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M6 13-005

Exam 8: Reproductive System; Infection of the Female Reproductive System

Vaginitis Inflammation of the vagina
Vaginitis: Etiology Common vaginal infection caused by: E. Coli Staphylococcal Organisms Streptococcal Organisms
Vaginitis: Pathophysiology If Pt changes perineal pads or tampons infrequently: Vaginal tract and groin become irritated. Creates a medium suitable for organism growth.
Vaginitis: Types Simple (bacterial) Vaginitis Senile/atrophic Vaginitis
Simple Vaginitis: Causative Organisms E. Coli Trichomonas vaginalis Gardnerella bacillus Candida albicans
Senile/ Atrophic Vaginitis: Causative Factors Decreased levels of estrogen causes the vagina to atrophy. Occurs in women post-menopause. Naturally occurs as women ages.
Vaginitis: Clinical Manifestations Pruritis burning Edema of surrounding tissue Dysuria Exudate (yellow, white, grayish white, or curd)
Exudate for Tichomoniases Vaginalis Diffusely foamy (bubbly)
Exudate for Candida Albicans Thick and cheese like
Vaginitis: Assessment Menstrual Hx Birth Control Methods Current Medications Family Hx of DM Hx of vaginal infections or STI Sexual Hx
Vaginitis: Diagnostic Tests Direct Visualization Culture of Organism Bi-manual Examination
Vaginitis: Medical Management Douching Creams, ointments, suppositories (depends on cause) Oral Meds Refrain from intercourse or use condom For senile/ atrophic vaginitis, estrogen, vaginal suppositories and ointments may be prescribed
Vaginitis: Goals of Treatment Cure the infection Prevent Reinfection Prevent Complications Prevent infection of sexual partner(s)
Vaginitis: Patient Teaching Wash hands b&a vaginal applications Use Meds at night and remain recumbent for more than 30 minutes Discourage douching Heat may be applied to area as sitz bath, perineal irrigations & douches Sexual partner should also be treated Change pads/tampon
Vaginitis: Prognosis Good with proper treatment
A female client with a history of diabetes mellitus is at risk for developing vaginitis due to what occurrence? Presence of glucose in the urine
Cervicitis Infection of the cervix
Cervicitis: Causes Vaginal infection or STI Childbirth or abortion in which lacerations occured
Cervicitis: Clinical Manifestations Backaches Whitish exudate Pink-tinged menstrual discharge Dyspareunia
Cervicitis: Treatment Specific to causative organism Untreated, can spread to other pelvic organs Vaginal suppositories, ointments and creams Oral medications Sexual partners need to be treated as well
Oral Medications for Cervicitis Azithromycin (Zithromax) Doxycycline (Vibramycin)
Cervicitis: Patient Teaching Personal hygiene/warm tub baths to decrease discomfort and odor. Avoid intercourse. Wash hands before and after vaginal applications. Use vaginal meds at bedtime and remain recumbent for more than 30 mins
An STI caused by herpes type 2 can cause Cervicitis
Pelvic Inflammatory Disease (PID) Any infection that involves the cervix, uterus, fallopian tubes, ovaries and may extend to connective tissue lying between the broad ligaments.
Pelvic Inflammatory Disease (PID): Pathophysiology When cervical mucus is altered or destroyed, bacteria ascend into the uterine cavity and other reproductive structures. Causes adhesions and can lead to sterility.
