CHAPTER 48 / Nursing Care of Women with Reproductive Disorders 1571
Nursing Care Plan
A Woman with Endometriosis
Angela Hall is a 31-year-old married accountant, who relates a
history of severe dysmenorrhea and menorrhagia, a feeling of
pelvic heaviness and pain that radiates down her thighs.
Because of her discomfort, her husband has complained about
the quality of their sex life and has expressed concerns about
their plans for having children. Mrs. Hall reports being so tired
she doesn’t care whether she has sex or not, and, in fact, would
really prefer not to: “Sex hurts so much, I just can’t stand it.”
Endometriosis is suspected, and a diagnostic laparoscopy has
been scheduled.
ASSESSMENT
Christine Brigham, RN, NP, interviews Mrs. Hall and makes the
following assessments: BP 110/70, P 68, R 18, T 98.2°F (36.7°C).
Mrs. Hall’s weight is 130 lb (59 kg) and within normal limits for her
height. Review of laboratory findings indicate a hemoglobin level
of 9.8 g/dL (normal range: 12 to 16 g/dL) and a hematocrit of
33.1% (normal range: 35% to 45%). Physical examination reveals
pelvic tenderness on manipulation of the cervix, and small masses
that are palpable on abdominal/pelvic examination.
DIAGNOSIS
• Chronic pain, related to endometrial pelvic implants
• Anxiety, related to effect of endometriosis on fertility
• Deficient knowledge, related to diagnosis and treatment
options
• Ineffective sexuality patterns, related to the manifestations of
endometriosis
EXPECTED OUTCOMES
• Develop effective self-care measures to deal with the pain and
discomfort.
• Verbalize decreased anxiety.
• Demonstrate understanding of the disease and treatment
options.
• Verbalize an improvement in sexual functioning and a decrease
in interpersonal stress between herself and her husband.
Table 48–2 FIGO Staging Classification
for Cervical Cancer
Stage Description
0 Carcinoma in situ, intraepithelial carcinoma
I Carcinoma that is strictly confined to the cervix
II Involvement of the vagina, limited to the upper
two-thirds of the vagina, or infiltration of the
parametria (connective tissue surrounding the
uterus) but not the side wall of the pelvis
III Involvement of the lower third of the vagina or
extension to the pelvic side wall
IV Extension outside the reproductive tract
PLANNING AND IMPLEMENTATION
• Identify the location, type, duration, and his-
tory of the pain.
• Recommend analgesics and heat therapy.
• Provide information on biofeedback, relaxation, and imagery
to lessen pain.
• Discuss with Mr. and Mrs. Hall the causes of endometriosis and
its manifestations.
• Encourage the Halls to discuss their feelings about the effect
of the disease on their sex life, lifestyle, and fertility.
• Refer the couple to the local mental health center if appro-
priate.
EVALUATION
Two years after the initiation of treatment, Mr. and Mrs. Hall have
become parents of a baby girl. Mrs. Hall states that the discomfort
and other manifestations of endometriosis have eased. Relaxation
and imagery have effectively minimized her pain and brought
about improvement in her function as wife, mother, and sexual
partner. Counseling has improved the interpersonal and sexual
relations between the Halls. Dietary management has improved
her anemia, although the menorrhagia persists. The Halls are try-
ing to have a second child, understanding the advantages of rapid
succession of pregnancies. They will be followed in the nursing
clinic and referred to an infertility clinic if conception does not
occur within 1 year.
Critical Thinking in the Nursing Process
1. Explain the pathophysiologic basis for Mrs. Hall’s anemia.
2. How would you handle the situation if Mr. and Mrs. Hall were
extremely uncomfortable and embarrassed about discussing
their sexual problems?
3. Develop a plan of care for Mrs. Hall for the nursing diagnosis,
Situational low self-esteem, related to the manifestations of
endometriosis.
See Evaluating your Response in Appendix C.
Preinvasive cancer is limited to the cervix and rarely causes
symptoms. Invasive cancer produces vaginal bleeding after in-
tercourse or between menstrual periods, and vaginal discharge
that increases as the cancer progresses. These changes are subtle,
and may be more readily noticed by the postmenopausal woman.
Manifestations of advanced disease include referred pain in the
back or thighs, hematuria, bloody stools, anemia, and weight loss.
Risk Factors
As described by the American Cancer Society (2001), risk fac-
tors for cervical cancer include infection of the external geni-
talia and anus with HPV, first intercourse before 16 years of
age, multiple sex partners or male partners with multiple sex
partners, a history of sexually transmitted infections, and in-
fection with HIV. The most important risk factor is infection by