FNP Adult Health Male Health Case Study Assignment Paper

In this assignment, students will apply knowledge and skills learned to a clinical scenario. The case study assignment will help promote critical-thinking skills and develop good clinical judgement. You will read the case study and respond to the prompts. You will need to support your responses with evidence, utilizing at least 3 current evidence-based sources. An APA-formatted title page and reference list is required for the assignment.

This assignment is designed to promote the development of the following: AACN Essentials (2022): Domains 1, 2, 4, 6, and 9; NONPF NP Core Competencies (2022): 1, 2, 4, 6, and 9; and NONPF Population-Focused Competencies (2012): Scientific Foundation, Leadership, Quality, Technology and Information Literacy, and Independent Practice.  FNP Adult Health Male Health Case Study Assignment Paper

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FNP Adult Health I Male Health Case Study Assignment

J.C., a 23-year-old male naval officer recently stationed in the Philippines, complains of dysuria, meatal pain, and a profuse yellow urethral discharge for 2 days. He admits to extramarital sex with a prostitute over the past week. He states that his wife, B.C, is 8 weeks pregnant but she is asymptomatic. J.C tells you that if this is a sexually transmitted disease then he does not want the wife to know about this diagnosis and the extramarital affair.

Past Medical History: COVID infection 2020, acute pharyngitis (5 months ago – treated with antibiotics)

Medication History: Patient takes no medications.

Drug Allergy: NKDA, NKFA FNP Adult Health Male Health Case Study Assignment Paper

Family Medical History: Patient is adopted. He does have a twin brother – healthy. The rest of family history is unknown.

Surgical History: Appendectomy at age 11. Denies any other surgeries or hospitalizations.

Social History: Denies use of cigarettes. Reports weekly alcohol use – about 3-4 beers on the weekends while watching sports. Denies the use of recreational drugs. Currently employed as a naval officer. He lives locally in a 2-bedroom apartment with his wife of 4 years. His wife is currently 8 weeks pregnant, and this will be their first child. His family, including twin brother, are not local – he does try to see them at least once a year.

Vaccinations: He has had all of the usual childhood immunizations: MMR, Hepatitis b, varicella, IPV, HIB, PCV13, DTaP series as a child, Tdap booster – last at age 21. He also reports receiving several vaccinations before being stationed but does not know specific details at this time.

Review of Systems:

General: denies recent weight loss or weight gain, no fever, no chills

HEENT: denies vision loss, denies hearing loss. Denies asthma, hay fever, frequent colds, nasal discharge, sinus problems; no dental problems – reports regular preventive dental care

Cardiovascular: No history of heart murmur or heart problems. Denies chest pains or palpitations. Denies edema. FNP Adult Health Male Health Case Study Assignment Paper

Respiratory: Denies any difficulty with breathing, asthma, or bronchitis. Denies cough or wheezing.

Abdominal/Gastrointestinal: Denies heartburn, abdominal pain, constipation, diarrhea, rectal bleeding; no history of liver or gallbladder disease

Genitourinary: First intercourse at age 16; two sexual partners in his lifetime. Frequent intercourse. He does not use any protection. His wife had an IUD until it was removed in order to start trying to conceive. Complaints of dysuria, meatal pain, and a profuse yellow urethral discharge for 2 days.

Neurological: Denies history of headaches or migraines; no history of seizures

Endocrine: Denies any fatigue, heat or cold intolerance

Musculoskeletal: No complaint; no history of injuries, muscle pain, or joint pain

Skin: Denies rashes or sores.

Psychiatric: Reports occasional anxiety. Denies depression.

Physical Exam:

V/S: Temperature 99.2 F; BP 115/62 mm Hg Height: 74 inches Weight: 193 lbs. BMI 24.8

Gen:  Alert, oriented, well-built male in no acute distress. Well developed, hydrated.

