The Biological Basis for Disease in Adults and Children

Responses to classmates must consist of at least 350 words (not including the greeting and the references), do NOT repeat the same thing your classmate is saying, try to add something of value like a resource, educational information to give to patients, possible bad outcomes associated with the medicines discussed in the case, try to include a sample case you've seen at work and discuss how you feel about how that case was handled. Try to use supportive information such as current Tx guidelines, current research related to the treatment, anything that will enhance learning in the online classroom. February 25, 2020 4:15 p.m. 123 MainStreet, Any Town USA (212)777-9999 DOB:05/20/1997 C.P.is a 22-year-old Hispanic female seeking medical attention for “pelvic pain”. Chief Complaint: “I have very bad pain, with discharge and a smelly odor and I also missed my period last month”. “I can’t even have sex”. History of Present Illness: Onset: 7 days ago Location: Across pelvis under the umbilicus Duration: Constant pain; progressively worse the past 2 days. Vaginal discharge for 7 days. Characteristics: Dysmenorrhea in the prior 4 cycles; dyspareunia; vaginal discharge has a foul odor. Aggravating Factors: Constipation, intercourse, tight binding clothing. Relieving Factors: Analgesics, increase in bowel movements, abstinence. Treatments: Ibuprofen 400 mg every 6-8 hours; Monistat 1-day yeast treatment, Dulcolax 2 tablets at bedtime. Past Medical History: The patient denies any history of childhood diseases, accidents, injuries or hospitalizations. Past Surgical History: Denies any history of surgeries or medical procedures. Obstetric History: She is nulliparous and denies any miscarriages or termination of pregnancies. Family History: Older sister with a history of Endometriosis and has not been able to conceive. No other contributory history for the present chief complaint. Social History: Lives with her 28-year-old boyfriend for the last two years in a one-bedroom apartment. It has heat, refrigerator, and a stove and is "comfortable. She is employed as a teacher’s assistant in a grade school for the past year and describes a relationship as "stable". Denies any physical abuse or domestic violence. Denies any use of alcohol, tobacco, illicit or prescription drugs but does consume caffeine on occasion. Denies any body-piercings and tattoos. Presently on oral contraceptive pills but does not use condoms. History of one previous sexual partner and unprotected intercourse. Medications: Presently taking Ibuprofen 400 mg every 6-8 hours for pain, Microgestin FE 1/20 mg daily, one therapy of Monistat 1-day yeast treatment. Denies any other use of prescription or over the counter medications, herbal supplements or vitamins. Allergies: Denies any allergies to foods, medications, tints or dyes. Review of Systems . Constitutional: Denies any fever, chills, lethargy, weight loss or gain, and weakness. The patient states she has been experiencing general body discomfort. Onset: 7 days ago Location: Abdomen and pelvis Duration: Constant pain; progressively worse the past 2 days. Characteristics: Cramping and bloating. Aggravating Factors: Constipation, intercourse, tight binding clothing. Relieving Factors: Analgesics, increase in bowel movements, abstinence. Treatments: Ibuprofen 400 mg every 6-8 hours; Dulcolax 2 tablets at bedtime. Eyes: Denies any vision loss or change, pain, double vision, redness, glasses or contacts, glaucoma, or cataracts. The last eye exam was one year ago. ENT: Ears: Denies any hearing changes, ringing in the ears, dizziness, discharge or pain. Nose: Denies any runny nose, congestion allergies or sinus pain. Throat: Denies sore throat, voice changes, hoarseness, mouth sores, dental implants, loose teeth or removable bridges. The last dental examination was six months ago. Cardiovascular: Denies any chest pain, tightness, palpitations, discomfort, racing heart, shortness of breath with and without activity, difficulty breathing while lying down, swelling, sudden awakening from sleep from shortness of breath, high blood pressure, high cholesterol, heart attack or leg cramping. Respiratory: Denies any shortness of breath, coughing, sputum, coughing up blood, painful breathing, or wheezing. Gastrointestinal: Denies any problem in swallowing, indigestion, heartburn, change in appetite, nausea, vomiting, or diarrhea; patient states she has constipation (colonoscopy not applicable because of age and lack of indication), or bloody stools. Onset: 7 days ago Location: Abdomen and pelvis. Duration: pain occurs when no bowel movement for more than one day. Progressively worst the past 2 days. Characteristics: Painful cramping and difficulty moving bowels. Aggravating Factors: Constipation, pelvic pain. Relieving Factors: Increase in bowel movements. Use of laxatives. Treatments: Dulcolax 2 tablets at bedtime. Female Genitourinary: The patient states that she has pelvic pain, mal-odorous vaginal discharge but denies itching. Painful menses progressively getting worst and dyspareunia. Onset: 7 days ago Location: Across pelvis under the umbilicus Duration: Constant pain; progressively worse the past 2 days. Vaginal discharge for 7 days. Characteristics: Dysmenorrhea in the prior 4 cycles; dyspareunia; yellowish vaginal discharge with a foul odor. Aggravating Factors: Constipation, intercourse, tight binding clothing. Relieving Factors: Analgesics, increase in bowel movements, abstinence. Treatments: Ibuprofen 400 mg every 6-8 hours; Monistat 1-day yeast treatment, Dulcolax 2 tablets at bedtime. Denies any dark concentrated urine or bloody urine. Denies having intercourse since the start of the symptoms and last menses was January 6, 2020. On oral contraceptive pills, denies use