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.
Monday, August 30, 2010
Top Business Schools in South Africa
South African business schools are ranked highly in international rankings. According to the Financial Times rankings of business schools and MBA programs, University of Cape Town is ranked in the global top 100 for its M.B.A. program (rated 71st in 2009 and 89th in 2010). It is also rated highly in the FT "Executive Education Customised" rankings 2010, ranked 2nd in South Africa and 49th in the
Sunday, August 29, 2010
Jobs For The Boys
I am feeling a bit better after my last rant, so the pills must be working. However, that's not something which can be said about Scottish Football.
The (English) FA is even longer-established than that mob at Hampden, but at least, they acknowledge there are two games of football played in these islands. In England they have "the professional game" and "the community game".
Now there may well be as huge a gulf between Chelsea and Manchester United and whichever team is bottom of their Fourth Division as there is between the Old Firm and the bottom of the SFL's Third Division, but, at least all 92 "league" clubs in England are full-time.
If the SFA was to be split into a professional and a community game (which would be no bad thing), less than half of our "league" clubs would qualify for the entry to the "professional" game.
A "professional" club should be full-time, have if not an all-seater, certainly a clean, safe, covered stadium, proper youth development programmes and players who had a professional attitude to their job.
Even this basic and of necessity broad brush criteria for a professional club would rule out all but a minority of our so-called "league" clubs - but it will not happen. And it will not happen because of the way the SFA is set-up.
I spent a mind-boggling time today trying to make sense of the Byzantine internal politics of this body, it is chilling.
The day-to-day running of the SFA is currently, pending Stuart Regan being given out lbw at Yorkshire CCC, in the hands of George Peat and the Board of Directors, a board which sadly does not meet Tommy Docherty's criteria for the ideal board - three-strong, one dead and two dying.
The SFA "parliament" is the Council, which meets quarterly. This body is 35-strong - if you include those two living fossils, Jack McGinn and John McBeth, the last two presidents, neither of whom has any current affiliation with a club.
Only Aberdeen, Inverness Caledonian Thistle, Motherwell and St Mirren of the 12 SPL clubs are not represented on the SFA Council, while eight of the 30 SFL clubs have a man therein. But, only Rangers' Andrew Dickson, (or should that be Andrew Who?), Dundee United's Stephen Thompson and Kilmarnock's Michael Johnston are actually elected as SPL representatives.
Campbell Ogilvie is first vice president, but owes his position to his Heart of Midlothian affiliation; Celtic's Eric Riley represents the Glasgow FA (members: Celtic, Clyde, Glasgow University??, Partick Thistle, Queen's Park and Rangers); Hibs' Rod Petrie supposedly represents the 26 East of Scotland FA clubs, of whom just three, Hearts, Hibs and Berwick Rangers are "league" clubs; Steven Brown of St Johnstone represents the seven Forfarshire FA clubs and Hamilton Accies' Scott Struthers sits on behalf of the seven West of Scotland FA clubs (Albion Rovers, Ayr United, Hamilton, Kilmarnock, Motherwell, St Mirren and junior side Girvan).
It's much the same as regards the SFL clubs. Airdrie United's Jim Ballantyne, Ewen Cameron of Alloa Athletic and Lachlan Cameron of Ayr United are the three SFL reps, but East Fife's Derrick Brown, sits on behalf of the five Fife FA clubs (Cowdenbeath, Dunfermline, East Fife, Raith Rovers and Burntisland Shipyard??); SFA board member Richard Shaw of Annan Athletic sits on behalf of the 15 Southern Counties FA clubs, just three of which - his own, Queen of the South and Stranraer are "league" clubs; Falkirk's Martin Ritchie represents the six Stirlingshire FA clubs (Alloa, Dumbarton, East Stirlingshire, Falkirk, Stenhousemuir and Stirling Albion).
You have the East of Scotland League, represented by former referee Dr Andrew Waddell of Preston Athletic, Findlay Noble of Fraserburgh sitting on behalf of the Highland League clubs, while David Dowling of Clachnacuddin represents the North of Scotland FA's 13 clubs and Keith's Sandy Stables sits on behalf of the 12 Aberdeen & District FA Clubs (Aberdeen, nine Highland League clubs and two North Junior clubs) and Colin Holden the Threave Rovers chairman represents the dozen or so South of Scotland League clubs.
