Juliana Mirabelles iHuman Case Study CC: Dysuria Burning During Urination, Exams of Nursing

Download Juliana Mirabelles iHuman Case Study CC: Dysuria Burning During Urination and more Exams Nursing in PDF only on Docsity! 1 Juliana Mirabelles iHuman Case Study CC: Dysuria Burning During Urination IHuman J. Mirabelles 25y/o female, reason: pain with urination : HPI year old female p/w 3-day history of dysuria, urinary frequency as well as mucopurulent vaginal 25 discharge. She denies fever, chills, myalgia. She has a previous hx of UTI, smoking, and multiple sex . partners with some unprotected sex. The pain is alleviated by a warm bath and increased with standing Physical exam shows cervical friability : Questions ? How can I help you today .1 ? Do you have any other symptoms or concerns we should discuss .2 ? When did your pain/discomfort with urination start .3 ? Do you have fever? /Have you been having fevers .4 ? What is the appearance, smell, texture, and quantity of the vaginal discharge .5 ? Does anything make your pain/discomfort with urination better or worse .6 ? How severe is your pain/discomfort with urination .7 ? Do you have vaginal discomfort or itching .8 ? Have you had vaginal discharge/discomfort like this before .9 ? Are you sexually active .10 ? Do you have more than one sexual partner .11 ? Have you had any sexually transmitted infections .12 ? Do you have allergies .13 ? Are your immunizations up to date .14 ? When did your last period begin .15 ? Are you having or have you had unprotected sex .16 ? Is your pain/discomfort worse with start or end of urination .17 ? Do you have pain with sex .18 ? Has there been a change in your urination frequency .19 ? Do you use precautions to prevent the transmission of sexual infections .20 ? Do you have bleeding between your menstrual cycles .21 ? Are you taking any OTC or herbal medications .22 ? Any new or recent changes to your medications .23 2 ? Do you have new or multiple sexual partners with similar symptoms .24 of 1 Index of Exercises Ba nunprs acauat parurcis 0 Vulvar itching Dysuria O Fever 1 Urinary incontinence 1 Malodorous discharge 1 Labial lesion Mucopurulent vaginal discharge 01 Nontender inguinal adenopathy Unprotected intercourse 1 Abdominal pain O Vaginal wall petechiae 1 Maculopapular rash 1 Suprapubic tenderness on exam Cervical friability 1 Nausea & vomiting 1 Cervical motion tenderness  Your Findings Key Finding MSAP Relation dysuria RELATED urinary frequency RELATED mucopurulent vaginal discharge MSAP UTI hx UNKNOWN multiple sex partners RELATED unprotected sex RELATED friable cervix RELATED Your Problem Statement J.M. is a 25 y/o female presenting with painful urination and frequency, and mucopurulent vaginal discharge. Cervical friability noted on exam. Hx of multiple sex partners, with unprotected sex, and UTIs. Denies fever, chills, chest pain, SOB, N/V, or abdominal pain.  Your Selections 0 Cardiovascular J Endocrine 0 Gastrointestinal O Integumentary 5 Musculoskeletal 1 Neurological Genitourinary/Renal 0 Respiratory 5 Hematologic 5 Lymphatic 0 Immune 0 Psychologic Sexual/Reproductive Your Differential Diagnoses candida vaginitis bacterial vaginosis cervicitis  40f4 Index of Exercises Identify the organism in the following wet-mount image. trichomonas vaginalis O bacterial vaginosis © candida O chlamydia © Neisseria gonorrhoeae Your Plan JM. is a 25 y/o female presenting with painful and frequent urination, with mucopurulent vaginal discharge. Treatment for cervicitis is necessary, with Ceftriaxone 500mg IM X 1 dose and Azithromycin 1g PO X 1 dose. Education provided - Contact all sexual partners, within the past 3 months, to inform them of her STD status and possible needed treatment. - Importance of safe sex practices. - Routine Pap smears, and HIV, HPV, and Syphilis screenings - Importance of receiving HPV vaccination 7of9 Index of Exercises After treatment of the patient for gonorrhea, the physician should test for a cure in the following circumstances: O A. Treatment with oral cefixime O B. Treatment with ceftriaxone and persistent symptoms O C. Treatment with fluoroquinolone O Both AandB © All of the above  8o0f9 Index of Exercises In order to prevent the spread of gonorrhea, you should counsel your patient regarding the following measures: O Notify all sexual partners over the past 60 days of exposure and recommend that they receive treatment. O Notify last sexual partner even if this has been greater than 60 days. O Use barrier protection with all intercourse. O Abstain from sexual intercourse until treatment is complete. © All of the above O None of the above  9of9 Index of Exercises Which of the following should require treatment of any partners, as well as the patient (select all that apply)? gonorrhea chlamydia trichomoniasis 0 bacterial vaginosis candida vaginitis Scoring: Your score will be scaled downward for incorrect selections you make.