MED/SURG EXAM 2: Reproductive System Diseases and Sexually Transmitted Infections (STIs)

pelvic inflammatory disease (PID)

infection of the pelvic cavity

***usually the result of untreated chlamydia or gonorrhea infection

***major cause of female infertility

typically involves pelvic pain and discharge with fever, chills

Syphilis

ORGANISM - Treponema pallidum - Spirochete

--spread by sex, contact with infectious lesions

--spirochete spreads via bloodstream and lymphatics to various body organs

Infection occurs in stages that may be separated by periods of remission

Stages of syphilis - PRIMARY

begins within 2 weeks to 3 months of contact

---develop firm, round painless lesion/chancres at site where organism entered body

---chancres can heal but patient needs treatment or remains infectious

Stages of syphilis - SECONDARY

within a week to 6 mos after chancres gone and can last 1-2 years

---classic symptoms - flu like symptoms, rash to palms and soles of feet

---can contract through rash

Stages of syphilis - LATENT

when secondary symptoms disappear

Stages of syphilis - Tertiary stage

systemic problem

results from no treatment

destructive internal lesions/gummas

---can affect skin, bone, heart, CNS/brain

PERMANENT DAMAGE

Syphilis testing

Microscopic evaluation of serous fluid from a lesion

Antibody test RPR - active infection

(Might show up positive even after they have been cured)

Syphilis treatment

Penicillin

Bacteria not showing infection

Gonorrhea

ORGANISM - Neisseria gonorrhae

Very common STI in US

--more common in males

Presents as an infection with a purulent discharge from the cervix, urethra, pharynx or rectum

Course of gonorrhea for men

urethritis, dysuria, most diagnostic is purulent penile drainage, swollen and painful testicles

Course of gonorrhea for women

can be asymptomatic, but can develop urethritis, purulent vaginal discharge, can develop PID leading to infertility

(more likely for women to be asymptomatic)

Gonorrhea testing

gram stain/culture of purulent discharge

nucleic acid amplification probes - super sensitive, 24 hours results

urine - first drops

Gonorrhea treatment

IM cetriaxone (cephalasporin) + doxycycline or azithromysin

SUPER gonorrhea

Chlamydia

ORGANISM - chlamydia trachomatis

Most common STI in US

Higher incidence in women

often asymptomatic

Chlamydia testing

DNA probe - urethral swab, in urine, vaginal fluid

Chlamydia treatment

Doxycycline or azithromycin

Genital Herpes

Herpes simplex type II (HSV)

Viral infection

Course of illness:

Begins with "prodromal" symptoms:

burning

itching

tingling in perineal area

Lesions/blisters develop, eventually crust over and heal

Organism migrates up the nerve to the root ganglia where it remains dormant

Future "outbreaks" can be triggered by a weakened immune system or stress of illness

Genital warts (Human Papilloma virus) HPV

Highly contagious

Young/sexually active adults

Enters through an abrasion

Infected cells form warty growth

(can be obstructive)

Cervical cancer relationship

HPV symptoms

White to gray and pink flesh colored papillary growths

May coalesce

Most people have 1-10 warts

MEN - penis, scrotum, anal, urethral

WOMEN - inner thighs, vulva, vagina, cervix and perineal area

HPV is linked to

cervical, vulvar, anorectal and penile cancer

Prevention for HPV

Vaccine

---best if given before sexually active

---females 9-26 years. Will also help protect against cervical cancer

---Males 9-21 years

---does not treat active infections

Treatments for HPV

Goal - removal of symptomatic warts

Difficult to treat - will often need multiple modalities

---laser or ablative remove

---acid treatment trichlorocetic (TCA) or bichloracetic acid (BCA)

---Cytotoxic agent-podophyllin resin

---Other topical medications

General Nursing care for STIs

---Partners should be treated

---Effective antibiotic therapy (TEACHING)

---Avoidance of intercourse during treatment

---Counselling on risky behaviors

---Promotion of barrier protection (condoms)

Cervical Cancer

Mortality is decreasing thanks to papanicolaou tests (PAP)

---looks for abnormal cells that may indicate cancerous or precancerous lesions

---screening between age of 21-65 at least every 3 years

Endometrial/Ovarian Cancer

---role of estrogen

---age (occurs later in life "usually")

