music It's a typical day. A patient has noticedsome itching, or maybe an unpleasant vaginal odor. During her exam, the ian willcheck vaginal pH, examine any discharge that's present, and collect a sample. Then, it'son to the microscope. music This is where you'll gather more specificinformationabout what's causing those vaginal symptoms. We'll show you how to prepare andexamine vaginal wet preps and how to do a whiff test. The results, combined with the patient's vaginal pH test, will aidthe diagnosis.
Under the microscope, you'll be looking for trichomonads, yeast, and the clue cells associated with bacterial vaginosis. We'll show you how to recognize them. music First, the microscope itself: This is a compoundlight microscope. It has several objective lenses on a rotating mount. For our purpose,one of these has to be a 10x low power objective, and one has to be a 40x for greater magnifiion.This flat part, under the objectives, is the stage. Under the stage is the condenser. Belowthat, at the base of the microscope, is the light source. There are two knobs that controlfocus; one for coarse adjustment and one for
fine adjustment. And these are the oculars,or eyepieces. We'll come back to the microscopea minute, but first, let's look at how to prepare wet mount slides. The complete vaginal wet mount involves botha saline prep and a potassium hyoxide, or KOH, prep. When the vaginal sample was collected,the swab was placeda test tube with approximately half a milliliter of saline. So, for the salineprep, you only have to take a op of the suspension and place it on a slide. Add acoverslip, being careful to avoid trapping air bubbles. Your saline slide is ready.Place a second op of the vaginal sample on another slide and add one op of 10 percentKOH. Sniff the preparation immediately, using
your hand to waft any odor toward your nose.This is the whiff test. Note if there's a fishy or amine odor. Then add a coverslip,avoiding air bubbles. Keepmind that you must work quickly to prepare and examine thewet mounts. That's because trichomonads may lose their characteristic motility within15 to 20 minutes. Before we move on now, though, let's lookat the cast of characters you may discover. These are normal squamous epithelial cellsfoundthe vagina. They're large, flat cells with a small nucleus and a large area of cytoplasm.Note that there is some granularitythe cytoplasm.
Polymorphonuclear leukocytes are known asPolys, or PMNs. They may also be called white blood cells, or WBCs. These are small roundcells. Several lobes of the nucleus are visible within the surrounding cell cytoplasm. Findingmany PMNs may indie infection. Trichomonads are pearshaped protozoa whichmove by means of flagella. Trichomonads are similarsize to PMNs and are identifiedby their characteristic jerking movement. The actual flagella may be too thin and toorapidlymoving to be seen. A clue cell is a squamous epithelial cellcoated with enough small bacteria that at least 75 percent of the cell's border is obliterated.It may look as if someone has spread glue
over the cell and pressed itsand. Cluecells are associated with bacterial vaginosis, a conditionwhich the normal microbialflora of the vagina is disrupted. Yeast may be foundtwo forms. Pseudohyphaeare the long, tubular, branching forms. Budding yeast are paired yeast cells that resemblea shoe print. The larger part is the sole and the smaller bud is the heel of the shoe. The saline prep will allow you to see epithelialcells, PMNs, trichomonads, and clue cells. You can also see yeastsaline, but sometimesit's hidden by epithelial cells or by PMNs. Red blood cells, sperm, and bacteria can alsobe seen.
