22. Sperm antibodies- Antibody reactions occur when the female's body mistakes the sperm for invading pathogens and seeks to destroy them. The male can also rarely produce anti-sperm antibodies.
45. acute inflammation of the cervix CERVICAL BIOPSY A test in which tissue samples are taken from the cervix and examined for disease or other problems.
112. The state of a woman who is unable to carry a pregnancy to full term. There are many biological causes of infertility, some which may be bypassed with medical intervention. Types of infertility Subfertility - less fertile than a typical couple Primary infertility - couples have never been able to conceive. Secondary infertility - is difficulty conceiving after already having conceived Combined infertility - both the man and woman may be infertile Unexplained infertility - abnormalities are present but not detected by current methods
113. PATHOPHYSIOLOGY and Etiology Possible causes of infertility include uterine displacement by tumors, congenital anomalies, and inflammation. For an ovum to become fertilized, the vagina, fallopian tubes, cervix, and uterus must be patent and the mucosal secretions of the cervix must be receptive to sperm. Semen and cervical secretions are alkaline, where as normal vaginal secretions are acidic. Often more than one factor is responsible for the problem. Identifying the causes may require the services of a gynecologist, urologist and endocrinologist. The etiologies of infertility include ovulatory dysfunction, tubal/pelvic pathology, male factor, other factors and unexplained infertility. Anovulation is the underlying cause of infertility in approximately 30% of women, uterine or tubal factors are responsible for another 20%, a male factor is identified in approximately 40% of cases, approximately 5% of cases anatomic abnormalities, cervical factors, or immunological problems are identified and in the remainder of cases no specific abnormality is identified (unexplained infertility). In approximately 20% of cases, an abnormality is identified in both partners
115. Common Causes of Infertility Factors that can cause male as well as female infertility are: Genetic Factors A Robertsonian translocation in either partner may cause recurrent spontaneous abortions or complete infertility. General factors Diabetes mellitus, thyroid disorders, adrenal disease Hypothalamic-pituitary factors Kallmann syndrome Hyperprolactinemia Hypopituitarism Environmental Factors Toxins such as glues, volatile organic solvents or silicones, physical agents, chemical dusts, and pesticides. Ovulation problems tubal blockage male associated infertility Age related factors uterine problems previous tubal ligation previous vasectomy unexplained infertility
116. NURSING INTERVENTION advise the couple to intercourse within the fertile zone (cycle days 1216) inform them that conception can occur with intercourse occurring as distant as five days prior to ovulation discourage from using any form of artificial lubricants as all of these agents have a deleterious effect on sperm function and viability Advise the patient of living a healthy lifestyle MEDICAL TREATMENT Drugs: Clomiphene (Clomid) Menotropine (Pergonal) Urofollitropine (Metrodin) Chorionic Gonadotropin Artificial insemination - Dipositing semen into the female genital tract by artificial means.
129. Assessment Evaluate the amount of color and blood that is present; determine the time, the bleeding and any precipitating factors. Determine whether a positive pregnancy test has been previously been obtained, also date the last menstrual period. Monitor maternal vital signs for indications of such as hemorrhage, infection. Evaluate any blood or clot tissues for the presence fetal membranes, placenta or fetus .
130. Damage to the Cervix - The cervix may be cut, torn, or damaged by abortion instruments. This can cause excessive bleeding that requires surgical repair. Scarring of the Uterine Lining – Suction tubing, curettes, and other abortion instruments may cause permanent scarring of the uterine lining. Perforation of the Uterus - The uterus may be punctured or torn by abortion instruments. The risk of this complication increases with the length of the pregnancy. If this occurs, major surgery may be required, including removal of the uterus (known as a hysterectomy). Damage to Internal Organs - When the uterus is punctured or torn, there is also a risk that damage will occur to nearby organs such as the bowel and bladder. Death - In extreme cases, other physical complications from abortion including excessive bleeding, infection, organ damage from a perforated uterus, and adverse reactions to anesthesia may lead to death. This complication is rare, but is real.
