Case Studies: Sexually Transmitted Infections Difficulty Int

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Case Study Sexually Transmitted Infections Difficulty: Intermediate Setting: Outpatient clinic Index Words: sexually transmitted infection (STI), pelvic inflammatory disease (PID), human immunodeficiency virus (HIV), assessment, pain management, patient education Giddens Concepts: Health Care Law, Infection, Patient Education, Reproduction, Sexuality HESI Concepts: assessment, Health Care Law, Infection, Patient Education, Sexuality/Reproductive You are the nurse in a walk-in clinic. A.P. is being seen this morning for a 2-day history of diffuse, severe abdominal pain. She has complaints of nausea without vomiting; she denies vaginal bleeding or dis- charge. A.P. reports having unprotected sex with several partners recently, two of whom had penile dis- charge. Her last menstrual period ended 3 days ago. She has no known drug allergies and denies previous medical or psychiatric problems. Vital signs are 108/60, 110, 20, 100.6 ° F (38.1 ° C). Physical examination reveals that her abdomen is very tender. The slightest touch of her abdomen causes her to wince with pain. Bowel sounds are normal. Pelvic examination reveals purulent material pooled in the vaginal vault, which appears to be coming from the cervix. a sample of the vaginal drainage is obtained and sent for culture. The result of a pregnancy test is negative; a rapid diagnostic test for chlamydial infection has a positive result. Scenario 1. Which of these assessment findings are significant and why? 2. What medical interventions can you anticipate? 3. What should you teach A.P. about chlamydial infection? 4. How would you provide emotional support to A.P. at this time? Part 2 Pediatric, Maternity, and WoMen’s HealtH cases 668 Case Study Progress The physician has the option of treating A.P. by one of two different methods. First, the physician could prescribe treatment over a period of 1 week. A.P. would be given the first dose of doxycycline (Monodox) 100 mg PO, and then she would be prescribed the same dose to be taken PO bid for 7 days. Second, the physician could prescribe a one-time dose of azithromycin (Zithromax) 1 g PO, which could be adminis- tered in the clinic. 5. Which choice is best for A.P.? Explain your reasoning. 6. You tell A.P. that chlamydial infection is a sexually transmitted infection (STI) that is mandated to be reported to the public health department. What is the purpose of reporting the infection, and what actions will be taken? 7. A.P. says she does not understand why her partners must be told about the infection. How would you respond? 8. Based on the information A.P. has given you, you determine that she is at risk for other STIs and unplanned pregnancy. What risk assessment questions do you need to ask A.P.? 9. You ask whether someone has talked with A.P. about “safe sex.” She laughs and tells you there is nothing safe about sex. Undaunted, you ask if she would be willing for you to discuss the use of condoms with her sexual partners. She tells you that she is already careful; if she does not “know the guy,” then she uses a condom. How are you going to respond? 10. You ask A.P. whether she has been tested for HIV. She says no, she does not know anyone with acquired immunodeficiency syndrome (AIDS) and she does not have sex with gay men. Now what are you going to say? 11. You ask her whether she would like to be tested for HIV. It will not cost her anything, no one will know the results but she, and it is completely confidential. She agrees to the test. What counseling will you provide A.P.? 12. You make an appointment for A.P. to return to the clinic in 1 week for her HIV test results. Describe the instructions you will give to A.P. before she leaves the clinic. Case Study Progress A.P. returns to the clinic in 1 week for her HIV test results, which are negative. Her culture results confirm the diagnosis of chlamydial infection. 13. What are your primary nursing concerns at this time? 14. A.P. has completed the course of antibiotic therapy and is no longer experiencing any symptoms. After counseling her on ways to reduce her risk of acquiring another STI, you determine that A.P. understood your teaching regarding safe sexual practices if she states that she will do which of the following? Select all that apply. a. Use a new application of spermicidal jelly before each sexual encounter b. Not worry about contacting an STI if the man states he has few partners c. Have her partner and her both wear a new condom with each sexual encounter d. Douche with an over-the-counter solution within 4 hours of having intercourse e. Inspect the genitalia of her partner before intercourse or other contact with perianal area

Paper For Above instruction

Sexually transmitted infections (STIs) remain a significant public health concern globally, with implications that extend beyond individual health to broader societal impacts. Among these, chlamydial infection is particularly prevalent, especially among young adults and sexually active populations. This case study examines the clinical presentation, assessment, management, and patient education related to an STI, emphasizing the importance of a comprehensive nursing approach within an outpatient clinical setting.

In this case, A.P., a woman presenting with severe, diffuse abdominal pain, reflects the complexities involved in diagnosing and managing STIs. Her symptoms—rapid onset of severe abdominal tenderness, nausea, purulent vaginal discharge, and recent unprotected sexual activity—highlight the potential for serious complications such as Pelvic Inflammatory Disease (PID). PID, an ascending infection of the female reproductive organs, can lead to long-term health issues including infertility, ectopic pregnancy, and chronic pelvic pain (Haggerty et al., 2010). The clinical findings, including abdominal tenderness and purulent cervical discharge, underscore the urgency of prompt diagnostic evaluation and intervention.

