Case study: J.R. is a 36-year-old white, middle-class woman who has been sexually active with one partner for the past 2 years. She and her partner have no history of STIs, but her partner has a history of fever blisters. She reports genital pain, genital vesicles and ulcers, and fever and malaise for the last 3 days. Examination reveals adenopathy and vaginal and cervical lesions.
1. What drug therapy would you prescribe? Why?
2. What are the parameters for monitoring the success of the therapy?
3. Discuss specific education for J.R. based on the diagnosis and prescribed therapy.
SOLUTION TO CASE STUDY
- What drug therapy would you prescribe? Why?
Based on the signs and symptoms observed, Ms. J.R could be having genital herpes. Most individuals affected with this disease present with herpes lesions typically as one or more vesicles, or small blisters around the genital area (Centers for Disease Control and Prevention (CDC), 2021). After some time, the vesicles break leaving a painful ulcer that may take several days or weeks to heal. The use of antiviral drugs could prove to be an important way of handling the patient’s problem. According to the CDC, antiviral medication offers clinical benefits to symptomatic patients with the treatment goal being to treat the infection and prevent recurrence. I will prescribe drugs like acyclovir or famciclovir to help suppress the virus and use pain medication like acetaminophen. I will prescribe acycolvir 400 mg orally three times a day for 7 to 10 days or famciclovir 250 mg orally tds for 7 to 10 days as recommended (CDC, 2021).
- What are the parameters for monitoring the success of the therapy?
For a nurse to monitor the success of the treatment that has been administered to the patient, it could be important to check on the size of the lesions and also the lymph nodes. The body’s immune response is another important factor to consider when observing the effectiveness of the treatment. Many medically approved methods can be used to observe the size of lymph nodes, including ultrasonography, computerized abdominal tomography, gallium scanning, and lymphangiography, among others (Sanchez et al., 2022). If the size of the nodes is reduced during the treatment, then the therapy is working well, and no need for alternative medication or therapy in the process. The nurse should also be keen to observe how the size of the spleen changes during the period. A reduction in pain and complete absence of the lesions could mean that the problem has been managed well and the patient is on the path to recovery.
- Discuss specific education for J.R. based on the diagnosis and prescribed therapy.
The patient should be made aware of the severity of the disease and its impact on the immune system. The nurse has to guide her on the need to avoid any form of viral or bacterial infection during her suffering through good hygiene as this could prove to be lethal to her. It is also important for the couple to be aware of their sexual practices to allow the drugs to work effectively without reinfection. For instance, abstaining from sexual activity with uninfected partners when lesions or prodromal symptoms are present is necessary. The patient can monitor the lesions and adenopathy by observing the size of the lesions to know when there is a need to inform the health practitioner if the condition is getting worse or improving.
Drugs to be avoided during the period and should be included in the education plan are malarial medication and Dilantin. These drugs can interfere with the treatment process as they may promote the swelling of the lymph nodes (Haloot et al., 2021). J.R. must also ensure that dosage for the problem is completed because incomplete dosage might make the body immunity to respond differently affecting treatment. According to the CDC, daily suppressive antiviral therapy is necessary for preventing symptomatic recurrent episodes of the disease. Effective use of antivirals can reduce the risk of disease transmission with episodic short therapies available for recurrent episodes.
Centers for Disease Control and Prevention. (2021). Sexually transmitted infections treatment guidelines, 2021: Genital herpes. https://www.cdc.gov/std/treatment-guidelines/herpes.htm
Haloot, J., Estrada, D. A. C., Kendall, G., Ahmed, M., Dodd, K., & Anderson, A. (2021). Tongue tied in al amyloids: Al amyloidosis in a patient presenting with tongue lesions and cervical adenopathy. Journal of the American College of Cardiology, 77(18_Supplement_1), 2185-2185. https://www.jacc.org/doi/abs/10.1016/S0735-1097%2821%2903540-3
Sanchez, E. G., Ramos, C., Ratnarajah, K., Bravo, F. P., Del Solar, M. A., Le, M., & Netchiporouk, E. (2022). Adenopathy and extensive skin patch overlying plasmacytoma syndrome—The clue to early diagnosis of polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes: A case series and literature review. SAGE Open Medical Case Reports, 10, 2050313X221091602. https://doi.org/10.1177/2050313×221091602
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