Management of Patients with Female

Reproductive Disorders

Candidiasis is a fungal or yeast infection caused by strains of Candida. Miconazole

(Monistat) is an antifungal medication used in the treatment of candidiasis. This agent is
inserted into the vagina with an applicator at bedtime and may be applied to the vulvar
area for pruritus. HPV, bacterial vaginosis, and TSS are not treated by Monistat.
Acyclovir (Zovirax) is an antiviral agent that can suppress the symptoms of genital
herpes and shorten the course of the infection. It is effective at reducing the duration of
lesions and preventing recurrences. Clotrimazole is used in the treatment of yeast
infections. Metronidazole is the most effective treatment for trichomoniasis. Posophyllin
is used to treat external genital warts. Acyclovir is used in the treatment of genital herpes.
The most effective treatment for trichomoniasis is metronidazole (Flagyl). Both partners
receive a one-time loading dose or a smaller dose three times a day for 1 week. In pelvic
inflammatory disease, menstrual difficulties and constipation may occur. Kegel exercises
are prescribed to help strengthen weakened muscles associated with cystocele and other
structural deficits. Hormone therapy does not address the etiology of trichomoniasis.
Because of the high incidence of coinfection with chlamydia and gonorrhea, the patient
should also be treated for chlamydia. Avoiding the use of tampons is part of the self-care
management of a patient with possible toxic shock syndrome (TSS). The patient is not
susceptible to incontinence and there is no indication for the use of oral contraceptives.
HPV is the most salient risk factor for cervical cancer, exceeding the risks posed by
smoking, late childbearing, and postmenopausal bleeding.
The intestinal tract and the bladder need to be empty before the patient is taken to the OR
to prevent contamination and injury to the bladder or intestinal tract. The patient is
informed that her periods are now over, but she may have a slightly bloody discharge for
a few days. The patient is instructed to avoid straining, lifting, or driving until her
surgeon permits her to resume these activities. The patients hormonal balance is upset,
which usually occurs in reproductive system disturbances. The patient may experience
depression and heightened emotional sensitivity to people and situations.
An important intervention for the patient who has undergone vulvar surgery is to monitor
closely for signs of infection in the surgical site, such as redness, purulent drainage, and
fever. The patient should be placed in low Fowlers position to reduce pain by relieving
tension on the incision. Sitz baths are discouraged after of wide excision of the vulva
because of the risk of infection. Analgesics should be administered preventively on a
scheduled basis to relieve pain and increase the patients comfort level.
Gray-white discharge that clings to the external vulva and vaginal walls is indicative of
an overgrowth of Gardnerella vaginalis. The patients discharge is not a normal
assessment finding. Antiviral medications are ineffective because of the bacterial
etiology. This diagnosis is unlikely to have a long-term bearing on the patients fertility.
HIV-positive women have a higher rate of HPV. Infections with HPV and HIV together
increase the risk of malignant transformation and cervical cancer. Thus, women with HIV
infection should have frequent Pap smears. Because condylomata acuminata is a virus,
there is no permanent cure. Because condylomata acuminata can occur on the vulva, a

