week 4

Home>Homework Answsers>Nursing homework helpNURSEcase studyapa format and scholarly references please No cdc Or WHOa year ago18.06.202412Report issuefiles (2)NRNP6552Week4CaseStudyTemplate.docxNRNP6552week4cases.pdfNRNP6552Week4CaseStudyTemplate.docxCase # (1, 2, 3 or 4) and Description of the Case Chosen:·Case 1: Debbie·Case 2: Wendy·Case 3: Randi·Case 4: RobertaOutline Subjective data.Identify data provided in your chosen case and any additional data needed.OutlineObjective findings.Identify findings provided in your chosen case and any additional data needed.Identify diagnostic tests, procedures, laboratory work indicated.Describe the rationale for each test or intervention with supporting references.Distinguish at least three differential diagnoses.Describe the rationales for your choice of each diagnosis with supporting references.Identify appropriate medications, treatments or other interventions associated with each differential diagnosis.Describe rationales and supporting references for each.Explain keySocial Determinants of Heath (SDoH) for your chosen case.Describe collaborative care referrals and patient education needs for your chosen case.Describe rationales and supporting references for each.NRNP6552week4cases.pdfNRNP 6552 Week 4 case study scenariosCase #1. Debbie.History of Present Illness (HPI): Debbie is a 19-year-old female G1P0010. She presents to your office as anew patient for GYN visit. Her chief complaint is mild lower abdominal pain and a copious amount ofvaginal discharge that started a little over 1 week ago. She is sexually active and reports having four malepartners in the last six months.Prior medical history: Depression, HSV-2. Prior surgical history: Surgical termination of pregnancy 1year agoCurrent medications: Lo loestrin Fe. Allergies: NoneOB- GYN History: Surgical TOP x 1. Menarche age 9, cycle length- 7 days- frequency every 28 days- 3 -4tampons per day. Hx of HSV-2. Never had pap smear.LMP: 2 weeks ago – normal. Contraception history: OCP since TOP 1 year ago.Social history: Lives parents. Denies ETOH or recreational drug use, never smoker. Graduated highschool. Not in college. Works FT as a waitress.Family history: Mother – depression. Father – unknownReview of Systems (ROS): Negative except as noted in HPI.Physical Exam (PE)VS: BP: 112/80, P: 72, RR: 16, T: 98.4, Weight: 110 lbs., Height 54 in, BMI 18.9 kg/m2• General: WDWN female in NAD• Abd: Soft, NT/ND, no masses/HSM• GU: No external lesions, no erythema. Mucopurulent endocervical exudate visible in theendocervical canal, sample obtained – cervix is friable. Mild CMT, no uterine tenderness, noadnexal tenderness, no masses.Case #2. Wendy.History of Present Illness (HPI): Wendy, a 33-year-old woman, presents to the office with c/o of a 7-month history of nipple discharge. She has noticed that her breasts are tender and both nipples producemilky discharge on applying mild pressure. She has not noted any bloody or clear nipple discharge,breast lumps, or skin changes. She also states she has not had a menstrual period for 7 months, and herperiods had been irregular for 8 months before they stopped altogether. Prior to her menstrualirregularities, her menses occurred at a normal frequency and duration. She is sexually active with asingle partner and is trying to conceive.Prior medical history: Headaches (past 6 months). Prior surgical history: NoneCurrent medications: ibuprofen 400mg daily. Allergies: NoneOB- GYN History: Spontaneous VD x 1. Menarche age 14, normal throughout life, until recentcomplaints. No history of sexually transmitted infections (STDs). Last pap smear age 31 years, normal.LMP: 7 months ago. Contraception history: None.Social history: Lives with husband and 5-year-old son. Elementary school teacher. ETOH: 1-2 glasseswine per month. No recreational drug use. Never smoked. Does not exercise. Last travel outside of thecountry – Italy 8 months ago.Family history: Mother – osteoporosis. Father (deceased age 80) – CVAReview of Systems (ROS): General: Fatigue over the past 3 months; Skin – No rash, excessive facial hairor acne; Gynecologic – Decreased libido. Vaginal dryness during sexual intercourse. She has been tryingto conceive for the last 2 years. One full-term, uncomplicated pregnancy 