Group 6 Robb


Published on

1 Like
  • Be the first to comment

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Group 6 Robb

  1. 1. Endometriosis <ul><li>Introduction </li></ul><ul><li>Endometriosis ( from endo “inside”, and metra , “womb”) is a common medical condition in women in which endometrial cells are deposited in the areas outside the uterine cavity .the uterine cavity is lined by endometrial cells, which are under the influence of female hormones. Endometial cells deposited in the areas outside the uterus (endometriosis) continue to be influenced by these hormonal changes and respond similarly as do these cells found inside. </li></ul><ul><li>Endometriosis is a chronic disease that affects between 5% to 15% of women of reproductive age. It is a benign lesions with cells similar to those lining the uterus. Often, extensive endometriosis causes a few symptoms, whereas an isolated lesion may produce severe symptoms. </li></ul>
  2. 2. <ul><li>Endometriosis is found most commonly in premenauposal women aged 30 to 40s. It rarely occurs in women yuonger than 20 years of age. </li></ul><ul><li>It appears to be hereditary, occuring more commonly in women whose had the disorder. The highest incidence is in nulliparous white women </li></ul>
  3. 3. Etiology <ul><li>The cause of endometriosis is unknown. </li></ul><ul><li>Several theories have been proposed: </li></ul><ul><li>implantation theory – menstrual flow regurgitates through the fallopian tubes and deposit particle of viable endometrial tissue outside the uterus cavity spread then occurs via metaplasia (endometrial tissue reproducing itself) </li></ul><ul><li>Vascular and lymphatic dissemination theory – spread of endometrial glands occurs through the lymphatic and vascular system to location outside the uterus . </li></ul>
  4. 4. Pathophysiology <ul><li>Although the abnormally located tissue is usually confined to the pelvic cavity, it may occur in the other areas. The most frequent sites are the ovary and dependent portion of the pelvic peritoneum. rarely, tissue may be found outside the pelvis, such as in surgical scars, lungs, and extremities. </li></ul><ul><li>Regardless of the site, this misplaced endometrial tissue responds to hormonal stimulation and bleeds, producing a variety of manifestation. Scarring and inflammation occurs at sites of endometriosis. Repeated episodes of inter-peritoneal bleeding (from hormonal stimulation of the endometrial tissue) cause adhesions. Eventually, one peritoneal surface may become fixed to another. </li></ul>
  5. 5. <ul><li>Infertility is a major complication of endometriosis. Usually the cause of infertility is unknown; sometimes ,however endometriosis produces tubal obstruction. </li></ul><ul><li>Endometrial tissue is hormonal-dependent; therefore the tissue usually atrophies with the normal ovarian regression assoc. with menopause. It also regress during pregnancy. </li></ul>
  6. 6. <ul><li>Menstrual flow regurgitation </li></ul><ul><li>metaplasia </li></ul><ul><li>Misplaced endometrial tissue </li></ul><ul><li>Scarring and inflammation </li></ul><ul><li>Interperitoneal bleeding </li></ul><ul><li>Adhesions </li></ul><ul><li>Tissue atrophy </li></ul>
  7. 7. Assessment <ul><li>Fixed tender nodules </li></ul><ul><li>Fatigue </li></ul><ul><li>Menstrual cramping </li></ul><ul><li>A health history, including an account of the pattern </li></ul><ul><li>Diagnostic </li></ul><ul><li>Laparoscopic examination(help staging the disease </li></ul><ul><li>stage 1-px. Have superficial or minimal lesion </li></ul><ul><li>Stage 2-mild involvement </li></ul><ul><li>Stage 3- moderate involvement </li></ul><ul><li>Stage 4-extensive involvement and dense adhesion with obliteration of the cul-de-sac </li></ul>
  8. 8. Medical management <ul><li>NSAID’s </li></ul><ul><li>Nursing Diagnosis </li></ul><ul><li>Pain </li></ul><ul><li>Knowledge deficit </li></ul><ul><li>Altered Health Maintenance </li></ul><ul><li>Risk for ineffective individual coping </li></ul>
  9. 9. <ul><li>While the exact cause of endometriosis remains unknown, many theories have been presented to better understand and explain its development. </li></ul><ul><li>*Estrogen- it is a condition that is estrogen-dependent and thus seen primarily during the reproductive years. </li></ul><ul><li>*Retrograde menstruation- </li></ul><ul><li>*Metaplasia </li></ul><ul><li>*Genetics </li></ul><ul><li>*Transplantation </li></ul><ul><li>*Immune system </li></ul><ul><li>*Environment </li></ul><ul><li>*Birth defect </li></ul>
