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Jalilova Surayo Abduhalimovna, Head of the Department of Public Health and Health Of the Tashkent Medical Academy, Republic of Uzbekistan
E-mail: evovision@bk.ru
THE ROLE OF THE NURSE IN EARLY DIAGNOSTICS CERVICAL DISEASES
Abstract: every woman should undergo a prophylactic examination every year throughout her life. Correct and competent organization of the nurse's work of the examination room, contributes to the increase of detectability of cervical disease and can be one of the most promising and effective forms of preventive examination of the female population.
Keywords: Disease, cervix, nurse.
Diseases of the cervix in the modern world are common among women. At the same time, there is no tendency to reduce their number. In general, such diseases are typical of young women who are in the reproductive age. The pathology of the cervix is one of the most frequent gynecological diseases and is diagnosed in 2545% of women [1; 2].
Recently there has been a trend towards an increase in the number of cases of cervical disease at a young age (15-24 years), which is explained primarily by the early onset of sexual life, frequent changes in sexual partners, infection with various sexual infections, which often end with abortions.
The most important method of secondary prevention of DC is to conduct a total screening of the female population using a simple unified method (clinical examination or preventive examinations, since the progression of subclinical forms of DC to the stage of cervical cancer takes a long time (10-15 years), the purpose of screening is diagnosis early disease and treatment in the period of precancer [3; 4].
Research objective. Show the importance of nursing a woman for the early detection and prevention of cervical disease.
Materials and methods. The study was conducted on the basis of gynecological offices in the Central Polyclinic of the Bektemirsky district, polyclinic № 4 of Mirzo Ulugbek district, polyclinic № 60 of the Yakkasa-ray district and polyclinics № 23 and 25 of the Uchtepa district in 2015-2016.
All studies were conducted by a nurse, in the presence of a doctor, 1019 women were examined.
Results and its discussion. A significant role in solving the tasks assigned to early diagnostics of DC is assigned to the work of nurses in the examination rooms. The main task of the nurse of the examination room is to examine women with the purpose of revealing tumoral and premalignant diseases. Mostly these are people from a contingent of unorganized population, which is especially important, since among them there are often elderly and elderly women, especially those who are at risk ofDC. Experienced specially trained nurses, participating in regular trainings, work in the examination rooms. The nurse of the examination room uses all available methods of examination: questioning, examination, palpation, bimanual examination, cytological examination. These methods do not compete with each other, but complement each other. A close inspection, oncological alertness and knowledge allow the nurse of the examination room to detect precancerous diseases and cancer. Before the beginning of the examination, the nurse conducts a survey, paying attention to the menstrual cycle, the presence and appearance of pain and atypical blood secretions in the intermenstrual period and in menopause. An important stage in the work of the nurse of the examination room is a gynecological examination. In the study, the nurse evaluates the condition ofthe mucous walls of the vagina, the presence of foci of hyperemia around the outer throat of the cervix, and the formation of an outward projection in the form of a "tongue" can be observed, the formations resembling the "cauliflower" characteristic of cervical cancer.
Currently, it is generally accepted that active detection of ZSH without cytology is impossible. Under the conditions of the examination room, the nurse takes the
THE ROLE OF THE NURSE IN EARLY DIAGNOSTICS CERVICAL DISEASES
cellular material for cytological examination from the entire surface of the cervix and from the cervical canal. The collection of material for cytological examination is taken by all women without exception, regardless of the presence of complaints and examination data. In case of suspected pathology, the nurse of the examination room directs the patients to the appropriate specialist for an in-depth examination. If a malignant neoplasm is suspected, the form of the alarm notice of the examination room is filled in, which is sent to the primary oncology room.
The study included data on preventive examination of 1019 women who had a reproductive history on a specially developed questionnaire, and a gynecological examination was performed. The examination included examination of the skin and mucous membranes of the preanal area and the vulva, palpation of the inguinal lymph nodes, examination of the cervix and vagina with the help of mirrors. When conducting a clinical and visual examination, the cervix was examined first without mucus removal and treatment with solutions. The examination was done clockwise, the color, relief, borders of the flat and cylindrical epithelium, the location and state of the vessels were studied. Then, the state of the mucous cervix was studied by tests with 3% acetic acid solution and 0.5% lugol solution (clinico-visual method) and the epithelial response to the above effects was determined.
Among the women we examined, two groups were identified: 1 group consisted of women, practically healthy, the second group included women with a positive "clinical-visual test", that is, with various pathological changes in the cervix. Patients of this group were referred to the doctor for colposcopy, examination of the smears of prints from the surface of the exoendocervix by the method of the papanikolaou, or to the histological examination of the biopsy material (as necessary).
Women with confirmed gynecological disease came under clinical supervision to doctors of the appropriate profile, for further treatment and follow-up. The results of the in-depth examination were recorded and used to calculate morbidity according to the medical examination. The conducted activities allowed:
- determine the frequency of DC detection according to the medical examination for 100 women examined;
- to determine the most significant and common pathologies of the cervix uteri in the studied group in the range of age characteristics and place of residence;
- determine the effectiveness of clinical and visual examination of the cervix, conducted by a nurse.
The primary incidence is in this case the number of newly diagnosed diseases per 1000 women of childbear-ing age. According to official statistical data, the highest level of primary morbidity was observed in Khamzin (13.6 ± 0.5% 0), Chilanzar (12.9 ± 0.4% 0), Bektimir (9.8 ± 1.1% 0) and Mirabad (9.2 ± 0.6% 0) areas. The lowest incidence rates were recorded in Uchtepa (1.0 ± ± 0.1% 0), Shaykhantohur (2.7 ± 0.2% 0) and Yakkasarai (2.7 ± 0.2% 0) areas.
Special studies show that 40-60% ofwomen in active reproductive age suffer from gynecological diseases. A significant part of the structure of gynecological morbidity is made up by the cervical diseases that we study, which very often transform into chronic forms, lead to functional disorders of the female reproductive system and require long-term treatment. It should be noted that the level of primary incidence of DC, which are mainly represented by erosion and ectropion and, most importantly, it was revealed over the years studied in Tashkent city tended to decrease.
Conclusions. An important role in the identification of patients with various pathological conditions is the prophylactic examinations conducted by the nurse in the outpatient and polyclinic stage. Reducing mortality from cancer depends not so much on improving treatment methods, as on the timely diagnosis of premature diseases. The referral to the examination room is mandatory for all women who first applied to the clinic.
Correct and competent organization of the nurse's work of the examination room, contributes to the increase in the detectability of the incidence of the cervix and can be one of the most promising and effective forms of preventive examination of the female population.
References:
1. Игонина С. А., Дубинникова А. Ш. Всероссийский съезд средних медицинских работников. Роль медсестры в профилактике заболеваний шейки матки. - Екатеринбург, - 2009. - С. 90-91.
2. Костава М. Н. Заболевания шейки матки: Клинические лекции. - М., - 2003. - С. 30-32.
3. Коханевич Е. В., Ганина К. П. Кольпоцервикоскопия. Атлас. - Киев: Выща школа, - 1997. - 49 с.
4. Новик В. И. Цитологический скрининг предрака и рака шейки матки (обзор) // Вопр. онкол. - 1990. - Том. 36. - № 12. - С. 1411-1418.
