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1. Case Study Of Pelvic Pain And Bleeding On And Off Paper
Case Study Of Pelvic Pain And Bleeding On And Off PaperPatient Information:Initials: M.A
Age: 54 Sex: Female Race: African AmericanSUBJECTIVE:Chief Complaint (CC): “Pelvic pain,
bleeding on and off”History of Present Illness (HPI): 54-year-old African American, married,
female presents to the clinic today with complaints of right sided pelvic pain and bleeding
that is on and off. She reports that it began three months ago and she describes the pain as
stabbing pain which can be debilitating. She reports experiencing vomiting and nausea. Case
Study Of Pelvic Pain And Bleeding On And Off PaperOnset: 3 months agoLocation: pelvic
region - vaginaDuration: 3 monthsCharacteristics: inconsistent bleeding, stabbing
painAggravating Factors: NoneRelieving Factors: Ibuprofen 600mg and heating padORDER
A PLAGIARISM-FREE PAPER HERESeverity: 7/10Current Medications:Ibuprofen 600mg
every 4-6 hours as required to relieve painAllergies: Kenalog and TramadolPast Medical
History (PMH): Fibromyalgia, Fibroid Uterus, PCOSPast Surgical History
(PSH): Tonsillectomy and CholecystectomyPersonal/Social History: M. A is married, college
graduate, and working. She lives at her hometown with her husband and one of her
children. She reports intermittent use of alcohol (dinner/ social). Denies, tobacco abuse or
illicit drug abuse.Family History: Mother (deceased): diabetes mellitus, hypertension,
hyperlipidemia; Father (deceased): kidney failure. All siblings are alive and well.OB/GYN
History:Menstrual History:Age at menarche – 14LMP – 2010Menstrual Pattern: 28-day
cycleMenopause:2010Contraception:N/ACervical & Vaginal cytology:Most recent pap -
6/2017History of abnormal pap smear – no historyInfections:No history of STIs, vaginitis or
PIDSexual History:Heterosexual, mutually monogamous relationshipNo history of sexual
assault or abuseReview of Systems:General: No reported weight gain or loss, no reduced
appetite, no fatigue, no chills or fever.Head: Denies headache, migraine, and dizziness. Eyes:
no issues with vision Chest: no SOB, cough or chest pain Heart: No irregular heartbeat, no
palpitation Breast: No breast pain, no inflammation, nipple discharge or
erythema.Gastrointestinal: Reports lower abdominal pain. Reports vomiting and nausea. No
diarrhea or constipation Case Study Of Pelvic Pain And Bleeding On And Off Paper. Urinary:
no history of UTI. No urinary frequency or dysuria.Musculoskeletal: no joint or muscle pain.
Denies pain radiation.Skin: No skin changes like itching, dryness or rashesPsychiatric: No
mental issues; anxiety, depression or mood changes.Neurological: Denies seizures,
weakness or dizziness.Endocrinological: No cold or heat intolerance, no diabetes or thyroid
problem.Immunologic: No immune deficiencies or recurrent infections.Hematologic: No
anemia, cancer, bleeding disorder or blood transfusion.Lymphatics: no history of

2. splenectomy, no cervical lymphadenopathy,Allergies: No rhinitis, eczema, hives or
asthma.OBJECTIVE:Vital Signs: Ht. 5’6” Wt. 196lbs, BMI = 31.5, T-max 88.5, BP 102/64,
pulse 79, respirations 16, o2, saturation 99% on RA.Physical Exam:General: Well-nourished,
well-appearing, clean, femaleHEENT: PERRLA, no rhinorrhea, clear ears, hoarseness in
voice erythema to throat, or cervical lymphadenopathySkin: Intact, no dryness or
rashesRespiratory: Lungs bilateral and clear to auscultation. No rales, wheezing, or rhonchi.
