Answer: 1) Abdominal surgery: from xiphoid arch upward, pubic symphysis and medial thigh downward 1/3, from both sides to axillary midline.
2) Vaginal operation: It starts from the pubic symphysis 10cm, including the inner thigh of inguinal region13, and goes down to the anus by 5cm, from both sides to the axillary midline.
2. Why should I leave a catheter in gynecological surgery?
Answer: 1) Because the female genitalia is in front of the bladder and behind the rectum, it is inconvenient and easy to operate when the bladder is full.
Bladder damage. Therefore, it is necessary to indwelling catheter and open urination during the whole operation.
2) After the operation, in order to prevent the full bladder from squeezing the operation site, causing pain and bleeding.
3) It is convenient to observe urine volume after operation.
3. Please do a good job in the nursing measures of vaginal preparation before abdominal hysterectomy.
Answer: 1) Vaginal irrigation with 1: 5000 potassium permanganate solution every day on the third day before operation.
2) On the morning of the operation, the vagina was routinely washed and dried, and then 2% gentian violet was applied to the cervix and vaginal vault, and dried with a cotton ball. As an indication of abdominal hysterectomy.
4. What are the dietary care before and after gynecological abdominal surgery?
A: Increase the intake of protein and vitamins before operation, eat digestible food for dinner before operation, and fast after midnight. A small amount of liquid diet can be started12 hours after operation, but avoid milk and high-sugar diet to avoid flatulence after operation. Patients can automatically enter semi-liquid and eat normally after 3-4 days.
5. What are the nursing observations after gynecological abdominal surgery?
A: After returning to the ward, the patient should know about the operation and treatment, and observe vital signs, including measuring blood pressure, P and R every 30 minutes until it is stable, and measuring T, P and R every 4 hours for at least three days. At the same time, he should observe whether the abdominal incision dressing is loose. Observe whether there are abdominal bleeding symptoms, such as peritoneal irritation symptoms, vaginal bleeding and other abnormalities. If any abnormality is found, inform the doctor in time and deal with it in time. Postoperative catheter should be kept unobstructed to avoid slipping out under pressure, and urine volume should be observed and recorded correctly.
6. What is the purpose of the patient taking a semi-recumbent position after the operation?
A: You can take a semi-recumbent position the day after operation. In order to reduce abdominal muscle tension, relieve pain, help deep breathing, reduce pulmonary complications, and also help inflammatory exudates accumulate in the pelvic cavity, which is conducive to drainage.
7. Nursing of indwelling catheter after abdominal operation (urination nursing)
Answer: 1. ) Observe urine volume and urine color-urine will be secreted quickly by routine rehydration after operation. Pay attention to keep the catheter unobstructed to avoid slipping out under pressure, and observe and record the urine volume and urine color.
2) Catheter indwelling time: (1) General operation requires indwelling catheter 1~2 days. (2) Vaginal hysterectomy and vaginal anterior and posterior wall repair for 3-5 days. (3) extensive hysterectomy and pelvic lymphadenectomy are reserved for 5-7 days.
3) Keep the vulva clean, scrub the vulva twice a day, and change the urine collection bag every day to prevent urinary tract infection. 4. Unplug the indwelling catheter, pay attention to open the clamping tube regularly to train the bladder to recover its contractility, encourage patients to drink more water, and make the diuretic pathway unobstructed.
8. Nursing care of discomfort after abdominal surgery;
1) Pain care:
(1) Keep the room quiet, provide a comfortable environment, help choose a comfortable posture, and help patients turn over and urinate in bed.
(2) sedatives and analgesics can be given according to the doctor's advice when necessary.
(3) When nausea and vomiting occur, hold it with an arc plate, rinse your mouth with warm water, and hold the abdomen on both sides of the incision to relieve the pain.
2) Nursing care of abdominal distension: If intestinal peristalsis does not return to normal 48 hours after operation, the possibility of paralytic intestinal obstruction and mechanical intestinal obstruction should be ruled out. There are many measures to stimulate intestinal peristalsis and relieve abdominal distension:
(1) low-level enema with normal saline, 1.2.3 solution enema.
(2) hot compress the lower abdomen.
