NRNP 6552 Gynecologic Health
Case Study
The chosen case study demonstrates that Cindy, a 25-year-old Hispanic woman, seeks an annual gynecologic examination. She is currently not experiencing any symptoms, does not have any abnormal uterine bleeding, and has never had cervical cancer screening. She has engaged in sexual activity with three different partners during the last six months. Cindy has a documented case of chlamydia and has not had any cervical cancer screenings. Cindy lacks a history of using contraception and refrains from using condoms. She cohabitates with a roommate and is employed as a bartender. This paper provides a comprehensive health history of this patient in addition to the differential diagnosis and treatment.
Table 1: Case Study #1- Cindy
| Outline Subjective data.
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Outline
Objective findings.
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Identify diagnostic tests, procedures, and laboratory work indicated. | Distinguish at least three differential diagnoses. | Identify appropriate medications, treatments, or other interventions for each differential diagnosis.
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Explain key
Social Determinants of Health (SDoH) for your chosen case. |
Describe collaborative care referrals and patient education needs for your chosen case.
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| The onset of menstruation occurred at 13, with a menstrual cycle lasting for seven days. The frequency is every 28 days, averaging 4-5 tampons daily. The last menstrual period (LMP) occurred one week ago. The patient does not use any contraception, such as birth control or condoms. States absence of abnormal uterine bleeding despite having engaged in sexual activity with three different partners throughout the last six months. The previous occurrence of chlamydia infection was one year ago. Lives with a roommate who works as a bartender and consumes 3-4 vodka cocktails two evenings per week. Refutes engagement in recreational drug use and has never partaken in smoking activities. ROS: Not present. Family history: Non-noteworthy
Additional data required: Was her chlamydia infection successfully treated in the previous year? Is she now in a relationship with the same person, and were they also given the same treatment? |
Vital signs: Blood pressure is 110/70, pulse rate is 90, respiratory rate is 18, and temperature is 98.4 degrees Fahrenheit. Weight: 122 pounds. My height is 5’6″, and my BMI is 19.7.
There is an appropriate distribution of hair. There are no visible lesions. A small, painless lump was felt at the left vaginal opening, accompanied by mild swelling. Upon examination, there was a small amount of yellow vaginal discharge present, with no visible lesions or signs of cervical motion tenderness (CMT). ( The bimanual examination revealed a uterus of average size that was firm and non-tender. No palpable masses were detected in the adnexal region, and no tenderness was reported. The breast examination yielded no abnormalities. The physical examination is otherwise regular.
Additional data is required: Are there any odors or discharge present in the vaginal area? |
Diagnostic tests, procedures, and laboratory work are necessary to ascertain the presence of an HPV infection, STIs, or a benign lump in this patient. Cervical cancer screening involves a Pap Smear, while HPV testing is necessary to detect any HPV infection. Additionally, NAAT for STIs is required to exclude any present infections. An examination of vaginal discharge using wet mount/microscopy is essential for determining the underlying cause of the discharge (Abdul-Aziz et al., 2024). | 1. Bartholin Cyst: This condition typically involves a one-sided, symptomless obstruction of the Bartholin gland, which is situated in the lower right and left areas of the vaginal opening at the 4 o’clock and 8 o’clock positions (Abdul-Aziz et al., 2024). It is often found by chance during a pelvic examination or imaging tests. Based on the symptoms described, it is likely that the patient is experiencing a Bartholin’s gland cyst or abscess.
2. Chlamydia: This bacterium is the predominant cause of sexually transmitted infections (STIs) in the United States. Chlamydia infection typically shows no symptoms (Hocking et al., 2023). Symptoms may manifest as a burning or painful sensation during urination, along with an increase in vaginal discharge. The patient’s positive test result suggests the presence of a yellow discharge, which may indicate a potential yeast infection. It is noteworthy that yeast infections typically manifest as white and curdy discharge.
3. Vulvar Leiomyoma: These are uncommon and often mistaken for Bartholin cysts before surgery due to their deceptive nature. Smooth muscle tumors are usually painless, solitary, and well-defined. They can occur in females of all age groups (Kalambe et al., 2023). |
1. Bartholin cyst: Use sitz baths and consider surgical drainage if necessary. If cysts reoccur or cause discomfort, a marsupialization operation might be beneficial (Abdul-Aziz et al., 2024).
2. Chlamydia: Administer 100 mg of doxycycline orally twice daily for seven days. Alternative treatment options include a single oral dosage of 1 gram of Azithromycin or a daily oral dose of 500 milligrams of Levofloxacin for seven days (Hocking et al., 2023).
