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1

Normal Vaginal Secretions

They are normal

Clear to mlky white in color 

little to no odor

no itching ir irritation.

2

Pathophysiology of Vulvovaginal infections

Common problem

Vagina is normally protected by maintained acid PH, - lactobacillus acidophilus

Vaginal epithelium is responsive to estrogen, which induces glycogen formation, which breaks down into lactic acid: therefore decreased estrogen deceases acid production.

With perimenopause and menopause, decreased estrogen is related to more susceptibla to vaginal and labial atrophy and tissue is more susceptiable to infection.

3

Candidiasis 

 

Fungus - yeast 

 

4

Candidiasis fungus infections 

Risk Factors

 

use of antibiotics

diabetes 

HIV

5

Candidiasis fungus infections 

S/S

DX

Treatment

Itching, White - cottage cheese like appearance. 

 

Microscope exam to DX. 

Treatment: is fluconazole PO or miconazole vaginally.

 

6

Vulvovaginal Infection

Gardnerella 

AKA bacterial vaginosis - normal flora but overgrown d/t absence of lactobacilli.

7

Vulvovaginal Infection

Gardnerella 

Risk factors 

S/S 

DX

treatment

 

RF: douching, smoking, mulitple sex partners. 

S/S: can be asymptomatic, discharge grey yellowish white color fishlike odor more noticeable after intercourse. 

DX: Whiff test - slide with drop of potassium hydroxide. 

Treatment: Metronidazole treatment

8

Vulvovaginal Infection

Trichomonas vaginalis 

Flagellated protozoan causes this STI, Aka Trich. 

Usually asymptomatic.

9

Vulvovaginal Infection

Trichomonas vaginalis 

RF

S/S

Treatment

RF: Increases risk of contracting HIV,

S/S Thin Frothy, yellow to yellow-green, malodorous discharge causes burning and itching. 

DX: Microscopic exam reveals motile oragnisms. 

10

Risk Factors for Vulvovaginal Infections

Premenarche, perimenopause, menopause, low estrogen levels. 

Pregnancy or oral contraceptives

poor hygiene

tight garments and synthetic clothing

freq douching

antibiotics

Allergies, diabetes, intercouse with an infected partner, oral gential contact, HIV.

11

Assessment of patient with vulvovaginal infection

- exam as soon as possible after onset of symptoms. 

- instruct pt not to douche b4 assessment.

- Pt HX: - Physical and chemical factors

-psychogenic factors

-medical conditiond

-use of medications

-sexual activity and hx.

12

Nursing Dx - Vulvovaginal Infection

- Impaired comfort related to burning, odor, or itching from the infectious process. 

- Anxiety related to stressful symptoms

- Risk for infection or spread of infection- should refain from sexual activity till after treatment for both partners if trichomonas infection. 

- Deficient knowledge about proper hygiene  and preventive measures. 

13

Goals for patient with vulvovaginal infection

Goals: - Relief of impairment comfort

- reduction of anxienty related to symptoms

- prevention of reinfection of sexual partner. 

- Acquisition of knowledge about methods for preventing vulvovaginal infections and managing self-care.

14

Interventions for patient with vulvovaginal infection. 

- Sitz baths help relieve discomfort. 

- Explanation of 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. 

- PT edu includes: Handwashing, proper hygiene, preventive strategies, measures to reduce risk, information regarding medications and information regarding self-exam.

15

education for patient with vulvovaginal infection. 

- Treatment in indicated may include sexual partner. 

- Instruct pt to wear loose fitting cloths and loose fitting cotton underwear. 

- abstain from sexual intercourse until treatment is completed. 

-Avoid irritation to vaginal tissue and tight clothing.

-sitz baths to decrease irritation. 

- Topical cortisone cream to vulve. 

- Edu pt on medication admin (suppository applicators.) 

16

Genital Viral Infections

HPV 

Herpes type 2 infection (herpes genitalis)

17

HPV - The most common sexually transmitted disease among sexually active young people.

 

***ASSOCIATED WITH CERVIAL DYSPLASIA AND CERVICAL CANCER: NEED ANNUAL PAP SMEARS.

18

Treatment of HPV.

- Exteral gential warts: topical applications or surgical removal. 

- Prevention

Vaccine boys and girls at age 11 or 12 years old. 

Cervical screening as recommended.

