English Language I
Reproductive System Physiology Anatomy and Nursing Care in Cervical
Cancer
Group 6 Class 3C :
Ayu Wahyuni : 18301082
Emmi Lestari : 18301087
Maulida Akisah : 18301093
Tsamara Dhila Utami : 18301112
Program Studi S1 Keperawatan
STIKes Payung Negeri
Pekanbaru
2020
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FOREWORD
Praise the author, say the presence of Allah SWT. only because with His grace
and guidance the papers can be completed on time. Salawat and greetings do not
forget to say to the Prophet Muhammad. The purpose of writing the paper
"Nursing Care Reproductive System Anatomy And Cervical Cancer" is to
broaden the readers' insight. The author would like to thank the lecturer who is
teaching english language I for the guidance given in composing the paper. Paper
writing is not perfect. Therefore, the authors expect criticism and suggestions
from readers.
Pekanbaru, 11 December 2020
Author
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TABLE OF CONTENTS
FOREWORD..............................................................................................................
TABLE OF CONTENTS...........................................................................................
CHAPTER I PRELIMINARY.................................................................................
1.1 Background..................................................................................................
1.2 Destination...................................................................................................
1. General Purpose.................................................................................
2. Special Purpose..................................................................................
CHAPTER II THEORETICAL REVIEW..............................................................
2.1 Medical Concept: Definition, Etiology, Clinical symptoms,
Pathophysiology,
Physical examination, Management..............................................................
2.2 Nursing Care: Assessment, Diagnosis, Intervention.....................................
CHAPTER III CLOSING.......................................................................................
3.1 Conclusion.................................................................................................
3.2 Suggestion ................................................................................................
REFERENCES
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CHAPTER I
PRELIMINARY
1.1. Background
In general, cervical cancer is defined as a pathological condition, where
there is uncontrolled growth of tissue in the cervic which can cause
interference with the form and function of normal cervical tissue. In the case
of objective malignancy still not known with certainty due to inaccurate
supporting data to establish a diagnosis of cervical cancer. Existence the
known signs of malignancy from the Pap smear are not sure sign of cervical
cancer so that diagnosis must be supported with the results of the biopsy. This
condition is complicated by the degree of the client's cancer it is still in an
early stage so that macroscopically the diagnosis is still up not yet accurate.
When viewed from the etiology of cervical cancer, in this case there is no
suspicion of dominant involvement of one factor, such as sexual behavior of
clients and partners of clients, carcinogenic factors of environment or disease
that can predispose to the onset cervical cancer. Tracing the offspring as an
attempt to find genetic factors, also cannot be used as guidelines for the
factors involved in the occurrence of cancer in clients.
The habit of using vaginal cleaners can predispose to the onset vaginitis or
other fungal infections. thus it can be assumed that contact with this vaginal
cleanser could be a triggering factor disturbance of acid-base balance in the
vagina which can make it easier the emergence of intravgina infection both
by bacteria and viruses on can eventually cause irritation and signs of
malignancy. Cervical cancer is still a scourge for all women and is a big
problem in health development efforts in indonesia so that management
requires participation and cooperation from all parties including the nursing
profession.
1.2. Purpose
a. General Purpose
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To describe the anatomy, physiology of the reproductive system and
nursing care in cervical cancer.
b. Special Purpose
1) To describe the definition of cervical cancer.
2) To describe the etiology of cervical cancer.
3) To describe the pathophysiology of cervical cancer.
4) To describe the diagnostic examination.
5) To describe the manifestations or signs and symptoms of cervical
cancer.
6) To describe medical management.
7) To describe nursing care for cervical cancer.
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CHAPTER II
THEORETICAL REVIEW
2.1. Medical Concept
A. Reproductive System Physiology Anatomy
1. Anatomy of female external organs (Genetalia Eksterna)
b. Mons Pubis
Mounted area above the symphysis, which will grow pubic hair
(pubis) as a woman grows up. This hair forms a curved angle (in
women) while men form a pointed angle upwards.
b. Labia Mayora
Located on the right and left, oval-shaped, which in adult
women grows hair from the mons pubis, the meeting of the labia
majora forms the posterior commissura.
c. Labia Minora
The inside of the big lips are pink. It is a right and left fold
meeting above the prepusium of the clitoridis and under the
clitoris. The back of the two folds after surrounding the fused
vaginal orifice is called a faurchet (seen only in women who
have never given birth).
d. Clitoris
About the size of green beans to cayenne pepper and covered
with clitoridic frenulum. The glans clitoris contains erectile
tissue, which is very sensitive because it has many nerve fibers.
e. Vestibule
It is a cavity that is laterally bounded by the two labia minora,
anteriorly by the clitoris and dorsally by the faurchet. The
vestibule also empties the urethra and 2 skene glands and 2
Bartholin glands, which these glands will secrete during coitus.
