Transcript Nursing Process: Care of the Patient With a Vulvovaginal

Chapter 47
Management of Patients With Female
Reproductive Disorders
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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.
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Vaginal Infections (See Table 47-1)
• Candidiasis
• Gardnerella
• Trichomonas vaginalis
• Bartholinitis
• Cervicitis
• Atrophic vaginitis
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Pathway for Spread of Microorganisms in
Pelvic Infections
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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
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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
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Nursing Process: Care of the Patient With
a Vulvovaginal Infection: Diagnosis
• Discomfort
• Anxiety
• Risk for infection or spread of infection
• Deficient knowledge
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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 selfcare and prevention of infection.
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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.
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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
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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.
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Nursing Process: Care of the Patient With
Genital Herpes: Assessment
• Health history
• Pelvic examination
• Assess for risk factors for STDs.
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Nursing Process: Care of the Patient With
Genital Herpes: Diagnosis
• Acute pain
• Risk for infection
• Risk for spread of infection
• Anxiety
• Deficient knowledge
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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.
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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
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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.
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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.
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Pelvic Floor Relaxation
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Complete Prolapse of the Uterus
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Uterine Fibroids or Myomas
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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
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Nursing Process: Care of the Patient
Undergoing a Hysterectomy: Assessment
• History
• Physical and pelvic exam
• Psychosocial and emotional responses
• Patient knowledge
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Nursing Process: Care of the Patient
Undergoing a Hysterectomy: Diagnosis
• Anxiety
• Disturbed body image
• Acute pain
• Deficient knowledge
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Collaborative Problems/Potential
Complications
• Hemorrhage
• DVT
• Bladder dysfunction
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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.
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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.
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Cancer of the Vulva
• 4% of gynecologic cancers; most often seen in
postmenopausal women
• Encourage regular pelvic exams, Pap smears, and selfexamination 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.
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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.
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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
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Radiation Therapy
• External radiation therapy
• Intraoperative radiation therapy
• Internal (intracavity irradiation)
• Care of the patient undergoing radiation therapy
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Placement of Tandem and Ovoids for
Internal Radiation Therapy
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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.
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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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