Patient Case Study
\nPatient\u2019s Chief Complaints
\n\u201cI probably have done something that I shouldn\u2019t have on prom night and now it hurts when I go to the bathroom.\u201d
\nHPI
\nJ.L. is a 17 yo junior in high school who presents to her pediatrician\u2019s office. She has been in reasonably good health for the past 17 years but has recently developed urinary tract manifestations\u2014urgency to urinate, more frequent urination, and increasingly severe urethral burning during urination that has persisted for three days. She awoke from sleep with urgency last night and noticed an abnormal discharge from her vagina. She describes the discharge as \u201cyellow and kind of thick.\u201d She reported this to her mother who kept her out of school today and immediately
\nmade a doctor\u2019s appointment. She also reports mild anal itching, but denies chills, fever, nausea, vomiting, and abdominal pain. When questioned further, she reported that she \u201chad sex for the very first time with my prom date two weeks ago.\u201d They did not use a condom, but she has been taking the pill for six months. She denies oral and anal intercourse. Her LMP occurred four days ago. She denies any recent travel other than to local volleyball games on the school bus.
\nPMH
\n\u2022 (\u2013) previous history of urinary or female reproductive tract infections
\n\u2022 (\u2013) previous pregnancies
\n\u2022 Asthma \u0001 11 years
\n\u2022 Immunizations are up to date and patient receives annual physical examinations and routine follow-up care for asthma
\nFH
\n\u2022 Father died last year from sudden cardiac death at age 45
\n\u2022 Mother has a heart murmur
\n\u2022 Younger brother, age 15, is in good physical health Older brother, age 19, is having \u201cmuscle problems in his hands and arms, but the doctors
\ndon\u2019t know yet what is causing them\u201d
\n\u2022 Maternal grandmother has \u201chigh blood pressure\u201d
\nSH
\nJ.L. is very popular at school and is well liked by her teachers and classmates. She has dated a few boys from school, but claims not to have been sexually active before prom night. She comes from an upper socioeconomic background. She does not drink alcohol, smoke, or use any recreational drugs. She claims that it is \u201cvery uncool\u201d with her friends to engage in any activities like that. She is on the varsity volleyball team and practices most days after school.
\nHer home life has been difficult during the past 10 months due to the death of her father, with whom she was very close. J.L. claims that, for the most part, she has a very caring and close family.
\nMeds
\n\u2022 Ethinyl estradiol 35 \u00b5g with norethindrone 0.5 mg (7 tablets) ethinyl estradiol 35 \u00b5g with norethindrone 0.75 mg (7 tablets) ethinyl estradiol 35 \u00b5g with norethindrone 1 mg
\n(7 tablets)
\n\u2022 Albuterol 90 \u00b5g MDI 2 puffs PRN
\n\u2022 Beclomethasone 42 \u00b5g MDI 2 puffs TID
\n\u2022 Salmeterol 21 \u00b5g 2 puffs Q 12 h
\n\u2022 Albuterol 2.5 mg with ipratropium bromide 0.5 mg per 3 mL for nebulization PRN
\nAll
\nNKDA
\nPatient Case Question 1. Why is the patient taking ethinyl estradiol and norethindrone?
\nPatient Case Question 2. Why is the patient taking albuterol and beclomethasone?
\nPatient Case Question 3. Briefly describe the mechanisms of drug action for albuterol
\nand beclomethasone that make them uniquely different but important.
