子宮肌瘤護(hù)理

Nursingofuterinemyoma

Nursingroundstarget查房目標(biāo)1、Mastertheclassificationandclinicalmanifestationofmyoma掌握子宮肌瘤分類、臨床表現(xiàn)

2、Masterthenursingmeasuresanddischargeguidance掌握護(hù)理措施及出院指導(dǎo)3、withtheprincipleoftreatmentandsurgicalindicationsBefamiliar熟悉治療原則及手術(shù)適應(yīng)癥4、Tounderstandthesecondarydegenerationofuterinefibroids了解

子宮肌瘤的繼發(fā)變性子宮肌瘤二、PATHOGENESIS發(fā)病機(jī)制Feature特點(diǎn)：

1．Afterpubertyoccurs,postmenopausalatrophy青春期后發(fā)生，絕經(jīng)后萎縮

2、Pregnancyorestrogenincreases妊娠或應(yīng)用雌激素增大

3、Multicoexistwithendometrialhyperplasia多與子宮內(nèi)膜增生過長并存

4、Tumorestrogenreceptorlevelsincreased,andestradiolbindingforceincreasedby20%瘤組織中雌激素受體含量增高，與雌二醇的結(jié)合力增加20％。三、CLASSIFICATION分類Palacefibroidsandcervicalfibroids宮體肌瘤和宮頸肌瘤。１、intramuralmyoma（肌壁間肌瘤）60％～70％２、subserousmyoma（漿膜下肌瘤）20％３、Submucosalmyoma（粘膜下肌瘤）10％～15％，宮體肌瘤宮頸肌瘤四、Pathology病理Degenerationofmyoma：（肌瘤變性）Fibroidslosingitstypicalstructure肌瘤失去其原有典型結(jié)構(gòu)

hyalinedegeneration（玻璃樣變）Themostcommon最多見。cysticdegeneration：（囊性變）Secondarytohyalinization繼發(fā)于玻璃樣變。reddegeneration：（紅色變）Morecommoninpregnancyorpostpartum多見于妊娠期或產(chǎn)褥期。sarcomatouschange

（肉瘤變）

degenerationwithcalcification：（鈣化）

ReddegenerationSarcomatouschange鈣化脂肪變五、Clinical

Manifestation臨床表現(xiàn)SYMPTOM（癥狀）1、Changeofmenorrhea（月經(jīng)改變）2、Bellytumor（腹塊）3、Moreleucorrhea(白帶增多)4、Infertility（不孕）20％～40％5、Abdominalpain,backache,abdominalbulge,compressionsymptoms（腹痛、腰酸、下腹墜脹、壓迫癥狀）6、Secondaryanemia(繼發(fā)性貧血)

五、Clinical

Manifestation臨床表現(xiàn)2、Bellytumor（腹塊）Moreintheventralmidline多位于下腹正中

Earlyinthemorningwhenthebladderfillingandeasypalpable清晨膀胱充盈時(shí)易捫及Hardtexture,irregularshape質(zhì)地堅(jiān)硬，形態(tài)不規(guī)則

五、Clinical

Manifestation臨床表現(xiàn)SIGN（體征）Intramuraluterinefibroidsincreases,surfaceirregularities,nodulessense肌壁間肌瘤子宮增大，表面不規(guī)則、有結(jié)節(jié)感Submucosalfibroidsoftheuterusevenincrease,sometimesdilationoftheuterus,fibroidscanbeseeninthecervixorvagina粘膜下肌瘤子宮均勻增大，有時(shí)子宮口擴(kuò)張，在宮口內(nèi)或陰道內(nèi)可見肌瘤Subserosalfibroidscanhithard,sphericalobjectswithathinuterinepedicleconnected漿膜下肌瘤可觸及質(zhì)硬、球狀物與子宮有細(xì)蒂相連

六、診斷B型超聲檢查

六、診斷B型超聲檢查

八、TREATMENT治療Indicationssurgery手術(shù)治療適應(yīng)癥

Thereareobvioussymptoms有明顯的癥狀，Morethanthreemonthsthesizeoffibroids肌瘤超過三個(gè)月大小。Rapidgrowthoffibroids,thereisthepossibilityofmalignanttransformation肌瘤生長迅速，有惡性變之可能。Pedunculatedsubmucosalfibroids,especiallythosewhoareprominentcervix粘膜下肌瘤有蒂，特別是突出宮頸口者。宮頸肌瘤Fibroidstorsionorinfection(butneedtocontrolinflammation)肌瘤有蒂扭轉(zhuǎn)或發(fā)生感染時(shí)（但需先控制炎癥）Notyoungwomengivebirthtoavoidaffectfertility,canbeearlymyomectomy青年婦女尚未生育為避免影響生育，可及早行肌瘤核除術(shù)。Diagnosisisnotclear,theremaybepersonsofovariantumor診斷不明確，有卵巢瘤可能者八、TREATMENT治療Surgicalapproach手術(shù)方式

