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Chapter 47 Management of Patients With Female Reproductive Disorders

Chapter 47 Management of Patients With Female Reproductive Disorders. Vulvovaginal Infections: Pathophysiology. Common problem The vagina is normally protected by acid pH, which is maintained in part by Lactobacillus acidophilus .

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Chapter 47 Management of Patients With Female Reproductive Disorders

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  1. Chapter 47Management of Patients With Female Reproductive Disorders

  2. Vulvovaginal Infections: Pathophysiology • Common problem • The vagina is normally protected by acid pH, which is maintained in part by Lactobacillus acidophilus. • The vaginal epithelium is responsive to estrogen, which induces glycogen formation, which breaks down into lactic acid; therefore, decreased estrogen decreases acid production. • With perimenopause and menopause, decreased estrogen is related to vaginal and labial atrophy, and tissue is more susceptible to infection.

  3. Vaginal Infections (See Table 47-1) • Candidiasis • Gardnerella • Trichomonas vaginalis • Bartholinitis • Cervicitis • Atrophic vaginitis

  4. Pathway for Spread of Microorganisms in Pelvic Infections

  5. Risk Factors for Vulvovaginal Infections (See Chart 47-1) • Premenarche/perimenopause/menopause/low estrogen levels • Pregnancy/oral contraceptive use • Poor hygiene • Tight garments and synthetic clothing • Frequent douching • Antibiotics • Allergies • Diabetes mellitus • Intercourse with infected partner/oral-genital contact/HIV

  6. Nursing Process: Care of the Patient With a Vulvovaginal Infection: Assessment • Examine as soon as possible after onset of symptoms. • Instruct patient not to douche prior to assessment. • History includes: • Physical and chemical factors • Psychogenic factors • Medical conditions • Use of medications • Sexual activity/history

  7. Nursing Process: Care of the Patient With a Vulvovaginal Infection: Diagnosis • Discomfort • Anxiety • Risk for infection or spread of infection • Deficient knowledge

  8. Nursing Process: Care of the Patient With a Vulvovaginal Infection: Planning • Major goals may include relief of discomfort, reduction of anxiety, prevention of reinfection, prevention of infection of sexual partner, acquisition of knowledge about self-care and prevention of infection.

  9. Interventions • Sitz baths may help relieve discomfort. • Explaining the cause of symptoms and methods to help prevent infections may help reduce anxiety. • Douching is usually avoided; however, therapeutic douching may be prescribed to reduce odors and remove excessive drainage. • Patient education includes handwashing, proper hygiene, preventive strategies, measures to reduce risk, information regarding medications, and information regarding self-examination.

  10. Genital Viral Infections • Human papillomavirus (HPV) • Most common STD among sexually active young people • Vaccine • Treatment of genital warts • Associated with cervical dysplasia and cervical cancer. Need annual Pap smears! • Herpes type 2 infection (herpes genitalis) • A recurrent life-long viral infection • An STD that also may be transmitted by contact; it may be transmitted when the carrier is symptomatic • Causes painful itching and burning herpetic lesions

  11. Treatment of HSV-2 • No cure • Antiviral agents acyclovir (Zovirax), valacyclovir (Valtrex), and famiciclovir (Famvir) can suppress symptoms. • Recurrences may be associated with stress, sunburn, dental work, inadequate rest, and inadequate nutrition. • Infants delivered vaginally are at risk for becoming infected; therefore, cesarean delivery may be performed.

  12. Nursing Process: Care of the Patient With Genital Herpes: Assessment • Health history • Pelvic examination • Assess for risk factors for STDs.

  13. Nursing Process: Care of the Patient With Genital Herpes: Diagnosis • Acute pain • Risk for infection • Risk for spread of infection • Anxiety • Deficient knowledge

  14. Nursing Process: Care of the Patient With Genital Herpes: Planning • Major goals include relief of pain and discomfort, control of the infection and its spread, relief of anxiety, knowledge of and adherence to treatment regimen, and knowledge regarding implications for the future.

