Chapter 6
Duct ectasis
And information of the ducks behind the nipple, commonly occurs during or near the onset of menopause and is not associated with malignancy. The condition typically occurs in women who are born in nurse children. It increased results because of an increase in maternal glandular secretion with the resulting production of an irritating lipid fluid that can produce nipple discharge. This is characterized by thick, sticky nipple discharge and by burning pain, pruritus, and inflammation Nipple retraction may also be noted, especially in postmenopausal women. Treatment is conservative with drug therapy aimed at symptomatic relief. The major central decks of the breast occasionally have to be excised.
Nursing Plan and Implementation
As provide the woman with information to help her recognize the signs of UTI, so she can contact her caregiver as soon as possible. Discuss hygiene practices, the managers of wearing cotton underwear, and I need to void frequently to prevent urinary stasis. Stress the importance of maintaining good food intake also reinforce instructions and answer any questions the woman may have. UTIs usually respond quickly to treatment but follow clinical evaluation and urine cultures are important.
Care of the Woman with PID
A clinical syndrome of inflammatory disorders of the upper female genital tract that includes any combination of endometriosis, salpingitis, tube- ovarian abscess, pelvic abscess, and pelvic peritonitis. The disease is more common in women who have had multiple sexual partners, a history of PID, early onset of sexual activity, or recent insertion of an IUD, and a woman who dishes regularly. The greatest problem of PID is post infection to build damage, which is closely associated with infertility. Symptoms of PID include bilateral sharp, cramping pain in the lower quadrant, fever greater than 101, chills, pregnant vaginal discharge, irregular bleeding, malaise, nausea, and vomiting. However, it is also possible to be asymptomatic and have normal laboratory values. physical examination usually reveals direct abdominal tenderness with palpation, adnexal tenderness, and cervical and uterine tenderness with movement. A palpable mass is evaluated with ultrasound. Laparoscopic may be used to confirm the diagnosis and to enable the examiner to obtain cultures from the fimbraited ends of the fallopian tubes. The main treatment is multiple different antibiotics the treatment can either be done in an outpatient facility or they can be hospitalized that's based in the clinical judgment and severity of symptoms. If the woman has an ID, it is generally removed 24 to 48 hours after antibiotic therapy is started.
Fibroadenoma
A common benign tumor seen in women in their teens and early 20s. It has not been significantly associated with breast cancer. These are free movable, solid tumors that are well defined, sharply delineated, and rounded, with a rubbery texture. Ultrasound is the best method for imaging women under the age of 30 with a palpable mass because of the density of the breast tissue. Surgical removal may be recommended recommended if any findings from the clinical breast examination, ultrasound, or biopsy are abnormal
Care of the Women with Endometriosis
A condition characterized by the presence of endometrial tissue outside the uterine cavity. Endometriosis has been found almost everywhere in the body, including the vagina, lungs, cervix, central nervous system, G.I. tract. The most common location, however is the pelvic cavity. Endometrial tissue bleeds cycling in response to the hormone hormonal changes of the menstrual cycle. The bleeding results and inflammation, scarring of the peritoneum, information of adhesions. Endometriosis may occur at any age after puberty, although it is most common in women between ages of 20 and 45. Most common symptoms of endometriosis is pelvic pain, which is often dollar cramping. Because the pain is usually related to menstruation that women typically assume it is dysmenorrhea. Dyspareunia (painful intercourse) and abnormal uterine bleeding are other common signs. The condition is often diagnosed when the woman seeks evaluation for infertility. Endometriosis has no permanent cure. Treatment may be medical, surgical, or a combination of the two. And women with mental disease and symptoms, treatment includes observation, analgesics, and nonsteroidal anti-inflammatory drugs. The mirena intrauterine system has also been used. If they can cervical mucus in results and atrophy of the endometrium. Pain scores for pelvic pain and dysmenorrhea show incident show significant improvement in many women. It has fewer side effects than oral progestins and last five years. And more advanced pain cases, surgery may be done to remove endometrial implants and break up adhesions. In advance cases in which child bearing is known issue, treatment may be a hysterectomy with removal of fallopian tubes and ovaries.
