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Genital Urinary System
Female Reproductive System Part 2
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Vaginitis Pathophysiology Vaginitis = inflammation of the vagina
Normally pH ( ) Maintained by Lactobacillus acidophilus, suppress the growth of anaerobes produces lactic acid i pH Produces hydrogen peroxide Vaginitis Brunner and Suddarth’s Medical Surgical nursing pg 1411 Pathophysiology of Vaginitis The vagina is normally protected against infection by its normally low pH ( ) “The low pH is maintained in part by the action of Lactobacillus acidophilus, the dominant bacteria in a healthy vaginal ecosystem.” These good bacteria suppress the growth of anaerobes and produce lactic acid whish maintains normal pH. These good bacteria also produce hydrogen peroxide, which is toxic to anaerobes. The risk of infection rises if a women’s resistance is reduced by Stress Illness If the pH is altered If a pathogen is introduced
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Vaginitis Pathophysiology h risk if…
Stress Illness Alt. pH Pathogen Candida,Trichomonas or other bacteria invade the vagina.
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Vaginitis: Clinical manifestations
Vaginal discharge + Itching Odor Redness Burning Edema Aggravated by voiding Urethritis (possibly) Clinical manifestations Vaginitis = inflammation of the vagina Occurs when Candida or Trichomonas species or other bacteria invade the vagina. Vaginal discharge Normally slight amounts during ovulation or just before onset of menstruation Menstruation Becomes more profuse when Vaginitis occurs Urethritis May accompany Vaginitis because of the proximity of the urethra to the vagina Discharge may produce: Itching Odor Redness Burning Edema Aggravated by voiding
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Vaginitis: Candidiasis
Candidiasis / Vulvovaginal Candidiasis Fungal or yeast infection Asymptomatic symptomatic Use of antibiotics i bacteria i protective organisms Pg DM HIV Corticosteroid Oral contraceptives
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Vaginitis: Candidiasis
Clinical manifestations Vaginal discharge Color White, cottage cheese like The pH if the discharge is < 4.5 Pruritus Itching
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Vaginitis: Candidiasis
Medical Management Anti-fungal agents Miconazole (Monistat) Without prescription Medical management Eliminate symptoms Anti-fungal agents Miconazole (Monistat) These agents are inserted into the vagina with an applicator May be applied to the vulvar area for pruritus Available without prescription Need to be careful and know that it is a yeast infection. If not healed within time frame of medication – see a doctor. If reoccurring see a doctor
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Bacterial Vaginitis Overgrowth of anaerobic bacteria normally found in the vagina Absence of lactobacilli
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Characterized by: No discomfort Fish-like odor h vaginal pH
h discharge Gray –yellowish white No discomfort
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Medical Management Metronidazole (Flagyl) Clindamycin (Cleocin) PO
Bid x 1wk Clindamycin (Cleocin) Vaginal cream
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Vaginitis: Trichomoniasis “TRICK”
STD Sexually transmitted Vaginitis Asymptomatic carrier Trichomoniasis STD Sexually transited Vaginitis AKA: “trich” It may be transmitted by asymptomatic carrier who harbors the organism in the urogenital tract Clinical manifestations Vaginal discharge Thin Sometimes frothy Yellow to yellow-green Malodorous Very irritating Cervical erythema (redness) Multiple small Petechiae (strawberry spots) A pH greater than 4.5
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Vaginitis: Trichomoniasis
Clinical manifestations Vaginal discharge Frothy Yellow-green Malodorous Irritating Cervical erythema Multiple small Petechiae pH > 4.5
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Vaginitis: Trichomoniasis
Complications Not life threatening Medical Management Metronidazole (Flagyl) Anti-bacterial Anti-protozoal Both partners! Complications Not life threatening Medical Management The most effective treatment for Trichomoniasis is metronidazole (Flagyl) Both partners are treated
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Nursing process of Patients with Vulvovaginal infection
