NURS 6550 Week 7 Discussion Part I: Assessment and Treatment of the Genitourinary Gynecologic and Renal Systems and Acid/Base Disorders

Common emergency department complaints are vaginal bleeding, and STIs. An understanding of the differential diagnoses that might occur with pregnant and non-pregnant women is important to grasp. Advanced clinical skills that the Acute Care Nurse Practitioner must be familiar with include the auscultation of fetal heart tones, basic fetal heart monitoring, pelvic exams, and delivery of fetal demise or precipitous deliveries of viable fetuses. Pregnancy can alter the diagnostic possibilities of a patient with acute abdominal pain and change the clinical findings. Advanced pregnancy can make it even more difficult.

The Centers for Disease Control and Prevention estimates that there are 19 million new cases of sexually transmitted infections every year in the United States. STIs may present serious health implications for infected patients—especially for those who are unaware of their health condition. Studies show that women are not only at greater risk of contracting these infections, but they also tend to have more severe health problems resulting from infections than men. As an advanced practice nurse, you must educate female patients and emphasize the importance of prevention and STI testing for all women regardless of marital status, race, ethnicity, or socioeconomic status.

Case Study 1: A 19-year-old Asian American female comes into the urgent care clinic. She is complaining of severe abdominal pain, that radiates to her back. She is having a moderate amount of vaginal bleeding. She has a past medical history of PID and has used an IUD in the past. Her vitals are T 37.7, P 116, RR 18, BP 88/50.

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Case Study 2: A 31-year-old African American female is brought into the ER with vaginal hemorrhage. She is unsure of her last menstrual period. States she is sexually active and does not use protection. On exam there are large clots noted in the vaginal vault, with possible tissue. Vital signs are T 37, P 134, RR 26, BP 180/110.

Case Study 3: A 21-year-old nulligravida comes to the ER, concerned about vague lower abdominal pain for two days associated with a yellowish, nonodorous, vaginal discharge. Past history reveals regular menstrual periods and no previous surgeries or significant medical problems. Her last menstrual period was normal and ended two days ago. She had a similar episode about eight months ago for which she did not seek care because of lack of health insurance. She is currently sexually active with one partner and has had two partners in the past year. She is not using any type of contraception. On physical exam you note a temperature of 38º C, a regular pulse of 100, and a BP of 110/65. Her abdomen is diffusely tender in both lower quadrants. Pelvic exam reveals a yellowish cervical discharge with cervical motion tenderness and a tender fullness in both adnexa.

To prepare:

Review and select one of the three provided case studies. Reflect on the patient information.

Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.

Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.

Consider strategies for educating patients on the treatment and management of the gynecological condition you identified as your primary diagnosis.

Post on or before Day 3 an explanation of the differential diagnosis for the patient in the case study you selected. Provide a minimum of three possible diagnoses, and list them from highest priority to lowest priority. Explain which is the most likely diagnosis for the patient and why. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patient.

Read a selection of your colleagues’ responses.

Respond on or before Day 6 to at least two of your colleagues on two different days in both of the ways listed below. Respond to colleagues who selected different case studies than you did.

Based on your personal and/or professional experiences, expand on your colleagues’ postings by providing additional insights or contrasting perspectives.

Week 7 Discussion Part II: Pharmacology

Read the following article to enhance your knowledge of commonly prescribed medications:

Harder, S., & Graff, J. (2013). Novel oral anticoagulants: clinical pharmacology, indications and practical considerations. European Journal Of Clinical Pharmacology, 69(9), 1617-1633. doi:10.1007/s00228-013-1510-z

Stöllberger, C., & Finsterer, J. (2013). Concerns About the Use of New Oral Anticoagulants for Stroke Prevention in Elderly Patients with Atrial Fibrillation. Drugs & Aging, 30(12), 949-958. doi:10.1007/s40266-013-0119-3

Wright, P., & Antoniou, S. (2013). Acute coronary syndrome: potent oral antiplatelets. Nurse Prescribing, 11(8), 397-400.

Lira, A., & Pinsky, M. R. (2014). Choices in fluid type and volume during resuscitation: impact on patient outcomes. Annals Of Intensive Care, 438. doi:10.1186/s13613-014-0038-4 Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4298675/

All of the following groups of medications are commonly prescribed in the acute care setting. Choose one of the topics below to discuss. If it is a medication group, select a specific drug within that group. (This is a good way for you to prepare for clinical practice, because you will get to know the drugs you will prescribe for patients.). Focus your discussion on the hospital or ICU setting and IV usage.

Anticoagulants: rivaroxaban, apixaban, dabigatran,

Antiplatelets: ASA, Clopidogrel, Dipyridamole,

IV insulin,

IV fluids: volume expanders colloids vs saline-

Isotonic,

Hypotonic,

Hypertonic,

Potassium,

Topical anesthetics

sq anesthetics

Note: When sharing your initial post, select a drug that has not yet been discussed. If all drugs have been discussed, then you may select that drug again.

For this Discussion, address 1 of the following options. Post by day 3:

Option 1: Post a description of a patient you have taken care of (inpatient as an RN, or as an NP student) who has been prescribed the medication you selected. Include the scenario, indication, dosing, complications, and outcome. Then explain whether or not you would have ordered the same drug and same dose.

Option 2: Conduct an evidence-based drug search on the drug you selected and post an explanation of any possible issues. Are there any drug interactions? Any black box warnings? To what type of patient would you prescribe this medication?

Option 3: Post an explanation of the properties of the drug you selected, including usages and dosing in the hospital or ICU. Describe a patient to whom you would prescribe this medication.

Note: To be considered as one of your required responses, your pharmacology rationale must include a supporting reference.

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NURS 6550 Week 7 Discussion Part I: Assessment and Treatment of the Genitourinary Gynecologic and Renal Systems and Acid/Base Disorders