Kayla’s Case Study: Nausea and Lower Abdominal Pain Overview: Three months after the children’s abdominal illnesses, Kayla, still 26 years old, has come to see you today for complaints of nausea and lower abdominal pain. She has not had a well-woman exam since the birth of her youngest child. The nausea and intermittent abdominal pain have been intermittent for about 2 weeks.

Kayla’s Case Study: Nausea and Lower Abdominal Pain

HPI: There is abdominal pain to the lower quadrants intermittent for 2 weeks. She has not had a fever, diarrhea, dysuria, rash, headache, blurred vision, and no other household members are ill. She is not taking any current medications. She has been able to eat and drink with some limitations. She has vomited on two occasions, once each week of the abdominal pain. Her LNMP was 3 months ago, and she has a history of irregular periods and PCOS, so this pattern is not unusual. She reports she is not currently sexually active and has only been sexually active with her husband whom she is separated from. Her last timing of sexual intercourse was 14 weeks ago, with her estranged husband after an emotional meeting of custody of their children.

 

Kayla’s Case Study: Nausea and Lower Abdominal Pain

 

She also has had trouble sleeping and reports continuing anxiety over her living situation and the inability to adequately provide for her family financially.

PMH: G – 3, T-1, P-1, A-1, L-2; cesarean section X 2; no trauma history; 10 year 1PPD smoker, smoking cessation 2 years ago; gestational diabetes with last pregnancy; history of PCOS.

Social History: She continues to live with her parents and is working part time at the children’s school library. She reports her divorce will be final in a matter of a few weeks.

Vital Signs: Weight: 74.5 kilograms, B/P:128/68, T: 98.7, HR: 92, Resp: 16, reg, non-labored, SpO2: 99%

General: Awake, alert, appropriate; well groomed; tearful at times throughout the exam; skin: warm, dry, intact; HEENT: head normocephalic; Conjunctiva clear, non-icteric, PERRLA, EOM’s intact; tympanic membranes intact, unremarkable; nares patent, unremarkable bil; pharynx unremarkable tonsils 2/4 bil; neck supple w/o lymphadenopathy.

Kayla’s Case Study: Nausea and Lower Abdominal Pain

CARDIOPULMONARY: Heart RRR w/o murmur; lungs CTA throughout; respirations even and unlabored; abdomen, soft, with normoactive bowel sounds throughout; tenderness to palpation in the super-pubic area; no masses or organomegally; peripheral pulses reg., equal; pelvic exam reveals pink vaginal mucosa with a moderate whitish-clear discharge; she is exceedingly tender to palpation and her uterus is enlarged to about the size of a softball.

Urinalysis in the office: Cloudy amber yellow urine, specific gravity 1.010, positive WBCs, nitrites, and leukoesterase; negative for RBCs, glucose, and ketones.

UA Lab Results

Chlamydia and Gonorrhea vaginal cultures sent.

STD Lab Results

Urine Pregnancy Test—Positive

Discussion Questions Part Two:

What is the primary diagnosis for Kayla, with rationale?

What is the differential diagnosis with rationale and support from evidence?

If she were pregnant, she may have some concerns. Education throughout pregnancy is critical. Please choose one common symptom, complaint, question, or concern that a mother might have and briefly review it here. Some examples might be topics such as cord blood banking, Pica, heartburn, varicosities, ptyalism, leucorrhea, exercise, weight gain, and so forth. Please do not choose the same topic as any other classmate, so be sure to go in and read other’s posts. Cite all sources of information. List the following.

Topic

Definition

Specific educational points

Please list a primary diagnosis and at least 2 other differential diagnoses with rationale with support from evidence based articles that are dated no earlier than 2011, preferably the most recent. In addition, I need a complete reference guide. Please write a summary of one of the complications listed above: cord blood banking, Pica, heartburn, varicosities, ptyalism, leucorrhea, exercise, weight gain.