Question

In: Nursing

History  Stanley is a 19-year-old male who presents to the STD clinic because he’s had...

History
 Stanley is a 19-year-old male who presents to the STD clinic because he’s had a sore
on his penis for one week.
 Last sexual exposure was three weeks prior, without a condom.
 No history of recent travel.
 Predominantly female partners (five in the last six months), and occasional male
partners (three in the 1-2 years).
 Last HIV antibody test (two months prior) was negative. Reports three children with two
different women. All children were in the province taking care of by his parents. He is
single and always on the go to mingle.
Physical Exam
 No oral, perianal, or extra-genital lesions.
 Genital exam shows an uncircumcised penis with a lesion on the ventral side near the
frenulum. Lesion is red, indurated, clean-based, and non-tender.
 Two enlarged tender right inguinal nodes, 1.5 cm x 1 cm.
 Scrotal contents are without masses or tenderness.
 No urethral discharge.
 No rashes on torso, palms, or soles. No alopecia. Neurologic exam within normal limits.
Laboratory
The results of stat laboratory tests showed the following:
 Darkfield examination of penile lesion—Positive for T. pallidum
 FTA-ABS—Reactive
 HSV culture—Negative
 Gonorrhea NAAT—Negative
 Chlamydia NAAT—Negative
 HIV antibody test—Negative
Medications
May give Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million
units IM each at 1-week intervals, but after the skin testing, Stanley shows with allergy in
penicillin so the doctor advised to take vancomycin 250 mg orally 4 times a day for 10 days
PLUS Rifampin 600 mg orally twice a day.
Partner Management
Stanley had the following sex partners during the past year:
Tracy—(met in QC Circle) Last sexual exposure three weeks ago (receptive oral and vaginal
sex with Stanley)
Richelle—(met in SM Manila) Last sexual exposure four weeks ago (vaginal sex with Stanley)
Carmina—(met in Luneta) Last sexual exposure five weeks ago (vaginal sex with Stanley)
Danielle—(met in Divisoria) Last sexual exposure six weeks ago (vaginal sex with Stanley)
Jonathan—(met in Trinoma) Last sexual exposure six month ago (receptive anal sex with
Stanley)
Tony—(met in Quiapo) Last sexual exposure eight months ago (insertive oral and anal sex
with Stanley)
Calvin—(met in Recto) Last sexual exposure ten months ago (receptive oral and anal sex with
Stanley

Follow-Up
Stan returned to the clinic for a follow-up exam one week later. Results were as follows:
 His penile lesion was almost completely healed.
 He had not experienced a Jarisch-Herxheimer reaction.
 The RPR (repeated at the follow-up visit because the initial one was negative) was 1:2.


MAKE A DISCHArge PLANNING FOR THIS CASE

Solutions

Expert Solution

#. Patient Teaching-General :

disorder, diagnosis, and treatment, including the need to comply with treatment

prescribed medications, such as penicillin, and the intended course of therapy depending on the stage of the disease

possible adverse effects of penicillin therapy, including headache, fever, chills, sweating, malaise, and hypotension or hypertension (Jarisch-Herxheimer reaction)

need to complete the course of therapy even after symptoms subside

importance of informing, testing, and treating sexual partners

need to refrain from sexual activity until treatment is completed and follow-up VDRL or RPR test results are normal

importance of repeat serology testing at 3, 6, 9, and 12 months after treatment and again at 24 months if the disease lasts longer than 1 year

possible need for retreatment if clinical signs persist or recur, a fourfold rise in titers occurs, or initially high titers fail to decrease fourfold by 6 months

risks to the fetus if the patient is contemplating pregnancy and the need for all pregnant patients to be screened at the first prenatal visit

information for the patient and sexual partners about human immunodeficiency virus infection

importance of safer sex practices, including the use of condoms.

#. Patient Teaching-Discharge Planning

As needed, obtain a physical or occupational therapy consultation.

Refer the patient for contact tracing.

Refer the patient to a specialist if congenital syphilis is suspected.

Consult a social worker to determine home care needs.