No cough, no sputum productionCardiovascular: regular rate and rhythmGastrointestinal:
Soft, nontender, no changes in bowel movementsGenital/Rectal: normal external genitalia,
pink, no trauma, masses, or lesions. Hair is distributed evenly. Urethra: midline, no
irritation, Vagina: healthy pink mucosa, watery smelly discharge, no gross lesions
noted. Cervix: pink, no lesions, closed OS. No cervical motion tenderness. Uterus: small, no
palpation or tenderness, no masses, freely movable, anteverted, Genitourinary: No
problems notedNeurological: no seizures, or focal deficits. AOx4, moves all extremities
without tremors. Clear speech, appropriate communication.Psychiatric: appropriate,
cooperative, calmMusculoskeletal: normal ROM, no joint pain or muscle
achesLabs/Diagnostic Tests & Results:Pap test – abnormal cells detected in the
cervixTransvaginal US – negative; normal ovaries and uterus (no fibroids)Complete Blood
Count – to be completed as outpatientManual breast exam – negative Case Study Of Pelvic
Pain And Bleeding On And Off PaperASSESSMENT:Primary Diagnosis –Cervical
cancerCervical cancer is cancer type that forms in the cervix cells. Different strains of the
human papillomavirus (HPV), a sexually transmitted infection, lead to most cervical cancer
(Small et al., 2017). Normally, when women are subjected to HPV, the body's immune
system stops the virus from causing damage. Nevertheless, the virus survives for a long time
in a small number of individuals, resulting in a process which causes some cervical cells to
become cancer cells. More advanced cervical cancer indications and manifestations usually
entail on and off vaginal bleeding, pelvic pain, and watery or bloody vaginal discharge that
has a foul smell (Small et al., 2017). As per these manifestations, it is therefore evident that
M.A is suffering from cervical cancer.Differential Diagnosis #1 – EndometriosisRationale:
Endometriosis is the formation of cells such as those that form inside the uterus
(endometrial cells), but beyond the uterus. Endometrial cells are identical cells that are
produced monthly during the feminine process. Endometriosis is widespread in women of
regenerative age, although clinical outcomes differ greatly based on the duration, number
and degree of implants (Brinton, et al., 2016). Endometriosis is projected to impact more
than 1 million people in the United States. Irregular bleeding and pelvic pain are basic signs
of endometriosis. Endometriosis can be integrated into this patient's problems, but a
definitive review cannot be carried out without more suggestive research.ORDER A
PLAGIARISM-FREE PAPER HEREDifferential Diagnosis #2 – Uterine FibroidsUterine
fibroids present as uterine tumors of smooth muscle root. This condition usually leads to
pelvic pain, irregular uterine bleeding, and often intestinal, urinary, and pressure
symptoms. Fibroids are assessed through ultrasonography, pelvic examination, and other
screening (Mutch & Biest, 2019). Uterine fibroids are the most common pelvic tumors
commonly found in approximately 70 percent of women by age 40. It has also been
established that elderly women of age 45 and above are at risk of developing uterine

3. fibrioids. There also exist tiny and asymptomatic fibroids. Around 20 percent of white and
half African American women ultimately experience symptomatic fibroids (Mutch & Biest,
2019). Fibroids are increasingly popular among women with a high BMI. Defensive
elements include tobacco using. Considering M. A's history, there may be a risk, but it
should be ruled out because the findings of the ultrasound are negative Case Study Of Pelvic
Pain And Bleeding On And Off Paper.Differential Diagnosis #3 – Pelvic Inflammatory
Disease (PID)Rationale: PID inflammation and discomfort arises in the pelvic organs,
namely the uterus, the fallopian tubes and the ovary. PID is a generic word for serious,
subacute, sporadic or persistent infection of ovaries, oviducts and neighboring tissues
(Brunham et al., 2017). Many PID diseases are caused by bacteria classified as N.
Gonorrhoeae (GC) and Chlamydia trachomatis can also be infectious or bacterial. PID is
probable, but not likely to accept any single differential result. This patient has no prior
history of PID, no former sexually transmitted diseases (STIs) and no vaginal discharge
modification. PID, as it may be, should be regarded as effective on the grounds that it
induces lower abdominal or pelvic pain every now and then on both sides /
diffuse.PLAN:Laboratory /Diagnostic Tests and Results:Complete the ordered lab work as
outpatient and patient will be notified of results; will follow up in 2 weeks with patient for a
plan of how to handle the condition.Treatment / Management Plan and Follow up
CareCervical cancer is chosen as the key diagnosis because diagnostic, laboratory, and
physical testing eliminated other potential alternative diagnoses, so the treatment /
management strategy for the disease may focus on the patient's wishes or priorities.
