NURS 6550:Week 7: Conditions of the Genitourinary, Gynecologic, and Renal Systems and Acid/Base Disorders Essay Assignment Paper

This week, you will discuss the effectiveness of health promotion and patient education interactions. Then, as you study patient presentations of genitourinary, gynecologic, renal, and acid/base conditions in acute care settings, you will examine strategies for assessing, diagnosing, and treating patients with these conditions.

Learning Objectives

By the end of this week, students will:

• Evaluate patient interactions in relation to health promotion and patient education
• Evaluate patients with conditions of the genitourinary, gynecologic, and renal systems and acid/base disorders
• Develop differential diagnoses for patients with conditions of the genitourinary, gynecologic, and renal systems and acid/base disorders
• Develop treatment plans for patients with conditions of the genitourinary, gynecologic, and renal systems and acid/base disorders

Learning Resources

Required Readings

Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F.A. Davis Company.

 

• Section 3, “Genitourinary and Breast Procedures”
  • Chapter 41, “Bladder Catheterization”
  • Chapter 42, “Breast Biopsy: Fine Needle Aspiration”
  • Chapter 43, “Breast Examination”
  • Chapter 44, “Colposcopy: Endocervical Curettage and Cervical Biopsy”
  • Chapter 45, “Endometrial Biopsy”
  • Chapter 46, “Specimen Collection: Gram’s Stain, Wet Mount (Saline and KOH)”
  • Chapter 47, “Specimen Collection: Papanicolaou (Pap) Smear”
  • Chapter 48, “Administration of Vaginal Medications and Condoms”
  • Chapter 50, “Cervical Cap Fitting: Insertion and Removal”
  • Chapter 51, “Cervical Lesions: Cryotherapy”
  • Chapter 53, “Condyloma Acuminata Removal”
  • Chapter 54, “Diaphragm Fitting, Insertion, and Removal”
  • Chapter 55, “Intrauterine Device (IUD) Insertion”
  • Chapter 56, “Norplant Insertion”
  • Chapter 57, “Norplant Removal”
  • Chapter 59, “Pessary Insertion”
  • Chapter 60, “Vaginal Examination”

Papadakis, M. A., McPhee, S. J., & Rabow, M. W. (2018). Current medical diagnosis & treatment (57th ed.). New York, NY: McGraw Hill.

 

• Chapter 18, “Gynecologic Disorders” (pp. 771-804)
• Chapter 19, “Obstetrics & Obstetric Disorders” (pp. 805-833)
• Chapter 21, “Electrolyte & Acid-Base Disorders” (pp. 893-921)
• Chapter 22, “Kidney Disease” (pp. 922-961)
• Chapter 23, “Urologic Disorders” (pp. 962-985)
• Chapter 42, “Women’s Health Issues” (p. e7, online chapter, www.accessmedicine.com/cmdt”)

Weber, E. C., Vilensky, J. A., & Fog, A. M. (2013). Practical radiology: A symptom-based approach. Philadelphia, PA: F.A. Davis Company.

• Chapter 7, “Breast” (pp. 151–162)
• Chapter 9, “Male and Female Urinary Tract and Male Genital Tract” (pp. 181–197)
• Chapter 10, “Female Pelvic Imaging” (pp. 199–213)

Agency for Healthcare Research and Quality. (2014). Clinical practice guideline on diagnosis and treatment of hyponatraemia. Retrieved from https://guideline.gov/summaries/summary/49536/clinical-practice-guideline-on-diagnosis-and-treatment-of-hyponatraemia?q=hypotonic

Agency for Healthcare Research and Quality. (2013). Screening, monitoring, and treatment of stage 1 to 3 chronic kidney disease: a clinical practice guideline from the Clinical Guidelines Committee of the American College of Physicians. Retrieved from https://guideline.gov/summaries/summary/47453/screening-monitoring-and-treatment-of-stage-1-to-3-chronic-kidney-disease-a-clinical-practice-guideline-from-the-clinical-guidelines-committee-of-the-american-college-of-physicians?q=hyperkalemia

Centers for Disease Control and Prevention. (2014a). Gynecologic cancers: What should I know about screening? Retrieved from http://www.cdc.gov/cancer/cervical/basic_info/screening.htm

Centers for Medicare & Medicaid Services. (n.d.-b). Your Medicare coverage: Pap tests/pelvic exams (screening). Retrieved October 27, 2014, from https://www.medicare.gov/coverage/cervical-vaginal-cancer-screenings.html

Deepa, C., & Muralidhar, K. (2012). Renal replacement therapy in ICU. Journal of Anaesthesiology Clinical Pharmacology, 28(3), 386–396. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3409957/

