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Case Study

Case Study. Rebecca is visiting the clinic seeking birth control pills. She had sexual intercourse for the first time 8 weeks ago. Subjective data: Her partner does not use a condom or spermicide with intercourse Her last menstrual period was 2 weeks ago

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Case Study

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  1. Case Study • Rebecca is visiting the clinic seeking birth control pills. She had sexual intercourse for the first time 8 weeks ago. • Subjective data: • Her partner does not use a condom or • spermicide with intercourse • Her last menstrual period was 2 weeks ago • Denies any symptoms other than frequent • urination and some dysuria. • Interested in using oral contraceptives • Very nervous Rebecca, a 16 year old white female

  2. Further Examination The Health Care provider after talking with her does a physical exam including a pelvic exam. Lab work is also drawn.

  3. Objective data obtained from examination and lab results: • Cervical ectopy noted during Pap test • Mucopurulent cervical discharge • Urine pregnancy test is negative • Nucleic acid amplification test is suspect for Chlamydia and gonorrhea.

  4. Critical Thinking • After gathering this data, what conclusions can be drawn? • Why did she not suspect that she might have a STD? • What risk factors were present? • What do you think is the next step? Explain.

  5. Endocervical Culture is completed – came back positive for Chlamydia and gonorrhea. • Why was a endocervical culture done? • Explain why smears, the nucleic acid amplification test and EIA tests are not used in confirming the diagnosis in a female.

  6. Critical Thinking Health Care Providers Orders: • Doxycycline 100mg bid for 7 days • Ceftriaxone 250mg IM once • When you see above medications ordered, what did this tell you? • What are the side effects of these medications? • What medication would be ordered if Rebecca only had gonorrhea?

  7. Critical Thinking Questions • What does she need to know about other STD’s What other testing would you recommend. • What is important to teach regarding Health Prevention? • What complications can occur is she does not follow the health teaching?

  8. What symptoms might her sexual partner exhibit of chlamydia or gonorrhea? • Where is the initial site of infection in the male? • Why does the male seek medical care early? • How is the male diagnosis confirmed? • Does the partner need to be treated? Explain.

  9. Which of the following medications would be used in treatment. Select all that apply. • doxycycline (Vibramycin) • Cefixime (Suprax) • levofloxacin (Levaquin) • ceftriaxone (Rocephin) • ciprofloxacin (Cipro) • Amoxicillin (Ampicillin) • acyclovir (Zovirax)

  10. Syphilis

  11. What makes this STD Different ?

  12. Syphilis How is syphilis transmitted?

  13. SyphilisClinical Manifestations • Primary stage • When does this occur? What is this?

  14. SyphilisClinical Manifestations • In what stage does this Bilateral symmetric rash on trunk, extremities, and palms appear? • What other symptoms will the patient exhibit?

  15. SyphilisComplications • Occur mostly in late syphilis • Gummas can produce irreparable damage to bone, liver, or skin • Aneurysm may press on structures such as intercostal nerves, causing pain • Scarring of aortic valve • Neurosyphilis • Tabes dorsalis • Sudden attacks of pain • Loss of vision and sense of position

  16. SyphilisDiagnostic Studies How is Syphilis diagnosed?

  17. Diagnostic Testing • Nonspecific antitreponemal Tests used for screening: • VDRL • RPR • Specific treponemal Tests for confirmation: • Fluorescent treponemal antibody absorption (FTA-Abs) All these tests – tests for antibodies Even Better - presence of spirochetes on dark field microscopy

  18. Testing • Mr. L., 61 years old, was admitted to the hospital for pre-operative preparation for surgery. His pre-operative blood work included a VDRL test and it came back positive. • What would be most important for the nurse to ask the patient? • Why? • What would be different in this situation if the patient was 16?

