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Women Health Module 7 Clinical discussion

Coming to the end of this clinical rotation was very exciting for all the students. Students have been allowed to do primary work in this rotation with possibly remote supervision by the preceptor. This is considered a success by itself since students have been allowed to care for their patients from A to Z and chart their findings and put their names in the chart as APRN students.

An interesting case this week is a 37-year-old Caucasian female who presents with pain under the breast, tender to the touch. Symptoms started yesterday, with a generalized rash to the abdomen that is “itchy.” Her pain is exacerbated with lying on the left side and raising her arm on the same side for the last five days. The patient admitted to testing positive for COVID on 9/7/21. She also received “monoclonal” antibodies on 9/8/21. The patient has only taken Tylenol with some relief two days ago. LMP: 9/5/2021.It is very important to ask about the last menstrual period since pregnancy can manifest with mastitis. Also, mastitis can be caused by cysts, abscesses, and cancer (Schuiling & Likis, 2022, p.340). The patient has no significant past medical history. Family history is relevant for diabetes in the patient’s mother’s history and hypertension in the patient’s father’s history. The patient is a former smoker, but she denied any alcohol or illicit drug use. She is up to date with her immunizations and her mammogram and pap smear were done in 2021 with normal results. ROS: General: No weight change, generally healthy, no change in strength or exercise tolerance. Head: No headaches, no vertigo, no injury. Eyes: Normal vision, no diplopia, no tearing, no scotomata, no pain. Ears: No change in hearing, no tinnitus, no bleeding, no vertigo. Nose: No epistaxis, no coryza, no obstruction, no discharge. Mouth: No dental difficulties, no gingival bleeding. Neck: No stiffness, no pain, no tenderness, no noted masses. Chest: No dyspnea, no wheezing, no hemoptysis. Heart: No chest pains, no palpitations, no syncope, no orthopnea. Abdomen: No change in appetite, no dysphagia, no abdominal pains, no bowel habit changes, no emesis, no melena. GU: No urinary urgency, no dysuria, no change in nature of urine. Musculoskeletal: No pain in muscles or joints, no limitation of range of motion, no paresthesia or numbness. Neurologic: No weakness, no tremor, no seizures, no changes in mentation, no ataxia. Psychiatric: No depressive symptoms, no changes in sleep habits, no changes in thought content. Denies fever, chills, nausea, vomiting, foreign travel. Not exposed to similar sick contacts. Vitals are within normal limits including blood pressure 122/82, temperature 98 degrees Fahrenheit, the pulse is 92 beats per minute, respiratory rate is 18 breaths per minute, and oxygen saturation is 98 %. Objective physical assessment is normal except for the skin which shows raised round erythematous areas covering the abdomen only with no vesicles found. The assessment was done in the office to test again for the COVID PCR test, not the rapid test and a specimen was collected in the clinic and sent to the lab. The plan was discussed, and the patient will have to have a STAT chest X-ray done in Tower Radiology. Also, CBC was drawn and tolerated well for CBC with differential, CMP, lipid panel, A1c, and EBV titers. The PCR covid test was sent to the lab as well. The patient was given education on COVID-19 CDC quarantine including isolation rules, hygiene rules, rest, OTC medications for comfort, as well as an education to follow up with PCP and to go to the ER if there are worsening of symptoms. Differential diagnosis of this case includes COVID complications including rash, EBV infection, and fungal infection. Although EBV usually manifests also with fever, sore throat, and neck lymphadenopathy, it can also manifest with rash (Dlugasch & Story, 2021, p.414).

I believe I learned a lot during this rotation not just clinically but also how to choose appropriate ICD-10, CPT codes, and appropriate billing for different insurances as well. The clinical place prepares us not only to be good clinicians but also teaches us the administrative part of the healthcare business.

References

Dlugasch, L., & Story, L. (2021). Applied pathophysiology for the advanced practice nurse. Jones & Bartlett Learning.

Schuiling, K. D., Likis, F. E. (2022). Gynecologic Health Care with an Introduction to Prenatal and Postpartum Care (4th Ed). Jones & Bartlett Learning, Burlington, MA. ISBN: 9781284182347