Case Presentation on pelvic inflammatory disease (PID).pptx

Alhamdulillah.
Here, the file, Case Presentation on pelvic inflammatory disease (PID).pptx includes- detail history of a case of (PID), and about disease condition like definition, classification, signs & symptoms, causes, risk factors, radiological findings, laboratory investigations,
treatments and nursing managements and nursing care plan, health education on discharge etc. thanks to all.

1. Clinical conference on Pelvic Inflammatory Disease (PID) Presented by Rabeya sultana Reta MSN (WHMN) 2 nd semester BSMMU 1

2. Objectives of the case conference General Objectives To enhance learning and improve clinical reasoning and judgment about the case (Pelvic Inflammatory Disease). Specific Objectives To compare the causes, clinical types and features, and diagnostic investigations   between the patient & book. To apply nursing process to care the women. To save the patient from further complications of PID . To reach the latest clinical practices  for professional development . 2

3. Demographic Data Name of Patient : Mrs. S Age:47years . Name of Father: Md . S. Ali . Religion: Islam Address (permanent) : A ustagram, Kishorgonj. Contact number: 019*****011 Name of Hospital: BSMMU Hospital . Ward : antetnatal (Paying) Unit: Orrange-1 Bed: A-2 Date of Admission: 13/02/24 Date of Discharge: 27/02/24 Time: 11: 00 AM 3

4. Subjective Data Chief Presenting Complaints: Severe lower abdominal Pain for 4 days. Heavy vaginal bleeding for 3 days. Whitish vaginal discharge since 1 yr. Irregular period for last 1yr. History Of Present Illness: Lower abdominal and pelvic pain with vaginal bleeding. 4

5. Subjective Data cont’d Past Medical & surgical History No any medical & surgical history. History of urinary tract infection(UTI). Menstrual History Age of menarche: 14 years. Pattern : Irregular for last 1 yr. Post coital bleeding : no any. LMP:25/01/24 5

6. Subjective Data cont’d Obstetric history Married for:18 yrs. Age of marriage:30 yrs. Para:2(c/s)+1 (abortion ) ALC:14 yrs. Family history Family has history of DM & bronchial asthma. No others chronic diseases like- HTN, heart disease, thyroid disease. Husband has history of Urinary Tract Infection. 6

7. Subjective Data cont’d Personal history Bowel pattern: Irregular & Constipation History of tobacco use & passive smoking . History of using common toilet. Social history Occupation: Housewife. Education: unto secondary school. Housing: village in common family. Financial Condition: husband’s monthly income - 25,000tk. 7

8. Objective Data General Inspection Anxious facial expression and ill looking. Behavior, Responses, and Speech is responding well . Dry skin and dehydrated. Family members are supportive and caring to her. 8

9. Objective Data cont’d Vital Signs Blood Pressure: 110/60 mm of Hg. Temperature:102°F, Respiratory Rate: 22/min Pulse Rate: 98 b/min Weight: 68 kg .   Anemia: no. Jaundice : Negative. Edema: no any. 9

10. Obstetric examinations Abdominal examination No any scar mark on inspection. Tender abdomen on palpation. Cervical/adnexal motion tenderness also be observed. Pelvic examination : heavy vaginal bleeding present. Whitish plug in vaginal area present. 10

11. Laboratory Investigations Name of investigations Patient’s value Normal value Blood group A(+ ve ) Hemoglobin ( Hb ) 11.7 g/dl 12-16 g/dl Urine for R/M/E Pus cell 1-2/HPF Pus cell 3-5/HPF TSH 4.45 mIU /L 0.3-3.5 mIU /L S. Creatinine 0.7 1 mg/dl 0.60 mg/dl FBS 5.2 mmol /L <5.7 mmol /L HBsAg Negative VDRL Non reactive CBC 18000/µliter 4500-11000/µliter. 11

12. Radiological findings USG of whole: Fatty change in liver (grade-1), small uterine fibroid (1.7 x 1.3 cm). Right adnexal mass- mixed echogenic area with solid & cystic 9.2 cm x 6.6 cm. Nabothian cyst in cervix. Chest X-ray(P/A): suggestive of bilateral pulmonary inflammatory lesion. Echocardiography : Normal findings. 12

13. Nursing Diagnosis Severe pelvic pain related to inflammation as evidenced by facial expression and abdominal tenderness. Increased temperature related to inflammatory process manifested by dry & warm skin. Knowledge Deficit related to prevention, treatment, and potential complications of PID. 13

14. Disease Condition Pelvic inflammatory disease Pelvic inflammatory disease (PID) is an infection of one or more of the upper reproductive organs, including the uterus, fallopian tubes and ovaries. Untreated can cause scar tissue and pockets of infected fluid (abscesses) to develop in the reproductive tract, which can cause permanent damage. 14

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16. Risk factors for PID Book picture Pt.'s pic. Previous pelvic or abdominal surgery No Previous history of abortion Yes Women’s age > 45 years Yes Smoking / tobacco use Yes History of UTI/STIs Yes Intrauterine devices (IUD )/copper-T No Implantation and tubal ligation Yes Intercourse with multiple partners No Husband have multiple partners No 16

