Domain 1: Management of Patient Health/Illness Status
- Overview -
The essentials and competencies in Domain 1: Patient Health and Illness were met through several courses throughout my master’s program. Nurse practitioners help manage acute and chronic illnesses. An example of the fulfillment of this domain is the entire NG 744 Healthcare of the Adult clinical practicum. This clinical practicum provides a broad experience that allows the application and integration of management of the patient health and illness status. An example of this is the patient encounter note on Gonorrhea. The information below involves the assessment, differential diagnoses, plan of care, and rationales.
- Assessment -
Differential Diagnosis
Gonorrhea (O98.23) Primary – Gonorrhea is a sexually transmitted infection that impacts young adult population. Research shows that gonorrhea is the second most common cause of sexually transmitted infections worldwide (Springer & Salen, 2022). Gonorrhea usually produces purulent inflammation of the mucous membranes. This sexually transmitted infection can be asymptomatic in early stages of infection. When gonorrhea is untreated significant complications may occur
Chlamydia (A74.9) - According to Hollier (2021), chlamydia is usually an asymptomatic in many patients. Chlamydia can cause urethritis in women. If chlamydia is not treated in women than pelvic inflammatory disease can occur (Hollier, 2021). Infertility, ectopic pregnancy, and chronic pain can also occur without treatment.
Trichomoniasis (A59.9) – Trichomoniasis is nearly always sexually transmitted. Women can acquire this infection from other women. Men can be infected with trichomoniasis but rarely spread it to other men (Hollier, 2021). Research shows that trichomoniasis is highest incidence in black women. The lowest prevalence is in non-Hispanic white women (Hollier, 2021).
- Recommendations -
Plan: Treat with two antimicrobials antibiotics with different mechanisms of actions.
Pharmacologic: ceftriaxone/Rocephin 250mg IM, azithromycin/Zithromax 1g PO one time dose
Non-pharmacologic: Educate on good perineal hygiene and give the patient information on gonorrhea and report this infection to the CDC. This infection is a reportable disease.
Patient Education: The patient received information on the importance of using good hygiene. The patient also received information on the importance of using contraceptives for protection. The patient verbalized understanding of the importance of getting sexually transmitted infections. The patient also received information on not using sanitary napkins, panty liners, and avoiding nylon underwear. The patient verbalized understanding of education given. The patient also understands the importance of all sexual partners being treated for gonorrhea to avoid spreading the infection back and forth to one another.
Follow-up: The patient should have the test of cure which should include the NAAT culture. All parties involved should be retested within three months from the initial treatment.
- Rationale -
Gonorrhea is a sexually transmitted infection that affects individuals of all ages. Gonorrhea disproportionally affects younger populations. Women with untreated gonorrhea are prone to pelvic inflammatory disease (Springer & Salen, 2022). Gonorrhea affects far more young people between the ages of 15-24 (Hollier, 2021). Sexually transmitted infections affect individuals from all walks of life worldwide. According to the World Health Organization (WHO), gonorrhea can cause short and long-term complications (2022). According to Hollier, gonorrhea can be asymptomatic in early infection. When a sexually transmitted infection goes untreated, significant complications may occur. Research shows that rates have risen by 82.6% since the all-time low in 2009.
Women who go without treatment for gonorrhea may be at a higher risk for developing the pelvic inflammatory disease. Pelvic inflammatory disease (PID) can lead to scarring of the fallopian tubes, affecting fertility. Symptoms of PID can include pain, fever, unusual vaginal discharge, and painful or frequent urination (Hollier, 2021). Research shows that the use of two antibiotics for the treatment of gonorrhea proves to
References
Chlamydia, gonorrhoea, trichomoniasis and syphilis: Global prevalence and incidence estimates, 2016. (n.d.). Retrieved May 29, 2022, from https://www.who.int/publications-detail-redirect/chlamydia-gonorrhoea-trichomoniasis-and-syphilis-global-prevalence-and-incidence-estimates-2016
Cuevas, A.G., Williams, D.R., & Albert, M.A. (2017). Psychosocial Factors and Hypertension: A Review of the Literature. Cardiology Clinics, 35(2), 223-230. https://doi.org/10.1016/j.ccl.2016.12.004
Dunphy, L.M., Winland-Brown, J.E., Porter, B.O., & Thomas, D. J. (2019). Primary Care: The art and science of advanced practice nursing (5 ed.). Philadelphia, PA: F.A. Davis
Hollier, A. (2021). Clinical Guidelines in primary care (4th ed.). Lafayette, LA: APEA
Springer, C., & Salen, P. (2022). Gonorrhea. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK558903/