Journal Entry: Week 4- Sexually Transmitted Disease(STD)Sign and Symptomsconsistent with Sexually Transmitted Infection (STI) VS non-STISTI’s are mostlyspread through sexual contact which includes, vaginal, anal, and/or oral sex.Gonorrhea is one of STI’s that is caused by Neisseria gonorrhoeae, and 50 % ofwomen who have gonorrhea may present with no clinical symptoms (Turner, Brown,Davidson, & Roberts, 2014).However, when symptomatic, the patient maypresent with clinical symptoms such as urinary frequency or burning, dysuria,yellow vaginal discharge, or itchiness of the vaginal area (Turner et al.,2014).
During my clinical rotation, the patient complained of white-yellowishtick vaginal discharge with mild itchiness and no order which common explainedin women health. The patient clinical physical sign and symptoms complainedcould have been attributed to Vulvovaginal Candidiasis. However, after furtherdiagnostic testing, it was confirmed that she was suffering from gonorrhea (anSTI disease).ThePatient Scenario, Medical History, and Treatment PlanA 17 years old femalepatient, G0P0, came to the clinic accompanied by her mother because she wascalled to come in for abnormal vaginal swab result done three days ago.
Patientcame to the clinic 3 days ago for a complaint of increase in vaginal discharge,white-yellowish, tick, with mild itchiness on and off, and no odor times 3days. The urine dipstick was done, no leukocyte found in the urine, pregnancytest was negative, urine and the vaginal swab were performed, to check for STD(HPV, gonorrhea, syphilis, trichinosis and yeast infection). The patient has nopast medical history, was not taking any medications, and her last menstrualperiod was 12/28/17. The result of the vaginal smear showschlamydia was negative, but gonorrhea was positive.
The patient denied anysymptoms, denied abnormal vaginal discharge, denied itchiness, bleeding orurinary burning during the clinic visit. The patient was prescribedAzithromycin 1 g by mouth single dose. The patient was also referred to the ERfor Rocephin 250 mg intramuscular injection. The doctor wrote a note to give tothe ER. The patient was given a copy of her lab result and advice tonotified her partner to go get tested. Follow up in 3 months.
The healthdepartment was informed of the positive gonorrhea test. ThePatient Reaction to the Diagnosis of STI Resultbefore reading theresult, my preceptor asked the patient if her mother could excuse us or whethershe wanted her mother when reading the result. The patient stated she was ok tohave her mother present for the result.
The patient and the mother seemsurprised when the result of positive gonorrhea was read to them. The mother ofthe patient started to scream at her daughter saying, she was verydisappointed, and she taught her better than that. The daughter stated shenever had sex with someone. The mother asked the daughter how she gotgonorrhea which is a sexually transmitted disease if she claimed of neverhaving sexual intercourse. The mother stood up, stated she needs to go smoke tocome to her nerve. When the mother left the room, my preceptor informed thepatient that the information’s shared between us will be confidential, themother will not be informed, and it was important for her to tell us the truth.The patient stated she had 1 boyfriend and had sexual intercourse unprotected withher boyfriend only one time. The patient was informed to notified her partnerof the diagnosis so that he can go get tested and prevent complication orspread of the disease.
Short-termand Long-term Impact on the Patient’s LifeGonorrhea is thesecond notifiable disease in the United States, and if not treated adequately,can increase the patient risk of developing pelvic inflammatory disease (PID,and ease the transmission of HIV (Watson, Carlile, Dunn, Evans, Fratto,Hartsell, & Nakashima, 2016). Gonorrhea long-term impact on patient life isthe increased risk of having an ectopic pregnancy or being infertile. Prompt treatment can lessen the chance of permanent damage to the fallopiantubes which can cause infertility (Schuiling&Likis, 2013).
ReferencesSchuiling, K. D., &Likis, F.
E.(2017). Women’s gynecologic health (3rd ed.). Burlington,MA: Jones and Bartlett Publishers.Turner, R., Brown, L.
, Davidson, C.,& Roberts, C. (2014). Diagnosis, treatment and prevention ofgonorrhoea.
Nursing Standard, 28(27), 37-41.doi:10.7748/ns2014.03.
28.27.37.e8336Watson, J., Carlile, J.
, Dunn, A.,Evans, M., Fratto, E., Hartsell, J., & ..
. Nakashima, A. (2016).IncreasedGonorrhea Cases – Utah, 2009-2014. MMWR: Morbidity & MortalityWeekly Report, 65(34), 889-893. doi:10.15585/mmwr.
mm6534a1 Journal Entry: Week 5- EndometriosisEndometriosis is a common gynecology disease that is common in womenduring their reproductive age and is widespread in 3 to 10 percent of cases (Tharpe, Farley & Jordan, 2017). A patient with endometriosis might beasymptomatic but can also present with severe debilitating pelvic pain anddyspareunia.Patient ScenarioA 37 years old female patient G1P1 with past medical history ofendometriosis, came to the clinic for follow up the result of her procedure.
