Te Manaaki Kaiwhakawhanau i ngā Take o te Myoma Uterine
Pendahuluan
Ko ngā fibroids uterine he pukupuku pai e ahu mai ana i te uaua maeneene o te kōpū (myometrium). He tino noa tēnei āhuatanga i roto i ngā wāhine o te tau whānautanga, ā, ka kore e kitea he tohu, ka puta rānei ngā tohu e whakararuraru ana i te kounga o te oranga. I roto i ngā ratonga hauora whaea, he mahi nui tā ngā kaiwhakawhanau ki te kimi wawe, ki te mātauranga, ki te tautoko, me te tuku tahi mai i ngā fibroids, inā koa ka pāngia te momonatanga, te haputanga, te whānautanga, me te wā i muri i te whānautanga e ngā fibroids. Ka matapakihia e tēnei tuhinga te tiaki whānui a te kaiwhakawhanau mō ngā fibroids uterine, mai i te aromatawai ki te aromatawai, me te whakanui i te kaupapa o te tiaki e aro ana ki te wahine.
Te Ariā Taketake o te Myoma Uterine
Ko ngā myoma o te kōpū he tipu pai e kitea ana i roto i ngā paparanga rerekē o te kōpū:
1. I raro i te kiriuhi o te kiko (i raro i te endometrium): he maha ngā wā ka puta te toto nui o te paheketanga.
2. I roto i te pakitara o te kōpū (i roto i te pakitara o te kōpū): ka taea te whakanui i te kōpū me te mamae/pēhanga.
3. Kei raro i te kōpū (kei waho o te kōpū): he maha ake ngā wā ka puta ngā amuamu mō te pēhanga ki ngā whekau e karapoti ana.
4. Pedunculated (pedunculated): kei te mōrearea te hurihanga ka puta ai te mamae nui.
Ko ngā āhuatanga mōrearea e pā ana ko te 30–50 tau te pakeke, te hītori whānau, te tīmatanga o te paheketanga, te momona, me te roa o te pānga ki te estrogen. Ka pāngia ngā fibroids e ngā homoni estrogen me te progesterone, nō reira ka nui haere i te wā e hapu ana, ka mimiti hoki i muri i te menopause.
Ngā Whakaaturanga Hauora me te Pānga ki te Hauora Whakaputa Uri
Ko ngā amuamu noa ko:
– Te paheketanga nui, te roa rānei o te paheketanga, ka pā mai pea te anemia.
– Te mamae o te hope, te kare ā-roto e kī ana, te pēhanga rānei i te puku o raro.
– Ngā mate mimi (te mimi pinepine) nā te pēhanga ki runga i te pūkahukahu.
– Te kōroke nā te pēhanga o te pūkahukahu.
– Te ngoikore o te pēpi i ētahi wā.
– Te kore tamariki, te mate pāwera rānei, inā koa i roto i ngā myoma submucous e pokanoa ana ki te kōhao kōpū.
I roto i te horopaki o te whānautanga, ka pāngia pea koe e ngā myoma:
– Te hapūtanga: te mōrearea o te whakatahe, te mamae nā te pirau whero, te whakaroa o te tipu o te kukune i ētahi wā, me te pakaru o te whenua.
– Te whānautanga: te āhua hē o te whānautanga, te dystocia, me te tūponotanga ka whānau tākutatia.
– Wā muri i te whānautanga: te nekenekehanga o te kōpū me te toto i muri i te whānautanga.
Aromatawai i te Manaaki Kaiwhakawhanau
Ka whakahaerehia te aromatawai ma te pūnaha hei aromatawai i te āhua whānui, ngā amuamu matua, me te pānga o te myoma ki te mahi whakaputa uri.
1. Te Whakamātautau i te Anamnesis
Ka keri te kaiwhakawhanau i ngā kōrero:
– Te āhua o te paheketanga: te nui o te toto, te roa o te paheketanga, te kitea o ngā toto totoka, te toto i waenga i ngā paheketanga.
