1. menstruating woman
2. Chronic vaginal infection
3. Pelvic infection
4. Lung abscess
5. Postpartum and gyn infections
6. Surgical wound infection
7. IV or injectable drug use
8. Use of super absorbent tampons- leaving in too long
9. Diaphram use (oral contraceptives reduce risk)
10. Client with abrasions of the vaginal canal (portal of entry)

S/SX

1. * Sudden severe elevated temperature
2. *Chills
3. * Rash on the palms of hands, soles of feet, and some on torso
4. N/V/D, hypotension (due to septic shock), H/A, muscle pain

Major complications are septic shock and DIC (disseminated intravascular coagulation)

Management:

Antibiotics-massive doses.

CBR, reverse acidosis, prevent complications and reoccurrence (more susceptible if you had it before)

BENIGN CONDITIONS

Bartholin’s cysts- Tumor of the vulva. Obstruction of a duct in one of the vestibular glands in the posterior third of the vulva. It’s common to obstruct and develop into an abscess.

S/sx-

1. Asymptomatic- treatment is unnecessary
2. Pain, pressure, painful intercourse, redness

Manage:

Lance the cyst, incise and drain, sitz bath and antibiotics.

Ovarian cyst- common. They originate from ovarian tissue, graafian follicle, or corpus Luteal. Or abnormal growth of the ovarian epithelium.

Dermoid cyst falls under this category.

Dermoid cyst- consists of undifferentiated embryonal cells. They have hair, teeth, bone and nails.

S/sx

1. Chronic or acute pain
2. Irregular menstrual period
3. Abdominal swelling if cyst is large enough
4. No ovulation

Management:

1. Oophorectomy- removal of the ovaries
2. Oral contraceptive pills to decrease ovarian activity and resolve the cyst

Fibroid tumors- AKA myoma’s

They are found in the uterus and are 99.5% of the time are benign. They affect any of the three layers of the uterus.

S/sx- abnormal vaginal bleeding

Backache

Menorrhagia- excessive amount of vaginal bleeding

Metrorrhagia- excessive frequency

Constipation

Abdominal pain

Urinary probs.

Management:

1. TAH- total abdominal hysterectomy
2. If fallopian tubes are involved then bilateral salpingo oophorectomy
3. myoectomy- remove myoma

Endometriosis- characterized by the development of lesions with cells that are similar to the endometrium but grow outside the uterine cavity. This is a major cause of infertility. There are abrasions, scars, and cyst formation. This can affect the ovaries, fallopian tubes, and appendix

S/sx

1. *Severe Dysmenorrhea

2. Abnormal uterine bleeding

3.back ache, low abdominal pain, pain in vagina and posterior pelvis 1-2 days before the menstrual cycle.

Management:

1. Treat Dysmenorrhea- prostaglandin inhibitor
2. Hormonal therapy- oral contraception, synthetic androgen (danazol)
3. GNRH blocker
4. Surgery-
1. Laser surgery- laperoscopy to get rid of the adhesions, scarring, and remove cysts
2. Hysterectomy
3. Appendectomy
4. Oophorectomy
5. Bilateral salpingo oophorectomy

Adenomyoma- tumor that originated from inside a gland

Adenomyosis- tissue that lines the endometrium invades the uterine wall. This causes abnormal vaginal bleeding. Management is a hysterectomy

MALIGNANT CONDITIONS

1. Cervical Cancer- caused by exposure to Human Papiloma Virus (HPV).

1. PAP smear
2. Biopsy

CIS- cancer has no evidence of invading other parts.

Management:

1. Cryotherapy- freezing the ca with nitrous oxide done in DR. office
2. LEEP- loop electrocautery excision procedure- a thin wire loop with a laser is used to cut away a thin layer of the cervical tissue. Outpatient with local anesthesia
3. Conization- removal of a cone shaped piece of tissue from the cervix. AKA cone biopsy. Outpatient

Invasive surgical cancer- if cancer has metastasized. The type of treatment depends on the age of the client, the stage of the lesion, patient’s general health, and the doctor’s judgment and experience

1. Radiation- internal or external
2. Chemotherapy- Cistplatin (common chemo drug), Taxol, Carboplatin
3. Surgery

Cancer of the uterus:

Adenocarcinomas

Endometrial layer is the original site to develop.

Manage:

Surgery

Radiation

Hormonal therapy

S/sx- abdominal pain, swelling, abdominal mass, dysfunctional vaginal bleeding, impinges on the bladder and rectum.

Ovarian cancer:

Leading cause of cancer death among females

It could be a primary or secondary site

More likely to metastasize to the breast and vice versa

Risk factors:

1. 50-59 years of age
2. Heredity
3. Females who never had a baby. Nullpara- beyond 20 weeks and no delivery
4. Infertile women
5. Inability to ovulate

1. Total abdominal hysterectomy

HYSTERECTOMY:

Removal of the uterus

Indications

1. Malignancy
2. Endometriosis
3. Dysfunctional uterine bleeding- can lead to anemia and hypovolemic shock
4. Prolapsed uterus
5. Severe trauma to the uterus that cannot be repaired.

Preparing the patient:

Possibly shave

Indwelling catheter

Cleansing enema and vaginal douche

Reduce anxiety

Body image disturbance R/T change in sexual function and sexual satisfaction

Goals:

Pain management- there is excessive managing of the organs and incisions

Prevent complications by promoting early ambulation and promote bowel and bladder function.

Increase client knowledge of self-care, limitations of activity, and reporting abnormal s/sx

Menstruation will cease if in 2-3 weeks there is breakthrough-bleeding go to the hospital

Major complications-

1. Hemorrhage- any blood loss over 500ml
2. DVT-
3. Bowel and bladder dysfunction

Assess:

Abdominal incision site

Amount of vaginal bleeding- count pads, look at color and for clots

For s/sx of pulmonary embolism #1 is SOB

TVH- vaginal hemovac look at amount of drainage and color

Bowel/bladder- assess for paralytic ileus, NPO till bowel sounds or gas (not burp). After the foley is removed, the patient needs to void within 6 hours if not get an order to put a foley in. Urinary retention- frequent small amounts, if residual is over 150cc call dr.

Tell patient to avoid:

Straining, lifting, and sex because it may tear the sutures.

Look at the color of urine

Ted hose, walk, don’t cross legs,