(3) When intestinal peristalsis has recovered, but it cannot be exhausted, acupuncture at Zusanli or subcutaneous injection of neostigmine 0.5mg can be used.
(4) exhaust of anal canal.
(5) Get out of bed early after operation to improve gastrointestinal function and reduce abdominal distension.
9. What are the indications for 9.PP sitz bath?
A: PP sitz bath can clean the local area, promote blood circulation and help tissue repair. It is suitable for perineal wound inflammation, preoperative preparation of anus, vulva and vagina, vulvar itching, urethritis and vulvar infection.
10, what are the precautions for PP sitz bath?
Answer: 1) Note that the water temperature should be around 4 1℃ to prevent burns.
2) Mix PP powder evenly to avoid scalding.
3) Bathing is prohibited during menstruation, vaginal bleeding, late pregnancy and acute pelvic inflammatory disease.
4) Preoperative preparation of patients with uterine prolapse should guide patients to take a bath after uterine prolapse.
5) You can take a sitz bath for more than 7 days after delivery. If lochia is fashionable, it should be extended.
6) The water temperature of patients with uterine prolapse should not exceed 38℃.
1 1. What are the causes of cervical cancer?
A: Factors related to the etiology of cervical cancer: ① It is closely related to early marriage and childbearing and sexual dysfunction; ② related to scale; ③ Related to virus infection (human papillomavirus, human herpesvirus, human cytomegalovirus, etc.). ).
12. Briefly describe the pathological features of cervical cancer?
A: Pathology of cervical cancer: Cervical cancer can be divided into squamous epithelial carcinoma and adenocarcinoma. Squamous cell carcinoma accounts for 90% ~ 95%, and most of them occur at the junction of squamous epithelium of the external cervix and columnar epithelium of the cervical canal. Adenocarcinoma accounts for 5% ~ 10%, which comes from columnar epithelium or glandular epithelium of cervical canal.
13. Briefly describe the occurrence and development of cervical cancer?
A: The development of cervical cancer can be divided into three stages: ① atypical hyperplasia of cervical squamous epithelium, which is precancerous lesion; ② Carcinoma in situ: The lesion was confined to the epithelial layer and did not penetrate the basement membrane and interstitial infiltration; ③ Invasive cancer: The cancer focus has penetrated the basement membrane and invaded the human stroma. According to the depth and width of infiltration, it can be divided into early invasive cancer (the depth of infiltration is less than 5mm and the width is less than 7mm) and microscopic invasive cancer.
14, briefly describe the principle of cervical iodine examination?
Answer: iodine test principle: normal cervical or vaginal squamous epithelium is rich in glycogen and can be dyed brown by sulfur solution; However, columnar epithelium of cervical canal, chyme of cervix and abnormal squamous epithelium have no glycogen, so they are not timbre. Applying iodine solution to cervix and fornix, and taking cervical biopsy in the uncolored area can not only improve the diagnostic accuracy of precancerous lesions and cervical cancer, but also understand the spread range of cancer to fornix.
15. What are the clinical stages of cervical cancer?
A: Cervical cancer stage: pre-invasive cancer: stage 0: carcinoma in situ.
Invasive cancer: stage I: confined to cervix;
Stage Ⅱ: Vaginal invasion, which did not reach1/3 (a); Or invade the tissue beside the uterus and fail to reach the pelvic wall (b);
Stage Ⅲ: 183 (a) invading vagina; Or extend to the basin wall (b);
Ⅳ; Has spread outside the pelvis. Or has spread to bladder or rectal mucosa clinically.
16. What are the key points of nursing evaluation of cervical cancer?
Answer: Key points of cervical cancer nursing evaluation (1) Health history: There is often a history of chronic cervical erosion, especially moderate and severe erosion. (2) Physical condition: ① Early symptoms are generally asymptomatic, similar to chronic cervicitis, which is easily overlooked; (2) Vaginal bleeding: contact bleeding at first, and massive bleeding at the later stage; ③ Vaginal drainage: watery and tasteless at first, and a large amount of rice soup in the later stage; ④ Pain and cachexia are mostly late symptoms. (3) Psychological state: Fear of life-threatening malignant tumor leads to fear and anxiety. (4) Auxiliary examination: Cervical curettage can find early cancer; Cervical biopsy is a reliable method to diagnose cervical cancer.