Care of the Woman with Pelvic Relaxation
A cystocele is the downward displacement of the bladder, which appears as a bulge in the interventional wall. Genetic. Disposition, childbearing, obesity, increased age or factors that may contribute. Symptoms of stress urinary incontinence are most common. Including loss of urine with coughing, sneezing, laughing, or sudden exertion. Vaginal fullness is, a bulging out of it vaginal wall or a dragon sensation may also be noticeable. If a pelvic relaxation is mild, Kegel read exercises are helpful in restoring tone. The exercises involve contraction and relaxation of the pubococcygeal muscle. Estrogen the condition of vaginal mucous membranes, especially in menopause women. Duloxetine, a balanced serotonin on every definitely a take inhibitor used to treat major depressive disorder in the painter fibromyalgia or diabetic neuropathy, is the only medication trying to help decrease SUI. Although approved for treatment of SUI and European Union is not approved for that purpose in the United States, and it administration would be an off label use. surgery may be considered if it's considered moderate to severe. A rectocele May develop when the posterior vaginal wall is weekend. Anterior wall of the rectum and then sagging forward, ballooning into the vagina, pushing the weekend posterior wall of the vagina in front of it. To defecate, a woman with may find it necessary to press the tissue between the vagina and rectum, which elevates the rectocele. Diagnosis is based on history and physical examination. Uterine Prolapse occurs when the uterus protrudes downward into the upper vagina, pulling the vagina with it. In severe cases the uterus may prolapse below the vaginal introitus. The woman may report a dragging sensation in her groin and backache over the sacrum which is caused by pulling of the uterus sacred ligaments. The symptoms are you usually relieved when the woman lies down. Surgery for your in prolapse often involves hysterectomy and repair of the pull ups vaginal walls.
Vulvovaginal candidiasis
Also called a yeast infection is one of the most common forms of vaginitis that women experience. Factors that contribute to the occurrence of this infection or the use of oral contraceptives, you know suppressant, and antibiotics, which destroy populations of normal bacteria that usually keep the yeast cells in check. Other factors are frequent douching, pregnancy, diabetes. Women with these infection often complaint of thick, curdy vaginal discharge, severe itching, dysuria, and dyspareunia. A male sexual partner may experience a rash or excoriation of the skin of the penis and possibly pruritus. Diagnosis is confirmed by microscopic examination of vaginal discharge; other diagnoses test including a probe and culture, although cultures are not used for routine diagnosis. The pH of the vagina remains 4.8 4.5 or less. This vaginal pH level is in contrast to the pH noted with BV or trich. Medics treatment of VVC includes intravaginal clotrimazole or miconazole cream or suppository, which are available over the counter. Women who continue to have symptoms after using over the counter preparation and women who have recurrence of symptoms within two months should be evaluated during an office visit because inappropriate use of OTC preparation can lead to delay in treatment If a woman experiences recurrent BBC she should be tested for an elevated blood glucose level to determine whether diabetic or pre-diabetic condition is present.
Condylomata acuminata
Also called genital warts is a commonly sexually transmitted condition caused by HPV. Transmission can occur through vaginal, oral, or anal sex. The infection has received considerable attention because HPV is almost always the cause of cervical cancer. A woman sex medical care after noticing single or multiple soft, grayish paint, cauliflower like lesions in her genital area. The most, warm environment of the genital area is conductive to the growth of the words, which may be present on the vulva, vagina, cervix, in the anus. The incubation period following exposure is three weeks to three years with the average being about three months. Provider administered therapies include Chiro therapy with liquid nitrogen or Cyroprobe; TCA; BCA; surgical removal by tangential genital scissor excision, shave excision, electrocautery. Three HPV vaccines are now available against herpes simplex virus types 16 and 18 which cause 66% of cervical cancer's. Women who have received the vaccine should receive regular Pap smears as recommended. Sex partners of infected females are probably also infected but do not require treatment unless large lesions are present. The use of male or female condoms may reduce the risk of transmitting the virus to an uninfected partner
Nursing Plan and Implementation
Be available to explain the condition, it's symptoms, treatment alternatives, and prognosis. Help the woman evaluate treatment options and make appropriate choices. Make sure the woman knows any side effects or any warning signs for any medication's that she may take. A woman with endometriosis is often advised not to delay pregnancy because the increased risk of infertility.
