Reference no: EM133629019

Assignment:

A journal entry about three challenging patients I provided care for. Below are the three most challenging patients I saw during the first week of GYN clinical rotation. Please include three scholarly journals for references and citations.

1. A 64 y/o female patient presents to the office with c/o urinary frequency and vaginal discharge a week ago. Patient reports vaginal discharge is thin yellowish and malodorous - fishy smell. ROS neg except above complaints. Reports have one new sexual partner and not using condoms during sex. PE normal. Pelvic exam revealed small red ulcerations on the vaginal wall. VSS. Patient is stable. Treatment plan: Urine collected for UA/urine culture, F/U results Aptima swab done - F/U results Trichomoniasis - Metronidazole 500 mg PO BID x 7 days. I was worried about this woman because she's in her menopause with vaginal atrophy and not using condoms with the new partner for protection increase her risk for STD's.

2. A 35 y/o female presents to the office for PPD (Tdap) placement. Patient is 5 months pregnant and following up with her OB/GYN. Patient didn't receive Tdap yet. Patient reports previous hx of ectopic/miscarriages so very happy pregnancy is going well with no issues. Normal pregnancy in second trimester. Patient reports good family support. ROS neg. PE normal. VSS. Patient is stable. Treatment plan: PPD given Counseling other - continue moderate exercise, keep hydrated, and eat healthy. Urine collected for UA, F/U results Blood drawn - F/U results. I was worried for this patient because she's a new expectant mother and the father of the baby walked out of her life. She reported the father of the baby wanted her to do an abortion and she refused.

3. A 34 y/o female patient presents to the office for annual well visit and abnormal bilateral breast mammogram. Patient had screening for BRCA this year which revealed multiple cyst and dense breast tissues - needs mammo twice a year. Patient was emotional about results. PMHx: Anxiety attack, depression, previous smoker. PSHx negative. FHx: Mother - obesity, OA, HLD, Father - HTN, SHx: occasional drinker, doesn't take tobacco anymore. Patient is sexually active and uses birth control. Pt is stable. Treatment Plan: Blood drawn - F/U results Positive BRCA gene, F/U GYN Oncology.

Question:

1. Reflect on the 3 most challenging patient encounters and discuss what was most challenging for each.
2. What did you learn from this experience?
3. What resources did you have available?
4. What evidence-based practice did you use for this patient?
5. What new skills are you learning?
6. What would you do differently?
7. How are you managing patient flow and volume?
8. How might I improve on my skills and knowledge, and how to communicate that back to my Preceptor?
9. How am I doing? What is missing?
10. What type of feedback am I receiving from my Preceptor?