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Nursing of Adults with Medical & Surgical Conditions Reproductive Disorders.

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Presentation on theme: "Nursing of Adults with Medical & Surgical Conditions Reproductive Disorders."— Presentation transcript:

1 Nursing of Adults with Medical & Surgical Conditions Reproductive Disorders

2 Amenorrhea Etiology/Pathophysiology –Absent or suppressed menstrual flow –Primary Menarche has not occurred by age 18 years –Secondary Menarche has occurred but ceased for at least 3 months

3 Amenorrhea –Frequent, vigorous exercise –Depression –Anorexia or bulimia –Normal Before puberty After menopause During pregnancy –Hormonal abnormalities –Surgical interventions Hysterectomy

4 Amenorrhea Signs & Symptoms –No menstrual flow for at least 3 months

5 Amenorrhea Treatment –Based on underlying cause –Hormone replacement may be necessary

6 Dysmenorrhea Etiology/Pathophysiology –Uterine pain with menstruation –Primary Not associated with pelvic disorders Usually disappears with pregnancy or by the woman’s late 20’s –Secondary Caused by organic disease –PID –Endometriosis –Usually over 20 years of age

7 Dysmenorrhea Signs & Symptoms –Breast tenderness –Abdominal distention –Nausea and vomiting –Headache –Vertigo –Palpitations –Excessive perspiration –Colicky and cyclic pain –Dull pain in the lower pelvis

8 Dysmenorrhea Treatment –Exercise –Nutritious foods, high in fiber –Heat to pelvic area –Mild analgesics –Prostaglandin inhibitors Ibuprofin (Motrin) Naproxen (Anaprox)

9 Abnormal Uterine Bleeding Menorrhagia –Excessive bleeding at the time of the regular menstrual flow –Endocrine disorders –Inflammatory disdurbances –Uterine tumors Metrorrhagia –Uterine bleeding between regular menstrual periods or after menopause –May indicate cancer or benign tumors of the uterus

10 Premenstrual Syndrome (PMS) Etiology/Pathophysiology –Related to the neuroendocrine events occurring within the anterior pituitary gland –Occurs 7-10 days prior to the menstrual period –Subsides within the first 3 days after the onset of menstrual flow

11 Premenstrual Syndrome (PMS) Signs & Symptoms –Irritability –Lethargy & Fatigue –Sleep disturbances –Depression –Headache –Vertigo –Backache –Breast tenderness –Abdominal distention –Acne –Paresthesia of hands and feet

12 Premenstrual Syndrome (PMS) Treatment –Analgesics –Diuretics –Progesterone –Diet High in complex carbohydrates Moderate in protein Low in refined sugar and sodium Limit caffeine, chocolate, and alcohol –Reduce or eliminate smoking –Exercise –Adequate rest, sleep, and relaxation

13 Female Climacteric (menopause) Etiology/Pathophysiology –The normal decline of ovarian functin resulting from the aging process –Begins between the ages of 35 and 60 years (average 51yrs) –May be induced by irradiation of the ovaries or surgical removal of both ovaries –Not considered complete until 1 year after the last menstrual period

14 Female Climacteric Signs & Symptoms –Decrease in frequency, amount, and duration of the normal menstrual flow –Shrinkage of vulval structures –Shortening of the vagina –Dryness of the vaginal wall –Pelvic relaxation –Loss of skin turgor and elasticity –Increased subcutaneous fat –Decreased breast tissue –Thinning of hair –Osteoporosis

15 Female Climacteric (menopause) Treatment –Estrogen therapy Premarin Provera –Calcium supplements

16 Male Climacteric Etiology/Pathophysiology –Gradual decrease of testosterone levels and seminal fluid production –Occurs between the ages of 55 and 70

17 Male Climacteric Signs & Symptoms –Decreased erections –Enlarged prostate gland –Decreased seminal fluid –Loss or thinning of hair –Decreased muscle tone