Nursing Assessment and Diagnosis
Be aware of the common symptoms of endometriosis and elicit accurate history if a woman mentions the symptoms. If a woman is being treated for endometriosis, assess the woman's understanding of the condition, it's implications, and the treatment alternatives. ND: Pain, Acute, related to peritoneal irritation secondary to Endometriosis Coping: Family, Compromised, related to depression secondary to infertility
Fibrocystic breast changes
Benign breast disease BBD commonly called fibrocystic breast changes, is the most common of the benign breast disorders. Fibrosis is a thickening of the normal breast tissue. This formation that may accompany fibrosis is considered a later change in the condition. Generally fibrocystic breast changes are not a risk factor for breast cancer. The women with fibercystic breast changes often reports pain, tenderness, and swelling that occur Saikaly in our most pronounce just performances. Physical examination may reveal only mild signs of irregularity, or the breast may feel dense, with areas of irregularity in nodularity. Some women may also have expressed nipple discharge. A cyst may be more differentiated from a malignancy because assist is Moore mobile Antenor, whereas cancer may be fixed and may be associated with skin retraction in the surrounding tissue. Mammography, sonography, magnetic resonance imagery, palpitation , and fine needle aspiration maybe used to confirm fibrocystic breast changes and will rule out malignancy Woman with mild symptoms may benefit from restricting sodium intake and taking a mile diarrhetic during the week before the onset of menses. This counteracts fluid retention, relieves pressure in the breast, and helps decrease the pain. Some richer researchers suggest that methylxanthines ( found caffeine products, such as coffee, tea, colas, and chocolate and some medications) May contribute to the development of a fibrocystic breast changes and that the limiting intake of these substances will have decrease fibrocystic changes
Care of the woman with a abnormal finding during pelvic examination
Cervical cancer is now considered a percent preventable disease because it is slow growing, has a lengthy pre-invasive state, and has an expensive and readily available screening programs, and has effective treatment approaches for pre-invasive lesions. Early detection of abnormalities allows changes to be treated before cells reach the pre-cancerous or cancerous stage. Notification of an abnormal Pap smear usually causes is 80 for women, so it is important that she be told in a caring way. The woman needs accurate, complete information about the meaning of the results in the next steps to be taken. Colposcopy The direct detail the visualization and examination of the cervix, has become an appropriate second step in many cases of abnormal pap results, examination, done in an officer clinic, permits more detailed visualization of the service in bright light, using high power microscope the cervix to be visualized directly in again following application of acetic acid. The acid causes abnormal epithelium to assume a characteristic white appearance. Endocervical curettage May also be done at this time to evaluate for extension into the cervical canal. This involves scraping the endocervix from the internal Aussie eggs are lost obtain endocervical cells for testing. Histologic evaluation of tissue biopsies and ECC samples is necessary for a definitive diagnosis. Loop electrosurgical excision procedure can be used to treat cervical, vaginal, and vulvar intraepithelial neoplasia. When abnormal Pap smear and colposcopic evaluation indicate a pre-malignant lesion, a small electrically hot wire loop can be used to excess the entire lesion, Squier you look lumbar Junction, and transfer motion zone. This procedure can be performed an outpatient basis, often in a gynecological office, under local anesthesia. Women who have had an LEEP procedure and subsequently become pregnant have a slightly increased risk of preterm birth.
Lower UTI
Cystitis, or inflammation of the bladder, usually occurs secondary to an ascending infection. E. coli is president in the majority of cases. When is the status develops, the initial symptoms often dysuria, specifically at the end of urination. Urgency and frequency also occur. Societies is usually accompanied by Lil gray fever 101 or lower, and hematuria is occasionally seen. Diagnosis is made from a urine culture. Treatment depends on the causative organism. Nitrofurantoin has reemerged has an effective first line treatment and is given twice daily for five days.
Intraductal papilloma
Most often occurring during the menopausal years, or tumors growing in the terminal portion of the duct or, sometimes, throughout the duct system within a section of the breast. Symptoms may include a unilateral mass or a spontaneous, and often bloody nipple discharge The majority of papillomas are present as solitary nodules. The small, ball leg lesions may be detected on mammography better often on palpable. They are typically benign but are generally excised to rule out the possibility of cancer.
Evaluation
Outcomes: - The woman is able to discuss her fears, concerns, and questions during the period of diagnosis. - The diagnosis is made quickly and accurately, and treatment is initiated if indicated.
Nursing Plan and Implementation
You can play a vital role in helping to prevent or detect PID accordingly spend time discussing respect is related to this infection. The woman who uses an IUD for contraception and multiple sexual partners need to be understand clearly the rest she bases. Discussed signs and symptoms of PID and stress the importance of early detection. Cancel the woman who develops PID on the importance of completing her antibiotic treatment and of returning for a follow up evaluation. She should also understand the possibility of decreased fertility following the infection.
Care of the woman with an UTI
Defined as significant bacterium in the presence of symptoms car is one of the most common problems with an experience. I Teri usually enter the year in a truck by the Reuther. Organisms are capable of migrating against the downward flow of urine. The shortness of the female urethra facilitates the passage of bacteria into the bladder. Wiping from back to front of urination may transfer bacteria from the rectal area to the urethra Voluntary suppression the desire to urinate appreciate disposing three, retention over distance the bladder and can lead to an infection. Sexual activity is a strong risk factor for UTI. General poor health or lowered resistance to infection can increase a woman susceptibility to UTI Asymptomatic bacteriuria ASB is a condition that becomes significant if a woman is pregnant because if untreated ASP can lead to polynephritis in a pregnant woman and low birth weight and the newborn. ASB is always caused by E. coli. A woman who has had a UTI susceptible to recurrent infection. If a pregnant woman develops an acute UTI, especially with high temperature, amniotic fluid infection may develop and retard the growth of the placenta.
