Medical-Surgical Nursing 13th Edition

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1

What are the S/S of PMS?

Physical Symptoms
-H/A
-Fatigue
-Low Back Pain
-Painful Breast
-Fluid retention, bloating
Behavioral & Emotional/Affective Symptoms
-Irritability/Anxiety
-Mood Swings
-Fear of Loosing Control
-Binge Eating
-Crying Spells
-Confusion

2

What is Tx for PMS?

-Nutritious diet consisting of:Whole Grains, Fruits, Veggies, ^ Water intake, Exercise prog, Stress reduction program.

-SSRIs, (fluoxetine [Prozac, Sarafem]).

-NSAIDs(prostaglandin antagonists), Ibuprofen[Motrin] & Naproxen[Anaprox, Alevel].

-Alprazolam (Xanax) has been effective, risk of physical & psychological dependence is high.

-Spironolactone, a Diuretic, may be effective in tx fluid retention.

-Oral contraceptives containing Drospirenone (synthetic progestin).

3

What can the patient do to alleviate the symptoms of PMS?

-Keep a record of symptoms to anticipate to better cope.
-Regular exercise
-Avoid: Caffeine, high-fat foods, refined sugars.

ALTERNATIVE Therapies:
-Vit B6 (pyridoxine)
-Vit E
-Calcium
-Magnesium
-Oil of primrose capsules

4

Testicular Cancer?

Unexplained pain is key to early detection

-Most common cancer diag in men 15-35yr.
-Classified as Germinal or Nongerminal(Stromal)

5

What are Germinal Tumors?

What are Seminomas?
What are Nonseinomas?

Germinal Tumors:
-90% of all cancers of the testis.

Seminomas:
-Slow-growing forms of testicular cancer usually found in men 30-40yrs. (usually localized in testis)

Nonseminomas:
-MORE COMMON-grow fast
-embryonal carcinoma
-teratomas
-Yolk sac tumors
Crucial to determine between the 2, for prognosis and tx.

6

What are Nongerminal(Stromal)Tumors?
pg1741

Account for less than 10% of testicle cancers.

7

What is Tx for Testicular Cancer?

What are the S/S of Testicular Cancer?

Easiest to tx if found early, usually curable form of cancer.
S/S:
-Mass/lump
-Painless enlargement of the testis-BIG ONE
-Heaviness in scrotum, inguinal area, lower abdom.
-Back ache
-Abdominal pain
-Wt loss
-General weakness

8

What are the Risk For with Testicular Cancer?

-Cryptorchidism(undescended testicles)
-Family/self hx of testicular cancer
-Race-White men greater risk
-HIV positive

Occupational Hazards:
-Chemicals encountered in mining
-Oil gas production
-Leather processing

9

Testicular Tumor Markers for Diag?

-Alpha-fetoprotein(AFP) and beta-human chorionic gonadotropin (beta-hCG)may be elevated in pt w/ testicular cancer

-Blood chemistry, including lactate dehydrogenase is also necessary testing for testicular cancer.

-Inguinal Orchiectomy(removal of testis) is the standard way of diagnosing testicular cancer.

10

What are Interventions for Testicular Cancer?

-Self exam monthly
-Clinical exam yearly
-DIGITAL Exam yearly after 40yrs.

Unexplained pain is Key to early detection.

11

What is Pelvic Inflammatory Disease(PID)?

-Inflammation of the pelvic cavity that may begin w/ cervicitis & involve the uterus(endometritis), fallopian tubes(salpingitis), ovaries(oophoritis), pelvic peritoneum, or pelvic vascular system.

-May be acute, subacute, recurrent, or chronic & localized or widespread.

12

Pathophysiology of PID?

-The exact pathogenesis of PID has not been determined but presumed organisms enter through the vagina, pass through the cervical canal, colonize the endocervix, then move upward into the uterus. Under various conditions, the organism may proceed to 1/both fallopian tubes, ovaries then in the pelvis.

-In bacterial infections that occur after childbirth or abortion, pathogens are disseminated(spread) directly through the tissues that support the uterus by way of the lymphatics/blood vessels. In preg the increased blood supple required by the placenta provides a wider pathway for infection.

-These infections can cause perihepatic inflammation when the organism invades the peritoneum(thin membrane lining the abdominal wall/covering abdom. organs).

-In rare instances, organisms(tuberculosis) gain access to the reproductive organs through the bloodstream from the lungs.

13

S/S of PID?

-Begin with purulent discharge, dyspareunia(pain w/ sex), lower abdom. pelvic pain/tenderness after menses. Pain may increase after voiding or defecation. Fever, N/V, H/A, anorexia.

-During pelvic exam, intense tenderness may be noted on palpation of uterus or movement of cervix. Symptoms may be acute/severe or low grade/subtle.

14

PID is Caused by?

-Bacteria but may be attributed to a virus, fungus, or parasite.

-Gonorrheal & Chlamydial organisms are common causes.

-Most cases are associated w/ more than 1 organism.

15

Pelvic infection is most often sexually transmitted but can also occur with invasive procedures such as?

