APANo plagirism
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· You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Formatted and cited in current APA style with support from at least 1 academic source.
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· All replies must be constructive and use literature where possible.
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Response to Posts of Peers |
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Reply 1
This week was great as I have completed the required clinical hours for this course The patient that is being detailed in this discussion post was seen last week
in the clinical setting. This case was very challenging as this patient was very shy and seemed embarrassed about her chief complaint. She did not really want a
student at first, but then agreed to have me participate in her care. I had to be mindful and extremely sensitive to her needs, while ensuring privacy and
attentiveness. This required an extra amount of time which caused me to be extremely late seeing the next patient on the schedule. This is beneficial to me as this
situation may present itself again with a patient and I will be able to handle the situation effectively and confidently.
Chief Complaint: “Foul smelling discharge”
HPI
DF is a 25-year-old Hispanic female presenting to the clinic for foul smelling vaginal discharge that started three days ago. DF describes the vaginal
discharge has a copious amount of yellow greenish discharge that has a pungent odor. DF describes the smell as fishy and denies any vaginal or pelvic pain
associated with the discharge. Furthermore, one day ago DF did use a vaginal boric acid suppository to help with her symptoms. She explains that the vaginal
suppository worsened her symptoms and caused some irritation to her peri area. She denies irregular bleeding, painful coitus, and pelvic/abdominal pain. DF is
sexually active and has had four new partners within the last six months. She reports that she occasionally uses condoms and does have a positive history for STDs
(reportedly gonorrhea). Her last sexual encounter was right after using the vaginal suppository, and she denied condom use.
ROS
General: denies fevers, chills, fatigue, weight gain
Dermatology: denies moles, rashes, pruritis
HEENT: denies headache, nasal congestion, earaches
Neck: denies painful swallowing, swelling,
Pulmonary System: denies cough, increased work of breathing, or breathlessness
Cardiovascular System (CVS): denies chest pressure, dizziness, irregular heartbeat
Breast: denies breast tenderness, breast discoloration, mass
Gastrointestinal (GI) System: denies constipation, abdominal pain, nausea and vomiting
Genitourinary (GU) System: denies polyuria, dysuria, incomplete emptying of bladder
Female Genitalia: reports copious amounts of yellowish green vaginal discharge, reports fishy vaginal odor, and vaginal irritation. LMP 1/2/23.
Musculoskeletal System: denies noisy joints, difficulty bending, and joint stiffness
Psychologic: denies suicidal ideation or feelings of wanting to harm others, anxiousness, sadness, and feeling overwhelmed
Assessment
Vitals: BP 136/ 78, RR 22, Temp 37 , HR 66, O2 97% RA, Weight 176 lb, Height 5ft 5nch, BMI 29.3 (overweight)
General: Alert and oriented, in no acute distress, well groomed, behavior appropriate
HEENT: Head is normocephalic. Scalp clean without dandruff. Ears: Ear canal patent. Tympanic membrane without peroration. Eyes: PERRLA, EOM intact.
20/20 vision in both eyes. No nystagmus. No conjunctival irritation. Nose: Mucosa is pink. No bleeding. Throat: Moist oral mucosa
Cardiovascular: S1 & S2 auscultated. No abnormal heart sounds. JVD is negative. Carotid, radial and pedal pulses +2 bilaterally. No extremity edema present.
Respiratory: Respirations are even and unlabored. Respiratory rate 18. No SOB. Chest expansion equal. Clear lung sounds in all lobes.
GI: Normoactive bowel sounds. No abdominal distention. Abdomen nontender to palpation.
GU: Bladder is not palpable. Right kidney palpable. Left kidney not palpable. CVA without tenderness.
Female Genitalia: vaginal cultures: Yellowish greenish discharge with potent fishy odor. Uterus not enlarged. Non tender uterus. Ovaries are not palpable. Cervix
with small petechiae.
Breast: breast size equal in size bilateral, no dimpling present, no mass palpated; breast is nontender and nonpainful
Musculoskeletal: : No gait unsteadiness. Active ROM in all joints. Spine is without deformity. No muscle weakness noted.
Integumentary: Skin is intact. Skin tone is even. No jaundice present. Skin turgor is normal. Skin is warm to touch. Normal nail bed, no clubbing
Neuro: A/O X 3. Speech is slowed and clear. Sensation is intact in all extremities. Tendon reflexes are +2 bilateral. Cranial nerves not tested.
Hematologic: No active bleeding. No bruising present. No petechiae.
Psych: Normal and coherent thought processes. No signs of mania. No signs of depression.
Differential Diagnosis
Trichomonas (A59.9) is a sexually transmitted disease that is caused by T.
vaginalis. This STD is highly associated with HIV and can cause symptoms of
yellow to green vaginal discharge, malodorous discharge, inflammation to the vulva/vagina, as well as pruritus, dysuria, and dyspareunia (Schuiling & Likis, 2022).
Diagnosis can be made from physical examination of the patient as well as patient history and symptoms. Other confirmatory diagnostics include examining the
vaginal discharge under microscopy and the presence of one celled flagellate. Treatment regimens for trichomonas is the nitroimidazoles antibiotics and can
include either metronidazole or tinidazole.
Chlamydia (A74.9) is another common STD that is caused by C.
trachomatis. This bacterium can cause symptoms such as smelly discharge, burning when
peeing, bleeding between periods, urinary symptoms, and abdominal pain (Rietmeijer, 2019). Women who have more than one sexual partner especially without
using protection are at an increased risk of contacting the STD. A significant complication of the STD is Pelvic Inflammatory Disease (PID), which is the infection
and inflammation of the female organs. Physical examination findings for abdominal guarding, referred pain, or rebound tenderness upon abdominal examination
should raise the level of suspicion for PID (Schuiling & Likis, 2022).