131. Diagnostic exams Pregnancy test - using your urine sample to perform a pregnancy test and use the blood sample to check the iron count and Rh factor. Pelvic examination: The cervix is examined to determine if it is dilated (open) or closed. Blood test –to know presence of anemia Ultrasound – to detect fetal heart beat. Hysteroscopy
132. Consider the Risks of Abortion Heavy Bleeding - Some bleeding after abortion is normal. However, if the cervix is torn or the uterus is punctured, there is a risk of severe bleeding known as hemorrhaging. When this happens, a blood transfusion may be required. Severe bleeding is also a risk with the use of RU486. One in 100 women who use RU486 require surgery to stop the bleeding. Infection – Infection can develop from the insertion of medical instruments into the uterus, or from fetal parts that are mistakenly left inside (known as an incomplete abortion). A pelvic infection may lead to persistent fever over several days and extended hospitalization. It can also cause scarring of the pelvic organs. Incomplete Abortion - Some fetal parts may be mistakenly left inside after the abortion. Bleeding and infection may result. Sepsis – A number of RU486 or mifepristone users have died as a result of sepsis (total body infection). Anesthesia – Complications from general anesthesia used during abortion surgery may result in convulsions, heart attack, and in extremecases, death. It also increases the risk of other serious complications by two and a half times.
141. Etiology 1. Usually occurs at beginning of lactation in first-time, breast-feeding mothers.May also occur later in chronic lactation mastitis and central duct abscesses. 2.Milk stasis may lead to obstruction, followed by non-infectious inflammation, then infectious mastitis. 3. Source of infection may be from hands of patient, personnel caring for patient, baby’s nosse or throat, or blood borne. 4.Most common pathogens: Staphylococcus aureus, Escherichia coli, streptococcus.
142. Assessment Breast tenderness or warmth to touch General malaise or feeling ill Swelling of the breast Pain or a burning sensation continuously or while breast-feeding Skin redness, often in a wedge-shaped pattern Fever of 101 F (38.3 C) or greater
143. Complications Recurrence. Once you've had mastitis, you're more likely to get it again. Milk stasis. When the milk isn't completely drained from your breast during breast-feeding, milk stasis can occur. This causes increased pressure on the ducts and leakage of milk into surrounding breast tissue, which can lead to pain and inflammation. Abscess. When mastitis is inadequately treated, or if it's related to milk stasis, a collection of pus (abscess) can develop in your breast. An abscess usually requires surgical draining.
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146. May apply cold to decrease tissue metabolism and milk production.
147. Apply icy compresses to the breasts after breast-feeding to relieve pain and swelling.
156. Early sexual activity, multiple sexual partners, and history of STD’s, especially HPV and HSV, are major risk factors.
157.
158. RISK FACTORS HUMAN PAPILLOMA VIRUS MULTIPLE SEX PARTNERS EARLY SEXUAL ACTIVITY OTHER STD INFECTIONS FAMILY HISTORY OF CERVICAL CANCER AGE CONTRACEPTIVE PILLS CIGARETTE SMOKING INCOME/SOCIOECONOMIC STATUS RACE UNHEALTHY DIETS HIGH FASTING GLUCOSE LEVELS (140mg/DL) MULTIPLE PREGNANCIES DIETHYSTILBESTROL (DES)
159. SIGNS AND SYMPTOMS OF CERVICAL CANCER VAGINAL BLEEDING AFTER SEXUAL INTERCOURSE PELVIC PAIN PAIN DURING SEXUAL INTERCOURSE OFFENSIVE VAGINAL DISCHARGE ( PALE, PINK, BROWN, BLOOD STREAKED, AND FOUL-SMELLING) ABNORMAL BLEEDING BETWEEN MENSTRUAL PERIODS HEAVY BLEEDING DURING MENSTRUAL PERIOD INCREASED URINARY FREQUENCY BLEEDING AFTER MENOPAUSE PAINFUL URINATION (DYSURIA) LOW BACK PAIN URETHRITIS OR URINARY INFECTION
160. Diagnostic Exams for cervical cancer Biopsy Colposcopy LEEP (Loop electrosurgical excision procedure ) Endocervical curettage Conization NURSING DIAGNOSES: Anxiety related to cancer and treatment Body image disturbance related to surgical treatment Acute pain related to post-operative pain Ineffective sexuality pattern Risk for ineffective coping related to threat of malignancy and inadequate support system.
