ESSAY: Common emergency department complaints are vaginal bleeding, and STIs.

Common emergency department complaints are vaginal bleeding, and STIs. An understanding of the differential diagnoses that might occur with pregnant and non-pregnant women is important to grasp. Advanced clinical skills that the Acute Care Nurse Practitioner must be familiar with include the auscultation of fetal heart tones, basic fetal heart monitoring, pelvic exams, and delivery of fetal demise or precipitous deliveries of viable fetuses. Pregnancy can alter the diagnostic possibilities of a patient with acute abdominal pain and change the clinical findings. Advanced pregnancy can make it even more difficult.

The Centers for Disease Control and Prevention estimates that there are 19 million new cases of sexually transmitted infections every year in the United States. STIs may present serious health implications for infected patients—especially for those who are unaware of their health condition. Studies show that women are not only at greater risk of contracting these infections, but they also tend to have more severe health problems resulting from infections than men. As an advanced practice nurse, you must educate female patients and emphasize the importance of prevention and STI testing for all women regardless of marital status, race, ethnicity, or socioeconomic status.

Case Study 1

A 19-year-old Asian American female comes into the urgent care clinic. She is complaining of severe abdominal pain, that radiates to her back. She is having a moderate amount of vaginal bleeding. She has a past medical history of PID and has used an IUD in the past. Her vitals are T 37.7, P 116, RR 18, BP 88/50.

To prepare

• Review and select one of the three provided case studies. Reflect on the patient information.
• Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.
• Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.
• Consider strategies for educating patients on the treatment and management of the gynecological condition you identified as your primary diagnosis.

By Day 3

Post an explanation of the differential diagnosis for the patient in the case study you selected. Provide a minimum of three possible diagnoses, and list them from highest priority to lowest priority. Explain which is the most likely diagnosis for the patient and why. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patient.

ANSWER

Intermenstrual Bleeding

The patient discussed in the case study is an African American female in the emergency room with a vaginal hemorrhage problem. The medical problem entails unusual bleeding from the female reproductive system. It can be an external or internal condition. The lady is not sure of her last ministration period; states she is sexually active and never use protection. Medical tests from the laboratory shows that there are large clots on the vaginal vaults and possible tissues. Further tests on the patient helped in identification of vital signs which are T 37, P 134, RR 26 and BP 180/110.

Differential diagnosis on the patient will help rule out other infections that may have slightly similar signs and symptoms to administer timely and safe treatment. First, blood count is essential to determine the degree of anemia which helps point out the bleeding problem (Andrikopoulou & Lazarou, 2015). Second, ultrasonography is performed to eliminate uterine lesions from the infections list.

A pregnancy test is the third step and should be performed if the lady has not yet reached the level of menopausal mandatory. Speculum examination is after that performed so that samples to test for cancer are obtained. Dilation and curettage processes are carried out to get a specimen for histology and control bleeding. Lastly, colposcopy test to examine the lady’s cervix, vagina, and vulva for signs of illnesses (KIKUCHI et al., 2016). The most likely condition the lady may be suffering from according to the outlined symptoms and tests is intermenstrual bleeding. The best treatment and management plan for intermenstrual bleeding is the use of oral contraceptives. Oral contraceptive pills reduce the rates of endometrial development, re-establish predictable menstruation patterns, lower risks of iron deficiency and decrease menstruation rates (Crawford et al., 2016). Heavy bleeding…