Download Nursing 220 Test 3: Comprehensive STI Review and more Exams Nursing in PDF only on Docsity!
CCTC NUR 220 UNIT 4, 5, 6, & 7 TEST 3 with
Complete Solutions | A+ Grade
Tx of trichomonas vaginalis - ✔✔-Metronidazole or tinidazole
- tx patient and partner
- avoid intercourse until cured Nursing interventions for metronidazole: - ✔✔-NO ALCOHOL OR ALCOHOL PRODUCTS for 24 hours after completing metronidazole (mouthwash, aftershave, deodorant, and bath splashes) Side effects of metronidazole: - ✔✔headache dry mouth fatigue metallic bitter taste GI distress chlamydial infection - ✔✔-bacterial infection
- caused by chlamydia trachomtis
- transmission occurs through vaginal sex a strain of chlamydia trachomatis is responsible for? - ✔✔trachoma (world's leading cause of preventable blindness)
Newborn of a woman with untreated chlamydia is at risk of: - ✔✔-developing ophthalima neonatorum, which responds to erythromycin ophthalmic ointment prophylaxis at birth
- chlamydia pneumonia S/S of chlamydia: - ✔✔Women
- often asymptomatic
- may have thin or purulent discharge
- burning and frequency of urination
- friable cervix (bleeds easily)
- lower abdominal pain Dx chlamydia with: - ✔✔nucleic acid amplifiction testing (most sensitive)
- polymerase chain reaction assay
- antigen detection Tx for chlamydia: - ✔✔-single dose of azithromycin orally or doxycycline 100 mg orally twice daily for 7 days (doxycycline not during pregnancy)
- treat sexual partners
- abstain from sex for 7 days Gonorrhea: - ✔✔-bacterial infection
- caused by neisseria gonorrhoeae
s/s of herpes genitalis: - ✔✔-inguinal lymph node enlargement
- flulike symptoms
- genital pruritis or tingling
- primary episodes last the longest (2-4 weeks); recurrent episodes not as severe Dx of herpes genitalis: - ✔✔clinical appearance culture of lesion PCR identification HSV specific glycoprotein G2 and glycoprotein G1 assay Tx for herpes genitalis: - ✔✔oral acyclovir (can be used during pregnancy), valacyclovir, or famciclovir
- Acyclovir can decrease incidence of herpes if used from 36 weeks gestation to birth Nursing interventions with herpes genitalis: - ✔✔-keep genital area clean and dry, wear loose clothing, wear cotton underwear or none at all to help promote healing
- c/s delivery if lesions visible when labor begins Syphilis: - ✔✔-Caused by spirochete Treponema pallidum
- acquired through vaginal, oral, or anal sex. Can be transmitted transplacentally. When infected in utero, the newborn exhibits secondary-stage symptoms of syphilis.
- transplacentally transmitted syphilis may cause IUGR, preterm birth, still birth
- divided into early and late stages
Early (primary) stage of syphilis: - ✔✔-can last about 4 weeks
- chancre appears at the site where T. pallidum organism entered the body
- Symptoms: slight fever, loss of weight, and malaise
- Chancre persists for about 4 weeks and then disappears P = Painless lesion R = Regional lymphadenopathy E = Exudate S = Single lesion S = Sexual contact can cause Secondary Stage of syphilis: - ✔✔-occurs in 6 weeks to 6 months
- skin eruptions called condylomata lata, which resemble wartlike plaques and are highly infectious, may appear on the vulva.
- Symptoms: rash on the palms and soles of feet, acute arthritis, enlargement of the liver and spleen, nontender enlarged lymphnodes, iritis, and a chronic sore throat w/ hoarseness. C = Condyloma lata A = Acute infection symptoms (fever, sore throat, malaise, weight loss) M = Mucocutaneous lesion, mucous patches P = Papules, Pustules Tertiary stage of syphilis - ✔✔CV and neurovascular involvement
Symptoms of Condylomata Acuminata: - ✔✔Soft, grayish-pink cauliflower like lesions Tx of condyloma acuminatum - ✔✔-Podofilox solution or gell
- imiquimod cream
- sinecatechin ointment
- cryotherapy w/ liquid nitrogen
- trichloroacetic acid (TCA)
- bichloracetic acid
- surgical removal by tangential scissor excision, shave excision, curettage, or electrocautery
- laser surgery Nursing intervention with imiquimod, sinecatechins oinment, and podofilox: - ✔✔-not used during pregnancy (teratogenic; associated w/ fetal death)
- Imiquimod and sinecatechin ointment must be washed off after specified time period. Vaccine for HPV: - ✔✔Gardasil and Cervarix
- recommended for girls ages 11-12 but can be given at 9, and for 13-26 y/o females who did not receive or complete the 3 dose vaccine series.