Assessment Examine Do not douche Observe the area for: Erytherma Edema Excoriation Discharge Nursing process of Patients with Vulvovaginal infection Assessment Examine as soon as possible after the onset of symptoms Do not douche (it removed the discharge that is needed for the diagnosis Observe the area for: Erytherma Edema Excoriation Discharge Have patient describe symptoms Odor Itching Burning Dysuria Prepare a vaginal smear Testing the pH of the discharge
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Nursing process of Patients with Vulvovaginal infection
Describe symptoms Odor Itching Burning Dysuria Prep vaginal smear Test pH of discharge
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Nursing process Patients w/ Vulvovaginal infection
Assess though questions factors that might contribute to the infections Physical /chemical factors Constant moisture from tight or synthetic clothing Perfumes and powders Soaps & Bubble baths Poor hygiene Feminine hygiene products Assess though questions factors that might contribute to the infections Physical /chemical factors Constant moisture from tight or synthetic clothing Perfumes and powders Soaps Bubble baths Poor hygiene Use of feminine hygiene products Psychogenic factors Stress Fear Abuse Medical conditions Diabetes Medication history Antibiotics Sex partners
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Nursing process Patients w/ Vulvovaginal infection
Psychogenic factors Stress Fear Abuse Medical conditions DM Antibiotics Sex partners
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Nursing process Patients w/ Vulvovaginal infection
Diagnosis Discomfort related to burning, odor or itching from the infectious process Anxiety related to stressful symptoms Risk for infection or spread of infection Deficient knowledge about proper hygiene and preventive measures Diagnosis Discomfort related to burning, odor or itching from the infectious process Anxiety related to stressful symptoms Risk for infection or spread of infection Deficient knowledge about proper hygiene and preventive measures
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Nursing process Patients w/ Vulvovaginal infection
Nursing Interventions Admin. meds Sitz baths Cornstarch powder Educate patient Douching discouraged Loose fitting underwear = good Tight, synthetic, non-absorbent, heat-retaining underwear = bad Nursing Interventions Treat with prescribed meds Sitz baths Cornstarch powder may help Educate patient Douching is discouraged normal baths and showers should be good enough – douches wash away normal flora) Keep perineum as dry as possible Loose fitting underwear is good Tight fitting, synthetic, nonabsorbent, heat-retaining underwear is bad
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Pelvic Inflammatory Disease
Etiology AKA: Pelvic Infection PID is an inflammation of the pelvic cavity Begins with cervicitis uterus, fallopian tubes, ovaries, pelvic peritoneum &/or pelvic vascular system Usually caused by bacteria Gonorrheal and Chlamydial organisms Most common STD but… Not always STD Pelvic Inflammatory disease Brunner and Suddarth’s Medical Surgical nursing pg Pelvic Inflammatory Disease - etiology Pelvic inflammatory disease (PID) is an inflammation condition of the pelvic cavity that may begin with cervicitis and may involve the uterus, fallopian tubes, ovaries pelvic peritoneum or pelvic vascular system Infection is usually caused by bacteria, but may be attributed to a virus, fungus, or parasite Gonorrheal and chlamydial organisms are the most likely causes PID is the most common STD but can occur with invasive procedures
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PID Pathophysiology Enters through vagina Cervical canal
Colonizes Uterus Fallopian tubes & ovaries Pelvis Pathophysiology Organism enters the body through the vagina Passes through he cervical canal Colonizes the endocervix Moves upward into the uterus Proceeds to one or both fallopian tubes and ovaries Proceeds into the pelvis
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PID Risk factors Early age 1st intercourse h # sexual partners
Sex with a partner with an STD Hx of STD’s Previous pelvic infection Invasive procedure Risk factors Early age at first intercourse Multiple sexual partners Frequent intercourse Intercourse without condoms Sex with a partner with an STD History of STD’s Previous pelvic infection
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PID: Clinical manifestation
Vaginal discharge Dyspareunia Lower abd. pelvic pain Tenderness after menses. Pain h while voiding Other S&S: Fever Gen. malaise N/V H/A Clinical manifestation Vaginal discharge Dyspareunia (pain with intercourse) Lower abdominal pelvic pain Tenderness that occurs after menses. Pain increases while voiding or defecation Other symptoms may be Fever General malaise Anorexia Nausea Headache
