Nursing Care of Clients With Reproductive Health Problems

7/25/2019 Nursing Care of Clients With Reproductive Health Problems

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NURSING CARE OFCLIENTS WITHREPRODUCTIVE

HEALTH PROBLEMSADULT WOMEN


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Mastitis

Infection of the breast usually caused by

Staphylococcus aureus

Risk factors: plugged ducts, untreated engorgement,

cracked nipples, missed feedings, excessive fatigue,

decreased resistance to infection

Common occurring in 5%!"% of breastfeeding

#omen

$ost common in rst month Recurrences occur in &%!'% of #omen and

commonly ()5%* leads to lactation cessation

Reference &, ++


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Mastitis History and

Physical Exam

ever, di-use myalgias, ./u0like1 symptoms, breastpain

2edge0shaped, tender, erythematous, usuallyunilateral

3pper, outer 4uadrant most common


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Mastitis Treatment

6 768 stop breastfeeding on the a-ected side,

empty the breast

If mild, symptoms occur for less than )+ hours and

may attempt to resolve #ith fre4uent nursing or

pumping and supportive measures including bed rest

/uids, analgesics

9ntibiotic options include dicloxicillin 5"" mg po 4id

cephalexin 5"" mg po 4id, or clindamycin ;"" mg po4id for !" to !+ days

6bserve carefully for signs of abscess formation

Reference !, )", ;'


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Endometriosis

Presence of endometrial tissue outside uterus (ectopic) Found on ovaries, ligaments, colon, sometimes lungs

Responds to cyclic hormonal variations Grows and secretes then degenerates, sheds and bleeds

What is the problem (Where does it go)

!lood irritating to tissues " inflammation and pain

Recurs w# e# cycle w# eventual fibrous tissue $auses adhesions and obstruction

%iagnosis confirmed w# laparoscopy


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Endometriosis

&nfertility results from 'dhesions pulling uterus out of normal position

!locage of fallopian tubes

chocolate cyst* develops on ovary Fibrous sac containing old brown blood

Primary manifestations %ysmenorrhea

+ore severe e# month

Painful intercourse if vagina and supporting ligaments affected

adhesions


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Endometriosis

$ause not established +igration of endometrial tissue up thru tubes to peritoneal cav

menstruation, development from embryonic tissue at other sitethru blood or lymph, transplantation during surgery ($sectionpossibilities

-reatment .ormonal suppression of endometrial tissue

/urgical removal of endometrial tissue

Pregnancy and lactation delay further damage and allevsymptoms


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Endometriosis


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Pelvic &nflammatory %isease (P&%

$ommon infection of reproductive tract Particularly fallopian tubes and ovaries

&ncludes0 $ervicitis (cervi1) Endometritis (uterus) /alpingitis (fallopian tubes) 2ophoritis (ovaries)

&nfection either cute or chronic /hortterm concerns0 peritonitis, pelvic abscess 3ongterm concerns0 infertility, high ris of ectopic preg


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P&%4Pathophysiology

5sually originates as vaginitis or cervicitis 2ften involves several causative bacteria

5terusfallopian tube Edema, fills w# purulent e1udate

2bstructs tube and restricts drainage into uterus E1udate drips out of fimbriae onto ovaries and surrounding tissue

Peritoneal membrane attempts to locali6e but peritonitis may develop 'bscesses may form7 lifethreatening $ause septic shoc

'dhesions affect tubes and ovaries 3ead to infertility and ectopic pregnancies


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P&%


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P&%4Etiology

'rise from se1ually transmitted diseases

Gonorrhea $hlamydiosis

Prior episodes of vaginitis or cervicitis precedes develop &nfection acute during or after menses

Endometrium more vulnerable

$an also result from &5% or other contaminated instrum $an perforate wall and lead to inflammation and infection


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P&%4/igns and /ymptoms

3ower abdominal pain (8stindication) /udden and severe or gradually increasing in intensit

-enderness during pelvic e1ams

Purulent discharge at cervi1

%ysuria

Fever and leuocytosis can occur %epends on causative organism


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P&%4-reatment

'ggressive antibiotics $efo1itin, do1ycycline

Recurrent infections common /e1 partners should be treated as well

Followup appt to ensure eradication


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!enign -umors0 2varian $ysts

