Question

A 21-year-old white woman who is seen at the outpatient clinic with complaints of purulent yellow-white discharge and frequent urination over the past 2 weeks. She is sexually active with a new partner.

Subjective data:

• Her sexual partner does not use a condom or spermicidal with intercourse
• Her last menstrual period was 2 weeks ago
• Her sexual partner was recently treated for epididymitis
• Appears very anxious

Objective data:

• Cervical ectopy noted during Pap test
• Mucopurulent cervical discharge
• Urine pregnancy test is negative
• Nucleic acid amplification test is positive for Neisseria gonorrhoeaeand Chlamydia trachomatis

Discussion Questions:

1. Identify the categories of the health history that have been addressed and those for which additional data must be obtained.
2. What were K.M.’s risk factors for acquiring gonorrhea and chlamydial infections?
3. What impact is her diagnosis likely to have on K.M.’s self-image? On her relationship with her sexual partner?
4. Discuss the developmental (physical, cognitive, psychosocial and behavioral), age, socioeconomic and cross-cultural considerations that should be considered during the gathering of subjective and objective data and the provision of health care?
5. Relate expected (normal) findings to those described for this patient and discuss any additional information that might be needed before a diagnosis can be made?
6. Based on the assessment data presented, what are the health issues? Provide rationale.

Answer 1

●The patients demographic history (age ,gender)sexual history (relationship)as been obtained. Additional data which can be collected are review of system which enables to identify the relationship of patient's physical,social,psychological past and present history to get information on hidden causes.

● The main risk factor is the active sexual relationship who is a known case of epididymitis.

●This can affect her self image in the following way

• Low self esteem and confidence to face the external world
• Psychological disturbances die to infection
• Hatred on the partner if suspecting the infection is the result of relationship or feeling depressed and difficult in the way to express this to her partner
• Anxiety making her to perform poor in her activity
• Lack of concentration
• Fear towards the treatment and its relapse

● Upon considering her age she is in child bearing age group and chance of these type of infection is high if the sexual history of the partner is unknown.

The socioeconomic status can make her to handle the burden of medical expenses and lifestyle changes in the society

The patients emotions or intimacy in deep should be avoided and should not be forced to be disclosed

Culture plays a vital role ,the patient's background on it can help to assess the way the patient can recover.

● The findings are

• Cervical ectopy (skin should cover the cervix normally) but the epithelial tissue covers externally
• Mucopurulent cervical discharge (clear white transparent discharge is normal during the period of ovulation).This shows the patient has infection
• Nucleic acid amplification test should be negative normally.A positive in it shows the patient is infected.
• Additional information to diagnose are any STD for partner, for patient cervical ,vaginal specimen testing .Along with this urine test can also detect this infection. Antibody test for chlamydia can be found with a blood test.

● The following health issues can be observed

• Mucopurulent discharge is a clear indicator of infection
• Frequent urination is a sign of urinary tract infections
• Cervical ectopy, due to the infection