18 Male Climacteric Treatment –Emotional support –Treatment for impotence

19 Impotence Etiology/Pathophysiology –Inability of an adult man to achieve penile erection –Functional Psychological –Anatomical Physical defect of genital structures –Atonic Disturbed neuromuscular function

20 Impotence Treatment –Remove cause if possible Medications Illicit or abused substances –Alcohol, cocaine, nicotine –Treat diseases DM, renal, heart and pulmonary diseases –Viagra –Mechnical devices Penile prostesis

21 Penile Prosthesis

22 Infertility Etiology/Pathophysiology –Inability to conceive after 1 year of sexual intercourse without birth control –Impaired sperm or ovum production –Occlusion in the reproductive system that prevents the sperm and ova from meeting –Infections of the reproductive tract –Primary Never conceived –Secondary Conceived but are now unable to do so –Females most fertile time is between the ages of 20 and 29

23 Infertility Treatment –Depends on the cause –Hormone therapy –Repair occlusion –Intrauterine insemination Partner or donor sperm –In vitro fertilization

24 Simple Vaginitis Etiology/Pathophysiology –Common vaginal infection –Causitive organisms E. coli Staphylococcal Streptococcal T. vaginalis C. albicans (yeast) Gardnerella

25 Simple Vaginitis Signs & Symptoms –Inflammation of the vagina –Yellow, white, or grayish white, curdlike discharge –Pruritus –Vaginal burning –T. vginalis Profuse foamy exudate –C. albicans Thick, cheeselike discharge –Bacterial Milk-like discharge; foul odor

26 Simple Vaginitis Treatment –Douching –Vaginal suppositories, ointments, and creams Organism specific –Sitz baths –Abstain from sexual intercourse during treatment –Treat partner if necessary

27 Cervicitis Etiology/Pathophysiology –Infection of the cervix –One of the most common diseases of the reproductive system –May be caused by vaginal infection, STD, childbirth or abortion

28 Cervicitis Signs & Symptoms –Backache –Whitish exudate –Menstrual irregulatities

29 Cervicitis Treatment –Vaginal suppositories, ointments, and creams Organism specific

30 Pelvic Inflammatory Disease (PID) Etiology/Pathophysiology –Any acute, subacute, recurrent or chronic infection of the cervix, uterus, fallopian tubes and overies that has extended to the connective tissues –Most common causative organisms Gonorrhea Streptococcus Staphylococcus Chlamydia Tubercle bacilli

31 Pelvic Inflammatory Disease (PID) –Surgical and examination procedures –Sexual intercourse Especially with multiple partners –Pregnancy

32 Pelvic Inflammatory Disease (PID) Signs & Symptoms –Fever –Chills –Severe abdominal pain –Malaise –Nausea and vomiting –Malodorous purulent vaginal exudate

33 Pelvic Inflammatory Disease (PID) Treatment –Antibiotics IV or IM –Analgesics –Bedrest

34 Toxic Shock Syndrome Etiology/Pathophysiology –Acute bacterial infection caused by Staphylococcus aureus –Usually occurs in women who are menstrujating and using tampons

35 Toxic Shock Syndrome Signs & Symptoms –Usually occur between days 2 and 4 of the menstrual period –Flulike symptoms Temperture up to 102 degrees Vomiting Diarrhea Myalgia Hypotension –Sore throat –Headache –Red macular palmar or diffuse rash

36 Toxic Shock Syndrome –Decreased urinary output –BUN elevated –Disorientation –Pulmonary edema –Inflammation of mucous membranes

37 Toxic Shock Syndrome Treatment –Antibiotics Bacterial specific –IV fluid therapy –Oxygen

38 Endometriosis Etiology/Pathophysiology –Endometrial tissue appears outside the uterus –The tissue responds to the normal stimulation of the ovaries; bleeds each month –Most common in caucasian women 25 to 35 years old

39 Endometriosis Signs & Symptoms –Lower abdominal pain –Pelvic pain –May radiate to lower back, legs, and groin –Most acute during menstruation and subside after menstruation

40 Endometriosis Treatment –Antiovulatory medications Suppress menstruation –Pregnancy –Laparoscopy Remove endometrial cells and adhesions –Total hysterectomy

