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Genital Urinary System
Female Reproductive System
Part 2
Vaginitis
Pathophysiology
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Vaginitis = inflammation of the vagina
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Normally pH (3.5-4.5)
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Maintained by Lactobacillus acidophilus,
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suppress the growth of anaerobes
produces lactic acid 
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i pH
Produces hydrogen peroxide
Vaginitis
• Pathophysiology
– h risk if…
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Stress
Illness
Alt. pH
Pathogen
– Candida,Trichomonas or other bacteria invade the
vagina.
Vaginitis: Clinical manifestations
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Vaginal discharge +
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Itching
Odor
Redness
Burning
Edema
Aggravated by voiding
Urethritis (possibly)
Vaginitis: Candidiasis
Candidiasis / Vulvovaginal Candidiasis
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Fungal or yeast infection
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Asymptomatic  symptomatic
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Use of antibiotics  i bacteria
Pg
DM
HIV
Corticosteroid
Oral contraceptives
 i protective organisms
Vaginitis: Candidiasis
Clinical manifestations
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Vaginal discharge
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Color
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White, cottage
cheese like
The pH if the
discharge is < 4.5
Pruritus
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Itching
Vaginitis: Candidiasis
Medical Management
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Anti-fungal agents
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Miconazole (Monistat)
Without prescription
Bacterial Vaginitis
• Overgrowth of
anaerobic bacteria
normally found in
the vagina
• Absence of
lactobacilli
• Characterized by:
– Fish-like odor
– h vaginal pH
– h discharge
• Gray –yellowish
white
• No discomfort
• Medical
Management
– Metronidazole
(Flagyl)
• PO
• Bid x 1wk
– Clindamycin
(Cleocin)
• Vaginal cream
Vaginitis: Trichomoniasis “TRICK”
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STD
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Sexually
transmitted
Vaginitis
Asymptomatic
carrier
Vaginitis: Trichomoniasis
Clinical manifestations
• Vaginal discharge
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Frothy
Yellow-green
Malodorous
Irritating
• Cervical erythema
• Multiple small Petechiae
• pH > 4.5
Vaginitis: Trichomoniasis
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Complications
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Not life threatening
Medical Management
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Metronidazole (Flagyl)
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Anti-bacterial
Anti-protozoal
Both partners!
Nursing process of Patients with
Vulvovaginal infection
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Assessment
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Examine
Do not douche
Observe the area for:
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Erytherma
Edema
Excoriation
Discharge
Nursing process of Patients with
Vulvovaginal infection
• Describe symptoms
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Odor
Itching
Burning
Dysuria
• Prep vaginal smear
• Test pH of discharge
Nursing process
Patients w/ Vulvovaginal infection
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Assess though questions factors that might
contribute to the infections
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Physical /chemical factors
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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
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Diagnosis
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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
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Nursing Interventions
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Admin. meds
Sitz baths
Cornstarch powder
Educate patient
Douching discouraged
Loose fitting underwear = good
Tight, synthetic, non-absorbent, heat-retaining
underwear = bad
Pelvic Inflammatory Disease
Etiology
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AKA: Pelvic Infection
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PID is an inflammation of the pelvic cavity
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Begins with cervicitis  uterus, fallopian tubes,
ovaries, pelvic peritoneum &/or pelvic vascular
system
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Usually caused by bacteria
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Gonorrheal and Chlamydial organisms
Most common STD but…
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Not always STD
PID
Pathophysiology
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Enters through
vagina 
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Cervical canal 
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Colonizes 
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Uterus 
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Fallopian tubes &
ovaries 
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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
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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
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Peritonitis
Abscesses
Strictures / adhesions
– chronic pelvic pain
PID: Complications
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Fallopian tube
obstruction
– Ectopic pregnancy
– Occlude tubes 
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sterility
PID:Complications
• Bacteremia 
– septic shock
• Thrombophlebitis 
– embolization
PID: Medical management
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Brood spectrum Antibiotics
Treat Partners
Treatment at home
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mild
Intensive therapy / Hospital
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Rest
IV fluids
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IV antibiotics
PID: Nursing Interventions
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Activity
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Bed rest
Position
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Semi-fowler’s
Vital signs
Assess
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Drainage
Administer
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Analgesics / Antibiotics
Pain relief
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Heat to abd.
Endometriosis
Etiology
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“A benign lesion or lesions with cells similar to
those lining the uterus grow aberrantly in the
pelvic cavity outside the uterus.”
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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
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Dysmenorrhea
Dyspareunia
Pelvic pain
Depression
Loss of work
Relationship difficulty
Infertility
Endometriosis
Assessment & diagnostic
findings
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Health hx
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Pelvic exam
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Laparoscopy exam
Endometriosis
Medical managements
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NSAIDS
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Oral contraceptives
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Side effects:
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fluid retention
weight gain
Nausea
Surgery
Pregnancy
Endometriosis: Nursing process
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Assessment
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Diagnosis, Planning and Goals
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Relief of pain, Dysmenorrhea, dyspareunia
Avoidance of infertility
Nursing Interventions
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Hx & PE focus on specific symptoms, effects of meds,
reproductive plans
Dispel myths and encourage the patient to seek care
if dysmenorrhea or dyspareunia occurs
Evaluations/Expected patient outcomes