Catheterassociated Urinary Tract Infection CAUTI with Case Studies Part I
Silence gt;gt; Good morning everyone andwelcome to our third and final day of the 2014 NHSN Training Course. We want to acknowledge again, all of you here who have given your undividedattention and great participation. Everyonethe room as well aseveryone watching the live webstream, we do appreciate your participation. I have multiple updates that I'll givethroughout the day but I have a couple
of important things that you'llneed to know first thing. We wanted to remind you that theevaluation forms arethe back on the back table outside of this room. I was told that if you are getting CE's,well, when you apply for that you'll be able to do the evaluation on the computer so youdon't necessarily have to complete it today. But if you aren't going to beapplying for CE's then we ask that you do complete the evaluation form today,and leave it on the table before you have to go. We really appreciate your feedback andyour input and it is important to us,
so we do ask that you complete thatif you are able to give your input. With regards to feedback and input we wantedto let you know, we know some of the peoplethe front have a hardtime with the bright lights. We can't unfortunately dim the lights any more than we already have becauseof the live webstreams. So we apologize if they're a littlebright or hot on the tops of your heads. We also know that the round tableshaven't been ideal for youthe room. Again, hoping that you've been ableto see the presentations with all
of the opdown slide viewing but I knowit's difficult if you have to have your back or have to turn around to face the front. Just so you know, the reason we chose todo it this way was because we really wanted to maximize the amount of people we could get ina room and get here to this inperson training so that you'd be able to actuallybethe room if you wanted to. So many people enroll and register to try to geton the random list that we felt that we should, you know, try to do this so that wecould maximize to the 300 or over, but we will evaluate for next year to see
if there's any way we can fixthat or get a bigger room. Let's see, I wanted to remind you that the teamoutside the door isthe back to help you with your transport to the airport. So, they can help you with all of that but theyneed you to sign up on a sheet and let them know when your flight is so thatthey can group people together and make sure everybody getsto the airport on time. And if you are leaving early, which wewant you to stay today as late as possible to hear all the important information beingpresented today, but if you do need to leave
and you know that it's going to be ahead ofschedule, please let them know now or as early as possible so that they can make sureto set you up front aside to get you out early for the transportation. We ask that oh, yes this is very important. So, you have met many of the individualswho answer the NHSN mailbox for you. There is a group of user supportteam that you were not able to meet because they were not presenters and they'veactually been working behind the scenes to continue to answer the mailbox of questionsthat comeover the course of this training
Different Vaginal Itching And Vaginal Odor Conditions
Good day, Eric Bakker, naturopath, authorof Candida Crusher. I often get asked by different women manyquestions regarding vaginal yeast infections. One or two key symptoms which many talk aboutthat is quite embarrassing for them is the vaginal odor and the terrible vaginal itch.Many woman seem to get this, and some women who've had Skype consultations with me tendto be very embarrassed about this. That's why I'm speaking a bit softer. They get veryembarrassed. And some women actually think that this condition is caused because they'reunclean. And other women think it's because they've got poor social standing. There areall these reasons why they think they've got
this terrible itch and this terrible odor.Any woman can get potentially this condition. And while many women will get this maybe onceor twicetheir lifetime, some women experience this all the time, and it ives them literallycrazy and they want to know how to get on top of this problem. In my book, Candida Crusher, I've got a nicelittle chart here which I've made for you. I'll just show you here. You may be able tosee this chart. This chart isSection 5 on chronic vaginal infections. Signs and symptomsof vaginal infections and inflammations. So I'm just going to run over a couple of thingswith you now to show you which of these vaginal
conditions can give you a tremendous itchand have quite a strong odor. So we know that Candida yeast infections canhave a yeasty or musty odor and can have an incredible itch about them, an itch that canive you literally crazy. Herpes is another condition which can affectthe female vaginal area. It can cause tremendous itching, but there's no odor associated witha herpes infection. Trichomoniasis is a parasite or what we calla quot;Trichquot;. This can also have an itch, but not quite as severe as the Candida. This canhave a very foul or strongsmelling discharge. The discharge with Trichomoniasis, though,tends to be more frothy or green. It's not
really white or creamy like the vaginal yeastinfection. Gardnerella vaginalis is another particulartype of bacterial infection, what we call BV. With Gardnerella, you're not generallygoing to have an itch with it, and the smell can be a bit fishy or brinythis condition.And some women actually get bacterial vaginosis mixed up with the yeast infection, althoughthe yeast is not really bacteria, so it's a different kind of an infection. Itchy or irritable vulva can also be causedby a sexually transmitted disease called Gonorrhea, although it's much less common.
But the point I'm making here is it's importantfor you to get diagnosed and checked out to see if you've got a vaginal yeast infectionor a bacterial infection called bacterial vaginosis. I offer many solutions for BV and for Candidayeast infectionsmy book, Candida Crusher. SoChapter 5, it explains all about that,and it's good for you to get on top of this odor and itch because it can ive peoplecrazy. I've had incredible phone calls from womencrying and Skype consultations. One woman recently whose relationship fell apart becauseof the terrible odor and the itch. And I've
had many other women ranging from 18 rightup to 60s, huneds of them over the years, very upset and distraught with recurring infections,getting nowhere with medical treatment; and for those women, I've written this chapter. So if you're serious about getting rid ofthe vaginal infection, get a copy of the book. You're sure to get a good result. So there'sno need to put up with embarrassing smell, this terrible itch, and a condition that couldliterally wreck your life and your relationship. So get onto your chronic infection now becausethere's plenty you can do about them. Thank you.