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Group 4 Robb


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Group 4 Robb

  2. 2. FEMALE REPRODUCTIVE SYSTEM <ul><li>EXTERNAL STRUCTURES : </li></ul><ul><li>Mons Pubis (veneris) </li></ul><ul><li>- rounded pad of flesh lies over the synthesis pubis </li></ul><ul><li>Labia Majora </li></ul><ul><li>-two elongated folds of tissues are separated by cleft </li></ul><ul><li>Labia Minora </li></ul><ul><li>- two small, thin, elongated folds of tissuses; lie one on each side between the labia majora and the vaginal opening </li></ul><ul><li>-they form the clitoris hoodlike prepuce and enclose the clitoris </li></ul><ul><li>Clitoris </li></ul><ul><li>- small elongated, highly sensitive erectile structure is located under the anterior labial commisure </li></ul>
  3. 3. <ul><li>Fourchette </li></ul><ul><li>- located at the vagina’s posterior commisure; tense band of mucous membrane connects posterior ends of labia minora </li></ul><ul><li>Fosa Navicularis </li></ul><ul><li>- located anterior to the fourchette separates the latter from the hymen </li></ul><ul><li>Vestibule </li></ul><ul><li>- an almond shape space between the labia minora </li></ul><ul><li>-the four major structure opening into the vestibules: </li></ul><ul><li>a.) urethra (anteriorly) </li></ul><ul><li>b.) vagina (posteriorly) </li></ul><ul><li>c.) two secretory ducts of Bartholin’s glands (laterally ) </li></ul><ul><li>Vestibular bulbs </li></ul><ul><ul><li>- two sacculated collections of veins (homologous to the male corpus spongiosum) </li></ul></ul><ul><ul><li>-lie on either side of the vagina </li></ul></ul><ul><li>Skene’s ducts (glands, tubules ) </li></ul><ul><ul><li>- openings of these two glands lie on either side of the urethra’s floor </li></ul></ul><ul><li>Bartholin’s glands (vulvovaginal glands) </li></ul><ul><ul><li>-two small mucous glands lie on either lateral wall of the vagina’s tubule </li></ul></ul><ul><li>Hymen </li></ul><ul><ul><li>-fold of mucous membrane, partially covering the opening of the vagina </li></ul></ul>
  4. 4. <ul><li>INTERNAL STRUCTURES </li></ul><ul><li>Ovaries </li></ul><ul><ul><li>- are the female sex glands. </li></ul></ul><ul><ul><li>-Produce female reproductive cell or germ cell ( ovum, pleural ova) and hormones ( estrogens and progesterone ) </li></ul></ul><ul><li>Germinal Epithelium </li></ul><ul><ul><li>- single layer of cells (simple, cuboidal, epithelium) covering the ovary surface </li></ul></ul><ul><li>Ovarian follicles </li></ul><ul><li>- basic unit of female reproductive biology and is composed of roughly spherical aggregations of cells found in the ovary. They contain a single oocyte (aka ovum or egg ). </li></ul><ul><li>Tunica Albuginea </li></ul><ul><ul><li>- capsule of dense, collagenous connective tissue beneath the germinal epithelium </li></ul></ul><ul><li>Stoma </li></ul><ul><li>-connective tissue beneath the tunica albuginea. </li></ul><ul><li>- consist of a cortex (an outer, dense layer)and a medulla ( an inner, loose layer) </li></ul><ul><li>Corpus luteum </li></ul><ul><ul><li>-produces estrogen and progesterone hormones </li></ul></ul>
  5. 5. <ul><li>Fallopian Tube </li></ul><ul><ul><li>- two fallopian tubes connect the uterus to the ovaries and are the usuan site of fertilization; they connect the ovuum to the uterus </li></ul></ul><ul><li>Uterus </li></ul><ul><li>-located in the pelvic cavity slightly below and between the fallopian tubes, almost at a right angle to the vagina </li></ul><ul><li>-hallow thick walled muscular organ (1-2 inches thick) looks like an inverted pear.; about 2 inches long and 2 inches at the widest portion , 1 inch wide at the narrowest portion </li></ul><ul><li>-3 functional layers: </li></ul><ul><li>a.)parametrium- thin peritoneal and fascial covering of the uterus </li></ul><ul><li>b.) myometrium (bulk of the uterus)- muscular layer composed of three layers, mainly of involuntary muscles </li></ul><ul><li>c.) endomitrium- the mucous membrane lining the inner surface of the uterus </li></ul><ul><li>VAGINA </li></ul><ul><ul><li>- a musculomembranous canal connecting the uterus with external genitalia. </li></ul></ul><ul><ul><li>-3 layers of vagina: </li></ul></ul><ul><li>a.)epithelium </li></ul><ul><li>b.)fibrous connective tissue </li></ul><ul><li>c.)muscular layer </li></ul>
  6. 6. MALE REPRODUCTIVE ORGAN <ul><li>PENIS </li></ul><ul><ul><li>-both a sexual organ and an organ for urination </li></ul></ul><ul><ul><li>-ejects semen forf ertilization; excretes urine </li></ul></ul><ul><li>BULBOURETHRAL GLANDS </li></ul><ul><ul><li>Two small glands above the corpus spongiosum </li></ul></ul><ul><ul><li>Enhances lubrication during intercourse </li></ul></ul><ul><li>SCROTUM </li></ul><ul><ul><li>Double pouch of muscular contractile tissue between the root of the penis and the perinium </li></ul></ul><ul><ul><li>Provides protective environment for production of sperm </li></ul></ul><ul><li>TESTICLES </li></ul><ul><ul><li>Two smooth solid ovoid structures </li></ul></ul><ul><ul><li>Produce testosterone and sperm </li></ul></ul><ul><li>SPERM </li></ul><ul><ul><li>Germ cell with flattened broad oval hal with a nucleus protoplasmic middle piece or neck </li></ul></ul><ul><ul><li>Fertilizes ovuum </li></ul></ul>
  7. 7. <ul><li>PROSTATE </li></ul><ul><ul><li>-surrounds the neck of the male urinary bladder and urethra; cosist of five lobes( anterior, posterior, median, right lateral and left lateral </li></ul></ul><ul><ul><li>-consist of: </li></ul></ul><ul><li>a.)periurethral or internal glands </li></ul><ul><li>b.) follicle like tubules </li></ul><ul><li>SEMEN </li></ul><ul><li>-(seminal fluid or ejaculate) </li></ul><ul><li>- a viscid, thick, opalescent secretion discharge by males at a climax of sexual excitement or orgasm </li></ul><ul><li>EPIDYDIMIS </li></ul><ul><li>- small oblong structures consisting of a convoluted tube 4-6 m long attaches to upper and testicle; transport sperm </li></ul><ul><li>VAS DEFERENS </li></ul><ul><ul><li>- Smooth muscle tube about 46cm long; stores and transmits sperm from testicles </li></ul></ul>
  8. 8. GYNECOLOGICAL AND DIAGNOSTIC PROCEDURES <ul><li>PELVIC EXAMINATION </li></ul><ul><ul><li>An inspection of external genitalia for signs of inflammation, swelling, bleeding, discharge, or local skin epithelial changes. </li></ul></ul><ul><ul><li>speculum is inserted to permit the examiner to visualize the vagina and cervix. </li></ul></ul><ul><ul><li>PATIENT’S PREPARATION: </li></ul></ul><ul><ul><li>provide psychological support </li></ul></ul><ul><ul><li>instruct the patient to avoid douching for 24 hours before the examination </li></ul></ul><ul><ul><li>encourage the patient to void and evacuate the the bowels </li></ul></ul><ul><ul><li>remove sufficient clothing </li></ul></ul><ul><ul><li>POSITIONING : </li></ul></ul><ul><ul><li>lithotomy </li></ul></ul><ul><ul><li>sim’s </li></ul></ul><ul><ul><li>knee-chest </li></ul></ul><ul><ul><li>semi-sitting </li></ul></ul>
