Health Medical Homework Help

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Elizabeth Varona-Martin

Module 2

This week has been productive. As I continued to learn as a potential Advanced Nurse Practitioner, I became more at ease and acquainted with the clinic setting. So far, I’ve had a good time with it and am eager to keep continuing. One of the patients I had the opportunity to work with was a 32-year-old Caucasian female who came into the office complaining about vaginal itching, vulvar burning & soreness, accompanied by curd-like vaginal discharge. The symptoms have lasted for five days. Associated symptoms consist of urinary frequency, dysuria, and dyspareunia. She has not had a fever. The severity of the symptoms is moderate and worsening.

Physical exam:

Physical examination of the external genitalia, vagina, and cervix revealed vulvar erythema and vulvar edema. White, thick, adhering to the vaginal sidewalls, clumpy discharge (curd-like or cottage cheese-like) was observed.

Vital signs

Ht: 5’4 WT: 80 kg BMI: 30.17 B/P: 126/82 HR: 93bpm RR: 16 RPM O2Sat: 100%

Differential Diagnosis:

Vaginal candidiasis: Vaginal candidiasis is characterized by a thin, white, odorless discharge that is frequently curd-like. Frequently manifests with severe inflammatory signs (pruritus and soreness) (Sobel, 2021).

Trichomoniasis: Trichomoniasis is distinguished by a purulent, malodorous discharge that may be accompanied by burning, itching, dysuria, frequency, and dyspareunia (Sobel, 2021).

Bacterial vaginosis (BV): BV discharge is a common complaint, and it is often malodorous, thin, and grey (never yellow). Only minor inflammation and irritative symptoms are linked with BV (Sobel, 2021).

Estrogen status: Low estrogen levels can induce a genitourinary syndrome of menopause (vulvovaginal atrophy), which manifests as vaginitis symptoms. Vaginal dryness and dyspareunia are two different symptoms (Sobel, 2021).

Plan:

ICD-10 B37.3 Vulvovaginal candidiasis

• Fluconazole 150 mg one pill by mouth once.
• The swab of the vaginal sidewall and discharge was sent to the lab.

Treatment is recommended to alleviate symptoms. Ten to twenty percent of reproductive-age women who carry Candida species are asymptomatic and do not require treatment.

Fluconazol remains in therapeutic quantities in vaginal secretions for at least 72 hours after a single 150 mg pill is consumed (Sobel, 2021).

We educated the patient that oral nystatin doesn’t prevent vaginal candidiasis.

Learning about vaginitis is a critical lesson that will help me improve as a healthcare provider. Vaginitis broadly encompasses several vaginal illnesses caused by infection, inflammation, or alterations in the normal vaginal flora. Pruritus, vaginal discharge, odor, and pain are common symptoms (Sobel, 2021).

The first evaluation often includes a history, physical examination, microscopy, and cervical testing for sexually transmitted infections. Women who get an initial assessment that confirms a diagnosis are then given specialized therapy (Sobel, 2021).

Infectious agents are frequently the cause of vaginitis. More than 90 percent of infections are caused by bacterial vaginosis, candida vulvovaginitis, and trichomoniasis (Sobel, 2021).

All women with suspected vaginitis should have a physical checkup as well as some diagnostic tests. The physical examination determines the extent of vulvovaginal irritation, the features of vaginal discharge, and the presence of lesions or foreign things (Sobel, 2021).

On initial diagnostic examination, around 25 to 40 percent of individuals with vaginitis symptoms do not recognize a particular etiology. These patients are subjected to secondary assessment. If the patient had minor symptomatology at the initial examination and the evaluation was nondiagnostic, the assessment should be redone when she is symptomatic at a subsequent appointment. Providers should avoid empiric blind treatment, which frequently worsens symptoms (Sobel, 2021).

References

Sobel, J. (2021, May 25). Approach to females with symptoms of vaginitis. UpToDate. Retrieved from https://www.uptodate.com/contents/approach-to-females-with-symptoms-of-vaginitis?search=vaginitis&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1.

Sobel, J. D. (2021, June 18). Candida vulvovaginitis: Treatment. UpToDate. Retrieved from https://www.uptodate.com/contents/candida-vulvovaginitis-treatment?search=candida+vaginitis&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1.