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Instructions:
Please respond to at least 2 of your peer’s posts. To ensure that your responses are substantive, use at least two of these prompts:
Do you agree with your peers’ assessment of this patient’s symptoms?
Take an alternate perspective to a peer and present a logical argument supporting a different approach.
Present new references that support your opinions.
Please be sure to validate your opinions and ideas with citations and references in APA format.
1st person post Hannah Roush
As you enter the treatment
room, the patient appears anxious and uncomfortable. What additional history
should you obtain from the patient?
It is important to provide empathy first and foremost before
gathering excessive additional history. The negative stigma surrounding STIs
can lead patients to downplaying their symptoms, delayed treatment, further
transmission and even partner violence (Chesang et al.,2022). By providing
empathetic care and letting patients know that what they are experiencing is
normal and it does happen. Additional history could be onset of the patient’s
symptoms, duration of symptoms characteristics such as urinary concerns and
complaints as well location of testicular pain, and when the penile discharge
began. The CDC recommends using the “5Ps” to guide dialogue between the
practitioner and the patient this consists of number and newness of sexual
partners as well as the gender of the partners, we may also inquire regarding
the partners risk factors. The second P is practices, this inquiries about any
sexual practices that may be taking place. The third P is protection of STIs
was or has there been any protection used? The fourth P is history of STIs for
the patient and we may inquire about their partner. Lastly are pregnancy
intentions (CDC, n.d.).
What physical examination
components are indicated for this presentation?
For a male physical exam component would be lower abdominal
palpitation, a testicular exam, and a digital rectal examination for a patient
where prostatitis may be suspected. We should also assess the skin for presence
of a maculopapular rash which could be an indicator for syphilis (Dunphy et
al.,2022).
Based on the presentation
and history, you recognize the need to screen for sexually transmitted
infections (STIs). What are the most common STIs for this presentation?
Differential or common STIs to consider for this patient due to
his presentation would be Trichomoniasis- infected males could have symptoms of
urethritis, or prostatitis. This patient may also have gonorrhea. He reports
urinary frequency and patients with gonorrhea often reports symptoms of
urethral discharge and dysuria. Lastly this patient is also showing symptoms of
chlamydia which consists of urethral discharge, and pain and swelling of the
testicles.
After your assessment, all
subjective and objective findings should be considered when developing
differential diagnoses for scrotal pain and swelling with accompanying urinary
complaints. What may be included on a differential list?
Differential diagnoses we may include for this patient may be
any of the STIs discussed above as well as possible acute epididymitis,
testicular torsion, varicocele, or possible Fournier’s gangrene. All of the
above diagnoses often present with acute onset scrotal pain and possible
swelling, while not all diagnoses may present with urinary complaints this is
still an associated symptoms to be mindful of.
Name your priority
diagnosis and provide the treatment plan. If you elect to treat with
medications, provide full prescription details and follow up plan.
My primary diagnosis for this patient is an STI. It is highly
likely that he has contracted Chlamydia. His initial onset of this case could
have presented asymptomatically in his partner and now he is showing symptoms.
(Dunphy et al.,2022) I favor a diagnosis of Chlamydia due to his urethral
discharge, urinary frequency, and pain present in his testicles. He may also be
masking any febrile symptoms with the Tylenol he has been taking. Diagnostic
testing can include a urethral versus a rectal swab.
Treatment: Azithromycin 1g PO Once Quantity:1 Refills: 0
This patient should also discuss any other sexual partners he
has had in the past 60 days and recommend that they obtain testing and pursue
treatment. (Dunphy et al.,2022) Follow up testing will not be recommended
unless symptoms continue to persist. This patient would not necessarily need to
return to follow up in clinic unless symptoms persist. However, education
regarding prevention is vital. This will include use of condoms for sexual
intercourse and refraining from oral sex or use of prevention. Limiting sexual
partners is another way to prevent against STIs and finally youth should always
receive an HPV vaccine to prevent HPV.
As the practitioner, you
are required to report certain STIs to your state health department. Provide a
list of the STI’s that must reported in your state along with the information
that needs to be included when reporting these.
The state of Wisconsin where I reside the reportable STDs
consist of chlamydia, gonorrhea, syphilis, pelvic inflammatory disease, and
chancroid. This requires the practitioner who discovered the positive result to
report the case by name and address to a local health officer. This is required
in an individual who has tested positive or who has evidence to testing
positive from the infection. A practitioner may also treat a minor who has
contracted one of these reportable infections without consent of a legal
guardian (WI State Legislature, 2018).
2nd person post Fredrick Kariuki
NU623-7B, 2242C16DiscussionsUnit 8: Discussion Scrotal Pain
You are seeing a 22-year-old male patient at the college student
health clinic. His chief complaint is scrotal pain and swelling. He has had
some frequency of urination and purulent penile discharge but no fever. He
admits to being sexually active with his new girlfriend of two weeks. He has
tried Tylenol and ibuprofen at home, but nothing has helped.
As you enter the treatment
room, the patient appears anxious and uncomfortable. What additional history
should you obtain from the patient?