Management of Patients with Female

Reproductive Disorders

condom will not protect sexual partners. HPV can be transmitted to other parts of the
body, such as the mouth, oropharynx, and larynx.
Risk factors associated with vulvovaginal infections include pregnancy, premenarche,
low estrogen levels, and frequent douching.
In pregnant women with active herpes, babies delivered vaginally may become infected
with the virus. There is a risk for fetal morbidity and mortality if this occurs. Lesions are
not controlled with excision. Itching and pain accompany the process as the infected area
becomes red and swollen. Aspirin and other analgesics are usually effective in controlling
the pain.
Clinical manifestations of ovarian cancer include enlargement of the abdomen from an
accumulation of fluid. Flatulence and feeling full after a light meal are significant
symptoms. In bacterial vaginosis, a fish-like odor, which is noticeable after sexual
intercourse or during menstruation, occurs as a result of a rise in the vaginal pH. Fever,
chills, and abdominal pelvic pain are atypical.
Most cases of ovarian cancer are random, with only 5% to 10% of ovarian cancers having
a familial connection. Contraceptives and tobacco have not been identified as major risk
factors.
Sitting in a chair would not be recommended immediately in the postoperative period.
This would place too much tension on the incision site. A low Fowlers position or,
occasionally, a pillow placed under the knees, will reduce pain by relieving tension on the
incision. Application of compression stocking would prevent a deep vein thrombosis
from occurring. A low-residue diet would be ordered to prevent straining on defecation
and wound contamination.
The clinical manifestations indicate T. vaginalis, which is treated with metronidazole in
the form of oral tablets. Candidiasis produces a white, cheese-like discharge. Gardnerella
is characterized by gray-white to yellow-white discharge clinging to external vulva and
vaginal walls. Gonorrhea often produces no symptoms.
A leiomyoma is a usually benign tumor of the uterus, commonly referred to as a fibroid.
A Bartholins cyst is a cyst in a paired vestibular band in the vulva, whereas a dermoid
cyst is a benign tumor that is thought to arise from parts of the ovum and normally
disappears with maturation. A hydatidiform mole is a type of gestational neoplasm.
The symptoms of C. albicans include itching and a scant white discharge that has the
consistency of cottage cheese. Yellow-green discharge is a sign of T. vaginalis. Graywhite discharge and a fishy odor are signs of G. vaginalis.
Instead of tight-fitting synthetic, nonabsorbent, heat-retaining underwear, cotton
underwear is recommended to prevent vaginal infections. Douching is generally
discouraged, as is the use of feminine hygiene products. Daily bathing is not restricted.
HSV-2 causes genital herpes and is known to ascend the peripheral sensory nerves and
remain inactive after infection, becoming active in times of stress. The virus is not
curable, but treatment is aimed at controlling symptoms. HSV1 causes cold sores,
and varicella zoster causes shingles.

Management of Patients with Female

Reproductive Disorders

The risk of reinfection and spread of infection to others or to other structures of the body
can be reduced by handwashing, use of barrier methods with sexual contact, and
adherence to prescribed medication regimens. The lesions should be allowed to dry.
Touching of lesions during an outbreak should be avoided; if touched, appropriate
hygiene practices must be followed.
Vulvitis, an inflammation of the vulva, may occur as a result of other disorders, such as
diabetes, dermatologic problems, or poor hygiene. Obesity, kidney disease, and allergies
are less likely causes than diabetes.
Vulvodynia is a chronic vulvar pain syndrome. Symptoms may include burning, stinging,
irritation, or stabbing pain and may follow the initial use of tampons or first sexual
experience. Vulvitis is an inflammation of the vulva that is normally infectious.
Bartholins cyst results from the obstruction of a duct in one of the paired vestibular
glands located in the posterior third of the vulva, near the vestibule.
Lifestyle modification is critical in the treatment of PCOS, and weight management is
part of the treatment plan. As little as a weight loss of 5% of total body weight can help
with hormone imbalance and infertility. Antibiotics are irrelevant, as PCOS does not have
an infectious etiology. Fluid intake and Kegel exercises do not influence the course of the
disease.
Symptoms of endometriosis vary but include dysmenorrhea, dyspareunia, and pelvic
discomfort or pain. Dyschezia (pain with bowel movements) and radiation of pain to the
back or leg may occur. Ineffective tissue perfusion is not associated with endometriosis
and there is no plausible risk of fluid overload. Endometriosis is not transmittable.
In adenomyosis, the tissue that lines the endometrium invades the uterine wall. This
disease is not characterized by loss of muscle tone, the presence of tumors, or excessive
estrogen.
Patients with PID need to take action to avoid infecting others. Antibiotics are frequently
required. Pregnancy does not necessarily need to be avoided, but there is a heightened
risk of ectopic pregnancy. Weight loss does not directly alleviate symptoms. Regular
follow-up is necessary, but Pap smears do not need to be performed every 3 months.
Because patients may be reluctant to discuss risk-taking behavior, routine screening
should be offered to all women between the ages of 13 to 64 years in all health care
settings. Assuring a woman that the offer of testing is not related to a heightened risk may
alleviate her anxiety. Middle-aged women are not the prime demographic for HIV
infection. The nurse should avoid causing fear by immediately discussing treatment or the
fact that many patients are unaware of their diagnosis.
To reduce pain, the lesions should be kept clean and proper hygiene practices maintained.
Topical ointments are avoided and antibiotics are irrelevant due to the viral etiology.
Activity should be maintained as tolerated.
Emotional support is an integral part of nursing care at this point in the disease
progression. It is not normally appropriate for the nurse to inform the family of the
patients diagnosis. It may be inappropriate and simplistic to focus on distraction,
relaxation, and positive thinking.