161.
162. Regular screening for and treatment of cervical cell abnormalities can prevent the abnormal cell changes from developing into cancer.
179. Women in their 20s and 30s should have a clinical breast exam (CBE) as part of a periodic (regular) health exam by a health professional, preferably every 3 years.
180. Women age 40 and older - mammogram every year and should continue to do so for as long as they are in good health.
181.
182. BREAST CANCER STAGING Staging - is the process of finding out how widespread a cancer is when it is diagnosed.
205. Sexually Transmitted Diseases An STD is any disease that is spread primarily by sexual contact. One partner transmits the disease-causing organism to the other partner during sex (oral/vaginal/anal/etc.). Not all diseases that affect the sex organs are sexually transmitted. Some are not at all connected with sex. Other diseases are simply sexually associated
206. 1. Chlamydia Cause/ Etiology Chlamydia trachomatis -most common curable STD -It infects the cervix in women, and the penile urethra in men -symptoms are pain during sex, and discharge from the penis or vagina Pathophysiology and Etiology The result of sexual intercourse, with infection entering the vagina, infecting the cervix, and possibly spreading up through the endometrium and fallopian tubes. Adolescents ages 15 to 19 and young women ages 20 to 24 are at highest risk for infection, possibly because of susceptibility of cervical tissue to the organism
210. Erythromycin and ofloxacin (Floxin)Abstinence until treatment has been completed Rescreening is recommended 3 to 4 months after treatment to detect reinfection Ensure that partner is treated at the same time Present partners should receive treatment despite lack of symptoms and negative chlamydia result. Report case to local public health department Ensure that patient begins treatment and will have access to prescription and transportation for follow up. Explain mode of transmission, complications and risk for other STDs
211. NURSING DIAGNOSES Acute or chronic pain related to vaginal irritation Impaired tissue integrity related to vaginal infection Sexual dysfunction related to abstinence secondary to treatment
218. Opthalmianeonatorum and sepsis (rare) caused by infant born through infected birth canalPATIENT EDUCATION Teach the patient about all possible STD’s, their prevalence and their mode of transmission. Advise the patient of complications of gonorrhea. Teach protection of STD’s by abstinence, monogamous relationships, condoms. Encourage follow-up for routine women’s health care and periodic STD screening
219.
220. 3. Syphilis Caused by the bacterium Treponemapallidum transmitted by direct contact with syphilis sores, which can appear on the external genitals and the mouth, as well as in the vagina or rectum
221.
222. Non-pregnant individuals who have severe allergic reactions to penicillin (e.g., anaphylaxis) may be effectively treated with oral tetracycline or
223. All pregnant women with syphilis should be desensitized and treated with penicillin. Follow-up includes clinical evaluation at 1 to 2 weeks followed by clinical and serologic evaluation at 3, 6, 9, 12, and 24 months after treatment.
224. Azithromycin - easy once-only dosing. 4. MycoplasmaGenitalium In 2007, a prominent study of U.S. adolescents found that a little known STD, Mycoplasmagenitalium had surpassed gonorrhea in prevalence. Most cases of M. genitalium don't cause symptoms and it had been difficult to, including infertility from pelvic inflammatory disease MG, like gonorrhea and chlamydia, may emerge as a major cause of cervicitic in women, and nongonococcalurethritis in men.
