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Endometriosis is a hormonal and immune system diseasecharacterized by a benign growth of endometrial tissue that

occurs atypically outside of the uterine cavity. Whenendometrial tissue appears outside the lining of the uterinecavity, endometriosis results. Such ectopic tissue is

generally confined to the pelvic area, most commonly aroundthe ovaries, uterovesical peritoneum, uterosacral ligaments,and the cul-de-sac, but it can appear anywhere in the body.

This ectopic endometrial tissue responds to normalstimulation in the same way that the endometrium does.During menstruation, the ectopic tissue bleeds, which

causes inflammation of the surrounding tissues. Thisinflammation causes fibrosis, leading to adhesions, whichproduce pain and infertility. Active endometriosis usually

occurs between ages 30 and 40. Severe symptomsof endometriosis may have an abrupt onset or may developover many years. This disorder usually becomes

progressively more severe during the menstrual years buttends to subside after menopause.

Causes for Endometriosis

The direct cause is unknown, but the most predominanttheory is the

retrogrademenstruation theory, research focuses on thefollowing possible causes:

y Transportation (retrograde menstruation).During menstruation, the fallopian tubes expelendometrial fragments that implant outside theuterus.

y Formation in situ. Inflammamsstion or a hormonalchange triggers coelomic metaplasia.

y Induction. The endometrium chemically inducesundifferentiated mesenchyma to form endometrialepithelium. (This is the most likely cause.)

y Immune system defects. Endometriosis may resultfrom a specific defect in cell mediated immunity.

Complications for EndometriosisPrimary complication

y Infertility.Other complications

y Spontaneous abortion,y Anemia due to excessive bleeding.y Emotional problems resulting from infertility.

Nursing Assessment Nursing Care Plansfor Endometriosis

y Patient History Elicit a complete history of thewomans menstrual, obstetric, sexual,and contraceptive practices

y The patient may complain of cyclic pelvic pain,infertility and, the classic symptom, acquireddysmenorrhea.

y The patient typically reports pain in the lowerabdomen, vagina, posterior pelvis, and back. This

pain usually begins from 5 to 7 days beforemenses, reaches a peak, and lasts for 2 to 3 days.

y Patient may complain of deep-thrust dyspareunia(ovaries and cul-de-sac);

y suprapubic pain, dysuria, and hematuriay painful defecation, rectal bleeding with menses,

and pain in the coccyx or sacrum

y nausea and vomiting that worsen before mensesand abdominal cramps

y Palpation may disclose multiple tender nodules onuterosacral ligaments or in the rectovaginalseptum.

y Palpation may also uncover ovarian enlargementin the presence of endometrial cysts on

the ovaries or thickened, nodular adnexa.Diagnostic tests for EndometriosisLaparoscopy

Scoring and staging system created by the American Societyfor Reproductive Medicine quantifiesendometrial implants according to size, character, and

location.

y Stage I is minimal disease (0 to 5 points);

y Stage II signifies mild disease (6 to 15 points);y Stage III, moderate disease (16 to 40 points); andy Stage IV, severe disease (more than 40 points).

Treatment for Endometriosis

The stage of the disease and the patient's age and desire tohave children are considered in determining the course oftreatment.

y Conservative therapy for young women who wantto bear children with androgens, which produce a

temporary remission in Stages I and II.

y Progestins and hormonal contraceptives alsorelieve symptoms.

y Gonadotropin releasing analogues, such asleuprolide, suppress estrogenproduction.

y Laparoscopy, used for diagnostic purposes, canalso be used therapeutically to lyse adhesions,remove small implants, and cauterize implants.The goal is to remove as much of the ectopic

endometrial tissue as possible

y Laparoscopy also permits laser vaporizationof implants. This surgery is usually followed withhormonal therapy to suppress the return of

endometrial implants.

y Surgery may be needed to rule out cancer.y Conservative surgery is possible, but the

treatment of choice for women who don't want tobear children or for those who have extensivedisease (Stages III and IV) is a total abdominal

hysterectomy with bilateral salpingo-oophorectomy.

y Minor gynecologic procedures are contraindicatedimmediately before and duringmenstruation.

Nursing diagnosis nursing care plans for endometriosisPrimary nursing diagnosis nursing care plans forendometriosis

Pain, chronic, related to cramping, internal bleeding,swelling, and inflammation during the menstrual cycleCommon nursing diagnosis found on nursing care plans

for endometriosis:

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y Anxietyy Chronic painy Deficient knowledge (diagnosis and treatment)y Disturbed body imagey Feary Ineffective copingy Risk for infectiony Sexual dysfunction

Key outcomes Nursing Care Plans for Endometriosis

y Comfort level, Pain control, Depression control,Pain: Disruptive effects, Pain: Psychological

response

y Patient will identify strategies to reduce anxiety.y Patient will express feelings of comfort.y Patient and her family will express understanding

of the disorder and its treatment.

y Patient will express feelings about self.y Patient will discuss fears and concerns.y Patient will develop adequate coping behaviors.

y Patient will remain free from signs and symptomsof infection.

y Patient will verbalize feelings regarding sexualimpairment.

Patient teaching Nursing Care Plans for Endometriosis

y Ensure that the patient understands the dosage,route, action, and side effects before going home.

y Explain all procedures and treatment options.Clarify misconceptions about the disorder,

associated complications, and fertility.

y Advise adolescents to use sanitary napkinsinstead of tampons. This can help preventretrograde flow in girls with a narrow vagina or

small vaginal meatus.

y Because infertility is a possible complication,counsel the patient who wants children not topostpone childbearing.

y Advise the patient to have an annual pelvic

examination and a Pap test.

Encourage the patient to be alert to her emotions, behavior,

physical symptoms, diet, and rest and exercise. Encouragethe patient to maintain open communication with hersignificant other and her family to discuss concerns she may

have about the disease process.