Assignment Katherine Harris iHuman Case Study

NSG 6435 Week 4 Discussion: iHuman Case Study – HEENT and Respiratory Infections

This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered. For this assignment, make sure you post your initial response to the Discussion Area.

To support your work, use your course textbook readings and the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.

Start reviewing and responding to the postings of your classmates as early in the week as possible. Respond to at least two of your classmates’ initial postings. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Assignment Katherine Harris iHuman Case Study. Cite sources in your responses to other classmates. Complete your participation for this assignment.

For this assignment, you will complete an iHuman case study based on the course objectives and weekly content. iHuman cases emphasize core learning objectives for an evidence-based primary care curriculum. Assignment Katherine Harris iHuman Case Study.

Throughout your nurse practitioner program, you will use the iHuman case studies to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.

The iHuman assignments are highly interactive and a dynamic way to enhance your learning. Material from the iHuman cases may be present in the quizzes, the midterm exam, and the final exam.

  • Here you can view information on how to access and navigate iHuman.
  • This week, complete the iHuman case titled “Katherine Harris.”

Apply information from the iHuman Case Study to answer the following questions:

  • Do you recommend a limited or an involved use of antibiotics in treatment of these diseases and other unconfirmed bacterial illnesses and why? What are the standards regarding the use of antibiotics in pediatric population, and what assessment findings would warrant prescribing an antibiotic for Asthma symptoms?
  • Using national guidelines and evidence-based literature, develop an Asthma Action Plan for this patient. Assignment Katherine Harris iHuman Case Study.
  • Do the etiology, diagnosis, and management of a child who is wheezing vary according to the child’s age? Why or why not? Which objective of the clinical findings will guide your diagnosis? Why? When is a chest x-ray indicated in this case?

Week 7 Assignment 1: Discussion: iHuman Case Study-Gonorrhea

**Discuss the questions that would be important to include when interviewing a patient with this issue.

Why are you seeking help today? I have been having burning when I pee and vaginal discharge for a few days. I was worried that I had another bladder infection, but these symptoms are a little different.

When did your pain with urination start? About three days ago

What are the events surrounding the start of your pain with urination? Well, it came on pretty much with the discharge. It was hard to tell what’s what

Does anything make your pain with urination better or worse? Soaking in a warm bath helps

Do you have any other symptoms associated with painful urination? Well, yeah. The discharge I told you about.

Have you had problems with painful urination like before? Yes, with my bladder infection last year. But I’m wondering if this is really the same thing.

How often do you have pain with urination?   Every time I pee.

What is the appearance, smell, texture and quantity of the vaginal discharge? Oh boy…I hate having to answer these questions. Yellow, kind of mucousy, kind of creamy. Not too smelly.

Is there vaginal discomfort or itching? No, nothing like a yeast infection.

Are you sexually active? Yes, I am.

How often are you having intercourse? Well, let’s just say I like men and they like me. I’ve been with a few different guys over the last 6 months. I haven’t done it with anyone since this started a few days ago. The last time was maybe a week ago?

Are you having or have you had unprotected sex? Yeah, I guess so. Sometimes I forget about condoms if I’ve been drinking. I’m on the pill, so I guess I’m protected that way.

Do you use precautions to prevent the transmission of sexual diseases? Nothing but the pill.

Do you have more than one sexual partner? Yes

Do you have new or multiple sexual partners with similar symptoms? Well, no one has told me he has any problem.

Have you had any sexually transmitted disease? Not that I know of.

Do you have sex with men, women, or both?  I’m heterosexual.

Are you taking any prescription medications? No, other than the pill.

Are you taking any over the counter medications? Yeah, sometimes I take ibuprofen with my period. You know, like for cramps and headaches.

Do you have any pelvic pain? No

Do you have any blood in your urine? No

Do you have any genital sores or discharge? No sores, but I do have some vaginal discharge.

 

**Describe the clinical findings that may be present in a patient with this issue.

 Symptoms are often nonspecific and may include increased vaginal discharge, dysuria, urinary frequency, and intermenstrual or postcoital bleeding. If the infection has been long-standing, symptoms can include low abdominal or low back pain (Dowell & Kirkcaldy, 2013)

**Are there any diagnostic studies that should be ordered on this patient? Why?

The Centers for Disease Control and Prevention (CDC) recommends testing on self- or clinician-collected endocervical and vaginal swab specimens, as well as on urine specimens. Nucleic acid amplification testing (NAAT) is the most sensitive and specific for gonorrheal and chlamydial infections, and it also allows for testing on the widest variety of specimen types (“Cervicitis Workup,” 2017).   

