Nancy Campbell Case Study Kimberly Ross NURSING 6430 – Women’s Health Summary of Case Stud, Exams of Nursing

Download Nancy Campbell Case Study Kimberly Ross NURSING 6430 – Women’s Health Summary of Case Stud and more Exams Nursing in PDF only on Docsity! Nancy Campbell Case Study Kimberly Ross NURSING 6430 – Women’s Health Summary of Case Study- Guaranteed Success • • 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, mucous, 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 • Nose/Mouth/Throat: Denies sore throat, sinus congestion, or nasal discharge. • Breast: Denies tenderness or discharge. • Cardio: Denies chest pain or palpitations. ROS - Continued • Respiratory: Denies cough, shortness of breath, or difficulty breathing, wheezing. • GI: Denies bad pain, nausea, vomiting, diarrhea, or constipation. • GU/GYN: Relates pain with urination, vaginal discharge, increased frequency of urination, is sexually active with multiple partners, and is on oral contraceptives. Denies condom use, abnormal PAPs, previous STDs, or missed period. • Musculoskeletal: Denies joint or muscle pain. • Neuro: Denies numbness or tingling. • Psych: Denies depression, SI or HI. Exam • Hot: 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 so 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) • Ms. Campbell will need to contact all recent sexual partners, at least those she has had in the last 60 days, to inform them of her STD status and recommend that they get tested and treated. • She should be educated on the importance of safe sex practices, such as condom use and STD testing before intercourse with new partners • It is recommended that she have a PAP smear to further determine if the cervicitis was caused by the gonorrhea infection of by something else. • She should complete the STD screening for HIV and syphilis. • She should abstain from sexual intercourse for at least 7 days after treatment and have a follow-up in a week to determine if the infection is gone. • It is recommended she receive the HPV vaccine as she is under 25-years- old. • She should follow-up in three months for a recheck vaginal culture to ensure there is no reinfection. • She should be educated about chlamydia being a known coinfection with gonorrhea but not present with symptoms. (Gorges et al., 2016; Kidd & Workowski, 2015; Polk, Mattson & Nyirjesy, 2015) Evidence-Based Article I •Title, author(s), and year of article: Chronic cervicitis: Presenting features and response to therapy. Polk J, Mattson, S., and Nyirjesy, P. 2015. •Brief summary/purpose of the study: This study was conducted to review the symptoms present with a diagnosis of cervicitis and the effectiveness of various treatment options. This study was a retrospective review of a small pool of patients based of their ICD 10 code for cervicitis and requires two of three criteria to be included in the review. This inclusion criterion was mucopurulent discharge noted by either the patient or the provider and cervical bleeding with probing via cotton swab. The symptoms that were reviewed included abnormal discharge, irritation, itching, odor, burning, inter-menstrual bleeding, bleeding with coitus, and urinary symptoms. Treatment options included azithromycin, doxycycline, moxifloxacin, additional antibiotic treatments with clindamycin, flaggy, and the afore mentioned antibiotics, hormonal treatments, vaginal hydrocortisone, cryotherapy, LEEP, and silver nitrate. The success rates for each treatment vary with the LEEP and silver nitrate having a 100% success rate and cryotherapy and vaginal hydrocortisone completely failing. Antibiotic treatment had a 43% success rate and hormone therapy had a 50% success rate. •How did the study support Ms. Campbell’s case?: This study supports Ms. Campbell’s case as it provides symptoms of cervicitis, some of which Ms. Campbell had and treatment options with success rates. Evidenced-Based Article IV 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 Evidenced-Based Article V 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. •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. Evidenced-Based Article VI •Title, author(s), and year of article: Treatment of cervicitis; LEEP versus cryotherapy. Mustafa Oz Turk, Mustafa Lube. 2016. •Brief summary/purpose of the study: This study was conducted to determine whether the LEEP or hydrotherapy 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.