41 Vaginal Fistula Etiology/Pathophysiology –Abnormal opening between two organs –Named for organs involved Urethrovaginal fistula: between the urethra and vagina Vesicovaginal fistula: between the bladder and vagina Rectovaginal fistula: between the rectum ad the vagina Vesicouterine fistula: between the bladder and the uterus Vesicocervical fistula: between the bladder and the cervix Perineovagina fistula: between the perineum and the vagina

42 Fistulas

43 Vaginal Fistula –Result from Cancer Radiation Weakening of tissue by pregnancies Surgical interventions

44 Vaginal Fistula Signs & Symptoms –Urine and/or feces being expelled from vagina

45 Vaginal Fistula Treatment –Oral or parenteral antibiotics –Diet High protein Increase Vitamin C –Surgery Repair fistula Urinary or fecal diversion

46 Displaced Uterus Etiology/Pathophysiology –Congenital –Childbirth –Backward Displacement Retroversion Retroflexion –Forward Displacement Anteversion Anteflexion


48 Displaced Uterus Signs & Symptoms –Backache –Muscle strain –Leukorrheal discharge –Heaviness in the pelvic area

49 Displaced Uterus Treatment –Pessary Rubber or plastic doughnut-shaped ring –Uterine Suspension

50 Uterine Prolapse Etiology/Pathophysiology –Obstetrical trauma –Overstretching of the support system –Coughing, straining, and lifting heavy objects

51 –A. Normal –B. First Degree Cervix comes down into the vagina (approx half way) –C. Second Degree Cervix comes down to the vaginal opening –D. Third Degree The cervix and uterus protrude through the vaginal opening

52 Uterine Prolapse Signs & Symptoms –Fullness in vaginal area –Backache –Bowel or bladder problems –Protrusion of cervix and vaginal walls in perineal area

53 Uterine Prolapse Treatment –Pessary –Surgery Vaginal hysterectomy Anteroposterior colporrhaphy –Anterior and posterior repair of the vagina –Shortening of the supporting muscles

54 Cystocele and Rectocele Etiology/Pathophysiology –Cystocele Displacement of the bladder into the vagina –Rectocele Rectum moves toward the posterior vaginal wall –Supporting tissues, muscles and ligaments have been stretched and weakened Childbirth Multiple births Cervical tears

55 Cystocele Rectocele Bladder Rectum

56 Cystocele and Rectocele Signs & Symptoms –Cystocele Urinary urgency, frequency, and incontinence Fatigue Pelvic pressure –Rectocele Constipation Rectal pressure Hemorrhoids

57 Cystocele and Rectocele Treatment –Surgical repair Anteroposterior colporrhaphy (A&P Repair) Shortening of the muscles that support the bladder

58 Benign Tumors of the Uterus Fibroid Tumors (Myomas) Etiology/Pathophysiology –Arise from the musle tissue of the uterus –Stimulated by ovarian hormones

59 Benign Tumors of the Uterus Fibroid Tumors (Myomas) Signs & Symptoms –Pelvic pressure –Pain –Dysmenorrhea –Abnormal uterine bleeding –Menorrhagia –Backache –Constipation –Urinary symptoms

60 Benign Tumors of the Uterus Fibroid Tumors (Myomas) Treatment –Surgery Myomectomy –Removal of uterine myomas Hysterectomy

61 Ovarian Cysts Etiology/Pathophysiology –Benign tumors that arise from dermoid cells of the ovary or from a corpus luteum or graafian follicle

62 Ovarian Cysts Signs & Symptoms –May be no symptoms –Palpable on examination –Disturbance of menstruation –Pelvic heaviness –Slight vaginal bleeding –Pain, with enlargement

63 Ovarian Cysts Treatment –Ovarian cystectomy

64 Cancer of the Cervix Etiology/Pathophysiology –Squamous cell carcinoma –Carcinoma in situ Preinvasive, asymptomatic carcinoma 100% curable –Untreated, invades the vagina, pelvic wall, bladder, rectum, and regional lymph nodes –High Risk Sexually active during teens Multiple sexual partners Multiple births

