The patient is a 21-year-old female who arrives at the clinic for follow-up with pap smear results from two weeks ago
Subjective:
Chief Complaint: I have a lot of painful red bumps that will not go away.
HPI- The patient is a 21-year-old female who arrives at the clinic for follow-up with pap smear results from two weeks ago, however, started to complain of “painful red bumps all over and points to her genital area” Patient states that she noticed the bumps seven days ago and stated that they are getting worse. She said that she noticed the bumps around her pubis area and started to spread down to her inner and outer labia. The duration of the pain is constant and
rates the pain as a 5 out of 10. The patient describes the pain as burning and throbbing. She states that nothing alleviates the pain, and poppingthe bumps makes it worse. Patient says that
the blisters have spread quickly over the last few days. She denies taking any over the counter medication or attempted any treatments for her symptoms. Patient states that she has only been with one partner who she has been”on and off” with and does not use any condoms.
PMH- patient denies any previous surgical problems, medical problems, or taking any
medications or over the counter medications. Denies any allergies. All childhood inmunizations are up to date, fu shot received last years Mirado/, etanus injection
Sert 2018
received March (2016. Preventative health maintenance: last pap smear was lastweek
7/5/2023
054AlAA20, healthy diet, annual vision screening, annual dental screening, and practice safe
sex.
3.4
GYN HX: patient states that she has regular monthly menses g 28 days, duration & days,light
06/29/23
flow. Her first menarche was at age 10. GOPO. LMP: 06/012020. Patient had IC since last menstrual period and her BCM is condoms only.
FAMILY HX: no family history of cancers SOCIAL HX: patient is currently a college student studying for child development to become a
teacher. She currently lives in a dorm on campus and her family visits often. She has a group of
close friends that she can express her feelings to. She is in a “on andoff” relationship with one
partner for the last two years who she has IC with. Patient denies IPV and is satisfied with her
relationship, until now. Patient states that she maintains a healthy diet and tries to do daily
exercise to stay healthy. She denies any substance abuse or smoking, however she drinks
occasionally with friends
Review of Systems (ROS):
• General: denies fevers, chills, recent weight loss, fatigue, changes in sleep
• Respiratory: denies SOB or cough, chest pain with cough, hemoptysis, wheezing
• Cardiovascular: denies chest pain or pressure, murmurs, gallops, palpitations, or
sleepapnea
• Integumentary: denies any rashes, redness, lesions, or itching in the body other
thangenital area.
• Genitourinary: denies urinary frequency, incontinence, nocturia, burning, or
odor. Admits to painful itchy, red, bumps in genital area.
Objectives
103
1825
• Height: 5°3 tall, Weight: MOB Ibs, BMI: 1978
11070
981
gO
100
• VS as follows: BP»10956, Temp: 986 degrees Fahrenheit, P: 89, RR: 18, 02:1099% RA
• General- AAO×4 with mild distress and worrisome, calm, interactive, answers
questionappropriately, and is appropriately dressed for the weather.
• Respiratory- 18 bpm, clear lung fields bilaterally, (-) rhonchi (-) wheezing, (-) chest
walltenderness, (-) SOB
• Cardiovascular- (+) SIS2, RRR w/o splitting, (-) JVD, (-) S354, (-) Murmurs
• Integumentary: intact except for genital, no rashes, lesions, redness, or swelling.
• Genitourinary: external genitalia: no urethral swelling or discharge. Noted small
clustered fluid filled vesicles, scattered, various stages of healing with scabs,
redness, warm and painful to touch.
• Results: Patient’s GC/Chlamydia urine NAAT result is negative from last week and
HIVand syphilis blood test is negative.
Assessment Differential:
1. Chancroid: Although the prevalence of chancroid has declined in the United States, it is still
possible to get the infection. Chancroid is a sexually transmitted disease caused by the bacteria
Haemophilus ducreyi (Centers for Disease Control and Prevention [CDC], 2015). This type of bacteria causes painful genital ulcers and swollen inguinal lymph nodes. Pertinent positives: had unprotected intercourse and painful bumps in the genital area. Pertinent negatives: no signs of swollen inguinal lymph nodes and red bumps are clustered fluid-filled vesicles instead of ulcers.
