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The Gynecologist's Perspective
The eChapter begins by introducing a gynecological assessment methodology that is thorough, easy to understand and simple to apply in clinical practice. Starting with the presenting complaint, the aut...hor emphasizes the need to track back to the time of suspected onset, be it puberty, onset of menopause, incidence of first intercourse, surgery or even an episode of exceptional emotional stress, and what specifically about this complaint is disturbing the patient at the time of consultation. Detailed examples of this approach are described, including candidiasis and it’s relationship to puberty, atrophic vaginitis to ovarian failure, vulvar dermatoses to psychosexual disturbances, inflammatory disorders to fissure development and so on. The author then progresses to consider the importance of the related history, and stresses the need to incorporate parity, gravidity, mode of contraception, fertility requirements and a detailed menstrual history into the assessment. Once again, practical examples are given to illustrate the process, including the relationship between lactation and atrophic vaginitis, depression and infertility, and the importance of identifying intercurrent diseases such as vulvar psoriasis and extragenital lesions. The importance of identifying any topical treatment history is emphasised, as are systemic therapies such as HRT and contraception, and their relevance to diagnosis. The eChapter also describes in detail methods of physical examination, including appropriate positioning, the placement of hands, dealing with menstrual discharge, and the use of the Sims’ speculum, colposcopy, and the loupe. How to perform a Wright’s stain to identify host cell and microorganism morphology is described in detail, and normal, atrophic, infected and eroded slides are described with the support of color illustrations. This eChapter forms part of the Ausmed publication The Vulva and Vaginal Manual, edited by Graeme Dennerstein, James Scurry, John Brenan, David Allen and Maria-Grazia Marin. A richly illustrated and comprehensive guide to the identification and treatment of over 275 vulvovaginal diseases The Vulva and Vagina Manual is an invaluable resource especially suitable for: Gynecologists Dermatologists General Practitioners Obstetricians Midwives General nurses Practice nurses Nurse Practitioners There are also 14 additional eChapters from The Vulva and Vaginal Manual available for members to download from the Ausmed website. Subscription also entitles members to access the full range of resources that compliment and build upon the material described within The Vulva and Vaginal Manual, including a richly populated catalogue of Audio Lectures, Fast Facts and Video Learning Activities on the topics of gynecology, obstetrics, oncology, women’s health and a wide range of other healthcare topics. Both members and non-subscribers alike may also purchase a hard copy of this book of from the Ausmed Education Online Bookstore, along with hard copies of the complimentary publication Gynecological Cancer Care: A Guide to Practice.
Symptom Assessment in Palliative Care
Effective assessment and management of symptoms is core business for palliative care. Because of their extended contact with ill people, nurses are particularly well placed to assess and manage sympto...ms experienced by those with life-limiting conditions. In the context of symptom assessment, Aranda highlights numerous issues faced by dying people – confrontation with dying, death, and loss, and the changing of social roles and relationships – and describes their symptoms as ‘an ever- present and distressing reminder of advanced disease that has a major negative impact on quality of life and the capacity to engage in daily activities.’ These observations create an overall picture of a person whose condition is more likely to deteriorate than to improve, and in whom the development of a new symptom, exacerbation of existing symptoms, or a change or deterioration in general condition may be sudden and rapid. This chapter will provide a framework for symptom assessment that takes into account the complex and multiple issues outlined above and sets symptom assessment within the wider context of the nursing admission assessment, key assessment principles, and the communication skills and attitudes that characterize the ‘human element’ of assessment.
A Framework for Symptom Assessment
Symptom control is a key component of comprehensive palliative care, and is a major emphasis of this book. This chapter aims to provide a generic framework for the assessment and understanding of s...ymptoms in advanced disease. The chapter emphasises an integrated approach, recognising that various symptoms are often related. Unfortunately, most symptoms and their management are studied individually and understanding of this relationship is therefore currently limited, underscoring the need for further research in this area.
Assessment involves gathering the data related to a person’s physical, psychological and social status before admission, at the time of admission and following admission to any aged care facility. T...he gathering of data incorporates the full spectrum of psychosocial, physical and historical data and documenting the findings. This can be very stressful for the individual being assessed and, in order to facilitate a non-threatening approach, it is essential that the process is not overly formal. There is no doubt that conducting a formal assessment in an informal manner is difficult, and this chapter explores how to reconcile informality with the requirement for thoroughness and efficiency in the gathering of information essential for determining the best options for care.