-Endometrial biopsy, abortion, hysteroscopy(view uterus), or insertion of an intrauterine device.

-Bacterial vaginosis may predispose women to pelvic infection.

16

Risk factors for PID include?

-Early age first time of sex
-Multiply partners
-Freq. douching
-Substance abuse
-Hx of STIs/pelvic infections
-No protection

17

With Pelvic Inflammatory disease PID all pt are prone to complications of Ectopic pregnancy due to fallopian tube obstruction and need to be informed of the S/S which are?

Pain, abnormal bleeding, delayed menses, faintness, dizziness, and SHOULDER PAIN.

18

What are Tx for PID?

What alleviates S/S?

Broad spectrum antibiotic therapy Usually combo of:
-ceftriaxone(Rocephin)
-azithromycin
-docxycycline

19

Indications for hospitalization from PID include?

Surgical emergencies, pregnancy, no clinical response to oral antimicrobial therapy, inability to follow or tolerate outpatient oral regimen, severe illness(N/V, High fever), tubo-ovarian abscess(pocket of pus formed during infect).

20

What Interventions are for PID?

-Antibiotics
-Laparoscopic(sm incision surgery for Adhesions)
-STD testing
-Education

21

Nursing Mgmt. for PID includes?

-Assess physical/emotional effects. Pt may feel well 1 day then discomfort the next.

-May suffer constipation/menstrual difficulties.

-Recording Vitals, I/O, Vaginal discharge(amount, color, odor, consistency) necessary as a guide for therapy.

-Nurse administers analgesics for pain. Adequate rest/healthy diet are encouraged.

-Nurse minimizes transmission of infect by adhering to appropriate infect control practices & performing meticulous hand hygiene.

22

Promoting Home/Community-Bases Care (Pt teaching) for PID?

-Inform pt how pelvic infections occur, how to control/avoid & S/S.

-Inform ALL pt w/ PID of S/S of ectopic preg.

-If reinfection occurs/spreads S/S may include: abdominal pain, n/v, malaise, malodorous(smelly) purulent vag. discharge, leukocytosis(increased WBC).

23

Upon completion of hm care education with PID pt/caregiver will be able to?
pg1657, 57-3

-State any pelvic pain/abdom discharge after: sex, birth, pelvic surgery, needs evaluated ASAP.

-State abx(antibiotics)may be Rx after insertion of intrauterine devices.

-Describe proper perineal care/wiping front-back.

-State douching reduces natural flora, may introduce bacteria upward.

-Identify importance of consulting HCP of unusual vaginal discharge/odor.

-Discuss importance of proper: nutrition, exercise, wt. control. Safe sex practices: condom, 1 partner.

-Explain importance of consistent use of condoms before sex or any penile-vaginal contact if there is any chance of transmitting infect.

-STATE THAT GYNECOLOGIC EXAM at least 1 A YEAR.

24

What is Prostatitis?
pg1722

S/S of Prostatitis?

Inflammation of the prostate gland, often associated w/ lower urinary tract symptoms, sexual discomfort/dysfunction.

S/S:
-Sudden fever
-dysuria(painful urination)
-Perineal prostatic pain
-Severe lower urinary tract symptoms(dysuria, frequency,urgency, nocturia)

25

Causes for Prostatitis?

Infectious agents;
-Bacteria (Escherichia Coli,most common), Klevsiella, Proteus species also found.
-Fungi
-Mycoplasma

26

How many types of Prostatitis?

4 Types:
-Acute bacterial TypeI
-Chronic bacterial TypeII
-Chronic Prostatitis/chronic pelvic pain syndrome TypeIII-occurs in 90% of cases (often have no bacteria in urine in presence of genitourinary pain)
-Asymptomatic inflammatory prostatitis typeIV

27

What is Tx for Prostatitis?

The tx goal is to eradicate the causal organism,so specific tx is bases on type of prostatitis & results of culture/sensitive urine testing.

-Antibiotics if Bacteria in urine trimethoprim-sulfamethoxazole(BACTRIM) or a fluoroquinolone (ciprofloxacin[Ciprol]).

-Anti-inflammatory(NSAIDs) if pt is afebrile(no fever), has normal urinalysis.

-Alpha-adrenergic blocker (tamsulosin, [Flomax]) promote bladder & prostate relaxation.

Hospital w/ IV antibiotics for acute:
-unstable Vitals
-Sepsis
-Intractable pelvic pain
-Immunosuppressed pts
-Diabetes
-Renal insufficiency

28

What alleviates S/S of Prostatitis?

-Warm sitz bath 10-20min several times daily, analgesics for pain.
-Fluid if pt wants, for thirst.

AVOID-Foods/Liquids w. diuretic action or increase secretions:
-Alcohol
-Coffee
-Tea
-Chocolate
-Cola
-Spices

-Suprapubic Catheter for severe urinary retention.
-Avoid sitting for long periods if discomfort.
-Follow up visits 6mo-1yr to check recurrence.

29

Psychogenic causes for Erectile Dysfunction?