\nROS
\n\u2022 () increased frequency of urination and urgent urination with mild incontinence
\n\u2022 (\u2013) rectal discharge and bleeding
\n\u2022 (\u2013) rectal pain, tenesmus, and constipation
\n\u2022 (\u2013) rash and other skin manifestations
\n\u2022 (\u2013) joint\/tendon pain and swelling
\n\u2022 (\u2013) recent onset headache, neck pain, and stiffness
\n\u2022 (\u2013) chest pain, cough, SOB, and palpitations
\n\u2022 (\u2013) sore throat and dysphagia
\nPE and Lab Tests
\nGen
\n\u2022 WDWN young, white female in NAD
\n\u2022 Pleasant and trim but appears mildly fatigued
\nVS
\nSee Patient Case Table 100.1
\nPatient Case Table 100.1 Vital Signs
\nBP 114\/64 mm Hg, sitting RR 16 not labored WT 114 lbs
\nP 120 BPM regular T 98.7\u00b0F HT 65 in
\nSkin
\n\u2022 Intact, warm, and dry with good turgor
\n\u2022 (\u2013) rashes, bruises, papules, and pustules
\nHEENT
\n\u2022 PERRLA
\n\u2022 (\u2013) photophobia
\n\u2022 EOMI
\n\u2022 No hemorrhages, exudates, or papilledema on funduscopic exam
\n\u2022 Sclerae white without icterus
\n\u2022 (\u2013) conjunctival erythema, edema, and exudate
\n\u2022 TMs clear throughout with no drainage
\n\u2022 (\u2013) erythema, swelling, and exudate within pharynx
\nNeck\/LN
\n\u2022 Neck supple without masses
\n\u2022 (\u2013) lymphadenopathy, JVD, bruits, and thyromegaly
\nChest
\n\u2022 Normal breath sounds without wheezes
\n\u2022 Good air entry
\n\u2022 (\u2013) breast lesions or discoloration
\nCardiac
\n\u2022 RRR
\n\u2022 (\u2013) murmurs and rubs
\n\u2022 S1 and S2 normal
\n\u2022 No S3 and S4
\nAbd
\n\u2022 (\u2013) for rebound tenderness and guarding in all 4 quadrants with palpation
\n\u2022 Soft and non-distended
\n\u2022 () BS
\n\u2022 (\u2013) HSM
\n\u2022 (\u2013) masses and bruits
\nGenit\/Rect
\n\u2022 (\u2013) vulval erythema and edema
\n\u2022 Vagina with thick yellow-white discharge and mild erythema
\n\u2022 Cervix is friable and shows yellow-white discharge from os
\n\u2022 (\u2013) masses on bimanual exam
\n\u2022 () cervical motion tenderness
\n\u2022 (\u2013) adnexal tenderness
\n\u2022 (\u2013) stool heme
\n\u2022 () mild anal erythema and edema
\nMS\/Ext
\n\u2022 (\u2013) adenopathy, lesions, and rashes
\n\u2022 (\u2013) arthritis and tenosynovitis
\n\u2022 Capillary refill WNL at 2 sec
\n\u2022 (\u2013) femoral bruits
\n\u2022 (\u2013) CCE
\n\u2022 Pulses 2 throughout
\n\u2022 Normal ROM and muscle strength at 5\/5 throughout Neuro
\n\u2022 A & O \u0001 3
\n\u2022 CNs II\u2013XII intact
\n\u2022 DTRs 2 and symmetric bilaterally
\n\u2022 No gross motor-sensory deficits present
\n\u2022 (\u2013) Babinski
\nLaboratory Blood Test Results
\nSee Patient Case Table 100.2
\nPatient Case Table 100.2 Laboratory Blood Test Results
\nNa 134 meq\/L Glu, fasting 98 mg\/dL WBC 13.5 \u0001 103\/mm3
\nK 4.4 meq\/L Mg 1.9 mg\/dL \u2022 Neutros 70%
\nCl 101 meq\/L Phos 4.2 mg\/dL \u2022 Bands 8%
\nHCO3 27 meq\/L Hb 13.4 g\/dL \u2022 Lymphs 17%
\nBUN 12 mg\/dL Hct 43.1% \u2022 Monos 4%
\nCr 1.1 mg\/dL Plt 225 \u0001 103\/mm3 \u2022 Eos 1%
\nUA
\n\u2022 Color: dark yellow
\n\u2022 Appearance: slightly cloudy
\n\u2022 SG: 1.022
\n\u2022 pH 5.0
\n\u2022 10 WBC\/HPF
\n\u2022 10 RBC\/HPF
\n\u2022 () gram-negative diplococci
\nNucleic Acid Amplification Test
\n\u2022 PCR of cervical swab specimen: () Neisseria gonorrhoeae and Chlamydia trachomatis
\n\u2022 PCR of urine specimen: () Neisseria gonorrhoeae and Chlamydia trachomatis
\nPatient Case Question 4. Identify the single most important risk factor in this case study.