of condoms; Denies any pregnancies, spontaneous losses or termination of pregnancies. Musculoskeletal: Denies any muscle or joint pain, back pain, swelling or redness of joints, stiffness injuries or any joint replacement surgeries. Integumentary System: Denies any breast pain, skin lesions, rashes, lumps, itching, hair or nail changes, or changing or new moles, Neurological: Denies headaches, head injury, dizziness, fainting, seizures, tingling, numbness, tremors, memory loss balance problems or falls. Psychiatric: Denies depression, decreased need for sleep, diminished interest in activities, feelings of hopelessness, suicidal or homicidal tendencies. The patient states are worried that she will not be able to conceive. Background: Fears that she has Endometriosis like her sister and not be able to conceive. Affect: Unsure of what will happen to her relationship if she is not able to give him a child. Trouble: Concerned about reproductive ability and how the partner will react if unable to conceive. Condition is limiting sexual contact and does not want to drive him away. Handling: Encouraged partner to accompany her to the visit and is seeking possible treatment options if diagnosed with Endometriosis. Empathy: Acknowledged that it is difficult for her to deal with the possible diagnosis and that further testing can give a true picture of her condition. Endocrine: Denies any heat or cold intolerance, unexplained weight loss or gain, excessive thirst or hunger or sweating. Hematologic/Lymphatic: Denies any excessive or easy bruising, bleeding, anemia, blood disease, cancer, enlarged lymph nodes or glands or blood transfusions. Allergic/Immunologic: Denies any medication or environmental allergies, hay fever, hives, eczema, psoriasis rheumatoid arthritis, lupus or any other autoimmune diseases. Physical Examination Vital Signs: Weight is 135 lbs; height 5ft-1in; BMI 25.5; pulse 74bpm; respirations 20; blood pressure 113/73; and temperature 99.1. General survey: Age appears as stated and sexual development appears to be appropriate for gender. Maintains eye contact and responses are appropriate to the situation. The patient is alert, oriented, and cooperative. Speech is clear and understandable and responds appropriately. Dressed appropriately for age, body size, occupation, and socioeconomic status. Her appearance is neat, clean and well-groomed. Noticeably uncomfortable lightly stroking lower abdomen. Skin tone is even, bilaterally paired body parts and facial features are symmetrical. Constitutional: Alert and oriented to time, place, and person, well-nourished, well developed, overweight. Neck: Inspected and palpated; symmetrical; no lymphadenopathy; neck is supple; no masses; thyroid midline, no nodules or enlargement; full ROM. Chest: Inspected, percussed, palpated, and auscultated. Symmetrical; tactile fremitus present; no crepitus, lumps, masses or skin lesions; breath sounds present. Breasts: Inspected and palpated; symmetrical no nipple retractions, no nipple discharge, no tenderness, no masses or lumps; no skin lesions; even contour, consistency, no lymphadenopathy Respiratory: Inspected, palpated auscultated; lungs clear; no wheezing, crackles, rales, or rhonchi in any of the lobes; effortless respirations; symmetric expansion; skin free of pallor, lips, and nails free of cyanosis. Cardiac: Auscultated; Heart S1 & S2 sounds heard, no extra heart sounds heard; no murmurs, thrills, heaves or abnormal pulsations. Abdomen/Gastrointestinal: Inspected, palpated, percussed and auscultated; symmetrical no masses; no distention; tympanic; tenderness in the lower right and left quadrants and around umbilicus upon palpation; tenderness over the bladder; no abnormal densities; bowel sounds present. No organomegaly, lesions or scars. Genitourinary: Palpation, inspection; tenderness over the bladder; inspection and palpation of the vagina; inspection of genitalia for lesions, discharge; a vaginal examination to assess for vaginal lacerations, masses, uterine enlargement, uterine prolapse, and enlarged adnexa (Jarvis, 2020). Specimens for pap smear and cultures are to be obtained at this time. Anus to be assessed for fissures, lesions, hemorrhoids; rectum to be assessed for masses or tenderness; Hematest to be performed at this time. Psychiatric: Verbal and visual assessment; alert, oriented times three; no apparent issues with judgment; affect appropriate, cooperative; demonstrating anxiety. Possible Diagnosis The possible diagnosis of Endometriosis is supported by the history of constipation, pelvic pain, dyspareunia, amenorrhea, and dysmenorrhea (Jarvis, 2020). Genetic predisposition may also contribute to the possibility of Endometriosis (McCance & Huether, 2019). Gold Standard Diagnostic Study for Confirmation The diagnostic test of choice for Endometriosis is a Laparoscopy allowing for the diagnosis of fibroids, adhesions, cysts, malignancies, infections, and inflammatory processes associated with pelvic pain. It allows for visualization of the ovaries, uterus and fallopian tubes. Biopsies and the release of adhesions may also be done as well as laser treatments for Endometriosis (Fischbach & Fischbach, 2019). References Fischbach, F.T. & Fischbach, M.A. (2018). A Manual of Laboratory and Diagnostic Tests. Philadelphia, PA: Wolters Kluwer. Jarvis, C. (2020). Physical Examination & Health Assessment. St. Louis: Elsevier. McCance K.; Huether, S. (2019). Pathophysiology; The Biological Basis for Disease in Adults and Children. St. Louis: Elsevier. Read: Medical Condition During Pregnancy  

ANSWER. PAPER DETAILS
Academic Level	Masters
Subject Area	Nursing
Paper Type	Admission - Application Essay
Number of Pages	1 Page(s)/275 words
Sources	0
Format	APA
Spacing	Double Spacing

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