Psychogenic:
-Anxiety
-Fatigue
-Depression
-Pressure to perform sexually
-Negative body image
-Absence of desire
-Privacy/Trust/Relationship issues

30

Organic causes of Erectile Dysfunction?

Organic:
-Cardiovascular Disease(meds & afraid of MI)
-Endocrine Disease(diabetes, pituitary tumors, testosterone deficiency, hypERthyroidism, hypOthyroidism),
-Cirrhosis
Chronic kidney failure
-Genitourinary conditions(radical pelvic surgery)
-Hematologic(Hodgkin/lymphoma/leukemia/Anemic)
-Neurologic disorders(neuropathies)
-Parkinsonism
-Spinal cord injury,
-Multiple sclerosis(autoimmune affects cns)
-DIABETICS HAVE BIG PROBLEM
-Trauma to pelvic or genital area
-Alcohol decreases libido
-Smoking
-Medications/drug abuse(cocaine)

31

Ejaculation problems?

-Premature ejaculation
-Retrograde(instead of coming out it goes back/causing all kinds of disease processes)

32

What Tx Medications used for Erectile Dysfunction?
pg1720
*CALL Dr. if erection last ^ 4hrs.(no blood flow)

-Sildenafil(Viagra)30-4hrs prior sex
*S/E H/A, flushing, heartburn
Caution-Retinopathy pt(increase press on retina)

-Vardenafil(Levitra)1hr prior

-Taldalafil(Cialis)before sex, may last 36hrs.

33

What are the Contraindications for Erectile Dysfunction Medications?

DO NOT Take if:(Tell Nurse if on ED meds)
-Taking Nitrate meds(Nitroglycerin)will cause bp to bottom out & will need to be coded.

-High BP, Coronary artery dis, MI in past 6mo.
-Diag w/Cardiac dysrhythmia or Kidney/Liver dysf.

34

What is Priapism?

Persistent, Uncontrolled Painful Erection from Neural or vascular causes including:
-Medications
-Sickle cell
-Thrombosis
-Leukemia cell infiltration
-Spinal cord tumors

35

What is Benign Prostatic Hyperplasia BPH?
Causes of BPH?
Generalized Symptoms of BPH?
pg1724

Noncancerous enlargement/hypertrophy of the prostate, 1 of most common diseases in aging men usually older than 40. By 85yr 90% of men are affected.

Causes-not well understood:
-Elevated levels of Estrogen
-When prostate tissue becomes more sensitive to estrogen and less responsive to DHT(sex steroid/androgen hormone).

Generalized Symptoms:
-Fatigue
-Anorexia
-N/V
-Pelvic discomfort

36

Risk factors for BPH?
pg1723

-Smoking
-Heavy Drinking
-Obesity
-HTN(hypertension)
-Heart disease
-Diabetes
-Western diet(high in animal fat, protein, refined carbohydrates, low fiber)

BPH develops over a prolonged period and is a result of complex interactions involving resistance in the prostatic urethra to mechanical & spastic effects such as:
-Bladder pressure/voiding
-Detrusor muscle strength(squeezes bladder)
-Neurologic functioning
-Hypertrophied lobes of prostate may obstruct the bladder neck or urethra, causing urinary retention.

37

What is Prostatism(poss.clinical manifestations of BPH)?

Symptoms related to bladder function and urination.

Obstructive/irritative symptom complex that includes:
-Increased frequency & hesitancy starting urination
-Decrease in volume/force of urinary stream
-NOCTURIA
-Acute urinary retention
-Dribbling
-Recurrent urinary tract infections

Normal Residual Urine Amounts:
-50 mL or less middle age
-50-100 mL or less older adult

38

Assessments and Tests?

BPH Lab Values?

-Digital Rectal Exam(DRE) often reveals (Lg rubbery non tender prostate gland.
-Urinalysis screen for hematuria & UTI
-PSA(Prostate-specific antigen) level(will be ^ W/ some meds)
-Recording urinary flow rate & measurement of postvoid residual urine.

-International Prostate Symptom Score(IPSS)

-Cardiac/Respiratory function are assessed because high number pt w/ BPH have cardiac/respiratory disorders due to age.

39

If BPH Symptoms are moderate/severe additional tests called urodynamic studies may done which are?
per.webMD

-Blood Creatinine(kidney function)
-Post-void residual(PVR)(amt of urine left in bladder)
-Cystoscopy(thin lighted instrument to view inside the bladder & urethra) see if prostate enlarged.

40

What Nursing priority that requires evaluation regarding BPH?
pg1715

New-onset of urinary incontinence(leaking urine)

41

BPH predisposes men to Prostate cancer what should men do to prevent/diagnose early PC?

-PSA(prostate pacific antigen test by blood)-High levels ^4ng/mL may indicate prostate cancer, drawn yearly
-Digital Rectal Exam(ERE) annually, Neither are 100% accurate, but together accuracy increases.
-Urinalysis(screens for hematuria),PSA,DRE-All 3 tests may uncover a higher % of malignancies pg1715

42

Menstrual Disorders?

