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Discussion: Common Gynecologic Conditions, Part 1

Discussion: Common Gynecologic Conditions, Part 1 Discussion: Common Gynecologic Conditions, Part 1NRNP 6552 Week 4: Common Gynecologic Conditions, Part 1Patients can present a variety of symptoms including breast or vaginal discomfort that may indicate gynecologic conditions. These conditions may range from minor and easy- to-treat infections to more serious issues related to cancer or sexually transmitted diseases.Nurse practitioners must apply expertise and best practices to early interventions to contribute to diagnoses of issues and plans for treatments. These activities typically begin with analysis of findings from interviews and screenings.For this week, you will practice these approaches by considering circumstances of case study. You will analyze a patient history and symptoms presented and recommend tests and treatment options.Learning ObjectivesStudents will:Identify key symptoms consistent with a medical diagnosisAnalyze the health history and presentation of a patientAnalyze patient diagnosesApply case-specific clinical guidelinesRecommend diagnostic tests and treatment optionsLearning ResourcesORDER A PLAGIARISM-FREE PAPER HERERequired Readings (click to expand/reduce)Optional Resource (click to expand/reduce)Case Study Discussion: Common Gynecologic Conditions, Part 1Discussion: Common Gynecologic Conditions, Part 1Case studies provide the opportunity to simulate realistic scenarios involving patients presenting with various health problems or symptoms. Such case studies enable nurse learners to apply concepts, lessons, and critical thinking to interviewing, screening, and diagnostic approaches, as well as to the development of treatment plans.Photo Credit: Teodor Lazarev / Adobe StockFor this Case Study Discussion, you will once again review a case study scenario to obtain information related to a comprehensive well-woman exam and determine differential diagnoses, diagnostics, and develop treatment and management plans.To prepare:By Day 1 of this week, you will be assigned to a specific case study scenario for this Discussion. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.Review the Learning Resources for this week and specifically review the clinical guideline resources specific to your assigned case study.Use the Focused SOAP Note Template found in the Learning Resources to support your Discussion. Complete a SOAP note and critically analyze this and focus your attention on the diagnostic tests. You are NOT to post your SOAP note. This is for your information only to help you develop your differential diagnosis and additional questions.By Day 3DO NOT POST A SOAP NOTE. Post your primary diagnosis. Include the additional questions you would ask the patient and explain your reasons for asking the additional questions. Then, explain the types of symptoms you would ask. Be specific and provide examples. (Note: When asking questions, consider sociocultural factors that might influence your question decisions.)Based on the preemptive diagnosis, explain which treatment options and diagnostic tests you might recommend. Use your Learning Resources and/or evidence from the literature to support your recommendations.Read a selection of your colleagues’ responses.Discussion: Common Gynecologic Conditions, Part 1By Day 6Respond to at least two of your colleagues’ posts on two different days and explain how you might think differently about the types of diagnostic tests you would recommend and explain your reasoning. Use your Learning Resources and/or evidence from the literature to support your position.Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit! Rubric Detail Select Grid View or List View to change the rubric’s layout.ContentName: NRNP_6552_Week4_Case_Study_Discussion_RubricDiscussion: Common Gynecologic Conditions, Part 1Grid ViewList ViewExcellentPoint range: 90–100GoodPoint range: 80–89FairPoint range: 70–79PoorPoint range: 0–69Main Posting:Response to the case study discussion questions includes appropriate diagnoses with explanations of appropriate diagnostic tests and treatment options as directed, is based on evidence-based research where appropriate, and is incorporates syntheses representative of knowledge gained from the course readings for the module and current credible sources.Points Range: 40 (40%) – 44 (44%)Thoroughly responds to the discussion question(s).Post includes approprite diagnoses including explanations of appropriate diagnostic tests and treatment options.Incorporates syntheses representative of knowledge gained from the course readings for the module and current credible sources, with no less than 75% of post the post having exceptional depth and breadth. Discussion: Common Gynecologic Conditions, Part 1Supported by at least 3 current credible sources.Points Range: 35 (35%) – 39 (39%)Responds to most of the discussion question(s)Post includes approprite diagnoses with explanations of appropriate diagnostic tests and treatment options. Discussion: Common Gynecologic Conditions, Part 1Somewhat incorporates syntheses representative of knowledge gained from the course readings for the module and current credible sources with no less than 50% of the post having exceptional depth and breadth.Supported by at least 3 credible references.Points Range: 31 (31%) – 34 (34%)Responds to some of the discussion question(s).Post contains incomplete or vague diagnoses or explanations of appropriate diagnostic tests and treatment options.Is somewhat lacking in synthesis of knowledge gained from the course readings for the module and current credible sources.Post is cited with fewer than 2 credible references.Points Range: 0 (0%) – 30 (30%)Does not respond to the discussion question(s).Post contains incomplete diagnoses or explanations of appropriate diagnostic tests and treatment options, or diagnoses and/or explanations are missing.Lacks synthesis gained from the course readings for the module and current credible sources.Contains only 1 or no credible references.Main Posting:WritingPoints Range: 6 (6%) – 6 (6%)Written clearly and concisely.Contains no grammatical or spelling errors.Further adheres to current APA manual writing rules and style.Points Range: 5 (5%) – 5 (5%)Written concisely.May contain one to two grammatical or spelling errors.Adheres to current APA manual writing rules and style.Discussion: Common Gynecologic Conditions, Part 1Points Range: 4 (4%) – 4 (4%)Written somewhat concisely.May contain more than two spelling or grammatical errors.Contains some APA formatting errors.Points Range: 0 (0%) – 3 (3%)Not written clearly or concisely.Contains more than two spelling or grammatical errors.Does not adhere to current APA manual writing rules and style.Main Posting:Timely and full participationPoints Range: 9 (9%) – 10 (10%)Meets requirements for timely, full, and active participation.Posts main discussion by due date.Points Range: 8 (8%) – 8 (8%)Posts main discussion by due date.Meets requirements for full participation.Points Range: 7 (7%) – 7 (7%)Posts main discussion by due date.Points Range: 0 (0%) – 6 (6%)Does not meet requirements for full participation.Does not post main discussion by due date.First Response:Post to colleague’s main post that is reflective and justified with credible sources.Points Range: 9 (9%) – 9 (9%)Response exhibits critical thinking and application to practice settings.Responds to questions posed by faculty. Discussion: Common Gynecologic Conditions, Part 1The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.Points Range: 8 (8%) – 8 (8%)Response has some depth and may exhibit critical thinking or application to practice setting.Points Range: 7 (7%) – 7 (7%)Response is on topic, may have some depth.Points Range: 0 (0%) – 6 (6%)Response may not be on topic, lacks depth.First Response:WritingPoints Range: 6 (6%) – 6 (6%)Communication is professional and respectful to colleagues.Response to faculty questions are fully answered, if posed.Provides clear, concise opinions and ideas that are supported by two or more credible sources.Response is effectively written in Standard, Edited English.Points Range: 5 (5%) – 5 (5%)Communication is mostly professional and respectful to colleagues.Response to faculty questions are mostly answered, if posed.Provides opinions and ideas that are supported by few credible sources.Response is written in Standard, Edited English.Discussion: Common Gynecologic Conditions, Part 1Points Range: 4 (4%) – 4 (4%)Response posed in the discussion may lack effective professional communication.Response to faculty questions are somewhat answered, if posed.Few or no credible sources are cited.Points Range: 0 (0%) – 3 (3%)Responses posted in the discussion lack effective