Etiology and pathophysiology of leiomyomas
Leiomyomas is a uterine smooth muscles’ benign tumor and are the most common uterine mass and neoplasm found in the pelvis of females (Fonseca, Castro, Machado, Conte & Girao, 2017). Moreover, they are present in women of 35 years and above at 20-40 percent and can rarely be present in adolescents. These tumors range from 1 millimeter to more than 20 centimeters and they may be single although they are often multiple since a hundred or more have been found in one uterus. Consequently, the tumors are smooth, stable and generally pinkish-white depending on the degree of vascularity (Lau & Koh, 2018).
Discuss the etiology and pathophysiology of the presenting condition (Fibroids or benign prostatic hyperplasia)
Leiomyomas are the most regular benign gynecologic growth and although their exact etiology is not known it is thought to be multifactorial incorporating hormonal, tissue growth and genetic factor variations (Fonseca, Castro, Machado, Conte & Girao, 2017). Furthermore, it is believed that the tumors grow in the majority of American females and become asymptomatic in a third of these females. Progesterone and estrogen are recognized as promoters of tumor development, and the potential responsibility of environmental estrogens has only currently been explored.
The pathophysiology of uterine fibroids is uncertain, and therefore therapeutic measures have been majorly empirical as it is documented that development factors control the histological and functional integrity of many tissues. Currently, the presence of growth substances in uterine tissues suggested that the responsibility of sex steroid hormones in the fibroid pathophysiology may be mediated by elements influencing the proliferation of fibroblasts and smooth muscle cells (Lau & Koh, 2018).
Suggestions from some studies say that fibroids arise from a single neoplastic smooth muscle cell (Schwetye, Pfeifer & Duncavage, 2014). That is, they are monoclonal tumors as a result of somatic mutations. Several chromosomal abnormalities involving chromosomes 6, 7, 12 and 14 have been noted suggesting a genetic responsibility in the pathophysiology of the tumors (Singh & Belland, 2015). However, the disruption of the high morbidity group genes on chromosome 12 appears to contribute to the development of fibroids. Hormones have an impact on the growth of fibroids although they don’t seem to cause the condition.
What are they and briefly how do they occur?
Uterine fibroids are benign masses that grow in the womb for unclear reasons and are called by the shorter name “fibroids” which refer to a proliferation growth of smooth muscle tissues (Kinkel, Ascher & Reinhold, 2018). They start in the muscle tissues of the womb and can grow into the submucosal or the uterine cavity, into the intramuscular or uterine wall or on the womb surface also called subserosal into the abdominal cavity.
Clinical presentation of uterine fibroids
The signs and symptoms of leiomyoma vary greatly contingent depending on the number, location along with size of the fibroids. Most females who have fibroids are asymptomatic, and symptoms occur in 10-40 percent of patients. The most common sign of uterine fibroids is the abnormal uterine bleeding which occurs in as many as 30 percent of symptomatic females, and the general pattern of bleeding is excessive bleeding at the period of menses or menorrhagia which is usually more than 80 milliliters (Ono, Maruyama, Fujiwara & Bulun, 2018).
Consequently, the rise in the flow typically occurs gradually although the bleeding may cause profound anemia. The factors that result to abnormal uterine bleeding incorporate of an alteration in the endometrial microvasculature, a disturbance in the hemostatic contraction of regular muscle bundles when extensive intramural myomatous development occurs in conjunction with a rise in the surface area of the endometrial cavity (Smith, 2018). Fibroids can be associated with endometrial hyperplasia and polyps which may produce an abnormal bleeding sequence, and the abnormal bleeding may be related to the anovulatory state.
Urinary frequency is another symptom when a growing fibroid exerts pressure on the bladder. Also, a rare occurrence of urinary retention can result when myomatous growth creates a fixed retroverted uterus which pushes the cervix anteriorly under the symphysis pubis in the sector of the posterior urethrovesicular angle. Another symptom is the reproductive disorders whereby it is not universal, and it may result when fibroids interfere with the implantation of the fertilized ovum or the regular tubal transport. Moreover, constipation and painful defecation may be caused by large posterior fibroids (Ono, Maruyama, Fujiwara & Bulun, 2018). Also, compression of the pelvic vasculature by a markedly enlarged womb may result in varicosities of the lower extremities. In that case, when the pelvic vessels compress they lead to the growth of deep venous thrombosis within the pulmonary embolus and the pelvis. Lateral extension causes a unilateral ureteral obstruction, and an enlarged womb that extends above the pelvic brim can result to hydronephrosis, hydropower and a ureteral compression.
