Nursing Care Plan | NCP Chlamydial Infection
Infection with Chlamydia trachomatis is the most common sexually transmitted infection (STI) in the United States today, with approximately 5 million cases reported annually. While chlamydial infections are reportable in all 50 states, underreporting of this STI is substantial owing to the number of individuals who may have the infection and not know it. Because 70% of women and 50% of men with chlamydial infections are asymptomatic, they transmit the disease but are unaware that they harbor the bacteria. Untreated infections in women can result in cervicitis, endometritis, acute salpingitis, bartholinitis, irregular menses, ectopic pregnancy, pelvic inflammatory disease, and infertility. Untreated infections in men can result in nongonococcal urethritis (NGU), epididymitis, or prostatitis. Infections in either gender can result in proctitis, lymphogranuloma venereum (LGV), and, potentially, infertility and sterility.
During pregnancy, C. trachomatis may be transmitted from mother to fetus, which may cause premature rupture of the membranes, premature labor, and increased fetal morbidity and mortality. Pregnant women who deliver vaginally or by cesarean section can transmit the bacteria to their infants. These newborns can develop otitis media, conjunctivitis, blindness, meningitis, gastroenteritis, respiratory infections, and pneumonia. Because mothers are often asymptomatic, medical personnel are unaware that the maternal-infant transmission has occurred until infants become very ill.
C. trachomatis is an obligate, gram-negative, intracellular bacterium with several different immunotypes. It resembles a virus in that it requires a tissue culture for isolation, but like a bacteria, it has RNA and DNA and is susceptible to antibiotics. It is transmitted through sexual intercourse and from mother to fetus during birth. The chlamydial infections exists in two forms: The elementary bodies are the infectious particles that enter uninfected cells; and the reticulate bodies are an active form of the organism that reproduce and form more elementary bodies that are released from the bursting infected cell and can then infect other cells. Replication begins only 12 hours after invasion. The pathogen invades and reproduces inside of the cells that line the cervix, endometrium, fallopian tubes, and urethra. Symptoms can occur after a 1- to 3-week incubation period; however, overt symptoms often occur late in the disease.
Nursing care plan assessment and physical examination
Although sexual activity is potentially a sensitive topic, it is critical to obtain a detailed sexual and gynecologic history. Inquire about the number of partners, use of barrier protection and birth control measures, participation in oral or anal intercourse, and previous STIs. Most patients who present with C. trachomatis have a history of multiple sex partners and engaging in sexual intercourse without the use of barrier protection. Often, patients are also positive for gonorrhea. Inquire if the patient has any thin or purulent discharge, burning or frequent urination, mucus-covered stools, lower abdominal pain, dyspareunia (painful sexual intercourse), headache, nausea, vomiting, chills, or bleeding after intercourse. Often, patients are asymptomatic, and some may complain only of an increase in vaginal discharge. Male patients may report dysuria, urinary frequency, and pruritus. Ask the patient if she or he is experiencing any diarrhea, tenesmus, or pruritus, any of which indicates that the infection involves the rectum.
For females, inspect the vagina, cervix, and labia and note any mucopurulent discharge. Bartholin glands may be involved. Gently touch the cervix; note any bleeding (friable cervix). Inspect males for purulent discharge at the urinary meatus. Scrotal swelling occurs if the organism has caused epididymitis. Inspect the anus for discharge and excoriation. If LGV is present, ulcerative lesions on the cervix, vagina, labia, anal/rectal area, or penis may occur. Enlarged lymph nodes also can be palpated in the groin. If these nodes rupture, they secrete a thick yellow granular substance.
Assess the patient’s knowledge of STIs and the implications. Assess the patient’s ability to cope with having an STI. The diagnosis of an STI can be very upsetting to a male or female who believes he or she was involved in a monogamous relationship. Patients may feel embarrassed and guilty about their condition. Inquire about the patient’s ability to obtain condoms. Identify all partners with whom the patient has been sexually active so that they can be examined and treated. Assess the patient’s support system; this is especially important if the patient is pregnant.
Nursing care plan primary nursing diagnosis: Infection related to bacterial invasion.
Nursing care plan intervention and treatment
chlamydial infections can easily be cured with oral antibiotics, and patients are rarely hospitalized. Patients need to know to continue to take medication as ordered, even if the symptoms subside. Follow-up with both partners is recommended to assure that neither partner is still infected. Patients should abstain from sexual intercourse until they are infection free.
Because patients are often asymptomatic, nurses need to identify those patients at risk for chlamydial infections and recommend screening. Prevention is an important nursing intervention. Teach patients that monogamous relationships with uninfected partners, use of mechanical barriers, and simultaneously treating the partner to prevent reinfection are ways to prevent transmission of C. trachomatis. Emphasize that it is possible for them to carry and transmit the bacteria, even if they are asymptomatic. Since a chlamydial infections is easily cured by antibiotics, teach the patient about taking the medications properly. Instruct patients to take all medication until the course of treatment is finished, even if the symptoms subside. Explain that the patient should abstain from intercourse until all medication is gone to prevent reinfection. For discomfort, teach the patient about warm sitz baths and taking prescribed analgesics as ordered.
