Transcript Nursing of Adults with Medical & Surgical Conditions

Nursing of Adults
with
Medical & Surgical Conditions
Reproductive
Disorders
Amenorrhea
• Etiology/Pathophysiology
– Absent or suppressed menstrual flow
– Primary
• Menarche has not occurred by age 18 years
– Secondary
• Menarche has occurred but ceased for at least 3
months
Amenorrhea
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Frequent, vigorous exercise
Depression
Anorexia or bulimia
Normal
• Before puberty
• After menopause
• During pregnancy
– Hormonal abnormalities
– Surgical interventions
• Hysterectomy
Amenorrhea
• Signs & Symptoms
– No menstrual flow for at least 3 months
Amenorrhea
• Treatment
– Based on underlying cause
– Hormone replacement may be necessary
Dysmenorrhea
• Etiology/Pathophysiology
– Uterine pain with menstruation
– Primary
• Not associated with pelvic disorders
• Usually disappears with pregnancy or by the
woman’s late 20’s
– Secondary
• Caused by organic disease
– PID
– Endometriosis
– Usually over 20 years of age
Dysmenorrhea
• Signs & Symptoms
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Breast tenderness
Abdominal distention
Nausea and vomiting
Headache
Vertigo
Palpitations
Excessive perspiration
Colicky and cyclic pain
Dull pain in the lower pelvis
Dysmenorrhea
• Treatment
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Exercise
Nutritious foods, high in fiber
Heat to pelvic area
Mild analgesics
Prostaglandin inhibitors
• Ibuprofin (Motrin)
• Naproxen (Anaprox)
Abnormal Uterine Bleeding
• Menorrhagia
– Excessive bleeding at the time of the regular
menstrual flow
– Endocrine disorders
– Inflammatory disdurbances
– Uterine tumors
• Metrorrhagia
– Uterine bleeding between regular menstrual
periods or after menopause
– May indicate cancer or benign tumors of the
uterus
Premenstrual Syndrome (PMS)
• Etiology/Pathophysiology
– Related to the neuroendocrine events occurring
within the anterior pituitary gland
– Occurs 7-10 days prior to the menstrual period
– Subsides within the first 3 days after the onset
of menstrual flow
Premenstrual Syndrome (PMS)
• Signs & Symptoms
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Irritability
Lethargy & Fatigue
Sleep disturbances
Depression
Headache
Vertigo
Backache
Breast tenderness
Abdominal distention
Acne
Paresthesia of hands and feet
Premenstrual Syndrome (PMS)
• Treatment
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Analgesics
Diuretics
Progesterone
Diet
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High in complex carbohydrates
Moderate in protein
Low in refined sugar and sodium
Limit caffeine, chocolate, and alcohol
– Reduce or eliminate smoking
– Exercise
– Adequate rest, sleep, and relaxation
Female Climacteric
(menopause)
• Etiology/Pathophysiology
– The normal decline of ovarian functin resulting
from the aging process
– Begins between the ages of 35 and 60 years
(average 51yrs)
– May be induced by irradiation of the ovaries or
surgical removal of both ovaries
– Not considered complete until 1 year after the
last menstrual period
Female Climacteric
• Signs & Symptoms
– Decrease in frequency, amount, and duration of
the normal menstrual flow
– Shrinkage of vulval structures
– Shortening of the vagina
– Dryness of the vaginal wall
– Pelvic relaxation
– Loss of skin turgor and elasticity
– Increased subcutaneous fat
– Decreased breast tissue
– Thinning of hair
– Osteoporosis
Female Climacteric
(menopause)
• Treatment
– Estrogen therapy
• Premarin
• Provera
– Calcium supplements
Male Climacteric
• Etiology/Pathophysiology
– Gradual decrease of testosterone levels and
seminal fluid production
– Occurs between the ages of 55 and 70
Male Climacteric
• Signs & Symptoms
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Decreased erections
Enlarged prostate gland
Decreased seminal fluid
Loss or thinning of hair
Decreased muscle tone
Male Climacteric
• Treatment
– Emotional support
– Treatment for impotence
Impotence
• Etiology/Pathophysiology
– Inability of an adult man to achieve penile
erection
– Functional
• Psychological
– Anatomical
• Physical defect of genital structures
– Atonic
• Disturbed neuromuscular function
Impotence
• Treatment
– Remove cause if possible
• Medications
• Illicit or abused substances