17. What are the nursing points of cervical cancer?
A: Key points of cervical cancer care (1) Patients who need surgery should make good preparations before abdominal surgery and postoperative care according to the doctor's advice. (2) Patients with vaginal bleeding should pay attention to the amount of bleeding. If there is massive bleeding, they should immediately report it to the doctor and assist the doctor to stop bleeding with gauze. (3) Keep the vulva clean, especially for those with heavy leucorrhea, and clean the vulva 1~2 times a day. (4) If pain is caused in the late stage, analgesic measures can be taken according to the doctor's advice. (5) Do psychological nursing, help patients to eliminate fear, encourage patients to maintain Yueqing mood, establish confidence in overcoming diseases, and actively cooperate with treatment and nursing.
18. Briefly describe the nursing diagnosis of cervical cancer and its related factors?
A: The nursing diagnosis and related factors of cervical cancer are as follows
1) lack of knowledge and knowledge about the treatment of cervical cancer.
2) Anxiety/fear is related to life-threatening tumors.
3) Malnutrition: Less than the body's requirement is related to the chronic consumption of cancer.
4) The risk of infection is related to repeated vaginal bleeding, drainage, surgery and decreased body resistance.
19, please describe the formation process of cervical cancer;
A: Cervical cancer mostly occurs at the junction of scales and columns at the external cervix. Hyperactivity of cervical metaplasia → cervical epithelial sarcomatoid lesions (atypical hyperplasia of cervix) → carcinoma in situ → invasive carcinoma of cervix.
20. The patient is 54 years old and has been menopausal for 5 years. In the past four months, she has had vaginal contact bleeding and occasional bloody leucorrhea. No vulvovaginal itching. Gynecological examination, vulva and vagina (-), mild cervical erosion, granular type with contact bleeding, uterus smaller than normal, active, bilateral appendages (-). According to the comprehensive nursing evaluation of the patient, it is suspected that the patient has cervical cancer. Please develop a method for further evaluation and examination of patients.
A: The evaluation methods of cervical cancer are:
1) cervical smear cytology. 2) Iodine test. 3) Nitrogen laser tumor intrinsic fluorescence diagnosis.
4) Colposcopy 5) Cervical and cervical canal biopsy.
2 1, what are the types of hysteromyoma?
A: Myomyoma is also called intramuscular myoma, subserous myoma, submucosal myoma and cervical myoma.
22. What are the main clinical manifestations of hysteromyoma?
A: 1) Menstruation and secondary anemia. Subserosal or small intramural myomas are mostly asymptomatic. Submucosal myoma
Symptoms can appear earlier.
2) When the intermuscular myoma grows larger than the pelvic cavity, a solid mass can be felt in the lower abdomen. The palpation is more obvious when the bladder filling makes the mass bulge.
3) Myomas are generally painless. Acute abdominal pain can occur when subserous myoma is pedicled with torsion or pregnancy complicated with red degeneration of uterine myoma.
23. What is the treatment principle of hysteromyoma?
A: According to the patient's age, symptoms, myoma size, location, fertility requirements and general situation, androgen therapy, total hysterectomy or myomectomy can be used. 24. What is uterine fibroid degeneration?
A: The tumor of hysteromyoma increases to a certain extent, which can cause a series of degeneration due to insufficient blood supply or obstacles. Common degeneration such as vitreous degeneration, cystic degeneration and red degeneration are all benign degeneration. Very few uterine fibroids become sarcomas, and the incidence rate is about 0.5%. Red degeneration often occurs during pregnancy or puerperium, and symptoms of acute abdomen often appear.
25. What are the main points of hysteromyoma evaluation?
A: 1) health history: there are often factors such as elevated estrogen levels or long-term stimulation.
2) Physical condition: ① Excessive menstrual flow, prolonged menstrual period, causing anemia; (2) Abnormal urination and defecation, resulting from increased compression of myoma; ③ Infertility: it affects the implantation of pregnant eggs, accounting for 25% ~ 30%; ④ Pain: uncommon. Myoma can have acute pain when it has red degeneration or pedicle torsion; ⑤ Gynecological examination found that the uterus was large and hard.