The vaginal introitus is also found here.
f. Hymen
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It is a membrane that covers the vaginal introitus, usually
perforated to form the semilunaris, anularis, filters, septata, or
fimbria. If there is no hole it is called atresia himenalis or hymen
imperforate. Hymen will be torn in the coitus especially after
childbirth (this hymen is called karunkulae mirtiformis). The
holes in the hymen serve for the discharge of secretions and
menstrual blood.
g. Perineum
Located between the vulva and anus, about 4 cm long.
h. Vulva
The part of the uterine apparatus is oblong, starting from the
clitoris, right and left above the labia minora, to the back of the
perineum.
1. Anatomy of the female internal reproductive organs (Genetalia
Interna)
a. Vagina
Is a burrow or tube that connects the vulva and uterus, located
between the bladder and rectum. The front wall of the vagina is
7-9 cm long and the back wall 9-11 cm. The vaginal walls are
folded and run circularly and are called rugae, while in the
middle there is a harder part called the rugarum column. The
vaginal wall consists of 3 layers, namely: the mucosal layer
which is the skin, the muscle layer and the connective tissue
layer. Bordering the cervix to form an arch space, including the
right and left lateral fornix, anterior and posterior fornix. The
part of the cervix that protrudes into the vagina is called the
portio. The important functions of the vagina are:
- The outlet to drain menstrual blood and other secretions
from the uterus.
- Tools for copulation.
- The birth canal during childbirth.
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b. Cervix
The part that connects the vagina and uterus, the cervix has
several parts, namely:
- Pars vaginalis servisis uteri called portio.
- Pars supra vaginalis servisis uteri is the part of the cervix
that is located above the vagina.
The channel that is located in the cervix is known as the cervical
canal in the form of a channel with a length of 2.5 cm. The inner
door of the cervical canal is called the ostium uteri internum and
the outside is called the ostium uteri externum.
c. Uterus
The uterus is shaped like an avocado, the size of a hollow
chicken egg, its walls consist of smooth muscle. The uterus is 7
- 7.5 cm long, 5.25 cm wide, 2.5 cm thick and 1.25 cm thick.
Physiologically, the uterus is in an antversionoflexion state (the
cervix is forward and angles to the vagina, likewise the uterine
body is forward and angles with the uterine cervix). The uterus
consists of:
- Endometrium, consisting of the cubic epithelium, glands
and tissue with many blood vessels. The endometrium
covers the entire uterine cavity and has an important role in
a woman's menstrual cycle.
- Myometrium is made up of smooth muscle.
- Perimetrium, the inner smooth muscle layer is circular, the
middle part is oblique and the outer part is longitudinal.
This whole layer is very important in labor because after the
placenta is born this part contracts to clamp the blood
vessels.
d. Fallopian Tubes
The base of the fallopian tube is located in the uterine fundus,
consisting of:
- The interstitial pars located at the base of the tube.
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- Pars ismika is a rather broad section, as a place of
conception.
- Infudibulum, the end of the tube that opens towards the
abdomen and has a fimbria that functions to catch ripe eggs
to be carried into the tube.
e. Ovaries
Each woman has two ovaries about the size of her thumbs, about
4 cm long, and 1.5 cm thick. Its upper edge connects to the
mesovarium where many blood vessels and nerve fibers are
located. The ovaries consist of an outer (cortex) and an inner
(medulla). In the cortex, there are primordial follicles,
approximately 100,000 per month, one follicle will mature and
come out, sometimes coming out at once, these primary follicles
will become de graaf follicles. In the medulla there are blood
vessels, nerves, and lymph vessels. The functions of the ovaries
are:
- Release the hormones estrogen and progesterone.
- Remove eggs every month.
f. Nerves of the Genetalia
The superior hypogastric plexus is a major component of the
autonomic nervous system that supplies the internal genetalia.
g. Lymphatic Flow
The vulva and the distal 1/3 of the vagina are supplied with a
series of anatomical lymphatic channels which coalesce to drain,
primarily to the superficial inguinal lymph nodes.
1. Physiology of Female Reproduction Based on its function
(Physiology)
a. Sexual Function:
- The tools that play a role are the vulva and vagina.
