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  3. 3. <ul><li>Overview of the system </li></ul><ul><li>Although the reproductive organs in men and women are very different, they do share common function: </li></ul><ul><ul><li>Enabling sexual pleasure and reproduction. </li></ul></ul><ul><ul><li>Produce hormones important in biologic development nad sexual behavior. </li></ul></ul><ul><ul><li>Encloses and are integral to the function of the urinary system. </li></ul></ul><ul><li>Male Reproductive System consist of: </li></ul><ul><ul><li>Paired testes </li></ul></ul><ul><ul><li>The scrotum </li></ul></ul><ul><ul><li>Ducts </li></ul></ul><ul><ul><li>Glands </li></ul></ul><ul><ul><li>Penis </li></ul></ul><ul><li>Female Reproductive System: </li></ul><ul><li>Internal Structures: </li></ul><ul><ul><li>Ovaries </li></ul></ul><ul><ul><li>Fallopian tubes </li></ul></ul><ul><ul><li>Uterus </li></ul></ul><ul><ul><li>Vagina </li></ul></ul><ul><li>External Structures: </li></ul><ul><li>External genitalia collectively are called vulva ,they include: </li></ul><ul><ul><li>Mons pubis </li></ul></ul><ul><ul><li>Labia </li></ul></ul><ul><ul><li>Clitoris </li></ul></ul><ul><ul><li>Vaginal and urethral openings </li></ul></ul><ul><ul><li>glands </li></ul></ul>
  5. 5. <ul><li>Basal Body Temperature </li></ul><ul><li>Determining the basal body temperature is helpful, particularly in determining the time of ovulation in women who experience frequent menstrual irregularities and in identifying anovulatory menses in women who are otherwise without evidence of abnormality . . </li></ul><ul><li>Cervical mucus examination </li></ul><ul><li>Cervical mucus responses include decreased viscosity, ferning and increased alkalinity. Abundant alkaline, clear, watery, elastic mucus facilitates sperm penetration and survival. </li></ul><ul><li>Cervical mucus ferning </li></ul><ul><li>Ferning is caused by the effects of estrogen on the concentration of sodium chloride and other electrolytes in the mucus; high estrogen levels produce more complete arborization. When the mucus is spread on a glass slide and allowed to dry, the pattern it forms resembles a fern leaf. Ferning is absent in anovulatory women. </li></ul>GYNECOLOGICAL TEST OR DIAGNOSTIC PROCEDURES
  6. 6. <ul><li>Plasma progesterone </li></ul><ul><li>Serum progesterone assays are drawn between the second day after ovulation and the onset of menses. </li></ul><ul><li>Pelvic ultrasonography </li></ul><ul><li>Abdominal or vaginal ultrasonography may be used to visualized the reproductive structures. Ultrasonography can identify anatomic abnormalities and often used to determine follicular development and maturation in planning for therapeutic interventions, e.g. surgical removal of an ovum for use in in vitro fertilization. </li></ul><ul><li>Invasive Procedures </li></ul><ul><li>Endometrial biopsy </li></ul><ul><li>- identifies estrogen/progesterone-induced endometrial changes and is helpful in ruling out a chronic inflammatory condition of the endometrium. </li></ul>
  7. 7. <ul><li>Uterine and tubal factor assessment </li></ul><ul><li>The patency of the fallopian tubes can be assessed by introducing co2 gas under pressure through the uterine cavity. </li></ul><ul><li>Hysterosalphingography </li></ul><ul><li>Instilling radiopaque dye through a small tube into the uterus permits roentgenographic visualization of the uterus and fallopian tubes. </li></ul><ul><li>Laparoscopy </li></ul><ul><li>Insertion of an endoscope through a small abdominal incision permits direct visualization of pelvic structures. </li></ul><ul><li>Double puncture technique </li></ul><ul><li>The double puncture technique allows the surgeon to use a probe to move the ovaries and tubes for optimum visualization, to explore the fimbriated ends of the fallopian tubes, and to view the undersurface of the broad ligaments if the ovaries. </li></ul>
  8. 8. <ul><li>Male </li></ul><ul><li>Semen analysis </li></ul><ul><li>Diagnostic test for cervical cancer </li></ul><ul><li>papanicolau smear (pap test) </li></ul><ul><li>Client preparation: </li></ul><ul><li>1. Instruct the woman to empty the bladder. </li></ul><ul><li>2. Explain that the test should be painless and quick, although slight cramping may be experienced when the endocervical specimen is obtained. </li></ul><ul><li>Client and family teaching </li></ul><ul><li>1. Teach the woman about the recommended frequency of screening every 3 years until age 65 after two successive negative results a year apart or more frequently if the woman has a specific risk factors for cervical cancer. </li></ul><ul><li>2. Teach the woman to schedule the pap test for a time when she is not menstruating. Blood interfere with interpretation of the smear. </li></ul>
  9. 9. <ul><li>3. Teach the woman to avoid intercourse, douching or placing of any medication in the vagina for 36 hours prior to the test. </li></ul><ul><li>Cervical biopsy </li></ul><ul><li>performed to women whose pap smear findings indicate possible cervical cancer or cervical intraepithelial neoplasia </li></ul>
  11. 11. <ul><li>Introduction of the Disease </li></ul><ul><li>INFERTILITY </li></ul><ul><li>-not being able to become pregnant after a year of trying. If a woman keeps having miscarriages, it is also called infertility </li></ul><ul><li>ETIOLOGY </li></ul><ul><li>Pretesticular : endocrinopathy, sexual dysfunction, e.g., excessive ejaculation frequency </li></ul><ul><li>Testicular : varicocele, failure of testicle to produce sperm, e.g., due to effects of drugs, environmental factors, development of chromosomal abnormalities, mumps orchitis, spinal cord injury. </li></ul><ul><li>Post-testicular : ejaculatory dysfunction, obstruction, e.g., from trauma, infection, surgery </li></ul><ul><li>Genitourinary : infection </li></ul><ul><li>Immunologic : sperm antibodies in one or both partners </li></ul>
  12. 12. <ul><li>ASSESSMENT </li></ul><ul><li>Detailed History-taking (sexual, medical, and reproductive) </li></ul><ul><li>Physical examination </li></ul><ul><li>Lab test: semen analysis includes </li></ul><ul><ul><li>Gross examination noting volume , viscosity, and color </li></ul></ul><ul><ul><li>pH, concentration. Motility, motphology and sperm agglutination. </li></ul></ul><ul><li>Urinalysis, urine culture, serum creatinine assessment, and examination of prostatic secretions </li></ul><ul><li>DIAGNOSTICS </li></ul><ul><li>Both partners </li></ul><ul><li>Medical and sexual history (to evaluate possible causes of infertility and if sexual intercourse has been appropriately timed) </li></ul><ul><li>Female </li></ul><ul><li>Physical examination </li></ul><ul><li>Ovulation evaluation </li></ul><ul><li>Hormone testing </li></ul><ul><li>Ultrasound </li></ul><ul><li>X-rays </li></ul><ul><li>Male </li></ul><ul><li>Semen analysis </li></ul>
