Approved Case Study: Gynecologic Emergency
Emily Ramirez, a 36 year old Asian patient presenting to the ER with c/o light vaginal bleeding 3-4 days and severe right lower abdominal pain that radiates to her right shoulder since morning. She works as a Travel Nurse and states she has been working a lot of hours over the past couple of months due to the COVID-19 Pandemic. She is currently not taking any medication, no allergies. Pt had a history of unexplained infertility and has been trying to conceived for 4 years now, she has tried taking Clomid in the past but states it didn’t help so she stopped taking them 4 months ago. Other than her history of infertility, she also has a history of induced abortion when she was 15 years old. Emily denies any surgical history. Her family history is non-contributory. Pt reports she smoke a pack of cigarette
per week since she was 15 years old. Drinks socially about a 4-6 can of beer but she denies illegal drug use. Emily states her LMP was 10/30/2020.She does not use any contraceptive method and is sexually active with her husband John for 6 years. Pt reported not being able to exercise lately due to her work and has been eating junk foods at work, she wears seatbelts when in the car. She has been so bloated this past couple of weeks, denies having fever but she lost consciousness (syncope) 1 episode since morning.
Emily’s vital signs are taken and were temperature 99.4 pulse 106, RR 20/min, BP is 96/54 on right arm supine position, height 5’2” and weight 190 lbs. and her BMI is 34.7
· HEENT: WNL except some anterior cervical adenopathy bilaterally, and throat appears reddened.
· Lung: clear to auscultation
· CV: regular sinus rhythms without murmur or gallop
· Abd: distension +, tenderness over right suprapubic area.
· Breasts: fibrocystic changes bilaterally, no masses, dimpling, redness or discharge, no adenopathy, and bilateral nipple piercings.
· VVBSU: Light vaginal bleeding per vagina, UPT+
· Cervix: Cervical rocking ++
· Uterus: Uterus bulky
· USG Findings: Non-intra-uterine gestational sac, free fluid in the abdomen noted.
· Adnexa: bilateral adnexal tenderness
· Perineum: wnl
· Rectum: wnl
· Extremities: full rom, skin clear, no edema, reflexes 1+.
· Neurological: CN II-12 grossly intact.
Discussion: Case Study: Common Gynecologic Conditions, Part 2
For this Case Study Discussion, you will propose a case study to your Instructor that demonstrates a gynecological disease process from your practicum experience or your professional practice that would be quite challenging for you as a clinician(Please refer to the following case study above). Once your instructor approves your case study, you will then explore this case study to determine the diagnosis