Question

CASE SCENARIO

Chief Complaint: “I think I am allergic to something.”

Patient’s Profile
Name: Roger
Age: 26
Civil Status: Single
Children: None
Race: African American
Education: High School Graduate
Employment Status: Bartender
Sexual Activity: Active
Sexual Partners: Multiple
Engaged in unprotected sex: Yes

History of Present Illness
Roger is a 26-year-old man consulted to hospital. He states he was in his usual state of health until about 3 days ago when he began developing a rash on his stomach that is now on the palms of his hands and soles of his feet. The rash is not painful or itchy. He states that he had this strange little “ulcer-like” thing on his private part a couple weeks ago but it went away and never really hurt. He is single and sexually active with two to three concurrent male partners. He has had unprotected sex with “at least one of his partners” in the past couple of weeks. He doesn’t know the sexual histories of his current or past sexual partners and admits to over 15 lifetime partners. He
endorses rectal and oral sex. He doesn’t ever recall being tested for HIV, and knows he received all his childhood vaccines, “cause my mom told me.” He has never been vaccinated against HPV stating, “that’s a woman’s disease,” and is unsure if he ever has received a hepatitis A vaccine.

Past Medical History: None
Surgical History: None
Family History:Father had HTN and passed away from a stroke 4 years ago; mother is still living and has type 2 DM
Social History:MSM with multiple sexual partners; (+) EtOH, (–) Tobacco, (+) Marijuana, (–) Illicit drugs
Allergies: NKDA
Home Medications: Ibuprofen 200 mg PO PRN pain (has taken 4 doses in the last day)

Physical Examination
Physical examination revealed a painful ulcerated plaque on the upper lip, a macular rash with three crater-like scarred painless lesions (considered to be healing chancres) on the glans, a nonpruritic hyperkeratotic maculopapular palmar rash and bilateral submandibular lymphadenopathy. No alopecia, neurologic deficits or ocular or cardiovascular abnormalities were noted.

Results of laboratory testing included a positive reactive syphilis immunoglobulin G (IgG) enzyme immunoassay and a positive rapid plasma reagin (RPR) test (titer 1:256). Human immunodeficiency virus (HIV) testing was negative, and serologic testing demonstrated prior immunization to hepatitis B virus. Given the clinical presentation and laboratory findings, secondary syphilis was considered the most probable diagnosis.

The patient was treated with benzathine penicillin G 2.4 million units intramuscularly

1. Develop a Nursing care plan (ADPIRE, Assessment, Diagnosis, Planning-short term and long term goal, Intervention-Rationale, Evaluation) for Mr. Roger according to your identified priority plan of care.

Answer 1

assessment:

1. subjective data:

• rash on the stomach, soles of hands and feet

2. objective data:

• macular lesions with crater like scarred painless lesions on the glans
• rashes on the palm
• ulcerated plaque on the upper lip

diagnosis:

risk of infection transmission related to unprotected sex and multiple sex partners as evidenced by positive blood for syphilis.

planning:

1. short term objectives:

the patient will verbalize abstain from unprotected sex

2. long term objectives:

the patient will engage in sex with all protective precautions

interventions:

• educate the patient regarding abstinenece from until the lesions are healed (rationale: prevents transmission of infection)
• guide the patient in making a list of sexual partners who has to undergo testing for syphilis and other sexually transmitted infections (rationale:helps in detection of std's)
• provide free supply of condoms to the patient and educate on how to use it (rationale: helps in prevention of (rationale:helps in prevention of std's)

evaluation:

patient is able to explain the methods of preventing sexually transmitted diseases and able to abstain from unprotected sex