Endometriosis

Pathophysiology

Endometrial tissue implantation outside the uterine cavity

Tissue appears on the ovaries and cul-de-sac

Responds to cyclic hormonal stimulation

Monthly bleeding irritates and scars the surrounding tissue

Scarring can lead to adhesions, causing infertility

Progresses slowly

Cause is unknown

Endometriosis

Manifestations

Cyclic pain

-Pain may be deep, unilateral or bilateral, and either sharp or dull

-Pain is usually constant and beings 36-48 hours before menses

Dysparenuia (painful intercourse) 

-Typical, particularly with deep penetration

Rectal pain

-During defecation

Diarrhea, constipation, and sensations of rectal pressure or urgency

Infertility

Drug therapy-Used to suppress endometrial tissue proliferation

Acknowledge the pain in a supportive manner- gives patient support

Suggest nonpharmacologic pain-relief mueasures-decreases pain

Suggest relaxation techniques-may decrease muscle tissue hypoxia and hypertonicity and relive ischemia by increaseing blood flow to the affected areas

Diagnostic studies to rule out pelvic inflammatory disease caused by chlamydia or gonorrhea

Serum cancer antigen CA-125- helps screen for ovarian cancer but can be positive with endometriosis

Transvaginal ultrasound-differentiate pelvic masses 

Laparoscopy -examination of tissue specimens used to confirm diagnosis

GnRH agoinst

-Suppresses hormones causes pseudo-menopause, which allows the ectopic tissue to atrophy

Side effects: Hot flashes, and vaginal dryness

Block the formation of new blood vessels

-Used to decrease ectopic endometrial growth

Testosterone derivative

Interferes with hormones causing pseudomenopause

Side effects: Masculinizing effects, weight gain, hot flashes, vaginal dryness, insomnia, decreased libido, and  reduced bone density

Laprascopic removal of endometrial implants and adhesions

A laser may be used to vaporize adhesions and endometrial implants

Severing a pelvic nerve may provide relief

IUD may be placed to prevent recurrence of painful periods

The uterus and ovaries may be removed

Lower abdominal pain

Infertility

Gastrointestinal complications

Colonized endometrial tissue in other sites

Patient will have reduced pain

Patient will have restored sexual function

Patient wil have decreased anxiety related to the disease and the uncertainty of the diagnosis

Patient will have increased self-esteem related to infertility

Educating the patient about the disease and its treatments

Education about nonpharmacologic pain-relief measures

Expected effects of over-the-counter or prescribed medications

Instruct about side or adverse effects specific to the medications recommended that should be reported

Teach expected effects for drugs

Give information about measures that promote sleep and relaxation

McKinney, E. S., James, S. R., Murray, S. S., & Ashwill, J. (2009). Maternal-child nursing. (3rd ed., pp. 776-777). St. Louis: W B Saunders Co.

Ignatavicius, D., & Workman, L. (2010). Medical-surgical nursing patient-centered collaborative care. (6 ed., Vol. 2, pp. 1687-1688). St. Louis: Missouri.