Discomforts and Questions - Is there any discomfort or complaint you may want to report that have come up after the end of brachytherapy? - Are there any questions you want to ask? |
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Sexual relations - Do you have sexual relations? ( ) Yes ( ) No - If so, how many times a week? - If not, why not? |
Sexual relations - Do you have sexual relations with vaginal penetration? ( ) Yes ( ) No - How many times a week? - If not, Why don't you have sexual relations with vaginal penetration?
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Vaginal dilation exercise - Do you do vaginal dilation exercise? ( ) Yes ( ) No - If so, how many times a week? - If not, why not? - Please, describe the directions given by the nurse for the performance of vaginal physiotherapy: ( ) reported in full ( ) reported partially ( ) did not report - If REPORTED PARTIALLY, record the identified health education needs: |
Vaginal dilation exercise - Do you do vaginal dilation exercise? ( ) Yes ( ) No - How many times a week? If not, why don't you perform the exercises? - Please, describe the directions given by the nurse and/or other professional of the health team to perform the vaginal dilation exercise: ( ) reported in full the institutionally recommended care ( ) reported partially ( ) did not report - If REPORT PARTIALLY or DID NOT REPORT, record the health education needs: |
Pain perception - Do you feel pain during the sexual act or at another moment? ( ) Yes ( ) No - If so, what is the pain intensity (from 1 to 10)? - If so, what is the location of the pain? - If so, how long does the pain last? - If so, what are the characteristics of pain? - If so, what do you do to control the pain? |
Pain perception - During the sexual act, or at another moment, do you feel pain in the region where the radiotherapy was performed (pelvic, vaginal, perianal region)? ( ) Yes ( ) No - What is the intensity (from 1 to 10), duration, characteristics and location of the pain? - What are the strategies used for controlling the pain?
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Vaginal bleeding - Do you have any bleeding or other vaginal secretion? ( ) Yes ( ) No - If so, what are the characteristics of the bleeding or secretion? - If so, when (approximate start date) did this bleeding or secretion start? - Are you under treatment to control the bleeding and/or vaginal secretion? ( ) Yes ( ) No - If so, what is the treatment? - If not, why don't you or why didn't you seek care to start the treatment? |
Bleeding and vaginal secretion - Do you have any vaginal bleeding? ( ) Yes ( ) No, or do you have any other type of secretion? ( ) Yes ( ) No - What is the start date and the characteristics of the bleeding and/or secretion? - Are you under treatment to control the bleeding and/ or vaginal secretion? ( ) Yes ( ) No. What is the treatment performed? - If the patient does not perform treatment, ask and record the reason for this attitude.
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Use of intimate tampons - Do you use intimate tampons? ( ) Yes ( ) No - If not, why not? |
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Previous gynecological examination - Have you had a gynecological examination after the end of the brachytherapy? ( ) Yes ( ) No - If so, when were you examined? ___/___/___ - Was there any difficulty in performing the previous gynecological examination? ( ) Yes ( ) No - If so, what were the difficulties encountered? - If not, why weren't you examined? |
Previous gynecological examination - Have you had a gynecological examination after the end of the brachytherapy? ( ) Yes ( ) No - When were you examined after the end of the brachytherapy? - Was there any difficulty in performing the previous gynecological examination? ( ) Yes ( ) No - What were the difficulties and/or discomforts felt? - If you did NOT undergo gynecological examination after the end of the brachytherapy, why not?
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Vaginal lubrication - Do you use or feel the need to use vaginal lubricant? ( ) Yes ( ) No - If so, why do you feel the need? - If so, which lubricant do you use? - If so, how often do you use the lubricant? |
Vaginal dryness and use of lubricant - Do you experience vaginal dryness? ( ) Yes ( ) No - Do you use or feel the need to use vaginal lubricant? ( ) Yes ( ) No - Why do you feel the need to use lubricant? - What is the lubricant and how often do you use it?
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Gynecological examination: - Examination performed ( ) Yes ( ) No. - Size of the speculum used: ( ) small ( ) medium ( ) large - Characteristics of the vaginal canal and uterus that show physiological abnormalities: - If there were any obstacles to the gynecological exam, mention the reason(s): - Was the collection of material for oncotic colpocitology performed? ( ) Yes ( ) No - If the oncotic colpocitology was not performed, mention the reason(s): |
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Classification of vaginal stenosis: ( ) Degree 0; ( ) Degree 1; ( ) Degree 2; ( ) Degree 3; ( ) Degree 4; ( ) Degree 5. To define the degree of vaginal stenosis consider the following characteristics: Degree 0: asymptomatic woman; Degree 1: woman who reports some vaginal discomfort, but what does not prevent the use of tampons, sexual activity and gynecological examination; Degree 2: woman who presents vaginal narrowing and/or shortening that partially interferes with the use of intimate tampons, sexual activity and gynecological examination; Degree 3: woman who presents complete constriction of the vagina, identified in the visual inspection during the gynecological examination and that makes it impossible to perform the gynecological examination and sexual activity; Degree 4: woman who presents ulcer and necrosis in the vaginal canal (presence of ulcer and necrosis confirmed by medical evaluation and/or examinations); Degree 5: woman who presents vesical and/or intestinal fistulas (presence of ulcer and necrosis confirmed by medical evaluation and/or examinations). |
Classification of vaginal stenosis: ( ) Degree 0; ( ) Degree 1; ( ) Degree 2; ( ) Degree 3; ( ) Degree 4; ( ) Degree 5. To define the degree of vaginal stenosis consider the following characteristics: Degree 0: asymptomatic woman; Degree 1: woman who reports some vaginal discomfort, but what does not prevent sexual activity, the performance of gynecological examination or the recommended vaginal dilation exercise after brachytherapy; Degree 2: woman who presents vaginal narrowing and/or shortening that partially interferes with the use of intimate tampons, sexual activity, gynecological examination, and in the exercise of recommended vaginal dilation after brachytherapy; Degree 3: woman who presents complete constriction of the vagina, identified in the visual inspection during the gynecological examination and that makes it impossible to perform the gynecological examination and sexual activity; Degree 4: woman who presents ulcer and necrosis in the vaginal canal (presence of ulcer and necrosis confirmed by medical evaluation and/or examinations); Degree 5: woman who presents vesical and/or intestinal fistulas (presence of ulcer and necrosis confirmed by medical evaluation and/or examinations). |
Nursing prescriptions oriented or implemented
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Record of nursing interventions oriented or implemented
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Referrals to other indicated professionals
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