for NRNP 6552 Week 10 WORKING THROUGH COMMON PREGNANCY CASE STUDIES AND OTHER ISSUES IN ADVANCED NURSING PRACTICE Case # (1, 2, 3 or 4) and Description of the Case Chosen: Case 4: Laura

·         16-year-old Caucasian G1P0

·         Missed second period

·         Daily nausea, vomiting and dysuria for the past 2 weeks

·         LMP: 2 months ago.

·         Sexually active with her boyfriend

·         No history of condom use and uses withdrawal method.

·         History of chlamydia and gonorrhea earlier this year

Objective findings.

·         VS: BP: 110/68, P: 80, RR: 18, T: 37.1 Weight: 110 lbs.

·         A cloudy, yellow mucoid cervical discharge on speculum exam

·         Friable appearance of the cervix with cervical motion tenderness (CMT).

·         An 8-week size uterus on bimanual palpation.

·         Urine 2+ ketones, 2+ nitrates, and 3+ leukocytes.

·         Positive urine pregnancy test

·         Cervical discharge for culture- To diagnose for presence of C trachomatis and N gonorrhoeae (Shroff, 2023).

·         Nucleic acid amplification tests (NAATs) – To diagnose if the patient has diagnosing gonococcal and chlamydial infections (Hocking et al., 2023).

Cervicitis in Pregnancy:

·         Physical exam findings in cervicitis include cervical motion tenderness; an erythematous, edematous, or easily friable cervix; and a thick yellow or green pus protruding from the cervical os (Bansal et al., 2022).

·         Pertinent positive findings include cloudy, yellow mucoid cervical discharge on speculum exam; friable cervix, and cervical motion tenderness.

·         The patient has a history of infection by Chlamydia trachomatis and Neisseria gonorrhoeae, which are the common organisms that cause cervicitis (Shroff, 2023).

Chlamydia in Pregnancy:

·         Physical findings include purulent or mucopurulent cervical discharge and cervical friability (Hocking et al., 2023).

·         The patient has yellow mucoid cervical discharge and a friable cervix.

·         The patient has a history of chlamydia, which could be a reinfection.

Pelvic Inflammatory Disease (PID) in Pregnancy:

·         Physical findings indicative of PID in the patient include cervical motion tenderness and a cloudy, yellow mucoid cervical discharge.

·         The history of chlamydia and gonorrhea increases the risk of PID as they are the most common STIs is associated with PID (Mitchell et al., 2021).

Cervicitis in Pregnancy: Erythromycin base 500 mg PO four times daily for 7 days (Shroff, 2023).

Chlamydia Amoxicillin, 500 mg TDS for seven days (Hocking et al., 2023).

PID in Pregnancy

Clindamycin at 900 mg IV TDS PLUS

Gentamicin loading dose IV (2 mg/kg body weight), followed by a maintenance dose (1.5 mg/kg body weight) TDS (Yusuf & Trent, 2023).

Social Determinants of Heath (SDoH) for your chosen case.

·         SDOH factors associated with a high risk of STI incidence include lack of health insurance, using public transportation, and income below the poverty level (Jenks et al., 2023).

·         Unequal access to sexual health services and differences in sexual network characteristics explain the differences in the prevalence of STIs like cervicitis.

Referrals:

Referral to an obstetrician/gynecologist for routine test-of-cure since the patient is pregnant (Shroff, 2023).

Patient education:

·         Comply with treatment to prevent reinfections (Shroff, 2023).

·         Adopting safe sexual practices by using condoms.

·         Avoid sexual intercourse until she and her sexual partner have been treated and all symptoms have abated (Shroff, 2023).