  9. 9. <ul><ul><li>NURSING CARE </li></ul></ul><ul><ul><li>Encourage patient to relax </li></ul></ul><ul><ul><li>Wipe discharge from the patient before assisting her from the table </li></ul></ul><ul><ul><li>Answer any questions the patient may have </li></ul></ul><ul><ul><li>Assist the patient with dressing if necessary </li></ul></ul><ul><ul><li>Have the patient slide up on the table before removing feet from the stirrups </li></ul></ul><ul><li>VAGINAL EXAMINATION </li></ul><ul><ul><ul><li>inspect the vaginal canal and cervix </li></ul></ul></ul><ul><ul><ul><li>obtain tissue specimen for cervical cytology </li></ul></ul></ul><ul><ul><ul><li>PATIENT’S PREPARATION </li></ul></ul></ul><ul><ul><ul><li>Have the patient void </li></ul></ul></ul><ul><ul><ul><li>Encourage the patient to relax </li></ul></ul></ul><ul><ul><ul><li>Tell the patient about the procedure </li></ul></ul></ul><ul><ul><ul><li>Position the patient on the examining table </li></ul></ul></ul><ul><ul><ul><li>Make the patient as comfortable as possible </li></ul></ul></ul><ul><ul><ul><li>Drape the patient to permit the minimal exposure </li></ul></ul></ul>
  10. 10. <ul><li>NURSING ACTION: </li></ul><ul><li>Encourage relaxation in the patient </li></ul><ul><li>Gently place the tip of finger into introitus </li></ul><ul><li>Gently insert warm speculum horizontally </li></ul><ul><li>Inspect the cervix which should be pink </li></ul><ul><li>Do bimanual examination </li></ul><ul><li>Gently wipe the perineal area with soft tissue or gauze </li></ul><ul><li>Elevate the lower third of the examining table to receive legs </li></ul><ul><li>Assist the patient in dressing </li></ul><ul><li>PAPANICOLAUO </li></ul><ul><ul><ul><li>to screen for cervical dysplasia or cervical cancer </li></ul></ul></ul><ul><ul><ul><li>Cytology is the examination of the structure, function. Pathology and chemistry of the cell. </li></ul></ul></ul><ul><ul><ul><li>Pap smear identifies the preinvasive and invasive cervical cancer </li></ul></ul></ul>
  11. 11. <ul><li>WET SMEAR </li></ul><ul><ul><li>Used to detect vaginal infection with candida albicans, trichomonas vaginalis or organisms that causes bacterial infections. </li></ul></ul><ul><ul><li>A copious specimen of discharge from the vagina vault is obtained with a cotton-tipped swab and place in warm normal saline and potassium hydroxide. </li></ul></ul><ul><li>CERVICAL CULTURE </li></ul><ul><ul><li>Antigen detection can be done to detect infection with Neisseria gonorrhea or chlamydia trachomatis. </li></ul></ul><ul><ul><li>A cotton-tipped swab is rotated at endocervical canal. </li></ul></ul><ul><li> PRE OPERATIVE CARE </li></ul><ul><ul><li>The women should not be menstruating at the time of specimen are collected. </li></ul></ul><ul><ul><li>Instruct to avoid sexual intercourse, douching, or using vaginal hygiene sprays or deodorants for two (2) to three(3) days before the test. </li></ul></ul><ul><ul><li>Explain to the client the procedure. </li></ul></ul><ul><ul><li>Vital signs </li></ul></ul><ul><ul><li>Provide privacy </li></ul></ul><ul><li>POST OPERATIVE CARE </li></ul><ul><ul><li>Help the client out of the stirrups and tell her not to get up too rapidly especially if she is older. </li></ul></ul><ul><ul><li>Clean off any excess lubricants or allow the client to do so </li></ul></ul><ul><ul><li>Ensure that the client understand how sge will receive the results of her pap smear. </li></ul></ul>
  12. 12. <ul><li>CERVICAL BIOPSY & CAUTERIZATION </li></ul><ul><ul><ul><ul><ul><li>- To remove cervical tissue for laboratory study </li></ul></ul></ul></ul></ul><ul><li>PATIENT PREPARATION </li></ul><ul><ul><li>Explain the procedure to the patient </li></ul></ul><ul><ul><li>Place the patient in lithotomy position and drape her properly </li></ul></ul><ul><ul><li>explain to the patient that no anesthesia is required, since cervix does not have pain </li></ul></ul><ul><li>NURSING CARE </li></ul><ul><ul><li>Avoid heavy lifting for 24 hours </li></ul></ul><ul><ul><li>obtain physicians instructions regarding douching and sexual relations </li></ul></ul><ul><ul><li>packing may remain from 12-24 hours, depending on physician’s preference </li></ul></ul><ul><li>UTEROTUBAL INSUFFLATION (RUBIN’S TEST ) </li></ul><ul><ul><ul><ul><li>Carbon dioxide is injected under pressure through a special cannula into the cervical canal. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>grave speculum is positioned in the vagina </li></ul></ul></ul></ul><ul><ul><ul><ul><li>special cannula passed through the intrauterine canal </li></ul></ul></ul></ul><ul><ul><ul><ul><li>tubing is connected to a machine that measures and </li></ul></ul></ul></ul>
  13. 13. <ul><li>CULDOSCOPY </li></ul><ul><ul><ul><ul><ul><li>Visualization of the uterus, tubes, broad ligaments, uterosacral ligaments, rectal wall, sigmoid, and small intestines. </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Anesthesia may be local, general, or regional </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Patient is in knee chest position </li></ul></ul></ul></ul></ul><ul><li>HYSTEROSCOPY </li></ul><ul><ul><ul><ul><ul><li>- Endoscopic visualization of the uterine cavity by means of a hysteroscope </li></ul></ul></ul></ul></ul><ul><ul><ul><li>PATIENT PREPERATION </li></ul></ul></ul><ul><ul><ul><li>Place the patient in lithotomy position </li></ul></ul></ul><ul><ul><ul><li>Cleanse the prenium and vagina immediately prior to sterile draping </li></ul></ul></ul><ul><ul><ul><li>Inject local anesthesia into the cervix </li></ul></ul></ul><ul><ul><ul><li>Uterine walls are visualized with a 30 degree oblique lens </li></ul></ul></ul><ul><ul><ul><li>Patient id encouraged to rest following removal </li></ul></ul></ul><ul><ul><ul><li>Patient may be discharged later the same day </li></ul></ul></ul><ul><li>HYSTEROSALPINGOGRAM </li></ul><ul><ul><ul><li>-an x-ray study of the uterus and uterine tubes following the injection of a contrast medium </li></ul></ul></ul>
  14. 14. <ul><li>COLPOSCOPY </li></ul><ul><ul><ul><ul><ul><li>To determine distribution of abnormal squamous epithelium </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>To pinpoint areas to which biopsy tissue can be taken </li></ul></ul></ul></ul></ul><ul><li>PATIENT PREPERATION </li></ul><ul><li>Identical to that for preparation of patient having pelvic examination </li></ul><ul><li>NURSING ACTION </li></ul><ul><ul><ul><li>Use a long sticky applicator to dry the cervix </li></ul></ul></ul><ul><ul><ul><li>swab cervix with saline, usinglong cotton applicator </li></ul></ul></ul><ul><ul><ul><li>paint cervix with 3% acetic acid </li></ul></ul></ul><ul><ul><ul><li>note colposcopic patterns </li></ul></ul></ul><ul><ul><ul><li>if bleeding occurs, direct pressure will usually stop it </li></ul></ul></ul><ul><ul><ul><li>insert a vaginal tampon following examination </li></ul></ul></ul><ul><li>SEMEN EXAMINATION </li></ul><ul><ul><ul><li>Used to evaluate fertility. </li></ul></ul></ul><ul><ul><ul><li>To provide an adequate sample, the client must abstain from ejaculation for 2-5 days before the test </li></ul></ul></ul><ul><ul><ul><li>Prolong abstinence-decrease sperm quality and motility </li></ul></ul></ul>