-Premenstrual Syndrome
-Dysmenorrhea(painful menses)
-Amenorrhea(No menses) normally start 12yr, 13 if athletic

-Abnormal uterine bleeding
*Menorrhagia(heavy bleeding >2 full pads daily)
*Metrorrhagia(irregular bleeding)
*Postmenopausal bleeding (could be cancer)

43

What is Amenorrhea?
Primary?
Secondary?

Absence of menstrual flow, a symptom of a variety of disorders & dysfunctions.

-Primary Amenorrhea (delayed menarche) refers to young women who by age 14 has not begun developing secondary sex characteristics or who by 16 or older has developed secondary sex characteristics but has not started menstruation.

-Secondary(absence of menses for 3 cycles or 6 mo after a normal menarche).

44

Causes of Primary Amenorrhea?

Tx?

Many reasons for Primary including:
-Genetic
-Congenital disorders
-Malnutrition
-Hyperthyroidism

Tx is geared toward correcting any abnormalities

45

Causes of Secondary Amenorrhea?

Tx?

-Pregnancy
-Breastfeeding
-Menopause
-Too Little Body Fat
-Eating Disorder
-Thyroid Disease
-Polycystic Ovary Syndrome
-Asherman's Syndrome
-Cervical Stenosis
-Excessive Exercise
-Medications
-In adolescents, from emotional upset (being away from home-college, tension-school work).

These dysfunctions can be tx successfully by tx of the underlying endocrine disorder.

46

What is Dysmenorrhea?

S/S of Dysmenorrhea?

Primary-Painful menstruation 48-72hrs.
Thought to be caused by excessive production of prostaglandins, which causes painful contractions of the uterus.
S/S: Nausea, diarrhea, dizziness, backache

47

What is Tx for Dysmenorrhea?

What alleviates S/S of Dysmenorrhea?

-NSAIDs
-Low-dose oral contraceptives provide relief in more than 90% of pts and my be prescribed for woman sexually active but don't desire preg.

-Heating pad
-Increased physical activity, relieves discomfort for some.

48

What is Menorrhagia?
pg1629

Risks of Menorrhagia?

Heavy bleeding >2 full pads daily.

-In young woman the cause is usually related endocrine disturbance.

-Older woman usually from inflammatory disturbance, tumors of uterus, hormonal imbalance.

-Can also be sign of a bleeding disorder or result from anticoagulant therapy.

Risks: Persistent heavy bleeding can result in Anemia.

49

What is Tx for Menorrhagia?

What alleviates S/S?

Urged to see Dr. to describe amount of bleeding by pad count/saturation hourly.

-Tx may involve endometrial ablation or hysterectomy.

50

Benefits of Hormone Replacement Therapy?
pg1642

Decreases:
-Hot Flashes
-Risk of Osteoporotic Fx
-Colorectal Cancer

51

What are the Contraindications/ Risks with (HRT)?

Contraindicated:
-Hx of breast cancer
-Vascular thrombosis
-Impaired Liver function
-Uterine Cancer
-Undiagnosed abnormal vag bleeding.

Increases Risk Of:
-Venous Thrombosis increased w/ HT
-Breast Cancer
-Heart Attack
-Stroke
-Blood Clots

52

Woman taking Hormone Replacement Therapy should be assessed for?

-Leg redness
-Tenderness
-Chest pain
-Shortness of Breath
-Since the risk of complications increase the longer HT is used, HT should be used for shortest time possible.

53

Alternative Therapy for hot flashes?

-Vit B6
-Vit E
-Paxil
-Effexor
*Low doses of antidepressants meds may help forestall a hot flash by rebalancing or intercepting the chemicals in the brain that transmit the hot flash alarm, epinephrine & Serotonin.

54

How Often should Paps be done?

-19-30yrs, Pap every 3yrs once sexually active.
-40-64, Pap every 2-3yrs 3 consecutive neg tests, if no hx of cervical abnorm., HIV, Diethylstilbestrol exposure(man made form of estrogen).
-Precancerous leisions indicated on pap retest(4-6mo).

55

What should nurse Teach Pt about a Pap smear exam?

-Do not use douches prior to exam.
-Exam can't be done while on menses.
-Pap will be done first when other test are to be completed as well.

56

What is Toxic Shock Syndrome?

Systemic Infection caused by:
-Streptococcus pyogenes(group A Strep)
-Staphylococcus aureus(Staph)Bacteria

57

S/S of Toxic Shock Syndrome?

-Fever-may be w/ chills
-Sore Throat
-H/A
-Dizziness/Confussion
-Low BP
-Organ Failure (Kidneys, Liver)
-Redness of Palms/Soles(Peeling 1/2 wks after rash)
-Seizures
-Skin Rash
-Blisters
-Petechiae

58

What causes Toxic Shock Syndrome?

-Highly Absorbent Tampons
-Other Packing ex.Cash, other objects
-Rare complication of Chicken Pox, Flu, & other respiratory infections, & wounds or injuries to the skin.

