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Pelvic inflammatory disease (PID): Nursing process (ADPIE)
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Pelvic inflammatory disease (PID): Nursing process (ADPIE)
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Reproductive system
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Cervical cancer: Nursing
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Pelvic inflammatory disease (PID): Nursing process (ADPIE)
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Pelvic Inflammatory Disease (PID) Assessment
Picmonic Nursing
Pelvic Inflammatory Disease (PID) Interventions
Picmonic Nursing
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Transcript
Content Reviewers
Antonella Melani, MD, Lisa Miklush, PhD, RNC, CNS, Gabrielle Proper, RN, BScN, MN
Contributors
Elijah Lee, MScBMC, Filip Vasiljević, MD, Sam Gillespie, BSc, Alaina Mueller
Margarita Salvador is a 25-year-old female client who presents to her gynecologist’s office
with a report of lower abdominal pain, a fever of 101°F or 38.3°C, chills and thick, yellow
foul smelling vaginal discharge.
She states her symptoms began three days ago. A pelvic examination is positive for cervical
motion tenderness and right-sided adnexal tenderness. A transvaginal ultrasound visualizes
a 4 cm right-sided tubo-ovarian abscess.
A vaginal swab was sent for laboratory analysis to check for chlamydia and gonorrhea. Ms.
Salvador is diagnosed with pelvic inflammatory disease, or PID, and will be admitted to the
medical surgical unit for treatment.
Pelvic inflammatory disease, or PID for short, is an infection of the upper female reproductive
system, which includes the uterus, fallopian tubes, and ovaries.
Most often, PID develops from a bacterial infection that begins in the vagina or cervix, such
as sexually transmitted infections, or STIs, like chlamydia, caused by Chlamydia trachomatis,
and gonorrhea, caused by Neisseria gonorrhoeae.
Another cause of PID can be bacterial vaginosis, which refers to the infection of the vagina
due to overgrowth of bacteria like Gardnerella vaginalis, which are normally present in low
numbers in the vaginal flora.
Occasionally, PID can be caused by other forms of bacteria introduced in the reproductive
tract during surgery, abortion, or even childbirth. Now, PID is typically caused by only one
type of bacteria, but in some clients, the infection can become polymicrobial, meaning the
original infection makes it easier for other bacteria to settle into the reproductive tract.
Risk factors associated with pelvic inflammatory disease can be subdivided into two main
groups. Modifiable risk factors include having unprotected sexual contact, as well as new or 2
multiple sexual partners.
On the other hand, non-modifiable risk factors include being under the age of 35, since
they’re more likely to have new or multiple sexual partners, as well as having a history of
prior pelvic inflammatory disease, STIs, or bacterial vaginosis.
Some clients with PID will have no or mild symptoms. On the other hand, symptomatic
clients may present with fever, pelvic pain, and tenderness around the ovaries and fallopian
tubes, as well as dyspareunia, which is pain during sexual intercourse.
Additionally, some may complain of mucopurulent vaginal discharge or irregular uterine
bleeding. Pelvic inflammatory disease can cause some serious complications, such as
adhesions and strictures of the fallopian tubes, subsequently increasing the risk of ectopic
pregnancy and infertility.
In addition, if pus builds up in a tube and ovary, it can turn into a tubo-ovarian abscess, which
can rupture and spread into the bloodstream, leading to sepsis.
Finally, if the inflammation affects the peritoneum and Glisson’s capsule surrounding the
liver, it can result in strings of scar tissue that attach the liver to the peritoneum.
These “violin string” adhesions are also known as Fitz-Hugh-Curtis syndrome, which is also
called perihepatitis. Diagnosis of PID is usually based on history and clinical findings, such as
pelvic pain and cervical motion tenderness, which refers to the pain and discomfort that
occurs during mobilization of the cervix.
In some clients, the cervix can also be inflamed, erythematous, and bleed easily when
touched. In addition, it’s important to check blood levels of beta human chorionic
gonadotropin, or beta hCG for short, and perform an ultrasound to rule out pregnancy.
Ultrasound can also help visualize complications like a tubo-ovarian abscess. Next, a swab
sample from the inside of the vagina or cervix can be tested for chlamydia and gonorrhea,
using the nucleic acid amplification test or NAAP for short.
Finally, urinalysis can be performed to rule out urinary tract infections that might present
with similar clinical findings. Clients with pelvic inflammatory disease are typically treated
with a mix of antibiotics, including ceftriaxone or cefotetan, doxycycline, and metronidazole.
Additionally, analgesics like acetaminophen or NSAIDs can be used to manage pain. Some
clients might require surgery to remove adhesions or treat complications.
Now, let’s get back to Ms. Salvador and begin her assessment. As you enter her room you
note Ms. Salvador appears uncomfortable and is guarding her lower abdomen.
