NURS 6512 Advanced Health Assessment Paper

NURS 6512 Advanced Health Assessment Paper

Advanced Health Assessment

Human papillomavirus (HPV) is one of the most common sexually transmitted infections among late teens and young adults. In the year 2018, approximately 43 million cases of HPV were reported in the United States. Studies show that there are over 100 varieties of HPV (Breznik et al., 2020). Routine screening is recommended among sexually active individuals for early detection of the infection and treatment. The diagnosis of the disorder involves pap tests, DNA tests, and acetic acid solution tests. There is no cure for the disease. However, individuals can benefit from treatment options available for symptomatic relief. The purpose of the paper is to demonstrate the assessment and diagnosis of a 21-year-old female patient with a chief complaint of bumps on her bottoms, and medical history of chlamydia, which was diagnosed about two years before the present visit.

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Subjective Data

Based on the provided subjective data, the patient has provided limited information concerning her chief complaint and associated symptoms. She states that she is not aware of the onset of the bumps on her bottom. She, however, has multiple sex partners and has a history of Chlamydia. However, some information crucial for diagnosis is missing. For starters, she should be able to provide additional symptoms and relate the current symptoms to the previous chlamydia diagnosis. She should mention the character of the bumps, and whether they have extended to other body parts. Consequently, she should be able to state whether the bumps are increasing in number or changing in size, and what factors lead to such changes. She should also state whether she has been taking any medication for her present condition (Barrow et al., 2020). Her sexual history is also quite limited, missing information such as the exact number of sexual partners and whether she uses protection and birth control pills.

Objective Data

The objective portion is expected to focus mainly on examinations that will contribute to further evaluation of the patient’s chief complaint. The patient’s vital signs have been clearly outlined together with heart, lungs, genital, and abdominal examination. Additionally, the general evaluation of the patient is necessary to assess whether the patient might be having additional symptoms such as fatigue, weight changes, and sleeping problems. Given that HPV can lead to different types of cancer, it was necessary to examine the patient’s breasts for lumps, abnormalities, and tenderness (O’Byrne & Orser, 2019). The genitourinary examination is also necessary for assessing the patient menstrual trends, such as whether it’s regular. Additional information such as painful sex, or vaginal bleeding will also help rule out other STIs. Lastly, for diagnosis, only the HSV specimen was obtained. However, additional tests such as urinalysis for UTI, chlamydia, and gonorrhea, scraping test for spirochetes, the acetic acid test for HPV lesion, and Tzanck smear test for herpes virus must have been ordered.

Assessment

            The assessment is not fully supported by both subjective and objective data. For instance, the chancre is a painless genital ulcer that normally presents during the primary stage of syphilis. As such, the subjective data of the patient should have been focused on evaluating whether the patient is presenting with other symptoms of syphilis. However, the patient only mentioned bumps, multiple sexual partners, and history of chlamydia. The assessment would have been further supported by the subjective data if the patient had described the characteristics of the named bumps as round and firm, and not just painless. The objective portion is even far much worse in supporting this assessment as the examination of the genitalia revealed no masses or swelling (Lindley et al., 2020). Additionally, no tests were ordered for the assessment of syphilis or chancre. Generally, the subjective and objective data do not support the assessment for chancre.

Diagnostics

            The information provided on both the subjective and objective portion of the patient history is quite limited for making a diagnosis. As such, several diagnostics must be ordered to avoid instances of misdiagnosis. Starting with the lab tests, HSV Specimen for Viral Culture, lesion test, takes up to 7 days but will help in ruling out herpes simplex viral infection. Tzanck smear tests will also help in ruling out the herpes virus. Nucleic acid amplification tests (NAATs) should be ordered for diagnosis of chlamydia and gonorrhea (Caruso et al., 2021). Pelvic examination, with KOH wet mount and pH litmus of vaginal discharge, will help evaluate the presence of other bacterial or fungal infections. An acetic Acid Test is also necessary for detecting subclinical lesions from HPV Scraping to assess for diagnosis of spirochetes. A positive EIA test must also be confirmed with either the VDRL or RPR tests, before making a diagnosis of syphilis. Lastly, imaging such as pelvic x-ray and mammogram are also necessary for assessment of any abnormal growths to rule out cervical and breast cancer among others.