  10. 10. Treatment <ul><li>May include the use of oral contraceptives to minimize endometrial buildup or medications to suppress menstruatio (danocrine,synarel) </li></ul><ul><li>Surgical intervention </li></ul><ul><li>Removal of endometrial implants mat be helpful </li></ul><ul><li>Hysterectomy and salphingo-oophorectomy are curative. </li></ul>
  11. 11. Dysmenorrheal <ul><li>Dysmenorrhea literally means ”pain with menses” </li></ul><ul><li>Classification </li></ul><ul><li>Primary dysmenorrhea </li></ul><ul><li>Secondary dysmenorrhea </li></ul>
  12. 12. Dysmenorrheal <ul><li>Primary or idiopahic dysmenorrhea </li></ul><ul><li>Is essential in nature and the etiolagy ot the problem is not really known. </li></ul><ul><li>Usually does not occur until several years after the menarche, when ovulatory cycles more regularly. Anovulatory cycles rarely, if ever,cause primary dysmenorrhea </li></ul>
  13. 13. Clinical Manifestations and Diagnostic Findings <ul><li>Primary dysmenorrhea </li></ul><ul><li>-characteristic begins to 1 to 2 months after manarche in conjunction with ovulatory cycles. </li></ul><ul><li>-it is often assoc. with prolonged menstrual flow and is more common in obese, sedentary women. </li></ul>
  14. 14. Manifestation <ul><li>Nausea and vomiting </li></ul><ul><li>Diarrhea </li></ul><ul><li>Syncope </li></ul><ul><li>Headache </li></ul><ul><li>Leg pain </li></ul>
  15. 15. Pathphysiology <ul><li>It appears that prostaglandin synthesis at the time of menstruation produces strong myomertrial contractions. The severe muscle spasms constrict blood vessels supplying the uterus, causing ischemia and pain. The excess prostaglandin in smooth muscle also help explain the presence of GI manifestation, such as nausea and vomiting and diarrhea or headache. </li></ul>
  16. 16. <ul><ul><li>Increase prostaglandin </li></ul></ul><ul><li>Constricted blood vessel in the uterus </li></ul><ul><ul><li>Produces myometrial contraction </li></ul></ul><ul><ul><ul><ul><li>pain </li></ul></ul></ul></ul>
  17. 17. Dysmenorrheal <ul><li>Assessment Findings: </li></ul><ul><li>-malaise </li></ul><ul><li>-nausea and vomiting </li></ul><ul><li>-chills </li></ul><ul><li>-headache </li></ul><ul><li>-diarrhea </li></ul><ul><li>-flushing </li></ul><ul><li>-premenstrual tension syndrome </li></ul>
  18. 18. <ul><ul><li>Despite the lack of firm knowledge of the etiology of p.d several factors are related: </li></ul></ul><ul><li>Psychologic factor </li></ul><ul><li>Low pain threshold </li></ul><ul><li>Some hormonal imbalance </li></ul><ul><ul><li>Factors which aggravate the condition include: </li></ul></ul><ul><li>A sedentary occupation </li></ul><ul><li>Poor posture </li></ul><ul><li>Poor personal hygiene </li></ul><ul><li>Constitutional illness such as anemia. </li></ul>
  19. 19. <ul><li>Treatment: </li></ul><ul><li>mild to moderate attack includes: </li></ul><ul><li>Resting for 1 or 2 hours </li></ul><ul><li>Aspirin </li></ul><ul><li>Hot beverages </li></ul><ul><li>Application of heat to the lower abdomen </li></ul><ul><li>Drug therapy options </li></ul><ul><li>Antispasmodics </li></ul><ul><li>Vasodilators </li></ul><ul><li>Tranquilizers </li></ul><ul><li>Narcotics </li></ul>
  20. 20. Diagnosis <ul><li>Diagnosis is based on thorough Gynecologic History </li></ul><ul><li>The History </li></ul><ul><li>-the gynecologic history is designed to provide information for the physician </li></ul><ul><li>-this way it guides the physical examination </li></ul><ul><li>Nursing Diagnosis </li></ul><ul><li>Pain </li></ul><ul><li>Knowledge deficit </li></ul><ul><li>Altered Health Maintenance </li></ul><ul><li>Risk for ineffective individual coping </li></ul>
  21. 21. Interventions: <ul><li>A. Medical Management </li></ul><ul><li>the current therapeutic approach to p.d emphasizes prevention and education. </li></ul><ul><li>Non-pharmacologic remedies might be effective..For ex: biofeedback, therapeutic touch or acupuncture might be helpful </li></ul><ul><li>if contraception is desired as well as relief of dysmenorrhea combination of oral contraceptives may relieve menstrual pain. </li></ul><ul><li>Prostaglandin synthesis inhibitor – it decreases prostaglandin activity </li></ul><ul><li>-ibuprofen (motrin) </li></ul><ul><li>-mefenamic acid (ponstel) </li></ul><ul><li>-naproxen (naprosyn) </li></ul>
  22. 22. B. Surgical <ul><li>Treatment measures to which the physician may resort to eradicate dysmenorrhea are </li></ul><ul><li>a) Dilatation of the cervix </li></ul><ul><li>b) Presacral neurectomy </li></ul>