Infections often disappears as the results of an effective immune system response. 

19

Herpes type 2 infections (herpes genitalis) 

A recurrent lifelong viral infection

***AN STD THAT ALSO MAY BE TRANSMITTED BY CONTACT AND THAT MAY BE TRANSMITTED WHEN THE CARRIER IS ASYMPTOMTIC.

A causes painful itching and buring herpetic lesions. 

20

Treatment of HSV-2

No cure 

Antiviral agents (acyclovir), valacyclovir, and famciclovir can supress symptoms.

- recurrance may be associated with stress, sunburn, dental work, inadequate rest, and inadequate nutrition. 

- Risk for infants delivered vaginally to become infected; therefore, C-Section delievery may be performed. 

21

Pelvic Inflammatory Diease (PID)

- inflammatory condition of the pelvic cavity that may begin w/ cervicitis and involve the uterus (endometritis), fallopian tubes (salpingitis), ovasies (oophoritis), pelvis peritoneum, or pelvic vascular system. 

- Gonorrheal and chlamydial organisms are common causes, but most cases are associated with more than one organism. 

-Short and long term consequences can occur. 

22

PID Nursing Assessment 

- Vaginal Discharge 

- Dyspareunia - painful intercourse

- Low abd pelvic pain, and tenderness that occurs after menses that may increase with voiding or with defecation. 

- Other symptoms : Fever, general malaise, anorexia, nausea, headache, and possible vomiting. 

-Pelvic Exam - intense tenderness may be noted on palpation of the uterus or movement of the cervix (cervical motion tenderness).

23

PID : Treatment

- Broad - spectrum antibiotics.

- Treat sexual partner to prevent reinfection.

- Analgesics for pain and relief.

- Adequate rest and nutrition. 

- Pt education: How to prevent reinfection.

24

HIV and AIDS 

- 25% living with HIV are women

- Counseled about safer sex and informed about the dangers of unprotected sex. 

- BC there is a risk of perinatal transmission, decisions to conceive or to use contraception, must be based on education, accurate information, and care. 

- Prgenant women are advised to have an HIV test. The use of antiretroviral agents by pregnant women significantly decreases perinatel transmission of HIV infection. 

25

Structural Disorders

- Fistulas of the vagina abnormal opening between two internal hollow organs or between internal hollow organ and the exterior of the body-often require surgical repair. 

- Pelvic organ prolapse: Cytocell, Rectocele, Enterocele.

*All can cause dyspareunia*

- Treatment: Surgical, Medical - Pessaries, pelvic floor muscle training. 

26

Structural Disorders: Nursing Management 

- Implementing preventive measures

- per/post operative care

- Promoting home and community-based care. 

27

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Cystocele - damaged to anterior vaginal wall, surgical correction called anterior colporrhaphy.

- Risk Factors are from damage to vaginal support d/t injury and strain during childbirth. usually appears later when gential atrophy occurs associated with aging but young mulitparous, premenopausal women may be affected. 

28

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Rectocele damage to posterior vaginal wall, surgical correction - posterior colporrhaphy.

- Risk factors are from muscle tears below the vagina may effect muscles and tissues of pelvic floor which may occur during childbirth. 

29

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Enterocele a protrusion of intestinal wall into vaginal, from weakening of support structures of the uterus itself. This can lead to prolapsed uterus through vagina. 

30

Symptoms of Cystocele:

Pelvic pressure, urinary problems - incontinence, frequency and urgency, back pain. 

31

Symptoms of Rectocele: 

Constipation, uncontrolled gas, fecal incontinence. 

32

Symptoms of prolapse

Prolapse, pressure and ulceration, bleeding. 

 All can cause dyspareunia.

33

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Complete prolapse of the uterus. 

34

Nursing interventions for symptoms of csytocele, rectocele, prolapse. 

Kegal excercise - contracting vaginal muscles to strengthen weakened muscles - more effective if done in eariler stages. Recommended for all women even without weakened pelvic floor. These are advised for pregnant and postpartum women. 

35

Benign Disorders

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36

Endometriosis Pharmacotherapy 

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37

Malignant disorders of the female reproductive tract.

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38

Treatment of Reproductive Malignancies.

- Surgury, 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.

39

Hysterectomy

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40

Assessment of the pt undergoing a Hysterectomy.

- Pt HX.

