Prenatal Care: Contraceptives & Fertility PDF

Care for Mother, Child at Risk or with Problems o On the day of ovulation (the peak day), it (Acute and Chronic): PRELIMS becomes copious, thin, watery, and transparent Topic: MADAMI...

Care for Mother, Child at Risk or with Problems o On the day of ovulation (the peak day), it (Acute and Chronic): PRELIMS becomes copious, thin, watery, and transparent Topic: MADAMI It feels slippery and stretches at least 1 BSN3-C | Prof. Esther Shiela Gorospe | SEM 1 2024 | inch before the strand breaks transes by Brillantes, Ira L. Called spinnbarkeit Breast tenderness and anterior tilt to the CONTRACEPTIVES cervix occur o 100% effective method of contraception: o All the days on which cervical mucus is copious, ABSTINENCE and for at least 3 to 4 days afterward, are o An ideal contraceptive should be: considered to be fertile days ✓ Safe o Has high failure rate bc of difficulty in interpreting ✓ Effective mucus status ✓ Compatible with spiritual and cultural beliefs and personal preferences of both 4. TWO-DAY METHOD the user and the partner o A woman assesses for vaginal secretions daily. ✓ Free of bothersome side effects o If she feels secretions for 2 days in a row, she ✓ Convenient to use and easily obtainable avoids coitus that day and the day following as ✓ Affordable and needing few instructions the presence of secretions suggests fertility. for effective use ✓ Free of effects on future pregnancies 5. SYMPOTHERMAL METHOD o Natural Family Planning, Fertility Awareness o Combines the cervical mucus and BBT methods Methods, Periodic Abstinence o The woman takes her temperature daily, watching for the rise in temperature that marks 1. ABSTINENCE ovulation. o refraining from sexual relations, has a theoretical o She also analyzes her cervical mucus every day 0% failure rate and is also the most effective way and observes for other signs of ovulation such as to prevent STIs mittelschmerz (midcycle abdominal pain) or if her o Periodic Abstinence: a method to avoid cervix feels softer than usual. pregnancy by avoiding sex on the days a woman o More effective than either the BBT or the cervical may conceive. mucus method alone PERIODIC ABSTINENCE 6. STANDARD DAYS METHOD (CYCLEBEADS) 1. COITUS INTERRUPTUS (WITHDRAWAL METHOD) o one of the oldest known methods of contraception. o The couple proceeds with coitus until the moment of ejaculation. Then, the man withdraws and spermatozoa are emitted outside the vagina. FERTILITY AWARENESS METHODS 1. CALENDAR METHOD o Requires a a couple to abstain from coitus on the days of a menstrual cycle when the woman is most likely to conceive o To calculate “safe” days, she subtracts 18 from o This method is designed for women who have the shortest cycle she documented. menstrual cycles between 26 and 32 days This number predicts her first fertile day. o The first bead on the ring is red and marks the o Then subtracts 11 from her longest cycle first day of her menstrual flow Represents her last fertile day o This is followed by six brown beads which o When used conscientiously, the method has a indicate “safe” days. low failure rate; in typical use, however, this rate o Twelve glow-in-the-dark white beads, which mark rises substantially because of irregular menstrual fertile days (during which she needs to abstain cycles, miscalculation, or disregard for predicted from coitus), and 13 additional brown “safe” days fertile days follow. o If she reaches a dark brown bead (appears on the 2. BBT Method 27th day) before she begins her next menses, her o Basal Body Temperature or the temp of the body cycle is too short for the method to be reliable. at rest falls about 0.5°F o If she reaches the end of the string of beads (32 o At the time of ovulation, her BBT rises a full days) before menses, she knows her cycle is too Fahrenheit degree (0.2°C) because of the rise long for the method to be reliable. in progesterone with ovulation. o Woman takes her temp orally or with a tympanic 7. OVULATION DETECTION thermometer each morning immediately after o The use of an over-the-counter ovulation waking before rising from bed or before taking detection kit. any activities o These kits detect the midcycle surge of o A problem with assessing BBT for fertility luteinizing hormone (LH) that can be detected in awareness is that many factors can affect BBT urine 12 to 24 hours before ovulation. o Such kits are 98% to 100% accurate in predicting 3. CERVICAL MUCUS METHOD OR BILLING’S ovulation. METHOD o Before ovulation each month, the cervical mucus 8. MARQUETE MODEL is thick and does not stretch when pulled between o This method combines the use of ovulation the thumb and finger. detection with other signs of ovulation (cervical Brillantes, Ira L. RN 2027! – SMOC 100% BSN 3C  mucus, BBT, cervix position and softness) to o made of soft rubber shaped like a thimble, which avoid pregnancy during a woman’s fertile period. fits snugly over the uterine cervix o It was developed in the late 1990s by nurses and o The precautions for use are the same as for doctors at Marquette University in Wisconsin. diaphragm use except caps can be kept in place longer (up to 48 hours) because they do not put BARRIER METHODS pressure on the vaginal walls or urethra. 1. SPERMICIDE o CONTRAINDICATIONS: o is an agent that causes the death of spermatozoa ✓ An abnormally short or long cervix before they can enter the cervix. ✓ Current abnormal Pap smear o It is a chemical barrier method and is often used ✓ History of TSS in combination with other physical barrier ✓ Allergy to latex or spermicide methods. ✓ History of Cervicitis or cervical infection o not only actively kill sperm but also change the ✓ History of cervical cancer vaginal pH to a strong acid level, a condition not ✓ Undiagnosed vaginal bleeding conducive to sperm survival. o They do not protect against STIs HORMONAL CONTRACEPTIONS 1. ORAL CONTRACEPTIVES SIDE EFFECTS AND CONTRAINDICATIONS o Commonly known as pills, Ocs, or COCs ✓ Contraindicated in women with acute cervicitis (combination oral contraceptives) Might further irritate the cervix o composed of varying amounts of natural ✓ May cause vaginal leakage after use that is estrogen (17β-estradiol, estradiol valerate) or bothersome synthetic estrogen (ethinyl estradiol) combined with a small amount of synthetic progesterone 2. MALE AND FEMALE CONDOMS (progestin) o Male condom: a latex rubber or synthetic sheath o Estrogen: suppress FSH and LH to suppress that is placed over the erect penis before coitus ovulation to trap sperm o Progesterone: causes a decrease in the ADVANTAGE: no healthcare visit or permeability of cervical mucus and limits sperm prescription is needed motility and access to ova o Female condoms: are sheaths made of latex or Interferes w tubal transport and polyurethane, prelubricated with a spermicide endometrial proliferation offer protection against conception as o BENEFITS: in addition to prevention of well as STIs, including HIV pregnancy, it also decreases the incidence of ✓ Dysmenorrhea SIDE EFFECTS AND CONTRAINDICATIONS ✓ PDD ✓ No contraindications to both ✓ Iron deficiency anemia ✓ Allergy or sensitivity to latex ✓ Acute PID ✓ Endometrial and ovarian cancer, ovarian 