  13. 13. <ul><li>RISKS FACTORS </li></ul><ul><li>Alcohol </li></ul><ul><li>Drugs </li></ul><ul><li>Environmental toxins, including pesticides and lead </li></ul><ul><li>Cigarette smoking </li></ul><ul><li>Health problems </li></ul><ul><li>Radiation treatment </li></ul><ul><li>Age </li></ul>
  14. 14. <ul><li>NURSING DIAGNOSIS </li></ul><ul><li>INTERVENTIONS </li></ul><ul><li>MEDICAL </li></ul><ul><li>Cervical cap </li></ul><ul><li>In vitro fertilization (IVF) </li></ul><ul><li>SURGICAL </li></ul><ul><li>Intracytoplasmic Sperm Injection (ICSI)] </li></ul><ul><li>Intrauterine Insemination </li></ul><ul><li>NURSING CARE </li></ul><ul><li>PROMOTIVE </li></ul><ul><li>Avoiding excessive use of alcohol </li></ul><ul><li>Avoid smoking </li></ul><ul><li>Always wash fruits and vegetables carefully before consumption to remove pesticides </li></ul>
  15. 15. <ul><li>PREVENTIVE </li></ul><ul><li>Developing effective means of stress reduction </li></ul><ul><li>Avoiding transmission of sexually transmitted orgasms by limiting the number of sexual partners and using condoms, diaphragms, contraceptive foam and other spermecides, especially with new partner </li></ul><ul><li>Keep the scrotum cool </li></ul><ul><li>Decrease exposure to occupational and environmental hazards , including toxic substances and radiation </li></ul><ul><li>Avoid tobacco, marijuana and other recreational drugs </li></ul><ul><li>Counseling for both partners </li></ul><ul><li>REHABILITATIVE </li></ul><ul><li>Bed rest </li></ul><ul><li>Maintain a well-balance diet </li></ul><ul><li>Continue prescribed medications </li></ul>
  16. 16. ABORTION
  17. 17. <ul><li>Introduction of the Disease </li></ul><ul><li>ABORTION </li></ul><ul><li>is a procedure to end a pregnancy by removing the fetus and placenta from the mother's womb. </li></ul><ul><li>The most common complication of pregnancy </li></ul><ul><li>which occurs in an estimated 10-15% of pregnancies </li></ul><ul><li>TYPES OF ABORTION </li></ul><ul><li>Spontaneous abortion or miscarriages </li></ul><ul><li> Is a type of abortion that occur without medical or other intervention </li></ul><ul><li>SYMPTOMS </li></ul><ul><li>(10TH WEEK) very heavy menstrual period </li></ul><ul><li>several days of bleeding and cramps before the contents of the uterus are removed </li></ul><ul><li>followed by a short period of bleeding until the lining of the uterus heals </li></ul>
  18. 18. <ul><li>12th week is like a mild version of the labor of during childbirth </li></ul><ul><li>with strong contractions that dilate the cervix and expel the fetus </li></ul><ul><li>13th and 24th weeks (second trimester) are most often caused by faulty attachment of the placenta to the walls of the uterus or from a weak cervix that dilates too soon </li></ul><ul><li>2. INDUCED ABORTION </li></ul><ul><li>-this type of abortion uses drugs or instruments to stop the normal course of pregnancy </li></ul><ul><li>3. HABITUAL ABORTION </li></ul><ul><li>Successive (3) repeated abortions of unknown cause. </li></ul>
  19. 19. <ul><li>ETIOLOGY </li></ul><ul><li>Abortion is by definition a reproductive failure. The failure can be the result of the mother's lack of access to care, failure of the contraceptive method, failure to use contraceptives, or failure of the normal reproductive process (eg, fetal anomalies, fetal death, maternal illness) </li></ul><ul><li>FETAL CAUSES </li></ul><ul><li>Most common cause of early sponatneous abortion is abnormal development of the zygote, embryo and fetus </li></ul><ul><li>MATERNAL CAUSES </li></ul><ul><li>Congenital or acquired conditions of the mother and environmental factors that had adversely affected the pregnancy outcome and led to abortion. It includes Diabetes Mellitus, incompetent cervix, exposure to radiation and infection. </li></ul>
  20. 20. <ul><li>A missed abortion is a nonviable intrauterine pregnancy that has been retained within the uterus without spontaneous abortion. </li></ul><ul><li>A septic abortion is a spontaneous or therapeutic/artificial abortion complicated by a pelvic infection. </li></ul><ul><li>is a completed miscarriage </li></ul><ul><li>spontaneous expulsion of the products of conception after the fetus had died in the uterus </li></ul><ul><li>is the partial expulsion of the products of conception before the 20th week of gestation. </li></ul><ul><li>is defined as bleeding of intrauterine origin with continuous and progressive dilation of the cervix but without expulsion of conception products before the 20th week of gestation. </li></ul><ul><li>is a condition of pregnancy, occurring before the 20th week of gestation, the patient usually experiences vaginal bleeding with or without some cramps, and the cervix is closed </li></ul>MISSED SEPTIC COMPLETE INCOMPLETE INEVITABLE THREATENED TYPES OF SPONTANEOUS ABORTION
  21. 21. PATHOPHYSIOLOGY THREATENED - consists of any vaginal bleeding during early pregnancy without cervical dilatation or change in cervical consistency. Usually, no significant pain exists, although mild cramps may occur. More severe cramps may lead to an inevitable abortion INEVITABLE - Genetic anomalies (trisomies); hormonal abnormalities; and infectious, immunologic, and environmental factors usually result in first-trimester loss. Anatomic factors usually are associated with second-trimester loss INCOMPLETE - Genetic anomalies (eg, trisomies); hormonal abnormalities; and infectious, immunologic, and environmental factors usually result in first-trimester pregnancy loss. Anatomic factors usually are associated with second-trimester pregnancy loss. COMPLETE - a history of vaginal bleeding, abdominal pain, and passage of tissue exists. After the tissue passes, the patient notes that the pain subsides and the vaginal bleeding significantly diminishes. The examination reveals some blood in the vaginal vault; a closed cervical os; and no tenderness of the cervix, uterus, adnexa, or abdomen. The ultrasound demonstrates an empty uterus.
  22. 22. SEPTIC - Infection usually begins as endometritis and involves the endometrium and any retained products of conception. If not treated, the infection may spread further into the myometrium and parametrium. Parametritis may progress into peritonitis. The patient may develop bacteremia and sepsis at any stage of septic abortion. Pelvic inflammatory disease (PID) is the most common complication of septic abortion MISSED - Causes include anembryonic gestation (blighted ovum), fetal chromosomal abnormalities, maternal disease, embryonic anomalies, placental abnormalities, and uterine anomalies. Virtually all spontaneous abortions are preceded by missed abortion.