The Council is completed by the representatives of the affiliated associations: the Juniors, Amateurs, Scottish Welfare FA, Scottish Schools FA, Scottish Youth FA and the Scottish Women's FA, plus four "Regional Representatives", whose function they themselves would be hard-pushed to explain.
At a time when the full United Kingdom of Great Britain and Northern Ireland government is considering boundary changes to level-out the playing field of constituency sizes, so each MP is representing more or less the same number of constituents, how can the SFA justify a system whereby Eric Riley represents six clubs, Rod Petrie 26 and so on; each senior club has in effect two votes - one through the SPL or SFL representatives, another via their affiliated local FA, while the SJFA and the SAFA, the two organisations which represent respectively over 150 and 1500 community clubs have just two representatives on the SFA Council?
The whole system is slewed towards keeping power in the hand of a very few and democracy at bay. It's about getting as many snouts as possible into the feeding trough and for as long as two clubs' supporters bank-roll every other Scottish "league" club, the system will not change.
By the way, the make-up of the SFA Council disproves the old theory that these two clubs effectively run Scottish football. Ignoring Jack McGinn, Celtic's Riley and Rangers' Andrew Dickson are the only Old Firm men inside the Hampden corridors of power, and with every respect to the two men concerned - within their clubs they are hardly big hitters. They are just as body of the kirk in the SFA, Dickson sitting on the professional football and general purposes committees, Riley on the appeals committee.
I finish with a story told me by a now-retired freelance football writer, who was chuffed to bits to be elected as the Scottish Football Writers Association's representative onto the SFA's international match sub-committee, his remit, to ensure that the needs of the working press were met when it came to covering Scottish internationals.
He emerged from his first sub-committee meeting to announce: "They spent more time arguing about what type of wine to serve at the post-match banquet than about arrangements for the actual game".
I think that tale sums-up Scottish football and guys with that me-first attitude will never make the necessary changes.
It's going to be a long, hard, winter.
Top Universities in Portugal
Following are the top leading universities in Portugal:
University of Porto
- It is the largest education and research institution in Portugal.
- The University provides an exceptional variety of courses, covering the whole range of study areas and all levels of higher education.
- Ranked among the world's top 500 institutions in the Academic Ranking of World Universities (ARWU) 2009.
University of Porto
- It is the largest education and research institution in Portugal.
- The University provides an exceptional variety of courses, covering the whole range of study areas and all levels of higher education.
- Ranked among the world's top 500 institutions in the Academic Ranking of World Universities (ARWU) 2009.
Gordon Institute of Business Science
Founded in 2000, Gordon Institute of Business Science (GIBS) is a leading accredited business school based in Johannesburg, South Africa’s economic hub. It is the business school of the University of Pretoria. the School has been consistently rated as one of the top five business schools in South Africa by the Financial Mail.
The Gordon Institute of Business Science offers a wide range of
The Gordon Institute of Business Science offers a wide range of
Nursing Care Plan | NCP Uterine Cancer
Uterine cancer most commonly occurs in the endometrium, the mucous membrane that lines the inner surface of the uterus. Endometrial cancer, specifically adenocarcinoma (involving the glands), accounts for more than 95% of the diagnosed cases of uterine cancer. There has been an increase noted in the number of women with endometrial cancer, partly owing to women living longer and more accurate reporting. Endometrial cancer is the fourth most common cause of cancer in women, ranking behind breast, colorectal, and lung cancer. It is the most common neoplasm of the pelvic region and reproductive system of the female, and it occurs in 1 in 100 women in the United States. Other uterine tumors include adenocarcinoma with squamous metaplasia (previously referred to as adenoacanthoma), endometrial stromal sarcomas, and leiomyosarcomas.
Endometrial cancer can infiltrate the myometrium, thus resulting in an increased thickness of the uterine wall, and it can eventually infiltrate the serosa and move into the pelvic cavity and lymph nodes. It can also spread by direct extension along the endometrium into the cervical canal; pass through the fallopian tubes to the ovaries, broad ligaments, and peritoneal cavity; or move via the bloodstream and lymphatics to other areas of the body. It is a slow-growing cancer, taking 5 or more years to develop from hyperplasia to adenocarcinoma. Endometrial cancer is very responsive to treatment, provided it is detected early. Prognosis depends on the stage, uterine signs, and lymph node involvement. In 2005, 40,880 new cases of uterine cancer would be diagnosed and 7310 women would die in the United States.
