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Nursing Practice II — Maternal and Child Health Nursing
문제

Situation: A nurse at the reproductive health clinic of a district hospital cares for adult men and women with gynecologic and reproductive tract problems. A 27-year-old woman is diagnosed with pelvic inflammatory disease (PID). Her urine pregnancy test is negative, and ultrasound shows no pelvic abscess. Which additional finding indicates that she needs hospital admission rather than outpatient treatment?

해설
Most women with PID are treated as outpatients. Admission is needed when a surgical emergency cannot be excluded, with a tubo-ovarian abscess, pregnancy, severe illness with vomiting or a temperature above 38.5 °C, inability to take or tolerate oral therapy, or no response within 72 hours. Vomiting that prevents oral drugs means she needs parenteral therapy in the hospital.
같은 주제 다음 문제Situation: A nurse at the infertility clinic of a tertiary hospital assesses couples who h…이 문제가 수록된 문제집PLNE Question Bank 150014,000원 · 무료 체험 가능

심화 해설

Most PID is treated as an outpatient
Pelvic inflammatory disease (PID) is an infection of the upper genital tract, often caused by sexually transmitted organisms such as chlamydia and gonorrhea. Most women with PID can be treated safely with oral antibiotics as outpatients. Admission is reserved for specific situations. This client has a negative pregnancy test and no pelvic abscess on ultrasound, which rules out two of those situations. Vomiting that keeps her from taking oral drugs means oral therapy cannot work, so she needs admission for parenteral antibiotics.

Criteria for hospital admission

Admission criterionReason
A surgical emergency cannot be excludedConditions such as appendicitis need urgent surgical assessment
Tubo-ovarian abscessNeeds parenteral therapy and possibly drainage
PregnancyHigher risk to mother and fetus; drug choices are limited
Severe illness, vomiting, or temperature above 38.5 °CSystemic illness needs closer monitoring
Inability to take or tolerate oral therapyOral regimen cannot be completed
No response to oral therapy within 72 hoursTreatment failure needs reassessment

Why the other findings do not require admission
A positive chlamydia test identifies a common cause of PID that standard outpatient regimens already cover. Yellow mucopurulent cervical discharge and cervical motion tenderness are findings that support the diagnosis of PID; they show that the condition is present but not that it is severe. Watch out! Diagnostic findings and admission criteria are different lists. An item that asks about admission is testing whether the client can be treated safely at home, not whether she has PID.

Nursing care beyond the antibiotic choice
Whether she is treated in or out of the hospital, the nurse teaches her to complete the full course, to avoid sexual intercourse until treatment is finished and symptoms resolve, and to return if pain worsens or fever develops. Her sexual partners need evaluation and treatment to prevent reinfection. The nurse also counsels on condom use and explains that untreated or repeated PID raises the risk of infertility, ectopic pregnancy, and chronic pelvic pain.

Exam takeaway
Admit a woman with PID when oral therapy is not possible, when she is pregnant or severely ill, when an abscess or surgical emergency is suspected, or when outpatient therapy fails. Key point! Vomiting that prevents oral drugs is a practical, high-yield criterion: if she cannot keep the medicine down, she needs parenteral treatment.

임상 시나리오

PID: Outpatient or Admission?Woman with PID who cannot keep oral drugs down

Most women with PID are treated as outpatients with oral antibiotics.

Admit when a surgical emergency cannot be excluded, with a tubo-ovarian abscess, pregnancy, severe illness or temperature above 38.5 °C, inability to take oral therapy, or no response within 72 hours.

Teach completion of therapy, abstinence until cured, partner treatment, and condom use.

Caution

Cervical motion tenderness, mucopurulent discharge, and a positive chlamydia test support the diagnosis but are not reasons for admission.

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