| SIDE EFFECT |
Toxic shock syndrome
(TSS) |
| ASSESSMENT |
Examine for signs/symptoms of TSS (e.g., fever, rash,
nausea, vomiting, diarrhea, conjunctivitis, weakness, decreased blood pressure and shock). |
| MANAGEMENT |
When used properly, the risk of TSS among diaphragm
users is very low. Clients should know how to use method properly and be aware of
warning signs. If TSS is suspected, refer client to center where intravenous fluids and
antibiotics are available. Give oral rehydration as needed and a non-narcotic analgesic
(NSAID or aspirin) if fever is high (> 38EC). |
| |
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| SIDE EFFECT |
Urinary tract infections (UTIs) |
| ASSESSMENT |
Urinalysis: > 10 WBC/high power field in unconcentrated
specimen Culture: > 100,000 organisms/ml |
| MANAGEMENT |
Treat with appropriate antibiotic. If client has frequent
UTIs and diaphragm remains her first choice for contraception, advise emptying bladder
(voiding) immediately after intercourse. Offer client postcoital prophylactic (single
dose) antibiotic. Otherwise, help client to choose another method. |
| SIDE EFFECT |
Suspected allergic
reaction (diaphragm) |
| ASSESSMENT |
Symptoms of vaginal irritation, especially after
intercourse, and no evidence of GTI |
| MANAGEMENT |
Allergic reactions, although uncommon, can be
uncomfortable and possibly dangerous. If allergy, help client choose another method. |
| SIDE EFFECT |
Suspected allergic
reaction (spermicide) |
| ASSESSMENT |
Symptoms of vaginal irritation, especially after
intercourse, and no evidence of GTI |
| MANAGEMENT |
Allergic reactions, although uncommon, can be
uncomfortable and possibly dangerous. Provide another spermicide or help client choose
another method. |
| SIDE EFFECT |
Pain from pressure on
bladder or rectum |
| ASSESSMENT |
Client complains of vaginal discomfort. Vaginal
ulcerations are noted on examination. |
| MANAGEMENT |
Assess diaphragm fit. If current device is too large, fit
with smaller device. Follow up to be sure problem is solved. |
| SIDE EFFECT |
Vaginal
discharge and odor if left in place for more than 24 hours |
| ASSESSMENT |
Check for GTI or foreign body in vagina (tampon, etc.). |
| MANAGEMENT |
If no GTI or foreign body, advise client to remove
diaphragm as early as is convenient after intercourse, but not less than 6 hours
after last act. If symptoms recur, counsel regarding vaginal hygiene. (Diaphragm should be
gently cleaned with mild soap and water after removal. Powder or talc should not be
used when storing diaphragm.) If GTI, manage as appropriate (see STDs and Family Planning chapter). |
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