59

How can Toxic Shock Syndrome be prevented?

Pt Teaching

-Change Tampon every 4 hours
-Substitute for Pads instead
-Do not use High Absorbency
-Wash Hands
-Care w/ Barrier Contraceptives
-Report Symptoms Promptly

60

Tx for Toxic Shock Syndrome?

-Removal of foreign materials, tampons, sponges, nasal packing.

Goal of tx is to maintain important body functions, this may include:
-Antibiotics for infection(can be IV)
-Dialysis(if kidney problems present)
-Fluids through IV
-Methods to control BP

61

Oral Contraceptives Provide?

Oral contraceptives provide protection against:
-Uterine Cancer
-Ovarian Cancer
-Anemia
-Pregnancy
-Fibrocystic Breast Changes
-Relief from Perimenopausal Symptoms.

WOMAN WHO SMOKE & ARE 35 SHOULD NOT TAKE ORAL CONTRACEPTIVE AGENTS-Due to increased risk for CVD.

62

What is Perimenopausal?

Period extending from first signs of menopause, lasting 1yr after the last menstrual period.

63

What is Postmenopausal?

Period beginning from about 1yr after menses cease.
-Lining uterine in postmenopausal woman should be thin due to LOW ESTROGEN levels.

64

What Supplements help with Osteoporosis Prevention?

-Hormone Replacement Therapy
-Vitamin D
-Calcium
Foods

65

What is Abnormal Uterine Bleeding?

-Irregular, painless bleeding of endometrial origin that may be excessive, prolonged, or w/out pattern. Common in adolescents/woman approaching menopause.

-Abnormal uterine bleeding
*Menorrhagia(heavy bleeding >2 full pads daily)
*Metrorrhagia(irregular bleeding)
*Postmenopausal bleeding (could be cancer)

66

Causes of Abnormal Uterine Bleeding?

-Adolescents often don't ovulate regularly due to the pituitary ovarian axis maturing.
-Fibroids
-Obesity
-Hypothalamic dysfunction.

67

What should be done if you have Abnormal uterine Bleeding?

Abnormal vag bleeding that is atypical(not specific) in time/amount must be evaluated for manifestations of a major disorder.

Physical Exam to check for:
-Preg
-Neoplasm
-Infection
-Endocrine Disorders
-Trauma
-Blood Disorder
-Platelet dysfunction
-Hypothalamic Disorders

68

What are Interventions for Possible Violence?

Always do HIV Test?

69

What is Primary Infertility?
What is Secondary Infertility?

What are the causes of Infertility?

-Primary(couple never had a child)
-Secondary(at least 1 conception has occurred, but can not get preg).

Causes are usually related to:
-Azoospermia(failure to produce sperm).
-Anovulation(menstrual cycle ovaries don't release an oocyte)

-High Prolactin levels, which inhibit ovulation.

-Varicose veins around the testicles).
-Less than 20 million sperm/mL.
-Testicular Temp increased.
-Retrograde ejaculation(semen enters bladder)

70

Infertility is deemed after 1yr of trying.

What testing can be done on Females?
pg1636-1637

-Serum Progesterone Level-Determines if ovulation is regular & if progestational endometrium is adequate for implantation.

-Serum progesterone level

-Ovulation Index-involves a urine dipstick test to determine whether the surge in LH that precedes follicular rupture has occurred.

-HSG is used to rule out uterine or tubal abnormalities. A contrast agent injected into the uterus through the cervix produces an outline of the shape of the uterine cavity & patency of the tubes (the process sometimes removes mucus/tissue lodged in the tubes). Laparoscopy permits direct visualization of the tubes & other pelvic structures & can assist in identifying conditions that may interfere w/ fertility ex. endometriosis.

Other Causes affecting the Uterus determined by Pelvic Exam, Hysteroscopy(thin lighted tube in vag),saline songogram:
-Fibroids
-polyps
-Congenital malformations
-Endometriosis

71

What testing can be done on Males regarding fertility?

Sperm analysis
-Number
-Percentage of moving forms
-Quality of forward movement
-Morphology(shape/form)

-Blood tests measuring testosterone, FSH, LH, prolactin levels.

72

Genital Herpes Pathophysiology and different types?

There are 9 types of herpes viruses belonging to 3 dif. groups that cause infections in humans.

-Herpes simplex Type 1(HSV-1)cold sores.

-Herpes simplex type 2(HSV-2)genital herpes, varicella zoster or shingles; Epstein-Barr virus; cytomegalovirus; human B-lymphotrophic virus; and others. STI, but can be transmitted asexually from wet surfaces, self-transmission(touching cold sore then genitalia), initial infec. very painful.

-Close human contact by mouth, oropharynx, mucosal surface, vagina, or cervix appears necessary to acquire infection. Other susceptible sites are skin lacerations, conjunctivae(eye).

73

What is Genital Herpes & Causes?

-Herpes simplex type 2(HSV-2)genital herpes, varicella zoster or shingles; Epstein-Barr virus; cytomegalovirus; human B-lymphotrophic virus; and others. STI, but can be transmitted asexually from wet surfaces, self-transmission(touching cold sore then genitalia), initial infec. very painful.