Radiation and chemotherapy or a mixture of these two will be used. Radiation therapy is
will be administered directly, by targeting the radiation ray to the impacted region of the
body or internally, by inserting a tube loaded with radioactive substance in patient's vagina,
typically for some minutes. On the other hand, chemotherapy will be given through a vein.
Because the patient has locally advanced cervical cancer, small doses of chemotherapy
should be accompanied with radiation therapy, as chemotherapy can improve radiation
impact. Larger doses of chemotherapy would be suggested to better manage effects of very
advanced cancer Case Study Of Pelvic Pain And Bleeding On And Off
Paper.MedicationMedications will Aid to eliminate or minimize the treatment side effects or
to relieve pelvic pain. Antiemetic, specifically Prochlorperazine 5mg daily by slow IV
injection will be administered to assist in treating vomiting and nausea that may be caused
by radiation or chemotherapy. Corticosteroid (Dexamethasone 4mg daily orally) will also
help to reduce pelvic pain and to relieve bleeding. The patient may experience pain because
of various causes, such as bone pain from cancer that has spread to the patient’s bones or
edema brought by treatment or tumors. Additionally, opioid (morphine every four hours
orally) will be provided to the patient work on the central nervous system to ease
symptoms. This medication can be very powerful but it should be used with extreme care as
it can be psychologically and physically addictive.Patient will be instructed to follow up
every three to six months for re-evaluation of management and treatment therapy, like
opioid resistance re-evaluation, management of weight, and re-evaluation of corticosteroid
and antiemetic management therapy to assess the efficacy of the treatment and make
treatment changes, if any, appropriately. Alternative TherapyThe most appropriate

4. alternative therapy for this patient includes palliative and supportive care. Having this
excruciatingly debilitating disease makes one’s quality of life challenged, and though there
will be treatments, it is important that loved ones or family of a person with cancer should
be around offering support and love. This is the essence of palliative or supportive care.
Although quite challenging, palliative or supportive care focuses on easing the suffering and
improving quality of life of the patient and her family (Kim et al., 2015). With palliative care,
she will be relieved from symptoms common in cancer such as nausea, pain, fatigue,
shortness of breath and others. This kind of therapy will not only treat the illness but also
addresses everything about the patient, thus improving her quality of life Case Study Of
Pelvic Pain And Bleeding On And Off Paper.Health PromotionPatient will be equipped with
age-appropriate educational resources on the risk factors, causes, diagnosis and treatment
of cervical cancer. she will also be advised of the importance of healthier lifestyle
modifications; diet and physical activity; constructive strategies to deal with distress.
Patient will be informed to include regular physical activity as part of everyday life by
practising up to five times per week for a minimum of 30 minutes a day, and also eating
vegetables and fruit; cutting down on high-cholesterol diet and including legumes in the
diet. Continuous assistance will also be made accessible to the client. For any follow-up
appointment, the patient's issues will be heard and resolved. Clarification will be made
about cervical cancer myths. Patient will be educated that the disease can be treated and
therefore should not panic but be cooperative and adhere to medication and therapies
(Musa et al., 2018). Patient will be educated on the possibility of certain health issues
connected with cervical cancers, like decreased immunity. In addition, patients should be
informed regarding the possibility of experiencing depression and anxiety because of the
condition, but focus should be put on the value of seeking mental health assistance. Services
would be given to the individual to support her manage body weight and sustain a
productive life. No referral was made at this particular moment as there was no clearly
defined necessity referral Case Study Of Pelvic Pain And Bleeding On And Off
Paper.Reflection:I am discovering this clinical as being fascinating. I did not figure I would
think about it and I am gradually picking up a superior comprehension of the different
purposes behind various forms of treatment that help in managing cervical cancer. These
treatment options will assist in improving the daily performance of a patient. Without the
utilization of these different treatment options and medication, women with this condition
would not have the option to leave home because of pelvic pain and bleeding. I equally
learned that there is an alternative therapy which is palliative care that aims at restoring
the patient’s quality of life. With palliative care, specialists form a group that may include
doctors, nurses, pharmacists, psychologists, dieticians and, religious people who work
together with the oncology care team in maintaining and managing quality of life the patient
Case Study Of Pelvic Pain And Bleeding On And Off Paper.I would not have done anything
differently because I considered I had performed an thorough patient evaluation in
coordination with my preceptor depending on the patient's health condition, so I
implemented the correct clinical procedure in coordination with my preceptor to reach an
acceptable primary and differential diagnosis and a treatment strategy for the patient's
health problem.I would have liked to collect more information about a patient 's maternal

5. grandmother or great grandmother's medical history to see if there was anyone in the
person's family history who had cervical cancer. This knowledge will help to prove or
disapprove the claim that cervical cancer is often genetic. The patient, however, denied that
her mother or sister had the disease. While the patient told the author and the author's
preceptor that she had little details of her maternal background as a result of the adoption
of her mother. I would not have performed additional test components since this physical,
diagnostic, and laboratory exams were rather comprehensive on the basis of the relevant
professional procedure criteria for the treatment of the disease Case Study Of Pelvic Pain
And Bleeding On And Off Paper.ORDER A PLAGIARISM-FREE PAPER
HEREReferencesBrinton, L. A., Trabert, B., Anderson, G. L., Falk, R. T., Felix, A. S., Fuhrman, B.
