Management of Patients With Female Reproductive Disorders

Chapter 47
Management of Patients With

Female Reproductive Disorders
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Vulvovaginal Infections—Pathophysiology
• Common problem.
• Vagina is normally protected by acid pH maintained, in
part, by Lactobacillus acidophilus.
• Vaginal epithelium is responsive to estrogen, which
induces glycogen formation, which breaks down into
lactic acid; therefore decreased estrogen decreases acid
production.
• With perimenopause and menopause, decreased
estrogen is related to vaginal and labial atrophy, and
tissue is more susceptible to infection.

Vaginal Infections
• Candidiasis
• Gardnerella
• Trichomonas vaginalis
• Bartholinitis
• Cervicitis
• Atrophic vaginitis

Pathway for Spread of Microorganisms in
Pelvic Infections

Risk Factors for Vulvovaginal Infections
• Premenarch/perimenopause/menopause/low estrogen
levels
• Pregnancy/oral contraceptives
• Poor hygiene
• Tight garments and synthetic clothing
• Frequent douching
• Antibiotics
• Allergies
• Diabetes mellitus
• Intercourse with infected partner/oral genital contact/HIV
Nursing Process: The Care of the Patient
with a Vulvovaginal Infection—
Assessment
• Examine as soon as possible after onset of symptoms.
• Instruct patient not to douche prior to assessment.
• History includes:
– Physical and chemical factors
– Psychogenic factors
– Medical conditions
– Use of medications
– Sexual activity/history
with a Vulvovaginal Infection—Diagnoses
• Discomfort
• Anxiety
• Risk for infection or spread of infection
• Deficient knowledge

with a Vulvovaginal Infection—Planning
• Major goals may include relief of discomfort, reduction of

anxiety, prevention of reinfection, prevention of infection
of sexual partner, acquisition of knowledge about self-
care, and prevention of infection.

Interventions
• Sitz baths may help relieve discomfort.

• Explanation of cause of symptoms and methods to help
prevent infections may help reduce anxiety.
• Douching is usually avoided; however, therapeutic
douching may be prescribed to reduce odors and remove
excessive drainage.
• Patient education includes handwashing, proper hygiene,
preventive strategies, measures to reduce risk,
information regarding medications, and information
regarding self-examination.

Question
Is the following statement True or False?
A diagnostic sign of bacterial vaginosis is a vaginal pH less

than 4.

Answer
False
A diagnostic sign of bacterial vaginosis is not a vaginal pH

less than 4. A diagnostic sign of bacterial vaginosis is a
vaginal pH greater than 4.7.

Genital Viral Infections
• Human papillomavirus (HPV)
– The most common sexually transmitted disease among
sexually active young people
– Vaccine
– Treatment of genital warts
– Associated with cervical dysplasia and cervical cancer.
Need annual PAP smears
• Herpes type 2 infection (herpes genitalis)
– A recurrent lifelong viral infection
– An STD that also may be transmitted by contact and that
may be transmitted when the carrier is symptomatic
– Causes painful itching and burning herpetic lesions

Treatment of HSV-2
• No cure
• Antiviral agents acyclovir (Zovirax) valacyclovir (Valtrex),
and famiciclovir (Famvir) can suppress symptoms
• Recurrences may be associated with stress, sunburn,
dental work, inadequate rest, and inadequate nutrition
• Risk for infants delivered vaginally to become infected;
therefore cesarean delivery may be performed

with Genital Herpes—Assessment
• Health history
• Pelvic Examination
• Assess for risk factors for STDs

with Genital Herpes—Diagnoses
• Acute pain
• Risk for infection
• Risk for spread of infection
• Anxiety

with Genital Herpes—Planning
• Major goals include relief of pain and discomfort, control

of the infections and control of its spread, relief of
anxiety, knowledge and adherence to treatment regimen,
and knowledge regarding implications for the future.

Interventions
• Proper hygiene
• Clean, soft, loose, absorbent clothing
• Avoid ointments and powders
• Encourage fluid intake and good nutrition
• Measures related to discomfort with urination
• Instructions regarding medications
• Rest
• Measures to prevent reinfection and spread of infection
• Measures to reduce anxiety

Question
Is the following statement True or False?
The herpes virus that is accountable for the majority of

genital and perineal lesions is cytomegalovirus.

Answer
False
The herpes virus that is accountable for the majority of

genital and perineal lesions is not cytomegalovirus, it is
the Epstein-Barr virus.

