NWT Clinical Practice Guidelines for Primary Community Care Nursing - Women’s Health and Gynecology

Acute Pelvic Of Gynecological Origin

Definition Differential Diagnosis Acute due to dsyfunction or • Ectopic pregnancy disease of reproductive tract • Spontaneous abortion • Pelvic inflammatory disease Causes • Bleeding • Unsuspected ectopic pregnancy • Adnexal torsion • Ruptured or twisted • Mittelschmerz • Acute pelvic inflammatory disease • • Severe • Dysmenorrhea • Cystitis History • Pyelonephritis • Abdominal pain of sudden or gradual onset • Ureteral stone • Pain becoming increasingly severe • Inflammatory bowel disease • Pain made worse with cough, straining at stool • Irritable bowel or urination • Bowel obstruction • Pain may be referred to the shoulder tip (e.g. in ectopic pregnancy) Complications • Abnormal may have occurred • Internal hemorrhage with hypovolemic shock • Fever, chills and may be Sepsis present • Nausea and vomiting may be present Diagnostic Tests • Syncope may have occurred • Hemoglobin • Urine sample for urinalysis and culture; urine Physical Findings pregnancy test • Temperature may be elevated • Swabs (pv) if purulent discharge • Heart rate rapid • Blood pressure may be normal, reduced or Management hypotensive Goals of Treatment • Client appears in moderate-to-acute distress • Relieve pain • Client may walk slowly, bent over and holding • Prevent complications • Abdomen appears normal If pelvic inflammatory disease is suspected, • Vaginal examination may reveal pus from see "Pelvic Inflammatory Disease," above, this or bleeding chapter. • Bowel sounds may be reduced or absent • Lower abdominal tenderness If ectopic pregnancy is suspected, see "Ectopic • Signs of localized or generalized peritonitis may Pregnancy," in chapter 12, "Obstetrics" be present • Bimanual pelvic examination reveals acute Appropriate Consultation cervical motion tenderness Consult a physician as soon as possible, unless a • Adnexal tenderness or mass may be present minor cause has been definitively identified • Pregnancy test may be positive (e.g. Mittelschmerz or dysmenorrhea).

September 2004 Acute Of Gynecological Origin - Adult 1 NWT Clinical Practice Guidelines for Primary Community Care Nursing - Women’s Health and Gynecology

Nonpharmacologic Interventions Pharmacologic Interventions • Nothing by mouth Analgesia for pain: • Bed rest meperidine (D class drug), 50-100 mg IM • Consider inserting nasogastric tube if there are signs of peritonitis or bowel obstruction Monitoring and Follow-Up • Consider inserting a Foley catheter if patient is Monitor ABC (airway, breathing and circulation), hemodynamically unstable vital signs, and intake and output.

Adjuvant Therapy Referral • Start large-bore IV (14- or 16-gauge) with Medevac as soon as possible. normal saline • Adjust rate according to age and state of hydration • Oxygen by mask prn if client is in shock; keep oxygen saturation > 97%

September 2004 Acute Pelvic Pain Of Gynecological Origin - Adult 2