1.2.1 Administration of Aperients

1.2.2 Administration of rectal suppositories

1.2.3 Administration of enema

Disposable enema

Tap water enema

Retention enema (Oil infusion)

1.2.4 Bowel Examinations

1.2.4.1 Colonic Lavage

1.3 Enteral Tubes

1.3.1 Insertion of a nasogastric tube

1.3.2 Nasogastric feeding

1.3.3 Medication Administration

1.3.4 Removing a nasogastric tube

1.4 Respiratory support

1.4.1 Inhalations

1.4.2 Nebulisations

1.4.3 Oxygen Therapy

1.4.3.1 Nurse / Midwife Initiated Oxygen therapy

1.4.3.2 Nasal prongs

1.4.3.3 Simple mask

1.4.3.4 Non Rebreather Bag and Mask

1.4.3.5 Venturi Mask

1.5 Thoracocentesis

1.5.1 Intercostal Catheter Care

1.5.1.1 Insertion of intercostal catheter and connection to underwater seal drain

1.5.1.2 Ongoing Management of an Intercostal Catheter

1.5.1.3 Changing an ICC Canister

1.5.1.4 Removal of an Intercostal Catheter

1.6 Vaginal Procedures

1.6.1 Insertion of a Vaginal Pack for Uterine Procedentia

1.6.2 Vaginal Irrigation

1.6.3 Insertion and Removal of a Vaginal Pack

2. Managment of the Surgical Patient

2.1 Routine Preoperative Care

2.1.1 Fasting guidelines, refer to Section E

2.1.2 Pre-operative hair removal

2.1.3 Pre-Admission Clinic For Elective Non-Urgent Gynaecology And Urogynaecology Surgery

2.2 Routine Post Operative Care

2.2.1 Receiving patient from recovery

2.2.2 Care following minor surgery for gynaecology,oncology urogynaecology

2.2.2.4 Cervial suture

2.2.3 Major surgery

2.2.3.1 Care following major surgery for gynaecology, oncology,urogynaecology

2.3 Post-operative nausea and vomiting (PONV)

3. Pain Management (pending)

3.1 Pain Control

3.1.1 Types of pain and suggested use of analgesia

3.1.2 Suggested aids to control pain and increase comfort

3.2 Use of nitrous oxide and oxygen inhalation analgesia (Entonox apparatus)

3.3 Epidural narcotic and local anaesthetic analgesia therapy

3.4 Intravenous narcotic infusion

3.4.1 Patient controlled analgesia (PCA)

3.5 Use of ketorolac trometamol

3.6 Local applications

3.6.1 Hot pack

3.6.2 Cold pack

4. Pre Existing Medical Conditions in Gynaecology Management

4.1 Anti embolic therapy

4.1.1 Risk assessment and recommended venous thromboembolic prophylaxis in patients admitted for Gynaecological conditions

