Exam 8: Reproductive System; Infection of the Female Reproductive System
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| Vaginitis | Inflammation of the vagina
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| Vaginitis: Etiology | Common vaginal infection caused by:
E. Coli
Staphylococcal Organisms
Streptococcal Organisms
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| Vaginitis: Pathophysiology | If Pt changes perineal pads or tampons infrequently:
Vaginal tract and groin become irritated.
Creates a medium suitable for organism growth.
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| Vaginitis: Types | Simple (bacterial) Vaginitis
Senile/atrophic Vaginitis
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| Simple Vaginitis: Causative Organisms | E. Coli
Trichomonas vaginalis
Gardnerella bacillus
Candida albicans
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| Senile/ Atrophic Vaginitis: Causative Factors | Decreased levels of estrogen causes the vagina to atrophy.
Occurs in women post-menopause.
Naturally occurs as women ages.
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| Vaginitis: Clinical Manifestations | Pruritis
burning
Edema of surrounding tissue
Dysuria
Exudate (yellow, white, grayish white, or curd)
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| Exudate for Tichomoniases Vaginalis | Diffusely foamy (bubbly)
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| Exudate for Candida Albicans | Thick and cheese like
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| Vaginitis: Assessment | Menstrual Hx
Birth Control Methods
Current Medications
Family Hx of DM
Hx of vaginal infections or STI
Sexual Hx
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| Vaginitis: Diagnostic Tests | Direct Visualization
Culture of Organism
Bi-manual Examination
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| 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
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| Vaginitis: Goals of Treatment | Cure the infection
Prevent Reinfection
Prevent Complications
Prevent infection of sexual partner(s)
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| 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
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| Vaginitis: Prognosis | Good with proper treatment
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| 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
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| Cervicitis | Infection of the cervix
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| Cervicitis: Causes | Vaginal infection or STI
Childbirth or abortion in which lacerations occured
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| Cervicitis: Clinical Manifestations | Backaches
Whitish exudate
Pink-tinged menstrual discharge
Dyspareunia
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| 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
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| Oral Medications for Cervicitis | Azithromycin (Zithromax)
Doxycycline (Vibramycin)
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| 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
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| An STI caused by herpes type 2 can cause | Cervicitis
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| 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.
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| 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.
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| Pelvic Inflammatory Disease (PID): Causes | Insertion of biopsy curette or irrigation catheter
Abortion
Pelvic Surgery
Sexual Intercourse
Pregnancy
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| Pelvic Inflammatory Disease (PID): Causative Organisms | Neisseria gonnorrhoeae
Strptococci
Staphylococci
Chlamydiae
Tubercle bacilli
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| Pelvic Inflammatory Disease (PID): Clinical Manifestations | Elevation in temperature
Chills
Severe ABD pain
Malaise
N/V
Malodorous purulent vaginal exudate
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| Pelvic Inflammatory Disease (PID): Assessment | Assess severity of disorder
Occurrences (Primary or recurrent)
Sexual Hx
Recent pelvic examinations or precedures
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| Pelvic Inflammatory Disease (PID): Diagnostic Tests | Gram Stain of Secretion
C&S of secretions
Laproscopic Visualization
Vaginal US
Leukocyte and erythrocyte sedimenation rate (ESR)
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| 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
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| Pelvic Inflammatory Disease (PID): Meds | Cefoxitin (Mefoxin)
Doxycycline (Vibromycin)
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| 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
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| 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
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| Pelvic Inflammatory Disease (PID): Prognosis | Good with adequate treatment
Can lead to complications such as infertility
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| Toxic Shock Syndrome (TSS) | Acute bacterial infection caused by stphylococcus aureus
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| 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
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| Toxic Shock Syndrome (TSS): Cause | When a tampon is left in place for too long, bacteria flourish and release toxins into the bloodstream
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| 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
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| 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
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| Toxic Shock Syndrome (TSS): Diagnostic Tests | No definitive test
Cervical/vaginal smear
Blood, urine and throat cultures
Labs
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| Toxic Shock Syndrome (TSS): Labs | Leukocytosis
Thrombocytopenia
Elevated levels of : bilirubin, BUN, Creatinine, SGPT, SGOT, CPK
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| 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
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| Toxic Shock Syndrome (TSS): Nusring interventions | Bed Rest
Administer ABx
moniot VS and fluid status
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| 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)
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| Toxic Shock Syndrome (TSS): Prognosis | Dependent upon severity of disease and time medical management are instituted
Rare disease that can be fatal
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| Antifungals | Used to treat vaginitis and cervitis caused by Candida Albicans (yeast infections)
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| Antifungals: Predisposing factors | Broad-spectrum antibiotic therapy
Immunodeficiency disorders
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| Antifungals: Generic/Trade names | Butonazole (Femstat 3)
Clotrimazole (Gyne-Lotimin 3 or Mycelex-7)
Miconazole (Monistat)
Tioconazole (Vagistat)
Fluconazole (Diflucan)
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| Antifungals: Action | Inhibits growth of fungi by interfering with DNA replication
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| Antifungals: Common Adverse Effects | Vulvovaginal burning and itching
Pelvic cramps and rash
Uticaria
Stining
Contact Dermatitis
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| Anitfungals: Nursing implications | Wash hands and don gloves
Observe for adverse effects
Ensure adequate perineal hygiene
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| 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
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