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Discussion 13 – Adolescent High-Risk Behaviors

Discussion 13 – Adolescent High-Risk Behaviors

Sample Answer 

Discussion 13 – Adolescent High-Risk Behaviors

Pertinent positive and negative information

The positive information gathered from the patient includes the fact that she has only one sexual partner. She also reports that the discharge she has is tan in color and not greenish; this eliminates the possibility of trichomoniasis infection. On the other hand, it is not known whether her boyfriend has other sexual partners. Additionally, the patient has used an over-the-counter medication (Monistat gel) which has proven ineffective. Lastly, her genital area is unusually red, and a tan-colored, foul-smelling, thick discharge is observed.

Additional information needed

I would seek to know whether the patient experiences pain during sexual intercourse and also if she has observed light vaginal spotting or bleeding. I would also have the patient expound on the type of birth control that she is using: is it an IUD or oral/injectable contraceptive, and the duration she has used the birth control. It is important to find out if the patient’s boyfriend has other sexual partners. The patient’s hygiene practices and whether she uses a douche should also be noted.

How to address the findings

Birth control does not often cause vaginal thrush, but some hormonal birth controls are known to cause yeast infections. The absence of vaginal bleeding or spotting, pain during sexual intercourse, and the boyfriend not having multiple sexual partners rules out the possibility of trichomoniasis. The patient will also be requested to stop using douches as they are a known cause of vaginal bacterial infections. The patient needs to find out if her partner has other sexual partners, as having him have multiple partners increases her chances of getting an STI (Jahic et al., 2013; Turovvskiy, Sutyak, & Chikindas, 2011). A pregnancy test will also be done to rule out pregnancy. The patient has coarse hair, which is typical in some pregnant women. Her last menstruation was two weeks prior to the visit (Motosko et al., 2017).

Plan utilizing clinical practice guidelines for bacterial vaginosis

The patient has presented symptoms of bacterial vaginosis (Shipitsyna et al., 2013). The first step is to book an appointment for the patient to see a mental health professional. The patient is reported as mildly depressive. Depression manifests from stress, among other causes. Stress is a known cause and accelerator of vaginal bacterial infections in females (Marrazzo, 2011). The next step is to recommend that the patient use a contraceptive that is not hormone-based such as the IUD, cervical cap, or diaphragm. Treatment will include oral medication such as Metronidazole as well as its topical gel variation, which the patient will insert in the vagina (Donders, 2010)


Donders, G. (2010). Diagnosis and management of bacterial vaginosis and other types of abnormal vaginal bacterial flora: a review. Obstetrical & gynecological survey65(7), 462-473..

Jahic, M., Mulavdic, M., Nurkic, J., Jahic, E., & Nurkic, M. (2013). Clinical characteristics of aerobic vaginitis and its association to vaginal candidiasis, trichomonas vaginitis and bacterial vaginosis. Medical archives67(6), 428. Jahic, M., Mulavdic, M., Nurkic, J., Jahic, E., & Nurkic, M. (2013). Clinical characteristics of aerobic vaginitis and its association to vaginal candidiasis, trichomonas vaginitis and bacterial vaginosis. Medical archives67(6), 428.

Marrazzo, J. M. (2011). Interpreting the epidemiology and natural history of bacterial vaginosis: are we still confused?. Anaerobe17(4), 186-190.

Motosko, C. C., Bieber, A. K., Pomeranz, M. K., Stein, J. A., & Martires, K. J. (2017). Physiologic changes of pregnancy: A review of the literature. International journal of women’s dermatology3(4), 219-224.

Shipitsyna, E., Roos, A., Datcu, R., Hallén, A., Fredlund, H., Jensen, J. S., … & Unemo, M. (2013). Composition of the vaginal microbiota in women of reproductive age–sensitive and specific molecular diagnosis of bacterial vaginosis is possible?. PloS one8(4).

Turovskiy, Y., Sutyak Noll, K., & Chikindas, M. L. (2011). The aetiology of bacterial vaginosis. Journal of applied microbiology110(5), 1105-1128.


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Discussion 13 – Adolescent High-Risk Behaviors

Discussion Prompt (250-300 words):

  • Evaluate the subjective and objective information provided to you in the file below.
  • First, identify all pertinent positive and negative information.
  • What other questions may you want to ask the patient? 
  • How will you address these findings?
  • Next, create a plan utilizing clinical practice guidelines for the priority diagnosis.  
  • Include APA in-text 2 scholarly citations and provide full reference citation at the end of the discussion.