  23. 23. Assessment ASSESSING ABORTION Smaller than expected for length of pregnancy Closed No No No Slight MISSED Any of the above with tenderness Usually open; fever present Varies; fever present Varies; fever present Varies; fever present Varies; usually malodorous; fever present SEPTIC Smaller than expected for length of pregnancy Closed Possible Mild Mild Heavy COMPLETE Smaller than expected for length of pregnancy Open with tissue in cervix Possible Yes Severe Slight INCOMPLETE Agrees with length of pregnancy Open No No Moderate Moderate INEVITABLE Agrees with length of pregnancy Closed No No Mild Slight THREATENED SIZE OF UTERUS INTERNAL CERVICAL OS TISSUE IN VAGINA PASSAGE OF TISSUE UTERINE CRAMPING AMOUNT OF BLEEDING TYPE
  24. 24. <ul><li>DIAGNOSTICS </li></ul><ul><li>Laboratory Studies </li></ul><ul><li>pregnancy test, blood-type determination , and CBC count </li></ul><ul><li>Screen for common sexually transmitted diseases (eg, chlamydia, gonorrhea, HIV, hepatitis B) in geographic areas with high prevalence (eg, urban, inner city) and in age groups commonly at risk (women <25 y). </li></ul><ul><li>Imaging Studies </li></ul><ul><li>Pelvic ultrasound Chest x-ray </li></ul><ul><li>MRI </li></ul><ul><li>Other Tests </li></ul><ul><li>ECG </li></ul>
  25. 25. <ul><li>NURSING DIAGNOSIS </li></ul><ul><li>Risk for Infection </li></ul><ul><li>Ineffective Individual Coping related to high degree of threat </li></ul><ul><li>Dysfunctional Grieving related to Actual on perceived object loss </li></ul><ul><li>Fear related to separation from support system in potentially stressful situation </li></ul><ul><li>Altered role performance related to health alteration </li></ul><ul><li>INTERVENTIONS </li></ul><ul><li>MEDICAL </li></ul><ul><li>Medical abortion using one of the following regimens: </li></ul><ul><ul><li>mifepristone plus misoprostol </li></ul></ul><ul><ul><li>methotrexate plus misoprostol </li></ul></ul><ul><ul><li>misoprostol alone </li></ul></ul><ul><ul><li>Anti-D immune globulin as indicated </li></ul></ul><ul><ul><li>Non-steroidal anti-inflammatory drugs, or narcotics for pain relief when indicated (considered, but not specifically recommended) </li></ul></ul>
  26. 26. <ul><li>SURGICAL </li></ul><ul><li>Manual vacuum aspiration (menstrual extraction) is used at 4-10 weeks of gestation and is 99.2% effective. </li></ul><ul><li>Suction curettage is used at 6-12 weeks of gestation </li></ul><ul><li>Sharp curettage is used at 4-12 weeks of gestation but is not currently used because of increased blood loss and retained POC compared to suction </li></ul><ul><li>Dilation and extraction (D&E) is used at 13-24 weeks of gestation </li></ul><ul><li>Intact dilation and extraction (D&X) is used at more than 16 weeks' gestation </li></ul><ul><li>Hysterotomy is used at 12-24 weeks of gestation and is reserved for the rare instances in which all other methods of abortion have failed or are contraindicated </li></ul><ul><li>Hysterectomy is reserved for rare instances in which other gynecological pathology dictates removal of the uterus. </li></ul>
  27. 27. <ul><li>PRE-OP </li></ul><ul><li>Monitor vital signs. </li></ul><ul><li>Stabilize with IV fluids (eg, normal saline, Ringer lactate). </li></ul><ul><li>Administer oxygen. </li></ul><ul><li>Provide detailed counseling about procedure, risks, complication rates, and alternatives. For manual vacuum aspiration, suction curettage, and D&E, obtain the patient's medical history with an emphasis on bleeding disorders and allergies. </li></ul><ul><li>Obtain the patient's obstetric/gynecologic history with an emphasis on last menstrual period (LMP), fibroids, and uterine anomalies. </li></ul><ul><li>Perform a pelvic examination to determine uterine size and position and to exclude pelvic mass(es). </li></ul><ul><li>Lab work is required, including—at minimum—a pregnancy test and an Rh status. </li></ul><ul><li>Vaginal probe ultrasound can be used as indicated for preoperative confirmation of pregnancy, gestational age, and location of pregnancy, and it can be used postoperatively to confirm termination of the pregnancy. </li></ul><ul><li>Assess the patient's need for pain relief, and administer pain medication. </li></ul>
  28. 28. <ul><li>POST-OP </li></ul><ul><li>Observe the patient for a minimum of 20-30 minutes </li></ul><ul><li>Consider the possibility of retained POC, uterine perforation, cervical laceration, hematometra, or heterotopic pregnancy </li></ul><ul><li>Activity: You may be referred for ongoing counseling and support after an abortion. You may eat a regular diet and resume normal activity. Avoid heavy activity or lifting for a few days. Do not use tampons, douche , or have sexual intercourse for one week. </li></ul><ul><li>Medications: You may be given medication for pain, but these are usually not necessary. Your doctor may prescribe medications for painful contractions and cramping of your uterus, but with a first-trimester procedure, none are usually needed. f you have pain, your doctor may suggest acetaminophen (such as Tyleno)l or ibuprofen (such as Advil) and similar pain relievers. </li></ul>
  29. 29. <ul><li>COMPLICATIONS </li></ul><ul><li>Heavy Bleeding </li></ul><ul><li>Infection </li></ul><ul><li>Incomplete Abortion Sepsis </li></ul><ul><li>Damage to the Cervix </li></ul><ul><li>Scarring of the Uterine Lining Perforation of the Uterus </li></ul><ul><li>Damage to Internal Organs </li></ul><ul><li>Death </li></ul><ul><li>Risks of surgical abortion include: </li></ul><ul><li>Excessive bleeding </li></ul><ul><li>Infection of the uterus or fallopian tubes </li></ul><ul><li>Damage to the uterus or cervix </li></ul><ul><li>Emotional or psychological distress </li></ul><ul><li>The risks of surgical abortion increase as a woman gets further along in her pregnancy. That's why it's important to make a decision about abortion as early as possible, when the procedure is safest. </li></ul>
  30. 30. <ul><li>Risks of medical (non-surgical) abortion include: </li></ul><ul><li>Prolonged bleeding </li></ul><ul><li>Fetus not passing completely from body, making surgery necessary </li></ul><ul><li>Nausea </li></ul><ul><li>Vomiting </li></ul><ul><li>Diarrhea </li></ul><ul><li>Pain </li></ul><ul><li>The risks for any anesthesia are: </li></ul><ul><li>Reactions to medications </li></ul><ul><li>Problems breathing </li></ul><ul><li>The risks for any surgery are: </li></ul><ul><li>Bleeding </li></ul><ul><li>Infection </li></ul>
  31. 31. <ul><li>LEVELS OF NURSING CARE </li></ul><ul><li>PROMOTIVE </li></ul><ul><li>Prenatal care </li></ul><ul><li>PREVENTIVE </li></ul><ul><li>Contraception to prevent unwanted pregnancies </li></ul><ul><li>Safe and legal abortions </li></ul><ul><li>Easy access to prenatal care </li></ul><ul><li>Prompt diagnosis of septic abortion </li></ul><ul><li>Timely treatment with IV antibiotics </li></ul><ul><li>Prompt evacuation of retained tissue from the uterus </li></ul><ul><li>CURATIVE </li></ul><ul><li>Perform a prompt evacuation of retained products of conception from the uterus. </li></ul><ul><li>Administer aggressive antibiotic therapy. </li></ul><ul><li>Monitor temperature, vaginal discharge, and bleeding. </li></ul><ul><li>REHABILITATIVE </li></ul><ul><li>Bed rest </li></ul>
