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Pamela Flowers - iHuman Case Study (updated) 2020/21

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Pamela Flowers - iHuman Case Study (updated) 2020/21-Pamela Flowers is a 24-year-old presenting with a chief complaint of vaginal bleeding and pelvic pain for the past 24 hours. • Discuss the questions that would be important to include when interviewing a patient with this issue. • What are the events surrounding the start of your abnormal vaginal bleeding? • Do you have any other symptoms associated with your abnormal vaginal bleeding? • How severe is your abnormal vaginal bleeding? • Have you had abnormal vaginal bleeding like this before? • Do you have any menstrual irregularities? • Do you have bleeding between your menstrual cycles? • Have you recently missed or stopped taking your birth control or hormone pills? • When did your last period begin? • How severe (1-10 scale) is your pelvic pain? • When and what was the result of your last gynecological exam? • Is it possible that you are pregnant? • Have you had a previous ectopic pregnancy, abortion, miscarriage, uterine surgery, pelvic inflammatory disease, history of STD/STI’s, and/or history of fibroids? In addition to gathering information based on your chief complaint, it is important to ask about past medical history, prior surgeries/hospitalizations, prescription and over the counter medications (Schuiling & Likis, 2016). • Describe the clinical findings that may be present in a patient with this issue. Clinical assessment findings of ectopic pregnancy include spotting, vaginal bleeding, dizziness, pelvic and/or abdominal pain (Buttaro, Trybulski, Polgar-Bailey, & Sandberg-Cook, 2017). Patients often present with complaints of a unilateral pelvic pain that is cramping or sharp (Buttaro et al., 2017). The nurse practitioner (NP) may find that on physical examination with a speculum there is a Chadwick’s sign, a bluish color of the cervix, possible uterine enlargement, abdominal tenderness with guarding and possible cervical motion tenderness (Buttaro et al., 2017). • Are there any diagnostic studies that should be ordered on this patient? Why? • Human chorionic gonadotropin (HCG) serum to check for pregnancy along with a plateau or fall in the titer which is indicative of an ectopic pregnancy or miscarriage (Buttaro et al., 2017). • Complete blood count (CBC) because of the correlation of ectopic pregnancies and anemia (Buttaro et al., 2017). • Transvaginal Ultrasound is the best diagnostic tool to adequately provide imaging of a viable pregnancy or ectopic pregnancy (Buttaro et al., 2017). • List the primary diagnosis and three differential diagnoses for this patient.

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