Final Exam - Ch. 28 Flashcards
Urinary tract infections are infections that occur anywhere between what structures?
The kidneys and urethra
What is the most common form of UTI and where it is located?
Cystitis - the bladder
What are the symptoms of a UTI?
Urinary frequency, urinary urgency, a sensation of incomplete emptying, pain and burning with urination, and sometimes hematuria.
What is hematuria?
Blood in the urine.
What values do you look at to check for a UTI?
Urinalysis may be used to assess for UTI’s - look at leukocytes, nitrates, and blood values.
What is the most definitive test for UTI?
Urine culture = must be done in a lab. Dipstick and clean catch for lab.
In pregnancy, what can a UTI cause?
Preterm labor.
T/F: UTI’s often resolve on their own.
True
What are the two medications used to treat UTI’s?
Antibiotics and phenazopyridine
What does phenazopyridine do?
OTC urinary analgesic for symptom management (pain and stinging).
Why should someone not take phenazopyridine for more than 2 days?
It will mask the symptoms of a UTI.
What is Pyelonephritis?
A UTI that has ascended into the kidneys (AKA kidney infection).
What are the S/S of pyelonephritis?
Cystitis S/S plus (Urinary frequency, urinary urgency, a sensation of incomplete emptying, pain and burning with urination, and sometimes hematuria) plus fever, chills, flu-like symptoms, and back pain.
How is pyelonephritis diagnosed?
Diagnosed by urine culture to ensure that the right antibiotic is prescribed to avoid long-term consequences.
What are the antibiotics used to treat pyelonephritis?
Ciprofloxacin and levofloxacin
If symptoms of pyelonephritis don’t improve in 2-3 days, what should happen?
Another antibiotic might be in order.
What is vaginosis?
Vaginosis refers to any abnormality of vaginal discharge
What is bacterial vaginosis?
Bacterial vaginosis (BV) is abnormal discharge from the vagina that is caused by bacteria.
What level of pH is bacterial vaginosis associated with?
Associated with higher-than-normal pH in the vagina that allows certain bacteria to become dominant.
How is bacterial vaginosis transmitted?
Not sexually transmitted but is sexually associated.
S/S of bacterial vaginosis
Fishy vaginal odor
Thin white/gray vaginal discharge
After invasive procedure like D&C, what is vaginosis associated with?
Infection
In pregnancy, what is vaginosis associated with?
In pregnancy, associated with preterm labor
T/F: Vaginosis never resolves spontaneously.
False. It often resolves spontaneously
With what medication is bacterial vaginosis treated?
Metronidazole oral or vaginal cream.
What is vaginitis?
Vaginitis means inflammation of the mucosa of the vagina.
What is a yeast infection called?
Candida vulvovaginitis
What is the most common cause of a yeast infection?
Candida vulvovaginitis
What condition is associated with some antibiotics, restrictive clothing, underwear made with artificial fibers, and diabetes (high levels of glucose).
Candida vulvovaginitis
What conditions are associated with candida vulvavaginitis?
Some antibiotics, restrictive clothing especially made with artificial fibers, and high levels of blood glucose (diabetes).
If a patient presents with recurrent candida vulvovaginitis, what should they be tested for?
Diabetes
What is pruritis?
Itchy skin
Symptoms of dandida vuvovaginitis?
Pruritis, thick, cottage cheese-like vaginal discharge or acute vaginal dryness.
Pruritis, thick, cottage cheese-like vaginal discharge or acute vaginal dryness are associated with what condition?
Candida vulvovaginitis
How is candida vulvovaginitis treated?
May be treated with OTC medications or fluconazole.
What is flucanazole used to treat?
Candida vulvovaginitis.
What is trichomoniasis?
Trichomoniasis is a sexually transmitted form of vaginitis caused by Trichomonas vaginalis (protozoan parasite).
T/F: Trichomoniasis is not sexually transmitted.
False. Trichomoniasis is sexually transmitted.
T/F: Trichomoniasis is caused by a parasite.
True.
Trichomoniasis is a form of vaginitis of vaginosis?
Vaginitis
What is the most common non-viral STI?
Trichomoniasis.
What is the treatment for trichomoniasis?
Treatment: a single dose of metronidazole
What is a distinguishing feature of trichomoniasis?
Strawberry cervix
Which condition presents with strawberry cervix?
