Advanced Concept of Nursing- II

Advanced Concept of Nursing- IIUnit –X

Advance Nursing Management Of ReproductiveDiseases

Pelvic inflammatory disease (PID)

In The Name of God

(A PROJECT OF NEW LIFE HEALTH CARE SOCIETY, KARACHI)

Unit –XAdvance Nursing Management Of Reproductive

DiseasesPelvic inflammatory disease (PID)

Shahzad BashirRN, BScN, DCHN,MScN (Std.DUHS)

InstructorNew Life College of NursingUpdated on June 24, 2016

Objectives• At the end of the unit, students will be able to:1. Utilize Functional health pattern to identify patients problems

related to neurovascular disorders including:– PELVIC INFLAMMATORY DISEASE– Uterine prolapse & Fistulas– Benign prostate hypertrophy– Hypo/ hyperspadiasis

2. Integrate pathophysiology and pharmacology concepts of disease.3. Apply nursing process with support on Evidence-Based Nursing

(EBN) to provide to the clients with neurovascular disorders.4. Discuss the holistic approach for nursing management of the

patient with neurovascular diseases.5. Develop a teaching plan for a client experiencing disorders of the

neurovascular disorders.

• At the end of the unit, students will be able to:1. Utilize Functional health pattern to identify patients problems

related to neurovascular disorders including:– PELVIC INFLAMMATORY DISEASE– Uterine prolapse & Fistulas– Benign prostate hypertrophy– Hypo/ hyperspadiasis

2. Integrate pathophysiology and pharmacology concepts of disease.3. Apply nursing process with support on Evidence-Based Nursing

(EBN) to provide to the clients with neurovascular disorders.4. Discuss the holistic approach for nursing management of the

patient with neurovascular diseases.5. Develop a teaching plan for a client experiencing disorders of the

neurovascular disorders.8/22/2016 2Shahzad Bashir NLCON

Pelvic inflammatory disease (PID)• Pelvic inflammatory disease (PID) is an

inflammatory condition of the pelvic cavitythat may begin with cervicitis and may involvethe:– uterus (endometritis),– fallopian tubes (salpingitis),– ovaries (oophoritis),– pelvic peritoneum, (Peritonitis)or– pelvic vascular system.

• Pelvic inflammatory disease (PID) is aninflammatory condition of the pelvic cavitythat may begin with cervicitis and may involvethe:– uterus (endometritis),– fallopian tubes (salpingitis),– ovaries (oophoritis),– pelvic peritoneum, (Peritonitis)or– pelvic vascular system.

Causes

Causes of PID

Bacteria

Gonorrhea Chlamydia

Viral

CMV

Fungal Parasite

Risk Factors• Most common cause STDs

• Also occur with invasive procedures such asendometrial biopsy, surgical abortion,hysteroscopy, or insertion of an intrauterinedevice.

• Early age at first intercourse, multiple sexualpartners, frequent intercourse, intercourse withoutcondoms, sex with a partner with an STD, and ahistory of STDs or previous pelvic infection.

• Most common cause STDs

• Also occur with invasive procedures such asendometrial biopsy, surgical abortion,hysteroscopy, or insertion of an intrauterinedevice.

• Early age at first intercourse, multiple sexualpartners, frequent intercourse, intercourse withoutcondoms, sex with a partner with an STD, and ahistory of STDs or previous pelvic infection.

PathophysiologyOrganisms usually enter the body through the vagina, pass through the

cervical canal, colonize the endocervix, and move upward into the uterus.

The organisms may proceed to one or both fallopian tubes and ovaries andinto the pelvis.

In bacterial infections that occur after childbirth or abortion, pathogens aredisseminated directly through the tissues that support the uterus by way of

the lymphatic and blood vessels.

In bacterial infections that occur after childbirth or abortion, pathogens aredisseminated directly through the tissues that support the uterus by way of

the lymphatic and blood vessels.

In pregnancy, the increased blood supply required by the placenta providesmore pathways for infection.

