内膜异位护理普本护理.ppt

内膜异位内膜异位内膜异位内膜异位护护理普本理普本理普本理普本护护理理理理内膜异位内膜异位护理普本理普本护理理Aims and demands Aims and demands Aims and demands Aims and demands n nTo master the definition of endometriosis and its typical clinical manifestation.To master the definition of endometriosis and its typical clinical manifestation.To master the definition of endometriosis and its typical clinical manifestation.To master the definition of endometriosis and its typical clinical manifestation.n nTo know well about the main treatments for endometriosis and the main nursing To know well about the main treatments for endometriosis and the main nursing To know well about the main treatments for endometriosis and the main nursing To know well about the main treatments for endometriosis and the main nursing interventions.interventions.interventions.interventions.n nTo understand the pathology of endometriosis.To understand the pathology of endometriosis.To understand the pathology of endometriosis.To understand the pathology of endometriosis.3What is endometriosisWhat is endometriosis4 Definition Definition Definition Definition Endometriosis Endometriosis Endometriosis Endometriosis is is is is a a a a disorder disorder disorder disorder in in in in which which which which abnormal abnormal abnormal abnormal growths growths growths growths of of of of tissue tissue tissue tissue,histologically,histologically,histologically,histologically resembling the endometrium are present in locations outside the uterine cavity.resembling the endometrium are present in locations outside the uterine cavity.resembling the endometrium are present in locations outside the uterine cavity.resembling the endometrium are present in locations outside the uterine cavity.5Which locations Which locations The most common location is _.The most common location is _.6Figure 7.1 shows the sites at which endometriosis may Figure 7.1 shows the sites at which endometriosis may Figure 7.1 shows the sites at which endometriosis may Figure 7.1 shows the sites at which endometriosis may occur.occur.occur.occur.7It is influnced by the action of It is influnced by the action of oovarion hormones.oovarion hormones.It is often found in 25-45 reproductive age women and normally not seen before menarche or It is often found in 25-45 reproductive age women and normally not seen before menarche or after menopause.after menopause.The incidence of it is about 10-15%.The incidence of it is about 10-15%.8whywhy9Endometriosis is a benign disease,the cause of it is still uncertain.Endometriosis is a benign disease,the cause of it is still uncertain.10 Etiology Etiology Etiology Etiology1.Implantation of viable Endometrial cells theory 1.Implantation of viable Endometrial cells theory 1.Implantation of viable Endometrial cells theory 1.Implantation of viable Endometrial cells theory(1)retrograde menstruation theory(1)retrograde menstruation theory(1)retrograde menstruation theory(1)retrograde menstruation theory(2)implantation from medical infection2)implantation from medical infection(2)implantation from medical infection(2)implantation from medical infection2.lymphatic and vascular metastasis 2.lymphatic and vascular metastasis 2.lymphatic and vascular metastasis 2.lymphatic and vascular metastasis 3.Coelomic metaplasia theory 3.Coelomic metaplasia theory 3.Coelomic metaplasia theory 3.Coelomic metaplasia theory 4.Immune system morbidity theory4.Immune system morbidity theory4.Immune system morbidity theory4.Immune system morbidity theory11How can we recogniaze Endometriosis How can we recogniaze Endometriosis 12 Pathology Pathology Pathology Pathologyn nThere are two basic features:There are two basic features:There are two basic features:There are two basic features:n n1.cyclic bleeding in the endometriotic site accompanied by the ovarian cycle.1.cyclic bleeding in the endometriotic site accompanied by the ovarian cycle.1.cyclic bleeding in the endometriotic site accompanied by the ovarian cycle.1.cyclic bleeding in the endometriotic site accompanied by the ovarian cycle.n n2.surrounded by a zone of fibrosis and contracture or“puckering”.2.surrounded by a zone of fibrosis and contracture or“puckering”.2.surrounded by a zone of fibrosis and contracture or“puckering”.2.surrounded by a zone of fibrosis and contracture or“puckering”.131415161718Microscopic changes:Microscopic changes:Microscopic changes:Microscopic changes:n nThe classic microscopic picture of endometriosis consists of The classic microscopic picture of endometriosis consists of The classic microscopic picture of endometriosis consists of The classic microscopic picture of endometriosis consists of：n nendometrial glandsendometrial glandsendometrial glandsendometrial glandsn nendometrial stroma endometrial stroma endometrial stroma endometrial stroma n nhemosiderin-laden macrophages hemosiderin-laden macrophages hemosiderin-laden macrophages hemosiderin-laden macrophages n nsurrounding inflammatory