Create a comprehensive plan of care for acute/chronic care, disease prevention,

Question

Create a comprehensive plan of care for acute/chronic care, disease prevention, and health promotion for that patient and disorder for the case study below. Your care plan should be based on current best practices and supported with citations from current literature, such as systematic reviews, published practice guidelines, standards of care from specialty organizations, and other research based resources. In addition, you will provide a detailed scientific rationale that justifies the inclusion of this evidence in your plan.

Patient Setting: 28-year-old female presents to the clinic with a 2 day history of frequency, burning and pain upon urination; increased lower abdominal pain and vaginal discharge over the past week.

HPI Complains of urinary symptoms similar to those of previous urinary tract infections (UTIs) which started approximately 2 days ago; also experiencing severe lower abdominal pain and noted brown fouls smelling discharge after having unprotected intercourse with her former boyfriend.

PMH Recurrent UTIs (3 this year); gonorrhea X2, chlamydia X 1; Gravida IV Para III

Past Surgical History Tubal ligation 2 years ago.

Family/Social History Family:

Single; history of multiple male sexual partners; currently lives with new boyfriend and 3 children.

Social: Denies smoking, alcohol and drug use.

Medication History None

Trimethoprim (TOM)/ Sulfamethoxazole (SMX) -Rash ROS

Last pap 6 months ago, Denies breast discharge. Positive for Urine looking dark.

Physical: BP 100/80, HR 80, RR 16, T 99.7 F, Wt 120, Ht 5’ 0”

Gen: Female in moderate distress.

Abd: soft, tender, increased suprapubic tenderness.

GU: Cervical motion tenderness, adnexal tenderness, foul smelling vaginal drainage. Rectal: WNL.

Laboratory and Diagnostic Testing Lkc differential: Neutraphils 68%, Bands 7%, Lymphs 13%, Monos 8%, EOS 2% UA: Starw colored. Sp gr 1.015, Ph 8.0, Protein neg, Glucose neg, Ketones neg, Bacteria – many, Lkcs 10- 15, RBC 0-1

Urine gram stain – Gram negative rods

Vaginal discharge culture: Gram negative diplococci, Neisseria gonorrhoeae, sensitivities pending Positive monoclonal AB for Chlamydia, KOH preparation,

Explanation / Answer

The patient seems to be suffering from urinary tract infection caused by Neisseria gonorrhoea and chlamydia. Both these organisms are sexually transmitted. They cause recurrent urinary tract infection. Risk factors are unprotected sexual intercourse and having multiple sex partners.

Acute care:

The Center for Disease Control (CDC) advocates the following treatment regimen for uncomplicated gonococcal with concominant chlamydial infection of the cervix and urethra.

Disease prevention:

Disease prevention will focus on preventing the development of chronic disease. The following disease preventive strategies can be applied in this patient.

Health promotion:

Health promotion enables people to have increased control over their health. The health promotion strategies that can be applied to this particular patients are given below.

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