Case study 1
A 23-year-old man presents with painful, burning urination of more than 1 week’s duration. It is getting worse. He has also noticed a yellowish penile discharge. He denies fever, testicular or abdominal pain, and rash. He is sexually active with multiple partners.
CC: “I think I have the ‘clap’.”
Physical exam: Afebrile; vital signs normal. Exam essentially normal, except for yellowish discharge from the urinary meatus and penile shaft pain. Negative for abdominal pain, costovertebral angle tenderness, lymphadenopathy, rash. Negative for urinary retention, back pain, perineal pain, testicular pain.
Questions:
1. What are the differential diagnoses for this patient?
2. How do you rule in or out various possibilities?
3. How would you manage this patient?
4. What health promotion strategies are important for this patient at this point in time and WHY?
5. What patient education is needed?
6. How does this relate to Healthy People 2020 objectives and/or public health concerns?
7. What are rates, both prevalence and incidence, of STDs in both men and women? Are racial disparities involved? What are potential sequelae?
8. Would any complementary therapies be appropriate for a long-range plan of care for this patient? Support with evidence from the literature.
9. What are the data on STDs by population? Do health disparities exist? WHY? How can advanced practice nurses impact these statistics?
Case Study 2
A 42-year-old man presents with 8-hour history of testicular pain which is increasing in severity. He is in acute distress by the time you see him and complains of groin pain. He notes some urinary frequency and nausea. His physical exam is unremarkable with normal testicular and scrotal examination and mild left costovertebral angle tenderness. Urinalysis reveals significant microscopic hematuria.
Questions:
1. What other data might you need, whether history and/or physical exam, to assist you in making a diagnosis?
2. What laboratory tests and/or imaging are important for you to make a diagnosis?
3. Identify referred pain patterns and what these mean.
4. How will you manage this patient?
5. Will you treat and/or refer? What follow-up is needed?
6. What education is needed for this patient for the future?
7. Are there any complementary therapies to assist this patient in control of his underlying condition long range? Support with evidence from the literature.
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