– Alcohol, cocaine, nicotine
– Treat diseases
• DM, renal, heart and pulmonary diseases
– Viagra
– Mechnical devices
• Penile prostesis
Penile Prosthesis
Infertility
• Etiology/Pathophysiology
– Inability to conceive after 1 year of sexual
intercourse without birth control
– Impaired sperm or ovum production
– Occlusion in the reproductive system that
prevents the sperm and ova from meeting
– Infections of the reproductive tract
– Primary
• Never conceived
– Secondary
• Conceived but are now unable to do so
– Females most fertile time is between the ages of
20 and 29
Infertility
• Treatment
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Depends on the cause
Hormone therapy
Repair occlusion
Intrauterine insemination
• Partner or donor sperm
– In vitro fertilization
Simple Vaginitis
• Etiology/Pathophysiology
– Common vaginal infection
– Causitive organisms
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E. coli
Staphylococcal
Streptococcal
T. vaginalis
C. albicans (yeast)
Gardnerella
Simple Vaginitis
• Signs & Symptoms
– Inflammation of the vagina
– Yellow, white, or grayish white, curdlike
discharge
– Pruritus
– Vaginal burning
– T. vginalis
• Profuse foamy exudate
– C. albicans
• Thick, cheeselike discharge
– Bacterial
• Milk-like discharge; foul odor
Simple Vaginitis
• Treatment
– Douching
– Vaginal suppositories, ointments, and creams
• Organism specific
– Sitz baths
– Abstain from sexual intercourse during
treatment
– Treat partner if necessary
Cervicitis
• Etiology/Pathophysiology
– Infection of the cervix
– One of the most common diseases of the
reproductive system
– May be caused by vaginal infection, STD,
childbirth or abortion
Cervicitis
• Signs & Symptoms
– Backache
– Whitish exudate
– Menstrual irregulatities
Cervicitis
• Treatment
– Vaginal suppositories, ointments, and creams
• Organism specific
Pelvic Inflammatory Disease
(PID)
• Etiology/Pathophysiology
– Any acute, subacute, recurrent or chronic
infection of the cervix, uterus, fallopian tubes
and overies that has extended to the connective
tissues
– Most common causative organisms
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Gonorrhea
Streptococcus
Staphylococcus
Chlamydia
Tubercle bacilli
Pelvic Inflammatory Disease
(PID)
– Surgical and examination procedures
– Sexual intercourse
• Especially with multiple partners
– Pregnancy
Pelvic Inflammatory Disease
(PID)
• Signs & Symptoms
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Fever
Chills
Severe abdominal pain
Malaise
Nausea and vomiting
Malodorous purulent vaginal exudate
Pelvic Inflammatory Disease
(PID)
• Treatment
– Antibiotics
• IV or IM
– Analgesics
– Bedrest
Toxic Shock Syndrome
• Etiology/Pathophysiology
– Acute bacterial infection caused by
Staphylococcus aureus
– Usually occurs in women who are
menstrujating and using tampons
Toxic Shock Syndrome
• Signs & Symptoms
– Usually occur between days 2 and 4 of the
menstrual period
– Flulike symptoms
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Temperture up to 102 degrees
Vomiting
Diarrhea
Myalgia
Hypotension
– Sore throat
– Headache
– Red macular palmar or diffuse rash
Toxic Shock Syndrome
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Decreased urinary output
BUN elevated
Disorientation
Pulmonary edema
Inflammation of mucous membranes
Toxic Shock Syndrome
• Treatment
– Antibiotics
• Bacterial specific
– IV fluid therapy
– Oxygen
Endometriosis
• Etiology/Pathophysiology
– Endometrial tissue appears
outside the uterus
– The tissue responds to the
normal stimulation of the
ovaries; bleeds each month
– Most common in caucasian
women 25 to 35 years old
Endometriosis
• Signs & Symptoms
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Lower abdominal pain
Pelvic pain
May radiate to lower back, legs, and groin
Most acute during menstruation and subside
after menstruation
Endometriosis
• Treatment
– Antiovulatory medications
• Suppress menstruation
– Pregnancy
– Laparoscopy
• Remove endometrial cells and adhesions
– Total hysterectomy
Vaginal Fistula
• Etiology/Pathophysiology
– Abnormal opening between two organs
– Named for organs involved
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Urethrovaginal fistula: between the urethra and vagina
Vesicovaginal fistula: between the bladder and vagina