Patients with submucosal fibroids experience an increased incidence of premature labor and abortion. Although females with fibroids experience a higher rate of spontaneous abortion, the tumors are an uncommon etiology of abortion. Less successful outcomes with in vitro fertilization happen in patients with submucosal leiomyoma when compared to controls. Finally, pregnancy-related disorders are symptoms of uterine fibroids found in 0.3-7.2 percent of pregnancies and are typically present before conception and may increase in size significantly at the time of gestation.
Causes of uterine fibroids
What is the cause?
Although the development of leiomyomas is illegible, there are some parameters that lead their arrangement. Hormones that are produced by ovaries which are the estrogen and progesterone generate the lining of the womb to rejuvenate in each cycle of menstruation and this may affect the development of leiomyomas (Kinkel, Ascher & Reinhold, 2018). Fibroids may also grow fast when someone is pregnant since pregnancy increases the production of progesterone and estrogen in the body. Also, family history matters because if a member of a family has ever experienced this condition, then it can affect the next generation.
The etiology of Cynthia’s low blood pressure is due to blood loss during the uterine bleeding. The reduction in the blood amount in the body leads to a severe drop in the blood pressure (Dünser, Druml, Petros & Grander, 2018). Furthermore, the high pulse rate is due to the depression and the bleeding she is experiencing which significantly increases the heart rate. Also, when the blood pumped per beat is reduced the heart tries to compensate by increasing the pace. On the other hand, Cynthia’s high respiratory rate was due to the anxiety from the mild depression. Cynthia’s hypotension may be have resulted to high respiratory rate and pulse rate, and therefore the pathophysiology of hypotension is the fall in systolic pressures at least 20 mmHg or a fall in diastolic pressure by at least ten mmHg or more. This happens when there is a failure in autoregulatory systems which generally maintain the blood pressure on standing.
What are usual vital signs (reference required?)
Vital signs are measurements of the most basic functions of the body and are routinely monitored by healthcare providers and medical professionals (Khan, Ostfeld, Lochner, Pierre & Arias, 2016). These vital signs are used in monitoring and detecting medical issues and can be measurable at home or in a medical setting. The usual vital signs are the respiration rate of 12-20 breaths per minute in adults and 30-40 in children, body temperature ranging from 36.5 to 37.3 degree Celsius and blood pressure of 120/80. Also, the standard heart rate to adults and children is 60-100 and 80-120 beats per minute respectively.
How do the vital signs link to their presenting condition?
According to Cynthia’s observations on return to the ward, it is clear that her temperature is reasonable since it recorded 36.5. However, her blood pressure is 90/50 indicating low blood pressure, and that demonstrates insufficiency in blood flow to transport nutrients and oxygen. Also, her respiration rate 30 is not healthy which is considered abnormal might be as a result of anxiety, dehydration or medication (Dünser, Druml, Petros & Grander, 2018). Cynthia’s pulse rate is 130 bpm, and it suggests an early pathology that needs to be evaluated professionally.
Etiology and pathophysiology of Cynthia or Peters vital signs post-op
How might they be influenced by their comorbidities or lifestyle, and what effect might these have?
Cynthia has a history of mild depression, and this affects the blood pressure. Studies have shown that stress minimizes the ability of blood vessels to pump blood all over the body hence few nutrients and oxygen are transported throughout the body leading to hypotension. If hypotension causes symptoms for a long time, it can lead to severe problems such as kidney failure, shock, heart attack or stroke (Singh & Belland, 2015).
On the other hand, the body responds to anxiety, worry, and stress similarly in how it responds to excitement and fear. Therefore when the body releases a series of hormones, it makes the person energized, focused and hyper-alert, and this chemical cascade increases the respiratory rate together with the pulse rate. Excessive breathing generates a low level of carbon dioxide in the blood and may cause several symptoms of hyperventilation. Consequently, individuals who experience a high pulse rate are at risk of losing their lives even if they are healthy or physically fit.
What could be the causes of all her symptoms if taken together?
The primary dysmenorrhea is caused by excessive prostaglandins levels. These are hormones that make the womb to contract during menstruation and the pain results from the hormone release when the lining is sloughing off during menstruation (Stewart et al., 2016). On the other hand, the cause of mild depression can be genetic or may be triggered by a life event like grief, relationship issues or maybe sickness. For instance, from the case study, Cynthia is widowed since her husband is dead and this might have resulted in her mild depression history.