5 years ago; Neuro – 6-monthhistory of dull frontal and occasionally retro-orbital headaches that are increasing in frequency and thatnow occur almost daily. There are no associated neurologic symptoms. She denies nausea, photophobia,or phonophobia. Until 1 month ago, the headaches would resolve completely with ibuprofen, but for thelast month ibuprofen does not work. She denies history of headaches prior to 6 months ago.Physical Exam (PE)VS: BP: 133/68, P: 68, RR: 16, T: 97.3, Weight 134lbs, Height 64 inches, BMI 23 kg/m2Breast – No breast masses or skin changes. No axillary lymphadenopathy. Mild diffuse breast tendernesson palpation. Milky nipple discharge elicited bilaterally with pressure around areola.Skin – Normal color, no rash, hirsutism, or acne.Neuro- Normal and symmetric motor strength and reflexes on extremities. Sensation grossly intact tolight touch. Cranial nerves 2 through 12 intact. Gait and balance normal.Thyroid – no thyromegaly or nodulesCase #3. Randi.History of Present Illness (HPI): Randi, a 22-year-old female, presents to the clinic with c/o of a 3-dayhistory of thick white vaginal discharge, intense vaginal itching, and dysuria. She reports she is sexuallyactive with 1 partner. No history of STI’s. She had a recent sinus infection and was on amoxicillin x 10days.Prior medical history: None.Prior surgical history: None.Current medications: Mirena IUD – inserted last year. Allergies: SulfaSocial history: College student. Lives with mother. Denies smoking or recreational drugs. Vapes daily.Family history: Mother alive and well. Father alive and well. Sister – diabetes: uses insulin pumpOB- GYN History: Menarche age 13, cycle length 5 days – frequency every 28 days. No history ofsexually transmitted infections (STIs). Never had a pap smear.Review of Systems (ROS): As noted in HPI.Physical Exam (PE)VS: BP: 110/70, P: 109, RR: 17, T: 98.9, Weight: 132 lbs., Height 65 inches, BMI 22 kg/m2• General: AAO x 3, pleasant.• Gynecological: EXTERNAL EXAM: mild erythema, white clumpy discharge. SPECULUM/INTERNALEXAM: Cervix: normal appearance, no lesions, no bleeding, white discharge, no cervicalmovement tenderness. UTERUS: normal size, shape, and consistency, normal mobility,nontender. ADNEXA: no masses or tenderness bilaterally.Case #4. Roberta.History of Present Illness (HPI): Roberta, a 53-year-old mother of two children, presents to your clinicwith c/o vaginal dryness and low sexual desire. She went into surgical menopause at the time of a totalhysterectomy for leiomyomas 5 years ago. She took HRT for severe climacteric symptoms for 2 years,which she discontinued 3 years ago due to breast pain and a fear of breast cancer. She states her sex lifebefore surgery was active and satisfying. After the hysterectomy, her desire diminished considerably,although at first she was not too concerned about it. Lately, however, because of this lack of desire, shenow complains of quite a reduction in sexual activity which is also less satisfying. When she does haveintercourse, she experiences dyspareunia. She is now worried about it because it is affecting her qualityof life and negatively impacting her relationship with her husband.Over this past year, she has had a mammogram and general blood tests which were all normal.Prior medical history: Uterine fibroids. Prior surgical history: TAH 5 years agoCurrent medications: None. Allergies: Sulfa.OB- GYN History: NSVD x 2 (2014 and 2012). Menarche age 12, cycle length was 8 -10 days- frequencyevery 21 days- heavy flow with clots – tampons 5-6/day.LMP: 5 years ago. Contraception history: NoneSocial history: Lives with her husband and 2 children. Works as an attorney. Denies EtOH, smoking, orrecreational drug use.Family history: Mother – osteoporosis, thyroid disease. Father – prostate cancer. MGM – breast cancerdiagnosed at age 81 yo.Review of Systems (ROS): Unremarkable with exception of as noted in HPI.Physical Exam (PE)VS: BP: 134/78, P: 58, RR: 16, T: 98.8 Weight: 144 lbs., Height: 65 inches, BMI 24General Examination: Well developed, well nourished, in no acute distress.Psych: alert and oriented, cooperative with exam, appears frustrated.Abdomen: Soft, NTND, no massesGynecological: EXTERNAL EXAM: sparse hair distribution, pale and shiny – dry labia, no