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NRNP 6552 Week 4 Discussion: Common Gynecologic Conditions

NRNP 6552 Week 4 Discussion: Common Gynecologic Conditions NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsPatients 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:NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsIdentify 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 optionsORDER A PLAGIARISM-FREE PAPER HERELearning ResourcesRequired Readings (click to expand/reduce)Schuiling, K. D., & Likis, F. E. (2022). Gynecologic health care (4th ed.). Jones and Bartlett Learning.Chapter 17, “Breast Conditions” (pp. 337-349)Chapter 18, “Alterations in Sexual Function” (pp. 353-364)Chapter 20, “Infertility” (pp. 383-398)Chapter 21, “Gynecologic Infections” (pp. 401-432)Chapter 22, “Sexually Transmitted Infections” (pp. 437-466)Reproductive Health Access Project (2020). Your birth control choices. https://www.reproductiveaccess.org/wp-content/uploads/2014/06/contra_choices.pdfOffice of Women’s Health: Womenshealth.gov. (2017). Birth control methods. https://www.womenshealth.gov/a-z-topics/birth-control-methodsClinical Guideline Resources As you review the following resources, you may want to include a topic in the search area to gather detailed information (e.g., breast cancer screening guidelines; for CDC – zika in pregnancy).American Cancer Society, Inc. (ACS). (2020). Information and Resources about for Cancer: Breast, Colon, Lung, Prostate, Skin. https://www.cancer.org/American College of Obstetricians and Gynecologists (ACOG). (2020).  https://www.acog.org/American Nurses Association (ANA). (n.d.). Lead the profession to shape the future of nursing and health care. https://www.nursingworld.org/Centers for Disease Control and Prevention. (CDC). (n.d.). https://www.cdc.gov/HealthyPeople 2030. (2020). Healthy People 2030 Framework.  https://www.healthypeople.gov/2020/About-Healthy-People/Development-Healthy-People-2030/FrameworkThe American Association of Nurse Practitioners (AANP). (2020). https://www.aanp.org/Document: Focused SOAP Note Template (Word document)Optional Resource (click to expand/reduce)Case Study Discussion: 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.NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsBy 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_RubricNRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsGrid 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).NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsPost 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.Supported by at least 3 current credible sources.NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsPoints 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.Somewhat 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. NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsIs 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.NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsPoints 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.NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsPoints 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.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.NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsPoints 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.NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsPoints Range: 5 (5%) – 5 (5%)Communication is mostly professional and respectful to colleagues. NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsResponse 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.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.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.NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsPoints 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.Responds to questions posed by faculty.The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsPoints 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.NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsPoints Range: 5 (5%) – 5 (5%)Communication is mostly professional and respectful to colleagues.Response to faculty questions are mostly answered, if posed. NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsProvides opinions and ideas that are supported by few credible sources.Response 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_RubricMain postEpisodic/Focused SOAP Note TemplateNRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsPatient 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:NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsAssociated 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.NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsROS: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.NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsV/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.NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsDiagnostic 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.2. 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.NRNP 6552 Week 4 Discussion: Common Gynecologic Conditions3, 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.NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsP.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?NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsAlso 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).References 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)CollapseNRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsMain Initial Post Week 4Based on the given history and physical examination of the patient in the case studies the presumptive diagnosis for this patient is Gonorrhea (vaginal and oral).I believe that it is Gonorrhea because of the friable cervix, postcoital bleeding, and frothy yellow discharge noted around the cervix.  In addition, the postcoital bleeding has only been for the last 6 weeks which leads me to believe that she contracted the infection 6 weeks ago.  Gonorrhea can also be found orally.  This patient complains of a sore throat and fever.  Upon physical examination of this patient, patient has some anterior cervical adenopathy bilaterally and erythema of throat.Additional Questions:These questions are important to rule out any malignancies as a small percentage of patients with cervical cancer may have postcoital bleeding (Uptodate, 2021).What is the approximate volume of bleeding?Does postcoital bleeding occur with every episode of vaginal sexual activity?When was your last pap smear? Results?NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsSexual History A sexual history should always be completed when patient has symptoms that may indicate a sexually transmitted infection (U.S Department of Health and Human Services, n.d.).  These following questions would be asked in order to screening this patient for all sexual health concerns.These questions determine the number of partners without assuming the patient’s sexual orientation (U.S health and human services, n.d.).Are you in a monogamous relationship?What are/is the gender of your partners?How many sexual partners have you had in the last 3-6 months?Do you and your partner(s) have other sexual partner(s)? This will guide the diagnostic test and screening that will need to done.  For instance, this patient complains of a sore throat, so if she admits to oral sex a throat culture may be indicated. In addition, a past history STI puts patient at greater risk for another infection (U.S Department of Health and Human Services, n.d.).Do you have vaginal, oral, or anal sex?Do you or any of your sexual partners use recreational drugs?Do you know if your partners have ever had a STI or what their HIV status is/was?Have you ever had any Sexually Transmitted Infections (STI)?NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsThese questions will narrow down the history of present illness to determine if and when the patient was infected.Have you had unprotected sex in the last 3-6 month?Do you and your partners practice STI prevention by using condoms?Diagnostic Test:Wet mount microscopyImportant to rule out Bacterial Vaginosis and Trichomoniasis as these STI can also cause postcoital bleeding and friable cervix (CDC, 2021)Nucleic Acid Amplification Test (NAAT)Throat cultureNAAT and cultures are standard diagnostic test for detecting N. gonorrhoeae infections.  A throat culture will be necessary to check for an oropharyngeal infection.HIV TestDepending on how the patient answers the additional questions, its important to rule out HIV if patient reveals risky sexual behaviors like multiple partners and lack of condom use.HCG pregnancy: Always important to check for pregnancy in females of child-bearing age.Treatment Ceftriaxone 500 mg IM x1 dose (CDC, 2021)NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsReferencesCenters for Disease Control and Prevention. (2021). Sexually Transmitted Infections Treatment Guidelines, 2021: Gonorrhea. Retrieved from https://www.cdc.gov/std/treatment-guidelines/gonorrhea-adults.htmUptodate. (2021). Postcoital bleeding in females. Retrieved from http://www.uptodate.com/contents/postcoital-bleeding-in-females/printU.S Department of Health and Human Services, Center for Diseases Control and Prevention. (n.d.). A guide to taking a sexual history. https://www.cdc.gov/std/treatment/SexualHistory.pdfResponse #1CollapseHello !I agree with your diagnosis of Gonorrhea based on the patient’s symptoms and clinical presentation. It is a good idea to test your patient for HIV if she consents to this test since every patient should have accessibility to this testing especially with the Medicare expansion from 2010 (Gai & Marthinsen, 2019). When testing for STIs, it is important to not exclude HIV. Although with the patient’s sore throat the patient could very likely have 2 different pathologies occurring such as vaginal gonorrhea and viral pharyngitis, I like that you did consider oral sex. Gonorrhea is often times asymptomatic and is increasing in prevalence. Since asymptomatic the pharynx can be a reservoir for this bacterial infection to be found (“A Dangerous “Silent Reservoir” for Gonorrhea: The Throat”, 2017). Gonorrhea in some studies is besoming resistant to antibiotics, therefore, ceftriaxone 500mg IM and azithromycin 1000mg PO are being prescribed