STDs+PID=Salpingitis

Salpingitis is one of the complications caused by Pelvic Inflammatory Disease, a sexually transmitted infection whereby the causative agent, usually a Gonococcus or Chlamydial infection, ascends upwards throughout the female genital tract, starting in the vagina and spreading to the superior structures of the uterus, fallopian tubes, and ovaries. The resulting inflammation usually causes severe abdominopelvic pain and tenderness, with accompanying fever and vaginal discharge (Kumar, 2010).

Although Pelvic Inflammatory Disease is a treatable condition, the infection has the potential to produce long-term structural defects, that could cause infertility (Gibson, 1999). In the attempt to fight off the infection by the body’s immune response, many histological changes may result from the process, leading to scar tissue formation in place of normal endometrial tissue. In the organs where optimal functioning of the structures is essential for successful reproductivity, alterations resulting from cellular tissue repair may impede the ability for normal ovulation processes to occur. Some of the dysfunctions are the result of scarring of the tubes, and tuboovarian abscesses that permanently occlude the fallopian tube, inhibiting the passing of the ovum for fertilization (Bozoyan, 2006). Furthermore, the inflammation to the adnexa significantly increases the risk of ectopic pregnancies due to the resulting damages in tissue function induced by the infection and immune responses (Gibson, 1999).  In addition, acute salpingitis is often undiagnosed, or seen in later stages, due to a slow progression of symptoms that may be only mildly experienced.  When symptoms present as severe enough to seek treatment, the infection has often progressed to encompass the majority of the reproductive organs, and significant structural damage may have already occurred (Gibson, 1999).

As healthcare professionals, it is imperative to initiate aggressive treatment to eliminate the inflammation as soon as possible in order to prevent further damage and complications. Furthermore, early education on healthy and safe sexual practices should be initiated whenever possible to enhance understanding, and  prevent incidences of sexually transmitted infections.

References:

Bozoyan, M., (2006). Pelvic inflammatory disease; Sexually transmitted infections.

Armenian Medical Network. Retrieved from http://www.health.am/sex/more/pelvic_inflammatory_disease/

Gibson, M. (1999). Pelvic inflammatory disease: chronic sequelae of salpingitis.

Contemporary OB/GYN, 44(8) 123

Kumar, V. (2010).  The female genital tract. Robbins and Cotran; Pathologic basis of disease, pp 1009-1010. Philadelphia: Elsevier.

Traumatized: post-partum post traumatic stress disorder

The study that was conducted in this article was to recognize the prevalence of post traumatic stress disorder in post partum women. It is understood that in a period of about 4-6 months after childbirth, women may begin to experience symptoms of depression, that is linked with the hormonal and drastic environmental changes associated with bringing home a new baby. Recent research has questioned however, whether it is not only depression that these women are developing, but possible a form of post traumatic stress disorder following events involved during childbirth. This study looks to support this theory. Symptoms that are characteristic of PTSD are “persistent re-experiencing of the event, avoidance of stimuli associated with the traumatic event, numbing of general responsiveness and symptoms of increased arousal” (American Psychiatric Association, 1994). It has been seen that many women have had these symptoms following childbirth. The sample used was 102 women that anonymously completed and returned a questionnaire regarding the history and events of childbirth, as well as their current feelings and experiences on the topic. The method used to obtain the data was comparing the information given on the perinatal post-traumatic stress disorder questionnaire, to a screening of several evaluation tools: a history of traumatic events, a post traumatic stress disorder check list, a postnatal depression questionnaire, and a questionnaire on the perceptions of labor and delivery. What was found was that there were a significant number of differences in the results of women that experienced symptoms of PTSD and their childbirth experience. These women reported higher levels of distress during labor, with a greater fear of losing control and not being prepared, as well as higher levels of interventions by the obstetrician. Interestingly, there was no specific correlation with women experiencing PTSD symptoms and who had previously experienced a traumatic event. This article is very pertinent to nursing in labor and delivery, because as the nurses, we are supposed to be the rock that the woman can depend on as a source of support during childbirth. This study shows that labor is a very big experience to a woman, and without appropriate support and interventions, it is possible that women could suffer a range of psychological responses. This article also suggests the high rate of undetected PTSD in women, because it is not an expected finding. Reading this article, there are ways provided to detect PTSD in women, so it is not mistaken for postpartum depression, and does not go undetected, so that we can treat and help these women to the full capacity. References American Psychiatric Association (1987 and 1994). Diagnostic and statistical manual for mental disorders (3rd and 4th edns). Washington, DC: American Psychiatric Association. Leeds L, Hargreaves I; The psychological consequences of childbirth, Journal of reproductive and infant psychology (2008) 26(2): 108-22

Nursing School 101: Bed Baths

Previously in nursing history, performing bed baths on patients was a trivial, time-consuming task that not only has been seen to be cost inefficient due to the amount of time taken to prepare and perform the bed bath, but also poses several risks to the skin integrity of the patient in a number of circumstances, due to cross-contamination, drying out of skin from soap, and removal of critical natural substances essential to maintaining skin integrity. There have been many attempts to improve the effectiveness of the bed bath, in the form of inventions such as using soaked wash cloths, and various types of bath mitts, (U.S. Patent) that have decreased time consumption of the bed bath, but still posed challenges when maintaining skin integrity of the client. It wasn’t until 1995, that a team of nurses addressed each individual problem of the bed bath, and came up with a solution that not only decreased the workload for nurses, and improves cost effectiveness, but allows for cleansing and removal of dirt without drying of the skin or sacrificing the skin’s natural defenses.

