Task 1
Pathophysiology of endometriosis:
Endometrium is one of the three layers of uterus in the female gynecological tract. It is directly opposed to myometrium that is the muscular layer of the uterus the endometrium is composed of stroma and glands the function of endometrium is to provide the bed in which the zygote is implanted after fertilization. The glands in endometrium produce mucus and glycogen secretions that provide nutrition for the implanting embryo. Endometrium after pregnancy is known as decidua. Endometriosis is mal-occurrence of endometrium-like tissue away from the usual place (Radzinsky et al., 2019). The abnormal positioning of endometriosis leads to many problems of reproductive system among females (Orazov et al., 2019). The most common sites are the ovary, peritoneum, pouch of Douglas, and uterine ligaments. The signs and symptoms arising from endometriosis depend upon the part affected (Vercellini et al., 2018). Pain is the most common symptom associated with endometriosis and the pain is caused by inflammation and irritation of the abnormal tissue. Interestingly the menstrual cycle of endometrial glands is similar to the endometrium that is not normally present in the uterus during earlier phase of female menstrual cycle There is proliferation of glands and decidua functionalis. During secretory phase the glands secrete their secretions. If conception doesn’t occur then the glands are disintegrated. And hence menstruation occurs. When the abnormal endometrium enters the menstrual cycle, it causes abnormal bleeding. In that process, the glands are abnormally present in different structures so when the glands and stronger disintegrate it causes bleeding from the side of implantation of endometriosis. The pathological composition of lesion caused by endometriosis is similar to granulomatous inflammation except the giant cells are absent and the lesion is composed of histiocytes and fibroblasts. And thus, it leads to abnormal bleeding from the site of implantation (Tomassetti & D'Hooghe, 2018). Several implantation sites are also reported to be pigmented and it is directly related to the time duration of the lesion. The odds of an older to be e pigment are greater than a newer lesion. Exactly legion of endometriosis looks like is highly very variable. The component of endometriosis maybe predominant in a lesion or it may be totally regressed in other. The endometrium has glands and supportive tissue likewise endometriosis involves gland and stromal components, there is a difference in histological composition of endometriosis implant a metal or plastic changed may be seen in case of endometriosis and it is rarely seen in normal endometrium. (Orazov et al., 2019). There may be dominance of glands stroma or the pathological cells surgery as histiocytes or white blood cells (Radzinsky et al., 2019). Next to bleeding is the pain associated with endometrosis and it may be the presenting complaint in many cases of endometriosis. Painful bleeding is often the hallmark of this disease. The site of pain is often variable in different patients sometimes the infra umbilical region or the whole pelvic area is involved. The severity of the pain is also different and it depends upon the number of lesions. Endometriosis may be an underlying cause of infertility, and a matter of concern for infertile couples. Inconspicuous occurrence of endometriosis may be first picked up in the fertility clinic where the patient comes with the complaint of infertility. (Vercellini et al., 2018).
Spotting and inter-menstrual bleeding is often seen in patients (Tomassetti & D'Hooghe, 2018). Pain, discomfort, depression, anxiety and irritation are seen in the patient. Sometimes the chief complaint is inability to conceive (Orazov et al., 2019).
Task 2:
Nursing Care for Anemia:
Bleeding episodes associated with endometriosis are the causes of blood loss and resulting anaemia in the patients of endometriosis. After puberty, females experience menstrual bleeding for a period of 4 to 5 days each month and it accounts for the blood loss in the normal females. This bleeding entails are risk of developing anemia in the patient so the physician must keep this aspect in mind and whenever anemia is suspected the patient must be given supplements of iron and folic acid so that the nema in such patients can be prevented successfully (Tomassetti & D'Hooghe, 2018). Besides normal menstrual bleed the patient if has endometriosis increases the risk of developing anemia to a greater extent then in a normal female. As a nursing practitioner one must know the association of anaemia with endometriosis. The definition of anaemia is extremely important here. Anemia is either the deficiency of red cell mass or hemoglobin or below 11.5 mg/dL in women. The gross blood loss associated with endometriosis is an obvious cause of anaemia in such patients. The patient may or may not be aware of her anemic condition or the patient may be concerned about anemia and the link of blood loss due to endometriosis (Tomassetti & D'Hooghe, 2018). If bleeding episodes of endometresses are associated with bleeding from any other portal of the body such that epistasis or bleeding hemorrhoids, the risk of developing anaemia for the increases (Vercellini et al., 2018). The history of patients is extremely important in these conditions. Hence the burden of bleeding episode is even greater than and that of a patient suffering from endometriosis alone. When the patient suffers from anaemia that results from endometriosis the nursing interventions are extremely important to absolve the signs and symptoms of anaemia. The chief complaint associated with anemia that deteriorates the ability to do normal routine work is fatigue associated with anemia. The patient maybe ask to optimize her activities such that the balance between physical activity and exertion is maintained and fatigue is avoided as far as possible. After then the dietary therapy of anaemia should be implemented as steadfastly as possible. The patient may be motivated to stick to the instructions (Orazov et al., 2019). The dietary support in such patients is extremely important because effectively restores the blood hemoglobin levels. The patient must be advised to take that diet rich in elemental iron so that the deficiency of iron can be compensated (Radzinsky et al., 2019). Alcohol deteriorates the iron metabolism and hands it should be awarded in patients that are compensating for anemia or related symptoms. The new mechvation very blood transfusions and the nursing stuff must ensure that the blood transfusion occurs without any complication and the standard protocol of blood transfusion is followed when the patient is being transfused (Vercellini et al., 2018). The signs and symptoms of the patient must be regularly monitored and documented by the nursing staff and then they can help the medical staff to analyse the compliance and betterment of the patient's symptom (Tomassetti & D'Hooghe, 2018).