3. DIAPHRAGMS cysts, and ectopic pregnancies o Diaphragms: a circular rubber disk that is placed ✓ Fibrocystic breast disease over the cervix before intercourse to mechanically ✓ Possibly osteoporosis, endometriosis, halt the passage of sperm uterine myomata, and rheumatoid is prescribed and fitted initially by a arthritis healthcare provider to ensure a correct ✓ Colon camcer fit. Because estrogen interferes with lipid because the shape of a woman’s cervix metabolism, it may also lower the changes with pregnancy, miscarriage, concentration of low-density lipoproteins cervical surgery (dilatation and curettage (LDL) and increase the high-density [D&C]), or elective termination of lipoprotein (HDL) level. pregnancy, teach women to return for a second fitting if any of these SIDE EFFECTS AND CONTRAINDICATIONS OF ALL circumstances occur OC: ✓ Nausea SIDE EFFECTS AND CONTRAINDICATIONS ✓ Weight gain ✓ Diaphragms may not be effective if a uterus is ✓ Headache prolapsed, retroflexed, or anteflexed ✓ Breast tenderness ✓ Users of diaphragms may experience a higher ✓ Breakthrough bleeding (spotting outside the number of urinary tract infections (UTIs) than menstrual period) nonusers probably because of pressure on the ✓ Monilial vaginal infections urethra ✓ Mild hypertension ✓ Diaphragms should not be used in the presence ✓ Depressions of acute cervicitis, herpes virus infection, or a o Advise all women taking COCs to notify their papillomavirus infection healthcare provider if symptoms of myocardial or close contact of the rubber and the use of thromboembolic complications occur, such as: a spermicide can cause additional ✓ Chest pain (pulmonary embolus or irritation myocardial infarction) ✓ CONTRAINDICATIONS: ✓ Shortness of breath (pulmonary embolus) a. History of TSS ✓ Severe headache (cerebrovascular accident) b. Allergy to rubber or spermicide Severe leg pain (thrombophlebitis) c. History of recurrent UTIs ✓ Eye problems, such as blurred vision 4. CERVICAL CAPS (hypertension, cerebrovascular accident) Brillantes, Ira L. RN 2027! – SMOC 100% BSN 3C 2. INTRAUTERINE DEVICES OR IUDs o A small plastic device that is inserted into the o a small puncture wound (referred to as “no- uterus through the vagina. scalpel technique”) is made on the scrotum. o Can be hormonal or nonhormonal o Irreversible; permanent o UDs may be used by women who have never had o The vas deferens on each side are then pulled children as well as those who have. forward, cut and tied, cauterized, or plugged, o The device must be fitted by a healthcare provider blocking the passage of spermatozoa who first performs a pelvic examination o Can be done under local anesthesia in an o FOUR TYPES: ambulatory setting, such as in a primary a. Copper: T-shaped plastic device wound with healthcare provider’s office or a reproductive life copper. It is effective for 10 years planning clinic. b. Levonorgestrel-releasing intrauterine o There are very few complications associated with system: Mirena or Liletta ; 52 mg a vasectomy. features a drug reservoir of progesterone A hematoma at the surgical site may in the stem occur, although this is seen less progesterone in the drug reservoir frequently with “no scalpel” or puncture gradually diffuses into the uterus through incisions. the plastic; it both prevents endometrium o Side Effects: proliferation and thickens cervical mucus. ✓ May also be associated with the Effective for 5 years development of urolithiasis (kidney c. Levonorgestrel-releasing intrauterine stones). system: Skyla ; 13.5 mg ✓ A few men develop chronic pain after has a lower dose of progesterone in the vasectomy (postvasectomy pain stem syndrome) works similarly to Mirena and is effective ✓ Some men develop autoimmunity or form for 3 years antibodies against sperm following a d. Levonorgestrel-releasing intrauterine vasectomy system: Kyleena ; 19.5 mg has a lower dose of progesterone in the 2. TUBAL LIGATION stem as compared to Mirena but higher o Sterilization of women could include removal of than that of Skyla the uterus or ovaries (hysterectomy), but it approved for 5 years and has a bleeding usually refers to a minor surgical procedure profile similar to Mirena. fallopian tubes are occluded by cautery, crushed, clamped, or blocked, thereby SIDE EFFECTS AND CONTRAINDICATIONS preventing passage of both sperm and ✓ Spotting or uterine cramping for the first 2-3 ova weeks after IUD insertion o Irreversible; permanent ✓ Nulliparous women may have a higher o Associated with a decreased incidence of ovarian percentage of spontaneous expulsion than cancer others o After a menstrual flow and before ovulation, with ✓ Contraindicated for women who has distorted the woman under general or local anesthesia, an uteris incision as small as 1 cm is made just under the ✓ Copper IUD is not advised for women who woman’s umbilicus by laparoscopy technique. has severe dysmenorrhea or menorrhagia o Laparoscopy is a surgical procedure where a ✓ Anemic patients is contraindicated with use of small incision is made in the abdomen for the copper IUD purpose of viewing or performing surgery on the organs of the pelvis or abdomen. SURGICAL METHODS 1. VASECTOMY SIDE EFFECTS AND CONTRAINDICATIONS: ✓ If tubal ligation surgery is done by laparoscopy, an umbilical hernia or ureter or bowel perforation are possible complications. ✓ Extensive obesity might require a full laparotomy to allow adequate visualization ✓ POSTTUBAL LIGATION SYNDROME: Vaginal spotting Intermittent vaginal bleeding Severe lower abdominal cramping ✓ Anastomosis site could cause an ectopic (tubal) pregnancy because of its irregular surface. FERTILITY ✓ Infertility is a term used to describe the inability to conceive a child or sustain a pregnancy to birth. A couple is said to be infertile if they have not become pregnant after at least 1 year of unprotected sex ✓ Subfertility is said to exist when a pregnancy has not occurred after at least 1 year of engaging in unprotected coitus Primary Subfertility: no previous conceptions Brillantes, Ira L. RN 2027! – SMOC 100% BSN 3C  Secondary Subfertility: there has been ✓ Erythrocyte sedimentation rate (increased a previous viable pregnancy but the rate indicates inflammation) couple is unable to conceive at present ✓ Protein bound iodine (for thyroid function) ✓ Sterility is the inability to conceive because of a ✓ Cholesterol level (arterial plaques could known condition, such as the absence of uterus. interfere with pelvic blood flow) ✓ FSH, LH, and testosterone levels SUBFERTILITY o For women: ✓ The cause of subfertility is multi-factoral ✓ Rubella titer for adv testing Age is related to subfertility ✓ Serologic test for syphilis ✓ Those who engage in coitus DAILY, may have ✓ HIV evaluation more difficulty conceiving than those who space ✓ Thyroid uptake determination coitus every other day ✓ Assays for FSH, estrogen, LH, and serial Too frequent sex can lower a man’s sperm progesterone levels. count to a level below optimal fertility ✓ If a woman has history of galactorrhea, serum prolactin level will be obtained. FERTILITY ASSESSMENT Galactorrhea: breast milk ✓ If a woman is younger than 35 years of age, it is secretions usually suggested she have an evaluation after 1 