Nursing Information for Evaluation, Diagnosis, and Treatments

NOTE FOR WRITERS: CLIENT REQUEST OBGYN EXPERIENCE FOR THIS ORDER
Resources
Schuiling, K. D. (2017). Women's gynecologic health (3rd ed.). Jones and Bartlett Learning.
o Chapter 12
o Chapter 15
o Chapter 17
o Chapter 18
o Chapter 19
o Chapter 20
o Chapter 22
Reproductive Health Access Project (2020). Your birth control choices. https://www(dot)reproductiveaccess(dot)org/wp-content/uploads/2014/06/contra_choices.pdf
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Office of Women’s Health: Womenshealth.gov. (2017). Birth control methods. https://www(dot)womenshealth(dot)gov/a-z-topics/birth-control-methods
Clinical Guideline Resources
As you review the following resources, you may want to include a topic in the search area to gather detailed information (e.g., breast cancer screening guidelines; for CDC – zika in pregnancy).
American Cancer Society, Inc. (ACS). (2020). Information and Resources about for Cancer: Breast, Colon, Lung, Prostate, Skin. https://www(dot)cancer(dot)org/
American College of Obstetricians and Gynecologists (ACOG). (2020). https://www(dot)acog(dot)org/
American Nurses Association (ANA). (n.d.). Lead the profession to shape the future of nursing and health care. https://www(dot)nursingworld(dot)org/
Centers for Disease Control and Prevention. (CDC). (n.d.). https://www(dot)cdc(dot)gov/
HealthyPeople 2030. (2020). Healthy People 2030 Framework. https://www(dot)healthypeople(dot)gov/2020/About-Healthy-People/Development-Healthy-People-2030/Framework
The American Association of Nurse Practitioners (AANP). (2020). https://www(dot)aanp(dot)org/
Case Study: Missed Period
PLEASE answer the questions not knowing the update that she is already pregnant.
Juanita Morales is a 47-year-old G5. P5 LC 6, Hispanic female who presents to the office complaining of lower abdominal cramping, and urinary leakage for past day. She states the abdominal cramping, suprapubic, started several hours ago, is sharp, intermittent, and getting more frequent and painful. She tried Motrin but states it did not help. She had a UTI years ago and it was like this, except the incontinence. She has been more tired for the past several months. She relates she stopped getting her period about 8-12 months ago, and relates her menopause was easy. She relates no medical or surgical history. She has no known drug allergies and takes no medications. Social history is negative for alcohol, tobacco, and recreational drugs. Her last exam was several years ago.

Vital signs: temperature 99.1, BP 140/ 82, pulse 88, respirations 12. Height is 5’ and weight 235 lbs. (BMI 45.89). A clean catch urine was obtained, and the urine dipstick showed SG 1.010, trace blood, neg nitrates, neg leukocytes, negative glucose, 3+ protein. She thinks that maybe she had some vaginal spotting several days ago, but nothing since.

Pt relates that she has had some constipation, and increased gas for past several months. She was using NFP for contraception prior to her stopping her period. No other urinary symptoms reported.

Update:

• Limited physical exam shows well developed, well-nourished obese Hispanic female in no apparent distress.
• Breasts: pendulous, bilateral white/yellow nipple discharge noted
• Abd: obese, ? mass in Abd but difficult to assess due to body habitus, otherwise soft and non-tender. Fungal dermatitis under pannus.
• CVA: No cva tenderness.
• VVBSU: WNL, some watery d/c noted, nitrazine positive. Vagina with pink with rugae present. Good pelvic support, no cystocele or rectocele noted.
• Cervix: soft, smooth without CMT, os parous, slightly open
• Uterus: difficult to assess due to body habitus however feels enlarged by bi manual exam.
• Adnexa: not palpated

QUESTIONS:

1. What testing are you considering?
2. What is your differential diagnosis?
Post your primary diagnosis. Include the additional questions you would ask the patient and explain your reasons for asking the additional questions. Then, explain the types of symptoms you would ask for. Be specific and provide examples. (Note: When asking questions, consider sociocultural factors that might influence your question decisions.)
Based on the preemptive diagnosis, explain which treatment options and diagnostic tests you might recommend.
BMP, wnl
CBC 10.2/29.8 wbc 11.1, platelets 220
TSH and prolactin pending
UPT positive
Update:

ULTRASOUND demonstrates single live intrauterine pregnancy at 38 weeks gestation in the vertex presentation. EFW 5’2”. Amniotic fluid appears subjectively decreased.
Juanita has been admitted to the local hospital and diagnosed with premature rupture of the membranes and subsequently went on to deliver a healthy male infant 4 hours later.