lesions, Mildintroital stenosis noted. SPECULUM/INTERNAL EXAM: Vaginal lining is thin and dry. Cervix: surgicallyabsent. UTERUS: surgically absent. ADNEXA: surgically absent.NRNP6552week4cases.pdfNRNP 6552 Week 4 case study scenariosCase #1. Debbie.History of Present Illness (HPI): Debbie is a 19-year-old female G1P0010. She presents to your office as anew patient for GYN visit. Her chief complaint is mild lower abdominal pain and a copious amount ofvaginal discharge that started a little over 1 week ago. She is sexually active and reports having four malepartners in the last six months.Prior medical history: Depression, HSV-2. Prior surgical history: Surgical termination of pregnancy 1year agoCurrent medications: Lo loestrin Fe. Allergies: NoneOB- GYN History: Surgical TOP x 1. Menarche age 9, cycle length- 7 days- frequency every 28 days- 3 -4tampons per day. Hx of HSV-2. Never had pap smear.LMP: 2 weeks ago – normal. Contraception history: OCP since TOP 1 year ago.Social history: Lives parents. Denies ETOH or recreational drug use, never smoker. Graduated highschool. Not in college. Works FT as a waitress.Family history: Mother – depression. Father – unknownReview of Systems (ROS): Negative except as noted in HPI.Physical Exam (PE)VS: BP: 112/80, P: 72, RR: 16, T: 98.4, Weight: 110 lbs., Height 54 in, BMI 18.9 kg/m2• General: WDWN female in NAD• Abd: Soft, NT/ND, no masses/HSM• GU: No external lesions, no erythema. Mucopurulent endocervical exudate visible in theendocervical canal, sample obtained – cervix is friable. Mild CMT, no uterine tenderness, noadnexal tenderness, no masses.Case #2. Wendy.History of Present Illness (HPI): Wendy, a 33-year-old woman, presents to the office with c/o of a 7-month history of nipple discharge. She has noticed that her breasts are tender and both nipples producemilky discharge on applying mild pressure. She has not noted any bloody or clear nipple discharge,breast lumps, or skin changes. She also states she has not had a menstrual period for 7 months, and herperiods had been irregular for 8 months before they stopped altogether. Prior to her menstrualirregularities, her menses occurred at a normal frequency and duration. She is sexually active with asingle partner and is trying to conceive.Prior medical history: Headaches (past 6 months). Prior surgical history: NoneCurrent medications: ibuprofen 400mg daily. Allergies: NoneOB- GYN History: Spontaneous VD x 1. Menarche age 14, normal throughout life, until recentcomplaints. No history of sexually transmitted infections (STDs). Last pap smear age 31 years, normal.LMP: 7 months ago. Contraception history: None.Social history: Lives with husband and 5-year-old son. Elementary school teacher. ETOH: 1-2 glasseswine per month. No recreational drug use. Never smoked. Does not exercise. Last travel outside of thecountry – Italy 8 months ago.Family history: Mother – osteoporosis. Father (deceased age 80) – CVAReview of Systems (ROS): General: Fatigue over the past 3 months; Skin – No rash, excessive facial hairor acne; Gynecologic – Decreased libido. Vaginal dryness during sexual intercourse. She has been tryingto conceive for the last 2 years. One full-term, uncomplicated pregnancy 5 years ago; Neuro – 6-monthhistory of dull frontal and occasionally retro-orbital headaches that are increasing in frequency and thatnow occur almost daily. There are no associated neurologic symptoms. She denies nausea, photophobia,or phonophobia. Until 1 month ago, the headaches would resolve completely with ibuprofen, but for thelast month ibuprofen does not work. She denies history of headaches prior to 6 months ago.Physical Exam (PE)VS: BP: 133/68, P: 68, RR: 16, T: 97.3, Weight 134lbs, Height 64 inches, BMI 23 kg/m2Breast – No breast masses or skin changes. No axillary lymphadenopathy. Mild diffuse breast tendernesson palpation. Milky nipple discharge elicited bilaterally with pressure around areola.Skin – Normal color, no rash, hirsutism, or acne.Neuro- Normal and symmetric motor strength and reflexes on extremities. Sensation grossly intact tolight touch. Cranial nerves 2 through 12 intact. Gait and balance normal.Thyroid – no thyromegaly or nodulesCase #3. Randi.History of Present Illness (HPI): Randi, a 22-year-old female, presents