Patho. Case:

A 32-year-old female presents to the ED with a chief complaint of fever, chills, nausea, vomiting, and vaginal discharge. She states these symptoms started about 3 days ago, but she thought she had the flu. She has begun to have LLQ pain and notes bilateral lower back pain. She denies dysuria, foul-smelling urine, or frequency. States she is married and has sexual intercourse with her husband. PMH negative.

Labs: CBC-WBC 18, Hgb 16, Hct 44, Plat 325, Neuts & Lymphs, sed rate 46 mm/hr, C-reactive protein 67 mg/L CMP wnl

Vital signs T 103.2 F Pulse 120 Resp 22 and PaO2

99% on room air. Cardio-respiratory exam WNL with the exception of tachycardia but no murmurs, rubs, clicks, or gallops. Abdominal exam + for LLQ pain on deep palpation but no rebound or rigidity. Pelvic exam demonstrates copious foul-smelling green drainage with reddened cervix and + bilateral adenexal tenderness. + chandelier sign. Wet prep in ER + clue cells and gram stain in ER + gram negative diplococci. 99 percent of the air in the room Exam of the cardiovascular and respiratory systems found no abnormalities, with the exception of tachycardia; there were also no murmurs, rubs, clicks, or gallops. Abdominal exam revealed a positive result for discomfort in the LLQ region with deep palpation, however there was neither rebound nor rigidity. A thorough pelvic exam reveals enormous amounts of foul-smelling green drainage, a reddish cervix, bilateral adenexal pain, and a chandelier sign. Wet prep was performed on ER+ clue cells, and gram stain was performed on ER+ gram-negative diplococci.

For this assignment, you will examine a case study and analyze the symptoms presented:

· You will develop a potential diagnosis. You will identify the elements that may be factors in the diagnosis (any patient factors like gender, race, or ethnicity that contribute to the diagnosis.) and you will explain the implications to patient health. Assignment help – Discuss the factors that affect fertility (STDs).

· Assignment help – Discuss why inflammatory markers rise in STD/PID

Assignment ( 2 or 3-page case study analysis + introduction, + conclusion, and references pages)

Develop the work, putting each question with its answer individually, Not explain altogether….. Plagiarism document…

Include citation, the statements with citation, References at least 4 and not more than 5 years ago …..

Using formal Help write my thesis – APA writing,using the 7th Edition
—-
Provide recommendations for alternative drug treatments to address the patient’s pathophysiology. Be specific and provide examples.

The patient that I have is a 46-year-old female who is 230 pounds and has a history of breast cancer. Patient is up to date on her yearly mammograms and has a history of hypertension. Patient complains of night sweats, hot flashes, and genitourinary symptoms. Patient also has a history of ASCUS about 5 years ago on pap smear, but all other pap smears have been normal. Patient has regular menstrual cycles, states that last one was 1 month ago. Patient currently takes Amlodipine (Norvasc) 10mg PO daily and Hydrochlorothiazide (Microzide) 25mg PO daily. Patients’ blood pressure today is 150/90. In this case study, I feel like this patient is experiencing symptoms of perimenopause. The patients’ healthcare needs include hypertension management, yearly pap smears because of her history of ASCUS, yearly mammograms due to family history of breast cancer, and weight management. To better manage the patients’ blood pressure, I would discontinue the Amlodipine (Norvasc) 10mg PO daily and start Lisinopril 20mg PO daily for hypertension. With discontinuing the Amlodipine (Norvasc) 10mg PO daily this might would help stop the hot flushing. With taking Amlodipine (Norvasc), researchers observed edema, dizziness, flushing, and palpitations in controlled clinical trials in a dose-dependent manner (Bulsara & Cassagnol, 2022). With starting patient on Lisinopril 20mg PO daily, I would have the patient record her blood pressure in the morning and at bedtime for 2 weeks and then follow up with her to see how her blood pressure is running. If the patients’ blood pressure was controlled, I would discontinue the Hydrochlorothiazide (Microzide) 25mg PO daily and see how the patient done for 2 more weeks with just the Lisinopril 20mg PO daily. If the patients’ blood pressure was controlled with just the Lisinopril 20mg PO daily and I could discontinue the Hydrochlorothiazide (Microzide) this would help alleviate some of the genitourinary problems that the patient is having. I would consider a Hormone Replacement Therapy due to patient being perimenopause. Hormone replacement therapy (HRT) can help balance estrogen and progesterone levels during or near menopause (“Hormone replacement therapy: Uses, types, and alternatives”). HRT can help relieve hot flushing and night sweats. Before prescribing any Hormone Replacement Therapy I would order some blood work to check the patients’ levels before initiating HRT. I would educate the patient on the importance of getting yearly mammograms due to her family history of breast cancer and HRT could increase the risk of breast cancer as well. I would also educate the patient on the importance of getting yearly pap smears due to a history of ASCUS. Patient education would include education on the side effects of lisinopril include feeling tired, feeling dizzy or lightheaded, cloudy urine, decrease in urine output, confusion, blurred vision, and sweating (“Lisinopril (oral route) side effects”). Also, I would educate the patient on the importance of knowing how to recognize signs and symptoms of hypotension. I would educate the patient on weight management techniques and would also recommend some exercise regimens due to the patient being overweight. During the patient’s weight loss, her blood pressure will need to be monitored closely so hypotension can be avoided.

Reference

Bulsara, K., & Cassagnol, M. (2022). Amlodipine – StatPearls – NCBI Bookshelf. Retrieved July 26, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK519508/

Hormone replacement therapy: Uses, types, and alternatives. (n.d.). Medical News Today. Retrieved July 26, 2022, from https://www.medicalnewstoday.com/articles/181726

Lisinopril (oral route) side effects. (2022). Mayo Clinic. Retrieved July 26, 2022, from https://www.mayoclinic.org/drugs-supplements/lisinopril-oral-route/side-effects/drg-20069129

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