Anxiety - Nursing Care Plan for Uterine Fibroids (Myoma)

Nursing Diagnosis : Anxiety

Uterine Fibroids (Myoma) is a benign, well-circumscribed, not encapsulated, which is derived from smooth muscle and fibrous connective tissue. Also called fibromyoma, leiomyomas. This benign tumor is a benign neoplasm that is most commonly found in the genital tract of women, especially women of childbearing age. Although not frequent, reproductive dysfunction associated with myomas include infertility, spontaneous abortion, premature delivery, and malpresentation (Crum, 2003).


Myoma (fibroids) are generally classified by the location and the direction in which they grow. Classification as follows :

1. Intramural fibroids (myoma) : myomas are most commonly found. Most of the lining of the uterus grows in between the thickest and most central, the myometrium.
2. Subserous myoma : myoma which grew out of the outermost layer of the uterus, which is serous and grow toward the peritoneal cavity. This type of myomas pedunculated or have a wide base. When detached from the parent and a walk or can be attached to the peritoneal cavity is called wandering / parasitic fibroids, the second most points were found.
3. Submucosal myoma : myoma grows from the uterine wall in that protrude into the uterus. This type can also be stemmed or based on width. Sessile polyps can grow into, then born through the cervical canal, called myomas Geburt. (Chelmow, 2005)

Definite etiology is unknown.

1. Increased estrogen - progesterone receptors in uterine myoma tissue affects tumor growth.
2. Predisposing factors are hereditary, has identified 145 chromosomes that carry genes, estimated to affect fibroid growth. Some experts say that uterine fibroids inherited from the paternal genes.
3. Myomas usually enlarges during pregnancy and shrink after menopause is rare before menarche. (Crum, 2005)

Risk factor for uterine fibroids (myoma), namely :
1. Age of patients
Uterine fibroids are found approximately 20 % in women of reproductive age and about 40 % -50 % in women aged over 40 years (Suhatno, 2007). Uterine fibroids are rare before menarche (before menstruation). While uterine fibroids in postmenopausal women was found to be 10 % (Joedosaputro, 2005).

2. Endogenous hormonal
The concentration of estrogen in uterine fibroids tissue, higher than normal myometrium tissue. (Djuwantono, 2005)

3. Family history
Women with a first -level lineages with uterine fibroids sufferer has 2.5 times more likely to suffer myomas compared with women without uterine fibroids sufferer lineage. (Parker, 2007)

4. Body Mass Index (BMI)
Obesity also plays a role in the occurrence of uterine fibroids. (Parker, 2007)

5. Food
Reported that beef, undercooked meat (red meat), and pork increased incidence of uterine fibroids, however greens lowering the incidence of uterine fibroids. (Parker, 2007)

6. Pregnancy
Pregnancy can affect uterine fibroids due to high estrogen levels in pregnancy and increased vascularity to the uterus. This speeds enlargement uterine fibroids. (Manuaba, 2003).

7. Parity
Uterine fibroids are more common in multiparous women compared with women who have a history of giving birth frequency of 1 (one) or 2 (two) times (Khashaeva, 1992).



Nursing Care Plan for Uterine Fibroids (Myoma)

Nursing Diagnosis for Uterine Fibroids (Myoma) : Anxiety related to situational crisis (hysterectomy or chemotherapy), threats to self-concept, changes in health status, stress

NOC :

Anxiety Control

Can be expected to control anxiety

Outcomes :

• The nurse monitors the patient's level of anxiety.
• Clients are able to lower the causes of anxiety.
• Nurses and families can lower the environmental stimulus when the patient is anxiety.
• Clients are able to search for information about things to do to reduce anxiety.
• Clients are able to use effective coping strategies.
• Clients report to the nurse decreased anxiety.
• Clients are able to use relaxation techniques to reduce anxiety.
• Clients are able to maintain social relationships, and concentration.
• Clients report to nurse enough sleep, no physical complaints due to anxiety, and no behavior indicating anxiety.

NIC

Lowering Anxiety

• Reassure the patient and assess the patient's level of anxiety .
• Explain to the patient throughout the procedure actions and feelings that might arise during the action .
• Trying to understand the patient's condition ( empathy ) .
• Provide information about the diagnosis , prognosis and act with good communication .
• Accompanying patients to reduce anxiety and increase comfort .
• Encourage the patient to express feelings .
• Create a trusting relationship .
• Help the patient to explain the circumstances that can lead to anxiety .
• Help the patient to reveal things that provoke anxiety and listen attentively .
• Teach the patient relaxation techniques .
• Instruct the patient to enhance the worship and prayer .
• Collaboration with physicians for the provision of drugs that relieve anxiety.