  32. 32. MASTITIS
  33. 33. - Mastitis is a condition that causes the breast tissue to become inflamed. It usually occurs in women who are breastfeeding, so it is often referred to as lactation mastitis. OVERVIEW OF THE DISEASE <ul><li>Symptoms </li></ul><ul><ul><li>Fatigue </li></ul></ul><ul><ul><li>Malaise </li></ul></ul><ul><ul><li>Myalgias </li></ul></ul><ul><ul><li>Headache </li></ul></ul><ul><li>Signs </li></ul><ul><ul><li>Fever </li></ul></ul><ul><ul><li>Unilateral Breast inflammation </li></ul></ul><ul><ul><li>Warmth </li></ul></ul><ul><ul><li>Tenderness </li></ul></ul><ul><ul><li>Erythema </li></ul></ul><ul><ul><li>Observe for signs of breast abscess </li></ul></ul><ul><ul><li>Requires needle aspiration </li></ul></ul>
  34. 34. <ul><li>Types of mastitis </li></ul><ul><li>non-infectious mastitis , which is typically caused by breast milk remaining within the breast tissue (milk stasis), and is due to a blocked milk duct or problems with breastfeeding, and </li></ul><ul><li>infectious mastitis , which is caused by bacteria. </li></ul><ul><li>ETIOLOGY </li></ul><ul><ul><li>Staphylococcus aureus </li></ul></ul><ul><ul><li>Escherichia coli </li></ul></ul><ul><ul><li>Haemophilus Influenzae </li></ul></ul><ul><ul><li>PATHOPHYSIOLOGY </li></ul></ul><ul><ul><ul><li>Generally occurs in Lactation several weeks postpartum </li></ul></ul></ul><ul><ul><ul><li>Bacteria enter through a cracked nipple </li></ul></ul></ul>
  35. 35. <ul><li>ASSESSMENT </li></ul><ul><li>Chills </li></ul><ul><li>Aching muscles </li></ul><ul><li>Edema and breast heaviness </li></ul><ul><li>Fatigue </li></ul><ul><li>Headache </li></ul><ul><li>Localized area of redness and inflammation on the breast with possible streaks over the breast </li></ul><ul><li>Malaise </li></ul><ul><li>Purulent drainage </li></ul><ul><li>Temperature of 101.1 ºF (38.4ºC) or higher </li></ul>
  36. 36. <ul><li>DIAGNOSTICS </li></ul><ul><li>- MILK CULTURE </li></ul><ul><li>ndications (not routine) </li></ul><ul><ul><ul><li>Severe mastitis </li></ul></ul></ul><ul><ul><ul><li>Refractory despite optimal antibiotics for at least 48 hours </li></ul></ul></ul><ul><ul><ul><li>Hospital acquired infection </li></ul></ul></ul><ul><ul><li>Technique </li></ul></ul><ul><ul><ul><li>Cleanse nipple </li></ul></ul></ul><ul><ul><ul><li>Hand express small quantity of breast milk and discard </li></ul></ul></ul><ul><ul><ul><li>Hand express a sample into a sterile container </li></ul></ul></ul><ul><li>Complications </li></ul><ul><ul><li>Breast Abscess </li></ul></ul><ul><ul><ul><li>Obtain bacterial culture </li></ul></ul></ul><ul><ul><ul><li>Treat with needle aspiration or Incision and Drainage </li></ul></ul></ul>
  37. 37. <ul><li>NURSING DIAGNOSIS: </li></ul><ul><li>Knowledge deficit related to prevention of infection. </li></ul><ul><li>Acute pain related to breast engorgement. </li></ul><ul><li>Altered family process related to possible separation from newborn. </li></ul><ul><li>Ineffective coping related to </li></ul><ul><li>Situational low-esteem related to </li></ul><ul><li>INTERVENTION </li></ul><ul><li>MEDICAL </li></ul><ul><li>Antibiotics </li></ul><ul><ul><li>Course: 10 to 14 days </li></ul></ul><ul><ul><li>Coverage: Staphylococcus aureus (or as directed by culture) </li></ul></ul><ul><ul><li>Antibiotics: Nursing Mothers </li></ul></ul><ul><ul><ul><li>Amoxacillin-Clavulanate ( Augmentin ) 875 mg orally twice daily </li></ul></ul></ul><ul><ul><ul><li>Cephalexin ( Keflex ) 500 mg orally four times daily </li></ul></ul></ul><ul><ul><ul><li>Dicloxacillin 500 mg orally four times daily </li></ul></ul></ul>
  38. 38. <ul><ul><ul><li>Clindamycin 300 mg orally four times daily (for MRSA ) </li></ul></ul></ul><ul><ul><ul><li>Ciprofloxacin 500 mg orally twice daily (for MRSA ) </li></ul></ul></ul><ul><li>Antibiotics: Non- Breast Feeding women </li></ul><ul><li>Trimethoprim-sulfamethoxazole ( Septra ) 160mg/800 mg orally twice daily (for MRSA ) </li></ul><ul><li>SURGICAL </li></ul><ul><ul><li>If not better in 48 hours examine breast for abscess consider Incision and Drainage </li></ul></ul><ul><li>NURSING CARE </li></ul><ul><li>PROMOTIVE </li></ul><ul><li>Optimal Breast Feeding Technique with good latch-on by infant </li></ul><ul><li>Breastfeed frequently </li></ul><ul><li>Avoid sleeping on your stomach or so far over on your side that your breasts are compressed against the mattress </li></ul>
  39. 39. <ul><li>PREVENTIVE </li></ul><ul><li>Relieve engorgement promptly. Milk that doesn't flow gets thicker and clogs the ducts, which is a set-up for mastitis. </li></ul><ul><li>Breastfeed frequently. Don't restrict the length of feedings. </li></ul><ul><li>If you feel your breasts getting full, encourage your baby to nurse. You don't have to wait for baby to tell you he's hungry. </li></ul><ul><li>Avoid sleeping on your stomach or so far over on your side that your breasts are compressed against the mattress. </li></ul><ul><li>Take care of yourself and get plenty of rest (both of mind and body). </li></ul><ul><li>CURATIVE </li></ul><ul><li>Alternate warm and cold compresses on your breasts. </li></ul><ul><li>Gently massage the area of tenderness. </li></ul><ul><li>Breastfeed frequently on the affected side. </li></ul><ul><li>Vary the baby's position at the breast </li></ul><ul><li>Take analgesics for fever and pain. </li></ul><ul><li>Drink lots of fluids </li></ul><ul><li>Boost your immune system with good nutrition </li></ul><ul><li>Don't quit nursing at this point </li></ul>
  40. 40. <ul><li>REHABILITATIVE </li></ul><ul><li>Rest </li></ul><ul><li>Sleep without a bra </li></ul><ul><li>Drink lots of fluids </li></ul><ul><li>continue analgesics for fever and pain </li></ul><ul><li>Increase vitamin C intake </li></ul><ul><li>Breastfeed frequently. Don't restrict the length of feedings </li></ul><ul><li>Take care of yourself and get plenty of rest (both of mind and body). </li></ul>
  42. 42. <ul><li>ANATOMY AND PHYSIOLOGY </li></ul><ul><li>The breast is a mass of glandular, fatty, and fibrous tissues positioned over the pectoral muscles of the chest wall and attached to the chest wall by fibrous strands called Cooper’s ligaments. </li></ul><ul><li>The breast is composed of: </li></ul><ul><li>milk glands (lobules) that produce milk </li></ul><ul><li>ducts that transport milk from the milk glands (lobules) to the nipple </li></ul><ul><li>nipple </li></ul><ul><li>areola (pink or brown pigmented region surrounding the nipple) </li></ul><ul><li>connective (fibrous) tissue that surrounds the lobules and ducts </li></ul><ul><li>fat </li></ul>
  43. 43. BREAST CANCER -Malignant proliferation of epithelial cells lining the ducts or lobules of the breast. -Most common cancer affecting women. May develop anytime after puberty; most common after age 50. ETIOLOGY / CAUSES -Exact cause unknown -possibly estrogen therapy, antihypertensive agents, high fat diet, obesity, fibrocystic breast disease, or heredity PATHOPHYSIO - Breast cancer spreads by the way of lymphatic system.and the bloodstream, through the right side of the heart to the lungs, and to the other breast, chest wall,liver, bone and brain. -If infiltrating, occurs in parenchymal tissue. -If adenocarcinoma, arises from epithelium.