– Mamae: te wāhi, te kaha, ngā mea whakaoho, me te pānga ki ngā mahi.
– Hītori whānautanga: te maha o ngā hāputanga, ngā whānautanga, ngā materoto, ngā mahere hāputanga.
– Hītori ārai hapūtanga: te whakamahinga IUD/hormone, te tutuki i ngā whakaritenga, ngā pānga taha.
– Ngā tohu ā-tinana: ngoikore, whanoke (ngā tohu o te anemia), poto o te manawa i te wā e mahi ana.
– He hītori whānau mō te myoma me ētahi atu mate (te toto toto tiketike, te mate huka).
– Hinengaro pāpori: manukanuka e pā ana ki te momonatanga, ngā whanaungatanga takirua, te ahotea.
2. Whakamātautau Tinana
– Te tirotiro i ngā tohu ora me te āhua whānui.
– Whakamātautau puku: te rahi o te kōpū, te puku, te ngawari.
– Te whakamātautau i te hope (e ai ki ngā paerewa a te mana whakahaere me ngā ratonga): te rahi o te kōpū, te nekenekehanga, te mamae, ngā puranga pea.
- Ngā tohu o te anemia: te mā o te kanohi, te tachycardia.
3. Te Tautoko i te Whakamātautau (Whakakotahi)
Ahakoa kāore ngā kaiwhakawhanau e whakahaere tika i ngā whakamātautau tautoko i ngā wā katoa, he mahi tā ngā kaiwhakawhanau ki te ārahi me te āwhina i:
– Te tirotiro i te puku me te ihu (transvaginal ultrasound) hei whakatau i te rahi, te maha, me te wāhi o ngā myoma.
– Hb/Ht hei aromatawai i te mate toto kore toto.
– Ētahi atu whakamātautau e tohuhia ana: ferritin, whakamātautau hapūtanga, te tuku rānei mō te hysteroscopy/MRI i ngā wā motuhake.
Te Tātaritanga Whānau me ngā Raru Pea
I runga i ngā raraunga, ka whakatakoto te kaiwhakawhanau i tētahi tātaritanga whānau, hei tauira:
– Ngā mate o te paheketanga e pā ana ki te myoma o te kōpū.
– E pā ana te anemia ngawari ki te toto nui o te paheketanga.
– Te mamae o te hope e pā ana ki te rahi, te pirau rānei o te myoma.
– Te manukanuka e pā ana ki te whānautanga/te pokanga.
Ngā raruraru pea hei matapae: te toto nui, te toto toto nui, ngā raruraru momona, ngā raruraru hāputanga, me te hiahia mō te pokanga.
Te Whakamahere Manaaki Kaiwhakawhanau
Ka arotahi te whakamahere ki te mātauranga, te aukati i ngā raruraru, te aroturuki, me te tuku karere i te wā tika.
1. Mātauranga me te Tohutohu
– E whakamārama ana he pai noa iho ngā myoma, engari me aroturuki tonu.
– Whakamāramahia ngā tohu mōrearea: te toto nui, te hemo o te ngākau, te mamae ohorere, te kirika, ngā tohu rānei o te anemia kino.
– Te tohutohu mō te whānautanga me te whakamahere hapūtanga: ka taea e ētahi fibroid te whakararuraru i te whakaurunga, te tipu rānei o te kukune.
– Te tohutohu mō ngā kōwhiringa whakahaere hauora/pokanga e whakahaerehia ana e ngā tākuta: ētahi maimoatanga homoni, te tango i te kōpū i te uma (myomectomy), te tango rānei i te kōpū i te uma mō ngā tohu motuhake.
2. Te Wawaotanga a te Kaiwhakawhanau
– Te aro turuki i te toto me te āhua whānui.
– Ngā taunakitanga mō ngā kai e tika ana kia nui te rino (mīti whero, ate, huawhenua matomato), huaora C hei āwhina i te mimiti.