17. Clinical types of PID Book picture Patient picture Acute PID (>30 days) No Chronic/old PID Yes Subclinical / asymptomatic No 17

18. Symptoms of PID Book picture Pt.’s pic. Pain in lower abdomen and pelvis Yes Heavy vaginal discharge Yes Irregular vaginal bleeding Yes Fever, sometimes with chills Yes Pain, bleeding during sex No Painful, frequent or difficult urination No Unusual bleeding between periods Yes 18

19. Signs of PID D ifficult to recognize, sometimes asymptomatic Book picture Patient picture Weak appearance and ill looking Yes Elevated temperature Yes Abdominal tenderness Yes Insufficient and difficulty to urinate No Elevated WBC count Yes 19

20. Treatment of PID Medical treatment for PID most often includes:  Antibiotics with plenty of oral fluids. combination of antibiotics to start immediately, partner also. After receiving lab test results, might adjust prescription to better match what's causing the infection . Surgical treatment may involve unilateral salpingo -oophorectomy or hysterectomy and bilateral salpingo -oophorectomy. Ideally, the operation is performed after the acute infection and inflammation have resolved. 20

21. Indications for surgery in PID Surgery is rarely needed. An abscess ruptures or threatens to rupture. Family complete. D on't respond to antibiotic treatment. A questionable diagnosis with multiple complications. Operation done after resolve the sign of acute inflammation, like severe pain and fever . For this patient, plan for total abdominal hysterectomy. 21

22. Complications of PID Chronic pelvic pain. Infertility. Increased risk of ectopic pregnancy . Tubo-ovarian abscess.  Loss of social image and personality related to offensive discharge. 22

23. Nursing care plan 2. Subjective data: I feel severe pain in lower abdomen Objective data : looking anxious , tender abdomen. Severe pelvic pain related to inflammation evidenced by facial expression and abdominal tenderness. -To reduce pain. -To relief from anxiety. -to prevent infection. -To improve better feelings. - Administered analgesic & antibiotics as prescription. - offer to urinate. -used hot water bag and pelvic massage. -Educate and encourage for deep breathing. M Rekatsina ,2024 -medication reduce pain & prevent infection. -Deep breathing increase oxygen supply thus reduce anxiety and pain. H Jafari ,2020 After 2 hrs. of intervention, reduced pain and Anxiety, patient feel better. Assessment Nursing Diagnosis Nursing Goal Nursing intervention Rationale Evaluation 23

24. Nursing care plan cont’d. Assess ment Nursing Diagnosis Nursing Goal Nursing intervention Rationale Evaluation 3. Subjective data: I feel weak & thirsty. Objective data: T – 102⁰F, Skin dry and warm to touch   Increased temperature related to inflammatory process. manifested by warm & flushed skin . -to reduce fever. -to hydrate the patient -to facilitate recovery. -Administered prescribed anti pyretic orally. - Tepid sponge bath giving. - combing hair. - Provide plenty of liquid & high calorie diet. -provide vit -c rich food, lemon. LCV de Britto,2023 -anti pyretic reduce fever. -TSB facilitate recovery. -diet improve hydration & immunity. M Muthupriya,2020  after 4 hrs. of nursing intervention the patient’s temperature has been decreased to normal, 98⁰F 24

25. Nursing care plan cont’d. Assess ment Nursing Diagnosis Nursing Goal Nursing intervention Rationale Evaluation 5. Subjective data: We don't know what should we do after discharge. Objective data: As Interview, they were worried about treatment . Knowledge Deficit related to prevention, treatment, and potential complications of PID. -To improve knowledge about care . - To prepare for hysterectomy. -To remove fear & stigma on STDs . -Provide knowledge and h ealth education on diet and drug dosage and adverse effects. -prepare for OT -provide mental support to cope with stress . D Lemly , 2020 -maintain drug dose and manage side effects. - Physical and mental preparation of patient and family for next treatment. E Cicinelli , 2024 Goal met, patients and family were understood about the care . 25

26. Health Education on Discharge Focus on methods of preventing PID and STIs, avoiding unsafe sexual practices, and routinely using appropriate barrier protection. Partners need to be checked and treated for STDs. Give psychological support to the patient. Healthy balanced diet intake , rich in protein and calcium. Antioxidants, vitamin-C and other nutritional supplements. 26

27. Health education cont’d Maintain hygiene, adequate sleep and rest ,. Timely intake of prescribed medicine especially sedative at night. Maintain full course of antibiotics prescribed by doctor, ensure resolution of infection and monitor for complications. Health education to the husband for caring and helping of women . Education to the family members about mental changes and coping on menopause . Encourage for follow up on USG, urine for R/E . 27

28. References AskMayoExpert. Pelvic inflammatory disease. Mayo Clinic; April. 30, 2022. Pelvic inflammatory disease: Gynecologic problems FAQ077. American College of Obstetricians and Gynecologists. Jan . 13, 2020 . Pelvic inflammatory disease (PID) — CDC Fact Sheet: Detailed version. Centers for Disease Control and Prevention. Jan . 13, 2020 . Yusuf , H., & Trent, M. (2023). Management of pelvic inflammatory disease in clinical practice.  Therapeutics and Clinical Risk Management , 183-192 . 28

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