to the clinic with c/o of a 3-dayhistory of thick white vaginal discharge, intense vaginal itching, and dysuria. She reports she is sexuallyactive with 1 partner. No history of STI’s. She had a recent sinus infection and was on amoxicillin x 10days.Prior medical history: None.Prior surgical history: None.Current medications: Mirena IUD – inserted last year. Allergies: SulfaSocial history: College student. Lives with mother. Denies smoking or recreational drugs. Vapes daily.Family history: Mother alive and well. Father alive and well. Sister – diabetes: uses insulin pumpOB- GYN History: Menarche age 13, cycle length 5 days – frequency every 28 days. No history ofsexually transmitted infections (STIs). Never had a pap smear.Review of Systems (ROS): As noted in HPI.Physical Exam (PE)VS: BP: 110/70, P: 109, RR: 17, T: 98.9, Weight: 132 lbs., Height 65 inches, BMI 22 kg/m2• General: AAO x 3, pleasant.• Gynecological: EXTERNAL EXAM: mild erythema, white clumpy discharge. SPECULUM/INTERNALEXAM: Cervix: normal appearance, no lesions, no bleeding, white discharge, no cervicalmovement tenderness. UTERUS: normal size, shape, and consistency, normal mobility,nontender. ADNEXA: no masses or tenderness bilaterally.Case #4. Roberta.History of Present Illness (HPI): Roberta, a 53-year-old mother of two children, presents to your clinicwith c/o vaginal dryness and low sexual desire. She went into surgical menopause at the time of a totalhysterectomy for leiomyomas 5 years ago. She took HRT for severe climacteric symptoms for 2 years,which she discontinued 3 years ago due to breast pain and a fear of breast cancer. She states her sex lifebefore surgery was active and satisfying. After the hysterectomy, her desire diminished considerably,although at first she was not too concerned about it. Lately, however, because of this lack of desire, shenow complains of quite a reduction in sexual activity which is also less satisfying. When she does haveintercourse, she experiences dyspareunia. She is now worried about it because it is affecting her qualityof life and negatively impacting her relationship with her husband.Over this past year, she has had a mammogram and general blood tests which were all normal.Prior medical history: Uterine fibroids. Prior surgical history: TAH 5 years agoCurrent medications: None. Allergies: Sulfa.OB- GYN History: NSVD x 2 (2014 and 2012). Menarche age 12, cycle length was 8 -10 days- frequencyevery 21 days- heavy flow with clots – tampons 5-6/day.LMP: 5 years ago. Contraception history: NoneSocial history: Lives with her husband and 2 children. Works as an attorney. Denies EtOH, smoking, orrecreational drug use.Family history: Mother – osteoporosis, thyroid disease. Father – prostate cancer. MGM – breast cancerdiagnosed at age 81 yo.Review of Systems (ROS): Unremarkable with exception of as noted in HPI.Physical Exam (PE)VS: BP: 134/78, P: 58, RR: 16, T: 98.8 Weight: 144 lbs., Height: 65 inches, BMI 24General Examination: Well developed, well nourished, in no acute distress.Psych: alert and oriented, cooperative with exam, appears frustrated.Abdomen: Soft, NTND, no massesGynecological: EXTERNAL EXAM: sparse hair distribution, pale and shiny – dry labia, no lesions, Mildintroital stenosis noted. SPECULUM/INTERNAL EXAM: Vaginal lining is thin and dry. Cervix: surgicallyabsent. UTERUS: surgically absent. ADNEXA: surgically absent.NRNP6552Week4CaseStudyTemplate.docxCase # (1, 2, 3 or 4) and Description of the Case Chosen:·Case 1: Debbie·Case 2: Wendy·Case 3: Randi·Case 4: RobertaOutline Subjective data.Identify data provided in your chosen case and any additional data needed.OutlineObjective findings.Identify findings provided in your chosen case and any additional data needed.Identify diagnostic tests, procedures, laboratory work indicated.Describe the rationale for each test or intervention with supporting references.Distinguish at least three differential diagnoses.Describe the rationales for your choice of each diagnosis with supporting references.Identify appropriate medications, treatments or other interventions associated with each differential diagnosis.Describe rationales and supporting references for each.Explain keySocial Determinants of Heath (SDoH) for your chosen case.Describe