Task 3:
Medicinal Therapy for Endometriosis:
Chevrolet drugs have been tried and documented to be effective and managing the symptoms of endometriosis. But the treatment plan always revolves around the scientific evidence of drug safety and effectiveness. The treatment of endometriosis changes from person to person as it is directly related to severity of signs and symptoms in individuals. On one side of the spectrum is the mild treatment with medications like non-steroidal anti-inflammatory drugs and the last resort of treatment is surgical removal of individual implants from the areas (Radzinsky et al., 2019).
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At first the medical therapy is adopted in patients depending upon their disease severity and there is a consolation of drugs that can be employed to treat endometriosis. (Vercellini et al., 2018). Nonsteroidal anti-inflammatory drugs are of the first line of treatment in in these patients as these drugs reduce inflammation and are effective in controlling the pain associated with endometriosis. Out of many drugs that have been used in endometriosis hormonal therapy is one of the most effective therapies. The long term effect of these drugs are really safe for use and these drugs are fairly effective so that some of the gynecologist consider this drug as the first line therapy. The easy availability, accessibility, and tolerance of these drugs make them extremely useful in treatment of endometriosis. (Tomassetti & D'Hooghe, 2018). One of the benefits while using these drugs is that extra contraceptive measures may not be needed while the patient is on oral contraceptive pills so these drugs confirm dual protection against birth and also protection against endometriosis associated pain and bleeding (Becker et al., 2017). The mechanism of fraction of known anti-inflammatory drugs is such that it in a bits the cyclooxygenase enzyme so they have analgesic action. NSAIDS and hormone based contraceptives are preferred due to multiple reasons as these therapies have the least side effects these are low risk and fairly effective in most of the cases. One important consideration is that Nonsteroidal anti-inflammatory drugs and hormone-based contraceptives are used in mild cases (Tomassetti & D'Hooghe, 2018). But he said studies suggest that Nonsteroidal anti-inflammatory drugs and hormones drugs are both very effective and safe for managing the condition of endometriosis. But the question that I just hear that what should I physician prescribe to the patient. The answer lies in the fact that the clinical acumen of the physician may decide which drug to be used and which not to be used (Becker et al., 2017). Interestingly some studies have investigated the combined effect of these drugs when they are huge simultaneously. However there is not much evidence of increase our significant difference between the effectiveness of this therapy as compared to any of the drug alone (Vercellini et al., 2018). The time duration of this therapy is at least three months till the symptoms of the visions are relieved but the continuation of this therapy beyond menopause or at the time when the patient wants to conceive is not recommended by the researchers (Radzinsky et al., 2019). The patients that show no response to the above-mentioned therapy are given different known combinations that are based on oral norethisterone acetate or depot medroxyprogesterone acetate every three months. However, these drugs are not suitable during conception so these drugs must be excluded or starved when pregnancy is desired. Severe disease that affects the work or school life of the individual must be treated by GnRH analogs (Tomassetti & D'Hooghe, 2018). Interestingly, this therapy can also be used for long term (Orazov rt al., 2019). The next option of therapy in cases where the above medical therapies failed to produce desirable results are treated by aromatase inhibitors. The diagnostic and therapeutic labroscopy may be indicated if all the non-invasive medical treatments fail to produce desirable effects (Vercellini et al., 2018). In this surgery, endometrial implants are excised laparoscopically, and the adhesions are removed (Radzinsky et al., 2019).