Rectovaginal fistula: between the rectum ad the vagina
Vesicouterine fistula: between the bladder and the uterus
Vesicocervical fistula: between the bladder and the cervix
Perineovagina fistula: between the perineum and the
vagina
Fistulas
Vaginal Fistula
– Result from
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Cancer
Radiation
Weakening of tissue by pregnancies
Surgical interventions
Vaginal Fistula
• Signs & Symptoms
– Urine and/or feces being expelled from vagina
Vaginal Fistula
• Treatment
– Oral or parenteral antibiotics
– Diet
• High protein
• Increase Vitamin C
– Surgery
• Repair fistula
• Urinary or fecal diversion
Displaced Uterus
• Etiology/Pathophysiology
– Congenital
– Childbirth
– Backward Displacement
• Retroversion
• Retroflexion
– Forward Displacement
• Anteversion
• Anteflexion
Displaced Uterus
• Signs & Symptoms
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Backache
Muscle strain
Leukorrheal discharge
Heaviness in the pelvic area
Displaced Uterus
• Treatment
– Pessary
• Rubber or plastic doughnut-shaped ring
– Uterine Suspension
Uterine Prolapse
• Etiology/Pathophysiology
– Obstetrical trauma
– Overstretching of the support system
– Coughing, straining, and lifting heavy objects
– A. Normal
– B. First Degree
• Cervix comes
down into the
vagina (approx
half way)
– C. Second Degree
• Cervix comes
down to the
vaginal opening
– D. Third Degree
• The cervix and
uterus protrude
through the
vaginal opening
Uterine Prolapse
• Signs & Symptoms
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Fullness in vaginal area
Backache
Bowel or bladder problems
Protrusion of cervix and vaginal walls in
perineal area
Uterine Prolapse
• Treatment
– Pessary
– Surgery
• Vaginal hysterectomy
• Anteroposterior colporrhaphy
– Anterior and posterior repair of the vagina
– Shortening of the supporting muscles
Cystocele and Rectocele
• Etiology/Pathophysiology
– Cystocele
• Displacement of the bladder into the vagina
– Rectocele
• Rectum moves toward the posterior vaginal wall
– Supporting tissues, muscles and ligaments have
been stretched and weakened
• Childbirth
• Multiple births
• Cervical tears
Cystocele
Bladder
Rectocele
Rectum
Cystocele and Rectocele
• Signs & Symptoms
– Cystocele
• Urinary urgency, frequency, and incontinence
• Fatigue
• Pelvic pressure
– Rectocele
• Constipation
• Rectal pressure
• Hemorrhoids
Cystocele and Rectocele
• Treatment
– Surgical repair
• Anteroposterior colporrhaphy (A&P Repair)
• Shortening of the muscles that support the bladder
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Benign Tumors of the Uterus
Fibroid Tumors
(Myomas)
• Etiology/Pathophysiology
– Arise from the musle tissue of the uterus
– Stimulated by ovarian hormones
Benign Tumors of the Uterus
Fibroid Tumors
(Myomas)
• Signs & Symptoms
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Pelvic pressure
Pain
Dysmenorrhea
Abnormal uterine bleeding
Menorrhagia
Backache
Constipation
Urinary symptoms
Benign Tumors of the Uterus
Fibroid Tumors
(Myomas)
• Treatment
– Surgery
• Myomectomy
– Removal of uterine myomas
• Hysterectomy
Ovarian Cysts
• Etiology/Pathophysiology
– Benign tumors that arise from dermoid cells of
the ovary or from a corpus luteum or graafian
follicle
Ovarian Cysts
• Signs & Symptoms
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May be no symptoms
Palpable on examination
Disturbance of menstruation
Pelvic heaviness
Slight vaginal bleeding
Pain, with enlargement
Ovarian Cysts
• Treatment
– Ovarian cystectomy
Cancer of the Cervix
• Etiology/Pathophysiology
– Squamous cell carcinoma
– Carcinoma in situ
• Preinvasive, asymptomatic carcinoma
• 100% curable
– Untreated, invades the vagina, pelvic wall,
bladder, rectum, and regional lymph nodes
– High Risk
• Sexually active during teens
• Multiple sexual partners
• Multiple births
Carcinoma of the Cervix
Cancer of the Cervix
• Signs & Symptoms
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Few symptoms in early stages
Leukorrhea
Irregular vaginal bleeding
Spotting between periods
• Often occurs after coitus
– Advanced
• Pain in the back, upper thighs and legs
Cancer of the Cervix
• Treatment
– Carcinoma in situ
• Removal of the affected area
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Electrocautery