The exact cause of uterine cancer is not known, although it is considered to be dependent on endogenous hormonal levels for growth. Risk factors associated with the development of uterine adenocarcinoma include age, genetic and familial factors, early menarche (before age 12), late menopause (after 52 years), hypertension, nulliparity, unopposed estrogen hormonal replacement therapy, pelvic irradiation, polycystic ovarian disease, obesity, and diabetes mellitus. Leiomyosarcomas are more common among African Americans.
Nursing care plan assessment and physical examination
Establish a history of risk factors. The major initial symptom of endometrial cancer occurring in 85% of women is abnormal, painless vaginal bleeding, either menometrorrhagia or postmenopausal. A mucoid and watery discharge may be noted several weeks to months before this bleeding. Postmenopausal women may report bleeding that began a year or more after menses stopped. A mucosanguineous, odorous vaginal discharge is noted if metastases to the vagina has occurred. Younger women may have spotting and prolonged, heavy menses. Inquire about pain, fever, and bowel/bladder dysfunction, which are late symptoms of uterine cancer. Assess the use and effectiveness of any analgesics for pain relief and also the location, onset, duration, and intensity of the pain.
Conduct a general physical and gynecologic examination. The woman should be directed to not douche or bathe for 24 hours before the examination so that tissue is not washed away. Inspection of any bleeding or vaginal discharge is imperative. The characteristics and amount of bleeding should be noted. Upon palpation, the uterus will feel enlarged and may reveal masses.
Women with the disease often exhibit depression and anger, especially if they are a nulligravida. Therefore, a thorough assessment of the woman’s perception of the disease process and her coping mechanisms is required. The family should also be included in the assessment to examine the extent of support they can provide for the patient. Family anger, ineffective coping, and role disturbances may interfere with family functioning and need careful monitoring.
Nursing care plan primary nursing diagnosis: Knowledge deficit related to treatment procedures, treatment regimens, medications, and disease process.
Nursing care plan intervention and treatment plan
If uterine cancer is detected early, the treatment of choice is surgery. A total abdominal hysterectomy (TAH) with removal of the fallopian tubes and ovaries, bilateral salpingo-oophrectomy (BSO) is generally performed. Common complications after a hysterectomy are hemorrhage, infection, and thromboembolitic disease. Premenopausal women who have a BSO become sterile and experience menopause. Hormone replacement therapy may be warranted and is appropriate. In a total pelvic exenteration (evisceration or removal of the contents of a cavity), the surgeon removes all pelvic organs, including the bladder, rectum, and vagina. This procedure is performed if the disease is contained in the areas without metastasis. If the lymph nodes are involved, this procedure is usually not curative.
Radiation therapy may also be given in combination with the surgery (before or after) or it may be used alone, depending on the staging of the disease, whether the tumor is not well differentiated, or whether the carcinoma is extensive. Radiation may be the treatment of choice for the very elderly woman with an advanced stage of endometrial cancer for whom surgery would not improve quality of life. With radiation, the possible complications are hemorrhage, cystitis, urethral stricture, rectal ulceration, or proctitis. Intracavity radiation or external radiation therapy may be given 6 weeks before surgery to limit recurrence or to improve the chance of survival. An internal radiation device may be implanted during surgery (preloaded) or at the patient’s bedside (afterloaded). If the device is inserted during the surgical procedure, the postoperative management needs to include radiation precautions. Provide a private room for the patient and follow the key principle to protect against radiation exposure: distance, time, and shielding. The greater the distance from the radiation source, the less exposure to ionizing rays. The less time spent providing care, the less radiation exposure. The source of radiation determines if lead shields are necessary to provide care. All healthcare workers coming in contact with a “hot” patient (a patient with an internal radiation implant) need to monitor their exposure with a monitoring device such as a film badge.
The major emphasis is prevention, either primary by reduction of risk factors or secondary by early detection. Encourage women to seek regular medical checkups, which should include gynecologic examination. Discuss risk factors associated with the development of endometrial cancer, particularly as they apply or do not apply to the particular woman. Encourage the older menopausal woman to continue with regular examinations. If the woman is bleeding heavily, monitor her closely for signs of dehydration and shock (dry mucous membranes, rapid and thready pulses, delayed capillary refill, restlessness, and mental status changes). Encourage her to drink liberal amounts of fluids, and have the equipment available for intravenous hydration if necessary. A balanced diet promotes wound healing and maintains good skin integrity.
