Case 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.
For 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.
By Day 3
Based on the case study scenario provided, complete a comprehensive well-woman exam and critically analyze the exam to focus attention on the diagnostic tests. Then,
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 for. 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.
CASE STUDY
Case Study: STI Investigation
Susan Lang is a 24-year-old Caucasian female presenting to the clinic for regular care. She works full-time as an administrative assistant, and relates she loves her job. She has no medical or surgical history, takes no medication, and has no allergies. Family history is non-contributary. 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. Gyn history is onset of menses age 13, menses every 28-32 days, lasting 4-6 day and using 3 tampons daily. She has some cramping during her menses for which she takes otc Pamprin. She jogs 3-4 times a week, wears seatbelts when in the car, and “occasionally” uses sunscreen. Susan 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.
Susan’s vital signs are taken and were 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.
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.
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.
QUESTIONS:
What other information do you need?
What testing would you perform/order?
What are your initial thoughts for diagnosis?
2.
Update:
Susan relates she “sometimes” uses condoms but feels like she gets irritation from them. She does not desire pregnancy, but not sure what type of other options are available. She relates she has had 13 partners in the last 12 months, her partners have all been male except one in the past year. She has never received the Gardasil vaccine as her mother doesn’t believe it’s been tested enough and reports no history of STI’s but doesn’t remember being tested in the past.
CAGE Questionnaire:
She has not felt the need to cut down on her drinking, feeling that “everyone drinks like she does.” She is occasionally awakened in the am sleeping next to a stranger but does not remember how it happened.
She has been occasionally annoyed about her parent’s criticism about drinking but has been better since she moved into her own apartment. She relates she does not feel guilty about drinking. She has never taken an “eye opener.”
Pap returns as normal, with trichomonads noted
Throat culture returns positive for gonorrhea
Vaginal culture returns positive for chlamydia
Wet mount shows many WBC’s, many trichomonads, positive clue cells, positive amine (whiff test)
RPR negative, hepatitis c negative, HIV negative’
QUESTIONS:
What are your next steps?
Last Completed Projects
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