NUR 2502 NUR2502 MULTIDIMENSIONAL CARE III MDC 3 EXAM 1 STUDY GUIDE LATEST 2022/ 2023 RASMUSSEN

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NUR 2502 NUR2502: MULTIDIMENSIONAL CARE III / MDC 3 EXAM 1 STUDY GUIDE LATEST 2021/ 2022 RASMUSSEN UTERINE LEIOMYOMA WHAT IS IT? ▪ Uterine leiomyomas, also known as a uterine fibroids ▪ Common... benign tumors of smooth muscle cells or myometrium. ▪ Composed of smooth muscle that is replaced by fibrous (collagen and fibronectin) connective tissue ▪ Growth is promoted by estrogen ▪ Estrogen is the most important stimulus for leiomyoma growth ▪ Recent findings suggest that volume and growth of myomas are also heavily progesterone dependent ▪ Distinct, firm and round ▪ Often occur in groups ▪ Classified according to location ▪ Intramural - within the muscular wall of uterus ▪ Subserous –on the outside surface of uterus ▪ Submucosal – on the inside of the uterus lining ▪ May be attached by stem, increased risk to torsion or infection) ▪ Can be located in cervix, or within ligaments ▪ Can detach from uterus, feeds of blood supply from abdominal organs RISK FACTORS ▪ 30 to 50 % of women over 30 years old have leiomyomas ▪ African Americans have 3 to 4 times higher chances of development when compared to Caucasian women, in AA women, fibroids develop at earlier ages ▪ Family history has a three fold risk ▪ Obesity, which is possibly due to the association between obesity and high circulating estrogen levels ▪ Hypertensive women have a fivefold increase for diagnosis ▪ Intake of food additives and soybean increase risk; soybean has a 2.5 fold increase ▪ Consumption of red meat increases risk for fibroids ▪ Higher parity is associated with a reduced risk (80% reduction with 3 or more deliveries) ▪ 3 to 5x more common in premenopausal women than postmenopausal women ▪ Women who began taking oral contraceptives before the age of 16 are at a greater risk ▪ However, using progestin-only contraceptives is associated with a reduced risk of fibroids. SYMPTOMS ▪HISTORY ▪ In non pregnant women these are typically asymptomatic ▪ If symptoms are present ▪ frequent urination, urinary incontinence, hydronephrosis, tenesmus, constipation, dysmenorrhea, bleeding between periods, pelvic pressure or menorrhagia ▪ Infertility may be caused by leiomyoma due to distortion of uterine cavity ▪ May cause miscarriage by 2 nd month ▪ Increase in growth in pregnancy DIAGNOSIS ▪ Physical exam ▪ Discovered by pelvic examination ▪ Enlarged, irregular firm, non tender uterus ▪ Ultrasound ▪ Excludes pregnancy due to uterine enlargement ▪ Hypoechoic (hypoechoic mass is a lump which appears relatively darker on ultrasound, because it reflects fewer ultrasound waves) ▪ MRI ▪ Best method for mapping and numbering fibroids ▪ Hysteroscopy ▪ Can show number, size and location of tumors ▪ Diagnostic for submucous fibroids ▪ Hemoglobin can show anemia due to excessive bleeding, TREATMENT ▪ Small, asymptomatic leiomyomas not treated, monitored at 6 months intervals ▪ Options range from acupuncture to hysterectomy ▪ Surgical intervention usually not required unless: ▪ Significant pressure is put on adjacent organs(ureters, bladder, bowel) ▪ Significant bleeding leading to anemia ▪ Rapidly growing ▪ Located in the cervix or protruding through cervix ▪ Hysterectomy ▪ Immediately cures symptoms and prevent recurrence ▪ Myomectomy treatment of choice during childbearing years, making future pregnancies possible ▪ They can recur ( 50 to 60 % of pts will have new myomas within 5 years and need another surgical intervention) ▪ Can be laparotomy or performed laparoscopically ( even w robotic approach) TREATMENT ▪ Endometrial ablation ▪ Excludes women with significant myomas ▪ Should only be considered if a t of childbearing age has renounced pregnancy ▪ Quicker recovery ▪ Myolysis ▪ Needle is inserted into fibroid, typically guided by laparoscopy and electric current or freezing is used to destroy the fibroid ▪ Use is limited due to reported cases of uterine rupture ▪ Uterine artery embolization (UAE) and uterine fibroid embolization ▪ Delivers emboli through uterine arteries to block blood supply to leiomyoma vessels ▪ Quicker recovery, safe effective ▪ The best candidates for UAE: ▪ Have fibroids that cause heavy bleeding ▪ Have fibroids that are causing pain/pressing on the bladder or rectum ▪ Do not want a hysterectomy ▪ Don’t want children in the future MEDICATIONS ▪ No definitive medications at this time ▪ Gonadotroin releasing hormone analogues (GnRHa) ▪ Inhibit the production of estrogen in the ovaries, which temporarily slows down the growth of fibroid or causes shrinkage ▪ Can be used prior to myomectomy to shrink down fibroid ▪ Effective in reducing menstrual bleeding and dysmenorrhea ▪ Not suitable for long term due increased risks of osteoporosis ▪ Estrogen is so low that pregnancy is not possible during use ▪ Side effects of GnRH are very similar to those associated with menopause: hot flashes, sweating and vaginal infections ▪ Hormonal IUDs ▪ Release progestin (similar to progesterone, which prevents the lining of the uterus from building up during the menstrual cycle ▪ Only suitable for treating small fibroids ▪ Wont reduce size of fibroid, but can lower the amount of blood lost during menstruation, preventing anemia MEDICATIONS CONTINUED… ▪ Ulipristal acetate (Esmya) ▪ Morning after pill, typically taken after unprotected sex to prevent unwanted pregnancy ▪ Has been approved in lower doses to treat uterine fibroids ▪ It blocks the effect of progesterone and progesterone promotes fibroid growth. ▪ Can be used in preparation for surgery of long term theray with the aim to shrink fibroids and educe menstrual bleeding. ▪ It can be taken in a three month cycle and can be repeated multiple times with one month break. ▪ Effects of ulipristal go away soon after medication cessation COMPLICATIONS ▪ In a non-pregnant woman ▪ Excessive bleeding and pain [Show More]

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