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Questions and Answers
What is the most common bacteria associated with toxic shock syndrome?
Which of the following is NOT a common laboratory finding in toxic shock syndrome?
What is the primary goal of medical management for toxic shock syndrome?
What is the most important nursing implication for a client with toxic shock syndrome?
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Which of the following is a key patient education recommendation for clients using tampons?
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What is the primary cause of endometriosis?
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Which of the following is NOT a common clinical manifestation of endometriosis?
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What is the primary purpose of using high-dose antiovulatory medications in the treatment of endometriosis?
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What is the most common surgical intervention for severe and chronic endometriosis?
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Which of the following is NOT a recommended nursing intervention for managing discomfort or pain in clients with endometriosis?
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What is the most significant risk factor for Toxic Shock Syndrome?
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Which symptom typically occurs first in Toxic Shock Syndrome?
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What is a common manifestation of Toxic Shock Syndrome?
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Which diagnostic test definitively confirms Toxic Shock Syndrome?
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Who is most at risk of developing Toxic Shock Syndrome?
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What physical assessment should be performed to help diagnose Toxic Shock Syndrome?
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What is a potential consequence of leaving a tampon in place for too long?
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What is one of the key signs of septic shock in Toxic Shock Syndrome?
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What might a healthcare provider ask about in the subjective assessment of a patient with suspected Toxic Shock Syndrome?
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Why is asking about tampon use important in assessing for Toxic Shock Syndrome?
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Study Notes
Toxic Shock Syndrome
- Acute bacterial infection caused by Staphylococcus aureus
- Risk factors:
- Using tampons with fingers instead of the inserter
- Chronic vaginal infections
- Genital herpes
- Recent childbirth
- Surgery
- Internal medical packing
- Can occur in non-menstruating women
- Most commonly occurs in women using tampons
- When a tampon is left in place for too long, bacteria proliferate and release toxins into the bloodstream
Clinical Manifestations
- Begins with flu-like symptoms within the first 24 hours, then worsen between days 2-4
- Symptoms:
- Elevated temperature up to 102 degrees
- Vomiting
- Diarrhea
- Dizziness
- Headache
- Myalgia
- Sore throat
- Red macular palmar or diffuse rash followed by desquamation of the skin
- Decreased urinary output
- Disorientation
- Elevated blood urea nitrogen (BUN)
- Hypotension and other signs of septic shock
- Pulmonary edema
- Inflammation of mucous membranes
Assessment
- Subjective:
- Tampon use and how long she used a single tampon before changing it
- Myalgia
- Sore throat
- Headache
- Fatigue
- Objective:
- Assess palms and soles of feet for erythematous rash
- Check for edema and signs of shock such as hypotension
- Level of consciousness
Diagnostic Tests
- No definitive test
- Cervical/vaginal smear (S. Aureus present 90% of the time)
- Blood, urine, and throat cultures
- Blood tests:
- Leukocytosis
- Thrombocytopenia
- Elevated bilirubin
- Blood urea nitrogen/creatinine
- Alanine aminotransferase (SGPT)
- Aspartate aminotransferase (SGOT)
- Creatinine phosphokinase (CPK)
Medical Management
- Antibiotics dependent on results of culture and sensitivity
- Parenteral fluids to maintain fluid balance and correct electrolyte imbalances
- Monitor renal labs
- Monitor liver function tests
Nursing Implications and Patient Teaching
- Client is hospitalized:
- Bedrest
- Administer antibiotics
- Monitor vitals and fluid status
- Oxygen therapy if needed
- Patient & Family Teaching:
- Advise client not to use super absorbent tampons
- Alternate tampons with pads
- Inspect tampon for defects before insertion
- Change tampons frequently (every 4 hours)
- Insert tampon using inserter to avoid abrasions
- Wash hands thoroughly before and after inserting tampon
- Observe for signs of toxic shock syndrome if using tampon
- Sudden high fever with vomiting or diarrhea
- Remove tampon and seek immediate medical attention
Endometriosis
- Endometrial tissue appears outside the endometrial cavity
- Tissue may be found on:
- Ovaries
- Fallopian tubes
- Uterus
- Abdominal cavity
- Vagina
- Pelvic cavity
- Spread of tissue is believed to be through:
- Lymphatic circulation
- Menstrual backflow to the fallopian tubes and pelvic cavity
- Congenital displacement of endometrial cells
Risk Factors
- Sister or mother has it (7x greater risk)
- Highest incidence of endometriosis in among Caucasian women
- 25 to 35 years of age who are in the higher socioeconomic classes
- Who postpone childbearing until the later reproductive years
Clinical Manifestations
- Dysmenorrhea
- Lower abdominal and pelvic pain with or without pain in the rectum
- May be unilateral or bilateral and may radiate to the lower back/legs/groin
- Symptoms may worsen with menstruation
Assessment
- Subjective:
- History of symptoms
- Dysmenorrhea
- Aching cramping
- Bearing down-sensation in the pelvis or lower back
- Dyspareunia
- Menstrual irregularities (amenorrhea)
- Objective:
- Noting signs of symptoms of abnormal uterine bleeding
- Infertility
Diagnostic Tests
- Ultrasound to identify cysts and large areas of endometrial tissue outside of the uterus
- Laparoscopy with biopsy of lesions may confirm the diagnosis
- Regular pelvic examinations to monitor progress
Medical Management
- Occasionally disappears spontaneously
- Some are asymptomatic after pregnancy
- Medications:
- High dose antiovulatory medications to inhibit ovulation and induce a state physiologically similar to pregnancy
- Synthetic androgen (male hormone) such as danazol (Danocrine) or a Gonadotropin-releasing hormone
- Surgery:
- Laparoscopy can be used to remove small areas of endometrial tissue & relieve adhesions
- Laser may be used to vaporize the small implants of endometrial tissue
- Extensive and chronic endometriosis may require drastic surgical treatment, such as panhysterectomy or oophorectomy
Nursing Implications and Patient Teaching
- Manage discomfort/pain:
- Use of medications
- Heating pads
- Acupuncture
- Transcutaneous electrical nerve stimulation (TENS)
- Yoga
- Eating a balanced diet and physical activity may be beneficial
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Description
Explore the key information about Toxic Shock Syndrome, an acute bacterial infection caused by Staphylococcus aureus. Learn about the etiology, pathophysiology, risk factors, and clinical manifestations of this condition.