simultaneously. NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsReferencesGai, Y., & Marthinsen, J. (2019). Medicaid Expansion, HIV Testing, and HIV-Related Risk Behaviors in the United States, 2010–2017. American Journal of Public Health, 109(10), 1404–1412. https://doi–org.ezp.waldenulibrary.org/10.2105/AJPH.2019.305220A Dangerous, “Silent Reservoir” for Gonorrhea: The Throat. (2017, August 2). UWIRE Text, 1.Vincent, L. R., & Jerse, A. E. (2019). Biological feasibility and importance of a gonorrhea vaccine for global public health. Vaccine, 37(50), 7419–7426. https://doi-org.ezp.waldenulibrary.org/10.1016/j.vaccine.2018.02.081 I agree with gonorrhea as a differential diagnosis as you discussed how the client’s symptoms correlate with this diagnosis. I would also want to rule out chlamydia as it appear to correlate with the client’s presentation as well. A friable cervix, vaginal discharge, and bleeding following intercourse are some of the symptoms that are found with chlamydia (Schuiling & Likis, 2022). Chlamydia is also approximately 10 times more likely than gonorrhea. Gonorrhea and chlamydia can both be tested with a single swab by nucleic acid amplification test (NAAT). A NAAT can also be used to detect gonorrhea in the throat and has superior sensitivity and sensitivity than a culture (Fyle-Thorpe, 2019).NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsReferencesFyle-Thorpe, O. (2019). Chlamydia and gonorrhea: An update. Journal for Nurse Practitioners, 15(6), 424–428. https://doi-org.ezp.waldenulibrary.org/10.1016/j.nurpra.2018.12.027Schuiling, K. D., & Likis, F. E. (2022). Gynecologic health care (4th ed.). Jones and Bartlett Learning.CollapsePeer Response            Great job, Silvia. I agree that gonorrhea is a good differential diagnosis based on the medical history provided.  I think you did an excellent job asking pertinent questions and suggesting appropriate diagnostic testing. As providers, we are similar to detectives. We investigate and follow the evidence. We work so hard at supporting a diagnosis and ruling out others. Completing this case study was a good reminder that a patient may be experiencing more than one issue simultaneously. They could be related or completely unrelated. Often having one illness increases the risk of having or contracting another.  For example, trichomoniasis enhances the transmission of HIV (Campbell et al., 2020)NRNP 6552 Week 4 Discussion: Common Gynecologic Conditions. That is what makes your health history collection and diagnostic testing results so important. As previously mentioned, I believe you have done an excellent job at this already. As I read through these case studies again, I wondered if I would know her sore throat was from an STI right away or if I wanted to find out more. It may be a good idea to ask if she has been around anyone else that has been feeling sick. Or potentially complete a COVID test. I think you did a great job investigating further into her sexual history and assessing for risky behavior. If she reports recreational drugs use (especially with needles) or unprotected sex with whose using needles, her risk for contracting HIV increases (McCance & Huether, 2019). Therefore, an HIV antigen/antibody test serum should be completed (Ball et al., 2019; McCance & Huether, 2019). I really liked that you included a Nucleic Acid Amplification Test (NAAT) and a pregnancy test. I believe I forgot to mention those in my post. A NAAT is highly accurate and the preferred test for diagnosing gonorrhea (Ball et al., 2019). A pregnancy test is also essential. Not only to rule out pregnancy causing these issues but also to help with the proper treatment plan. Treatment options need to be carefully considered when treating a pregnant patient as some medications are not recommended while pregnant (Rosenthal & Burchum, 2021). NRNP 6552 Week 4 Discussion: Common Gynecologic Conditions ReferencesBall, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.Campbell, L., Woods, V., Lloyd, T., Elsayed, S., [email protected], D. L. C., L. CampbellCalgary Laboratory Services Calgary, A., V. Woods Calgary Laboratory Services Calgary, A., T. LloydCalgary Laboratory Services Calgary, A., S. ElsayedDepartment of Pathology & Laboratory Medicine, U. of C., & D. L. Church [email protected]Calgary Laboratory Services Calgary, A. (2020, December 1). ASM journals. Journal of Clinical Microbiology. https://journals.asm.org/doi/10.1128/jcm.00671-08?permanently=true&.McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.Week 5: Common Gynecologic Conditions, Part 2Patients who present with symptoms of gynecologic conditions may require careful analysis, as symptoms may suggest a variety of potential issues. Patients can present symptoms such as bleeding and discomfort which may indicate gynecologic conditions. While some symptoms may be normal effects of female health, others may indicate problems such as infections, cancer, or organ damage.NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsHence nurse practitioners must be prepared to apply best practices to the analysis of findings from interviews and screenings and must be prepared to suggest further testing to best contribute to diagnoses and ultimately to treatment.