Traditional Chinese medicine nursing protocols for leukorrheal disease (pelvic inflammatory disease)

ABSTRACT: Leukorrheal disease is an ascending infection of the female genital tract, with high morbidity among reproductive age women. Antibiotics are usually used to treat leukorrheal disease in clinic, but they can lead to a variety of side effects if improper use or long-time use. In recent years, traditional Chinese medicine (TCM) has shown its unique advantages in the treatment of leukorrheal disease. This article mainly explored the key points of common syndromes, TCM nursing methods and health guidance of leukorrheal disease in order to further develop the advantages of TCM, improve its efficacy and standardized its nursing behavior.

KEY WORDS: leukorrheal disease; pelvic inflammatory disease; menstruation; chronic pain; traditional Chinese medicine nursing; syndrome differentiation

Leukorrheal disease, also termed pelvic inflammatory disease (PID), is an ascending infection of the female genital tract caused by the spread of bacteria from the vagina to the pelvic reproductive organs and occasionally the peritoneum[1]. It has a high morbidity among reproductive age women, with abnormal leucorrhea volume, color and texture as well as pain in the waist and abdomen as the major clinical manifestation. Leukorrheal disease can produce acute symptoms, and result in infertility, ectopic pregnancy and chronic pelvic pain if the treatment is delayed due to its nonspecific signs and symptoms, which not only threaten the female reproductive health, but also bring a great economic burden for the family[2-3].

Antibiotics are usually used to treat leukorrheal disease in clinic, but they can lead to a variety of side effects if improper use or long-time use[4]. In recent years, traditional Chinese medicine (TCM) has gradually shown a certain effect in the treatment of leukorrheal disease, such as TCM retention enema, acupoint massage, moxa-wool moxibustion, TCM washout and TCM fumigation[5]. Tong et al.[6]systematically evaluated the efficacy and safety of TCM in the treatment of vaginitis, and found that TCM was effective in vaginitis, and none of obvious adverse reactions occurred. In order to maintain and develop the advantages of TCM, improve its efficacy and standardized its behavior, TCM nursing protocols for leukorrheal disease are formulated byStateAdministrationofTraditionalChineseMedicineofthePeople'sRepublicofChina.

Keypointsofcommonsyndromes

Syndromeofaccumulateddampnessandheat: distending pain in the lower abdomen, much yellow leucorrhea; red tongue with yellow greasy tongue coating.

Syndromeofqistagnationandbloodstasis: stabbing pain in the lower abdomen, much leucorrhea, unsmooth menstruation with blood clots, bad mood; dark red tongue or with petechiae, white or yellow tongue coating.

Syndromeofaccumulatedcoldanddampness: cold pain in the waist and abdomen, white leucorrhea thin in texture, accompanied by scanty menstruation or dysmenorrhea in the late stage of menstruation; gloomy tongue with white greasy tongue coating.

Syndromeofkidneydeficiencyandbloodstasis: dull pain in the lower abdomen, lumbosacral soreness and pain, white leucorrhea thin in texture, dizziness, tinnitus; gloomy tongue with white tongue coating.

Syndromeofqideficiencyandbloodstasis: bearing-down pain in the lower abdomen, much white leucorrhea, prolonged menstruation period or profuse menstruation; gloomy tongue with white tongue coating.

Nursingforcommonsymptoms/syndromes

Pain

·Observe the part, nature and duration of pain, and make the pain score. In order to record the specific score, the numerical rating scale (NRS), a sort of self-assessment tool for pain, can be applied.

·Take a semireclining position for the patients who stay in bed, avoid standing and walking for a long time, and prohibit doing heavy work.

·Keep the abdominal and lumbosacral portions warm. For the patients with syndrome of accumulated dampness and heat, hot compress should be used with caution.

·Perform acupoint massage following the doctor's advice, and select the points of Guanyuan, Qihai, Zusanli, Sanyinjiao, etc.

·Perform moxa-wool moxibustion following the doctor's advice, and select the points of Qihai, Guanyuan, etc.

·According to the doctor's advice, conduct TCM retention enema which is unsuitable during menstruation.

·According to the doctor's advice, apply TCM hydropathic compress in the lower abdomen and lumbosacral portion, unsuitable during menstruation.