Pelvic Inflammatory Disease (PID): Causes Insertion of biopsy curette or irrigation catheter Abortion Pelvic Surgery Sexual Intercourse Pregnancy
Pelvic Inflammatory Disease (PID): Causative Organisms Neisseria gonnorrhoeae Strptococci Staphylococci Chlamydiae Tubercle bacilli
Pelvic Inflammatory Disease (PID): Clinical Manifestations Elevation in temperature Chills Severe ABD pain Malaise N/V Malodorous purulent vaginal exudate
Pelvic Inflammatory Disease (PID): Assessment Assess severity of disorder Occurrences (Primary or recurrent) Sexual Hx Recent pelvic examinations or precedures
Pelvic Inflammatory Disease (PID): Diagnostic Tests Gram Stain of Secretion C&S of secretions Laproscopic Visualization Vaginal US Leukocyte and erythrocyte sedimenation rate (ESR)
Pelvic Inflammatory Disease (PID): Medical Management Goal: Control and eradicate infection, prevent systemic spreading Systemic antibiotics intravenously or intramuscularly. Corticosteroids no intercourse for 3 weeks Sexual partner evaluated and treated Pain control
Pelvic Inflammatory Disease (PID): Meds Cefoxitin (Mefoxin) Doxycycline (Vibromycin)
Pelvic Inflammatory Disease (PID): Nursing Interventions Client is usually hospitalized Observe standard precautions Assess Pain and administer analgesics as ordered Monitor VS Provide fluids and monitor fluid status Palliative measures for comfort Support client with positve, non-judgemental attitude F
Pelvic Inflammatory Disease (PID): Pt teaching low grade fever persists or purulent vaginal discharge occurs call provider Understand significance of PID Compliance with medication therapy Importnece of hand washing and personal hygiene, sexual partner evaluated/treated. Painful intercourse after
Pelvic Inflammatory Disease (PID): Prognosis Good with adequate treatment Can lead to complications such as infertility
Toxic Shock Syndrome (TSS) Acute bacterial infection caused by stphylococcus aureus
Toxic Shock Syndrome (TSS): Most common in menstruating women using tampons. Can occur in non menstruating women Greatest risk are those who insert with fingers and not applicator
Toxic Shock Syndrome (TSS): Cause When a tampon is left in place for too long, bacteria flourish and release toxins into the bloodstream
Toxic Shock Syndrome (TSS): Clinical Manifestations Begins with flu-like symptoms (first 24 hours) Elevated temperature Vomiting Dizziness Headache Diarrhea Myalgia Sore throat Red macular palmar or diffuse rash followed by desquamation of the skin
Toxic Shock Syndrome (TSS): Assessment Tampon usage and time between changes Other TSS symptoms (fatigue, headache, myalgia, sore throat) Eythematous rash on palms ans soles Edema and signs of shock. Desquamation
Toxic Shock Syndrome (TSS): Diagnostic Tests No definitive test Cervical/vaginal smear Blood, urine and throat cultures Labs
Toxic Shock Syndrome (TSS): Labs Leukocytosis Thrombocytopenia Elevated levels of : bilirubin, BUN, Creatinine, SGPT, SGOT, CPK
Toxic Shock Syndrome (TSS): Medical Management ABx based on C&S Parental Fluids Correct Electrolyte imbalances Monitor renal labs (BUN & Creatinine) Monitor LFTs, SGPt and SGOT
Toxic Shock Syndrome (TSS): Nusring interventions Bed Rest Administer ABx moniot VS and fluid status
Toxic Shock Syndrome (TSS): Patient Teaching Advise client not to use super absorbent tampons Obsers S/S of TSS Alternate tampons with pads Inspect tampon for defects before insertion Change tampons frequently (every 4 hours)
Toxic Shock Syndrome (TSS): Prognosis Dependent upon severity of disease and time medical management are instituted Rare disease that can be fatal
Antifungals Used to treat vaginitis and cervitis caused by Candida Albicans (yeast infections)
Antifungals: Predisposing factors Broad-spectrum antibiotic therapy Immunodeficiency disorders
Antifungals: Generic/Trade names Butonazole (Femstat 3) Clotrimazole (Gyne-Lotimin 3 or Mycelex-7) Miconazole (Monistat) Tioconazole (Vagistat) Fluconazole (Diflucan)
Antifungals: Action Inhibits growth of fungi by interfering with DNA replication
Antifungals: Common Adverse Effects Vulvovaginal burning and itching Pelvic cramps and rash Uticaria Stining Contact Dermatitis
Anitfungals: Nursing implications Wash hands and don gloves Observe for adverse effects Ensure adequate perineal hygiene
Antifungals: Patient Teaching Apply and insert creams/vaginal tablets at bedtime and remain in recumbent position for at least 30 minutes Keep the area cleansed and dry If using Diflucan (flucanazole) prophylactically, do not take until there are signs of a yeast infection
Created by: jtzuetrong