  23. 23. <ul><li>Secondary Dysmenorrhea or acquired dysmenorrhea </li></ul><ul><li>assoc. with pelvic disease </li></ul><ul><li>with the px. Having the disease history of previously painless period. </li></ul><ul><li>The pain often starts 2 to 3 days before the menses appear and radiates into the entire abdomen the small of the back and down the legs. </li></ul><ul><li>Usually assoc. with pelvic disease such as tumors, inflammatory problems, endometriosis, a fixed malpositioned uterus and other problem </li></ul><ul><li>Teatment by removing the cause either medically or surgically </li></ul><ul><li>-Treatment must be palliative </li></ul>
  24. 24. Ovarian cysts <ul><li>are small fluid-filled sacs that develop in a woman's ovaries. </li></ul><ul><li>In a ultrasound image, ovarian cysts resemble bubbles. </li></ul><ul><li>It develops if a follicle fails to rupture and release the egg, the fluids remains and cam form a cyst in the ovary. </li></ul><ul><li>Most ovarian cysts aree benign, meaning they are not cancerour. </li></ul>
  25. 25. <ul><li>Follicle fails to rupture and release the egg </li></ul><ul><li>Fluid remain </li></ul><ul><li>Form cyst in the ovary </li></ul><ul><li>ovarian cyst </li></ul>
  26. 26. Classification <ul><li>Follicular cyst </li></ul><ul><li>Corpus luteum cyst </li></ul><ul><li>Hemorrhagic cyst </li></ul><ul><li>Dermoid cyst </li></ul><ul><li>Endometriomas or endometriod </li></ul><ul><li>Nursing Diagnosis </li></ul><ul><li>Pain </li></ul><ul><li>Knowledge deficit </li></ul><ul><li>Altered Health Maintenance </li></ul><ul><li>Risk for ineffective individual coping </li></ul>
  27. 27. intervention <ul><li>a) Medical management </li></ul><ul><li>NSAID’s – may help reduce pelvic pain. for ex: </li></ul><ul><li> -ibuprofen (advil) </li></ul><ul><li>Analgesic (pain reliever) </li></ul><ul><li>Oral contraceptives – birth control pills may be helpful to regulate the menstral cycle, prevent the formation of the follicles that can turn into cysts. </li></ul>
  28. 28. <ul><li>b) Surgical management </li></ul><ul><li>Laparoscopic surgery </li></ul><ul><li>Laparotomy </li></ul><ul><li>Surgery for ovarian torsion </li></ul>
  29. 29. Pre-menstrual Dysphoric Disorder <ul><li>Introduction </li></ul><ul><li>*Premenstrual dysphoric disorder (PMDD) a is identified by a variety of physical and emotional symptoms that occur during the last week of the luteal phase of the menstrual cycle and that remit within a few days after the onset of the follicular phase. In most women, these symptoms occur in the week before, and remit within a few days after, the onset of menses. The disorder has also been reported in non menstruating women who have had a hysterectomy but who retain ovarian function. The diagnosis is given only when the symptoms are sufficiently severe to cause marked impairment in social or occupational functioning and have occurred during a majority of menstrual cycles in the past year </li></ul><ul><li>*PMDD is a severe form of a common problem called premenstrual syndrome, or PMS. About 75 percent of women of childbearing age have some PMS problems. About 2 to 10 percent of women in this age group have PMDD </li></ul>
  30. 30. Symptoms <ul><li>Markedly depressed mood, </li></ul><ul><li>feelings of hopelessness, or self-deprecating thoughts </li></ul><ul><li>Marked anxiety, </li></ul><ul><li>tension, </li></ul><ul><li>feelings of being “keyed up” or “on edge” </li></ul><ul><li>Marked affective lability (e.g., feeling suddenly sad or tearful or increased sensitivity to rejection) </li></ul><ul><li>Persistent and marked anger or irritability or increased interpersonal conflicts </li></ul>
  31. 31. <ul><ul><li>Decreased interest in usual activities (e.g., work, school, friends, hobbies) </li></ul></ul><ul><ul><li>Marked change in appetite, overeating, or specific food cravings </li></ul></ul><ul><ul><li>Hypersomnia or insomnia </li></ul></ul><ul><ul><li>Cramps </li></ul></ul><ul><ul><li>Alcohol intolerance </li></ul></ul><ul><ul><li>Acne </li></ul></ul><ul><ul><li>Altered sexual drive </li></ul></ul><ul><ul><li>Forgetfulness </li></ul></ul><ul><ul><li>Suicidal ideations or attempts </li></ul></ul>
  32. 32. The symptoms of PMDD are: • Sadness and crying • Feeling nervous, anxious, and irritable • Strong cravings for certain foods • Problems paying attention and concentrating • Physical problems such as breast tenderness, headaches, joint or muscle pain and swelling or bloating • Trouble sleeping