Patients require careful instruction before radiation therapy or surgery. Explain the procedures carefully, and notify the patient what to expect after the procedure. For surgical candidates, teach coughing and deep-breathing exercises. Fit the patient with antiembolism stockings. If the patient is premenopausal, explain that removal of her ovaries induces menopause. Unless she undergoes a total pelvic exenteration, her vagina is intact and sexual intercourse remains possible. During external radiation therapy, the patient needs to know the expected side effects (diarrhea, skin irritation) and the importance of adequate rest and nutrition. Explain that she should not remove ink markings on the skin because they direct the location for radiation. If a preloaded radiation implant is used, the patient has a preoperative hospital stay that includes bowel preparation, douches, an indwelling urinary catheter, and diet restrictions the day before surgery.
If the woman has pain from either the surgical procedure or the disease process, teach her pain-relief techniques such as imagery and deep breathing. Encourage her to express her anger and feelings without fear of being judged. Note that surgery and radiation may profoundly affect the patient’s and partner’s sexuality. Answer any questions honestly, provide information on alternatives to traditional sexual intercourse if appropriate, and encourage the couple to seek
counseling if needed. If the woman’s support systems and coping mechanisms are insufficient to
meet her needs, help her find others. Provide a list of support groups that may be helpful.
Nursing care plan discharge and home health care guidelines
Teach the need for regular gynecologic examinations, even though she had a hysterectomy. Teach the patient to report any abnormal vaginal bleeding to the healthcare provider. The woman who has had a TAH with BSO is at risk for developing osteoporosis. Recommend a daily intake of up to 1500 mg of calcium through diet and supplements. Recommend vitamin D supplements to enable the body to use the calcium. Stress the need for regular exercise, particularly weight-bearing exercise. Discuss the exercise schedule and type with the patient in light of her treatment and expected recovery time.
Ensure that the patient understands the dosage, route, action, and side effects of any medication she is to take at home. Note that, to monitor her response, some of the medications require her to have routine laboratory tests following discharge from the hospital.
Discuss any incisional care. Encourage the patient to notify the surgeon for any unexpected wound discharge, bleeding, poor healing, or odor. Teach the patient to avoid heavy lifting, sexual intercourse, and driving until the surgeon recommends resumption.
To decrease bulk, teach the patient to maintain a diet high in protein and carbohydrates and low in residue. If diarrhea remains a problem, instruct the patient to notify the physician or clinic because antidiarrheal agents can be prescribed. Encourage the patient to limit her exposure to others with colds because radiation tends to decrease the ability to fight infections. To decrease skin irritation, encourage the patient to wear loose-fitting clothing and avoid using heating pads, rubbing alcohol, and irritating skin preparations.
Teach the patient appropriate self-care for her specific treatment. Teach the patient to be able to identify where she can obtain assistance should postoperative or posttreatment complications occur. Make sure that the significant others are aware of the expectations of a normal convalescence and whom to call should concerns arise.
Endometrial cancer can infiltrate the myometrium, thus resulting in an increased thickness of the uterine wall, and it can eventually infiltrate the serosa and move into the pelvic cavity and lymph nodes. It can also spread by direct extension along the endometrium into the cervical canal; pass through the fallopian tubes to the ovaries, broad ligaments, and peritoneal cavity; or move via the bloodstream and lymphatics to other areas of the body. It is a slow-growing cancer, taking 5 or more years to develop from hyperplasia to adenocarcinoma. Endometrial cancer is very responsive to treatment, provided it is detected early. Prognosis depends on the stage, uterine signs, and lymph node involvement. In 2005, 40,880 new cases of uterine cancer would be diagnosed and 7310 women would die in the United States.
The exact cause of uterine cancer is not known, although it is considered to be dependent on endogenous hormonal levels for growth. Risk factors associated with the development of uterine adenocarcinoma include age, genetic and familial factors, early menarche (before age 12), late menopause (after 52 years), hypertension, nulliparity, unopposed estrogen hormonal replacement therapy, pelvic irradiation, polycystic ovarian disease, obesity, and diabetes mellitus. Leiomyosarcomas are more common among African Americans.