  15. 15. <ul><li>NURSING CARE </li></ul><ul><ul><ul><li>Provide explanation before and during the procedure </li></ul></ul></ul><ul><ul><ul><li>Informed consent is necessary </li></ul></ul></ul><ul><ul><ul><li>Psychological preparations may be required </li></ul></ul></ul><ul><ul><ul><li>During the test tell the client what is happening and help him to maintain the required position </li></ul></ul></ul><ul><ul><ul><li>Observe the client during and after the test for pain, excessive anxiety, palor or nausea </li></ul></ul></ul><ul><li>ULTRASONOGRAPHY </li></ul><ul><ul><ul><li>Transrectal approach is used for prostatic ultrasonography </li></ul></ul></ul><ul><ul><ul><li>After rectal examination, a well-lubricated transducer is inserted. </li></ul></ul></ul><ul><ul><ul><li>Cover the probe with a water-filled condom to enhance sound wave transmission </li></ul></ul></ul><ul><ul><ul><li>The examiner moves the probe along the prostate to complete the scan </li></ul></ul></ul><ul><li>NURSING CARE </li></ul><ul><ul><ul><li>Explain the procedure to the client </li></ul></ul></ul><ul><ul><ul><li>Instruct the patient that the rectum must be free from feces or enema might be administered </li></ul></ul></ul><ul><ul><ul><li>Help the client Into the left lateral sims position </li></ul></ul></ul><ul><ul><ul><li>Tell the client that some discomfort may be felt with probe insertion and manipulation </li></ul></ul></ul>
  16. 16. INFERTILITY <ul><ul><ul><li>Inability to conceive after at least 1 year of unprotected sexual relations. </li></ul></ul></ul><ul><ul><ul><li>Inability to deliver a live infant after three consecutive pregnancies. </li></ul></ul></ul><ul><ul><ul><li>For the male, inability to impregnate a female partner within the same conditions. </li></ul></ul></ul><ul><ul><ul><li>May be primary (never been pregnant/never impregnated) or secondary (pregnant once then unable to conceive or carry again). </li></ul></ul></ul><ul><ul><ul><li>Affects approximately 10-15% of all couples. </li></ul></ul></ul>
  17. 17. <ul><li>TEST FOR INFERTILITY </li></ul><ul><ul><li>For female </li></ul></ul><ul><ul><li>Examination of basal body temperature and cervical mucus and identification of time of ovulation. </li></ul></ul><ul><ul><li>Plasma progesterone level: assesses corpus luteum </li></ul></ul><ul><ul><li>Hormone analysis: endocrine function </li></ul></ul><ul><ul><li>Endometrial biopsy: receptivity of endometrium </li></ul></ul><ul><ul><li>Postcoital test: sperm placement and cervical mucus </li></ul></ul><ul><ul><li>Hysterosalpingography: tubal patency/uterine cavity </li></ul></ul><ul><ul><li>Rubin’s test: tubal patency (uses carbon dioxide ) </li></ul></ul><ul><ul><li>Pelvic ultrasound: visualization of pelvic tissues </li></ul></ul><ul><ul><li>Laparoscopy: visual assessment of pelvic/abdominal organs; performance of minor surgeries </li></ul></ul><ul><ul><li>For male </li></ul></ul><ul><ul><li>Sperm analysis: assesses composition, volume, motility, agglutination. </li></ul></ul><ul><ul><li>There are fewer assessesment test as well as interventions and successes fpr male infertility. </li></ul></ul>
  18. 18. <ul><li>Medical Management </li></ul><ul><li>Infertility of female partner, causes and therapy </li></ul><ul><ul><li>Congenital anomalies (absence of organs, improperly formed or abnormal organs) surgical treatment may help in some situations but cannot replace absent structures. </li></ul></ul><ul><ul><li>Irregular/absent ovulation (ovum released irregularly or not at all) ; endocrine therapy with clomiphene citrate (clomid)/ menotropins (pergonal) may induce ovulation; risk of ovarian hyperstimulation and release of multiple ova. </li></ul></ul><ul><ul><li>Tubal factors (fallopian tubes blocked or scarred from infection, surgery, endometrial neoplasm): treatment may include antibiotic therapy, surgery, hysterosalpingogram. </li></ul></ul><ul><ul><li>Uterine conditions (endometrium unreceptive, infected): removal of IUD, antibiotic therapy ,or surgery may be helpful. </li></ul></ul><ul><ul><li>Vaginal/cervical factors (hostile mucus, sperm allergies, altered pH due to infection): treatment with antibiotics, proper vaginal hygiene, or artificial insemination may be utilized. </li></ul></ul><ul><ul><li>In fertility of male partner, causes and therapy </li></ul></ul><ul><ul><li>Impotence: may be helped by psychologic counseling? Penile implants, medications. </li></ul></ul><ul><ul><li>Low abnormal sperm count (fewer than 20 million/ml semen. Low motility, more then 40% abnormal forms): </li></ul></ul><ul><ul><li>Varicocele (varicosity within spermatic cord): ligation may be successful. </li></ul></ul>
  19. 19. <ul><ul><li>Infection in any area of the male reproductive system ( may affect ability to impregnate): appropriate antibiotic therapy is advised. </li></ul></ul><ul><ul><li>Social habits (use of nicotine, alcohol, other drugs; clothes that keep scrotal sac too close to warmth of body): changing these habits may reverse low/absent fertility. </li></ul></ul><ul><li>Alternatives for infertile couples include: </li></ul><ul><ul><li>Artificial insemination by husband or donor </li></ul></ul><ul><ul><li>In vitro fertilization </li></ul></ul><ul><ul><li>Adaption </li></ul></ul><ul><ul><li>Sorrogate Parenting </li></ul></ul><ul><ul><li>Embryo Transfer </li></ul></ul><ul><ul><li>Accepting Childlessness as a lifestyle may also be necessary,support groups may be helpful </li></ul></ul><ul><li>NURSING INTERVENTION </li></ul><ul><ul><li>Assist with assessment including a complete history, physical exam, laboratory, and test for both partners </li></ul></ul><ul><ul><li>Monitor psychological reaction of infertility </li></ul></ul><ul><ul><li>Support couples through procedures and tests </li></ul></ul><ul><ul><li>Identify any existing abnormalities and provide couple with information about the conditions </li></ul></ul><ul><ul><li>Help couple acknowledge and express their feelings both separately and together </li></ul></ul>
  20. 20. TERMINATION OF PREGNANCY (ABORTION) <ul><ul><ul><ul><li>Deliberate interruption of pregnanacy in previable time.(20 weeks of gestation or fetal weight of 500gm.[1.1 lbs] </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Indications may be physical or psychological, socioeconomic, or genetic. </li></ul></ul></ul></ul><ul><li>TYPES OF ABORTION </li></ul><ul><ul><li>Spontaneous </li></ul></ul><ul><ul><ul><li>a .) Threatened abortion </li></ul></ul></ul><ul><ul><ul><li>b.) Inevitable abortion </li></ul></ul></ul><ul><ul><ul><li>c.) Habitual aboriton </li></ul></ul></ul><ul><ul><ul><li>d.) Incomplete aboriton </li></ul></ul></ul><ul><ul><ul><li>e.) Missed abortion </li></ul></ul></ul><ul><ul><li>Therapeutic </li></ul></ul><ul><ul><ul><ul><li>- Termination of pregnancy before the time of fetal viability for the purpose of safeguarding the health of the mother. </li></ul></ul></ul></ul>