65 Carcinoma of the Cervix

66 Cancer of the Cervix Signs & Symptoms –Few symptoms in early stages –Leukorrhea –Irregular vaginal bleeding –Spotting between periods Often occurs after coitus –Advanced Pain in the back, upper thighs and legs

67 Cancer of the Cervix Treatment –Carcinoma in situ Removal of the affected area –Electrocautery –Cryosurgery (freezing) –Laser –Conization »Removal of cone-shaped section of cervix –Early Carcinoma Hysterectomy Intracavitary radiation –Advanced carcinoma Radical hysterectomy with pelvic lymph node dissection

68 Cancer of the Endometrium Etiology/Pathophysiology –Adenocarcinoma of the uterus Slow growing tumor –Usually affects postmenopausal women –More likely to be localized can spread to cervix, bladder, rectum and lymph nodes –High risk History of irregular menstruation Difficulty during menopause Obesity Hypertension Diabetes mellitus No children Family history of cancer of the uterus –

69 Cancer of the Endometrium Signs & Symptoms –Postmenopausal bleeding 50% will have cancer Abdominal pressure Pelvic fullness

70 Cancer of the Endometrium Treatment –Surgery TAH-BSO –Radiation Intracavitary radiation –Chemotherapy

71 Cancer of the Ovary Etiology/Pathophysiology –4 th most common cause of cancer death in women –High Risk Infertile Anovulatory Nulliparous Habitual aborters High fat diet Exposure to industrial chemicals –Asbestos and talc –Common sites of metastisis Peritoneum, Omentum, Bowel surfaces

72 Cancer of the Ovary Signs & Symptoms –Early Vague abdominal discomfort Flatulence Mild gastric disturbance –Advanced Enlarged abdominal girth Flatulence with distention Urinary frequency Nausea Vomiting Constipation Weight loss

73 Cancer of the Ovary Treatment –Surgery TAH-BSO and omentectomy –Radiation –Chemotherapy –Combination of the above

74 Hysterectomy Total hysterectomy Removal of the uterus including the cervix Total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO) Removal of the uterus, fallopian tubes, and ovaries Radical hysterectomy TAH-BSO with removal of the pelvic lymph nodes Vaginal Hysterectomy The uterus is removed through the vagina Abdominal Hysterectomy Abdominal incision is made to perform procedure

75 Hysterectomy Preoperative Interventions –Reinforce explanation of procedure –Answer questions –Instruct on TCDB –Empty colon Low-residue diet Enemas –Indwelling catheter –Vaginal douche Antiseptic –Surgical skin prep of the abdomen, pelvis, and perineum –Consent form –NPO after midnight

76 Hysterectomy Postoperative Interventions –Vital signs –Monitor urinary output –Assess bowel sounds and function No oral intake until bowel sounds have returned –Early ambulation Promotes peristalsis Prevents thrombophlebitis –Antiembolic stockings –Analgesics Demerol –Monitor for vaginal bleeding May have slight vaginal drainage for 1-2 days –Assess abdominal dressing for bleeding Change dressing using aseptic technique as ordered –Pelvic rest (4-6 weeks) –No heavy lifting (nothing over 10 pounds)

77 Fibrocystic Breast Condition Etiology/Pathophysiology –Benign tumors of the breast –Hyperplasia and cystic formation in mammary ducts –Usually occurs in women 30-50 years of age –Rarely become malignant, but increases risk of breast cancer

78 Fibrocystic Breast Condition Signs & Symptoms –Cysts are soft, well-differentiated, tender, and freely moveable –Often bilateral and multiple –More apparent before menses

79 Fibrocystic Breast Condition Treatment –Eliminate methylxanthines Found in caffeine – coffee, tea, colas – Danazol (Danocrine) Inhibits FSH and LH production; decreases estrogen production –Vitamin E