Nursing care plan assessment and physical examination
Establish a history of risk factors. The major initial symptom of endometrial cancer occurring in 85% of women is abnormal, painless vaginal bleeding, either menometrorrhagia or postmenopausal. A mucoid and watery discharge may be noted several weeks to months before this bleeding. Postmenopausal women may report bleeding that began a year or more after menses stopped. A mucosanguineous, odorous vaginal discharge is noted if metastases to the vagina has occurred. Younger women may have spotting and prolonged, heavy menses. Inquire about pain, fever, and bowel/bladder dysfunction, which are late symptoms of uterine cancer. Assess the use and effectiveness of any analgesics for pain relief and also the location, onset, duration, and intensity of the pain.
Conduct a general physical and gynecologic examination. The woman should be directed to not douche or bathe for 24 hours before the examination so that tissue is not washed away. Inspection of any bleeding or vaginal discharge is imperative. The characteristics and amount of bleeding should be noted. Upon palpation, the uterus will feel enlarged and may reveal masses.
Women with the disease often exhibit depression and anger, especially if they are a nulligravida. Therefore, a thorough assessment of the woman’s perception of the disease process and her coping mechanisms is required. The family should also be included in the assessment to examine the extent of support they can provide for the patient. Family anger, ineffective coping, and role disturbances may interfere with family functioning and need careful monitoring.
Nursing care plan primary nursing diagnosis: Knowledge deficit related to treatment procedures, treatment regimens, medications, and disease process.
Nursing care plan intervention and treatment plan
If uterine cancer is detected early, the treatment of choice is surgery. A total abdominal hysterectomy (TAH) with removal of the fallopian tubes and ovaries, bilateral salpingo-oophrectomy (BSO) is generally performed. Common complications after a hysterectomy are hemorrhage, infection, and thromboembolitic disease. Premenopausal women who have a BSO become sterile and experience menopause. Hormone replacement therapy may be warranted and is appropriate. In a total pelvic exenteration (evisceration or removal of the contents of a cavity), the surgeon removes all pelvic organs, including the bladder, rectum, and vagina. This procedure is performed if the disease is contained in the areas without metastasis. If the lymph nodes are involved, this procedure is usually not curative.
Radiation therapy may also be given in combination with the surgery (before or after) or it may be used alone, depending on the staging of the disease, whether the tumor is not well differentiated, or whether the carcinoma is extensive. Radiation may be the treatment of choice for the very elderly woman with an advanced stage of endometrial cancer for whom surgery would not improve quality of life. With radiation, the possible complications are hemorrhage, cystitis, urethral stricture, rectal ulceration, or proctitis. Intracavity radiation or external radiation therapy may be given 6 weeks before surgery to limit recurrence or to improve the chance of survival. An internal radiation device may be implanted during surgery (preloaded) or at the patient’s bedside (afterloaded). If the device is inserted during the surgical procedure, the postoperative management needs to include radiation precautions. Provide a private room for the patient and follow the key principle to protect against radiation exposure: distance, time, and shielding. The greater the distance from the radiation source, the less exposure to ionizing rays. The less time spent providing care, the less radiation exposure. The source of radiation determines if lead shields are necessary to provide care. All healthcare workers coming in contact with a “hot” patient (a patient with an internal radiation implant) need to monitor their exposure with a monitoring device such as a film badge.
The major emphasis is prevention, either primary by reduction of risk factors or secondary by early detection. Encourage women to seek regular medical checkups, which should include gynecologic examination. Discuss risk factors associated with the development of endometrial cancer, particularly as they apply or do not apply to the particular woman. Encourage the older menopausal woman to continue with regular examinations. If the woman is bleeding heavily, monitor her closely for signs of dehydration and shock (dry mucous membranes, rapid and thready pulses, delayed capillary refill, restlessness, and mental status changes). Encourage her to drink liberal amounts of fluids, and have the equipment available for intravenous hydration if necessary. A balanced diet promotes wound healing and maintains good skin integrity.
Patients require careful instruction before radiation therapy or surgery. Explain the procedures carefully, and notify the patient what to expect after the procedure. For surgical candidates, teach coughing and deep-breathing exercises. Fit the patient with antiembolism stockings. If the patient is premenopausal, explain that removal of her ovaries induces menopause. Unless she undergoes a total pelvic exenteration, her vagina is intact and sexual intercourse remains possible. During external radiation therapy, the patient needs to know the expected side effects (diarrhea, skin irritation) and the importance of adequate rest and nutrition. Explain that she should not remove ink markings on the skin because they direct the location for radiation. If a preloaded radiation implant is used, the patient has a preoperative hospital stay that includes bowel preparation, douches, an indwelling urinary catheter, and diet restrictions the day before surgery.
