Elizabeth Walker iHuman Reflection NRP/563: Management Of Women’s Health Issues

Elizabeth Walker iHuman Reflection NRP/563: Management Of Women’s Health Issues

iHuman Patient Elizabeth Walker Reflection

Steps to Differential Diagnosis

Managing Acute Pelvic Pain in Women: A Comprehensive Approach

Acute pelvic pain, lasting no more than three months, can originate from diverse gynecologic and non-gynecologic causes. Elizabeth’s case exemplifies the need for a meticulous approach to differential diagnosis, emphasizing thorough history-taking and physical examination.

Steps to Final Diagnosis

To pinpoint the cause, a comprehensive physical examination is crucial. Clinical evaluation and blood tests, in conjunction with patient history, aid in diagnosing pelvic pain causes. Absence of specific symptoms like inappetence and vomiting helps rule out digestive tract disorders, while negative HCG tests eliminate ectopic pregnancy possibilities. Ultrasonography, focusing on ovarian characteristics, serves as the definitive diagnostic modality. In Elizabeth’s case, an enlarged right ovary lacking blood flow on ultrasound points to ovarian torsion.

Application of Watson Theory

The Watson theory underscores the significance of addressing emotional needs for self-healing. Nurses play a vital role by fostering a caring environment, understanding patient beliefs, and maintaining a trusting relationship. Spiritual concerns are addressed with empathy, providing information about corrective procedures and allaying fears, such as concerns about infertility post-surgery.

Management

Ovarian torsion, resulting from the twisting of ovarian ligaments, necessitates prompt diagnosis to prevent ischemia and infertility. Surgical detorsion with adnexal sparing is the primary treatment. Adequate analgesia manages pain and tachycardia pre-surgery.

Conclusion

Swift and accurate diagnosis is imperative in managing acute pelvic pain, considering potential complications. A holistic clinical and physical examination approach, guided by patient needs and values, is essential for effective diagnosis and patient-centric management.

References

Brady, P. C., & Carusi, D. (2016). Acute Pelvic Pain. Handbook of Consult and Inpatient Gynecology, 3-29. https://link.springer.com/chapter/10.1007/978-3-319-27724-0_1

Guile, S. L., & Mathai, J. K. (2021). Ovarian Torsion. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK560675/

Hecht, S., Meissnitzer, M., & Forstner, R. (2019). Acute Pelvic pain in women-gynaecological causes. Der Radiologe, 59(2), 126-132. https://doi.org/10.1007/s00117-018-0475-4

Pajnkihar, M., Štiglic, G., & Vrbnjak, D. (2017). The concept of Watson’s carative factors in nursing and their (dis) harmony with patient satisfaction. PeerJ, 5, e2940.  https://dx.doi.org/10.7717%2Fpeerj.2940

SOAP Note Template

Abdominal pain RLQ one hour with nausea. Reports pain is stabbing, sharp, strong, feels deep, rates pain 8 on scale 0-10.

HPI

History (including PMH, surgical, family, and social)

Clinical Presentation of Elizabeth Walker: Managing Acute RLQ Abdominal Pain

Elizabeth Walker, a 34-year-old married woman, seeks evaluation for sudden right lower quadrant (RLQ) abdominal pain accompanied by nausea persisting for one hour. Describing the pain as sharp, constant, exacerbated by movement, she denies vomiting, fevers, chills, diarrhea, abnormal vaginal bleeding, or urinary symptoms. Currently undergoing hormonal fertility treatments (G0P0), Elizabeth presents with tachycardia, RLQ pain with guarding and rebound, and a tender right adnexal mass during the pelvic examination.

Medical History

• Currently undergoing hormonal stimulation fertility treatments (G0P0).
• Surgical History: Tonsillectomy at age 14.
• Preventive Measures: Yearly flu immunization, BMI of 22.3, regular seat belt use, and no texting while driving.
• Immunizations: Up to date on Tdap and influenza vaccination.

Obstetric History

• Gravida 0, Para 0, Abortus 0.

Family History

• Mother (62): Hypertension, alive and well.
• Father (65): Diabetes, alive and well.
• Sister (36): Two children, alive and well.
• Grandparents: Deceased due to unknown causes.

Social History

• No tobacco, alcohol, or recreational drug use.
• Married with monogamous relationship.
• Education: College graduate.
• Occupation: Elementary-school principal.
• No recent travel, pets, or guns in the household.

This comprehensive patient profile will guide the diagnostic process and inform a patient-centered management plan for Elizabeth’s acute RLQ abdominal pain.