80 Acute Mastitis Etiology/Pathophysiology –Acute bacterial infection –Usually caused by S. aureus or streptococci –Most often occurs during lactation and late pregnancy

81 Acute Mastitis Signs & Symptoms –Breasts are tender, inflamed and engorged

82 Acute Mastitis Treatment –Keep breasts clean –Application of warm packs –Support Well fitting bra –Systemic antibiotics

83 Chronic Mastitis Etiology/Pathophysiology –Common in women 30-50 years of age –Increased risk in women with inverted, cracked nipples, and problems with breast feeding –Traumatic blow to the breasts –Occurs most frequently in obese women

84 Chronic Mastitis Signs & Symptoms –Tender, painful, and palpable cysts –Usually unilateral

85 Chronic Mastitis Treatment –Same as for Acute Mastitis –Keep breasts clean –Application of warm packs –Support Well fitting bra –Systemic antibiotics

86 Breast Cancer Etiology/Pathophysiology –Unknown cause –Usually adenocarcinoma –Factors that influence formation Exposure to heavy radiation Immunodeficiency Estrogen therapy Diet high in fat Fibrocystic breast condition

87 Breast Cancer –High Risk Factors Gender –Female Age –Over 40 Race –Caucasian Genetics –Women whose mother and sisters have breast cancer Menarche –Occurred before age 12 Parity –Decreased for women who gave birth before age 18 –Increased for women who are not sexually active, infertile or became pregnant after age 35. Menopause after age 55 Other - Cancer of the uterus, ovaries, colon, breast

88 Breast Cancer Signs & Symptoms –Small, solitary, irregular-shaped, firm, nontender, and nonmobile tumor –Change in skin color –Puckering or dimpling of tissue –Nipple discharge –Retraction of nipple –Axillary tenderness

89 Breast Dimpling & Nipple Retraction

90 Breast Cancer Treatment –Depends on the Stage Stage I –Tumor is 1-2 cm or smaller –No nodal or metastatic involvement Stage II –Tumor is 2-5 cm –With or without nodal involvement and no metastasis Stage III –Tumor is 5-10 cm –Usually with lymph node involvement and no metastasis Stage IV –Indicates the presence of metastatic spread, regardless of tumor size or lymph node involvement

91 Breast Cancer –Surgery Lumpectomy –Removal of a circumscribed area along with the tumor Partial mastectomy –The quadrant of the breast in which the tumor is located is removed. Subcutaneous mastectomy –Removal of malignant breast tissue, leaving the skin surface and nipple in place. Simple mastectomy –Removal to the entire breast Modified radical mastectomy –All breast tissue, overlying skin, nipple, and pectoralis minor muscles are removed with samples of axillary nodes.



94 Modified Radical Mastectomy

95 Breast Cancer Nursing Interventions –Reach to Recovery Preop if possible –Post-op Monitor vital signs Assess for s/s of shock and hemorrhage Hemovac drain Assess dressings for drainage TCDB Analgesics Elevate arm on affected side

96 Breast Cancer No procedures involving the arm on the affected side –B/P, injections, IV’s, drawing of blood Exercises to restore muscle strength –Page 535; figure 12-17 Psychological support Prosthesis –Gels, molded silicone, saline –Match remaining breast Breast reconstruction –Breast implant »Silicone or saline implant under skin –Latissimus dorsi flap graft »Flap of muscle, fat and skin is transferred to breast area from latissiumus dorsi area –Transabdominal island flap »Section of abdominal skin and fat and part of the rectus abdominis muscle are transferred to the breast area.