  33. 33. causes PMDD <ul><li>The exact cause of PMDD is not known. </li></ul><ul><li>Changes in hormones related to your period may cause PMDD. </li></ul><ul><li>Stressful life events and a family history of PMS or PMDD may increase your chances of getting PMDD. </li></ul>
  34. 34. Intervention <ul><li>Medical intervention </li></ul><ul><li>● Selective serotonin reuptake inhibitors help by increasing the effect of a brain chemical called serotonin </li></ul><ul><li>Diagnosis </li></ul><ul><li>● There is no test that can diagnose PMDD. </li></ul>
  35. 35. Vaginal Fistula <ul><li>-is an abnormal passage that connects the vagina to other organs, such as the bladder or rectum, resulting in leakage of urine or feces into the vagina. A vagina fistula could also be described as a hole in the vagina that allows stool or urine to pass through the vagina . </li></ul><ul><li>Vaginal Fistulas include: </li></ul><ul><ul><li>Vesicovaginal fistula –also called bladder fistulas, occur between the vagina and urinary bladder. This is the common type of vaginal fistula. </li></ul></ul><ul><ul><li>Ureterovaginal fistula –ureter fistulas, occur between the vagina and distal ureter (ureters are ducts that carry urine from the kidney to the bladder). </li></ul></ul><ul><ul><li>Urethrovaginal fistula - urethra fistulas, occur between the vagina and urethra ( tube that carries urine out the body). </li></ul></ul><ul><ul><li>Rectovaginal fistula -rectum fistulas, occur between the vagina and the rectum. </li></ul></ul>
  36. 36. <ul><li>All the above vaginal fistulas cause some similar symptoms such as: </li></ul><ul><li>1. Urine or flatus and feces leak into the vagina. </li></ul><ul><li>2. Excoriation and irritation of the vaginal and vulvar tissues occur. </li></ul><ul><li>3. Severe infection may result from this irritation. </li></ul><ul><li>4. Psychologically distressing problems which women face. ex. Patients with those disorders frequently become social recluses, causing great disruption to their family relationships and other social activities. So, they often fail to consult a physician until the problem has become severe, and even then they are reluctant to discuss it. </li></ul>
  37. 37. Nursing care <ul><li>a . Perineal hygiene measures Cleansing the perineum about every four hours, sitz baths, douches, and perineal pads (which should be changed frequently). </li></ul><ul><li>b. Deodorizing and comforting measures </li></ul>
  38. 38. Diagnosis: <ul><li>For Vesicovaginal fistula : </li></ul><ul><ul><li>Watery vaginal discharge </li></ul></ul><ul><ul><li>Urinary incontinence </li></ul></ul><ul><ul><li>Leakage of urine through the vagina </li></ul></ul><ul><ul><li>Vaginal irritation </li></ul></ul><ul><ul><li>Recurrent episodes of cystitis or vaginitis </li></ul></ul><ul><li>For ureterovaginal fistula: </li></ul><ul><ul><li>Watery vaginal discharge </li></ul></ul><ul><ul><li>Urinary incontinence </li></ul></ul><ul><ul><li>Leakage of urine through the vagina </li></ul></ul><ul><ul><li>Vaginal irritation </li></ul></ul>
  39. 39. <ul><li>For uterovaginal fistula: </li></ul><ul><ul><li>Urine leaking into vagina during urination </li></ul></ul><ul><ul><li>Urinary incontinence </li></ul></ul><ul><ul><li>Vaginal irritation </li></ul></ul><ul><li>For Rectovaginal fistula: </li></ul><ul><ul><li>Fecal incontinence </li></ul></ul><ul><ul><li>Leakage of feces into the vagina </li></ul></ul><ul><ul><li>Vaginal irritation </li></ul></ul><ul><li>Diagnostic medical and surgical intervention </li></ul><ul><li>Dye test </li></ul><ul><li>Cytoscopy </li></ul><ul><li>Retrograde pyelogram </li></ul><ul><li>Fistula gram </li></ul><ul><li>Anoscopy /flexible sigmoidoscopy </li></ul><ul><li>Nursing diagnosis </li></ul><ul><ul><li>Acute pain </li></ul></ul><ul><ul><li>Altered urinary elimination </li></ul></ul><ul><ul><li>Infection </li></ul></ul><ul><ul><li>Sexual dysfunction </li></ul></ul><ul><ul><li>Knowledge deficit </li></ul></ul>
  40. 40. Uterine Prolapsed <ul><li>Uterine prolapse or downward displacement of the uterus into the vagina may be caused by weakening of the pelvic supports, including ligaments, fascia and muscles. </li></ul><ul><li>uterine prolapse may result from: </li></ul><ul><li>a. childbirth injuries </li></ul><ul><li>b. loss of elasticity due to aging </li></ul><ul><li>c. congenital weaknesses or increase intra abdominal pressure (e.g. from tumors or occupations requiring heavy lifting). </li></ul>