ROS (general, skin, HEENT, neck, breasts, resp, CV, GI, peripheral vascular, urinary, genital/LMP, MSK, psych, neuro, hematologic, endocrine)

Patient History and Objective Findings: Elizabeth Walker

General:

• No signs of fever, chills, fatigue, malaise, night sweats, or unexplained weight changes.
• Skin/Breasts: No abnormalities like rashes, bruising, jaundice, pruritus, acne, sores, ulcers, or changes in moles, hair, or nails. No breast pain, lumps, discoloration, or nipple discharge. Regular self-breast exams.
• Menstrual History: Regular periods every 26-28 days, with the last menstrual period (LMP) three weeks ago. Uses three pads or tampons per day.

HEENT/Neck:

• No vision changes, blurred vision, eye pain, discharge, itching, or redness. No ear pain, discharge, hearing difficulty, vertigo, nasal issues, sinus pain, sore throat, or dental problems.

Cardiovascular:

• No chest pain/pressure, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, palpitations, or ankle swelling.

Respiratory:

• Denies shortness of breath, wheezing, cough/sputum, hemoptysis, chest tightness, or pleuritic chest pain.

Abdominal/GI:

• Reports nausea and RLQ abdominal pain for the last hour. No appetite changes, dysphagia, vomiting, heartburn, or gastrointestinal issues.

Genitourinary:

• No menstrual irregularities, amenorrhea, dysmenorrhea, or dyspareunia. Denies urinary symptoms or menstrual irregularities.

Musculoskeletal:

• No joint or muscle pains, stiffness, swelling, or limitations in movement.

Neurological:

• No headaches, syncope, presyncope, dizziness, weakness, paralysis, numbness/tingling, or balance issues.

Allergic/Immunologic:

• Allergic to penicillin, otherwise, no known food allergies, hives, or rashes.

Lymphatic/Endocrine:

• Denies symptoms like polyuria, polydipsia, polyphagia, tremor, heat or cold intolerance, or hot flashes.

Hematologic:

• Denies excess bruising, bleeding, or swollen glands/lymphadenopathy.

Psychological:

• No mood changes, depression, manic behaviors, hallucinations, anxiety, insomnia, or suicidal/homicidal ideations.

Allergies:

• Allergic to penicillin. No known food allergies (NKFA).

Current Medications:

• FSH and HCG injections.

Objective Findings:

• Vital Signs: BP 106/70 mmHg (sitting), RR 14 (unlabored), Pain score 8, Height 5’ 4”, Weight 130 lbs. (59.1kg), BMI 22.3, Temp 98.6°F (oral), Pulse Ox 99% room air.

Physical exam (general, HEENT, neck/lymph, breasts, chest/respiratory, CV, GI/abdomen, GU/rectal, back, MSK, skin, neuro, psych)

Patient Assessment and Management – Elizabeth Walker

Introduction:

Elizabeth Walker, a 34-year-old married female, sought evaluation for acute onset right lower quadrant abdominal pain with associated nausea. This essay details the comprehensive patient assessment, differential diagnoses, and the formulated plan for her management.

Patient History and Physical Examination:

Elizabeth reported sharp, constant pain exacerbated by movement, associated with nausea. Her medical history revealed ongoing fertility treatments. On examination, she exhibited tachycardia, guarding, and rebound tenderness, with a tender right adnexal mass during the pelvic examination. No overt inflammatory signs were observed, and her breasts were normal.

Systemic Review:

A systemic review revealed no concerning findings related to fever, chills, fatigue, malaise, or weight changes. Elizabeth denied respiratory, cardiovascular, gastrointestinal, genitourinary, musculoskeletal, and neurological symptoms. Skin and breast examinations showed no abnormalities, and her menstrual history was regular.

Assessment and Differential Diagnoses:

The primary issue identified was Right Ovarian Torsion. Differential diagnoses considered included ectopic pregnancy, tubo-ovarian abscess, ovarian cyst rupture, and appendicitis. Thorough physical examination and additional diagnostic tests were essential for a conclusive diagnosis.

Diagnostic Tests and Results:

1. Pelvic Ultrasound:
   • Confirmed an enlarged right ovary with no blood flow, supporting the diagnosis of ovarian torsion.
   • Right ovary: 11cm x 4cm with a small cyst; no blood flow.
   • Left ovary: 4cm overall size; no pathology.
2. CBC:
   • Indicated leukocytosis, consistent with an inflammatory process.
3. hCG, Urine:
   • Confirmed non-pregnancy.
4. Urinalysis (UA):
   • Showed normal parameters.

Management Plan:

1. Surgical Referral:
   • Immediate STAT GYN surgical referral for the removal of the right torsed ovary.
   • Initiate IV access for analgesia.
2. Blood Work:
   • Order chemistries and coagulation studies as part of the preoperative workup.
3. Education and Counseling:
   • Refer for infertility and loss of ovary support groups.
4. Follow-up:
   • Monitor vital signs, expecting improvement with analgesia.
   • Prepare for emergent laparoscopy to detorse the ovary.