Nursing care plan discharge and home health care guidelines
Be sure the patient understands the correct dosage, route, and time of the medication, as well as the importance of taking all prescribed medication, even if the symptoms resolve. Emphasize any dietary restrictions.
Teach the patient about the importance of barrier contraception, especially latex condoms. Often, patients on oral contraceptives do not realize that, although they probably will not get pregnant, they are not protecting themselves from STIs. Emphasize the importance of follow-up visits to assure that the infection has resolved. Encourage the patient to enforce follow-up of all sexual partners and to refrain from intercourse during antibiotic therapy to prevent reinfection. While experts recommend that all women less than 25 years of age be screened annually for chlamydia, this recommendation for routine screening does not include men.
During pregnancy, C. trachomatis may be transmitted from mother to fetus, which may cause premature rupture of the membranes, premature labor, and increased fetal morbidity and mortality. Pregnant women who deliver vaginally or by cesarean section can transmit the bacteria to their infants. These newborns can develop otitis media, conjunctivitis, blindness, meningitis, gastroenteritis, respiratory infections, and pneumonia. Because mothers are often asymptomatic, medical personnel are unaware that the maternal-infant transmission has occurred until infants become very ill.
Nursing care plan assessment and physical examination
Although sexual activity is potentially a sensitive topic, it is critical to obtain a detailed sexual and gynecologic history. Inquire about the number of partners, use of barrier protection and birth control measures, participation in oral or anal intercourse, and previous STIs. Most patients who present with C. trachomatis have a history of multiple sex partners and engaging in sexual intercourse without the use of barrier protection. Often, patients are also positive for gonorrhea. Inquire if the patient has any thin or purulent discharge, burning or frequent urination, mucus-covered stools, lower abdominal pain, dyspareunia (painful sexual intercourse), headache, nausea, vomiting, chills, or bleeding after intercourse. Often, patients are asymptomatic, and some may complain only of an increase in vaginal discharge. Male patients may report dysuria, urinary frequency, and pruritus. Ask the patient if she or he is experiencing any diarrhea, tenesmus, or pruritus, any of which indicates that the infection involves the rectum.
For females, inspect the vagina, cervix, and labia and note any mucopurulent discharge. Bartholin glands may be involved. Gently touch the cervix; note any bleeding (friable cervix). Inspect males for purulent discharge at the urinary meatus. Scrotal swelling occurs if the organism has caused epididymitis. Inspect the anus for discharge and excoriation. If LGV is present, ulcerative lesions on the cervix, vagina, labia, anal/rectal area, or penis may occur. Enlarged lymph nodes also can be palpated in the groin. If these nodes rupture, they secrete a thick yellow granular substance.
Assess the patient’s knowledge of STIs and the implications. Assess the patient’s ability to cope with having an STI. The diagnosis of an STI can be very upsetting to a male or female who believes he or she was involved in a monogamous relationship. Patients may feel embarrassed and guilty about their condition. Inquire about the patient’s ability to obtain condoms. Identify all partners with whom the patient has been sexually active so that they can be examined and treated. Assess the patient’s support system; this is especially important if the patient is pregnant.
Nursing care plan primary nursing diagnosis: Infection related to bacterial invasion.
Nursing care plan intervention and treatment
chlamydial infections can easily be cured with oral antibiotics, and patients are rarely hospitalized. Patients need to know to continue to take medication as ordered, even if the symptoms subside. Follow-up with both partners is recommended to assure that neither partner is still infected. Patients should abstain from sexual intercourse until they are infection free.
Because patients are often asymptomatic, nurses need to identify those patients at risk for chlamydial infections and recommend screening. Prevention is an important nursing intervention. Teach patients that monogamous relationships with uninfected partners, use of mechanical barriers, and simultaneously treating the partner to prevent reinfection are ways to prevent transmission of C. trachomatis. Emphasize that it is possible for them to carry and transmit the bacteria, even if they are asymptomatic. Since a chlamydial infections is easily cured by antibiotics, teach the patient about taking the medications properly. Instruct patients to take all medication until the course of treatment is finished, even if the symptoms subside. Explain that the patient should abstain from intercourse until all medication is gone to prevent reinfection. For discomfort, teach the patient about warm sitz baths and taking prescribed analgesics as ordered.
Nursing care plan discharge and home health care guidelines
Be sure the patient understands the correct dosage, route, and time of the medication, as well as the importance of taking all prescribed medication, even if the symptoms resolve. Emphasize any dietary restrictions.
Teach the patient about the importance of barrier contraception, especially latex condoms. Often, patients on oral contraceptives do not realize that, although they probably will not get pregnant, they are not protecting themselves from STIs. Emphasize the importance of follow-up visits to assure that the infection has resolved. Encourage the patient to enforce follow-up of all sexual partners and to refrain from intercourse during antibiotic therapy to prevent reinfection. While experts recommend that all women less than 25 years of age be screened annually for chlamydia, this recommendation for routine screening does not include men.
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Nursing Care Plan
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I was diagnosed as HEPATITIS B carrier in 2013 with fibrosis of the
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