·According to the doctor's advice, apply hot medicinal compress in the lower abdomen and lumbosacral portion, unsuitable during menstruation.

·According to the doctor's advice, conduct TCM iontophoresis which is unsuitable during menstruation.

·According to the doctor's advice, conduct TCM fumigation which is unsuitable during menstruation.

Abnormalleucorrhea

·Observe the changes of leucorrhea volume, color and taste.

·Keep the perineum clean.

·Perform TCM washout following the doctor's advice.

Abnormalmenstruation

·Observe the menstrual volume, color, nature, cycles and concomitant symptoms, and inform the doctor immediately if the disease condition changes.

·Pay attention to sanitation during menstruation, select to wear loose and air-permeable clothes, and prohibit using unclean sanitation supplies.

·Teach the patients to monitor their menstrual cycles by measuring the basal body temperature on their own.

·Take the auricular-plaster therapy according to the doctor's advice, and select the points like Shenmen, Jiaogan, endocrine, uterus, etc.

·Perform external compress of TCM following the doctor's advice.

·According to the doctor's advice, apply hot medicinal compress in the lower abdomen and lumbosacral portion, unsuitable during menstruation.

·Perform acupoint massage following the doctor's advice, and select the points of Guanyuan, Xuehai, Sanyinjiao, etc.

TCMspecialnursing

Medications

InternalapplicationofChineseherbs

·Medication time: Each dose of herbs can be taken generally in twice or three times. The specific medication time depends on the property and function of herbs as well as the patients' pathological condition. Chinese herbs for relieving exterior and clearing heat should be taken 1 h before meals, in which application of exterior-reliving Chinese herbs should avoid wind chill, or putting on more clothes or having some porridge induces diaphoresis. Chinese herbs for promoting digestion, purgation, expelling parasites, tranquilization and tonification are taken respectively after meals, before meals, on an empty stomach in the morning, before sleep and on an empty stomach. Emergency drug use follows the doctor's advice.

·Medication temperature: The administered warm is usually adopted. For the patients with special treatment, it should be followed the doctor's advice.

·Medication dose: 200 mL is taken per time for the adult; 100 mL is taken per time for the patients with heart failure and those of controlling the dose. The elderly and children should take according to the doctor's advice.

Injection

·Inquire the history of allergy carefully before medication.

·Make allocation and administration according to the requirements and injection speed recommended in the drug instructions.

·Apply TCM injection alone, and use it right after it was ready.

·Chinese and western drugs should be separated when Chinese and western injections are in combination.

·It is inappropriate to use a venous channel for two or more kinds of drugs except for special instructions.

·Medication reactions are observed closely, especially for the elderly, children, people with liver and kidney dysfunction and those that use TCM injections initially. Medication is suspended, and the doctors should be told to deal with it if adverse reactions occur.

·Nursing for allergic reactions: stop to use the drugs immediately, change the infusion channel and inform the doctor; seal the liquid and channel that cause adverse reactions; do allergic identification and inform patients and their relatives firmly to avoid re-medication; guide the patients to have a bland diet during the treatment of allergic reactions, forbid to eat the food like fish, shrimps, etc.

ExternalapplicationofChineseherbs

·Keep dry and clean skin before medication, and do local debridement if necessary.

·Observe reactions closely after medication. For example, the doctor should be informed immediately if local symptoms like scorching heat, redness, pruritus and stabbing pain appear; The medication should be stopped immediately if the symptoms, such as dizziness, nausea, palpitation and shortness of breath, appear, and meanwhile, corresponding measures should be taken and the doctor should be informed.

·Use with caution for patients with allergic constitution.

Specialtechniques

Acupointmassage

·Conduct acupoint massage according to the doctor's advice.

·Assess the skin condition around the massage area and degree of tolerance to the pain; prohibit using it in women during menstruation and pregnancy.

·For the operator, trim the fingernails to prevent the skin from injury.

·Keep the strength even and moderate, and pay attention to keeping warm for the patients and protecting their privacy.

·Observe the patients' reactions closely when the operation is done; stop the massage and take corresponding measures once discomforts occur.

