WHcL D5 response

APANo plagirism

· You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth

2 points

(1 point per response.) 

· All replies must be constructive and use literature where possible. Must include at least 1 academic source formatted and cited in APA style.

Response 1

Did you face any challenges, any success? If so, what were they?

This week I felt overwhelmed during clinical with school, work and sick children at home.. Since I come from a background of pediatrics, women’s health is a little challenging for me. My preceptor always encourages me to strive for the best, and if there is something I do not understand, her purpose is to teach me. Should my future career lead me to pediatrics, I must familiarize myself with women’s health since adolescent girls need to be examined as well. This week, I learned about dyspareunia, a sexual disorder defined by genital pain that can be experienced before, during, or after intercourse (Hill & Taylor, 2021). Prior to this semester, I never knew that dyspareunia was a condition, and that there was actual treatment for this.

Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and at least 3 possible differential diagnosis with rationales.

This week, I encountered a 51-year-old female A.P. who came in feeling very emotional because she was unable to have intercourse with her husband due to a sharp, stabbing pain in the vagina. The patient stated “It hurts at the beginning of intercourse, and at the end. I also bleed during intercourse”. The patient explained that this has been an ongoing issue for about six months now. She is not experiencing pain now, so on a numeric level, the pain is 0 out of 0. The patient said that the only aggravating factor was continuing to engage in sexual activity, and the only relieving factor was to discontinue sexual activity. When she is in pain, it lasts for up to thirty minutes. and the bleeding subsides after intercourse is complete.

The assessment started by obtaining a detailed history, including pain descriptors such as duration, intensity, location, exacerbating and alleviating factors. A burning pain more commonly links to vaginitis, vulvodynia, atrophy, or inadequate lubrication. A physical exam and pelvic exam of the genitalia was then completed, and there was vaginal irritation and dryness of the vaginal tissues. A bimanual was then completed to search for masses, cysts or abnormalities, but the exam was within normal limits. The plan of care for this patient consisted of Estradiol vaginal cream to be applied twice a week at bedtime. When women enter menopause, estrogen synthesis significantly decreases due to lower-functioning ovaries causing postmenopausal symptoms such as hot flashes, vaginal dryness, vaginal itchiness, dysuria, and dyspareunia. Studies have found that using estradiol vaginal cream twice a week has significantly reduced vaginal dryness and dyspareunia compared to placebo pills (Hariri & Rehman, 2022). A referral to pelvic floor therapy was recommended to help relax the muscles and aid with pain during intercourse.

Three possible differential diagnosis with rationales are endometriosis, uterine fibroids, and vulvodynia. Endometriosis is a condition in which the uterus’ lining, or endometrium, or cells that resemble it, proliferate outside the womb. Clinical manifestations of the condition are chronic pelvic pain, pain in the vagina, pain during intercourse, abnormal bleeding, and impaired fertility (Tsamantioti & Mahdy, 2022). Uterine fibroids are a very prevalent benign tumor in women of reproductive age. Uterine fibroids cause abnormal uterine bleeding, pelvic pain, disruption of surrounding pelvic structures such as the bowel and bladder, and back pain (Barjon & Mikhail, 2022). Vulvodynia is a vulvar ache that lasts at least three months without a clearly defined cause. The discomfort that vulvodynia patients experience can be excruciating, incapacitating, and tragic (Faye & Paraccini, 2022). Patients often complain of pain in the vagina, pain during intercourse, vaginal itchiness, and dryness.

Mention the health promotion intervention for this patient.

Several women’s health suggestions are included in the promotional health interventions for this patient. To start, lifestyle adjustments need to be made for a healthy vagina. A nourishing, balanced diet is important, as well as proper hygiene. Natural lubrications such as olive oil during intercourse is recommended to avoid vaginal dryness. Lubricant jelly is water based and is absorbed in the vaginal tissue as opposed to olive oil which is oil based and will leave the vagina lubricated. Getting routine medical care is also important to prevent further damage or complications of the vagina. Incorporating Kegel exercises in a daily routine is strongly encouraged to help relax spasmed muscles, which could help the vaginal pain.

