Primary Nursing Diagnosis

Holistic Hormone Balance

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Knowledge deficit related to treatment procedures, treatment regimens, medications, and disease process

OUTCOMES. Knowledge: Treatment procedures; Knowledge: Treatment regimens; Knowledge: Medications; Knowledge: Disease process

INTERVENTIONS. Teaching: Disease process; Teaching: Prescribed medication; Teaching: Procedure/treatment; Teaching: Preoperative


SURGICAL. If uterine cancer is detected early, the treatment of choice is surgery. A total abdominal hysterectomy (TAH) with removal of the fallopian tubes and ovaries, bilateral salpingo-oophrectomy (BSO) is generally performed. Common complications after a hysterectomy are hemorrhage, infection, and thromboembolic disease. Premenopausal women who have a BSO become sterile and experience menopause. Hormone replacement therapy may be warranted and is appropriate. In a total pelvic exenteration (evisceration or removal of the contents of a cavity), the surgeon removes all pelvic organs, including the bladder, rectum, and vagina. This procedure is performed if the disease is contained in the areas without metastasis. If the lymph nodes are involved, this procedure is usually not curative.

RADIATION. Radiation therapy may also be given in combination with the surgery (before or after) or it may be used alone, depending on the staging of the disease, whether the tumor is not well differentiated, or whether the carcinoma is extensive. Radiation may be the treatment of choice for the very elderly woman with an advanced stage of endometrial cancer for whom surgery would not improve quality of life. With radiation, the possible complications are hemorrhage, cystitis, urethral stricture, rectal ulceration, or proctitis.

Intracavity radiation or external radiation therapy may be given 6 weeks before surgery to limit recurrence or to improve the chance of survival. An internal radiation device may be implanted during surgery (preloaded) or at the patient's bedside (afterloaded). If the device is inserted during the surgical procedure, the postoperative management needs to include radiation precautions. Provide a private room for the patient and follow the key principle to protect against radiation exposure: distance, time, and shielding. The greater the distance from the radiation source, the less exposure to ionizing rays. The less time spent providing care, the less radiation exposure. The source of radiation determines if lead shields are necessary to provide care. All healthcare workers coming in contact with a "hot" patient (a patient with an internal radiation implant) need to monitor their exposure with a monitoring device such as a film badge. Nursing care of patients with radiation implants is detailed in Table 1.

• TABLE 1 Nursing Care of Patients with Radiation Implants

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