Increased prolactin levels reduce year of subfertility. secretion of pituitary hormones ✓ If a woman is older than 35 years, she should be ✓ Pelvic sonogram may be performed to rule our seen after 6 months. ovarian, tubal, or uterine structural disorders. ✓ If the couple is extremely apprehensive or knows of a specific problem that could be causing their FACTORS THAT CAUSE MALE SUBFERTILITY difficulty in conceiving, studies should never be ✓ Disturbance in spermatogenesis delayed, regardless of the couple’s age ✓ Inadequate production of FSH and LH in the pituitary (stimulates production of sperm) NURSING RESPONSIBILITIES ✓ Obstruction in the seminiferous tubules, ducts, or ✓ Educating couples about the variety of tests and vessels (prevent movement of spermatozoa) procedures that may be performed ✓ Qualitative or quantitative changes in the seminal ✓ Helping patients identify and express their fluid (prevent sperm motility) feelings about their desire to have a child ✓ Development of autoimmunity (immobilizes ✓ Helping patients express how far they are willing sperm) to go in testing and procedures to achieve a child ✓ Problems in ejaculation or deposition or how they might feel if, at the end of testing, it is ✓ Chronic or excessive exposure to radioactive revealed pregnancy will not be possible substances, general ill health, poor diet, and ✓ Assuming responsibility for health assessment, stress- may interfere with production of sperm patient education, and counseling ✓ Helping educate couples about advanced 1. LIMITED SPERM COUNT techniques of assisted reproduction, many of o Sperm count: number of sperm in a single which are complex and demand knowledgeable, ejaculation or in a mm of semen ongoing involvement from the couple o Normal sperm count: ✓ Counseling patients about available alternatives ✓ 33-46 million / mm of seminal fluid or 50 when pregnancy cannot be achieved, such as million per ejaculation adoption or child-free living ✓ 50% of sperm that are motile ✓ 30% that are normal in shape and form PHYSICAL ASSESSMENT o ANY condition that significantly increases body MEN WOMEN temperature, such as chronic infection has o Secondary o Breast and potential to raise scrotal heat to lower sperm sexual thyroid count. characteristics examination One factor: working at a desk job or (pubic hair, no o Secondary driving everyday genital sexual Frequent use of hot tubs or saunas abnormalities, characteristics o Maintaining ideal body weight is a general absence of vas o Complete pelvic preventative health measure deferens, or examination Excessive weight may alter testosterone presence of including Pap production and sperm production undescended test o Abnormalities testes or ✓ Cryptorchidism: undescended testes varicocele) ✓ Varicocele: enlargement of the internal Hydrocele is spermatic vein rarely ✓ Other condition: associated ▪ Past trauma to the testes with ▪ Surgery on or near the testicles subfertility that has resulted in impaired testicular circulation FERTILITY TESTING ▪ Endocrine imbalances (thyroid, o For men: pancreas, or pituitary glands) ✓ Urinalysis ▪ Drug use or excessive alcohol ✓ CBC use ✓ Blood typing- Rh fator ▪ Environmental factors ✓ Serologic test for syphilis ✓ Test for presence of HIV TESTING FOR SPERM NUMBER AND AVAILABILITY Brillantes, Ira L. RN 2027! – SMOC 100% BSN 3C  ✓ Semen analysis and sperm motility: identify Often attributed to psychological causes whether adequate sperm are present for conception ✓ Analysis of Pituitary Hormone: blood test and FACORS THAT CAUSE FEMALE SUBFERTILITY analysis to determine whether adequate levels of ✓ Limited production of FHS or LH FSH and LH are present ✓ Anovulation ✓ Semen analysis: ejaculation for a semen ✓ Problems of ova transport through the fallopian analysis should produce a minimum of 1.4 to 1.7 tubes to the uterus ml of semen and should contain a minimum of 33 ✓ Uterine factors, such as tumors or poor to 46 million spermatozoa per milliliter of fluid endometrial development May need to be repeated after 2 or 3 ✓ Cervical and vaginal factors, which immobilize months because spermatogenesis is an spermatozoa on going process ✓ Poor nutrition, increased body weight, and lack of 30-90 days is needed for new sperm to exercise, which may compound these problems reach maturity. 1. ANOVULATION 2. OBSTRUCTION OR IM o Absence of ovulation or release of ova from the PAIRED SPERM MOTILITY ovary o Diseases such as the ff can result in this type of o Most common cause of subfertility in women obstruction bc adhesions form and occlude o May occur from a genetic abnormality such as sperm transport: Turner Syndrome ✓ Mumps Orchitis: testicular inflammation Hypogonadism and scarring due to mumps virus In wc, there is limited ovarian tissue ✓ Epididymitis: inflammation of the available to produce ova epididymis Results from hormonal imbalance ✓ Infections such as gonorrhea or caused by hypothyroidism wc interferes ascending urethral infection with hypothalamus-pituitary-ovarian o Congenital stricture of a spermatic duct may interaction occasionally be seen o Other causes: o Benign hypertrophy of the prostate gland occurs ✓ ovarian tumors or PCOS in most men ✓ chronic/excessive exposure to x-rays or o Pressure from the enlarged gland on the vas radioactive substances deferens ✓ general ill health o Infection of the prostate: which the sperm and ✓ poor diet seminal fluid must pass, or infection of the ✓ stress: limits ovulation as it may lower seminal vesicles (spread from a urinary tract hypothalamic secretion of GnRH, wc infection) can change the composition of the lowers production of LH and FSH seminal fluid enough to reduce sperm motility ✓ decreased body weight: can reduce o Anomalies of the penis: pituitary hormones such as FSH and LH ✓ Hypospadias: urethral opening on the and halt ovulation (hypogonadotrophic ventral surface of the penis hypogonadism) ✓ Epispadias: urethral opening on the o Either glucose of insulin levels are too high, they dorsal surface can disrupt the FSH and LH production leading to ✓ Peyronie disease: a bent penis failed ovulation o Vitamin D: for maintaining pituitary hormone TESTING FOR SPERM Sperm transport levels TRANSPORT disorders are suspected o PCOS is associated with metabolic syndrome, DISORDERS when FSH and LH are which is diagnosed in patients with: adequate but the sperm ✓ Waist circumference of 35 in. or more in counts remains limited women ✓ Fasting blood glucose over 100 mg/dl 3. EJACULATION PROBLEMS ✓ Serum triglycerides over 150mg/dl o Erectile Dysfunction or inability to achieve an ✓ Blood pressure over 135/85 mmHg erection ✓ High-density lipoprotein cholesterol over Formerly called impotence 50mg/dl May occur from ✓ Development of hirsutism or unwanted ✓ Psychological problems, body hair ✓ diseases such as cerebrovascular accident, OVULATION ✓ Measure the diabetes, or Parkinson disease MONITORING woman’s serum ✓ Use of certain antihypertensive progesterone agents level during luteal ✓ Discontinuation of finasteride (a phase of drug used for male pattern menstrual cycle baldness) If elevated, o Primary condition: if the man has never been corpus luteum able to achieve erection and ejaculation has formed, o Secondary: if the