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:Analyze differential diagnoses for patientsDetermine prioritized patient assessmentsRecommend diagnostic tests and treatment optionsIdentify key terms, concepts, and principles related to the primary care of individuals, families, and communitiesLearning ResourcesRequired Readings (click to expand/reduce)Optional Resources (click to expand/reduce)Case Study Discussion: Common Gynecologic Conditions, Part 2NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsCase 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, diagnostic approaches, as well as to the development of treatment plans.Photo Credit: Erica Smit / Adobe StockFor this Case Study Discussion, you will propose a case study to your instructor that demonstrates a gynecological disease process from your practicum experience or your professional practice that would be quite challenging for you as a clinician. Once your instructor approves your case study, you will then explore this case study to determine the diagnosis, diagnostic tests, and treatment options for the patient.To prepare:Consider a case study you would like to propose to your instructor related to a patient that demonstrates a gynecological disease process in your practicum experience or professional practice that would be your biggest challenge as a clinician. Note: Possibly use your “FNP or AGPCNP Skills and Procedures Self-Assessment” in your practicum experience to guide your case study selection.Review the Learning Resources for this week and specifically review the clinical guideline resources specific to your proposed case study.NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsUse the Focused SOAP Note Template found in the Learning Resources to support 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 1Email your Instructor with your proposed case study (NOT a SOAP note) for approval. Once approved, you may move on to your Day 3 Discussion post.By Day 3Based on your approved case study, post the following:DO NOT POST A SOAP NOTE only describe your case study.Provide a differential diagnosis (dx) with a minimum of 3 possible conditions or diseases.Define what you believe is the most important diagnosis. Be sure to include the priority in conducting your assessment.Explain which diagnostic tests and treatment options you would recommend for your patient and explain your reasoning.Also, share with your colleagues your experiences as well as what you learned from these experiences.Use your Learning Resources and/or evidence from the literature to support your thinking and perspectives.Read a selection of your colleagues’ responses.NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsBy 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 tests or treatment options for your colleagues suggested and why. 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_Week5_Case_Study_Discussion_RubricNRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsGrid 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.NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsIncorporates 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.Supported 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.Somewhat 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.NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsPoints 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.NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsLacks 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.Points 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.NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsMeets 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. NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsResponds 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.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.NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsResponse 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.NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsPoints 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.Responds to questions posed by faculty.The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsPoints Range: 8 (8%) – 8 (8%)NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsResponse 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.NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsPoints 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.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.NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsPoints Range: 0 (0%) – 2 (2%)Does not meet requirements for full participation.Does not post by due date. Total Points: 100Name: NRNP_6552_Week5_Case_Study_Discussion_RubricCollapseMain Initial Post Week 5Proposed Case Study:25-year-old Native American female comes in to clinic with a chief compliant of inability to lose weight and irregular menses for the last 6 months.  She reports she is trying to have a baby with her significant other and has taken multiple pregnancies test that have been negative.  Her medical history and surgical history is unremarkable. Patient reports she drinks alcohol socially and denies cigarette smoking.  