Women clincial d3
Melissa
During one of my clinical experiences as a nurse practitioner, a female client presented with signs and symptoms of Bacterial Vaginosis. The client was hesitant when I first mentioned the diagnosis. Calmly, I tried to talk to her about it. I discussed all the available treatment options to gain her consent. In addition, I established a rapport and created a conducive environment for the client to open up to me and discuss her sexual history (McCuistion et al., 2021). While she explained, I actively listened, making a client-centered and holistic approach essential to nursing care. To clear her doubts, I referred her for differential tests that included candidiasis and trichomoniasis vaginalis. She was satisfied at the end of her visit because I could develop a tailored care plan for her and engaged her in a health promotion strategy.
Challenges and Successes
A significant challenge was navigating the trauma associated with reproductive health diseases. Initially, the client was not willing to open up about her sexual history, which made it challenging for me to tailor a care plan. Due to the stigma associated with these diseases, healthcare providers should ensure that they provide a nonjudgemental and supportive environment characterized by active listening skills and affirmation of clients to develop trust. A notable success was the rapport we finally built that enabled me to tailor a care plan and educate the client about BV and how to handle it.
Assessment
Signs and Symptoms (S&S)
According to the patient, she was experiencing a greyish vaginal discharge, fish smell, and itching. On examination, whiff test odor and a PH higher than 4.5 were present (Kairy & Garg, 2023).
Differential Tests
Differential Diagnosis: Bacterial Vaginosis
Rationale: The symptoms presented concur with Amsel’s odor, discharge, and high PH (more than 4.5), which indicates bacterial vaginosis (Kairys & Garg, 2023).
Differential Diagnosis: Vulvovaginal Candidiasis
Rationale: Vulvovaginal candidiasis is characterized by a cottage cheese discharge with high Ph but lacks fish odor. Also, upon examination, microscopic yeast would further differentiate it (Jeanmonod et al., 2023).
Differential Diagnosis: Trichomoniasis
Rationale: Like the two diseases mentioned above, trichomoniasis presents with high ph, vaginal discharge but lacks the fish odor. Upon examination, motile trichomonads are present (Schumann & Plasner, 2023).
Plan of Care
Metronidazole, an antibiotic that has shown effectiveness against pathogenic bacteria for Bacterial Vaginosis, is prescribed to remove the patient’s distressing symptoms like fishy odor and abnormal discharge (Coudray & Madhivanan, 2020). Furthermore, eliminating the infection with such focused therapy helps in restoring balance in vaginal microbiota, thus significantly helping to eliminate Bacterial Vaginosis and ensure its prevention.
Health Promotion Intervention
I insisted on condom use and having one sexual partner to minimize the risks of developing other infections, such as chlamydia and gonorrhea (Kairy & Garg, 2023). Also, the approach will reduce pregnancy complications that BV might cause. Besides, I advised the client to maintain optimal vaginal microbiome by using probiotics.
Clinical Learning
The clinical experience underscored the importance of reproductive health education among patients. Also, it reinforced the significance of destigmatizing these illnesses. Accurate diagnosis and treatment were made possible by clinical guidelines such as those from the World Health Organization (WHO) and the Center for Disease Control and Prevention (CDC).
Plan of Care and Research Guideline
CDC approves metronidazole as a first-line pharmacological treatment for BV (Coudray & Madhivanan, 2020). In addition, insistence on health promotion strategies concurs with global health organizations’ mandates that advocate for and advance reproductive health among women
Yulemis
This week’s clinical gave me the chance to evaluate, diagnose, and manage the patients with diverse health ailments or issues. I had a patient who was 44 years old and of African American descent with a uterine fibroid history. In this case, the major challenge posed by the patient was her worry and fear over how fibroid would affect her fertility and quality of life. As reported by Angioni, D’Alterio & Daniilidis (2021), fibroids may block the fallopian tubes and disrupt gamete transport that leads to infertility; thus, creating alarming fears in the patient’s mind. My success in this interaction was based on true collaboration through the teamwork of other health care providers, patients, and family to provide patient-centered and comprehensive education.
The patient had a long and heavy menstrual flow during the last four days. She reported chronic pain in the pelvic area which was especially painful during sex and menstruation. In this visit, the patient admitted to experiencing shortness of breath in addition to generalized weakness and tiredness. These symptoms could be attributed to her long and heavy menorrhagia, suggesting a potential iron-deficiency anemia that necessitated a workup and treatment (Mansour, Hofmann, & Gemzell-Danielsson, 2021). Apart from the uterine fibroids, the medical history of the patient was notable for pulmonary emboli and deep venous thrombosis. Both her social history and family history were not contributory.
Upon initial evaluation, the patient appeared appropriately dressed, with signs of fatigue and distress. Her vital signs include a BP of 122/78mmHg, Pulse of 98/min, RR of 20/min, Temp of 98.6oF, BMI of 28.4, and pain of 5/10. Palpitation of the lower abdomen revealed enlarged uterus with irregular contours, and pelvic exam revealed palpable masses that were indicative of the presence of fibroids within the uterus (Ahmad et al., 2023). Consequently, we consulted Gynecology and a diagnosis of multiple large fibroids was made after a transvaginal ultrasound exam. The core differential diagnoses that were considered included adenomyosis and endometrial polyps.
Based on the presumptive diagnosis of multiple large fibroids, a hysterectomy was recommended. However, the patient’s hemoglobin level of 3.8 g/dL during this visit was too low for surgery. Consequently, the physician started the patient on Lupron to help with the cessation of hemorrhage from uterine fibroids. She was started on iron sucrose 200mg intravenously daily and given darbepoetin alpha 25mcg intravenously every week. This treatment plan was based on the recommendations by Angioni, D’Alterio & Daniilidis (2021) that uterine fibroids is treated with medications that target hormones controlling the menstrual cycle. The medications target such symptoms as pelvic pressure and heavy menstrual bleeding, and work to shrink fibroids and not get rid of them.
In conclusion, the clinical experience for this week provided another opportunity to assess, diagnose, and manage patients presenting with different health conditions and problems, including uterine fibroids. In the case of the 44-year-old patient, the health promotion intervention that was addressed entailed education about lifestyle alterations, an iron-rich healthy diet, and supplementary regular exercise and stress management to improve the patient’s general wellness during recovery. The clinical experience confirmed the importance of patient education, shared decision-making, and a holistic approach to women’s health care. It emphasized that constant research and knowledge of the current guidelines in obstetrics and gynecology were needed to provide client-centered care.
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