NURS 6550 FINAL EXAM STUDY GUIDE (2
VERSIONS)
, NURS 6550 FINAL EXAM STUDY GUIDE
Genitourinary, gynecologic, renal and acid/base conditions
o Carcinoma of the Cervix
Increased risk in women who smoke and those with HIV or high-risk HPV
types.
Considered a sexually transmitted disease as both squamous cell and
adenocarcinoma of the cervix are secondary to infection with HPV; squamous cell
accounts for 80 percent of cervical cancers, 15 % adenocarcinoma, and 3-5 %
neuroendocrine.
Prevention through vaccination- recombinant 4 or 9-valent HPV vaccination
which target HPV types that pose the greatest risk.
Prognosis- overall 5- year relative survival rate is 68 % for white women and
55 % in black women- survival rates are inversely proportionate to the stage of
cancer.
Signs/Symptoms-
Metrorrhagia, postcoital spoting, and cervical ulceration. Gross edema of the
legs may be indicative of vacular and lymphatic stasis due to tumor. Pain in the
back (lumbosacral plexus region) indicates neurologic involvement. Bladder and
rectal dysfunction or fistulas are severe late symptoms. Two to 10 years are
,required for carcinomas to penetrate the basement layer of the membrane and
become invasive- screening has decreased mortality.
Diagnostic Tools-
Cervical Biopsy- After a positive papnicolaou smear biopsy or endocervical
curettage is necessary to determine the extent and depth of the cancer cells.
Surgery and radiation should be delayed until biopsy results.
Imaging- CT, MRI, lymphangiography, fine-needle aspiration, ultrasound,
and laparoscopy are utilized for staging of invasive cancer. Allows for more
specific treatment planning.
Complications-
Metastases to regional lymph nodes occurs with increasing frequency from
Stage I to Stage IV. Extension occurs in all directions from the cervix.
Hydronephrosis (urine-filled dilation of the renal pelvis due to obstruction)
and hydroureters (dilation of the ureter), is a result of the ureters becoming
obstructed lateral to the cervix which can lead to impaired kidney function.
Treatment/Management- Refer all patients to Gynecologic Oncologist
Carcinoma in situ (Stage 0)- women whom child-bearing is not a
consideration, total hysterectomy is definitive treatment.
Retain uterus- cryosurgery, laser surgery, LEEP, or cervical conizations are
options. Close follow-up with pap smears every 3 months for 1 year and every 6
months for another year after cryo/laser surgery.
Invasive Carcinoma- treated with hysterectomy. Stage IA1, IBI, and IIA
hysterectomy and concomitant radiation and chemotherapy or with radiation and
chemo alone; Stages IB2, IIB, III, and IV cancers treated with radiation therapy
plus concurrent chemotherapy.
Emergency presentation- vaginal hemorrhage- due to gross ulceration and
cavitation of cervix- late stage- packing, cautery, tranexamic acid to stop bleeding
temporarily. Ligation and suturing not an option due to diffused ulceration.
o Fibroid Tumor
, Uterine leiomyomas are the most common neoplasm in the female genital
tract- it is a round, firm, often multiple uterine tumor composed of smooth muscle
and connective tissue.
Classification by anatomical location- 1. Intramural, 2. Submucous, 3.
subserious, 4. Intraliagmentous, 5. Parasitic (blood supply from an organ to which
its attached) 6. cervical
In non-pregnant women, myomas are frequently asymptomatic- symptoms
which prompt for treatment include AUB and pelvic pain or pressure.
Complications of fibroids include miscarriage if they block the uterine cavity or
preterm delivery and malpresentation.
Diagnostic-
Patients may present with iron deficiency anemia (blood loss). Imaging to
include a pelvic ultrasound and monitor growth. MRI can be delineate intramural
and submucous myomas and is required prior to uterine artery embolization to
assess the blow flow to the fibroid.
R/O: subserous myomas from oviarian tumors
Treatment/Management
Small asymptomatic myomas can be evaluated annually- Patients who defer
surgery, non-hormonal therapies (NSAIDs and tranexamic acid) have been show to
decrease menstrual blood loss.
Hormonal therapies- GnRH agonists and SPRMs, shown to reduce myoma
volume, uterine size, and menstrual blood loss.
Surgical intervention should be based on patient’s symptoms and desire for
future fertility- uterine size is not an indication alone for surgery- cervical myomas
3-4 cm in diameter that protrude through cervix, can cause infection, bleeding,
pain, or urinary retention, which require removal.
Emergency Surgery- indicated for acute torsion of the pendunculated
myoma. Marked anemia, heavy menstrual period post-operative treatment includes
DMPA IM q3 months. Only indication for emergency surgery during pregnancy is
torsion of a pendunculated fibroid.