  41. 41. <ul><li>Prolapsed or descent of the uterus occurs in three stages: </li></ul><ul><li>First degree- uterus descends into the vaginal canal and the cervix reaches but does not go through the introitus. </li></ul><ul><li>Second degree- body of the uterus is still within the vagina, but the cervix protrudes through the introitus. </li></ul><ul><li>3.Third degree- (also called “procidentia” or “complete prolapse”)- the entire uterus and the cervix protrude through the introitus with inversion of the vaginal canal. </li></ul><ul><li>Uterine prolapsed varies in severity. In mild uterine prolapsed can experience no signs and symptoms or you could have moderate to severe uterine prolapsed. If that’s the case, you may experience the ff. </li></ul><ul><ul><li>sensation of heaviness or pulling in your pelvis </li></ul></ul><ul><ul><li>tissue protruding from your vagina </li></ul></ul><ul><ul><li>urinary difficulties, such as urine leakage or urge incontinence </li></ul></ul><ul><ul><li>trouble having a bowel movement </li></ul></ul><ul><ul><li>low back pain </li></ul></ul><ul><ul><li>feeling as if you’re sitting on a small ball or as if something is falling out of your vagina </li></ul></ul><ul><ul><li>symptoms that are less bothersome in the morning and worsen as the day goes on </li></ul></ul>
  42. 42. <ul><li>Risk factors: </li></ul><ul><ul><li>one or more pregnancies and vaginal births </li></ul></ul><ul><ul><li>giving birth to a large baby </li></ul></ul><ul><ul><li>increasing age </li></ul></ul><ul><ul><li>frequent heavy lifting </li></ul></ul><ul><ul><li>chronic coughing </li></ul></ul><ul><ul><li>frequent straining during bowel movement </li></ul></ul><ul><ul><li>Diagnostic examination </li></ul></ul><ul><li>A. Imaging Test </li></ul><ul><ul><li>Magnetic Resonance Imaging </li></ul></ul><ul><ul><li>Ultrasound </li></ul></ul><ul><ul><li>Cystourethroscopy </li></ul></ul><ul><li>B. Exam Tests </li></ul><ul><ul><li>Q-tip Test </li></ul></ul><ul><ul><li>Bladder-function tests </li></ul></ul><ul><ul><li>Pelvic floor strength tests </li></ul></ul>
  43. 43. Complications <ul><li>Ulcers. </li></ul><ul><li>Prolapse of other pelvic organs . </li></ul><ul><li>Medical Intervention </li></ul><ul><li>Estrogen supplementation </li></ul><ul><li>Electrical stimulation – a device which delivers small electrical currents is applied to targeted muscles within the vagina or on the pelvic floor. The current causes muscles to contract, which strengthens them. </li></ul><ul><li>Biofeedback </li></ul><ul><li>Surgical Interventions </li></ul><ul><li>Vaginal hysterectomy with anterior and posterior colporraphy (repair of vagina and underlying fascia) </li></ul>
  44. 44. Nursing care <ul><li>Prevention </li></ul><ul><ul><li>The nurse must encourage pregnant patients to seek qualified obstetric care. </li></ul></ul><ul><ul><li>Teaching patients after delivery to alternately tense and relax their gluteal muscles and the muscles of the pelvic floor. </li></ul></ul><ul><ul><li>Maintain a healthy weight. By keeping or getting your weight control, you may decrease your risk of uterine prolapse. </li></ul></ul><ul><ul><li>Practice Kegel exercises. Because of pregnancy or childbirth can weaken pelvic floor muscles and connective tissue, your doctor may recommend Kegel exercises- special exercises in which you repeatedly squeeze and relax the muscles of your pelvic floor. </li></ul></ul><ul><ul><li>Control coughing. </li></ul></ul>
  45. 45. <ul><li>Nursing diagnosis </li></ul><ul><ul><li>Acute pain </li></ul></ul><ul><ul><li>Altered urinary elimination </li></ul></ul><ul><ul><li>Infection </li></ul></ul><ul><ul><li>Sexual dysfunction </li></ul></ul><ul><ul><li>Knowledge deficit </li></ul></ul>
  46. 46. Rectal prolapsed <ul><ul><ul><ul><li>Introduction </li></ul></ul></ul></ul><ul><li>The term rectum refers to the 12-15 cm. of the large intestine. The rectum is located just above the anal canal. Normally, the rectums securely attached to the pelvis with the help of ligaments and muscles. This attachment to the body also weakens. This causes the rectum to prolapsed, meaning its splits or falls out of place. Occasionally, large hemorrhoids (large, swollen veins inside the rectum) may predispose the rectum to prolapsed. </li></ul>
  47. 47. Stages of rectal prolapsed <ul><li>1. Mucosal prolapsed or partial prolapsed </li></ul><ul><ul><li>- only the inner lining of the rectum protrudes from the anus. </li></ul></ul><ul><ul><li>- occurs when the connective tissues within the rectal mucosa loosen and stretch, allowing the tissue to protrude. </li></ul></ul><ul><ul><li>2. Complete prolapsed </li></ul></ul><ul><ul><li>- as the rectum becomes more prolapsed, the ligaments and muscles may weaken to the point that a large portion of the rectum protrudes from the body through the anus. </li></ul></ul><ul><ul><li>3. Internal intussusceptions </li></ul></ul><ul><ul><li>- its similar to those mucosal or complete prolapsed; however in the internal intussusceptions, the rectum protrudes from the body nor enters the anal canal. </li></ul></ul>