What is the normal hourly urine output (reference required) and what reasons could there be a low output
The normal hourly urine output is 30 Ml to 50 Ml per hour. In neonate it is less than 2 Ml/kg per hour, for children is less than 1 Ml/kg per hour and for adults is less than 0.5 Ml/kg per hour. However, a low output of urine is termed as oliguria and is considered to be a urinary output of fewer than 400 Ml over the course of 24 hours. The reasons behind the low urine output are due to dehydration, trauma or urinary track obstruction (Kunst & Ostermann, 2017).
What is the specific care needs 1 hr post-op for Cynthia or Peter?
Usual vital signs
The specific care needs 1 hr. post-op for Cynthia are the nasogastric tube which will remain in place postoperatively till it is determined that the abdomen is healing well and the setting up of Patient Controlled Analgesia for the administration of medication dose to manage pain. The nasogastric tube also removes secretions and assists in preventing enlargement of the upper pouch. Also, an Incentive Spirometer is provided to take about ten deep breaths into the spirometer each hour to prevent pneumonia or other breathing issues (Nascimento Junior et al., 2014).
In patient’s safety, the response of nursing to unnatural vital signs is one of the most critical levers through provision of timely recognition of early clinical deterioration. What needs to be done is continuous multi-parameter monitoring of Cynthia and Peter improvised on surgical points with a minor together with proper level of audible alerts (Watkins, Whisman & Booker, 2016). Therefore, continuous evaluation of vital signs in some cases may have initiated nursing interventions which prevented failure-to-rescue events and this surveillance assists in improving the safety of patients.
What is safe care 1 hrs post-operatively for Cynthia or Peter?
Postoperative care starts at the end of the surgery and continues in the recovery room and throughout the hospitalization period. The immediate critical concerns for Cynthia are airway protection, wound healing where the surgeon must individualize care of every wound and blood pressure variability (Singh & Belland, 2015). Urinary retention is another safe care where the urine output should be monitored.
Review Cynthia and Peter’s history. Which MDT professionals would assist them best in their recovery post-discharge from the hospital?
The multidisciplinary team is team of experts from diverse disciplines who converge together to give regular evaluation and consultation in abuse cases. The multidisciplinary team professionals who would assist Cynthia and Peter best in their recovery post-discharge is the pathologist and physical therapists. Pathologists examine the tissues removed during the surgery while the physical therapists evaluate the ability of the patient to climb stairs and walk safely before being discharged from the hospital (Sarr-Jansman & Sier, 2018). Also, the physical therapists assist the clients to gain balance and strength.
Discuss the aetiology and pathophysiology of the patient’s presenting condition. (LO3)
It’s Leiomyoma which are the most regular benign gynecologic growth and although their exact etiology is not known it is thought to be multifactorial incorporating hormonal, tissue growth and genetic factor variations (Fonseca, Castro, Machado, Conte & Girao, 2017). Furthermore, it is believed that the tumors grow in the majority of American females and become asymptomatic in a third of these females. Progesterone and estrogen are recognized as promoters of tumor development, and the potential responsibility of environmental estrogens has only currently been explored.
Critically discuss the underlying pathophysiology of the patient’s post-operative deterioration. Priorities, outline and justify the appropriate nursing management of the patient during this time. (LO1, LO2, LO3, LO5, LO6)
The primary factor that influenced the post-op deterioration of the patient was the mild depression. It is a severe disorder of vast clinical and sociological importance, and it is possibly life-threatening. The pathophysiological condition comprises a triad of symptoms with low or depressed mood and fatigue or low energy. There are other symptoms like low self-esteem and sleep which are also present ((Watkins, Whisman & Booker, 2016)). However, it is not a similar disease but a complex phenomenon with several subtypes and more than one cause.
Depression incorporates of predisposition to episodic and often progressive mood disturbances, interactions with other somatic disorders and differences in symptomatology ranging from mild to severe symptoms. During the monitoring of the patient, it was found out that she had low blood pressure and this could be increased through positioning whereby the head of the bed is made flat, introducing medications of intravenous fluids and also considering the diet (Watkins, Whisman & Booker, 2016). The nursing management involves limitation activities to preserve the consumption of oxygen and lower breathlessness.