2. Syphilis: Syphilis is also a sexually transmitted disease caused by the bacteria Treponema
pallidum. This infection comes in different stages, such as primary, secondary, latent, and tertiary syphilis. In the primary stage of syphilis, the infected individual may or may not develop a painless ulcer in the genital, mouth, or anus. A body rash, fever, and swollen lymph nodes can
develop in the second stage of infection. In the latent stage, there are no signs or symptoms; however, without treatment, it can advance to the tertiary stage where it will damage internal organs such as the brain, heart, and other organs (CDC, 2017). Pertinent positive: had unprotected intercourse and bumps in the genital area. Pertinent negative: painful bumps and red bumps are clustered fluid-filled vesicles instead of ulcers. 3.Lymphogranuloma venereum (LGV): LGV is a sexually transmitted infection caused by Chlamydia trachomatis. LGV is a chronic infection that affects the lymphatic system. Those who
met the bacteria develop inguinal lymph nodes drainage, painless sores, redness in the genital area, swelling lymph nodes, or blood or pus in the stool in few days to a month. Pertinent
positive: painful bumps in genital. Pertinent negatives: no swelling or draining from inguinal
lymph nodes and no blood in the stool.
Diagnosis
Herpes viral infection of genitalia and urogenital tract: Genital herpes is a viral, sexually transmitted disease. The most contagious stage of the virus is when the fluid from the sores breaks and enters the body through the mucus membrane. Once the virus enters the body, it
implants itself in the nerve cells of the pelvis, where it stays dormant until there is an outbreak
(CDC, 2017). When an outbreak occurs, there will be one or more genital sores that are painful.
The sores will multiply, and pain will persist until medication shortens the duration. The sores
are cluster fluid-filled blisters that occur on different days and is normal to see the blisters at
various stages of healing. Pertinent positive: unprotected intercourse, painful red bumps with
classic fluid-filled vesicles clustered in different areas of the genital, and patient states that it occurred seven days ago, and it will not go away. Pertinent negative: one been with one partner.
Plan
• D× Plan: None needed, diagnosed by physical symptoms and classic clinical presentation.
• Tx plan: Acyclovir 400 mg three times a day for 10 days (Hollier, 2018).
• Patient education: Including specific medication teaching points, behaviors, specific
to diagnosis/EGA/subjective complaint:
I. Complete the full course of acyclovir. Monitor for hallucination, delirium, or
abnormal behaviors. Common side effects of acyclovir medication are nausea,
diarrhea, headache, or vomiting may occur (Woo, 2018).
• 2. Take Ibuprofen medication with food to decrease stomach upset. Do not take
medication if there is an allergic reaction, severe kidney disease, or noticed any
bleeding (Woo, 2016).
3. Drink plenty of water to stay hydrated, rest, fluid in the vesicles is highly contagious, do not pop blisters, and do not have intercourse until all blisters are healed. Non-
pharmacological management is over-the-counter colloidal oatmeal baths to reduce
itchiness or a sitz bath.
4. It is essential to educate the patient about the nature of genital herpes, signs, and
symptoms of when an outbreak is going to occur (prodromal symptoms), it is a sexuallytransmitted disease, use condoms during intercourse, avoid triggers for
recurrent infection, avoidsexual contact during symptomatic periods and 48 hours
after symptoms resolve, and during asymptomatic shedding, the virus can be
transmitted.
• Referral/follow-up: follow-up in one week to ensure that vesicles are improving. If
symptoms are worse, return to clinic. Referral to counseling or support groups for
genitalherpes.
• Health maintenance:
• Pap smear due 2023
• Tetanus due in 2026
• Annual physical and health screening 2022
Reference
Centers for Disease Control and Prevention. (2015). Chancroid.
https://www.cdc.gov/std/tg2015/chancroid.htm
Centers for Disease Control and Prevention. (2017). Genital herpes – CDC fact sheet.
https://www.cdc.gov/std/herpes/stdfact-herpes.htm
Centers for Disease Control and Prevention. (2017). Syphilis – CDC fact sheet.
https://www.cdc.gov/std/syphilis/stdfact-syphilis.htm
Hollier, A. (2018). Clinical guidelines in primary care. Scott, LA: Advanced Practice
Education Associates.
U.S. Preventive Services Task Force. (n.d.). Search for recommendations. Retrieved
from https://epss.ahrq.gov/ePSS/GetResults.do?method-search
Woo, T. M., Robinson, M. V. (2016). Pharmacotherapeutics For Advanced Practice
Nurse Prescribers. [VitalSource Bookshelf].
https://online.vitalsource.com/#/books/9780803658110/
Pls use references less than 5 years. I will include the rubric to follow. Thank you
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