J., ... & Strickler, H. D. (2016). Serum estrogens and estrogen metabolites and endometrial
cancer risk among postmenopausal women. Cancer Epidemiology and Prevention
Biomarkers, 25(7), 1081-1089.Brunham, R. C., Gottlieb, S. L., & Paavonen, J. (2015). Pelvic
inflammatory disease. New England Journal of Medicine, 372(21), 2039-2048.Johnson, L. G.,
Armstrong, A., Joyce, C. M., Teitelman, A. M., & Buttenheim, A. M. (2018). Implementation
strategies to improve cervical cancer prevention in sub-Saharan Africa: a systematic review.
Implementation Science, 13(1), 28.Kim, J. J., Burger, E. A., Regan, C., & Sy, S. (2018).
Screening for cervical cancer in primary care: a decision analysis for the US Preventive
Services Task Force. Jama, 320(7), 706-714.Kim, Y. J., Munsell, M. F., Park, J. C., Meyer, L. A.,
Sun, C. C., Brown, A. J., ... & Ramondetta, L. M. (2015). Retrospective review of symptoms and
palliative care interventions in women with advanced cervical cancer. Gynecologic
oncology, 139(3), 553-558.Musa, J., Achenbach, C. J., O’Dwyer, L. C., Evans, C. T., McHugh, M.,
Hou, L., ... & Jordan, N. (2017). Effect of cervical cancer education and provider
recommendation for screening on screening rates: A systematic review and meta-analysis.
PloS one, 12(9), e0183924.Mutch, D. G. & Biest, S. W. (2019). Uterine Fibroids. Merck
Manual. Retrieved fromhttps://www.merckmanuals.com/professional/gynecology-and-
obstetrics/uterine-fibroids/uterine-fibroidsSmall Jr, W., Bacon, M. A., Bajaj, A., Chuang, L. T.,
Fisher, B. J., Harkenrider, M. M., ... & Gaffney, D. K. (2017). Cervical cancer: a global health
crisis. Cancer, 123(13), 2404-2412.Think about the details of the patient’s background,
medical history, physical exam, labs and diagnostics, diagnosis, treatment and management
plan, as well as education strategies and follow-up care. To complete Write an 8- to 10-page
comprehensive assessment that addresses the following: Age, race and ethnicity, and
partner status of the patient Current health status, including chief concern or complaint of
the patient Contraception method (if any) Patient history, including medical history, family
medical history, gynecologic history, obstetric history, and personal social history (as
appropriate to current problem) Review of systems Physical exam Labs, tests, and other
diagnostics Differential diagnoses Management plan, including diagnosis, treatment, patient
education, and follow-up care. Important to address the following: CC Pertinent positives
and negatives in the ROS Pertinent PMH, SH,and FH Allergies Vital Signs Physical Exam
Diagnostic test results Assessment with 3 priority diagnosis Medications new and d/c'd
Alternative therapies if appropriate Diagnostic tests ordered with time frame Referrals or
consultations if appropriate Follow up interval Reflection should include the following:
What did I learn from this experience? Any ah-ha's? What would you do differently? What

6. additional data would you have gathered? What additional elements of the exam would you
have done? Do you agree with your preceptor based on the evidence? Case Study Of Pelvic
Pain And Bleeding On And Off Paper