In pregnancy, the increased blood supply required by the placenta providesmore pathways for infection.

Postpartum and post abortion infections tend to be unilateral.

Conti…In gonorrheal infections, the gonococci pass through the cervical

canal and into the uterus, where the environment, especially duringmenstruation, allows them to multiply rapidly and spread to the

fallopian tubes and into the pelvis

The infection is usually bilateral.

The infection is usually bilateral.

Pathway by which micro-organismsspread in pelvic infections

Spread of bacterial infection Spread of gonorrheaSpread through bloodvia circulatory system

Clinical Manifestations• Vaginal discharge• Dyspareunia• Lower abdominal pelvic pain• Tenderness that occurs after menses• Other symptoms:– fever,– general malaise, anorexia, nausea, headache, and

possibly– vomiting.

• Vaginal discharge• Dyspareunia• Lower abdominal pelvic pain• Tenderness that occurs after menses• Other symptoms:– fever,– general malaise, anorexia, nausea, headache, and

possibly– vomiting.

Criteria for PID

Complications• Pelvic or generalized peritonitis, abscesses,

strictures, and fallopian tube obstruction maydevelop.• Ectopic pregnancy in the future if a fertilized

egg cannot pass a tubal stricture, or scar tissuemay occlude the tubes, resulting in sterility.• Adhesions• Bacteremia with septic shock• Thrombophlebitis with possible embolization.

• Pelvic or generalized peritonitis, abscesses,strictures, and fallopian tube obstruction maydevelop.• Ectopic pregnancy in the future if a fertilized

egg cannot pass a tubal stricture, or scar tissuemay occlude the tubes, resulting in sterility.• Adhesions• Bacteremia with septic shock• Thrombophlebitis with possible embolization.

Medical Management• Broad-spectrum antibiotic therapy

• Intensive therapy includes bed rest,intravenous (IV) fluids, and IV antibiotictherapy. If the patient has abdominal distentionor ileus, nasogastric intubation and suction areinitiated.

• Broad-spectrum antibiotic therapy

• Intensive therapy includes bed rest,intravenous (IV) fluids, and IV antibiotictherapy. If the patient has abdominal distentionor ileus, nasogastric intubation and suction areinitiated.

Nursing Management• Keep patient in the semi-Fowler’s position to

facilitate dependent drainage.• Accurate recording of vital signs and the

characteristics and amount of vaginaldischarge is necessary as a guide to therapy.• The nurse administers analgesic agents as

prescribed for pain relief. Heat applied safelyto the abdomen may also provide some painrelief and comfort.

• Keep patient in the semi-Fowler’s position tofacilitate dependent drainage.• Accurate recording of vital signs and the

characteristics and amount of vaginaldischarge is necessary as a guide to therapy.• The nurse administers analgesic agents as

prescribed for pain relief. Heat applied safelyto the abdomen may also provide some painrelief and comfort.

Home Remedies for PID

References• Porter, P. A & Perry, A. G. (2003). Basic

Nursing: Essentials for practice (5th ed.) St.Louis: Mosby.• Erb, G. K., (2000). Fundamentals of Nursing:

Concept, process and practice (5th ed.).Addison: Wesley.• Bruner, L.S., & Suddarth, D.S. (2001). Text

book of Medical-Surgical Nursing (9th Ed.).Philadelphia: Lippincott.

• Porter, P. A & Perry, A. G. (2003). BasicNursing: Essentials for practice (5th ed.) St.Louis: Mosby.• Erb, G. K., (2000). Fundamentals of Nursing:

Concept, process and practice (5th ed.).Addison: Wesley.• Bruner, L.S., & Suddarth, D.S. (2001). Text

book of Medical-Surgical Nursing (9th Ed.).Philadelphia: Lippincott.

8/22/2016 17Shahzad Bashir NLCON

THANKSTHANKS THANKS

8/22/2016 18Shahzad Bashir NLCON