collaborative care referrals and patient education needs for your chosen case.Describe rationales and supporting references for each.NRNP6552week4cases.pdfNRNP 6552 Week 4 case study scenariosCase #1. Debbie.History of Present Illness (HPI): Debbie is a 19-year-old female G1P0010. She presents to your office as anew patient for GYN visit. Her chief complaint is mild lower abdominal pain and a copious amount ofvaginal discharge that started a little over 1 week ago. She is sexually active and reports having four malepartners in the last six months.Prior medical history: Depression, HSV-2. Prior surgical history: Surgical termination of pregnancy 1year agoCurrent medications: Lo loestrin Fe. Allergies: NoneOB- GYN History: Surgical TOP x 1. Menarche age 9, cycle length- 7 days- frequency every 28 days- 3 -4tampons per day. Hx of HSV-2. Never had pap smear.LMP: 2 weeks ago – normal. Contraception history: OCP since TOP 1 year ago.Social history: Lives parents. Denies ETOH or recreational drug use, never smoker. Graduated highschool. Not in college. Works FT as a waitress.Family history: Mother – depression. Father – unknownReview of Systems (ROS): Negative except as noted in HPI.Physical Exam (PE)VS: BP: 112/80, P: 72, RR: 16, T: 98.4, Weight: 110 lbs., Height 54 in, BMI 18.9 kg/m2• General: WDWN female in NAD• Abd: Soft, NT/ND, no masses/HSM• GU: No external lesions, no erythema. Mucopurulent endocervical exudate visible in theendocervical canal, sample obtained – cervix is friable. Mild CMT, no uterine tenderness, noadnexal tenderness, no masses.Case #2. Wendy.History of Present Illness (HPI): Wendy, a 33-year-old woman, presents to the office with c/o of a 7-month history of nipple discharge. She has noticed that her breasts are tender and both nipples producemilky discharge on applying mild pressure. She has not noted any bloody or clear nipple discharge,breast lumps, or skin changes. She also states she has not had a menstrual period for 7 months, and herperiods had been irregular for 8 months before they stopped altogether. Prior to her menstrualirregularities, her menses occurred at a normal frequency and duration. She is sexually active with asingle partner and is trying to conceive.Prior medical history: Headaches (past 6 months). Prior surgical history: NoneCurrent medications: ibuprofen 400mg daily. Allergies: NoneOB- GYN History: Spontaneous VD x 1. Menarche age 14, normal throughout life, until recentcomplaints. No history of sexually transmitted infections (STDs). Last pap smear age 31 years, normal.LMP: 7 months ago. Contraception history: None.Social history: Lives with husband and 5-year-old son. Elementary school teacher. ETOH: 1-2 glasseswine per month. No recreational drug use. Never smoked. Does not exercise. Last travel outside of thecountry – Italy 8 months ago.Family history: Mother – osteoporosis. Father (deceased age 80) – CVAReview of Systems (ROS): General: Fatigue over the past 3 months; Skin – No rash, excessive facial hairor acne; Gynecologic – Decreased libido. Vaginal dryness during sexual intercourse. She has been tryingto conceive for the last 2 years. One full-term, uncomplicated pregnancy 5 years ago; Neuro – 6-monthhistory of dull frontal and occasionally retro-orbital headaches that are increasing in frequency and thatnow occur almost daily. There are no associated neurologic symptoms. She denies nausea, photophobia,or phonophobia. Until 1 month ago, the headaches would resolve completely with ibuprofen, but for thelast month ibuprofen does not work. She denies history of headaches prior to 6 months ago.Physical Exam (PE)VS: BP: 133/68, P: 68, RR: 16, T: 97.3, Weight 134lbs, Height 64 inches, BMI 23 kg/m2Breast – No breast masses or skin changes. No axillary lymphadenopathy. Mild diffuse breast tendernesson palpation. Milky nipple discharge elicited bilaterally with pressure around areola.Skin – Normal color, no rash, hirsutism, or acne.Neuro- Normal and symmetric motor strength and reflexes on extremities. Sensation grossly intact tolight touch. Cranial nerves 2 through 12 intact. Gait and balance normal.Thyroid – no thyromegaly or nodulesCase #3. Randi.History of Present Illness (HPI): Randi, a 22-year-old female, presents to the clinic with c/o of a 3-dayhistory