{"id":2518,"date":"2020-10-30T09:54:14","date_gmt":"2020-10-30T09:54:14","guid":{"rendered":"http:\/\/onlineclassesguru.com\/?p=2518"},"modified":"2020-10-30T09:54:14","modified_gmt":"2020-10-30T09:54:14","slug":"is-the-pain-localized-or-difficult-to-pinpoint","status":"publish","type":"post","link":"https:\/\/onlineclassesguru.com\/index.php\/2020\/10\/30\/is-the-pain-localized-or-difficult-to-pinpoint\/","title":{"rendered":"Is the pain localized or difficult to pinpoint"},"content":{"rendered":"<style type=\"text\/css\"><\/style><div id=\"questionDescription\">\n<div class=\"user-generated-description\">\n<p>Please paraphrase text to be plagiarism free. APA format.<\/p>\n<p><strong>Questions that would be important to include when interviewing patient with this issue<\/strong><\/p>\n<p>Is the pain localized or difficult to pinpoint?<\/p>\n<p>Any you having any other symptoms?<\/p>\n<p>Have you ever had anything like this before?<\/p>\n<p>How many tampons or pads do you use daily?<\/p>\n<p>Are you passing any clots?<\/p>\n<p>When did your abnormal vaginal bleeding start?<\/p>\n<p>What are the events surrounding the start of abnormal bleeding?<\/p>\n<p>Have you inserted any foreign bodies into your vagina?<\/p>\n<p>Does anything make your abnormal vaginal bleeding better or worse?<\/p>\n<p>How quickly did your abnormal vaginal bleeding come on?<\/p>\n<p>Does the abnormal vaginal bleeding come and go?<\/p>\n<p>Is there any pattern to your abnormal bleeding?<\/p>\n<p>Are you sexually active? If so, are you using any kind of protection?<\/p>\n<p>Have you ever had a STD?<\/p>\n<p>Any pain with intercourse?<\/p>\n<p>At what age did you become sexually active?<\/p>\n<p>Any bleeding during or after intercourse?<\/p>\n<p>How regular are your periods?<\/p>\n<p>Any bleeding between your menstrual cycle?<\/p>\n<p>What is the usual length of your period?<\/p>\n<p>When did your last period begin?<\/p>\n<p>Is your period late?<\/p>\n<p>Any possibility you could be pregnant?<\/p>\n<p>What was the age of menarche?<\/p>\n<p>Are you having any vaginal discharge?<\/p>\n<p>When did your pelvic pain start?<\/p>\n<p>What are the events surrounding the start of your pelvic pain?<\/p>\n<p><strong>Describe the clinical findings that may be present in a patient with this issue<\/strong><\/p>\n<p>Symptoms of an unruptured ectopic pregnancy can be vague and sub-acute\u00a0<a name=\"C424994661574074I129368T429449570717593\"><\/a>(Buttaro, Trybulski, Bailey, &amp; Sandburg-Cook, 2013). A woman with an ectopic pregnancy may experience abdominal tenderness with or without rebound tenderness\u00a0<a name=\"C427488678703704I70404T429449524421296\"><\/a>(Domino, Baldor, Golding, &amp; Stephens, 2017). Abdominal pain is the most common symptom and may occur alone or with vaginal bleeding, spotting, dizziness, and shoulder pain\u00a0<a name=\"C424994661574074I129368T429449604629630\"><\/a>(Buttaro et al., 2013). Sudden, acute, localized abdominal pain occurs with fallopian tube rupture\u00a0<a name=\"C427518232060185I70404T429449546180556\"><\/a>(Cash &amp; Glass, 2014). Vaginal bleeding and pelvic pain usually occur soon after the first missed period, while the patient is unaware of pregnancy\u00a0<a name=\"C427518232060185I70404T429449538773148\"><\/a>(Cash &amp; Glass, 2014). It usually occurs between weeks six and twelve weeks of gestation. It can appear generalized, unilateral pelvic or abdominal pain described as sharp, cramping, continuous, or intermittent\u00a0<a name=\"C424994661574074I129368T429449623263889\"><\/a>(Buttaro et al., 2013).<\/p>\n<p><strong>Are there any diagnostic studies that should be ordered in this patient?