Assignment Task:
You should respond to both case studies separately--with constructive literature material- extending, refuting/correcting, or adding additional nuance to their posts.
Minimum 150 words each reply with references under each reply.
Incorporate a minimum of 2 current (published within the last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work. Journal articles should be referenced according to the current APA style (the online library has an abbreviated version of the APA Manual).
Case study 1:
Female Genitourinary, & Musculoskeletal
A 19-year-old female presents with a history of painful genital sores, dyspareunia, and dysuria, accompanied by yellowish vaginal discharge and inguinal lymphadenopathy for the past 3 months. The patient is also presenting a low-grade fever and pelvic tenderness on exam, are suspicious of sexually transmitted infections (STIs) or other gynecological conditions. This case requires a complete assessment that includes a detailed sexual history, focused physical examination, and appropriate diagnostic testing to identify the underlying etiology. Need Assignment Help?
Additional Subjective Data:
Additional subjective information gathered from this patient would be beneficial to further evaluate this patient. One aspect can include the number of partners, intercourse frequency, history of STI (both patient and partner) and consistent use of condoms. Another aspect to consider is recent use of antibiotics since they can predispose to infections such as candidiasis. Also, inquiring about constitutional symptoms like fever, fatigue or joint that could help identify other conditions such gonorrhea or reactive arthritis. Finally, including the patient's menstrual history (that includes changes in cycle, regularity and flow) can help the practitioner rule out hormonal influence or pelvic inflammatory disease (PID).
Additional Objective Findings:
To have a complete clinical picture of this patient, additional objective information can be gathered by the advanced practitioner. A complete skin assessment can be important to establish the presence of vesicles, pustules or warts that can be suggestive of herpes simplex virus (HSV) or human papilloma virus (HPV) (Jarvis, 2019). A cervical examination with speculum to assess cervix friability, mucopurulent discharge or cervical motion tenderness indicative of PID. Also, a wet mount and potassium hydroxide (KOH) prep of the vaginal discharge should be performed to rule out other vaginal infections. Finally, a thorough palpation of other lymph node groups should be performed due to the presence of inguinal lymphadenopathy to assess for systemic infection.
Diagnostic Exams:
To confirm the patient's underlying cause of symptoms, the advanced practitioners must order several diagnostic tests. A nucleic acid amplification test (NAAT) for Chlamydia trachomatis and Neisseria gonorrhoeae should be performed due to the greenish discharge and pelvic tenderness, which are concerning for these infections. Given the presence of genital lesions, a herpes simplex virus (HSV) PCR swab should be obtained (Dunphy et al., 2022). Also, a rapid plasma reagin (RPR) or treponemal test for syphilis should also be ordered, as syphilis can present. A wet mount and vaginal pH test can help identify bacterial vaginosis or trichomoniasis. Lastly, a urine pregnancy test should be performed to rule out pregnancy-related complications.
Differential Diagnoses:
1. Genital Herpes (HSV-2) - The presence of multiple painful ulcerations with inguinal lymphadenopathy is highly suggestive of HSV. Recurrent outbreaks and viral shedding support this diagnosis.
2. Chlamydia or Gonorrhea Infection - The greenish discharge, dysuria, and pelvic tenderness raise concern for these bacterial STIs, which can lead to PID if untreated.
3. Syphilis (Primary or Secondary) - Although the patient's ulcers are painful (unlike the classic painless chancre of syphilis), secondary syphilis can present with condyloma lata and systemic symptoms such as fever.
Patient Teachings:
Due to the patient's history and symptoms, education should focus on safe sex practices to prevent STI such as the consistent use of barrier methods even with a steady partner. Information about the chronicity of HSV and the importance of antiviral therapy if the diagnosis is confirmed. If the diagnostic test confirms an STI, the partner must be also treated to prevent reinfection. Also, the patient should be advised to consistently follow-up with the provider for test results and return if symptoms worsen (increased pelvic pain or fever) which could be indicative of disease progression.
Case study 2:
Female Genitourinary, & Musculoskeletal
Additional subjective data
I would also ask the patient further about his back issue, including whether he has experienced a similar issue in the past and how the previous episodes were managed. I would ask him to provide me with additional information about the phases of discomfort he is experiencing, including if the pain started right away when lifting or if it developed a few hours after the work was completed. Additionally, he should be questioned about the frequency and intensity of his discomfort, whether it varies throughout the day, and what activities make it worse or better. I would look into his past employment history and any strain or injuries he may have had while working as a painter. Furthermore, more details regarding his overall level of activity, his exercise regimen, and the potential existence of comorbidities like obesity or a history of musculoskeletal issues must be obtained (Markman et al., 2020).
Additional Objective Data
I would also conduct a neurological test as part of the physical examination to evaluate motor loss of power, altered sensation, and diminished muscle reaction in the lower limbs as a result of pressure on the nerve roots. Additionally, I would perform certain tests, such as the straight leg raising test, which would reveal signs of radicular pain and, consequently, a herniated disc. Additionally, by palpating the paraspinal muscles, evaluating range of motion in multiple vectors, and looking for any notable edema, a methodical physical examination of the back area, particularly the lumbar region, may indicate pain or spasm (Markman et al., 2020). Dynamic assessment, which involves watching the patient walk and evaluating his balance, may reveal compensatory mechanisms that are not visible from palpation and general examination.
Diagnostic exams
I would look into imaging to see if the pain gets worse or if any warning signs appear, as the diagnosis of acute low back pain might be clinical. A lumbar spine X-ray is used in the initial examination to rule out any fractures, spinal deviations, or degenerative alterations. When disc herniation is suspected due to radicular pain, magnetic resonance imaging (MRI) is the best imaging modality for soft tissue evaluation. To rule out infection or inflammation as the cause of the itching, additional blood tests such as CBC, ESR, and CRP may be conducted in situations where these conditions are plausible (See et al., 2021).
Differential Diagnosis
- Acute lumbar strain/sprain
- Lumbar disc herniation
- Facet joint syndrome
Rationales
The most common result of heavy lifting is lumbar strain or sprain, which is characterized by strong, localized pain at the injury site, tenderness in the muscles, and restricted movement. The patient's pain symptomatically radiates down the right lower extremity, which raises the possibility that the patient may have compressed a nerve root despite the patient's current lack of neurological symptoms. This helps determine the order of lumbar disc herniation (Ferdinandov et al., 2024). Also, facet joint syndrome may be one of the major diagnostic issues because it is characterized by localized pain and limited spinal extension. The syndrome arises from irritation or injury of the minimal articular joint in the spinal case following a mechanical stress event (Ferdinandov et al., 2024).
Teachings
A patient's recuperation and the avoidance of additional injuries depend on patient education. He cannot be moved; thus, in order to avoid re-injury, I would teach him safe body mechanics and lifting techniques. Particular attention would be given to the schedule that alternates the day between rest and progressive active mobilization, such as stretching and strengthening exercises, which are frequently started with the assistance of a physical therapy program. I would also discuss with him the risks of becoming overly dependent on painkillers and how to take NSAIDs (Zhou et al., 2024).