Case StudyÂ Sexually Transmitted Infections
Setting:Â Outpatient clinic
Index Words:Â sexually transmitted infection (STI), pelvic inflammatory disease (PID), human immunodeficiency virus (HIV), assessment, pain management, patient education
Giddens Concepts:Â Health Care Law, Infection, Patient Education, Reproduction, Sexuality
HESI Concepts:Â assessment, Health Care Law, Infection, Patient Education, Sexuality/Reproductive
You are the nurse in a walk-in clinic. A.P. is being seen this morning for a 2-day history of diffuse, severe abdominal pain. She has complaints of nausea without vomiting; she denies vaginal bleeding or dis- charge. A.P. reports having unprotected sex with several partners recently, two of whom had penile dis- charge. Her last menstrual period ended 3 days ago. She has no known drug allergies and denies previous medical or psychiatric problems. Vital signs are 108/60, 110, 20, 100.6 Â° F (38.1 Â° C). Physical examination reveals that her abdomen is very tender. The slightest touch of her abdomen causes her to wince with pain. Bowel sounds are normal. Pelvic examination reveals purulent material pooled in the vaginal vault, which appears to be coming from the cervix. a sample of the vaginal drainage is obtained and sent for culture. The result of a pregnancy test is negative; a rapid diagnostic test for chlamydial infection has a positive result.
Part 2 Pediatric, Maternity, and WoMenâ€™s HealtH cases
Copyright Â© 2016 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
The physician has the option of treating A.P. by one of two different methods. First, the physician could prescribe treatment over a period of 1 week. A.P. would be given the first dose of doxycycline (Monodox) 100 mg PO, and then she would be prescribed the same dose to be taken PO bid for 7 days. Second, the physician could prescribe a one-time dose of azithromycin (Zithromax) 1 g PO, which could be adminis- tered in the clinic.
A.P. returns to the clinic in 1 week for her HIV test results, which are negative. Her culture results confirm the diagnosis of chlamydial infection.
14. A.P. has completed the course of antibiotic therapy and is no longer experiencing any symptoms. After counseling her on ways to reduce her risk of acquiring another STI, you determine that A.P. understood your teaching regarding safe sexual practices if she states that she will do which of the following? Select all that apply.
a. Use a new application of spermicidal jelly before each sexual encounter
b. Not worry about contacting an STI if the man states he has few partners
c. Have her partner and her both wear a new condom with each sexual encounter
d. Douche with an over-the-counter solution within 4 hours of having intercourse
e. Inspect the genitalia of her partner before intercourse or other contact with perianal area
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