Genital Urinary System
Female Reproductive System Part 2
Vaginitis
Pathophysiology • Vaginitis = inflammation of the vagina • Normally pH (3.5-4.5)
–
• •
•
Maintained by Lactobacillus acidophilus,
suppress the growth of anaerobes produces lactic acid
i pH
Produces hydrogen peroxide
Vaginitis
• Pathophysiology
h risk if i resistance
• • • • Stress Illness Alt. pH Pathogen
– Candida,Trichomonas or other bacteria invade the vagina.
Vaginitis: Clinical manifestations
•
– – – – – – –
Vaginal discharge +
Itching Odor Redness Burning Edema Aggravated by voiding Urethritis (possibly)
Vaginitis: Candidiasis
Candidiasis / Vulvovaginal Candidiasis • Fungal or yeast infection • Asymptomatic symptomatic
– – – – – – Use of antibiotics i bacteria Pg DM HIV Corticosteroid Oral contraceptives
i protective organisms
Vaginitis: Candidiasis
Clinical manifestations • Vaginal discharge
–
•
Color
White, cottage cheese like
–
The pH if the discharge is < 4.5
•
–
Pruritus
Itching
Vaginitis: Candidiasis
Medical Management • Anti-fungal agents
– – Miconazole (Monistat) Without prescription
Vaginitis: Trichomoniasis “TRICK”
•
–
STD
Sexually transmitted Vaginitis
•
Asymptomatic carrier
Vaginitis: Trichomoniasis
Clinical manifestations
• Vaginal discharge
– – – – Frothy Yellow-green Malodorous (fishy) Irritating
• Cervical erythema • Multiple small Petechiae • pH > 4.5
Vaginitis: Trichomoniasis
•
–
Complications
Not life threatening
•
–
Medical Management
Metronidazole (Flagyl)
• • Anti-bacterial Anti-protozoal
–
Both partners!
Vaginitis: Trichomoniasis
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
• Describe symptoms
– – – – Odor Itching Burning Dysuria
• Prep vaginal smear • Test pH of discharge
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
Nursing process Patients w/ Vulvovaginal infection
– Psychogenic factors
• Stress • Fear • Abuse
– Medical conditions
• DM • Antibiotics • Sex partners
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
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, heatretaining underwear = bad
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
PID
Pathophysiology • Enters through vagina • Cervical canal • Colonizes • Uterus • Fallopian tubes & ovaries • Pelvis
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
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
PID: Complications
• • •
–
Peritonitis Abscesses Strictures / adhesions
chronic pelvic pain
PID: Complications
•
– –
•
Fallopian tube obstruction
Ectopic pregnancy Occlude tubes
sterility
Strictures / adhesions
Ectopic pregnancy
PID:Complications
• Bacteremia
– septic shock
• Thrombophlebitis
– embolization
PID: Medical management
• • •
–
Brood spectrum Antibiotics Treat Partners Treatment at home
mild
•
– –
Intensive therapy / Hospital
Rest IV fluids
• IV antibiotics
PID: Nursing Interventions
•
–
Activity
Bed rest
•
–
Position
Semi-fowler’s
• •
–
Vital signs Assess
Drainage
•
–
Administer
Analgesics / Antibiotics
•
–
Pain relief
Heat to abd.
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
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
Endometriosis
Clinical manifestations
• • • • • • • Dysmenorrhea Dyspareunia Pelvic pain Depression Loss of work Relationship difficulty Infertility
Endometriosis
Assessment & diagnostic findings • Health hx • Pelvic exam • Laparoscopy exam
Endometriosis
Medical managements • NSAIDS • Oral contraceptives
–
• • •
Side effects:
fluid retention weight gain Nausea
• •
Surgery Pregnancy
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