74

S/S of Genital Herpes?

-Itching, pain as infected area becomes red & edematous. May begin w/ MACULES, PAPULES & progress to VESICLES & ULCERS.

-Primary site in woman is labia, for men the glans penis, foreskin, or penile shaft.

-Flu like s/s may occur 3-4 days after lesions appear. Inguinal lymphadenopathy(enlarged lymph nodes in groin), H/A, myalgia(aching muscles), dysuria.

-Lesions last 4-15 days before crusting over. Other potential problems are aseptic meningitis, neonatal transmission, & severe emotional stress related to diag.

75

What is Medical Mgmt.(Tx) for Genital Herpes?

-No Cure for HSV-2 tx aimed at relieving symptoms, prevent spread, initiating counseling.

-Med. 3 oral antiviral agents. acyclovir (Zovirax), valacyclovir (Valtrex), famciclovir (Famvir)can suppress systems & shorten course of infection.

76

What alleviates the S/S of Genital Herpes?

-Relieving Pain, keep lesions clean, SITZ Baths, lose soft clothing, aspirin & other analgesic agents for pain.

77

What are the Risks with Genital Herpes?

Childbirth & Genital Herpes? pg1653

-Increased risk of contacting HIV
- In Preg woman w/ active Herpes, infants delivered vag. may become infected. There is a risk of fetal morbidity & mortality if this occurs: therefore, a cesarean delivery may be performed if virus recurs near time of delivery.

78

What Interventions for Genital Herpes?

-Relieving Pain, keep lesions clean, sitz baths, lose soft clothing, aspirin & other analgesic agents for pain.

-Preventing Infection/Spread proper hand hygiene, use barrier methods w/ sex, can spread when no lesions are present.

-Relieving Anxiety: Nurse serves as important source of support by listening to pts concerns, providing info & instruction. Pt may be upset w/ partner for infection or need assistance discussing the infect w/ partner.

-Increasing Knowledge about the disease and its Tx:
because of the increased risk of HIV/other STIs in the presence of skin lesions, an important part of pt education involves instruct pt to protect herself from exposure to HIV & other STIs.

79

What are some Goals for pt with Genital Herpes?
pg1655

1.Experiences a reduction in paint/discomfort.
2.Keeps infections under control.
-Demonstrates proper hygiene techniques.
-Takes meds as prescribed.
-CONSUMES adequate fluids.
-Assess own current lifestyle(diet,fluid intake, safer sex practices, stress management).
3.Uses strategies to reduce anxiety.
-Verbalizes issues & concerns related to genital herpes infection.
-Discusses strategies to deal w/ issues & concerns w/ current & future sexual partners.
-Initiates contact w/ support group if indicated.
4.Demonstrates knowledge about genital herpes & strategies to control & minimize recurrences.
-Identifies methods of transmission of herpes infection & strategies to prevent transmission to others.
-Discuss strategies to reduce recurrence of lesions.
-Takes medications as prescribed.
-Reports no recurrence of lesions.

80

Upon completion of hm care education pt/caregiver will be able to?
p1654, 57-2

-State herpes transmitted mainly by direct contact.
-State abstinence frm sex req. during tx.
-State sex during outbreak increases risk for transmission & increases chance of contracting HIV.
-State transmission is poss in absence of lesions.
-State condoms may provide some protection against viral transmission.
-Explain OB should be informed hx of herpes. In cases of recurrence at birth c-section may be req.
-Describe approp. hygiene practices(hand, perineal, gentle washing of lesions w/ mild soap, running water & lightly drying lesions), avoiding occlusive(air tight)ointments, strong perfumed soaps/bubble bath.
-State control of condition may req. changes in sexual behavior and/or use of meds.
-Describe strategies to avoid self-infect(avoid touching lesions during outbreak).
-Explain rational for avoiding self-infect(lesions can become infected frm germs on hand, & the virus frm the lesion can be transmitted frm hand to another area of body/another person).
-Describe health promotion strategies: wear loose, comfortable clothing; eat a balanced diet; get adequate rest/relaxation.
-state rational for avoiding exposure to sun(can cause recurrences/skin cancer.
-Identify importance of taking meds, keeping follow up apts & reporting repeated recurrences.
-Describe poss benefits of joining groups to share solutions & experiences & hear about newer tx.

81

Human Papillomavirus Pathophysiology, What is HPV?
pg1652

S/S of HPV?

-More than 100 types exist. Most common strains of HPV 6, 11, usually cause condylomata(warty growths) on vulva, rarely premalignant, low risk for cervical cancer.

-Incidence high for HPV in young sexually active woman, usually disappears as result of effective immune system response.

-Also found in young girls non-sexually active(perinatal transmission-being researched, as is autoinoculation(self spreading herpes to other parts of your own body.

82

High risk Oncogenic types of HPV cause almost all cases of Cervical Cancers and include strains?