9ariety of types

Follicular and corpus luteal cysts common %evelop unilaterally in both ruptured and unruptured follicles

5sually multiple fluidfilled sacs under serosa that cover +ay become large enough to cause discomfort, urinary

or menstrual irreg !leeding if ruptures

$ause even more serious inflammation Ris of torsion of the ovary

5ltrasound and laparoscopy to &% cyst


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2varian $ysts


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$9796R8I67


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8hreatened 9bortion

Conservative #ith bed rest and

reassurance till bleeding stops? Sexual intercourse best avoided?

ollo# up #ith 3@8R9S6370presence ofetal cardiac activity predicts good

outcome in '5%of cases? Aormone therapy 0+""mg natural

progesterone in )divided doses orally orvaginally on empirical basis?

9nti if mother is Rh negative and

re nanc is be ond !) #eeks?


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Inevitable 9bortion

Immediate evacuation of pregnancy?

(If duration of pregnancy less than !)#eeks0suction evacuation and greaterthan !) #eeks oxytocin infusion?*

Shock0resuscitation #ith iBv /uids and

blood transfusion? rophylactic antibodies and anti0?


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Click icon to add picture


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Suction abortion



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Incomplete 9bortion

Resuscitation if patient is in shock and

evacuation by suction evacuation? If the os is closed


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Complete abortion

Conservative

9nti not indicated if pregnancy is lessthan !) #eeks and there #as nooperative intervention?


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$issed 9bortion

3terus evacuated as soon as possible?

donor should be kept ready? If uterine siDe is less than !) #eeks of

gestation


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Septic 9bortion

olice notication if a criminal abortion

suspected? $ild cases0broad spectrum antibiotics a

started and uterus evacuated?

Severe cases0maintenance of perfusion

and ventilation? IBv infusion and CF line is inserted

>lood transfusion

6xygen given by nasal catheter?



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CF line

p

S ti 9b ti ( t *


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Septic 9bortion(contGG??*

9ntibiotics commenced after taking a

high vaginal s#ab? 9mpicillin,


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Recurrent $iscarriage

Due to cervical incometence

Management is be cervical cerclage if therea well documented history otherwise seriafollow up is done with transvaginalultrasound for early signs ofincompetence.Cervical cerclage is usuallydelayed upto 12-14 weeks so that

miscarriage due to other causes can beeliminated.

Sonography is done to conrm live fetus anif there is infection!it should be treated anse"ual intercourse should be avoided.

Contraindications-



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Cerclage


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atient is in lithotomy position and cervix isexposed #ith SimHs speculum?8he cervical lipsare held #ith sponge holding forceps and a purstring suture #ith a non absorbable material lik

black silk is taken all around the cervix?isadvantage suture may be belo# internal os

!?$conaldHs Cerclage



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$conaldHs cerclage


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Small transverse incision is made onanterior lip of cervix at cervicovaginalunction )cm above the external

os?>ladder is then pushed up and asuture of black silk or mersilene tapeis passed from anterior to posterioraspect submucosally using ShirodkarHsor any curve bodied needle?) ends of

the suture are pulled and tied

)?$odied ShirodkarHs cercla



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ShirodkarHs cerclage


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one in cases of repeated failure ofvaginal approach and cervix is inaccessibl

isadvantage0Caesarean section

In case of miscarry cerclage has to beremoved at laparotomy?

;?8ransabdominal cerclage

ost operative care


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ost operative care

>ed rest for +& hours

9ntibiotic cover 9void sexual intercourse

Cerclage is removed at ;J #eeks or atthe onset of labour ,if not it can result i

rupture uterus?

Ot!e" ca#e# o$ "ecu""ent mi#ca""ia%


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Ot!e" ca#e# o$ "ecu""ent mi#ca""ia%

Chromosomal abnormalities0karyotyping of bothparents and prenatal diagnosis in the nextpregnancy?

3terine factors0hysteroscopic resection in case ofseptum or division of the adhesion in 9shermanHssyndrome? $yomectomy in case of broid?

9@9 Syndrome0Combination of lo# dose aspirin

and lo# $2 heparin as soon as pregnancy isconrmed?9spirin preconceptionally?

Inherited thrombophilia0@o# dose aspirin andheparin?