Cryosurgery (freezing)
Laser
Conization
» Removal of cone-shaped section of cervix
– Early Carcinoma
• Hysterectomy
• Intracavitary radiation
– Advanced carcinoma
• Radical hysterectomy with pelvic lymph node
dissection
Cancer of the Endometrium
• Etiology/Pathophysiology
– Adenocarcinoma of the uterus
• Slow growing tumor
– Usually affects postmenopausal women
– More likely to be localized
• can spread to cervix, bladder, rectum and lymph nodes
– High risk
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History of irregular menstruation
Difficulty during menopause
Obesity
Hypertension
Diabetes mellitus
No children
Family history of cancer of the uterus
Cancer of the Endometrium
• Signs & Symptoms
– Postmenopausal bleeding
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50% will have cancer
• Abdominal pressure
• Pelvic fullness
Cancer of the Endometrium
• Treatment
– Surgery
• TAH-BSO
– Radiation
• Intracavitary radiation
– Chemotherapy
Cancer of the Ovary
• Etiology/Pathophysiology
– 4th most common cause of cancer death in
women
– High Risk
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Infertile
Anovulatory
Nulliparous
Habitual aborters
High fat diet
Exposure to industrial chemicals
– Asbestos and talc
– Common sites of metastisis
• Peritoneum, Omentum, Bowel surfaces
Cancer of the Ovary
• Signs & Symptoms
– Early
• Vague abdominal discomfort
• Flatulence
• Mild gastric disturbance
– Advanced
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Enlarged abdominal girth
Flatulence with distention
Urinary frequency
Nausea
Vomiting
Constipation
Weight loss
Cancer of the Ovary
• Treatment
– Surgery
• TAH-BSO and omentectomy
– Radiation
– Chemotherapy
– Combination of the above
Hysterectomy
• Total hysterectomy
• Removal of the uterus including the cervix
• Total abdominal hysterectomy with bilateral
salpingo-oophorectomy (TAH-BSO)
• Removal of the uterus, fallopian tubes, and ovaries
• Radical hysterectomy
• TAH-BSO with removal of the pelvic lymph nodes
• Vaginal Hysterectomy
• The uterus is removed through the vagina
• Abdominal Hysterectomy
• Abdominal incision is made to perform procedure
Hysterectomy
• Preoperative Interventions
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Reinforce explanation of procedure
Answer questions
Instruct on TCDB
Empty colon
• Low-residue diet
• Enemas
– Indwelling catheter
– Vaginal douche
• Antiseptic
– Surgical skin prep of the abdomen, pelvis, and
perineum
– Consent form
– NPO after midnight
Hysterectomy
• Postoperative Interventions
– Vital signs
– Monitor urinary output
– Assess bowel sounds and function
• No oral intake until bowel sounds have returned
– Early ambulation
• Promotes peristalsis
• Prevents thrombophlebitis
– Antiembolic stockings
– Analgesics
• Demerol
– Monitor for vaginal bleeding
• May have slight vaginal drainage for 1-2 days
– Assess abdominal dressing for bleeding
• Change dressing using aseptic technique as ordered
– Pelvic rest (4-6 weeks)
– No heavy lifting (nothing over 10 pounds)
Fibrocystic Breast Condition
• Etiology/Pathophysiology
– Benign tumors of the breast
– Hyperplasia and cystic formation in mammary
ducts
– Usually occurs in women 30-50 years of age
– Rarely become malignant, but increases risk of
breast cancer
Fibrocystic Breast Condition
• Signs & Symptoms
– Cysts are soft, well-differentiated, tender, and
freely moveable
– Often bilateral and multiple
– More apparent before menses
Fibrocystic Breast Condition
• Treatment
– Eliminate methylxanthines
• Found in caffeine – coffee, tea, colas
– Danazol (Danocrine)
• Inhibits FSH and LH production; decreases estrogen
production
– Vitamin E
Acute Mastitis
• Etiology/Pathophysiology
– Acute bacterial infection
– Usually caused by S. aureus or streptococci
– Most often occurs during lactation and late
pregnancy
Acute Mastitis
• Signs & Symptoms
– Breasts are tender, inflamed and engorged
Acute Mastitis
• Treatment
– Keep breasts clean
– Application of warm packs
– Support
• Well fitting bra
– Systemic antibiotics
Chronic Mastitis
• Etiology/Pathophysiology
– Common in women 30-50 years of age
– Increased risk in women with inverted, cracked
nipples, and problems with breast feeding
– Traumatic blow to the breasts
– Occurs most frequently in obese women