She admits to smoking marijuana at least 1-2 times per month.  Her maternal and paternal family history is positive for HTN, obesity, and insulin-dependent diabetes.  Her father had a stoke at the age of 55 but does not have any deficits from the stroke. She denies allergies and only takes Ibuprofen and Tylenol as needed for headaches.NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsHeight 5’ 6” Weight 185 (BMI 30.2), BP 127/76, HR 90HEENT:  thick facial hair noted to chin and upper lip, dark discoloration of neck skin fold, pustules and papules noted around chin and cheeksNeck: supple without adenopathyLungs/CV: wnlBreast: soft without masses, dimpling or dischargeAbd: soft, +BS, no tendernessVVBSU: wnlCervix: firm, smooth, parous, without CMTUterus: RV, mobile, non-tender, approximately 8 cm,Adnexa: without masses or tenderness 3 Differential DiagnosisPolycystic Ovary Syndrome (PCOS) is the main diagnosis for this patient.  PCOS pathophysiology is complex syndrome and since there is no definitive defect from PCOS it makes it difficult to diagnosis (Williams, Mortada, Porter, 2016).  PCOS symptoms can manifest with gynecologic, dermatologic, or metabolic conditions.  This particular patient has gynecological, metabolic, and dermatological symptoms, irregular menses, facial acne, hirsutism, acanthosis nigricans, and obesity. NRNP 6552 Week 4 Discussion: Common Gynecologic Conditions. The Endocrine Society advices clinicians to use the 2003 Rotterdam criteria to diagnose PCOS.  If a patient meets 2 out of three, hyperandrogenism, ovulatory dysfunction, and/or polycystic ovaries, patient has a higher probability for PCOS (Kriedt, Alchami, and Davies, 2019).  This patient has hyperandrogenism signs and ovulatory dysfunction.  The diagnosis of PCOS entails a complete history and physical, laboratory testing, and imaging.Hypothyroidism is another differential diagnosis that must be considered.  Due to the inability to lose weight, obesity, and menstrual inabilities hypothyroidism must be ruled out.  Patients with hypothyroidism, nonetheless, do not have hyperandrogenism symptoms that this patient exhibits.Cushing syndromeThis is another possibility as it can also cause absence of pregnancy and menstrual irregularities. Other common features include obesity, diabetes mellitus, acne, and hirsutism.  Patient has many of the identifying clinical features of Cushing’s syndrome with the exception of the buffalo hump and muscle wasting (Kirk et al., 2000). Diagnostic TestSerum Dehydroepianosterone Sulfate level (DHEAS)An elevated DHEAS level could indicate Cushing’s Syndrome, only 25% of women with PCOS have an elevated DHEAS level (Epocrates, LLC, 2021)NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsTSHThyroid-Stimulating Hormone is required in order to rule hypothyroidism as the cause of ,her inability to lose weight.Oral Glucose Tolerance Test Insulin resistance is an aggravating factor of PCOS (Kriedt, Alchami, Davies, 2019). Patient must be screened for impaired glucose tolerance.Fasting lipid panel Women with PCOS are at greater risk for cardiovascular disease and dyslipidemia.Serum 17-hydroxyprogestroneThis test is required in order to rule out Congenital adrenal hyperplasia (CAH)Serum ProlactinHyperprolactinemia may also cause amenorrhea (Kriedt et al., 2019).Serum Total and Free Testosterone                                                                                                 According to Kriedt et al., 2019, 1/3 of women with PCOS have elevated total testosterone.Serum LH and Follicle-stimulating hormone (FSH)Patients with PCOS may have raised or normal LH and normal FSH. High LH is associated with menstrual cycle disturbance (Kriedt et al., 2019).Transvaginal UltrasoundUltrasound was considered but was not ordered as patient already met the 2003 Rotterdam criteria and a tumor was not suspected (Williams et. Al., 2016)NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsRecommended TreatmentBecause the patient is attempting to get pregnant oral contraceptives are not the recommended choice. According to Williams et. al (2016), weight loss and increasing physical activity has its benefits. If weight loss is unsuccessful, patient should also be started on Metformin 500mg twice a day as it has proven to increase ovulation and pregnancy rates (Epocrates, LLC, 2021). Clomiphene 50 mg orally daily for 5 days consecutive days initially, increased by 50mg/day increments in subsequent cycles until ovulation is achieved. Clomiphene increases FSH in order to allow follicular maturation and ovulation (Williams et al., 2016).NRNP 6552 Week 4 Discussion: Common Gynecologic Conditions Lessons LearnedThis case scenario opened my eyes to endocrine disorders that are way more complicated then I had ever imagined.  The negative feedback loops of the hormones make it difficult for me as a novice nurse practitioner to properly treat and diagnose patient.  