04.01 Nursing Care and Pathophysiology for Pelvic Inflammatory Disease (PID)

Hi guys, today’s lesson is on pelvic inflammatory disease. By the end of today’s lesson you will have a better understanding of what pelvic inflammatory disease is, what causes it, associated complications with the disease, as well as assessment findings and diagnostic testing options, and nursing considerations relating to the disease.

Okay guys so pelvic inflammatory disease is an infection of any part of the female reproductive tract caused by changes to the mucous in the cervix which basically serves as a protective barrier and keeps bacteria out. So since the mucous isn’t providing that protective barrier like it should, bacteria can get into the uterine cavity and cause infection and inflammation in the uterus or other reproductive structures if it spreads. Like with most infections, pelvic inflammatory disease can be fatal if untreated because the infection can spread and become system wide.

The most common cause of pelvic inflammatory disease or PID is STDs like Chlamydia and Gonorrhea. So how is a STD transmitted? Sex, right? So the bacteria enters the vagina then is able to spread because there are changes to the cervical mucus or vaginal flora. So like I mentioned in the previous slide with a change in the cervical mucus, the protective barrier is basically broken, which allows bacteria to pass through the cervix. Another sort of protective mechanism the body has is the naturally occurring vaginal flora, which is the good bacteria that lives in the vagina. With vaginal flora overgrowth, it throws off the pH in the vagina and makes it more susceptible to infection. Another cause of PID is an infection of the pelvic structures, like a pelvic abscess, because the infection can spread to the reproductive tract and lead to PID.

So let’s touch on the risk factors for PID really quick. One of the risk factors is having multiple sexual partners, because there is a higher risk of contracting a STD, putting the patient at a greater risk of developing PID. IUD placement also puts the patient at risk because there is a chance for bacteria to enter the uterus during placement. Since STD’s are a common cause of PID, they are definitely a risk factor for the development of PID. And like I mentioned before, an infection somewhere else in the body, like one of the pelvic structures can cause PID as well if it spreads to the reproductive tract.

So with PID, it can cause inflammation and scarring to build up in the fallopian tubes, which can interrupt the natural flow of eggs. So if there is enough scarring in the fallopian tubes, the eggs can’t go from the ovary through the fallopian tube to the uterus. Because of this, the egg can get stuck in the fallopian tube and can cause ectopic pregnancy and infertility. So ectopic pregnancy is not a complication of PID, but having PID puts patients at a higher risk of ectopic pregnancy even up to a year later due to the scar tissue build up. Since PID is an infection, patients can have serious complications like sepsis or death if there is a delay in treatment or inadequate treatment.

So patients with PID can either be asymptomatic, which is called silent PID, or they can have a few different symptoms. A lot of the symptoms are due to infection and the inflammatory response to infection. So one symptom is pain in the lower abdomen and lateral abdomen like where the fallopian tubes are, due to increased inflammation. Lower abdominal pain is one of the most frequent symptoms you’ll see with PID. Patients can also have abnormal vaginal bleeding, like spotting between periods, as well as abnormal yellow or green vaginal discharge due to the bacterial infection. Pain with urination and intercourse can also be experienced due to the inflammation present. Another common symptom is pain with movement and an altered gait - like walking kind of hunched over to protect their abdomen due to the increased inflammation. And as with any infection, patients can have malaise, fever, and chills.

PID can be hard to diagnose sometimes if the patient has subtle symptoms that are not typical of the disease, or if they are asymptomatic like with silent PID. Early diagnosis and treatment is important to prevent scarring and damage to the reproductive system and hopefully prevent infertility. Diagnosis is usually based on clinical history - so seeing if the patient has any risk factors, how long they have had symptoms for, etc. The physical exam is also helpful for diagnosis - so patients will usually have the dull abdominal pain, fever, chills, malaise, etc. Since PID is an infectious process, we need to do a gram stain and a culture and sensitivity to find out what the infectious organism is to choose the right antibiotic. Further imaging and diagnostics are usually not needed but they are usually used if we need to rule out other diseases or if the assessment alone is not enough for diagnosis.

So with our treatment guys, our goal is to get rid of the infection, relieve symptoms, and protect the reproductive system. Uncomplicated cases can be treated at home with oral antibiotics. If the patients don’t respond well to treatment, they may be hospitalized for IV antibiotics and for further evaluation to rule out other diagnoses like appendicitis. Since abdominal pain is one of the most common symptoms, NSAIDs are usually given to help with pain control. Heat packs can be applied to the lower abdomen to provide a soothing effect as well. Positioning the patient in semi-fowler’s position can help facilitate drainage of infection which can also help with pain. As with any disease, we want to do frequent assessments to identify complications like sepsis and infertility, as well as chronic pelvic pain. We will also be monitoring the effectiveness of antibiotics and look for persistent or recurrent infection.

Okay guys so when we are teaching about PID, we want to make sure that we teach patients to practice abstinence during treatment to try to prevent further infection. Patients should check their temperature daily and report a fever to their provider, because this could mean the infection is getting worse. Compliance with treatment is very important because patients should take the whole course of antibiotics as well as go to their outpatient appointments for follow up to make sure that the infection is improving and to prevent permanent scarring. We need to teach patients that their sexual partners should be evaluated and treated as well if PID is due to a STD. We also want to teach our patient how to prevent future episodes - so using condoms and limiting sexual partners if PID was due to a STD.

One of the nursing concepts is an alteration in comfort as patients usually have pain and discomfort with this disease. Patients can also have an alteration in reproduction because PID can cause infertility.

Okay guys, so the key points I want you to remember include the assessment findings, so patients can be asymptomatic, but they can also have symptoms like lower abdominal pain, abnormal vaginal bleeding and discharge, as well as painful urination. Some of the complications include infertility, ectopic pregnancy, and sepsis or death if there is a delay in treatment or inadequate treatment. Our management of these patients includes antibiotics, pain control, and hospitalization in some cases. We want to teach about abstinence during treatment, importance of checking their temperature daily, compliance with treatment, as well as importance of treating their sexual partners.

Okay guys, that is it on our lesson on pelvic inflammatory disease. Make sure to check out all the awesome resources attached to this lesson. Now, go out there and be your best self today, and as always, Happy Nursing!