26. What are the nursing points of hysteromyoma?
Answer: (1) Monitor vaginal bleeding to prevent anemia and infection. Keep the menstrual pad, estimate the amount of bleeding, give intravenous transfusion immediately, and give testosterone propionate, hemostasis and antibacterial drugs according to the doctor's advice. (2) Pay attention to the situation of defecation. Patients with large fibroids and compression symptoms have urinary retention and urine. Constipation can be relieved by laxatives. (3) Those who need surgical treatment should be well cared for before and after abdominal surgery according to the doctor's advice. (4) Eliminate the patients' nervousness and fear.
27. Tell me the contents of vaginal preparation for total hysterectomy of hysteromyoma?
Answer: Vaginal preparation for total hysterectomy of hysteromyoma: Wash vagina with 1: 1000 benzalkonium bromide or 0.02% iodophor solution 3 days before operation, once a day, and dry it after routine vaginal washing on the morning of operation, then coat the cervix and vaginal vault with 2% methyl violet, and try to dry it with cotton balls.
28, endometrial cancer patients, what are the characteristics of clinical evaluation.
A: menopausal women have irregular vaginal bleeding, often accompanied by yellow water samples or serous vaginal secretions. Gynecological examination can find that the uterus is slightly larger and softer. If there is pain in the lower abdomen and lumbosacral region in the later stage. Segmental curettage is the most commonly used method to curettage endometrial tissue to diagnose endometrial cancer.
29. What are the characteristics of clinical evaluation of patients with endometrial cancer?
A: menopausal women have irregular vaginal bleeding, often accompanied by yellow water samples or serous vaginal secretions. Gynecological examination can find that the uterus is slightly larger and softer. If there is pain in the lower abdomen and lumbosacral region in the later stage. Staged curettage is the main method to diagnose endometrial cancer.
30. Briefly describe the high risk factors related to endometrial cancer?
A: The high risk factors related to endometrial cancer include prolonged menopause, endometrial hyperplasia, polycystic ovary, ovarian feminization tumor, unmarried, childless, low yield and postmenopausal estrogen replacement therapy. History of obesity, hypertension and diabetes; Family members have a history of cancer.
3 1. What are the key points of nursing evaluation for endometrial cancer?
A: Key points of nursing evaluation of endometrial cancer (1) Health history: obesity, infertility, hypertension, diabetes, irregular vaginal bleeding (2) Physical condition: ① a small amount of irregular vaginal bleeding after menopause; ② Before and after menopause, there were yellow watery or serous leucorrhea, which was smelly and purulent, mostly caused by infection; ③ There are pain in lower limbs, lumbosacral region, anemia and cachexia in the late stage.
32. What are the nursing points of endometrial cancer?
Answer: Nursing points of endometrial cancer (1) Psychological nursing is the same as cervical cancer. Inform patients that surgery is the first choice for treatment. (2) For patients with inoperable advanced cancer, hormone, radiotherapy or chemotherapy should be used, and attention should be paid to these side effects. (3) Relieve the pain of patients and use analgesics according to the doctor's advice.
33. Preventive measures for endometrial cancer?
Answer; Preventive measures include prevention of high-risk factors, general survey and treatment, early detection and treatment.
34. What are the main symptoms of ovarian tumor pedicle torsion?
A: Sudden and severe pain in the lower abdomen may be accompanied by nausea and vomiting, and in severe cases, shock may occur. There are different degrees of abdominal muscle tension and tenderness.
35. Briefly describe the preventive measures for ovarian tumors?
A: Preventive measures include prevention, general survey and treatment of high-risk factors, early detection and treatment.
36. What kinds of ovarian non-redundant fibroids are there?
A: There are many types of ovarian tumors, one of which is ovarian tumor-like lesions (non-tumor tumors), not real tumors.
(1) Ovarian follicular cyst: a cyst caused by anovulation of follicles.
(2) Luteal cyst: It is often related to pregnancy, and the corpus luteum persists.
