{
  "name": "Uterine Fibroids",
  "slug": "uterine-fibroids",
  "url": "https://nursingplex.com/care-plans/uterine-fibroids",
  "category": "Reproductive & Genitourinary",
  "summary": "Benign uterine tumors with bleeding and pressure symptoms; anemia and surgical prep.",
  "nursing_diagnoses": [
    "Acute pain",
    "Risk for bleeding",
    "Fatigue"
  ],
  "overview": [
    "Uterine fibroids (leiomyomas) are benign smooth muscle tumors of the myometrium. They are estrogen and progesterone dependent, so they grow during the reproductive years and pregnancy and usually shrink after menopause. Location determines symptoms more than size: submucosal fibroids distort the cavity and cause heavy bleeding and pregnancy loss, intramural fibroids enlarge the uterus and cause bulk symptoms, and subserosal fibroids press on the bladder and bowel.",
    "Many fibroids are asymptomatic and need only observation. When they cause problems, the dominant issues are heavy prolonged menstrual bleeding with iron deficiency anemia, pelvic pressure, urinary frequency, constipation, dyspareunia and sometimes infertility. Treatment ranges from tranexamic acid, NSAIDs and hormonal suppression to a levonorgestrel IUD, uterine artery embolization, myomectomy for those who want future pregnancy, and hysterectomy as definitive therapy. Nursing care centers on quantifying blood loss, correcting anemia, and helping the woman weigh options against her fertility goals."
  ],
  "key_facts": [
    {
      "label": "Location drives symptoms",
      "text": "Submucosal — bleeding; intramural — bulk and cramping; subserosal — pressure on bladder and bowel."
    },
    {
      "label": "Quantify bleeding",
      "text": "Pads or tampons soaked per hour, clot size, flooding, and days of flow — 'heavy' is too vague to act on."
    },
    {
      "label": "Anemia",
      "text": "Chronic iron loss is the most common complication; check hemoglobin and ferritin and treat before surgery."
    },
    {
      "label": "Myomectomy",
      "text": "Preserves the uterus for future pregnancy but fibroids can recur and a uterine scar may require cesarean delivery."
    },
    {
      "label": "Embolization",
      "text": "Expect post-embolization syndrome — cramping, low-grade fever and malaise for several days; not first choice if pregnancy is planned."
    }
  ],
  "nursing_priorities": [
    "Quantify and control abnormal uterine bleeding.",
    "Detect and correct iron deficiency anemia.",
    "Relieve pain and pressure symptoms.",
    "Support informed choice among treatment options based on fertility goals.",
    "Provide safe perioperative care and prevent surgical complications.",
    "Address fatigue, sexuality and body-image concerns."
  ],
  "assessment": {
    "subjective": [
      "Heavy prolonged periods, flooding, passing large clots, needing double protection or waking at night to change",
      "Pelvic pressure, heaviness or a feeling of fullness; increasing abdominal girth",
      "Urinary frequency, urgency or incomplete emptying; constipation",
      "Dysmenorrhea, dyspareunia, low back pain",
      "Fatigue, weakness, dizziness, shortness of breath on exertion, pica",
      "Distress about fertility, recurrent pregnancy loss, or fear of hysterectomy"
    ],
    "objective": [
      "Enlarged, firm, irregularly contoured uterus on bimanual examination",
      "Palpable abdominal mass in large fibroids",
      "Pad count and documented clot size; hemoglobin, hematocrit and ferritin values",
      "Pallor, tachycardia, orthostatic changes, brittle nails and conjunctival pallor",
      "Ultrasound, sonohysterography or MRI showing fibroid number, size and location",
      "Hydronephrosis on imaging with severe ureteral compression",
      "Postoperative findings: incision status, bleeding, vital sign trends, urinary output"
    ],
    "related_factors": [
      "Estrogen- and progesterone-dependent growth of myometrial tumors",
      "Increased endometrial surface area and distorted cavity causing heavy bleeding",
      "Mass effect on bladder, ureters, bowel and pelvic nerves",
      "Chronic iron loss exceeding dietary replacement",
      "Uncertainty about treatment choices and fertility outcomes"
    ]
  },
  "goals": [
    "The client will report menstrual bleeding reduced to a manageable volume and duration.",
    "The client will maintain hemoglobin within normal limits with no symptoms of anemia.",
    "The client will report pelvic pain and pressure reduced to an acceptable level.",
    "The client will describe the risks and benefits of each treatment option and make an informed choice.",
    "The client will recover from any procedure without hemorrhage, infection or thromboembolism.",
    "The client will express her feelings about fertility and body changes and identify support."