CV: External chest is normal in appearance without lifts, heaves, or thrills. PMI is not visible and palpated at the 5^th intercostal space at the midclavicular line. Heart rate and rhythm are normal. Normal S1& S2 present and are of normal intensity. No murmurs, gallops, or rubs auscultated.

Resp:  Chest wall is symmetric and without deformity. No signs or respiratory distress. Lung sounds are clear in all lobes bilaterally without rales, rhonchi, or wheezes.

Abdomen: Soft, symmetric, non-distended, non-tender, bowel sounds + and normoactive x 4 quadrants, no masses palpated. No hepatomegaly or splenomegaly are noted.

Genital: External genitalia reveals erythema to the meatus, presence of yellow discharge.

Neuro/Psych: alert and oriented X 3. CN II-XII grossly intact.  Good eye contact, speech clear and goal oriented. Affect normal.

Skin: No rashes or sores present FNP Adult Health Male Health Case Study Assignment Paper

Diagnostic Tests:  Gram stain (urethral exudates)

Case Questions:

1. What is/are the diagnoses? Support with literature evidence and interpretation of data presented in the case study.
2. Discuss the pathophysiology of the selected diagnosis.
3. Present and briefly discuss (rationale) 3 differential diagnoses for this patient.
4. Discuss plan of care for this patient.
   1. What is the CDC’s drug of choice for treating this condition and what are some alternates?
   2. What additional therapy should be included and why?
   3. Discuss pharmacological, education, referral, and need for further diagnostic testing if any. Do not forget to include health promotion. Support your plan of care/interventions with literature evidence.
5. Provider Implications: Reflect on the case presentation and the importance of accurate interpretation of subjective and objective data.
   1. C. tells you that he does not want the wife to know about this diagnosis; what is the best answer to this request?
   2. Should B.C. (J.C.’s pregnant wife) be treated?  If so, with what?
   3. Is this a reportable disease to public health? If so, how best can you report this? FNP Adult Health Male Health Case Study Assignment Paper

FNP Adult Health I Male Health Case Study Assignment Rubric

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1. What is/are the diagnoses? Support with literature evidence and interpretation of data presented in the case study. 

The diagnosis presented in the case study is that of sexually transmitted Neisseria gonorrhea. Some of the clinical manifestations of the patient that confirms the diagnosis include a profuse yellow urethral discharge, difficulty during urination as well as urethral pain (Bodie et al., 2019). In some instances, patients may have testicular discomfort and penile edema. FNP Adult Health Male Health Case Study Assignment Paper

2. Discuss the pathophysiology of the selected diagnosis.

Gonorrhea is a sexually transmitted infection that is caused by a bacterium, Neisseria gonorrhea. The bacterium only survives in humans and it is transmitted after sexual contact where it binds to the wall of the urinary tract with the aid of pili, which are surface proteins. After attachment, Neisseria attacks the epithelial cells of the urethra or cervix and even the anus with reference to the site of sexual contact (Humbert & Christodoulides, 2019). Opacity-associated proteins and other bacterial factors aid in attachment to sperms and hence enhanced rate of transmission.

3. Present and briefly discuss (rationale) 3 differential diagnoses for this patient.

A possible differential diagnosis for the patient is trichomonas vaginalis, a protozoan infection that is transmitted as a result of sexual contact with an infected host. The infection is mostly symptomatic in females and rarely symptomatic in males. Males can present cloudy urine, dysuria, testicular pain and penile discharge (Schumann & Plasner, 2022).

The second differential diagnosis is Chlamydia infection, a sexually transmitted infection that is caused by chlamydia trachomatis bacteria. The infection has similar symptoms as those for gonorrhea such as prostatitis, urethritis and epididymitis. Among men patients may present dysuria with a clear or grey discharge.

