Health Medical Homework Help

I’m working on a nursing discussion question and need an explanation to help me understand better.

Sexually Transmitted Disease Treatment

The 36-year-old white female patient has presented with adenopathy and vaginal and cervical lesions. Patient reports genital pain, genital vesicles and ulcers, fever and malaise for 3 days. Patient also reports her partner has a history of fever blisters. This would lead me to believe the patient has herpes simplex type 1 (HSV-1) and it was acquired from genital contact with her partner. Blood labs could confirm the diagnosis and it is recommended HIV test should be administered as well, (Arcangelo et al., 2016). The patient should be counseled on the increased risk of acquiring HIV based on the skin ulcerations, inflammatory process, and impaired immune system, (Lutgendorf et al., 1997).

Based upon the findings, this appears to be the primary infection for the patient. Although there is no cure for HSV-1, the virus can be managed pharmacologically. The first-line treatment I would prescribe for the patient would be acyclovir if cost is an issue. If not, I would start the patient on valacyclovir due to its high bioavailability in the patient’s system. The recommended dosage I would start her at would be 1,000 mg twice a day for 7-10 days. I would stress to the patient this is not the maintenance dosage and I would bring her back in to see how she tolerated initial treatment, if ulcers resolved and to discuss either daily suppression therapy or episodic treatment, (Arcangelo et al., 2016).

Patient education I would include would start with pharmacological treatment options and having the patient give input on the most appropriate choice for her as far as suppressive versus episodic therapy. Side effects, cost, and medication compliance rates should be explored to help the patient decide which therapy would work best for her lifestyle. I would also disclose to the patient if she becomes pregnant, therapy options would change and discuss the risk of transmitting the virus to the infant, (Arcangelo et al., 2016).

Another patient education topic I would address is prevention of transmitting the disease to partners. Abstinence from sexual activity is advised during an outbreak. Educating the patient that it is still a possibility the virus can be transmitted even when she is not experiencing symptoms is an important topic to address with the patient as well. Use of proper use of condoms should be a topic of counsel as well with the patient, (Arcangelo et al., 2016).

Lastly, receiving the diagnosis of an incurable and chronic sexually transmitted infection (STI) can be devastating to a patient. The practitioner should approach the topic gently, but factually in order to help the patient process the news as best as possible. The patient may need help processing the news of such a life changing magnitude. Stress management and therapy have shown to be beneficial in reducing reoccurrences of the virus. High cortisol levels are known to reduce the efficiency of the immune system, making an outbreak more likely, (Agrawal, 2019).

Resources should be provided to the patient for psycho-social purposes. Support groups, cognitive behavioral therapy, exercise, alcohol intake and nicotine cessation are all topics to be broached with the patient to help with stress management, (Lutgendorf et al., 1997).

References

Agrawal, R. (2019). Herpes zoster in a healthy 24-year old final year medical student one month before final examinations. Our Dermatology Online, 10(4), 385–386. https://doi.org/10.7241/ourd.20194.31

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (2016). Pharmacotherapeutics for advanced practice (4th ed.). Lippincott Williams and Wilkins.

Lutgendorf, S. K., Antoni, M. H., Ironson, G., Klimas, N., Kumar, M., Starr, K., McCabe, P., Cleven, K., Fletcher, M. A., & Schneiderman, N. (1997). Cognitive-behavioral stress management decreases dysphoric mood and herpes simplex virus-type 2 antibody titers in symptomatic HIV-seropositive gay men. Journal of consulting and clinical psychology, 65(1), 31–43. https://doi.org/10.1037//0022-006x.65.1.31