Pelagio, Shiena Mae B.

BSN 2-A

Case Study: Problems in Reproduction and Sexuality

A Client with Gonorrhea

Janet Cirit, a 33-year-old legal secretary, lives in a suburban Midwestern community. She is unmarried but dating a man named Jim Adkins, who lives in an adjacent suburb. Ms.
Cirit visits her gynecologist because her periods have become irregular and she is experiencing pelvic pain and an abnormal amount of vaginal discharge. Recently she has
developed a sore throat. The pelvic pain has begun to disrupt her sleeping pattern, and she is concerned that she might have cancer because her mother recently died of ovarian
cancer.

Assessment Diagnosis Planning Implementation Evaluation

Subjective: Acute pain related to After the nursing intervention, Independent:  After the nursing
 Reports periods inflammation of mucosa and the patient will:  Perform a intervention, the patient
become irregular effects of circulating toxins as
comprehensive states that she is feeling
evidenced by verbal reports of  Report pain is
 Reports pelvic pain and assessment of pain to much better and sleeping
pharyngeal irritation and relieved/controlled
abnormal amount of pelvic pain. include location, well at night since the pain
vaginal discharge characteristics, has ended. Also, the patient
 Reports that she has  Verbalize methods that
onset/duration, was able to verbalize
developed a sore throat provide relief
frequency, quality, methods that provide relief
recently severity of pain (0 to 10 or and demonstrate use of
 Demonstrate use of
faces scale), and relaxation and diversional
relaxation and diversional
Objective: aggravating factors. activities as indicated for
activities as indicated for
 Physical examination individual situation.
individual situation
reveals both pharyngeal  Observe nonverbal
and cervical inflammation, cues and pain behaviors
and lower abdominal (e.g., how client walks,
tenderness. holds body, sits; facial
 Temperature is 98.5°F expression; cool
(37.0°C) fingertips/toes, which can
 Test results are mean constricted blood
positive for gonorrhea vessels) and other
 Slightly elevated WBC objective.
 Perform pain
assessment each time
pain occurs. Note and
investigate changes from
previous reports.

 Monitor vital signs.

 Provide comfort
measures (e.g., back rub,
change of position, use of
heat/cold).

 Provide quiet
environment, calm
activities.

 Instruct in and
encourage use of
relaxation techniques,
such as focused breathing,
imaging, CDs/tapes (e.g.,
“white” noise, music,
instructional).

 Encourage
diversional activities (e.g.,
TV/radio, socialization
with others).

 Encourage adequate
rest periods.
 Dependent:
 Administer
ceftriaxone IM as ordered.

DRUG STUDY

Brand / Classification Action / Contraindications Side Effects/Adverse Dosage Nursing Patient Teaching
Generic Name Indications Reactions Considerations
Therapeutic  Contraindic  CNS: Headache, Adults  History:  Tell patient to
actions: ated with allergy dizziness, lethargy, 1–2 g/day IM or IV Hepatic and renal report evidence of
Brand name: once a day or in equal
Inhibits synthesis to paresthesias impairment, blood dyscrasia or
Rocephin divided doses bid. Do
of bacterial cell cephalosporins not exceed 4 g/day. lactation, superinfection to
 Antibiotic wall, causing cell or penicillins.  Gonorrhea: pregnancy prescriber immediately.
death Single 250-mg IM
Generic name:  GI: Nausea, vomiting,
dose.
Ceftriaxone Cephalosporin diarrhea, anorexia,
 Use  Physical: Skin
sodium (third Therapeutic abdominal pain,  Meningitis: 1–2
cautiously with status, LFTs, renal
generation) Effects: flatulence, g IM or IV once a  Urge patient to
renal failure, function tests,
pseudomembranous day or in equal report watery, bloody
Bactericidal lactation, culture of affected
colitis, hepatotoxicity divided doses bid stools to prescriber
pregnancy area, sensitivity
for 4–14 days. immediately, even up to
tests
Longer therapy may 2 months after drug
Indications:
 GU: Nephrotoxicity be required. Do not therapy has ended.
 Lower exceed 4 g/day
respiratory
 Perioperative
infections  Hematologic: Bone
prophylaxis: Give 1
caused by marrow depression—
g IV 30–120 min  Advise patient to
Streptococcus decreased WBC count,
before surgery. report any
pneumoniae, decreased platelets,
hypersensitivity
Staphylococcu decreased Hct
reactions, such as a
s aureus,
Pediatric patients rash, itching skin, or
Klebsiella,
hives, to prescriber
Haemophilus  Hypersensitivity: 50–75 mg/kg/day IV or
immediately and to stop
influenzae, Ranging from rash to fever IM in divided doses
taking the drug.
Escherichia to anaphylaxis; serum every 12 hr. Do not
coli, Proteus sickness reaction exceed 2 g/day
mirabilis,
 Meningitis: 100 Teaching points
Enterobacter
mg/kg/day IV or IM
aerogenes,  Local: Pain, abscess at  Avoid alcohol while
in divided doses
Serratia injection site; phlebitis, taking this drug and for
every 12 hr for 7–14
marcescens, inflammation at IV site 3 days after because
days. Do not exceed
Haemophilus severe reactions often
4 g/day. Loading
parainfluenzae occur.
dose of 100 mg/kg
, Streptococcus  Other:
may be used.
(excluding Superinfections, disulfiram-
enterococci) like reaction with alcohol  You may
experience these side
 Acute effects: Stomach upset
bacterial otitis or diarrhea.
media caused
by S.
pneumoniae,  Report severe
H. influenzae, diarrhea, difficulty
Moraxella breathing, unusual
catarrhalis tiredness or fatigue,
pain at injection site.
 UTIs
caused by E.
coli, Klebsiella,
Proteus
vulgaris,
Proteus
mirabilis,
Morganella
morganii

 Gonorrhe
a caused by
Neisseria
gonorrhoeae

 Intra-
abdominal
infections
caused by E.
coli, Klebsiella
pneumonia

 PID
caused by N.
gonorrhoeae

 Skin and
skin structure
 infections
caused by S.
aureus,
Klebsiella,
Enterobacter
cloacae, P.
mirabilis,
Staphylococcu
s epidermidis,
Pseudomona
aeruginosa,
Streptococcus
(excluding
enterococci)

 Septicemi
a caused by E.
coli, S.
pneumoniae,
H. influenzae,
S. aureus, K.
pneumonia

 Bone and
joint infections
caused by S.
aureus,
Streptococcus
(excluding
enterococci),
P. mirabilis, S.
pneumoniae,
E. coli, K.
pneumoniae,
Enterobacter
 Meningitis
caused by H.
influenzae, S.
pneumoniae,
Neisseria
meningitides

 Periopera
tive
prophylaxis for
patients
undergoing
coronary
artery bypass
surgery and in
contaminated
or potentially
contaminated
surgical
procedures
(eg, vaginal or
abdominal
hysterectomy)
● Unlabeled
uses:
Treatment of
Lyme disease
in doses of 2 g
IV daily for 14–
28 days,
epididymitis,
proctitis,
proctocolitis,
enteritis,
gonococcal
meningitis,
endocarditis