Management of Patients with Female

Reproductive Disorders

Preventive measures relevant to cervical cancer include regular pelvic examinations and
Pap tests for all women, especially older women past childbearing age. Preventive
counseling should encourage delaying first intercourse, avoiding HPV infection,
participating in safer sex only, smoking cessation, and receiving HPV immunization.
Calcium and vitamin D supplementation are not relevant.
The patient should resume activities gradually. This does not mean sitting for long
periods, because doing so may cause blood to pool in the pelvis, increasing the risk of
thromboembolism. Sitting for long periods after a hysterectomy does not cause
postoperative nerve damage; it does not increase the fatigue factor after surgery or the
risk of hemorrhage.
The patient needs reassurance that she will still have a vagina and that she can experience
sexual intercourse after temporary postoperative abstinence while tissues heal.
Information that sexual satisfaction and orgasm arise from clitoral stimulation rather than
from the uterus reassures many women. Most women note some change in sexual
feelings after hysterectomy, but they vary in intensity. In some cases, the vagina is
shortened by surgery, and this may affect sensitivity or comfort. It would be inappropriate
to reassure the patient that she will still be able to have children; there is no reason to
reassure the patient about not being able to have sex. There is no way you can know how
the patient is feeling and it would be inappropriate to say so.
If the patient has abdominal distention or flatus, a rectal tube and application of heat to
the abdomen may be prescribed. Ice and carbonated beverages are not recommended and

prone positioning would be uncomfortable.

To detect bleeding, the nurse counts the perineal pads used or checks the incision site,
assesses the extent of saturation with blood, and monitors vital signs. The perineum is not
swabbed and there is no reason to prohibit the use of the toilet. Absorbent pads are
applied to the perineum; it is not open to air.
Care must be taken to protect the safety of patients, family members, and staff during
radiation therapy. Hemorrhage is not a common complication of radiation therapy and the
treatment can be curative. Dietary restrictions are not normally necessary during
treatment.
Chemotherapy is usually administered IV on an outpatient basis using a combination of
platinum and taxane agents. Paclitaxel (Taxol) plus carboplatin (Paraplatin) are most
often used because of their excellent clinical benefits and manageable toxicity.
Leukopenia, neurotoxicity, and fever may occur. Acidbase imbalances and elevated
phosphate levels are not anticipated.
Because of the wide excision, the patient may experience severe pain and discomfort
even with minimal movement. Therefore, analgesic agents are administered preventively
(i.e., around the clock at designated times) to relieve pain, increase the patients comfort
level, and allow mobility. Opioids are usually required.
Radiation, which is often part of the treatment to reduce recurrent disease, may be
delivered by an external beam or by brachytherapy (method by which the radiation
source is placed near the tumor) or both.

Management of Patients with Female

Reproductive Disorders

A procedure called a radical trachelectomy is an alternative to hysterectomy in women

with invasive cervical cancer who are young and want to have children. In this procedure,
the cervix is gripped with retractors and pulled down into the vagina until it is visible.
The affected tissue is excised while the rest of the cervix and uterus remain intact. A
drawstring suture is used to close the cervix. For a woman who wants to have children, a
radical hysterectomy would not provide the option of children. A radical culposcopy and
a radical trabeculectomy are simple distracters for this question.
Some disorders related to relaxed pelvic muscles (cystocele, rectocele, and uterine
prolapse) may be prevented. During pregnancy, early visits to the primary provider
permit early detection of problems. During the postpartum period, the woman can be
taught to perform pelvic muscle exercises, commonly known as Kegel exercises, to
increase muscle mass and strengthen the muscles that support the uterus and then to
continue them as a preventive action. Fluid intake, prevention of constipation, and
hygiene do not reduce this risk.