Endometriosis is a hormonal and immune disorders are characterized by a positive growth of endometrial tissue, which rarely occurs outside the womb. Although endometriosis can grow anywhere in the body is found mostly in the vicinity of the ovaries, Nick Douglas (Pat), cervical, left uterosacral, rectovaginal septum, sigmoid, round ligament and pelvic peritoneum. During the reproductive years, atypical endometrial tissue meets the hormonal stimulation of the same as the tissue in the uterus. Thus, the growth of tissues during the proliferative and secretory phases of the menstrual cycle of women, and bleeding during or immediately after. This bleeding is administered into the abdominal cavity and cause an inflammatory process with subsequent fibrosis and adhesions. Such injuries can lead to blocked or compliance with any of the surrounding organs. The main complication of endometriosis is infertility, which is due to adhesions and signs of abnormal bleeding, endometrial tissue damage. These adhesions may occur in the uterus and leave it in a retroverted position. They can block the fallopian tubes or fimbriated purposes, making them the egg of the bears in the womb. Endometriosis can cause a miscarriage and anemia.

The cause of endometriosis is unknown. The most common theory is retrograde menstruation theory, which suggests that endometriosis is the result of the return of endometrial tissue from the uterus into the pelvic cavity during menstruation. This stream begins with the tubes and go into the abdominal cavity where the implants are atypical (ectopic)
sites in the endometrium. Other theories are the transformation of the etiology of endometrial cells in the lining of the peritoneum undergoes metaplastic transformation and lead to damage of the endometrium, the tissue distribution via blood vessels and lymphatic system, and the notion that passive, immature cells of the embryonic period and allocated metaplaziya are now in adulthood. There is also a genetic susceptibility to endometriosis. Women who are mothers and sisters with the disease process at a higher risk of endometriosis.

Care Plan assessment and physical examination
Get a complete menstrual history, obstetric, sexual and contraceptive practices of women. Endometriosis is difficult to determine because some symptoms are symptoms of other diseases such as pelvic pelvic inflammation, and ovarian cysts. For a complete description of the symptoms of the patient, it is important that an early diagnosis of this disease. Symptoms of endometriosis vary depending on the location of ectopic tissue. Some women may be asymptomatic during the course of the disease. The classic triad of symptoms of endometriosis are dysmenorrhea, dyspareunia and infertility. Symptoms may vary over time. The main symptom is dysmenorrhoea (pain associated with menstruation), which differs from the usual uterine cramping during the menstrual cycle in women. This contraction is referred to as deep pain, pressure or time in the abdomen, vagina, pelvis and spine or back. It usually occurs 1-2 days before the start of the menstrual cycle and lasts 2-3 days. Other possible symptoms include pain during bowel movements during menstruation, indicated an interest in the pelvis area, painful menstruation, nausea, diarrhea and pain during intercourse (dyspareunia), or exercise. Some women have no symptoms, and endometriosis detected during investigation for infertility.

During a pelvic exam, the cervix laterally left or right of center. Abdominal palpation may reveal nodules in the uterosacral ligament with tenderness in the back of the fornix, and restricted movement of the uterus. Palpation, the presence of enlargement of the ovaries to determine cause cysts. Mirror investigation revealed blue button on the back of the cervix or vaginal wall.

During acute flares of disease, internal pelvic examination which the patient excruciating abdominal pain and suprapubic. In acute disease can be difficult to distinguish from appendicitis or other conditions that cause patients a strong stomach, abdominal guards and low temperatures "acute abdomen" have ..

Endometriosis is a chronic, chronic disease, with symptoms for 2-3 days every month until menopause. Serious problems can interfere with daily activities or leisure activities, sexual dysfunction, infertility, and frustration may contribute to depression in women with these chronic diseases. Inquire about the level of partner support.

Plan for nurses in the primary nursing diagnosis: pain, chronic, associated with seizures, internal bleeding, swelling and inflammation during the menstrual cycle.

Nursing interventions and treatment
Women approaching menopause are usually the treatment until menopause. As a woman approaching menopause problems and requires no treatment, but after disease progression. Unlike the younger woman who wants to think of a more aggressive treatment. Some women may be instructed to get pregnant as soon as possible if they want children. Pregnancy and lactation suppress menstruation and cause a decrease in endometrial tissue implants. Relief of symptoms was observed many years after pregnancy.

Conservative surgery is performed laparoscopically or via laparotomy using a laser laparoskoop. The goal is to increase the ectopic endometrial tissue collected from women's reproductive capacity and a reserve. In older women with severe symptoms who have completed their fertility, or at least during pregnancy in age, hysterectomy, surgery with or without bilateral salpingo-oophorectomy is selected.

If total hysterectomy is performed, the patient must understand that all other treatments to relieve, but not cured. My sister has excellent communication skills training, information and support to patients. Care focuses on pain and discomfort of strategies to support the patient during stressful times reduction, and patient education. The pain of endometriosis can be serious or light. If the patient has other underlying diseases are usually managed in outpatient surgery is needed. For pain relief, let the woman over the counter painkillers such as acetaminophen is a better non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin, because of the tendency to increase bleeding. Some patients get relief from cramps lying on their side with legs bent, such as warm baths or heating in the abdomen. Make sure that the patient used a heater to a lower value to avoid burns. Careful patient with acute abdominal pain of unknown cause heating time can not be used because the risk of perforated appendix.

Evaluation of the effects of cultural and ethnic women a role in his understanding and subsequent treatment of endometriosis. They are emotionally supportive. Interested couples about the Endometriosis Association (promoting education, research group for infertile couples), and newer techniques to address the management of infertility. Pair to stimulate the disease and its consequences openly discuss their sexual compatibility, and asked his wife to tell a partner discomfort during sexual intercourse to reduce misunderstandings. Support for different positions during intercourse for most women who try.

Nursing guidelines for discharge planning and home care
Make sure that the average patient dose, mechanism of action and side effects
before heading home. Encourage the patient to pay attention to emotions, behavior, physical complaints, diet and rest and exercise. Encourage open communication of the patient to his significant other and her family maintain that they have the disease can be discussed.


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