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Nursing care of patients with gestational trophoblastic disease
Obstetrics and Gynecology Nursing 7th Edition #Nursing of patients with gestational trophoblastic disease. Gestational trophoblastic disease is a group of diseases originating from placental trophoblast cells. According to histological characteristics, it is mainly divided into mole, erosive mole and chorionic villus. Cancer and placental site trophoblastic tumors.
Edited at 2024-10-22 21:52:49- ルミ：10精神的高次元の目覚め
ルミ：精神的な目覚めの10次元。あなたが自分自身を探すのをやめるとき、あなたが探しているのはあなたを探しているので、あなたは宇宙全体を見つけるでしょう。あなたが毎日忍耐することは何でもあなたの精神の深みへの扉を開くことができます。沈黙の中で、私は秘密の領域に滑り込み、私は私の周りの魔法を観察するためにすべてを楽しんだが、何の騒ぎをしなかった。翼で生まれたときに、なぜcraいるのが好きですか？魂には独自の耳があり、心が理解できないことを聞くことができます。すべてへの答えを内向きに求めてください、宇宙のすべてがあなたの中にあります。恋人たちはどこかで会うことはなく、この世界には別れもありません。傷は光があなたの心に入るところです。
- 病態生理 - 心不全
慢性心不全は、心拍数の速度の問題だけではありません！これは、心筋収縮と拡張期機能の減少によって引き起こされ、それが不十分な心拍出量につながり、肺循環の鬱血と全身循環のうっ血を引き起こします。原因、誘導、補償メカニズムまで、心不全の病態生理学的プロセスは複雑で多様です。浮腫を制御し、心臓の前面と後負荷を減らし、心臓の快適機能を改善し、基本的な原因を予防し、治療することにより、この課題に効果的に対応できます。心不全とマスタリング予防と治療戦略のメカニズムと臨床的症状を理解することによってのみ、心臓の健康をよりよく保護できます。
- 病態生理 - 虚血 - 再灌流障害
虚血再灌流損傷は、臓器や組織が血液供給を回復すると、細胞機能と代謝障害、構造的損傷が悪化する現象です。その主なメカニズムには、フリーラジカル生成の増加、カルシウム過負荷、および微小血管および白血球の役割が含まれます。心臓と脳は一般的な損傷した臓器であり、心筋の代謝と超微細構造の変化、心機能の低下などの変化として現れます。予防と制御の測定には、フリーラジカルの除去、カルシウム過負荷の減少、代謝の改善、低温、低温、低圧などの再灌流条件の制御が含まれます。これらのメカニズムを理解することは、効果的な治療オプションの開発に役立ち、虚血性損傷を軽減するのに役立ちます。
Nursing care of patients with gestational trophoblastic disease
- ルミ：10精神的高次元の目覚め
ルミ：精神的な目覚めの10次元。あなたが自分自身を探すのをやめるとき、あなたが探しているのはあなたを探しているので、あなたは宇宙全体を見つけるでしょう。あなたが毎日忍耐することは何でもあなたの精神の深みへの扉を開くことができます。沈黙の中で、私は秘密の領域に滑り込み、私は私の周りの魔法を観察するためにすべてを楽しんだが、何の騒ぎをしなかった。翼で生まれたときに、なぜcraいるのが好きですか？魂には独自の耳があり、心が理解できないことを聞くことができます。すべてへの答えを内向きに求めてください、宇宙のすべてがあなたの中にあります。恋人たちはどこかで会うことはなく、この世界には別れもありません。傷は光があなたの心に入るところです。
- 病態生理 - 心不全
慢性心不全は、心拍数の速度の問題だけではありません！これは、心筋収縮と拡張期機能の減少によって引き起こされ、それが不十分な心拍出量につながり、肺循環の鬱血と全身循環のうっ血を引き起こします。原因、誘導、補償メカニズムまで、心不全の病態生理学的プロセスは複雑で多様です。浮腫を制御し、心臓の前面と後負荷を減らし、心臓の快適機能を改善し、基本的な原因を予防し、治療することにより、この課題に効果的に対応できます。心不全とマスタリング予防と治療戦略のメカニズムと臨床的症状を理解することによってのみ、心臓の健康をよりよく保護できます。
- 病態生理 - 虚血 - 再灌流障害
虚血再灌流損傷は、臓器や組織が血液供給を回復すると、細胞機能と代謝障害、構造的損傷が悪化する現象です。その主なメカニズムには、フリーラジカル生成の増加、カルシウム過負荷、および微小血管および白血球の役割が含まれます。心臓と脳は一般的な損傷した臓器であり、心筋の代謝と超微細構造の変化、心機能の低下などの変化として現れます。予防と制御の測定には、フリーラジカルの除去、カルシウム過負荷の減少、代謝の改善、低温、低温、低圧などの再灌流条件の制御が含まれます。これらのメカニズムを理解することは、効果的な治療オプションの開発に役立ち、虚血性損傷を軽減するのに役立ちます。
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Nursing care of patients with gestational trophoblastic disease
definition
Gestational trophoblastic disease (GTD): a group of diseases originating from placental trophoblast cells
According to histological characteristics
①Gestational trophoblastic tumor (GTN)
choriocarcinoma
placental site trophoblastic tumor
epithelioid trophoblastic tumor
②Molar pregnancy
complete mole
partial hydatidiform mole
erosive hydatidiform mole
③Non-tumor lesions
Extra long placenta site reaction
placental site nodules
④Abnormal (non-molar) villous lesions
Section 1 molar pregnancy
definition
It is caused by the proliferation of placental villous trophoblast cells and interstitial edema and degeneration after pregnancy, forming blisters of different sizes. The blisters are connected in clusters by pedicles and are shaped like grapes. It is named after the placental villous trophoblast cells and interstitial edema and degeneration. It is also called a vesicular vesicular mass (HM). benign lesions of trophoblast
Classification
complete mole
Performance
The uterine cavity is filled with vesicular tissue, without the fetus and its appendages
Related factors
Regional differences
age
nutritional status
socioeconomic factors
