NURS664B Week 2 | Nursing in Health Care - Westcoast university

NURS664B Primary Care Women's Health Theory Week 2 Discussion Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example, #2 a post-menopausal 57-year old woman. Discuss what questions you would ask the patient, what physical exam elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals, and other team members needed to complete patient care. Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas. Please refer to evidence-based guidelines to support your decision-making. In your peer replies, please reply to at least one peer who chose a different case study.

1. A 19-year-old female comes to your clinic complaining of severe menstrual pain that is usually worse just prior to and during the first two days of her menses. The pain is sometimes so severe that she has fainted. She states that defecation can cause severe pain and she therefore frequently becomes constipated. She often must miss work when experiencing the severe pain. Her periods are heavy and last seven days with a tapering of the bleeding from days 3 to 7. Her BMI is 23.9 and her VS are all WNL. She is G0 P0.

What additional history do you need to ask this patient? What are your differential and presumptive diagnoses? How will you manage this patient, and why?

1. A 35-year-old African American female comes to the clinic complaining of pelvic pain that started as intermittent, but now is almost constant. She also complains of irregular vaginal bleeding/spotting that has occurred in between her monthly menses for the last six months. She has no family history of breast or ovarian cancer. Her vital signs (VS) and BMI are all within normal limits (WNL), but upon physical examination, you palpate a firm, raised area on her uterus. You note no cervical motion tenderness (CMT), no adnexal tenderness (AT), and no other abnormalities. She is G2 P2 with both normal spontaneous vaginal deliveries (NSVD) 10 and 8 years ago.

What are your differential and presumptive diagnoses? Explain the pathophysiology of your presumptive diagnosis. What test(s) will you order to confirm the diagnosis? What is your plan of care for this patient?

1. A 20-year-old nulliparous female presents to student health with complaints of chronic pelvic pain. She shares that she has always had painful periods. She has taken OCs in the past to help with the pain but stopped secondary to side effects of weight gain. She adds that she only has sex with females and does not need birth control. Her LNMP was 2 weeks ago. Her pelvic exam reveals uterosacral nodularity. Abdominal exam is negative. Height 5'7", weight 120, and BP 132/78.

What additional history do you need from this patient? What is your differential diagnosis? What laboratory tests do you need and why? What is your plan of care?