Pelvic inflammatory disease

Overview-Causes

Aerobic or anaerobic organisms (commonly, overgrowth of one or more of the bacterial species found in the cervical mucus) Diverticulitis of the sigmoid colon Infected drainage from a chronically infected fallopian tube Pelvic abscess Ruptured appendix Septicemia Sexually transmitted infections (STIs; Neisseria gonorrhoeae and Chlamydia trachomatis ) Use of intrauterine device

Nursing Considerations-Nursing Diagnoses

Acute pain Anxiety Ineffective coping Ineffective sexuality patterns Risk for imbalanced fluid volume Risk for infection

Treatment-For mild to moderate PID

Antibiotics, such as cefoxitin sodium or cefotetan IV plus doxycycline orally; clindamcin phosphate IV plus gentamicin IV Oral clindamycin hydrochloride or metronidazole plus doxycycline to treat pelvic abscess Ampicillin sodium and sulbactam sodium IV plus doxycycline or azithromycin plus metronidazole

Treatment-Medications

Antibiotics, such as cefoxitin sodium or cefotetan IV plus doxycycline orally; clindamcin phosphate IV plus gentamicin IV Oral clindamycin hydrochloride or metronidazole plus doxycycline to treat pelvic abscess Ampicillin sodium and sulbactam sodium IV plus doxycycline or azithromycin plus metronidazole

Treatment-For severe PID

Ceftriaxone sodium IM plus doxycycline or cefoxitin sodium with probenecid and doxycycline Cefotaxime sodium or ceftizoxime IM plus doxycycline Metronidazole for patients with Trichomonas vaginalis or recent history of uterine instrumentation Azithromycin as alternative agent to doxycycline Analgesics/antipyretics, such as acetaminophen or ibuprofen I.V. fluids as needed

Treatment-Activity

Bed rest

Diagnostic Test Results-Diagnostic Procedures

Culdocentesis obtains peritoneal fluid or pus for culture and sensitivity testing. Diagnostic laparoscopy identifies cul-de-sac fluid, tubal distention, and masses in a pelvic abscess.

Diagnostic Test Results-Laboratory

Culture and sensitivity and Gram stain of endocervix or cul-de-sac secretions show the causative agent. Urethral and rectal secretions show the causative agent. C-reactive protein and erythrocyte sedimentation rate are elevated. White blood cell count is elevated

Treatment-General

Frequent perineal care if vaginal discharge occurs

Overview

General term that refers to any acute, subacute, recurrent, or chronic infection of the oviducts and ovaries, with adjacent tissue involvement Includes inflammation of the cervix (cervicitis), uterus (endometritis), fallopian tubes (salpingitis), and ovaries (oophoritis) Possible extension of the inflammation to connective tissue lying between the broad ligaments (parametritis) Commonly called PID

Nursing Considerations-Nursing Interventions

Give prescribed antibiotics and analgesics. Initiate I.V. access and ensure patency if antibiotics are ordered I.V. Provide I.V. site care according to facility policy. Provide frequent perineal care. Use meticulous hand-washing technique. Encourage the patient to discuss her feelings related to her condition and sexuality; offer emotional support. Assist patient to position of pelvic dependence with head and feet elevated slightly. Help the patient develop effective coping strategies. Palpate the patient's abdomen for pain and tenderness; note any distention or rigidity; auscultate bowel sounds for changes. Inspect the patient's perineal pads for color and characteristics of drainage. Provide perineal care. Prepare the patient and her family for possible surgery if abscess develops or ruptures.

Treatment-Surgery

Laparoscopy for drainage of pelvic abscess, pelvic lavage or lysis of adhesions

Overview-Risk Factors

Multiple sex partners Sexual intercourse at a young age Conditions or procedures that alter or destroy cervical mucus Procedures that risk transfer of contaminated cervical mucus into the endometrial cavity by an instrument Infection during or after pregnancy Cigarette smoking Multiparity Douching Intercourse during menses Therapeutic abortion

Treatment-Diet

Nothing by mouth if surgery is planned

Nursing Considerations-Associated Nursing Procedures

Oral drug administration Pain management Postoperative care Preoperative care Preparing a patient for gynecologic surgery, OR Reportable diseases Temperature assessment Vaginal examination

Assessment-Physical Findings

Pain with cervical movement or adnexal palpation Unilaterally or bilaterally tender adnexal mass Profuse, purulent vaginal discharge Rebound tenderness, involuntary guarding (suggestive of peritonitis)

Assessment-History

Possibly asymptomatic Low-grade fever Malaise Lower abdominal pain, worsening with intercourse Irregular vaginal bleeding Nausea and vomiting Abnormal vaginal discharge Postcoital bleeding

Patient Teaching-Discharge Planning

Refer the patient to infertility counseling if indicated.

Overview-Incidence

The disorder affects women ages 15 to 24; about two-thirds of patients are older than 25. PID is rare after menopause. About 1 million women are treated for PID each year.

Diagnostic Test Results-Imaging

Transvaginal ultrasonography may show the presence of thickened, fluid-filled fallopian tubes. Computed tomography scan may show complex tubo-ovarian abscesses and is useful in diagnosing PID. Magnetic resonance imaging provides images of soft tissue; useful not only for establishing the diagnosis of PID but also for detecting other processes responsible for symptoms.

Overview-Complications

Tubo-ovarian abscess Septicemia (potentially fatal) Pulmonary embolism Infertility Chronic pelvic pain Peritonitis Shock Ectopic pregnancy Death

Overview-Pathophysiology

Various conditions, procedures, or instrumentation can alter or destroy the cervical mucus and cervicovaginal flora, which normally serve as protective barriers. Bacteria enter the vagina and cervix and ascend from the vagina and cervix and enter the uterine cavity, causing inflammation of various structures. Retrograde menstrual flow may help promote ascent of organisms. (See Distribution of adhesions in pelvic inflammatory disease.)

Nursing Considerations-Monitoring

Vital signs Hydration status and fluid balance Abdomen Pain Vaginal drainage

Patient Teaching-General

disorder, possible underlying causes, diagnosis, and treatment, including parenteral and oral antibiotic therapy and screening for STIs ways to prevent a recurrence, including safe sex practices, avoidance of multiple sexual partners, and use of barrier contraceptives. need for patient's sexual partner to be examined and treated for infection signs and symptoms of infection after a minor gynecologic procedure

Nursing Considerations-Expected Outcomes

express feelings of increased comfort identify strategies to reduce anxiety demonstrate adaptive coping behaviors express feelings about potential or actual changes in sexual activity maintain fluid balance remain free from signs or symptoms of infection.