Question

In: Nursing

A  36 year old female, has had lower back pain that radiates to her right abdomen for...

A  36 year old female, has had lower back pain that radiates to her right abdomen for the last several days. The pain is dull and difficult to localize. As an Olympic shot putter, she had originally attributed the pain to muscle strain. However, today the pain has become persistent and intense. Now she is seeking your expert help.

Part A: Lower back pain may include many body systems that we have studied. For each system listed below, list one disorder that could cause this patient’s pain.

Muscular

Skeletal

Nervous

Digestive

Urinary

Reproductive

Reproductive

Reproductive

Part B: Exam: Her temperature is normal. Respirations 15, Her HR 90 and blood pressure is 135/80.

Hct: 48%, WBC: 12,300, Neutrophils 7500, Bands 1000, Lymphocytes, 3000, Monocytes: 800. She has no cough, incontinence, U/A is normal. She has no nausea, vomiting or diarrhea. Her menses have been irregular for years due to her strenuous work-outs. She has 4 children, including her last, Bruno, who was 11 lb 8 oz and is now 3 years old. She uses a diaphragm as her method of birth control. Her back muscles are not tender, but abdominal palpation is difficult due to guarding and tensing of her considerable abdominal muscles.

Anything in that data that concerns you? __________________________________________________

___________________________________________________________________________________

Suggest some tests that might rule in or out items on your list of possibilities from Part A above.

1.

2.

3.

Did you say pregnancy test? I thought you did.

Her pregnancy test is positive. She says this doesn’t feel like her other pregnancies.

What test or procedure (s) should we do now? ________________________________________

What possible problem are you concerned about? _____________________________________

She is going to undergo surgery for an ectopic pregnancy.

Where is the pregnancy located?

This is an emergency situation because rupture of could cause rapid blood loss and death.   It is also true that she has an increased chance of future ectopic pregnancies now that she has had one. Even if the surgery is successful and only one oviduct is affected, her fertility will likely be reduced. Prior to surgery, it is important to explain potential problems to patients. Sometimes a patient may opt to have a surgery that will change her ability to become pregnant.

If the doctor does a hysterectomy but leaves the ovaries, will Bromhilda have menses? ____

Will she ovulate? ______ Where will the oocyte go? ____________________________

If the doctor does a bilateral salpingo-oophorectomy and hysterectomy will Bromhilda have menses? _____________

Will she ovulate? ___________   

If the ovaries are taken, then the patient immediately experiences the condition called__________________.

She is thinking about having a tubal ligation. What is that?

Solutions

Expert Solution

1 PART A =reproductive

2 A pelvic exam will help to assess the areas of pain and tenderness or mass in the fallopian tube.Further blood tests and Ultrasound will aid in the diagnosis.HCG tests are performed are repeated until the USS rule out an ectopic pregnancy.

3 the problem is normally,a fertilized egg cant develop outside the uterus .Therefore to prevent further life threatening complications ectopic tissue need to be removed.if it is an ectopic pregnancy a laproscopic or abdominal surgery is performed.

4 In most cases ectopic pregnancies occur in the ampulla.The other sites are isthmus,fimbria and cornua.

5Once uterus is removed there will no loger be any period .But if a portion of the cervix or ovary is retained ,miniperiods may occur because of the endometrial lining left back in the cervix.Otherwise since the uterus is removed she can never become pregnant again.Since the ovaries are retained there will be signs of menopause.Menstruation is an event which happens inside trhe body ,but the target organ where the endproduct of menstruation occurs is uterus.if there is no uterus to show the result menstruation doesnt happen.

6 Yes if the ovaries are kept ovulation will occur ,as the ovaries are still producing estrogen.the ovaries will ovulate as usual and it will form its follicles .

7 it will be released into the pelvic cavity and the body and peritoneal cavity will take care of that fluid through reabsorption .

8 The removal of the ovaries is called an oopherectomy and is often compined with hysterectomy.After the removl of ovaries women will go into a period of surgical menopause.Estrogen leel plummet during surgical menopause and can lead to menopausal symptoms.Therefore they might require Estrogen Replacement therapy.

9 No she will not ovulate ,as ovaries are required for ovulation.

10 No menses will not take place as ovulation is not happening.

11 the patient experiences the condition called Surgical menopause.