  44. 44. ASSESSMENT: -Lump or mass in breast -nipple inversion or discharge -breast tenderness -change in contour -dimpling, puckering, or retraction -change in breast shape DIAGNIOSTIC TEST: -Mammography: presence of tumor that’s too small to palpate. -Utrasonography: Fluid-filled cyst or solid mass. -Fine-needle aspiration and excisional biopsy: procurement of cells for histologic examination to confirm diagnosis. -Blood chemistry reveals distant metastasis. -Chest x-ray can pinpoint metastases in chest. -Magnetic resonance imaging (MRI) can be used to look specifically at the breast. COMPLICATIONS: -distant metastasis -infection -CNS effects -respiratory effects
  45. 45. Nursing Diagnosis: -Fear related to procedure and cancer diagnosis -Pain related to postoperative status Rationale: Chronic pain can also be an after-effect of surgery. It may initially begin at the same time as the expected post-operative acute pain, but chronic pain continues beyond the normal time expected for resolution of the problem. Instead, the pain persists and recurs. -Body image disturbance related to loss of breast -Impaired skin integrity related to incision -Anxiety related to sugery Interventions: Treatment -radiation -chemotherapy -hormone therapy
  46. 46. Surgical -Depending on the stage of your cancer, you may have a choice of: Surgery to remove just the cancer from the breast (breast-conserving surgery, or lumpectomy ). You will need to have several weeks of radiation after surgery. -Surgery to remove the breast ( mastectomy ). If you choose mastectomy, you can have an operation to make a new breast. This is called breast reconstruction. Nursing Care Pre-op: -Provide pre-operative patient teaching about the disease -Give prescribe drugs -Encourage patient to express fears and concerns Post-op: -Monitor wound site, vital signs, and intake and output. -Instruct patient to exercise hand and arm regularly. -Emotional support; support groups -No restrictive garment, BP measurement or IVs on affected side.
  47. 47. <ul><li>Promotive: </li></ul><ul><li>-Perform BSE 1 week after menstrual period, after menopause same day each month. </li></ul><ul><li>-Screening mammogram baseline: </li></ul><ul><li>35 to 50 year old, every 1 to 2 year; over 50 y.o, every year. </li></ul><ul><li>Prevention: </li></ul><ul><li>Eat a healthy diet with lots of fruits, vegetables, and whole grains. </li></ul><ul><li>Be active. Try to get 30 minutes of exercise at least 5 days a week. </li></ul><ul><li>Stay at a healthy weight. Getting regular exercise and watching what you eat can help. </li></ul><ul><li>If you drink alcohol, limit the amount. After menopause, even having one drink a day or less may increase the risk for breast cancer. </li></ul><ul><li>Rehabilitative </li></ul><ul><li>Adequate rest and emoitiona support </li></ul><ul><li>Participation in breast cancer support group </li></ul>
  49. 49. Anatomy and Physiology The cervix is one part of your reproductive system.It is the lower part of your womb, also called the uterus.The cervix connects your uterus and vagina.And your vagina leads to the outside of your body and the vulva, which is the skin area where you have pubic hair.These are the other parts of your reproductive system.They are all in the pubis. >Vagina >2 Ovaries >2 Fallopian tubes The cervix has two parts: 1.ECTOCERVIX-the outer part which is closest to the vagina 2.ENDOCERVIX-the inner part which is closest to the uterus.
  50. 51. TRANSFORMATION ZONE -where the ectocervix and endocervix meet where most cervical cancers start. Two types of cells which are on the surface of the cervix: 1.Squamous epithelial cells-line the outer part of the cervix. 2.Columnar epithelial cells-line the inner part of the cervix.
  51. 52. <ul><li>INTRODUCTION OF THE DISEASE </li></ul><ul><li>Is malignant cancer of the cervical area. </li></ul><ul><li>Stages of cervical cancer includes: </li></ul><ul><li>Stage 0 – also called carcinoma in situ or non-invasive cancer, this early cancer is small and confined to the surface of the cervix. </li></ul><ul><li>Stage 1 – cancer is confined to the cervix. </li></ul><ul><li>Stage 2 – cancer at the stage includes the cervix and uterus, but hasn't spread to the pelvic wall or the lower portion of the vagina . </li></ul><ul><li>Stage 3 – cancer at the stage has moved beyond the cervix and uterus to the pelvic wall or the lower portion of the vagina </li></ul><ul><li>Stage 4 – at this stage the cancer spread to nearby organs, such as the bladder or rectum, or it has spread to other areas of the body, such as the lungs, live or bones . </li></ul>
  52. 54. <ul><li>ETIOLOGY </li></ul><ul><li>Commonly various strains of the Human papilloma virus (HPV). </li></ul><ul><li>The incidence is grater in blacks than whites. </li></ul><ul><li>The age of the diagnosis is between 50-55 year;however,it begins to appear in woman in their 20s. </li></ul><ul><li>Risk Factor: </li></ul><ul><li>Having sex at an early age </li></ul><ul><li>Multiple sexual partner </li></ul><ul><li>Sexual partners who have multiple partners or who participate in high risk sexual activities. </li></ul><ul><li>Infection by the HPV(the most important risk factors) </li></ul><ul><li>Other includes: </li></ul><ul><li>Weakened immune system </li></ul><ul><li>Poor economic status </li></ul><ul><li>Poor nutritional status </li></ul>
  53. 55. <ul><li>Symptoms: </li></ul><ul><li>Continuous vaginal discharge which maybe pale ,watery, pink, brown, bloody, or foul-smelling </li></ul><ul><li>Abnormal vaginal bleeding between periods, after intercourse, or after menopause </li></ul><ul><li>Periods become heavier and last longer than usual </li></ul><ul><li>Any bleeding after menopause </li></ul><ul><li>Symptoms of advanced cervical cancer may include: </li></ul><ul><li>Loss of appetite </li></ul><ul><li>Weight loss </li></ul><ul><li>Fatigue </li></ul><ul><li>Pelvic pain </li></ul><ul><li>Back pain </li></ul><ul><li>Leg pain </li></ul><ul><li>Single swollen leg </li></ul><ul><li>Heavy bleeding from the vagina </li></ul><ul><li>Leaking of urine and feces from the vagina </li></ul><ul><li>Bone fracture </li></ul>
  54. 56. <ul><li>Pathophysiology: </li></ul><ul><li>Potentially, all women with carcinoma in situ and 90% of women with nonmetastatic disease can be cured. Five to ten years may elapse between the preinvasive and invasive stages of cervical cancer. Most cervical cancers are of the squamous cell type. Squamous cell carcinoma usually begins at the squamocolumnar junction near the external end of the cervix. Some cervical adenocarcinomas occur but are more difficult to diagnose. Adenocarcinoma generally involves the endocervical glands. </li></ul><ul><li>Cervical dysplasia, the earliest premalignant change noted in cervical epithelium, is now further divided into several levels of cervical intraepithelial neoplasia (CIN):MILD DYSPLASIA is CIN1, MODERATE DYSPLASIA is CIN 2, SEVERE DYSPLASIA and carcinoma in situ are CIN </li></ul>
  55. 57. The spread of squamous cell cerervical cancer occurs first by direct extensionto the vaginal mucusa, the lower uterine segment,parametrium, pelvic wall, bladder, and bowel. Distant metastasis occurs mainly through lymphatic spread, with some spread occurring through the circulatory system to the liver, lungs, or bones. The 5 year survival rate for women with cervical cancer is 65% for nonlocalized disease.