  48. 48. Causes of rectal prolapsed <ul><li>Rectal prolapsed is caused by weakening of the ligaments and the muscles that hold the rectum in place. </li></ul><ul><li>Advanced age </li></ul><ul><li>Long term constipation </li></ul><ul><li>Long-term diarrhea </li></ul><ul><li>Long-term straining during defecation </li></ul><ul><li>Pregnancy and the stresses of childbirth </li></ul><ul><li>Previous surgery </li></ul><ul><li>Whooping cough </li></ul>
  49. 49. <ul><li>Symptoms of Rectal prolapsed </li></ul><ul><li>Blood in stool </li></ul><ul><li>Mucus in stool </li></ul><ul><li>Anal protrusion </li></ul><ul><li>Pain during bowel movements </li></ul><ul><li>Loss of urge to defecates </li></ul><ul><li>Complications </li></ul><ul><li>The list of complications for Rectal prolapsed includes : </li></ul><ul><li>Female genital prolapsed </li></ul><ul><li>Constipation </li></ul>
  50. 50. Diagnostic exam test <ul><li>Defecogram </li></ul><ul><ul><li>A test that evaluates bowel control, may help distinguish between a mucosal prolapsed and a complete prolapsed. </li></ul></ul><ul><ul><li>Prevention </li></ul></ul><ul><ul><li>Avoid straining from constipation </li></ul></ul><ul><ul><li>Pelvic floor exercis e </li></ul></ul><ul><li>Defecogram </li></ul><ul><ul><li>A test that evaluates bowel control, may help distinguish between a mucosal prolapsed and a complete prolapsed. </li></ul></ul><ul><ul><li>Prevention </li></ul></ul><ul><ul><li>Avoid straining from constipation </li></ul></ul><ul><ul><li>Pelvic floor exercis e </li></ul></ul>
  51. 51. <ul><li>Nursing diagnosis </li></ul><ul><li>Fecal incontinence (inability to control bowel movement) </li></ul><ul><li>Rationale: </li></ul><ul><li>Medical management </li></ul><ul><li>Bulking agents </li></ul><ul><li>Stool softeners </li></ul><ul><li>Suppositories or enemas </li></ul><ul><li>Nursing care </li></ul><ul><li>Prevention </li></ul><ul><li>*a high fiber and daily intake of plenty of fluids </li></ul><ul><li>*seek medical attention if experiencing long-term diarrhea and constipation in order to lessen the chance to develop a prolapsed rectum. </li></ul>
  52. 52. Imperforated hymen <ul><li>Introduction </li></ul><ul><ul><ul><li>Imperforate hymen: Lack of opening in the vaginal hymen </li></ul></ul></ul><ul><li>Symptoms of Imperforate hymen </li></ul><ul><li>› No menstrual bleeding </li></ul><ul><li> › Enlarged uterus </li></ul>
  53. 53. Complications for Imperforate hymen <ul><li>The list of complications that have been mentioned in various sources for Imperforate hymen includes: </li></ul><ul><li>Amenorrhoea </li></ul><ul><li>Dyspareunia </li></ul><ul><li>Hydrometrocolpos </li></ul><ul><li>Hematosalpinx </li></ul><ul><li>Female infertility </li></ul><ul><li>Cryptomenorrhea </li></ul>
  54. 54. Toxic shock syndrome <ul><li>Overview </li></ul><ul><li>By the time a person with toxic shock syndrome (TSS) sees a health professional, immediate medical treatment is usually necessary. Because TSS can progress rapidly and cause life-threatening complications, treatment almost always takes place in a hospital where a person's condition can be closely monitored. Treatment for shock or organ failure is usually necessary before any test results are available. Admission to the intensive care unit (ICU) is usually needed when a person shows signs of shock or has problems breathing (respiratory failure). </li></ul><ul><li>Toxic shock syndrome ( TSS ) is a very rare but potentially fatal illness caused by a bacterial toxin . Different bacterial toxins may cause toxic shock syndrome, depending on the situation. The causative-positive bacteria include Staphylococcus aureus and Streptococcus pyogenes . Streptococcal TSS is sometimes referred to as Toxic shock-like syndrome ( TSLS ). </li></ul>
  55. 55. <ul><li>Routes of infection </li></ul><ul><li>TSS can occur via the skin (e.g., cuts, surgery, burns), </li></ul><ul><li>vagina, (prolonged tampon exposure), or pharynx . </li></ul><ul><li>Causes </li></ul><ul><li>Toxic shock syndrome is the rare result of infection by Streptococcus pyogenes (group A strep) or Staphylococcus aureus (staph) bacteria. These bacteria make toxins that cause TSS. These bacteria are common but usually don't cause problems. They can cause infections of the throat or skin that are easy to treat, such as strep throat or impetigo . In rare cases, the toxins enter the bloodstream and cause a severe immune reaction in people whose bodies can't fight these toxins. </li></ul>