The patient came to the clinic prior to this clinic visit due to pelvic painand bleeding in between her period. Patient was prescribed to do an ultrasoundof the pelvic and the result yield endometrium thickness greater than 4 mm. Thepatient has a scheduled an endometrial biopsy. Before the procedure, thepatient was pre-medicated with Ibuprofen 800 mg po one hour earlier. The doctorapplies 20 % benzocaine gel to the biopsy site, and an adequate amount ofspecimen was removed, collected and send to the lab for testing. Pressure andsilver nitrate applied to the puncture site. Assessed for bleeding andvasovagal response. The patient was lay in a supine position.
The vital signwas stable, 120/68, pulse 72. Instruct patient to monitor for side effect suchas bleeding, cramping, vasovagal syncope, dizziness, and to report to theclinic. Follow up in 3 weeks.Personal,Medical History and Treatment PlanWhen gathering patient history data, the patient mention that she hadher first period at age 11 years old, she had the history of endometriosis andwas diagnosed five years ago but never follow up with her previousprovider. Early menarche and shortmenstrual cycles have been associated with increased risk of endometriosis inaddition to those who have first-degree relatives who are affected byendometriosis (Shuiling, 2017).
She stated the main reason she seekstreatment the last visit was because of the pelvic pain and bleeding in betweenher period. The patient was referred for the ultrasound of the pelvic and cameback to the clinic with the result. The pelvic ultrasounds yield the result ofendometrium thickness greater than 4 mm.
The patient has scheduled anendometrial biopsy. The doctor performed the endometrial biopsy, specimencollected, was sent to the lab for further study. One of the complications ofendometriosis if infertility, as a provider, since the patient is atchildbearing age, prior to deciding which treatment therapy approach to take,one should assess if the patient desired to give birth. The treatment for endometriosis depends on the patient age and thewiliness or preference for fertility. One of the treatments option to managethe symptoms of endometriosis is progestogens and anti-progestagens, which areGonadotropin-releasing hormone (GnRH) (Dunselman, Vermeulen, Becker, Calhaz-Jorge,D’Hooghe, De Bie, & Prentice, 2014). The provider can also perform ablationto remove the endometrial implants (Tharpe et al., 2017). Furthermore, surgical treatment such as,hysterectomy with oophorectomy can be done for a patient who no longer desiresto have a child or in severe cases of endometriosis (Tharpe et al.
, 2017).Differencebetween Endometriosis, Ovarian cysts, and AmenorrheaOvarian Cyst is a fluid-filled cyst that can develop in the ovary; itcan be malignant or nonmalignant of origin. According to Oliver & Overton,(2014), “The classic description of ovarian torsion is sudden onset of severecolicky unilateral pain radiating from groin to loin.” (p. 16). An ovarian cystcan be diagnosed by performing physical examination and ultrasound of theabdomen and pelvis. A physiology ovarian cyst that is less than 5 cm can clearwithout treatment, however, when the ovarian cyst increase in size andunrelenting ovarian cystectomy can be done (Oliver & Overton, 2014).
Primary amenorrhea is the absence of menstrual by age 16 but haddeveloped secondary sex characteristic, and it can occur due to malnutritionhyperthyroidism, and genetic or congenital predisposition (Tharpe et al.,2017). The treatment option with amenorrhea is the medication such ” as Provera 10 mg for 10 days or Prometrium400 mg, po, at bedtime for 10 days or crinone 4%, progesterone gel 45 mgvaginally four times a day for six doses.” (Tharpe et al., 2017, p. 374).
The provider should educate the patient toexpect extraction of bleeding at around 10 days after medication is started(Tharpe et al., 2017)ReferencesDunselman, G. A. J., Vermeulen, N.
, Becker, C.,Calhaz-Jorge, C., D’Hooghe, T., DeBie, B.,& Prentice, A.
(2014). ESHRE guideline: management of women withendometriosis.Human Reproduction, 29(3), 400-412.Oliver, A., & Overton. C. (2014). Detecting ovariandisorders in primary care.
ThePractitioner, 258(1769), 15.Schuiling, K. D., , F. E.(2017). Women’s gynecologic health (3rd ed.
). Burlington, MA: Jones andBartlett Publishers.Tharpe, N. L., Farley, C., &Jordan, R. G. (2017).
