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Case Study Sexually Transmitted Infections

 

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Difficulty: Intermediate

Setting: Outpatient clinic

Index Words: sexually transmitted infection (STI), pelvic inflammatory disease (PID), human immunodeficiency virus (HIV), assessment, pain management, patient education

Giddens Concepts: Health Care Law, Infection, Patient Education, Reproduction, Sexuality

HESI Concepts: assessment, Health Care Law, Infection, Patient Education, Sexuality/Reproductive

 

 

 

 

 

You are the nurse in a walk-in clinic. A.P. is being seen this morning for a 2-day history of diffuse, severe abdominal pain. She has complaints of nausea without vomiting; she denies vaginal bleeding or dis- charge. A.P. reports having unprotected sex with several partners recently, two of whom had penile dis- charge. Her last menstrual period ended 3 days ago. She has no known drug allergies and denies previous medical or psychiatric problems. Vital signs are 108/60, 110, 20, 100.6 ° F (38.1 ° C). Physical examination reveals that her abdomen is very tender. The slightest touch of her abdomen causes her to wince with pain. Bowel sounds are normal. Pelvic examination reveals purulent material pooled in the vaginal vault, which appears to be coming from the cervix. a sample of the vaginal drainage is obtained and sent for culture. The result of a pregnancy test is negative; a rapid diagnostic test for chlamydial infection has a positive result.

· Scenario

 

 

1. Which of these assessment findings are significant and why?

 

 

 

 

 

 

 

2. What medical interventions can you anticipate?

 

 

 

 

 

3. What should you teach A.P. about chlamydial infection?

 

 

 

 

 

 

 

4. How would you provide emotional support to A.P. at this time?

 

 

 

 

Part 2 Pediatric, Maternity, and WoMen’s HealtH cases

 

 

 

 

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Copyright © 2016 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

 

 

 

Case Study Progress

The physician has the option of treating A.P. by one of two different methods. First, the physician could prescribe treatment over a period of 1 week. A.P. would be given the first dose of doxycycline (Monodox) 100 mg PO, and then she would be prescribed the same dose to be taken PO bid for 7 days. Second, the physician could prescribe a one-time dose of azithromycin (Zithromax) 1 g PO, which could be adminis- tered in the clinic.

 

5. Which choice is best for A.P.? Explain your reasoning.

 

 

 

 

 

6. You tell A.P. that chlamydial infection is a sexually transmitted infection (STI) that is mandated to be reported to the public health department. What is the purpose of reporting the infection, and what actions will be taken?

 

 

 

 

 

 

7. A.P. says she does not understand why her partners must be told about the infection. How would you respond?

 

 

 

 

 

 

8. Based on the information A.P. has given you, you determine that she is at risk for other STIs and unplanned pregnancy. What risk assessment questions do you need to ask A.P.?

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