NURS 6501 Week 10 Concepts of Women’s and Men’s Health , Infections, and Hematologic Disorders
Sexually Transmitted Infection Case Study
The inability to get pregnant despite having frequent, unprotected sexual contact for at least a year is known as infertility. Globally, infertility is a significant public health issue. Women shoulder the majority of the responsibility for infertility. Endocrine factors, vaginal factors, cervical factors, uterine factors, tubal factors, and pelvic-peritoneal abnormalities are just a few of the causes of female infertility (Tsevat et al., 2018 NURS 6501 Week 10 Concepts of Women’s and Men’s Health , Infections, and Hematologic Disorders). The most frequent reason for infertility is tubal factor insufficiency.
STDs and Infertility
Tubal factor infertility is mostly attributed to untreated infections of the female reproductive tract. Sexually transmitted infections can ascend along the reproductive tract and cause inflammation of the fallopian tubes as well as scarring and damage. Scarring of the fallopian tubes interferes with the motility of ova to the uterus. This also predisposes the woman to an ectopic pregnancy in the event that fertilization occurs. Pelvic-peritoneal adhesions may result from persistent infections. Chlamydia trachomatis and Neisseria gonorrhoeae are the most common causes of STIs associated with tubal factor infertility and pelvic inflammatory disease (Low & Broutet, 2017).
From the case study provided, it is highly likely that the woman has an STI that may have progressed to a PID. This is evidenced by the manifestation of symptoms. She has fever, nausea, vomiting, abdominal pain, and vaginal discharge. Her fertility can be affected because her STI has resulted in the development of PID. The signs of PID are adnexal tenderness, lower abdominal pain, fever, chills and the chandelier sign which is usually an indication of inflammation in the pelvis. Pelvic inflammation causes scarring and adhesions that contribute to tubal factor infertility. The scarring interferes with motility of both the sperms and ova.
Inflammatory Markers and STDs
An STD is an infection. An infection is an inflammatory process. Inflammatory markers such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and plasma viscosity (PV) are commonly used in primary care for diagnosis of inflammatory conditions such as infections. ESR is defined as the distance that erythrocytes settle in anticoagulated blood in one hour. CRP is usually better for checking infections (Watson et al., 2019). Other inflammatory markers such as white blood cells are also useful for checking for infections caused by bacteria. Therefore, WBC and CRP will rise in STD or PID. The lab results for this patient indicate a high CRP and WBC levels.
During an infection, pathogen-associated molecular patterns activate pattern recognition receptors of the innate immune system. Proinflammatory and anti-inflammatory mediators are produced as a result with the main aim being to contain the infection. Inflammation is critical in the resolution of infection. Neutrophils are mobilized to the site of infection to try and fight the infection.
Neutrophils are the most common type of white blood cells and increase during bacterial infections (McCance & Huether, 2019). This increase in neutrophils can be elicited by lab testing which is seen as high WBCs. As in the case provided, the patient has both high WBCs and CRPs. The congregation of neutrophils to the site of infection leads to the secretion of inflammatory markers to recruits more defense cells against the infection. This explains the rise in WBCs and other inflammatory markers in STD/PID.
Conclusion
STIs such as chlamydia and gonorrhoea generally affect female fertility due the sequelae of such infections. One such sequelae of such infections is pelvic inflammatory disease which lead to scarring and adhesions in the fallopian tube. Also, STDs are infections that cause an inflammatory process that leads to a rise in inflammatory markers. White blood cells are also recruited to fight infections.
References for NURS 6501 Week 10 Concepts of Women’s and Men’s Health, Infections, and Hematologic Disorders
Low, N., & Broutet, N. J. (2017). Sexually transmitted infections-Research priorities for new challenges. PLoS Medicine, 14(12), e1002481. https://doi.org/10.1371/journal.pmed.1002481
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
Tsevat, D. G., Wiesenfeld, H. C., Parks, C., & Peipert, J. F. (2017). Sexually transmitted diseases and infertility. American Journal Of Obstetrics And Gynecology, 216(1), 1–9. https://doi.org/10.1016/j.ajog.2016.08.008
Watson, J., Jones, H. E., Banks, J., Whiting, P., Salisbury, C., & Hamilton, W. (2019). Use of multiple inflammatory marker tests in primary care: using Clinical Practice Research Datalink to evaluate accuracy. The British Journal Of General Practice: The Journal Of The Royal College Of General Practitioners, 69(684), e462–e469. https://doi.org/10.3399/bjgp19X704309
NURS 6501 Week 10 Concepts of Women’s and Men’s Health , Infections, and Hematologic Disorders Instructions
Assignment (1- to 2-page case study analysis)
In your Case Study Analysis related to the scenario provided, explain the following as it applies to the scenario you were provided (omit those that don’t apply to the scenario):
• The factors that affect fertility (STDs).
• Why inflammatory markers rise in STD/PID.
