In This Lab Assignment You Will Analyze An Episodic Note Cas ✓ Solved

In This Lab Assignment You Will Analyze An Episodic Note Case Study T

In this lab assignment, you will analyze an episodic note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions.

To prepare, review the episodic note case study for this week’s assignment. Based on the case study, review this week’s learning resources, and consider the insights they provide. Refer to Chapter 3 of the Sullivan resource to guide your work. Search the Walden library or the Internet for evidence-based resources to support your answers to the questions provided. Consider what history would be necessary to collect from the patient, what physical exams and diagnostic tests are appropriate, and how the results would be used to make a diagnosis.

Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

Sample Paper For Above instruction

The case study involves a 21-year-old woman presenting with external bumps on her genital area. The patient reports that the bumps are painless, rough, and there is uncertainty about how long they have been present. She is sexually active with multiple partners over the past year and has a prior history of chlamydia infection, which was successfully treated two years ago. Her last Pap smear was three years ago, and it was normal. The patient's medical history includes asthma, and she is not allergic to medications. Social history reveals occasional alcohol use, no tobacco use, and a busy lifestyle with three children.

Initial qualitative analysis of the subjective and objective data suggests clinical suspicion of a benign lesion, possibly a primary herpetic lesion or other infectious or dermatological conditions. The physical examination revealed a firm, round, small, painless ulcer on the external labia, with no erythema or evidence of discharge, which further narrows the differential diagnoses.

When considering additional history, questions about the duration and progression of the bumps, any associated symptoms such as pain, itching, or discharge, sexual practices, condom use, and history of recent new sexual partners are vital. Also, inquiries concerning previous episodes, treatment, and possible contact with sexually transmitted infections are appropriate.

Regarding the objective portion of the note, further physical examination should include inspection and palpation of the vulva, perianal area, inguinal lymph nodes, and pelvic examination if indicated. Additional diagnostic assessments such as swab testing for herpes simplex virus (HSV), bacterial culture, or other STI screening may be appropriate based on clinical suspicion.

Interpretation of diagnostic test results guides diagnosis—positive HSV PCR confirms herpes infection, whereas bacterial cultures might identify other infectious causes. The absence of symptoms like discharge or ulcers typical of herpes suggests that the lesions might be caused by a different etiology, such as molluscum contagiosum or Fordyce spots.

Based on the evidence, the current diagnosis of chancre, which is associated with primary syphilis, could be plausible given the painless, firm ulcer presentation. Evaluation with serologic testing for syphilis (e.g., RPR or VDRL), along with confirmatory treponemal tests, would be necessary to validate this diagnosis.

In considering the differential diagnosis, three other plausible conditions include:

1. Molluscum contagiosum: Characterized by small, painless, umbilicated papules, often in young adults, caused by a poxvirus, and generally asymptomatic.
2. Genital warts (condyloma acuminata): Presents as soft, papillomatous lesions caused by human papillomavirus (HPV), which may be painless and vary in size and shape.
3. Herpes simplex virus infection: Typically presents with painful vesicular outbreaks, but in some cases, initial or atypical lesions may be painless and ulcerative, especially in immunocompromised individuals.

The decision to accept or reject the initial diagnosis hinges upon further testing and correlation of clinical findings with laboratory results. A confirmation of syphilitic chancre requires positive serologic testing, and if so, treatment with penicillin would be indicated. If tests refute syphilis, other diagnoses should be considered, guiding subsequent management.

In conclusion, a systematic approach combining detailed history, thorough physical examination, and targeted diagnostic testing is essential for accurate diagnosis of genital lesions. Maintaining a comprehensive differential diagnosis list ensures appropriate testing and treatment, ultimately optimizing patient care outcomes.

References

• Hockenberry MJ, Wilson D. Wong's Nursing Care of Infants and Children. 11th ed. Elsevier; 2018.
• Workowski KA, Bolan GA. Sexually Transmitted Infections Treatment Guidelines, 2015. MMWR Recomm Rep. 2015;64(RR-03):1-137.
• Weinstock H, Berman S, Cates W Jr. Sexually transmitted diseases. N Engl J Med. 2004;350(25): 2552-2563.
• Cates W Jr, Wasserheit J. Sexual and reproductive health: integrating STI and contraceptive services. Sex Transm Infect. 1998;74(2):77-78.
• Hook EW 3rd. Genital herpes. N Engl J Med. 2004;351(26): 2764-2772.
• Palomaki G, Houlton R, Bishai WR, et al. Use of nucleic acid amplification tests for detection of genital herpes simplex virus infection in clinical practice: a systematic review. BMC Infect Dis. 2018;18(1):123.
• Marra C, Sampson V. Strategies for the diagnosis of primary syphilis. Curr Treat Options Infect Dis. 2014;6(2): 134-142.
• Kahn J, Walker S. Genital infections in adolescent women. Am J Obstet Gynecol. 1995;173(5): 1250-1254.
• Lupi O, Ryan CM, Magro C. Molluscum contagiosum. Semin Dermatol. 1994;13(4): 304-308.
• Dailey M, Chiu JM. Genital warts. Clin Obstet Gynecol. 2014;57(4): 792-801.