Endoscopic examination
1. Colposcopy
Colposcopy can enlarge the cervical and vaginal mucosa 10 ~ 40 times, and can find atypical epithelium and blood vessels related to cancer in the cervix, so as to select suspicious parts for biopsy, which has certain value for early diagnosis of cervical cancer.
2. Hysteroscopy
Used to explore the causes of primary or secondary infertility caused by abnormal uterine bleeding; It is also used for taking out impacted intrauterine devices and operations such as adhesion and blockage of fallopian tubes.
3. Laparoscopy
You can look directly at whether there is abnormality in bilateral uterine appendages and the shape of the lesion site, and if necessary, you can clamp the lesion tissue for pathological examination. It is often used for gynecological diseases that are difficult to be diagnosed clinically. It is also feasible to apply laparoscopy, tubal drainage, sterilization, ectopic endometrial electrotomy and other preoperative preparation and postoperative care: it is basically the same as the exhaust of laparotomy patients, but shoulder pain and upper abdominal discomfort may occur due to abdominal residual gas, and the end of the bed may be raised, and sexual intercourse is not allowed within 2 weeks after operation.
Puncture of posterior fornix of vagina
Puncture of posterior fornix of vagina is often used for the auxiliary diagnosis of ectopic pregnancy and pelvic effusion. It is helpful for patients to take bladder lithotomy position after urination. Routine disinfection of vulva and vagina, laying sterile towel and placing speculum, fully exposing the posterior vault, disinfecting the center of the posterior vault with iodine, and puncturing 2 ~ 3 cm for suction. No fluid is negative. If there is effusion, take out about 5ml, and pay attention to avoid damaging adjacent organs during puncture. Observe the changes of the condition closely during the operation, and pay attention to whether there is pallor, blood pressure drop and severe abdominal pain. When pulling out the needle, observe whether there is local bleeding. If there is bleeding, wrap it with sterile dry gauze first, and take out the speculum after the bleeding stops.
Class A3 problem
Wang, 24, had normal menstruation for 40 days, vaginal bleeding for 2 days, sudden abdominal pain, nausea, vomiting and syncope. Physical examination: temperature 36.4℃, pulse 120 beats/min, blood pressure 10.7/6.7kPa(80/50mmHg), pale and miserable. Shuanghe Town:
1. According to the patient's condition, the most appropriate method for further diagnosis of this patient is (E).
A. Pregnancy examination B. Ultrasound examination C. Blood routine D. Colposcopy E. Puncture of posterior fornix of vagina
2. Which patient's nursing measures are wrong (B)
A. Cooperate with the rescue B. Prepare for vaginal surgery C. Keep warm D. Take oxygen E. Lie flat by the pillow.
The patient, a 29-year-old female, complained of sudden severe pain in the right lower abdomen with vaginal drip bleeding for half a day. She was rushed to the hospital and asked about her medical history. She stopped menstruating for 40 days, got married for 5 years, lived with her husband and wife, didn't use contraception, and never got pregnant. Her blood pressure is13.3/6.7kpa (10/50mmhg). The total number of white blood cells was 8 × 109/L (8000 /mm3), and the neutrality was 0.7 (70%). There is a little dark red blood in the vagina, the cervical pain is obvious, the posterior vault is full, and the uterine palpation is not satisfactory.
3. The greatest possibility of diagnosis is (b)
A. threatened abortion B. inevitable abortion C. tubal pregnancy rupture D. appendicitis E. overdue abortion
4. The main method to diagnose this kind of patient is (D)
A. pregnancy test B. hemoglobin C. cervical mucus test D. posterior fornix puncture E. abdominal examination
5. In patient care, the mistake is (e)
A. closely observe blood pressure, pulse and breathing. The patient immediately took a semi-recumbent position.
C. Observe the change of body temperature D. Prepare blood transfusion immediately E. Prepare enema immediately.
Nursing care of postpartum hemorrhage
1. general care: ensure adequate sleep, strengthen nutrition, give a high-calorie diet, eat more foods rich in iron, and eat more meals; Encourage getting out of bed after the condition is stable, and the activity should be gradually increased; Assisting pregnant women to breastfeed can stimulate uterine contraction, which is beneficial to lochia discharge.