97 Prostatitis Etiology/Pathophysiology –Acute or chronic infection of the prostate gland –E. coli, Klebsiela, Proteus, Pseudomonas, Streptococcus, and Staphyloccoccus

98 Prostatitis Signs & Symptoms –Chills and fever –Urgency and frequency of urination –Dysuria –Cloudy urine –Perineal fullness –Lower back pain –Arthralgia –Myalgia –Tenderness, edema and firmness of the prostate gland

99 Prostatitis Treatment –Antibiotics –Digital massage of the prostate Increased flow of infected secretions –Sitz baths –Monitor I&O

100 Epididymitis Etiology/Pathophysiology –Infection of the epididymis The cord like excretory duct of the testicle –S. aureus, E. coli, Streptococcus, N. gonorrhoeae –Associated with urethral strictures, cystitis, and prostatisis

101 Epididymitis

102 Signs & Symptoms –Scrotal pain –Edema –“waddling gait” –Pyruia –Chills and fever

103 Epididymitis Treatment –Bed rest –Elevate scrotum –Cold compresses –Antibiotics –I&D for abscess

104 Phimosis Etiology/Pathophysiology –Prepuce is too small to allow retraction of the foreskin over the glans. –Usually congenital; may be due to inflammation or disease

105 Phimosis

106 Signs & Symptoms –Infection of foreskin and glans penis. –Occasionally causes obstruction of urine flow

107 Phimosis Treatment –Circumcision

108 Hydrocele Etiology/Pathophysiology –Accumulation of fluid between the membranes covering the testicle and the membrane enclosing the testicle –May be caused by trauma, orchitis, or epididymitis

109 Hydrocele

110 Signs & Symptoms –Enlargement of the scrotum –Pain

111 Hydrocele Treatment –Aspiration of fluid –Surgical removal of testicular sac –Bed rest –Elevate scrotum –Cold compresses

112 Varicocele Etiology/Pathophysiology –Dilation of scrotal veins causing obstruction and malfunction of circulation

113 Varicocele Signs & Symptoms –Engorgement and elongation of the scrotum –Pulling sensation in scrotum –Dull aching pain

114 Varicocele Treatment –Surgery Removal of obstruction –Bedrest –Elevate scrotum –Cold compresses

115 Cancer of the Testis Etiology/Pathophysiology –Cause unknown –High risk Cryptorchidism –Undesended testes Testicular atrophy Scrotal trauma

116 Cancer of the Testis Signs & Symptoms –Enlarged scrotum –Firm, painless, smooth mass –Feeling of heaviness

117 Cancer of the Testis Treatment –Radical inguinal orchiectomy Removal of the testis, epididymis, a portion of the gonadal lymphatics, and their blood supply. –Radiation –Chemotherapy –Teach testicular self-examination

118 Cancer of the Penis Etiology/Pathophysiology –Very rare –Usually in men over 50 yrs –High risk Uncircumcised Poor personal hygiene STD’s

119 Cancer of the Penis Signs & Symptoms –Painless, wartlike growth or ulceration, usually on the glans penis

120 Cancer of the Penis Treatment –Surgery Removal of tissue Partial or total amputation of the penis Metastisis may require more radical surgical procedures

121 Herpes Genitalis (Herpes Simplex Virus Type II) Etiology/Pathophysiology –Infectious viral disease –Usually acquired sexually

122 Herpes Genitalis (Herpes Simplex Virus Type II) Signs & Symptoms –Fluid-filled vesicles Cervix, labia, rectum, vulua, vagina, glans penis, foreskin, and penile shaft. –Eventually rupture and develop shallow, painful ulcers –Ulcers are erythematous with edema and tenderness

123 Herpes Genitalis (Herpes Simplex Virus Type II) –Initial lesion Lasts 3-10 days –Recurrent lesions Last 7-10 days –Fever –Malaise –Dysuria –Leukorrhea (female)

124 Herpes Genitalis (Herpes Simplex Virus Type II) Exacerbation –Fever –Stress –Emotional upset –Intense heat

125 Herpes Genitalis (Herpes Simplex Virus Type II) Treatment –No cure; treat symptoms –acyclovir (Zovirax) Oral, IV, topical –Sitz baths –Local anesthetic Lidocaine –Analgesics –Keep lesions clean and dry

126 Herpes Genitalis (Herpes Simplex Virus Type II) –GOOD handwashing –No sexual contact while lesions are present –Encourage use of condoms May be spread even if lesions are not present