man was able to achieve meaning ejaculation in the past but now has difficulty ovulation o Can be a difficult problem to solve if it is happened. associated with stress ✓ Record BBT for at o Premature ejaculation or ejaculation before least 4 months. penetration is another factor Brillantes, Ira L. RN 2027! – SMOC 100% BSN 3C  If the temperature 3. UTERINE CONCERNS rise does not o Tumors (fibromas/leiomyomas): can be a rare last at least cause of subfertility 10 days, it o Congenitally deformed uterine cavity may also suggests a limit implantation sites (also rare) woman has a o Endometriosis and poor secretion of estrogen luteal phase and progesterone are more common uterine defect concerns for subfertility (progesterone As they results to: inadequate is not being endometrial formation (overproduction or produced underproduction) long enough o Endometriosis: implantation of uterine in a cycle so endometrium, or nodules, that have spread from adequate the interior of the uterus to locations outside the endometrium uterus for occurrence of endometriosis may implantation indicate the endometrial tissue has can be laid different or more friable qualities than down). usual (perhaps due to a luteal phase defect) THERAPY FOR ANOVULATION the most common sites of endometrium ✓ Administration of GnRH spread to the fallopian tubes, the cul-de- Stimulate the pituitary to secrete more FSH sac of Douglas, the ovaries, the uterine and LH ligaments, and the outer surface of the ✓ With Climiphene Citrate or Letrozole uterus and bowel ✓ Administration of combinations of FSH and LH in conjunction with administration of hCG THERAPY FOR UTERINE CONCERNS ✓ If prolactin levels are increased, bromocriptine is o If the problem of subfertility appears to be a luteal added phase defect, this can be corrected by To reduce prolactin levels and allow for the progesterone vaginal suppositories rise of pituitary gonadotropins o If a myoma (fibroid tumor) or intrauterine adhesions are found to be interfering with fertility, 2. TUBAL TRANSPORT PROBLEMS a myomectomy, or surgical removal of the o Occurs bc of development of scarring in the tumor and adhesions, can be scheduled fallopian tubes o If the growth is small, this can be done by a Caused by chronic salpingitis (chronic hysteroscopic ambulatory procedure pelvic inflammatory disease) During the procedure, an intrauterine o Could also result from a ruptured appendix or device (IUD) may be inserted to prevent from abdominal surgery the uterine sides from touching and Involved infection that spread to the fallopian forming new adhesions tubes and left adhesion formation in the tubes Px may be prescribed estrogen for 3 o PID: infection of the pelvic organs including months as another method to prevent the uterus, fallopian tubes, ovaries and their formation of adhesion formation supporting structures. Invasion of fallopian tubes is most apt to 4. VAGINAL AND CERVICAL CONCERNS occur at the end of a menstrual period o Infection or inflammation of the cervix (erosion) because menstrual blood provides such an can also cause cervical mucus to thicken so much excellent growth medium for bacteria. that spermatozoa cannot penetrate it easily or Loss of normal cervical mucus barrier at this survive in it time stenotic cervical os or obstruction of the os by If untreated and unrecognized, , it enters a a polyp may further compromise sperm chronic phase, which causes the scarring that penetration can lead to stricture of the fallopian tubes and o Infection of the vagina can cause the pH of the resulting fertility problem vaginal secretions to become acidotic, thus limiting or destroying the motility of spermatozoa. THERAPY FOR LACK OF TUBAL PATENCY o If the subfertility problem is identified as tubal TESTING AND THERAPY FOR VAGINAL AND insufficiency from inflammation, the prescription CERVICAL CONCERNS of diathermy or steroid administration o If sperm do not appear to survive in vaginal To reduce adhesions secretions because secretions are too scant or o Hysterosalpingography: instillation of a tenacious, a woman may be prescribed low-dose contrast dye under x-ray monitoring estrogen therapy can be attempted to see if the force of the to increase mucus production during days 5 dye insertion will break adhesions. to 10 of her cycle o Canalization of the fallopian tubes and plastic Conjugated estrogen: a type of estrogen surgical repair (microsurgery) are other possible prescribed for this purpose treatments o If a vaginal infection is present, the infection will o Laparoscopy or laser surgery: if peritoneal be treated according to the causative adhesions or nodules of endometriosis are organism based on culture reports holding the tubes fixed and away from the ovaries o Caution women who are prescribed o Irregular incision line left by surgery can result in metronidazole for a Trichomonas infection an ECTOPIC PREGNANCY. Brillantes, Ira L. RN 2027! – SMOC 100% BSN 3C  it may be teratogenic early in pregnancy ✓ Symptoms each month may begin with bloating and therefore should not be continued if and light cramping 24 hours before menstrual the woman suspects she has become flow. pregnant. ✓ Sharp pain is superimposed on a dull, nagging pain across the lower abdomen and an “aching, UNEXPLAINED SUBFERTILITY pulling” sensation of the vulva and inner thigs o Nursing responsibility: when the flow begins. ✓ Offer active support to help the couple ✓ Some have mild diarrhea find alternative solutions at this point, ✓ These are also present: such as continuing to try to conceive, Mild breast tenderness using an assisted reproductive Abdominal distention technique, choosing to adopt, or Nausea agreeing to a child-free life. Vomiting Headache ASSISTED REPRODUCTIVE TECHNIQUES (basahin nio nlng i2 ng kanya kanya guys kz andami THERAPEUTIC MANAGEMENT 1. Alternative Insemination ✓ Can be controlled by NSAIDS 2. IVF or In-vitro Fertilization Not take these drugs on an empty stomach 3. Gamete Intrafallopian and Zygote Intrafallopian as they can be irritating to gastric mucosa Transfer ✓ If symptoms do not respond to NSAIDS, 4. Surrogate Embryo Transfer hormonal treatment can be tried 5. Preimplantation Genetic Diagnosis Combined estrogen and progestin oral contraceptive pills (COCs) ALTERNATIVES TO CHILDBIRTH Disadvantage of COC therapy: is the possible 1. Surrogate Mothers adverse effects of long-term estrogen 2. Adoption administration such as: 3. Child-free Living Thrombophlebitis Early closure of epiphyseal lines of long REPRODUCTIVE DISORDERS IN FEMALES bones MENSTRUAL DISORDERS ✓ If the patient does not improve with the use of o Fall into two categories: NSAIDs or COCs, she should be evaluated for a. Menstruation that is painful or uncomfortable endometriosis b. infrequent or too frequent cycles Which is characterized by dysmenorrhea and non-menstrual pelvic pain 1. MITTELSCHMERZ o Abdominal pain during ovulation from the release 3. MENORRHAGIA of accompanying prostaglandins o An abnormally heavy menstrual flow o Pain may also be caused by a drop (or two) of o >80 ml per menses or a flow that soaks more than follicular fluid or blood spilling into the abdominal one pad or tampon an hour cavity. o Occurs in girls close to puberty