I realized that this was an area of weakness for me and I must focus more of my time in endocrine disorders and their clinical manifestations. NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsReferencesEpocrates. LLC. (2021) Polycystic ovary syndrome. Epocrates version 21.9.1Kirk, L. F., Jr, Hash, R. B., Katner, H. P., & Jones, T. (2000). Cushing’s disease: clinical manifestations and diagnostic evaluation. American family physician, 62(5), 1119–1134.Kriedt, K. J., Alchami, A., & Davies, M. C. (2019). PCOS: diagnosis and management of related infertility. Obstetrics, Gynaecology & Reproductive Medicine, 29(1), 1–5. https://doi-org.ezp.waldenulibrary.org/10.1016/j.ogrm.2018.12.001Williams, T., Mortada, R., & Porter, S. (2016). Diagnosis and Treatment of Polycystic Ovary Syndrome. American family physician, 94(2), 106–113.NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsDiscussion Response #1CollapseI agree with your diagnosis of PCOS. The first line of treatment for this disorder is estrogen and progesterone combined oral contraception. However, since the patient is trying to conceive this treatment modality in contraindicated (McCance & Huether, 2019). Therefore, as you mentioned Metformin is the treatment for PCOS. Metformin for pregnant ladies also will decrease their chances of having gestational diabetes in pregnancy as this is a common complication (Ball, Danis, Flynn, Solomon & Stewart, 2019). Before taking any medication in pregnancy the risks and benefits need to be presented to the patient. The patient should watch out for signs of virilization, the development of male physical characteristics, in pregnancy as this raises suspicions for a luteoma (Rosenthal & Burchum, 2021).NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsReferencesBall, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.Response 1Week 5Thank you for your post this week.  I agree that my primary diagnosis would be PCOS.  According to the Mayo Clinic (2020), physicians still do not know what causes PCOS and is also under diagnosed in many women.  Clomiphene can be started to help the pt get pregnant with PCOS if she does not then you can also add Metformin which combined can help with PCOS patients getting pregnant (Epocrates, 2021).  PCOS is also hereditary (Mayo Clinic, 2020). Silvia do you know if PCOS is more prevalent in native American genetics?NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsReferences:Epocrates. LLC. (2021) Polycystic ovary syndrome. Epocrates version 21.9.1Week 5 Case StudyCollapseNRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsMy week 5 case study:JM is a 38-year-old Caucasian female, G1 P1 LC1, presenting to the clinic for a follow up visit. This is the patient’s second visit. She states she has seen 3 other gynecologists in the last 6 years. Patient states she has not had a period since the age of 25. She denies any pain, vaginal discharge, or bleeding. She is currently not on any oral birth control. She states that past physicians have attempted multiple types of oral birth control to try to bring about and regulate periods but were unsuccessful. She states she is not currently in a relationship. She has an allergy to eggs and is unable to receive the influenza vaccine due to hives and urticaria. Past medical history is positive for HPV seen in her last Pap smear on 5/2021, genital warts, anal condyloma and obesity. Surgical history: vaginal birth X1 with no complications; and wisdom tooth extraction. Patient states no family history of cancer or amenorrhea. Social history: not married; one female child, currently 19 years old and lives with patient; positive tobacco use, smokes 1 pack every 4 days; states social ETOH use, one glass of wine per week.NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsHeight 5’ 2,” Weight 161lbs (BMI 29.4), BP 128/72 P 70HEENT: wnlNeck: supple without adenopathyLungs/CV: wnlBreast: soft, bilaterally, without masses, dimpling or dischargeAbd: soft, +BS, no tendernessVVBSU: + vulvar lesionCervix: + cervical lesionUterus: mobile, non-tenderAdnexa: without masses or tendernessDifferential diagnosis:Cervical Carcinoma (primary diagnosis): Cervical cancer is when malignant cells form in the tissue of the cervix. It is the fourth common cancer in women (Ngoma and Autier, 2019).  Some symptoms of cervical cancer are abnormal bleeding, irregular menstrual bleeding, unusual vaginal discharge, pelvic pain and pain during intercourse. Risk factors of cervical cancer include: obesity, smoking, long term use of oral contraceptives and having the human papillomavirus (HPV) (Centers for Disease Control and Prevention, 2021).  99.7% of cervical cancers are caused by HPV (Ngoma and Autier, 2019). JM has a history of HPV, smoking and obesity. She also stated that she was prescribed multiple oral contraceptives during the 13 years of amenorrhea. During the assessment the patient did not complain of any pain, abnormal vaginal discharge or bleeding.NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsSyphilis: Syphilis is an STI that is caused by a bacterium called T. pallidum. It is characterized by a chancre sore that can be found on the genitalia, cervix, perianal area, and mouth. Patients can also develop fever, headache, malaise, and condylomata lata (wart like lesions) that can develop on the vulva, perineum, or anus (Schuiling & Likis, 2022). Although syphilis rates are highest in men, rates are increasing in women. Throughout the years 2016-2017, rates increase 21.1% in women (Schuiling & Likis, 2022)NRNP 6552 Week 4 Discussion: Common Gynecologic Conditions.  