Case Study: Diagnosis and Management of Cervicitis in a 25-Year-Old Female Patient, Exams of Nursing

Download Case Study: Diagnosis and Management of Cervicitis in a 25-Year-Old Female Patient and more Exams Nursing in PDF only on Docsity! N ancy Campbell Case Study Kimberly Ross NSG 6430 – Women’s Health Summary of Case Study2024/// Ms. Campbell is a 25-year-old female patient that presented to the facility c/o of burning and pain with urination for 3 days. • After interview and assessment, it was discovered she has unprotected sex, reported and observed mucopurulent vaginal discharge, cervix had a friable appearance, and she was positive for gonorrhea on culture. • She is diagnosed with cervicitis. • Her treatment plan is for dual antibiotics given as a one-time dose, education on safe sex practices, importance of informing all recent partners so they may be tested and treated, and recommendations for further screening, exams, and vaccinations. HPI • Chief Complaint: “I have been having burning when I pee. I was worries that I had another bladder infection, but these symptoms are a little different that the symptoms I had with my last UTI.” • A 25-year-old female patient presents to facility complaining of pain with urination for three days. She relates she has some vaginal discharge that is yellow, mucousy, and creamy that began at the same time as the dysuria. She relates the pain is 4/10, subsides when urination is completed, and a warm bath helps with the pain. She relates she is in the middle of her menstrual cycle. She denies fever, chills, chest pain, shortness of breath, headache, nausea, vomiting, or abdominal pain. Medical History • Allergies: None • Medication Intolerances: None • Medications: ethinyl estradiol/drospirenone (PO once daily); Ibuprofen (PO as needed for pain) • Past Medical History: None • Chronic Illness/Major Traumas: None • Hospitalizations: None Family History • Neuro: Denies numbness or tingling. • Psych: Denies depression, SI or HI. Exam • Ht: 5’5” Wt: 135 lbs BMI: 22.5 HR: 66 BP: 116/64 R: 12 SPO2: 99% Temp: 98.7 F (oral) • General Appearance: Pt is A&O x 4, answering question appropriately, appears well groomed and without distress • Skin: Intact warm, pink, dry. • HEENT: Head normocephalic, a traumatic, without lesions. PERRLA at 4mm. Sclera white, conjunctiva pink. TM pearlescent bilaterally. Nasal mucosa pink, no sinus drainage noted. Airway patent. Pharynx clear without erythema, edema or exudate noted. Good dentation. • Breast: Non-tender. • Cardio: Heart sounds normal with normal rate and rhythm. Exam - Continued • Respiratory: BBS equal coarse all fields. No retractions crepitus, flail segment or paradoxical notion noted. • GI: Abd soft, non-tender without guarding, distortion. rigidity, pulsating masses. • GU/GYN: Vaginal vault pink without ulceration, cervical os open with mucopurulent discharge present, vaginal pH 4.0, cervix friable. Bimanual exam showed no cervical-motion tenderness, ovaries were nonpalpable, no adnexal tenderness, and no palpable masses or lesions. • Musculoskeletal: Full ROM in all extremities. • Neuro: Steady gait and clear speech. • Psych: A&0 x 4, well groomed. Labs (In-house) • Urinalysis and Urine culture • Vaginal pH • STD screen • Cervical swab/Gram stain • Gonorrhea and Chlamydia culture • Vaginal wet mount/smear • HIV antibody • Serum Hcg • Amine/whiff test Diagnosis and Differentials • Diagnosis: • Cervicitis – ICD 10: O86.11 • Bases for diagnosis: Reported discharge, sexually active without condom use, urinary symptoms, mucopurulent discharge from cervical os, cervix friable appearance, and positive culture for gonorrhea. (CDC, 2017) Evidenced-Based Article II •Title, author(s), and year of article: Relationship of specific bacteria in the cervical and vaginal microbiotas with cervicitic. Linda M. Gorgos, Laura K. Sycuro, Sujatha Srinivasan, Tina L. Fiedler, Martin L Morgan, Jennifer E. Balkus, R. Scott McClelland, David N. Fredricks, and Jeanne M. Marrazzo. 2016. •Brief summary/purpose of the study: This study was a retrospective, controlled case study that attempted to identify a correlation between bacterial vaginosis and cervicitis. There were two cohort groups for this study, one in Seattle and one in Kenya. The study utilized PCR and 16S rRNA gene PCR to identify what bacteria was present on the cervical swabs. The presence of bacterial vaginosis was present in many of the cases reviewed. However, 4:14 cases of cervicitis found the cause to be a common STD infection, such as gonorrhea, chlamydia, or trichomoniasis. Using the PCR and 16S rRNA gene PCR, a link was found between cervicitis and M. indolicus in the Seattle cohort while the Kenyan cohort had a lower incidence of bacterial vaginosis but a higher incidence of HIV. Ultimately, the study linked a specific bacterial vaginosis-associated species to cervicitis. •How did the study support Ms. Campbell’s case?: This study supports Ms. Campbell’s case as it provides another possible cause to cervicitis if the condition persists after treatment for gonorrhea. •Title, author(s), and year of article: Cervicitis: A prospective observational study of empiric azithromycin treatment in women with cervicitis and non- specific cervicitis. Josephine Lusk, Frances L Garden, Robert G Cumming, William D Rawlinson, Zin W Naing, Pam Konecny. 