Trichomoniasis
What is dyspareunia?
Genital pain that can be experienced before, during, or after intercourse.
What is genital pain that is experienced before, during and after intercourse?
Dyspareunia.
Thin or thick, slippery, sticky, white or clear discharge are an indication of what condition?
Normal vaginal discharge.
Acute pruritus, vulvar swelling, dyspareunia and soreness are indications of what condition?
Candida
Sparse, white, clumpy and adherent discharge is an indication of what condition?
Candida
Mil irritation and fishy smelling discharge are symptoms of what condition?
Bacterial vaginosis
This white or gray discharge is an indication of what condition?
Bacterial vaginosis
Dyspareunia, dysuria, copious fishy discharge and burning are symptoms of what condition?
Trichomoniasis
Volvovaginal erythema, yellow or green frothy discharge and strawberry cervix are symptoms of what condition?
Trichomoniasis
What is Volvovaginal erythema?
Redness of the vulva and vagina
Examination findings of trichomoniasis.
Vulvovaginal erythema, yellow or green frothy discharge, strawberry cervix.
Examination findings of bacterial vaginosis
Thin, white or gray discharge, mild irritation and fishy smelling discharge
Examination findings of candida.
Acute pruritus, vulvar swelling, dyspareunia and soreness with sparse or white, clumpy and adherent discharge.
What two vaginitis conditions present with dyspareunia?
Candida and trichomoniasis.
Which two vaginosis/vaginitis conditions present with a fishy smell?
Bacterial vaginosis and trichomoniasis.
What is the most commonly diagnosed bacterial STI?
Chlamydia
T/F: Chlamydia is often asymptomatic.
True. Men might experience urethritis and women might experience cervicitis.
T/F: Chlamydia is often asymptomatic.
True
What can Chlamydia cause in pregnancy?
Infertility and ectopic pregnancy
How does Chlamydia cause infertility and ectopic pregnancy?
Chlamydia causes inflammation of the fallopian tubes, ovaries and endometrium, resulting in scarring.
How is chlamydia diagnosed?
Urinalysis or swab sampling
What are the treatments for chlamydia?
Azithromycin or doxycycline
Which STI should be retested after 3 months of testing?
Chlamydia
in trichomoniasis and chlamydia, sexual partners should also be what?
Tested.
What is the 2nd most prevalent STI in the US?
Gonorrhea
T/F: Unlike chlamydia, gonorrhea can also be asymptomatic.
False, Chlamydia can also be asymptomatic.
What conditions can gonorrhea cause to women?
May cause infertility, ectopic pregnancy, PID and pelvic pain.
Some strains of this STI are antibiotic-resistant.
Gonorrhea
What antibiotics are used to treat gonorrhea?
Ceftriaxone and azithromycin
Rates of what STI have been on the rise since 2000.
Syphilis
Which STI is identified by 4 stages
Syphilis
How does primary syphilis present?
Single, painless chancre –or- multiple or uncomfortable lesions that resolve in ~6 weeks.
How does the secondary stage of syphilis present?
Generalized flu-like symptoms (fever, headache, malaise), individual may have a rash on trunk, palms of hands/feet.
What is the latent stage of syphilis?
Asymptomatic period that may last for years.
What is the tertiary stage of syphilus?
Cardiovasular, neurologic & gummatous manifestations (purple pic - necrotic tissue more in liver, bone and can’t see on outside). May affect multiple organ systems including brain, nerves, and joints.
What are the four stages of syphilis?
Primary
Secondary
Latent
Tertiary
What are the qualities of the four stages of syphilis?
Primary: May present as single, painless chancre –or- multiple or uncomfortable lesions that resolve in ~6 weeks (onset w/in 3-90 post-infection)
Secondary: Generalized flu-like symptoms (fever, HA, malaise), individual may have a rash on trunk, palms of hands/feet
Latent: Asymptomatic period that may last for years.
Tertiary: CV (cardio), neurologic & gummatous manifestations (purple pic - necrotic tissue more in liver, bone and can’t see on outside). May affect multiple organ systems including brain, nerves, and joints.
What STI has four stages?
Syphilus
What STI has the following stages? Primary, secondary, latent and tertiary?
Syphilis
What is the treatment for syphilis?