**List the primary diagnosis and three differential diagnoses for this patient. Explain your reasoning for each.

Primary diagnosis – Cervicitis: Culture-proven, uncomplicated gonorrhea

Candida vaginitis is a vaginal yeast infection that is caused by the organism

Candida albican that is a naturally occurring microorganism in the vaginal area. Lactobacillus bacteria keeps its growth in check although if there’s an imbalance in your system, these bacteria won’t work effectively (Martin Lopez, 2015). This leads to an overgrowth of yeast, which causes the symptoms of vaginal yeast infections. Clinically a diagnosis is made by the presence of external dysuria and vulvar pruritus, pain, swelling, and redness. Signs also include vulvar edema, fissures, excoriations, and thick curdy vaginal discharge. This is not supported by clinical & physical assessment.

Pelvic inflammatory disease (PID) is an infection of the upper part of the female reproductive system namely the uterus, fallopian tubes, and ovaries, and inside of the pelvis (Brunham, Gottlieb & Paavonen, 2015). Signs and symptoms, when present may include lower abdominal pain, vaginal discharge, fever, burning with urination, pain with sex, or irregular menstruation. Untreated PID can result in long term complications including infertility, ectopic pregnancy, chronic pelvic pain, and even cancer (Brunham et al, 2015). This is not supported by clinical & physical assessment.

Urinary Tract Infection is caused by a bacterium or virus infecting the kidneys. The infection may affect one or both upper urinary tracts which consist the ureter, renal pelvis, and kidney interstitium (Flores-Mireles, Walker, Caparon, & Hultgren, 2015). The infection is probably spread by ascending uropathic microorganisms along the ureters, or can be carried through the bloodstream from other parts of the body.

Though many bacteria and viruses can cause pyelonephritis, it is usually associated with Proteus, Pseudomonas though bacterium Escherichia coli is often the cause (Flores-Mireles et al., 2015). Symptoms are usually acute, with fever, chills, and flank or groin pain with most cases occurring in young adult women although older adults may have nonspecific symptoms, such as low-grade fever and malaise (Flores-Mireles et al., 2015). This is not supported by clinical & physical assessment.

**Discuss your management plan for this patient, including pharmacologic therapies, tests, patient education, referrals, and follow-ups.

Several factors should affect the decision to provide presumptive therapy for cervicitis or to await the results of diagnostic tests. Treatment with antibiotics for C. trachomatis should be provided for those women at increased risk for this common STD with a dose of Ceftriaxone 250 mg IM and Doxycycline 100 mg orally twice a day for 7 days can be used as an alternative in women who are not pregnant or breast feeding (Ebrahimy et al., 2015).

Patients must be educated that cervicitis is a preventable, sexually transmitted infection (STI) and that the most effective way to prevent the transmission of the infective agents is to avoid sexual intercourse without protection or infected partners. Partners should be notified and examined if chlamydia, gonorrhea, or trichomoniasis. Partners should then be treated for the STDs for which the index patient received treatment. Education on avoiding reinfection, patients and their sex partners should abstain from sexual intercourse until therapy is completed (Öztürk & Ulubay, 2016).

Follow-up should be conducted as recommended for the infections for which a woman is treated. If symptoms persist, women should be instructed to return for re-evaluation because women with documented chlamydial or gonococcal infections have a high rate of reinfection within 6 months after treatment. Therefore, repeat testing of all women with chlamydia or gonorrhea is recommended 3-6 months after treatment, regardless of whether their sex partners were treated (Ebrahimy et al., 2015).

References for Assignment Katherine Harris iHuman Case Study:

  • Brunham, R. C., Gottlieb, S. L., & Paavonen, J. (2015). Pelvic inflammatory disease. The New England Journal of Medicine, 372(21), 2039.
  • Cervicitis Workup. (2017).  Retrieved from http://www.cdc.gov/std/treatment/2013/chlamydial-infections.htm
  • Dowell, D., & Kirkcaldy, R. D. (2013). Effectiveness of gentamicin for gonorrhoea treatment: Systematic review and meta-analysis. Postgraduate Medical Journal, 89(1049), 142-147. doi:10.1136/postgradmedj-2012-050604rep
  • Ebrahimy, F., Dolatian, M., Moatar, F., & Majd, H. A. (2015). Comparison of the therapeutic effects of garcin and fluconazole on candida vaginitis. Singapore Medical Journal, 56(10), 567-572. doi:10.11622/smedj.2015153
  • Flores-Mireles, A. L., Walker, J. N., Caparon, M., & Hultgren, S. J. (2015). Urinary tract infections: Epidemiology, mechanisms of infection and treatment options. Nature Reviews. Microbiology, 13(5), 269. doi:10.1038/nrmicro3432
  • Martin Lopez, J. E. (2015). Candidiasis (vulvovaginal). BMJ Clinical Evidence, 2015
  • Öztürk, M., & Ulubay, M. (2016). Treatment of cervicitis; LEEP versus cryotherapy. Journal of the Turkish German Gynecological Association, 17, S7.
  • Taylor, S. N. (2014). Cervicitis of unknown etiology. Current Infectious Disease Reports, 16(7), 1-5. doi:10.1007/s11908-014-0409-x
  • Cervicitis Workup. (2017).  Retrieved from http://www.cdc.gov/std/treatment/2013/chlamydial-infections.htm