N675L Week 7&8 – GYN and STI Assignment with complete solution
1 view 0 purchase
Course
N675L
Institution
N675L
N675L Week 7&8 – GYN and STI Assignment with complete solution
N675L Week 7&8 – GYN and STI Assignment with complete solution
N675L Week 7&8 – GYN and STI Assignment with complete solution
n675l week 7amp8 – gyn and sti assignment with complete solution
Written for
N675L
All documents for this subject (10)
Seller
Follow
BSNGUIDER
Reviews received
Content preview
1
Week 7&8 –
GYN and STI
In Canvas - Instructions – You are a NP in a PRIMARY CARE PRACTICE. Please succinctly note
in the following five (5) cases your responses. You are only asked to address actions or items
for this INITIAL PRIMARY CARE VISIT.
Case 1
You are a NP in a primary care clinic. You are seeing a pt with a CC of “bleeding in between
period.” She is a 48 G3P3 year-old woman who presents with intermenstrual bleeding x2 mos.
She is c/o BRB, but lighter than her normal period. She reports it can last 1-6 days. She denies
pain, hot flushes, or night sweats. She is monogamous, and is sexually active with her long-term
male partner. She denies any vaginal dryness and with no associated pain.
Q1: How would you further investigate and manage this pt?
I would address the following things:
Thorough history and physical using the PALM (polyps, adenomyosis, leiomyomata, malignancy)
and COEIN (coagulation disorders, ovulatory dysfunction, endometrial, iatrogenic, not yet
classified) screening tools, past medical history, last PAP smear, and current medications taken.
Physical exam to include a pelvic exam, breast exam, thyroid exam, pulmonary and
cardiovascular.
Q2: What are your ddx? Please select the three (3) MOST PROBABLE ddx, and your rationale
for selecting it as your dx or your r/o.
The differential ddx:
1) Uterine/endometrial Cancer bleeding pattern regular but heavy and prolonged,
enlarged uterus on examination, discrete masses may be palpated. The patient states
that she is having intermenstrual bleeding
2) Irregular bleeding due to OCP (oral contraceptive pills) irregular or heavy bleeding
related to OCPs or IUDs. The H&P would rule out the use of either modalities. The
patient is not on OCPs or IUDs
3) Endometrial polyps (leiomyomas) regular menses with intermenstrual bleeding.
Endometrial polyps are more likely to be malignant in postmenopausal women who
present with bleeding. The polyps should be removed to assess for malignancy and to
stop the bleeding.
Final DX: Endometrial polyps because they are a common cause of abnormal uterine
bleeding in both pre and post-menopausal women.
Case 2
1
, 2
You have a new pt that is establishing care. She is 21 y/o nulliparous and not sexually active.
She asked you whether there is a need for her to have a “woman’s exam.”
Q1: How will you respond to her statement? Your response will be:
I would provide a print out of the latest guidelines and educate the patient about the current
recommendations. The current USPSTF guidelines recommend cervical cancer screening for
women 21 to 65 years of age with cytology PAP smear every 3 years. Women 30-65 need a PAP
smear and HPV testing every 5 years.
On visit #2, this same pt, RTC for review of her lab and pap result. Her pap result is as follows:
Q2: What is your interpretation of this result, and what will you tell your pt (next step)?
Atypical squamous cells of undetermined significance (ASCUS) are thin and flat they grow on
the surface of a healthy cervix. On the Pap smear, ASCUS are slightly abnormal squamous cells,
but the changes do not clearly suggest precancerous cells are present. ASCUS indicates some
abnormality, but the cause is not clear. If the cytology is unsatisfactory then repeat testing in 1
year (>30 yrs old) or continue routine screening (21-29 yrs old) then resume routine screening if
testing is normal at 3 years. If the cytology is positive for intraepithelial lesion or malignancy (+
or – HPV) referral for colposcopy required.
Low-grade squamous intraepithelial lesion (LSIL) indicates mild dysplasia or cervical
intraepithelial neoplasia (CIN) I negative for HPV high risk.
Next step: Pt is 21 years old she would need to repeat PAP with HPV testing in 12 months. If
results are unsatisfactory then refer for colposcopy if results are normal test at 3 years then
routine screening.
Case 3
28 y/o woman RTC for abnormal Pap smear result. She is very anxious as she thinks that she
might have cervical cancer. The Pap smear result is reported as “LSIL, hrHPV positive or
unknown.” She had a previous normal result at age 25 yrs. She has not had any postcoital or
intermenstrual bleeding or dysparenuia.
Q1: Any other information you would like to know?
-Do you have any chronic conditions?
-Have you ever had a STI?
-What medications are you taking?
-Do you use birth control, if so which kind of birth control?
-How many sexual partners do you have?
-What age did you start having sexual intercourse?
-Do you smoke or use any recreational drugs?
2
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller BSNGUIDER. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $12.99. You're not tied to anything after your purchase.