225. Pathology The urogenital tract appears to be the primary tissue infected by M. genitalium. Tissue damage is only partially caused by toxins and harmful metabolites produced by M. genitalium, such as hydrogen peroxide and super-oxide metabolites. Most likely the much of the damage is caused by the inflammatory response of the host immune system. M. genitalium can be sexually transmitted with rates similar to Chlamydia trachomatis, another pathogen which can cause urethritis. Adhesion of mycoplasmas to host cells is required for colonization and for infection. Without adhesion there can be no infection.
226. Antibiotics Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting. Whenever feasible, guide antibiotic selection using culture sensitivity. Erythromycin Inhibits bacterial growth. For treatment of staphylococcal and streptococcal infections. In children, age, weight, and severity of infection determine proper dosage. The macrolide antibiotic group appears to be the most effective form of treatment of M. genitalium. 5. Trichomoniasis is the most common STD in sexually active young women Symptoms: Frothy, green-yellow vaginal discharges strong vaginal odor pain on intercourse irritation and itching
227. Diagnostic Culture of vaginal secretions Normal saline wet preparation HIV screening Treatment: Antiprotozoals, such as metronidazole Intervention Comply with the treatment regimen. Use safer sex practice. Abstinence Prevent future transmission of the infection.
228.
229. 6. Crabs/Pubic Lice "Crabs" are a form of lice that live on the hair in the genital area and occasionally on other course-haired areas of the body, such as the armpits or the eyebrows usually spread by sexual contact, also can be transmitted by infested linens and clothing MEDICATIONS Over-the-counter lotions or shampoos. These products are usually the first line of defense. Malathion (Ovide). apply lotion to the affected area and wash it off after eight to 12 hours. Malathion is flammable - so keep it away from heat sources such as hair dryers, electric curlers and cigarettes. Eye treatments (physostigmine) – BID (8-10 days). If public lice are found in eyelashes Making sure all the nits are removed and that all clothing, bedding, personal items and furniture are decontaminated.
236. 9. HIV/AIDS the virus associated with AIDS can only be transmitted by an exchange of bodily fluids -- including semen, vaginal secretions, breast milk and blood cannot be transmitted by casual contact Causative agent: retrovirus that infects and depletes the protector cells of the immune system (lymphocytes) Initial treatment discuss the use of highly active antiretroviral therapy (HAART) with your doctor. HAART medicines : Nucleoside/nucleotide reverse transcriptase inhibitors: zidovudine (ZDV, formerly AZT) stavudine (d4T). Nonnucleoside reverse transcriptase inhibitors (NNRTIs): Efavirenz Nevirapine delavirdine
237. Protease inhibitors (PIs), atazanavir Fusion inhibitors, such as enfuvirtide. Other medicines that may be used to treat HIV or AIDS-related conditions include cytokines, such as interferon alfa-2a and interferon alfa-2b. ASSESSMENT Obtain hx of risk factors, signs and symptoms, recent infections, + blood tests for HIV antibodies Review px presents complaints Evaluate nutritional status Assess respiration, skin color, temp.,palpable lymph nodes, fever, night sweata Inspect mouth for lesions Examine skin for rash, sores Bowel patterns Assess the patients adherence to meds
243. Preventing spread of infection: Frequent handwashing Use of sexual barrier (e.g. condoms) Avoid contact Avoiding stress, sunburn, and other stress-producing situation (to decrease the episodes of recurrence) Keep lesions clean & dry. Teach patient not to rub or scratch lesions Apply moist tea bags MANAGEMENT Relieving Pain: Lesions should be kept clean, and proper hygiene practices. Sitz bath – to ease discomfort when urinating Bed rest Increase fluid intake – to check bladder distention Administer pain medication if Rx Insert indwelling catheter for painful urination
244. Relieving Anxiety: Provide emotional support Listen to patient’s concerns Provide additional information and instructions Encourage to join support groups MEDICATIONS Anti-viral agent that can suppress the symptoms and shorten the course of infection: Acyclovir (Zovirax) Valacyclovir (Valtrex) Famcyclovir (Famvir) Pain medication Local comfort measures (e.g. sitz bath) Immunization
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