·Record the massage acupoints, techniques and time as well as the patients' feelings.

TCMretentionenema

·Conduct TCM retention enema following the doctor's advice.

·Nursing assessment: presence or absence of inflamed and ruptured perianal skin, history of drug allergy, recent surgeries related to the anus, rectum and colon as well as fecal incontinence. Before operation, the diseased location should be known in order to master the decubitus and depth of anal tube at the time of enema.

·Pay attention to keeping warm and protecting the privacy when the operation is done.

·Warn patients to defecate repeatedly before operation, and conduct cleansing enema following the doctor's advice if necessary.

·Keep the temperature of drug liquid at 39-41 ℃. Low temperature can enhance the intestinal peristalsis and aggravate abdominal pain, while high temperature can result in empyrosis of intestinal mucosa or dilatation of intestine and strong desire to defecate, consequently leading to short retention and less absorption of drug liquid in the intestine.

·Elevate the hip 10 cm, and make the depth of anal tube into the anus be 10-15 cm. When rectoclysis is adopted, the distance of drug liquid level to the anus is about 30-40 cm, with 60-80 drops of dripping speed per minute. It should be noted that the perfusion volume is less than 200 mL every time.

·Perform enema before sleep at night, and don't be up and about after enema. Assist the patients to take a suitable decubitus and keep the drug liquid remain more than 1 hour as soon as possible to improve the efficacy after the drug liquid is perfused.

·The times of defecation increase after TCM retention enema. The perianal skin should be observed and protected. Oiling agent or ointment can be smeared in the local part if necessary.

·Inquire the patients' feelings, tell him to take a deep breath to relieve the desire to defecate, and prolong the retention time of drug liquid. Stop enema immediately and inform the doctor to take some measures if discomforts occur.

·Record the enema time, retention time and defecation condition after the operation is finished.

ExternalcompressofTCM

·Conduct external compress of TCM following the doctor's advice.

·Nursing assessment: assess the condition of skin in the part of external compress and the sensory perception of patients to the temperature. It is used with caution for the patients who have drug and skin allergy and the infants.

·Tell the patients the process and notes of external compress of TCM, and immediately inform the doctor to take some measures if discomforts occur.

·Keep the operating environment warm.

·Expose the medication part thoroughly, and be cautious to keep warm and protect the privacy.

·According to the doctor's advice, confirm the medication part which is larger than the diseased part.

·Keep a certain thickness and humidity during TCM smear, and keep an appropriate degree of tightness in externally-fixed dressing.

·Observe the patients' local and systemic condition, and immediately inform the doctor to take measures when the symptoms like erythema, pruritus, vesicles appear in the local skin.

·Record the condition of skin in the medication part and the patients' feelings after the operation is finished.

Hotmedicinalcompress

·Apply hot medicinal compress following the doctor's advice.

·According to the doctor's advice, prepare the required herbs, then put them into a cloth bag, and make it into a TCM bag of hot compress at 60-70 ℃.

·Nursing assessment: assess the condition of skin in the part of hot medicinal compress, tolerance to the heat, previous history and history of drug allergy. It is forbidden in the abdomen for female patients during menstruation or pregnancy.

·Tell the patients to urinate thoroughly before hot medicinal compress.

·Take a suitable position.

·Keep the temperature of the herbal bag constant during hot medicinal compress, and immediately change another one or reheat after cooling. The temperature should be tolerated by the patients, usually not more than 70 ℃. However, for the elderly, infants and those with sensory disturbance, the temperature should be no more than 50 ℃ to avoid scalding.

·Observe the patients' reactions and skin condition, and immediately inform the doctor to take measures when the symptoms like erythema, pruritus, vesicles appear in the local skin.

·Record the temperature, part and time of hot medicinal compress and the patients' feelings after the operation is finished.

TCMiontophoresis

·Conduct TCM iontophoresis following the doctor's advice.

·Nursing assessment: the condition of skin in the part of iontophoresis; it should be used with caution for pregnant women, infants and those with drug and skin allergy.

·Tell the patients the process and notes of iontophoresis before operation, and inform the doctor to deal with it if discomforts occur.

·Keep the operating environment warm, expose the treatment part, and be cautious to keep warm and protect the privacy.