<\/strong><\/p>\n<p>Pregnancy tests have become increasingly sensitive in recent years and are the first step in the diagnosis of any suspected ectopic pregnancy\u00a0<a name=\"C424994661574074I129368T429449725694444\"><\/a>(Buttaro et al., 2013). Recent evidence suggests that declining hcg levels in spontaneous abortions can be distinguished from those in an ectopic pregnancy\u00a0<a name=\"C424994661574074I129368T429449747569444\"><\/a>(Buttaro et al., 2013). Other initial tests include a CBC, type and cross and Rh determination\u00a0<a name=\"C424994661574074I129368T429449753125000\"><\/a>(Buttaro et al., 2013). Ultrasound can also detect ectopic pregnancy in one third of women with hcg levels of less than 1000. Many clinicians use combined transvaginal sonography with b-hcg levels with the ability to detect earlier and smaller ectopic pregnancies without the risks of surgical procedure\u00a0<a name=\"C424994661574074I129368T429449777430556\"><\/a>(Buttaro et al., 2013).<\/p>\n<p><strong>Three Differential Diagnoses:<\/strong><\/p>\n<p><strong>1) Ovarian cyst-\u00a0<\/strong>A ruptured ovarian cyst usually resolves with the menstrual period beginning but significant tenderness to palpation or an acute abdomen if the peritoneum is irritated or inflamed\u00a0<a name=\"C427488678703704I70404T429449879166667\"><\/a>(Domino et al., 2017).<\/p>\n<p><strong>2) Spontaneous abortion-\u00a0<\/strong>Speculum exam will show blood, and products of conception (which also confirms the diagnosis). Vaginal bleeding is present with abdominal pain, cramping and possible nausea, vomiting, and syncope\u00a0<a name=\"C427488678703704I70404T429449908796296\"><\/a>(Domino et al., 2017). P.F. had these symptoms so we had to rule this out.<\/p>\n<p><strong>3) Ovarian\/adnexal torsion-\u00a0<\/strong>The symptoms can be nonspecific. However, there is usually sudden, unilateral with moderate to severe pelvic pain\u00a0<a name=\"C429450044212963I70404T429450064004630\"><\/a>(Dugal, Chiang, &amp; Sobel, 2016). P.F. had these symptoms, so it was important to rule this out to preserve the ovary.<\/p>\n<p><strong>Primary diagnosis:<\/strong><\/p>\n<p><strong>Ectopic pregnancy:\u00a0<\/strong>Vaginal bleeding with unilateral lower abdominal pain or tenderness are common symptoms of ectopic pregnancy. E. F. had these symptoms so we had to keep this in the top differentials. In cases of rupture, signs of shock such as pallor, tachycardia, and hypotension may be present\u00a0<a name=\"C427488678703704I70404T429450152662037\"><\/a>(Domino et al., 2017). E.F. had abnormal vaginal bleeding but she did not have the usual symptoms of her menstrual period so this was another big clue.<\/p>\n<p><strong>Management Plan:<\/strong><\/p>\n<p><strong>1) Pharmaceutical Therapies:<\/strong>\u00a0Methotrexate or potassium chloride has been used in ultrasound-guided local injections, equally successfully, in unruptured, live ectopic pregnancies\u00a0<a name=\"C424994661574074I129368T429450219791667\"><\/a>(Buttaro et al., 2013). HCG levels should be done on days four and seven after injection and then weekly until it reaches zero. Intravenous fluids or blood transfusion may be needed if not hemodynamically stable.<\/p>\n<p><strong>2) Tests:\u00a0<\/strong>Hcg must be done until a 0 is reached to ensure that there is no need for surgical intervention\u00a0<a name=\"C427488678703704I70404T429450270949074\"><\/a>(Domino et al., 2017). A CBC, LFT, and renal function test, blood type and screen should be done before treating.