The current diagnosis for Chancre is inappropriate. For instance, several diagnostic tests supporting this diagnosis were not ordered. Consequently, the patient’s subjective data points towards a different diagnosis, of HPV, as the patient’s symptoms do not qualify for a diagnosis of chancre (Lindley et al., 2020). The objective data also reveals no lumps on the genital area with no signs of syphilis, which are the main diagnostic requirements for chancre.

Differential Diagnosis

            Based on the provided patient history, the three main differential diagnoses are anal warts, molluscum contagiosum, and Herpes simplex II. Genital warts are the growth of tissues that result from sexually transmitted infections such as HPV. The anal warts are usually small, about 5 mm but can grow with time and even spread to the anal opening (Kleinsorge &Schmidmayr, 2018). Anal warts normally occur without pain or discomfort at first, just like the patient in the provided case study. However, with time, they can be itchy, with bleeding leading to discharge from the anus. Molluscum contagiosum on the other hand is a viral-like infection that leads to lesions called papules on the skin. The papules are normally firm smooth and domed. They are transmitted through sexual intercourse, as the lesions normally develop on the upper thighs, bottom, lower stomach, and genital region (Lindley et al., 2020). The last differential diagnosis, herpes simplex II, is less likely as the lesions are normally painful and accompanied by several other symptoms such as abnormal discharge and burning urination. However, HSV is a common sexually transmitted infection among the youth and young adults who are sexually active.

Conclusion

            The provided case study demonstrates a young female adult with a sexually transmitted infection. However, additional subjective and objective data is required to determine the patient’s primary diagnosis for the development of an appropriate care plan. For instance, based on the provided information the patient would have been misdiagnosed with chancre, whereas she actually presents with signs of anal warts.

References

Barrow, R. Y., Ahmed, F., Bolan, G. A., & Workowski, K. A. (2020). Recommendations for providing quality sexually transmitted diseases clinical services, 2020. MMWR Recommendations and Reports, 68(5), 1.DOI: 10.15585/mmwr.rr6805a1

 

Caruso, G., Giammanco, A., Virruso, R., & Fasciana, T. (2021). Current and Future Trends in the Laboratory Diagnosis of Sexually Transmitted Infections. International Journal of Environmental Research and Public Health, 18(3), 1038. https://doi.org/10.3390/ijerph18031038

Kleinsorge, F., &Schmidmayr, M. (2018). HPV infection in women: Diagnostics, treatment and the relevance of vaccination. Der Urologe. Ausg. A, 57(12), 1445-1451.DOI: 10.1007/s00120-018-0795-z

Lindley, L. L., Sharif, A. I. M., & Chowdhury, T. (2020). College students’ comfort with and intention to use self-collection services for STI testing. Journal of American College Health, 1-10.DOI: 10.1080/07448481.2020.1820511

O’Byrne, P., & Orser, L. (2019). Express testing for sexually transmitted infections: clinical results. Journal of Research in Nursing, 24(7), 541-547.https://doi.org/10.1177/1744987119843152

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Week 10 assignment , Walden University 6512N Advanced Health Assessment .

Week 10
Posted on: Sunday, January 30, 2022 10:13:50 AM EST

Hello class,

Welcome to Week 10

Please find this weeks case study assignment.

GENITALIA ASSESSMENT

Subjective:

• CC: “I have bumps on my bottom that I want to have checked out.”

• HPI: AB, a 21-year-old WF college student reports to your clinic with external bumps on her genital area. She states the bumps are painless and feel rough. She states she is sexually active and has had more than one partner during the past year. Her initial sexual contact occurred at age 18. She reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She reports one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed.

• PMH: Asthma

• Medications: Symbicort 160/4.5mcg

• Allergies: NKDA

• FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD

• Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)

Objective:

• VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs

• Heart: RRR, no murmurs

• Lungs: CTA, chest wall symmetrical

• Genital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia

• Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, negMcBurney

Diagnostics: HSV specimen obtained

Assessment: Chancre

PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

Using evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature.

Analyze the subjective portion of the note. List additional information that should be included in the documentation.
Analyze the objective portion of the note. List additional information that should be included in the documentation.
Is the assessment supported by the subjective and objective information? Why or why not?
Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis?
Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.
Please do not write the paper in soap note format. PLEASE ANSWER ONLY THE QUESTIONS. DO NOT REWRITE THE CASE STUDY. Title page and Reference page required ( APA format ).