CHAPTER 65 Coordinating Care for Female Patients With Reproductive and Breast Disorders

CHAPTER 65: Coordinating Care for Female Patients With Reproductive and Breast Disorders

Learning Outcomes

• Epidemiology of reproductive disorders

• Clinical manifestations correlated to pathophysiological processes:

  • Breast cancer

  • Dysmenorrhea

  • Endometriosis

  • Menopause

  • Fibroids

  • Ovarian cancer

  • Uterine cancer

  • Cervical cancer

• Diagnostic results for confirming reproductive disorder diagnoses

• Interprofessional management of:

  • Breast cancer

  • Dysmenorrhea

  • Endometriosis

  • Menopause

  • Fibroids

  • Ovarian cancer

  • Uterine cancer

  • Cervical cancer

• Comprehensive nursing care plans for reproductive disorders

• Teaching plans covering pharmacological, dietary, and lifestyle considerations

Key Concepts

• Caring

• Cellular Regulation

• Comfort

• Medication

• Nutrition

• Reproduction and Sexuality

Essential Terms

• Aromatase inhibitor

• Breast cancer type 1 gene (BRCA1)

• Breast cancer type 2 gene (BRCA2)

• Breast conservation therapy

• CA 125

• Ductal carcinoma in situ (DCIS)

• Dysmenorrhea

• Dysplasia

• Endocrine therapy

• Endometriosis

• Hormone therapy (HT)

• Human papillomavirus (HPV)

• Invasive breast cancer

• Leiomyoma

• Lobular carcinoma in situ (LCIS)

• Mastectomy

• Menopause

• Menorrhagia

• Metastasis

• Prostaglandins

• Sentinel node

• Tamoxifen

• Vasomotor symptoms

Case Study: Episode 1

• Patient Profile: Karen Sims, 43, presents with a "knot" in her right breast, has not had a mammogram since age 40.

• Health Background: Joint use of combination oral contraceptives; in good health otherwise; concerns about potential breast issues.

Breast Cancer

Epidemiology

• Predominantly affects females; increasing survival rates — still the second leading cause of cancer-related deaths in females.

• Risk Factors:

  • Age: 15 times higher risk for those aged 80-85 vs. 30-35.

  • Ethnicity: Black females under 50 at higher risk, while older Black females have a lower risk compared to their White counterparts.

  • Hispanic women have a lower incidence than European or Asian descent women.

  • Higher ovulatory cycles increase risk (early menarche/late menopause raises risk by 30-50%).

  • Lack of childbirth before age 30 nearly doubles risk.

  • Family history and benign proliferative breast disease link to increased risk.

Genetic Connections

• Genetic Testing: Test for BRCA1/BRCA2; identify hereditary breast cancer risk.

  • Recommended for individuals with breast/ovarian cancer history, especially before age 50.

Pathophysiology

• Cancer is characterized by unregulated cellular division, potentially causing invasion and metastasis.

• Stages of Breast Cancer:

  • Stage 0: Includes DCIS and LCIS.

  • Invasive stages indicate spread beyond initial tumor site.

Clinical Manifestations

• Common symptoms include lumps, skin changes, beauty and color changes, and nipple discharge.

Interprofessional Management

Diagnosis

• Diagnostic tools: mammography, ultrasound, MRI, biopsy.

• Sentinel Node Biopsy: Determines cancer spread extent; if nodes are clear, further removal may not be necessary.

Treatment Options

• Medical Management: Surgery, chemotherapy, hormonal therapy (Tamoxifen, aromatase inhibitors).

• Surgical Options: Breast-conserving surgery or mastectomy.

Endometriosis

Epidemiology

• Uterine endometrial tissue grows outside the uterus.

• Common cause of infertility; 5-10x higher risk in those with first-degree relatives with the disorder.

Dysmenorrhea

• Common gynecological issue, particularly overwhelming in the younger menstrual population.

• NSAIDs and combined hormonal contraceptive strategy recommended.

