Why did you choose ectopic pregnancy as the primary dx and not ovarian torsion?
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Attached you will see my discussion where I chose Ectopic Pregnancy as the primary diagnosis.
Important questions to include when interviewing a patient with this issue include:
· Does your pelvic pain turn worse or better getting involved in an activity?
· Any improvement in your pelvic pain since it started?
· How can you describe the kind of pain you are experiencing?
· Have you ever experienced pelvic pain before?
· Does the pain seem to come from another region, if so, where?
· Have you recently visited a clinic; if so, what medications were you prescribed?
· What are the events surrounding the pelvic pain?
· Is your pelvic pain superficial or deep inside?
· How severe is the pain on a scale of 0-10?
· Do you have bleeding between your menses?
· Do you have pain with intercourse?
· How long do your periods last?
· Are your breasts tender?
· Have you been diagnosed with a pelvic inflammatory disease?
· Is there a chance your pregnant now?
· Have you ever been pregnant?
· Has there been any trauma to the pelvis?
· Also, are there any urinary symptoms?
The clinical findings that may be present in a patient with this issue
Clinical results such as missed menstrual cycles, abdominal pain presented with palpation, tachycardia, vaginal discharge, vomiting, and acute pelvic pain would be shown when there is tubal pregnancy (Michigami et al., 2020). According to Schuiling & Likis (2016), abdominal, vaginal discharge, pelvic/LLQ pain, and amenorrhea are typical clinical symptoms for ectopic pregnancy.
Diagnostic studies ed on this patient
A doctor would perform these diagnostic tests based on the recorded client history. They include – plasma human chorionic gonadotropin (HCG), liver function test (LFT), blood type and screen, obstetric ultrasound, progesterone, urinalysis (UA), and complete blood count (CBC) (Schuiling & Likis, 2016). A physician will be able to rule out some differential diagnoses and other complications. For instance, pelvic pain/bleeding from endometriosis, or low H&H from blood loss (Michigami et al., 2020).
The primary diagnosis and three differential diagnoses for this patient
Ectopic pregnancy could be the primary diagnosis because the client said she engaged in unprotected sexual intercourse. Ovarian cyst, spontaneous abortion, and endometriosis are the other three differential diagnoses (Schuiling & Likis, 2016). Ultrasound test results confirmed the presence of ectopic pregnancy. The type of differential diagnosis to perform as determined by the test performed and the client’s present symptoms. The appearance of dyspareunia, irregular menses, and unilateral pelvic pain suggested ovarian cyst (Schuiling & Likis, 2016). Symptoms like dysmenorrhea, irregular vaginal or uterine bleeding, and chronic intermittent pelvic would indicate endometriosis. Lastly, spontaneous abortion presents with pelvic pain, sometimes back pain, and vaginal discharge.
The management plan for this patient, including pharmacologic therapies, tests, patient education, referrals, and follow-ups
My management plan for this client would involve monitoring for signs and symptoms of ectopic mass rupture, maintaining her hemodynamic levels, and determining if the patient requires surgical or medication intervention depending on her condition level. Surgical alternatives available are either salpingectomy or salpingostomy. Salpingectomy is the removal of the oviduct, while salpingostomy creates an opening in the oviduct (Shatkin Hamish et al., 2020). Methotrexate drugs would be prescribed in she does not go for a surgery. According to Shatkin Hamish et al. (2020), medication is advantageous over the surgical method since the patient will terminate her early pregnancy stage using Methotrexate (MTX) dosage to stop cells from dividing and multiplying without undergoing an excruciating pain. After two days, I would follow up with OB/GYN if treated with MTX for repeat bloodwork, ultrasound, and plasma HCG. I will advise the patient to go for ER in case the symptoms worsen.
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