because without o Pain can range from a few sharp cramps to ovulation and subsequent progesterone several hours of discomfort secretion, estrogen secretion causes extreme o Can be typically felt on one side of the abdomen proliferation of endometrium. Near an ovary o Unusual amount of flow for those using IUDs o Advantage: marks ovulation o With oral contraceptives, flow is often light. o If pain is felt in the right lower quadrant, it should o Can also indicate: be differentiated from appendicitis Endometriosis o Can be relieved by a mild analgesics. Systemic disease (Anemia) 2. DYSMENORRHEA Blood dyscrasia such as a clotting defect o Painful menstruation Uterine abnormality such as a myoma o Caused by the release of prostaglandins in (fibroid) tumor. response to tissue destruction during the o Can be a symptom of infection: ischemic phase of the menstrual cycle PID Which leads to smooth muscle contraction Early pregnancy loss that is coincidentally and uterine pain. occuring at the time of an expected menstrual o Although it is common, it needs for further period examination as it can be a preliminary symptom Breakthrough bleeding from an oral contraceptive of an underlying disorder such as: PID THERAPEUTIC MANAGEMENT Uterine myomas ✓ If a pad or tampon is saturated in less than 1 hour, Endometriosis the flow is heavier than usual. ✓ Px who is losing excessive blood because of ASSESSMENT anovulatory cycles may be prescribed ✓ During 1st-2nd year of menstruation, it rarely progesterone during the luteal phase. occurs because early menstrual cycles are ✓ If the ability to conceive is unimportant, may usually anovulatory be prescribed a low-dose oral contraceptive ot ✓ Categorized as “primary” – occurred in the GnRH inhibitor to decrease the flow absence of organic disease ✓ If anemia is occuring from the heavy blood ✓ “Secondary” – occurred as a result of organic loss, an iron supplementation may be necessary. diseases 4. METRORRHAGIA Brillantes, Ira L. RN 2027! – SMOC 100% BSN 3C  o AUB or abnormal uterine bleeding between ✓ Can be medical or surgical (depends) menstrual period ✓ Estrogen or progesterone based oral o Can be normal in some who have spotting at the contraceptives may reduce the amount of time of ovulation (mittelstaining) extrusion into the peritoneal cavity o Can also occur in teenagers taking oral ✓ Danazol – a synthetic androgen can be of help to contraceptives (breakthrough bleeding) during shrink abnormal tissue the first 3 or 4 months of use. ✓ Administration of GnRH agonist (Leuprolide o Can occur from vaginal irritation caused by acetate) – can reduce hormone stimulation infection or spotting from a temporarily low level ✓ Aromatase inhibitors can reduce estrogen levels of progesterone production ✓ Laparotomy with excision by laser surgery – can Leads to endometrial sloughing - be the most effective measure but is HIGHLY dysfunctional uterine bleeding or a luteal INVASIVE procedure. phase defect o Occurs for more than one menstrual cycle in a 7. AMENORRHEA person who is not taking oral contraceptives o Absence of menstrual flow Needs further examination bc abnormal o Strongly suggests pregnancy by no means vaginal bleeding is an early sign of uterine or definitive cervical carcinoma or ovarian cyst. As it can also result from tension, fatigue, chronic illness, extreme dieting or strenuous 5. MENSTRUAL MIGRAINE exercise. o Refers to a shard, disabling headache, often ❖ Prolactin causes a decrease in GnRH fr the accompanied by nausea or vomiting or vision hypothalamus, followed by declines in FSH, changes follicular development, and estrogen secretion o Occurs at the same time as a menstrual flow (RELATED SA ATHLETES) o Caused by the drop of estrogen, which occurs o If menstrual flow is delayed and pregnancy is immediately prior to a menstrual flow suspected, BROMOCRIPTINE should be o Therapy: NSAIDs or sumatriptan discontinued because it is potentially teratogenic. Decrease inflammation o Occurs in women who diet excessively Reduces swollen blood vessels Partially as a defense mechanism to limit o More intense in Px taking birth control pills ovulation and as a means of conserving body fluid 6. ENDOMETRIOSIS o Adolescents with anorexia nervosa or bulimia o Abnormal growth of extrauterine endometrial often develop amenorrhea cells After approx. 3 months of excessive dieting o Often in the cul-de-sac of the peritoneal cavity or and caused by an increase in prolactin. on the uterine ligaments or ovaries o One of the main causes of dysmenorrhea in 8. PREMENSTRUAL DYSPHORIC DISORDER adolescents o A condition that occurs in the luteal phase of the o Results from excessive endometrial production menstrual cycle and is relieved by the onset of and a reflux of blood and tissue through the menses fallopian tubes during menstrual flow o Possible symptoms: The excessive production of endometrial ✓ Anxiety tissue can be related to a deficient ✓ Fatigue immunologic response ✓ Abdominal bloating It appears to be related to excess estrogen ✓ Headache production or a failed luteal menstrual phase ✓ Irritability caused by not ovulating or ovulating ✓ Depression irregularly. May begin as early as adolescence o Dysmenorrhea occurs as the abnormal tissue May become so extreme that they are begins to slough in the same manner as the incapacitating uterine lining in response to estrogen and o Cause is unproven but it must be due to more progesterone stimulation and withdrawal. than a drop in progesterone before menses This causes inflammation of surrounding o Oher syndrome similar to PPD: tissue in the abdominal cavity and a release a. After tubal ligation, a decrease in blood of prostaglandins supply to the ovary results in decreased luteal o Abnormal tissue in the pelvic cul-de-sac —> function. dyspareunia b. Vitamin-B complex deficiency may lead to Painful coitus estrogen excess causing abnormal ratio of As it puts pressure on the posterior vagina estrogen to progesterone Subfertility may result if the fallopian tubes c. Other related causes may be poor renal become immobilized and blocked by tissue clearance leading to water 2901 retention, or implants or adhesion preventing peristaltic hypoglycemia leading to a surge of motion and transport of ova epinephrine and low calcium levels and interference with serotonin synthesis. ASSESSMENT o Therapy: Agents that suppress ovarian function, ✓ Pelvic examination = uterus is displaced by: such as oral contraceptives or the GnRH agonist Tender leuprolide, may be prescribed. Fixed o IF DEPRESSION IS A MAJOR SYMPTOM, Palpable nodules (nodules in cul-de-sac antidepressant may be prescribed: serotonin- or on an ovary may be palpable and reuptake inhibitors painful) prescribed with caution in adolescents because they may be responsible for an THERAPEUTIC MANAGEMENT increase in suicidal behavior Brillantes, Ira L. RN 2027! – SMOC 100% BSN 3C  Enter through vaginal walls that have 9. FEMALE CIRCUMCISION been damaged by the insertion of o Incision and removal of clitoris tampons at the time of a menstrual period o No medical reason or advantage of the procedure but performed just prior to puberty- depends on ASSESSMENT age ritual or religious practices in some cultures. o Symptoms: o Major