Nursing Assessment and Diagnosis
During the clients visit, obtain a sexual and then medical history to identify whether the woman is at risk for UTI. A clean catch urine specimen is evaluated for evidence of ASB. ND: Pain, acute, related to dysuria, system of discomfort, or a renal pain secondary to upper UTI Siri are related to the possible long-term effects of the disease
Nursing Assessment and Diagnosis
During the period of diagnosis of any breast disorder, the woman may be anxious about a possible change in body image or diagnosis of cancer. Use therapeutic communication to assess the significance the woman places on her breast; her current emotional status, coping mechanisms during periods of stress, and knowledge of beliefs about cancer; and other variables that may influence her coping adjustment. ND: - knowledge, readiness for enhanced, about diagnosis procedures for breast disorders related to an expressed desire for further information - anxiety related to threat to body image
Nursing plans and implementation
During the pre-diagnosis. Clarify misconceptions encourage women to express her anxiety. When a diagnosis is made, ensure that the woman clearly understands her condition, it's associated to breast malignancy, and treatment options. Point out that frequent professional breast examinations and regular mammograms are tools to help detect any more abnormalities. Also most professionals agree that women should be familiar with their own breasts by doing breast self examination so they may be able to no changes if they occur
Uterine abnormalities
Endometrial polyps are pedunculated growing on the stock overgrowth of the endometrium. Take her a single or multiple gross. Polyps are common often accompanied by symptoms of midcycle bleeding responding, bleeding or spotting after intercourse, or Palarm bleeding or spotting with menstrual cycles. Polyps are generally benign but they can occasionally coexist with carcinoma of the endometrium. Treatment is dilation and curettage using a hysteroscope for visualization. Fibroid tumors are among the most common benign disease entities in women and the most common reason for gynecologic surgery. Most uterine fibroid tumors are asymptomatic and require a new treatment. The most common symptoms include pelvic pain, menstrual irregularities, and infertility. Women most often seek treatment for bleeding and pain, on pelvic examination the women may have an irregular Lee shaped come in large uterus. Diagnosis is most made using pelvic ultrasound and MRI. Treatments: - combine oral contraceptives to control heavy menstrual bleeding - GNRH analog such as Lupron to reduce the size and subsequent bleeding; GnRH analoge also may be used before surgery to reduce the size of the fibroid and decrease complications. - Levonorgestrel Intrauterine system for contraception in control of axis Mitchell bleeding by suppression of the endometrial growth - MRI guided ultrasound, which focus high intensity sound waves on the fibroids, resulting in clotting, necrosis, and shrinkage of the tumor - myomectomy, A surgical procedure to remove the fibroid without removing the uterus, which can preserve or improve fertility - uterine artery embolization, and interventional radiologic procedure in which the uterine arteries are blocked, resulting in diminished blood flow to the uterus and the necrosis of the fibroids - hysterectomy may be indicated and can be performed laparoscopically or abdominally depending on the size of the uterus. Endometrial cancer is the most common female genital tract malignancy, occurring in about one and every 45 women. Fortunately it has a high risk rate of cure if detected early. Although endometrial cancer can occur in younger women, the homework sign is vaginal bleeding and post menopausal women not treated with hormone replacement therapy. Diagnosis is made by endometrial biopsy by transvaginal ultrasound, or by post hysterectomy pathology examination of the uterus. The treatment is total abdominal hysterectomy and bilateral BSO. Radiation therapy may also be indicated depending on the stage of the cancer.
Evaluation
Expected Outcomes: - The infection is identified and cured, if possible. If not, supportive therapies provided. - The woman and her partner can describe the infection, its method of transmission, its complications, and the therapy. - The woman cope successfully with the impact of the diagnosis on her self-concept.
Evaluation
Expected Outcomes: The woman completes her prescribed course of anabiotic therapy The woman's infection is cured. The woman incorporates preventive self-care measures and her daily regimen.
Evaluation
Expected outcome: - The woman is able to discuss her condition, its implications for fertility, and her treatment options - after considering the alternatives, the woman chooses appropriate treatment options.
Evaluation
Expected outcomes: The woman describes her condition, her therapy, and the possible long-term implications of PID on her fertility. The woman completes her course of therapy and the PID is cured.