Malignant Disorders of the Female
Reproductive Tract
• Cervical, uterine, vaginal, vulvar, and ovarian cancers

• Early disease may not have symptoms
• Signs and symptoms depend upon location and may
include vaginal discharge, pain, bleeding and systemic
symptoms (weight loss and anemia)
• Prevention, screening, and early detection are vital

Treatment of Reproductive Malignancies
• Surgery, chemotherapy, radiation, or a combination of

these.
• Treatment may be curative or palliative
• Care of the surgery patient is similar to care of patients
with other abdominal surgeries

Pelvic Floor Relaxation

Complete Prolapse of the Uterus

Uterine Fibroids or Myomas

Hysterectomy
• Surgical removal of the uterus to treat cancer,
dysfunctional uterine bleeding, endometriosis,
nonmalignant growths, persistent pain, pelvic relaxation
and prolapse, and previous injury to the uterus
• Total hysterectomy
• Radical hysterectomy
• Types of approaches
– Laparoscopic
– Vaginal
– Abdominal
Undergoing a Hysterectomy—Assessment
• History
• Physical and pelvic exam
• Psychosocial and emotional responses
• Patient knowledge

Undergoing a Hysterectomy—Diagnoses
• Anxiety
• Disturbed body image
• Acute pain

Collaborative Problems/Potential
Complications
• Hemorrhage
• DVT
• Bladder dysfunction

Undergoing a Hysterectomy—Planning
• Major goals may include relief of anxiety, acceptance of

loss of the uterus, absence of pain or discomfort,
increased knowledge of self-care requirements, and
absence of complications.

Interventions
• Anxiety
– Allow patient to express feelings
– Explain physical preparations and procedures
– Provide emotional support
• Body image
– Listen and address concerns
– Provide appropriate reassurance,
– Address sexual issues
– Approach and evaluate each patient individually

Cancer of the Vulva
• 4% of gynecologic cancers; most often seen in
postmenopausal women
• Encourage regular pelvic exams, Pap smears, and self-
examination for early diagnosis
• Risk factors include smoking, HPV infection, HIV,
immunosuppressant therapy
• Symptoms:
– Long-standing pruritis and soreness
– May present as a chronic dermatitis, or a lump, ulcer,
or mass
– Bleeding, foul-smelling discharge, and pain are late
signs
Vulvectomy
• Treatment for vulgar cancer in includes wide excision of the
vulva: vulvectomy
– May be done with lymph node dissection
– Additional therapy may include radiation and/or
chemotherapy
• Preoperative preparation includes assessment of patient
including factors that may have delayed seeking care, health
habits, and lifestyle; include psychological assessment and
provide support
• Postoperative care includes addressing issues of anxiety, pain,
impaired skin integrity, sexual dysfunction, change in body
image; and potential complications including infection, sepsis,
DVT, and hemorrhage

Chemotherapy
• Usually administered IV
• Patients undergoing chemotherapy need specific care to
address the side effects and complications of the
chemotherapy agent or agents administered. Side effects
may include neutropenia, thromobocytopenia,
nephrotoxicity, neurotoxicity, hair loss, hypersensitivity
reactions, nausea, and vomiting
• Paclitaxil (Taxol)
• Carboplatin (paraplatin)
• Liposomal therapy

Radiation Therapy
• External radiation therapy

• Intraoperative radiation therapy
• Internal (intracavity irradiation)
• Care of the patient undergoing radiation therapy

Placement of Tandem and Ovoids for
Internal Radiation Therapy

Nursing Considerations Related to
Intracavity Radiation Therapy
• Foley catheter
• Absolute bed rest, positioning restrictions
• Diet: low residue
• Hygiene
• Monitoring of patient
• Side effects of therapy
• Emotional support of patient
• Address potential for isolation
Safety (Intracavity Radiation)
• Follow specific precautions related to time, distance, and

use of shielding
• Methods to monitor staff exposure (film badges)
• No pregnant caregivers, and no pregnant visitors or
visitors under age 18
• Teaching for family/others in contact with patient
• Monitor that device is not dislodged. If it is dislodged, do
not touch the radioactive object and notify radiation
safety
• Discharge survey

Question
Which statement is true about the way the nursing staff

can minimize radiation exposure?
A.Maximize the amount of time near a radioactive source.
B.Minimize the distance from the radioactive source.
C.Use required shielding to minimize exposure.
D.All of the above.

Answer
Nursing staff can minimize exposure to themselves by

minimizing the amount of time near a radioactive source,
maximizing the distance from the radioactive source, and
using required shielding to minimize exposure.

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Chapter 47

Management of Patients With

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Major goals may include relief of discomfort, reduction of

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Sitz baths may help relieve discomfort.

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Is the following statement True or False?

A diagnostic sign of bacterial vaginosis is a vaginal pH less

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

A diagnostic sign of bacterial vaginosis is not a vaginal pH

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Major goals include relief of pain and discomfort, control

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Is the following statement True or False?

The herpes virus that is accountable for the majority of

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

The herpes virus that is accountable for the majority of

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Cervical, uterine, vaginal, vulvar, and ovarian cancers

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Surgery, chemotherapy, radiation, or a combination of

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Major goals may include relief of anxiety, acceptance of

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

• External radiation therapy

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Follow specific precautions related to time, distance, and

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Which statement is true about the way the nursing staff

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nursing staff can minimize exposure to themselves by

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

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