Induced abortion


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Induced abortion

8A= $=IC9@ 8=R$I798I67 6 R=e it enacted by arliament in the 8#enty0second Kear of the Republic of India as follo#s :0

*' S!o"t title0 e1tent an2 commencement 3

8his 9ct may be called the $edical 8ermination of regnancy 9ct, !'J!?

It extends to the #hole of India except the State of Mammu and Nashmir? It shall come into force on such date as the Central


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(d* .registered medical practitioner1 means a medical practitioner #ho possesses anyrecogniDed medical 4ualication as dened in clause (h* of section ) of the Indian $edicalCouncil 9ct, !'5E, (!") of !'5E*, #hose name has been entered in a State $edical Register an

#ho has such experience or training in gynaecology and obstetrics as may be prescribed byrules made under this 9ct?

Place where pregnancy may be terminated - :o termination of pregnancy shall be made in accordance with this

any place other than

a hospital established or maintained by Government, or

a place for the time being approved for the purpose of this 'ct by Government;


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Premenstrual Syndrome (PMS)

A cluster of symptoms that regularly occur several dprior to onset of menstruation

More frequently in thirties and forties


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Etiology

Cause is not clearly understood Attributable to water retention, estrogen progester

imbalance, psychological factors or dietary deficien


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Signs and Symptoms

Irritability Sleeplessness

Fatigue

epression

!eadaches

"ertigo

Abdominal bloating or weight gain


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Diagnostic Procedures

#eep a $ournal recording %valuation of estrogen and progesterone levels

&lood tests to rule out anemia


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Treatment

A reduction of salt inta'e for ( wee's prior to mensminimi)e water retention

Avoid coffee, nicotine, and alcohol

*roper diet and e+ercise and rest

eduction of stress and rela+ation techniques


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Prognosis

"ariable


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Prevention

-o 'nown prevention


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Endometriosis

Appearance and growth of endometrial tissue in areoutside endometrium, the uterine cavity.s lining

Misplaced endometrial tisse in pelvic area


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Etiology

Cause is not 'nown


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Signs and Symptoms

ysmenorrhea occurs, with pain in lower bac' and

d


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/aparoscopy

T


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Treatment

!ormone therapy Surgery to include uterus, cervi+, ovaries, and fallop

tubes

P i


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Prognosis

"aries *rimary complication is infertility

P i


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Prevention

0se sanitary nap'ins rather than tampons

P l i I fl t Di


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Pelvic Inflammatory Disease

Acute, or subacute, or a recurrent or chronic infectiofallopian tubes, ovaries, and ad$acent tissues


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Eti l


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Etiology

*arturition

Infections from -1 gonorrhoeae, C1 trachomatis,

*seudomonas, and %1 coli

Iatrogenic

Coni)ation Most common in young nulliparous women

Signs and Symptoms


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Signs and Symptoms

Sudden pelvic pain

*urulent and foul2smelling vaginal discharge

Fever

Se+ual dysfunction



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0ltrasonography used to identify a uterine mass

Treatment


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Treatment

Antibiotics

Surgery may be necessary to prevent septicemia

Prognosis


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Prognosis

3ood when treated early

Menopause


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Menopause

4he cessation of menses and ovarian function

ecrease in estrogen levels

-ot a disease

Etiology


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Etiology

5ccurs naturally in women between ages 67 and 87

Signs and Symptoms


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Signs and Symptoms

Menstrual irregularities

ecrease in flow

!ot flashes

-ight sweats

4achycardia /oss of elasticity in s'in

eduction in si)e and firmness of breast



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&lood serum levels chec'ed for increased productiofollicle2stimulating hormone 9FS!: and luteini)ing

hormone 9/!:

Treatment


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Treatment

!ormonal replacement therapy if needed

Prognosis


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Prognosis

3ood

Prevention


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Prevention

Cannot be prevented but emotional swings occur


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3terine rolapse

repared by: Cheng Chan $ara

enition


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Ute"ine P"ola#e is the do#n#arddisplacement of the uterus into the vaginal canaor a gradually descends of the uterus in the axisof the vagina taking the vaginal #all #ith it?

enition


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3sually prolapse is rated by degrees:


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3sually, prolapse is rated by degrees:

irst0degree prolapse: the cervix rests in the

lo#er part of the vagina? Second0degree prolapse: the cervix is at the

vaginal opening?

