NURS 6552-Types of Diagnostic Tests Assignment

Discussion response 1 (Nel)
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. NURS 6552-Types of Diagnostic Tests Assignment

Patient Information:

SL, 24, Female, Caucasian

S.

CC (chief complaint): regular office visit

HPI: SL is a 24-year-old Caucasian female presenting to the clinic for regular care. relates she has been having some postcoital bleeding for the past 6 weeks and has had a sore throat for past 3 weeks. She did have a fever for a day or two, but Tylenol took care of it and she thought it was allergies. NURS 6552-Types of Diagnostic Tests Assignment

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Current Medications: Pamprin as needed, Tylenol as needed

Allergies: NKDA.

PMHx: no medical or surgical history

Soc & Substance Hx: Social history is remarkable for cigarette smoking at a rate of ½ packs per day (PPD) since age 14, / EtOH only on weekends, 6-8 hard liquor/ daily, and marijuana smoking. SL works full-time as an administrative assistant. Satisfied with her job. SL jogs 3-4 times a week, wears seatbelts when in the car, and “occasionally” uses sunscreen. NURS 6552-Types of Diagnostic Tests Assignment

Fam Hx: unrelated

Surgical Hx: no

Mental Hx: unknown.

Violence Hx: unknown

Reproductive Hx: of menses age 13, menses every 28-32 days, lasting 4-6 day and using 3 tampons daily. NURS 6552-Types of Diagnostic Tests Assignment

ROS: The information regarding ROS omitted in the case scenario. The healthcare provider should ask focused questions that relate to current case scenario and help to include or rule out a differential diagnosis.

HEENT: Since SL c/o sore throat three for the past three weeks, as an NP, I would like to investigate further on ears, nose, throat to rule out possible upper respiratory infection (URI), cold virus, flu. NURS 6552-Types of Diagnostic Tests Assignment

Do you have hearing loss?

Do you sneeze?

Do you have congestion?

GASTROINTESTINAL (GI) Some STI pathogens can cause abdominal pain and diarrhea (Jawale et al., 2018). Therefore, NP should ask the following questions:

Do you have unintentional weight loss, nausea, vomiting, or diarrhea? NURS 6552-Types of Diagnostic Tests Assignment

Do you have abdominal pain or blood?

Does your urine look

Do you have any urine order?

GENITOURINARY (GU). Multiple STIs cause GU symptoms. The following questions need to be asked:

Do you have burning or pain on urination? NURS 6552-Types of Diagnostic Tests Assignment

Do you have pain on your back sides?

Do you have a strong, persistent urge to urinate?

REPRODUCTIVE: The case scenario does not give a lot of information on LD reproductive system. Further questions need to be asked:

When was your first day of last menstrual period (LMP)?

Have you ever been pregnant? If yes, how many times.

Do you have any desire to have (more) children?

If yes, how many children would you like to have? When would you like to have a child? What are you and your partners doing to prevent pregnancy until that time? NURS 6552-Types of Diagnostic Tests Assignment

If no, are you doing anything to prevent pregnancy? How important is it to you to prevent pregnancy? Would you like to talk about birth control options?

Are you sexually active?

If yes, what type of sex do you have (vaginal, anal, or oral)?

Do you have sex with men, women, both, or another?

How many partners have you had in a last 6 months?

Have you ever had a sexually transmitted infection (or disease)? If yes, which STI(s)? Where on your body were the infections? When did you have it? Were your partners tested and treated too? NURS 6552-Types of Diagnostic Tests Assignment

It is essential to ask questions regarding protection. What do you do to protect yourself from STIs, including HIV?

When do you use this protection? With which partners?

Have you been vaccinated against HPV? Hepatitis A? Hepatitis B?

Have you noticed any vaginal discharge, burning, pain, odor?

ALLERGIES: In the case scenario, SL mentioned that she took Tylenol for possible allergies. As an NP, I would like to ask questions what does she think she is allergic to? NURS 6552-Types of Diagnostic Tests Assignment

O.

Physical exam:

Vital signs: temperature 97.8, pulse 68, BP 112/64, height 5’6” and weight 118 lbs. (which was the same as last year). BMI 19.04

• HEENT: WNL except some anterior cervical adenopathy bilaterally, and throat appears reddened. NURS 6552-Types of Diagnostic Tests Assignment

• Lung: clear to auscultation

• CV: regular sinus rhythms without murmur or gallop

• Abd: soft, non-tender, liver normal,

• Breasts: fibrocystic changes bilaterally, no masses, dimpling, redness or discharge, no adenopathy, and bilateral nipple piercings. NURS 6552-Types of Diagnostic Tests Assignment

• VVBSU: wnl, slight frothy yellow discharge by cervix, clitoral piercing noted

• Cervix: friable, some petechia no cervical motion tenderness.

• Uterus: mid mobile, non-tender

• Adnexa: without masses or tenderness

• Perineum: wnl

• Rectum: wnl

• Extremities: full rom, skin clear, no edema, reflexes 1+.

• Neurological: CN II-12 grossly intact.

Diagnostic results: NURS 6552-Types of Diagnostic Tests Assignment

Pregnancy test. It is essential to obtain HCG urine or blood test. It can determine the course of treatment. Certain antibiotics cannot be prescribed to pregnant women. A pregnancy test also can rule out ectopic pregnancy.