  19. How is Syphilis Treated?

  20. SyphilisTreatment and Nursing Care • Drug therapy • Benzathine penicillin G (Bicillin) • Aqueous procaine penicillin G • **Be sure they complete full course of therapy • Contact Isolation • Lesions of primary and secondary syphilis are highly infective. • Gloves should be worn in direct contact • Good Handwashing after removal of gloves

  21. Try this! Which of the following is NOT a symptom of syphilis? • a hard chancre sore • a rash on the skin including the palms and soles. • a thick, yellowish discharge • large ulcers called gummas.

  22. Genital Herpes

  23. Genital Herpes • What causes a patient with genital herpes to seek medical care?

  24. Genital HerpesClinical Manifestations • Primary (initial) episode • Burning or tingling at site • Small vesicular lesion appear on penis, scrotum, vulva, perineum, perianal areas, vagina, or cervix • Primary lesions present for 17 to 20 days • New lesions sometimes continue to develop for 6 weeks • Lesions heal spontaneously

  25. When are they most contagious?

  26. Genital HerpesClinical Manifestations • Recurrent genital herpes • Occurs in 50% to 80% in following year • Triggers • Stress • Fatigue • Sunburn • Menses • Prodromal symptoms of tingling, burning, itching at lesion site • Symptoms are less severe and lesions heal within 8 to 12 days • With time, lesions will occur less frequently

  27. Genital HerpesDiagnostic Studies • How is the diagnosis confirmed?

  28. Treatment • What is the major treatment for genital herpes?

  29. Genital HerpesTreatment and Nursing Care • Drug therapy • Inhibit viral replication • Suppress frequent recurrences • Acyclovir (Zovirax) • Valacyclovir (Valtrex) • Famciclovir (Famvir) • Given several times /day for 7-10 days.

  30. Treatment • Do the antiviral medications eradicate the disease?

  31. Genital HerpesTreatment and Nursing Care • Symptomatic care • Genital hygiene • Loose-fitting cotton underwear • Lesions clean and dry • Sitz baths • Barrier methods during sexual activity • Drying agents • Pain • Dilution of urine with water • Local anesthetic

  32. Try this! • A primary Herpes Simplex virus (HSV) infection differs from recurrent HSV episodes in that: • Only primary infections are sexually transmitted • Systemic manifestations such as fever and myalgia are more common • It is of shorter duration than recurrent episodes • Transmission of the virus to a fetus is less likely during primary infection.

  33. Genital Warts

  34. Genital Warts • What causes genital warts? • Who is most likely to get this condition?

  35. What manifestations would Lead the nurse to suspect Genital warts?

  36. Genital WartsDiagnostic Studies • How is this condition diagnosed?

  37. Genital WartsGoals of Treatment • What is the Primary goal in the treatment of genital warts? • Treatment includes a course of therapy rather than one treatment. Explain.

  38. True or False? • With removal of genital warts infectivity is decreased? Explain

  39. Genital WartsTreatment and Nursing Care • Treatments • Chemical • Trichloroacetic acid (TCA) • Bichloroacetic acid (BCA) • Podophyllin resin • For small external genital warts • Patient managed • Podofilox (Condylox/Condoylox gel) • Imiquimod (Aldara) • Immune response modifier

  40. Genital WartsCollaborative Care • Treatments • If warts do not regress with previously mentioned therapies • Cryotherapy with liquid nitrogen • Electrocautery • Laser therapy • Use of α-interferon • Surgical excision

  41. Genital WartsPatient Teaching • Recurrences and re-infection possible • Careful long-term follow-up advised • Health Preventive Measures • Vaccine to prevent cervical cancer, precancerous genital lesion, and genital warts due to HPV • Gardisal vaccine

  42. Question The age group that seems particularly susceptible to HPV infections is: • students of college age • teenagers • middle-aged adults • senior citizens

  43. Ask yourself? Human papilloma viruses (HPVs) are associated with: • cancer of the cervix • skin cancer • lung cancer • spontaneous abortions

  44. The End

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