Others: Previous molar pregnancy, miscarriage and infertility
partial hydatidiform mole
Performance
Partial vesicular degeneration of placental villi, combined with embryonic or fetal tissue, accompanied by trophoblast proliferation
pathology
complete mole
in general
The vesicles occupy the entire uterine cavity, with no trace of the fetus and its appendages or fetus.
under the mirror
Diffuse trophoblast hyperplasia, vesicular edema in the villous interstitium, and interstitial blood vessels disappear or are extremely rare
partial hydatidiform mole
in general
Only part of the villi turn into blisters, often combined with embryonic or fetal tissue, and the fetuses are often dead.
under the mirror
Some villous edema was seen, with varying sizes and degrees of edema. The villi showed a significant scallop-like outline, localized trophoblast cell proliferation, and trophoblast cell inclusions were seen in the stroma.
clinical manifestations
Vaginal bleeding after menopause (most common)
Irregular vaginal bleeding usually occurs around 8-12 weeks after menopause.
Abnormal enlargement and softening of the uterus
The uterus of most patients is larger than the month of menopause, is extremely soft, and is accompanied by an abnormal increase in hCG - the reason is the rapid growth of mole and intrauterine blood accumulation.
The uterus of a few patients is smaller than the month of menopause——the reason may be related to the degeneration of vesicles
Abdominal pain——paroxysmal lower abdominal pain
Vomiting of pregnancy
signs of preeclampsia
Hypertension, proteinuria, and edema may occur as early as 24 weeks of pregnancy
Ovarian luteinized cyst
A large amount of hCG stimulates ovarian endometrial cells to undergo luteinization and form cysts
Hyperthyroidism
nursing assessment
health history
physical condition
psychosocial status
Diagnostic points
B-ultrasound examination
complete mole
The uterus is larger than the gestational age, there is no gestational sac or fetal heartbeat, and the uterine cavity is filled with heterogeneous dense or short strip echoes, appearing like "falling snow"
If the bubbles are large and form echo zones of varying sizes, they will appear "honeycomb-shaped"
Human chorionic gonadotropin (hCG)
Treatment points
Hydatidiform mole should be eliminated as soon as possible once diagnosed
Common nursing diagnoses
Risk of infection
associated with vaginal bleeding
anxiety
Related to worry about uterine curettage surgery and prognosis
lack of knowledge
Lack of relevant knowledge about disease treatment and follow-up
Nursing measures
1.Psychological care
2. Closely observe the condition
Observe abdominal pain and vaginal bleeding
3. Make preparations before and during surgery
① Complete a full body examination before uterine evacuation, pay attention to signs of shock, preeclampsia, hyperthyroidism and anemia, follow the doctor's instructions for symptomatic treatment, and stabilize the condition
② Before the operation, instruct the patient to empty the bladder, match blood, establish intravenous access, and prepare oxytocin, rescue supplies and medicines.
② During the operation, closely observe blood pressure, pulse, respiration, signs of shock, and pay attention to whether there are signs of amniotic fluid embolism.
④Pay attention to vaginal bleeding and abdominal pain after surgery
4.Health education
Diet care————Intake foods rich in vitamin A and easy to digest
Activity and rest—appropriate exercise, adequate sleep and rest to improve the body’s immune function
Keep the vulva clean and dry, and refrain from sexual intercourse and bathing in the bath for 1 month after each dilation and curettage to prevent infection.
