Enter your email address:

Thursday, September 20, 2007

Nurse Practitioner Student Writeup Vaginal Candidiasis

Patient Profile: W.D., 36year old female, married
Chief Complaint: “I am having some discharge and it itches”
History of Present Illness: Pt states no illness at this time.
Past Health History: Asthma. Ovarian cysts.
Past Surgical History: Tubal ligation 2001.
Family History:
Paternal Grandfather (88) Healthy
Maternal Grandfather (82) Deceased
Paternal Grandmother (86) COPD Maternal Grandmother (68) Deceased Asthma, Sickle Cell Anemia
Father (65) Healthy
Mother (68)
Patient (36) Asthma

Current Health: Sulfa allergy. Denies drug and tobacco use. Drinks mix of soda, water and milk daily. Sleeps approx. 8 hours nightly. States moderate level of exercise due to taking care of 4 children.

Psychosocial History: Married, gravida 2, para 2 High school diploma. BCBS insurance. Works as cashier at this time.

Review of Systems:
States 2 successful pregnancies previously. Last pap smear done on 01/06. States no history of STDs. States menarche at age of 13 years. LMP 03/15/06 lasting 7 days with moderate to heavy flow. States regular cycles occur every 26-28 days. Does not use douche.

Physical Examination:
Vital signs: BP 117/62 Pulse 78 Resp. 20 Height 5’4” Weight 210

Normal distribution of pubic hair for age.
External genitalia dark purple colored and moist, with no varicosities, lesions, organisms. Noted redness of labias majora and minora with slight edema.
Thick, white, curdy discharge.
No swelling, tenderness, or discharge on palpation of Bartholin’s and Skene’s glands.
No masses, lesions, or anatomical deviations of the vulva and perineum.
Cervix smooth, moist, firm, and non-tender, slit sign noted. (previous pregnancy)
Vaginal walls are reddened, moist, rugose, without swelling or masses.
Uterus is appropriately sized for age and condition. Firm, pear shaped, slightly mobile and anteverted.
No tenderness. No lesions, nodules, masses, or bleeding.
Ovaries and fallopian tubes are nonpalpable.
No hemorrhoids, or painful areas on rectum.
Negative for kidney pain per percussion.

Medical Diagnosis: Candidiasis infection

Nursing Diagnosis:
Infection, r/t alteration in normal flora of vaginal canal, a.e.b. discharge and itching symptoms.

Vulvovaginal candidiasis: This is the second most common cause of vaginitis. The patient's history includes vulvar pruritus, vaginal discharge, dysuria, and dyspareunia. Approximately 10% of women experience repeated attacks of VVC without precipitating risk factors. The change from the normal, non-clinical presence of the fungus to a pathological attack may be the result of various factors. Antibiotics which influence the bacterial population present at any of the three sites may allow the proliferation of the fungus. Diabetes mellitus, pregnancy, malnutrition (including alcoholism) and, in the case of vaginal thrush, bath additives may contribute to the condition. Immunosuppressed and AIDS patients also readily contract it.
Physical examination findings include a vagina and labia that are usually erythematous, a thick curdlike discharge, and a normal cervix upon speculum examination. It is the extensive growth of the Candida species which produces inflammation, erythema and irritation. There is a school of thought that believes that recurrent thrush infections may be due to an excessive population of the normal intestinal flora of Candida species. It should also be borne in mind that systemic candidiasis, although rare, is a serious condition which requires referral.
Treatment and Education: Monistat vaginally x 7 days. The cream should also be applied to the male partner's penis even if he is asymptomatic. Diflucan 150mg PO x 1 dose as alternate medication. Wipe from front to back. Increase yogurt consumption with active cultures. Avoid tub bathing if seems to be precipitating factor.