cells and fibrosissurrounding inflammatory cells and fibrosissurrounding inflammatory cells and fibrosissurrounding inflammatory cells and fibrosis19diagnose diagnose 20historyhistoryhistoryhistory general data ,menstrual history,general data ,menstrual history,general data ,menstrual history,general data ,menstrual history,reproductive history,surgical historyreproductive history,surgical historyreproductive history,surgical historyreproductive history,surgical historycontraception history,contraception history,contraception history,contraception history,abnormal development of reproductive organs,abnormal development of reproductive organs,abnormal development of reproductive organs,abnormal development of reproductive organs,the treatment,the effect and so on.the treatment,the effect and so on.the treatment,the effect and so on.the treatment,the effect and so on.21Clinical manifestation Clinical manifestation 22Physical assessmentPhysical assessmentPhysical assessmentPhysical assessmentn n1.Symptoms1.Symptoms1.Symptoms1.Symptomsn n(1)pain(1)pain(1)pain(1)painn nPain is the most common symptom.It is mostly characterized by secondary and Pain is the most common symptom.It is mostly characterized by secondary and Pain is the most common symptom.It is mostly characterized by secondary and Pain is the most common symptom.It is mostly characterized by secondary and progressive dysmenorrhea(progressive dysmenorrhea(progressive dysmenorrhea(progressive dysmenorrhea(痛经痛经痛经痛经,cyclic pain in phase with menses).It can also,cyclic pain in phase with menses).It can also,cyclic pain in phase with menses).It can also,cyclic pain in phase with menses).It can also cause dyspareunia(cause dyspareunia(cause dyspareunia(cause dyspareunia(性交痛，性交痛，性交痛，性交痛，pain during or following interourse),chronic pain during or following interourse),chronic pain during or following interourse),chronic pain during or following interourse),chronic pelvic pain(pelvic pain(pelvic pain(pelvic pain(慢性盆腔痛慢性盆腔痛慢性盆腔痛慢性盆腔痛)and low back pain()and low back pain()and low back pain()and low back pain(腰背部痛腰背部痛腰背部痛腰背部痛).an acute abdominal emergency).an acute abdominal emergency).an acute abdominal emergency).an acute abdominal emergency n n(2)dysfunctional menstruation(2)dysfunctional menstruation(2)dysfunctional menstruation(2)dysfunctional menstruationn nAbout 15-30%of patients manifest as excessive menstruation,premenstrual About 15-30%of patients manifest as excessive menstruation,premenstrual About 15-30%of patients manifest as excessive menstruation,premenstrual About 15-30%of patients manifest as excessive menstruation,premenstrual spotting,or prolonged menses.spotting,or prolonged menses.spotting,or prolonged menses.spotting,or prolonged menses.n n(3)infertility(3)infertility(3)infertility(3)infertilityn novarian adhesions may prevent release of the ovum from the follicle ovarian adhesions may prevent release of the ovum from the follicle ovarian adhesions may prevent release of the ovum from the follicle ovarian adhesions may prevent release of the ovum from the follicle n npelvic adhesions may prevent the ovum from entering the fallopian tube;pelvic adhesions may prevent the ovum from entering the fallopian tube;pelvic adhesions may prevent the ovum from entering the fallopian tube;pelvic adhesions may prevent the ovum from entering the fallopian tube;n n(4)other special symptoms(4)other special symptoms(4)other special symptoms(4)other special symptomsn npainful urination,bloody urine or bloody stools.painful urination,bloody urine or bloody stools.painful urination,bloody urine or bloody stools.painful urination,bloody urine or bloody stools.23n n2.Signs2.Signs2.Signs2.Signsn nThese implants usually are nodular,firm,fixed,and discrete and are especially These implants usually are nodular,firm,fixed,and discrete and are especially These implants usually are nodular,firm,fixed,and discrete and are especially These implants usually are nodular,firm,fixed,and discrete and are especially sensitive during menstruation.When we examine,the patient maybe feel sensitive during menstruation.When we examine,the patient maybe feel sensitive during menstruation.When we examine,the patient maybe feel sensitive during menstruation.When we examine,the patient maybe feel tenderness.However,many patients have no abnormal findings on physical tenderness.However,many patients have no abnormal findings on physical tenderness.However,many patients have no abnormal findings on physical tenderness.However,many patients have no abnormal findings on physical examination.examination.examination.examination.24Diagnostic testsDiagnostic tests25Special examinationsSpecial examinationsSpecial examinationsSpecial examinationsn n1.ultrasonic scanning1.ultrasonic scanning1.ultrasonic scanning1.ultrasonic scanningn n2.CA125 measurement 2.CA125 measurement 2.CA125 measurement 2.CA125 measurement n n3.laparoscopy3.laparoscopy3.laparoscopy3.laparoscopy26MethodsMethodsTreatment