Health Medical Homework Help

All replies must be constructive and use literature where possible.

• Roodelyne Petit.

Vaginal discharge

• This week in clinicals I can honestly stated that I did not encounter any big challenges, but I continue to learn and acquire more experiences. I had the opportunity to care for a twenty-six-year-old woman with asthma exacerbation, after a thorough physical assessment with the help of my preceptor, I then conducted a peak flow test and recommended that the patient take prednisone by mouth to help with the exacerbation and suspected pulmonary inflammation.

However, the patient that peak my curiosity was a thirty five year old woman who came in complaining of yellowish foul mucous vaginal discharge for over a month. She stated that she took monostat and some other over the counter medication with little to no relief. Her other associated symptoms were itching, burning sensation upon urination and pain with urination as well. Her vital signs were as followed:  166.6 lbs With clothes, Ht 5 ft 6 in Stated, BMI 26.9, BP 132 / 83 sitting L arm adult, Pulse 83 bpm, RR 18, T 96.7 °F temporal artery Abnormal, O2Sat 97 % Room Air at Rest. After a thorough examination of the patient’s cervix and specimen collection. My preceptor suspects bacterial vaginosis.  Bacterial vaginosis, the most common cause of vaginal discharge, is a vaginal dysbiosis characterized by loss of lactic acid–producing lactobacilli and proliferation of facultative and strict anaerobes. Muzny et al. (2019) It is associated with multiple adverse outcomes, including an increased risk of preterm birth, as well as acquisition of human immunodeficiency virus (HIV) and other sexually transmitted pathogens.

This week I learn that not every patient’s symptom needs to be addressed or treated with medication right away. Although, my preceptor suspect that this might be bacterial vaginosis, she wants to wait for the lab results to confirm the diagnosis first, then she will call in a prescription for the patient to her pharmacy. She taught me that when it comes to prescribing antibiotics it is always safer when we can to know the bacteria we are trying to treat and order the appropriate medication for a better and successful treatment.

The treatment with these antibiotics for bacterial vaginosis is associated with high levels of failure and recurrence rates. These may be associated with antibiotic resistance, the inability to eradicate the polymicrobial biofilms, and failure to reestablish acidic pH and the lactobacillus-dominated commensal flora. Therefore, it is emergent to study alternative strategies to replace or to be combined with standard therapies in order to prevent and treat BV more efficiently. Alternative strategies may include antimicrobial substances (other antimicrobials, antiseptics and natural compounds) or substances that aim to reestablish the physiologic vaginal environment (probiotics, prebiotics and acidifying agents) while improving the local immunity response. (Tomás et al., 2020)

References

Muzny, C. A., Taylor, C. M., Swords, W. E., Tamhane, A., Chattopadhyay, D., Cerca, N., & Schwebke, J. R. (2019). An Updated Conceptual Model on the Pathogenesis of Bacterial Vaginosis. The Journal of Infectious Diseases, 220(9), 1399–1405. https://doi.org/10.1093/infdis/jiz342

Tomás, M., Palmeira-de-Oliveira, A., Simões, S., Martinez-de-Oliveira, J., & Palmeira-de-Oliveira, R. (2020). Bacterial vaginosis: Standard treatments and alternative strategies. International Journal of Pharmaceutics, 587, 119659. https://doi.org/10.1016/j.ijpharm.2020.119659