communication.Response to faculty questions are missing.No credible sources are cited.First Response:Timely and full participationPoints Range: 5 (5%) – 5 (5%)Meets requirements for timely, full, and active participation.Posts by due date.Points Range: 4 (4%) – 4 (4%)Meets requirements for full participation.Posts by due date.Points Range: 3 (3%) – 3 (3%)Posts by due date.Points Range: 0 (0%) – 2 (2%)Does not meet requirements for full participation.Does not post by due date.Second Response:Post to colleague’s main post that is reflective and justified with credible sources.Points Range: 9 (9%) – 9 (9%)Response exhibits critical thinking and application to practice settings. Discussion: Common Gynecologic Conditions, Part 1Responds to questions posed by faculty.The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.Points Range: 8 (8%) – 8 (8%)Response has some depth and may exhibit critical thinking or application to practice setting.Points Range: 7 (7%) – 7 (7%)Response is on topic, may have some depth.Points Range: 0 (0%) – 6 (6%)Response may not be on topic, lacks depth.Second Response:WritingPoints Range: 6 (6%) – 6 (6%)Communication is professional and respectful to colleagues.Response to faculty questions are fully answered, if posed.Provides clear, concise opinions and ideas that are supported by two or more credible sources.Response is effectively written in Standard, Edited English.Points Range: 5 (5%) – 5 (5%)Communication is mostly professional and respectful to colleagues.Response to faculty questions are mostly answered, if posed.Provides opinions and ideas that are supported by few credible sources.Discussion: Common Gynecologic Conditions, Part 1Response is written in Standard, Edited English.Points Range: 4 (4%) – 4 (4%)Response posed in the discussion may lack effective professional communication.Response to faculty questions are somewhat answered, if posed.Few or no credible sources are cited.Points Range: 0 (0%) – 3 (3%)Responses posted in the discussion lack effective communication.Response to faculty questions are missing.No credible sources are cited.Second Response:Timely and full participationPoints Range: 5 (5%) – 5 (5%)Meets requirements for timely, full, and active participation.Posts by due date.Points Range: 4 (4%) – 4 (4%)Meets requirements for full participation.Posts by due date.Points Range: 3 (3%) – 3 (3%)Posts by due date.Points Range: 0 (0%) – 2 (2%)Does not meet requirements for full participation.Does not post by due date. Total Points: 100Name: NRNP_6552_Week4_Case_Study_Discussion_RubricCervicitis is inflammation of the cervical lining which may result from infectious nor non-infectious agents. One crucial question is to isolate the cause and prescribed the appropriate treatment. Abnormal uterine or vaginal bleeding can be associated with numerous causes such as thyroid disease, thrombocytopenia, use of anticoagulant polyps or abnormal tissue growth, and cancer.  Additional questions are needed to solicit appropriate testing and diagnosis (Schuiling, K. D., & Likis, F. E. (2022).Additional information needed is:Discussion: Common Gynecologic Conditions, Part 1The bleeding frequency, amount, and colorMost recent PAP and resultsRecent UTIOdor, soreness, and itchingDysuriaDyspareuniaMultiple sex partner, a new partner, or use of sexual toysHx of leiomyomaVulvovaginal irritation Use of lubricant Genital to oral sex Discussion: Common Gynecologic Conditions, Part 1 Identifying and infection agents require the following test, sexually transmitted infection panel for gonorrhea, chlamydia, and trichomonas, vaginal wet mount with ph. including any biopsy of polyps (Fowler, G. C. (2019). Additional information needed to isolate causes for abnormal bleeding includes vulvovaginal examination for inflammation and trauma (Medical Procedures and Health Information. (2014, February 16). Untreated or unresolved infection can and may lead to fevers or adenopathy (K. D., & Likis, F. E. (2022).  Initial diagnosis includes the following acute cervicitis, abnormal uterine bleeding, cervical polyps, and vaginal trauma all of which can be associated with infectious or non-infectious causes of bleeding. One common sign is postcoital bleeding including the strawberry appearance of the cervix (K. D., & Likis, F. E. (2022).     References Fowler, G. C. (2019). Pfenninger and Fowler’s Procedures for Primary Care (4th ed.). Elsevier. Medical Procedures and Health Information. (2014, February 16). Pap test-procedure.        