Thursday, July 22, 2010
OCP, Cellulitis and Hernia...Oh My!
34 yo female G2 P2 seen for post-partum visit c/o redness to nipples and questions about OCP. Pt with hx of PCOS, post-partum depression with 1st child, (L) inguinal hernia that developed during pregnancy, and newborn with GERD and milk allergies. She also developed cellulitis to (R) knee from apparent bug bite after delivery. Treated with abx, worsened and required overnight stay in ER to I&D abcess. Given PO Augmentin and receives weekly debridement and dressing changes. Due to baby's milk allergies, transitioning new baby to Neocate formula (Rx) and is pumping to supplement. Noticed cracked, red nipples and was concerned with yeast infection. Stated baby had white covering to tongue that had easily wiped off but was starting to become more difficult to wipe off. Also had questions about OCP d/t hx of PCOS. Had hx of taking Trinesa (tricyclic OCP) with good result. After explanation of different types of OCP (specifically Yaz/Yasmin), decided to stay with previous tricyclic. Other meds prescribed: Diflucan and Newman's Cream for poss. yeast infection and breast redness. Other areas addressed: hernia (rechecked in clinic and continued to be followed by surgery), PPD (addressed and confirmed that even though high stress now, she saw that stress was near ending b/c baby would be transitioned to formula within a week or two and crazy breast pumping/feeding schedule would stop and trips to Dr/ER would be slowing down as her knee continued to get better).
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This is interesting because it was difficult for me to determine what to do with patients when they had a complaint unrelated to OB/GYN. For instance, we had a patient come in for her post-partum visit who had complaints of right wrist pain. Based on her story, I thought it was carpal tunnel and I wanted to do a physical exam. My preceptor did not want to address her wrist pain and referred her to the primary care provider. Although I know that this is the right answer, it was still hard for me to step out of the FNP role and only focus on the OB part.
ReplyDeleteI had the same issue related to complaints other than Ob/Gyn. My preceptor stated the response,"follow up with your PCM". I would have to agree, especially with only 20 minutes per visit...
ReplyDeleteThis woman obviously has issues with her immune system! Sheesh!
ReplyDeleteyou bring up good points about who follows these patients. You MAY find yourself in a Family Practice clinic where these OB patients are actually followed throughout. Which is really probably the best model of care - you WOULD take care of her and her newborn (diad). Great case.