low blood iron count), fatigue, and contribute to missed days at work or
school. Menorrhagia is generally defined as bleeding that lasts longer than seven days
or saturates more than one pad per hour for several hours.
Heavy or irregular bleeding are generally treated first with medication or other surgical
alternatives to hysterectomy. (See "Patient information: Menorrhagia (excessive
menstrual bleeding)".) However, abnormal uterine bleeding that does not improve with
conservative treatments may require hysterectomy.
Pelvic organ prolapse — Pelvic organ prolapse occurs due to stretching and weakening
of the pelvic muscles and ligaments. This allows the uterus to fall (or prolapse) into the
vagina. Prolapse is more common in women who have been pregnant, had vaginal
childbirth, and in those with certain genetic factors, lifestyle factors (repeated heavy
lifting over the lifetime), or chronic constipation.
Severe bleeding after childbirth — Hysterectomy may rarely be required in women who
have uncontrollable bleeding after childbirth.
Chronic pelvic pain — Chronic pelvic pain can be due to the effects of endometriosis or
scarring (adhesions) in the pelvis and between pelvic organs. However, pelvic pain can
also be caused by other sources, including the gastrointestinal and urinary systems.
(See "Patient information: Chronic pelvic pain in women".) It is important for a woman
with pelvic pain to ask about the probability that her pain will improve after hysterectomy.
Instrumentation
• 2 - 46118P Malleable 1” x 4”
• 2 - 46118 Malleable 1” x 8”
• 2 - 46122 Malleable 2” x 8”
• 1 - 46174 Deaver 2” x 5”
• 1 - 46180 Heany 1” x 4”
• 1 - 46160 Harrington 2” x 6”
• 2 - 46663 Double Angled 1/2” x 2”
• 1 - 46135 Fence 4” x 5”
• 1 - 46150 Richardson 2” x 4”
• 2 - 46143 Fenestrated 1” x 3”
Nursing Management
• Assess perceived impact of change on activities of daily living (ADLs), social behavior,
personal relationships, and occupational activities.
• Help patient identify actual changes. Patients may perceive changes that are not present
or real, or they may be placing unrealistic value on a body structure or function.
• Assist patient in incorporating actual changes into ADLs, social life, interpersonal
relationships, and occupational activities. Opportunities for positive feedback and
success in social situations may hasten adaptation.
• Teach patient about the normalcy of body image disturbance and the grief process.
• Teach patient adaptive behavior (e.g., use of adaptive equipment, wigs, cosmetics,
clothing that conceals altered body part or enhances remaining part or function, use of
deodorants). This compensates for actual changed body structure and function.
• Help patient identify ways of coping that have been useful in the past. Asking patients to
remember other body image issues (e.g., getting glasses, wearing orthodontics, being
pregnant, having a leg cast) and how they were managed may help patient adjust to the
current issue.
• Refer patient and caregivers to support groups composed of individuals with similar
alterations.
DRUG STUDY
NIFEDIPINE
CLASSIFICATION: Antianginals
INDICATION: Vasopastic angina, classic chronic stable angina pectoris
CONTRAINDICATION: contraindicated in patients hypertensive to drugs
ADVERSE EFFECTS: dizziness, light- headedness, somnolence, headache, weakness,
syncope, nervousness
MODE OF ACTION: thought to inhibit calcium ion influx across cardiac and smooth
muscle cells, decreasing contractility and oxygen demand. Also may dilate coronary
arteries and arterioles.
PATIENT TEACHING:
-tell patient that chest pain may occur or may worsen briefly when beginning drug or
when dosage increased
-instruct patient to swallow extended release tablets without breaking, crushing, or
chewing them
-advise patient to avoid taking drug with grape fruit juice
VITAMIN K
KETOROLAC
CLASSIFICATION: NSAID
INDICATION: short term management of moderately severe acute pain for single dose
treatment
CONTRAINDICATION: contraindicated as prophylactic analgesic before surgery or
intraoperatively when homeostasis is critical and in patients currently recieing aspirin,
NSAID or probenecid.
ADVERSE EFFECTS: drowsiness, sedation, dizziness, headache
MODE OF ACTION: may inhibit prostaglandin synthesis to produce anti- inflammatory,
analgesic, and anti pyretic effects
PATIENT TEACHING:
-correct hypovolemia before giving
-carefully observe patients with coagulopathies and those taking anticoagulants
-NSAID may mask signs and anti inflammatory actions
TRAMADOL HCl
Reference:
Website:
http://findarticles.com/p/articles/mi
http://www.allbusiness.com/health-care-social-assistance/nursing-residential/
http://www.google.com.ph/
https://profreg.medscape.com/px/getlogin.do
www. scribd.com
www.answer.com