Evaluation
Expected outcomes: - The woman's symptoms are relieved and the infection is cured - the woman is able to identify self care measures to prevent further episodes of VVC
Evaluation
Expected outcomes: The woman can discuss the reasons for her hysterectomy and the type of procedure performed, the alternatives, and the aspects of self-care following surgery The woman has an uneventful recovery without complications Woman participates in decision making about her care The woman can identify available resources if she has physical or emotional concerns in the postoperative period
Care of the Woman Requiring a Hysterectomy
Hysterectomy is the surgical removal of the uterus. In the United States it is the most common non-pregnancy related surgical procedure that women undergo. Removal of the uterus through a surgical incision is called total abdominal hysterectomy and removal of the fallopian tubes and ovaries is a bilateral salpingo oophorectomy. When both procedures are performed at the same time it is called a TAH - BSO. When the uterus is removed if Janet is a term called a total vaginal hysterectomy. A laparoscopic assisted vaginal hysterectomy may also be used. In this technique, the surgeon inserts a let laparoscope through a incision near the umbilicus and uses it to assist with visualization and the dissection to facilitate vaginal removal of the uterus. The benefit of this is said that there is not a large abdominal incision. Abdominal hysterectomy is the usual treatment for several conditions including cancer the cervix, endometrium, ovaries; large Ben Boyd; severe endometriosis; PID; & adenomyosis. TAH is performed when cancer is expected because it promotes easier exploration of the admin. It is also helpful when large uterine masses are present. Vaginal hysterectomy is generally done for public relaxation, I don't know uterine bleeding, or small hemorrhoids. Advantages include earlier ambulation, less postoperative pain, less anesthesia, and operative time, less blood loss, no visible scar, and a shorter hospital stay. The major disadvantage is the increased risk of trauma to the bladder.
Gonorrhea
If a non-pregnant woman contracts this is disease, she is at risk of developing PID. If a woman becomes infected after the third month of pregnancy, the mucous plug in the cervix will prevent the infection from ascending, and it will main localized in the uterus, cervix, Bartholin glands until the memories rupture. A newborn exposed to gonococcal infected birth now is at risk of developing the donate or conjunctivitis. By prophylaxis, generally with erythromycin, is indicated for all newborns to prevent this complication. Because the majority of women with gonorrhea are asymptomatic, it is excepted practice to screen for this infection by doing a cervical culture during the initial prenatal examination. The most common symptoms of gonorrhea infection include a Purland, greenish yellow vaginal discharge, dysuria, and urinary frequency. Some women also develop inflammation and swelling of the vulva. The cervix may appear swollen and eroded and may secrete a foul smelling discharge in which gonococcal are present. Diagnosis is confirmed by culture of swab specimens or NAAT The preferred treatment for both non-pregnant and pregnant women consist of antibiotic therapy with a single dose of ceftriaxone 200 mg intramuscularly plus a single 1 g dose of azithomycin orally. The dual treatment is used to address the risk of coinfection it was chlamydia because gonorrhea and chlamydia often occur together. All sexual partners must be treated or the woman may become reinfected.
Nursing Plan and Implementation
If the woman is experiencing discomfort because of the itching recommend gentle bathing the Volvo of the week sodium by carbonate solution. If the topical treatment is being used the women will need to be in the area before applying the medication. Discuss with the woman the factors that contribute to the development of BBC and suggest ways to prevent reoccurrence such as wearing cotton underwear and avoiding vaginal powders or sprays may irritate the vulva. Some providers recommend that women who are taking antibiotics consume yogurt a probiotic supplements simultaneously.
chlamydial infection
Is the most commonly reported infectious disease in the United States and is the most prevalent people under the age of 25. Transmission commonly occurs during vaginal sex. A strain of chlamydia is responsible for trachoma, the worlds leading cause of preventable blindness. In females, signs of chlamydia include a thin or. purulent discharge, Burning and frequency of urination, a friable ( bleeds easy) cervix, and lower abdominal pain. Women however are often asymptomatic. Screening of the following groups - annual screening for sexual active adolescent females and women under the age of 25 - in your screening for women over age 25 heart risk for chlamydia history of STI's common multiple sex sexual partners, new sexual partner, and consistent use of barrier contraceptive. - screening of all pregnant women under age 25 and older women at risk for chlamydia at their first prenatal visit and again during the third trimester of pregnancy.
Ovarian Masses
Ovarian masses can be palpated during the public exam. Between 70 and 80% of ovarian masses are benign. More than 50% are functional cysts, occurring more commonly in women 20 to 48 years of age. Functional sis or associated with abnormal hormone production in a rare and women who take oral contraceptives. No relationship exists between the presence of nine ovarian masses in the subsequent development of ovarian cancer. However, ovarian cancer is the most fatal all cancers in women because it's difficult to diagnose in often has spread throughout the pelvis before it is detected. Many women with benign ovarian masses are asymptomatic; the mass may be noted on a routine pelvic exam. Others experience a sensation of fullness or cramping in the lower abdomen, irregular bleeding, or delayed menstruation. Diagnosis is made on the basis of a palpable mass with or without tenderness and other related symptoms, radiography and ultrasonography may be used to assess the diagnosis. The woman is kept under observation for a month or two because most this will resolve on their own and are harmless. Or oral contraception's may be prescribed for one or two months to suppress ovarian function. If this resume is effective, repeat public examination should be normal. If the mass is still present after 60 days of observation and oral contraceptive therapy a diagnosis leprous copy or laboratory may be considered. Tubal or ovarian lesions, ectopic pregnancy, cancer, infection, or appendicitis must be ruled out before diagnoses can be confirmed. Surgical exploration is also indicated when a palpable mass is found in an infant, a young girl, or a post menopausal woman or if the mass is larger than 6 to 7 cm in circumference. Women may need a clear explanation as to why initial therapies observation. A discussion of the origin and resolution of ovarian cysts may clarify the treatment plan. If surgical treatment removes or impairs the function of one ovary, the woman needs to be assured that the remaining over the candy expected to take over very in function and that pregnancy is still possible.
