Week 4 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. Lisais a 19-year-old female who presents to the clinic c/o abnormal vaginal discharge for one week after having unprotected vaginal intercourse with a new male partner she has been dating for a couple of weeks.  Lisa’s pregnancy test is negative and her LMP was 2 weeks ago. As her health care provider, you will need to perform testing to determine if Lisa has contracted a sexually transmitted infection or other vaginal infection.

• Explain what test(s) you will order and perform, and discuss your rationale for ordering and performing each test.
• Based on the clinical information, explain what medications and treatments you would recommend (assume one of your diagnostic test results is positive), including any possible side effects of the medication and treatment(s), partner notification, and follow-up plan of care.

Please refer to evidence-based guidelines to support your decision-making.

2. Tinais a 27-year-old female who presents to the clinic complaining of a painful burning sensation in her left labial area for 3 days.  She reports recently having unprotected vaginal intercourse with a new male partner.  Upon examination, you note fluid-filled vesicles on the left labia minora that are painful to touch. 

• What are your presumptive and differential diagnoses, and why?
• What test(s) will you perform/order and what is your plan of care (assume one positive test result that requires you to provide the appropriate treatment)?

Please refer to evidence-based guidelines to support your decision-making.

3. Emily,an 18-year-old female presents with complaints of “problems with her birth control.” She was evaluated last month for a well-woman exam and was placed on Ortho Tri-Cyclen LO. Since then, she experienced spotting for one week prior to the “white pills” and then had her period.  She also complains of a foul-smelling discharge that she has noticed for the past few days. She is requesting to change her pills and requests “something for this discharge.” Her pelvic exam reveals minimal discharge without odor, cervix bleeds easily to touch, and negative cervical motion tenderness. Her urine pregnancy test is negative and she is positive for gonorrhea and negative for chlamydia.

• What is your plan of care for this patient?
• What additional screening tests and patient education would you recommended for this patient?

Please refer to evidence-based guidelines to support your decision-making.