<\/p>\n<p><strong>3) Pt Education:\u00a0<\/strong>A delay of subsequent pregnancy for at least three months after treatment with methotrexate due to teratogenicity\u00a0<a name=\"C427488678703704I70404T429450314120370\"><\/a>(Domino et al., 2017). During treatment food and vitamins high in folate should be avoided due to interaction with methotrexate efficacy\u00a0<a name=\"C427488678703704I70404T429450320370370\"><\/a>(Domino et al., 2017). Also, adequate hydration should be maintained. Signs and symptoms of ectopic pregnancy should be reviewed and the patient should be taught to plan subsequent pregnancies and seek early medical care on discovery of future pregnancies\u00a0<a name=\"C427488678703704I70404T429450332523148\"><\/a>(Domino et al., 2017).<\/p>\n<p><strong>4) Referrals:\u00a0<\/strong>Must refer to ER of obstetrician or gynecologist for surgical management for laparotomy for rupture, hypotension, anemia, or pain persisting beyond twenty-four hours\u00a0<a name=\"C427488678703704I70404T429450351388889\"><\/a>(Domino et al., 2017). Surgical laparoscopy or laparotomy remains the only treatment choice for ruptured ectopic pregnancy\u00a0<a name=\"C424994661574074I129368T429450363310185\"><\/a>(Buttaro et al., 2013).<\/p>\n<p><strong>5) Follow-Ups:\u00a0<\/strong>A woman should be monitored weekly until hcg is undetectable to ensure there is no need for surgical intervention. Adherence to scheduled follow-up appointments is critical. Liver and renal function tests should be repeated if methotrexate repeat dosing is required\u00a0<a name=\"C427488678703704I70404T429450398263889\"><\/a>(Domino et al., 2017).<\/p>\n<p>&nbsp;<\/p>\n<p>References<\/p>\n<p><a name=\"R424994661574074I129368\"><\/a>Buttaro, T., Trybulski, J., Bailey, P., &amp; Sandburg-Cook, J. (2013).\u00a0<em>Primary care 4th edition<\/em>\u00a0(4th ed.). St. Louis, MO: Mosby Inc.<\/p>\n<p><a name=\"R427518232060185I70404\"><\/a>Cash, J. C., &amp; Glass, C. A. (2014).\u00a0<em>Family practice guidelines<\/em>\u00a0(3rd ed.). New York, NY: Springer.<\/p>\n<p><a name=\"R427488678703704I70404\"><\/a>Domino, F. J., Baldor, R. A., Golding, J., &amp; Stephens, M. B. (2017).\u00a0<em>The 5-minute clinical consult<\/em>. Baltimore, Maryland: Wolters Kluwer.<\/p>\n<p><a name=\"R429450044212963I70404\"><\/a>Dugal, J., Chiang, W., &amp; Sobel, L. (2016). Ovarian torsion.\u00a0<em>The Journal of American Academy of Physicians Assistants<\/em>,\u00a0<em>29<\/em>(12), 57-58. https:\/\/doi.org\/DOI: 10.1097\/01.JAA.0000502871.97211.c2<\/p>\n<p>&nbsp;<\/p>\n<\/div>\n<\/div>\n<div class=\"honor-code-wrapper\"><\/div>\n<p><center><a href=\"http:\/\/onlineclassesguru.com\/orders\/ordernow\"><img decoding=\"async\" src=\"https:\/\/encrypted-tbn0.gstatic.com\/images?q=tbn:ANd9GcTyj99p60XCLyLk1htB7-1neRt8-2QdnenNlQ&usqp=CAU\"target=\"_http:\/\/onlineclassesguru.com\/orders\/ordernow\"\/><\/center><p>","protected":false},"excerpt":{"rendered":"<p>Please paraphrase text to be plagiarism free. APA format. Questions that would be important to include when interviewing patient with this issue Is the pain localized or difficult to pinpoint? Any you having any other symptoms? Have you ever had anything like this before? How many tampons or pads do you use daily? Are you&#8230;<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-2518","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v17.0 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Is the pain localized or difficult to pinpoint - onlineclassesguru<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/onlineclassesguru.com\/index.php\/2020\/10\/30\/is-the-pain-localized-or-difficult-to-pinpoint\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Is the pain localized or difficult to pinpoint - onlineclassesguru\" \/>\n<meta property=\"og:description\" content=\"Please paraphrase text to be plagiarism free. 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