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PID: Complications Peritonitis Abscesses Strictures / adhesions
chronic pelvic pain Complications Peritonitis Abscesses Strictures / adhesions Results in chronic pelvic pain Fallopian tube obstruction Ectopic pregnancy Occlude tubes --> sterility Bacteremia --> septic shock Thrombophlebitis --> embolization
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PID: Complications Fallopian tube obstruction Ectopic pregnancy
Occlude tubes sterility Complications Peritonitis Abscesses Strictures / adhesions Results in chronic pelvic pain Fallopian tube obstruction Ectopic pregnancy Occlude tubes --> sterility Bacteremia --> septic shock Thrombophlebitis --> embolization
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PID:Complications Bacteremia septic shock Thrombophlebitis
embolization
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PID: Medical management
Brood spectrum Antibiotics Treat Partners Treatment at home mild Intensive therapy / Hospital Rest IV fluids IV antibiotics
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PID: Nursing Interventions
Activity Bed rest Position Semi-fowler’s Vital signs Assess Drainage Administer Analgesics / Antibiotics Pain relief Heat to abd. Nursing Interventions Bed rest Semi-fowler’s position to facilitate dependent drainage Accurate vital signs Characterizes and amount of vaginal drainage Administer analgesic agents as prescribed Heat to abdomen helps relief pain
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Endometriosis Etiology
“A benign lesion or lesions with cells similar to those lining the uterus grow aberrantly in the pelvic cavity outside the uterus.” Chronic pelvic pain & infertility Endometriosis Brunner and Suddarth’s Medical Surgical nursing pg 1428 Endometriosis – etiology “A benign lesion or lesions with cells similar to those lining the uterus grow aberrantly in the pelvic cavity outside the uterus.” Some women may have wide spread endometriousis and have few symptoms while one woman may have only a small lesion and have severe symptoms. Major cause of chronic pelvic pain and infertility More frequently diagnosis now because of increased use of laparoscopy. (Before we had to do major surgery)
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Endometriosis Pathophysiology
Misplaced endometrial tissue responds to hormone changes During menstruation, the extopic tissue bleeds, mostly into areas having no outlets pain and adhesions Causes lesions, cysts and or scar tissue Pathophysiology Misplaced endometrial tissue responds to and depends on ovarian hormonal stimulation During menstruation, the extopic tissue bleeds, mostly into areas having no outlets --> pain and adhesions Causes lesions, cysts and or scar tissue
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Endometriosis Clinical manifestations Dysmenorrhea Dyspareunia
Pelvic pain Depression Loss of work Relationship difficulty Infertility Clinical manifestations Vary Dysmenorrhea Dyspareunia Pelvic discomfort or pain Depression Loss of work Relationship difficulty Infertility d/t fibrosis and adhesions
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Endometriosis Assessment & diagnostic findings Health hx Pelvic exam
Laparoscopy exam Assessment and diagnostic findings Health history Pelvic exam Laparoscopy examination
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Endometriosis Medical managements NSAIDS Oral contraceptives Surgery
Side effects: fluid retention weight gain Nausea Surgery Pregnancy Medical managements NSAIDS Oral contraceptives Side effects: fluid retention weight gain Nausea Surgery Pregnancy often alleviates symptoms because neither ovulations nor menstruation occurs
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Endometriosis: Nursing process
Assessment Hx & PE focus on specific symptoms, effects of meds, reproductive plans Diagnosis, Planning and Goals Relief of pain, Dysmenorrhea, dyspareunia Avoidance of infertility Nursing Interventions Dispel myths and encourage the patient to seek care if dysmenorrhea or dyspareunia occurs Evaluations/Expected patient outcomes Nursing process of Patients with Endometriosis Assessment Health history and physical examinations focus on specific symptoms (e.g. Pain), the effects of prescribed medications, reproductive plans Diagnosis Planning and Goals Relief of pain, Dysmenorrhea, dyspareunia Avoidance of infertility Nursing Interventions Dispel myths and encourage the patient to seek care if Dysmenorrhea or dyspareunia occurs Evaluations/Expected patient outcomes
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