melissagirl2010
Case: James Lewis is a 24-year-old male who is seen in the clinic…
Case: James Lewis is a 24-year-old male who is seen in the clinic for “pain in the groin.” During the interview the patient states, “I have a soreness in my groin area on both sides.” Mr. Lewis denies any trauma to the area, states he has not done any heavy lifting, nor has he been involved in athletic activities or “working out.” He reports that he is in good health. He does not take any medications except vitamins and, occasionally, some non-aspirin product for a headache. He denies nausea, vomiting, diarrhea, or fever. He has no pain in his legs or back. He tells the nurse his appetite is okay, but he is tired. He thinks his fatigue is because he’s been “a little worried about this problem and really having a hard time deciding to come in for help.”
When asked about the onset of the problem, Mr. Lewis explains that he “started feeling some achiness about a week ago.” When asked if he has ever experienced these feelings before, he replies, “No.” He is then asked to describe or discuss any other symptoms. He looks away, shifts in his chair, and then says, “Well, I have had some burning when I pass urine and it’s kind of cloudy.”
When asked if he has ever had a problem like this before, he replies, “Yes, about 2 months ago.” With further questioning, the nurse learns that Mr. Lewis was diagnosed with gonorrhea and treated with an injection and pills he was supposed to take for a week. He says he was not supposed to have sex until he finished the pills. When asked if he followed the prescribed treatment, he reluctantly responds that he finished all, but a couple of pills and he did have sex with one of his girlfriends about 4 or 5 days after he got the injection. Mr. Lewis tells the nurse he did not inform his girlfriends of his problem and he generally avoids condoms because “I’ve known these girls for a long time.”
The physical assessment yields the following information: B/P 128/86, P 96, RR 20, T 98.6. His color is pale, and the skin is moist and warm. External genitalia are intact, without lesions or erythema. There is lymphadenopathy in bilateral groin areas. Compression of the glans yields milky discharge. A smear of urethral discharge is obtained. The nurse knows that Mr. Lewis’s original gonococcal infection was treated with an injection, most likely ceftriaxone. The nurse also knows that chlamydia is present in almost half of the patients with gonorrhea and is treated with a 7-day regimen of oral antibiotics. Between 40% and 60% of patients with gonorrhea have lymphadenopathy.
Based on the data, the nurse suspects that Mr. Lewis has a reinfection with gonorrhea and may have a concomitant chlamydial infection. The nurse recommends single-injection treatment for gonorrhea and a new oral regimen for chlamydia. A urine specimen will be obtained and submitted with the urethral discharge smear. The patient will be scheduled for a follow-up phone conference about the laboratory results in 48 hours and a return visit in 7 days. The nurse conducts an information, education, and advice session prior to discharge from the clinic. Jessica Johnson, a 24-year-old Caucasian female, arrives in the clinic with lower abdominal pain and nausea. She states, “I’ve had this throbbing pain for 3 days and it kept getting worse.” She further states, “I haven’t been able to eat. I feel awful. You have to do something for the pain.”
The nurse explains that more information is needed so that the proper treatment can be initiated. In further interview the following information is obtained. Ms. Johnson’s last menstrual period was 1 week ago, and she had more campiness than usual. She has had brownish, thick vaginal discharge on and off since then. She has had some itchiness in the vaginal area and burning when she voids. She states she has to go to the bathroom all the time: “All I did was pee little bits, until this pain got to me. I have hardly gone since last night.” When asked about the pain, Ms. Johnson says it is mostly 8 on a scale of 1 to 10 and getting pretty constant. “Nothing I do helps, except it helps a little if I curl up and hold still.”
Physical assessment reveals a thin, pale female. VS: B/P 108/64, P 92, RR 20, T 101.4°F. Skin is hot, dry, poor turgor. Mucous membranes dry. Postureabdominal guarding. Abdomen BS positive in all 4 quadrants, tenderness in RLQ drainage, pain upon cervical and uterine movement. Cultures from vaginal secretions obtained to lab, Blood drawn for CBC, to lab Urine specimen obtainedclear, yellow to lab. The patient’s clinic record reveals that she has been sexually active since age 16. She has had multiple partners and one abortion. She has been treated for an STD three times, most recently 2 months prior to this visit. The patient is on birth control pills. She has no allergies to medications, and no family history of cardiovascular, abdominal, neurologic, urologic, endocrine, or reproductive disease. Interpretation of the data suggests a diagnosis of PID. The options are outpatient treatment with antibiotics and education about limitations in activity and sexual practices, or inpatient treatment with intravenous fluids, antibiotics, analgesia, and bed rest. Because Ms. Johnson is acutely ill, with pain and dehydration, she is admitted to the acute care facility with a diagnosis of PID.
After reading the hypothetical situation answer the following questions:
What healthy people 2030 objectives are related to each scenario: James Lewis and Jessica Johnson?
Students must write their and upload them a total of three pages is required for this work.
Work format: follow the most recent edition of the APA manual (for this course will accept single space). pages student must summarize data and concepts demonstrating the integration of knowledge, according to the following distribution:
Revise and answer according to the rubric included in the work.
Part of scholarly writing involves the ability to synthesize information into succinct and clear writing “making a case” in your written discussion.
Part of scholarly writing involves the ability to synthesize information into succinct and clear writing “making a case” in your written discussion.
Apply the critical thinking to the hypothetical situation
Use the Healthy people 2030 objectives to determine the primary need of the patients and the role of the nursing professional
Identify and use an EBP article related to the main topic
Determine which EBP findings apply to the hypothetical situation
