Week 10 Case Study The Same For Everyonegenitalia Assessme ✓ Solved

Assessing the Genitalia and Rectum Photo Credit: Getty Images Patients are frequently uncomfortable discussing with healthcare professional’s issues that involve the genitalia and rectum; however, gathering an adequate history and properly conducting a physical exam are vital. Examining case studies of genital and rectal abnormalities can help prepare advanced practice nurses to accurately assess patients with problems in these areas.

In this Lab Assignment, you will analyze an Episodic note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions.

To Prepare, review the Episodic note case study your instructor provides you for this week’s Assignment. Based on the Episodic note case study, review this week’s Learning Resources, and consider the insights they provide about the case study. Refer to Chapter 3 of the Sullivan resource to guide you as you complete your Lab Assignment. Search the Walden library or the Internet for evidence-based resources to support your answers to the questions provided.

Consider what history would be necessary to collect from the patient in the case study. Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis? Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

The Lab Assignment: Using evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature:

  • Analyze the subjective portion of the note. List additional information that should be included in the documentation.

  • Analyze the objective portion of the note. List additional information that should be included in the documentation.

  • Is the assessment supported by the subjective and objective information? Why or why not?

  • Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis?

  • Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.

Paper For Above Instructions

The genitalia assessment case study presents a 21-year-old white female college student, AB, who visits the clinic complaining of painless bumps in the genital area. To provide a thorough assessment and determine potential diagnoses, it is crucial to gather a comprehensive history, perform appropriate physical examinations, and consider relevant diagnostic tests.

Subjective History Analysis

The subjective portion of the patient's note reveals several areas where additional information could be beneficial. Potential additional questions include:

  • Duration of symptoms: While the patient noticed the bumps a week ago, any prior history of similar lesions or skin changes should be explored.

  • Sexual history clarification: The number of sexual partners and whether protection was consistently used are important factors.

  • Associated symptoms: Inquiry about itching, burning, or any other discomfort, as well as whether the bumps have changed in size, number, or appearance.

  • History of prior STI infections: Although she reports a past chlamydia infection, history of HPV, herpes, or other STIs should be clarified.

  • Current relationship dynamics: Understanding if she has a primary partner and if they have concurrent relationships can provide insight into risk factors.

Objective Examination Analysis

The objective portion indicates a physical examination showing normal findings except for a firm, round, small, painless ulcer on the external labia. Additional objective information to document includes:

  • Inspection findings: Detailed description of the ulcer (size, texture, color, and any surrounding erythema).

  • Genital palpation findings: Noting any tenderness or fluctuation that might suggest an abscess or change in the lesion’s nature.

  • Pelvic examination results, if performed: Including evaluation of cervix, uterus, and adnexa to rule out other potential issues.

  • Evaluation of inguinal lymph nodes: Any swelling or tenderness could indicate an infectious process.

Assessment Support Analysis

To assess whether the diagnosis is supported by subjective and objective information, it is critical to analyze the recorded data. The subjective report of painless bumps is consistent with several conditions, including genital warts (caused by HPV), molluscum contagiosum, or herpes simplex virus (HSV). The physical exam finding of a painless ulcer raises the suspicion for herpes or other viral infections, such as syphilis or chancroid.

The assessment will likely focus on the need for further evaluation to differentiate among these possibilities, emphasizing the importance of correlating the history with the findings from the physical exam.

Appropriateness of Diagnostics

Diagnostics are highly appropriate given the potential differential diagnoses. The HSV specimen obtained is vital to confirm or rule out the presence of the herpes virus, which could lead to blister-like lesions. Additional diagnostic tests may include:

  • Polymerase chain reaction (PCR) testing: For HSV to determine viral presence.

  • Serological tests: For syphilis and other STIs to ascertain potential concurrency.

  • Pap smear: To assess for cervical changes given the patient's history.

Differential Diagnosis

Three possible conditions to consider in this case include:

  • Herpes Simplex Virus (HSV): Characterized by painful and vesicular lesions, HSV could present atypically as painless ulcerations.

  • Genital Warts (HPV): These are typically painless, firm lesions that can appear as small bumps on the genital area, supporting the finding of a painless ulcer.

  • Molluscum Contagiosum: This viral infection manifests as small, painless bumps and can be sexually transmitted, fitting the patient's sexual history.

In conclusion, a thorough collection of history and suitable examination, combined with targeted diagnostics, will provide the necessary data to reach an accurate diagnosis. Given the patient's history of STIs and the current findings, further evaluation is crucial in managing her condition effectively.

References

  • American Academy of Family Physicians. (2021). Clinical Updates in Sexual Health: Genital Ulcers.

  • Workowski, K.A., & Bolan, G.A. (2015). Sexually transmitted diseases treatment guidelines, 2015. Morbidity and Mortality Weekly Report, 64(3), 1-137.

  • CDC. (2021). Genital Herpes - CDC fact sheet. Centers for Disease Control and Prevention.

  • Siegel, R.L., Miller, K.D., & Jemal, A. (2020). Cancer statistics. CA: A Cancer Journal for Clinicians, 70(1), 7-30.

  • Marrazzo, J.M., & Cohn, D.L. (2019). Sexually transmitted infections. In Chapter 23. Infections in Women. 6th ed. McGraw-Hill Education.

  • Hollier, L.M., et al. (2017). Preventing Cervical Cancer through Vaccination and Screening. Clinical Obstetrics and Gynecology, 60(4), 725-741.

  • Wentzensen, N., et al. (2019). The role of HPV testing in cervical screening. Current Opinion in Obstetrics and Gynecology, 31(5), 251-258.

  • Chlamydia Treatment Guidelines - ACOG. (2021). American College of Obstetricians and Gynecologists.

  • Fitzgerald, H. (2020). Understanding Molluscum contagiosum. Advances in Dermatology and Allergology, 37(6), 913-919.

  • Becker, T. (2021). Contemporary Approaches to the Management of Genital Warts. Journal of Infectious Diseases, 223(7), 1091-1098.