If the woman has pain from either the surgical procedure or the disease process, teach her pain-relief techniques such as imagery and deep breathing. Encourage her to express her anger and feelings without fear of being judged. Note that surgery and radiation may profoundly affect the patient’s and partner’s sexuality. Answer any questions honestly, provide information on alternatives to traditional sexual intercourse if appropriate, and encourage the couple to seek
counseling if needed. If the woman’s support systems and coping mechanisms are insufficient to
meet her needs, help her find others. Provide a list of support groups that may be helpful.
Nursing care plan discharge and home health care guidelines
Teach the need for regular gynecologic examinations, even though she had a hysterectomy. Teach the patient to report any abnormal vaginal bleeding to the healthcare provider. The woman who has had a TAH with BSO is at risk for developing osteoporosis. Recommend a daily intake of up to 1500 mg of calcium through diet and supplements. Recommend vitamin D supplements to enable the body to use the calcium. Stress the need for regular exercise, particularly weight-bearing exercise. Discuss the exercise schedule and type with the patient in light of her treatment and expected recovery time.
Ensure that the patient understands the dosage, route, action, and side effects of any medication she is to take at home. Note that, to monitor her response, some of the medications require her to have routine laboratory tests following discharge from the hospital.
Discuss any incisional care. Encourage the patient to notify the surgeon for any unexpected wound discharge, bleeding, poor healing, or odor. Teach the patient to avoid heavy lifting, sexual intercourse, and driving until the surgeon recommends resumption.
To decrease bulk, teach the patient to maintain a diet high in protein and carbohydrates and low in residue. If diarrhea remains a problem, instruct the patient to notify the physician or clinic because antidiarrheal agents can be prescribed. Encourage the patient to limit her exposure to others with colds because radiation tends to decrease the ability to fight infections. To decrease skin irritation, encourage the patient to wear loose-fitting clothing and avoid using heating pads, rubbing alcohol, and irritating skin preparations.
Teach the patient appropriate self-care for her specific treatment. Teach the patient to be able to identify where she can obtain assistance should postoperative or posttreatment complications occur. Make sure that the significant others are aware of the expectations of a normal convalescence and whom to call should concerns arise.
Nursing Care Plan | NCP Urinary Tract Infection
Urinary tract infections (UTIs) are common and usually occur because of the entry of bacteria into the urinary tract at the urethra. Approximately 20% to 25% of women have a UTI sometime during their lifetime, and acute UTIs account for approximately 7 million healthcare visits per year for young women. About 20% of women who develop a UTI experience recurrences. Women are more prone to UTIs than men because of natural anatomic variations. The female urethra is only about 1 to 2 inches in length, whereas the male urethra is 7 to 8 inches long. The female urethra is also closer to the anus than is the male urethra, increasing women’s risk for fecal contamination. The motion during sexual intercourse also increases the female’s risk for infection.
Urinary reflux is one reason that bacteria spread in the urinary tract. Vesicourethral reflux occurs when pressure increases in the bladder from coughing or sneezing and pushes urine into the urethra. When pressure returns to normal, the urine moves back into the bladder, taking with it bacteria from the urethra. In vesicoureteral reflux, urine flows backward from the bladder into one or both of the ureters, carrying bacteria from the bladder to the ureters and widening the infection. If they are left untreated, UTIs can lead to chronic infections, pyelonephritis, and even systemic sepsis and septic shock. If infection reaches the kidneys, permanent renal damage can occur, which leads to acute and chronic renal failure.
The pathogen that accounts for about 90% of UTIs is Escherichia coli. Other organisms that are commonly found in the gastrointestinal tract and may contaminate the genitourinary tract include Enterobacter, Pseudomonas, group B beta-hemolytic streptococci, Proteus mirabilis, Klebsiella species, and Serratia. Two growing causes of UTI in the United States are Staphylococcus saprophyticus and Candida albicans. Predisposing factors are urethral damage from childbirth, catheterization, or surgery; decreased frequency of urination; other medical conditions such as diabetes mellitus; and in women, frequent sexual activity and some forms of contraceptives (poorly fitting diaphragms, use of spermicides).
