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Yerenis Llanes.
- Female Patient Cases 2
Discuss and described the pathophysiology and symptomology/clinical manifestations of TSS: toxic shock syndrome is an acute illness that is shown by fever, hypotension, a sunburn-type rash, and end-organ damage. Toxic shock syndrome is usually associated with tampons and now menstrual cup use. Some men and nonmenstruating women are also susceptible to toxic shock syndrome (“TSS”, n.d.).
- Staphylococcus aureus and streptococcus pyogenes are usually the pathogens that cause toxic shock syndrome. With toxic shock syndrome, there is multisystem organ involvement, myalgias, headache, pharyngitis, which could then lead to organ dysfunction. Organ failure is characterized by hypotension, tachycardia, and tachypnea. Organs affected may be the kidneys, liver, lung, and blood (Schuiling & Likis, 2022).
It is important that apart from the physical assessment, that the patient is asking about menses with tampon use in the past 5 days, history of toxic shock syndrome, and history of a recent wound. Physical manifestations with include an erythematous and macular rash, edema, and erythema of palms and soles (Schuiling & Likis, 2022). After acute illness, there may be peeling of the skin and desquamation of the extremities. Pelvic exam will show hyperemic vaginal mucosa and vulvar tenderness. The patient may have ulcerations to the mouth and vagina (“TSS”, n.d.).
Discuss three differential diagnoses for Vaginitis/Vaginosis with ICD 10 numbers for each: Trichomoniasis ICD 10 A59.01, presents with purulent, malodorous, thin discharge associated with burning, pruritus, and dysuria. Vaginal candidiasis ICD 10 B37.49, presents with vulvar pruritus and cottage cheese-like vaginal discharge with no or minimal odor. Atrophic vaginitis ICD 10 N90.5, presents with yellow and malodorous vaginal discharge, vaginal dryness, post coital bleeding, and dyspareunia with the sign of vaginal inflammation (Sexually Transmitted Diseases , 2021).
Discuss patient education: some education to prevent toxic shock syndrome includes women with a history of toxic shock syndrome should avoid using tampons, since reinfection is common. Prompt and thorough wound care is important to avoid toxic shock syndrome. Also, women should be educated on minimal usage of vaginal foreign bodies such as diaphragms, tampons, and menstrual cups (Schuiling & Likis, 2022).
Develop the management plan (pharmacological and nonpharmacological): antibiotic therapy will usually include clindamycin to reduce toxic production. Penicillin is the preferred antibiotic for group A strep. The recommendation for antibiotic therapy is 14 days. Intravenous immunoglobulin may be given to neutralize toxin activity. Hospitalization is required. Standard treatment of shock and organ failure, such as fluid resuscitation, is imperative as the first step in treatment (“TSS”, n.d.).
Apart from a physical assessment, it may be beneficial to assess predisposing risk factors such as recent tampon or menstrual cup use, recent influenza illness, or any immunocompromised states. The clinician should be assessing the patient’s hygiene and how often they are changing their menstrual devices (“TSS”, n.d.).
The middle-aged adult such as the 42-year-old woman in this case study begins to develop physical changes and possible chronic health problems. Women go through menopause. Mentally, they use past experiences to learn, create and solve problems. People of this age are concerned about staying productive, and they hope to contribute to future generations and strive to balance dreams with reality. They start planning for retirement and may end up taking care of parents or children (Schuiling & Likis, 2022).
In the midlife years, some women that were parenting during earlier adulthood, may transitions to other aspects of their lives because of their children leaving home. Others may be in the active phase of parenting, as people are now delaying childbearing until later into the early phases of midlife (Schuiling & Likis, 2022).
References
Sexually Transmitted Diseases . (2021, January 28). Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/std/default.htm (Links to an external site.)
Schuiling, K. D., & Likis, F. E. (2022). Gynecologic health care: With an introduction to prenatal and postpartum care. Jones & Bartlett Learning.
Toxic Shock Syndrome (TSS). Johns Hopkins Medicine. (n.d.). https://www.hopkinsmedicine.org/health/conditions-and-diseases/toxic-shock-syndrome-tss (Links to an external site.).
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