Vaginitis (N77.1) is the infection and inflammation if the vagina. Symptoms include vaginal discharge, vaginal pain, and pruritus. Vaginal discharge can also
be described as a yellowish color. This disease happens when the vaginal environment is altered either by m microorganism, or by a disturbance allowing
pathogens normally found in the vagina to proliferate (Schuiling & Likis, 2022).
Plan of Care & Patient Education
· Patient should start taking metronidazole 500mg BID for 7 days
· Patient should avoid alcohol when taking antibiotics and should still avoid alcohol 72 hours after treatment
· Patient should have sexual partners treated for the STD and should abstain from sexual intercourse until treatment has been completed and there are no symptoms present
· Evaluation and repeat testing should be checked within three months as there is an increased chance of reinfection (Schuiling & Likis, 2022)
· Patient educated on the need for contraception measures to avoid unwarranted pregnancies
Health Promotion
· Prevention is key to the differential diagnoses, DF should use barrier contraceptives to avoid STDs especially HIV
· Patient should be screened and made sure that all immunizations are up to date such as Human Papillomavirus and Hepatitis
· Patient should routinely get screened for STDs, as she is at high risk for infections due to multiple partners
· Patient should openly talk to partners to discuss sexual health status
REPLY 2
Introduction
To properly diagnose and treat gynecological patients in an outpatient setting, it is crucial to perform a thorough examination of the patient. The best course of treatment can only be determined after collecting relevant patient medical history, conducting a thorough physical examination, and performing any necessary diagnostic tests.
Challenges and Success
One of the challenges of this week’s clinical experience was dealing with a patient who came in with various gynecological complaints. However, a successful care plan was developed by applying evidence-based guidelines and best practices to the patient’s situation. As a result, I feel more at ease treating patients at the clinic, and the knowledge and experience I have gained will enable me to give the highest standard of care. My mindset towards helping the patients also shifted positively.
Assessment
The patient is a 35-year-old female who presents with a history of dysmenorrhea, heavy menstrual bleeding, and irregular menstrual cycles. No masses or tender spots in the patient’s lower abdomen could be felt during the physical examination. The external genitalia appear normal, but the uterus is slightly enlarged, and the adnexa is mobile but not tender. This was discovered during the vaginal exam. I did an objective evaluation to check for organ contribution. Her vitals included temperature 98.3 F, circulatory strain 130/78 mmHg, BMI – 28, pulse – 80 bpm, and a respiratory pace of 16 bpm. By and large, the patient was well-showing up, all around prepped, and sound without any indications of actual trouble. HEENT uncovered the shortfall of head injury, ordinary facial evenness, typical visual sharpness, nonappearance of nasal release, ordinary sound discernment, and non-kindled neck organs. Appraisal of the neck uncovered the shortfall of solidness and no indications of lymphadenopathy. Her lungs were clear, and her heart was without extrinsic sounds. Her skin was without ulcerations, breaking, whiteness, or blushing. Her midsection evaluation uncovered typical entrail sound in all quadrants and nonappearance of throb or uneasiness on palpation. Her pelvis evaluation uncovered overcast, yellow mucoid release from the cervical os, cervical movement delicacy, and a friable appearance of the cervix.
Diagnosis
Considering the patient’s experience with excessive monthly bleeding and an enlarged uterus, the possibility of the patient having fibroids should be considered. Secondly, there is a possibility that the patient could be suffering from Endometrial Hyperplasia. This is due to the patient’s chronic pain during menstruation, and erratic menstrual cycles may be symptoms of endometrial hyperplasia, a pre-cancerous disease. Additionally, polyps are another potential reason for heavy menstrual bleeding. Uterine polyps have been associated with this disorder.
Plan for Care
Firstly, there is a need for a transvaginal ultrasound of the uterus and adnexa to assess fibroid or polyp size, location, and number. Secondly, there is a need for a cervix examination through hysteroscopy. Finally, a uterine lining biopsy should be done to check for endometrial hyperplasia or malignancy.
Treatment
Through medical management, hormonal therapies, including oral contraceptives, progestins, and GnRH agonists, may alleviate symptoms and shrink fibroids (Freytag et al., 2021). Secondly, the treatment of fibroids, polyps, or endometrial hyperplasia can be achieved through minimally invasive surgical techniques like hysteroscopic polypectomy, myomectomy, and endometrial ablation.
Intervention for Health Promotion
To alleviate menstrual discomfort and prevent unintended pregnancies, hormonal contraceptives should be discussed as a treatment option in a comprehensive education program on birth control. Secondly, there is a need to adjust to the patient’s way of life. In this, to enhance the patient’s general health and maybe minimize the size and growth of fibroids, it is essential to advise them to adopt a balanced diet, engage in regular exercise, and manage their stress.
This week’s clinical experience could be beneficial.
This week’s clinical experience reinforced the need for thorough and precise examinations while identifying and treating gynecological illnesses. I intend to put everything I’ve learned to use in the future. I also acquired excellent experience dealing with patients in pain or suffering. I learned how to effectively interact with patients and offer them the information they need to make educated healthcare decisions.
Peer-Reviewed Research
Patients seeking gynecological care in an outpatient environment might benefit from thorough diagnostic procedures and analyses in the peer review journal “Obstetrics and gynecology” by Miller et al. (2019). Improved patient outcomes and quality of life can be achieved by implementing evidence-based recommendations and best practices, such as diagnostic tests, medical and surgical procedures, and health promotion programs, as stated by Freytag et al. (2021).
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