Background of The Condition:: Those That Put A Person at Risk of Developing A Problem)

Background of the condition:
Introduction:
It is a gynecological condition involving the presence of endometrial tissue in abnormal
locations. Affects approximately 5-15% of reproductive-aged females. Also affects fertility in
patients. And it causes impaired fertility in 30-40% of patients with the condition endometriosis.
*Notes: endometrial tissues also called mucosa (outside the uterus)
Pathophysiology: HOW IT HAPPENS?
When the endometrium is sloped off during menstruation, the cells escape and go to the
location where they shouldn’t be, including the surrounding areas like fallopian tube, ovaries,
and other parts of the body.
Unfortunately, endometriosis is a long-term condition. Women may experience relief after

surgery, but the symptoms may return within a few years. For most women, endometriosis
recedes with menopause. Some women find relief from endometriosis during pregnancy. In
some cases, symptoms may simply go away.
Lifestyle factors such as alcohol/caffeine intake, smoking, and physical activity influence
estrogen levels in the body and, therefore, may impact development of endometriosis.
Types:
● Superficial peritoneal endometriosis - in this type, the endometrial tissue attaches to the
peritoneum, a thin membrane that lines the abdomen and pelvis. It also covers most of
the organs in these cavities. This is the least severe form.
● Endometriomas - a dark, fluid-filled cysts. Also called chocolate cysts. It varies in size
and can appear in different parts of your pelvis or abdomen. This is most common in the
ovaries.
● DIE (Deeply Infiltrating Endometriosis) - the endometrial tissue invades the organs either
within or outside the pelvic activity. This includes ovaries, rectum, bladder, and bowels. It
is rare, but sometimes a lot of scar tissue can bond organs so they become stuck in
place. This condition is called frozen pelvis. Happens to 1-5% of people with
endometriosis.
● Abdominal Wall Endometriosis - the endometrial tissue can grow on the abdominal wall.
The cells may attach to a surgical incision, like one from a C-section.
Predisposing Factors (those that put a person at risk of developing a problem):

● Women who never gave birth.
● Women who started her period at an early age (earlier than 11).
● Women who go through menopause at an older age.
● Women who have short menstrual cycles (less than 27 days).
● Women who have higher levels of estrogen in her body or a greater lifetime
exposure to estrogen her body produces.
● Women who have low body mass index.
● Women who have one or more relatives having the same condition,
endometriosis.
● Women who have any medical condition that prevents the passage of blood from
the body during menstrual periods.
● Women who have reproductive tract disorders.
Signs and symptoms:

● Pain - 1. pelvic pain, 2. lower abdomen, groin, and back, 3. Dysmenorrhea, 4.
Dyspareunia (a pain during intercourse), 5. Pain while urinating, 6. pain while exercising
*note: pain is most severe during onset of the period
● Heavy or irregular menstruation
● Dyschezia (constipation-like)
● Bloating
● Nausea
● Vomiting
Diagnostic procedure (all labs, etc):
● Pelvic exam - palpates the areas in the patient's pelvis for abnormalities like cysts. But
often it is impossible to feel small areas of endometriosis unless they have caused a cyst
to form.
● Ultrasound
● MRI (Magnetic Resonance Imaging)
● Laparoscopy
Medical-Surgical Management:
Medical - treatment depends on the symptoms, the patients desire for pregnancy, and the
extent of the disease.
1. Routine examination (if no symptoms)
2. NSAIDs
3. Oral contraceptives
4. GnRH agonists (Gonadotropin-releasing hormone)
5. Surgery
Surgical - if conservative measures are not helpful;
1. Laparoscopy
2. Laser surgery
3. Endocoagulation
4. Electrocoagulation
5. Laparotomy
6. Abdominal hysterectomy - total hysterectomy is an option for women who are willing to
sacrifice reproductive capability.
7. Oophorectomy - removal of one or both ovaries.
8. Bilateral salpingo-oophorectomy
9. Appendectomy
Nursing management:
There are three (3) pieces of information that helps in determining the treatment plan for a
patient;
● Specific symptoms (eg, pain) and when how long they have been bothersome,
● The effect of prescribed medications, and
● The patient’s reproductive plans.
Explain thoroughly the various diagnostic procedures to alleviate the patient’s anxiety.
Goals: relief of pain, dysmenorrhea, dyspareunia, and avoidance of infertility.
*Note: as the treatment progresses, the patient and her partner may find that pregnancy is not
easily possible, and the psychosocial impact of this realization must be recognized and
addressed. Alternatives, such as in vitro fertilization or adoption, may be discussed at an
appropriate time and referrals offered.
Nursing Diagnosis
● Activity intolerance related to acute pain secondary to endometriosis as evidenced by
pain score of 10 out of 10, fatigue, disinterest in activities of daily living due to pain,
verbalization of tiredness and generalized weakness.
● Acute pain related to abdominal cramping secondary to endometriosis as evidenced by
pain score of 10 out of 10, guarding sign on abdomen, restlessness, and irritability.
● Deficient knowledge related to acute pain management of endometriosis as evidenced
by patient’s verbalization of “I want to know how to relieve my pain.”
Health teachings
● Educate the patient to dispel myths and encourage the patient to seek care if
dysmenorrhea or dyspareunia occurs.
● Educate the patient to take prescribed pain medication as needed.
● Educate the patient to use heat therapy that helps in dilating the blood vessels that
promotes blood flow and helping muscles relax, thus combat pain.
● Educate the patient to change its diet. Plan the diet around vegetables, fruits, whole
grains, and foods rich in omega-3 fatty acids. Avoid processed foods and foods that
contain trans fats, limit intake of caffeine and alcohol, and avoid animal products and red
meat that increases estrogen production, which can cause abnormal tissue growth.
● Educate the patient to exercise regularly. This [promotes less production of estrogen and
increases circulation of blood.
● Educate the patient about pain management. These are techniques that help the patient
feel better mentally and ease pain.
● Educate the patient about hormone therapy. This eases and/or ends the menstrual
cycle, reduces the pain and inflammation, and slows endometrial tissue growth.
● Educate the patient to openly discuss surgical options with the doctor.
****
treatments :
Do Type and Stage Affect Treatment?
Doctors usually decide on your treatment based on your symptoms and whether
you want to get pregnant. In most cases, you’ll start with pain medication. The
doctor might also give you hormone therapy, like birth control pills, progestin
therapy, aromatase inhibitors, and gonadotropin-releasing agonists and
antagonists. Doctors used to think hormone therapy didn’t work for deeply
infiltrating endometriosis, but recent research suggests that isn’t the case.
If these treatments don’t help, you may need surgery to remove the implants. This
can be done by laparoscope or by abdominal surgery. Another option for women
who don’t want to get pregnant is to surgically remove the uterus. This is called a
hysterectomy. It could be paired with an oophorectomy, where the surgeon takes
out your ovaries, too.
NOTE: There's no cure for endometriosis and it can be difficult to treat. Treatment
aims to ease symptoms so the condition does not interfere with your daily life.
Treatment can be given to: relieve pain.
Endometriosis only recedes when MENOPAUSE.
BUT there is one thing that can put endometriosis to an end without experiencing
menopause, and that is by undergoing HYSTERECTOMY, a surgery of removing a
woman's uterus.
https://www.mayoclinic.org/diseases-conditions/endometriosis/diagnosis-treatment/drc-
20354661
https://www.webmd.com/women/endometriosis/endometriosis-types-stages
https://nursestudy.net/endometriosis-nursing-diagnosis/
https://www.newh-obgyn.com/blog/living-with-endometriosis#:~:text=To%20improve%20life
%20with%20endometriosis,and%20alcohol%20intake%20as%20well.

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Background of The Condition:: Those That Put A Person at Risk of Developing A Problem)

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Background of the condition:

Unfortunately, endometriosis is a long-term condition. Women may experience relief after

Predisposing Factors (those that put a person at risk of developing a problem):

Signs and symptoms:

Do Type and Stage Affect Treatment?

therapy, aromatase inhibitors, and gonadotropin-releasing agonists and

can be done by laparoscope or by abdominal surgery. Another option for women

hysterectomy. It could be paired with an oophorectomy, where the surgeon takes

out your ovaries, too.

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