VAGINAL FISTULA

VAGINAL FISTULA- an abnormal tortuous opening between internal hollow organs, or between the internal hollow organ and the exterior of the body


Uterovaginal fistulas- opening between the ureter and the vagina

Vessicovaginal fistula- opening between the bladder and the vagina

Retrovaginal fistula - opening between the rectum and the vagina


CAUSES:

• injury during the prolonged labor
• vaginal reconstruction or injury
• carcinoma

SIGNS AND SYMPTOMS:

• fecal in continence
• loss of urge to void
• bladder contineously emptying
• inflammation of the vulva
  

VULVITIS ( ABSCESS OF THE BARTHOLIN'S GLANDS)

VULVITIS - inflammation of the vulva

CAUSES:

• due to poor perineal hygiene
• discharge of infection

CAUSATIVE AGENT:

• gonococcos
• escherichia coli
• staphylococcus
• streptococcus
• trichonomas vaginitis

SIGNS AND SYMPTOMS

• burning pain during defecation and urination
• edematous genetalia
  
• profuse purulent exudate

BARTHOLIN'S GLANDS INFECTION- will leads to the formation of abscess characterized by pain and swelling of labia

TREATMENT:

• broads spectrum antibiotic
• or combination therapy like tetracycline, penicillin and streptomycin
• hot packs for comfort
• sitz bath -promotes healing
• analgesics for pain

Bartholin's cyst - normally surgically remove


Bartholinectomy- removal of bartholin's glands

Indication for Bartholinectomy

• due to chronic condition, provokes fear of carcinoma
• occur an obstruction when coitus

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HYDRAMNIOS

HYDRAMNIOS (POLYHYDRAMNIOS) -

• caused by excessive amount of amniotic fluid
• unknown cause but frequently seen in diabetic women
• elevated prolactin levels in amniotic fluid

SIGNS AND SYMPTOMS:

• increase uterine size for gestation
• big uterine size for gestational age
• difficulty in palpating fetal parts
• difficulty to auscultate fetal heart

DIAGNOSTIC PROCEDURE:

• ultrasound shows large pocket of fluid

NURSING CARE:

• provide emotional support to prevent anxiety
• record intake and output
• monitor fetal heart
• adequate rest and avoid stressful activity
• encourage nutritious foods that are rich in protein
  

OLIGOHYDRAMNIOS

OLIGOHYDRAMNIOS -

• there is a decreased amount of amniotic fluid and fluid becaome concentrated.
• this causes cord compression and fetal distress
  
• due to lack of fluid in the terminal air sacs, the infant may manifest to pulmonary hyperplasia
• cause is unknown
  

PREDISPOSING FACTORS:

• postdate pregnancy
• fetal renal disease
• fetal obstruction

SIGNS AND SYMPTOMS:

• prominent fetal parts are palpated in the abdomen
• small for date

NURSING CARE:

• psychological support to patient and family and allow to discuss about the diagnosis and the outcome
  

CERVICAL BIOPSY

CERVICAL BIOPSY -to get cervical tissue for further laboratory examination if there is lesion

Procedure:

• procedure should be done one week after end of menstruation
• explain to the patient about the procedure and its purpose
• let the patient to lie down in lithotomy position with foot on the stirrup
• Doctor nibbles tissue with the use of biopsy forceps( forceps instrument with teeth) There is no need of anesthesia because cervix has no pain receptor and patient does not experience pain when nibbling tissue. Some bleeding is expected from the site of nibbling tissue so, pressure dressing like packing is inserted.
• cervical tissue is preserved in 10%formalin and labeled properly before sending to laboratory for examination

CYTOLOGY TEST FOR CANCER (PAPANICOLAOU)

CYTOLOGY TEST- for Cancer (PAPANICOLAOU)- test for diagnosing cervical cancer by swabbing or or aspirating vaginal secretion from the posterior fonix and making a smear on a glass slide and examines and interpret by the pathologist.
This examination must not be performed to a patient who is presently on menstrual flow.

CLASSIFICATION for cytological findings suggested by Papanicolaou test

Class 1- absence of atypical or abnormal cells
Class 2- atypical cytology but no evidence of malignancy
Class 3- cytology suggestive of but not conclusive for malignancy
Class 4- cytology strongly suggestive of malignancy
Class 5- cytology conclusive to malignancy

SCHILLER IODINE TEST

MODIFIED SCHILLER IODINE TEST- to outline unhealthy epithelium
Cancer epithelium contains no glycogen because cannot anymore absorb iodine while
Normal cervical epithelium- contains glycogen because has the ability to absorb iodinea

Procedure: Long cotton applicator is used to paint the cervix with 7 percent tincture of iodine

• negative result- if a mahogany brown color covering the entire surface -indicates reaction between the iodine and the glycogen of normal cells
• positive result- if tissues not stained brown -indicates immature cells is abnormally present
  

PELVIC EXAMINATION

PELVIC EXAMINATION OF THE EXTERNAL GENETALIA- is an inspectionof the external genitalia for any bleeding, swelling, inflammation, lesions, discharges and local skin or epithelial changes .

PELVIC EXAMINATION OF THE INTERNAL GENETALIA :
1. Inspection of speculum - to enable the gynecologist to visualize the cevrix
* Smaller speculum is used for young virgin or not be used at all as much as possible and observe or inspect the the appearance of vaginal tissue and the nature of the cervix

2Bimanual examination is an insertion of 1 or 2 gloved fingers of the left hand in the vagina while the right hand palpating the fundus so that the uterus and the adnexa are further reach by fingers and be examined by the gynecologist

3. Rectal examination is made by the gynecologist by inserting his gloved fingers to detect abnormalities in the contour motility and placement of adjacent structure of tissue

NURSING RESPONSIBILITIES:

• explain to the patient about the examination to be done to her
  
• assist the doctor and focus the light
• after examination, wipe perineum from excess jelly and dischargest and removed legs from stirrup
• advise patient to sit first a minute or two minutes to take the opportunity to ask question and ask the nurse to explain further what have doctor said to her
  

ENDOMETRIOSIS

ENDOMETRIOSIS- benign lesions in which cells resembling the endometrium growth outside the the uterus

CHARACTERISTICS:

• found growing abruptly in the pelvic cavity outside the uterus
• occur at any age but more on 25 -45 years old
• may cause sterility

SIGNS AND SYMPTOMS:

• painful defication
  
• abnormal uterine bleeding
• persistent infertility
• hematuria and dysuria due to bladder involvement
• hematuria- blood in the urine
• dysuria-difficulty in urination
• ruptured cyst-mimic acute ruptured appendicitis and ruptured ectopic pregnancy
  

NURSING MANAGEMENT

• Provide emotional support- allow patient to discuss feelings and concerns including family
• encourage bed rest
• observation of abdominal pain and may apply hot bags to relieve the pain
• Prepare patient for surgery if ordered by the physician

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PELVIC INFLAMMATORY DISEASE

PELVIC INFLAMMATORY DISEASE-( PID)

• it is an inflammatory condition of the pelvic cavity that may involve the fallopian tubes and ovaries, pelvic peritoneum or pelvic vascular system
• due to invasion of staphylococcus, streptococcus or other venerial organisms from outside through the cervical canal to the uterus and into the pelvic by way of lymphatic channels, uterine veins or the fallopian tubes

SIGNS AND SYMPTOMS:

• abdominal pain
  
• nausea and vomiting
  
• high grade fever
• malaise
• weakness
• malodorous, purulent vaginal discharge
• leukocytosis

NURSING MANAGEMENT:

1. Control the spread of infection

• proper handling of perenial pads,by using instrument to pick up or sterile globes
• proper disposal of soil pads by putting in plastic put in the trash box
  
• careful handwashing technique procedure before and after attending the patient

2 Comforting patient from pain by applying hot bags to the abdomen externally , hot douches may ordered to improve circulation
3. Monitor vital sign and record for doctor's evaluation of the disease
4. Observe of patient's physical and mental response to the treatment
5. Observe the nature and amount of vaginal discharge are very necessary to guide the doctor's future therapy


UNTREATED PELVIC INFLAMMATORY DISEASE -( PID )

• will lead to pelvic discomfort
• a scar tissue may close the fallopian tube and may cause ectopic pregnancy or sterility
• may develop adhesion
  - are common development that may eventually require removal of the uterus , tubes and ovaries