  21. 21. <ul><li>TECHNIQUES </li></ul><ul><li>FIRST TRIMESTER </li></ul><ul><ul><ul><li>Vacuum extraction or dilatation and curettage </li></ul></ul></ul><ul><li>SECOND TRIMESTER </li></ul><ul><ul><ul><li>Saline Abortion </li></ul></ul></ul><ul><ul><ul><li>Prostaglandins </li></ul></ul></ul><ul><ul><ul><li>Hysterotomy </li></ul></ul></ul><ul><li>THIRD TRIMESTER </li></ul><ul><ul><ul><li>Same as second trimester if permitted by state law. </li></ul></ul></ul><ul><li>COMPLICATION </li></ul><ul><ul><ul><li>Hemorrhage </li></ul></ul></ul><ul><ul><ul><li>Infection </li></ul></ul></ul><ul><li>ASSESSMENT </li></ul><ul><ul><ul><li>Vaginal bleeding </li></ul></ul></ul><ul><ul><ul><li>Vital signs </li></ul></ul></ul><ul><ul><ul><li>Excessive cramping </li></ul></ul></ul><ul><ul><ul><li>Painful uterine contraction </li></ul></ul></ul><ul><ul><ul><li>Membranes rupture </li></ul></ul></ul><ul><ul><ul><li>Cervix dilated </li></ul></ul></ul><ul><ul><ul><li>maceration </li></ul></ul></ul>
  22. 22. <ul><ul><li>NURSING DIAGNOSIS </li></ul></ul><ul><ul><li>Risk for deficient fluid volume </li></ul></ul><ul><ul><li>Risk for injury </li></ul></ul><ul><ul><li>Deficient knowledge </li></ul></ul><ul><ul><li>Potential for hemorhage related to abortion </li></ul></ul><ul><ul><li>Pain related to uterine cramping </li></ul></ul><ul><li>NURSING INTERVENTION </li></ul><ul><ul><li>Explain procedure to the client </li></ul></ul><ul><ul><li>Vital signs </li></ul></ul><ul><ul><li>Monitor blood loss </li></ul></ul><ul><ul><li>Aseptic technique to prevent infection </li></ul></ul><ul><ul><li>Antimicrobial, analgesic as prescribed </li></ul></ul><ul><ul><li>Breathing exercise </li></ul></ul><ul><ul><li>Monitor client during the procedure] </li></ul></ul><ul><ul><li>Provide contraceptive information as appropriate </li></ul></ul>
  23. 23. MASTITIS <ul><ul><ul><ul><ul><li>breast inflammation, usually caused by infection. </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>inflammation of the ductal and lobular system (galactophoritis) and surrounding tissue. </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>The presumed pathogenesis is milk stasis which leads to periductal inflammation, leakage of glandular secretions sand periductal plasmacell inflammation. </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Autoimmune reaction to the sevretions also appear to be a factor, especially in idiopathic granulomatous mastitis . </li></ul></ul></ul></ul></ul><ul><li>RISK FACTORS </li></ul><ul><ul><li>Sore of cracked nipples, although mastitis can developed without broken skin. </li></ul></ul><ul><ul><li>A previous bout of mastitis while breast feeding-you’ve experienced mastitis in the past, you’re more likely to experience it again </li></ul></ul><ul><ul><li>Using only one position to breast feed, which may not fully drain your breast. </li></ul></ul><ul><ul><li>Wearing a tight fitting bra, which may restrict milk flow. </li></ul></ul>
  24. 24. <ul><li>Assessment </li></ul><ul><li>Breast tenderness or warm to touch </li></ul><ul><li>General malaise or felling ill </li></ul><ul><li>Swelling of the breast </li></ul><ul><li>Pain or a burning sensation continuously or while breast feeding </li></ul><ul><li>Skin redness, often in a wedge-shaped pattern </li></ul><ul><li>Fever 38.3 dc </li></ul><ul><li>Swelling of lymphnodes in the armpit </li></ul><ul><li>Cheesy-appearing discharge from the nipples </li></ul><ul><li>Odorless or unpleasant smelling discharge from the nipples </li></ul><ul><li>Bad tasting milk that is rejected by the child </li></ul><ul><li>Blood in the breast milk </li></ul><ul><li>Intense itching of the breast and nipples. </li></ul><ul><li>Pain upon lifting the arms </li></ul><ul><li>Fatigue </li></ul><ul><li>redness of the face. </li></ul>
  25. 25. <ul><li>NURSING DIAGNOSIS </li></ul><ul><ul><ul><li>Knowledge deficit </li></ul></ul></ul><ul><ul><ul><li>Ineffective coping </li></ul></ul></ul><ul><li>NURSING INTERVENTION </li></ul><ul><ul><li>Have the patient stop breast feeding </li></ul></ul><ul><ul><li>Apply heat or cold (depending on infection) </li></ul></ul><ul><ul><li>Administer chemotherapeutic agents as prescribed </li></ul></ul><ul><ul><li>Gibe progesterone to relieve congestion </li></ul></ul><ul><ul><li>Have the patient wear firm breast support </li></ul></ul><ul><ul><li>Practice meticulous personal hygiene </li></ul></ul>
  26. 26. BREAST CANCER <ul><li>Etiology: </li></ul><ul><li>-the cause is not known. Many women are anxious about their risk for breast cancer, and many tend to overestimate their risk. Even though genetic, hormonal, or biochemical factors are likely to be involved, 70% of women with breast cancer have no known risk factors. </li></ul><ul><li>Risk Factors: </li></ul><ul><ul><li>female gender </li></ul></ul><ul><ul><li>increasing age </li></ul></ul><ul><ul><li>personal history of breast cancer </li></ul></ul><ul><ul><li>family history of breast cancer </li></ul></ul><ul><ul><li>genetic mutations </li></ul></ul><ul><ul><li>hormonal factors: </li></ul></ul><ul><ul><ul><li>early menarche </li></ul></ul></ul><ul><ul><ul><li>late menopause </li></ul></ul></ul><ul><ul><ul><li>null parity </li></ul></ul></ul><ul><ul><ul><li>first child after 30 years of age </li></ul></ul></ul><ul><ul><ul><li>hormone therapy (HT) </li></ul></ul></ul><ul><ul><li>exposure to ionizing radiation during adolescence and early adulthood </li></ul></ul><ul><ul><li>history of benign proliferative breast disease </li></ul></ul><ul><ul><li>obesity </li></ul></ul><ul><ul><li>high-fat diet </li></ul></ul><ul><ul><li>alcohol intake </li></ul></ul>
  27. 27. <ul><li>Types of breast cancer </li></ul><ul><ul><li>Ductal carcinoma in situ </li></ul></ul><ul><li>characterized by proliferation of malignant cells inside the milk ducts without invasion into the surrounding tissue. Therefore non invasive form of cancer (also called intraductal carcinoma). </li></ul><ul><ul><li>Invasive cancer </li></ul></ul><ul><ul><ul><li>infiltrating ductal carcinoma - The tumors arise from the duct system and invade the surrounding tissue. They often form a solid irregular mass in the breast. </li></ul></ul></ul><ul><ul><ul><li>infiltrating lobular carcinoma – the tumors arise from the lobular epithelium and typically occur as an area of ill-defined thickening in the breast. They are often multicentric and can be bilateral. </li></ul></ul></ul><ul><ul><ul><li>medullary carcinoma – the tumors grow in a capsule inside a duct. They can become large and maybe mistaken for a fibroadenoma.. </li></ul></ul></ul><ul><ul><ul><li>mucinous carcinoma – often present in post menopausal women 75 years and older. A mucin producer, the tumor Is also slow-growing and thus the prognosis is more favorable than in many other types. </li></ul></ul></ul><ul><ul><ul><li>tubular ductal carcinoma – axillary metastases are uncommon with this histology, prognosis is usually excellent. </li></ul></ul></ul><ul><ul><ul><li>inflammatory carcinoma –Characterized by diffuse edema and brawny erythema of the skin, often referred to as peau d’ orange (resembling an orange peel). </li></ul></ul></ul>