Assessment plays a pivotal role in managing STIs. Key assessment findings—such as severe abdominal pain, purulent vaginal discharge, and recent unprotected sex—are significant because they suggest possible pelvic or abdominal infection requiring immediate attention. Vital signs, while relatively stable, indicate the need for close monitoring, especially considering the risk of sepsis or worsening infection. Physical examination confirming abdominal tenderness and pelvic findings directs focus toward reproductive system infection, necessitating laboratory testing, including vaginal cultures and rapid diagnostic tests for chlamydia (Workowski & Schneiderman, 2015). The positive chlamydial test confirms the diagnosis, guiding targeted antimicrobial therapy.

Medical interventions for A.P. include initiating antibiotic therapy tailored to the infection. The physician's options—doxycycline for a week or a single dose of azithromycin—are supported by clinical guidelines, with azithromycin being preferred for ease of compliance and reduced risk of missed doses, particularly in outpatient settings (Workowski & Bolan, 2015). In this case, the single-dose azithromycin is often favored for its simplicity, especially for patients who may have adherence challenges. The choice, however, should be individualized, considering factors like allergies, pregnancy status, and partner treatment needs.

Patient education is crucial in managing STIs. A.P. must understand that chlamydial infections are transmitted sexually and can often be asymptomatic, which emphasizes the need for regular screening (CDC, 2021). Explaining that treatment not only cures her but also prevents further transmission is vital. She should inform her sexual partners about her infection so they can seek testing and treatment to prevent reinfection and facilitate public health efforts. Reporting to the health department enables contact tracing, education, and prevention strategies, which are essential components of STI control programs (CDC, 2021).

Effective communication about the necessity of partner notification can be challenging. A.P. expressing confusion about why her partners must be informed provides an opportunity for empathetic counseling. Explaining that untreated STIs can reinfect her and others, and potentially cause long-term health problems, highlights the importance of partner treatment (Hillis et al., 2010). Encouraging supportive dialogue and confidentiality helps motivate her to disclose her status responsibly.

Assessment of her risk for other STIs involves asking about her sexual behaviors, number of partners, condom use, history of previous STIs, and testing history. It also includes screening for other infections, particularly HIV, which has synergistic effects with certain STIs, increasing transmission risk (Fleming & Wasserheit, 1999). Addressing misconceptions about condom effectiveness and discussing safer sex practices critically empower her to make informed decisions. Encouraging consistent condom use with every sexual encounter and educating about the benefits of dual protection strategies are essential (UNAIDS, 2020).

Regarding HIV testing, A.P.'s initial refusal and subsequent acceptance after counseling reveal the importance of providing nonjudgmental, confidential education. Clarifying that HIV can be asymptomatic and that risk exists even with perceived low exposure promotes informed decision-making (CDC, 2021). Counseling should include information about the benefits of knowing one’s status, preventing transmission, and accessing early treatment if necessary. Assuring her of confidentiality and free testing services helps alleviate fears and misconceptions.

Before she leaves the clinic, instructions should focus on adherence to prescribed therapy, recognizing signs of complications, and following up for test results. Reinforcing safe sexual practices, explaining the importance of partner treatment, and providing resources for further education support ongoing prevention efforts. Emphasizing the importance of returning for her HIV results and future screenings sustains engagement with healthcare services.

Follow-up is essential, especially given the initial presentation, diagnosticconfirmation, and counseling provided. Her negative HIV result reassures her safety, but ongoing risk reduction remains paramount. During follow-up, primary nursing concerns include ensuring completion of therapy, assessing understanding of safe sex practices, and supporting her emotional well-being. Addressing any anxieties or concerns related to her health or social circumstances fosters trust and adherence to care plans.

Finally, her understanding of safe sexual practices can be evaluated by her willingness to implement recommended behaviors such as consistent condom use, abstaining from risky behaviors, and maintaining communication with partners. Her affirmation to use condoms and avoid risky behaviors indicates improved awareness and commitment to reducing her risk of future STIs (Frieden et al., 2010). Reinforcing these behaviors through counseling consolidates her readiness to make safer choices, ultimately reducing STI transmission in her community.

References

• Centers for Disease Control and Prevention (CDC). (2021). Sexually Transmitted Infections Treatment Guidelines. Retrieved from https://www.cdc.gov/std/treatment/default.htm
• Fleming, D. T., & Wasserheit, J. N. (1999). From epidemiological synergy to public health policy and practice: The contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sexually Transmitted Infections, 75(1), 3–17.
• Frieden, T. R., et al. (2010). Evidence-Based Strategies for Preventing HIV Infection: What Works? Public Health Reports, 125(2), 208–222.
• Haggerty, C. L., et al. (2010). Pelvic inflammatory disease: Pathogenesis, diagnosis and management. The Obstetrician & Gynecologist, 12(2), 79–86.
• Hillis, S. D., et al. (2010). Why do women fail to disclose a prior sexually transmitted infection? A qualitative analysis. Sexually Transmitted Diseases, 37(8), 379–385.
• Workowski, K. A., & Schneiderman, J. F. (2015). Sexually transmitted diseases treatment guidelines, 2015. MMWR Recommendations and Reports, 64(RR-03), 1–137.
• Workowski, K. A., & Bolan, G. A. (2015). Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep, 64(3), 1-137.
• UNAIDS. (2020). Prevention methods for HIV/AIDS. Retrieved from https://www.unaids.org/en/resources/documents/2020/prevention
• American College of Obstetricians and Gynecologists (ACOG). (2020). Practice Bulletin No. 225: Bacterial Vaginosis. Obstetrics & Gynecology, 135(3), e81–e94.
• Guevara, J. P., et al. (2012). Screening recommendations for reproductive-aged women. JAMA, 308(20), 2094–2102.