  56. 56. symptoms associated with TSS <ul><li>Strep TSS most often occurs after childbirth, the flu ( influenza ), chickenpox , surgery, minor skin cuts or wounds, or injuries that cause bruising but may not break the skin. </li></ul><ul><li>Staph TSS most often occurs after prolonged use of a tampon (menstrual TSS) or after a surgical procedure, such as nose surgery using packing bandages (nonmenstrual TSS). </li></ul><ul><li>TSS symptoms develop quickly and can become life-threatening within 2 days. First signs of TSS usually include: </li></ul><ul><li>Severe flu-like symptoms, such as muscle aches and pains, stomach cramps, a headache, or a sore throat. </li></ul><ul><li>Sudden fever over 102F. </li></ul><ul><li>Vomiting and diarrhea. </li></ul>
  57. 57. <ul><li>Signs of shock , including low blood pressure and rapid heartbeat, often with lightheadedness, fainting, nausea, vomiting, or restlessness and confusion. </li></ul><ul><li>A rash that looks like a sunburn. The rash can be over several areas of your body or just in specific places such as the armpits or the groin. </li></ul><ul><li>Severe pain at the site of an infection (if a wound or injury to the skin is involved). </li></ul><ul><li>Redness in the nasal passages and inside the mouth. </li></ul><ul><li>Other TSS symptoms that may follow include: </li></ul><ul><li>Conjunctivitis (pinkeye). </li></ul><ul><li>Involvement of more than one organ system, most commonly the lungs and kidneys. </li></ul><ul><li>Blood infection ( sepsis ) that affects the entire body. </li></ul><ul><li>Skin tissue death (necrosis), which occurs early in the syndrome. </li></ul><ul><li>Skin tissue shedding, which occurs during recovery. </li></ul>
  58. 58. <ul><li>Diagnosis </li></ul><ul><ul><ul><li>Because it progresses so quickly, toxic shock syndrome is usually diagnosed and treated based on symptoms and signs of infection without waiting for laboratory results. Additional blood and tissue tests can help identify the type of bacterium causing the infection. </li></ul></ul></ul><ul><li>Treatment </li></ul><ul><li>*intravenous fluid replacement </li></ul><ul><li>* antibiotics </li></ul><ul><li>Treatment for strep or staph toxic shock syndrome includes: </li></ul><ul><li>Removal of the source of the infection . If a woman is using a tampon, diaphragm, or contraceptive sponge, it is removed immediately. Infected wounds are usually drained and cleaned to rid the area of bacteria. remove dead or severely infected tissue. This is called surgical debridement. </li></ul><ul><li>Intravenous immunoglobulin (IVIG) can be used when toxic shock syndrome is severe or does not improve with antibiotics </li></ul>
  59. 59. <ul><li>Treatment of complications of the illness , including low blood pressure, shock, and organ failure. The specific treatment depends on what problems have developed. Large amounts of intravenous (IV) fluids are typically used to replace fluids lost from vomiting, diarrhea, and fever and to avoid complications of low blood pressure and shock. </li></ul><ul><li>Antibiotics to kill the bacteria that are producing the toxins causing TSS. </li></ul><ul><li>Clindamycin Other medicines, such as cloxacillin or cefazolin. </li></ul><ul><li>methicillin-resistant Staphylococcus aureus ( MRSA ). </li></ul>
  60. 60. complications <ul><li>Shock , causing decreased blood and oxygen circulation to the vital organs. </li></ul><ul><li>Acute respiratory distress syndrome (ARDS). Lung function decreases, breathing becomes difficult, and blood oxygen levels drop. </li></ul><ul><li>Disseminated intravascular coagulation (DIC). This condition causes the clotting factors in the blood to become too active. Many blood clots may form throughout the body, which uses up the clotting factors. This can cause excessive bleeding. </li></ul><ul><li>Kidney failure, also called end-stage renal disease. Failure happens when kidney damage is so severe that treatment with dialysis or a kidney transplant is needed to prevent death. </li></ul>