  28. 28. <ul><li>Assessment </li></ul><ul><li>Early signs are insidious </li></ul><ul><li>A contender lump appears in the breast, most frequently in the upper quadrant; it may be movable and isolated. </li></ul><ul><li>Pain usually is absent except in the late stages. A recent pain study indicated that 13% of patients described pain as a primary symptom; 7% indicated that it was the first clue that led to probe and examine the breast. Pain was described as “hurt” or “funny feeling” rather than acute or sharp. </li></ul><ul><li>Retraction or dimpling of the skin over the mass may be noted. </li></ul><ul><li>On mirror examination, asymmetry may be observed-the affected breast appears more elevated than the other. </li></ul><ul><li>Nipple retraction or nipple bleeding may be apparent. </li></ul><ul><li>Later, the nodule becomes more fixed to the chest wall. </li></ul><ul><li>Nodular axillary masses may appear. </li></ul><ul><li>Ulceration appears in late stages. </li></ul>
  29. 29. <ul><li>NURSING CARE </li></ul><ul><li>Pre-op </li></ul><ul><ul><li>Begin emotional support when the patient is told that biopsy and hospitalization may be required. </li></ul></ul><ul><ul><li>Dispel fear by: </li></ul></ul><ul><ul><li>a.) listening to the patient’s concerns and dispeliing misconceptions. </li></ul></ul><ul><ul><li>b.) collaboration with physician on a unified approach to informing the patient. </li></ul></ul><ul><ul><li>c.) emphasizing successful program of rehabilitation, use of prosthesis, and possibly reconstruction. </li></ul></ul><ul><ul><li>d.) having a patient who made a satisfactory post-operative adjustment visit present patient. </li></ul></ul><ul><ul><li>e.) soliciting support of the husband and/or significant others. </li></ul></ul><ul><ul><li>f.) providing encouragement and reassurance. </li></ul></ul><ul><ul><li>minimize delay before operation. Determine physical, nutritional, and emotional needs. </li></ul></ul><ul><ul><li>include the patient’s husband/partner by keeping him informed of the treatment plan and its progress. </li></ul></ul><ul><ul><li>administer hypnotic to block the patient’s concerns. </li></ul></ul><ul><ul><li>relay any positive verified information related to the successful removal of all tumors, limited spread, etc.; this can accelerate recovery. </li></ul></ul><ul><ul><li>Support the surgeon’s plan to remove malignancy, minimize disfigurement, and prevent spread of cancer cells. </li></ul></ul><ul><ul><li>Work with the patient in preparation for anesthesia and surgery; describe each activity to the patient. </li></ul></ul><ul><ul><li>instruct the client to wash operative area with a detergent-germicide for several days before admission. </li></ul></ul>
  30. 30. <ul><li>Intra-op care </li></ul><ul><ul><li>when skin graft is anticipated, shave and clean donor area (usually anterior aspect of thigh. </li></ul></ul><ul><ul><li>if radical surgery is anticipated, have blood replacement available. </li></ul></ul><ul><li>Post-op care </li></ul><ul><ul><li>Upon the patient’s return from the recovery room, promote comfort and rest; administer analgesics for pain. </li></ul></ul><ul><ul><li>Encourage fluid and nutritional support as tolerated and desired. </li></ul></ul><ul><ul><li>Position the patient comfortably in semi-fowler’s position; if arm is free, elevate on a pillow; the most distal part (hand) is placed higher to permit gravity to aid in removal of fluid via lymphatics and venous pathways. </li></ul></ul><ul><ul><li>Check dressings for undue constriction, signs of hemorrhage, etc.; ensure that portable suction or other drainage devices are operating properly. </li></ul></ul>
  31. 31. CERVICAL CANCER <ul><ul><ul><ul><ul><li>- occurs when abnormal cells on the cervix grow out of control. The cervix is the lower part of the uterus that opens into the vagina. </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>exact cause of cervical cancer is unknown </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Human Papillovirus (HPV) is the leading cause of cervical cancer </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Early cancer of the cervix is usually asymptomatic; it is almost always curable in its preinvasive stage. </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Viral and chronic infections, as well as erosions of the cervix, appear to be significant in the development of cancer. </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Incidence of cancer of the cervix is higher in groups with low socioeconomic status; occurs more often in black women than in white. </li></ul></ul></ul></ul></ul><ul><ul><li>Risk Factors: - having multiple sexual partners or a partner who has had multiple sexual partner -early age of first intercourse -smoking tobacco -low socioeconomic status -STD’s -having sexual partner with a history of penile or prostate cancer It is most common between the ages of 35 and 55, but it can occur at any age </li></ul></ul>
  32. 32. <ul><li>PATHOPHYSIOLOGY </li></ul><ul><li>- most cervical cancers are of the squamous cell type. Squamous cell carcinoma ussually begins at the squamocolumnar junction, near the external end of the cervix. The spread of squamous cell cervical cancer occurs first by the direct extension to the vaginal mucosa the lower uterine segment, parametrium, pelvic wall, bladder and bowel. Distant metastasis occurs mainly through lymphatic spread, with some spread occuring through the circulatory system to the liver, lungs, or bones. </li></ul><ul><li>CLINICAL MANIFESTATIONS </li></ul><ul><ul><ul><li>- no early indications of carcinoma in situ or early cervical cancer </li></ul></ul></ul><ul><ul><ul><li>-abnormal pap smear result </li></ul></ul></ul><ul><li>Assessment </li></ul><ul><ul><li>- presence of vaginal discharge </li></ul></ul><ul><ul><li>-bleeding especially after intercourse </li></ul></ul><ul><ul><li>-metrorrhagia </li></ul></ul><ul><ul><li>-postmenopausal bleeding </li></ul></ul><ul><ul><li>-polymenorrhea </li></ul></ul><ul><ul><li>-vaginal discharge which is normally watery, becomes dark and foul smelling </li></ul></ul>
  33. 33. <ul><li>- infection of neoplastic area </li></ul><ul><li>-pressure on bowel, bladder or both </li></ul><ul><li>-bladder irritation </li></ul><ul><li>-rectal discharge </li></ul><ul><li>-manifestation of ureteral obstruction </li></ul><ul><li>-heavy aching abdominal pain </li></ul><ul><li>-cachexia or general wasting syndrome </li></ul><ul><li>Complication </li></ul><ul><li>-fistulae may form as the malignancy erodes through the walls of adjacent organs </li></ul>
