NRNP 6552 Differential Diagnosis of Gynecologic Health Case Study

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.

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.

Elaine Goodwin is a 38-year-old G5 P5 LC 6presenting 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, migraines, and IBS.?Her surgical history?is 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 only vitamin C.?Hospitalizations were only for childbirth.?Family history?reveals that her maternal grandmother is alive with dementia, while her maternal grandfather is alive with 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.? NRNP 6552 Differential Diagnosis of Gynecologic Health Case Study

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 10 cm,?
Adnexa: without masses or tenderness?

QUESTION:

What other information do you need??

MORE QUESTIONS:

What has she used in the?past?? Why did she stop a?method?? How many partners in past 12?months??
What are her current cycles like??
When was her last gyn exam?and what were the results of?the?tests???
Are her migraines with or without auras??
What method has she considered.?

ANSWERS:

Elaine relates to you that she has used birth control pills before but “would keep messing them up.”? After that she switched to the patch, which she found worked well but discontinued use for reasons she does not remember.?After that she used?natural family planning but still conceived her last two children unexpectedly.??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.”??? NRNP 6552 Differential Diagnosis of Gynecologic Health Case Study

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.? NRNP 6552 Differential Diagnosis of Gynecologic Health Case Study

In further questioning, you ask her?about her migraines. She shares that these migraines occur just before her period, or when she’s stressed, and are?preceded?by?a vision change in her right eye.?She takes Excedrin Migraine?for them and rests in a dark room until the migraine is done.?

She has heard about?a pill where she?will only?get her period four times a?year and?feels now that she’s older she can remember to take the pill daily and plans on putting a reminder in her phone.?