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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… • • • • 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 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” • STD – • Sexually transmitted Vaginitis Asymptomatic carrier Vaginitis: Trichomoniasis Clinical manifestations • Vaginal discharge – – – – Frothy Yellow-green Malodorous 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! 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, heat-retaining 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 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 – • Diagnosis, Planning and Goals – – • Relief of pain, Dysmenorrhea, dyspareunia Avoidance of infertility Nursing Interventions – • 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