Weekly Clinical Experience 1
Describe your clinical experience for this week.
Did you face any challenges any success? If so what were they?
Describe the assessment of a patient detailing the signs and symptoms (S&S), assessment, plan of care, and at least 3 possible differential diagnosis with rationales.
Mention the health promotion intervention for this patient.
What did you learn from this week’s clinical experience that can beneficial for you as an advanced practice nurse?
Support your plan of care with the current peer-reviewed research guideline.
Submission Instructions:
Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)
Case: 25 year old female, has pelvic pain and drainage. She has had multiple partners in the last few months. No medical problems, No allergies, no medications. Last pap was 4 years ago
Weekly Clinical Experience 1
This week in my clinical rotation, I encountered a case that provided a valuable learning opportunity and challenged my diagnostic and clinical skills. I assessed a 25-year-old female presenting with pelvic pain and abnormal vaginal discharge. She reported having multiple sexual partners in the past few months. Her medical history was unremarkable, with no known allergies or current medications, and her last Pap smear was performed four years ago.
Challenges and Successes
One of the primary challenges was navigating the patient’s discomfort in discussing her sexual history, which is crucial for a thorough assessment and accurate diagnosis. Building rapport and ensuring a non-judgmental environment were essential to gaining her trust. Another challenge was considering the broad differential diagnoses for her symptoms, which required a detailed and systematic approach to narrow down the possibilities.
A notable success was successfully obtaining a comprehensive history and conducting a focused physical examination, which guided the subsequent diagnostic testing and management plan. Establishing a trusting relationship with the patient and providing her with education on her condition and preventive measures were also significant achievements.
Patient Assessment
Signs and Symptoms (S&S):
- Pelvic pain
- Abnormal vaginal discharge
- Multiple sexual partners
Assessment: During the physical examination, the patient exhibited lower abdominal tenderness upon palpation. A speculum examination revealed mucopurulent cervical discharge and cervical motion tenderness. These findings, combined with her sexual history, raised suspicion for a sexually transmitted infection (STI).
Plan of Care: The immediate plan included obtaining laboratory tests to confirm the diagnosis:
- Nucleic acid amplification tests (NAAT) for Chlamydia trachomatis and Neisseria gonorrhoeae.
- Wet mount and KOH tests for bacterial vaginosis and trichomoniasis.
- A pregnancy test to rule out pregnancy-related complications.
- Urinalysis and urine culture to rule out urinary tract infection (UTI).
Differential Diagnoses:
- Pelvic Inflammatory Disease (PID): Given the patient’s symptoms of pelvic pain, mucopurulent discharge, and multiple sexual partners, PID is a primary consideration. PID results from the ascent of microorganisms from the vagina and cervix to the upper genital tract, often associated with STIs like Chlamydia and Gonorrhea. Left untreated, PID can lead to serious complications, including infertility and chronic pelvic pain (Centers for Disease Control and Prevention [CDC], 2021).
- Bacterial Vaginosis (BV): The presence of abnormal discharge raises the possibility of BV, a common vaginal infection caused by an imbalance of normal vaginal flora. BV is characterized by a thin, white or gray discharge with a fishy odor. Risk factors include multiple sexual partners, douching, and a new sexual partner (Workowski & Bolan, 2015).
- Cervicitis: Inflammation of the cervix, often caused by STIs such as Chlamydia and Gonorrhea, can present with similar symptoms. Cervicitis can lead to mucopurulent discharge and cervical tenderness, aligning with the patient’s presentation. Diagnosis and treatment are crucial to prevent ascending infections and complications (Hatch, 2020).
Health Promotion Intervention: For this patient, health promotion interventions focused on STI prevention and reproductive health education. Counseling on the consistent and correct use of condoms, regular STI screening, and the importance of monogamous relationships or limiting the number of sexual partners were emphasized. Additionally, educating the patient about the importance of routine Pap smears for early detection of cervical dysplasia and cancer was crucial. The patient was encouraged to follow up for a Pap smear given that her last screening was four years ago, which is beyond the recommended interval for her age group (U.S. Preventive Services Task Force, 2018).
Learning and Application as an Advanced Practice Nurse: This clinical experience underscored the importance of a thorough patient history and physical examination in guiding differential diagnoses and management plans. It also highlighted the significance of patient education in preventive care and health promotion. As an advanced practice nurse, I learned to approach sensitive topics with empathy and professionalism, ensuring comprehensive care that addresses both the physical and emotional needs of the patient.
Supporting the plan of care with current peer-reviewed research and guidelines ensures evidence-based practice. The CDC’s guidelines on the diagnosis and treatment of STIs and the U.S. Preventive Services Task Force recommendations for cervical cancer screening provide a robust framework for managing such cases effectively and safely (CDC, 2021; U.S. Preventive Services Task Force, 2018).
References:
Centers for Disease Control and Prevention. (2021). Sexually transmitted infections treatment guidelines, 2021. Retrieved from https://www.cdc.gov/std/treatment-guidelines/default.htm
Hatch, K. D. (2020). Cervicitis. In J. S. Berek (Ed.), Berek & Novak’s Gynecology (16th ed.). Wolters Kluwer.
U.S. Preventive Services Task Force. (2018). Screening for cervical cancer: US Preventive Services Task Force recommendation statement. JAMA, 320(7), 674-686. doi:10.1001/jama.2018.10897
Workowski, K. A., & Bolan, G. A. (2015). Sexually transmitted diseases treatment guidelines, 2015. MMWR Recommendations and Reports, 64(RR-03), 1-137.