2. Psychological nursing: Nurses should have a strong sense of responsibility and compassion, listen to patients' complaints patiently, give psychological support, inform the parturient of their own illness, increase their understanding of the illness, make patients feel warm and increase their confidence in recovery. Satisfy patients' reasonable requirements, such as touching or wiping sweat, and at the same time teach lying-in women some relaxation therapy, let them participate in taking care of the baby, communicate with the baby and distract their attention. Correct their misunderstanding of bleeding at any time, eliminate their worries and fears, and improve the confidence of patients.
3. Prevention of infection: keep the environment clean, ventilate indoors for 30 minutes, twice a day, and disinfect regularly; Keep the sheets clean, flat and dry, change sanitary napkins frequently, and keep the perineum clean. Wash the perineum with 1‰ bromogeramine twice a day, and use antibiotics according to the doctor's advice.
Nursing routine of acute pelvic inflammatory disease
(1) according to the gynecological routine nursing.
(2) Bedrest in semi-recumbent position is beneficial to the accumulation of pus cavity and the depression of uterus and rectum, thus limiting inflammation.
(3) Physical cooling is adopted in case of high fever.
(4) Try to avoid all kinds of unnecessary inspections, so as not to cause the spread of inflammation.
(5) Closely observe the changes of T, P, R and BP, and make records.
(6) Observe the condition closely, report to the doctor in time if there is any change, and prepare for the rescue.
Management of cervical cancer
1. Nursing before treatment
(1) Psychological nursing
Psychological nursing often plays a very important role in patients. Patients with cervical cancer have complex psychology, fear, anxiety, pain, long-term suffering from illness, abandonment by their husbands and even death. They have high expectations for treatment, and expect symptoms to be relieved or even cured after treatment. Therefore, we should take the initiative to care for patients, introduce the status quo of cervical cancer treatment to patients and their families, encourage patients to express their feelings, understand their fears, briefly explain their possible feelings, and guide patients to learn how to talk and calm themselves down, such as taking a deep breath, listening to music, comforting themselves, practicing Qigong and Tai Ji Chuan. And it is best to express your feelings by curing patients. I am too afraid of cancer. Patients can get good results. And enlighten patients to face reality, treat diseases correctly, eliminate fear and anxiety, and actively cooperate with treatment.
(2) Nursing care of radiotherapy
① Nursing care of external radiotherapy
Explain the necessity and possible side effects of radiotherapy to patients, explain the treatment process and matters needing attention, keep the skin in the irradiated field clean and pay attention to the skin reaction; Pay attention to whether there are anorexia, nausea, vomiting, abdominal pain, vaginal bleeding and other symptoms; Observe the changes of urine volume, and pay attention to the changes of frequent urination, urgency, dysuria, defecation habits or defecation characteristics.
② Keep the vagina clean.
Vaginal irrigation before gynecological malignant tumor can prevent preoperative and postoperative infection; In the course of treatment, washing vagina can remove tumor necrosis tissue and secretion in vagina in time, prevent vaginal adhesion and reduce local inflammatory reaction. Moreover, vaginal administration after washing has a good therapeutic effect on vaginal and cervical inflammation. Vaginal irrigation is the use of irrigation device, through the pressure of water level difference, the prepared irrigation solution is input into the vagina for repeated irrigation, and at the same time, the position of the speculum is rotated to rinse the whole vagina and posterior fornix. Thoroughly irrigate vagina 1 time every day to improve the therapeutic effect of tumor and reduce the occurrence of complications.
2. The cooperation of afterloading therapy
(1) 30 minutes before the treatment, instruct the patient to empty the urine, thoroughly clean the vagina once, assist the patient to take the lithotomy position, put on special pants, spread a hole towel to disinfect the perineum, and fully expose the vagina and uterus with a vaginal dilator. Assist doctors in vaginal, cervical and fornix application. Fill the source with gauze and fix it with adhesive tape to prevent it from falling off. If cervical cancer is infected with too much pus, prepare 3 ~ 4 cotton balls and scrub them with 3% hydrogen peroxide. Simulate the positioning, shoot the positioning film, connect the connector of the applicator, observe whether the applicator is fixed again, and start the treatment.
