FSU Bacterial Vaginosis Diagnosis and Management Discussion

Please respond to discussion below:

L.R. is a 28-year-old female patient who was evaluated at the clinic because she presented thin and white vaginal discharge which was increased after sexual intercourse. The vaginal discharge has a pH of 5.2, a positive KOH test, and clue cells (more than 40% of epithelial cells) on microscopic examination. The primary diagnosis for L.R. is bacterial vaginosis. Bacterial vaginosis is a condition resulting from the excessive growth of the typical vaginal microorganisms (Kairys & Garg, 2023). Clinically, it is often characterized by elevated vaginal discharge, which emits a fishy odor or smell. The discharge is typically thin in consistency and is usually either gray or white. The ICD-10 Code for this primary diagnosis is N76.0.

Discuss three differential diagnoses for AUB with ICD 10 numbers for each.

Three Differential Diagnoses for AUB (Abnormal Uterine Bleeding) would include Cervicitis, Trichomoniasis, and Candida Vulvovaginitis. Cervicitis is the inflammation of the ectocervix and shares symptoms with AUB, including the presence of mucopurulent cervical discharge (Iqbal & Wills, 2023). The ICD-10 Code for Cervicitis is N72. Trichomonas vaginalis is a protozoan parasite that causes trichomoniasis. Women with trichomoniasis typically exhibit symptoms such as vaginal discharge (Schumann & Plasner, 2023). The ICD-10 Code for Trichomonas vaginalis is A59.0. Vulvovaginitis, the inflammation of the vulva and vagina, predominantly affects women of reproductive age and is frequently the result of infections. Patients commonly report symptoms including irritation, itching, a burning sensation, the presence of thick white adherent discharge, and swelling (Jeanmonod & Jeanmonod, 2023). The ICD-10 Code for Candida Vulvovaginitis is B37.3.

Discuss patient education

The patient L.R. should be educated on the importance of adherence to treatment and the significance of not engaging in sexual activity during the treatment period. The patient should be educated to refrain from douching, the patient should use gentle soap for cleansing, choose cotton underwear, and practice good sexual hygiene which includes practicing safe sexual habits and getting screened for STIs. Patients should also be advised to follow up and seek medical care if symptoms get worse.

Develop the management plan (pharmacological and nonpharmacological).

The Pharmacological Treatment for L. R. would include an order for metronidazole 500 mg orally twice daily for a week to address BV (Kairys & Garg, 2023). It should be emphasized to L.R. the significance of finishing the entire antibiotic treatment. Patients should be advised not to drink alcohol during treatment due to potential interactions. If L.R. has a sexual partner, it should be recommended that they undergo an assessment and treatment to prevent potential reinfection. Non-pharmacological approaches encompass vaginal pH maintenance, safe sexual practices, and ongoing follow-up and assessment. The nurse should encourage the adoption of protective measures, like condom use. Additionally, the nurse practitioner should suggest lifestyle adjustments like promoting a healthy lifestyle with a well-rounded diet, regular physical activity, and stress management to enhance overall well-being.

Effective health assessment

An effective health assessment for the diagnoses of bacterial vaginosis includes several assessments which include taking a medical history, which includes sexual history, and previous sexually transmitted infections. A physical exam which includes a pelvic exam, the “whiff test” can be done with KOH and vaginal discharge with a fishy odor released during this test, a PCR and a culture test can also be administered to identify the bacteria.

Different family developmental stages

The family life cycle comprises eight distinct stages, also referred to as family developmental stages. This journey commences with the stage of a newly married couple without children (Joronen, & Rantanen, 2021). Subsequently, the family life cycle progresses to the stage of a married couple welcoming their first children. The next phase finds the family with children, typically with the oldest child being around 6 years old (Joronen, & Rantanen, 2021). Upon completing this stage, the family enters the realm of school-age children, with the oldest child now around 13 years old. The subsequent stage is characterized by families with teenagers, where the oldest child reaches the age of 20 (Joronen, & Rantanen, 2021). This transition to families with children leaving home can be experienced in both positive and negative ways, with possible outcomes including exhaustion, reduced personal time, and increased disagreements, or conversely, a sense of gratification and joy (Abreu-Afonso et al., 2022). The journey then proceeds to the empty nesters stage, where parents enter middle age. Finally, the last stage of the family life cycle encompasses retirement, the aging process, and the potential loss of a spouse (Joronen, & Rantanen, 2021).

Family structure and function

The dynamics within a family hold a significant influence on health outcomes, making them a crucial focus in clinical settings. Experiencing a medical condition can be stressful so families should offer emotional support to the family member with BV, they should also listen to their concerns, provide reassurance, and be understanding of their feelings.  Family members should educate themselves about BV and understand the condition which can help reduce stigma and provide a more supportive environment for the affected family member. Families should be cognizant of not making any insensitive or judgmental comments about the condition.