Writing Homework Help

Reply to Frantz :

I had great clinical experience this current week and past weeks. My preceptor has given me autonomy to examine and assess patients. I was able to obtain patient’s chief complaints, vitals, medication, past medical history, and discuss labs results and stimulate a diagnosis and medical regiment for their chief complaints.

Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and possible differential diagnosis.

A 20-year-old Hispanic woman comes to the clinic and reports discomfort and vaginal discharge with intercourse. She reports that for the past 3 weeks after having intercourse with her boyfriend, she notices a fishy odor and a grey vaginal discharge in her underwear. She also reports mild irritation on urination. She reports that the worsening factor is sexual intercourse, and the reliving factor is abstinence. She also reports she tried Monistat vaginal antifungal one day treatment for yeast infection and did not help. She reports being sexually active, with her boyfriend and being on birth control. She denies ever having sexually transmitted disease nor her boyfriend. She also refutes pain to her back or flank, or fever or blood in urine. Denies ever been pregnant

Examination: VS B/P 135/80, P; 80, R: 20, T: 36.7, Pain: 0

On examination patient noted with a homogeneous, frothy vaginal discharge that is grayish white to yellowish white in color. The discharge appears adherent to the vaginal mucosa.

Plan of care: Bacterial Vaginosis

Bacterial vaginosis is the most common vaginal infection worldwide and is associated with a range of adverse public health issues, such as preterm birth, gynecologic postoperative infection, and increased risk of STIs. It happens when there is an imbalance and overgrowth of the normal bacteria inside the vagina

Differential diagnosis:

1. Bacterial Vaginosis ICD code N 771
2. Chemical vaginitis
3. Chlamydia
4. Gonorrhea

Management: 

      The recommended treatment for recurrent BV is metronidazole, 0.75% gel twice weekly for 4 to 6 months, after appropriate treatment of the initial episode of BV with metronidazole or clindamycin. This method has been shown to reduce the rates of BV recurrence by more than 50%. Some data support the use of boric acid intravaginally to reacidify the vagina and help create an environment that encourages Lactobacillus and a healthy flora, resulting in a decrease of BV recurrence. With this regimen, metronidazole is prescribed for the usual 7-day course along with vaginal boric acid, 600 mg once daily at bedtime for 21 days. The patient is seen immediately after completion of this regimen and reassessed. If in remission, the patient begins a twice-weekly metronidazole regimen for 4 to 6 months (Jones, 2019)

Diagnostic test

A microscopic examination of vaginal secretions was performed by preparing a slide for wet moment examining using both 10 percent potassium hydroxide and normal saline The KOH solution is used to test for amine odor: Amines are produced as a byproduct of anaerobic metabolism. The fishy odor released when KOH is added to vaginal secretions on a slide or on the lip of the withdraw speculum results in a positive KOH or whiff test. Patient was ordered oral metronidazole 500mg twice daily for 7 days.

Education

Safe sex and STD counseling may help decrease the rates of reinfection. So, my preceptor discusses further preventive efforts, including proper hygiene and toilet techniques, when it is appropriate to do so. patient was reminded that douching can spread a vaginal or cervical infection into the uterus, increasing the likelihood of PID; douching can also be associated with endometritis

Support your plan of care with the current peer-reviewed research guideline

The CDC’s recommended treatment options for symptomatic women diagnosed with bacterial vaginosis. Symptomatic pregnant women are treated the same as those who are not pregnant. Metronidazole is considered safe even in the first trimester and does not appear to contribute to low birth weight, premature birth, or birth defects. Tinidazole has not been studied in pregnant women and should be avoided in this population. Breastfeeding women can be treated safely with either oral or vaginal metronidazole. Women who are HIV-positive receive the same treatment medications. Advise patients to abstain from sex during treatment or use condoms.

      What did you learn from this week’s clinical experience that can be beneficial for you as an advanced practice nurse?

    Under my preceptor supervision, I was able to complete a thorough assessment on my patient. I was able to teach my patient about bacterial vaginosis disease process and management.

References

Dunphy, L. M. (2019). Primary care The Art and Science of Advanced Practice nursing. Philadelphia: F.A. Davis Company.

Jones, A. (2019). Bacterial Vaginosis:A review of treatment, recurrence and disparities. The Journal for Nurse practitioners, Volume 15, issue 6, P420-423,june01,2019.