VERSIONS)
, NURS 6550 FINAL EXAM STUDY GUIDE
Genitourinary, gynecologic, renal and acid/base conditions
o Carcinoma of the Cervix
Increased risk in women who smoke and those with HIV or high-risk HPV
types.
Considered a sexually transmitted disease as both squamous cell and
adenocarcinoma of the cervix are secondary to infection with HPV; squamous cell
accounts for 80 percent of cervical cancers, 15 % adenocarcinoma, and 3-5 %
neuroendocrine.
Prevention through vaccination- recombinant 4 or 9-valent HPV vaccination
which target HPV types that pose the greatest risk.
Prognosis- overall 5- year relative survival rate is 68 % for white women and
55 % in black women- survival rates are inversely proportionate to the stage of
cancer.
Signs/Symptoms-
Metrorrhagia, postcoital spoting, and cervical ulceration. Gross edema of the
legs may be indicative of vacular and lymphatic stasis due to tumor. Pain in the
back (lumbosacral plexus region) indicates neurologic involvement. Bladder and
rectal dysfunction or fistulas are severe late symptoms. Two to 10 years are
,required for carcinomas to penetrate the basement layer of the membrane and
become invasive- screening has decreased mortality.
Diagnostic Tools-
Cervical Biopsy- After a positive papnicolaou smear biopsy or endocervical
curettage is necessary to determine the extent and depth of the cancer cells.
Surgery and radiation should be delayed until biopsy results.
Imaging- CT, MRI, lymphangiography, fine-needle aspiration, ultrasound,
and laparoscopy are utilized for staging of invasive cancer. Allows for more
specific treatment planning.
Complications-
Metastases to regional lymph nodes occurs with increasing frequency from
Stage I to Stage IV. Extension occurs in all directions from the cervix.
Hydronephrosis (urine-filled dilation of the renal pelvis due to obstruction)
and hydroureters (dilation of the ureter), is a result of the ureters becoming
obstructed lateral to the cervix which can lead to impaired kidney function.
Treatment/Management- Refer all patients to Gynecologic Oncologist
Carcinoma in situ (Stage 0)- women whom child-bearing is not a
consideration, total hysterectomy is definitive treatment.
Retain uterus- cryosurgery, laser surgery, LEEP, or cervical conizations are
options. Close follow-up with pap smears every 3 months for 1 year and every 6
months for another year after cryo/laser surgery.
Invasive Carcinoma- treated with hysterectomy. Stage IA1, IBI, and IIA
hysterectomy and concomitant radiation and chemotherapy or with radiation and
chemo alone; Stages IB2, IIB, III, and IV cancers treated with radiation therapy
plus concurrent chemotherapy.
Emergency presentation- vaginal hemorrhage- due to gross ulceration and
cavitation of cervix- late stage- packing, cautery, tranexamic acid to stop bleeding
temporarily. Ligation and suturing not an option due to diffused ulceration.
o Fibroid Tumor
, Uterine leiomyomas are the most common neoplasm in the female genital
tract- it is a round, firm, often multiple uterine tumor composed of smooth muscle
and connective tissue.
Classification by anatomical location- 1. Intramural, 2. Submucous, 3.
subserious, 4. Intraliagmentous, 5. Parasitic (blood supply from an organ to which
its attached) 6. cervical
In non-pregnant women, myomas are frequently asymptomatic- symptoms
which prompt for treatment include AUB and pelvic pain or pressure.
Complications of fibroids include miscarriage if they block the uterine cavity or
preterm delivery and malpresentation.
Diagnostic-
Patients may present with iron deficiency anemia (blood loss). Imaging to
include a pelvic ultrasound and monitor growth. MRI can be delineate intramural
and submucous myomas and is required prior to uterine artery embolization to
assess the blow flow to the fibroid.
R/O: subserous myomas from oviarian tumors
Treatment/Management
Small asymptomatic myomas can be evaluated annually- Patients who defer
surgery, non-hormonal therapies (NSAIDs and tranexamic acid) have been show to
decrease menstrual blood loss.
Hormonal therapies- GnRH agonists and SPRMs, shown to reduce myoma
volume, uterine size, and menstrual blood loss.
Surgical intervention should be based on patient’s symptoms and desire for
future fertility- uterine size is not an indication alone for surgery- cervical myomas
3-4 cm in diameter that protrude through cervix, can cause infection, bleeding,
pain, or urinary retention, which require removal.
Emergency Surgery- indicated for acute torsion of the pendunculated
myoma. Marked anemia, heavy menstrual period post-operative treatment includes
DMPA IM q3 months. Only indication for emergency surgery during pregnancy is
torsion of a pendunculated fibroid.