(2) After the treatment, assist the doctor to take out the applicator and dressing, and observe whether there is bleeding and gauze residue in the patient's vagina.
(3) The irradiation site of afterloading therapy is mainly aimed at cervix, uterus, vagina and tissues around uterus, and the early radiation reaction causes inflammation and ulcer of local mucosal tissues. Manifested as abdominal pain, falling, burning sensation and other radioactive inflammatory reactions in rectum, bladder and vagina, anti-inflammatory and analgesic drugs can be put into anus. Vulvitis can be treated with borneol starch for external application to diminish inflammation and relieve itching. In addition, complications such as radiation vaginitis, cervical adhesion, uterine cavity effusion, empyema and so on. Not only during radiotherapy, but also after radiotherapy. Therefore, patients with gynecological tumors should continue vaginal irrigation from 6 months to 12 months after radiotherapy to keep the perineum clean and prevent infection.
3. Observation and nursing of complications
(1) Radiodermatitis
Keep the skin of the patient's pelvis, sacrococcygeal region and perineum clean, wear loose cotton underwear and keep the skin of radiation field dry. During the treatment, erythema, exfoliation and itching were externally applied with calamine lotion, and skin ulcer was externally applied with MEBO.
(2) radiation vaginitis and proctitis
Observe whether the patient has symptoms of bladder irritation such as frequent urination, urgency, dysuria, hematuria, dysuria, and symptoms and signs such as changes in defecation habits, increased frequency, loose stool, and lower abdominal pain. And promptly report to the doctor for treatment, and instruct patients to drink more water, 2000~3000ml per day, and wipe the vagina once a day to reduce the occurrence of radiation vaginitis.
Health knowledge of obstetrics and gynecology
1, give up abusing antibiotics
Cough, fever, headache and antibiotics? As we all know, antibiotics may inhibit some beneficial bacteria, and mold will take the opportunity to reproduce. Therefore, the use of antibiotics should be cautious.
Step 2 wash underwear separately
Mold can reproduce on the skin surface, gastrointestinal tract, nails and other places. If family members or themselves suffer from tinea pedis, onychomycosis, etc. It is easy to cause cross infection of mold. So underwear must be washed separately.
3. Avoid excessive cleaning
Often use acidic gynecological cleaning disinfectants, disinfection pads, etc. It is easy to produce a humid and acidic environment that breeds mold. Gynecological cleaning products with weak alkali formula are more suitable for daily cleaning and maintenance.
4. Pay attention to nursing during pregnancy.
During pregnancy, the levels of sex hormones, glycogen and acidity in vagina will increase, which is easy to be attacked by mold. For pregnant women, oral drugs should not be used, and local prevention and adjuvant treatment should be chosen.
Step 5 be wary of washing machines
Almost every washing bucket contains mold! And the more washing machines are used, the more molds there are! But don't worry, there is a killer to deal with the mold in the washing machine: just wash the washing bucket with hot water at about 60℃!
6. Pay attention to public health.
There may be many molds hidden in public places. When going out, don't use the hotel bathtub, wear long pajamas, use toilet paper before going to the toilet, and so on. At the same time, choose the appropriate personal cleaning care products.
7. Correct contraception
Estrogen in birth control pills can promote the invasion of mold. If fungal vaginitis recurs, try not to use drugs for contraception.
8. Peer governance
If you are infected with fungal vaginitis, it is not only you who need treatment, but also you who need treatment, in order to have the expected curative effect.
9. Wear cotton underwear
Tight-fitting chemical fiber underwear will increase the temperature and humidity of vagina, which is a "living" environment for molds to clap their hands! Choose cotton underwear!
10, control blood sugar, and clean vulva with alkaline products.
The content and acidity of vaginal glycogen in female diabetic patients are high, which is easy to be invaded by mold. Therefore, while controlling blood sugar, we should also pay attention to cleaning vulva and choose products with weak pH value.