Grogono, A. W. (2011). Acid-base tutorial. Retrieved from http://www.acid-base.com/index.php

National Kidney Foundation. (2013). Guidelines and commentaries. Retrieved from http://www.kidney.org/professionals/kdoqi/guidelines_commentaries.cfm

University of Virginia. (2013a). An introduction to genitourinary radiography. Retrieved from http://www.med-ed.virginia.edu/courses/rad/gu/index.html

University of Virginia. (2013s). Top 10 testicular ultrasound diagnoses. Retrieved from http://www.med-ed.virginia.edu/courses/rad/testicularUS/index.html

Required Media

i-Human Patient Cases. (2014). Retrieved from https://ih2.i-human.com/users/sign_in

University of Virginia. (2013d). Cross sectional male pelvis. Retrieved from http://www.med-ed.virginia.edu/courses/rad/MalePelvis/index.html

University of Virginia. (2013e). Cross sectional pelvic anatomy. Retrieved from http://www.med-ed.virginia.edu/courses/rad/CTPelvisAnatomy/

Optional Resources

Barkley, T & Myers, C. (2015). Practice Considerations for Adult-Gerontology Acute Care Nurse Practitioners, Volumes 1 and 2 West Hollywood,, Ca: Barkley and Associates, Inc.

Sullivan, D. D. (2012). Guide to clinical documentation (2nd ed.). Philadelphia, PA: F.A. Davis.

Discussion: Assessment and Treatment of the Genitourinary, Gynecologic, and Renal Systems and Acid/Base Disorders

Common emergency department complaints are vaginal bleeding, and STIs. An understanding of the differential diagnoses that might occur with pregnant and non-pregnant women is important to grasp. Advanced clinical skills that the Acute Care Nurse Practitioner must be familiar with include the auscultation of fetal heart tones, basic fetal heart monitoring, pelvic exams, and delivery of fetal demise or precipitous deliveries of viable fetuses. Pregnancy can alter the diagnostic possibilities of a patient with acute abdominal pain and change the clinical findings. Advanced pregnancy can make it even more difficult.

The Centers for Disease Control and Prevention estimates that there are 19 million new cases of sexually transmitted infections every year in the United States. STIs may present serious health implications for infected patients—especially for those who are unaware of their health condition. Studies show that women are not only at greater risk of contracting these infections, but they also tend to have more severe health problems resulting from infections than men. As an advanced practice nurse, you must educate female patients and emphasize the importance of prevention and STI testing for all women regardless of marital status, race, ethnicity, or socioeconomic status.

Case Study 1

A 19-year-old Asian American female comes into the urgent care clinic. She is complaining of severe abdominal pain, that radiates to her back. She is having a moderate amount of vaginal bleeding. She has a past medical history of PID and has used an IUD in the past. Her vitals are T 37.7, P 116, RR 18, BP 88/50.

Case Study 2

A 31-year-old African American female is brought into the ER with vaginal hemorrhage. She is unsure of her last menstrual period. States she is sexually active and does not use protection. On exam there are large clots noted in the vaginal vault, with possible tissue. Vital signs are T 37, P 134, RR 26, BP 180/110.

Case Study 3

A 21-year-old nulligravida comes to the ER, concerned about vague lower abdominal pain for two days associated with a yellowish, nonodorous, vaginal discharge. Past history reveals regular menstrual periods and no previous surgeries or significant medical problems. Her last menstrual period was normal and ended two days ago. She had a similar episode about eight months ago for which she did not seek care because of lack of health insurance. She is currently sexually active with one partner and has had two partners in the past year. She is not using any type of contraception. On physical exam you note a temperature of 38º C, a regular pulse of 100, and a BP of 110/65. Her abdomen is diffusely tender in both lower quadrants. Pelvic exam reveals a yellowish cervical discharge with cervical motion tenderness and a tender fullness in both adnexa.

To prepare

• Review and select one of the three provided case studies. Reflect on the patient information.
• Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.
• Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.
• Consider strategies for educating patients on the treatment and management of the gynecological condition you identified as your primary diagnosis.

By Day 3

Post an explanation of the differential diagnosis for the patient in the case study you selected. Provide a minimum of three possible diagnoses, and list them from highest priority to lowest priority. Explain which is the most likely diagnosis for the patient and why. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patient.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days in both of the ways listed below. Respond to colleagues who selected different case studies than you did.

Based on your personal and/or professional experiences, expand on your colleagues’ postings by providing additional insights or contrasting perspectives.