Summary NR 603 ADVANCED WEEK 5 PART 2

NR 603 Week 7 Case Study Discussion, RA and OA Chief Complaint:“I am having pelvic pain, irritation and vaginal discharge from last 3 days”. HPI:G.S. is a 21-year-old African American female that came to the clinic with a chief complaint of pelvic pain, irritation and vaginal discharge from the last three days. She also reported burning sensation and frequent urination with purulent and yellowish vaginal discharge. Nothing aggravates or relief the symptoms. Rate the pelvic pain 3/10. Did not take any medication for the symptoms. She admits having unprotected sexual acts with two persons in the last one month. She is currently not using any birth control and denies a history of previous sexually transmitted diseases (STD). Her immunizations are up to date but deny having HPV vaccination. Current Medications: Only takes Tylenol as needed for headache. Allergies:No food or drug allergies. Past Medical History: No significant past medical history, occasionally takes acetaminophen for headache, and takes birth control pill, never been pregnant, PAP smear last year was normal. Past Social History: pt is single, lives with her friend, broke-up with boyfriend three months ago, sexually active. She is an occasional drinker but denies smoking or using illegal drugs. Family History:Pt denies providing any family history Assessment Constitutional: No weight loss, fever, chills, weakness or fatigue. HEENT: Eyes: No visual loss, blurred vision, double vision or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose or sore throat. SKIN: No rash or itching. CARDIOVASCULAR: No chest pain, or chest discomfort. Denies any palpitations or edema. RESPIRATORY: No shortness of breath, cough or sputum. GASTROINTESTINAL: Complaints of lower abdominal pain, denies any nausea, vomiting or diarrhea. GENITOURINARY: Last menstrual period, 10/24/2019. Periods starts at age of 13. Complaint of yellowish purulent vaginal discharge, itching, burning, and dyspareunia. No pregnancies. NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. MUSCULOSKELETAL: No muscle, back pain, joint pain or stiffness. HEMATOLOGIC: No anemia, bleeding or bruising. LYMPHATICS: No enlarged nodes. No history of splenectomy. PSYCHIATRIC: No history of depression or anxiety. ENDOCRINOLOGIC: No reports of sweating, cold or heat intolerance. ALLERGIES: No history of asthma, hives, eczema or rhinitis. Diagnostics:BV can be diagnosed by the use of clinical criteria (i.e., Amsel’s Diagnostic Criteria) or Gram stain. A Gram stain is used to determine the relative concentration of lactobacilli, Gram-negative and Gram-variable rods and cocci and curved Gram-negative rods characteristic of BV (CDC, 2015). Clinical criteria require at least three symptoms or signs such as homogeneous, thin, white discharge that smoothly coats the vaginal walls;clue cells, pH of vaginal fluid 4.5; ora fishy odor of vaginal discharge before or after addition of 10% KOH(CDC, 2015). Bacterial vaginosis is not screened for on a regular basis, but when symptoms arise this condition should be ruled out based on Amsel criteria (Smith & Schub, 2018). Treatment Plan:CDC (2015) recommends treatment of all symptomatic patients to control the symptoms and reduce risk of acquiring C. trachomatis, N. gonorrhoeae, T. vaginalis, HIV, and herpes simplex type 2. Metronidazole 500 mg orally twice a day for 7 days, Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, once a day for 5 days and Clindamycin cream 2%, one full applicator (5 g) intravaginally at bedtime for 7 days (CDC,2015). Alternative Treatment:Tinidazole 2 g orally once daily for 2 days, Tinidazole 1 g orally once daily for 5 days, Clindamycin 300 mg orally twice daily for 7 days, Clindamycin ovules 100 mg intravaginally once at bedtime for 3 days (CDC,2015).Clindamycin should not be used in second half of pregnancy die to its adverse effects for newborns (Cash & Glass, 2017). Patient education:Patient need to do proper basic hygiene, avoid douching, and refrain from sexual activity or use condom for protection.Alcohol consumption should be avoided during the whole treatment. Treatment of partners is not recommended as it is not correlated to relapse or reoccurrence.All women with BV should be tested for HIV and other STDs (CDC,2015). Referral: no referral is needed at this time. Follow up: No follow up required if patient is symptom free after treatment. Treatment can be repeated if the symptoms persist after completion of symptoms. In repeated reoccurring cases, 0.75% metronidazole gel twice weekly for 4–6 months can be used (CDC,2015). Data from clinical trials indicate that a woman’s response to therapy and the likelihood of relapse or recurrence are not affected by treatment of her sex partner. Therefore, routine treatment of sex partners is not recommended (CDC,2015). References Cash, J.C.,& Glass, C.A. (2017). Family Practice Guideline (4th e.d.). Springer publishing company, N.Y. Centers for Disease Control and Prevention. (2015). Gonorrhea. Retrieved from Hollier, A. (2016). Clinical guidelines in primary care (2nd ed.). Scott, LA.: Advanced Practice Education Associates. Smith, N. R. M. C., & Schub, T. B. (2018). Bacterial Vaginosis. CINAHL Nursing Guide. Retrieved from https://search-ebscohost-