of thick white vaginal discharge, intense vaginal itching, and dysuria. She reports she is sexuallyactive with 1 partner. No history of STI’s. She had a recent sinus infection and was on amoxicillin x 10days.Prior medical history: None.Prior surgical history: None.Current medications: Mirena IUD – inserted last year. Allergies: SulfaSocial history: College student. Lives with mother. Denies smoking or recreational drugs. Vapes daily.Family history: Mother alive and well. Father alive and well. Sister – diabetes: uses insulin pumpOB- GYN History: Menarche age 13, cycle length 5 days – frequency every 28 days. No history ofsexually transmitted infections (STIs). Never had a pap smear.Review of Systems (ROS): As noted in HPI.Physical Exam (PE)VS: BP: 110/70, P: 109, RR: 17, T: 98.9, Weight: 132 lbs., Height 65 inches, BMI 22 kg/m2• General: AAO x 3, pleasant.• Gynecological: EXTERNAL EXAM: mild erythema, white clumpy discharge. SPECULUM/INTERNALEXAM: Cervix: normal appearance, no lesions, no bleeding, white discharge, no cervicalmovement tenderness. UTERUS: normal size, shape, and consistency, normal mobility,nontender. ADNEXA: no masses or tenderness bilaterally.Case #4. Roberta.History of Present Illness (HPI): Roberta, a 53-year-old mother of two children, presents to your clinicwith c/o vaginal dryness and low sexual desire. She went into surgical menopause at the time of a totalhysterectomy for leiomyomas 5 years ago. She took HRT for severe climacteric symptoms for 2 years,which she discontinued 3 years ago due to breast pain and a fear of breast cancer. She states her sex lifebefore surgery was active and satisfying. After the hysterectomy, her desire diminished considerably,although at first she was not too concerned about it. Lately, however, because of this lack of desire, shenow complains of quite a reduction in sexual activity which is also less satisfying. When she does haveintercourse, she experiences dyspareunia. She is now worried about it because it is affecting her qualityof life and negatively impacting her relationship with her husband.Over this past year, she has had a mammogram and general blood tests which were all normal.Prior medical history: Uterine fibroids. Prior surgical history: TAH 5 years agoCurrent medications: None. Allergies: Sulfa.OB- GYN History: NSVD x 2 (2014 and 2012). Menarche age 12, cycle length was 8 -10 days- frequencyevery 21 days- heavy flow with clots – tampons 5-6/day.LMP: 5 years ago. Contraception history: NoneSocial history: Lives with her husband and 2 children. Works as an attorney. Denies EtOH, smoking, orrecreational drug use.Family history: Mother – osteoporosis, thyroid disease. Father – prostate cancer. MGM – breast cancerdiagnosed at age 81 yo.Review of Systems (ROS): Unremarkable with exception of as noted in HPI.Physical Exam (PE)VS: BP: 134/78, P: 58, RR: 16, T: 98.8 Weight: 144 lbs., Height: 65 inches, BMI 24General Examination: Well developed, well nourished, in no acute distress.Psych: alert and oriented, cooperative with exam, appears frustrated.Abdomen: Soft, NTND, no massesGynecological: EXTERNAL EXAM: sparse hair distribution, pale and shiny – dry labia, no lesions, Mildintroital stenosis noted. SPECULUM/INTERNAL EXAM: Vaginal lining is thin and dry. Cervix: surgicallyabsent. UTERUS: surgically absent. ADNEXA: surgically absent.NRNP6552Week4CaseStudyTemplate.docxCase # (1, 2, 3 or 4) and Description of the Case Chosen:·Case 1: Debbie·Case 2: Wendy·Case 3: Randi·Case 4: RobertaOutline Subjective data.Identify data provided in your chosen case and any additional data needed.OutlineObjective findings.Identify findings provided in your chosen case and any additional data needed.Identify diagnostic tests, procedures, laboratory work indicated.Describe the rationale for each test or intervention with supporting references.Distinguish at least three differential diagnoses.Describe the rationales for your choice of each diagnosis with supporting references.Identify appropriate medications, treatments or other interventions associated with each differential diagnosis.Describe rationales and supporting references for each.Explain keySocial Determinants of Heath (SDoH) for your chosen case.Describe collaborative care referrals and patient