- boys 11-12 now recommended to get it to protect against HPV and help provide indirect protection of women by reducing HPV transmission. HIV/AIDS: - ✔✔-viral infection
- transmitted through blood, blood products, semen, vaginal fluid, breast milk
- affects t-cells, decreasing immune responses
- AIDS is HIV plus with an opportunistic infection
- No cure Symptoms of HIV/AIDS: - ✔✔-can be asymptomatic
- weight loss
- fatigue Female
- recurrent vaginal yeast infection
- diarrhea
- oral thrush Dx HIV/AIDS with: - ✔✔ELISA, Western Blot test, CD4 counts tx of HIV/AIDS: - ✔✔-Antiretroviral medications - zidovudine (Retrovir)
- ZDV oral during pregnancy, IV during labor & birth,
- Infant - ZDV for 6 weeks
- c/s before ROM
- Avoid breastfeeding pelvic inflammatory disease (PID) - ✔✔-clinical syndrome of inflammatory disorders of the upper female genital tract that includes any combination of endometritis, salpingitis (tubal infection), tubo-ovarian abscess, pelvic abscess, and pelvic peritonitis
- more common in sexually active women younger than 25
- RPR or VDRL to check for syphilis
- may have elevated C-reactive protein and sedimentation rate
- Abdominal tenderness on palpation, cervical and uterine tenderness on movement (chandelier sign), palpable mass.
- ultrasound
- laparoscopy (confirms diagnosis) Tx of PID: - ✔✔-Inpatient - IV fluids, pain meds, IV antibiotics - cefoxitin or cefotan w/ doxycycline or clindamycin and gentamicin
- Outpatient - ceftriaxone w/ doxycycline w/ or w/o metronidazole
- Treat sexual partner
- Remove IUD 24 - 48 hours after starting antibiotics
- Counseling for medications, sexual activity, possible infertility Symptoms of Ovarian masses: - ✔✔-can be asymptomatic
- Cramping, abdominal fullness feeling, dyspareunia, irregular bleeding, delayed menses Dx of ovarian masses: - ✔✔basis of palpable mass w/ or w/out tenderness and other related symptoms. Radiography or u/s may be used to assist in the dx tx of ovarian masses: - ✔✔Oral contraceptives, surgery considered for large masses Risk factors for Ovarian Masses: - ✔✔-white women
- 50 and older
- early menarche
- late menopause Endometrial polyps: - ✔✔pedunculated (growing on a stalk) over-growths of the enometrium. They can occur as single or multiple growths.
- accompanied by symptoms of midcycle bleeding or spotting, bleeding or spotting after sex, or prolonged bleeding or spotting with menstrual cycles.
- tx: dilation and curettage (D&C) using a hysteroscope for visualization fibroid tumors (leiomyomas) - ✔✔-most common benign disease in women
- most are asymptomatic and require no tx. Sometimes seek tx for bleeding and pain
- symptoms: pelvic pain, menstrual irregularities, and infertility Endometrial cancer: - ✔✔most common disease in postmenopausal women
- high cure rate if detected early Hallmark sign of endometrial cancer: - ✔✔Vaginal bleeding in postmenopausal women not tx with hormone replacement therapy Dx of endometrial cancer: - ✔✔Endometrial biopsy, transvaginal ultrasound, posthysterectomy pathology of uterus Tx of endometrial cancer: - ✔✔-Total abdominal hysterectomy (TAH)
- bilateral salpingo-oophorectomy (BSO)
- urinary frequency
- low-grade fever(101 F (38.3 C) or lower)
- hematuria
- abnormal number of leukocytes and bacteria Tx of cystitis: - ✔✔-nitrofurantoin (first line tx),
- TMP-SMZ,
- fluoroquinolones (such as levofloxacin (Levaquin) for more serious infection Cystitis in pregnancy may lead to: - ✔✔amniotic fluid infection retard growth of placenta Dx cystitis with: - ✔✔Urine culture Pyelonephritis: - ✔✔inflammation of the renal pelvis and the kidney. Often preceded by lower UTI (cystitis) Symptoms of pyelonephritis - ✔✔-High fever
- chills
- flank pain
- N/V
- malaise
- may have frequency, burning, urgency w/ urination
- edema of kidney & ureters (severe, colicky pain, vomiting, dehydration, ileus of large bowel) Dx of pelonephritis: - ✔✔-Increased diastolic blood pressure
- positive fluorescent antibody titer (FA test)
- low creatinine clearance
- bacteremia in urine
- pyuria
- white blood cell casts Tx of UTI: - ✔✔-Inpatient - IV hydration, IV antibiotics, Urinary analgesics - phenazopyridine(Pyridium)- orange pee, pain medications, antipyretics for fever, urinary catheterization if indicated
- Outpatient - IV antibiotic for 1 dose, Oral antibiotics - fluoroquinolones (ciprofloxacin, levofloxacin), ceftriaxone or gentamicin Nursing management of UTI: - ✔✔-Sexual & medical history
- Clean-catch urine specimen
