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Chapter 14

Chapter 14. Genitourinary Problems. Lesson Objectives (1 of 2).

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Chapter 14

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  1. Chapter 14 Genitourinary Problems

  2. Lesson Objectives (1 of 2) • Recognize and manage female genital problems, including vaginitis, vulvar irritation, problems with urination, missed menses, heavy or prolonged bleeding, bleeding with pregnancy, pain due to infections, ruptured cysts or ectopic pregnancy, and pain associated with pregnancy. • Know how to perform an emergency delivery. • Understand general considerations for pregnancy and wilderness travel.

  3. Lesson Objectives (2 of 2) • Recognize and manage male genital problems, including problems with urination, bloody urine, frequent urination, inability to urinate, testicular pain, pain and swelling of the foreskin, and kidney stones. • List guidelines for evacuating victims with genitourinary problems.

  4. Overview (1 of 4) • Term genitourinary refers to the reproductive and urinary systems.

  5. Overview (2 of 4) Urinary system

  6. Overview (3 of 4) • Female reproductive system • Ovaries • Fallopian tubes • Uterus • Vagina

  7. Overview (4 of 4) • Male reproductive system • Testicles • Prostate • Spermatic cords • Penis

  8. Female Problems (1 of 26) • Vaginitis • Occurs when the normal balance of microbes in the vagina is altered. • Common causes include yeasts, bacteria, or protozoa. • Vaginal infections are uncomfortable but not usually dangerous.

  9. Female Problems (2 of 26) • Vaginitis • What to look for: • Vaginal soreness, burning, and itching • Increased vaginal discharge • Pain with urination

  10. Female Problems (3 of 26) • Vaginitis • What to do: • Women should wear cotton underwear and loose-fitting pants. • Irrigate the vulva with clean water several times daily. • Use vaginal antifungal medication.

  11. Female Problems (4 of 26) • Vulvar irritation • The vulva is the area of external folds around the vagina • Can be caused by allergic reaction or irritation.

  12. Female Problems (5 of 26) • Vulvar irritation • What to look for: • Vulvar soreness, burning, and itching • Vulvar redness • Pain with urination

  13. Female Problems (6 of 26) • Vulvar irritation • What to do: • Avoid contact with irritating substances. • Keep affected area clean. • Apply hydrocortisone cream.

  14. Female Problems (7 of 26) • Problems with urination: • In absence of vaginitis, vulvitis, or sores, pain with urination is usually caused by urinary tract infection.

  15. Female Problems (8 of 26) • Problems with urination: • What to look for: • Frequent, burning urination • Low abdominal pain and cramping • Cloudy, bloody, or foul-smelling urine

  16. Female Problems (9 of 26) • Problems with urination: • What to do: • Drink water until the urine is pale yellow. • Drink acidic fluids or juices and take vitamin C. • Avoid sexual intercourse.

  17. Female Problems (10 of 26) • Missed menses • Temporary absence of menstrual periods is not necessarily abnormal. • Irregularity or absence of menstrual periods can result from stress, illness, starvation, and eating disorder. • Heavy, regular exercise can suppress ovulation and menstruation.

  18. Female Problems (11 of 26) • Missed menses • What to look for: • History of unprotected intercourse, breast tenderness, nausea or morning sickness (possible pregnancy) • Stress, heavy exercise • Severe weight loss due to poor eating

  19. Female Problems (12 of 26) • Missed menses • What to do: • A missed period usually requires no treatment. • The woman should consult a doctor if periods do not occur for 3 months.

  20. Female Problems (13 of 26) • Heavy or prolonged bleeding • What to look for: • Signs and symptoms of pregnancy • Amount and duration of bleeding • Pale skin, nails, and lips • Weakness • Signs and symptoms of shock

  21. Female Problems (14 of 26) • Heavy or prolonged bleeding • What to do: • Have the woman rest. • Give the victim generous amounts of fluids to drink. • Seek medical care if bleeding saturates a pad every 3 hours or less over a 24-hour period or if the woman becomes pale and weak.

  22. Female Problems (15 of 26) • Bleeding while on hormonal contraceptives • Irregular light bleeding is common in woman who take low-dose birth control pills.

  23. Female Problems (16 of 26) • Bleeding with pregnancy • Bleeding in a pregnancy of less than 12 weeks suggests possible miscarriage. • Bleeding in a pregnancy of more than 12 weeks occurs with miscarriage, labor, and abnormalities of the placenta.

  24. Female Problems (17 of 26) • Bleeding with pregnancy • What to look for: • Length of time since last period • Amount of bleeding: spotting or free-flowing • Low abdominal pain • Signs and symptoms of shock

  25. Female Problems (18 of 26) • Bleeding with pregnancy • What to do: • If less than 12 weeks pregnant and bleeding remains light and painless, have victim avoid physical exertion until bleeding stops. • Seek medical care or evacuate if there is heavy bleeding, the woman passes tissue vaginally, there is low abdominal pain, she is more than 12 weeks pregnant, or she becomes weak or pale.

  26. Female Problems (19 of 26) • Low abdominal pain • Precise cause cannot be determined in the wilderness. • Seek medical care if the woman is obviously sick and becoming worse.