3. The preferred therapy for vulvar leiomyoma is surgical excision (Kalambe et al., 2023). |
The patient’s primary social factors influencing their health include economic stability, education, access to healthcare and health services, social and communal circumstances, and the quality of their neighborhood and physical surroundings. Their socioeconomic condition might potentially influence their ability to receive healthcare, while their knowledge of sexual health and contraception choices could be restricted. Additionally, they encounter ambiguity about their HPV vaccination status (Boer et al., 2020). | This patient needs coordinated care recommendations from a gynecologist for further evaluation of cervical cancer screening, HPV vaccination, and possibly a biopsy of a vaginal lump. An expert in infectious diseases is required to address complicated cases of sexually transmitted infections (STIs). Patient education encompasses the dissemination of information on the adoption of secure sexual practices, the availability of various contraceptive methods, the need for HPV vaccination, and the necessity of undergoing routine gynecologic examinations. It is essential to provide the patient with information on condom use, various contraception methods, the significance of the HPV vaccine, and the need for frequent check-ups and screenings. (Boer et al., 2020) |
Conclusion
The patient has a history of chlamydia infections and needs diagnostic tests to determine HPV infection, STIs, or a benign lump. Social factors affecting their health include economic stability, education, healthcare access, and communal circumstances. Challenges include healthcare access, understanding sexual health choices, and HPV vaccination status. A gynecologist should provide coordinated care recommendations, HPV vaccination, and vaginal lump biopsy. Patient education on secure sexual practices, contraceptive methods, HPV vaccination, and routine gynecologic examinations is crucial. Collaborative care referrals and patient education are also necessary.
References
Abdul-Aziz, S., Abdul-Aziz, S., Abdul-Aziz, S., & Abdul-Aziz, S. (2024). Case series on the management and outcomes of Bartholin gland carcinoma. European Journal of Obstetrics, Gynecology, and Reproductive Biology/European Journal of Obstetrics & Gynecology and Reproductive Biology, 299, 26–31. https://doi.org/10.1016/j.ejogrb.2024.05.028
Boer, G. M. N., Dasgupta, S., Ewing-Graham, P. C., & Van Bockstal, M. R. (2020). Adenoid cystic carcinoma of the Bartholin gland is not HPV-related: A case report and literature review. Pathology, Research and Practice, 216(6), 152968. https://doi.org/10.1016/j.prp.2020.152968
Hocking, J. S., Geisler, W. M., & Kong, F. Y. (2023). Update on the Epidemiology, Screening, and Management of Chlamydia trachomatis Infection. Infectious Disease Clinics of North America, 37(2), 267–288. https://doi.org/10.1016/j.idc.2023.02.007
Kalambe, M., Gattani, P., & Bankar, N. J. (2023). A case report of vulvar leiomyoma: a rare pathological entity. Curēus. https://doi.org/10.7759/cureus.42878
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GYNECOLOGIC HEALTH
Case studies provide the opportunity to simulate realistic scenarios involving patients presenting with various health problems or symptoms. Such case studies enable nurse learners to apply concepts, lessons, and critical thinking to interviewing, screening, diagnostic approaches, as well as the development of treatment plans.
For this Case Study Assignment, you will analyze a case study scenario to obtain information related to a comprehensive well-woman exam and determine differential diagnoses, diagnostics, and develop treatment and management plans.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
To prepare:
- By Day 1 of this week, you will be choose one of the four case study scenarios provided.
- Review the Learning Resources for this week and pay close attention to the media program related to the basic microscope skills. Also, consider re-reviewing the media programs found in Week 1 Learning Resources.
- Carefully review the clinical guideline resources.
- Use the Case Study Template found in the Learning Resources to support the development of your assignment.
BY DAY 5 OF WEEK 3
Submit your case study assignment by Day 5 of Week 3.
SUBMISSION INFORMATION
Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.
- To submit your completed assignment, save your Assignment as Wk3Assgn_LastName_Firstinitial
- Then, click on Start Assignment near the top of the page.
- Next, click on Upload File and select Submit Assignment for review.
Rubric
NRNP_6552_Week3_Case_Study_Assignment_Rubric
| Criteria | Ratings | Pts | ||||
|---|---|---|---|---|---|---|
| This criterion is linked to a Learning OutcomeAnalyzes subjective and objective data and outlines applicable diagnostic tests related to case studies. |
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30 pts | ||||
| This criterion is linked to a Learning OutcomeIdentifies differential diagnoses related to case studies. |
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30 pts | ||||
| This criterion is linked to a Learning OutcomeFormulates a treatment plan related to case studies based on scientific rationale, evidence- based standards of care, and practice guidelines. Integrates ethical, psychological, physical, financial issues and Social Determinants of Health in plan. |
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30 pts | ||||
| This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards:Correct grammar, mechanics, and proper punctuation |
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5 pts | ||||
| This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. |
|
5 pts | ||||
| Total Points: 100 | ||||||