-16, 18, 31, 45 and affect the cervix, causing cell changes or dysplasia(found on a Papanicolaou{Pap} smear.
-Effects of these strains are usually invisible on exam but may be see on Colposcopy(special magify device, if abnormal a biopsy tissue sample may be taken).

83

What are Tx for HPV?

-Tx of external warts by Dr. are trichloroacetic acid, podophyllin (Podofin, Podocon), cryotherapy (freeze), surgical removal.

-Topical agents applied by pt to external lesions are podofilox (Condylox),and imiquimod (Aldara)do not use agents during preg. Mild pain or local irritation w/ use of med.

-Woman w/ HPV need annual PAP Smears due to the potential of HPV causeing dysplasia(abnorm changes in cells). Transmission can occur during skin-to-skin in areas not covered by condoms.

84

What are Possible Complications of HPV?

-Genital Warts
-Cervical Cancer

Dysplasia(abnorm changes in cells). Transmission can occur during skin-to-skin in areas not covered by condoms.

85

Prevention of HPV includes?

-CDC recommends routine vaccin. of boys/girls 11-12yrs before sexually active.

-Admin in 3 IM doses w/ initial dose followed by 2nd in 2 mo. then 3rd dose in 6 mo. after the 1st. Completion of all 3 doses is important for immunity to develop. Woman still need cervical screenings as recommended.

86

The vagina is protected by its normally low pH of?
And is maintained in part by the actions of?

pH (3.5 to 4.5), Lactobacillus acidophilus, the dominant bacteria in a healthy vaginal ecosystem.

87

Vaginitis is a group of conditions that cause vulvovaginal systems such as?

Itching, irritation, burning, and abnormal discharge.

88

Different Types of Vaginal Infections Include?
pg1648-1657

-Candidiasis
-Bacterial Vaginosis
-Trichomoniasis
-Human Papillomavirus
-Genital Herpes
-Endocervicitis & Cervicitis
*Chlamydia & Gonorrhea(most common)
-Pelvic Inflammatory Disease
-Human Immunodeficiency Virus(HIV)

89

Assessment: Factors that may initiate/Cause or predispose the vagina to Vulvovaginal infection include?

A decrease in flora due to antibiotic use, pregnancy, tight, nonabsorbent, heat and moisture-retaining clothing, Diabetes, corticosteroid or oral contraceptive use, perfumes, soaps, Psychogenic factors such as stress or abuse, sex.

90

Most common cause of Vaginitis?
pg1648

-Bacterial vaginitis (pH >4.7)
-followed by vulvovaginal candidiasis (fungal/yeast)
-Trichomoniasis.

91

What is Candidiasis or Vulvovaginal Candidiasis?

Fungal or yeast infect. caused by strains of Candida. Candida albicans accounts for MOST cases. Many woman w/ healthy ecosystem harbor Candida but are asymptomatic.

92

When do Candidiasis(yeast infect) Occur?

-Anytime
-More common in Preg.
-w/ systemic condition, Diabetes or HIV
-Medications Corticosteroid, oral contraceptive, Antibiotics(decrease bacteria, good flora)

93

The epithelium of the vagina is highly responsive to estrogen which induces?

Glycogen formation:
Glycogen is a multibranched polysaccharide of glucose that serves as a form of energy storage.

94

When estrogen decreases during lactation & menopause, glycogen also decreases and may lead to?

Infection.

95

As estrogen production ceased during peri- and postmenopausal periods, the vagina & labia may?

Atrophy (thin), making the vaginal area more susceptible to infection.

96

Clinical manifestations of Trichomonas vaginalis (flagellated protozoan) that may increase risk of contracting HIV, play a role in development of cervical neoplasia, PID, and infertility are?

Inflammation of the vaginal epithelium, producing burning, itching, & Frothy yellow-white or yellow-green vaginal discharge.

97

Treatment for Trichomonas vaginalis (flagellated protozoan)?

TX: 1x loading dose or smaller dose 3x a day for 1wk, PO Metronidazole (metallic taste, n/v) or tinidazole (Tindamax)- AVOID Alcohol.

98

What is the test and procedure for diagnosing Bacterial Vaginosis?

Whiff test; by adding a drop of potassium hydroxide to a glass slide with a sample of vaginal discharge, which releases amines.

99

Risk Factors/Prevention for Vulvovaginal Infections?
pg1648, 57-1

-Premenarche(before menses)
-Pregnancy
-Perimenopause/Menopause
-Poor personal hygiene
-Tight undergarments
-Synthetic clothing
-Frequent Douching
-Allergies
-Use of oral contraceptives
-Long-term or repeated use of Antibiotics
-Diabetes
-Low Estrogen levels
-Sex with infected partner
-Oral-genital contact (yeast can inhabit the mouth & intestinal tract)
-HIV

100

Nursing Diagnosis for Vulvovaginal infections include?

-Impaired comfort related to burning, order, or itching from the infectious process.
-Anxiety related to stressful systems.
-Risk for infection or spread of infection.
-Deficient knowledge about proper hygiene and preventative measures.

101

Nursing Interventions for Vulvovaginal infections include?