Task 4:
Critical Thinking:
1 out of 4 women suffering from endometriosis also suffers from infertility (Tanbo & Fedorcsak, 2017). Theology of endometriosis led information maybe different depending upon the implant (Becker et al., 2017). Endometriosis disrupts the gross structure of ovary converting it into a structure that is called chocolate cyst (Radzinsky et al., 2019). The chocolate cyst is unable to produce adequate hormones and the relation is also disturbed that is the main cause of infertility. The second cause of infertility in endometriosis is endometriosis causing anatomical destruction of the structure of the uterus. The lesions may result in adhesions that are problematic in themselves. These disruptions interfered with the normal integrity that is essential for conception and pregnancy (Vercellini et al., 2018). Already of the treating physician is to employ non-invasive and safe therapy as far as possible. The surgical management is reserved in severe cases when indicated (Tomassetti & D'Hooghe, 2018). The products of glands of endometriosis include some inflammatory markers and cytokines that interfere with the normal physiology of conception and pregnancy that is why this interference leads to disruption in the mechanism of conception and pregnancy leading to infertility (Opoku-Anane et al., 2020). It affects the normal milieu of the implantation site and thus disturbing the normal process of implantation leading to difficulty in conception and infertility.
As a part of nursing care, the registered nurse must be able to identify the risk factors of anxiety and other psychiatric problems in the patient. To identify anxiety the patient was examined by the registered nurse to look for science like panic and altered behavior of the patient (Vercellini et al., 2018). Or it may simply manifest as irritability (Radzinsky et al., 2019). As discussed earlier, the nursing staff must see some psychotic problems coming in that patient and their team must be ready to cope with the changes in behavior and mood of the patient (Opoku-Anane et al., 2020). The bond between nursing stuff and the patient is in dispensable as far as managing the psychiatric complaints of the patients are concerned (Radzinsky et al., 2019). Anxiety and stress of the patient is better managed by giving her complacent environment and this may be achieved by referring her to our clinical psychiatrist that may address her symptoms professionally and to decide whether she needs medication for her symptoms (Opoku-Anane et al., 2020). Person-centred care of the patient demands that the patient must be referred to all the clinicians that may help the patient relieve her symptoms. A gynecologist may help her in consultation regarding pregnancy and conception (Leonardi et al., 2020). So far holistic medicine stresses to practice the management of the patient as a whole organism also considering ads external factors such as environment (Becker et al., 2017). The psychiatric treatment plays an important role in managing the patient as far as the nursing care is concerned.
References:
Becker, C. M., Gattrell, W. T., Gude, K., & Singh, S. S. (2017). Reevaluating response and failure of medical treatment of endometriosis: a systematic review. Fertility and sterility, 108(1), 125-136.
Donatti, L., Ramos, D. G., Andres, M. D. P., Passman, L. J., & Podgaec, S. (2017). Patients with endometriosis using positive coping strategies have less depression, stress and pelvic pain. Einstein (Sao Paulo), 15, 65-70.
Leonardi, M., Ong, J., Espada, M., Stamatopoulos, N., Georgousopoulou, E., Hudelist, G., & Condous, G. (2020). One‐size‐fits‐all approach does not work for gynecology trainees learning endometriosis ultrasound skills. Journal of Ultrasound in Medicine, 39(12), 2295-2303.
Opoku-Anane, J., Orlando, M. S., Lager, J., Lester, F., Cuneo, J., Pasch, L., ... & Giudice, L. C. (2020). The development of a comprehensive multidisciplinary endometriosis and chronic pelvic pain center.
Orazov, M. R., Radzinsky, V. Y., Ivanov, I. I., Khamoshina, M. B., & Shustova, V. B. (2019). Oocyte quality in women with infertility associated endometriosis. Gynecological Endocrinology, 35(sup1), 24-26.
Radzinsky, V. Y., Orazov, M. R., Ivanov, I. I., Khamoshina, M. B., Kostin, I. N., Kavteladze, E. V., & Shustova, V. B. (2019). Implantation failures in women with infertility associated endometriosis. Gynecological Endocrinology, 35(sup1), 27-30.
Tanbo, T., & Fedorcsak, P. (2017). Endometriosis‐associated infertility: aspects of pathophysiological mechanisms and treatment options. Acta obstetricia et gynecologica Scandinavica, 96(6), 659-667.
Tomassetti, C., & D'Hooghe, T. (2018). Endometriosis and infertility: Insights into the causal link and management strategies. Best Practice & Research Clinical Obstetrics & Gynaecology, 51, 25-33.
Vercellini, P., Buggio, L., Frattaruolo, M. P., Borghi, A., Dridi, D., & Somigliana, E. (2018). Medical treatment of endometriosis-related pain. Best Practice & Research Clinical Obstetrics & Gynaecology, 51, 68-91.
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