focus on arresting the progression of the disease,symptom control,and Treatment focus on arresting the progression of the disease,symptom control,and preservation of fertility(if desired).preservation of fertility(if desired).27TreatmentTreatmentTreatmentTreatment1.Expectant management1.Expectant management1.Expectant management1.Expectant managementIf the patient has no symptom If the patient has no symptom If the patient has no symptom If the patient has no symptom，there is no need to insist on anythere is no need to insist on anythere is no need to insist on anythere is no need to insist on anytreatment,but the patient should be examined periodically.treatment,but the patient should be examined periodically.treatment,but the patient should be examined periodically.treatment,but the patient should be examined periodically.2.Hormonal therapy2.Hormonal therapy2.Hormonal therapy2.Hormonal therapyThe basis of hormonal methods treating endometriosis is the suppressionThe basis of hormonal methods treating endometriosis is the suppressionThe basis of hormonal methods treating endometriosis is the suppressionThe basis of hormonal methods treating endometriosis is the suppressionof cyclical ovarian function and avoiding menstruation.(progestins,androgen-of cyclical ovarian function and avoiding menstruation.(progestins,androgen-of cyclical ovarian function and avoiding menstruation.(progestins,androgen-of cyclical ovarian function and avoiding menstruation.(progestins,androgen-danazol ,Gonadotropin-releasing hormone-Diphereline)danazol ,Gonadotropin-releasing hormone-Diphereline)danazol ,Gonadotropin-releasing hormone-Diphereline)danazol ,Gonadotropin-releasing hormone-Diphereline)(1)Pseudopregnancy (1)Pseudopregnancy (1)Pseudopregnancy (1)Pseudopregnancy (2)Pseudomenopause(2)Pseudomenopause(2)Pseudomenopause(2)Pseudomenopause 3.Surgical treatment3.Surgical treatment3.Surgical treatment3.Surgical treatmentAccording to the operation range,it can be divided into conservative surgery and According to the operation range,it can be divided into conservative surgery and According to the operation range,it can be divided into conservative surgery and According to the operation range,it can be divided into conservative surgery and curative surgery.At the same time,medication may be used 2-3 months before curative surgery.At the same time,medication may be used 2-3 months before curative surgery.At the same time,medication may be used 2-3 months before curative surgery.At the same time,medication may be used 2-3 months before or after the operation to improve the therapy effect.or after the operation to improve the therapy effect.or after the operation to improve the therapy effect.or after the operation to improve the therapy effect.28How can we do How can we do as a nurseas a nurse29Psychosocial assessmentPsychosocial assessmentPsychosocial assessmentPsychosocial assessmentn n the patients feeling the patients feeling the patients feeling the patients feeling n nsocial support of the patient social support of the patient social support of the patient social support of the patient n nthe stress the stress the stress the stress n ncoping stylecoping stylecoping stylecoping style30Nursing diagnosisNursing diagnosisNursing diagnosisNursing diagnosisn nPain related to the abnormal endometrium replantedPain related to the abnormal endometrium replantedPain related to the abnormal endometrium replantedPain related to the abnormal endometrium replantedn nKnowledge deficit related to ignorance of the disease and its management Knowledge deficit related to ignorance of the disease and its management Knowledge deficit related to ignorance of the disease and its management Knowledge deficit related to ignorance of the disease and its management n nSex function disturbance related to the intercourse painSex function disturbance related to the intercourse painSex function disturbance related to the intercourse painSex function disturbance related to the intercourse painn nSelf-esteem disturbance related to infertilitySelf-esteem disturbance related to infertilitySelf-esteem disturbance related to infertilitySelf-esteem disturbance related to infertilityn nFear related to the prognosis of endometriosis Fear related to the prognosis of endometriosis Fear related to the prognosis of endometriosis Fear related to the prognosis of endometriosis 31Nursing interventionsNursing interventionsNursing interventionsNursing interventions1.Health education1.Health education1.Health education1.Health education2.Medication nursing 2.Medication nursing 2.Medication nursing 2.Medication nursing 3.Surgery nursing 3.Surgery nursing 3.Surgery nursing 3.Surgery nursing 4.Nursing care of infertility4.Nursing care of infertility4.Nursing care of infertility4.Nursing care of infertility5.Psychological counseling 5.Psychological counseling 5.Psychological counseling 5.Psychological counseling 3233医学资料仅供参考,用药方面谨遵医嘱