The third possible differential diagnosis is urinary tract infection. A urinary tract infection is an infection of the urinary tract that occurs when bacteria usually from the rectum or skin invades the urinary tract. The infection can infect various parts including the bladder and kidneys. Some of the common symptoms include dysuria, urinary frequency and urgency. FNP Adult Health Male Health Case Study Assignment Paper

4. Discuss plan of care for this patient.
   1. What is the CDC’s drug of choice for treating this condition and what are some alternates? 

The drug of choice for treating uncomplicated gonorrhea is the administration intramuscularly a single dose of ceftriaxone 500mg (Hussain et al., 2022).  Despite the increasing antimicrobial resistance, this choice has been effective and safe. The most effective alternative is a single dose of azithromycin 2g PO and a single dose of gentamicin 240 mg IM.

1. What additional therapy should be included and why? 

Additional therapy for the patient includes counseling to help minimize chances of transmission as well as abstaining from sexual activities until the symptoms subside. Also, there is need for the patient’s sexual partners to be treated.

1. Discuss pharmacological, education, referral, and need for further diagnostic testing if any. Do not forget to include health promotion. Support your plan of care/interventions with literature evidence.

To ensure that the patient gets optimum healthcare attention and help, there is need for him to be educated on the need to abstain from sexual activities until the symptoms resolves. Also, the patient should be educated on the need for abstaining from unprotected sexual contact with strangers such as the prostitute with whom he had intercourse. In addition, all sexual partners should be treated to prevent further transmission. After successful completion of therapy, a follow-up test should be done after 3 months (Douglas et al., 2021).

5. Provider Implications: Reflect on the case presentation and the importance of accurate interpretation of subjective and objective data.
   1. C. tells you that he does not want the wife to know about this diagnosis; what is the best answer to this request?

According to CDC, there should be appropriate management and treatment of all sexual partners in case of sexually transmitted diseases hence, the patient’s request not to inform the wife will put the wife into great risk therefore undermining the ethical principle of non-maleficence. The patient should be educated on risks associated with not informing the wife. Also, there is need for counseling and testing for other related STDs such as HIV.  FNP Adult Health Male Health Case Study Assignment Paper

1. Should B.C. (J.C.’s pregnant wife) be treated?  If so, with what?

The patient’s wife should be treated based on the information provided on the sexual contact between the two. Of significant concern is the fact that the wife is pregnant and in the event that she is not appropriately treated, there might be cases of pregnancy related complications. The treatment plan for the wife should be a single dose of ceftriaxone 500 mg administered intramuscularly.

1. Is this a reportable disease to public health? If so, how best can you report this?

This is a reportable disease to the public owing to the fact that the patient got infected by a prostitute he had sexual intercourse with who might as well have more sexual partners. This disease can be reported to the healthcare practitioners in the community for appropriate action.

References

Bodie, M., Gale-Rowe, M., Alexandre, S., Auguste, U., Tomas, K., & Martin, I. (2019). Multidrug resistant gonorrhea: addressing the rising rates of gonorrhea and drug-resistant gonorrhea: there is no time like the present. Canada Communicable Disease Report, 45(2-3), 54.

Douglas, C. M., O’Leary, S. C., Tomcho, M. M., Wu, F. J., Penny, L., Federico, S. G., … & Frost, H. M. (2021). Gonorrhea and chlamydia rates among 12–24 year old patients in an urban health system. Sexually transmitted diseases, 48(3), 161.

Humbert, M. V., & Christodoulides, M. (2019). Atypical, yet not infrequent, infections with Neisseria species. Pathogens, 9(1), 10.

Hussain, S., Mustafa, A., Mumtaz, A., Shaheen, G., Qaiser, F., & Ahmad, S. (2022). A Comparison of Spectinomycin with Ceftriaxone as Treatment for Uncomplicated Gonorrhea. Pakistan Journal of Medical & Health Sciences, 16(08), 587-587.

Schumann, J. A., & Plasner, S. (2022). Trichomoniasis. In StatPearls [Internet]. StatPearls Publishing. FNP Adult Health Male Health Case Study Assignment Paper