Sample Answer for NRNP 6552 Week 4 Common Gynecologic Conditions, Part 1  Case 1: Debbie

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Sample Answer for NRNP 6552 Week 4 Common Gynecologic Conditions, Part 1 

Case 1: Debbie

Outline Subjective data. 

 

 Outline 

Objective findings.

 

 Identify diagnostic tests, procedures, and laboratory work indicated. 

 

 Distinguish at least three differential diagnoses. Identify appropriate medications, treatments, or other interventions associated with each differential diagnosis. Explain key 

Social Determinants of Health (SDoH) for your chosen case.

 Describe collaborative care referrals and patient education needs for your chosen case.
The patient presents with mild lower abdominal pain with substantial vaginal discharge over the past week. The patient has had four sexual partners in the past six months and has a medical history that includes depressive disorders, HSV-2, and a previous surgical abortion. She is now using Loestrin Fe for contraception and has a regular menstrual cycle, with her most recent period happening two weeks prior. Socially, she lives with her parents, refutes drug usage, has completed high school, and is employed as a waitress. Her familial background includes a mother with depression. Further information is required about her sexual activities, the features of her vaginal discharge, specifics about her depression and HSV-2 care, contraception use, and understanding of Pap smears (Dombrowski, 2021). The patient’s vital signs are stable: blood pressure is 112/80 mmHg, pulse is 72 bpm, respiration rate is 16 bpm, temperature is 98.4°F, weight is 110 pounds, height is 54 inches, and BMI is 18.9 kg/m². The overall look is robust and well-fed, with no indications of distress. The abdominal examination indicates a soft, non-tender, and non-distended abdomen, devoid of masses or organ hypertrophy. The gynecological examination reveals no lesions or substantial abnormalities; nonetheless, slight cervical motion pain is seen. Further laboratory tests are required, including NAAT for chlamydia and gonorrhea (Dombrowski, 2021). Debbie’s symptoms and medical history need a thorough evaluation. The Nucleic Acid Amplification Test (NAAT) for Chlamydia and Gonorrhea is advised for detecting the pathogens responsible for these illnesses. At the same time, wet mount and KOH testing of vaginal discharge may assist in diagnosing bacterial vaginosis, trichomoniasis, along with yeast infections (Dombrowski, 2021). A Pap smear is advised for cervical cancer screening, whereas a PCR test may verify a herpes simplex virus infection in the presence of visible lesions. Pelvic ultrasonography may identify structural abnormalities, ovarian cysts, or other etiologies of abdominal discomfort. A CBC may detect markers of infection or anemia, while a urinalysis can exclude a UTI to distinguish between gynecological and gastrointestinal symptoms. The American College of Obstetricians and Gynecologists (ACOG) endorses these diagnostic tools for women suffering from abdominal pain. Chlamydia Trachomatis is the most frequently identified STD in the US, especially among young people and adolescents who are sexually active (Davidson et al., 2021). Debbie’s symptoms, characterized by mucopurulent cervical discharge and cervical friability, align with a chlamydial infection. The CDC’s STI Treatment Guidelines emphasize the need for screening for chlamydia in sexually active individuals. 

Gonorrhea is a prevalent sexually transmitted infection with similar symptoms, and the CDC advises concurrent treatment for chlamydia in those presenting with cervicitis and a history of many sexual partners (Van Ommen et al., 2023). Bacterial

Vaginosis (BV) is the predominant cause of vaginal discharge in women of reproductive age, often presenting as a homogeneous, off-white, thin discharge accompanied by a fishy odor. Debbie’s account of significant vaginal discharge suggests the potential of BV, and ACOG acknowledges its common occurrence and manifestation via discharge, warranting attention even in the absence of typical symptoms.

 For the treatment of Chlamydia Trachomatis infection, patients may administer either 1 g of azithromycin or 100 mg of doxycycline bi-daily for seven days, with a strong focus on completing the whole antibiotic regimen (Davidson et al., 2021). The prescribed therapy for gonorrhea is a single intramuscular dosage of 500 mg of Ceftriaxone for those weighing < 150 kg, accompanied by 1 g of oral azithromycin (Van Ommen et al., 2023). The CDC recommends dual medication to avoid co-infection with chlamydia and address antibiotic resistance. Treatment alternatives for BV are Clindamycin cream 2% administered intravaginally at night for seven days, Metronidazole gel 0.75% applied intravaginally once daily for five days, or Metronidazole 500 mg taken orally twice daily for seven days (Coudray & Madhivanan, 2020). Patients are instructed to refrain from douching and using harsh soaps and to recognize the impact of several sexual partners on vaginal flora and the heightened risk of BV (Chacra et al., 2022). Debbie, a waitress exhibiting signs of an STI, is affected by many SDOH. Her work, education, and socioeconomic level might influence her health literacy, comprehension of health risks, and access to healthcare services. Her little earnings may restrict her capacity to finance routine gynecological examinations, contraceptives, and therapies. Financial constraints may also impede her compliance with treatment protocols and access to therapy. Moreover, her insufficient access to comprehensive sexual education may impair her understanding of STI prevention, contraceptive use, and the need for regular gynecological treatment. Education, cultural norms, and access to resources such as condoms and contraceptive services influence her sexual health practices. Consequently, her health condition, access to healthcare, and possible health outcomes are all affected by these variables (Francisco-Natanauan et al., 2021). A comprehensive strategy that includes targeted patient education and coordinated care referrals is necessary to treat Debbie’s health challenges properly. It is advisable to send her to a gynecologist or an infectious disease expert for accurate diagnosis and treatment of suspected STIs and comprehensive gynecological evaluations. Furthermore, considering her history of depression, a referral to mental health services is essential for managing her emotional well-being, perhaps improving her receptiveness to medical counsel. Social services may address socioeconomic obstacles, while a patient navigator can facilitate access to essential resources. Additionally, Debbie necessitates instruction on sexual health, encompassing safe sex practices and the relevance of STI screening, along with comprehensive details about her treatment strategy and the essential of follow-up care to ensure efficient infection resolution and avert problems (Francisco-Natanauan et al., 2021).

 

References

Chacra, L. A., Fenollar, F., & Diop, K. (2022). Bacterial vaginosis: What do we currently know? Frontiers in Cellular and Infection Microbiology, 11. https://doi.org/10.3389/fcimb.2021.672429

Coudray, M. S., & Madhivanan, P. (2020). Bacterial vaginosis—A brief synopsis of the literature. European Journal of Obstetrics & Gynecology and Reproductive Biology, 245, 143–148. https://doi.org/10.1016/j.ejogrb.2019.12.035

Davidson, K. W., Barry, M. J., Mangione, C. M., Cabana, M., Caughey, A. B., Davis, E. M., Donahue, K. E., Doubeni, C. A., Krist, A. H., Kubik, M., Li, L., Ogedegbe, G., Pbert, L., Silverstein, M., Simon, M. A., Stevermer, J., Tseng, C., & Wong, J. B. (2021). Screening for chlamydia and gonorrhea. JAMA, 326(10), 949. https://doi.org/10.1001/jama.2021.14081

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