Protocols for the Most Common Diseases in Primary Healthcare Facilities

Nurse’s Role in Providing Nursing Care to a Patient with Vulvovaginal Infection (Candidal Vaginitis and Trichomonas Vaginitis):

Patient Assessment:

-        Perform a physical assessment of the different body systems according to the patient’s complaint, with particular focus on the reproductive system.

-        Review the medication history for immunosuppressive medications, diabetes treatment, and long-term antibiotic use.

-        Assess the use of hormonal contraceptive methods or an intrauterine device.

-        Assess pain and notify the physician if the pain score is 3 or higher.

-        Perform a fall-risk assessment for adults.

-        Conduct psychological, spiritual, and nutritional assessments.

-        Perform a geriatric assessment if the patient is 65 years of age or older. 

Nursing Procedures:

-        Measure vital signs (blood pressure, blood glucose, pulse, respiratory rate, and temperature).

-        Measure height and weight and calculate body mass index.

-        Develop and implement a nursing care plan.

-        Provide the patient with health education appropriate to the condition.

-        Complete electronic documentation of all nursing forms in the system. 

Health Education:

-        Explain vulvovaginal candidiasis and trichomoniasis to the patient:

Candidal vaginitis is an infection caused by a fungus known as Candida. Candida normally lives in the body—in areas such as the mouth, throat, intestines, and vagina, and 

sometimes on the skin—without causing problems. However, Candida may multiply and cause infection if the vaginal environment changes in a way that promotes fungal growth.

Trichomonas vaginitis is an infection caused by a protozoan parasite known as Trichomonas. It is one of the most common sexually transmitted infections. 

-        Explain the risk factors that contribute to the disease:

The risk of infection is increased in:

·       Pregnant women.

·       Women who use hormonal contraceptives.

·       Patients with diabetes mellitus.

·       Patients with impaired immunity.

·       Patients receiving long-term antibiotic therapy. 

-        Explain the symptoms of the condition to the patient:

·       Vaginal itching or soreness.

·       Pain during sexual intercourse.

·       Pain or discomfort during urination.

·       Abnormal, foul-smelling vaginal discharge. In candidiasis, the discharge is thick and resembles cottage cheese.

·       Redness, swelling, and fissures of the vaginal wall may occur. 

-        Educate the patient about preventing the condition: 

•        Wear cotton underwear.

•        Keep the genital area dry at all times.

•        Avoid spicy foods.

•        Limit antibiotic use to situations in which it is necessary and prescribed by a physician.

•        Do not overuse chemical products such as vaginal douches, because they may alter vaginal acidity.

•        Patients with diabetes should follow the physician’s instructions and take treatment regularly to limit hyperglycemia, which alters vaginal acidity.

•        Change sanitary pads and tampons regularly.

References:

Gonçalves B, Ferreira C, Alves CT, Henriques M, Azeredo J, Silva S. Vulvovaginal candidiasis: epidemiology, microbiology and risk factorsexternal icon. Criti Rev Microbiol 2016;42:905-27.

Sobel JD. Vulvovaginal candidosisexternal icon. Lancet 2007;369:1961-71.

Pappas PG, Kauffman CA, Andes DR, Clark CJ, Marr KA, Ostrosky-Zeichner L, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of Americaexternal icon. Clin Infect Dis 2016;62:e1-50.

Benedict K, Jackson BR, Chiller T, Beer KD. Estimation of direct healthcare costs of fungal diseases in the United Statesexternal icon. Clin Infect Dis. 2018 Sep 10 

2. Nurse’s Role in Providing Nursing Care to a Pregnant Woman with Gestational Diabetes:

Patient Assessment:

-        Perform a physical assessment of the different body systems according to the patient’s complaint, with particular focus on the reproductive system.

-        Assess pain and notify the physician if the pain score is 3 or higher.

-        Perform a fall-risk assessment for adults.

-        Conduct psychological, spiritual, and nutritional assessments.

-        Perform an obstetric assessment. 

Nursing Procedures:

-        Measure vital signs (blood pressure, blood glucose, pulse, respiratory rate, and temperature).

-        Measure height and weight and calculate body mass index.

-        Develop and implement a nursing care plan.

-        Direct the pregnant woman to complete the required laboratory tests according to the physician’s orders.

-        Provide the patient with health education appropriate to the condition.

-        Complete electronic documentation of all nursing forms in the system.

Health Education:

-       Definition of gestational diabetes: Gestational diabetes is a type of diabetes first identified during pregnancy. It reflects the body’s inability to use insulin effectively, resulting in elevated blood glucose levels. If not controlled, gestational diabetes can lead to serious complications for both the mother and fetus.

The purpose of this protocol is to provide detailed guidance for managing gestational diabetes in order to reduce risks and improve health outcomes for both the mother and fetus.

-       Nutrition and Self-Care

-        Nutrition:

-        Meal planning: 

-        The diet should provide a careful balance of carbohydrates, proteins, and fats, with emphasis on adequate fiber and vegetables.

-        Dividing food intake into three main meals and three snacks helps maintain stable blood glucose levels.

-        Avoid high-glycemic-index foods, such as sweets and baked goods, which cause a rapid rise in blood glucose. 

-        Physical activity:

-        Regular exercise, such as walking for 30 minutes daily, can improve the body’s response to insulin.

-        The physician should be consulted before beginning any exercise program to avoid activities that may pose a risk to the pregnancy.

Self-monitoring of blood glucose:

• Teach the patient how to use a blood glucose meter correctly and record the results.
• It is important to measure blood glucose at the following times:
• Before meals.
• Two hours after meals.
• On waking in the morning.