  56. 58. <ul><li>Assessment </li></ul><ul><li>Health history: </li></ul><ul><li>history of sexually transmitted infections </li></ul><ul><li>sexual history </li></ul><ul><li>family history of cervical cancer </li></ul><ul><li>vaginal bleeding or discharge </li></ul><ul><li>Smoking history </li></ul><ul><li>maternal treatment with DES. </li></ul><ul><li>Physical assessment: </li></ul><ul><li>pelvic examination </li></ul><ul><li>abdomen </li></ul><ul><li>lymph glands </li></ul>
  57. 59. <ul><ul><li>Diagnostic Test </li></ul></ul><ul><ul><li>Papanicolaou smear or PAP test , the primary screening tool for cervical carcinoma is used to screen for cervical intraepithelial neoplasia or CIN and cervical cancer. It can also be used to assess hormonal status and identify the presence of sexually transmitted diseases such as human papilloma virus or HPV or infections. </li></ul></ul><ul><li>Staging </li></ul><ul><li>Includes: </li></ul><ul><li>Imaging test </li></ul><ul><li>Visual examination of your bladder and rectum </li></ul><ul><li>Cervical biopsy or colposcopy </li></ul><ul><li>Loop diathermy technique or Loop electrosurgical excision procedure[ LEEP]) </li></ul><ul><li>MRI or CT of the pelvis, abdomen, or bones may be performed to detect the spread of the tumor. </li></ul>
  58. 60. <ul><li>Complications </li></ul><ul><li>Some type of cervical cancer do not respond well to treatment. </li></ul><ul><li>The cancer may comeback (reoccur) after treatment </li></ul><ul><li>Woman who have treatment to save the uterus have a high risk of the cancer coming back </li></ul><ul><li>Spread to bladder and rectum, metastasis to lungs, mediastinum, bones and liver </li></ul><ul><li>Complications of intracavitary radiotherapy arcystitis, proctitis, vaginal stenosis, uterine perforation </li></ul><ul><li>Complications of external radiation are bone marrow depression, bowel obstruction, fistula </li></ul>
  59. 61. <ul><li>Nursing Diagnosis </li></ul><ul><li>Anxiety related to cancer and treatment </li></ul><ul><li>Disturb body image related to surgical treatment </li></ul><ul><li>Fear </li></ul><ul><li>Impaired tissue integrity </li></ul><ul><li>Interventions </li></ul><ul><li>Medical </li></ul><ul><li>Irradiation – primary therapy for early cervical cancer, usually curative but induces menopause </li></ul><ul><li>Surgical </li></ul><ul><li>Laser therapy or surgery </li></ul><ul><li>Cryosurgery </li></ul><ul><li>Conization </li></ul><ul><li>Hysterectomy or radical hysterectomy </li></ul><ul><li>Pelvic exenterization </li></ul>
  60. 62. <ul><li>Pre-op </li></ul><ul><li>(Nursing preparation for a woman for cryosurgery and laser therapy involves: </li></ul><ul><li>Clarifying that this procedure is not actual surgery and an incision will not be made. </li></ul><ul><li>explain that the procedure is performed with a vaginal speculum in place, as during a routine pelvic examination. </li></ul><ul><li>During treatment, a few women experienced headache, dizziness, flushing, and some cramping </li></ul>
  61. 63. <ul><li>Intra-op </li></ul><ul><li>During the procedure, provide psychological support by : </li></ul><ul><li>Staying with the client </li></ul><ul><li>Informing her of what is to be done </li></ul><ul><li>Talking with her, listening to her, and facilitating her expression of concern </li></ul><ul><li>Continuing to acknowledge her presence during the procedure rather than excluding her </li></ul><ul><li>Allowing her to retain as much self control as possible </li></ul><ul><li>Assess the woman’s discomfort during the procedure </li></ul><ul><li>Post-op </li></ul><ul><li>Meticulous, perennial hygiene minimizes </li></ul>
  62. 64. <ul><li>Levels of Prevention </li></ul><ul><li>Primary </li></ul><ul><li>Instruct client to avoid or seek early treatment of vaginal or cervical infection </li></ul><ul><li>Instruct client to limit the number of sexual partners and use condoms and limit the transmission of STD and human papilloma virus </li></ul><ul><li>Secondary prevention </li></ul><ul><li>Emphasize that woman should get regular PAP smear per physician recommendations (yearly for high risks woman) </li></ul>
  63. 66. Co l poscopy Cervical biopsy
  64. 67. sexually transmitted diseases
  65. 68. <ul><li>Definition </li></ul><ul><li>Genital warts , also known as venereal warts or condylomata acuminata, are one of the most common types of sexually transmitted diseases </li></ul><ul><li>The virus that causes genital warts — the human papillomavirus (HPV) — has been associated with cervical cancer. </li></ul><ul><li>The signs and symptoms of genital warts include: </li></ul><ul><ul><li>Small, flesh-colored or gray swellings in your genital area </li></ul></ul><ul><ul><li>Several warts close together that take on a cauliflower shape </li></ul></ul><ul><ul><li>Itching or discomfort in your genital area </li></ul></ul><ul><ul><li>Bleeding with intercourse. </li></ul></ul>
  66. 69. <ul><li>When to see a doctor See a doctor if: </li></ul><ul><ul><li>You've developed bumps or warts in your genital area </li></ul></ul><ul><ul><li>Your sexual partner has developed genital warts or has been diagnosed with them </li></ul></ul><ul><li>ETIOLOGY </li></ul><ul><ul><li>genital warts are caused by a virus — HPV — that infects the top layers of your skin </li></ul></ul><ul><li>Risk factors </li></ul><ul><li>Risk factors of becoming infected with HPV include: </li></ul><ul><ul><li>Having unprotected sex with multiple partners </li></ul></ul><ul><ul><li>Having had another sexually transmitted disease </li></ul></ul><ul><ul><li>Having sex with a partner whose sexual history you don't know </li></ul></ul><ul><ul><li>Becoming sexually active at a young age </li></ul></ul><ul><li>Complications </li></ul><ul><ul><li>Cancer </li></ul></ul><ul><ul><li>Problems during pregnancy. </li></ul></ul><ul><ul><li>difficult to urinate. </li></ul></ul>
  67. 70. Vaginitis <ul><li>Definition </li></ul><ul><li>Vaginitis is an inflammation of the vagina that can result in discharge, itching and pain . </li></ul><ul><li>ETIOLOGY </li></ul><ul><li>The cause is usually a change in the normal balance of vaginal bacteria or an infection. Vaginitis can also result from reduced estrogen levels after menopause. </li></ul><ul><li>The most common types of vaginitis are: </li></ul><ul><ul><li>Bacterial vaginosis </li></ul></ul><ul><ul><li>Yeast infections. </li></ul></ul><ul><ul><li>Trichomoniasis. </li></ul></ul><ul><ul><li>Atrophic vaginitis </li></ul></ul>
  68. 71. <ul><li>Symptoms </li></ul><ul><li>Vaginitis symptoms may include: </li></ul><ul><ul><li>Change in color, odor or amount of discharge from your vagina </li></ul></ul><ul><ul><li>Vaginal itching or irritation </li></ul></ul><ul><ul><li>Pain during intercourse </li></ul></ul><ul><ul><li>Painful urination </li></ul></ul><ul><ul><li>Light vaginal bleeding </li></ul></ul><ul><li>When to see a doctor You probably need to see your doctor if you have new vaginal concerns and: </li></ul><ul><ul><li>You've never had a vaginal infection </li></ul></ul><ul><ul><li>You've had multiple sex partners or a recent new partner </li></ul></ul><ul><ul><li>You've completed a course of over-the-counter anti-yeast medication and your symptoms persist, you have a fever, or you have a particularly unpleasant vaginal odor. </li></ul></ul><ul><li>You probably don't need to see your doctor if you have vaginal discharge or burning, irritation and: </li></ul><ul><ul><li>You've previously had a diagnosis of vaginal yeast infections and your signs and symptoms are the same as before. </li></ul></ul><ul><ul><li>You know the signs and symptoms of a yeast infection, and you're confident that you have a yeast infection. </li></ul></ul>