  34. 34. <ul><li>NURSING CARE </li></ul><ul><ul><li>- Encourage clients who have been treated for cervical cancer to have frequent health examinations to identify manifestations of recurrence of the cancer. </li></ul></ul><ul><ul><li>-teach patient to wash perineal area with soap and water regularly,wiping from front to back </li></ul></ul><ul><ul><li>-teach clean perineal area after voiding and bowel movement. </li></ul></ul><ul><ul><li>-change tampons or pads three to four times daily during menstruation-wash hands before and after </li></ul></ul><ul><ul><li>-wear clean undergarments </li></ul></ul>
  36. 36. SEXUALLY TRANSMITTED DISEASE (STD ) <ul><ul><ul><ul><li>- illness that has a significant probability of transmission between humans or animals by means of sexual contact, including vaginal intercourse, oral sex, and anal sex. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>- transmitted through the mucous membranes of the penis, vulva, rectum, urinary tract </li></ul></ul></ul></ul><ul><ul><ul><ul><li>- Bacteria, fungi, protozoa or viruses are the causative agents </li></ul></ul></ul></ul>
  37. 37. RISK FACTORS FOR ACQUIRING STD <ul><li>Unprotected Sex </li></ul><ul><li>Multiple Partners </li></ul><ul><li>Being Under 25 Years Old/Early Age of Sexual Onset </li></ul><ul><li>Alcohol Use </li></ul><ul><li>IIllegal Drug Use </li></ul><ul><li>Trading Sex For Money / Drugs </li></ul><ul><li>Living In a Community With a High Prevalence of STDs </li></ul><ul><li>Serial Monogamy </li></ul><ul><li>Using Birth Control Pills As Your Sole Form of Contraception </li></ul><ul><li>PREVENTION </li></ul><ul><li>Vaccination before initiation of sexual contact is advised </li></ul><ul><li>Proper use of condoms (male or female) reduces contact and risk </li></ul><ul><li>Delay having sexual relations as long as possible. </li></ul><ul><li>Learn the symptoms of STDs. </li></ul><ul><li>Avoid having sex during menstruation </li></ul><ul><li>Avoid douching </li></ul>
  38. 38. GONORRHEA <ul><ul><ul><ul><li>- caused by the gram-negative diplococcus, Neisseria gonorrhea, (non-motile, gram negative diplococcus;0.6-1.0 u in diameter </li></ul></ul></ul></ul><ul><ul><ul><ul><li>spread through contact with the penis, vagina, mouth, or anus </li></ul></ul></ul></ul><ul><ul><ul><ul><li>gonococci infect mucus-secreting epithelial surfaces. They attach to the columnar or transitional epithelium and penetrate through or between the cells to the connective tissue. This causes inflammation and spread of the infection </li></ul></ul></ul></ul><ul><li>PATHOPHYSIOLOGY </li></ul><ul><ul><ul><ul><li>The causative agent is highly conatagious but does not live long outside the body. Gonorrhea is always transmitted through sexual contact. The incubation period is 3-8 days </li></ul></ul></ul></ul>
  39. 39. <ul><li>ASSESSMENT </li></ul><ul><li>Women: greenish or yellow-green vaginal discharge, irritation of vulva </li></ul><ul><li>Men: painful urination, urethral discharge that pururlent ,frequency </li></ul><ul><li>Both: after fellatio: sore throat or swollen glands </li></ul><ul><li>Anal gonorrhea: irritation of anus, discharge, or painful defecation </li></ul>
  40. 40. <ul><li>COMPLICATIONS: </li></ul><ul><ul><li>Severe inflammation of reproductive organs </li></ul></ul><ul><ul><li>Eventual sterility </li></ul></ul><ul><ul><li>Arthritis </li></ul></ul><ul><ul><li>Blindness </li></ul></ul><ul><ul><li>Prostitis </li></ul></ul><ul><li>INTERVENTIONS </li></ul><ul><ul><li>Administer antibiotic injection </li></ul></ul><ul><ul><li>Use condom </li></ul></ul><ul><ul><li>Avoid sex with casual partners </li></ul></ul><ul><ul><li>Practice sexual abstinence, or limit sexual contact to one uninfected partner </li></ul></ul><ul><li>Don't have sex until you have completed taking all of your medicine. </li></ul><ul><li>blood test three months after you have been treated for gonorrhoea </li></ul><ul><li>penicillin or, if allergic, a substitute </li></ul><ul><li>check reaction to medication </li></ul><ul><li>culture from infected sites (test of cure) to include rectal culture from all women with endocervical gonorrhoea </li></ul><ul><li>ensure contact tracing has occurred </li></ul><ul><li>screen for other STDs and arrange follow up at 3 months for blood borne virus serology and syphilis testing </li></ul>
  41. 41. SYPHILIS <ul><ul><ul><ul><li>- caused by Treponema palidum (motile spirochete with 6-14 spirals and ends pointed with finely spiral terminal filaments </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Acquired by sexual contact or may be congenital </li></ul></ul></ul></ul><ul><ul><ul><ul><li>in origin </li></ul></ul></ul></ul><ul><li>PATHOPHYSIOLOGY </li></ul><ul><ul><ul><ul><li>T. Pallidum enters the body through intact mucous membranes or abraded skin, almost exclusively by direct sexual contact. After entry, the organisms multiply locally an disseminate systematically through the blood stream and lympatics </li></ul></ul></ul></ul><ul><li>ASESSMENT: </li></ul><ul><ul><ul><ul><li>STAGES </li></ul></ul></ul></ul><ul><ul><ul><ul><li>PRIMARY </li></ul></ul></ul></ul><ul><ul><ul><ul><li>SECONDARY </li></ul></ul></ul></ul><ul><ul><ul><ul><li>LATE </li></ul></ul></ul></ul>
  42. 42. PRIMARY SYPHILIS <ul><ul><li>chancre (painless sore) appears at spot where syphilis bacteria entered body, </li></ul></ul><ul><ul><li>disappears 1-5 weeks without treatment </li></ul></ul><ul><ul><li>Enlarge lymp nodes in the area containing the chancre </li></ul></ul><ul><ul><li>a small painless open sore 3 to 6 weeks after exposure. </li></ul></ul>
  43. 43. <ul><li>Secondary Syphilis </li></ul><ul><ul><ul><ul><li>Rashes at palms and soles </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Flulike symptoms </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Mouth sores </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Patchy balding </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Fever </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Lumps on genitals </li></ul></ul></ul></ul>
  44. 44. <ul><ul><li>TERTIARY </li></ul></ul><ul><ul><ul><li>Infiltrative tumors of skin, bones, or liver ( gumma ) </li></ul></ul></ul><ul><ul><ul><li>Cardiovascular syphilis which affects the aorta and </li></ul></ul></ul><ul><ul><ul><li>causes aneurysms or valve disease </li></ul></ul></ul><ul><ul><ul><li>Central nervous system disorders (neurosyphilis) </li></ul></ul></ul>
  45. 45. <ul><li>COMPLICATIONS: </li></ul><ul><ul><li>Blindness </li></ul></ul><ul><ul><li>Insanity </li></ul></ul><ul><ul><li>Paralysis </li></ul></ul><ul><ul><li>Heart disease </li></ul></ul><ul><ul><li>Death </li></ul></ul><ul><li>INTERVENTIONS: </li></ul><ul><ul><li>Abstain from sexual contact for at least one month after treatment </li></ul></ul><ul><ul><li>Penicillin given by injection </li></ul></ul><ul><ul><li>Provide accurate information about reinfection </li></ul></ul><ul><ul><li>Proper hygiene and health habits </li></ul></ul><ul><ul><li>Individualized health teaching </li></ul></ul><ul><ul><li>Notify all sexual contacts immediately so they can obtain examination and treatment; </li></ul></ul><ul><ul><li>All pregnant women should receive at least one prenatal blood test for syphilis. </li></ul></ul>
