NURSING NSG6430Discuss the questiDiscussion question 8 - Turbo Ovarian Cyst
Discuss the questions that would be important to include when interviewing a patient with this issue.
A turbo-ovarian abscess is considered a surgical emergency and is considered a severe type of pelvic inflammatory
disease and can be linked to sexually transmitted diseases such as gonorrhea and chlamydia (Kerkar, 2017). Some
questions to consider when formulating this type of diagnosis are what are the events surrounding the start of your
pain with urination? Do you have or have you had a urinary tract infection? Any fevers? What do you think may be
causing the problem? Does anything make your dysuria better or worse? Has there been a change in urine
frequency? Have you ever had this problem before? And what treatment have you had? Any blood in your urine?
Any flank or pelvic pain? How severe is the pain with urination? Is the pain localized or diffused to a specific area?
Are your periods regular? When was your last period? Any history of blood clots? How longs do your periods last?
Do you have bleeding between periods? When and what was the results of your last gynecological exam? Are you
pregnant? When did your periods begin? Do you have a thyroid problem? Are you taking any prescription
medications? Have you recently stopped or missed taking birth control or hormone pills? What form of birth control
do you use? Are you having or have you had unprotected sex? When did the discharge occur relative to your
menstrual cycle? What is the appearance, smell, or quantity of your vaginal discharge? Is there vaginal discomfort
or itching? Any dull aching pain at mid-cycle? How severe is your vaginitis/vaginal discharge? What treatment have
you had for vaginitis? Have you had vaginitis/vaginal discharge like this before? Do you have any genital sores? Do
you have pain with intercourse? Do you bleed during or after intercourse? Have you had any STI? Do you have
more than one sexual partner? Do you have fibroids? Do you engage in vaginal douching? Do you have new or
multiple partners with similar symptoms? Do you use precaution to prevent the transmission of sexually transmitted
diseases?
Describe the clinical findings that may be present in a patient with this issue.
Patients typically present with a sudden onset 0f fever, chills, elevated white blood cell count, lower abdominal-
pelvic pain, which may prevent as a dull ache that may radiate to the lower back and thighs shortly before the period
begins or just before it ends and/or a foul-smelling vaginal discharge ( Mayo Clinic, 2014). There may also be a
sensation of fullness or heaviness in the abdomen. Pressure on the bladder that causes urination more frequently or
causing difficulty emptying the bladder completely. Sudden, severe abdominal or pelvic pain accompanied by fever
or vomiting and symptoms of shock — or those of shock, such as cold, clammy skin; rapid breathing; and
lightheadedness or weakness should be evaluated immediately (Mayo Clinic, 2014).
Are there any diagnostic studies that should be ordered for this patient? Why?
The initial examination should include a pelvic exam to check the pelvic organs for swelling and tenderness.
Imaging studies - either a transvaginal ultrasound (TVUS) or a computed tomography (CT) scan of the abdomen
and pelvis can be beneficial because an ultrasound is less expensive and avoids the need for radiation and contrast,
and the TVUS provides a direct route from the vagina into the adnexal regions or cul-de-sac (Campbell-Yesufu,
2017).
A urine pregnancy test should be performed in any woman of reproductive age with adnexal tenderness. If the
pregnancy test is positive, then a beta subunit of human chorionic gonadotropin (B-hCG) level needs to be obtained.
A complete blood count with differential may show an elevated WBC count with a left shift. If the patient is febrile
or hemodynamically unstable, then blood work, blood cultures, urine cultures, and tests similar to a Pap test to
gently remove a sample of cervical-vaginal fluid to test for sexually transmitted diseases including chlamydia,
trichomonas, and gonorrhea (Campbell-Yesufu, 2017). A urinalysis is also performed to rule out disorders of the
urinary tract, as well as, detect and manage a wide range of disorders, such as urinary tract infections, kidney
disease, and diabetes ( Mayo Clinic, 2014).
List the primary diagnosis and three differential diagnoses for this patient. Explain your reasoning for each.