2016. •Brief summary/purpose of the study: This study was conducted to determine the effectiveness of azithromycin when used empirically when treating cervicitis. This was a trial study with the participants divided into two groups. Cervicitis group 1 had 116 participants and cervicitis group 2 had 96 participants. Those in cervicitis group 1 consisted of women with STD infection but excluded those with trichomoniasis and those in cervicitis group 2 had the additional exclusion of gonorrhea, chlamydia, and mycoplasma. PCR was used to identify trichomoniasis, chlamydia, and mycoplasma while a culture was used to identify gonorrhea. It was found that empirical use of one gram of azithromycin was effective in treating less than Evidenced-Based Article III 25% of cervicitis group 2 participants and not effective on those in cervicitis group 2. Empirical treatment of cervicitis is effective in specific cervicitis has no benefit with non-specific cervicitis. •How did the study support Ms. Campbell’s case?: This study supports Ms. Campbell’s case as it shows that azithromycin should can be used in her treatment. While the study notes it is primarily effective against chlamydia and mycoplasma, chlamydia is known to have gonorrhea as a coinfection. Ms. Campbell has gonorrhea as evidenced by culture. •Title, author(s), and year of article: Management of Gonorrhea in Adolescents and Adults in the United States. Sarah Kidd and Kimberly A. Workowski. 2015. •Brief summary/purpose of the study: This study discusses the reported cases of gonorrhea in the US in adolescences and adults. The study utilized a STD Treatment and Guidelines Expert Consultation meeting, which was hosted by the CDC, to discuss recent developments in prevention and treatment of gonorrhea, and other STDs. Nine key questions were presented to the experts ranging from first line antibiotic changes to medication regimens with allergies to first line antibiotics to current recommendations of testing and treatment. It was determined there should be no changes to the first line antibiotic regimen of 250 mg IM ceftriaxone and 1 g PO azithromycin for the treatment of gonorrhea. The study does list all antibiotics that can be used with their associated effectiveness. It was determined that there should be a change to the recommended alternative first-line treatment of gonorrhea to be a dual regimen of 320 mg PO gemifloxacin and 2 g PO azithromycin, both give as a single dose, or a one-time dose of 240 mg IM gentamicin and 2 g PO azithromycin. The study also recommends this alternative dual regimen for treatment of gonorrhea when a cephalosporin allergy is present. The study concluded that 2 g PO azithromycin is no longer recommended as the risks out-weight the benefits and 1 g po azithromycin is just as effective when accompanied by another antibiotic. Evidenced-Based Article IV •How did the study support Ms. Campbell’s case?: This study supports Ms. Campbell’s case as it analyzes the current treatment recommendations by the CDC to ensure the most up-to-date treatment options are presented to the community and providers. •Title, author(s), and year of article: Treatment of cervicitis; LEEP versus cryotherapy. Mustafa Ozturk, Mustafa Ulubay. 2016. •Brief summary/purpose of the study: This study was conducted to determine whether the LEEP or cyrotherapy was more effective in the treatment of cervicitis. This study was a retrospective analysis of individuals that had a diagnosis of cervicitis and had either a loop electrosurgical excision procedure (LEEP) or cryotherapy as their course of treatment. There was a small pool of individuals, 52 patients, that were reviewed. It was found that cryotherapy failed in 18% of those reviewed and 36% experienced dizziness or near syncope. Those that had the LEEP performed had no treatment failures and approximately 27% experienced three days of postoperative bleeding or spotting. This study concluded that a LEEP was more effective than cryotherapy but had more incidence of postoperative bleeding. •How did the study support Ms. Campbell’s case?: This study supports Ms. Campbell’s case as it provides an effective treatment option for cervicitis. It also allows for the provider to have an alternative procedure to present to Ms. Campbell.