complication: women may have difficulty ✓ High temperature ((over 102°F [38.9°C]) with conception or childbirth because of vulvar ✓ Vomiting scarring and perineal contraction. ✓ Diarrhea ✓ Hypotension 10. IMPERFORATE HYMEN ✓ Severe muscle pain o Totally occludes the vagina, preventing the ✓ Decreased platelet count escape of vaginal secretions and menstrual ✓ Macular rash (sunburn-like) on palms blood. and soles o Before menarche, a girl with an imperforate o As the infection progresses, these may occur: hymen usually has no symptoms. With the onset ✓ Septic shock of menstruation, the menstrual flow builds up in ✓ Renal, liver, and CNS functions fail the vagina, causing increased pressure in the leading to disorientation and confusion vagina and uterus and, eventually, abdominal o Female who develops fever with diarrhea and pain. vomiting during a menstrual period should o On vaginal examination, an intact, bulging suspect TSS and must contact physician. hymen is evident o Treatment: surgical incision or removal of the THERAPEUTIC MANAGEMENT hymenal tissue. o Careful vaginal examination and removal of any tampon particles 11. POLYCYSTIC OVARY SYNDROME o Cervical and vaginal cultures for S. Aureus o Most frequent cause of ovulation failure seen o Iodine douches may reduce organisms present today vaginally o Adolescent with PCOS begin to develop an o Penicillinase-resistant antibiotics are prescribed increased androgen (male hormone) such as: Prevents follicular ovarian cysts from ✓ Cephalosporins maturing leading to: ✓ Oxacillins ✓ Irregular or missed menstrual ✓ Clindamycins cycles o IVF – to restore circulating fluid volume or ✓ Acne vasopressor like dopamine to increase BP ✓ Excessive hair growth or o Osmotic therapy to prevent renal and cardiac hirsutism failure ✓ overweight o Recovery: 7-10 days with adequate therapy ✓ male pattern baldness o Fatigue and weakness may last for months ✓ type 2 diabetes o TSS recurrence can occur because organism ✓ absence of ovulation was not completely eliminated from the body. Increased androgen is usually related to obesity and exacerbates insulin 13. VULVOVAGINITIS resistance. o Inflammation of the vulva or vagina is o Assessments would include: accompanied by pain, odor, pruritus, and vaginal ✓ Thorough history and physical discharge examination o Vaginal bleeding may be present ✓ Pelvic exam to determine the o May occur at any age but more frequent for those consistency and size of ovaries who reach puberty ✓ Ovarian ultrasound bc of the change to adult pH and ✓ Serum androgen and glucose levels are presence of vaginal secretions making assessed the vagina more receptive to infections o COC may be prescribed because it can change the ratio of estrogen and testosterone produced, 14. PELVIC INFLAMMATORY DISEASE OR PID leading to better regulated menstrual cycles. o Refers to various inflammatory conditions of the o To prevent development of Type-2 diabetes, genital tract in females: the uterus, fallopian metformin may be prescribed. tubes, ovaries, and their supporting structures o If woman wants to become pregnant, fertility o Can extend so far it causes pelvic peritonitis medications such as Clomiphene is suggested o STI accounts of all instances To stimulate ovulation o Those with multiple sexual partners and who ✓ IVF or in vitro fertilization and ovarian drilling: don’t use condoms have higher incidence of PID final therapies to help achieve pregnancy o Begins with a cervical infection and spreads by o To decrease hair growth and reduce acne surface invasion along the uterine endometrium, symptoms, antiandrogens such as then fallopian tubes and ovaries Spironolactone or Finasteride can be tried. o Most likely to occur at the end of menstrual period Finasteride is teratogenic: should not be Menstrual blood provides an excellent used when intend to become pregnant growth medium for bacteria and must be discontinued during Loss of normal barrier of cervical mucus pregnancy. ASSESSMENT 12. TOXIC SHOCK SYNDROME (TSS) o Acute PID: o An infection caused by toxin-producing strains of ✓ Severe pain in lower abdomen Staphylococcus aureus. ✓ Heavy, purulent discharge Brillantes, Ira L. RN 2027! – SMOC 100% BSN 3C  o As the infection progresses: o Occurs more often in premature or low-birth ✓ Fever weight babies. ✓ Leukocytosis ✓ Elevated erythrocyte sedimentation rate ASSESSMENT o If UNTREATED, it enters a chronic phase and o Early detection is important because the warmth fibrotic scarring with stricture of the fallopian of the abdominal cavity may inhibit development tubes results. of the testes o Chronic phase: abdominal pain lessens but Affecting spermatogenesis. dyspareunia and dysmenorrhea may be extreme o Laparoscopy is effective at identifying whether an If ovaries are affected, intermenstrual undescended testes is at the inguinal ring or spotting may occur. ectopic At the inguinal ring: true undescended THERAPEUTIC MANAGEMENT testis o Analgesia for comfort + broad spectrum antibiotic Ectopic: still in the abdomen Doxycycline or Clindamycin o If undescended testes and other factors such as o When pelvic abscess forms, it can be drained ambiguous genitals pose questions about a through cul-de-sac child’s gender, KARYOTYPE may be done o Women who have had 1 ep. Of PID have an To determine the child’s true gender increased chance of a second occurrence Immune protection of the tubes and ovaries THERAPEUTIC MANAGEMENT may have been damaged. o Boys may be given a short course of chorionic o Avoid coitus during menstruation gonadotropin hormone for 5 days o Early childbearing or IVF may be necessary for To see if testicular descent can be stimulated some bc extensive tubal scarring impaired their If not successful, ORCHIOPEXY or surgery fertility. by laparoscopy will correct the condition. REPRODUCTIVE DISORDERS IN MALES 4. HYDROCELE 1. BALANITIS (BALANIPOSTHITIS) o Is only excess fluid and the scrotal enlargement o Is the inflammation of the glans and prepuce of is not caused by an abnormal testis, tumor or the penis hernia. o Tends to occur in uncircumcised boys o May form later in life due to inguinal hernias o Usually caused by poor hygiene and may Inguinal hernias: abdominal contents accompany a urethritis or a regional dermatitis extruding into the scrotum through the inguinal ring, with accompanying fluid. ASSESSMENT When hernia is repaired, the hydrocele will be ✓ Prepuce and glans appear red and swollen and reabsorbed. there may be purulent discharge. Injection of a drug to decrease fluid ✓ May have difficulty viding because of crusting at production (sclerotherapy) may also be the meatal opening and of the acidic urine effective for older youths. touching the surface of the glans causes pain. 5. VARICOCELE THERAPEUTIC MANAGEMENT o Is an abnormal dilation of the veins of the ✓ Local application of heat by warm wet soaks or spermatic cord. warm baths. o It is important to identify this because the ✓ Local antibiotic ointment may be prescribed. increased heat and congestion in the testicles is ✓ Phimosis- a tight foreskin a possible cause of subfertility. Appears to be contributing to the condition, If fertility becomes a concern, the varicocele circumcisions may be advocated after the can be surgically removed. inflammation subsides for the prevention of The px will experience some local tenderness the condition from recurring. and edema for a few days after surgery. 