Education about how the virus can be transmitted to others was given, including that the virus can shed for as long as 3 weeks after lesions erupt.
Dear writer, I need a clinical discussion done on FNP obstetrics and gynecology class clinical rotation I am doing shadowing a Gynecologist. Please, pick a family planning case and expand on it. I will attach the class book please use it as a reference. In addition, i will attach a sample of a fellow classmates’ clinical rotation discussion done so you can guide yourself as well if need be. Any questions Classamets clinical discussion for sample/ guidance:One challenge I encountered this week was discussing sensitive health issues with a 25 year old female. It can be difficult to find a balance between being sympathetic to a patient’s condition and providing education when a patient is very upset over a diagnosis. This young woman had been into the office previously for an eruption of painful vesicles on her perineum. She had a low grade fever of 100.1 F and reported feeling fatigued. She reported that she had been sexually active with a new partner in the last two weeks and did not use a condom, because she has the Mirena. Differential diagnoses include HSV-2, HSV-1, syphilis, chancroid, and granuloma inguinale (Bechmann et al., 2014, p. 271). A PCR was done for HSV and came back positive for herpes simplex virus-2. Additional sexually transmitted infection (STI) testing was done and all the results were negative, including HIV. When the patient had her follow up visit to discuss the result she refused to believe the test and wanted another test done. She privately paid for a western blot test.On this visit the patient was tearful and said her western blot test had also come back positive. She stated that she was in shock and had so many questions. She reported that the lesions and pain had resolved a few days before this visit. Her temperature on this visit was 97.6 F. Upon physical exam there were no lesions present.Education was provided that HSV-2 is the leading cause of genital infections and although there is currently no cure, it can be managed. We told her that many patients are asymptomatic. We also told the patient that the initial infection is usually the most severe. Education about how the virus can be transmitted to others was given, including that the virus can shed for as long as 3 weeks after lesions erupt. The patient was educated about signs of atypical presentations, such as itching (Bechmann et al., 2014, p. 271).Information about treatment options were provided. This included that antivirals such as acyclovir may be given for recurrent episodes, and if recurrences are frequent then the patient may need to be put on suppressive therapy. The patient wanted to know if a partner can still perform oral sex on her. I was not sure of how to answer the question, but my preceptor told her that it would not generally be advised since she can transmit the virus when lesions are not present. My preceptor did inform her that if she is in a committed relationship and the partner is willing to accept the risk it may be a good idea to be put on suppressive therapy to decrease the risk of transmission to her partner. We educated her about informing any new partners and using condoms to prevent transmission (Groves, 2016).This patient was also educated to notify her provider is she may be pregnant and that prophylaxis with acyclovir can be used to decrease the risk of transmission of HSV-2 to the baby (Groves, 2016). Written information was also provided about HSV-2. It can be especially difficult to provide education about sensitive health information as a student. Thankfully my preceptor was there to help me to cover all areas of education necessary and navigate this challenging situation. This experience allowed me to become more confident providing education on this subject, which will be helpful in my future practice. ReferencesBechmann, C.R., Ling, W. F., Herbert, N. W., Laube, W. D., Smith, P. R., Casanova, R., & Weiss, M.P. (2014). Obstetrics and gynecology (7th ed.). Philadelphia, PA: Lippincott, Williams, & Wilkins.Groves, M. J. (2016). Genital herpes: A review. American Family Physician, 93(11), 928-934. Retrieved from https://www.aafp.org/afp/2016/0601/p928.html
