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Female reproductive problems pt 1
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- Douglas College ( )
Female reproductive problems pt 1
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2211: Unit 11 Female reproductive problems pt. 1Leiomyomas, cervical polyps, benign ovarian tumours – PCOS
Nursing Management Conditions of VULVA, VAGINA, AND CERVIX
- Teach pts about genital conditions and reducing their risks – ability to recognize symptoms allows them
to seek care earlier
- Nursing Non-judgemental attitude makes women feel more comfortable and empowered and easier to
ask questions.
- Ensure pt understands directions for treatment – take full course of meds to decrease relapse, use
graphs and models to demonstrate, show applicator and how to fill (vaginal medications)
- Creams or vaginal suppositories should be inserted before bed so medication remains in vagina, can use
panty liners during the day
PELVIC INFLAMMATORY DISEASE (PID)
Infectious condition of pelvic cavity – can involve the fallopian tubes (salpingitis), ovaries (oophoritis),
and pelvic peritoneum (peritonitis)
Tubo-ovarian abscess may also form
~10,000 cases of symptomatic PID annually in Canada
Can be ‘silent’ or acute distress
Pathophysiology
PID is often the result of untreated cervicitis – the organism infecting cervix ascends higher into uterus,
fallopian tubes, ovaries, and peritoneal cavity
C. trachomatis & N. gonorrhoeae are most common – as well as anaerobes, mycoplasma, streptococci,
and enteric gram-negative rods –
They enter during intercourse or after pregnancy termination, pelvic surgery, or childbirth
Not all PID cases are a result of STI
Women at risk of chlamydial infections (<24 yrs with multiple sex partners or new partner) should be
routinely tested for C. trachomatis
Chlamydia can be asymptomatic silent PID is a major cause of female infertility
Manifestations
Usually seek help as experiencing lower abdominal pain – starts gradually and then becomes constant
Intensity can be mild to severe, movement can increase pain, or can be associated with intercourse
Spotting after intercourse and purulent cervical/vaginal discharge
Fever and chills
Women with less acute symptoms notice increased cramping pain with menses, irregular bleeding, and
some pain with intercourse
Women with mild symptoms may go untreated or have it misdiagnosed
, Pelvic exam is for diagnosis = there is pelvic organ tenderness with adnexal tenderness (uterine
appendages like fallopian tubes, ovaries, and ligaments that hold uterus in place), positive cervical
motion tenderness or uterine compression tenderness during bimanual exam
Additional criteria can be fever and abnormal discharge, and lower genital tract infection
Cultures for N. gonorrhoeae & C. trachomatis obtained, and pregnancy test = to rule out ectopic
pregnancy
Drug therapy begins with minimal diagnostic criteria met – we do not wait for culture results.
If pain or obesity compromise pelvic exam and tubo-ovarian abscesses may be present – do a Vaginal
Ultrasound
Complications
Immediate = septic shock, and “Fits-Hugh-Curtis syndrome” – occurs when PID spreads to the liver and
causes acute perihepatitis
o Pt has Right upper quadrant pain but liver function tests are normal
o Tubo-ovarian abscess may ‘leak’ or rupture causing pelvic or generalized peritonitis
o As general circulation flooded with bacterial endotoxins from infected areas – septic shock can
occur
o Embolisms can occur due to thrombo-phlebitis of pelvic veins
Can cause adhesions and strictures to develop in the fallopian tubes
Ectopic pregnancy can result when tube partially obstructed as sperm can pass through stricture but
fertilized ovum cannot reach uterus
After 1 episode of PID – risk of ectopic pregnancy increases ten-fold
Further damage can obstruct the fallopian tubes and cause infertility
Collaborative Care
- PID is usually treated on outpatient basis
o Pt given combination of antibiotics (cefoxitin & doxycycline) for broad coverage
o With effective antibiotics – pain should subside
o Pt shouldn’t have intercourse for 3 weeks
o Partners should be examined and treated
o Important physical rest and oral fluids
o Re-evaluation 48 – 72 hrs even if symptoms improving
- If outpatient treatment is unsuccessful or pt acutely ill or has severe pain – admission to hospital is
indicated
o If tubo-ovarian abscess is present pt must be hospitalized
o Max doses of parenteral antibiotics given in hospital
o Corticosteroids are added to reduce inflammation, allows faster recovery and improvement
in subsequent fertility
o Heat application to the lower abdominal or sitz bath can improve circulation and decrease pain
o Bed rest in Semi-fowler’s promotes drainage of pelvic cavity by gravity and can prevent
development of abscesses high in the abdominal
, o Analgesics for pain and IV fluids prevent dehydration
- Surgery indicated for abscesses that fail to resolve with IV antibiotics
o May be drained by laparoscopy or laparotomy
o In extreme cases of infection or severe chronic pelvic pain – Hysterectomy
o When surgery necessary every attempt is made to preserve fertility in women child-bearing age
Nursing Management
Urge women to seek medical attention for any unusual vaginal discharge or possible infection of
reproductive organs – help to understand not all discharge is indicative of infection but early diagnosis
and treatment of infection can prevent serious complications.
Inform women of methods to decrease risk of getting STI.
They may have guilt feelings about PID especially if associated with STI – may also be concerned about
complications (adhesions, strictures of fallopian tubes, infertility, increased incidence of ectopic
pregnancy)
Discussion about feelings and concerns assists coping.
For pts requiring hospitalization – drug therapy, monitor pts health status, provide symptoms relief,
teaching, vitals, character, amount, color & odour of vaginal discharge should be recorded.
Explain rest, semi-fowlers position, increased fluid intake to increase cooperation
Assess abdominal pain to determine effectiveness of therapy
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