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You are the nurse in a walk-in clinic. A.P. is being seen this morning for a 2-day history of diffuse, severe abdominal pain. She has some nausea; she denies vaginal bleeding or discharge. A.P. reports having unprotected sex with a few partners recently who “might have” had penile discharge. Her last menstrual period ended 3 days ago. She has no known drug allergies and denies prior medical or psychiatric prob-lems. Vital signs are 108/60, 110, 20, 100.6° F (38.1° C). Physical examination reveals her abdomen is very tender. The slightest touch of her abdomen causes her to wince with pain. Bowel sounds are normal. Pelvic examination reveals purulent material pooled in the vaginal vault, which appears to be coming from the cervix. A sample of the vaginal drainage is obtained and sent for culture. The result of a preg-nancy test is negative; a rapid diagnostic test for chlamydial infection has a positive result.

1. Which assessment findings are significant and why?

2. What medical interventions can you expect?

3. What are the risk factors for chlamydia?

4. Describe the common symptoms of chlamydia infection in men and women.

5. What are the consequences of an untreated chlamydia infection in women?

6. How will you offer emotional support to A.P.?

CASE STUDY PROGRESS 

The provider has 2 options of treating A.P. The first option is doxycycline 100 mg orally twice a day for 7 days. The second option is a one-time dose of azithromycin 1 gram orally, which would be given at the clinic.

7. Which choice is best for A.P.? Explain your reasoning.

8. You tell A.P. that chlamydial infection is a sexually transmitted infection (STI) that must be reported to the health department. What is the purpose of reporting the infection, and what actions will the health department take?

9. A.P. says she does not understand why her partners must be told about the infection. How will you respond?

10. Based on the information A.P. has given you, you decide that she is at risk for other STIs and unplanned pregnancy. Based on the “5 Ps,” what risk assessment questions do you need to ask A.P.?

11. You ask whether someone has talked with A.P. about “safe sex.” She laughs. Undaunted, you ask if she would be willing for you to discuss the use of condoms with her sexual partners. She tells you that she is already careful; if she does not “know the guy,” then she uses a condom. How are you going to respond?

12. You ask A.P. whether she has been tested for HIV. She says no, she does not know anyone with acquired immunodeficiency syndrome (AIDS) and she only has sex with “100% straight guys.” Now what are you going to say?

13. You ask her whether she would like to be tested for HIV. You tell her the test will not cost her anything, only she will know the results, no one else, and test results are completely confidential. She agrees to the test. What counseling will you provide A.P.?

14. You make an appointment for A.P. to return to the clinic in 1 week for her HIV test results. Describe the instructions you will give to A.P. before she leaves the clinic.

CASE STUDY OUTCOME 

A.P. returns to the clinic in 1 week for her HIV test results, which are negative. Her culture results confirm the diagnosis of chlamydial infection.

15. What are your primary nursing concerns right now?

16. A.P. has completed the course of antibiotic therapy and is not experiencing any symptoms. After counseling her on ways to reduce her risk for acquiring another STI, you determine A.P. understood your teaching about safe sexual practices if she says she will: (Select all that apply.) 

 a. Have her partner wear a new condom with each sexual encounter  

b. Not worry about contacting an STI if the man says he has few partners  

c. Apply a new application of spermicidal jelly before each sexual encounter  

d. Douche with an over-the-counter solution within 4 hours of having intercourse  

e. Inspect the genitalia of her partner before intercourse or other contact with perianal area

CASE STUDY OUTCOME 

A.P. returns to the clinic a few months later with symptoms of another STI and is diagnosed with both chlamydia and gonorrhea. Treatment of both infections is started, and you again review measures to prevent acquiring an STI. You report the STIs to the health department. A.P. does not return to your clinic for follow-up.

SCIENCE
HEALTH SCIENCE
NURSING
VN 101