While reviewing her history, she tells you she has had several male sexual partners in the
past and no female sexual partners. She does not routinely use protection and last had
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intercourse two days ago, which she recalls as being painful.
Her last menstrual cycle ended 5 days ago. Her vital signs are: temperature 101.2°F or
38.4°C, heart rate 100 beats per minute and regular, respirations 18 breaths per minute,
blood pressure 126/82 mmHg, and oxygen saturation 98% on room air.
Pain is 7/10 located in her lower abdomen, which she describes as an achy and cramping
that is worse with movement. You note her skin is warm, free of rashes or lesions, and has
normal turgor.
Her oral mucous membranes are moist and pink. Capillary refill is less than 3 seconds, and
peripheral pulses are 3+ and equal bilaterally. Ms. Salvador’s bowel sounds are active, and
she denies nausea, vomiting, or changes in bowel movements.
Reviewing her lab results, you note the following: leukocytes 14,000/mm3; erythrocyte
sedimentation rate 40 mm/h; beta hCG 1.0 IU/L; urinalysis is positive for WBCs with no
organisms present.
Results are pending for gonorrhea, chlamydia, and HIV. When your assessment is complete,
you document your findings and let Ms. Salvador know you will be back to check on her
shortly.
OK, you’ve gathered assessment data so now you develop nursing diagnoses for Ms.
Salvador, which include: risk for infection related to potential for abscess to rupture and
sepsis; acute pain related to pelvic inflammation; and ineffective health maintenance related
to deficient knowledge regarding prevention and treatment of STIs.
Alright, with nursing diagnoses in place you’re ready to plan goals for Ms. Salvador. By the
end of your shift, Ms. Salvador will exhibit no signs of a ruptured abscess or sepsis; she will
achieve pain control at her stated tolerable level of 3/10; and she will demonstrate
understanding of PID and ways to prevent STIs.
Implementing your plan with the help of the interdisciplinary team is the next step in caring
for Ms. Salvador. After reviewing orders placed by the physician, you collaborate with the
patient care technician, or PCT, and delegate collection of vital signs and intake and output,
requesting to be notified immediately of any changes.
To promote drainage of the pelvic cavity, you ensure Ms. Salvador remains in the semiFowler position while she is in bed. Next, you administer the ordered IV antibiotics cefoxitin
and doxycycline. Then, you administer the antipyretic acetaminophen, the analgesic tramadol
and apply a heating pad to her lower abdomen.
During your shift, you teach Ms. Salvador about PID and how to lower her risk of STIs by
using condoms with each sexual encounter and to seek STI testing if engaging in risky sexual
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behavior.
You teach her to recognize the signs and symptoms of infection in herself and her partners,
and you let her know that her most recent partners must be assessed and treated as needed.
You further stress the importance of waiting to resume sexual activity until after her
antibiotic regimen is completed and her follow-up STI test results are back.
Next, you explain how PID can lead to chronic pelvic pain and cause scarring of her fallopian
tubes, which can lead to impaired fertility and increase the risk of ectopic pregnancy.
Throughout your shift, you closely monitor Ms. Salvador for signs of sepsis and increasing
pain, knowing these changes warrant urgent physician notification and prompt action.
OK, it’s the end of your shift and time to evaluate the effectiveness of the nursing
interventions provided to Ms. Salvador so far. Her latest set of vital signs are: temperature
99.4°F or 37.4°C, heart rate 80 beats per minute, respirations 16 breaths per minute, blood
pressure 118/78 mmHg SpO2 99% on room air, and pain 3/10.
She has warm, dry, intact skin with normal turgor. Ms. Salvador verbalized her understanding
of the education you provided. You are happy to see her pain and fever improving, that she
isn’t showing signs of a ruptured abscess or sepsis, and that she has gained new
understanding of how she can promote her own sexual health.
You give the report to the next shift so Ms. Salvador’s plan of care can be continued and
adjusted as needed. Alright, as a quick recap... your client, Margarita Salvador, was treated
for PID, which is an infection and inflammation of the upper female reproductive system that
has resulted in a tubo-ovarian abscess.
Ms. Salvador’s assessment revealed fever, pelvic pain, and vaginal discharge as well as
unsafe sexual practices and painful intercourse. Nursing diagnoses to guide Ms. Salvador’s
care included: risk for infection; acute pain; and ineffective health maintenance.
Planned goals and interventions implemented for Ms. Salvador focused on treating her
infection; managing her pain and fever, monitoring for a ruptured abscess and signs of sepsis,
and providing health promotion education.
At the end of your shift, you evaluated the nursing care provided. The interdisciplinary team
will continue monitoring Ms. Salvador and adjusting her plan of care to help her reach the
best outcomes possible.
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