- Glands in the vulva that can secrete fluid, which are useful as
a lubricant during intercourse.
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- Apart from that the vulva and vagina also serve as a birth
canal.
b. Hormonal Functions:
- The so-called hormonal function is the role of the ovaries and
uterus in maintaining female characteristics and menstrual
regulation.
- Physical and psychological changes that occur throughout a
woman's life are closely related to the function of the ovaries
which produce female hormones, namely estrogen and
progesterone.
c. Reproductive Function:
- Reproductive tasks are carried out by the ovaries, fallopian
tubes, and uterus.
- Egg cells that are released every month by the egg bladder
during fertility will enter the oviduct to then meet and fuse
with male sperm cells (sprematozoa) to form new organisms
called zygotes, at this point the sex of the fetus and its genetic
characteristics is determined.
- Furthermore, the zygote will continue to travel along the
fallopian tube and enter the uterus.
- Usually at the top of the uterus the zygote will implant and
develop into an embryo.
- The embryo then grows and develops as a fetus which will
then be born at full term. The fertile period of the 28 day
menstrual cycle occurs around the 14th day of the first day of
menstruation.
2. Hormones in Female Reproductive Function
a. FSH (Folicle Stimulating Hormone): Serves to stimulate the
growth of follicles during fertility.
b. LH (Luteinizing Hormone): Serves to increase progesterone.
c. Prolactin: Serves to increase breast development and milk
secretion.
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d. Estrogen: Serves to stimulate the development of female genital
organs and secondary sex characteristics, such as breast growth,
a softer voice, and others.
e. Progesterone: Serves to prepare the uterus to receive a fertilized
egg.
f. Estradiol: Serves to control and regulate changes in a woman's
body at puberty, the growth of the uterus, vagina and external
genitals.
B. Definition of cervical cancer
Cervical cancer (cervix) or uterine cervical carcinoma is the
number two female killer cancer in the world after breast cancer. In
Indonesia, cervical cancer even ranks first. Cervical cancer that has
entered an advanced stage often causes death in a relatively fast period of
time. Cervical cancer is the most common malignancy among women.
This disease is a process of changing from a normal epithelium to an
invasive Ca that gives symptoms and is a process that takes years slowly.
C. Etiology
HPV (Human Papilloma Virus) is the most common cause. In
addition, cigarette smoking has been found to be a culprit as well.
Female smokers contain concentrated nicotine and cotinins in their cervix
which damage cells. Male smokers also have concentrations of this
substance in their genital secretions, and it can fill the cervix during
intercourse. Deficiencies of some nutrients can also cause cervical
dysplasia. The National Cancer Institute recommends that women should
consume five times fresh fruit and vegetables every day. If you are
unable to do this, consider taking a daily multivitamin with antioxidants
such as vitamin E or beta carotene. The cause of abnormalities in cervical
cells is not known with certainty, but there are several risk factors that
affect the occurrence of cervical cancer, namely:
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a) HPV (Human Papilloma virus) is the virus that causes genetal
warts (condyloma acuminota) which is transmitted through sexual
contact, the most dangerous variants are HPV types 16,18,45 and
56.
b) Smoking; tobacco damages the immune system and affects the
body's ability to fight HPV infection of the cervix.
c) The first sexual intercourse was carried out at an early age.
d) Multiple sexual partners.
e) Number of pregnancies and delivery; Cervical cancer is mostly
found in women who are frequently labored, the more likely it is to
get cervical carcinoma.
f) IUD (intrauterine device); The use of the IUD will affect the
cervix, starting with cervical erosion which then becomes an
infection in the form of continuous inflammation.
g) Genetal herpes infection or chronic chlamydial infection.
h) The economically weak group (because they are unable to carry
out regular pupsmear) is closely related to nutrition, immunity and
personal hygiene.
D. Clinical symptoms of cervical cancer
In the precancerous phase, there are often no symptoms or distinctive
signs. However, sometimes you can find the following symptoms:
1. Whitish or watery discharge from the vagina. The sap that comes
out of the vagina will have a foul odor due to infection and tissue
necrosis.
2. Bleeding after intercourse (post coital bleeding) which then
continues to be abnormal bleeding.
3. The onset of bleeding after menopause.
4. In the invasive phase, a yellowish, smelly, and can be mixed with
blood.
5. Symptoms of anemia arise when chronic bleeding occurs.
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6. There is pain in the pelvis (pelvis) or in the lower abdomen if there is
inflammation of the pelvis. If the pain occurs in the lower back area,
hydronephrosis is possible. In addition, pain may also arise in other
places.