Nursing Management
Pelvic examinations and Pap smears are not done by nurses unless they have special training. In most cases, nursing assessment is directed towards an evaluation of the woman's understanding of the findings and their implications of her psychosocial response The woman needs accurate information on ideology, symptomology, and treatment options. Encourage her to report symptoms and keep appointments for follow up examination and evaluation. The woman needs realistic assurance if her condition is benign; she may require counseling and effective emotional support if it is malignancy. If the management plan includes surgery, she may need your support in obtaining a second opinion and making her decisions.
Care of a Woman with PCOS
Polycystic ovarian syndrome is a complex endocrine disorder Bavarian dysfunction that is evidenced by menstrual dysfunction, signs of androgen excess and infertility Symptoms: - Menstrual dysfunction: Irregular menses, ranging from total absence of periods to intermittent or in frequent periods are the hallmarks of PCOS. - Hyperandrogenism: Women with PCOS consistently have elevated serum antigen levels. These elevated androgen levels often leads to clinical manifestations such as excess hair growth, acne, deepening voice, and increase muscle mass - Obesity: Between 30% and 75% of women who have PCOS or clinically obese. The obesity is generally of the android tight, with the increase tipped her waist ratio - Hyperinsulinemia: Women with PCOS may be insulin resistant. This insulin resistance characterized by the failure of insolent into the cells appropriate, places these women at increased risk for impaired glucose tolerance and type two diabetes - Infertility: The majority of women who have diagnosed with PCOS struggle with some degree of infertility related to anovulation
Upper UTI
Polynephritis, inflammation disease of the kidneys, is less common is more serious than cystitis it is often preceded by lower UTI. It is more common during the latter part of pregnancy early postpartum imposes a serious threat to maternal and fetal well-being. Women with symptoms of polynephritis during pregnancy have an increased risk of preterm birth and intrauterine growth restriction. Symptoms include sudden onset with chills, high temperature of 103 to 105 and flank pain in her either unilateral or bilateral. Nausea, vomiting and general malaise mean Sue. The woman may experience frequency, urgency, burning with urination. Many women can be treated as outpatients are given IV fluids and one IV dose of antibiotics, then discharge and oral medication's. Diagnosis is determined with urine culture and sensitivity done to determine the appropriate antibiotic. therapy also includes IV hydration, urinary analgesics, pain management, and medication to manage fever. In the case of obstructive Polynephritis, blood culture is Asseri. The man is kept on bedrest. With appropriate drug therapy, the woman's temperature should return it normal. The pain subsides in the urine shows no bacteria within 2 to 3 days. Following up urinary cultures are needed to determine if the infection has been eliminated completely.
Nursing Plan and Implementation
Preoperative teaching should include information about the procedure, expected preparation, effects of the anesthesia to The Used, possible risks and complications, postoperative care routines, and expected recovery time. Routine postoperative care includes monitoring of physiologic and emotional responses and implementation of nursing interventions to ensure physical well-being and comfort. The woman should be aware of any possible complications and went to follow up with her surgeon.
Bacterial Vaginosis (BV)
a condition in women in which there is an abnormal overgrowth of certain bacteria in the vagina. Because of this overgrowth is not clear, although trauma from Duchenne, frequent sexual intercourse without condom used, and an upset a normal vaginal flora are predisposing factors. Beauty during pregnancy may be a factor in premature rupture of the membranes and premature birth. The infected women often notices an excessive amount of thin, watery, white or gray vaginal discharge with a foul odor described as fishy. The vaginal pH is usually greater than 4.5. Do you symptomatic women, whether or non-pregnant or pregnant is generally treated with Metronidazole orally or as a vaginal cream. Women should either avoid intercourse or use condoms during the treatment period.
Nursing plan and Implementation
Some STI's can be simply treated but they also carry it carry a stigma and be emotionally devastating for the woman. Thus you should distress prevention with all women and encourage condoms. Well condoms offer protection from any STI's, they do not protect against infections like herpes and HPV, which are transmitted by direct skin to skin contact. Is important to emphasize that, to be affective, condoms must remain in place during each and every active intercourse. Allow the woman to explore her feelings about the diagnosis she may experience anger feel betrayed by her partner, she may feel guilt or see her diagnosis as a form of punishment, or she may feel concerned about the long-term implications for further childbearing or ongoing intimate relations. Provide the woman who has an STI with information about the infection, methods of transmission, implications for pregnancy or future fertilization, and importance of thorough treatment. If treatment of her partner is indicated, the woman must understand that it is necessary to prevent a cycle of ear infection. She should also understand the need to abstain from sexual activity, if necessary, during treatment.
