Primary Nursing Diagnosis

Pain (acute) related to postprocedure swelling and nerve damage OUTCOMES. Pain control; Pain: Disruptive effects; Well-being

INTERVENTIONS. Analgesic administration; Pain management; Meditation; Transcutaneous electric nerve stimulation (TENS); Hypnosis; Heat/cold application

H PLANNING AND IMPLEMENTATION Collaborative

Treatment depends on the stage of the cancer, the woman's age, and concern for future child-bearing. Preinvasive lesions (CIS) can be treated by conization, cryosurgery, laser surgery, or simple hysterectomy (if the patient's reproductive capacity is not an issue). All conservative treatments require frequent follow-up by Pap tests and colposcopy because a greater level of risk is always present for the woman who has had CIS. A cone-shaped piece of tissue is removed from the cervix after epithelial involvement is clearly outlined as described with the cone biopsy. The cone includes all the abnormal and some normal tissue. Following this procedure, the woman can still have children. The major complication is postoperative bleeding.

CRYOSURGERY. Cryosurgery is performed 1 week after the patient's last menstrual period (thereby avoiding treatment in early pregnancy). The surgeon uses a probe to freeze abnormal tissue and a small amount of normal tissue.

LASER SURGERY. For laser surgery, a carbon dioxide laser is used. Healing takes place in 3 to 6 weeks, and recurrence rates are lower than with cryosurgery.

HYSTERECTOMY. A hysterectomy, removal of the cervix and uterus, is the definitive therapy for CIS. The risks of general anesthesia and abdominal surgery are present. Major risks are infection and hemorrhage.

INVASIVE CANCER. Invasive cancer (stages I to IV) can be treated with surgery, radiotherapy, or a combination of both (Table 6). Pelvic exenteration can be done for recurrence and/or for advanced stage III or IV. Total exenteration entails the removal of the pelvic viscera, including the bladder, rectosigmoid, and all the reproductive organs. Irradiation of metastatic areas is done to provide local control and decrease symptoms.

• TABLE 6 Treatment Alternatives for Invasive Cervical Cancer
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