PROLAPSE of the UTERUS

PROLAPSE OF THE UTERUS- support of the uterus become weak after childbirth and descent into the vaginal orifice.

Signs and Symptoms: same as Displacement of the Uterus

• backache
• feeling of pelvic pressure
• easy fatigue
• leukorrheal discharge
• urinary incontinence or urinary retention due to displacement of the bladder

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Post operation care for Hysterectomy

• keep patient on bed for 2-3 days with vaginal packing or pessary in place
• perineal care after vaginal packing removed
• allow to void freely if catheter removed

Nursing Responsibilities:

Industrial Nurses or Public health nurse is her responsibility to encouraged an individual to seek a medical check up if they are manifesting symptoms of displacement of the uterus

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DISPLACEMENT OF THE UTERUS

UTERUS- normally lies with the cervix at the right angle to the long axis of the vagina and the body inclined slightly forward.It is movable freely for the requirement to the pregnancy.
BACKWARD DISPLACEMENT OF THE UTERUS- ( retroversion and retroverflexion)

SIGNS AND SYMPTOMS

• backache
• sense of pelvic pressure
• easy fatigue
• leukorrheal discharge

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Post operative care:

• keep on bed rest
• allow to void freely if catheter removed
• perineal care
  

Cystocele and Urethrocele

Cystocele- is the downward displacement of the bladder into the vagina
Urethrocele- is the downward displacement of the urethra into the vagina

Possible Causes :

• by genital atrophy associated with aging occurs
• congenital
• obstetric trauma

Signs and symptoms:

• pelvic pressure or heaviness
• backache
• urinary urgency , frequency, incontinence, incomplete emptying
• coughing , sneezing, long standing will cause more intra-abdominal pressure
• relieved by resting or lying down

Management:
Surgery

• Anterior vaginal colporrhaphy -repair of the anterior vaginal wall

Post- operative care:

• care of the catheter - should be in proper place and check if urine flowing freely
• check packing for presence of bleeding
• perineal care after each voiding or defecation
• heat lamp to dry incision and helps in the healing process
• apply ice packs locally to relieve discomfort
• analgesic for pain as prescribed by the physician

Nursing Intervention

• Encourage to increase fluid intake to prevents bacterial flora in the bladder
  
• Catheterize if necessary as per doctor's advised
• advised patient for Kegel's pelvic floor exercise - keep your pelvic floor muscles toned, tightens the vaginal muscles -hold for a count and then relax. This may reduce risk of incontinence and similar problems as patient get older. Kegel exercises can also help to control urinary incontinence.

Monilial Vaginitis

Monilial Vaginitis - is a fungal infection caused by Candida Albicans.

Predisposing factors:

• seen in a patient with diabetes mellitus because fungus thrives in an environment rich in carbohydrates
• monilial also found in patients who have been in antibiotic or steroid therapy for a while due to reduced natural protection against microorganism in the vaginal tract

Symptoms:

• irritation
• watery containing white cheesy particles
  
• presence of white material at the vaginal walls

Treatment: (note) as always prescribed by the doctor

• control diabetes mellitus
• gentian violet 5 % swabbing of the vagina 3x a week or more often

Trichonomas Vaginalis

Trichomonas Vaginalis- produced by protozoan., produces profuse frothy white irritating leukorrhea. This organism thrives in alkaline media and is detectable under microscopic examination.Remission may reoccur even under treatment because microorganism is resistant. This organisms harbored in the urinary tract or the other parts of the urogenital tract not as accessible to local treatment.The male partner may have the organism in the urogenetal tract causing the reinfection of mate so must have to be treated both.


Nursing Care

• thorough cleansing with soap solution containing hexachlorophene followed by local suppositories .
• if bladder is involved, instillation of silver protein Argyrol may be used
  

Gardnerella Vaginitis

Gardnerella Vaginitis ( non -specific or bacterial)- an inflammation of the vagina which may considered sexually transmitted disease but referred to non-specific vaginitis because it is not cause by Trichomonas Candida or gonorrhrea.

Symptoms:

• odorous vaginal dicharge
• itheness
  
• burning sensation
• if the discharge is color pink- it is benign
• maybe asymptomatic

Nursing care;

• Avoid alcohol intake when if under flagyl treatment
• Partner should also be treated
  

Simple Vaginitis

Simple Vaginitis-( Contact Vaginitis) an inflammation of the vagina due to invading microorganism

Symptoms:

• presence of discharge
• irritation
• redness of the vulva
  
• burning sensation
• edema
• voiding and defecation aggravate the symptoms above

'

• administer a weak acid douche (15 ml of vinegar to 1 qt. of water)
• insertion of beta lactose vaginal suppository per doctor's order
• proper perineal hygiene and meticulous care after defecation and urination
• discontinue the cause