– Te mahi tahi ki te whakarato i ngā papa Fe e ai ki te kaupapa me ngā āhuatanga haumanu.
– Te whakahaere mamae kore-rongoā: okiokinga, ngā kōpeke mahana, ngā tikanga whakangā.
– Whakatenatenahia te tuhi i te maramataka paheketanga hei aroturuki i ngā tauira toto.
3. Ngā Tohutoro me te Mahi Ngātahi
Me tuku kōrero ngā kaiwhakawhanau mēnā:
– Te Hb iti, ngā tohu rānei o te anemia nui.
– Te toto kāore e taea te whakahaere, te whakararuraru rānei i ngā mahi o ia rā.
– Te rahi o te myoma e tere haere ana te whakanui, te whakapae rānei he raruraru (torsion/degeneration).
– Ngā wāhine e hapu ana me te mate pukupuku, ā, e pāngia ana e te mamae nui, te toto rānei.
– Kei te whakapaehia he mate pukupuku (ahakoa he onge), hei tauira, te tere o te tipu i te tau e tata ana ki te paheketanga me ngā tohu ā-tinana.
Whakatinanatanga (Whakatinanatanga)
Ngā tauira o te whakatinana i te tiaki mō ngā kiritaki he myoma me te menorrhagia:
1. Inehia ngā tohu ora, ā, tirohia mēnā he tohu o te anemia.
2. Whakaratohia he mātauranga mō te aroturuki i te toto: te maha o ngā papa i ia rā, ngā toto totoka, me ngā tohu o te whanoke/ngoikore.
3. Ārahi i ngā kiritaki ki te whai i tētahi kai nui te rino, me te ū ki te kai i te Fe (mēnā i hoatu).
4. Me tuku tonu atu ki tētahi whare hauora mēnā ka piki ake te toto, ka poto rānei te manawa/ka hemo rānei.
5. Waihangahia he kaupapa whakahaere, ā, whakahaeretia ngā tukunga mō ngā whakamātautau ultrasound me te Hb.
Mō ngā hāpu e whai myoma ana, ko te whakatinanatanga he aro nui ki te aroturuki tata i te hāputanga, te mōhio ki ngā tohu mōrearea, me te mahi tahi me te tākuta whānau.
Aromatawai
Ka whakahaerehia te aromatawai hei aromatawai i te angitu o te wawaotanga, hei tauira:
– Ka whakaitihia te toto o te paheketanga, ka whakaitihia ngā amuamu mō te whanoke.
– Kua pai ake ngā uara Hb i muri i te wawaotanga kai me te tāpiringa kai.
– Ka whakahaeretia te mamae o te hope, ā, ka pai ake ngā mahi o ia rā.
– E mārama ana te kiritaki ki te āhua, e āhei ana ki te tautuhi i ngā tohu mōrearea, ā, e whai ana i te mahere whakahaere/tuku.
– Kua kōrerohia ngā whakataunga whakahaere anō (te mātakitaki, te whakaora, te pokanga rānei) me te tīma mahi tahi.
Te Katinga
Ko te tiaki i ngā fibroids uterine me arotakehia, me whai pūkenga mātauranga pakari, me te mahi tahi me ētahi atu tohunga hauora. Ko te mahi a te kaiwhakawhanau he mea nui ake i te aro atu ki ngā amuamu, ā, kei roto ko te ārai i ngā raruraru pēnei i te anemia, te whakarato tautoko hinengaro, me te āwhina i ngā wāhine ki te whakatau kaupapa mō ō rātou hauora uri. Mā te huarahi whānui, e aro ana ki te wahine, ka taea te whakapai ake i te kounga o te oranga o ngā kiritaki, ā, ka whakaitihia te mōrearea o ngā raruraru.
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Ki te hiahia koe, ka taea e au te tāpiri i tētahi tauira hōputu SOAP, he rangahau take katoa, he rārangi pukapuka rānei hei whakapakari i tēnei tuhinga ina hiahiatia mō te taumahi.