education needs for your chosen case.Describe rationales and supporting references for each.NRNP6552week4cases.pdfNRNP 6552 Week 4 case study scenariosCase #1. Debbie.History of Present Illness (HPI): Debbie is a 19-year-old female G1P0010. She presents to your office as anew patient for GYN visit. Her chief complaint is mild lower abdominal pain and a copious amount ofvaginal discharge that started a little over 1 week ago. She is sexually active and reports having four malepartners in the last six months.Prior medical history: Depression, HSV-2. Prior surgical history: Surgical termination of pregnancy 1year agoCurrent medications: Lo loestrin Fe. Allergies: NoneOB- GYN History: Surgical TOP x 1. Menarche age 9, cycle length- 7 days- frequency every 28 days- 3 -4tampons per day. Hx of HSV-2. Never had pap smear.LMP: 2 weeks ago – normal. Contraception history: OCP since TOP 1 year ago.Social history: Lives parents. Denies ETOH or recreational drug use, never smoker. Graduated highschool. Not in college. Works FT as a waitress.Family history: Mother – depression. Father – unknownReview of Systems (ROS): Negative except as noted in HPI.Physical Exam (PE)VS: BP: 112/80, P: 72, RR: 16, T: 98.4, Weight: 110 lbs., Height 54 in, BMI 18.9 kg/m2• General: WDWN female in NAD• Abd: Soft, NT/ND, no masses/HSM• GU: No external lesions, no erythema. Mucopurulent endocervical exudate visible in theendocervical canal, sample obtained – cervix is friable. Mild CMT, no uterine tenderness, noadnexal tenderness, no masses.Case #2. Wendy.History of Present Illness (HPI): Wendy, a 33-year-old woman, presents to the office with c/o of a 7-month history of nipple discharge. She has noticed that her breasts are tender and both nipples producemilky discharge on applying mild pressure. She has not noted any bloody or clear nipple discharge,breast lumps, or skin changes. She also states she has not had a menstrual period for 7 months, and herperiods had been irregular for 8 months before they stopped altogether. Prior to her menstrualirregularities, her menses occurred at a normal frequency and duration. She is sexually active with asingle partner and is trying to conceive.Prior medical history: Headaches (past 6 months). Prior surgical history: NoneCurrent medications: ibuprofen 400mg daily. Allergies: NoneOB- GYN History: Spontaneous VD x 1. Menarche age 14, normal throughout life, until recentcomplaints. No history of sexually transmitted infections (STDs). Last pap smear age 31 years, normal.LMP: 7 months ago. Contraception history: None.Social history: Lives with husband and 5-year-old son. Elementary school teacher. ETOH: 1-2 glasseswine per month. No recreational drug use. Never smoked. Does not exercise. Last travel outside of thecountry – Italy 8 months ago.Family history: Mother – osteoporosis. Father (deceased age 80) – CVAReview of Systems (ROS): General: Fatigue over the past 3 months; Skin – No rash, excessive facial hairor acne; Gynecologic – Decreased libido. Vaginal dryness during sexual intercourse. She has been tryingto conceive for the last 2 years. One full-term, uncomplicated pregnancy 5 years ago; Neuro – 6-monthhistory of dull frontal and occasionally retro-orbital headaches that are increasing in frequency and thatnow occur almost daily. There are no associated neurologic symptoms. She denies nausea, photophobia,or phonophobia. Until 1 month ago, the headaches would resolve completely with ibuprofen, but for thelast month ibuprofen does not work. She denies history of headaches prior to 6 months ago.Physical Exam (PE)VS: BP: 133/68, P: 68, RR: 16, T: 97.3, Weight 134lbs, Height 64 inches, BMI 23 kg/m2Breast – No breast masses or skin changes. No axillary lymphadenopathy. Mild diffuse breast tendernesson palpation. Milky nipple discharge elicited bilaterally with pressure around areola.Skin – Normal color, no rash, hirsutism, or acne.Neuro- Normal and symmetric motor strength and reflexes on extremities. Sensation grossly intact tolight touch. Cranial nerves 2 through 12 intact. Gait and balance normal.Thyroid – no thyromegaly or nodulesCase #3. Randi.History of Present Illness (HPI): Randi, a 22-year-old female, presents to the clinic with c/o of a 3-dayhistory of thick white vaginal discharge, intense