Menopause

Signs and Symptoms

• Vasomotor symptoms: hot flashes, night sweats, mood disturbances, sleep issues.

Overall, reproductive disorders need thorough understanding from epidemiological, pathophysiological, diagnostic, and management perspectives to implement effective care strategies.

CHAPTER 65: Coordinating Care for Female Patients With Reproductive and Breast Disorders

Learning Outcomes

• Epidemiology of reproductive disorders: Understand the prevalence, risk factors, and implications of various reproductive disorders in female populations.

• Clinical manifestations correlated to pathophysiological processes: Detail symptoms and signs associated with breast cancer, dysmenorrhea, endometriosis, menopause, fibroids, ovarian cancer, uterine cancer, and cervical cancer.

• Diagnostic results for confirming reproductive disorder diagnoses: Identify key diagnostic tools and laboratory tests essential for confirming suspicions of reproductive disorders.

• Interprofessional management of: Outline comprehensive care approaches for breast cancer, dysmenorrhea, endometriosis, menopause, fibroids, ovarian cancer, uterine cancer, and cervical cancer, focusing on teamwork across healthcare settings.

• Comprehensive nursing care plans for reproductive disorders: Formulate individualized nursing care plans that address patient-specific needs across various reproductive disorders.

• Teaching plans covering pharmacological, dietary, and lifestyle considerations: Develop educational materials that outline lifestyle modifications, dietary recommendations, and pharmacological treatments available for managing these disorders.

Key Concepts

• Caring: Recognizing the importance of empathy and support in patient care, particularly regarding sensitive topics related to reproductive health.

• Cellular Regulation: Understanding how normal cellular processes can become dysregulated in disorders such as cancer.

• Comfort: Providing symptomatic relief and enhancing quality of life for patients experiencing reproductive health issues.

• Medication: Knowledge about pharmacological interventions for managing symptoms and treating reproductive disorders effectively.

• Nutrition: The role of nutrition in supporting overall health and managing specific reproductive disorders.

• Reproduction and Sexuality: Addressing issues related to sexual health, function, and reproductive choices in female patients.

Essential Terms

• Aromatase inhibitor: A class of medications used in hormone therapy to reduce estrogen levels in postmenopausal women with breast cancer.

• Breast cancer type 1 gene (BRCA1) & Breast cancer type 2 gene (BRCA2): Genes that, when mutated, significantly increase the risk of developing breast and ovarian cancer.

• Breast conservation therapy: Treatment approach aiming to remove cancer while preserving as much of the breast as possible.

• CA 125: A protein marker elevated in certain conditions, particularly ovarian cancer, used to monitor treatment response or recurrence.

• Ductal carcinoma in situ (DCIS): A non-invasive breast cancer where abnormal cells are confined to the ducts.

• Dysmenorrhea: Painful menstruation affecting many women and often requiring medical intervention.

• Dysplasia: Abnormal cell growth, which can be a precursor to cancer in some tissues.

• Endocrine therapy: Treatment that alters hormone levels to manage cancer progression.

• Endometriosis: A condition where endometrial tissue grows outside the uterus, leading to pain and possible infertility.

• Hormone therapy (HT): Treatment that involves supplementation or altering hormone levels to relieve menopause symptoms or cancer treatment.

• Human papillomavirus (HPV): A group of viruses, some of which can cause cervical cancer, making vaccination essential.

• Invasive breast cancer: Cancer that has spread beyond the ducts or lobules and can metastasize to other organs.

• Leiomyoma: Also known as fibroids, these benign tumors can affect uterine health and cause discomfort.

• Lobular carcinoma in situ (LCIS): A condition where abnormal cells develop in the lobules of the breast, often considered a marker for increased cancer risk.

• Mastectomy: Surgical removal of one or both breasts, commonly performed to treat breast cancer.

• Menopause: The stage in a woman's life marked by the end of menstruation and associated hormonal changes.

• Menorrhagia: Excessive or prolonged menstrual bleeding, indicating underlying issues.

• Metastasis: The spread of cancer from the primary site to other areas of the body.

