Discussion Board: Pelvic Pain – Peer Response
To write a referral to a specialist, we first need to include our information (name, address, phone, fax, email) and the specialist’s information. Second, the reason for consult/referral, the patient’s biographical data, chief complaint, history of present illness, past medical history, allergies, current medications, family history, social history, vital signs, review of system, and physical examination need to be addressed. Also, we need to include labs and imaging studies, treatment plan, diagnosis, and recommendations. After the patient has been seen and treated by the gynecologist, we are responsible for advising the patient to come back to see us for follow-ups. Since PID can be recurrent, the patient needs to be tested for gonorrhea and chlamydia three to six months after the treatment (Ferri, 2018). Her sexual partner needs to be treated as well to prevent her from being re-infected. Untreated gonorrhea and chlamydia can cause PID; therefore, it is essential for NPs to screen female patients aged less than 25 and those at increased risk for these infections to reduce the incidence of PID (Kreisel, Torrone, Bernstein, Hong, & Gorwitz, 2017). We also need to offer HIV and other STI screenings to all women with PID.
Peer Resp.#2
Endometriosis
Endometriosis is a painful disorder that results from the endometrium growing outside of the uterus. This generally involves the pelvic region, ovaries, fallopian tubes and the pelvic lining. It can affect areas outside of the pelvic region as well. Though the endometrium is displaced, it continues to act as normal by thickening, breaking down and then bleeding during menstruation. Unfortunately, there is no place for this to go and it becomes trapped. Eventually, this causes scarring and adhesion’s which cause pelvic organs to adhere together. All this together causes the pain and can lead to infertility (Mayo Clinic, 2018). I chose this subject because I had endometriosis. It is a horrible disorder and very painful. There were times that it felt like someone was stabbing my insides with a knife. I would ball up into the fetal position and cry until the pain went away. I eventually had to have a hysterectomy at the age of 29. This was horrible because we tried to have another baby, but it left me unable to have anymore. I was so bad that I had bleeding outside of my menstrual cycle and it was in my rectum. Before my surgery, I bleed for more than 2 weeks straight despite medications. He said if I did not have the surgery, I would eventually hemorrhage.
Endometriosis S/S
- Dysmenorrhea
- Chronic Pelvic Pain
- Dyspareunia
- Abdominal Pain
- Menorrhagia
- Backache (during menses)
- Perimenstrual Tenesmus
- Diarrhea
- Constipation
- Dyschezia
- Dysuria
- Hematuria
- Nausea
(Youngkin, Davis, Schadewald & Juve, 2013)
Referral Process
Endometriosis generally does not require a referral. With this being said, women may become infertile with this issue (Johns Hopkins, 2018). If the woman would like to have children and has infertility issues, she can be referred to a fertility specialist. Some women require hysterectomies if the disease is severe (Johns Hopkins, 2018). In some cases, the woman may need to be referred to a physician within the practice that performs this.
Follow-up After Referral
It is known that 17-19% of women with endometriosis have spontaneous resolution of lesions. Many more women have a progression of lesions. This makes up 24-64% of the cases. Others remain stable. This is 9-59% of the cases. Follow-ups will depend on the treatment plans that are decided on. There should be, at the very least, a three-month follow-up to report any new, worsening or resolving symptoms. At the follow-up, side effects of treatment should be discussed as well. This follow-up can be used to discuss further pregnancy options if need be (Youngkin, Davis, Schadewald & Juve, 2013).
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