Bacterial Vaginitis History

The patient named; Diana Vet is a 26 years old single woman who had been presented to the professional care center with chief complaints of smelly and yellow colored vaginal discharge and minimal amounts of dysuria for a period of one week. However, the patient was physically fit and could not be diagnosed from the first view of her condition.

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She had been historically been associated with two sex partners for a period of more than six months in which case she did not use condoms with any of the partners or even oral birth control contraceptives.

Diana denied having experienced any time of vulvar itching, fever or even pelvic pains.

However, she reported no incidences of sexually transmitted infections in history except a single instance of trichomoniasis that had attacked her once, a year ago.

Concerning past check up, she made one check up only in about one year ago.

Manual Exam:

There were various aspects that the physician detected in order to evaluate the regarded form of treatment.

Important symptoms included blood pressure value at 112/78 and a pulse rate of 72, respiration 15 and body temperature level of 37.30c.

Ordinary external genitalia accompanied by minor excoriations adjacent to the introitus in isolation.

She was cooperative, characterized with good memory of her own life experiences.

Did not experience any flank pain in the thumping.

Bimanual test was ordinary devoid of adnexal tenderness or uterine.

The tests on breasts, chests and musculoskeletal segments were done within normal limits.

Health Promotion or prevention recommendations

Bacteria Vaginitis is a condition of inflammation of the vagina. More often however, the infections do not result into contraction of other health challenges. Nonetheless, when BV remains untreated for long periods of time, it creates significant risk of contracting other health complications such as sexually transmitted infections like Chlamydia and HIV. It may also result into the inflammation of the pelvic as the BV bacteria infects an individuals fallopian tubes or the uterus (Joesoef & Ryan, et al. 2001). The latter condition can result into infertility in the long-run. Any detection of probable invasion of BV infections must be faced with immediate diagnosis from the hospitals or specialized medical centers at the disposal of the victims.

For healthy victims, it is important that one avoid any form of contamination that would lead to contraction of the bacterial infections. For instance, individuals must protect their vagina as far as its ordinary bacterial balance within it is concerned. To achieve the latter, individuals must avoid douching, practicing unsafe sex and instead use condoms during sexual intercourse, mitigate the number of sex partners that on falls intimate with and wash their genitals section on a daily basis with small traces of soap and water. Besides, an individual may also ensure that they have sex with only one partner who must also be primarily screened for BV (Koumans & Markowitz, et al. 2007). These measures would assist immensely in resolving the problem of arbitrary transmission of the bacteria from one individual to another as well as reducing avenues for development of the problem by engaging in hygienic lifestyle characterized by full time cleanliness.

BV anatomy, epidemiology, physiology and pathological aspects essential for treatment

Vaginal discharge as witnessed in the case above comprises of grayish or yellowish thong and homogenous matter. The discharge is also adherent to vaginal mucosa which may be visualized pooling off the discharge within the posterior fornix as a result of adherence to the vaginal mucosa. The discharge fluid may also comprise of minor bubbles. Increased minute reflex along the vaginal walls may also be characteristic element that is wet in nature. Nonetheless, as the patients in the case demonstrate, there is no critical evidence of inflammation. Certain section such as cervix, introitus and cervical discharges does not appear changed in any way.

Standards of Care and diagnostic studies;

Evidence generated on cervicitis ought to prompt work up for the concomitant infections of Neisseria gonorrhea among other diagnostic constituents. Inquiries into the patients condition should infer on risk factors which might predispose patients in developing BV. Such risk factors include reduced secretion of estrogen on the host and wearing of intrauterine device (IUD) as well as sexual activities that may raise chances of infections. The patients ought to be diagnosing with Candidiasis, Gonorrhea, Cervicitis and Vaginitis as other elementary forms of infections that may share some of the ideal traits manifested in the case. These are also ideal features for patients presenting unusual clinical traits of the bacterial vaginitis. Subsequently, the physician must understand the possibility of coinfections which may include trichomoniasis, candidiasis or other alternative forms of diagnosis.

Literature Review:

Various laboratories studies have been prescribed to this problem of BV which depends immensely on history, examination of the vagina and other microscopic examinations that intend to describe the happenings of the internal and external segments of the vagina that may dictate inflammations. Merging data have also sought to support the sending of vaginal cultures into recalcitrant cases. One of the main elemental procedures involves the obtaining of historical information regarding the symptoms expressed by the patient as well as the nature of discharge. However, patients may report some of the conditions pertaining to their specific experience which may help modify the modes of treatments administered. For instance, patients may express lack of Dysuria and abdominal pain which may act as clear guides for the physician to resolve the health challenge (Hillier & Eschenbach, 2012).