7. At an advanced stage, the body becomes emaciated due to
malnutrition, leg edema, irritation of the bladder and lower large
intestine shaft.
E. Pathophysiology
In early development, cervical cancer does not give signs and complaints,
on examination with speculators, it appears as an erosive portion
(Metaplasia Squamora) which is physiologic or pathological. Tumors
can grow:
1. Exophilic, starting from squamo columnar (SCJ) towards the vaginal
lumen as a proliferative period that experiences secondary infection
and necrosis.
2. Endophilic, starting from SCJ grows into the cervical stroma and
tends to infiltrate into ulcers.
3. Ulcerative, start at SCJ and tend to damage cervical tissue structures
by involving the initial fornless vagina to become a large ulcer.
The normal cervix naturally undergoes a process of metaplasia (erosio)
due to the mutual pressing of the two types of epithelium lining, with the
entry of erosive mutagens (squamous metaplasia) which initially changes
to pathological (disoriotic diplastic) through the NIS-I, II, III and KIS
which eventually becomes invasive carcinoma and a malignant process
will continue. Generally, the pre-invasive phase ranges from 3-20 years
(average 5-10 years). Most of histopathologic (95-97%) are epidermoid
or squamor cell carcinoma, the rest are adenocarcinoma, clear cell
carcinoma/mesonephroid carcinoma and the rarest is sarcoma. Spread is
generally lymphogenous through lymph vessels in 3 directions: toward
the fornless and vaginal wall, toward the uterine body and toward the
parametrium. At an advanced level it can infiltrate the rectovaginal
septum and urinary tract.
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F. Physical examination/support/diagnostics
1. Cytology/pap smear
Advantage: cheap can check the parts that are not visible.
Weakness: unable to pinpoint localization.
2. Schillentest
Pitel cervical carcinoma does not contain glycogen because it does
not taking iodine, the normal carcinoma epithelium will be brown
old, being affected by carcinoma is colorless.
3. Photoscopy
Advantage: can see clearly the area concerned so easily to do a
biopsy.
Weakness: can only check the visible area, namely portionso,
meanwhile, abnormalities in the squamous columner juction and
intracervical were not seen.
4. Colpomicroscopy
View pop smears at a magnification of up to 200 times.
5. Biopsy
With a biopsy can be found or determined the type of carcinoma.
6. Conization
By removing the tissue containing the mucous membrane of the
cervix and flattened epithelium and gland. Performed when the
results of cytology and on the cervix no obvious abnormalities.
G. Management
Cervical carcinoma therapy is carried out when the diagnosis has been
confirmed histologically and after careful planning was done by the team
cancer / oncology team.
1. At the clinical level (KIS) electrocoagulation is not allowed,
electrophysization, cryosurgery or laser light, except where
otherwise handle an expert in colposcopy and the sufferer is still
young and don't have children yet. If the sufferer has had enough
children and is old enough performed a simple hysterectomy. If
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surgery is a contraindication to radium application at a dose of 6500-
7000 rads / c by point a without the addition of external lighting.
2. At the clinical level, the management is like the KIS
3. At the clinical level Ib, Ib OCC and IIa a medical hysterectomy is
performed with pelvic lymphatenectomy, post-surgery is usually
followed radiation, depending on the presence / absence of tumor
cells in the lymph nodes region appointed.
4. At levels IIb, III and IVb it is not allowed to perform surgery, the
primary action is radiotherapy.
5. At the clinical level IVa and IVb radiation is only palliative,
chemotherapy can be considered.
2.2. Nursing Care in Cervical Cancer
A. Assessment
1. Client Identity
Name, age (usually cancer attacks women at the age of 30-35 years),
gender, address, education (lower education puts patients at higher
risk of developing cancer because they have never had a pap smear
examination and lack knowledge).
2. The main complaint
Patients usually present with complaints of intracervical pain
accompanied by water-like discharge, odor, and even bleeding.
3. Current medical history
Usually the client at the early stage does not feel any disturbing
complaints, then at the final stage, namely stage 3 and 4, there are
complaints such as: bleeding, vaginal discharge, and intra-cervical
pain.
1. Past medical history
The data that need to be studied are history of abortion, post-abortion
infection, puerperal infection, history of uterine surgery, and
presence of tumors.
2. Family history
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It is necessary to ask whether anyone in the family has suffered from
a disease like this or other infectious diseases and a family history of
cancer.