Penicillan
Two types of herpes viruses
HSV1 – most commonly associated with cold sores
HSV2 – most commonly associated with genital lesions
Which herpes virus is associated with cold sores?
HSV1 – most commonly associated with cold sores
What herpes virus is associated with genital lesions?
HSV2 – most commonly associated with genital lesions
T/F: Only one herpes virus can be present on any mucosa at one time.
False, either virus can be present on any mucosa.
How is the herpes virus transmitted?
Transmitted by skin-to-skin contact, usually of the mucosa.
T/F: The herpes virus is highly contagious
False: The virus is usually dormant & not contagious.
T/F: A person is only contagious during an outbreak.
False: An individual is contagious just prior to, during, and after an outbreak.
What is the difference between a primary and secondary herpes outbreak?
Primary infections may be asymptomatic or may include a painful vesicular rash and skin erosions, fever, headache, and dysuria.
Secondary may be less acute and more likely to be asymptomatic.
What are the two types of herpes infections?
Primary genital herpes infections and secondary infections
Can herpes be cured?
No, herpes cannot be cured.
What is the treatment for herpes during pregnancy?
Treatment includes Acyclovir for HSV suppression during pregnancy to suppress outbreaks before delivery.
What is acyclovir prescribed for during pregnancy?
Herpes
How it hep A transmitted?
Transmitted via the fecal/oral route; incubation period of 28 days.
What is the incubation period for Hep A?
28 days
What are the risk factors for acquiring Hep A?
illicit drug use, living in a residential facility, exposure to day care centers, and homosexual activity between men.
What are the symptoms of Hep A?
Asymptomatic to abdominal pain, flu-like symptoms, N/V, anorexia, jaundice, and pruritis.
What condition can present with the following S/S?
Asymptomatic to abdominal pain, flu-like symptoms, N/V, anorexia, jaundice, and pruritis.
Hep A
What hepititis virus is self-limiting?
Hep A
When can Hep A sufferers expect symptoms to clear?
Generally self-limiting with full recovery for most patients within 2 to 3 months. Not chronic.
Is Hep A a chronic condition?
No, it is not chronic. It is usually cleared up within 2-3 months.
Is there a Hep A vaccine?
Yes. It has been recommended for infants since 2006.
What is the treatment for Hep A?
There is no treatment beyond supportive care because it’s self-limiting.
What is the primary mode of transmission of Hep B?
Primary modes of transmission: perinatally (during pregnancy), unprotected sex, IV drug use.
What are the symptoms of Hep B?
Symptoms range from asymptomatic to right upper quadrant pain, discomfort, N/V, anorexia, jaundice, and fatigue
Chronic Hep B patients are at risk for cirrhosis, liver failure, liver cancer, and death.
The following are symptoms of what disease?
Right upper quadrant pain, discomfort, N/V, anorexia, jaundice, and fatigue.
Hep B
What are chronic Hep B patients at risk for?
Chronic Hep B: at risk for cirrhosis, liver failure, liver cancer, and death
What is the most effective way to avoid hep B?
Vaccination
What is the schedule of Hep B vaccinations?
Vaccination is provided in 3 doses, with the second dose 1 month after the first and the third dose 6 months after the first.
Dose 1
1 month
Dose 2
5 months
Dose 3
What is the recommendation for a neonate born to a Hep B+ mother?
Recommendation: wash baby after birth, administer first dose of the Hep B vaccine at birth along with immunoglobulins.
What are the symptoms of Hep C?
Most patients with Hep C are asymptomatic or complain of nonspecific symptoms such as fatigue.
Which condition is a bloodborne disease with a low risk of sexual transmission?
Hep C
Which demographics have an increased risk of acquiring Hep C virus?
Heterosexuals with multiple partners and men who have sex with men.
What are the chronic implications of Hep C?
Hepatitis C risks include cirrhosis of the liver, liver failure, and liver cancer.
Is there a treatment for Hep C?
Yes. Treatment includes antiviral therapy that is curative for over 90% of patients; costly (40K-95K for 12-wk treatment).
What is the cure rate of Hep C when treated with antiviruals?
90%
What are the risks of being infected with HIV?
Risks for becoming infected with HIV include receiving contaminated blood products, IV drug use, and having unprotected sex.
What are the stages of HIV?
Acute and chronic
What is the difference between acute and chronic stages of HIV?
Acute: 1st 6 months. Chronic: After 6 months
How does acute HIV present?