-Relieving impaired comfort with meds, sitz bath.

-Reducing anxiety by explaining the cause & S/S, ways to prevent infections.

-Preventing reinfection/Spreading by explaining that candidiasis is not an STI, ways to prevent such as rest, decrease stress, healthy diet low in refined sugars. Advise pt some antibiotics cause yeast infections it is not an allergic reaction. For suppository & applicator use for creams the nurse may demonstrate procedure on plastic model of pelvis/vagina & instruct pt to recline for 30min after inserted.

-Promoting HM & Community-Based Care, teach pt douching & feminine sprays are unnecessary daily baths/showers, proper hygiene keep the perineal area clean. Douching eliminates normal flora.

102

Diagnostic Examinations and Tests for ( )?

-Pelvic exam
-Pap smear
-Colposcopy an cervical biopsy
-Cryotherapy and laser therapy
-Cone biopsy & loop electrosurgical excision(LEEP)-removal of abdominal tissue.
-Endometrial biopsy
-Dilation & Curettage
-Laparoscopy(pelvic peritoneoscopy) and hysteroscopy.

103

What is a Hydrocele?
S/S?

Fluid-filled sack in the scrotum.

104

Diagnostic Tests for Hydrocele?
pg1744

Collection of fluid most commonly located between the visceral & parietal layers of the tunica vaginalis of the testis, but can collect in spermatic cord.

-ACUTE hydrocele develops 40yrs & older
-Most common cause of scrotal swelling. Many infants have at birth.

TX is usually not required unless:
-Lg
-Bulky
-Tense
-Uncomfortable
-Compromises testicular circulation
-Undesirable appearance

105

What is a Cystocele?
S/S?

-BLADDER sags into the vaginal space due to lack of structural support(result of child birth or hysterectomy).

-Usually appears yrs later when genital atrophy(wasting away)associated w/ aging occurs, but younger, multiparous, premenopausal woman may also be affected.
-S/S Pelvic Pressure, stress incontinence.

-Because the Cystocele causes the anterior vag wall to bulge downward, the pt may report pelvic pressure & urinary incontinence, freq, & urgency. Back/pelvic pain as well.

106

Medical Mgmt of Pelvic Organ Prolaps?
pg1659

-Kegel exercises, are more effective in the early stages of a cystocele. Squeeze Pubococcygeal Muscle-hold 10 secs. relax 10 secs, repeat 15x daily (Book states 30-80x daily).

-Pessary ring-doughnut shaped, made w/ various materials, such as rubber or plastic.

-RUBBER Pessaries MUST BE AVOIDED in woman w/ RUBBER ALLERGIES!!

-Pt should have pessary removed, examined/cleaned by health care provider at prescribed intervals. At these checkup vag. walls should be examined for pressure points or signs of irritation. There should be no pain/discomfort/discharge.

-Colpexin Sphere is another nonsurgical device used. This intravaginal device is similar to a pessary, but it supports the pelvic floor muscles & facilitates exercise of these muscles & is removed daily for cleaning.

107

What is Enterocele?

-Protrusion of the INTESTINAL Wall into the vagina. Prolaps results from a weakening of the support structures of the uterus itself; the cervix drops and may protrude from the vagina.

-If complete prolapse occurs, it may also be referred to as Procidentia(falling down of an organ from original position)

108

What is Phimosis?
pg1745

Condition where foreskin(prepuce)cannot be retracted over the glans in uncircumcised men.
Often develops in adults as inflammation, edema, & constriction form poor hygiene or underlying medical conditions such as diabetes.

109

What is the Tx for Phimosis?

Secondary to inflammation it the application of steroidal cream to the foreskin to soften & correct the narrowness, resulting in decreased constriction.

110

Causes of Pelvic Organ Prolapse For Woman?

-Age & parity(# of full term births)can put a strain on the ligaments & structures that make up the female pelvis/pelvic floor.

-Childbirth can result in tears of the levator sling musculature, resulting in structural weakness.
-Hormone deficiency also may play a role.

111

Therapeutic Interventions for Pelvic Organ Prolapse include?
per/pp

-Pessary
-Surgical Correction
-Suspension
-Hysterectomy
-Kegel Exercises
-Squeeze Pubococcygeal Muscle
-Hold 10secs
-Relax (10sec/book 57-4)
-Repeat 15x daily (30-80/book 57-4)

112

What are other names for Testes?

-Gonads
Self exam every mo
clinical exam yearly

113

What Questions should be asked when taking a Menstrual History?

-Menstrual hx,
-Meds
-Pain with menses/intercourse
-Vag discharge, odor/color/itching
-Urinary/bowel function
-Sex hx including sexual or physical abuse
-Hx of STDs, surgeries, procedures
-Chronic illness/disabilities that affect health
-Family & genetic hx

114

What Questions should be asked when taking a Sexual History? p/pp.

-Subjective/Objective data
-Ask permission to discuss issues
-Ask sexual preferences
-Ask pt to label herself as Married, single, or in a meaningful relationship to be less offensive.