Clinical practice guidelines for midwifery & women’s health (5thed.). Burlington, MA: Jones & Bartlett Publishers Journal Entry: Week 6- Breast ConditionPatient scenario, Personal and MedicalHistoryA53-year-old Hispanic female G3P3, visited the clinic, c/o of greenishdischarge, swelling, pain to right nipple breast with a mass that moves timestwo days. She stated the nipple pain was 5/10, intermittent, does not radiate,started suddenly and worsened when the nipple is press. The patient said herlast mammogram and well women exam was two years ago.
The result of themammogram was normal, and Pap smear exam was normal. Her LMP was six years ago.She stays she performed a self-breast exam on the 1st of every month. She denied abdominal pain, denied vaginaldischarge, and stated her overall health was great except the right breast problem.The patient reported that her maternal grandmother died from breast cancer along time ago when she was still young.
She mentioned that both parents have ahistory of hypertension no cancer history. The patient had a history ofdiabetes type 2 and was diagnosed five years ago. She is presently not ondiabetic medication.
The only drug she takes was multivitamin and calcium withvitamin D daily. She had no known drugs and food allergy and loved drinking teadaily. During physical assessment, thepatient right breast appeared slightly larger than the left breast, a smallthick greenish discharge was noted, and a small moveable nontender cyst wasfelt on the anterior right breast, I was unable to determine the exact size. Nocyst or mass, and nipple discharge was noted on the left breast. She wasdiagnosed with Mammary Duct Ectasia (MDE). Treatment Plan and DrugsThepatient was referred for Diagnostic mammography. The patient was advised toapply warm compresses on her right breast, and OTC pain control, acetaminophen500 mg 2 tab, po, q6 PRN was ordered.
The patient was encouraged wearingsupportive bra and encourages continuing performing the self-breast exam. Thepatient was also educated to about colonoscopy and referred for colonoscopy.The diagnosis of a patient with MDE includes collecting the nipple discharge toassess if is due to bacterial or viral. The provider can refer the patient foran ultrasound of the breast tissues and evaluate the patient serum prolactinand TSH (Tharpe, Farley & Jordan, 2017). In the addition of OTC pain medication andwarm compression, antibiotics such as ” Dicloxacillin: 125mg -250mg IM or Poq6h, Oxacillin 250-500mg Po q6h, or Keflex 250-500mg Po q6hs, or Augmentin875mg PO BID, and Erythromycin for 10 days doxycycline 100 mg, by mouth,twice-a-day for 7 to 10″ may be used totreat an infection caused by mammary duct ectasia (Tharpe et al., 2017).
Education strategies for High-Risk PatientThemention that her maternal grandmother died of breast cancer, which increasesher likelihood of developing breast cancer the future. The patient will be advised to get hermammogram screening annually, and performed her monthly breast self-exams toaid in decrease her chance of developing cancer, and decreasing the risk of MDEto re-occur. The patient educationshould be aimed at improving breast cancer knowledge, the screening rates, andincorporate information about obstacles and predictors to screening (Patel,Kanu, Liu, Bond, Brown, Willimas, … & Hargreaves, 2014). Breast Self-Examinations EducationAsa practitioner, before initiating the education about breast self-exam, I willfirst ask the patient to explain how she performed herself the breast exam.Listening to the patient explanations of the self-breast exam will allow me toidentify the gap or lack of knowledge and emphasize more on those weaknesses.The self-breast education of the patient will consist of four steps:1. Standing up in front of a mirror undressfrom the waist up, put your hands on your hip and check you breast color,shape, symmetry, swelling, sores, lumps, nipples textures.
2. Continue standing up, take your left handand put behind your head and check the breast for the same finding as statedabove. Performed the same thing with the right hand behind your head3. Lay on your back, put a pillow under yourright shoulder, raise your hand and putit behind your head. Use your left-hand fingers pad, apply firmly on the rightbreast, starting from the nipple moving outward, follow the circular motionwhile keeping your left fingers pad firm on the breast.
Continue to run in the small circle, checkingfor mass, cyst, lumps, any abnormal breast tissues or nipple discharge, andnipple texture. Also, assess the surrounding of the breast tissue including themid axillaries. Report any abnormality to your provider. 4.
Repeat the same procedure as the 3 rd step,this time the pillow is on the left should, the left hand is raised behind thehead, and the right hand is performing the breast exam on the left breast asdirected in staged 3. Once the breastexam is completed, it is important the mark the date it was on the calendar.ReferencesPatel, K., Kanu, M., Liu, J., Bond, B.,Brown, E., Williams, E.
, . . . Hargreves, M.
(2014, October).Factors Influencing Breast Cancer Screening in Low-Income African Americans inTennessee. Journal of Community Health, 39, 943-950.
Retrieved fromWalden Library databaseTharpe, N. L., Farley, C., , R.
G. (2017). Clinical practice guidelines for midwifery ‘s health (5thed.). Burlington, MA: Jones & Bartlett Publishers
