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Nursing of Adults with Medical & Surgical Conditions Reproductive Disorders 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 Amenorrhea – – – – Frequent, vigorous exercise Depression Anorexia or bulimia Normal • Before puberty • After menopause • During pregnancy – Hormonal abnormalities – Surgical interventions • Hysterectomy Amenorrhea • Signs & Symptoms – No menstrual flow for at least 3 months Amenorrhea • Treatment – Based on underlying cause – Hormone replacement may be necessary 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 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 Dysmenorrhea • Treatment – – – – – Exercise Nutritious foods, high in fiber Heat to pelvic area Mild analgesics Prostaglandin inhibitors • Ibuprofin (Motrin) • Naproxen (Anaprox) 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 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 Premenstrual Syndrome (PMS) • Signs & Symptoms – – – – – – – – – – – Irritability Lethargy & Fatigue Sleep disturbances Depression Headache Vertigo Backache Breast tenderness Abdominal distention Acne Paresthesia of hands and feet 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 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 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 Female Climacteric (menopause) • Treatment – Estrogen therapy • Premarin • Provera – Calcium supplements Male Climacteric • Etiology/Pathophysiology – Gradual decrease of testosterone levels and seminal fluid production – Occurs between the ages of 55 and 70 Male Climacteric • Signs & Symptoms – – – – – Decreased erections Enlarged prostate gland Decreased seminal fluid Loss or thinning of hair Decreased muscle tone Male Climacteric • Treatment – Emotional support – Treatment for impotence Impotence • Etiology/Pathophysiology – Inability of an adult man to achieve penile erection – Functional • Psychological – Anatomical • Physical defect of genital structures – Atonic • Disturbed neuromuscular function 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 Penile Prosthesis 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 Infertility • Treatment – – – – Depends on the cause Hormone therapy Repair occlusion Intrauterine insemination • Partner or donor sperm – In vitro fertilization Simple Vaginitis • Etiology/Pathophysiology – Common vaginal infection – Causitive organisms • • • • • • E. coli Staphylococcal Streptococcal T. vaginalis C. albicans (yeast) Gardnerella 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 Simple Vaginitis • Treatment – Douching – Vaginal suppositories, ointments, and creams • Organism specific – Sitz baths – Abstain from sexual intercourse during treatment – Treat partner if necessary 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 Cervicitis • Signs & Symptoms – Backache – Whitish exudate – Menstrual irregulatities Cervicitis • Treatment – Vaginal suppositories, ointments, and creams • Organism specific 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 Pelvic Inflammatory Disease (PID) – Surgical and examination procedures – Sexual intercourse • Especially with multiple partners – Pregnancy Pelvic Inflammatory Disease (PID) • Signs & Symptoms – – – – – – Fever Chills Severe abdominal pain Malaise Nausea and vomiting Malodorous purulent vaginal exudate Pelvic Inflammatory Disease (PID) • Treatment – Antibiotics • IV or IM – Analgesics – Bedrest Toxic Shock Syndrome • Etiology/Pathophysiology – Acute bacterial infection caused by Staphylococcus aureus – Usually occurs in women who are menstrujating and using tampons 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 Toxic Shock Syndrome – – – – – Decreased urinary output BUN elevated Disorientation Pulmonary edema Inflammation of mucous membranes Toxic Shock Syndrome • Treatment – Antibiotics • Bacterial specific – IV fluid therapy – Oxygen 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 Endometriosis • Signs & Symptoms – – – – Lower abdominal pain Pelvic pain May radiate to lower back, legs, and groin Most acute during menstruation and subside after menstruation Endometriosis • Treatment – Antiovulatory medications • Suppress menstruation – Pregnancy – Laparoscopy • Remove endometrial cells and adhesions – Total hysterectomy 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 Fistulas Vaginal Fistula – Result from • • • • Cancer Radiation Weakening of tissue by pregnancies Surgical interventions Vaginal Fistula • Signs & Symptoms – Urine and/or feces being expelled from vagina Vaginal Fistula • Treatment – Oral or parenteral antibiotics – Diet • High protein • Increase Vitamin C – Surgery • Repair fistula • Urinary or fecal diversion Displaced Uterus • Etiology/Pathophysiology – Congenital – Childbirth – Backward Displacement • Retroversion • Retroflexion – Forward Displacement • Anteversion • Anteflexion Displaced Uterus • Signs & Symptoms – – – – Backache Muscle strain Leukorrheal discharge Heaviness in the pelvic area Displaced Uterus • Treatment – Pessary • Rubber or plastic doughnut-shaped ring – Uterine Suspension Uterine Prolapse • Etiology/Pathophysiology – Obstetrical trauma – Overstretching of the support system – Coughing, straining, and lifting heavy objects – 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 Uterine Prolapse • Signs & Symptoms – – – – Fullness in vaginal area Backache Bowel or bladder problems Protrusion of cervix and vaginal walls in perineal area Uterine Prolapse • Treatment – Pessary – Surgery • Vaginal hysterectomy • Anteroposterior colporrhaphy – Anterior and posterior repair of the vagina – Shortening of the supporting muscles 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 Cystocele Bladder Rectocele Rectum Cystocele and Rectocele • Signs & Symptoms – Cystocele • Urinary urgency, frequency, and incontinence • Fatigue • Pelvic pressure – Rectocele • Constipation • Rectal pressure • Hemorrhoids Cystocele and Rectocele • Treatment – Surgical repair • Anteroposterior colporrhaphy (A&P Repair) • Shortening of the muscles that support the bladder • Benign Tumors of the Uterus Fibroid Tumors (Myomas) • Etiology/Pathophysiology – Arise from the musle tissue of the uterus – Stimulated by ovarian hormones Benign Tumors of the Uterus Fibroid Tumors (Myomas) • Signs & Symptoms – – – – – – – – Pelvic pressure Pain Dysmenorrhea Abnormal uterine bleeding Menorrhagia Backache Constipation Urinary symptoms Benign Tumors of the Uterus Fibroid Tumors (Myomas) • Treatment – Surgery • Myomectomy – Removal of uterine myomas • Hysterectomy Ovarian Cysts • Etiology/Pathophysiology – Benign tumors that arise from dermoid cells of the ovary or from a corpus luteum or graafian follicle Ovarian Cysts • Signs & Symptoms – – – – – – May be no symptoms Palpable on examination Disturbance of menstruation Pelvic heaviness Slight vaginal bleeding Pain, with enlargement Ovarian Cysts • Treatment – Ovarian cystectomy 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 Carcinoma of the Cervix 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 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 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 Cancer of the Endometrium • Signs & Symptoms – Postmenopausal bleeding • 50% will have cancer • Abdominal pressure • Pelvic fullness Cancer of the Endometrium • Treatment – Surgery • TAH-BSO – Radiation • Intracavitary radiation – Chemotherapy Cancer of the Ovary • Etiology/Pathophysiology – 4th 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 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 Cancer of the Ovary • Treatment – Surgery • TAH-BSO and omentectomy – Radiation – Chemotherapy – Combination of the above 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 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 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) 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 Fibrocystic Breast Condition • Signs & Symptoms – Cysts are soft, well-differentiated, tender, and freely moveable – Often bilateral and multiple – More apparent before menses Fibrocystic Breast Condition • Treatment – Eliminate methylxanthines • Found in caffeine – coffee, tea, colas – Danazol (Danocrine) • Inhibits FSH and LH production; decreases estrogen production – Vitamin E Acute Mastitis • Etiology/Pathophysiology – Acute bacterial infection – Usually caused by S. aureus or streptococci – Most often occurs during lactation and late pregnancy Acute Mastitis • Signs & Symptoms – Breasts are tender, inflamed and engorged Acute Mastitis • Treatment – Keep breasts clean – Application of warm packs – Support • Well fitting bra – Systemic antibiotics 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 Chronic Mastitis • Signs & Symptoms – Tender, painful, and palpable cysts – Usually unilateral Chronic Mastitis • Treatment – – – – Same as for Acute Mastitis Keep breasts clean Application of warm packs Support • Well fitting bra – Systemic antibiotics 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 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 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 Breast Dimpling & Nipple Retraction 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 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. Modified