Week 5 Discussion Forum

Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example, #1 Maria, 49-year-old female, annual exam.

Discuss what questions you would ask the patient, what physical exam elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals and other team members needed to complete patient care.

Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas. 

In your peer replies, please reply to at least one peer who chose a different case study.

1. Toniais an 18-year-old female who presents to your office complaining of two months of amenorrhea. Her pregnancy test is positive and her LMP indicates she is 5.6 weeks EGA. She indicates plans to continue the pregnancy and parent the child.

• Describe all elements of the head-to-toe assessment you will perform for her initial prenatal visit and all lab tests you will order as well as the rationales for both the physical exam elements and the lab tests you will order. 
• Provide Tonia with an explanation of her anticipated prenatal appointment schedule and the testing that will be included at specific times throughout the pregnancy.

Provide evidence from the research to support your decision-making.

2. Lisais a 29-year-old female G3P2 at 25 weeks EGA who is coming to the clinic for her routine checkup and gestational diabetes screening. Her VS and prenatal routine screenings are WNL. Lisa asks if it is normal to be experiencing frequency and mild burning when she urinates which she says has increased over the last 2 days. She has been drinking more water recently and thinks that maybe this is causing the urinary frequency. 

• As Lisa’s nurse practitioner, what will you do, and why? Discuss evidence-based guideline recommendations for asymptomatic and symptomatic bacteruria during pregnancy.
• Write out your instructions for Lisa in layperson’s terms regarding the healthy behaviors she needs to continue or incorporate into her lifestyle as well as the behaviors she must avoid.

Provide evidence from the research to support your decision-making.

3. Malia,a 23-year-old female presents to the clinic for her initial OB visit. She says she did not know she was pregnant initially, but believes she is about 6 months pregnant now, and reports positive fetal movement. She states she was smoking about half a pack of cigarettes a day, but when she found out she was pregnant she stopped smoking. She has not received any prenatal care. This is her third pregnancy. Her previous pregnancies both delivered early, one at 20 weeks that did not survive, and the second at 32 weeks where the infant survived. Today, she complains of a backache that she has had for two days. Currently, she is unemployed and is supported by family. Her exam reveals the following: height 5’6”, weight 156, FH 27cm, FHR 152, BP 122/78, positive nitrates in urine, and positive bacterial vaginosis by micro.

• What lab tests and diagnostic screenings will you order, and why?
• What medications would you prescribe and what patient education will you provide?

Provide evidence from the research to support your decision-making.