Nightingale answered 1 year ago
Next > < Previous

Related Solutions

19-year-old male who presents to the STD clinic because he’s had a sore on his penis...
19-year-old male who presents to the STD clinic because he’s had a sore on his penis for one week. • Last sexual exposure was three weeks prior, without a condom. • No history of recent travel. • Predominantly female partners (three in the last six months), and occasional male partners (two in the past year). • Last HIV antibody test (two months prior) was negative. Reports three children with two different women. Physical Exam • No oral, perianal, or extra-genital...
Jenna Ward is a 19-year-old female who presents to the clinic with a chief complaint of...
Jenna Ward is a 19-year-old female who presents to the clinic with a chief complaint of 2-day history of burning with urination and vaginal discharge. The discharge is foul smelling. She has tried OTC vaginal treatment without improvement. She has been sexually active with several partners. She is G1, P0, A1. She takes oral contraceptives and menses are regular. She denies any cramping, abdominal pain, or unusual vaginal bleeding. No fever or chills. No routine medications. NKDA. Past Medical History:...
Timmy is a 6-year-old male who presents with a 1week history of an annular lesion on...
Timmy is a 6-year-old male who presents with a 1week history of an annular lesion on his left forearm. The lesion has raised edges and a slightly scaly cleared center. You diagnose him with ringworm (tinea corporis). 1. What is your plan of care for the treatment of tinea corporis?
A 6 month-old male with a past medical history of eczema presents to the clinic today...
A 6 month-old male with a past medical history of eczema presents to the clinic today with a chief complaint of a reddened area over the inner left thigh. The area is warm, mildly swollen and tender with a central lump. He started having tactile fevers, irritability, and poor feeding today which prompted the mother to bring him for evaluation. VS: T 38.5, P 110, R 26 He is fussy but distractible with a pacifier. He has a left upper...
Roman is a 63 year old male with a history of alcoholism. He presents with a...
Roman is a 63 year old male with a history of alcoholism. He presents with a erythematous, shiny, raised, hardened but tender plaque on his left cheek and nose. The plaque has a distinct border. Romansays that he woke up two days ago feeling “a little off” and experienced chills throughout the day. The facial rash progressively worsened yesterday. His temperature is elevated (39°C or 102.2°F). A sample is collected from one of the lesions, however, no obviously pathogenic organisms...
A 57 year-old male with history of HTN and HLP presents to your office with complaints...
A 57 year-old male with history of HTN and HLP presents to your office with complaints of transient chest pain during exertion. He denies associated nausea, diaphoresis however does complain of increase shortness of breath and dyspnea on exertion. His chest pain is substernal and does not radiate and seems to alleviate after 5-10 minutes with rest. The last occurrence of pain was one week ago. Pt denies palpitations, near syncope or syncopal episodes. 1. How would you classify the...
A 52-year-old male with a history of smoking and alcohol abuse. He presents to the ED...
A 52-year-old male with a history of smoking and alcohol abuse. He presents to the ED with complaints of "my skin looks yellow, my stomach hurts, and I feel nauseous". He is taken to CT and a tumor near the pancreas is observed. It appears to be blocking the common bile duct .please answer the questions below Possible Medications (Minimum of 2 medications needed) Clinical Manifestations Subjective: Objective: Possible Nursing Diagnosis           (Minimum of 2 needed)                                                                                                                                                                                                                               Medical Diagnosis Cirrhosis...
A 52-year-old male with a history of smoking and alcohol abuse. He presents to the ED...
A 52-year-old male with a history of smoking and alcohol abuse. He presents to the ED with complaints of "my skin looks yellow, my stomach hurts, and I feel nauseous". He is taken to CT and a tumor near the pancreas is observed. It appears to be blocking the common bile duct. please answer all the question below. Possible Medications (Minimum of 2 medications needed) Clinical Manifestations Subjective: Objective: Possible Nursing Diagnosis           (Minimum of 2 needed)                                                                                                                                                                                                                               Medical Diagnosis...
A 50-year-old male presents to the community clinic. He has just relocated to the area and...
A 50-year-old male presents to the community clinic. He has just relocated to the area and has no primary provider. He is a long distance truck driver and requires a physical examination to maintain his continued employment. Physical examination demonstrates a BMI of 33, blood pressure of 180/90 mm Hg, diminished femoral pulses and bilateral varicose veins with nonpitting edema in both ankles. He has a 30-year history of smoking two packs of cigarettes per day. Initial Discussion Post: What...
a 59 year old african american male presents to ambulatory clinic with increased shortness of breath...
a 59 year old african american male presents to ambulatory clinic with increased shortness of breath in the last week. He needs two pillows to sleep, swollen legs, malaise, weakness, and weight gain. his furosemide dose was decreased 2 weeks ago due to hypokalemia. shortness of breath is increasing with paroxsymal nocturnal dyspnea and ankle edema seems to be progressing
ADVERTISEMENT
Subjects
ADVERTISEMENT
Latest Questions
ADVERTISEMENT