Identify three members of the interdisciplinary healthcare team, apart from the primary medical and nursing team, who you would involve in the care of the patient before their discharge and provide justification for their involvement. (LO1, LO4, LO5, LO6)
An interdisciplinary team comprises of healthcare experts who are from diverse fields working in a coordinated fashion toward a typical patient’s objective (Ross, 2017). Social workers are interdisciplinary team members who counsel patients and provide them with psychological support; serve as part of the staff that ensures care along the continuum of attention after the discharge of a patient and the liaison with the community regarding financial needs of the patient. Also, the Registered Dietitian is a food and nutrition superstar on the healthcare team, and they assist in designing food plans and educate along with counselling clients in assisting them succeed some diseases (Ross, 2017). Dietitians also participate in clinical research and hospital food service management.
In conclusion, the Recreation Therapists provide a broad range of therapy and interventions designed for the functioning of the patient and keeping them active, independent and healthy. They work with patients of all ages and disease conditions and include particular interests of clients into therapeutic operations to assist the client in developing and maintain skills for daily living and promoting their emotional, physical and social well-being (Ross, 2017).
I would recommend recreation Therapist since they usually provide a range of therapy that are aimed to better the patients. Accordingly, I would recommend that clinicians who wish t do hysteroscopic morcellation of uterine Leiomyoma’s has to inform the clinical governance leads within their NHE trust. Furthermore, they have to make sure that patients comprehend the uncertainty concerning the procedure’s safety along with efficacy and provide them with written information and they have to be of specific training within this technique. Last but not least, all centres where the surgery is carried out should carry out a revision about their internal case studies.
References
Dünser, M. W., Druml, W., Petros, S., & Grander, W. (2018). The Hydration Status and the Kidneys. In Clinical Examination Skills in the Adult Critically Ill Patient (pp. 137-142). Springer, Cham.
Fonseca, M. C., Castro, R., Machado, M., Conte, T., & Girao, M. J. (2017). Uterine artery embolization and surgical methods for the treatment of symptomatic uterine leiomyomas: a systemic review and meta-analysis followed by indirect treatment comparison. Clinical Therapeutics, 39(7), 1438-1455.
Khan, Y., Ostfeld, A. E., Lochner, C. M., Pierre, A., & Arias, A. C. (2016). Monitoring of vital signs with flexible and wearable medical devices. Advanced Materials, 28(22), 4373-4395.
Kinkel, K., Ascher, S. M., & Reinhold, C. (2018). Benign Disease of the Uterus. In Diseases of the Abdomen and Pelvis 2018-2021 (pp. 21-33). Springer, Cham.
Kunst, G., & Ostermann, M. (2017). Intraoperative permissive oliguria–how much is too much?. BJA: British Journal of Anaesthesia, 119(6), 1075-1077.
Lau, S. K., & Koh, S. S. (2018). Cutaneous Smooth Muscle Tumors: A Review. Advances in anatomic pathology, 25(4), 282-290.
Nascimento Junior, P., Modolo, N. S., Andrade, S., Guimaraes, M. M., Braz, L. G., & El Dib, R. (2014). Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery. The Cochrane Library.
Ono, M., Maruyama, T., Fujiwara, H., & Bulun, S. E. (2018). Stem Cells and Uterine Fibroids. In Uterine Fibroids and Adenomyosis (pp. 59-67). Springer, Singapore.
Ross, C. M. (2017). Activities Professionals: Key Members of an Interdisciplinary Healthcare Team. BAJ Pall Medicine, 3, 037.
Sarr-Jansman, E. T. M., & Sier, C. (2018). Multidisciplinary Collaboration. In The Challenges of Nursing Stroke Management in Rehabilitation Centres (pp. 41-46). Springer, Cham.
Schwetye, K. E., Pfeifer, J. D., & Duncavage, E. J. (2014). MED12 exon two mutations in uterine and extrauterine smooth muscle tumors. Human pathology, 45(1), 65-70.
Singh, S. S., & Belland, L. (2015). Contemporary management of uterine fibroids: focus on emerging medical treatments. Current medical research and opinion, 31(1), 1-12.
Smith, R. P. (2018). The Clinical Classification and Causes of Dysmenorrhea. In Dysmenorrhea and Menorrhagia (pp. 55-64). Springer, Cham.
Stewart, E. A., Laughlin-Tommaso, S. K., Catherino, W. H., Lalitkumar, S., Gupta, D., & Vollenhoven, B. (2016). Uterine fibroids. Nature Reviews Disease Primers, 2, 16043.
Watkins, T., Whisman, L., & Booker, P. (2016). Nursing assessment of continuous vital sign surveillance to improve patient safety in the medical/surgical unit. Journal of clinical nursing, 25(1-2), 278-281.
Order an Essay Now & Get These Features For Free:
Turnitin Report
Formatting
Title Page
Citation
Outline