• Prostaglandins: Compounds involved in mediating inflammation and pain, often linked to menstrual cramps.

• Sentinel node: The first lymph node to which cancer cells are likely to spread from a primary tumor.

• Tamoxifen: An anti-estrogen medication used to treat and prevent breast cancer.

• Vasomotor symptoms: Symptoms such as hot flashes and night sweats associated with menopause due to hormonal changes.

Case Study: Episode 1

Patient Profile: Karen Sims, 43, presents with a "knot" in her right breast and has not had a mammogram since age 40.

Health Background: She has been using combination oral contraceptives; otherwise, she is in good health but expresses concern about potential breast issues. Close monitoring is crucial due to her age and lack of recent screenings.

Breast Cancer

Epidemiology

Breast cancer predominantly affects females and presents significant health concerns, despite advancements in treatment leading to increasing survival rates. It remains the second leading cause of cancer-related deaths in females, necessitating ongoing awareness and screening efforts.

Risk Factors:

• Age: Risk increases significantly with age, with women aged 80-85 having a 15 times higher risk than those aged 30-35.

• Ethnicity: Black females under 50 years old are at a higher risk, while older Black females have a lower risk compared to their White counterparts. Hispanic women exhibit a lower incidence relative to their European or Asian descent counterparts.

• Menstrual Factors: A higher number of ovulatory cycles—due to factors such as early menarche and late menopause—increase risk by 30-50%. Women who have not given birth before the age of 30 also show nearly double the risk.

• Family History: A strong correlation exists between family history of breast cancer and risk, especially in families with histories of benign proliferative breast disease.

Genetic Connections

• Genetic Testing: Testing for BRCA1 and BRCA2 genes is crucial for identifying hereditary breast cancer risk. It is recommended for women with a personal or family history of breast or ovarian cancer, particularly when occurring before age 50, to enable early interventions.

Pathophysiology

Breast cancer is characterized by uncontrolled cellular proliferation that can lead to invasion and metastasis. This process involves complex genetic and environmental interactions, underscoring the need for detailed understanding in treatment approaches.

• Stages of Breast Cancer:

  • Stage 0: Includes non-invasive forms like DCIS and LCIS.

  • Invasive Stages: Indicate spread beyond the initial tumor, reflecting the need for aggressive treatment options.

Clinical Manifestations

Common symptoms may include palpable lumps, noticeable skin changes, alterations in breast size or shape, and nipple discharge. Early detection through self-examinations and regular screenings is key.

Interprofessional Management

• Diagnosis: Includes the utilization of mammography, ultrasound, MRI, and biopsy to establish the presence and extent of disease.

• Sentinel Node Biopsy: Assists in determining the extent of cancer spread; if sentinel nodes are clear, additional lymph node removal may be unnecessary.

Treatment Options

• Medical Management: Options encompass surgery, chemotherapy, and hormonal therapy, including agents like Tamoxifen and aromatase inhibitors.

• Surgical Options: Select between breast-conserving surgery and mastectomy based on cancer staging and patient preference.

Endometriosis

Epidemiology: Endometriosis is characterized by the presence of endometrial tissue growing outside the uterus, leading to chronic pain and fertility issues. It occurs in approximately 10% of women of reproductive age, with incidence rates significantly higher in those with a family history of the disorder.

Dysmenorrhea

Clinical Overview: Dysmenorrhea, marked by painful menstrual cramps, is particularly overwhelming for younger menstruating populations. It can significantly impact daily functioning. Recommended treatment includes the use of NSAIDs and hormonal contraceptives to alleviate symptoms.

Menopause

Signs and Symptoms

Common symptoms associated with menopause include vasomotor symptoms such as hot flashes and night sweats, mood disturbances, and sleep issues. These symptoms stem from significant hormonal fluctuations as women transition out of their reproductive years.

Overall, comprehensive understanding from epidemiological, pathophysiological, diagnostic, and management perspectives is imperative for effectively implementing care strategies for female patients facing reproductive disorders.