Please respond to discussion below:

For my first week of clinical rotation, I had different emotions of anxiety, excitement, and I was a little overwhelmed at the same time. I was excited because I am finally able to obtain hands on training as nurse practitioner student and learn from other nurse practitioners and physicians. I was anxious because of my fear of not addressing all patient needs when interviewing with my preceptor, making mistakes and new environment, but I am aware that making mistakes is part of the learning process. Lastly for my challenges, the charting system for documenting SOAP notes and inputting information for patients at the facility that I am precepting at is unfamiliar to me, I feel that I need more practice with it.

For one of the patients seen this week with my preceptor, it was a 24-year-old Caucasian female with medical history of anxiety and seasonal allergies. The patient presented with complaints of needing a PPD for school and having malodorous greenish colored vaginal discharge prior to current menstrual period. Patient denies any itching, denies lesions, denies dysuria, denies painful intercourse, and denies vaginal pain. Patient reports mild abdominal pain but is on menstrual period. Patient reports being sexually active, but uses protection with partner, patient refused for STD panel screening to be done, reports last STD panel was done July 2023.

Assessment

The assessment of the patient was not difficult; there were no abnormal findings.  Patient is AAOx4 well dressed and in a good mood. Patient has functional ADLS. Patient had no abnormal labs. Vital signs stable. BMI 20 Normal. Patient is currently on menstrual period and refused examination of vaginal area. The diagnosis that me and my preceptor agreed to was abnormal vaginal discharge.

Plan of care:

• Monitor Vaginal discharge after current period is over, report to office for follow up if it occurs again.
• Provide education of vaginal hygiene practices, refraining from douching.
• Reinforce importance on using protection such as condoms when sexually active and routinely STD testing with partner.
• Education on risks of increasing STI with multiple sexual partners; education on vaginal health: refrain from douching, wear cotton underwear and not nylon, do not use fragranced vaginal powders or sprays. Increase fluid intake, refrain from alcohol and smoking, increase fruit and vegetable in balanced diet., Increase dairy intake such as yogurt.
• Follow up in two weeks in office; Order PH testing and rapid test for BV, gonorrhoeae and M. genitalium if vaginal discharge reoccurs.
• Order QuantiFERON test to be done in office 8/22/2023.
• Refer to a gynecologist for consultation.

Differential Diagnoses

Possible differential diagnoses include Chlamydia infection, cervicitis, trichomoniasis, and bacterial vaginosis (BV). However, the patient most likely may have bacterial vaginosis, as symptoms of thin bubbly discharge, having no inflammation on vaginal area, fishy or malodorous odor are indications of BV, and the patient presents with these symptoms. Vulvovaginal candidiasis, trichomoniasis, and BV are the three most common causes of infections that contribute to abnormal vaginal discharge, and bacterial vaginosis accounts for 50% of infections that cause abnormal vaginal discharge (Sim et al., 2020).

Health Promotion Interventions

Encouraged STD testing with sexually active partner, Education on risks of increasing STI with multiple sexual partners; education on vaginal health (refrain from douching, wear cotton underwear and not nylon, do not use fragranced vaginal powders or sprays); increasing fluid intake, refrain from alcohol, increase fruit and vegetable in balanced diet; educational pamphlet was also given on safe sex practices. Patient encouraged to increase dairy intake with milk and yogurt to increase healthy flora and decrease vaginal inflammation or vaginitis (World Health Organization, 2021).

What have I learned that will be beneficial for me as an advanced practice nurse?

What I learned this week during my clinical experience that I found to be beneficial as an advanced practice nurse is about the process of coordinating care in a primary care setting, as I have never worked in a primary setting before. I was able to learn about collaborating with other practitioners even if each had their own patient loads. I also learned that it is important to address patient needs and take into consideration their signs and symptoms to carefully make a diagnosis, implement proper treatment and referrals.