- Physical and pelvic exam 

-Psychosocial and emotional responses

-Pt knowledge

41

Nursing DX of pt with Hysterectomy

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42

Collaborative problems and potential complications of a hysterectomy. 

- Hemorrhage

- DVT

- Bladder dysfunction

- Infection

43

Goals of a pt undergoing a hysterectomy

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44

Of a pt undergoing a hysterectomy.

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45

Complications of Hysterectomy

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46

Radiation Therapy

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47

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Placement of Tandem and Ovoids for Internal Radiation Therapy

48

Nursing Considerations related to intracavity Radiation Therapy

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49

Safety (Intracavity Radiation)

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50

Breast Assessment

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51

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52

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Lymph Nodes

53

Diagnostic Assessment

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54

Surgical Biopsy

- Excisional Biopsy

- Incisional Biopsy 

- Wire needle localization

 

55

Nursing Management Surgical Biopsy

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56

Benign conditions of the Breast

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57

Malignant Conditions of the Breast

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58

Breast Cancer 

 

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59

Risk Factors for Breast Cancer

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60

Guidlelines for Early Detection of Breast Cancer

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61

Assessment for Breast Caner

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62

DX Breast Cancer

- Staging

-Prognosis 

Tumor size

Spread to lymph nodes?

Certein Genes (ERBB2)

 

63

Surgical Management: BC 

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64

NP: Assessment of a pt undergoing BC sx.

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65

Preop DX:

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66

NP: Postop DX

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67

Collaborative Problems and Potential Complications

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NP: Planning

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69

Preop Nursing Interventions

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70

Postop Nursing Intervention

- Relieve pain and discomfort

-Inform pt regarding common post op sensetions.

-maintain privacy

-bra with breast form

-profvide information about home plan of care

-support coping and adjustment - counseling anf referral 

-Monitor of potentional complications

-

71

Potential post op complications

***Lymphedema***

hematoma or serome, infection

 

72

***Nursing management*** for post op edema 

position arm on op side on a pillow slightly elevated.

encourage hand activity on effected side (squeeze ball) 

Use effected arm for reaching , brushing hair

Do arm exercise dail 4-6 weeks (wall climbing and rope pulling sewinging)

73

***Lymphedema***

complication of chronic sweeling of an extremity due to interrupted lymphatic circulation. Common after axillary lymph node dissection. 

74

***edu pt self care***

 

Pt are taught arm exercises on the affected side

to perform 3X day for 20 minutes at a time until full range of motion is restored (usally 4-6 wks) 

75

*** once lymphedema develops it tends to 

be chronic, so prevention is life long.

 

- Wear gloves for grandening 

maintain cuticles by pushing them back do not cut

use electric razor when saving arm pits

avoid lifting onjects more than 5-10 lbs

takes abput 4 weeks for collareral circulation to form- draining the area. 

 

76

***POst op D/C teaching***

arrange for reach for recovery to visit

have MD discuss with the patient reconstructince options

discuss the grief process with the pt and family.

77

***TRAM***

Transverse rectus abdominal myocutaneous flap.

 

autologous reconstructions of breast using pt tissue to creast breast mound.

Donor sites may include abdominal muscle, buttocks muscle or back muscle. 

A breast mound is creasted by tunnelin gabdominal skin , fat, and muscle to the mastectomy site. 

78

nonsurgical management of breast CA

radiation therapy

chemo

hormonal therapry

targeted therapry

79

*** Gynecomastia ***

 

Know how to spell

normal is adolescent males, benign, and resolves

can be painful

feminizing testicular tumors, infection, cirrhosis. 

certain meds can cause

ETOH use can cause. 

Surgical removal is avaiable. 

80

**Male reporductive - gerontologic considerations**

-Prostate enlarges and prostate secreations decrease

-Scrotum hang lower , pubic hair becomes sparse and stiff

-***Testes decrease in weight, atrophy and aoften, Decrease in testosterone and progesterone levels

-decrease in sexual function and libido, longer time till arousal.

-*** Men maintain reproductive capacity as spermatogenesis continues, decreased sperm production.

 

81

Male assessment 

urinary function and symptoms 

Sexual functions and manifestations of sexual dsyfunction

- inabilaty to achieve or maintain and erection.

***- has both psychologic and organic causes***

82

Male phyiscal assessment 

- digital rectal exam - to screen