Pelvic Inflammatory Disease Diagnosis And Management Nursing Essay

pelvic Inflammatory Disease Diagnosis And Management Nursing EssayPelvic inflammatory disease is an transmittance which causes wide variety of infection from upper to pull down genital tract.(1) It ascends from cervix or vagina to peritoneal cavity include endometritis, salpingitis, parametritis, oophoritis, tuboovarian abscess and pelvic peritonitis. (2,3) PID is a major problem in public health consequences because it is related to fallopian tube inflammation which can lead to infertility as a final complication.(1) PID is polymicrobial disease, so some sexually transmitted microorganisms are associated with PID. These are Chlamydia trachomatis, Mycoplasma genitalium, Neisseria gonorrhoea, and bacterial vaginosis, predominantly anaerobes. (4, 7) PID can be prevent by regular screening for Chlamydia infection and appropriate interference of it. (4) There is no single diagnosing or finding that can do specific diagnosis of PID. The diagnosis is based on the result of pelvic organ tenderness. Mild-to-moderate PID patients are treat as out patient which include tolerated antibiotic regimens against greens microorganism in PID clinically severe PID treatment done as hospitalization of the patient. (11) Sexually active women especially at the fruitful age and under the age of 25, are at the highest risk for acquiring this disease through sexually transmitted bacteria. The intrauterine devices (IUDs) are also increase risk in women who have this device in their uterus for contraception.(6)Pic The female anatomy (6)Differential diagnosisIn case of PID the clinician should caution about differential diagnosis before confirm the diagnosis.The differential diagnosis PID of can be as follows (3)Ectopic pregnancyEndometritisSalpingitis(8)Cervicitis (8)ovarian cyst torsion, rapture or malignancyUTIAppendicitisClinical Diagnosis of PIDClinical diagnosis of PID is based on the combination of patients clinical history, animal(prenominal) examination and some laboratory studies.(2,5)The following findings are important for diagnosis of PIDPhysical or general finding Low grade temperature, lower abdominal pain, abnormal intermenstrual bleeding or metrorrhagia, abnormal cervical discharge, postcoital pain and bleeding, urinary frequency, low back pain, nausea and vomiting.(5,8)Bimanual pelvic examination cervical and uterine motion tenderness or adnexal tenderness should present for confirming the diagnosis of PID.(10).Laboratory finding Leucocytosis more than 10 x 109 leukocyte/L , elevated C-reactive protein, elevated ESR, Gram negative intracellular diplococcic on gram stain, and positive Chlamydia test.(5)Some definitive diagnosis Endometrial biopsy for endometritis, transvaginal sonography or ultrasonography for pelvic or tubo-ovarian complex and the laparoscopic abnormalities associated with PID.(5)ManagementThe PID management include short term and long term treatment. Short term treatment help to reduce or eliminate the sign symptom of pati ents. On the other hand long term treatment help to decrease the gain complications.Outpatient therapy As aforementioned that mild-to-moderate PID patients are given treatment as out patient therapy (5)Recommended Regimenceftriaxone 250 mg im as one point + doxycycline 100 mg by word of mouth 12 hourly for 14 daysorAzithromycin 500 mg orally followed by 250 mg orallydaily for a total of 7 days+metronidazole 400 mg orally 12 hourly for 14 daysInpatient therapy Clinically severe PID treatment done as hospitalization of the patient. (11)Recommended Regimen(5)Clindamycin 900 mg intravenously every 8 hours for 14 daysPLUSCeftriaxone 1g intravenously every 12 hours for 14 daysAlternative Regimens(12)Cefoxitin 2 g intravenously every 6 hours for 14 daysORCefotetan 2 g intravenously every 12 hours for 14 daysPLUSDoxycycline 100 mg orally or intravenously every 12 for 14 dayshoursORAmpicillin/sulbactam 3 g intravenously every 6 hours for 14 daysPLUSDoxycycline 100 mg orally or intravenous ly every 12hours for 14 daysIndications for hospitalisationIf the patients are required intravenous therapy for serious clinical condition, then patient should be hospitalised. The following patients should be hospitalised, clinically severe patients, pregnant woman with PID, surgical emergency such as appendicitis, ectopic pregnancy, failure of out patient therapy and immunodeficiency patient. (5) removal of IUCDThe intrauterine devices (IUDs) increased the risk of PID. So IUCD should remove if there is any clinical evidence of PID.(6)Complication of PIDDelay in diagnosis and treatment, or inadequate treatment increase the rate of complications.(13)The complications are (13)Chronic lower abdominal painEctopic pregnancyIncreased risk of PID in futureTubo-ovarian abscess.InfertilityThe points should known to patients (5)It can be acquired other than sexually transmitted and the partners also should be tested and treated for sexually transmitted infections. The reputation of infectio n and complication should be known to patients and they should know the importance of follow up.Contact tracingContact tracing is finding and notifying the person with the infection so they can have counselling, testing and treatment and it is important for saloon the long term health problem.(9)Follow-upClose follow up is necessary for prevention of complications.(5)PreventionPrevention of STD is necessary to prevent PID. So early detection of any lower genital infections is necessary to prevent PID. (14) Cervical Chlamydial infection identification and treating can make smaller the incidence number of PID. (4) Finally, sex partners of women with PID should be examined and treated for gonococcal and Chlamydial infection for prevention the spread of STDs in the community.(14)