Optimal blood glucose targets:

• Before meals: 95 mg/dL or less.
• Two hours after meals: 120 mg/dL or less.

Medical Follow-Up and Continuing Care (Follow-Up Visits)

• Routine examinations:
• The patient should visit the physician regularly to monitor blood glucose levels and fetal growth.
• Ultrasound examination:
• Ultrasound examinations should be performed regularly by the physician to monitor fetal growth and assess amniotic fluid volume. 

Potential complications:

• Blood pressure monitoring:
• Blood pressure should be monitored continuously to detect preeclampsia.
• Assessment of fetal growth:
• If excessive fetal growth (macrosomia) is suspected, the physician may provide recommendations regarding the timing of delivery.

Postpartum Care:

Postpartum maternal follow-up

• Blood glucose testing:
• A test should be performed 6–12 weeks after delivery to confirm that blood glucose levels have returned to normal or to diagnose any persistent glucose abnormality.
• Future recommendations:
• Advise the mother about the importance of maintaining a healthy weight, following a balanced diet, and exercising regularly to reduce the future risk of type 2 diabetes.

Infant follow-up:

• Blood glucose monitoring:
• The infant’s blood glucose level should be measured shortly after birth to ensure that hypoglycemia is not present.
• Routine examinations:
• Monitor the child’s growth regularly to ensure that no complications have resulted from gestational diabetes. 

References:

- Pillay, J., Donovan, L., Guitard, S., Zakher, B., Gates, M., Gates, A., ... & Hartling, L. (2021). Screening for gestational diabetes: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA, 326(6), 539-562.

- Barani, M., Sargazi, S., Mohammadzadeh, V., Rahdar, A., Pandey, S., Jha, N. K., ... & Thakur, V. K. (2021). Theranostic Advances of Bionanomaterials against Gestational Diabetes Mellitus: A Preliminary Review. Journal of Functional Biomaterials, 12(4), 54.‏ 

3. Nurse’s Role in Providing Nursing Care to a Woman with Delayed Menstruation:

1-   Patient Assessment:

-        Perform a physical assessment of the different body systems according to the patient’s complaint, with particular focus on the reproductive system.

-        Assess pain and notify the physician if the pain score is 3 or higher.

-        Perform a fall-risk assessment for adults.

-        Conduct psychological, spiritual, and nutritional assessments. 

2-   Nursing Procedures:

-        Measure vital signs (blood pressure, blood glucose, pulse, respiratory rate, and temperature).

-        Measure height and weight and calculate body mass index.

-        Develop and implement a nursing care plan.

-        Provide the patient with health education appropriate to the condition.

-        Complete electronic documentation of all nursing forms in the system. 

Health Education:

A delayed menstrual period is one of the most common causes of anxiety and concern among women, particularly those with regular cycles, and may increase suspicion of pregnancy in married women. Delayed menstruation is defined as a menstrual period occurring more than ten days later than the usual date in an adult woman. 

A normal menstrual cycle lasts 28 days, plus or minus seven days. Therefore, a delay of up to 7 days may be considered the maximum normal delay or the normal range for a late period. 

Menstrual bleeding is considered irregular if it occurs more frequently than every 21 days or lasts longer than 8 days. Missed, early, or late periods are also signs of an irregular cycle. 

To determine whether menstruation is irregular, count from the last day of the previous period to the first day of the next period and repeat this for three consecutive months. If the number of days varies substantially from month to month, the cycle is irregular. 

When is a delayed period considered normal? 

It is entirely normal for a woman’s cycle to be irregular or delayed in the following circumstances: 

When menstruation first begins.

When menopause begins. The average age at menopause is usually 52 years, although symptoms may appear 10–15 years before menstruation ceases. Menopause causes changes in hormone levels, particularly estrogen, which may lead to absent or irregular menstruation. 

What should be done when menstruation is delayed? 

Changes in the human body may require time or medical intervention before returning to normal. Variation in a woman’s menstrual cycle is common. Factors that affect cycle length include: 

Adolescence.

Breastfeeding.

Approaching menopause.

Stress.

Travel.

Diet.

Illness and medications, including contraceptive medications. 

If menstruation is delayed by more than several days, the woman’s cycle is usually regular, and pregnancy is possible, it is advisable to perform a home pregnancy test. 

Home pregnancy tests vary considerably in sensitivity. For some people, several additional days may be required before a positive result appears. By one week after a missed period, all tests should be capable of detecting pregnancy. 

Lifestyle and Home Remedies

Certain lifestyle factors—such as excessive exercise or extreme restriction of food intake—can cause amenorrhea. Aim for balance between work, recreation, and rest. Evaluate sources of stress and conflict 

in your life. If you cannot reduce stress on your own, seek help from your family, friends, or physician.

Be aware of changes in your menstrual cycle and consult your physician if you have concerns. Keep a record of menstrual dates, noting the start date, duration, and any troublesome symptoms.

References:

Shen, H. H., Zhang, T., Yang, H. L., Lai, Z. Z., Zhou, W. J., Mei, J., ... & Li, M. Q. (2021). Ovarian hormones-autophagy-immunity axis in menstruation and endometriosis. Theranostics, 11(7), 3512.

Park, S., Yang, H. J., Kim, M. J., Hur, H. J., Kim, S. H., & Kim, M. S. (2021). Interactions between Polygenic Risk Scores, Dietary Pattern, and Menarche Age with the Obesity Risk in a Large Hospital-Based Cohort. Nutrients, 13(11), 3772.