Timby/Smith: Introductory Medical-Surgical Nursing, 9/e

Transcription

1 Timby/Smith: Introductory Medical-Surgical Nursing, 9/e Chapter 62: Caring for Clients With Sexually Transmitted Diseases Slide 1 Epidemiology Introduction Study of the occurrence, distribution, and causes of human diseases Role of Centers for Disease Control and Prevention (CDC): Gathers statistics Reportable diseases Diseases not reportable by law: Genital herpes; hepatitis B; venereal warts Women acquire STDs more often than men Slide 2 Epidemiology Assessment Obtain a sexual history Ask questions nonjudgmentally Treatment includes Curing disease Education and counseling Screening; counseling; treating the sexual partner(s) Slide 3 1

2 Diseases: Chlamydia Pathophysiology and Etiology Chlamydia trachomatis Spread by: Sexual intercourse; genital contact without penetration Transmission to infant during birth Autoinoculation: Ophthalmic infections Increased risk for other STDs Sterility in women Slide 4 Diseases: Chlamydia Sparse, clear urethral discharge; redness and irritation of infected tissue Burning on urination Women: Lower abdominal pain Men: Testicular pain Microscopic examination; culture of secretions Concurrent infections Medical Management Antimicrobial drugs Slide 5 Diseases: Chlamydia Obtain sexual history Assist in specimen collection Physical examination Follow precautions to prevent infection transmission Client teaching Treatment Preventing reinfection Slide 6 2

3 Diseases: Gonorrhea Pathophysiology and Etiology Neisseria gonorrhoeae Facilitates HIV transmission Signs and symptoms Men: Urethritis with purulent discharge; pain on urination Women: White or yellow vaginal discharge; intermenstrual bleeding; painful urination Skin rash; fever; painful joints Slide 7 Diseases: Gonorrhea Diagnostic findings Microscopic or culture tests Medical Management Resistant to penicillin; tetracyclines Drug therapy CDC recommendations Complicated gonococcal infections Hospitalization IV multiple-drug therapy; repeat antibiotic therapy Slide 8 Diseases: Gonorrhea Similar to that of chlamydia Culture collection Moisten speculum with water Lubrication may destroy the gonococci and cause inaccurate test results Slide 9 3

4 Pathophysiology and Etiology Treponema pallidum Three distinct stages Transmission from blood of infected person Directly from lesion Across the placenta to an unborn infant Figure 62-1 Syphilitic chancres Slide 10 Signs and symptoms Primary Genital; anal; cervical chancre Secondary Fever; malaise; rash; headache; sore throat; lymph node enlargement Tertiary Tabes dorsalis; ataxia; Charcot s joints; cardiovascular complications Slide 11 Latent Stage: Asymptomatic for 2 or more years after initial infection Can extend for rest of life Approx. 1/3 continue to last stage Tertiary Stage: Invasion of CNS and other body organs. *Not infectious Occurs 3-15 years after initial infection Neuropathic joint disease (Charcet s joints) Granulomatous lesions (gummas) Tabes dorsalis Mental illness and dementias Slide 12 4

5 Diagnostic findings Microscopic examination of chancre VDRL test; rapid plasma reagin FTA-ABS test; CSF examination Medical Management Antibiotic therapy Penicillin G-IM; tetracycline; doxycycline Follow-up examinations and laboratory tests Slide 13 Collect history: Health; allergy; sexual Provide emotional support Client preparation: Diagnostic tests Inform client: Case finding is reported to the public health department Client teaching: Treatment; prevention; reinfection Slide 14 Diseases: Herpes Infection Pathophysiology and Etiology HSV 2: Genital; perineal lesions HSV-1: Cold sores; anogenital lesions Transmission: Direct or sexual contact; autoinoculation Single or multiple vesicles on penis, prepuce, buttocks, thighs, introitus, and cervix Lesions; ulcers; swelling of inguinal lymph nodes; flu-like symptoms; headache Slide 15 5

6 Diseases: Herpes Infection Inspection of lesions Microscopic examination Medical Management Self-limiting infection Treatment may be unnecessary Antiviral drug therapy Figure 62-2 Herpes genitalis lesions Slide 16 Diseases: Herpes Infection Collect health and sexual data Assist in specimen collection; physical examination Use of standard precautions Client teaching Treatment; prevention of reinfection Inform all potential sexual partners Use condom; lesions care; bathing Clothing; hygiene; follow-up treatment Stress management Slide 17 Diseases: Venereal Warts Pathophysiology and Etiology Human papillomavirus (HPV) Transmission: Genital genital, genital anal, or genital oral contact; autoinoculation Uterine cervical abnormalities Painless Appearance: Single lesion; cluster of soft, fleshy growths on genitalia, on cervix, in vagina, on perineum, in anus, in throat, or on mouth; resemble a cauliflower Slide 18 6

7 Diseases: Venereal Warts Application of vinegar; visual inspection Figure 62-3 Venereal warts Slide 19 Diseases: Venereal Warts Medical and Surgical Management Self application of Podofilox (Condylox) solution or gel Imiquimod (Aldara) cream Application of chemicals: Podophyllum Surgical excision; laser therapy; electrocautery; cryosurgery Parenteral administration of natural or recombinant interferon Slide 20 Diseases: Venereal Warts Client history: Health and sexual history Client preparation: Medical examination; diagnosis; treatment Client teaching Avoid intimate contact Treatment; condom use; stress; genital trauma; yearly examination Provide information in future health histories Slide 21 7

8 Other Sexually Transmitted Diseases Granuloma Inguinale Calymmatobacterium granulomatis Characterized by lesions in Genital areas Inguinal areas Anal areas Treatment Antimicrobials Slide 22 Other Sexually Transmitted Diseases Chancroid Haemophilus ducreyi bacillus Characterized by Macule Vesicle pustule formation Painful genital ulcer Enlarged, tender lymph nodes in inguinal area Treatment Azithromycin; ceftriaxone Ciprofloxacin; erythromycin Slide 23 Other Sexually Transmitted Diseases Lymphogranuloma Venereum C. trachomatis Characterized by Small erosion or papule Enlargement of adjacent lymph nodes Usual site of infection Genital area Treatment Doxycycline or erythromycin Slide 24 8

9 General Pharmacologic Considerations General Pharmacologic Considerations Obtain an allergy history Client teaching Prescribed drug regimen; effects; side effects; contraindications Contraindicated during pregnancy Doxycycline Azithromycin Monitor clients for allergic reaction Slide 25 General Gerontologic Considerations General Gerontologic Considerations Obtain history: Health; sexual Abandon bias: Older adults and sexuality; same risks of acquiring STD if sexually active Syphilis causes approximately 10% of cases of heart disease in those older than 50 years of age Client teaching: STD transmission; treatment; prevention; follow-up examination or tests Slide 26 End of Presentation Slide 27 9