Clinical Question - Tampon left in for one month

[FullGlass, BSN, MSN, NP]

What is the standard process for a patient who left a tampon in? I had a patient who left one in for about a month, realized it, removed it. Prior to removal, she had developed foul odor, unpleasant discharge and a fever. After removal, the pt took some left over antibiotics she had and her lady partsl symptoms resolved and she felt ok, However, about 5 days later she developed left flank pain and felt sick. Fortunately, our WHNP was able to see her, but I'm wondering if there is a standard process I should follow with these types of patients, as I know this is a fairly common problem. Thank you all in advance.

[Dembitz, APRN]

Assess for PID (CBC, cervical motion tenderness, wet prep or swab for BV/yeast) and UTI/pyelonephritis due to flank pain (urinalysis with culture). Maybe ultrasound depending on exam and institutional availability. Treat according to CDC guidelines and culture results. Any suspicion for TSS or vomiting and can't hold down oral abx would warrant admission for IV antibiotics.

[Rnis, BSN, DNP, APRN, NP]

learned the hard way.......double bag in hazard bags .....the smell i atrocious!!!

Treat the cultures and assess for PID. IN my experience they usually have bacterial vaginitits.

[TuxnadoDO]

There is no one protocol for any particular patient complaint. Assess the patient, go from there.

[KatieMI, BSN, MSN, RN]

- fever +

- flank/back pain with CVA tenderness +

- any urinary symptoms

= UTI, it is 90+% specific symptom complex. Plus possible PID as well, although less possible.

Treat accordingly. I would probably go more aggressive with abx than Nitro/TMP/fosfo first line choices under these circumstances. Second-liners are either Augmentin or Vantin or quinolones, possibly with Flagyl, and I would go for that right after cultures. U/a double dipstick with C/s if "dirty" both times, STD pelvic smear (she could have unprotected sex with this thing still in). I think u/s woould be excessive unless the patient is looking toxic, in which case she got to go in acute anyway.

[TuxnadoDO]

16 hours ago, KatieMI said:

- fever +

- flank/back pain with CVA tenderness +

- any urinary symptoms

= UTI, it is 90+% specific symptom complex. Plus possible PID as well, although less possible.

Treat accordingly. I would probably go more aggressive with abx than Nitro/TMP/fosfo first line choices under these circumstances. Second-liners are either Augmentin or Vantin or quinolones, possibly with Flagyl, and I would go for that right after cultures. U/a double dipstick with C/s if "dirty" both times, STD pelvic smear (she could have unprotected sex with this thing still in). I think u/s woould be excessive unless the patient is looking toxic, in which case she got to go in acute anyway.

Someone with a tampon left in for a month needs a pelvic exam first, before any treatment is discussed. There was no mention of urinary symptoms.

[FullGlass, BSN, MSN, NP]

3 hours ago, TuxnadoDO said:

Someone with a tampon left in for a month needs a pelvic exam first, before any treatment is discussed. There was no mention of urinary symptoms.

The WHNP gave pt a rocephin injection. I'm not sure what happened after that.