Nursing care plan assessment and physical examination
The patient with a UTI has a variety of symptoms that range from mild to severe. The typical complaint is of one or more of the following: frequency, burning, urgency, nocturia, blood or pus in the urine, and suprapubic fullness. If the infection has progressed to the kidney, there may be flank pain (referred to as costovertebral tenderness) and low-grade fever.
Question the patient about risk factors, including recent catheterization of the urinary tract, pregnancy or recent childbirth, neurological problems, volume depletion, frequent sexual activity, and presence of a sexually transmitted infection (STI). Ask the patient to describe current sexual and birth control practices because poorly fitting diaphragms, the use of spermicides, and certain sexual practices such as anal intercourse place the patient at risk for a UTI.
Physical examination is often unremarkable in the patient with a UTI, although some patients have costovertebral angle tenderness in cases of pyelonephritis. On occasion, the patient has fever, chills, and signs of a systemic infection. Inspect the urine to determine its color, clarity, odor, and character. Surveillance for STIs is recommended as part of the examination.
UTIs rarely result in disruption of the patient’s normal activities. The infection is generally acute and responds rapidly to antibiotic therapy. The general guidelines to increase fluid intake and concomitant frequent urination may be problematic for some patients in restrictive work environments. The accompanying discomfort may result in temporary restriction of sexual activity, especially if an STI is diagnosed.
Nursing care plan primary nursing diagnosis: Altered urinary elimination related to infection.
Nursing care plan intervention and treatment plan
An acid-ash diet may be encouraged. A diet of meats, eggs, cheese, prunes, cranberries, plums, and whole grains can increase the acidity of the urine. Foods not allowed on this diet include carbonated beverages, anything containing baking soda or powder, fruits other than those previously stated, all vegetables except corn and lentil, and milk and milk products. Because the action of some UTI medications is diminished by acidic urine (nitrofurantoin), review all prescriptions before instructing patients to follow this diet.
UTIs are treated with antibiotics specific to the invading organism. Usually, a 7- to 10-day course of antibiotics is prescribed, but shortened and large single-dose regimens are currently under investigation. Most elderly patients need a full 7- to 10-day treatment, although caution is used in their management because of the possibility of diminished renal capacity. Women being treated with antibiotics may contract a vaginal yeast infection during therapy; review the signs and symptoms (cheesy discharge and perineal itching and swelling), and encourage the woman to purchase an over-the-counter antifungal or to contact her primary healthcare provider if treatment is indicated.
Encourage patients with infections to increase fluid intake to promote frequent urination, which minimizes stasis and mechanically flushes the lower urinary tract. Strategies to limit recurrence include increasing vitamin C intake, drinking cranberry juice, wiping from front to back after a bowel movement (women), regular emptying of the bladder, avoiding tub and bubble baths, wearing cotton underwear, and avoiding tight clothing such as jeans. These strategies have been beneficial for some patients, although there is no research that supports the efficacy of such practices.
Encourage the patient to take over-the-counter analgesics unless contraindicated for mild discomfort but to continue to take all antibiotics until the full course of treatment has been completed. If the patient experiences perineal discomfort, sitz baths or warm compresses to the perineum may increase comfort.
Nursing care plan discharge and home health care guidelines
Treatment of a UTI occurs in the outpatient setting. Teach the patient an understanding of the proposed therapy, including the medication name, dosage, route, and side effects. Explain the signs and symptoms of complications such as pyelonephritis and the need for follow-up before leaving the setting. Explain the importance of completing the entire course of antibiotics even if symptoms decrease or disappear. If the patient experiences gastrointestinal discomfort, encourage the patient to continue taking the medications but to take them with a meal or milk unless contraindicated. Warn the patient that drugs with phenazopyridine turn the urine orange.
Urinary reflux is one reason that bacteria spread in the urinary tract. Vesicourethral reflux occurs when pressure increases in the bladder from coughing or sneezing and pushes urine into the urethra. When pressure returns to normal, the urine moves back into the bladder, taking with it bacteria from the urethra. In vesicoureteral reflux, urine flows backward from the bladder into one or both of the ureters, carrying bacteria from the bladder to the ureters and widening the infection. If they are left untreated, UTIs can lead to chronic infections, pyelonephritis, and even systemic sepsis and septic shock. If infection reaches the kidneys, permanent renal damage can occur, which leads to acute and chronic renal failure.