2. PHIMOSIS AND PARAPHIMOSIS 6. TESTICULAR TORSION o Phimosis is the inability to retract the foreskin o Or the twisting of the spermatic cord from the glans of the penis. o Is a surgical emergency It can interfere with voiding. o Can be present in newborns, it occurs mostly Balanoposthitis may develop because the frequently during early adolescence. foreskin cannot be retracted for cleaning. o Px experiences immediate severe scrotal pain Circumcision- used to relieve phimosis. and N/V from the extent of pain o Paraphimosis is the inability to replace the o If condition is unrecognized within 4 hours, prepuce over the glans once it has been irreversible change in the testes can occur from retracted. lack of circulation to the organ. It is an emergency situation to address before Laparoscopy surgery may be necessary to circulation to the glans is impaired. reduce torsion and reestablish circulation 3. CRYPTORCHIDISM 7. TESTICULAR CANCER o Is a failure of one or both testes to descend from o Is rare (only 1% of all malignancies) but can be the abdominal cavity into the scrotum. an adolescent concern as it tends to occur o The cause of undescended testes is unclear. between ages 15-35 years old o Fibrous bands at the inguinal ring or inadequate o Symptoms: length of spermatic vessels may prevent descent. Painless testicular enlargement o This condition is found in about 3 out of every Feeling of heaviness in the scrotum 1,000 male newborns. o Metastasize rapidly leading to abdominal and back pain due to retroperitoneal node extension Brillantes, Ira L. RN 2027! – SMOC 100% BSN 3C  As well as weight loss and general weakness o hCG (human chorionic gonadotropin) and a- ASSESSMENT fetoprotein (AFP), tumor markers will be detected ✓ Slight vaginal discharge or extreme vaginal in blood serum of the Px. itching and a frothy white or grayish-green vaginal o Gynecomastia: enlargement of the breasts discharge. May also arise because of hCG produced by ✓ Upper vagina may look reddened and have a the tumor pinpoint petechiae. SEXUAL TRANSMITTED INFECTIONS ❖ Males with the same infection tend not to report o Are diseases that are spread through sexual any symptoms. contact with an infected partner. ✓ Is diagnosed by microscopic examination of a o They range in severity from easily treated sample of the vaginal discharge. infections which despite advances in treatment require a long-term therapy (e.g. Trichomoniasis THERAPEUTIC MANAGEMENT to HIV infection) ✓ Oral metronidazole or tinidazole eradicates o Abstinence or use of condom provides BEST trichomonal infections. PROTECTION against STIs. Because metrodinazole interacts with alcohol o Multiple sex partners increase the risk of (causes acute N/V), caution to the patient not acquiring STIs. to drink alcoholic beverages during the o EDUCATION about safe sex and the importance course of treatment. of health screening for these disorders: Important Nursing Responsibility 3. BACTERIAL VAGINOSIS o Defined as the absence or deficiency of 1. CANDIDIASIS lactobacilli in the vaginal flora o Vaginal infection spread by the fungus Candida o Occurs frequently among adolescents (an organism that thrives in glycogen) o An intensely pruritic vaginal discharge appears o 90% of women have it milky-white to gray and has a fishy-like odor. o Because oral contraceptives produce a o Can increase susceptibility to other STIs (herpes pseudopregnancy state, adolescents using OC simplex virus, gonorrhea and HIV) tend to have frequent vaginal candidal infections. o Treatment is oral for 7 days (Oral metronidazole) o If being treated with antibiotics for another infection, they are also susceptible to this 4. CHLAMYDIA TRACHOMATIS INFECTION infection o Have become the most commonly reported This is because it destroys the vaginal normal bacterial cause of STIs in the United States flora and lets fungal organisms grow more o Incubation period: 1-5 weeks readily. o Symptoms include: o This is also associated with immune suppression Heavy, grayish-white discharge and diabetes mellitus Vulvar itching Hyperglycemia provides the perfect glucose- o Diagnosis: rich environment for candidal growth Identification of organism at the point of care with a urethra or cervix swab ASSESSMENT Urine specimen can be used as an alternative ✓ May notice vulvar, vaginal reddening, burning, screening method itching, and bleeding from hairline fissures. o Therapy: ✓ A thick, cream cheese-like discharge can usually Oral doxycycline for 7 days be observed at the vaginal outlet. Azithromycin as a single dose ✓ Internally, the vagina shows white patches that ❖ Because there is a strong association between can not be scraped away without bleeding on the gonorrhea and chlamydia, if chlamydial infection walls. is documented, screening and possible treatment ✓ There may be presence of pain during coitus or for gonorrhea is indicated. on tampon insertion. ❖ Long-term effects of chlamydial infections ✓ Can be present at other body sites such as the include: oral cavity or a moist area such as the umbilicus. PID or Pelvic Inflammatory Disease leading to subfertility. THERAPEUTIC MANAGEMENT ✓ Vaginal tablets or cream applications of 5. HUMAN PAPILLOMA VIRUS antifungal preparations o Causes fibrous tissue overgrowth on areas of OTC miconazole or clotrimazole once a day external vulva, vagina, or cervix (condyloma for 3-7 days acuminatum) Oral fluconazole can also be administered as Sometimes termed as Genital Warts one-time dose. o At first, lesions appear as discrete papillary ❖ Treatment should not be interrupted until it is structures. Then, they spread, enlarge, and complete, even during a menstruation. coalesce to form large, cauliflower-like lesions. ✓ If Px has recurrent candidal infections, urine o Common in those who have multiple sexual should be tested for glucose to rule out diabetes partners. mellitus. o HPV infections must be considered serious because it can be associated with the TRICHOMONIASIS development of penile or cervical cancer. o The most prevalant, curable STI o Incubation period: 4 to 20 days THERAPEUTIC MANAGEMENT o Infection can cause such genital inflammation ✓ Aimed at dissolving the lesions and ending any that it makes it easier for the person to be infected secondary infection present. with the HIV virus or to pass the HIV to the ✓ Small growths often resolve spontaneously and partner. can be removed by application of Podophyllin. Brillantes, Ira L. RN 2027! – SMOC 100% BSN 3C  ✓ Large lesions can be removed by laser therapy, ✓ Topical imiquimod or foscarnet may be cryocautery, laser, or knife excision. prescribed for resistant lesions With cryocautery, ✓ Warm bath 3 x a day – reduce discomfort for the ▪ Edema at the site is evident immediately. patient. ▪ Lesions become gangrenous and ✓ An emollient can also reduce discomfort. sloughing in 7 days with healing ✓ Because of the possible association with cervical complete in 4-6 weeks with only slight cancer, any female with genital herpes should depigmentation at the site. have YEARLY