Scenario: A 32-year-old female presents to the ED with a chief complaint of fever, chills, nausea, vomiting, and vaginal discharge. She states these symptoms started about 3 days ago, but she thought she had the flu. She has begun to have LLQ pain and notes bilateral lower back pain. She denies dysuria, foul-smelling urine, or frequency. States she is married and has sexual intercourse with her husband. PMH negative. NURS 6501 Week 10 Concepts of Women’s and Men’s Health , Infections, and Hematologic Disorders
Labs: CBC-WBC 18, Hgb 16, Hct 44, Plat 325, ¬ Neuts & Lymphs, sed rate 46 mm/hr, C-reactive protein 67 mg/L CMP wnl
Vital signs T 103.2 F Pulse 120 Resp 22 and PaO2
99% on room air. Cardio-respiratory exam WNL with the exception of tachycardia but no murmurs, rubs, clicks, or gallops. Abdominal exam + for LLQ pain on deep palpation but no rebound or rigidity. Pelvic exam demonstrates copious foul-smelling green drainage with reddened cervix and + bilateral adenexal tenderness. + chandelier sign. Wet prep in ER + clue cells and gram stain in ER + gram negative diplococci.
Resources
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
• Chapter 24: Structure and Function of the Reproductive Systems (stop at Tests of reproductive function); Summary Review
• Chapter 25: Alterations of the Female Reproductive System (stop at Organ prolapse); pp. 787–788 (start at Impaired fertility) (stop at Disorders of the female breast); Summary Review
• Chapter 26: Alterations of the Male Reproductive System (stop at Hormone levels); Summary Review
• Chapter 27: Sexually Transmitted Infections, including Summary Review
• Chapter 28: Structure and Function of the Hematological System (stop at Clinical evaluation of the hematological system); Summary Review
• Chapter 29: Alterations of Erythrocytes, Platelets, and Hemostatic Function, including Summary Review. NURS 6501 Week 10 Concepts of Women’s and Men’s Health , Infections, and Hematologic Disorders
• Chapter 30: Alterations of Leukocyte and Lymphoid Function, including Summary Review
Low, N. & Broutet N. J. (2017). Sexually transmitted infections – Research priorities for new challenges. PLoS Medicine, (12), e1002481
Kessler, C. M. (2019). Immune thrombocytopenic purpura [LK1] (ITP). Retrieved from https://emedicine.medscape.com/article/202158-overview
Nagalia, S. (2019). Pernicious anemia[LK1] . Retrieved from https://emedicine.medscape.com/article/204930-overview#a3
Stauder, R., Valent, P., & Theurl, I. [LK1] (2019). Anemia at older age: Etiologies, clinical implications and management. Blood Journal, 131(5). Retrieved from http://www.bloodjournal.org/content/131/5/505?sso-checked=true
Credit Line: Anemia at older age: Etiologies, clinical implications and management by Stauder, R., Valent, P., & Theurl, I., in Blood Journal, Vol. 131/Issue 5. Copyright 2019 by American Society of Hematology. Reprinted by permission of American Society of Hematology via the Copyright Clearance Center.
CASE STUDY ANALYSIS
An understanding of the factors surrounding women’s and men’s health, infections, and hematologic disorders can be critically important to disease diagnosis and treatment in these areas. This importance is magnified by the fact that some diseases and disorders manifest differently based on the sex of the patient.
Effective disease analysis often requires an understanding that goes beyond the human systems involved. The impact of patient characteristics, as well as racial and ethnic variables, can also have an important impact..
An understanding of the symptoms of alterations in systems based on these characteristics is a critical step in diagnosis and treatment of many diseases. For APRNs, this understanding can also help educate patients and guide them through their treatment plans. NURS 6501 Week 10 Concepts of Women’s and Men’s Health , Infections, and Hematologic Disorders
In this Assignment, you examine a case study and analyze the symptoms presented. You identify the elements that may be factors in the diagnosis, and you explain the implications to patient health.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
To prepare:
By Day 1 of this week, you will be assigned to a specific case study scenario for this Case Study Assignment. Please see the “Announcements” section of the classroom for your assignment from your Instructor.
The Assignment (1- to 2-page case study analysis)
In your Case Study Analysis related to the scenario provided, explain the following:
- The factors that affect fertility (STDs).
- Why inflammatory markers rise in STD/PID.
- Why prostatitis and infection happens. Also explain the causes of systemic reaction.
- Why a patient would need a splenectomy after a diagnosis of ITP.
- Anemia and the different kinds of anemia (i.e., micro and macrocytic).
BY DAY 7 OF WEEK 10
Submit your Case Study Analysis Assignment by Day 7 of Week 10.
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The sample paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templatesLinks to an external site.). All papers submitted must use this formatting.
Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders Example 2
This discussion will be based on a case study of HH, a 68-year-old male who has been admitted to the medical ward with community-acquired pneumonia. His past medical history is significant for hypertension, hyperlipidemia, COPD, and diabetes. He is on day 3 of ceftriaxone 1 g IV qday and azithromycin 500 mg IV qday. His clinical status has improved since admission with decreased oxygen requirements, although he is not tolerating a diet due to nausea and vomiting. He is allergic to penicillin and has a BMI of 30. The subsequent paragraphs will explore his health needs, treatment regimen, and patient education.
