The Assignment (1- to 2-page case study analysis)
In your Case Study Analysis related to the scenario provided, explain the following as it applies to the scenario you were provided. You do not need to complete the items that are marked out. Students will receive full credit for those items that are marked out.
- The factors that affect fertility (STDs).
- Why inflammatory markers rise in STD/PID.
- You do not need to complete the followings, as these do not apply to the case:
Why prostatitis and infection happens. Also explain the causes of systemic reaction. Why a patient would need a splenectomy after a diagnosis of ITP. Anemia and the different kinds of anemia (i.e., micro and macrocytic).
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The sample paper provided at the Walden Writing Center provides an example of those required elements (available at to an external site.). All papers submitted must use this formatting.
Scenario: A 32-year-old female presents to the ED with a chief complaint of fever, chills, nausea, vomiting, and vaginal discharge. She states these symptoms started about 3 days ago, but she thought she had the flu. She has begun to have LLQ pain and notes bilateral lower back pain. She denies dysuria, foul-smelling urine, or frequency. States she is married and has sexual intercourse with her husband. PMH negative.
Labs: CBC-WBC 18, Hgb 16, Hct 44, Plat 325, Neuts & Lymphs, sed rate 46 mm/hr, C-reactive protein 67 mg/L CMP wnl
Vital signs T 103.2 F Pulse 120 Resp 22 and PaO2
99% on room air. Cardio-respiratory exam WNL with the exception of tachycardia but no murmurs, rubs, clicks, or gallops. Abdominal exam + for LLQ pain on deep palpation but no rebound or rigidity. Pelvic exam demonstrates copious foul-smelling green drainage with reddened cervix and + bilateral adenexal tenderness. + chandelier sign. Wet prep in ER + clue cells and gram stain in ER + gram negative diplococci.
Expert Solution Preview
In this case study analysis, we will explore the factors that affect fertility (STDs) in the given scenario and explain why inflammatory markers rise in STD/PID. We will not address the topics of prostatitis and infection, causes of systemic reaction, splenectomy after ITP diagnosis, anemia, and different types of anemia, as they are not relevant to this case.
Factors that affect fertility (STDs):
Sexually transmitted diseases (STDs) can have a significant impact on fertility. In the given scenario, the 32-year-old female presents with symptoms that are concerning for an STD. STDs can affect fertility through various mechanisms:
1. Pelvic Inflammatory Disease (PID): Untreated or inadequately treated STDs, particularly infections caused by bacteria such as Neisseria gonorrhoeae or Chlamydia trachomatis, can ascend into the upper reproductive tract, leading to PID. PID causes inflammation and scarring of the fallopian tubes, increasing the risk of tubal damage and blockage. This can prevent the egg from reaching the uterus or the sperm from reaching the egg, leading to infertility.
2. Ectopic Pregnancy: If the fallopian tubes are damaged or blocked due to STD-related inflammation or scarring, it increases the risk of ectopic pregnancy. In an ectopic pregnancy, the fertilized egg implants outside the uterus, usually in the fallopian tube. This can be life-threatening and may result in the loss of the fallopian tube, further impacting fertility.
3. Adhesions and Pelvic Adhesion Disease: Chronic inflammation caused by untreated STDs can lead to the formation of adhesions or scar tissue within the pelvis. These adhesions can cause organs to adhere to one another, leading to pelvic adhesion disease. Adhesions and pelvic adhesion disease can cause infertility by blocking the fallopian tubes or distorting the normal anatomy of the reproductive organs.
4. Infectious Impact on Sperm and Egg: Some STDs can directly affect the quality and health of sperm or eggs. For example, certain STDs may cause DNA damage in sperm, decreasing their fertilization potential. Similarly, STDs can affect the health and functionality of eggs, impacting successful fertilization and implantation.
Why inflammatory markers rise in STD/PID:
Inflammatory markers, such as sed rate and C-reactive protein, rise in cases of STDs and pelvic inflammatory disease (PID) due to the body’s immune response to infection and inflammation. In the given scenario, the patient presents with symptoms suggestive of an STD/PID, including fever, chills, nausea, vomiting, vaginal discharge, and lower abdominal pain.
During an infection, the body’s immune system recognizes the presence of pathogens and activates an inflammatory response. This response involves the release of pro-inflammatory chemicals and cytokines, which help to fight off the infection. As a result, the inflammatory markers in the blood, such as the sed rate and C-reactive protein, increase.
In the case of STDs/PID, the inflammatory markers rise due to the infection and inflammation in the reproductive organs, particularly in the fallopian tubes and pelvis. The presence of bacteria, such as Neisseria gonorrhoeae or Chlamydia trachomatis, triggers an immune response, leading to the release of inflammatory markers. The rise in these markers serves as an indication of ongoing infection and inflammation in the reproductive tract.
In conclusion, STDs can significantly affect fertility through mechanisms such as PID, ectopic pregnancy, adhesions, and the impact on sperm and egg health. Inflammatory markers rise in cases of STDs/PID due to the immune response and inflammation caused by the infection. It is important to diagnose and treat STDs promptly to prevent long-term complications and preserve fertility.