  46. 46. GENITAL HERPES INFECTION <ul><ul><ul><ul><ul><li>- caused by herpesvirus hominis (HVH) type II </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>- causes severity and recurs; highly contagious and ranks just below gonorrhea in incidence. </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Incubation takes 2 to 20 days from when the infection is transmitted </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>After a 12-24 hour period of hypersensitivity or local discomfort (burning or tingling), multiple vesicular lesions (small blisters) appear which may subsequently produce a rosette formation. </li></ul></ul></ul></ul></ul><ul><li>PATHOPHYSIOLOGY </li></ul><ul><ul><ul><ul><li>The HSV organism is present in the exudate of the lesion. Herpes can be transmitted while a lesion is present and for 10 days after a lesion has healed. Genital herpes is transmitted by direct contact with the exudate during during sexual activity, but transmission is possible by fomites (object that can harbor pathogenic microorganisms </li></ul></ul></ul></ul>
  47. 47. <ul><li>ASESSMENT </li></ul><ul><ul><ul><ul><ul><li>Small, red bumps, blisters (vesicles) or open sores (ulcers) in the genital, anal and nearby areas </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Pain or itching around your genital area, buttocks or inner thighs </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>vesicular lesions on vulva, perinium, vagina, and cervix in women </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>lesions on penile shaft,prepuce, glans penis,scrotum and perinium </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>tender adenopathy </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Dysuria </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>recurrent infections </li></ul></ul></ul></ul></ul>
  48. 48. <ul><li>24 and 72 hours after their appearance vesicles rupture to form superficial shallow painful ulcers. Regional lymph nodes are enlarged and tender . </li></ul><ul><li>Genital herpes is usually more painful in women because of their anatomy. Vaginal and labial blisters may be so painful that women become unable to pass urine and require catheterisation </li></ul>
  49. 49. <ul><li>COMPLICATIONS </li></ul><ul><ul><li>Keratitis </li></ul></ul><ul><ul><li>Encephalitis </li></ul></ul><ul><ul><li>Neonatal herpes infection </li></ul></ul><ul><li>INTERVENTIONS </li></ul><ul><ul><li>Administer acyclovir (Zovirax) </li></ul></ul><ul><ul><li>Advice the client to use a finger clot or rubber glove when applying ointment </li></ul></ul><ul><ul><li>Give the client information about the virus </li></ul></ul><ul><ul><li>Pour warm water over the “urinary opening” while voiding </li></ul></ul><ul><ul><li>Wear cotton underwear </li></ul></ul><ul><ul><li>Practice meticulous hand washing </li></ul></ul><ul><ul><li>Use, or have your partner use, a latex condom during each sexual contact. </li></ul></ul><ul><ul><li>Limit the number of sex partners. </li></ul></ul><ul><ul><li>Avoid intercourse if either partner has an outbreak of herpes in the genital area or anywhere else. </li></ul></ul>
  50. 50. SCABIES <ul><ul><ul><ul><li>- caused by the mite Sarcoptes scabiei, can cause severe </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Itching; A tiny mite (0.3 to 0.9 mm) may sometimes be seen at the end of a burrow </li></ul></ul></ul></ul><ul><ul><ul><ul><li>-a popular rash erupts on various parts of the body </li></ul></ul></ul></ul><ul><ul><ul><ul><li>including the genitalia and the anal area. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>-can be spread by scratching, picking up the mites under the fingernails and simply touching another person's skin </li></ul></ul></ul></ul><ul><li>ASSESSMENT </li></ul><ul><ul><ul><li>Linear burrows 1-10 mm in length with a red papule which contain in the mite </li></ul></ul></ul><ul><ul><ul><li>Common sites are finger webs, wrists, elbows, ankles, penis </li></ul></ul></ul><ul><ul><ul><li>Nighttime itching </li></ul></ul></ul>
  51. 51. <ul><li>SCABIES AT THE HANDS </li></ul><ul><li>SCABIES IN THE FINGER </li></ul>
  52. 52. <ul><li>COMPLICATIONS </li></ul><ul><ul><li>Impetigo </li></ul></ul><ul><ul><li>Pustular eczema </li></ul></ul><ul><li>INTERVENTIONS </li></ul><ul><ul><li>Apply a mite-killer like permethrin (Elimite). </li></ul></ul><ul><ul><li>Diphenhydramine (Benadryl) </li></ul></ul><ul><ul><li>Wash linens and bedclothes in hot water </li></ul></ul><ul><ul><li>Treat sexual contacts or relevant family members </li></ul></ul>
  53. 53. TRICHOMONIASIS <ul><ul><ul><ul><ul><li>-caused by trichomonias vaginalis </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>-caused by a one-cell parasite </li></ul></ul></ul></ul></ul><ul><li>PATHOPHYSIOLOGY </li></ul><ul><ul><ul><li>T. vaginalis prefers an alkaline environment (pH 6-7), and alterations in the vaginal flora from douching, for an instance, make a woman more susceptible to infection </li></ul></ul></ul><ul><li>ASSESSMENT </li></ul><ul><ul><ul><li>Changes in your vaginal discharge. You may notice a color or odor that is not normal. </li></ul></ul></ul><ul><ul><ul><li>Vaginal itching. </li></ul></ul></ul><ul><ul><ul><li>Pain during urination or sex. </li></ul></ul></ul><ul><ul><ul><li>In men, symptoms include: </li></ul></ul></ul><ul><ul><ul><li>An abnormal discharge from the penis. </li></ul></ul></ul><ul><ul><ul><li>Irritation of the tip of the penis. </li></ul></ul></ul><ul><ul><ul><li>A burning feeling when you urinate . </li></ul></ul></ul>
  54. 54. <ul><li>ASSESSMENT </li></ul><ul><ul><ul><li>Changes in your vaginal discharge. You may notice a color or odor that is not normal. </li></ul></ul></ul><ul><ul><ul><li>Vaginal itching. </li></ul></ul></ul><ul><ul><ul><li>Pain during urination or sex. </li></ul></ul></ul><ul><ul><ul><li>In men, symptoms include: </li></ul></ul></ul><ul><ul><ul><li>An abnormal discharge from the penis. </li></ul></ul></ul><ul><ul><ul><li>Irritation of the tip of the penis. </li></ul></ul></ul><ul><ul><ul><li>A burning feeling when you urinate. </li></ul></ul></ul><ul><ul><ul><li>blood spotting in vaginal discharge </li></ul></ul></ul><ul><ul><ul><li>heavy, yellowish-green or gray, frothy vaginal discharge </li></ul></ul></ul><ul><ul><ul><li>infection in the urethra, the tube that carries urine from the bladder out of the </li></ul></ul></ul>
  55. 55. <ul><li>VAGINAL DISCHARGE </li></ul><ul><li>INFECTED CERVIX </li></ul>
  56. 56. <ul><li>COMPLICATIONS: </li></ul><ul><ul><li>Rare </li></ul></ul><ul><ul><li>Epididymitis </li></ul></ul><ul><ul><li>Prostitis </li></ul></ul><ul><li>INTERVENTIONS </li></ul><ul><ul><li>Administer metronidazole (flagyl) </li></ul></ul><ul><ul><li>wearing loose cotton clothing and not using douches, vaginal deodorants, or sprays. </li></ul></ul><ul><ul><li>Use condoms </li></ul></ul>