  ],
  "interventions": [
    {
      "title": "1. Assessing and controlling bleeding",
      "points": [
        "Quantify blood loss objectively: number of saturated pads or tampons per hour, clot size compared with common objects, episodes of flooding and total days of flow.",
        "Monitor vital signs for tachycardia and orthostatic hypotension and reassess with any acute increase in bleeding.",
        "Give tranexamic acid, NSAIDs, combined hormonal contraceptives, progestins or GnRH therapy as prescribed and explain the expected effect on bleeding.",
        "Teach that a levonorgestrel intrauterine system markedly reduces bleeding when the cavity is not distorted.",
        "Prepare for emergency evaluation of hemorrhage — soaking a pad an hour for several hours, dizziness or syncope.",
        "Track hemoglobin and hematocrit serially rather than relying on a single value."
      ]
    },
    {
      "title": "2. Correcting anemia and managing fatigue",
      "points": [
        "Give oral iron with vitamin C on an empty stomach when tolerated, warn about dark stools and constipation, and add a stool softener.",
        "Arrange IV iron or transfusion as ordered for severe anemia or preoperative optimization.",
        "Teach iron-rich foods — red meat, liver, legumes, dark greens, fortified cereals — and to avoid tea, coffee and calcium at the same time as iron.",
        "Help plan energy conservation: pacing, prioritizing, rest periods and assistance with heavy tasks.",
        "Reassess hemoglobin, ferritin and symptom improvement at scheduled intervals."
      ]
    },
    {
      "title": "3. Relieving pain and pressure",
      "points": [
        "Give NSAIDs on a schedule during menses, which reduces both cramping and blood loss.",
        "Apply heat to the lower abdomen or back and encourage positions of comfort and gentle activity.",
        "Advise scheduled voiding for urinary frequency and adequate fluid despite the temptation to restrict it.",
        "Manage constipation with fiber, fluids, activity and stool softeners rather than straining against a pressing mass.",
        "Report new severe pain, which may indicate fibroid degeneration or torsion."
      ]
    },
    {
      "title": "4. Treatment decision support and perioperative care",
      "points": [
        "Review each option honestly — expectant management, medication, embolization, myomectomy, hysterectomy — including effect on fertility and recurrence rates.",
        "Explain GnRH agonist use before surgery to shrink fibroids and improve hemoglobin, along with its menopausal side effects.",
        "Prepare for uterine artery embolization including expected post-embolization cramping, fever and malaise for several days.",
        "Provide standard preoperative teaching and postoperative care after myomectomy or hysterectomy: pain control, early ambulation, incentive spirometry, VTE prophylaxis, catheter care and monitoring for hemorrhage and infection.",
        "Reinforce activity restrictions, no heavy lifting, nothing in the vagina for the prescribed period, and warning signs after discharge."
      ]
    },
    {
      "title": "5. Sexuality, fertility and emotional support",
      "points": [
        "Ask directly about fertility intentions, since they determine which treatments are acceptable.",
        "Discuss dyspareunia and offer practical strategies including positioning, timing and lubrication.",
        "Acknowledge grief when hysterectomy ends fertility and clarify that hysterectomy does not cause menopause unless the ovaries are removed.",
        "Correct the common fear that fibroids are cancerous; malignant transformation is rare.",
        "Refer for counseling or support groups when bleeding, fatigue and body-image changes affect quality of life."
      ]
    }
  ],
  "patient_teaching": [
    "Track your bleeding: count pads or tampons, note clots and flooding, and bring the log to appointments.",
    "Take iron as prescribed with vitamin C, expect dark stools, and use a stool softener.",
    "Start scheduled NSAIDs at the beginning of your period to reduce both pain and bleeding.",
    "Seek urgent care for soaking a pad every hour for several hours, dizziness, fainting or severe new pain.",
    "Fibroids are not cancer and often shrink after menopause; many need no treatment at all.",
    "Tell your provider if you plan to become pregnant — it changes which treatments are appropriate.",
    "After surgery, avoid heavy lifting and follow the restriction on tampons and intercourse until cleared."
  ]
}