Reference no: EM133648198

Women's Health

A 21-year-old female college student presents to your clinic with a chief complaint of abdominal pain, foul-smelling vaginal discharge, and fever and chills for the past 4 days. She denies nausea, vomiting, or difficulties with defecation. The last bowel movement was this morning and was normal for her. Nothing has helped with the pain despite taking ibuprofen 200 mg orally several times a day. She describes the pain as sharp and localizes the pain to her lower abdomen. Past medical history is noncontributory. GYN/Social history + for having had unprotected sex while at a fraternity party. Physical exam: a thin, ill-appearing, anxious-looking white female who is moving around on the exam table and unable to find a comfortable position. Temperature 101.6F orally, pulse 120, respirations 22 and regular. Review of systems negative except for chief complaint. A focused assessment of the abdomen demonstrated moderate pain to palpation left and right lower quadrants. The upper quadrants are soft and non-tender. Bowel sounds diminished in bilateral lower quadrants. Pelvic exam demonstrated + adnexal tenderness, + cervical motion tenderness, and copious amounts of thick greenish secretions.

Questions:

• What are initial differential diagnoses for this patient and why?
• What additional information should be obtain?
• What additional physical assessments or diagnostic testing should be completed?
• How would the NP treat this patient?
• What patient teaching will be incorporated into the visit?
• What additional screenings or follow-ups would you schedule for this patient?