Management of Female Reproductive Disorders Ch 47

Vulvovaginal infections Infections very common Normal vaginal defenses: pH 3.5 – 4.5 –Maintained by normal flora: Lactobacillus acidophilus Nsg goal: prevent re-occurrence of infections –Reduce stress and illness –Maintain normal pH –Avoid introduction of pathogen

Vaginitis Inflammation of the vagina Causes: Candida or Trichomonas Vaginal discharge Urethritis may develop due to close proximity of the urethra Sx. Redness, burning, ithing, odor, edema Tx: oral or local medication

Candidiasis Fungal or yeast infection – Candida albicans May be present without symptoms Common in pregnancy, DM and HIV Also common I patients taking corticosteroids or oral contraceptives. Sx: puritis, itching, irritation, white cottage cheese- like discharge Tx: anti-fungal agents (Monistat, Terazol, Mycostatin, Gyne-Lotrimin. Oral: Diflucan

Bacterial Vaginosis May occur throughout the menstrual cycle Discomfort or pain usually not associated Tx: Flagy B.I.D. (available in vaginal gel) Patients associated with vaginosis should be tested for other STDs

Bacterial Vaginosis Caused by overgrowth of anaerobic bacteria amd Gardnerella vaginalis Fish-like odor; pH > 4.7 Noticeable after sexual intercourse or during menstruation as a result of an increased vaginal pH Risk fx.: douching after menses, smoking nultiple sex partners, other STDs

Trichomoniais Second most common STD May be transmitted by asymptomatic carriers. May be associated with adverse pregnancy outcomes, PID, cervical neoplasia, infertility Vaginal discharge may appear thin, yellow- green, frothy, malodorous secretion

Trichomoniais Causes vaginal irritation, burning, itching Cervical erythema with multiple small petechiae (strawberry spots) pH usually > 4.5 Tx.: treat both partners with Flagyl

Gerontologic Consideratons Menopause, decreased estrogen Dry vaginal mucosa thins & atrophies Leukorrhea (vaginal discharge) Itching, burning Management: –Similar to bacterial vaginosis –Estrogen hormones help restore the epithelium

Nursing Care Relieve discomfort – sitz baths Reduce anxiety Prevent reinfection or spread –Patient education: preventive measures –Abstinence from intercourse –Treatment: antibiotics & iontments –Hygiene practices –Reporting symptoms

HPV – Human Papillomavirus Sexually transmitted Various HPV strains –18, 18, 31, 33, 45 result in abnormal pap-smears; cervical dysplagia, risk for cervical cancer –6, 11 result in condylomata (warts), low risk for cancer Prevalent among young sexually active females Tx: topical oint. Tichloroacetic acid, podophyllin (Condylox, Aldara)

Herpesvirus Type 2 Herpes Genitalis, Herpes Simplex Virus Herpetic lesions on external genitalia Tansmittable STD from wet surfaces Initial outbreak may be painful Recurrence are less painful, associated with stress, sunburns, inadequate rest & nutrition, Complications: spread to buttocks, thighs, eyes.

HPV – Human Papillomavirus Tx: Valtrex, Zovirax, Famciclovir HSV-1 ( simplex type 1 ) causes cold sores HSV 2 ( simplex type 2 ) genital herpes –Varicell zoster or shingles –Estein-Barr virus –Cytomegalovirus (CMV) –Human B-lymphotorphic virus Sx: papules, macules, vesicular ulcers, blisters on vaginal, cervix, perianal. Glans penis, foreskin & shaft. Flu-like symptoms, malaise, dysuria

Health Problems in Pediatric Females Adolescent Reproductive Health Problems

Adolescent Pregnancy Rates of adolescent births still remain high in the U.S. than other developing countries. 7 out of 10 adolescent mothers complete high school but are less likely to to to college. The less familiar an adolescent is with her partner, the less likely it is that they will use contraception during intercourse. Social factors: low socioeconomics, poverty Maternal success: participation in programs for pregnant teens, social support systems and a sense of control over one’s life.

Adolescent Pregnancy Medical aspects. Risk for complications exist when there is a lack of adequate care –Premature labor, low-birth infants, high neonatal mortality, iron deficiency anemia, fetopelvic disproportion, prolonged labor. Infants at risk – bacterial infections within the uterus are associated with early preterm delivery (<30 wks)