Undiagnosed and untreated syphilis can lead to cardiovascular, dermatologic and neurologic complications. It can also increase the susceptibility to other STIs. A vulvar lesion was seen on exam and the patient has a history of genital warts and an anal condyloma, along with HPV.Human immunodeficiency virus (HIV): HIV is an infection that attacks the immune system. It can be transmitted via oral or sexual intercourse, needle injections from drug use and blood transfusions. In 2018, there were about 36,400 new cases of HIV in the US; and 18% of those cases were among women (CDC, 2020). Those infected with HIV are susceptible to acquiring other STIs, just as those with STIs are at risk of acquiring HIV. This is due to compromised tissue in the genitalia and oral cavity from chancres, lesions, warts and condylomas (Schuiling & Likis, 2022). Due to the patient’s history of HPV, genital warts, lesions and anal condyloma, HIV should be ruled out.   NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsDiagnostic tests and treatment options:The patient should undergo cervical cancer screening, STI and HIV screening.Cervical cancer screening is conducted in a “Two-visit protocol.” The first visit will be to collect cervical cytology, and the second visit will consist of a colposcopy to obtain cervical biopsy with loop electrode excision (Ngoma and Autier, 2019). The “two-visit protocol” was conducted on this patient. She had a Pap smear on her first visit which assessed for pre-cancers and cell changes on the cervix. A colposcopy with cervical biopsy was conducted on the second visit. If cervical cancer is detected, the patient should be referred to a gynecologic oncologist, a medical oncologist, a surgeon and/or a radiation oncologist. This patient would have to choose on surgery to remove certain cancer tissue or for a hysterectomy. She would also have to choose on treatment options with chemotherapy and radiation.NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsPatients that are diagnosed or treated for STIs should be screened for HIV; and those at high risk for HIV should be screened for HIV at least yearly (Schuiling & Likis, 2022)NRNP 6552 Week 4 Discussion: Common Gynecologic Conditions. In syphilis screening, the patient’s skin would be checked for rashes and chancre sores. The external genitalia would also be checked for lesions and chancres. A Pap smear and bimanual examination would be conducted to evaluate the vaginal walls and cervix; and to assess uterine size, shape, consistency, mobility, and tenderness, and to palpate for adnexal masses and tenderness (Schuiling & Likis, 2022). Nontreponemal and treponemal serologic tests can be performed to presumptively diagnose syphilis. It is treated with parenteral penicillin G. Sexual partners must be treated as well.HIV screening consists of serologic tests and virologic tests. The serologic tests identify antibodies to HIV-1 and HIV-2; and virologic tests sense antigens to HIV or RNA (Schuiling & Likis, 2022). These tests are conducted via the ELISA or EIA tests and then by the Western blot, to confirm diagnosis.When undergoing these treatments, the women must be counseled and educated on the basis for the visits, screening and disease surveillance (Schuiling & Likis, 2022). This will ensure or improve treatment and monitoring compliance and decrease STI transmission.NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsWhat has been learned from this experience? The main things I have learned from this experience are the many steps that are involved with diagnosis. Presumptive diagnosis via assessment and lab studies must then be confirmed with biopsies and other lab studies. I have learned how important it is to ask those difficult questions, like the amount of current sexual partners. It is important to know the answer to this question because if this patient was diagnosed with another STI, then education and treatment are imperative to the current partners.  Lastly, I have also learned how important counseling and education are to ensure screening and treatment compliance. The multiple visits for screening and treatment can create a burden on these women, their families, work and childcare.   NRNP 6552 Week 4 Discussion: Common Gynecologic ConditionsReferencesCenters for Disease Control and Prevention. (2020). HIV and Women: HIV Incidence.https://www.cdc.gov/hiv/group/gender/women/incidence.htmlCenters for Disease Control and Prevention. (2021). Cervical cancer.https://www.cdc.gov/cancer/cervical/basic_info/symptoms.htmNgoma, M. & Autier, P. (2019). Cancer prevention: cervical cancer. E-cancer medical science, 13, p. 952. doi:10.3332/ecancer.2019.952. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6722108/Schuiling, K. D., & Likis, F. E. (2022). Gynecologic health care (4th ed.). Jones and Bartlett Learning.NRNP 6552 Week 4 Discussion: Common Gynecologic Conditions

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