  69. 72. . Definition Chlamydia is a bacterial infection of your genital tract that spreads easily through sexual contact. <ul><li>Chlamydia is one of the most common sexually transmitted diseases in the United States. Each year, nearly 3 million people in the United States are infected with chlamydia. The disease affects both men and women and occurs in all age groups, though chlamydia is most prevalent among U.S. teenagers. </li></ul><ul><li>Chlamydia isn't difficult to treat once you know you have it. If it's left untreated, however, chlamydia can lead to more-serious health problems </li></ul><ul><li>Signs and symptoms of chlamydia infection may include: </li></ul><ul><ul><li>Painful urination </li></ul></ul><ul><ul><li>Lower abdominal pain </li></ul></ul><ul><ul><li>Vaginal discharge in women </li></ul></ul><ul><ul><li>Discharge from the penis in men </li></ul></ul><ul><ul><li>Painful sexual intercourse in women </li></ul></ul><ul><ul><li>Testicular pain in men </li></ul></ul>Chlamydia
  70. 73. <ul><ul><li>ETIOLOGY </li></ul></ul><ul><ul><li>The bacterium Chlamydia trachomatis causes chlamydia. </li></ul></ul><ul><ul><li>A variety of the Chlamydia trachomatis bacterium causes another sexually transmitted disease called lymphogranuloma venereum (LGV) . </li></ul></ul><ul><li>Initial signs of LGV include genital sores , followed later by fever and swollen lymph nodes in the groin area . </li></ul><ul><li>You're in a high-risk group if you: </li></ul><ul><ul><li>Have multiple sexual partners </li></ul></ul><ul><ul><li>Don't use a condom during sex </li></ul></ul><ul><ul><li>Have other sexually transmitted diseases </li></ul></ul><ul><ul><li>Have a sexual partner who has had a sexually transmitted disease </li></ul></ul><ul><li>TEST AND DIAGNOSIS </li></ul><ul><ul><li>The Centers for Disease Control and Prevention recommends all pregnant women be screened for chlamydia during the first prenatal exam, and women should be screened again later during the pregnancy if they have a high risk of infection. All people who have a high risk of infection also should consider screening. </li></ul></ul><ul><ul><ul><ul><ul><li>A culture swab </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>A urine test. </li></ul></ul></ul></ul></ul>
  71. 74. <ul><li>Complications </li></ul><ul><li>Chlamydia can lead to or be associated with other health problems, such as: </li></ul><ul><ul><li>Human immunodeficiency virus (HIV). </li></ul></ul><ul><ul><li>Other sexually transmitted infections. </li></ul></ul><ul><ul><li>Pelvic inflammatory disease (PID). </li></ul></ul><ul><ul><li>Chronic pelvic pain. </li></ul></ul><ul><ul><li>Infertility. </li></ul></ul><ul><ul><li>Epididymitis </li></ul></ul><ul><li>Treatments and drugs </li></ul><ul><ul><li>antibiotics such as azithromycin (Zithromax), doxycycline or erythromycin. </li></ul></ul><ul><li>Prevention </li></ul><ul><li>The surest way to prevent a chlamydia infection is to abstain from sexual activities . Short of that, you can: </li></ul><ul><ul><li>Use condoms. </li></ul></ul><ul><ul><li>Limit your number of sex partners. </li></ul></ul><ul><ul><li>Get regular screenings for sexually transmitted diseases. </li></ul></ul><ul><ul><li>Avoid douching. </li></ul></ul>
  72. 75. <ul><li>Gonorrhea </li></ul><ul><li>- is a sexually transmitted bacterium that can infect men and women. Gonorrhea can affect the urethra, rectum and throat of both men and women. In women, gonorrhea can also infect the cervix. </li></ul><ul><li>Signs and symptoms of gonorrhea that affects the urethra in men include: </li></ul><ul><ul><li>Painful urination </li></ul></ul><ul><ul><li>Pus-like discharge from the tip of the penis </li></ul></ul><ul><ul><li>Pain or swelling in one testicle </li></ul></ul><ul><li>Signs and symptoms of gonorrhea that affects the cervix or urethra in women include: </li></ul><ul><ul><li>Increased vaginal discharge </li></ul></ul><ul><ul><li>Painful urination </li></ul></ul><ul><ul><li>Vaginal bleeding between periods, such as after vaginal intercourse </li></ul></ul><ul><ul><li>Abdominal pain </li></ul></ul><ul><ul><li>Pelvic pain </li></ul></ul><ul><li>Signs and symptoms of gonorrhea that affects the rectum include: </li></ul><ul><ul><li>Anal itching </li></ul></ul><ul><ul><li>Pus-like discharge from the rectum </li></ul></ul><ul><ul><li>Spots of bright red blood on toilet tissue </li></ul></ul><ul><ul><li>Straining to have a bowel movement </li></ul></ul>
  73. 76. <ul><li>Signs and symptoms of gonorrhea that affects the eye include: </li></ul><ul><ul><li>Eye pain </li></ul></ul><ul><ul><li>Pus-like discharge from the eye </li></ul></ul><ul><ul><li>Sensitivity to light </li></ul></ul><ul><li>Signs and symptoms of gonorrhea that affects the throat include: </li></ul><ul><ul><li>Sore throat </li></ul></ul><ul><ul><li>Swollen lymph nodes in the neck </li></ul></ul><ul><li>When to see your doctor </li></ul><ul><ul><li>Make an appointment with your doctor if you notice any troubling signs or symptoms, such as a burning sensation when you urinate or a pus-like discharge from your penis, vagina or rectum. </li></ul></ul><ul><ul><li>Also make an appointment with your doctor if your partner has been diagnosed with gonorrhea. You may not experience signs or symptoms that prompt you to seek medical attention. But without treatment, you can reinfect your partner even after he or she has been treated for gonorrhea. </li></ul></ul><ul><ul><li>ETIOLOGY </li></ul></ul><ul><ul><li>Gonorrhea is caused by the bacterium Neisseria gonorrhoeae . </li></ul></ul>
  74. 77. <ul><li>Risk factors </li></ul><ul><li>Factors that may increase your risk of gonorrhea infection include: </li></ul><ul><ul><li>Younger age </li></ul></ul><ul><ul><li>A new sex partner </li></ul></ul><ul><ul><li>Multiple sex partners </li></ul></ul><ul><ul><li>Previous gonorrhea diagnosis </li></ul></ul><ul><li>Complications </li></ul><ul><li>Untreated gonorrhea can lead to significant complications, such as: </li></ul><ul><ul><li>Infertility in women. </li></ul></ul><ul><ul><li>Infection that spreads to the joints and other areas of your body </li></ul></ul><ul><ul><li>Increased risk of HIV/AIDS. </li></ul></ul><ul><li>Tests and diagnosis </li></ul><ul><ul><li>Urine test. </li></ul></ul><ul><ul><li>Swab of affected area </li></ul></ul><ul><li>Treatments and drugs </li></ul><ul><li>Adults with gonorrhea are treated with antibiotics </li></ul>
  75. 78. <ul><li>Prevention </li></ul><ul><li>Take steps to reduce your risk of gonorrhea. Try to: </li></ul><ul><ul><li>Don't have sex with someone who has any unusual symptoms. </li></ul></ul><ul><ul><li>Ask your partner to be tested for sexually transmitted diseases. </li></ul></ul><ul><ul><li>Consider regular gonorrhea screening if you have an increased risk. </li></ul></ul>Syphilis Syphilis is a bacterial infection usually spread by sexual contact. The disease starts as a painless sore on your genitals, mouth or another part of your body. If untreated, syphilis can damage your heart and brain.