Conclusion:

In conclusion, Elizabeth Walker’s presentation of acute abdominal pain led to the diagnosis of Right Ovarian Torsion. The outlined management plan ensures prompt and effective intervention, emphasizing the importance of a multidisciplinary approach for comprehensive patient care.

Plan for Patient Management – Elizabeth Walker

Table 1: Summary of Patient Management Plan for Elizabeth Walker

This comprehensive plan encompasses medication management, diagnostic tests, laboratory assessments, and referrals to ensure prompt and effective intervention for Elizabeth Walker’s ovarian torsion.

NRP/563: Management of Women’s Health Issues

Wk 7 – iHuman Patient Elizabeth Walker Reflection

1. See attached SOAP note for Elizabeth Walker.
2. Write a 500-word summary (7^th edition APA format) regarding your patient encounter with Elizabeth Walker.
3. Include the following in your summary:
4. Explain how you arrived at your differential diagnoses.
5. Explain the steps you used to determine the final diagnosis.
6. Give examples of how you can integrate cultural preferences, values, health beliefs, and behaviors into the treatment plan using Watson’s theory Elizabeth Walker iHuman Reflection NRP/563: Management Of Women’s Health Issues.
7. Describe the appropriate management (e.g. health maintenance, diagnostics, medications/treatment) and support with evidence.
8. Critique your overall case evaluation, highlighting 2 to 3 takeaways to improve your clinical skills now that the diagnosis has been revealed.
9. Cite a minimum of 3 peer-reviewed journal references within the last 5 years supporting your responses according to 7th edition APA guidelines.
10. Course Textbooks:
11. Schuiling, K. D., Likis, F. E. (2017). Women’s gynecologic health (3rd ed.). Jones & Bartlett Learning.
12. Dunphy, L. (2019). Primary care: The art and science of advanced practice nursing (5th ed.). F.A. Davis Elizabeth Walker iHuman Reflection NRP/563: Management Of Women’s Health Issues.

Summary of Patient Encounter with Elizabeth Walker

I recently engaged in an iHuman patient encounter with Elizabeth Walker, a 34-year-old woman presenting with acute RLQ abdominal pain and nausea. This reflective summary explores the process of arriving at the differential diagnoses, determining the final diagnosis, integrating cultural preferences using Watson’s theory, outlining appropriate management, and critiquing the overall case evaluation.

Differential Diagnoses

Upon careful consideration of Elizabeth’s symptoms, the initial differential diagnoses included ectopic pregnancy, tubo-ovarian abscess, ovarian cyst rupture, appendicitis, and ovarian torsion. The analysis was based on her medical history, symptoms, and physical examination findings.

Determining the Final Diagnosis

To confirm the diagnosis, a pelvic ultrasound was conducted, revealing an enlarged right ovary (11cm x 4cm) with a small cyst and no blood flow, indicative of ovarian torsion. The CBC results showed an elevated white blood cell count (11,200 mm3), supporting the inflammatory nature of the condition. These findings led to a definitive diagnosis of right ovarian torsion.

Integrating Cultural Preferences with Watson’s Theory

Watson’s theory emphasizes the importance of a holistic and patient-centered approach. In Elizabeth’s case, understanding her cultural preferences, values, health beliefs, and behaviors became crucial. Communication was tailored to respect her individuality, and educational interventions were designed considering her cultural background to ensure optimal understanding and cooperation.

Appropriate Management

The immediate referral for the removal of the right torsed ovary was crucial, supported by the urgency to detorse the ovary through emergent laparoscopy. IV access was initiated for analgesia, and blood work for chemistries and coagulation studies were ordered as part of the preoperative workup. These interventions align with evidence-based practices for managing ovarian torsion.

Case Evaluation Critique: Reflecting on the overall case evaluation, two key takeaways emerge. First, the importance of prompt and thorough diagnostic procedures, such as pelvic ultrasound and CBC, cannot be overstated. Second, effective communication considering cultural nuances significantly impacts patient cooperation and satisfaction.

References:

1. Schuiling, K. D., & Likis, F. E. (2017). Women’s gynecologic health (3rd ed.). Jones & Bartlett Learning.
2. Dunphy, L. (2019). Primary care: The art and science of advanced practice nursing (5th ed.). F.A. Davis.
3. Author, A. A., Author, B. B., & Author, C. C. (Year). Title of the article. Journal Name, Volume(Issue), Page range. DOI (if available).

This summary encapsulates the patient encounter process, from differential diagnoses to the integration of cultural aspects and evidence-based management, providing a comprehensive view of Elizabeth Walker’s case.

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