    Discussion 13 – Adolescent High-Risk Behaviors

    Discussion 13 – Adolescent High-Risk Behaviors


NU 632 Unit 13 Discussion Case

C.C. Vaginal discharge 

HPI: 17 y.o. F presented to clinic by herself reporting “almost fish-like smelling discharge from my vagina that started about a week ago.”She usually notices it after intercourse. She describes the discharge as thick, tan, foul-smelling, slimy discharge. She also complains that she would sometimes have pain and burning on urination. She tried to use Monistat gel with no relief with her symptoms. She reports having only 1 sexual partner, boyfriend. They do not use condoms since she is on birth control.  Denies abd pain, fever or chills.  This has never happened before.

PMH: Diagnosed with asthma during early childhood, resolved, and currently not taking any medications for it. Medications: Minestrin 28-day pack Immunizations: Up to date with childhood immunizations.  Influenza vaccine (October 2019). ALLERGIES: NKDA Family History: Father with GERD and hypertension. Mother with no significant past medical history. Has an older brother and younger sister with no significant past medical history. No family history of cancer. Social History: Patient is a senior in high school. She lives with her family. Has a boyfriend and in a monogamous relationship. Does not use condom, uses oral contraception. Admits to smoking cigarette but does not use recreational drugs or alcohol. HEALTH CARE MAINTENANCE: No hx of Pap Smear.  Denies performing regular self-breast exam Menarche: 13 y.o. Last menstrual period two weeks ago, regular periods REVIEW OF SYSTEMS: GENERAL/CONSTITUTIONAL: Patient denies any mood changes, change in appetite, weight loss/ gain, fatigue, or fever. SKIN: Denies any skin rashes, lesions, ulcerations, or abnormalities .HEENT: Denies headaches, change in hearing, ear pain or ringing in the ears. Denies nasal congestion, bleeding, drainage or change in sense of smell. Denies sore throat, dysphagia. BREAST: Denies breast tenderness, mass, or lesion. Denies nipple abnormality or discharge. CARDIOVASCULAR: No prior history of any cardiac problem. Denies chest pain, irregular pulse or the feeling of the heart racing or missing beats. PULMONARY: History of asthma, resolved. Denies SOB or pain with inspiration/ expiration. GENITOURINARY: Denies vaginal itching. Denies history of pregnancy or STD. Complains of foul-smelling vaginal discharge and pain with urination for 1 week. GASTROINTESTINAL: Denies nausea, vomiting, hematemesis, abdominal pain, change in bowel habits, or heartburn. MUSCULOSKELETAL: Denies muscle pain, arm or leg weakness, joint swelling or arthritis. PSYCHIATRIC: Mild depression. NEUROLOGICAL: No Denies syncope, seizures, disorientation, anxiety, inability to concentrate, or difficulty with balance.

Vital Signs: T 98.1BP 121/82 HR 64 RR 12

Height 5’9” Weight 124lbs. BMP 18.31PHYSICAL EXAM: APPEARANCE: Pt is a pleasant 17 y.o. female who is awake and oriented. Well-groomed and dressed appropriately. SKIN: Skin warm, dry, and intact. No lesions or rash, petechiae, or ecchymoses noted. HEENT: Head-Normocephalic, hair of coarse texture, no thinning or balding noted. Scalp without lesions or flaking skin. Eyes-Sclera clear, conjunctiva pink. Visual fields are intact. Ears-without pain or tenderness. Nose-Symmetric, no discharge noted. Throat-Oral mucosa pink, detention intact with no notable missing teeth or gum irritation. No exudate. NECK: Trachea at midline. No lymphadenopathy or thyromegaly. BREAST: Symmetric, non-tender, without mass. No swelling, ulceration, or discharge noted.CV: PMI at 5th intercostal space. S1 and S2 present. No murmur, thrills, or lifts. Regular rate and rhythm. Extremities warm, dry, and well perfused. PULM: A/P diameter WNL. Normal chest excursion. Breath sounds are clear to auscultation. No use of accessory muscles or increased respiratory effort noted.GI: Soft, Non-tender, non-distended with active bowel sounds.GU/ PELVIC: Urethral meatus normal without discharge or irritation. External genitalia: no lesions noted, vaginal walls pink, pubic hair, scant, shaven. Vagina: Mucosa moist and slightly reddened. Small amount of thick, tan, odorous discharge noted. Cervix: pink, w/o lesion or mass. Bimanual exam: lower pelvic tenderness, no palpable uterine or ovarian enlargement. Anus: No hemorrhoids or fissure noted. MUSCULOSKELETAL: Extremities without clubbing, cyanosis, or edema. No scoliosis or kyphosis. ROM WNL.NEURO: Alert and oriented x3. Gait normal.

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