Introduction
Sexually transmitted diseases in general and chlamydial infection, in particular, are a serious threat to the U. S. nation’s health. Although there are many ways to treat some of the most common conditions, some diseases (for example, AIDS) remain impossible to recover from fully which may lead to death. Apart from causing severe symptoms, STD also places a significant financial burden, especially when the conditions remain repeated in patients. This calls for treatment and implementation of proper education and counseling to prevent diseases’ complementation and their becoming chronic. This paper provides coverage of a patient’s case. The most probable diagnosis is chlamydial infection. A related plan of care and other various considerations will be elucidated with the following conclusion.
Subjective Data
The patient is a 28-year-old female. The patient complains of urinary symptoms, burning sensation, and pain upon urination. The patient experienced similar symptoms before his current hospitalization when she was diagnosed with urinary tract infections (UTIs). The UTIs started approximately two days ago. The patient also complains about having severe pain in the lower abdominal and brown foul-smelling discharge after having unprotected intercourse with her former boyfriend. Medical history includes recurrent UTIs three times this year, two cases of gonorrhea, one case of chlamydia, and Gravida IV Para III. The patient also received tubal ligation two years before complaining.
The patient has been prescribed trimethoprim (TOM) and sulfamethoxazole (SMX) due to rash. Family and social history include a history of multiple male sexual partners and three children. No additional data was mentioned.
Objective Data
The nurse practitioner reported the following results of the observation: BP – 100/80, HR – 80, RR – 16, T – 99.7 F, Wt – 120, Ht – 5’0″, HEENT – WNL, cardio – regular rate and rhythm, normal S1 and S2, chest – WNL, abdominal – soft, tender, increased suprapubic tenderness, GU – cervical motion tenderness, adnexal tenderness, foul-smelling vaginal discharge, rectal – WNL.
Assessment
- Priority diagnoses include:
- Urinary tract infection (N39.0);
- Chlamydia infection (A74.9);
- Urethritis (N34.1).
The main reason found in subjective and objective data to suppose these diagnoses is the patient’s repeating the history of UTIs and cases of chlamydia diagnosed in the past. Additionally, symptoms (burning sensation upon urinating, pain in the lower abdominal area, foul discharge) mostly support the diagnosis of chlamydia infection and UTIs. However, since UTIs may be a condition preceding chlamydia infection, it would be reasonable to assume that the latter is the most probable cause of the symptoms.
Plan of Care
Firstly, to test if the diagnosis is accurate, the condition may be confirmed: “by testing first-catch urine or collecting swab specimens from the endocervix or vagina” (“Chlamydial infections in adolescents and adults,” 2015, para. 4). After confirming the diagnosis, it will be advisable to make sure that the patient agrees to receive prescribed treatment (Qureshi, 2017, para. 1).
World Health Organization (2016) provides a number of guidelines for regulating chlamydial infection treatment. If the patient’s case of chlamydia infection is uncomplicated, the following options may be offered to her: azithromycin, 1 g orally, a single oral dose; doxycycline 100 mg orally twice a day within a week of treatment. There are also a number of alternatives for doxycycline; these include tetracycline 500 mg orally four times a day, erythromycin 500 mg orally four times per day, and ofloxacin 200-400 mg orally twice a day. Each of these medications must be taken for a week to achieve recovery.
Naturally, the selection of medications would also depend on their costs, convenience of dosage. The quality of these medicaments must also be taken into consideration as well as equity concerns. Non-pharmacological treatment is not included due to the nature of the disease. However, certain non-pharmacological measures might be incorporated into further education and counseling. Lanjouw, Ouburg, Vries, Stary, Radcliffe, and Unemo (2015) mention the importance of contact notification and management of further sexual contacts. Since the patient is reported to have had multiple sexual partners, it is most advisable to provide proper coverage of means of preventing further complications as well as relapses.
Evaluation of Priority Diagnosis
Therefore, the priority diagnosis is chlamydia infection. The disorder is differentiated from normal development by the patient’s complaints and present symptoms. Physical and psychological demands that are placed on the patient’s family as well as herself are mostly connected to the necessary attention and protected sexual intercourses in the future. Additionally, the patient may find it hard to allow treatment due to the cost of some of the medications that are required. This might place a significant financial burden on the patient’s family and her children. This must be taken into consideration, and the hospital’s employees must seek to it that there is a way for the patient to receive proper treatment and care and recover in full.
Facilitators and Barriers
The primary barrier that might prevent the patient from fully recovering from this disease is the financial side of the problem. Additionally, the condition may already be chronic since there were repeated cases of chlamydial and other STD conditions in the past. To overcome these challenges, the patient must seek help from medical specialists and counselors to receive coverage of her treatment.
Conclusion
This case demonstrates how severe certain STDs maybe both regarding recovery and expenses required to cover treatment. Although treatment is achievable with a relatively small amount of effort spent, it often highly depends on the hospital’s ability to provide required medicine as well as proper conditions for recovery. It may not be possible for a hospital to provide a patient with more affordable medications instead of giving them more costly treatment. This is one of the troublesome concerns of the modern health care practice.
References
Chlamydial infections in adolescents and adults. (2015). Web.
Lanjouw, E., Ouburg, S., Vries, H. J., Stary, A., Radcliffe, K., & Unemo, M. (2015). European guideline on the management of chlamydia trachomatis infections. International Journal of STD & AIDS, 27(5), 333 – 348.
Qureshi, S. (2017). Chlamydial genitourinary infections treatment & management. Web.
World Health Organization. (2016). WHO guidelines for the treatment of chlamydia trachomatous. Web.