  76. 79. <ul><li>ETIOLOGY </li></ul><ul><li>The cause of syphilis is a bacterium called Treponema pallidum. </li></ul><ul><li>SYMPTOMS </li></ul><ul><li>Primary syphilis </li></ul><ul><li>These signs may occur from 10 days to three months after exposure: </li></ul><ul><ul><li>A small, firm, painless sore (chancre, pronounced &quot;SHANG-ker&quot;) on the part of your body where the bacteria entered, usually your </li></ul></ul><ul><ul><li>genitals, rectum, tongue or lips. A single chancre is typical, but you may have multiple sores. </li></ul></ul><ul><ul><li>Enlarged lymph nodes in your groin. </li></ul></ul><ul><ul><li>The sore will heal without treatment, but the syphilis infection remains. In some people, syphilis then moves to the secondary stage. </li></ul></ul><ul><li>Secondary syphilis </li></ul><ul><li>The signs and symptoms of secondary syphilis begin two to 10 weeks after the chancre appears and may include: </li></ul><ul><ul><li>Skin rash, often appearing as rough, red or reddish-brown, penny-sized sores, over any area of your body, including your palms and soles </li></ul></ul><ul><ul><li>Fever </li></ul></ul><ul><ul><li>Fatigue and a vague feeling of discomfort </li></ul></ul>
  77. 80. <ul><ul><li>Soreness and aching </li></ul></ul><ul><ul><li>Swollen lymph glands </li></ul></ul><ul><ul><li>Sore throat </li></ul></ul><ul><ul><li>Wart-like sores in the mouth or genital area </li></ul></ul><ul><li>These signs and symptoms may disappear within a few weeks or repeatedly come and go for as long as a year. </li></ul><ul><li>Latent syphilis </li></ul><ul><ul><li>If you aren't treated for syphilis, the disease moves from the secondary to the latent (hidden) stage, when you have no symptoms. The latent stage can last for years. Signs and symptoms may never return, or the disease may progress to the tertiary (third) stage. </li></ul></ul><ul><li>Tertiary or late syphilis </li></ul><ul><ul><li>About 15 to 30 percent of people infected with syphilis who don't get treatment will develop complications known as tertiary, or late, syphilis. In the late stages, the disease may damage your brain, nerves, eyes, heart, blood vessels, liver, bones and joints. These problems may occur many years after the original infection. </li></ul></ul>
  78. 81. <ul><li>Some of the signs and symptoms of late syphilis include: </li></ul><ul><ul><li>Jerky or uncoordinated muscle movements </li></ul></ul><ul><ul><li>Paralysis </li></ul></ul><ul><ul><li>Numbness </li></ul></ul><ul><ul><li>Gradual blindness </li></ul></ul><ul><ul><li>Dementia </li></ul></ul><ul><ul><li>Congenital syphilis </li></ul></ul><ul><li>If you're pregnant, you may pass syphilis to your unborn baby. Blood containing the bacteria reaches the fetus through the placenta, the organ that nourishes the developing baby. This is known as congenital syphilis. </li></ul><ul><li>Most infants born with syphilis have no symptoms of the disease. Almost all develop symptoms by 3 months of age, though some children with congenital syphilis show no signs of the disease until after age 2. </li></ul><ul><li>Early signs and symptoms, which occur before the age of two, may include: </li></ul><ul><ul><li>&quot;Snuffles&quot; (runny nose) </li></ul></ul><ul><ul><li>Skin sores </li></ul></ul><ul><ul><li>Rashes </li></ul></ul><ul><ul><li>Fever </li></ul></ul><ul><ul><li>Jaundice — yellow skin </li></ul></ul><ul><ul><li>Infection of the umbilical cord </li></ul></ul><ul><ul><li>Anemia </li></ul></ul><ul><ul><li>Swollen liver and spleen </li></ul></ul>
  79. 82. <ul><li>COMPLICATIONS </li></ul><ul><ul><li>Deformities </li></ul></ul><ul><ul><li>Tooth abnormalities </li></ul></ul><ul><ul><li>Deafness </li></ul></ul><ul><ul><li>Developmental delays </li></ul></ul><ul><ul><li>Seizures </li></ul></ul><ul><ul><li>Death </li></ul></ul><ul><li>Risk factors </li></ul><ul><li>You face an increased risk of acquiring syphilis if you: </li></ul><ul><ul><li>Engage in high-risk sexual activity, including unprotected sex , sex with multiple partners, having sex with a new partner, or having sex under the influence of drugs or alcohol </li></ul></ul><ul><ul><li>Are a man who has sex with men </li></ul></ul><ul><ul><li>Are infected with the human immunodeficiency virus (HIV) </li></ul></ul><ul><ul><li>The more sexual partners you have, the more likely you are to get syphilis or another sexually transmitted disease (STD). Even if you've had syphilis and been treated for it previously, you can get it again </li></ul></ul>
  80. 83. <ul><li>Tests and diagnosis </li></ul><ul><ul><li>Blood tests </li></ul></ul><ul><ul><li>Lab tests </li></ul></ul><ul><ul><li>Your doctor may scrape a small sample of cells from a sore to be analyzed by microscope in a lab </li></ul></ul><ul><ul><li>Cerebrospinal fluid test </li></ul></ul><ul><ul><li>Screening for pregnant women </li></ul></ul><ul><li>Treatments and drugs </li></ul><ul><li>Treatment follow-up </li></ul><ul><li>Penicillin </li></ul><ul><li>After you're treated for syphilis, your doctor will ask you to: </li></ul><ul><ul><li>Have periodic blood tests and exams to make sure you're responding to the usual dosage of penicillin. </li></ul></ul><ul><ul><li>Avoid sexual contact until the treatment is completed and blood tests indicate the infection has been cured. </li></ul></ul><ul><ul><li>Notify your sex partners so that they can be tested and get treatment if necessary. </li></ul></ul><ul><ul><li>Be tested for HIV infection. </li></ul></ul>
  81. 84. <ul><li>Prevention </li></ul><ul><li>To reduce your risk of syphilis and other sexually transmitted diseases, practice safe sex: </li></ul><ul><ul><li>Avoid sex, or have mutually monogamous sex with one partner who is uninfected. </li></ul></ul><ul><ul><li>Talk with your sex partners about your HIV status and history of other sexually transmitted diseases (STDs). </li></ul></ul><ul><ul><li>If you don't know the STD status of your partner, use a latex condom with each sexual contact. </li></ul></ul>