3. Psychosocial history
In health care, it is studied about maintaining nutrition at home and
how family knowledge is about cervical cancer. Cervical cancer is
often found in low socioeconomic groups, closely related to the
quality and quantity of food or nutrition that can affect immunity, as
well as the level of personal hygiene, especially the cleanliness of
the urogenital tract.
4. Physical examination
- Inspection : Client looks tired, has hair loss, the patient's body is
thin and seems to often want nausea, pale skin is caused by
anemia, sunken eyes are caused by lack of sleep, the client looks
grimacing in pain, the client experiences vaginal discharge, the
client also experiences frequent bleeding.
- Palpation : On palpation, there is pain in the abdomen and pain
in the lower back.
B. Nursing Diagnosis in Cervical Cancer
1. Impaired tissue perfusion associated with bleeding intra cervical.
2. Lack of fluid volume associated with loss of volume of body fluids
actively due to bleeding.
3. Changes in nutrition less than body requirements associated with
nausea and vomiting.
C. Intervention
1. Impaired tissue perfusion associated with bleeding intra
cervical.
Purpose: After nursing action, it is expected that tissue perfusion will
improve.
Result Criteria:
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a. Intra-cervical bleeding is reduced.
b. The conjunctiva is not anemic.
c. The lip mucosa is moist and reddish.
d. Extremity warm.
e. Vital signs are within normal limits.
Intervention:
a. Observation of vital signs every 7 hours.
b. Observe bleeding (amount, color, and duration of bleeding).
c. Collaboration :
- Installation of vaginal tampons.
- Therapy to stop bleeding.
- Giving oxygen (if necessary).
- Laboratory tests: Hb.
2. Lack of fluid volume associated with loss of volume of
body fluids actively due to bleeding.
Purpose: After nursing actions, it is expected that an adequate
balance of fluid volume is expected.
Result Criteria:
a. TTV within normal limits.
b. Moist mucous membranes.
c. Improved skin turgor.
d. Normal intake and output.
Intervention:
a. Monitor urine input and output.
b. TTV monitor every 7 hours.
c. Monitor peripheral pulse and capillary refill.
d. Assess skin turgor and mucous membrane moisture.
e. Encourage fluid intake according to client tolerance.
f. Observe for bleeding.
g. Collaboration with doctors for fluid administration as indicated.
h. Collaboration of laboratory examinations.
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3. Changes in nutrition less than body requirements associated
with nausea and vomiting.
Purpose: after nursing action, nutritional needs are expected to be
met.
Result Criteria:
a. Weight within normal limits.
b. The conjunctiva is not anemic.
c. The sclera is not icteric.
Intervention:
a. Monitor daily food
intake and output.
b. Monitor BB every
day.
c. Encourage clients to
eat foods high in calories and protein.
d. Identify a pleasant
dining atmosphere.
e. Encourage clients to
eat little but often.
f. Collaboration with
families in providing food.
g. Collaboration with
doctors for further treatment.
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CHAPTER III
CLOSING
3.1. Conclusion
Cervical cancer is a malignant tumor that grows inside the cervix / cervix
(the lowest part of the uterus that attaches to the top of the vagina. Cervical
cancer usually affects women aged 35-55 years. 90% of cervical cancer
comes from the squamous cells that line the cervix and 10%. the remainder
comes from mucus-producing glandular cells in the cervical canal leading
into the uterus.Canceroma of the cervix usually occurs in the transitional zone
that lies between the squamous cell epithelium and the columnar cell
epithelium.
The most important thing in dealing with cervical cancer sufferers is to
make the diagnosis as early as possible and provide effective therapy as well
as predict the prognosis. Until now, treatment options were limited to surgery,
radiation and chemotherapy, or a combination of these therapeutic modalities.
However, of course this therapy is still in the form of "symptomatic" because
it still has not touched the basic causes of cancer, namely changes in cell
behavior. More basic therapy or immunotherapy is still in the research phase.
3.2. Recommendations
1. It is hoped that readers can understand very well about cervical cancer
and detection as early as possible before cervical cancer.
2. It is hoped that readers will provide constructive criticism and suggestions
for the making of the next paper.
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REFERENCES
Carpenito, Lynda Juall, (2009). Buku Saku Diagnosa Keperawatan. Edisi 8.
Jakarta: EGC.
Hartono, Poedjo. (2010). Kanker Serviks, Leher Rahim & Masalah Skrining Di
Indonesia. Kursus Pra Kongres KOGI XI Denpasar. Mombar Vol.5
No.2 Mei 2001.
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