Question

M. S., a 23-year-old unmarried female, has a recent history of gonorrhea. For the past two weeks, she has had a heavy, purulent discharge and general malaise. Concerned that her symptoms appear to be worsening, M. S. made an appointment at the gynecologic clinic. The clinic physician palpated her abdomen and did an  examination. M. S. experienced lower abdominal pain and tenderness, which was increased during the pelvic examination. Cultures were taken on the material removed from the vagina and cervix. A diagnosis of acute PID was made based on the data gathered. It was decided that M. S. should be admitted to the hospital so that maximum doses of antibiotics could be administered and the course of her infection followed more closely.

1. What route does the gonococcus take in the development of PID?
2. What are the clinical manifestations of acute PID?
3. How would M. S.’s infection be managed if it were decided to treat her as an outpatient? What instructions should she receive? Include medications.
4. How does chronic PID compare with acute PID?
5. What are the possible complications of PID that M. S. could develop?
6. Identify 3 nursing diagnoses, short term and long term goals and expected outcomes for M.S.

Answer 1

Gonococcus enters through external genital route i.e. Through vaginaa and it is one of eg of sexually transmitted disseises .

Clinical features are as following

• Pain - it scan be from mild to severe , presenting in lower abdomen and pelvis.
• Abnormal or heavy vaginal discharge that may have an unpleasant odor.
• Abnormal uterine bleeding, especially during or after intercourse, or between menstrual cycles.

Outpatient treatment would be as following;

• Ceftriaxone 250 mg IM in a single dose on first visit diagnosis and following medication to be taken at home.
• Doxycycline 100 mg orally twice a day for 14 days.
• Metronidazole 500 mg orally twice a day for 14 days.

What instructions ;

• To msintsin personal genitsl hygiene
• To avoid intercourse
• To watch and measure fever if any
• If have severe bleeding, pain or multiple fever than to consult immediately for inpatkent admission for IV Antibiotics

Chronic PID Vs ACUTE PID

Acute PID is when there is sudden or severe inflammation of the uterus, fallopian tubes, ovaries and pelvic area due to infection.

Sometimes the inflammation can persist for a long time and this is known as chronic pelvic inflammatory disease .

COMPLICATIONS are as below;

• Ectopic pregnancy. PID is a major cause of tubal (ectopic) pregnancy.
• Infertility. Damage to your reproductive organs may cause infertility i.e. inability to become pregnant.
• Chronic pelvic pain. Pelvic inflammatory disease can cause pelvic pain that might last for months or years.
• Tubo-ovarian abscess.