PAP Test for the rest of her life ✓ Gardasil or Cervarix vaccines are recommended Menn need to self-inspect for recurrent to all adolescents to prevent many strains of HPV. lesions. PREGNANCY AND HUMAN PAPILLOMA VIRUS PREGNANCY AND HERPES SIMPLEX VIRUS TYPE 2 o HPV lesions tend to increase in size during INFECTION pregnancy due to high vascular flow in the pelvic o If a woman contracts an HSV-2 infection DURING area. PREGNANCY, it can be transmitted across They may become secondarily ulcerated and placenta to cause CONGENITAL INFECTION to infected. the newborn. Foul vulvar odor may develop. o If primary or secondary active lesions in the o Incubation period is 3-14 days vagina or on the vulva are present AT THE TIME o Podophyllum is contraindicated due to possible OF BIRTH, it can be transmitted to the newborn toxic effects on the fetus. AT BIRTH. o DURING PREGNANCY: Trichloroacetic acid or When this occurs, a severe systemic infection Bichloroacetic acid applied to the lesions weekly that is often fatal can result. may be effective and can be used. o Presence of vulvar lesions appears to have no 6. HEPATITIS B AND HEPATITIS C effect on the fetus. BUT, if they are large, they o Can be spread by semen as well as blood obstruct the birth canal for birth, CS may be o Because Hep. B can be spread by sexual scheduled. intercourse, adolescents who did not receive immunization against this as an infant and who 5. HERPES GENITALIS (HERPES SIMPLEX TYPE 2) are sexually active- need immunization. o Caused by herpesvirus hominis type 2 Also called HSV type 2 or HSV-2 7. GONORRHEA o Although the duration of the symptoms of the o Transmitted by Neiserria gonorrhoeae, a gram- virus can be shortened, unlike most other STIs, positive diplococcus, which thrives on the there is NO KNOWN CURE. mucous membrane of the vagina or penis. o The virus is spread by skin-to-skin contact, o In males, symptoms include entering through a break in the skin or mucous Urethritis: pain on urination and frequency of o membrane. urination) o In newborn, acquired at birth, the virus can be Urethral discharge that appears after 2-7 day systematic or even fatal. incubation period. If left untreated, the infection spreads easily ASSESSMENT among sexual partners and may spread to ✓ On first contact, extensive primary lesions the testes, scarring the tubules and causing originate as a group of pinpoint vesicles on an permanent sterility. erythematous base. o It often occurs concurrently with a chlamydial ✓ Then, the vesicles ulcerate and become: infection. Moist o In females, symptoms are not as visible. Painful There may be a slight yellowing discharge. Draining The Bartholin glands may become inflamed Open lesions and painful. ✓ Patient mat have accompanying flu-like If left untreated, the infection can: symptoms with increased temperature ✓ Spread to pelvic organs, most notably the ✓ Vaginal lesions may cause a profuse discharge. fallopian tubes ✓ Pain is intense on contact with clothing or acidic ✓ Cause PID urine. o For BOTH, if systemic involvement occurs, ✓ After its primary stage, that lasts approx. 1 week, arthritis or heart disease can develop. lesions heal but the virus lingers in a latent form in the sensory nerve ganglia. THERAPEUTIC MANAGEMENT ✓ The infection can become an active infection ✓ 1 intramuscular injection of Cetfriaxone + 7 days again during: of oral doxycycline or azithromycin is the current Illness recommended therapy. Prior to menstruation Effective for gonorrhea, chlamydia, and Fever syphilis Overexposure to sunlight Stress 8. SYPHILIS This as a secondary response usually o Systemic disease transmitted by Treponema produces ONLY local lesions rather than pallidum. systematic symptoms. o Incubation period of 10-90 days, a deeper ulcer is usually painless despite its size, appears usually THERAPEUTIC MANAGEMENT on the genitalia (penis or labia) or in vagina, ✓ Acyclovir and Valacyclovir are examples of mouth, lops, or rectal area from oral-genital or antivirals that can control the virus by interfering genital-anal contact with DNA reproduction & by reducing symptoms. o Swollen lymph nodes may also be present. Brillantes, Ira L. RN 2027! – SMOC 100% BSN 3C  o Without treatment, a chancre (ulcer) lasts approx. prevent their newborn from becoming infected 6 weeks and then fades. from placental transfer or direct contact with o It can also cover the soles and the palms as well vaginal secretions at birth. as the extremities and the body. If infected, neonates can develop severe o There may be secondary symptoms of pneumonia, sepsis, respiratory distress generalized illness like low-grade fever. syndrome or meningitis. o Latency period: may last from only a few years o TREATMENT OF CHOICE: Broad-spectrum to several decades. penicillin such as ampicillin o Final period: is a destructive neurologic disease that involves major body organs, such as the 10. HIV heart and the nervous system o Is carried by semen as well as other body fluids. With symptoms such as blindness, paralysis, mental confusion, slurred speech, and lack of coordination. THERAPEUTIC MANAGEMENT ✓ Benzathine penicillin G – given intramuscularly in two sites – considered to be an effective therapy. When sensitive to penicillin, either oral erythromycin or tetracycline can be given for 10-15 days ✓ After therapy, patient may experience a sudden episode of hypotension, fever, tachycardia, and muscle aches. PREGNANCY AND SYPHILIS o During early pregnancy (before 18 weeks), the placenta appears to provide some protection against syphilis. By time, the virus crosses the placenta freely and may be responsible for spontaneous miscarriage, preterm labor, stillbirth, or congenital anomalies in the newborn. o Those who have multiple sexual partners are typically tested again at about 36 weeks of pregnancy. o If the woman has syphilis, her infant needs penicillin therapy at birth as well. o If a woman contracted syphilis during pregnancy but unrecognized and untreated, and so the newborn is untreated, a congenital form of the disease can occur in the newborn. o Severely infected infants will be stillborn Others, less infected are born with congenital anomalies. o Infant does not develop chancre but about a week after birth, will develop a typical copper- colored rash That is most prominent over the face, soles of feet and palms of hand. The infant’s nose may show a severe rhinitis (stuffiness) o When the child’s permanent teeth erupt at 5-6 years of age, the tops may be pegged or notch (Hutchinson’s teeth) Tend to be of poor quality and decay easily. o If the disease remains untreated even with these symptoms, interstitial keratitis, an inflammatory reaction of the cornea that can result in scarring and blindness- may also develop by school age. as the disease progress further, it may become tertiary or lead to severe neurologic symptoms. 9. GROUP B STREPTOCOCCAL INFECTION o It may actually occur at a higher incidence o If contracted during pregnancy, consequences can include UTIs, intra-amniotic infections, perhaps preterm birth and postpartum endometritis. o Pregnant women are generally screened for streptococcus B at 35-38 weeks of pregnancy to Brillantes, Ira L. RN 2027! – SMOC 100% BSN 3C