Assignment: NR 602 Wk 7 Chunky Vaginal Discharge Case
H.C: Age 30, Sex: Female, Race: Caucasian, Insurance: yes
CC: “My vagina itches really bad, it burns when I pee, and I am having some white discharge that is chunky.”
“I have noticed my vagina smells really bad after I have sex and I have a weird milk like discharge too.”
“I am having a lot of vaginal discharge that is green, frothy, and it smells bad. Also, my vagina is irritated and sore.”
HPI: 30-year-old female presents with complaints of vaginal itching, burning with urination, and white, chunky discharge that has been going on for 8 days now. She states that it itches so bad that it wakes her up at night and that her vagina is really red from all the scratching. She has tried Monistat OTC, the 3-day treatment option with a topical cream but her symptoms have not improved. She also admits to using a vinegar and water solution that she applies externally to help relieve the itching
30-year-old female presents with complaints of malodorous, milky vaginal discharge that is most noticeable after she has intercourse. She is in a monogamous relationship and her partner is the one who pointed out the smell about 3 days ago. She admits that they do not use condoms. She reports trying a vaginal douche but was not sure if she picked the right one because it did not help her symptoms.
30-year-old female presents with complaints of increased vaginal discharge that is malodorous, green, and frothy that she discovered 4 days ago. She also has complaints of itching, mainly around the labia minora, that started 2 days ago and is now really irritated and she has burning when she urinates as well. She admits that she has a few different sex partners and she is not always diligent when it comes to condom use. She states that she has tried a few OTC options but nothing makes the discharge or irritation go away.
OTC Ibuprofen on occasion when she has menstrual cramps or minor headaches
Vitamin C 1000 mg PO BID
Mild tape allergy
No major illnesses or hospitalizations.
H.C. works as interior designer. She lives alone in a townhouse. She has 1 small dog and 2 cats. She denies cigarette smoking and illicit drug use. She admits to drinking alcohol, mostly on the weekends with her friends but she may have some wine during the week as well. She typically works out 4 to 6 days a week and sleeps maybe 6 hours a night.
Father: Alive, 68; hyperlipidemia
Mother: Alive, 65; HTN, anxiety
Siblings: One brother and two sisters, all in good health
Constitutional: No weight loss, chills, fever, or weakness.
HEENT: Head: Denies any dizziness, head congestion, or head injury. Eyes: Denies visual loss, double vision, and blurred vision. Ears: Denies hearing loss or any ringing in the ears. Nose: Denies any nasal congestion or post-nasal drip. Throat: Denies any sore throat or difficulty swallowing.
Cardiovascular: Denies any chest pain, chest tightness, chest pressure, or chest discomfort. Denies any palpitations and edema.
Respiratory: Denies any shortness of breath, cough, wheezing, or asthma.
Gastrointestinal: Denies back pain. Denies any abdominal pain, nausea, vomiting, diarrhea, constipation, bloody or black stools, heartburn, or indigestion.
Genitourinary: The patient has complaints of extreme vulvar pruritus that is so bad it wakes her up at night, vulvar erythema, dysuria, and white, chunky vaginal discharge. The patient denies any malodorous smell associated with the vaginal discharge. Pt denies any hematuria or urinary frequency or urgency.
The patient has complaints of malodorous, milky vaginal discharge that is most noticeable after she has intercourse. The patient denies any hematuria, dysuria, urinary frequency or urgency.
The patient complains of increased vaginal discharge that is malodorous, green, and frothy. She also has complaints of vaginal itching and irritation, and dysuria. The patient denies any hematuria, urinary frequency or urgency.
Vital Signs: HR: 69 RR: 15 BP: 116/ O2 Sats: 99% Temperature: 97.9 Weight: 138 Height: 5’11” BMI: 19.2
General: The patient is alert, oriented, and cooperative. However, the patient is visibly uncomfortable.
HEENT: Head: : Normocephalic, atraumatic, no masses visualized or palpated. Hair is thick and is evenly distribution throughout scalp. Eyebrows symmetrical. Eyes: Pupils equal, round, reactive to light, red reflexes noted bilaterally. Conjunctiva pink, sclera white. Ears: Tympanic membranes gray and intact with light reflex noted, no redness, tenderness, or bulging noted. Pinna and tragus nontender. Hearing WNL. Nose: Nostrils clear, turbinate’s clear and without narrowing, no redness, swelling, or drainage noted. Throat/Mouth: Oropharynx clear, moist, and pink, uvula noted midline, no redness, edema, lesions, cracks or dryness noted. Teeth in good repair, no cavities noted. No tonsillar hypertrophy.
Neck: Supple. No thyromegaly. No enlarged lymph nodes or masses palpated. No bruit.
Cardiovascular: Normal heart sounds noted on auscultation in all 4 quadrants. Regular rate and rhythm noted. No murmur, rub, or gallop noted.
Respiratory: All lung fields clear on auscultation and percussion. Lung expansion symmetrical, no consolidation noted. No SOB noted upon exertion.
Gastrointestinal: Bowel sounds present in all quadrants. Vascular sounds negative. No swelling or pain noted on palpation. No organ enlargement noted. No CVA tenderness.
Pelvic Exam: A pelvic exam was performed based on symptoms reported by the patient. Erythematous, excoriated vulva that includes the labia minor noted. Vaginal discharge is found to be thick, white, and curdy without odor. The vaginal canal was visualized and noted to be erythematous. Cervix visualized and noted to be pink, midline, smooth without excoriation, parous os. A vaginal culture was obtained.
A pelvic exam was performed based on symptoms reported by the patient. The vulva and labia minora are without erythema. The vaginal canal was visualized, no erythema noted. A malodorous, milky vaginal discharge was noted. Cervix visualized and noted to be pink, midline, smooth without excoriation, parous os. A vaginal culture was obtained.
A pelvic exam was performed based on symptoms reported by the patient. The vulva and labia minor are erythematous but without excoriation. Vaginal discharge is found to be malodorous, green, and frothy. The vaginal canal was visualized, erythema noted. The cervix was visualized, multiple petechiae noted.
Vaginal pH of 4.0
Vaginal secretions visualized under microscope using both wet prep and KOH solution.
Vaginal culture also sent to the lab.
Vaginal pH of 5.0
Vaginal culture obtained. Wet mount performed with clue cells visualized under microscopy.
Whiff test performed.
Vaginal pH of 6.5
Vaginal culture obtained. Polymorphonuclear cells and motile flagellates visualized under microscopy.
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