4.1.2 Existing therapy requiring special considerations

4.1.3.1 Intravenous heparin therapy

4.1.3.2 Warfarin therapy

4.1.4 Use of anti-embolic stockings/mobilisation

4.1.5 Use of desmopressin

4.1.6 Bibliography

4.2 Diabetes

4.2.1 Diagnoses and therapy

4.2.2 Insulin administration during and after gynaecological surgery for women with Type 1 & Type 2 diabetes

4.2.2.1 Elective surgery

4.2.2.2 Emergency surgery

4.2.3 Management of hypoglycaemia

4.2.4 Management of diabetic ketoacidosis

4.2.5 References

4.3 Cardiac conditions

4.3.1 Management of a Glyceral Trinitrate Infusion

4.3.2 Tachyarrythmia - use of Adenosine

5. Stoma Care

5.1 Pre-operative care

5.2 Post-operative care

5.3 Application of stoma appliance

5.3.1 Obtaining supply of stoma appliance

5.4 Emptying stoma bags

5.5 Removal of bridge

5.6 Stoma irrigation

5.7 Obtaining a urostomy specimen

6. Abdominal/Pelvic Pain

6.1 Acute pain

6.1.1 Aetiology

Gynaecologic causes

Obstetric causes

Other causes

6.1.2 Clinical assessment

6.1.3 Treatment

6.1.3.1 Acute pelvic inflammatory disease (PID)

6.1.3.2 Ovarian cyst accidents

6.2 Chronic pelvic pain (CPP)

6.2.1 Treatment

6.2.1.1 Laparoscopy

6.2.1.2 Endometreosis

6.2.1.3 Adhesions

6.2.1.4 Pelvic venous congestion

7. Sexually Transmitted Infections

7.1 Sexual health clinic

7.2 Screening for women

7.3 Gonorrhoea

7.4 Chlamydia

7.5 Genital ulceration

7.5.1 Genital herpes

7.5.2 Syphillis

7.6 Vaginal discharges

8. Reproductive Medicine

8.1 Management and referral for Fertility Services

8.1.1 Referral for IVF

8.2 Aetiology and treatment of infertility

8.2.1 Anovulatory infertility

8.2.2 Tubal infertility

8.2.3 Endometreosis associated infertility

8.2.4 Unexplained infertility

8.2.5 Male factor infertility

8.3 Donor insemination

8.4 Premature Ovarian Failure

8.5 Ovarian Hyperstimulation Syndrome (OHSS)

8.5.1 Inpatient management

9. Early Pregnancy Care

9.1 Early pregnancy complications - General considerations

9.1.1 History

9.1.2 Examination

9.1.3 Investigations

9.2 Early pregnancy bleeding

9.2.1 Investigations

BHCG

9.2.2 Treatment

Algorithm for the management of early pregnancy bleeding

9.2.3 Management of a Woman with Vaginal Bleeding and a Viable Intrauterine Pregnancy

9.3 Early pregnancy failure

9.3.1 Medical management

9.3.2 Surgical management

9.3.3 References

9.4 Ectopic pregnancy

9.4.1 Interpretation of findings

9.4.2 Medical management using methotrexate

9.4.2.1 Expectant

9.4.2.3 Surgical

9.4.3 Algorithm for the management of ectopic pregnancy

9.5 Other early pregnancy complications

9.5.1 Absence of chorionic villi in products of conception

9.5.2 Negative laparoscopy

9.5.3 Molar pregnancy

9.6 Management of hyperemesis gravidarum

9.6.1 Management in the home

9.7 The Kleihauer Test - refer to section A 1.9

9.8 Guidelines for the use of Rh(D) Immunoglobulin (formerly Anti D) - refer to section A 1.9

9.9 Referral to the early Pregnancy Assessment Service

9.10 Management of Early Gestational Sac

10. Mid Trimester Termination of Pregnancy

10.2 Insertion of an intra-uterine/extra-amniotic Foley's catheter for administration of prostaglandins

10.3 Augmentation of labour using Syntocinon

10.4 Delivery of fetus

10.5 Supression of lactation

10.6 Guidelines for the use of Mifepristone

10.7 Guidelines for the use of Misoprostol

11. Contraception – Refer to section A 9

12. Management of Menopause

12.1 Management of Menopausal Symptoms (pending)

12.2 Drug Therapy for Relief of Menopausal Symptoms

12.2.1 Hormone Replacement Therapy (HRT) (pending)

12.2.2 Use of androgens in women (pending)

12.3 Management of menopausal symptoms after breast cancer

12.3.1 Options for medication of menopausal symptoms after breast cancer

13. Gynaecological Cancers

13.1 Vulvar cancers

13.1.1 Classification and staging of vulvar cancers

13.1.2 Squamous cell carcinoma

Management of stage 1 and 11

Management of locally advanced vulvar cancer

Management of clinically suspicious inguino-femoral nodes

Management of clinically obvious inguino-femoral nodes

13.1.3 Care following simple/radical vulvectomy

13.1.4 Post operative radiotherapy options

13.2 Cervical cancer

13.2.1 Classification and staging of cervical cancers

13.2.2 Post operative adjuvant therapy

13.2.3 Relative risk of recurrance after hysterectomy for Stage 1 cervical cancer

13.2.4 Locally advanced cervical cancer

13.2.5 Metastatic/recurrant cervical cancer

13.2.6 Special situations

Adenocarcinoma in situ of the cervix (ACIS)

Microinvasive adenocarcinoma of the cervix

Non invasive adenocarcinoma of the cervix

Small cell neuoendocrine carcinoma

13.2.7 References

13.3 Vaginal cancer

13.3.1 Staging of vaginal carcinoma

13.3.2 Squamous cell and adenocarcinoma of the vagina

13.4 Uterine cancer

13.4.1 Classification and staging of the uterine body

13.4.2 Endometrioid adenocarcinoma Clinical Stage 1

13.4.2.1 Diagnosed after total hysterectomy

13.4.3 Endometrioid adenocarcinoma clinical Stage 2

13.4.3.1 Gross cervical involvement

13.4.3.2 Diagnosed after staging surgery - cervical involvement

13.4.4 Endometrioid adenocarcinoma Clinical Stage 3-4

13.4.4.1 Clinically advanced disease

13.4.4.2 Diagnosed after staging surgery

13.4.4.3 Positive peritoneal washings only

13.4.5 Special situations

13.5 Ovarian cancer

14. Palliative Care

14.2 Pain control in palliative care

14.2.1 Opiod availability and use

14.2.1.1 Initiating morphine

14.2.1.2 Use of methadone

14.2.1.3 Opiod conversions

14.2.2 Use of adjuvant analgaesics

14.2.2.1 Use of Ketamine in cancer pain

14.2.2.3 Graseby Syringe Driver

14.2.3 Management of breakthrough pain (BTP)

14.2.4 Intrathecal administration of medications