vaginal itching, and dysuria. She reports she is sexuallyactive with 1 partner. No history of STI’s. She had a recent sinus infection and was on amoxicillin x 10days.Prior medical history: None.Prior surgical history: None.Current medications: Mirena IUD – inserted last year. Allergies: SulfaSocial history: College student. Lives with mother. Denies smoking or recreational drugs. Vapes daily.Family history: Mother alive and well. Father alive and well. Sister – diabetes: uses insulin pumpOB- GYN History: Menarche age 13, cycle length 5 days – frequency every 28 days. No history ofsexually transmitted infections (STIs). Never had a pap smear.Review of Systems (ROS): As noted in HPI.Physical Exam (PE)VS: BP: 110/70, P: 109, RR: 17, T: 98.9, Weight: 132 lbs., Height 65 inches, BMI 22 kg/m2• General: AAO x 3, pleasant.• Gynecological: EXTERNAL EXAM: mild erythema, white clumpy discharge. SPECULUM/INTERNALEXAM: Cervix: normal appearance, no lesions, no bleeding, white discharge, no cervicalmovement tenderness. UTERUS: normal size, shape, and consistency, normal mobility,nontender. ADNEXA: no masses or tenderness bilaterally.Case #4. Roberta.History of Present Illness (HPI): Roberta, a 53-year-old mother of two children, presents to your clinicwith c/o vaginal dryness and low sexual desire. She went into surgical menopause at the time of a totalhysterectomy for leiomyomas 5 years ago. She took HRT for severe climacteric symptoms for 2 years,which she discontinued 3 years ago due to breast pain and a fear of breast cancer. She states her sex lifebefore surgery was active and satisfying. After the hysterectomy, her desire diminished considerably,although at first she was not too concerned about it. Lately, however, because of this lack of desire, shenow complains of quite a reduction in sexual activity which is also less satisfying. When she does haveintercourse, she experiences dyspareunia. She is now worried about it because it is affecting her qualityof life and negatively impacting her relationship with her husband.Over this past year, she has had a mammogram and general blood tests which were all normal.Prior medical history: Uterine fibroids. Prior surgical history: TAH 5 years agoCurrent medications: None. Allergies: Sulfa.OB- GYN History: NSVD x 2 (2014 and 2012). Menarche age 12, cycle length was 8 -10 days- frequencyevery 21 days- heavy flow with clots – tampons 5-6/day.LMP: 5 years ago. Contraception history: NoneSocial history: Lives with her husband and 2 children. Works as an attorney. Denies EtOH, smoking, orrecreational drug use.Family history: Mother – osteoporosis, thyroid disease. Father – prostate cancer. MGM – breast cancerdiagnosed at age 81 yo.Review of Systems (ROS): Unremarkable with exception of as noted in HPI.Physical Exam (PE)VS: BP: 134/78, P: 58, RR: 16, T: 98.8 Weight: 144 lbs., Height: 65 inches, BMI 24General Examination: Well developed, well nourished, in no acute distress.Psych: alert and oriented, cooperative with exam, appears frustrated.Abdomen: Soft, NTND, no massesGynecological: EXTERNAL EXAM: sparse hair distribution, pale and shiny – dry labia, no lesions, Mildintroital stenosis noted. SPECULUM/INTERNAL EXAM: Vaginal lining is thin and dry. Cervix: surgicallyabsent. UTERUS: surgically absent. ADNEXA: surgically absent.12Bids(58)Dr. Ellen RMMISS HILLARY A+Sheryl HoganProf Double RProf. TOPGRADEEmily ClareDr. Sarah BlakeProWritingGurufirstclass tutorDr. Freya WalkerPROF_ALISTERFiona Davasherry proffMUSYOKIONES A+Dr ClovergrA+de pluspacesetters2121Jahky BColeen AndersonIsabella HarvardShow All Bidsother Questions(10)MGT 311 Week 5 Learning Team ReflectionHUM 266 Week 2 Individual Assignment Architecture PaperA public opinion poll that gauges the popularity of the President of the United States is an example of”I used to be indecisive. Now I’m not so sure” Please respond to the following:1. Dickinson’s letters to Higginson suggest that her highest ambition for her poetry is that it be aesthetically vitalpublishabletechnically unique2. Dickinson’s poems 130…”Financial Statement Accuracy”LAB ASSIGNMENT FOR PROGRAMMING CLASSfours hours.RE: rection paperANALYSIS PAPER FOR BLAW 280…I HAVE THE PAPER, AND A MADE AN ANALYSIS

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