The pathogen that accounts for about 90% of UTIs is Escherichia coli. Other organisms that are commonly found in the gastrointestinal tract and may contaminate the genitourinary tract include Enterobacter, Pseudomonas, group B beta-hemolytic streptococci, Proteus mirabilis, Klebsiella species, and Serratia. Two growing causes of UTI in the United States are Staphylococcus saprophyticus and Candida albicans. Predisposing factors are urethral damage from childbirth, catheterization, or surgery; decreased frequency of urination; other medical conditions such as diabetes mellitus; and in women, frequent sexual activity and some forms of contraceptives (poorly fitting diaphragms, use of spermicides).
Nursing care plan assessment and physical examination
The patient with a UTI has a variety of symptoms that range from mild to severe. The typical complaint is of one or more of the following: frequency, burning, urgency, nocturia, blood or pus in the urine, and suprapubic fullness. If the infection has progressed to the kidney, there may be flank pain (referred to as costovertebral tenderness) and low-grade fever.
Question the patient about risk factors, including recent catheterization of the urinary tract, pregnancy or recent childbirth, neurological problems, volume depletion, frequent sexual activity, and presence of a sexually transmitted infection (STI). Ask the patient to describe current sexual and birth control practices because poorly fitting diaphragms, the use of spermicides, and certain sexual practices such as anal intercourse place the patient at risk for a UTI.
Physical examination is often unremarkable in the patient with a UTI, although some patients have costovertebral angle tenderness in cases of pyelonephritis. On occasion, the patient has fever, chills, and signs of a systemic infection. Inspect the urine to determine its color, clarity, odor, and character. Surveillance for STIs is recommended as part of the examination.
UTIs rarely result in disruption of the patient’s normal activities. The infection is generally acute and responds rapidly to antibiotic therapy. The general guidelines to increase fluid intake and concomitant frequent urination may be problematic for some patients in restrictive work environments. The accompanying discomfort may result in temporary restriction of sexual activity, especially if an STI is diagnosed.
Nursing care plan primary nursing diagnosis: Altered urinary elimination related to infection.
Nursing care plan intervention and treatment plan
An acid-ash diet may be encouraged. A diet of meats, eggs, cheese, prunes, cranberries, plums, and whole grains can increase the acidity of the urine. Foods not allowed on this diet include carbonated beverages, anything containing baking soda or powder, fruits other than those previously stated, all vegetables except corn and lentil, and milk and milk products. Because the action of some UTI medications is diminished by acidic urine (nitrofurantoin), review all prescriptions before instructing patients to follow this diet.
UTIs are treated with antibiotics specific to the invading organism. Usually, a 7- to 10-day course of antibiotics is prescribed, but shortened and large single-dose regimens are currently under investigation. Most elderly patients need a full 7- to 10-day treatment, although caution is used in their management because of the possibility of diminished renal capacity. Women being treated with antibiotics may contract a vaginal yeast infection during therapy; review the signs and symptoms (cheesy discharge and perineal itching and swelling), and encourage the woman to purchase an over-the-counter antifungal or to contact her primary healthcare provider if treatment is indicated.
Encourage patients with infections to increase fluid intake to promote frequent urination, which minimizes stasis and mechanically flushes the lower urinary tract. Strategies to limit recurrence include increasing vitamin C intake, drinking cranberry juice, wiping from front to back after a bowel movement (women), regular emptying of the bladder, avoiding tub and bubble baths, wearing cotton underwear, and avoiding tight clothing such as jeans. These strategies have been beneficial for some patients, although there is no research that supports the efficacy of such practices.
Encourage the patient to take over-the-counter analgesics unless contraindicated for mild discomfort but to continue to take all antibiotics until the full course of treatment has been completed. If the patient experiences perineal discomfort, sitz baths or warm compresses to the perineum may increase comfort.
Nursing care plan discharge and home health care guidelines
Treatment of a UTI occurs in the outpatient setting. Teach the patient an understanding of the proposed therapy, including the medication name, dosage, route, and side effects. Explain the signs and symptoms of complications such as pyelonephritis and the need for follow-up before leaving the setting. Explain the importance of completing the entire course of antibiotics even if symptoms decrease or disappear. If the patient experiences gastrointestinal discomfort, encourage the patient to continue taking the medications but to take them with a meal or milk unless contraindicated. Warn the patient that drugs with phenazopyridine turn the urine orange.
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