(3) Xanthine cyst: It is related to hydatidiform mole, which will subside after discharge due to a large amount of HCG stimulation.
(4) Polycystic ovary: Follicles do not ovulate, and many immature cystic follicles can be seen on the ovary. The diameter of non-neoplastic tumors usually
37. What are the evaluation points of ovarian myoma?
A: Key points of nursing evaluation for ovarian tumors.
(1) Health history: pelvic mass history.
(2) Physical condition: ① Benign and malignant tumors have no obvious symptoms in the early stage; ② Benign tumors, mostly of childbearing age, are slow growing, unilateral, cystic, active, smooth in surface and generally without ascites; ③ Malignant tumors, mostly adolescent or postmenopausal women, grow rapidly, bilateral, substantial, fixed, nodular on the surface, often ascites, mostly bloody, and cancer cells can be found; ④ The common complications of ovarian tumors are pedicle torsion, fracture, infection and malignant transformation.
(3) Psychological state: mainly anxiety, fear and despair. (4) Auxiliary examination B-ultrasound can determine the location, size and texture of tumor.
38. Ms. He, 4 1 year-old, married, 100 1, usually has normal menstruation. Gynecological examination found that the uterus was normal in size, the right appendix was smooth, and there was a fist-sized surface. She probably considered ovarian cyst. She has decided to have an operation as soon as possible. What complications may occur before operation?
A: The common complications of ovarian tumors are:
1) pedicle torsion-mostly occurs during pregnancy, puerperium and posture change. Medium-sized ovarian tumors with long pedicels, such as dermoid cysts (benign cystic teratomas).
2) Cyst rupture-it can be divided into spontaneous rupture and traumatic rupture. Spontaneous rupture is mostly caused by malignant transformation of tumor. Traumatic rupture can be caused by extrusion, puncture and pelvic examination.
3) Infection-mostly caused by the adhesion of the tumor to the intestine after torsion or rupture. It may also come from an infection of an adjacent organ.
4) Malignant transformation-the tumor grows rapidly in a short time, or there is unexplained abdominal distension.
38. What are the nursing points of ovarian myoma?
Answer: The main points of nursing for ovarian tumor.
(1) told the patient that if the benign tumor is smaller than 5cm, it should be checked regularly, and if it is larger, it should be operated immediately.
(2) Inform the patient that the benign tumor is larger than 5cm or the malignant tumor needs surgical treatment, and do a good job in preoperative and postoperative care. Chemotherapy and radiotherapy are needed when necessary, and the nursing before and after chemotherapy and radiotherapy should be done well.
(3) For patients with ovarian tumor complications, they should cooperate with doctors to do the corresponding nursing, and patients with pedicle torsion and fracture should be prepared for surgery; Patients infected with fever are given physical cooling, dehydration and acidosis are corrected, and antibiotics are given according to the doctor's advice.
(4) Patients with large tumor or ascites, whose abdomen is over-inflated, can't lie down, should be given a semi-recumbent position. If ascites is needed, prepare an abdominal puncture bag to assist the doctor in the operation. In the process of releasing ascites, closely observe the characteristics of blood pressure, pulse, respiration and ascites. According to the patient's condition, you can put about 3000ml, not too much, so as not to collapse and not too fast. After putting it away, wrap the abdomen with a belt, record the amount of ascites, and observe whether there are any adverse reactions.
(5) Dietary care: give a high-protein and high-vitamin diet, give support treatment to those who are underfed or generally malnourished, and supplement nutrition intravenously.
(6) Do psychological care to relieve anxiety and fear.
40. What is endometriosis? And adenomyosis?
A: Endometriosis refers to the growth of endometrioid tissue outside the uterine cavity.
The invasion of endometrium into myometrium is called adenomyosis.
4 1, clinical evaluation characteristics of endometriosis?
A: Dysmenorrhea is a typical symptom of endometriosis. Its characteristic is that dysmenorrhea is aggravated year by year with the aggravation of local lesions, so it is called secondary amenorrhea. Pain is mostly located in the lower abdomen and lumbosacral region, and radiates to vagina, perineum, anus or thigh.