A recent study in Japan showed that the workload of nursing care centers its highest percentage of time and cost in giving complete and partial bed baths. This survey, conducted using Conjoint Analysis, wanted to measure the value of hospital care and make an effort to estimate where the majority of the workload of nurses was being placed throughout daily tasks. The results were listed as bed baths holding the greatest workload, followed by giving intravenous medications in second, and assessing vital signs in third. In regards to cost, the survey concluded that, with the assumption that the average salary of a registered nurse in Japan was 25 thousand yen, a complete bed bath served a value of approximately 93.38 yen for a single unit (Anezaki, Aso, & Ohkusa, 2006). For a nurse that performs bed baths to several patients daily, it decreases the amount of time the nurse has to commit to more effective measures of care, such as administering medications on time, and adhering to the needs of more critical patients.

More importantly than the time consumed by the nurse in preparing and performing bed baths, is the lack in the overall quality of care a bed bath is really providing to the patients. Ideally, a bed bath would consist of numerous washcloths and water changes to prevent cross-contamination in different areas of the body being washed (Burke, 2002). In reality, there serves no time to complete such tasks, and the same water and washcloth is used to service the entire body. Because the skin is the body’s primary line of defense against the outside world, maintaining proper skin integrity is essential to many patients recovering in the hospital. The use of different kinds of soaps causes dryness to the skin of many individuals, especially the elderly, whose skin is at highest risk for breakdown due to a decrease in moisture and elasticity in the skin. These soaps also remove some of the essential acids and salts of the skin that help prevent growth of harmful bacteria (U.S. Patent). In an effort to decrease costs, washcloths that are used are of poor quality, and are coarse and harsh to the skin, increasing friction while cleaning. In combination with the skin drying action of the soap, the risk of skin breakdown increases dramatically, putting patients at higher risk of developing pressure ulcers and skin infections (U.S. Patent).

In attempts to improve washcloth quality by making softer texture cloths, there was a deficit in the ability to remove dirt and the cloths often would disintegrate after getting wet. Some of the solutions used as a substitute for soap did not prove to be effective in eliminating bacteria, nor did they leave the natural acid mantle of the skin intact (U.S. Patent). The solution of one problem often led to the deficit of another critical factor in developing a product that would not only be cost efficient and less time consuming for the nurse, but that would provide critically important quality of care to the patient’s skin in cleansing with effectiveness to reduce growth and transmission of bacterial organisms, and also provide safety to the integrity of the skin to prevent dryness and breakdown. Even better would be a way to produce bulk quantities of the product for efficient storage while maintaining proper sterile technique. Developing a product with all of these crucial characteristics seems impossible without sacrifice in another area. Originally thought up by Susan M. Skewes, RN, using a set of soft wash cloths soaked in cleanser and placed in sealed plastic bags until use, the “Bag Bath” took on a series of experiments, alterations and improvements to create the ultimate bathing tool (Skewes, 1994). After formulating this product, the question was if it was actually more efficient than the traditional bed bath. A study consisting of 30 patients and 21 nurses took place using the “Bag Bath” products, and a survey sought out questions to determine the level of satisfaction with the bathing technique. Overall, the survey showed that 81% of the nurses “stongly agreed” that the bag bath saved them a significant amount of time in bathing patients. The study showed that the average time to give the bed bath using the product was approximately 12 minutes (Skewes, 1994), compared to traditional bed baths requiring 20 minutes or more (Burke, 2002). Amongst other findings were the patient satisfaction rates. Skewes reports her findings in her article “No more bed baths” where approximately 80% of the patients strongly agreed that they felt cleaner, and their skin felt softer after receiving the ‘bag bath’. More importantly, nearly all the patients that received this bathing technique from admission to discharge had no findings of skin integrity break down or impairment, and those that had breakdown before use of the bag bath actually had improved skin integrity by discharge (Skewes, 1994).

Shortly after her debut with the “Bag Bath,” Skewes teamed up with fellow nurses and engineers John P. Martin, and Russell Raddatz to finding a more impressible form of the bag bath. After many long months of research and testing, the inventors finally developed the ideal product to performing the bed bath efficiently and cost friendly. The product, titled Cleanser-Impregnated Cloths for Cleansing the skin, was formulated with the idea of maintaining sterility until use, being kept in a sealed polyethylene bag for safe storage. The bags consist of a various number of disposable cloths in quantities of 2, 4, 6, 8, and 10 cloths, for a variety of complete, partial, pediatric, and facial cleansing techniques, that allows for disposal of each cloth after being used in a certain area. This technique prevents cross-contamination of the body parts, and risk of infections in greatly reduced. Each cloth consists of cotton and polyester fabrics, woven together with needle puncture to ensure the softness of the fabric, and maintaining the integrity of cloth. Each cloth is damp with a cleansing solution that does not need to be, and should not be rinsed from the skin. The solution will evaporate, leaving behind remnants of vitamin E and therapeutic skin formulas to render the skin feeling fresh and soft. Because the product is able to store indefinitely if unopened, it can be bought wholesale in large quantities to reduce cost. Because the cloths are disposable, and require almost no time for preparation, the workload is significantly reduced, and the nurses and patients are much happier with the use of the product in comparison to the traditional bed bath (U.S. Patent)

 

Anezaki, H., Aso, Y., & Ohkusa, Y. (2006). Evaluation of Nursing Care—Using

conjoint analysis. Journal of Japan ,Academy of Nursing Science 26(4): 102-109.

 

Burke, A. (2002). Personal Care II. Nursing Assistant Education. From

http://www.nursingassistanteducation.com/site/courses/eng/nae-pc2-eng.php

 

Skewes, S. (1994). No more bed baths! RN Magazine 57: pp 34