Commonly characterized by flu-like symptoms, fever, headache, sore throat, and rash. Could be mistaken for something else.
Which stage of HIV presents with flu-like symptoms, fever, headache, sore throat, and rash?
Acute HIV stage
How does chronic HIV present?
Without acquired immunodeficiency syndrome (AIDS): Begins 6 months after infection and lasts until the cluster of differentiation 4 (CD4) count is below 200 – is now AIDS. In the absence of therapy, this often persists as an asymptomatic stage typically lasting a decade or less.
Is chronic HIV the same as AIDS?
No. Chronic HIV begins 6 months after infection and lasts until the cluster of differentiation 4 (CD4) count is below 200 – is now AIDS. In the absence of therapy, this often an asymptomatic stage typically lasts a decade or less.
What is the defining difference between chronic HIV and AIDS?
The chronic stage begins 6 months after infection and lasts until the cluster of differentiation 4 (CD4) count is below 200 – is now AIDS.
How long can chronic HIV be asymptomatic?
In the absence of therapy, an asymptomatic stage typically lasts a decade or less.
When does HIV become AIDS?
HIV becomes AIDS when the HIV virus causes the CD4 count to drop below 200 cells/μL, or when the patient with HIV is diagnosed with an AIDS-defining condition.
What is ART therapy?
Antiretroviral therapy (ART) for HIV
How does ART help HIV patients?
ART reduces mortality, progression of HIV to AIDS, and AIDs-defining diagnoses.
What is preexposure prophylaxis (PrEP) for HIV?
A daily med that can almost eliminate transmission of HIV virus; must be HIV negative to initiate; costly.
What is post-exposure prophylaxis (PEP):
A PEP is taken w/in 72 hrs after possible HIV exposure; not meant for regular use. (Taken for 28 days)
T/F: You do not have AIDS even if you have one of the conditions acquired from AIDS but your CD4 count is above 200.
False. If count is above 400 but you have an AIDS acquired conditions, you have AIDS.
A number of HPV (Human Papilloma Virus) viruses can be prevented with what vaccine?
Gardasil
What are the S/S of genital warts?
Cauliflower-like papules or plaques; may appear as single or multiple lesions on genitalia, perineum or perianal mucosa.
HPV is high or low risk?
Low risk
Can HPV resolve on its own?
HPV may resolve if untreated but can take up to 6 to 12 months for healthy immune system to eliminate low-risk HPV – during that time can still pass virus to a partner
How is HPV diagnosed?
Clinical examination
What is the treatment for HPV?
Self-administered cream or clinician-administered trichloroacetic acid or cryotherapy
A patient calls the clinic with complaints of fever, back pain, urinary frequency, and urinary urgency. The nurse suspects the provider will do which of the following?
A. Recommend the patient stay home and drink a lot of water.
B. Recommend the patient come to the clinic to be evaluated for pyelonephritis.
C. Diagnose the patient with a urinary tract infection and call in a prescription.
D. Recommend the patient take phenazopyridine for 2 days and call back if symptoms persist.
B. Recommend the patient come to the clinic to be evaluated for pyelonephritis.
Is the following statement true or false?
People with HIV can obtain a vaccine that prevents them from acquiring AIDS.
False.
A woman has been diagnosed with primary syphilis. Which of the following physical findings would the nurse expect to see?
Cluster of vesicles on labia minora
Pain-free lesion on perineum
Macular rash on palms of hands
Foul-smelling discharge
Pain-free lesion on perineum.
Which of the following sexually transmitted infections would require both your client and her partner(s) to be treated? Select all that apply.
Trichomoniasis
Syphilis
Gonorrhea
Herpes simplex virus (HSV)
Chlamydia
HIV / AIDS
Trichomoniasis
Syphilis
Gonorrhea
Chlamydia
(When she states “treated” assume a cure.)
The nurse is giving a presentation about chlamydia to a group of adult women. The nurse would emphasize the need for annual screening for this infection in all sexually active women younger than which age?
< 25 years old
A client is suspected of having herpes simplex viral infection. The nurse would expect to prepare the client for which diagnostic test to confirm the infection?
viral culture of vesicular fluid
A nurse is presenting a program for a local women’s group about STIs. When describing the information, the nurse would identify which infection as the most common cause of vaginal discharge?
Candidiasis
