Answer the following question based on the discussion bellow. Please provide one reference.
Question:
She would like to know if she should get Hepatitis titers also. How do you respond?
Discussion:
Questions to Ask During Screening
Assessing the patient should be done holistically. This is the first visit in 4 years since she last had access to healthcare and therefore a comprehensive assessment is needed. In addition to concentrating on the reason for the visit (abdominal and pelvic pain), other body systems should also have evaluated and screened to ensure that she does not have any other problems with the goal of disease prevention and health promotion. The questions should be appropriate for her age, gender, and socioeconomic class. Confidentiality of the patient is quite important during the assessment because she needs a conducive environment to be able to open up about serious health issues such as mental health, abuse, and sexual health. The questions I would ask in relation to her chief complaint include; Where is the pain located? Has it been gradual or sudden? Is it centralized or it radiates to other areas? When was your LMP? how would score the pain on a scale of 10? Have you been taking any medications for the pain? Are you currently using any contraceptives? Do you have time for exercise after work? How safe are you from abuse both at home and at work? Have you experienced any physical or emotional abuse?
Summary of Clinical findings
Ms. Bell chief complaints are abdominal and pelvic pain. She complaints of pain during sexual intercourse and even admits to trying to avoid it. The last period was last month and she is not on any contraceptives. The patient has also been having nausea, vomiting, and constipation. The last pap smear was done 4 years ago results were abnormal but due to financial and time constraints, never went for a follow-up. She additionally mentions having a lot of anxiety and has been under a lot of stress which suggests the need to review her mental health. She reports being under numerous psychosocial stressors. She rarely takes alcohol, but her husband is a regular drinker. Upon physical examination of the patient, some tenderness on the mid-epigastric region and lower abdominal area has been noted. Yellow discharge with odor is also noted.
Tests and findings
The tests that Ms. Bell requires are pregnancy test, pap smear, HIV test, and the KOH/saline test which checks for bacterial vaginosis, vaginitis, and trichomonas. A urinalysis test is also crucial for testing UTIs. Due to not using any contraceptives, this is why a pregnancy test is needed. The results indicated that she is her urine test was normal with no UTIs, she was not pregnant but had trichomonas infection.
Diagnoses
The following differential diagnosis will allow making the primary one for Ms. Bell. Gastritis is suspected due to the presence of epigastric pain, constipation, nausea, and increased bloating. The pain is aggravated by stress and sometimes dietary changes. At the same time, there is a possibility of the patient suffering from pelvic inflammatory disease since she indicates having lower abdomen pain aggravated by activity or sexual intercourse, cervical motion tenderness, and menstrual irregularities. The sexual history of both partners and pelvic exams will confirm the diagnosis. Urinary tract infection is suspected due to the presence of lower abdominal pain that is aggravated by sexual intercourse (Perry et al., 2015). The diagnosis was confirmed by the lab test. Finally, she might suffer from vaginitis due to the presence of pelvic pain and vaginal discharge (Perry et al., 2015), which can be confirmed by the lab test.
Among the differential diagnoses mentioned above, the primary one is vaginitis due to the mentioned symptoms. The wet prep lab findings also show the presence of white blood cells and a few motile trichomonas, which is another indication of trichomonas vaginitis.
Management
The pharmacological management is by prescribing a drug for treating trichomonas vaginitis which has been confirmed as she waits for other results. For the pharmacological treatment care plan, metronidazole is prescribed to treat trichomonas vaginitis. Metronidazole dosage is 2g in a single dose or 500mg for 7 days in women found to be HIV positive. The non-pharmacological approach is by educating the patient on ways to protect herself from sexually transmitted diseases. She is advised to bring her husband for treatment to reduce the high risk of reinfection. She is also educated on various birth control methods (Fashner & Alfred, 2015). The presence of bruises indicates that the patient is the victim of domestic violence. Thus, Ms. Bell should learn about the indicators of partner violence, including verbal use, slapping, pushing, kicking, and assaults with or with no weapons since she mentions that they argue with her husband while he is at home.
References
Fashner, J., & Gitu, A. (2015). Diagnosis and treatment of peptic ulcer disease and H. Pylori infection. American Family physician, 91(4), 236-
242. https://www.aafp.org/afp/2015/0215/p236.html
Perry, A., Potter, P., & Ostendorf, W. (2015). Nursing interventions and clinical skills (6th ed.). Elsevier Health Sciences.
