The client arrives at the emergency room following a sexual trafficking incident. She is experiencing significant pain but has difficulty swallowing pills. The provider prescribes 15 mL of Codeine with acetaminophen oral elixir to be taken by mouth once.

Pharmacy Formulary

Codeine with acetaminophen oral elixir available:

2.4 mg/mL of codeine

24 mg/mL of acetaminophen

Complete the following sentence using the drop-down options. The client is prescribed

___i__

mL of codeine and acetaminophen elixir. She will receive

___ii___

  mg of codeine and

____iii___

mg of acetaminophen based on the formulary concentration.

A. Fetal heart rate (FHR): While FHR monitoring is important, the priority is assessing the mother's respiratory status due to the risk of magnesium toxicity, which can lead to respiratory depression.

B. Bowel sounds: Magnesium sulfate can cause decreased gastrointestinal motility, but bowel sounds are not the immediate priority. The nurse should monitor for paralytic ileus, but respiratory function takes precedence.

C. Respiratory rate: Magnesium sulfate is a central nervous system (CNS) depressant that can cause respiratory depression if levels become too high. A respiratory rate below 12 breaths per minute is a sign of magnesium toxicity, requiring immediate intervention (e.g., stopping the infusion and administering calcium gluconate).

D. Temperature: Temperature is not directly affected by magnesium sulfate administration, making it a lower-priority assessment compared to respiratory rate.

A. Assessment Cues

• Unprotected Sexual Activity increases the risk of sexually transmitted infections (STIs). The client has had multiple sexual partners in the past month without protection, making her susceptible to infections such as trichomoniasis, gonorrhea, chlamydia, and bacterial vaginosis. This is a significant risk factor for her symptoms.
• Foul-smelling discharge is a common symptom of trichomoniasis, bacterial vaginosis, and other vaginal infections. UTIs primarily cause dysuria, frequency, urgency, and suprapubic pain, not vaginal symptoms. Since the urinalysis does not show leukocytes, nitrates, or bacteria, a UTI is unlikely.

B. Condition – Trichomoniasis

The client's symptoms—green-yellow vaginal discharge, vaginal itching, and foul-smelling odor—are classic signs of trichomoniasis, a sexually transmitted infection caused by Trichomonas vaginalis. The disease is associated with malodorous discharge, vaginal irritation, and possible dysuria.

C. Anticipated Solutions

• Oral Metronidazole: The first-line treatment for trichomoniasis is oral metronidazole (Flagyl) 2g as a single dose or 500mg twice daily for 7 days. Metronidazole effectively eliminates the infection. Patients must be educated to avoid alcohol while taking metronidazole due to the risk of a disulfiram-like reaction (severe nausea and vomiting).
• Safe sexual behaviors, such as consistent condom use, regular STI screening, mutual monogamy, and open communication about sexual history, are essential for reducing the risk of sexually transmitted infections (STIs), including trichomoniasis.

Incorrect answers:

Human Papillomavirus (HPV): HPV causes genital warts and increases the risk of cervical cancer, but it does not typically cause vaginal discharge, itching, or foul odor. Therefore, HPV is not the most likely condition in this case.

Depression: While multiple sexual partners and STI diagnoses can cause emotional distress, depression is not directly relevant to her current presentation. However, mental health screening may be beneficial if she expresses concerns about her emotional well-being.

Herpes simplex virus (HSV) is a sexually transmitted infection (STI) that can cause genital ulcers, pain, and discomfort. However, based on the client’s symptoms, HSV is not the most likely diagnosis.