- Teach - s/s UTI, hygiene practices, cotton underwear, void frequently, increase fluid intake, follow-up care Cystocele- - ✔✔Relaxation of anterior vaginal wall with prolapse of bladder into vaginal wall Symptoms of cystocele: - ✔✔-Stress urinary incontinence w/coughing, sneezing, laughing, sudden exertion
- vaginal fullness, bulging of bladder out of vaginal wall, dragging sensation
tx of uterine prolapse: - ✔✔Topical or systemic estrogen Vaginal pessary: gellhorn provides support for 2nd-3rd degree. Donut for 3rd degree. Ring for 1st and 2nd degree Surgery When is total vaginal hysterectomy preferred? - ✔✔for small fibroids, abnormal uterine bleeding Advantages and disadvantages of total vaginal hysterectomy: - ✔✔Advantages: earlier ambulation, less postop pain, less anesthesia and operative time, less blood loss, no visible scar, short hospital stay Disadvantages: increased risk of trauma to bladder When is Total abdominal hysterectomy preferred? - ✔✔cancer is expected, large fibroids, severe endometriosis, chronic PID, and adenomyosis nursing interventions with hysterectomy: - ✔✔Teach s/s of menopause, resume intercourse in 6 weeks, use of vaginal lubricants, estrogen replacement creams Infertility- - ✔✔failure to achieve a successful pregnancy after 12 months or more of regular, unprotected sex Contributing factors to infertility: - ✔✔-decrease sperm production
- endometriosis
- ovulation disorder
- tubal occulusions
Factors associated w/ physical inabilities to conceive: - ✔✔-expense
- impact on couple's relationship
- lack of family support Investigation of infertility: - ✔✔least invasive first
- semen analysis
- Female pelvic examination
- ultrasounds (transvaginal or abdominal)
- hysteroscopy (exam uterus)
- Laparoscopy diagnostic procedures with infertility: Preliminary investigation- - ✔✔-Information about most fertile times for intercourse
- Explanation of basic infertility workup
- Basic assessments: Ovarian function Cervical mucus adequacy Semen analysis (#1) Tubal patency General condition of pelvic organs If lack of ovarian function is suspected for infertility: - ✔✔-Basal body temperature recording
- other Pharm intervention for infertility management: - ✔✔-clomiphene citrate (Clomid, GnRH) Ovulation- induction agents
- Luveris - Human Menopausal Gonadotropins
- bromocriptine (Parlodel) - prolactin inhibitor
- glucophage (Metformin) for PCO
- danazol (Danocrine) for endometriosis Therapeutic insemination: - ✔✔-depositing of semen at the cervical os or in the uterus by mechanical means Therapeutic insemination indicated for: - ✔✔-seminal deficiencies as oligospermia (low sperm count), asthenospermia (decreased motility), and teratospermia (low percentage, abnormal morphology)
- Anatomic defects accompanied by inadequate deposition of semen (hypospadia)
- ejaculatory dysfunction
- cases of unexplained infertility
- female factor infertility In vitro fertilization: - ✔✔mature eggs are collected from ovaries and fertilized by sperm in a lab. The fertilized egg or eggs are implanted in your uterus In vitro fertilization indications: - ✔✔-Tubal or Mucus abnormalities
- Male infertility
- Male & female immunologic infertility
- Cervical factors Infertility psychological problems: - ✔✔-Development of lack of spontaneity of sex. Constant attention to temp. charts. Instructions about their sex life from an outsider
- Feelings of loss of control
- Feelings of reduced competency
- Loss of status and ambiguity as a couple - infertility often becomes central focus for role identity Infertility Psychsocial Problems: - ✔✔-Sense of social stigma. Feelings of guilt or shame
- Stress on marital and sexual relationship. Heighten feelings of frustration or anger between partners
- Strained relationship with healthcare providers stages of Freud's theory of psychosexual development - ✔✔-oral (birth-1 year): the infant derives pleasure largely from the mouth, w/ sucking and eating as primary desires
- anal (1-3 years): the child's pleasure is centered in the anal area, w/ control over body secretions as a prime force in behavior
- Phallic (3-6 years): sexual energy becomes centered in the genitalia as the child works out relationships with parents of the same and opposite sexes
- Latency (6-12 years): sexual energy is at rest in the passage b/t earlier stages and adolescence
- Genital (12 years- adulthood): mature sexuality is achieved as physical growth is completed and relationships with others occur