  57. 57. CHANCROID <ul><ul><ul><ul><ul><li>Caused by hemophilus ducreyl </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Soft chancre, its base is covered with gray or yellow necrotic exudate. </li></ul></ul></ul></ul></ul><ul><li>ASESSSMENT </li></ul><ul><ul><li>“ kissing ulcers develop in women” </li></ul></ul><ul><ul><li>Tender inguinal adenopathy, </li></ul></ul><ul><ul><li>Women contact usually asymptomatic </li></ul></ul><ul><li>COMPLICATION </li></ul><ul><ul><li>Chronic fistulas of gland masses in groin </li></ul></ul><ul><li>INTERVENTION </li></ul><ul><ul><li>People with chancroid can be treated effectively with one of several antibiotics. </li></ul></ul>
  58. 58. GENITAL WARTS <ul><ul><li>caused by the human papillomavirus (HPV) </li></ul></ul><ul><ul><li>are skin growths in the groin, genital, or anal areas </li></ul></ul><ul><ul><li>spread by skin-to-skin contact </li></ul></ul><ul><ul><li>and sexual activity </li></ul></ul><ul><li>ASESSMENT </li></ul><ul><ul><li>Flesh-colored to pinkish papillary or sessile growths which occur around the vulva, introitus, vagina, cervix, perineum, anus, anal canal, uerthra, and glans penis. </li></ul></ul><ul><li>COMPLICATION </li></ul><ul><ul><li>Rare </li></ul></ul><ul><ul><li>Malignant change </li></ul></ul>
  59. 59. CLAMMYDIAL INFECTION <ul><ul><ul><li>The nations most common bacterial STD. </li></ul></ul></ul><ul><ul><ul><li>Most causative organism, chlamydia trachomatis is a non-motile gram negative bacteria. </li></ul></ul></ul><ul><ul><ul><li>This organism is the most common cause of what was previously diagnosed as non specific vaginititis in women and non-gonoccocal urethritis or NGU in men; transmitted by an intimate sexual contact the women usually acquire the infection during vaginal intercourse with an infected man and also oral, anal contact. </li></ul></ul></ul><ul><ul><ul><li>Can be transmitted to fetus at birth, causes neonatal ophthalmia. </li></ul></ul></ul>
  60. 60. PATHOPHYSIOLOGY <ul><ul><ul><li>Causes inflammation that leads to scarring and ulceration of involved tissue </li></ul></ul></ul><ul><ul><ul><li>In women the infection can extend to the endomitrium and salpinx (fallopian tube) the major consequence is salphingitis (inflammation of fallopian tube) with subsequent infertility or high risk of ectopic pregnancy and secondarily extension to the peritoneum can cause pelvic inflammatory disease or PID, if untreated </li></ul></ul></ul><ul><ul><ul><li>In men the infection can cause urethral stricture that may extend to the epididymis, sterility can result from ensuing the epididymis. A serious systemic complication more common in men is reiter’s syndrome which consist of urithritis, polyarthritis, conjunctivitis, </li></ul></ul></ul><ul><ul><li>ASSESSMENT </li></ul></ul><ul><ul><ul><li>In women endocervix becomes edematous and produce a yellow mucupurulent vaginal discharge accompanied by spotting at menstrual mids cycle or with sexual intercourse, causes urethritis with dysuria and frequency of urination </li></ul></ul></ul><ul><ul><ul><li>In males uretrritis with dysuria and clear to mucopurulent discharge </li></ul></ul></ul><ul><ul><ul><li>In both sexes: proctitis (rectal inflammation) and pharyngitis. </li></ul></ul></ul>
  61. 61. <ul><li>NURSING INTERVENTION </li></ul><ul><ul><li>Instruct clients about the greater risk of infection with multiple sexual partners and inform them of the serious danger of sterility, particularly for women .Stress that this infection may have long patency period. </li></ul></ul><ul><ul><li>Infected client should scrupulously avoid all sexual activity until both partners are cured and they should use condoms thereafter </li></ul></ul><ul><ul><li>Give doxycycline (vibramycin), zithromax and antibiotics. </li></ul></ul><ul><li>BACTERIAL VAGINITIS </li></ul><ul><li>Caused by other bacteria invading the vagina; most common cause of vaginal discharge in women </li></ul><ul><li>Link to sexual activity particularly having multiple sex partners; IT is often seen in women who douche, and it can occur after genital infection and invasive gynecological procedure </li></ul>
  62. 62. <ul><li>PATHOPHYSIOLOGY </li></ul><ul><ul><ul><ul><li>Infection is caused by the over growth of number of different organism including Gardenerela vaginalis and anaerobes overgrowth may occur when the normal flora and ph of the vagina altered and replace with high numbers of anaerobic bacteria. </li></ul></ul></ul></ul><ul><li>ASSESSMENT </li></ul><ul><ul><ul><ul><li>Mild or aymptomatic </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Mild ot moderate, mal odorous of vaginal discharge; a thin watery and grayish white intends to adhere the vaginal wall with the fishy smelling discharge </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Mild vaginal burning and irritation </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Presence of clue cells or either a saline wet mount or gram stain of vaginal fluid </li></ul></ul></ul></ul><ul><li>NURSING INTERVENTION </li></ul><ul><ul><ul><li>Administer flagyl (metronidazole); treatment is recommended only when recurrent and resistant infection occur. </li></ul></ul></ul>
  63. 63. LYMPHOGRANULOMA VENEREUM <ul><ul><ul><ul><ul><li>Cause by certain strains of C. trachomatis </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Primary lesion is small, painless papule on the glans penis or the vaginal mucosa that heals spontaneously and may gone unnoticed. </li></ul></ul></ul></ul></ul><ul><li>ASSESSMENT </li></ul><ul><ul><ul><li>Tender, enlarged, and inflamed inguinal lymph nodes (buboes) </li></ul></ul></ul><ul><ul><ul><li>Draining ulcerations </li></ul></ul></ul><ul><ul><ul><li>Scarring </li></ul></ul></ul><ul><ul><ul><li>Lymphatic obstruction </li></ul></ul></ul><ul><ul><ul><li>Genital deformity </li></ul></ul></ul><ul><ul><ul><li>Rectal fibrosis </li></ul></ul></ul><ul><ul><li>NURSING INTERVENTION </li></ul></ul><ul><ul><ul><li>Recommended therapy is doxycycline, given orally for 21 days. Oral erythromycin is an alternative. </li></ul></ul></ul>
  64. 64. NURSING DIAGNOSIS <ul><li>Deficient knowledge </li></ul><ul><li>Risk for injury </li></ul><ul><li>Ineffective health maintenance </li></ul><ul><li>Risk for deficient fluid volume </li></ul><ul><li>Impaired skin integrity </li></ul>
  65. 65. REFERENCES <ul><li>The Lippincott Manual of Nursing Practice 4 th Edition by Lilian Sholtis Brunner and Doris Smith Suddarth. </li></ul><ul><li>Medical Surgery Nursing 7 th Edition volume 1 by Joyce M. Black and Jane Hokanson Hawks </li></ul><ul><li>NCLEX-RN Review 5 th Edition by Alice M. Stein </li></ul><ul><li>Medical Surgical Nursing 3th Edition volume 2 by Joan Luckmann and Karen Creason Sorensen </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul>