Nursing Care Plan | NCP Vaginitis

Vaginitis is an inflammation of the vagina that includes three infections: Candidiasis, trichomoniasis, and bacterial vaginosis. Generally, it occurs with a hormonal imbalance and an infection with a microorganism. Vaginitis is associated with changes in normal flora, alkaline pH, insertion of foreign bodies such as tampons and condoms, chemical irritations from douches and sprays, and medications such as broad-spectrum antibiotics.

Trichomoniasis is an infection caused by Trichomonas vaginalis, a single-celled, anaerobic, protozoan parasite that is shaped like a turnip and has three or four anterior flagella. This parasite feeds on the vaginal mucosa and ingests bacteria and leukocytes.

Vulvovaginal candidiasis is caused by Candida albicans (most often), C. glabrata, or C. tropicalis. These organisms are normally present in approximately 50% of women and cause no symptoms until the vaginal environment is altered. Contributing factors to altering the vaginal environment and causing an overgrowth of Candida are: taking broad-spectrum antibiotics, which alter the protective bacterial flora; higher hormone levels from birth control pills and pregnancy, which increase glycogen stores that facilitate yeast growth; and diabetes mellitus or human immunodeficiency virus (HIV) infection that alters the immune system. Repeated candida infections may be an indicator of unrecognized HIV infections.

Bacterial vaginosis (nonspecific vaginitis) is characterized by an imbalance in the vaginal flora (absence of the normal Lactobacillus species) and an overgrowth of Gardnerella, Mycoplasma species, and anaerobic bacteria. The anaerobe raises the vaginal pH, producing favorable conditions for bacterial growth. Cervicitis and urethritis are frequent manifestations of gonococcal or chlamydial infections and result from infection by Neisseria gonorrhoeae or Chlamydia trachomatis, but other agents may also cause vaginitis.

Nursing care plan assessment and physical examination
Elicit a history of the onset and description of symptoms, with particular attention to the nature and amount of vaginal discharge, which may be frothy, thick, or malodorous. Question the patient to determine if she is experiencing discomfort such as external inflammation and pain, and pruritus. Patients may describe exertional dysuria, dyspareunia, and vulvular inflammation. Determine the medications that the patient is taking, with particular attention to antibiotics, hormone replacement therapy, and contraceptives. Take a menstrual history. Ask about the patient’s rest, sleep, nutrition, exercise, and hygiene practices. Ask the patient if she is pregnant or a diabetic, both of which place the patient at risk for vaginitis.

Vaginal examination should take place under the following conditions: not on menses; no douching or vaginal sprays for 24 hours prior to exam; no sexual intercourse without a condom for 24 hours prior to the exam. Physical examination generally reveals some type of discharge, such as frothy, malodorous, greenish-yellow, purulent vaginal discharge (trichomoniasis); thick, cottage cheese–like discharge (candidiasis); or malodorous, thin, grayish-white, foul, fishy odor discharge (bacterial). The external and internal genitalia are often reddened, inflamed, and painful on examination. Women with candidiasis often have patches on vaginal walls and cervix and signs of inflammation. Women with trichomoniasis have a strawberry spot on the vaginal surface and cervix. Bacterial vaginitis is often asymptomatic with a normal vaginal mucosa. Palpate the patient’s abdomen for tenderness or pain, which may indicate pelvic inflammatory disease.

Psychosocial assessment should include evaluation of the patient’s home situation and a sexual history. Ask the patient about the type of contraception she and her partner use. Provide a private environment to allow the patient to answer questions without being embarrassed.

Nursing care plan primary nursing diagnosis: Risk for infection related to invasion or proliferation of microorganisms.

Nursing care plan intervention and treatment plan
Encourage the patient to get adequate rest and nutrition. Encourage the patient to use appropriate hygiene techniques by wiping from front to back after urinating or defecating. Teach the patient to avoid wearing tight-fitting clothing (pantyhose, tight pants or jeans) and to wear cotton underwear rather than synthetics. Explain to patients that the risk of getting vaginal infections increases if one has sex with more than one person. Teach the patient to abstain from sexual intercourse until the infection is resolved. If the patient has Trichomonas, her partner needs treatment as well. Teach the patient that the inflammation caused by the Trichomonas increases her susceptibility to HIV.

The pain and itching from vaginitis may be quite intense until the medication is effective. Some women find that by applying wet compresses and then using a hair dryer on a cool setting several times a day provides some relief of itching. Other women find that a cool sitz bath provides comfort. For yeast infections, tepid sodium bicarbonate baths and applying cornstarch to dry the area may increase comfort during treatment. Be informed about which sexually transmitted diseases need to be reported to the local health department.

Nursing care plan discharge and home health care guidelines
Teach the patient how to maintain lifestyle changes with regard to rest, nutrition, and medication management. Make sure that the patient understands all aspects of the treatment regime with particular attention to taking the full course of medication therapy. Make sure the patient understands the necessity of any follow-up visits.