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Diagnosis
K. W. is a 26-year-old female who complains of vaginal discharge, painful intercourse, and irregular bleeding between menstrual periods during the last month. The young woman is single, no children, and she takes tests for gonorrhea and chlamydia annually. She was diagnosed with chlamydia (positive urethral swab) two years ago and treated with azithromycin (one week). Now, she is diagnosed with cervical erosion a Pap test is normal, and a physical exam reveals several glandular cells growing on the cervix.
Pathophysiology
The cervix is located in the lower part of the uterus and consists of the endocervix (proximal portion) and the ectocervix (distal portion). The development of erosion is explained by stratified squamous cells being changed and becoming columnar epithelium due to high estrogen levels (Ortiz-de la Tabla and Gutiérrez 662). There are mucus-secreting glands in the columnar epithelium, which explains increased vaginal discharge and bleeding.
Impact
Cervical erosion may stay asymptomatic for a long period and has no significant impact on the patients life. Women continue living with this condition and learn about it only after a pelvic examination. When glandular cells are delicate, such problems as painful urination and sexual intercourse, vaginal discharge, and bleeding challenge individuals. The patient addresses a healthcare expert to relieve pain and stabilize her sexual life.
Medications
It is important to normalize the cervix condition, relieve pain, and treat the infection. Several medications are recommended, along with nursing implications (Ortiz-de la Tabla and Gutiérrez 666):
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azithromycin, 1 g orally in a single dose (diarrhea, abdominal pain, fever, and nausea);
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moxifloxacin, 400 mg/day for a week (vomiting, nausea, sore throat, weakness, and yellow skin)
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doxycycline, 100 mg orally, twice a day for a week (anaphylaxis, chest tightness, wheezing, or rash).
Diagnosis and Procedure
Clinical diagnosis of cervicitis is based on a pelvic examination and the findings of cervical secretion. Ortiz-de la Tabla and Gutiérrez recommend the etiological diagnosis by studying endocervical exudates sample (665). Nucleic acid amplification techniques help identify the type of bacteria that causes metaplastic changes in the cervix. A colposcopy is also an effective method for evaluating the condition of the cervix and choosing the right intervention. If antibiotics are ineffective, cryotherapy (to freeze the cells) or laser therapy (to destroy the epithelium) are offered under local anesthesia.
Lab Tests
The abnormal lab results proved the presence of Chlamydia trachomatis, the source of infection in the patients cervix. A reduced number of T-lymphocytes will explain low cell immunity. Blood testing is required to exclude cervical cancer and the presence of other threats. K.W. has low iron and hemoglobin levels in the blood, which indicates iron deficiency anemia due to external bleeding between menstrual periods. Normal lab ranges for a woman of her age are 12-15 g/dL (hemoglobin), 60-170 mcg/dL (iron), and no bacteria or infections in a Pap smear.
Interprofessional Collaboration
The assessment, treatment, and follow-up depend on how well the patient understands her disease and adheres to recommendations. Interprofessional collaboration between a physician, a gynecologist, a nutritionist, and a nurse is required. A physician checks the patients overall condition, while a gynecologist provides her with effective treatment. A nurse focuses on the patients education, and a nutritionist suggests a diet to increase the hemoglobin level.
Services Required
K. W. is sent back home with oral and written instructions on how to monitor her sexual life and avoid cervicitis-related complications. No physical exercises during a week and one-day bed-rest are required. Following a new diet and using safe sex devices to protect her health are the main lifelong recommendations. It is necessary to give the cervix some time to heal, meaning no sexual intercourse during the next month.
Learning Objectives
The main learning objective is to consider the patients medical history, the pathophysiology of the disease, and their impact on the development of the current condition. Attention was paid to the previous chlamydia diagnosis and the presence of a bacterium in the cervix. I compared the past and recent tests and decided to use the recommendations of several specialists to help the woman promote her well-being.
Work Cited
Ortiz-de la Tabla, Victoria, and Felix Gutiérrez. Cervicitis: Etiology, Diagnosis and Treatment. Enfermedades Infecciosas y Microbiologia Clinica, vol. 37, no. 10, 2019, pp. 661-667.
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