Differential Diagnosis:
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Discuss the questions that would be important to include when interviewing a patient with this issue.
A turbo-ovarian abscess is considered a surgical emergency and is considered a severe type of pelvic inflammatory
disease and can be linked to sexually transmitted diseases such as gonorrhea and chlamydia (Kerkar, 2017). Some
questions to consider when formulating this type of diagnosis are what are the events surrounding the start of your
pain with urination? Do you have or have you had a urinary tract infection? Any fevers? What do you think may be
causing the problem? Does anything make your dysuria better or worse? Has there been a change in urine
frequency? Have you ever had this problem before? And what treatment have you had? Any blood in your urine?
Any flank or pelvic pain? How severe is the pain with urination? Is the pain localized or diffused to a specific area?
Are your periods regular? When was your last period? Any history of blood clots? How longs do your periods last?
Do you have bleeding between periods? When and what was the results of your last gynecological exam? Are you
pregnant? When did your periods begin? Do you have a thyroid problem? Are you taking any prescription
medications? Have you recently stopped or missed taking birth control or hormone pills? What form of birth control
do you use? Are you having or have you had unprotected sex? When did the discharge occur relative to your
menstrual cycle? What is the appearance, smell, or quantity of your vaginal discharge? Is there vaginal discomfort
or itching? Any dull aching pain at mid-cycle? How severe is your vaginitis/vaginal discharge? What treatment have
you had for vaginitis? Have you had vaginitis/vaginal discharge like this before? Do you have any genital sores? Do
you have pain with intercourse? Do you bleed during or after intercourse? Have you had any STI? Do you have
more than one sexual partner? Do you have fibroids? Do you engage in vaginal douching? Do you have new or
multiple partners with similar symptoms? Do you use precaution to prevent the transmission of sexually transmitted
diseases?
Describe the clinical findings that may be present in a patient with this issue.
Patients typically present with a sudden onset 0f fever, chills, elevated white blood cell count, lower abdominal-
pelvic pain, which may prevent as a dull ache that may radiate to the lower back and thighs shortly before the period
begins or just before it ends and/or a foul-smelling vaginal discharge ( Mayo Clinic, 2014). There may also be a
sensation of fullness or heaviness in the abdomen. Pressure on the bladder that causes urination more frequently or
causing difficulty emptying the bladder completely. Sudden, severe abdominal or pelvic pain accompanied by fever
or vomiting and symptoms of shock — or those of shock, such as cold, clammy skin; rapid breathing; and
lightheadedness or weakness should be evaluated immediately (Mayo Clinic, 2014).
Are there any diagnostic studies that should be ordered for this patient? Why?
The initial examination should include a pelvic exam to check the pelvic organs for swelling and tenderness.
Imaging studies - either a transvaginal ultrasound (TVUS) or a computed tomography (CT) scan of the abdomen
and pelvis can be beneficial because an ultrasound is less expensive and avoids the need for radiation and contrast,
and the TVUS provides a direct route from the vagina into the adnexal regions or cul-de-sac (Campbell-Yesufu,
2017).
A urine pregnancy test should be performed in any woman of reproductive age with adnexal tenderness. If the
pregnancy test is positive, then a beta subunit of human chorionic gonadotropin (B-hCG) level needs to be obtained.
A complete blood count with differential may show an elevated WBC count with a left shift. If the patient is febrile
or hemodynamically unstable, then blood work, blood cultures, urine cultures, and tests similar to a Pap test to
gently remove a sample of cervical-vaginal fluid to test for sexually transmitted diseases including chlamydia,
trichomonas, and gonorrhea (Campbell-Yesufu, 2017). A urinalysis is also performed to rule out disorders of the
urinary tract, as well as, detect and manage a wide range of disorders, such as urinary tract infections, kidney
disease, and diabetes ( Mayo Clinic, 2014).
List the primary diagnosis and three differential diagnoses for this patient. Explain your reasoning for each.
Differential Diagnosis:
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