Chronic Mastitis
• Signs & Symptoms
– Tender, painful, and palpable cysts
– Usually unilateral
Chronic Mastitis
• Treatment
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Same as for Acute Mastitis
Keep breasts clean
Application of warm packs
Support
• Well fitting bra
– Systemic antibiotics
Breast Cancer
• Etiology/Pathophysiology
– Unknown cause
– Usually adenocarcinoma
– Factors that influence formation
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Exposure to heavy radiation
Immunodeficiency
Estrogen therapy
Diet high in fat
Fibrocystic breast condition
Breast Cancer
– High Risk Factors
• Gender
– Female
• Age
– Over 40
• Race
– Caucasian
• Genetics
– Women whose mother and sisters have breast cancer
• Menarche
– Occurred before age 12
• Parity
– Decreased for women who gave birth before age 18
– Increased for women who are not sexually active, infertile or
became pregnant after age 35.
• Menopause after age 55
• Other - Cancer of the uterus, ovaries, colon, breast
Breast Cancer
• Signs & Symptoms
– Small, solitary, irregular-shaped, firm,
nontender, and nonmobile tumor
– Change in skin color
– Puckering or dimpling of tissue
– Nipple discharge
– Retraction of nipple
– Axillary tenderness
Breast Dimpling &
Nipple Retraction
Breast Cancer
• Treatment
– Depends on the Stage
• Stage I
– Tumor is 1-2 cm or smaller
– No nodal or metastatic involvement
• Stage II
– Tumor is 2-5 cm
– With or without nodal involvement and no metastasis
• Stage III
– Tumor is 5-10 cm
– Usually with lymph node involvement and no metastasis
• Stage IV
– Indicates the presence of metastatic spread, regardless of
tumor size or lymph node involvement
Breast Cancer
– Surgery
• Lumpectomy
– Removal of a circumscribed area along with the tumor
• Partial mastectomy
– The quadrant of the breast in which the tumor is located is
removed.
• Subcutaneous mastectomy
– Removal of malignant breast tissue, leaving the skin
surface and nipple in place.
• Simple mastectomy
– Removal to the entire breast
• Modified radical mastectomy
– All breast tissue, overlying skin, nipple, and pectoralis
minor muscles are removed with samples of axillary
nodes.
Modified Radical Mastectomy
Breast Cancer
• Nursing Interventions
– Reach to Recovery
• Preop if possible
– Post-op
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Monitor vital signs
Assess for s/s of shock and hemorrhage
Hemovac drain
Assess dressings for drainage
TCDB
Analgesics
Elevate arm on affected side
Breast Cancer
• No procedures involving the arm on the affected side
– B/P, injections, IV’s, drawing of blood
• Exercises to restore muscle strength
– Page 535; figure 12-17
• Psychological support
• Prosthesis
– Gels, molded silicone, saline
– Match remaining breast
• Breast reconstruction
– Breast implant
» Silicone or saline implant under skin
– Latissimus dorsi flap graft
» Flap of muscle, fat and skin is transferred to breast area from
latissiumus dorsi area
– Transabdominal island flap
» Section of abdominal skin and fat and part of the rectus
abdominis muscle are transferred to the breast area.
Prostatitis
• Etiology/Pathophysiology
– Acute or chronic infection of the prostate gland
– E. coli, Klebsiela, Proteus, Pseudomonas,
Streptococcus, and Staphyloccoccus
Prostatitis
• Signs & Symptoms
– Chills and fever
– Urgency and frequency
of urination
– Dysuria
– Cloudy urine
– Perineal fullness
– Lower back pain
– Arthralgia
– Myalgia
– Tenderness, edema and
firmness of the prostate
gland
Prostatitis
• Treatment
– Antibiotics
– Digital massage of the prostate
• Increased flow of infected secretions
– Sitz baths
– Monitor I&O
Epididymitis
• Etiology/Pathophysiology
– Infection of the epididymis
• The cord like excretory duct of the testicle
– S. aureus, E. coli, Streptococcus,
N. gonorrhoeae
– Associated with urethral strictures, cystitis, and
prostatisis
Epididymitis
Epididymitis
• Signs & Symptoms
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Scrotal pain
Edema
“waddling gait”
Pyruia
Chills and fever
Epididymitis
• Treatment
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Bed rest
Elevate scrotum
Cold compresses
Antibiotics
I&D for abscess
Phimosis
• Etiology/Pathophysiology
– Prepuce is too small to allow retraction of the
foreskin over the glans.
