内膜异位护理普本护理

1、endometriosis endometriosis aims and demandsaims and demands nto master the definition of to master the definition of endometriosis and its typical endometriosis and its typical clinical manifestation.clinical manifestation.nto know well about the main to know well about the main treatments for endo

2、metriosis and treatments for endometriosis and the main nursing interventions .the main nursing interventions .nto understand the pathology of to understand the pathology of endometriosisendometriosis .what is endometriosis? definition definition endometriosis is a disorder in endometriosis is a dis

3、order in which abnormal growths of which abnormal growths of tissue ,histologically resembling tissue ,histologically resembling the endometrium are present in the endometrium are present in locations outside the uterine locations outside the uterine cavity .cavity .which locations ?the most common

4、location is _.figure 7.1 shows the sites figure 7.1 shows the sites at which endometriosis may at which endometriosis may occur.occur. it is influnced by the action of oovarion hormones.it is often found in 25-45 reproductive age women and normally not seen before menarche or after menopause . the i

5、ncidence of it is about 10-15%. why?endometriosis is a benign disease ,the cause of it is still uncertain . etiology etiology1.implantation of viable endometrial cells 1.implantation of viable endometrial cells theory theory (1)retrograde menstruation theory(1)retrograde menstruation theory(2)implan

6、tation from medical infection(2)implantation from medical infection2. lymphatic and vascular metastasis 2. lymphatic and vascular metastasis 3.coelomic metaplasia theory 3.coelomic metaplasia theory 4.immune system morbidity theory4.immune system morbidity theoryhow can we recogniaze endometriosis?

7、pathology pathologynthere are two basic features:there are two basic features:1.cyclic bleeding in the 1.cyclic bleeding in the endometriotic siteendometriotic site accompanied by accompanied by the ovarian cycle.the ovarian cycle.2.surrounded by a zone of fibrosis 2.surrounded by a zone of fibrosis

8、 and contracture or “puckering” .and contracture or “puckering” .n nmicroscopic changes :microscopic changes : nthe classic microscopic picture of the classic microscopic picture of endometriosis consists of endometriosis consists of ：nendometrial glandsendometrial glandsnendometrial stroma endometr

9、ial stroma nhemosiderin-laden macrophages hemosiderin-laden macrophages nsurrounding inflammatory cells and surrounding inflammatory cells and fibrosisfibrosisdiagnose ?historyhistory general data , menstrual history ,general data , menstrual history ,reproductive history ,surgical historyreproducti

10、ve history ,surgical historycontraception history ,contraception history ,abnormal development of reproductive abnormal development of reproductive organs,organs,the treatment , the effect and so on .the treatment , the effect and so on .clinical manifestation ?physical assessmentphysical assessment

11、n1.symptoms1.symptomsn(1)pain(1)painnpain is the most common symptom. it is mostly characterized by secondary and progressive dysmenorrhea(痛经,cyclic pain in phase with menses ). it can also cause dyspareunia ( 性交痛，pain during or following interourse ), chronic pelvic pain(慢性盆腔痛)and low back pain(腰背部

12、痛). an acute abdominal emergency ?n(2)dysfunctional menstruation(2)dysfunctional menstruationnabout 15-30% of patients manifest as excessive menstruation , premenstrual spotting , or prolonged menses.n(3)infertility(3)infertilitynovarian adhesions may prevent release of the ovum from the follicle np

13、elvic adhesions may prevent the ovum from entering the fallopian tube; n(4)other special symptoms(4)other special symptomsnpainful urination, bloody urine or bloody stools .n2.signs2.signsnthese implants usually are nodular, firm, fixed, and discrete and are especially sensitive during menstruation.

14、 when we examine , the patient maybe feel tenderness. however , many patients have no abnormal findings on physical examination. diagnostic tests?special examinationsspecial examinationsn1.ultrasonic scanning1.ultrasonic scanningn2.ca125 measurement 2.ca125 measurement n3.laparoscopy3.laparoscopymet

15、hods?treatment focus on arresting the progression of the disease ,symptom control ,and preservation of fertility (if desired). treatmenttreatment1.expectant management1.expectant managementif the patient has no symptom ， there is no need to insist on anytreatment, but the patient should be examined

16、periodically. 2.hormonal therapy2.hormonal therapythe basis of hormonal methods treating endometriosis is the suppressionof cyclical ovarian function and avoiding menstruation. (progestins , androgen-danazol , gonadotropin-releasing hormone -diphereline )(1)pseudopregnancy (1)pseudopregnancy (2)pseu

17、domenopause (2)pseudomenopause 3.surgical treatment3.surgical treatmentaccording 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 or after the operation to improve the therapy effect .how can we do as

18、 a nurse?psychosocial assessmentpsychosocial assessmentn the patients feeling the patients feeling nsocial support of the patient social support of the patient nthe stress the stress ncoping stylecoping stylenursing diagnosisnursing diagnosisnpain related to the abnormal endometrium pain related to the abnormal endometrium replantedreplantednknowledge deficit related to ignorance of knowledge deficit related to ignorance of the disease an