Medical Case Study: Vaginal Yeast Infection
INITIAL HISTORY
• 32-year old white female • Has 5-day hx of fever, SOB, productive cough • R side pleuritic pain chest pain.
Question #1. What else would you like to ask this patient about her history of present illness and past medical history?
Answers:
• How many times a year were + for pneumonia? Infections per year? • What was the onset of when this first started taking place? Timeline? • What Antibiotic therapies were used? • Who is her primary MD? Assuming this is the ER? • Smoking hx? • Are you having night sweats or chills? • Inappropriate levels of fatigue? Outside when she is having bouts of pneumonia? • Any recent …show more content…
The long history of vaginal yeast infections with an abnormal PAP is concerning.
2). Fatigue coupled with a 7 pound weight not loss is not good either.
3). Also, the fact that how young she is with no apparent cardiac or lung history with a string of pneumonias is an outlier to me?
What I did find interesting is that Brashers (2006) listed her as “[leaving] college 10 years ago.” Often, college is a time of experimentation and for a lot of teens, and young adults, and this involves sex. And I would have asked her about her sexual hx in college, and if she had unprotected sex back then. Further, I am sure Brashers picked 10 years to be exact as Huether and McCance (2008) note, “the average time from infection to development of full-blown AIDS has been estimated at just over 10 years.”
The 2 & 3 joined together are the real sticklers to me.
Question #3. What do you think of her additional history and examination findings?
Answer:
Occasional night sweats coupled with mild anorexia in the past few months is suggestive of some type of infectious process. (This to me is classic TB or AIDS, as I remember this is textbook sign of symptoms of both from school even 15 years ago was I first started Nursing …show more content…
Fasting Lipid Profile 3. Hep A,B,C serologies if not already done 4. Toxoplasma IgG 5. CMV Ig 6. RPR 7. Gonococcal/Chlamydial Screening
CD4 cell count needs to be known with %, and determination of the plasma HIV RNA (viral load), and HIV genotype testing must be done and this woman needs consultation with infectious disease. (Brashers, 2006; R. Roth, personal communication, March 9, 2011).
Question 7. How should this patient be managed?
Her stage of disease needs to be established,
Estimate the risk and rate of HIV disease course.
Establish all baseline data.
Make sure all HIV- related lab tests are ordered.
Report dx to Health Department.
Educate the patient to virus etiology/dx/prognosis, and how the virus gets transmitted.
Reeval for any medical condition chronic or otherwise such as acute. & Reeval PAP status/monitor.
Talk to patient regarding antiretroviral therapy: The main goal here is to reduce the viral load to levels which can not be detected by lab assays and thus constrict any viral replication. Goal 48 to 75 HIV RNA copies/mL. (Barclay, 2009; Brashers, 2006, R. Roth, personal communication, March 11, 2011).
References
Barclay, L., (2009). Role of primary care clinicians in HIV management. America
• 32-year old white female • Has 5-day hx of fever, SOB, productive cough • R side pleuritic pain chest pain.
Question #1. What else would you like to ask this patient about her history of present illness and past medical history?
Answers:
• How many times a year were + for pneumonia? Infections per year? • What was the onset of when this first started taking place? Timeline? • What Antibiotic therapies were used? • Who is her primary MD? Assuming this is the ER? • Smoking hx? • Are you having night sweats or chills? • Inappropriate levels of fatigue? Outside when she is having bouts of pneumonia? • Any recent …show more content…
The long history of vaginal yeast infections with an abnormal PAP is concerning.
2). Fatigue coupled with a 7 pound weight not loss is not good either.
3). Also, the fact that how young she is with no apparent cardiac or lung history with a string of pneumonias is an outlier to me?
What I did find interesting is that Brashers (2006) listed her as “[leaving] college 10 years ago.” Often, college is a time of experimentation and for a lot of teens, and young adults, and this involves sex. And I would have asked her about her sexual hx in college, and if she had unprotected sex back then. Further, I am sure Brashers picked 10 years to be exact as Huether and McCance (2008) note, “the average time from infection to development of full-blown AIDS has been estimated at just over 10 years.”
The 2 & 3 joined together are the real sticklers to me.
Question #3. What do you think of her additional history and examination findings?
Answer:
Occasional night sweats coupled with mild anorexia in the past few months is suggestive of some type of infectious process. (This to me is classic TB or AIDS, as I remember this is textbook sign of symptoms of both from school even 15 years ago was I first started Nursing …show more content…
Fasting Lipid Profile 3. Hep A,B,C serologies if not already done 4. Toxoplasma IgG 5. CMV Ig 6. RPR 7. Gonococcal/Chlamydial Screening
CD4 cell count needs to be known with %, and determination of the plasma HIV RNA (viral load), and HIV genotype testing must be done and this woman needs consultation with infectious disease. (Brashers, 2006; R. Roth, personal communication, March 9, 2011).
Question 7. How should this patient be managed?
Her stage of disease needs to be established,
Estimate the risk and rate of HIV disease course.
Establish all baseline data.
Make sure all HIV- related lab tests are ordered.
Report dx to Health Department.
Educate the patient to virus etiology/dx/prognosis, and how the virus gets transmitted.
Reeval for any medical condition chronic or otherwise such as acute. & Reeval PAP status/monitor.
Talk to patient regarding antiretroviral therapy: The main goal here is to reduce the viral load to levels which can not be detected by lab assays and thus constrict any viral replication. Goal 48 to 75 HIV RNA copies/mL. (Barclay, 2009; Brashers, 2006, R. Roth, personal communication, March 11, 2011).
References
Barclay, L., (2009). Role of primary care clinicians in HIV management. America