---both have good survivability if detected early

Hysterectomy

Removal of uterus

Vaginal vs. abdominal

Partial vs. Total vs. Radical

Often patient will have a catheter

Oophorectomy

Removal of ovaries

If bilateral - it will cause menopause

Benign breast mass

Fibrocystic disease or mammary dysplasia

Mass usually tender, bilateral, regular in shape

Often increases in size prior to menses, then may decrease

Breast Cancer

A malignant tumor that arises from breast tissue

Second most common cancer in women in the US

2nd leading cause of death in women

Incidence decreasing

Risk factors for breast cancer

--female gender and advancing age

--cumulative effects of estrogen

--family history, personal history of breast cancer

***early menarche, late menopause

***hormone replacement post-menopause

--Family history/genetics

***mutation of BRCA genes

--Nulliparity

--Obesity

Evaluation of breast mass

---clinical breast exam

---mammogram (about 10-15% not seen on mammogram)

---ultrasound

---biopsies

****fine needle aspiration

****surgical

Breast changes

--usually in the upper outer quadrant where most glandular tissue is

--new lump or thickening in the breast: hard, not as movable, irregular shape

--swelling of part of the breast; usually not tender

--skin irritation

--dimpling

--nipple pain, retraction, nipple discharge that is clear or bloody

Stages of breast cancer

T -- Tumor

N -- Node

M -- metastasis

Stage 0 = in situ with no nodes involved

Stage IV = anyone with mets

Breast sparing surgery

Lumpectomy (partial mastectomy)

---Remove cancer and some normal tissue around it

Modified Radical Mastectomy

---Remove breast and axillary nodes; preserve pectoralis major muscle

---Patient may opt to have reconstruction at the time of surgery

---Preferred for larger area of cancer

---Lymph nodes and tissue are removed

Arm care

Prevent lymphedema

---No BP, venipuncture, IVs

---Check CMS (circulation motor sensory)

---Prevent frozen shoulder

Treatment for lymphedema

--elevate limb

--medications (mild diuretic)

Benign Prostatic Hypertrophy (BPH)

Benign enlargement of prostate gland

--not cancerous

--most common urological problem in men

****50% of men >50 years old

****80% of men >80 years old

--biggest risk factors are age and family history

****although it is thought that obesity, sedentary lifestyle, ETOH, ED (erectile dysfunction), smoking and DM may play a role

Manifestations of BPH - Irritative

(associated with inflammation)

nocturia

frequency

urgency

dysuria

bladder pain

incontinence

Manifestations of BPH - Obstructive

(caused by gland enlargement)

decreased stream of urine

decreased force of stream

retention

difficulty initiating urine

intermittency

dribbling at end of urination

Complication of BPH

urinary retention

UTI

hydronephrosis

(urine will back up to the kidneys, cannot pee, kidny failure. This is considered medical emergency)

Diagnosis of BPH

Palpate prostate by digital rectal exam (DRE)

Urinalysis, culture and sensitivity

Serum creatinine (checking to see if the kidneys are healthy)

Prostate specific antigen (PSA)

***controversial

Treatment of BPH

Non-surgical

--watchful waiting

--pharmacotherapy

*****alpha blockers - relaxes the smooth muscle in the urethra

*****5a-Reductase inhibitors

Treatment of BPH

Minimally invasive procedures

Needle ablation (radio frequency) (TUNA)

Thermotherapy (microwave) (TUMT)

High energy lasers - non invasive

Intraprostate ureteral stents

TURP - Trans urethral resection of the prostate

(roto rooter out) *Most common procedure*

Post operative care for BPH

General post op care

Continuous bladder irrigation (CBI)

**monitor for hemorrhage

**I and O - calculate true urine (must subtract from sterile solution)

Bladder spasms

Increase PO fluids if not contraindicated

Prostate Cancer

High incidence, especially >65 years

Role of DRE and PSA testing

Drug therapy versus surgery (prostatectomy)

Complications of prostate cancer

Urinary incontinence

Erectile dysfunction

Erectile dysfunction

Inability attain/maintain erection

Many potential causes: vascular, neurological, psychological

**may or may not be reversible depending on the cause

PDE-5 inhibitors (viagra, cialis -- helps with blood flow), implants, injectables

Psychosocial aspects