NURS664B Week 7 | Nursing in Health Care - Westcoast university

6. When is surgery indicated for prolapse?

Case Study #3: Gynecologic Abnormalities Mrs. Jones, a 42-year-old, G3P3, presents with a history of abnormal bleeding and pelvic pain. She was well until approximately age 35, when she began developing dysmenorrhea and progressive menorrhagia. The dysmenorrhea was not fully relieved by NSAIDs. Over the next several years, the dysmenorrhea and menorrhagia became more severe. She then developed intermenstrual bleeding and spotting as well as pelvic pain, which she describes as a constant feeling of pressure. She also complains of urinary frequency. Her past GYN history is negative. Her surgical history includes 3 C-sections and a bilateral tubal ligation at age 30. Her past medical history is unremarkable. Her physical exam reveals a well-developed, well-nourished woman in no distress. Vital signs and general physical exam are unremarkable. Her abdominal exam reveals an irregular-sized mass extending halfway between the symphysis pubis and umbilicus deviated to the right of the midline. The vagina and cervix appear normal on inspection. However, the cervix palpates firm. The uterus is markedly enlarged and irregular, especially on the right side. The adnexae are not palpable. Labs drawn: Hgb. 10.3 Hct. 31.2%. Indices are hypochromic, microcytic. Serum ferritin confirms mild iron deficiency anemia. Pap test is negative and an ultrasound reveals multiple large intramural fibroids, filling the pelvis and extending into the lower abdomen. The ovaries are not visualized.