Since the patient feels anxious and uncomfortable, it is
essential to approach him with empathy and reassurance, explain the examination
and its indication, ensure privacy, and assess for pain. When examining any
intimate region, explicit verbal consent and a chaperone are critical to
patient comfort (Please et al., 2022).
The additional history from the patient would be about the onset
and duration of symptoms, any recent trauma or injury to the scrotum, any
associated symptoms such as fever, chills, or urinary symptoms, and any history
of sexually transmitted infections. It is also important to inquire about any
recent surgeries or medical procedures involving the genital area, as well as
any history of hernias or other medical conditions. Additionally, ask about
using protective equipment during physical activities or sports and any recent
changes in physical activity. According to (Velasquez et al., 2023), the
causative etiologies of acute scrotum pain are broad. These include ischemic,
traumatic, infectious, inflammatory, referred pain, acute or chronic, or
idiopathic.
What physical examination
components are indicated for this presentation?
Physical examination components indicated this patient include
inspection, palpation, and possibly transillumination.
Inspection would allow visually assessing the scrotum for any
signs of redness, swelling, or skin changes.
Palpation involves gently feeling the scrotum to determine the
location and severity of the pain and check for lumps or masses.
Transillumination may be performed by shining a light through
the scrotum to help differentiate between fluid-filled masses, such as
hydroceles, and solid masses, such as tumors (Please et al., 2022).
Physical examination also includes assessing for tenderness or
warmth in the scrotal area. Depending on the findings of the physical
examination, further diagnostic tests, such as ultrasound or laboratory
studies, may be warranted to determine the underlying cause of the scrotal pain
and swelling.
Based on the presentation
and history, you recognize the need to screen for sexually transmitted
infections (STIs). What are the most common STIs for this presentation?
The most common sexually transmitted infections (STIs) that can
cause scrotal pain and swelling for this patient include:
·
Gonorrhea: This bacterial infection can cause inflammation and
pain in the scrotum.
·
Chlamydia: Bacterial infection that can lead to epididymitis,
causing pain and swelling in the scrotum.
·
Genital herpes: This viral infection can cause painful sores and
swelling in the genital area, including the scrotum.
·
Syphilis: Syphilis can lead to a condition known as syphilitic
orchitis, causing inflammation and pain in the testicles.
·
Trichomoniasis: This parasitic infection can cause irritation
and discomfort in the genital area, including the scrotum.
Epididymitis is most often associated with a sexually
transmitted disease. Chlamydia trachomatis and Neisseria gonorrhea account for
approximately 50% of cases of epididymitis associated with chlamydia and
gonorrhea in males less than 39 years of age (Rupp & Leslie, 2023).
After your assessment, all
subjective and objective findings should be considered when developing
differential diagnoses for scrotal pain and swelling with accompanying urinary
complaints. What may be included on a differential list?
The potential causes of scrotal pain and swelling with
accompanying urinary complaints include:
·
Epididymitis: Inflammation of the epididymis, often caused by a
bacterial infection.
·
Testicular torsion: A sudden, severe pain caused by the twisting
of the spermatic cord, which requires immediate medical attention.
·
Inguinal hernia: When a portion of the intestine or bladder
protrudes into the groin area, causing pain and swelling.
·
Orchitis: Inflammation of the testicle, commonly due to a viral
infection such as mumps.
·
Urinary tract infection (UTI) is an infection of the urinary
system that can cause pain and discomfort in the scrotum.
·
Prostatitis is inflammation of the prostate gland that leads to
urinary symptoms and pelvic pain (Mathews, 2023).
Name your priority
diagnosis and provide the treatment plan. If you elect to treat with
medications, provide full prescription details and a follow-up plan.
My priority diagnosis is epididymitis, an inflammation of the
epididymis often caused by a bacterial infection. The treatment plan
would involve antibiotics to target the underlying disease.
Ciprofloxacin 500mg by mouth twice a day for 10 days.
# 20, with 0 refill
Ibuprofen 600 mg by mouth 3 times daily as needed for pain
# 30 with 0 refill.
Additionally, I would recommend supportive measures such as
scrotal elevation, rest, and analgesics for pain relief.
The follow-up plan would involve a re-evaluation after the
antibiotic course is completed to assess the response to treatment and ensure
the resolution of symptoms after 2 weeks.
I would discuss safe sexual practices with the patient to
prevent future occurrences and instruct the patient to abstain from sexual
activity until the completion of treatment and follow-up (Leslie et al., 2023)
As the practitioner, you
must report certain STIs to your state health department. Provide a list of the
STIs that must be reported in your state and the information that must be
included when reporting them.
In the State of Massachusetts, the following STIs must be
reported to the health department: chlamydia, gonorrhea, syphilis, and
HIV/AIDS. When reporting these STIs, the following information must be
included: patient demographics (name, age, sex, race/ethnicity), contact
information, date of diagnosis, type of infection, and treatment information.
This information is critical for public health surveillance and intervention
efforts to prevent the spread of STIs and ensure that individuals receive
appropriate care and treatment (STD Information for Healthcare and Public
Health Professionals, 2024).
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