\nPatient Case Question 5. Identify the two most definitive signs of gonorrhea in this
\npatient.
\nPatient Case Question 6. Provide a specific assessment\/diagnosis of this patient\u2019s
\ncondition.
\nPatient Case Question 7. Briefly cite the clinical evidence that supports or excludes
\na diagnosis of gonococcal proctitis.
\nPatient Case Question 8. Briefly cite the clinical evidence that supports or excludes
\na diagnosis of gonococcal urethritis.
\nPatient Case Question 9. Briefly cite the clinical evidence that supports or excludes
\na diagnosis of gonococcal cervicitis.
\nPatient Case Question 10. Briefly cite the clinical evidence that supports or excludes
\na diagnosis of gonococcal pharyngitis.
\nPatient Case Question 11. Briefly cite the clinical evidence that supports or excludes
\na diagnosis of gonococcal conjunctivitis.
\nPatient Case Question 12. Briefly cite the clinical evidence that supports or excludes
\na diagnosis of gonococcal perihepatitis.
\nPatient Case Question 13. Briefly cite the clinical evidence that supports or excludes
\na diagnosis of gonococcal pelvic inflammatory disease.
\nPatient Case Question 14. Briefly cite the clinical evidence that supports or excludes
\na diagnosis of gonococcal meningitis.
\nPatient Case Question 15. Briefly cite the clinical evidence that supports or excludes
\na diagnosis of gonococcal endocarditis.
\nPatient Case Question 16. Which three blood test findings are consistent with a diagnosis of gonococcal infection?
\nPatient Case Question 17. Briefly cite the clinical evidence that supports or excludes
\na diagnosis of disseminated gonococcal infection<\/p>\n","protected":false},"excerpt":{"rendered":"
Patient Case Study Patient\u2019s Chief Complaints \u201cI probably have done something that I shouldn\u2019t have on prom night and now it hurts when I go to the bathroom.\u201d HPI J.L. is a 17 yo junior in high school who presents to her pediatrician\u2019s office. She has been in reasonably good health for the past 17 […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1644,1646,1645,774,782,780,1647],"tags":[1642,1643,1427,1648,1641],"class_list":["post-5212","post","type-post","status-publish","format-standard","hentry","category-patient-case-study-assignment-help","category-advanced-pathophysiology-assignment-help","category-assignment-help-writing-a-pathophysiology-paper","category-assignment-pathophysiology-case-study-homework-help","category-nursing-pathophysiology-case-study-assignment","category-pathophysiology-case-study-answers-examples","category-write-my-pathophysiology-assignment","tag-adolescent-sexual-health","tag-gonococcal-infection","tag-healthcare-essays","tag-medical-research-papers","tag-urinary-tract-symptoms"],"_links":{"self":[{"href":"https:\/\/www.colapapers.com\/nursing\/wp-json\/wp\/v2\/posts\/5212","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.colapapers.com\/nursing\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.colapapers.com\/nursing\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.colapapers.com\/nursing\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.colapapers.com\/nursing\/wp-json\/wp\/v2\/comments?post=5212"}],"version-history":[{"count":1,"href":"https:\/\/www.colapapers.com\/nursing\/wp-json\/wp\/v2\/posts\/5212\/revisions"}],"predecessor-version":[{"id":5213,"href":"https:\/\/www.colapapers.com\/nursing\/wp-json\/wp\/v2\/posts\/5212\/revisions\/5213"}],"wp:attachment":[{"href":"https:\/\/www.colapapers.com\/nursing\/wp-json\/wp\/v2\/media?parent=5212"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.colapapers.com\/nursing\/wp-json\/wp\/v2\/categories?post=5212"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.colapapers.com\/nursing\/wp-json\/wp\/v2\/tags?post=5212"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}