127 Syphilis Etiology/Pathophysiology –Treponema pallidum organism –Transmission occurs primarily through sexual contact –Infection from mother to fetus may occur –Can penetrate intact skin as well as openings

128 Syphilis Signs & Symptoms –5 Stages Incubation Period Primary Stage Secondary Stage Latent Stage Tertiary Stage (Late) –Incubation Period 10-60 days after contact no symptoms

129 –Primary Stage Chancre –Painless erosion or papule that ulcerates superficially –Will disappear in 3-4 weeks, with or without treatment Headaches Enlarged lymph nodes VDRL may be negative Highly contagious

130 Syphilis –Secondary Stage Rash on palms of hands and soles of feet Generalized enlargement of lymph nodes S/S may disappear and reoccur for as long as 2 years

131 Syphilis –Latent Stage No symptoms –Tertiary or Late Stage Lesions in skin, bones, liver, larynx, testes, eyes, heart, and central nervous system May be fatal 5-20 years after infection

132 Syphilis Treatment –Penicillin IV –Tetracycline or erythromycin If allergic to penicillin –May be treated in any stage; damage will not be reversed. –Treat all sexual contacts.

133 Gonorrhea Etiology/Pathophysiology –N. Gonorrhoeae –Transmitted by sexual contact –Most common communicable disease in the US –Primarily affects the genital or rectal mucosa; can involve mouth and throat

134 Gonorrhea Signs & Symptoms (According to location) –Vaginal (female) Urinary frequency and pain Yellowish discharge Nausea and vomiting –Urethra (male) Urethral discomfort Yellowish discharge containing pus (“the drip”) Red and swollen meatus Dysuria

135 Gonorrhea –Rectal (male & female) Perineal discomfort Purulent rectal discharge –Pharyngitis (male & female) Sore throat and swallowing discomfort Edema of the throat

136 Gonorrhea Treatment –Penicillin Some may be resistant –Rocephin Penicillinase-resistant cephalosporin –Doxycycline or Tetracycline Will treat co-infection of chlamydia –TREAT ALL SEXUAL CONTACTS

137 Trichomoniasis Etiology/Pathophysiology –T. vaginalis protozoan –Usually sexually transmitted

138 Trichomoniasis Signs & Symptoms –Most are asymptomatic –Male Urethritis, dysuria, frequency, pruritus, and purulent exudate –Female Frothy, gray, green or yellow malodorous discharge Pruritus Edema Tenderness of vagina Dysuria & Frequency Spotting Menorrhagia Dysmenorrhea

139 Trichomoniasis Treatment –metronidazole (Flagyl) No alcohol Urine may be dark brown –TREAT ALL SEXUAL CONTACTS

140 Candidiasis Etiology/Pathophysiology –C. albicans & Candida tropicalis –Fungal infection Normal flora of GI tract, mouth, vagina and skin Infection occurs –Lowered resistance; carcinoma –High blood glucose; DM –Radiation –Immunosuppressant drugs –Hyperalimentation –Antibiotic therapy –Oral contraceptives

141 Candidiasis Signs & Symptoms –Mouth Edema White patches –Nails Edematous Darkened, erythematous nail base Purulent exudate –Vaginal Cheesy, tenacious white discharge Pruritus Inflammation of the vulva and vagina

142 Candidiasis –Penis Purulent exudate –Systemic Chills Fever General malaise

143 Candidiasis Treatment –Treat underlying condition –nystatin (Mycostatin) ointment, spray, creams, suppositories –Topical amphotericin B skin and nail infections

144 Chlamydia Etiology/Pathophysiology –Chlamydia trachomatis –Causes Cervicitis Urethritis Epididymitis PID

145 Chlamydia Signs & Symptoms –Usually asympomatic –Male Scanty white or clear exudate Burning or pruritus Urinary frequency Mild dysuria –Female Vaginal pruritus or burning Dull pelvic pain Low-grade fever Vaginal discharge Irregular bleeding

146 Chlamydia Treatment –Tetracycline –Doxycycline –Zithromax –Erythromycin for pregnant patients –TREAT ALL SEXUAL CONTACTS

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