  15. Interventions • Proper hygiene • Clean, soft, loose, absorbent clothing • Avoid ointments and powders. • Encourage fluid intake and good nutrition. • Measures related to discomfort with urination • Instructions regarding medications • Rest • Measures to prevent reinfection and spread of infection • Measures to reduce anxiety

  16. Malignant Disorders of the Female Reproductive Tract • Cervical, uterine, vaginal, vulvar, and ovarian cancers • Early disease may not have symptoms. • Signs and symptoms depend upon location and may include vaginal discharge, pain, bleeding, and systemic symptoms (weight loss and anemia). • Prevention, screening, and early detection are vital.

  17. Treatment of Reproductive Malignancies • Surgery, chemotherapy, radiation, or a combination of these • Treatment may be curative or palliative. • Care of the surgery patient is similar to care of patients with other abdominal surgeries.

  18. Pelvic Floor Relaxation

  19. Complete Prolapse of the Uterus

  20. Uterine Fibroids or Myomas

  21. Hysterectomy • Surgical removal of the uterus to treat cancer, dysfunctional uterine bleeding, endometriosis, nonmalignant growths, persistent pain, pelvic relaxation and prolapse, and previous injury to the uterus. • Total hysterectomy • Radical hysterectomy • Types of approaches • Laparoscopic • Vaginal • Abdominal

  22. Nursing Process: Care of the Patient Undergoing a Hysterectomy: Assessment • History • Physical and pelvic exam • Psychosocial and emotional responses • Patient knowledge

  23. Nursing Process: Care of the Patient Undergoing a Hysterectomy: Diagnosis • Anxiety • Disturbed body image • Acute pain • Deficient knowledge

  24. Collaborative Problems/Potential Complications • Hemorrhage • DVT • Bladder dysfunction

  25. Nursing Process: Care of the Patient Undergoing a Hysterectomy: Planning • Major goals may include relief of anxiety, acceptance of loss of the uterus, absence of pain or discomfort, increased knowledge of self-care requirements, and absence of complications.

  26. Interventions • Anxiety • Allow patient to express feelings. • Explain physical preparations and procedures. • Provide emotional support. • Body image • Listen and address concerns. • Provide appropriate reassurance. • Address sexual issues. • Approach and evaluate each patient individually.

  27. Cancer of the Vulva • 4% of gynecologic cancers; most often seen in postmenopausal women • Encourage regular pelvic exams, Pap smears, and self-examination for early diagnosis. • Risk factors include smoking, HPV infection, HIV, immunosuppressant therapy. • Symptoms • Longstanding pruritus and soreness • May present as a chronic dermatitis or a lump, ulcer, or mass • Bleeding, foul-smelling discharge, and pain are late signs.

  28. Vulvectomy • Treatment for vulvar cancer includes wide excision of the vulva: vulvectomy • May be done with lymph node dissection • Additional therapy may include radiation and/or chemotherapy. • Preoperative preparation includes assessment of patient, including factors that may have caused her to delay seeking care; health habits and lifestyle; include psychological assessment and provide support • Postoperative care includes addressing issues of anxiety, pain, impaired skin integrity, sexual dysfunction, change in body image; and potential complications, including infection, sepsis, DVT, and hemorrhage.

  29. Chemotherapy • Usually administered IV • Patients undergoing chemotherapy need specific care to address the side effects and complications of the chemotherapy agent or agents administered. Side effects may include neutropenia, thromobocytopenia, nephrotoxicity, neurotoxicity, hair loss, hypersensitivity reactions, nausea, and vomiting. • Paclitaxel (Taxol) • Carboplatin (paraplatin) • Liposomal therapy

  30. Radiation Therapy • External radiation therapy • Intraoperative radiation therapy • Internal (intracavity irradiation) • Care of the patient undergoing radiation therapy

  31. Placement of Tandem and Ovoids for Internal Radiation Therapy

  32. Nursing Considerations Related to Intracavity Radiation Therapy • Foley catheter • Absolute bed rest, positioning restrictions • Diet: low residue • Hygiene • Monitoring of patient • Side effects of therapy • Emotional support of patient • Address potential for isolation.

  33. Safety (Intracavity Radiation) • Follow specific precautions related to time, distance, and use of shielding. • Methods to monitor staff exposure (film badges) • No pregnant caregivers, and no pregnant visitors or visitors under age 18 • Teaching for family/others in contact with patient • Monitor that device is not dislodged. If it is dislodged, do not touch the radioactive object, and notify radiation safety. • Discharge survey

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