Related Solutions

A 42-year-old male reports pain in his lower back for the past month. The pain sometimes...
A 42-year-old male reports pain in his lower back for the past month. The pain sometimes radiates to his left leg. In determining the cause of the back pain, based on your knowledge of anatomy, what nerve roots might be involved? How would you test for each of them? What other symptoms need to be explored? What are your differential diagnoses for acute low back pain? Consider the possible origins using the Agency for Healthcare Research and Quality (AHRQ) guidelines...
A 42-year-old male reports pain in his lower back for the past month. The pain sometimes...
A 42-year-old male reports pain in his lower back for the past month. The pain sometimes radiates to his left leg. In determining the cause of the back pain, based on your knowledge of anatomy, what nerve roots might be involved? How would you test for each of them? What other symptoms need to be explored? What are your differential diagnoses for acute low back pain? Consider the possible origins using the Agency for Healthcare Research and Quality (AHRQ) guidelines...
A 36-year-old woman presents to the emergency room with a history of right upper quadrant pain,...
A 36-year-old woman presents to the emergency room with a history of right upper quadrant pain, shaking chills and jaundice. This pain came on suddenly 6 hours earlier and has been progressing. She took her temperature at home and it was 102 F. She vomited once at the onset of pain. She has had intermittent episodes of epigastric and right upper quadrant pain after eating, for the past 6 months. The pain always abated after 30-60 minutes. Her BP is...
A 50 year old female was shot in the right side of her chest .she is...
A 50 year old female was shot in the right side of her chest .she is currently in the progrsssive care unit . Her arterial blood gases are as follows : pH -7.30 .PaO2 - 88 mmHg. PaCO2 -50 mmHg. Bicarbonate 26 mEg/L . Lactate 5 mg/dL. 1- does she have an acid base imbalance ? If so what type of imbalance ? 2- what likely caused her to have this condition ? 3 - Her condition continues to deteriorate...
A 28 year old female presents to the ER with upper right abdominal pain. She states...
A 28 year old female presents to the ER with upper right abdominal pain. She states her pain begins around abdomen and radiates to her right breast bone and upper back. She presents with nausea and vomiting x3 episodes, abdominal bloating, and flatulence. Her V/S are: TEMP 101.4°F, PR 92, BP 138/72, RR 20, O2 99% at room air. Patient is 5’3” and 181 lbs. with BMI of 32. Patient medical history: appendicitis with appendectomy 5/27/2020. MD wants to have...
Case 1 A 26-year-old female complained of severe, dull, aching pain, and cramping in the lower...
Case 1 A 26-year-old female complained of severe, dull, aching pain, and cramping in the lower abdomen. There were no other physical findings. A laparoscopy revealed the presence of ectopic endometrial tissue on the uterine wall and ovaries. Danazol (a synthetic androgen and inhibitor of gonadotropins), 600 mg/day, was prescribed for up to nine months to inhibit ovulation, suppress the growth of the abnormal endometrial tissue, and achieve appreciable symptomatic relief, with a 30% possibility of conception after withdrawal of...
2. Patient BN is a 36-year-old female with a type of organ failure that reduces her...
2. Patient BN is a 36-year-old female with a type of organ failure that reduces her quality of life to half of what it would be in good health. Without treatment she can expect to live only two years. With a successful transplant, BN can expect to live four years and have a quality of life that is near 80% what she would enjoy in good health. However, the transplant costs $100,000, plus $10,000 each year for drugs and follow-up...
Jackie, a 44-year-old female, has had HIV for 12 years. Her physician has recently diagnosed her...
Jackie, a 44-year-old female, has had HIV for 12 years. Her physician has recently diagnosed her with AIDS due to a decline in her CD4+ T cells over the past five years, an elevated viral load, and recurrent bacterial pneumonia. She has ongoing lipodystrophy; she lost approximately 30 pounds in the past year and has had diarrhea for the past six weeks. Her roommate reports that Jackie’s appetite has been minimal lately and he attributes this to a thrush infection...
A 40-year-old woman has been admitted with possible embolism. Her symptoms are chest pain, right leg...
A 40-year-old woman has been admitted with possible embolism. Her symptoms are chest pain, right leg temperature warmer than left, delivery of a baby by C-section three weeks ago, and fatigue and shortness of breath. 1.   Question: Explain the clotting cascade and the relevance to the symptoms described
The patient in this case is a 57 year old female that has experienced joint pain...
The patient in this case is a 57 year old female that has experienced joint pain for ~ 5 years. Her joints are becoming progressively deformed with swelling. Her physician decides to order a synovial fluid analysis, including a cell count, differential, RF, protein, glucose, LDH, and crystal analysis if indicated. He also orders blood work: Rheumatoid Factor and glucose level. Her results are as follows: Synovial Fluid Analysis Serum Results Appearance Yellow/Cloudy Protein 3.7 g/dL Glucose 81 mg/dL 100...
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT