Treatment for vaginal infection.

Case Study 1

You are seeing a 19-year-old female patient at a women’s health clinic. Her chief complaint is mild abdominal pain and a malodorous vaginal discharge. The nurse who escorted the patient to the treatment room stops you in the hall to express concern that the patient’s brother insisted on accompanying his sister to the treatment room, and she didn’t seem happy about it. Both the receptionist and nurse believe they have seen the patient in the clinic for treatment of another sexually transmitted infection; another nurse recalls a treatment for vaginal infection. A medical record search under the name given today provides no result. When you enter the room, the man identified as her brother informs you that he is there to translate for his sister.

Case Questions

1. As you enter the treatment room, the patient appears anxious and afraid. Coupled with the concerns expressed by the receptionist and nurse, you suspect domestic violence. What immediate actions can you take to help protect the patient and provide the necessary care?
2. After a brief discussion with the patient about symptoms, you recognize the need to screen for sexually transmitted infections (STIs), and you ask the nurse to prepare materials needed to collect specimens for testing. What are the most common STIs?
3. What physical examinations are indicated for this patient? What findings support the presence of an STI?
4. After your comprehensive assessment, all subjective and objective findings should be considered when developing differential diagnoses for patients presenting with a suspected STI. What may be included on a differential list?
5. You are required to report STIs to the state health department. Along with the diagnosed STI, what other information must you provide?
   Case Study 2

A 68-year-old patient with a history of diabetes presents with weakness and fatigue. The patient appears to be pale, and the skin demonstrates bruising. The patient’s spouse reports that the patient has been acting confused for the last 2 days. The patient has peripheral edema and crackles in the lungs. His blood pressure is 160/86. The patient has a history of neuropathy secondary to the diabetes, and his blood glucose is periodically out of control as revealed by an elevated hemoglobin A1c on previous visits. The practitioner suspects chronic kidney disease due to diabetic nephropathy. Previous lab values, including blood urea nitrogen (BUN), creatinine, and creatinine clearance, have demonstrated minimal alterations from normal.

Case Questions

1. Which laboratory tests should be ordered to evaluate the patient’s suspected kidney disease at this time?
2. What additional diagnostic tests should be completed to evaluate the patient’s condition?
3. What considerations are made in providing care for this patient?
4. What medications should be used to manage hypertension in the patient?
5. What patient education should be provided?