5. Follow-up guidance
①Quantitative measurement of serum hCG. After evacuation of hydatidiform mole, follow-up is conducted once a week until three consecutive negative results, then once a month for 6 months, then every 2 months for a total of 6 months, and a total of 1 time since the first negative result Year
② Ask for medical history and pay attention to whether menstruation is regular, whether there is abnormal vaginal bleeding, whether there is cough, hemoptysis and other metastatic symptoms
③Gynecological examination: B-ultrasound, chest X-ray
6. Contraceptive guidance
Strict contraception for 1 year
contraceptive methods
condom
oral contraceptive pills
Section 2 Gestational trophoblastic tumors
Classification
erosive hydatidiform mole
definition
Secondary to hydatidiform mole within six months after evacuation
source
secondary to molar pregnancy
pathology
in general
There are blister-like tissues of varying sizes and depths within the uterine muscle wall
When the erosion focus is close to the uterine serosa layer, purple-blue nodules can be seen on the surface of the uterus
under the mirror
Visible villous structures (differential sign from choriocarcinoma)
choriocarcinoma
definition
Secondary to hydatidiform mole more than 1 year after evacuation
source
Secondary to nonmolar pregnancy, including miscarriage, ectopic pregnancy, and term pregnancy
pathology
in general
Tumors are often located within the myometrium of the uterus, but may also protrude into the uterine cavity or penetrate the serosa.
No fixed shape, unclear boundaries with surrounding tissues, soft and brittle texture
under the mirror
Trophoblast cells do not form villi or vesicle-like structures
clinical manifestations
1. Non-metastatic trophoblastic tumors
Mostly secondary to molar pregnancy
①Vaginal bleeding
② Incomplete uterine involution or uneven enlargement
③Ovarian luteinized cyst
④Abdominal pain
⑤Symptoms of false pregnancy
Breast enlargement, nipple and areola discoloration
Colostrum-like secretion
2. Metastasis of trophoblastic tumors
More common after non-molar pregnancy
The most common site of metastasis: lungs, followed by vagina, pelvis, liver, and brain
①Lung metastasis
Cough, bloody sputum or repeated hemoptysis, chest pain and difficulty breathing
②Vaginal metastasis
Metastases are often located on the anterior vaginal wall and fornix
③Liver metastasis
poor prognosis
④Brain metastasis
The prognosis is dire and it is the main cause of death.
According to the progress of the disease
tumor thrombus stage
brain tumor stage
Cerebral herniation stage
⑤Other transfers
Spleen, kidney, bladder, digestive tract, etc.
nursing assessment
health history
physical condition
psychosocial status
Diagnostic points
B-ultrasound
Serum hCG
Treatment points
The treatment principle is comprehensive treatment based on chemotherapy, supplemented by surgery and radiotherapy.
first-line chemotherapy drugs
Methotrexate (MTX), fluorouracil (5-Fu), cyclophosphamide (CTX), vincristine (VCR)
Chemotherapy principles
Low-risk patients may choose single-agent chemotherapy
High-risk patients choose drug combination chemotherapy
Operation
To control various complications such as major bleeding, remove drug-resistant lesions, reduce tumor burden and shorten the course of chemotherapy
radiotherapy
Mainly used for the treatment of liver, brain metastases and drug-resistant lesions in the lungs
Common nursing diagnoses
Self-identity role disorder
Associated with longer hospitalization and chemotherapy
potential complications
Lung metastasis, vaginal metastasis, brain metastasis
Nursing measures
1.Psychological care
2. Closely observe the condition
Closely observe the patient's abdominal pain and vaginal bleeding, and accurately record the amount of bleeding
3. Cooperate well with treatment
4. Provide symptomatic care to those with metastases
①Nursing of patients with vaginal metastasis
Unnecessary vaginal examinations and vaginal speculum examinations are prohibited
Rest in bed as much as possible, and closely observe the vaginal metastases for ulceration and bleeding.
Match blood and prepare rescue supplies and medicines
If ulceration and massive bleeding occur, you should immediately notify the doctor and cooperate with rescue efforts. Use sterile gauze to fill the vagina to compress and stop the bleeding.
Keep the vulva clean and dry, and closely monitor bleeding
②Nursing of patients with lung metastasis
Bed rest, if you have difficulty breathing, take oxygen in a semi-recumbent position
Administer sedatives and chemotherapy drugs as directed by the doctor
When there is a large amount of hemoptysis, there is a risk of suffocation, shock or even death. The patient should be immediately placed in a lying position on the affected side and maintained in the respiratory tract. Pat the back gently to eliminate blood accumulation.
③Nursing of patients with brain metastasis
Stay in bed as much as possible and have someone with you when you get up.
Observe the increase in intracranial pressure, record the input and output, and observe whether there is any electrolyte imbalance.
Follow the doctor's instructions for intravenous rehydration, hemostatic agents, dehydrating agents, oxygen inhalation, chemotherapy, etc.
5.Health education
diet
High protein, high vitamin, easy to digest food
disease prevention guidance
Keep the vulva clean and dry to prevent infection
Moderate sexual life and provide contraceptive guidance
Follow up closely and be alert for recurrence