A nurse is caring for an adolescent.

Exhibits

Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

 

• Pelvic Inflammatory Disease (PID): The client’s mucopurulent cervical discharge, pelvic pain, recent multiple sexual partners, fever, and urinary discomfort point strongly toward PID, a common infection of the upper genital tract in sexually active adolescents.
• Administer acetaminophen 650 mg PO every 6 hr PRN pain: Acetaminophen is appropriate for managing PID-associated fever and cramping pain without interfering with diagnostic assessments.
• Place the adolescent on bedrest in semi-Fowler's position: Semi-Fowler's positioning facilitates pelvic drainage, reduces the risk of abscess formation, and supports comfort.
• Temperature greater than 38.3°C (100.9°F): Ongoing fever indicates systemic infection or lack of response to treatment, making it a key marker for disease progression or resolution.
• Vaginal bleeding: Monitoring for abnormal bleeding is important, as PID can involve endometrial inflammation or complications like ectopic pregnancy or miscarriage if not promptly managed.

Rationale for Incorrect Choices:

• Urinary tract infection: UTIs typically cause dysuria, frequency, and suprapubic pain, but PID presents with more systemic symptoms and pelvic tenderness, along with sexual history risk factors.
• Ectopic pregnancy: Though a possibility, the client recently had her period 7 days ago, making active ectopic pregnancy less likely; there is also no mention of missed periods or positive pregnancy test.
• Acute appendicitis: This usually involves right lower quadrant pain and rebound tenderness; cervical discharge and bilateral pelvic pain make PID more likely.
• Instruct the adolescent about the use of sitz baths: Sitz baths help with localized perineal discomfort but are not primary management for PID.
• Administer an enema: This is unrelated to PID and could worsen abdominal discomfort or cause unnecessary complications.
• Maintain an NPO status: NPO is reserved for surgical cases or procedures requiring sedation; PID is typically managed with medications and does not require dietary restrictions.
• Rebound tenderness: While it can indicate peritonitis as a result of peritoneal irritation, it's more typical of appendicitis than PID.
• Presence of a Cullen’s sign: Cullen’s sign (periumbilical bruising) is associated with intra-abdominal bleeding such as pancreatitis or ruptured ectopic pregnancy, not PID.
• Irritation of the phrenic nerve: This is associated with upper abdominal pathology like gallbladder disease, not with PID.