Endometriosis: The Nursing Process

This paper will focus the nursing process of endometriosis, including the pathophysiology, etiology, risk factors, signs and symptoms, assessments, diagnostic testing, interventions, medications and teaching. Therapy for a client with endometriosis will be individualized depending upon the severity of the disease, however, the basic information will be covered here. Endometriosis: The Nursing Process Endometriosis is a reproductive disease affecting 1%-2% of women in their late 20s to 30s (Ignatavicius, Workman, 2006). This disease causes numerous problems in afflicted women, from pain to infertility.

This paper will discuss what endometriosis is, what causes the disease, how this disease works in the body, what signs and symptoms a nurse can expect, what assessments and interventions should be planned, what diagnostic testing and medication may be prescribed, and what teaching will be needed for the client. The definition of endometriosis is “an abnormal gynecologic condition characterized by ectopic growth and function of endometrial tissue. ” (Mosby, 2002, p. 598) In the body, the endometrial tissue of the uterus begins to grow outside of this location.

This tissue can be found on any organ in the pelvic cavity, including the outside of the uterus, the ovaries, the bladder or bowel, and on the wall of the cavity. In rare cases, endometrial tissue can be found outside the pelvic cavity in such places as the lungs or kidneys. Once attached to abnormal locations, this tissue acts just as it would in the uterus. During menstruation, bleeding occurs, causing a trapping of blood in the tissues. Although the cause of endometriosis is unknown, there are several theories as to why this occurs.

In the first theory it is thought that endometrial tissue from the uterus moves during menstruation through the fallopian tubes and into the pelvic cavity. Another theory suggests endometrial tissue moves through vascular or lymphatic dissemination to foreign locations. This theory explains how endometrial tissue can sometimes be found outside the pelvic cavity. “Most researchers, however, agree that endometriosis is exacerbated by estrogen. ” (What Causes Endometriosis, 2006) Most commonly, women afflicted with endometriosis have pain as the only symptom of the disease.

This pain can be during a menstrual period or pelvic pain during other parts of the cycle. This pain can be mild to severe, depending on the woman. The severity of pain does not indicate the severity of the disease but often leads the medical staff to the site. (Ignatavicius, Workman, 2006). Other symptoms include “diarrhea and painful bowel movements, especially during menstruation, painful intercourse, abdominal tenderness, and severe cramping” (NWHRC, 2005). Some women will also experience hypermenorrhea and infertility. During a nursing assessment, the nurse should obtain information about the client’s menstrual cycle.

Specifically, ask about any changes in the normal menstruation. The nurse should also assess whether the client has had issues becoming pregnant. A detailed pain assessment should be completed on all clients, including location, duration, precipitating and relieving factors. The nurse should also assess any medications that client is currently taking. Assess whether the client has children or wishes to have children in the future. This information will be used for planning interventions. Interventions for endometriosis could be surgical or nonsurgical management. Nonsurgical management includes drug therapy and alternative therapies.

Drug therapy for endometriosis involves the use of NSAIDs and analgesics for pain relief (Ignatavicius, Workman, 2006). Hormonal drug therapy is aimed at reducing the symptoms of endometriosis. Oral contraceptives, progesterone, and ovarian suppression are used. The drug of choice is danazol, an antigonadotripin drug. This causes a pseudomenopause and causes ovarian suppression. The cost of this drug may be a problem for some clients, costing from $120-$180 per month. The side effects are also troublesome, including acne, hirsutism, weight gain, decrease in breast ize, hot flashes, and cardiovascular disease (Ignatavicius, Workman, 2006).

Alternative therapies aim at increasing blood flow to the effected area. These include applying heat to the abdomen and sacrum, yoga, and relaxation. When you increase blood flow to the area you relieve the pain caused by hypoxia (Ignatavicius, Workman, 2006). Surgical interventions usually include a hysterectomy or removal of endometrial tissue from foreign locations. Clients need to be fully aware that a hysterectomy will render them sterile, and they will no longer have the option of conception.

Each client needs to weight the benefits of having this procedure versus the drug therapy. If the side effects of the drugs are not acceptable and they no longer wish to conceive, a hysterectomy would be a good choice. Diagnostic testing for endometriosis includes laparoscopy, blood testing and ultrasonography. Blood testing is used to rule out pelvic inflammatory disease as the cause of the symptoms. Ultrasonography is used to observe the pelvic cavity for masses that could be mistaken for endometriosis. Laparoscopy is used to remove tissue for further pathology testing to confirm the diagnosis. Ignatavicius, Workman, 2006).

Teaching a client with endometriosis is management minded. Nurses should instruct the client on ways to deal with the symptoms of the disease. Instruct the client on pain management techniques, including the use of heat, exercise, analgesics, and NSAIDs such as ibuprofen. Clients should also be instructed to monitor their menstrual cycle and keep a log for the physician’s reference. Instruct the client on aspects of drug therapy, including what side effects they can expect and how long to take the medication.

Clients receiving a hysterectomy, especially at a young age, may need information on support groups. These clients may also wish to have information on adoption, if they still wish to have children. Endometriosis not only affects the client, but the entire family. The nurse should focus on caring for the client holistically, including the client’s emotional and spiritual well-being. Focus on the nursing process to assess and analyze the client, plan interventions that care for the client’s holistic needs, and implement and evaluate accordingly.

Endometriosis affects over 70 million women and girls world-wide (Endo Resolved). It is common among women of reproductive age, approximately 15%. On average it takes 7 years from the time symptoms appear to diagnosis and finally treatment. Women suffering from …

Endometriosis affects over 70 million women and girls world-wide (Endo Resolved). It is common among women of reproductive age, approximately 15%. On average it takes 7 years from the time symptoms appear to diagnosis and finally treatment. Women suffering from …

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