What did you learn from this week’s clinical experience that can be beneficial for you as an advanced practice nurse?

This week I learned about pharmacological and non-pharmacological interventions that can help female reproductive system. I will certainly face many female patients in the future who have a variety of diseases that need treatment, so learning about women’s health will be very beneficial to me. I learned how differentiate vaginal pain and bleeding from intercourse in a menopausal woman, from other female conditions such as endometriosis and uterine fibroids. I also learned some important health promotions that I was never fully aware such as the best type of vaginal lubricant to help relieve vaginal dryness.

Response 2

Women’s Health: Weekly Clinical Experience

            The clinical experience for this week involved a G1P0 female of age twenty-nine. The woman arrived at the clinic, presenting ten hours of abdominal pain linked to vomiting and nausea. Additionally, she had family history of diabetes and high blood pressure. The prompt will discuss the week’s challenge or success, assessment, care plan, differential diagnosis, health promotion intervention, and what I learned.

Challenges and Success

            The primary challenge I encountered was developing a comprehensive patient assessment and a care plan to address the woman’s needs. However, after taking much time, I managed to assess the patient and design a care plan. I was successful since I recognized the patient’s signs and symptoms and possible differential diagnosis and their rationales.

Assessment

            The patient presented ten hours of abdominal pain associated with vomiting and nausea. She reported a family history of diabetes and high blood pressure. Upon further assessment, the patient was found to be twenty-eight weeks pregnant, with no other signs or symptoms. The patient’s vital signs were all within normal ranges.

Care Plan

            The care plan was to offer the patient supportive care and manage pain. Based on the assessment and symptomatology, the plan included monitoring the patient’s vital signs and ordering laboratory tests to assess for possible infections or other causes of abdominal pain. The American College of Obstetricians and Gynecologists recommends screening and monitoring for conditions like gestational diabetes for females between twenty-four to twenty-eight gestation periods (Li-zhen et al., 2019). Additionally, the patient was prescribed Zofran for nausea and vomiting and was referred to a gynecologist for further assessment and care. Additionally, the patient needed follow-ups with her care provider for more management and analysis.

Differential Diagnosis

            Based on the assessment, the likely differential diagnosis was appendicitis, gestational diabetes, ectopic pregnancy, and ovarian cyst. According to Jones et al. (2019), appendicitis presents a swollen appendix with abdominal pain. The condition can also cause nausea, vomiting, and loss of appetite. The patient had abdominal pain associated with nausea, vomiting, and possible appendicitis. The clinical manifestation of ovarian cyst includes abdominal pain, and its risk factors may include pregnancy (Mobeen & Apostol, 2020). The patient was twenty-eight-week pregnant and experienced abdominal pain and nausea, an indicator of an ovarian cyst.

            Ectopic pregnancies happen when blastocysts attach outside the uterine cavity. Its clinical manifestation may include pain, vomiting, vaginal bleeding, and nausea (Mummert & Gnugnoli, 2019). The patient presented abdominal pain associated with nausea and vomiting, an indication of possible ectopic pregnancy. Lastly, gestational diabetes commonly occurs during pregnancy, presenting pain and associated vomiting and nausea. Medical history of diabetes can accelerate gestational diabetes (Quintanilla Rodriguez & Mahdy, 2022). The patient assessment indicated possible gestational diabetes due to her abdominal pain with vomiting and nausea and diabetes family history.

Health Promotion

            The health promotion intervention for this patient included education on healthy eating, exercise, and stress management. Additionally, the patient was encouraged to adhere to prenatal appointments and receive regular check-ups, such as glucose screenings and monitoring her blood pressure. Health promotion strategies help individuals to reduce health issues and control their well-being (Gallagher et al., 2021).

What I learned

            Throughout this week’s clinical experience, I understood how to assess a patient and develop a plan of care tailored to the patient’s individual needs. I also learned how to develop a differential diagnosis for a given patient and provide health promotion interventions that can benefit the patient. Additionally, I was able to use peer-reviewed research guidelines to support my plan of care. Therefore, the lessons I learned will benefit my practice as an advanced practice nurse to cater to my patients.

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