Nursing Assessment and Diagnosis
Suspect VVC if a woman complains of intense vulvar itching and a curdy white discharge. ND: Skin integrity, impaired, related to scratching secondary to discomfort of the infection Knowledge, Readiness for Enhanced about used infection related to express desire to learn about ways of preventing the development of VVC
Nursing Assessment and Diagnosis
The alert to factors in a woman's health that put her at risk for petty. Even if your types of IDs are available, many women still have them, and you should question the women about possible symptoms, so just aching pain in the lower abdomen, foul smelling discharge, malaise, etc. ND: pain, acute, related to peritoneal irritation Knowledge, deficit, related to the lack of information about the possible effects of PID on fertility
Clinical Therapy
The goals of treatment include: - Decrease the effects of hyperandrogenism - Restore reproductive functioning for women desiring pregnancy - protect the endometrium - Reduce long term risks, specifically type 2 diabetes and cardiovascular disease Is pregnancy is not an immediate gold CFCs or a Cichlid progesterone to be a treatment. See you see his help to regulate menstrual cycles; provide a balance between estrogen and progesterone, thereby protecting the endometrium and decrease risk of uterine cancer. Antiandrogens such as spironolactone may be used to decrease symptoms of androgen excess. It improves ovarian function, reduces the degree of hyperandrogenism, restores normal ovulation with PCOS, and is associated with an improved ability to lose weight. In addition lifestyle changes should also be a major component in the treatment of PCOS, modification should include weight loss, regular exercise, balance diet, and a smoking cessation. If initial approaches to helping women with PCOS become pregnant fail, assisted reproductive technology may be recommended. Long-term, PCOS may increase a woman's risk for developing type two diabetes, hypertension, cardiovascular disease, endometrial cancer, breast cancer, and ovarian cancer.
Trichomoniasis
The most prevalent non-viral STI in the United States, is an infection caused by trichomonas vaginalis, microscopic metal protozoan that thrives in an alkaline environment. almost all infections are required through sexual intimacy. Pregnant women with trich may be increased risk for premature rupture of the membranes, preterm birth, and a low birth weight newborn. Symptoms include yellow green, frothy, odorous discharge frequently accompanied by inflammation of the vagina and cervix, Volver itching, dysuria, and dyspareunia. Vaginal pH is 5.0 or higher. Microscopic visualization of mobile trichomonads and increase leukocytes is commonly used to detect trich because it is convenient and relatively inexpensive. Recommended treatment is metronidazole. Partner should avoid intercourse until both are cured.
Nursing Assessment and Diagnosis
The nurse will need to identify physiologic in psychological needs as she approaches approaches surgery. It is also important to evaluate her learning needs in relation to the surgery and its implications post operatively. It's also important to know what kind of support she has, the attitudes of her partner and family, her preoperative status, and whether the hysterectomy is being performed because of a cancer diagnosis. ND: Knowledge, deficit, related to a lack of information about preoperative routines, postoperative activities, and expected postoperative changes Fear related to the risk of possible surgical complications
Care of the Woman with a STI
The occurrence of STI or STD has increased during the past few decades. In fact vaginitis and STI's are the most common reasons for outpatient, community based treatment of women.
Care of a Woman with Toxic Shock Syndrome
Toxic shock syndrome is primarily a disease of women often occurring at or near menses or during the postpartum period. This causative organism is a toxin released by a strain of staph. The use of super absorbent tampons has been widely related to the incidence of TSS. However including the cervical us with a contraceptive device such as a diaphragm or a cervical cap during menses can also increase the risk of TSS Symptoms may include fever often greater than 102, hypertension systolic blood pressure less than 90, rash, multi system involvement. Systemic symptoms often include vomiting, diarrhea, severe Malaysia, inflamed mucous membranes. Women with TSS are generally hospitalized and given supportive therapy, including oxygen, fluids to maintain blood pressure, and antibiotics. Severe cases may require renal dialysis, administration of vasopressors, and intubation
herpes genitalis
Two types of herpes infections can occur HSV 1 the cold sore which can cause general herpes through oral dental contact, and HSV 2 to which is usually associated with genital infections. The clinical symptoms and treatment of both styles are the same The primary episode of herpes is characterized by the development of single or multiple blister like vesicles, which usually occur in the general area and sometimes affect the vaginal walls, cervix, urethra, and anus. The vesicles may appear within a few hours to 20 days after exposure and rupture spontaneously to form very painful, open, ulcerated lesions. Inflammation and pain secondary to the presence of herpes lesions can cause difficult urination and urinary retention. Flu like symptoms and genital tingling also may be noticed. Primary episodes usually last the longest and are the most severe. Lesions heal spontaneously in 2 to 4 weeks After the lesions heal, the virus enters a dormant face, residing in the nerve glandular of the infected area. Recurrences are usually less severe than the initial episode and seem to be triggered by emotional stress, menstruation, ovulation, pregnancy, frequent or vigorous intercourse, poor health status or a generally rundown physical condition, tight clothing, or overheating. Diagnosis is made on the basis of the clinical appearance of the lesions, culture of the lesions. No known cure for herpes exists. Medication's are available to provide relief from pain and prevent complications from secondary infection. If herpes is present in the genital tract of a woman during childbirth, it can be devastating, even fatal, effect on the newborn. Women with herpetic lesions when labor begins should be given birth by cesarean to prevent neonatal herpes.
