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Pelvic Inflammatory Disease (Assessment and common findings (Urinary…
Pelvic Inflammatory Disease
Definition
Simultaneous infection of several organs in the female reproductive system , with or without involvement of peritoneum.
Pathophysiology
Infection is acute , infecting organisms colonise the vagina and cervix causing low grade vaginitis and cervicitis
Infection then ascend to the uterus and fallopian tubes causing endometritis , salpingitis and oophoritis.
Endometrium may be necrotic in appearance
Salpingitis and oophoritis caused tubes to become congested and oedematous
Inflammation of tubes and ovaries may develop into and abcess, later will burst into peritoneal cavity
Assessment and common findings
Urinary frequency and urgency
lower abdominal pain from moderate to severe and worse
Mucopurulent and malodorous vaginal discharge or even abdominal vaginal bleeding
Pyrexia and tachycardia
Nausea and vomiting
Dyspareunia
Abscess forms, lower abdominal distention and rigidity
On palpation , there may be lower abdominal tenderness with guarding denoting peritonitis
Diagnostics studies
Raised ESR
Positive Wasserman reaction test denoting STI
White cell count , usually more than 10 000 /cm
Cervical swab and sensitivity to identify infecting organisms
Laparascopy visualize inflamed fallopian tubes
Nursing care plan
Nursing diagnosis
Altered comfort due to tension or pressure on pelvic organs
Expected outcomes
NO pain
N. interventions
Allow patient to assume position that relieves pain, Fowler's position
In cas of Surgery , ensure that urinary catheter is draining ,
Administer antibiotics and Analgesics as prescribed
Risk of Fluid volume deficit related to nausea and vomiting
Expected outcome
No nausea and vomiting
N. interventions
Ensure Clean environment , remove unsightly and smelly dressings and sanitary pads
Avoid fatty foods and give fruit juice and serve food attractively
Monitor intake and output to prevent dehydration
Administer antiboitics as prescribed because nausea and vomiting could be as a result of infection
Altered comfort related to fever
Expected outcomes
Normal temperature
N.interventions
Remove excess clothes and blankets to reduce heat
Open windows to allow cooling of the body
Administer and record prescribed antibiotics and antipyrectics
Health Education
Washing of hands after each pad change
Daily exercise and proper nutrition
Emphasize important of personal hygiene, such as washing genitals , changing of clothes when necessary
Management
Surgical
Oophorectomy
Total hesterectomy
Incision and drainage
Medical
Broad-spectrum antibiotic therapy is prescribed
Intensive therapy includes bed rest, intravenous fluids
If the patient has abdominal distention or ileus, nasogastric intubation and suction are initiated.
Treating sexual partners is necessary to prevent reinfection.
Nursing
Administer Analgesics and antibiotics as prescribed
Provide plenty of water to drink
Maintain patient's personal hygiene by giving daily baths, vulva swabing.
Wash hands before and after attending to the patient to avoid cross infection
Observe vaginal discharge from used gloves, recording pad check.
Causes and risk factors
Multiple sexual partners
Sex with a partner with an STD
History of STD and previous pelvic infection