·Select the prescription following the doctor's advice, regulate the current intensity, and inquire the patients' feelings during treatment. The current intensity should be regulated on time if discomforts occur.

·Observe the local and systemic condition, and inform the doctor to manage immediately if the allergy occurs, such as erythema, pruritus and vesicles.

·Record the iontophoresis skin condition and patients' feelings after the operation is finished.

TCMhydropathiccompress

·According to the doctor's advice, select the appropriate herbs to apply TCM hydropathic compress.

·Assess the condition of skin in the part of hydropathic compress. It should be used with caution for the patients with drug and skin allergy as well as those with rapidly-diffused sores and ulcers.

·Expose the part of hydropathic compress, and be cautious to keep warm and protect privacy.

·Make the gauze of 5-6 layers saturate in the drug liquid as the water drops disappear. The temperature of drug liquid, 38-41℃ in general, should be controlled to avoid scalding.

·Observe the local skin response, and immediately stop the treatment, inform the doctor to manage if the symptoms like paleness, erythema, vesicles, itching, pain or rupture occur.

·According to the doctor's advice, take corresponding nursing measures if there is specialist medication.

·Be cautious of disinfection and isolation to prevent cross infection.

·Record the temperature, part and time of hydropathic compress and the patients' feelings after the operations is finished.

TCMfumigation

·Perform TCM fumigation following the doctor's advice.

·Nursing assessment: the condition of skin in the part of fumigation. It is used with caution to the patients with drug and skin allergy, cardiopulmonary-cerebral disease and enema as well as the weak and the elderly. It is unsuitable for pregnancy women and those during menstruation to take a sitz bath or fumigate the vulva.

·Before operation, tell the patients the process and notes of TCM fumigation, and communicate with the medical staff immediately if discomforts occur.

·Keep the operation environment warm, and close the doors and windows.

·Expose the fumigated part, and pay attention to keeping warm and protecting the privacy.

·Keep the temperature of drug liquid at 50-70 ℃. Sitz bath and washout can be conducted to prevent empyrosis when the liquid temperature is decreased to 37-40 ℃.

·Keep 20-30 min of TCM fumigation.

·Inquire the patients' feelings, and regulate the liquid temperature timely.

·Tell the patients to have a rest for 30 min after TCM fumigation, and then go out in order to prevent invasion of exogenous pathogens.

·Observe the local and systemic condition of patients during operation, and immediately inform the doctor and deal with it if discomforts occur.

·Record the temperature and time of TCM fumigation as well as the skin condition and patients' feelings after the operation is finished.

Moxa-woolmoxibustion

·Perform the moxa-wool moxibustion following the doctor's advice and select the proper ways of moxa-wool moxibustion, such as moxibustion with moxa cone, moxibustion with moxa stick, moxibustion with moxa box, tec.

·Nursing assessment: the condition of skin in the area of moxibustion and acceptance level of patients to the moxibustion smell. It is unsuitable for moxibustion in the face, in the part of larger vessels as well as in the abdominal and lumbosacral portions of pregnant women.

·Regulate the room temperature timely, and maintain good indoor ventilation.

·Select a suitable position to fully expose the part of moxibustion, and be cautious to keep warm and protect privacy.

·Do moxibustion from top to bottom, namely the top of the head and chest-back first, and then the abdomen and four limbs.

·During moxibustion, inquire the patients whether they feel a burning sensation, regulate the distance and flip the moxa ash into the kidney basin to avoid burning the skin.

·Pay attention to moxibustion time. For instance, moxibustion is done for the patients with insomnia before sleep instead of moxibustion immediately before meals or after meals.

·After moxibustion, local reddish scorching skin is normal. The moxibustion-induced small vesicles can be absorbed by themselves, but for the large ones, the doctor should be informed immediately and corresponding measures are taken according to the doctor's advice.

·Place the moxa cone or moxa stick in the flame-out bottle to extinguish the moxibustion fire immediately after moxibustion.

·Small-dose and short-time moxibustion is applied to the initially-used patients, and the dose is increased gradually when the patients are tolerant.

·After moxibustion, record the way, part and skin of moxibustion as well as the patients' feelings.