  27. Female Problems (20 of 26) • Pain due to infections • What to look for: • Low abdominal pain • Fever • Nausea and vomiting • Diarrhea

  28. Female Problems (21 of 26) • Pain due to infections • What to do: • Give the victim as much fluid as tolerated. • If victim has increasing or constant pain, fever, nausea, and vomiting, seek medical care.

  29. Female Problems (22 of 26) • Pain with internal bleeding from ruptured cyst or ectopic pregnancy • If fertilized egg becomes lodged in fallopian tube, an ectopic pregnancy results. • Ovarian cysts can rupture, causing abdominal pain, internal bleeding, and signs of peritonitis.

  30. Female Problems (23 of 26) • Pain with internal bleeding from ruptured cyst or ectopic pregnancy • What to look for: • Low or generalized abdominal pain • Nausea • Signs of blood loss or shock

  31. Female Problems (24 of 26) • Pain with internal bleeding from ruptured cyst or ectopic pregnancy • What to do: • Keep the woman lying at rest. • Have her walk out of the area if she is capable and help is far away. • If she is unable to walk, send for help and evacuate.

  32. Female Problems (25 of 26) • Pain associated with pregnancy • What to look for: • Time since last period • Recurring pains • Signs of blood loss of shock

  33. Female Problems (26 of 26) • Pain associated with pregnancy • What to do: • Make sure woman is well hydrated and rests. • If more than 5 months pregnant with frequent cramping, drink a quart of water over 20 minutes.

  34. Emergency Delivery (1 of 4) • What to look for: • Regular contractions occurring every 4 minutes. • Mother feels the urge to push or move her bowels. • Baby’s head or other body part is visible.

  35. Emergency Delivery (2 of 4) • What to do: • Have the mother lie or squat in a clean area. • Mother and rescuers should wash hands if possible. • Have mother push with contractions and rest in between. • Apply gentle, firm pressure to the baby’s head.

  36. Emergency Delivery (3 of 4) • What to do: • If umbilical cord is wrapped around the baby’s neck, unloop it. • If any body part other than the head comes out first, evacuate immediately. • After infant is delivered, tie off umbilical cord in two places but do not cut it.

  37. Emergency Delivery (4 of 4) • What to do: • Hold baby facedown with face lower than body to allow drainage of fluids. • Dry the baby and keep warm. • Placenta should deliver within 15 minutes. • If mother continues to bleed heavily after delivering the placenta, massage the uterus firmly.

  38. Pregnancy and Wilderness Travel—General Considerations • Healthy pregnant women who are active before they become pregnant can usually continue to exercise moderately during pregnancy. • Pregnant women should avoid overheating and should maintain adequate hydration. • Avoid activities that pose a risk of abdominal trauma, high altitudes, and scuba diving.

  39. Male Problems (1 of 15) • Problems with urination • What to look for: • Frequent, painful urination • Pus at the end of the penis

  40. Male Problems (2 of 15) • Problems with urination • What to do: • Treat urinary tract infections accordingly. • If the victim has a sexually transmitted disease, he should avoid sex and seek medical care.

  41. Male Problems (3 of 15) • Bloody urine • What to look for: • Pink or red urine • Severe back or flank pain (kidney stone or infection) • Fever • Inability to urinate

  42. Male Problems (4 of 15) • Bloody urine • What to do: • Give victim several extra quarts of water per day unless he is unable to urinate. • Have the victim walk out of the wilderness if there is no pain or fever. • Evacuate if there is high fever with flank pain.

  43. Male Problems (5 of 15) • Frequent urination • What to look for: • Fever, chills, flank pain, and/or burning with urination • Constant thirst • Frequent small amounts of urine

  44. Male Problems (6 of 15) • Frequent urination • What to do: • Increase water intake unless you believe there is an obstruction. • Give vitamin C. • If infection is likely, victim should take antibiotics if he has them. • Seek medical care.

  45. Male Problems (7 of 15) • Inability to urinate • What to look for: • Painfully full bladder • Inability to pass any urine or frequent small amounts without relief

  46. Male Problems (8 of 15) • Inability to urinate • What to do: • Stop any medications for allergies, congestion/colds, stomach cramps, motion sickness, and sleep medications. • Limit fluid intake. • Have victim sit in warm water. • If victim is still unable to urinate, evacuate.

  47. Male Problems (9 of 15) • Testicular pain • What to look for: • Severe pain in the testicle. • Affected testicle is firm and swollen. • Difficulty urinating because of pain.

  48. Male Problems (10 of 15) • Testicular pain • What to do: • If twisting is suspected, attempt untwisting. • If pain does note resolve within a few minutes, evacuate. • If infection is suspected, use warm compresses and give antibiotics if available.

  49. Male Problems (11 of 15) • Pain and swelling of foreskin • Foreskin can become inflamed and it may become impossible to move foreskin back and forth over the penis.

  50. Male Problems (12 of 15) • Pain and swelling of foreskin • What to do: • Have victim gently compress tissue and try to move it. • Wash the area with mild soap cleaning beneath foreskin as well. • Dry the area and apply antifungal cream and/or antibiotic ointment.

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