Response 1: #1 Nancy is a 24-year-old female who is sexually active with multipl

Response 1:
#1 Nancy is a 24-year-old female who is sexually active with multiple partners who presents to the clinic with painful blister-like sores on the vagina, pain when having sex, and a foul-smelling vaginal discharge for the past two weeks. She is diagnosed with genital herpes and chlamydial infection.
My chlamydia treatment plan for Nancy would be to treat the chlamydia with a single dose of Azithromycin or Doxycycline for 7 days. Nancy’s sexual partners should be tested and treated as well. Her most recent partner should be evaluated. It is recommended to expedite partner therapy to decrease reinfection. While she is being treated for the chlamydia along with her sexual partners, they should abstain from sexual intercourse for 7 days after the single-dose therapy or 7 days after the completion of a 7-day regimen. My herpes treatment plan for Nancy and her sexual partners would be to utilize antivirals such as acyclovir, famciclovir, and valacyclovir. These antivirals can be administered episodically or continuously as suppressive therapy (Woo & Robinson, 2020). I would provide Nancy with a renewable prescription so that she can have this handy and be able to self-medicate immediately if her symptoms begin to flare up. If Nancy continues to have more than six outbreaks a year, then I would recommend for her begin suppressive therapy to help reduce the frequency in her attacks. I would rescreen Nancy in 3-month intervals. I would also notify her that it is required by law that laboratories report most STIs to the state, so she would be aware that she may be contacted as well as her partners for verification of treatment. I would also utilize the CDC website to inform and educate myself in knowing which STIs are mandatory to report. I would assist Nancy in getting her sexual partners to come in for treatment by educating her that this STI has a very high rate of reinfection and notifying them for treatment as soon as possible, will decrease the chances of reinfection or spreading of the STI. Having her sexual partners be aware of it sooner and treating the STI sooner would be beneficial to them. As a nurse practitioner it is my obligation to follow my ethical and legal role, to report STDs such as the ones contracted by Nancy, which would be chlamydia according to the CDC would be mandatory (Centers for Disease Control and Prevention 2021). A fascinating article I discovered was in regards to STD reporting during this COVID-19 pandemic. It was noted that STD has actually been on the rise during this time. Results have been reported mainly from individuals sending or mailing in their results on their own. The CDC has reported that STD has been at an all-time high these recent years with prevalence in chlamydia, gonorrhea, and syphilis prior to the pandemic. The researchers found that, among asymptomatic persons with STDs, not having a physical examination did not make any difference. Even though there are limitations, the findings prove that there is a critical need for transformative strategies in STD control. There are many strategies available but are still waiting for broader implementation (Crane et al., 2020).
Response 2:
Discussion Post Reponse to Topic# 3 Maria a 19 y.o. with Latent TB.
Latent Tuberculosis (TB) is diagnosed when an individual has TB in their system but it is not active. An individual with this diagnosis does not present with symptoms and cannot infect others. An individual with Latent TB should be treated at least once in their lifetime after finding that they have latent TB to prevent activation of Latent TB to active TB. Individuals will usually be diagnosed with latent TB if they encounter having a positive tuberculin skin test (induration of 15mm or larger) or a positive TB blood test but a negative assessment outcome of active TB and negative Xray result for TB. There are now a multitude of treatment options for someone who has latent TB. Seraphin et al. (2019) mention that in their analysis of latent TB treatment completion rates, there were high levels of treatment discontinuation. They found that most patients placed on the 9 month treatment of INH stopped taking their medication after 3 months and that patients who were at higher risk of latent TB to active TB progression were more likely to stop treatment. This only leads back to the importance of patient education on why latent TB treatment is crucial for the prevention of active TB. Maria began treatment of isoniazid (INH) once a day 4 months ago but has been off the medication for the last month. With that information, it is important to determine what dose Maria was taking to determine what length of treatment she was in. INH alone, usually deems a 6 to 9 month treatment determinant by the dosage. According to the CDC a 9 month treatment would be the plan of care for Maria if she were taking 5mg/kg/day (CDC, 2018). Due to the fact that she had already completed a 3 month regimen without interruption, restarting INH treatment is not recommended. Recommendation would be to continue the 9 month therapy after conducting lab work to assess for hepatotoxicity and after a thorough assessment to rule out active TB. Education for Maria would also include the importance of adhering to treatment as required to prevent her from acquiring drug resistant active tuberculosis. She should be made aware if she continues to be non-compliant with medication treatment she increases her chances of not only acquiring active TB but of acquiring active TB that is nearly impossible to treat and can be deadly (BREATHE, 2014). It is also important that Maria understands that she comes from a country that has high levels of TB infection and that because of this the likelihood of her latent TB becoming active TB is high if she goes untreated (CDC, 2018). The CDC mentions that all patients taking Latent TB medication should be monitored monthly to assess for adverse reactions to TB medication regimen. Although Maria is young, she should have her liver assessed for enzyme elevation, hepatitis (via symptoms such as nausea, vomiting, abdominal pain, fatigue, brown urine), and damage to sensory nerves of hands and feet (tingling sensation, weakened sense of touch, pain in hands, palms, soles, and feet) (CDC, n.d.). I would also like to mention that it is important for a provider to assess the patient they have in front of them and determine the best mode of treatment. The CDC (2018) mentions that a Shorter, rifamycin-based treatment regimen generally has a lower risk of hepatotoxicity than longer 6 to 9 months of isoniazid monotherapy. Sterling et al. (2020) have also mentioned that aside from being less toxic to the liver, short treatment regimens have a higher completion rate. Woo (2019) mentions that the Black Box Warning for INH includes patients developing severe and at times fatal hepatitis. Risks that can lead to this outcome include age (highest incidents in individuals 50 to 64 years of age), chronic daily consumption of alcohol, IV drug use, Black and Hispanic women, anyone postpartum woman taking INH. As mentioned previously, it is important for patients to be assessed and evaluated throughout their treatment regimen. It is also important to clarify that as long as they stay in the latent phase, they are not contagious, therefore Maria will be assessed for active TB and if she does not have active TB, she will be informed that she is okay to go to school with no precautions but that adherence to her medication is a must. To ensure she sticks to her treatment, follow up appointments will be requested every 4 weeks.