TCMwashout

·Perform TCM washout following the doctor's advice.

·It is forbidden for the patients with acute infectious disease, severe cardiopulmonary-cerebral disease, severe anemia, soft tissue injury and acute hemorrhage as well as the pregnant females and those during menstruation. It should be used with caution for the patients with drug and skin allergy. For the fasting patients and those 1 h after meals, it is unsuitable to operate.

·Keep the operating environment warm, close the doors and windows, and be cautious to keep warm and protect privacy.

·Tell the patients the notes of TCM washout before operation, and communicate with the medical staff immediately if discomforts occur.

·Maintain the temperature of drug liquid at 37-40 ℃ and the time in 10-20 min.

·Enhance to make inspection tours during washout; dry the sweat immediately for the patients with much sweating; be cautious to keep warm in winter.

·Arrange the specially-assigned person to accompany the old and weakling patients at the time of washout.

·Be cautious of disinfection and isolation to prevent cross infection. Each person uses the special washout supplies for special purpose.

·Record the temperature, time and skin condition of TCM washout and patients' feeling after the operation is finished.

Auricular-plastertherapy

·Embed beans at auricular points and select acupoints correctly according to the doctor's advice.

·Assess the condition of ear skin and degree of tolerance to the pain; prohibit using them in the inflammatory, ruptured and frozen skin as well as in pregnant women.

·Keep the intensity of probe moderate and accurately seek the sensitive point in acpoint area.

·Scrub the ears with 75% alcohol.

·Observe the patients' condition, stop immediately and inform the doctor to deal with it if discomforts occur.

·Select one ear for routine performance, keep the beans usually for 3-7 days and use them in two ears alternately; guide the patients to press them correctly.

·Observe the fixed degree of auricular point sticking, the improvement condition of symptoms and ear skin (redness, swelling, rupture, etc.).

·Record the bean-embedded location and time at auricular points as well as the patients' feelings after the operation is finished.

Healthyguidance

Dailylife

·Pay attention to personal hygiene, enhance the healthcare during menstruation, pregnancy and puerperium, and keep sanitation supplies clean.

·Avoid sexual life during treatment, and forbid sexual intercourse, tubing and swimming during menstruation and within three days after menstruation.

·Avoid filthy sexual intercourse. The sex partners with venereal disease need to be treated together.

·Take family-planning measures, and avoid performing abortion and sterilizing operations as soon as possible.

·Strengthen physical exercises, such as Qigong, Tai Chi, eight trigrams boxing and pelvic rehabilitation gymnastics.

Dietaryguidance

It is advisable to eat the food that can clear fire and promote dampness. The spicy, excitant and cold foods are forbidden.

·Syndromeofaccumulateddampnessandheat: It is advisable to eat the food that can clear fire and promote dampness, such as bitter gourd and white gourd. Dietary formula: white gourd and red bean soup.

·Syndromeofqistagnationandbloodstasis: It is advisable to eat the food that can sooth liver to promote qi circulation and resolve blood stasis to stop pain, such as smoked plum and lemon. Dietary formula: fingered citron and rose soup.

·Syndromeofaccumulatedcoldanddampness: It is advisable to eat the food that can dispel cold, remove dampness and resolve blood stasis to relieve pain, such as peach seed and litchi. Dietary formula: peach seed porridge.

·Syndromeofkidneydeficiencyandbloodstasis: It is advisable to eat the food that can replenish kidney and resolve blood stasis, such as black beans and rose. Dietary formula: black bean porridge.

·Syndromeofqideficiencyandbloodstasis: It is advisable to eat the food that can tonify qi, reinforce spleen and resolve blood stasis, such as peach seed and Chinese yam. Dietary formula: Chinese yam and peach seed porridge.

Emotionaladjustment

·Introduce the disease-related knowledge actively by the nurse, encourage the patients to insist on treatment to decrease the risk of recurrence.

·Encourage the relatives to spend more time with the patients and give them emotional support.

·Encourage more communications among the patients to remove the bad mood.

·Take a music therapy according to the patients' syndrome differentiation.

·Take the auricular-plaster therapy according to the doctor's advice, and select the points like heart, liver, Shenmen, Jiaogan, spleen, etc.