The nucleic acid amplification test (NAAT). NAATs are the preferred technique because they provide the highest sensitivity. This test to diagnose chlamydia, gonorrhea, trichomoniasis. NURS 6552-Types of Diagnostic Tests Assignment

Pharyngal culture. Specific culture of a swab from the site of infection is the gold standard for diagnosis at all potential sites of STI (Medscape, 2018).

Laparoscopic confirmation. If a suspected diagnosis of pelvic inflammatory disease, laparoscopy is the preferred invasive method of diagnosis, allowing direct visualization of the gynecologic and abdominal structures (Epocrates, n.d.). NURS 6552-Types of Diagnostic Tests Assignment

A.

Differential Diagnoses

Chlamydia A74. 9. Genital tract chlamydia infections are among the most frequently reported sexually transmitted (Centers for Disease Control and Prevention [CDC], 2021). The infections are caused by the bacterium Chlamydia trachomatis (CT) (Workowski et al., 2021). Chlamydia is almost always transmitted by sexual contact. The bacterium may cause symptoms, but in most people, the infection is asymptomatic (Epocrates, n.d.). Patients with chlamydia may have friable cervix when it may bleed easily with friction from a polyester swab. In addition, a cervical frothy yellow discharge has been noted that can be an indication of CT. One of the most common symptoms of STI, such as CT, is postcoital bleeding (Epocrates, n.d.). NURS 6552-Types of Diagnostic Tests Assignment Fever/chills can occur in women if the infection ascends to the upper urogenital tract or is rarely secondary to a pericapsular hepatic disease (Epocrates, n.d.). Patients who engage in oral sex may develop STIs such as chlamydia in their throat, leading to a sore throat. Based on clinical symptoms, SL has chlamydia. However, NAAT needs to confirm the diagnosis. NURS 6552-Types of Diagnostic Tests Assignment

Gonorrhea A54. 9 infection is a common STI caused by Neisseria gonorrhoeae (NG), a gram-negative diplococcus bacterium closely related to other human Neisseria species. The characteristic clinical picture of gonorrhea is frequently overlapped with chlamydia (Medscape, 2021). SL presents with some of the possible signs and symptoms of gonorrhea, such as cervical friability, slight frothy yellow discharge, postcoital bleed. Additionally, SL’s pharyngitis can be a sign of disseminated gonorrhea infection (DGI).). SL’s symptoms possibly represent gonorrhea. Once again, a NAAT needs to be performed to confirm the diagnosis of gonorrhea. NURS 6552-Types of Diagnostic Tests Assignment

Pelvic inflammatory disease (PID) N73. 9 is an infectious and inflammatory disorder of the upper female genital tract, including the uterus, fallopian tubes, and adjacent pelvic structures (Medscape, 2021). The classic high-risk patient is a menstruating woman younger than 25 who has multiple sex partners, does not use contraception, and lives in an area with a high prevalence of sexually transmitted disease (STD) (Medscape, 2021). SL matches the age criteria. However, more health history information is needed to see if SL meets another high-risk category. CDC (2021) states the following: “Maintain low threshold for dx of PID; test all pts for STIs, incl GC and CT (via urine NAAT) and HIV.” NP should initiate presumptive treatment of PID if a patient is at risk for STI with pelvic or lower abdominal pain and one or more following minimum criteria present on the pelvic exam: cervical motion tenderness, uterine tenderness, adnexal tenderness (CDC, 2021). CL’s pelvic exam did not reveal any of the mentioned physical findings in the criteria. For this reason, PID is less likely. NURS 6552-Types of Diagnostic Tests Assignment

P.

Treatment for chlamydia:

doxycycline 100 mg orally twice daily for 7 days (CDC, 2021)

Treatment for gonorrhea:

Ceftriaxone 500 mg intramuscularly (IM) as a single dose (CDC, 2021).

If chlamydial infection has not been excluded, patients should also receive oral doxycycline for 7 days (CDC, 2021).

Mouth wash for phalangeal infection. NURS 6552-Types of Diagnostic Tests Assignment

Treatment for PID: NURS 6552-Types of Diagnostic Tests Assignment

Ceftriaxone 500 mg IM as a single dose, plus doxycycline 100 mg orally twice daily for 14 days, plus metronidazole 500 mg orally twice daily for 14 days (CDC, 2021).

Education:

If SL’s NAAT tests comes back positive than sexual partner should be tested for STIs as well. The management of the patient’s sex partners is an important consideration to prevent reinfection and further transmission. NURS 6552-Types of Diagnostic Tests Assignment

During antibiotic treatment, patient should avoid sexual contact until their treatment is completed and all partners also have been evaluated and treated.

NP should provide consult on contraception and immunization.

Reflection NURS 6552-Types of Diagnostic Tests Assignment

Complete health history is essential in building a patient’s diagnosis and treatment plan. SL has a limited health history that requires the NP to ask more questions regarding the patient’s sexual status, STI history, pregnancy history, contraception use, etc. Furthermore, many STIs such as chlamydia and gonorrhea can have the same clinical presentation. It is essential to differentiate between the two because the treatment plan for chlamydia differs from gonorrhea. Before any clinical diagnosis, NP should perform a pregnancy test on a patient. The healthcare provider should always be concerned about PID and use clinical judgment to rule out PID. Additionally, a healthcare provider should discuss the importance of using contraception and immunizations with the patient. NURS 6552-Types of Diagnostic Tests Assignment