NR 511 Week 3 SNAPPS ORAL Presentation

-vaginal discharge -vaginal pain -vaginal odor Pertinent PE VS WNL Vaginal examination: +clumpy, thick white discharge on vaginal exam +vulvar and vaginal erythema/redness +inflammation/swelling seen -No pain/tenderness present on vaginal exam -masses, foreign bodies NARROW Based on the H&P key findings, identify an appropriate differential. *** My differential diagnoses are based on the history and physical key findings and I believe this could be a vulvovaginal yeast infection, bacterial vaginosis, or trichomoniasis. Vulvovaginal yeast infection +itching +burning +redness +irritation +pH of 4.0 on wet mount examination +candidiasis cells found under microscope +clumpy, white, thick vaginal discharge Bacterial vaginosis +itchy +redness +irritation +burning -no fishy odor -no thin white or gray vaginal discharge -no soreness -no history of STDs -no pH > 4.5 -no clue cells on microscope Trichomoniasis +itchy +yeast cells found under microscope +clumpy, white, thick vaginal discharge 2) Bacterial vaginosis – The patient has experienced itchiness, redness, burning, and irritation which is a common symptom found with bacterial vaginosis. However, the patient has not experienced vaginal discharge, an odor, the pH on the wet mount was 4.0, and yeast cells were found under the microscope. A diagnosis of bacterial vaginosis would be more likely with thin white or gray discharge, a pH over 4.5, a fishy vaginal odor present especially after sex, and the presence of clue cells under the microscope. It is important however, to consider a sexually transmitted disease since the patient recently had sexual intercourse with her partner and as the provider we do not know if one of them has been with another person recently as well. +itchy +redness +burning +irritation -vaginal discharge (thin white or gray discharge) -clue cells found in wet mount under microscope -pH 4.0 (for bacterial vaginosis pH would be over 4.5) -no odor (would involve a fishy odor) 3) Trichomoniasis – The patient has experienced itchiness, burning, redness, and irritation which are also a common symptom found with trichomoniasis. The patient has not experienced clear, white, yellowish, or greenish vaginal discharge, does not have vaginal soreness, does not have a fishy odor, does not have trichomoniasis cells found under the microscope, and does not have a pH of above 4.5 on the wet mount. These would have been common symptoms correlating with a diagnosis of trichomoniasis. However, it is important here as well to consider Trichomoniasis as it is a STD and as the provider we still do not know if the client or their partner has slept with another individual. +itchy +burning +redness +irritation -soreness -vaginal discharge (clear, white, yellowish, or greenish) -pH 4.0 (for trichomoniasis pH would be > 4.5) -no odor (fishy smell) -no trichomoniasis cells founds under microscope PROBE SELF-DIRECTED LEARNING Identify one issue for self-directed learning. ***** An issue identified for self-directed learning involves the identification of risk factors for developing yeast infections and ways to prevent the development of future infections. In the written portion of this assignment, you will present your findings.