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Management of Female Reproductive Disorders

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

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Management of Female Reproductive Disorders

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  1. Management of Female Reproductive Disorders Ch 47

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

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

  9. 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

  10. 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

  11. 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)

  12. Herpesvirus Type 2Herpes 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.

  13. 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

  14. Health Problems in Pediatric FemalesAdolescent Reproductive Health Problems

  15. 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.

  16. 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)

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