Schuiling, K. D., & Likis, F. E. (2022). Gynecologic health care (4th ed.). Jones and BartlettLearning.Discussion: Common Gynecologic Conditions, Part 1I definitely agree with both you and Mary on the need to rule out sexual assault or trauma for this patient. This is not a point that I mentioned in my post actually, but it is something I thought about. Bleeding frequency, amount, and color can give more information into the causative agent of the bleeding. I also think that it is important to investigate the possibility of pregnancy. It would also be important to ask her if there is any chance she is pregnant. Post coital bleeding can be especially common in early pregnancy as the cervix becomes more sensitive and so penetration of vagina may cause small amounts of bleeding (Godfrey, 2019). References Godfrey, M. A. L., Nikolopoulos, M., Povolotskaya, N., Chenoy, R., & Wuntakal, R. (2019). Post-coital bleeding: What is the incidence of significant gynaecological pathology in women referred for colposcopy? Sexual & Reproductive Healthcare : Official Journal of the Swedish Association of Midwives, 22, 100462. https://doi-org.ezp.waldenulibrary.org/10.1016/j.srhc.2019.100462 Shalini R, Amita S, Neera M, A: How Alarming Is Post-Coital Bleeding – A Cytologic, Colposcopic and Histopathologic Evaluation (2018). Gynecol Obstet Invest. doi: 10.1159/000009957Episodic/Focused SOAP Note TemplateDiscussion: Common Gynecologic Conditions, Part 1Patient Information:S.L., 24 y-o white femaleS.CC (chief complaint): post coital bleeding, sore throat, feverHPI: S.L., 24-year-old Caucasian female with no PMH/ PSH who presents to the clinic for regular check up and complaints of vaginal bleeding after sexual intercourse for 6 weeks and sore throat for 3. Pt also reported fever for 2 days which was treated with Tylenol. Pt has dLocation: vagina/uterusOnset: 6 weeksCharacter:Associated signs and symptoms: sore throat and feverTiming: after sexual intercourseExacerbating/relieving factors: sexSeverity: 7/10 pain scaleCurrent Medications: PamprinAllergies: NKDAPMHx: No medical history, no surgical historySoc & Substance Hx: S.L works full-time as an administrative assistant who jogs 3-4 times per week. She reports she uses sunscreen sometimes and uses her seat belt when she is in the car. Pt smokes ½ pack of cigarette per day for 10 years, consumes 6-8 hard liquor on weekend days and smokes marijuana,Fam Hx: No contributory family historySurgical Hx: No surgical historyMental Hx: No mental historyViolence Hx: No concerns notedReproductive Hx: Menarche- 13 years old, Regular menstrual period every 28-32 days lasting 4-6 days. Pt uses 3 tampons per day and has cramping during menstruation which she uses otc pamprin as treatment . Pt participates in vaginal sex.Discussion: Common Gynecologic Conditions, Part 1ROS:HEENT: WNL except some anterior cervical adenopathy bilaterally, and throat appears reddened.Lung: clear to auscultationCV:  regular sinus rhythms without murmur or gallopAbd:  soft, non-tender, liver normal,Breasts:  fibrocystic changes bilaterally, no masses, dimpling, redness or discharge, no adenopathy, and bilateral nipple piercings.VVBSU: slight frothy yellow discharge by cervix, clitoral piercing notedCervix:  friable, some petechia no cervical motion tenderness.Uterus: mid mobile, non-tenderAdnexa: without masses or tendernessPerineum: wnlRectum: wnlExtremities:  full rom, skin clear, no edema, reflexes 1+.Neurological:  CN II-12 grossly intact. V/S: T 97.8 F, P 68 bp, BP 112/64. Height; 5 ft 6 in. Weight 118 lbs. BMI 19.04O.Physical exam: 24 year-old Caucasian female presenting with post coital bleeding x6 weeks, sore throat x3 weeks and fever which lasted 2 days and was treated with Tylenol. CN 1- 12 intact. Bilateral anterior cervical adenopathy noted, redness noted to throat. Lung sounds clear on auscultation. NSR noted, S1 and S2 normal, no murmur or gallop on auscultation. Fibrocystic changes noted to both breasts, no masses, dimpling, redness, discharge, or adenopathy noted. Nipple piercings noted to both breasts. Abdomen soft and non-tender, liver span less than 7. Frothy yellow cervical discharge noted, cervix friable, petechia noted, no tenderness elicited, uterus non-tender, no tenderness or masses noted on palpation of adnexa, clitorial piercing noted. No anomalies noted to perineum or rectum. Full active ROM to all extremities, skin clear, no edema noted, +1 reflexes.Diagnostic results: STI panel, Pap smear, HCG, CBCA.Differential Diagnoses 1. Chlamydia. According to RANZCOG (2021), post coital bleeding is the most common sign of chlamydia. Therefore, it is necessary for the pt to complete and STI panel to rule out chlamydia. CDC (2021) explains young people ages 14-24 are most likely to contract Chlamydia. S.L is within this age range and presented with abnormal discharge which is an additional reason for this possible diagnosis.Discussion: Common Gynecologic Conditions, Part 12. Gonorrhea. Gonorrhea is one of the most common bacterial STI and usually affects mostly young people ages 15-24 (CDC, 2021). As aforementioned, Miss S.L is in the age range where these STIs are most prominent. CDC (2021) explains vaginal discharge, fever, sore throat and vaginal bleeding between periods are some clinical manifestations. These are all signs and symptoms which Miss S.L. is currently presently experiencing. CDC (2021) recommends that individuals who are sexually active discuss getting tested for STIs. 3, Cervicitis, According to John Hopkins Medicine (n.d), cervicitis is a cervical infection often caused by STIs and presents with purulent discharge and postcoital bleeding, Patient is noted to be having yellow frothy cervical discharge and bleeding after sex. CDC (2021) also corroborates this diagnosis as it explains the aforementioned signs and symptoms as well as a friable cervix are important clinical manifestations in diagnosing cervicitis.Discussion: Common Gynecologic Conditions, Part 1P.1. STI panel and wet mount. CDC (2021) recommends that individuals who are sexually active discuss getting tested for STIs. It is important for sexually active persons to get tested annually to ensure that2. pap smear3. blood test which includes CBC C-reactive protein4. pregnancy test4. Collect more information about sexual history (including sex partners, using protection)5. Treatment with antibiotics. “All sex partners during the previous 60 days should be referred for evaluation, testing, and presumptive treatment if chlamydia, gonorrhea, or trichomoniasis was identified” (CDC, 2021). Educate patient and partner(s) to get treated and abstain from sex until medication course is completed to prevent reinfection.6. dispo: discharge with medication after test have been resulted. Pt should f/u with PCP. If symptoms persist after treatment, refer to ob/gyn.Includes documentation of diagnostic studies that will be obtained, referrals to other health care providers, therapeutic interventions, education, disposition of the patient, and any planned follow-up visits. Each diagnosis or condition documented in the assessment should be addressed in the plan. The details of the plan should follow an orderly manner. Also included in this section is the reflection. The student should reflect on this case and discuss whether or not they agree with their preceptor’s treatment of the patient and why or why not. What did they learn from this case? What would they do differently?Also include in your reflection a discussion related to health promotion and disease prevention, taking into consideration patient factors (e.g., age, ethnic group), PMH, and other risk factors (e.g., socioeconomic, cultural background).Discussion: Common Gynecologic Conditions, Part 1References CDC. (2021, July 22). Chlamydia – CDC fact sheet (detailed). Center for Disease ControlPrevention. Detailed STD Facts – Chlamydia (cdc.gov)CDC. (2021, July 22). Gonorrhea – CDC fact sheet (detailed version). Center for DiseaseControl and Prevention. https://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea- detailed.htmCDC. (2021, July 22). Diseases characterized by urethritis and cervicitis. Center for DiseaseControl and Prevention. Urethritis and Cervicitis – STI Treatment Guidelines (cdc.gov)John Hopkins Medicine. (n.d.). Cervicitis. John Hopkins Medicinehttps://www.hopkinsmedicine.org/health/conditions-and-diseases/cervicitisRANZCOG (2021, July). Investigation of intermenstrual and postcoital bleeding. RANSCOG;Excellence in women’s health. Investigation-of-intermenstrual-and-postcoital-bleeding-(C-Gyn-6)-July-2021.pdf (ranzcog.edu.au)Discussion: Common Gynecologic Conditions, Part 1

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