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Case Study Discussion: Gynecologic Health

Case studies provide the opportunity to simulate realistic scenarios involving patients presenting with various health problems or symptoms. Such case studies enable nurse learners to apply concepts, lessons, and critical thinking to interviewing, screening, diagnostic approaches, as well as the development of treatment plans.

For this Case Study Discussion, you will review a case study scenario to obtain information related to a comprehensive well-woman exam and determine differential diagnoses, diagnostics, and develop treatment and management plans.
To prepare:
• By Day 1 of this week, you will be assigned to a specific case study scenario for this Discussion. Please see the “Course Announcements” section of the classroom for your case study assignment from your Instructor.
• Review the Learning Resources for this week and pay close attention to the media program related to the basic microscope skills. Also, consider re-reviewing the media programs found in Week 1 Learning Resources.
• Carefully review the clinical guideline resources specific to your assigned case study.
• Use the Focused SOAP Note Template found in the Learning Resources to support Discussion. Complete a SOAP note and critically analyze this and focus your attention on the diagnostic tests. You are NOT to post your SOAP note. This is for your information only to help you develop your differential diagnosis and additional questions.

DO NOT POST A SOAP NOTE. Post your differential diagnosis. Include the additional questions you would ask the patient. Be sure to include an explanation of the tests you might recommend, ruling out any other issues or concerns and include your rationale. Be specific and provide examples. Use your Learning Resources and/or evidence from the literature to support your explanations.

Case Study: Contraception
Scenario 2
Elaine Goodwin is a 38-year-old G1 P1 LC 1 presenting to your clinic today to discuss contraceptive options. She states that she is not interested in having more children but her new partner has never fathered a child. Her medical history is remarkable for exercise-induced asthma, seizure disorder (her last seizure was five years ago), and IBS. Her surgical history remarkable only for tonsils as a child. Her social history is negative for alcohol, tobacco, and recreational drugs. She has no known drug allergies and takes Lamictal (lamotrigine) and Trileptal (oxcarbazepine). Hospitalizations were only for childbirth.  Family history reveals that her maternal grandmother alive with dementia, while her maternal grandfather is alive COPD. Her paternal grandparents are both deceased due to an automobile accident. Her mother is alive with osteopenia and fibromyalgia, and her dad is alive with a history of skin cancer (basal cell). Elaine has one older sister with no medical problems and one younger brother with no reported medical problems. 

• Height 5’ 7” Weight 148 (BMI 23.1), BP 118/72 P 68 
• HEENT:  wnl 
• Neck: supple without adenopathy 
• Lungs/CV: wnl 

• Breast: soft, fibrocystic changes bilaterally, without masses, dimpling or discharge 
• Abd: soft, +BS, no tenderness 
• VVBSU: wnl, except 1st degree cystocele 
• Cervix: firm, smooth, parous, without CMT 
• Uterus: RV, mobile, non-tender, approximately 8 cm, 
• Adnexa: without masses or tenderness 


What other information do you need? 


  1. What has she used in the past?  Why did she stop a method?  How many partners in past 12 months? 
  2. What are her current cycles like? 
  3. When was her last gyn exam and what were the results of the tests?  
  4. What method has she considered. 

    Elaine relates to you that she has used birth control pills before but “would keep messing them up”.  She has had three partners in last 12 months and has been with her current partner for the previous two months. She believes that he is “the one.”   

Elaine relates that her cycles come every 28-32 days, for a duration of 5-8 days, and on her heaviest day she must use a super tampon every hour and get up to change her pad 2-3 times at night. Her last gyn exam was one year ago and she shows you a copy of the results on her patient portal. The results for the pap were NILM, HPV negative, and her cultures for GC/CT were negative. She has heard about an implant that is put in your arm, but her sister had it and she bled all the time. 

Sample Solution

More than twenty percent of patients died after showing signs and symptoms of yellow fever. “After the bite of the infecting mosquito, it takes several days before symptoms appear” (Grunfeld, 2006). Due to the delay of symptoms, many of those infected spread the disease unknowing. “The disease characteristically began with high fevers, shaking chills that progressed to rigors, tachycardia, photophobia, conjunctival injection, petechiae, muscle pains, and headaches. The disease was punctuated by bleeding from the gums, epigastric discomfort, bilious vomiting, diarrhea, and melena. Jaundice, for which the disease was given its nickname “Yellow Jack,” subsequently developed. Following a respite, where symptoms abated, there would be an exacerbation of all previous symptoms plus bloody diarrhea, black-stained vomitus, coma, and death” (Thompson, O’Leary, 1996). In the beginning of epidemic, physicians were unsure of treatment plans for early symptoms were mistaken for other diseases such as influenza. “The physicians knew not how to treat this uncommon disorder, which was suddenly caught and proved suddenly fatal. The calamity was so general, that few could grant assistance to their neighbors. So many funerals happening everyday, while so many lay sick, that white persons sufficient for burying the dead were scarcely to be found” (Simons, 1852). Unfortunately, yellow fever was a death sentence. Treatment “At the beginning of the twentieth century, there was no cure for yellow fever. The best that medical authorities could do was to quarantine the afflicted. Those quarantines usually waved the warning yellow flag, which gave the disease its colloquial name, “yellow jack” (Grunfeld, 2008). There were many poorly trained physicians who had no experiences with an infection of this magnitude. “Popular therapies included bloodletting, blistering, cold water immersion, sweating, purging, and leeching. All of these were thought to be appropriate therapy for fevers. Fundamental to the treatment of Yellow Fever was calomel (Mercurous chloride) given in sufficient doses to induce vomiting and diarrhea. In smaller dosages, this agent acted as a laxative. At higher doses, the patients experienced symptoms of acute mercurial toxicity, which includes salivation, diarrhea, vomiting, and eventually neurologic damage. Because the patients treated with calomel were instructed to take the drug until salivation occurred, they undoubtedly experienced toxicity from the drug. Quinine, prescribed to reduce fever, was an appropriate treatment of malaria, but had little therapeutic efficacy in the treatment of Yellow Fever. Needless to say, the American physicians’ success rate in treating patients with Yellow Fever was poor” (Thompson, O’Leary, 1996).

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