– Usually congenital; may be due to
inflammation or disease
Phimosis
Phimosis
• Signs & Symptoms
– Infection of foreskin and glans penis.
– Occasionally causes obstruction of urine flow
Phimosis
• Treatment
– Circumcision
Hydrocele
• Etiology/Pathophysiology
– Accumulation of fluid between the membranes
covering the testicle and the membrane
enclosing the testicle
– May be caused by trauma, orchitis, or
epididymitis
Hydrocele
Hydrocele
• Signs & Symptoms
– Enlargement of the scrotum
– Pain
Hydrocele
• Treatment
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Aspiration of fluid
Surgical removal of testicular sac
Bed rest
Elevate scrotum
Cold compresses
Varicocele
• Etiology/Pathophysiology
– Dilation of scrotal veins causing obstruction
and malfunction of circulation
Varicocele
• Signs & Symptoms
– Engorgement and elongation of the scrotum
– Pulling sensation in scrotum
– Dull aching pain
Varicocele
• Treatment
– Surgery
• Removal of obstruction
– Bedrest
– Elevate scrotum
– Cold compresses
Cancer of the Testis
• Etiology/Pathophysiology
– Cause unknown
– High risk
• Cryptorchidism
– Undesended testes
• Testicular atrophy
• Scrotal trauma
Cancer of the Testis
• Signs & Symptoms
– Enlarged scrotum
– Firm, painless, smooth
mass
– Feeling of heaviness
Cancer of the Testis
• Treatment
– Radical inguinal orchiectomy
• Removal of the testis, epididymis, a portion of the
gonadal lymphatics, and their blood supply.
– Radiation
– Chemotherapy
– Teach testicular self-examination
Cancer of the Penis
• Etiology/Pathophysiology
– Very rare
– Usually in men over 50 yrs
– High risk
• Uncircumcised
• Poor personal hygiene
• STD’s
Cancer of the Penis
• Signs & Symptoms
– Painless, wartlike growth or ulceration, usually
on the glans penis
Cancer of the Penis
• Treatment
– Surgery
• Removal of tissue
• Partial or total amputation of the penis
• Metastisis may require more radical surgical
procedures
Herpes Genitalis
(Herpes Simplex Virus Type II)
• Etiology/Pathophysiology
– Infectious viral disease
– Usually acquired sexually
Herpes Genitalis
(Herpes Simplex Virus Type II)
• Signs & Symptoms
– Fluid-filled vesicles
• Cervix, labia, rectum, vulua, vagina, glans penis, foreskin, and
penile shaft.
– Eventually rupture and develop shallow, painful ulcers
– Ulcers are erythematous with edema and tenderness
Herpes Genitalis
(Herpes Simplex Virus Type II)
– Initial lesion
• Lasts 3-10 days
– Recurrent lesions
• Last 7-10 days
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Fever
Malaise
Dysuria
Leukorrhea (female)
Herpes Genitalis
(Herpes Simplex Virus Type II)
• Exacerbation
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Fever
Stress
Emotional upset
Intense heat
Herpes Genitalis
(Herpes Simplex Virus Type II)
• Treatment
– No cure; treat symptoms
– acyclovir (Zovirax)
• Oral, IV, topical
– Sitz baths
– Local anesthetic
• Lidocaine
– Analgesics
– Keep lesions clean and dry
Herpes Genitalis
(Herpes Simplex Virus Type II)
– GOOD handwashing
– No sexual contact while lesions are present
– Encourage use of condoms
• May be spread even if lesions are not present
Syphilis
• Etiology/Pathophysiology
– Treponema pallidum organism
– Transmission occurs primarily through sexual
contact
– Infection from mother to fetus may occur
– Can penetrate intact skin as well as openings
Syphilis
• Signs & Symptoms
– 5 Stages
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Incubation Period
Primary Stage
Secondary Stage
Latent Stage
Tertiary Stage (Late)
– Incubation Period
• 10-60 days after contact
• no symptoms
– Primary Stage
• Chancre
– Painless erosion or papule that ulcerates superficially
– Will disappear in 3-4 weeks, with or without treatment
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Headaches
Enlarged lymph nodes
VDRL may be negative
Highly contagious
Syphilis
– Secondary Stage
• Rash on palms of hands and
soles of feet
• Generalized enlargement of
lymph nodes
• S/S may disappear and
reoccur for as long as 2
years
Syphilis
– Latent Stage
• No symptoms
– Tertiary or Late Stage
• Lesions in skin, bones, liver, larynx, testes, eyes,
heart, and central nervous
• system
• May be fatal
• 5-20 years after infection
Syphilis
• Treatment
– Penicillin
• IV
– Tetracycline or erythromycin
• If allergic to penicillin
– May be treated in any stage; damage will not be
reversed.
