Question

1. A 28-year-old woman complaining of lower abdominal pain, nausea & vomiting. She has noticed increased white vaginal discharge for 4 days. She is febrile. On pelvic exam, you note CMT (Cervical Motion Tenderness) and abdominal pain with palpation. Her diagnosis is pelvic inflammatory disease.

a. What will you prescribe? She is allergic to penicillin. What would you prescribe if she was not allergic to penicillin?

b. Discuss pathophysiology of the disease or physiology of the organism that the drug(s) are addressing.

c. Rationales for using the specific orders, emphasize the APRN role in the assessment, diagnosis, and pharmacological interventions of clients.

d. Indications, contraindications of the drug(s)

e. List the prices of three drugs to treat the selected problem from two different pharmacies.

f. Describe in detail the instructions the patient should receive for the selected drug(s). Write this at a fifth-grade level.

Answer 1

a. As the patient is allergic to penicillin, the following treatment can be given. The treatment depends on whether the patient is admitted or managed as outpatient basis. If the patient is admitted, we can give Clindamycin 900mg if 6 hourly  plus gentamicin loading dose of 2mg/kg if or I'm then maintenance dose of 1.5mg/kg 8 hourly.

If the patient is managed on outpatient basis,nofloxacin 400mg twice daily for 14 days plus metronidazole 400mg thrice daily for 14 days.

If the patient is not allergic to penicillin, then cefoxitin 2g iv twice daily for 14 days.

b. Pelvic inflammatory disease is caused by anaerobic organisms like moraxella, chlamydia, neisseria , trichomonas. The organism invade the genital tract and cause symptom like pain, vaginal discharge etc The drugs will cover both gram positive and gram negative and anaerobic should be given.

c. Rationale is the usage of antibiotics that covers both gram positive, negative and anaerobic should be given. The APRN should regularly monitor the vitals and appropriate administration of drugs should be given.

d. Indications are pelvic inflammatory disease, vaginal candidiasis, trichomoniasis,bacterial vaginitis.

Contraindications are allergy to particular antibiotic, renal and hepatic impairment.