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vagina above the hymen stage II - as descent to the hymen stage III - as descent beyond the hymen stage IV - as total eversion or procidentia
Uterine prolapse always is accompanied by some degree of vaginal wall prolapse..
Assessment
A complete pelvic examination is required, including a
rectovaginal examination to assess sphincter tone. A Sims speculum or a standard bivalve speculum with the anterior blade removed may facilitate diagnosis. Physical findings may be enhanced by having the patient strain during the examination or by having her stand or walk prior to examination. Standing with an empty bladder may result in a 1-2 stage difference in the degree of prolapse noted on examination when compared to a supine position with a full bladder. Mild uterine prolapse may be recognized only when the patient strains during the bimanual examination.
Loss of rugae in the vaginal mucosa Decreased secretions Thin perineal skin Easy perineal tearing Physical examination should also be directed toward ruling out serious conditions that may rarely be associated with uterine prolapse, such as infection, urinary outflow obstruction with renal failure, and hemorrhage. If urinary obstruction is present, the patient may exhibit suprapubic tenderness or a tympanitic bladder. If infection is present, purulent cervical discharge may be noted.
Lab Studies
Laboratory studies are
Imaging Studies
unnecessary in uncomplicated cases. Cervical cultures - cases complicated by ulceration or purulent discharge Papanicolaou test (Pap smear cytology) or biopsy - in rare cases of suspected carcinoma BUN and creatinine measurement - if PE findings suggest urinary obstruction
Pelvic ultrasound
Pelvic heaviness or pressure Protrusion of tissue: A patient who reports of a "bulge" has been
found to be a valuable screening tool for the detection of pelvic organ prolapse (81% PPV, 76% NPV). Pelvic pain Sexual dysfunction, including dyspareunia, decreased libido, and difficulty achieving orgasm Lower back pain Constipation Difficulty walking Difficulty urinating Urinary frequency Urinary urgency Urinary incontinence Nausea Purulent discharge (rare) Bleeding (rare) Ulceration (rare)
Pathophysiology
Age Race (Hispanic) Pelvic structure (Anthropoid) Uterine structure Lifestyle (occupation) Multiparus Menopause
Obstetrical trauma
Uterine prolapse
GI: Dysuria Constipation Urinary frequency Nausea & vomiting Urinary incontinence Urinary urgency Integumentary: Protrusion of tissue ulceration
Stage I (descent to any point of the vagina above the hymenal remnants)
Stage III (descent beyond the hymen) Circulatory: Bleeding Stage IV (total eversion or procidentia)
Complications:
Treatment/Medical Mngt:
Pessaries
+ fitted into the vagina to hold the uterus in place + temporary or permanent form + fitted individually for each woman + attaining and maintaining optimal weight is recommended
Surgery
+ uterus sutured back into place &
+ colpopexy - involves the use of surgical mesh for supporting the uterus
+ hysterectomy removal of uterus
Nursing management:
preventive measures:
Early visits to HC provider = early detection Teach Kegels exercises during PP period
on future sexual f(x) Laxative and cleansing edema (rectocele) independently, at home a day prior procedure Perineal shave prescribed also Lithotomy position for surgery
NURSING
Pain
Administer analgesic as
prescribed. Provide comfort measures such as backrub. Provide diversional activities such as guided imagery and
Constipation
Administer stool
softeners/laxatives as prescribed. Encourage increase in fluid and fiber intake. Encourage early ambulation.
Urinary Incontinence
Determine if client is aware of
incontinence. Developmental issues/ medical conditions that can impair patients awareness and sensory perception of voiding. Determine patients particular symptoms (e.g. continuous dribbling). Implement bladder training for incontinence management by providing ready acces to bathroom or commode, encouraging adequate fluid intake, and establishing voiding/bladder emptying.
Sexual dysfunction
o Provide factual information about
individual condition involved to promote informed decision making. o Provide for ways to obtain privacy to allow for sexual expression for individual and/or between partners with out embarrassment and/or objection of others. o Establish therapeutic nurse-client relationship to promote treatment and facilitate sharing of sensitive information.
infection. Note for signs and symptoms for sepsis. Stress proper hand hygiene.