– Treat all sexual contacts.
Gonorrhea
• Etiology/Pathophysiology
–
–
–
–
N. Gonorrhoeae
Transmitted by sexual contact
Most common communicable disease in the US
Primarily affects the genital or rectal mucosa;
can involve mouth and throat
Gonorrhea
• Signs & Symptoms (According to location)
– Vaginal (female)
• Urinary frequency and pain
• Yellowish discharge
• Nausea and vomiting
– Urethra (male)
•
•
•
•
Urethral discomfort
Yellowish discharge containing pus (“the drip”)
Red and swollen meatus
Dysuria
Gonorrhea
– Rectal (male & female)
• Perineal discomfort
• Purulent rectal discharge
– Pharyngitis (male & female)
• Sore throat and swallowing discomfort
• Edema of the throat
Gonorrhea
• Treatment
– Penicillin
• Some may be resistant
– Rocephin
• Penicillinase-resistant cephalosporin
– Doxycycline or Tetracycline
• Will treat co-infection of chlamydia
– TREAT ALL SEXUAL CONTACTS
Trichomoniasis
• Etiology/Pathophysiology
– T. vaginalis protozoan
– Usually sexually transmitted
Trichomoniasis
• Signs & Symptoms
– Most are asymptomatic
– Male
• Urethritis, dysuria, frequency, pruritus, and purulent exudate
– Female
•
•
•
•
•
•
•
•
Frothy, gray, green or yellow malodorous discharge
Pruritus
Edema
Tenderness of vagina
Dysuria & Frequency
Spotting
Menorrhagia
Dysmenorrhea
Trichomoniasis
• Treatment
– metronidazole (Flagyl)
• No alcohol
• Urine may be dark brown
– TREAT ALL SEXUAL CONTACTS
Candidiasis
• Etiology/Pathophysiology
– C. albicans & Candida tropicalis
– Fungal infection
• Normal flora of GI tract, mouth, vagina and skin
• Infection occurs
–
–
–
–
–
–
–
Lowered resistance; carcinoma
High blood glucose; DM
Radiation
Immunosuppressant drugs
Hyperalimentation
Antibiotic therapy
Oral contraceptives
Candidiasis
• Signs & Symptoms
– Mouth
• Edema
• White patches
– Nails
• Edematous
• Darkened, erythematous nail base
• Purulent exudate
– Vaginal
• Cheesy, tenacious white discharge
• Pruritus
• Inflammation of the vulva and vagina
Candidiasis
– Penis
• Purulent exudate
– Systemic
• Chills
• Fever
• General malaise
Candidiasis
• Treatment
– Treat underlying condition
– nystatin (Mycostatin)
• ointment, spray, creams, suppositories
– Topical amphotericin B
• skin and nail infections
Chlamydia
• Etiology/Pathophysiology
– Chlamydia trachomatis
– Causes
•
•
•
•
Cervicitis
Urethritis
Epididymitis
PID
Chlamydia
• Signs & Symptoms
– Usually asympomatic
– Male
•
•
•
•
Scanty white or clear exudate
Burning or pruritus
Urinary frequency
Mild dysuria
– Female
•
•
•
•
•
Vaginal pruritus or burning
Dull pelvic pain
Low-grade fever
Vaginal discharge
Irregular bleeding
Chlamydia
• Treatment
–
–
–
–
–
Tetracycline
Doxycycline
Zithromax
Erythromycin for pregnant patients
TREAT ALL SEXUAL CONTACTS