Question

A female older adult visits the clinic. The client states she was cleaning the kitchen, scrubbing the floor, and felt her "insides coming out." She says "it feels very uncomfortable and heavy." The nurse prepares the client for a vaginal examination and assists her into a lithotomy position. The client states that she "cannot lie like this.
The nurse changes the client's position and proceeds with the assessment. The nurse observes the uterus protruding from the vagina. The cervix appears dry. The nurse also observes urinary incontinence when the client coughs.

1. What is the most appropriate position for this client?
2. What should the nurse teach the client?
3. What is the most appropriate nursing diagnosis for this client?
4. What should the nurse instruct the client to do to help with urinary incontinence?
5. What comfort measures can the nurse offer this client during the assessment?

Answer 1

Uterine prolapse ,(also called descensus or procidentia) is a condition in which uterus has descended from its normal position in the pelvis.

1. Most apropriate position is dorasl position.

The degree of uterine prolapse should there fore be measured in standing position

The degree of bladder prolapse is best measured in dorsal position with the patient lying on back

Dorsal lithotomy,lateral positions also prefered according to the comfort of patient

2. Client education

client education include,

Try to perform kegal exercises to strengthen the pelvic muscles and support weakened fascia

• Avoid constipation byeating high fiber foods and drinking plenty of water.
• teach comfortable measures to reduce pain
• Avoid bearing down for bowel movement
• Avoid heavy lifting
• Contol coughing
• maintain clealiness to prevent infection.

3, Nursig diagnosis

• Acute pain on lower abdomen related to displacement of pelvic organ
• activity intololerance related to presence of prolapse
• risk for infection related to prolapse of internal organ

4. instructions reduce urinary incontinence

• Perform kegal exercises
• Treat and prevent constipation
• Control coughing
• Avoid heavy lifting
• avoid weight gain

4. comfort measures

• pessary treatment;- It shoud be emphasised that the pessary cannot cure prolapse but relieves the symptoms by stretching the hiatus urogenitalis thus preventing uterine descent.
• kegal exercises.