  61. 61. <ul><li>These people lack specific antibodies against the toxins of strep or staph. </li></ul><ul><li>People with immune system problems, such as diabetes , cancer, or autoimmune diseases , are also at higher risk for toxic shock syndrome because they are also more likely to lack the specific immune system response needed to fight the toxins. </li></ul><ul><li>Risk factors for menstrual TSS </li></ul><ul><li>The prolonged use of a tampon, especially the super absorbent type, increases a woman's risk for menstrual TSS. If you have had menstrual TSS in the past, you have an increased risk of developing it again . </li></ul>
  62. 62. <ul><li>Assessment </li></ul><ul><li>Urine output level increases </li></ul><ul><li>Blood urea nitrogen level increases </li></ul><ul><li>Disoriented </li></ul><ul><li>Laboratory test reveal leukocytes and elevated bilirubin </li></ul><ul><li>Uncontrolled hypotension </li></ul><ul><li>Disseminated intravascular coagulopathy </li></ul>
  63. 63. Exams and Tests <ul><li>Routine complete blood count (CBC) of red and white blood cells, platelets, and other basic qualities of your blood. </li></ul><ul><li>Cultures of blood and other body fluids and tissues for signs of strep or staph bacteria . For menstrual TSS, a vaginal fluid sample is tested. For nonmenstrual TSS, a swab or sample of a suspected wound, lesion, or other affected area is tested. Blood cultures do not usually detect staph TSS when it is present, but strep can be identified in a sample of blood or cerebrospinal fluid (CSF) or by a tissue biopsy . Cultures from the throat, the vagina , or a sputum sample may also show the bacteria. </li></ul><ul><li>Chest X-ray, to look for signs of damage to the lungs ( respiratory distress syndrome ). </li></ul><ul><li>Tests to rule out other infections that can cause symptoms similar to those of TSS, such as an infection of the blood ( sepsis ), a tick-borne bacterial infection ( Rocky Mountain spotted fever ), a bacterial infection caused by contact with the urine of infected animals ( leptospirosis ), or typhoid fever </li></ul><ul><li>Medical management </li></ul><ul><li>Elimination of the source of the infection </li></ul><ul><li>Administration of fluids, vasopressin, and antibiotic agent </li></ul>
  64. 64. <ul><li>Prevention </li></ul><ul><li>You can significantly lower your risk of toxic shock syndrome (TSS) by taking a few simple precautions. </li></ul><ul><li>Avoid using tampons and barrier contraceptives (such as a diaphragm, cervical caps, or sponges) during the first 12 weeks after childbirth, when the risk for TSS is higher. </li></ul><ul><li>If you have had menstrual TSS, do not use tampons, barrier contraceptives, or an intrauterine device (IUD) . </li></ul><ul><li>Careful tampon, diaphragm, and contraceptive sponge use </li></ul><ul><li>Follow the directions on package inserts when using tampons, diaphragms, or contraceptive sponges. </li></ul><ul><li>Wash your hands with soap before inserting or removing a tampon, diaphragm, or contraceptive sponge. </li></ul><ul><li>Change your tampon at least every 8 hours, or use tampons for only part of the day. Do not leave your diaphragm or contraceptive sponge in for more than 12 to 18 hours. </li></ul><ul><li>Alternate wearing tampons and sanitary pads. For example, use pads at night and tampons during the day. </li></ul><ul><li>Use tampons with the lowest absorbency that you need. The risk of TSS is higher with </li></ul>
  65. 65. <ul><li>Use tampons with the lowest absorbency that you need. The risk of TSS is higher with superabsorbent tampons. </li></ul><ul><li>Caring for skin wounds to prevent skin infection </li></ul><ul><li>Keep all skin wounds clean to prevent infection and promote healing. This includes cuts, punctures, scrapes, burns, sores from shingles , insect or animal bites, and surgical wounds. </li></ul><ul><li>Keep children from scratching chickenpox sores. </li></ul><ul><li>signs of infection </li></ul><ul><li>Increased pain, swelling, redness, or warmth around the affected area. </li></ul><ul><li>Red streaks extending from the affected area. </li></ul><ul><li>Drainage of pus from the area. </li></ul><ul><li>Swollen lymph nodes in the neck, armpit, or groin. </li></ul><ul><li>Fever. </li></ul><ul><li>Preventing strep infection during pregnancy or after giving birth </li></ul>
  66. 67. <ul><ul><ul><ul><ul><li>GROUP 6 </li></ul></ul></ul></ul></ul><ul><ul><ul><li>APRUEBO, KAREN JOY </li></ul></ul></ul><ul><ul><ul><li>BILAN, ROSE ANNE </li></ul></ul></ul><ul><ul><ul><li>FELIPE, DAPHNY FAITH </li></ul></ul></ul><ul><ul><ul><li>GUSTILO, CARL ANTHONY </li></ul></ul></ul><ul><ul><ul><li>LAGO, CECILE </li></ul></ul></ul><ul><ul><ul><li>LIBARDO, KATHLEEN </li></ul></ul></ul>