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NURS 6550 / NURS-6550N Advanced Practice Care of Adults in Acute Care Settings I
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NURS 6550 Final Exam Study Guide
Genitourinary, gynecologic, renal and acid/base conditions
o Carcinoma of the Cervix
Increased risk in women who smoke and those with HIV or high-risk HPV types.
Considered a sexually transmitted disease as both squamous cell and adenocarcinoma of
the cervix are secondary to infection with HPV; squamous cell accounts for 80 percent of
cervical cancers, 15 % adenocarcinoma, and 3-5 % neuroendocrine.
Prevention through vaccination- recombinant 4 or 9-valent HPV vaccination which target
HPV types that pose the greatest risk.
Prognosis- overall 5- year relative survival rate is 68 % for white women and 55 % in
black women- survival rates are inversely proportionate to the stage of cancer.
Signs/Symptoms-
Metrorrhagia, postcoital spoting, and cervical ulceration. Gross edema of the legs may be
indicative of vacular and lymphatic stasis due to tumor. Pain in the back (lumbosacral plexus
region) indicates neurologic involvement. Bladder and rectal dysfunction or fistulas are severe
late symptoms. Two to 10 years are required for carcinomas to penetrate the basement layer of
the membrane and become invasive- screening has decreased mortality.
Diagnostic Tools-
Cervical Biopsy- After a positive papnicolaou smear biopsy or endocervical curettage is
necessary to determine the extent and depth of the cancer cells. Surgery and radiation should be
delayed until biopsy results.
Imaging- CT, MRI, lymphangiography, fine-needle aspiration, ultrasound, and
laparoscopy are utilized for staging of invasive cancer. Allows for more specific treatment
planning.
Complications-
Metastases to regional lymph nodes occurs with increasing frequency from Stage I to
Stage IV. Extension occurs in all directions from the cervix.
Hydronephrosis (urine-filled dilation of the renal pelvis due to obstruction) and
hydroureters (dilation of the ureter), is a result of the ureters becoming obstructed lateral to the
cervix which can lead to impaired kidney function.
Treatment/Management- Refer all patients to Gynecologic Oncologist
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