8hird0degrees prolapse: the uterus protrudesthrough the introitus?

irst degree prolapse


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g p p

Second degree prolapse


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g p p

8hird degree prolapse


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g p p

=tiology


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Stretching of muscle and brous tissue?eg? regnancy and childbirth?

Increased intra0abdominal pressure as a resultof chronic coughing, lifting of heavy obectsand obesity, place pressure on the pelvic /oor?

9 constitutional predisposition to stretching of

the ligaments as a response presumably toyears in the erect position?

$enopause and ageing increase the risk ofprolapse? (The female hormone estrogen playsan important role in maintaining the strengthof the pelvic oor).

gy


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Clinical $anifestation


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eeling like you are sitting on a small ball

iOcult or painful sexual intercourse

re4uent urination or a sudden urge to emptythe bladder

@o# backache

3terus and cervix that stick out through the

vaginal opening Repeated bladder infections

eeling of heaviness or pulling in the pelvis

Faginal bleeding

Increased vaginal discharge

8reatment


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Va%inal e##a"78

8his device ts inside your vagina and holds youterus in place? 3sed as temporary or permanenttreatment, vaginal pessaries come in many shapeand siDes?


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8reatment (cont?*


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Su"%e"78Several di-erent types of surgery can be used

to treat a severe genital prolapse? 8heseprocedures include:

< surgery to repair the tissue that supports theprolapsed organ

< surgery to repair the tissue around the vagina< surgery to close the opening of the vagina

< surgery to remove the #omb (hysterectomy*

Collaborative Care


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preventive measures:

=arly visits to AC provider P early detection

8each NegelHs exercises during period

preoperative nursing care:

8horough explanation of procedure, expectation and e-ect on future

@axative and cleansing edema (rectocele* independently, at home procedure

erineal shave prescribed also

@ithotomy position for surgery

postop nursing care: t? is to void fe# hours after surgery catheter if unable (after E hrs*

Infections of the FemaleReproductive TractInfections of the FemaleReproductive Tract

/imple vaginitis


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+osby items and derived items ? @A88, @AAB by +osby, &nc;, an affiliate of Elsevier &nc;

/imple vaginitis

Etiology#pathophysiology

$ommon vaginal infection

$ausative organisms0 E. coli7 staphylococcal7 streptococcal7 T

albicans7 Gardnerella

$linical manifestations#assessment

&nflammation of the vagina

Cellow, white, or grayish white, curdlie discharge

Pruritus and vaginal burning

/imple vaginitis (continued)



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/imple vaginitis (continued)

+edical management#nursing interventions

%ouching

9aginal suppositories, ointments, and creams 2rganismspecific

/it6 baths

'bstain from se1ual intercourse during treatment

-reat partner if necessary

$ervicitis



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$ervicitis


&nfection of the cervi1


!acache

Whitish e1udate

+enstrual irregularities


9aginal suppositories, ointments, and creams7organismspecific

9aginal fistula

Disorders of the FemaleReproductive SystemDisorders of the FemaleReproductive System


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9aginal fistula


'bnormal opening between the vagina and another organ


5rine and#or feces being e1pelled from vagina


2ral or parenteral antibiotics

%iet0 high protein7 increase vitamin $

/urgery0 Repair fistula7 urinary or fecal diversion

Figure 1-1!Figure 1-1!


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-ypes of fistulas that may develop in the vagina and uterus;

(From .erbst, ';3;, et al; 8==HI; $omprehensive gynecology; > rded;I; /t; 3ouis0 +osby;)

$ystocele and rectocele



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$ystocele and rectocele


$ystocele %isplacement of the bladder into the vagina

Rectocele Rectum moves toward posterior vaginal wall

Figure 1-1Figure 1-1


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"#$ystocele; $#Rectocele;

(From 3ewis, /;+;, .eitemper, +;+;, %irsen, /;R; @AABI; Medical-surgical nursing: assessment and

management of clinical problems.Bthed;I; /t; 3ouis0 +osby;)

$ystocele and rectocele (continued)



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y ( )


$ystocele 5rinary urgency, freJuency, and incontinence7 pelvic pressure

Rectocele $onstipation7 rectal pressure7 hemorrhoids


/urgical repair

'nteroposterior colporrhaphy7 bladder suspension

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Nursing Care of Clients With Reproductive Health Problems