WestCoast NURS664B Week 7 Discussion Latest 2022 October

NURS664B Primary Care Women's Health Theory

Week 7 Discussion

Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example, #2 a post-menopausal 57-year old woman.

Discuss what questions you would ask the patient, what physical exam elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals, and other team members needed to complete patient care.

Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.  Please refer to evidence-based guidelines to support your decision-making.

In your peer replies, please reply to at least one peer who chose a different case study.

1.  A 25-year-old woman comes to your office for her first Pap smear exam. She tried to have a Pap smear before, but she was unable to tolerate insertion of the speculum. She cannot use tampons during her menses due to pain at her introitus when she tries to insert the tampon. Her last boyfriend broke up with her after 6 months because she was unable to have intercourse with him due to pain at her introitus when trying to insert his penis. The patient cannot remember exactly when this pain started because she didn’t attempt to use tampons until she was 19 years old. She did not attempt intercourse until she was 21 years old. She thinks she noticed this pain the first time she attempted to insert a tampon but cannot be sure. She is extremely anxious and almost in tears about the thought of having a Pap smear, but thinks she “must” have one even though she reports being unable to ever have vaginal intercourse.

How will you approach this patient?

What types of intervention will you attempt to use?

What are your presumptive (describe physiology and pathophysiology) and differential diagnoses?

What is your plan of care for this patient?

2.  A 21-year-old patient complains of being unable to achieve orgasm with any type of sexual activity. She does not believe she has ever achieved orgasm. She reports she has no difficulty with desire, lubrication, or pain, and she has tried different types of sexual toys. Her partner of three years has been supportive and has tried many different positions to try to help her to achieve orgasm.

What are your differential/presumptive diagnoses for this patient?

What is your plan of care?

3.  J. R. is a 55-year-old female who complains of poor vaginal lubrication, lack of genital tingling, and not feeling “turned on” by her partner during sexual activity. She looks forward to sexual activity with her partner and is receptive; however, once they are together, she is unable to become aroused. She is orgasmic. She also complains of daily hot flashes and night sweats. A typical sexual encounter occurs once weekly. There is adequate foreplay, sufficient privacy (the children are grown and are out of the home), and they are well rested. However, J.R. always has to use a lubricant and still experiences some dyspareunia during intercourse.

Her last menses was 2 years ago. Her medical history is significant for hypertension, well-controlled on a beta blocker (Inderal 120 mg twice a day), and hypothyroidism, controlled with levothyroxine (Synthroid 0.1 mg daily). She has had two vaginal deliveries. She does not drink alcohol or smoke. Her family and personal medical and psychiatric history are negative.

What medical conditions are most commonly associated with development of female sexual dysfunction?

Which medications are most likely to induce female sexual dysfunction?

What treatment would you recommend?