In vaginal examination, there may be two approaches to the process namely: observation of Typical BV discharge traits and insignificant vulvo-vaginal inflammations. However, there also exist Microscopic examinations of vaginal discharge. This process seeks to demonstrate among other traits, the clue cells within a saline smear which is the most common criterion for the Bacteria Vaginitis. The clue cells are mainly comprised of the Vaginas epithelial cells comprising of bacterial adherence on their surface. The examination of these cells is therefore critical in establishing the components and other important traits of the bacterial vaginitis if at all present (Koumans & Markowitz, et al. 2007).

Similarly, in micro-examination of the vagina, pH is also detected. Any pH level above 4.5 demonstrates an infection of the section detected. PH level may be raised up to about 90 percent on patients associated with BV infections. Similarly, as pointed out earlier, the disease may also entail a correspondent in which a characteristic discharge of thin, grayish and homogenous matter is observed. Similarly, a whiff test may be carried out in the process. In the case of BV infections, the test may show positive correlation of up to 70 percent of the total BV patients. Vaginal discharge among patients of BV infections is also recognized through lack of polymorphonuclear leukocytes (PMNs) which are present in proportions of one for every epithelial cell. However, the diagnosis of BV is often regarded very complicated in incidences of coinfection (Cottrell & Shannahan, et al. 2004). Nonetheless, the state of rise in the numbers of PMNs on every epithelial cell may create a probability of BV infection as the clinician may presuppose.

The bacteria flora may also be subjected to micro-examination to establish changes in the entire bacterial predominance status. Healthy vagina comprises of predominant lactobacilli. The actual flora of BV patients is credited with changing to have dominant coccobacilli which reflect a rise in the development of Gardnerella vaginalis among other forms f anaerobes. Majority of clinicians also use Nugents criteria to determine the quantity or grading the bacteria through the process of Gram stain regarding vaginal traces. In this regard, the Nugents criteria are credited with evaluating three specific bacteria namely: Mobiluncus, Lactobacillus and Bacteroides. In order to review all these findings the clinicians must also understand the vaginal culture which involves the obtaining of frequent vaginal traits or constituents among victims. Studies show that individuals with BV have no utility in their routinely collected vaginal culture since the infection is considered polymicrobial (Sewankambo & Rabe, 2007).In some women, they may also carry G-vaginalis organism which also deters the normalcy of the vaginal culture.

Cost of Treatment Bacterial Vaginitis

The cost of treatment of this condition is relatively high especially for the poor population. In most cases, it is administered through the dosage of Tinidazole which is given in 2-g oral doses. The costs of this administration ranges between $18 and $31 for per g dose which is the ideal form of per dose administration. This is administered for two days which implies 2 g dose is equivalent to a cost between $36 and $62 per day and a total costs range between $72 and $124 for the entire dose in addition to additional costs during the treatment which may entail consultations. Medicaid covers also cater for such patients which may involve pregnant mothers as well. Studies also shows that Medicaid and other insurance coverage patients are given first priority with a preference of 42 percent against those without, who had a preference share of 28 percent (Staras, & Clark, et al. 2014).

Challenges dealing with families and cultures

Some of the eminent challenges involve in this process included critical aspects of culture that enhanced social inclusions concerning privacy. Consequently, some the woman shied off making important disclosures which is perceived as an important lead in understanding the patients history. In addition, some regions defined by geography such as her case, was hardly accessible while the social-economic aspects defined her abilities and sense of visiting clinicians for early detection and probably, administration of treatment. This made the problem to be highly entrenched due to failure to execute early detection.

Moral/Ethical Issues

One of the ultimate moral or ethical issues involved in this case was the move to compel the patients to make important disclosures about her private life. Although this was an important element in understanding the problem and developing important resolves to the challenge, it comprised intrusion into private life of the victim which is morally retrogressive. However, to resolve this problem as defined by the nursing models of standard treatment of patients data, this information was treated with ultimate confidentiality belonging to the patients and the nurse alone.

Self-Evaluation

From the analysis made in the above case, I was able to convince the victim to make important disclosures despite her rigid stance that defined her willingness to make important disclosure. However, I was particularly unable to obtain some of the pertinent data regarding her family and social framework that could lead to important conclusion. I was left to make inferences to her disclosures as she expressed displeasure in some of my inquiries. For instance, it seemed logically inconclusive to ask her about her parents involvement in nurturing her sexual discourse. I believed that parental involvement in dictating or guiding individuals sexual discourse was important in shaping up individuals future sexual behaviors. However, this might not be always true as individuals are subject to making concrete decisions as th...