Care of Women with a Vaginal Infection
Vaginitis Is the most common reason women seek gynecologic care. Symptoms of vaginitis may include increased vaginal discharge, Volver irritation, foul odor, painful sexual intercourse, bleeding with intercourse, and pain with urination. May result from an alteration of normal flora, as in the case of bacterial vaginosis
Nursing Assessment and Diagnosis
When you're working with your clients you must become adept at taking a thorough history and identifying women at risk for STI's. Risk factors include multiple sexual partners, a partners involvement with other partners, Hi-Rez sexual behavior such as intercourse without barrier can contraception or anal intercourse, partners with high-risk behaviors, treatment with antibiotics while taking oral contraceptives, and the young age at onset of sexual activity. Be alert for signs and symptoms of STI's and be familiar with diagnostic procedures if an STI suspected - presence of a sore lesion on the vulva - increased vaginal discharge or malodorous vaginal discharge - Burning with urination - Volver/vagina itching or irritation - Dyspareunia - bleeding after intercourse - pelvic pain ND: Family processes, interrupted, related to the effects of the diagnosis of STI on the couples relationship Knowledge, readiness for enhanced, about preventing STI's related to an expressed desire to prevent infection
Syphilis
Which is acquired through vaginal, oral, or anal sex, is a chronic infection. Syphilis can be acquired congenitally through trans placental inoculation and consult from maternal exposure to infected exudate during sexual contact or from contact with open Windsor infected blood. The incubation period varies from 10 to 90 days, and even those no symptoms or liters are noted during this time, the woman's blood contains spirochetes and it is infectious. Syphilis is divided into early and late stages. During the early stage a Chan tree appears at the site where the organism enter the body. Symptoms include a slight fever, weight loss, and malaise. The Cancre process for about four weeks and then disappears. In six weeks to six months, secondary symptoms appear. Skin irruption's called condylomata lata, Which resemble wart like plaques and are highly infectious, may appear on the vulva. other secondary symptoms are rash on the palms of the hands and soles of the feet, acute arthritis, enlargement of the liver and spleen, nontender enlarge lymph nodes, and chronic sore throat with hoarseness. When infected in utero, the newborn exhibits secondary stage symptoms of syphilis. Transplant centrally in transmitted syphilis can cause intrauterine growth restriction, preterm birth, and is still birth. As a result of the Diseases impact on the fetus testing of every pregnant woman is recommended; some state laws require it. Testing is done at the initial prenatal screening and may be repeated in the third trimester. Diagnosis is made by dark field examination for spirochetes For pregnant non-pregnant women with syphilis less than a year's duration it is recommended that they receive 2.4 million units of penicillin administered intramuscularly in a single dose. But if the syphilis is longer than a year they get 2.4 million units of penicillin every week for three weeks
Nursing Care management
You can play a major role in helping educate women about ways to prevent TSS. Women should understand the importance of avoiding prolonged use of tampons. Women who used to continue using tampons may reduce the risk of TSS by alternating them with napkins and avoiding overnight use of tampons. Women who have a history PS I should never use tampons. Women should've was to use tampons six day weeks after childbirth.
Nursing Care Management
You can play a virtual role in the identification of PCOS and its evaluation, management, and follow up. The signs of PCOS especially hirsutism negatively impact women's feelings of femininity, and they may feel physically inferior and lack self-confidence. The woman with PCOS is at high risk for developing long-term complications, you and subsequent nurses can play a key role and follow up in continuity of care throughout the life of a woman facing this challenging disorder.
Galactorrhea
the production of breast milk in a woman who is not breastfeeding Non-clinically significant nipple discharge occurs in women who have fibrocystic changes in the breast, who are using contraceptives, or who are on hormone therapy. Certain medication's that are used to treat psychiatric disorders have a side effect of galactorrhea. The most common types occur in both breast, are secreted from several ducks, and are varying in color from white to brown. The likelihood of malignancy increases with the presence of spontaneous discharge arising from a single duct in one breast that is watery or bloody in nature