Radical Mastectomy 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 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. Prostatitis • Etiology/Pathophysiology – Acute or chronic infection of the prostate gland – E. coli, Klebsiela, Proteus, Pseudomonas, Streptococcus, and Staphyloccoccus 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 Prostatitis • Treatment – Antibiotics – Digital massage of the prostate • Increased flow of infected secretions – Sitz baths – Monitor I&O 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 Epididymitis Epididymitis • Signs & Symptoms – – – – – Scrotal pain Edema “waddling gait” Pyruia Chills and fever Epididymitis • Treatment – – – – – Bed rest Elevate scrotum Cold compresses Antibiotics I&D for abscess 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 Phimosis Phimosis • Signs & Symptoms – Infection of foreskin and glans penis. – Occasionally causes obstruction of urine flow Phimosis • Treatment – Circumcision 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 Hydrocele Hydrocele • Signs & Symptoms – Enlargement of the scrotum – Pain Hydrocele • Treatment – – – – – Aspiration of fluid Surgical removal of testicular sac Bed rest Elevate scrotum Cold compresses Varicocele • Etiology/Pathophysiology – Dilation of scrotal veins causing obstruction and malfunction of circulation Varicocele • Signs & Symptoms – Engorgement and elongation of the scrotum – Pulling sensation in scrotum – Dull aching pain Varicocele • Treatment – Surgery • Removal of obstruction – Bedrest – Elevate scrotum – Cold compresses Cancer of the Testis • Etiology/Pathophysiology – Cause unknown – High risk • Cryptorchidism – Undesended testes • Testicular atrophy • Scrotal trauma Cancer of the Testis • Signs & Symptoms – Enlarged scrotum – Firm, painless, smooth mass – Feeling of heaviness 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 Cancer of the Penis • Etiology/Pathophysiology – Very rare – Usually in men over 50 yrs – High risk • Uncircumcised • Poor personal hygiene • STD’s Cancer of the Penis • Signs & Symptoms – Painless, wartlike growth or ulceration, usually on the glans penis Cancer of the Penis • Treatment – Surgery • Removal of tissue • Partial or total amputation of the penis • Metastisis may require more radical surgical procedures Herpes Genitalis (Herpes Simplex Virus Type II) • Etiology/Pathophysiology – Infectious viral disease – Usually acquired sexually 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 Herpes Genitalis (Herpes Simplex Virus Type II) – Initial lesion • Lasts 3-10 days – Recurrent lesions • Last 7-10 days – – – – Fever Malaise Dysuria Leukorrhea (female) Herpes Genitalis (Herpes Simplex Virus Type II) • Exacerbation – – – – Fever Stress Emotional upset Intense heat 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 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 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 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 – 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 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 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 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. 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 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 Gonorrhea – Rectal (male & female) • Perineal discomfort • Purulent rectal discharge – Pharyngitis (male & female) • Sore throat and swallowing discomfort • Edema of the throat Gonorrhea • Treatment – Penicillin • Some may be resistant – Rocephin • Penicillinase-resistant cephalosporin – Doxycycline or Tetracycline • Will treat co-infection of chlamydia – TREAT ALL SEXUAL CONTACTS Trichomoniasis • Etiology/Pathophysiology – T. vaginalis protozoan – Usually sexually transmitted 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 Trichomoniasis • Treatment – metronidazole (Flagyl) • No alcohol • Urine may be dark brown – TREAT ALL SEXUAL CONTACTS 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 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 Candidiasis – Penis • Purulent exudate – Systemic • Chills • Fever • General malaise Candidiasis • Treatment – Treat underlying condition – nystatin (Mycostatin) • ointment, spray, creams, suppositories – Topical amphotericin B • skin and nail infections Chlamydia • Etiology/Pathophysiology – Chlamydia trachomatis – Causes • • • • Cervicitis Urethritis Epididymitis PID 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 Chlamydia • Treatment – – – – – Tetracycline Doxycycline Zithromax Erythromycin for pregnant patients TREAT ALL SEXUAL CONTACTS