Healthcare Needs
Complete evaluation of the patient’s needs is crucial. The patient requires constant monitoring of his vital signs. HH should be connected to an ECG monitor, and his vitals checked regularly to determine his oxygen needs and blood pressure levels. Likewise, a complete patient assessment is required. Nausea and vomiting are very non-specific symptoms that must be explored. The patient has a history of diabetes. Consequently, a random blood sugar level is essential to guide the treatment and check for hypoglycemia. Furthermore, the patient has been vomiting and not tolerating diet.
According to Cavallazzi and Ramirez (2020), vomiting is associated with electrolyte imbalances and dehydration. Subsequently, urea, creatinine, and electrolyte levels should be done, and abnormalities corrected. Similarly, he requires intravenous hydration, parenteral nutrition, and an antiemetic until nausea and vomiting resolve. HH further has a history of hyperlipidemia, which necessitates a lipid profile to guide his treatment. COPD patients are prone to exacerbations, particularly pneumonia (de Miguel-Diez et al., 2021). HH has community-acquired pneumonia and is on empirical treatment with azithromycin and ceftriaxone (Rosenthal & Burchum, 2020). Consequently, he requires tailoring the regimen according to culture and microscopy results.
Treatment Regimen
The infectious disease society of America (IDSA) guidelines for inpatient treatment of community-acquired pneumonia in a patient with comorbidities recommend a combination of an anti-pneumococcal beta-lactam such as ceftriaxone plus a macrolide such as azithromycin (Sucher et al., 2020). The patient is allergic to penicillin; therefore, cephalosporin is a viable option due to structural dissimilarity (Rosenthal & Burchum, 2020). For instance, the beta-lactam ring in penicillins is linked to a five-membered thiazolidine, while the beta-lactam ring in cephalosporins is connected to a six-membered dihydrothiazine ring; hence, less cross-reactivity (Bogas et al., 2020).
An alternative to this is monotherapy with respiratory fluoroquinolone. Fluoroquinolones are particularly important if the patient has an immediate penicillin allergy (Rosenthal & Burchum, 2020). HH is on ceftriaxone and azithromycin, but just for three days. IDSA recommends treatment for 5 to 7 days, after which he will be evaluated for resolution (Sucher et al., 2020). The treatment regimen should also consist of a statin for hyperlipidemia, maintenance fluids, antihypertensive medications, and insulin for diabetes. Finally, he should be evaluated for appropriate treatment of COPD.
Patient Education
He should be educated on lifestyle modifications, particularly physical activity, diet, smoking cessation, and alcohol cessation, which are vital for controlling hypertension, COPD, diabetes, hyperlipidemia, and obesity (Cavallazzi & Ramirez, 2020). He should further be enlightened on the importance of vaccinations and the need to avoid environmental exposures that may exacerbate COPD. HH should be educated on the need to take medications as required, as well as self-monitoring blood glucose and blood pressure levels (Cavallazzi & Ramirez, 2020). Finally, he should be enlightened about his condition, the need for long-term treatment and follow-up, and the side effects of medications.
NURS 6501 Week 10 Concepts of Women’s and Men’s Health, Infections, and Hematologic Disorders References
Bogas, G., Mayorga, C., Martín-Serrano, Á., Fernández-Santamaría, R., Jiménez-Sánchez, I. M., Ariza, A., Barrionuevo, E., Posadas, T., Salas, M., Fernández, T. D., Torres, M. J., & Montañez, M. I. (2020). Penicillin and cephalosporin cross-reactivity: role of side chain and synthetic cefadroxil epitopes. Clinical and Translational Allergy, 10(1), 57. https://doi.org/10.1186/s13601-020-00368-1
Cavallazzi, R., & Ramirez, J. (2020). Community-acquired pneumonia in chronic obstructive pulmonary disease. Current Opinion in Infectious Diseases, 33(2), 173–181. https://doi.org/10.1097/QCO.0000000000000639
de Miguel-Diez, J., Lopez-Herranz, M., Hernandez-Barrera, V., de Miguel-Yanes, J. M., Perez-Farinos, N., Wärnberg, J., Carabantes-Alarcon, D., Jimenez-Garcia, R., & Lopez-de-Andres, A. (2021). Community-acquired pneumonia among patients with COPD in Spain from 2016 to 2019. Cohort study assessing sex differences in the incidence and outcomes using hospital discharge data. Journal of Clinical Medicine, 10(21), 4889. https://doi.org/10.3390/jcm10214889
Rosenthal, L., & Burchum, J. (2020). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Saunders.
Sucher, A., BCIDP Professor of Pharmacy Practice Shannon Knutsen, PharmD Associate Professor of Pharmacy Practice Charles Falor, & PharmD Candidate 2021 Regis University School of Pharmacy Denver. (2020, April 17). Updated clinical practice guidelines for community-acquired pneumonia. Uspharmacist.com. https://www.uspharmacist.com/article/updated-clinical-practice-guidelines-for-communityacquired-pneumonia
Also Read: NURS 6003 Part 6: Finalizing the Plan