Nursing 5333 Family Nursing 1 // Martha STD Diagnostic Reasoning Case Study

1 STD DIAGNOSTIC REASONING CASE STUDY Nursing 5333 Family Nursing 1 // Martha STD Diagnostic Reasoning Case Study STD Diagnostic Reasoning Case Study Elizabeth Khan University of Texas at Arlington College of Nursing and Health Innovations Nursing 5333 Family Nursing 1 Bethany McClean MSN, APRN, FNP- BC April 23, 2021 STD Case Study Subjective: Martha is a 26-year-old female who reports vaginal burning for 3 days. She says that she can barely focus on other things because of the burning. She also reports a copious foul-smelling vaginal discharge. Her last pap smear was at age 21 and was negative. She has not received the HPV vaccine series. Martha denies previous episodes and states that she is otherwise healthy. She denies fever, chills, nausea, vomiting or diarrhea. She is sexually active and has been sexually active with males since age 15. She states that she has had 2 relationships in the past year. Last intercourse was last week. She admits to dyspareunia and burning with urination. She denies use of vaginal sprays, douches, or powders or the use of new soaps detergent or clothing. She wears a thong regularly. Past Medical History: Tonsillectomy at the age of 7. Currently on no medications or herbal/vitamin supplements Family History: Mom with diabetes; Dad COPD; Brother healthy Social History: Martha is a college graduate and lives alone in an apartment. She feels safe and has a good relationship with her boyfriend. Martha works as a teacher and feels financially secure. She does not smoke and denies drug abuse. She drinks socially on the weekends with 1-2 glasses of wine. NKDA Allergies: Seasonal in spring Objective Vital signs: Martha is afebrile. Her B/P is 110/70. Pulse is 64 and regular. Respirations are 18. She is 5 feet 3 inches tall and weighs 120 lbs. General: Martha is pleasant and cooperative but anxious about the visit Cardiac: Regular rate and rhythm without murmurs Respiratory: Lungs are clear Abdomen: Soft, nontender, nondistended, and without organomegaly Pelvic Exam: Inguinal lymph nodes are without swelling or tenderness; vaginal mucosa is moist, pink, and mildly swollen. There is a fishy odor; copious discharge in the introitus. The cervix is pink and friable. There is a negative chandelier sign. PH is mildly alkaline and wet prep indicates trichomads. Differential 1 Trichomonas vaginalis Differential 2 Bacterial vaginosis. Differential 3 Vulvovaginal candidiasis Epidemiology (short synopsis) for each Who, Where, When Trichomonas vaginalis is the most common non-viral STI worldwide with an estimate of 180 million infections per year (Konadu, et al., 2019). Bacterial vaginosis is a common disorder in women of childbearing age and accounts for one third of vaginal infections worldwide (Kamga, et al., 2019). About 75 percent of women will experience one episode of Vulvovaginal candidiasis while 40 to 45 % will have one or two episodes (Vaginitis, 2021). Pertinent positives for each • Trichomonad on wet prep • Burning upon urination • Dyspareunia • Fishy odor • Foul smelling vaginal discharge (Vaginitis, 2021). • Ph mildly alkaline • Fishy odor of vaginal discharge • Recent sexual activity (Vaginitis, 2021). • Dyspareunia • Abnormal vaginal discharge • Dysuria (Vaginitis, 2021). Pertinent negatives for each which require more analytical and creative thinking, are gleaned from the differential diagnosis and function to “rule out” other diagnostic possibilities • Negative for curd like discharge • Negative for clue cells • Negative for budding hyphae, yeast or pseudohyphae on gram stain (Vaginitis, 2021) • Negative for pruritus • Negative for budding hyphae, yeast or pseudohyphae on gram stain (Vaginitis, 2021) • Negative for clue cells • Negative for budding hyphae, yeast or pseudohyphae on gram stain • Negative for curd like discharge (Vaginitis, 2021).