1、Myomectomysurgery肌瘤切除手術(shù)Laparoscopyorlaparotomyunderdirectvision,canalsoberemovedthroughthevagina腹腔鏡或剖腹直視下進(jìn)行，也可經(jīng)陰道切除。2、Hysterectomy子宮切除手術(shù)Applyto適用于①Largefibroids,symptoms,drugtreatmentineffective肌瘤較大，癥狀明顯，藥物治療無效；②Notpreservefertility不保留生育功能；③Patientswithsuspectedmalignancy疑有惡變的患者。50yearsofage,patientswithnormalovarianappearance,mayretainovary50歲以下，卵巢外觀正常的患者，可保留卵巢。八、TREATMENT治療Uterinearteryembolizationsurgery

子宮動(dòng)脈栓塞手術(shù)九、Nursing護(hù)理Nursingassessment護(hù)理評(píng)估Childbearinghistory,menstrualhistoryhistory,whetherthereisahistoryofabortion,infertility,long-termuseofestrogen,drugtherapy病史月經(jīng)史、婚育史，是否有不孕、流產(chǎn)史、長期服用雌激素、藥物治療Physicalassessment身體評(píng)估

Symptom癥狀：Menstruation,anemiasymptoms,vaginaldischarge,thesizeofthesituation月經(jīng)、貧血癥狀、陰道分泌物、大小便情況；Thereisnoassessmentofbackache,abdominalbulge,abdominalpain評(píng)估有無腰酸、下腹部墜脹、腹痛。Observewhetherthedizziness,weakness觀察有無頭暈、虛弱。Signs體征：Abdominallumpsthesizeandnature腹部塊狀物大小及性質(zhì)；Uterinesize,texture,etc子宮大小、Bsuper,curettageB超、診刮Socialpsychology心理社會(huì)方面：Psychologicalimpact,marriedlife,rolefunction心理影響、夫妻生活、角色功能九、Nursing護(hù)理NursingDiagnosis護(hù)理診斷Infection感染Malnutrition營養(yǎng)失調(diào)Lackofknowledge知識(shí)缺乏Anxiety焦慮Self-imagedisorder自我形象紊亂

九、Nursing護(hù)理Nursinggoal護(hù)理目標(biāo)Infectioncontrol感染得到控制Anemiawascorrected,nutritionalstatusimproved貧血得到糾正，營養(yǎng)狀況改善。Knowledgeofpatientswithuterinefibroidsandtheirhealthcare病人獲得有關(guān)子宮肌瘤及其健康保健知識(shí)。Reducethepatient'sanxiety,increasedphysicalandpsychologicalcomfort患者的焦慮減輕，生理和心理上的舒適感增加Adapttothelifestyle適應(yīng)術(shù)后的生活方式九、Nursing護(hù)理Nursingmeasures護(hù)理措施Psychologicalnursing心理護(hù)理Provideknowledgeofdiseaseandhelppatientsandtheirfamiliestounderstandthedisease.提供疾病知識(shí)，幫助病人及家屬正確認(rèn)識(shí)疾病Emphasizesperiodicreview,thestrictsenseofmedication強(qiáng)調(diào)定期復(fù)查、嚴(yán)格用藥的意義Observationofvaginalsecretions,keepingthevulvacleandried觀察陰道分泌物，保持外陰清潔干燥Conditionobservation,symptomaticcare病情觀察，對(duì)癥護(hù)理Perioperativenursing圍手術(shù)期護(hù)理九、Nursing護(hù)理Preoperativepreparation術(shù)前準(zhǔn)備Skinpreparation備皮Crossmatchingblood合血Perinealdouchevaginallavage,vaginalpacking

會(huì)陰沖洗陰道灌洗上藥、陰道填塞Bowelpreparation腸道準(zhǔn)備Setcathetersurgery術(shù)中置尿管Calmsleep鎮(zhèn)靜入眠Basicanesthetics基礎(chǔ)麻醉藥九、Nursing護(hù)理Postoperativecare術(shù)后護(hù)理Strictshift嚴(yán)格交接班：Anesthesiaandsurgicalprocedures,intraoperativeconditions,medication,etc.麻醉及手術(shù)方式、術(shù)中情況、用藥等Orthostatic體位：Thelattersupinesupine6h平臥6h后半臥位Observationofvitalsigns生命體征觀察:Bodytemperature,pulse,respiration,bloodpressure,bloodoxygensaturation體溫、脈搏、呼吸、血壓、血氧飽和度Observewhetherthebleedingabdominalincision觀察腹部切口有無滲血Holdingvariouspipelinepatency保持各種管路通暢Venousaccess,analgesia,catheter靜脈通路、鎮(zhèn)痛泵、尿管；Observationofurinevolume,drainageandcolorproperties觀察尿量、引流量及顏色性質(zhì)Observevaginalbleeding,perinealcare觀察陰道流血情況，會(huì)陰護(hù)理Earlyactivity,stepbystep盡早活動(dòng)，循序漸進(jìn)Afterfasting6hliquiddiet,butfastingmilk,soymilk,sweetsandsoeasytogas-producingfoods,analtransitiontoanormaldietafterdischarge禁飲食6h后進(jìn)食流質(zhì)飲食，但禁食牛奶、豆?jié){、甜食等易產(chǎn)氣食物，肛門排氣后過渡到普通飲食Complicationobservation并發(fā)癥觀察九、Nursing護(hù)理Complicationnursing并發(fā)癥護(hù)理Bloating,vomiting腹脹、嘔吐Urinaryretention,urinarytractinfections尿潴留、泌