Differential Diagnoses With Rationales

Introduction

Encounter for supervision of other normal pregnancy, unspecified trimester (ICD-10: Z34.80): is the condition, when the patient has some symptoms of pregnancy but fails to believe that she could be pregnant at the moment some pain or other complaints bothers her. Thomas (2012) underlines that, nowadays, more than half of all cases of pregnancies are unplanned in the United States (p. 2). People introduce different causes for why unplanned pregnancies occur, and one of them is the lack of motivation to avoid pregnancies (Thomas, 2012, p. 3). People just forget the possibility of being pregnant after the only case of sexual intercourse. In this case, the rationale for diagnosis is the combination of the following factors: the woman refused to consider contraception several months ago, she has lower abdominal pain, nausea, fatigue, and myalgia. Still, she does not have cramping, headache, diarrhea, and blurred vision that could be defined as the symptoms of other diseases.

Menopausal and female climacteric states (ICD-10: N95.1): is a natural process that every woman after her 50s may experience (Murray et al., 2011, p. 186). However, sometimes, women may face their menopause earlier because of the presence of various disturbing factors in their lives. The main symptoms of this condition are abnormal vaginal bleeding or absence of menses, lower abdominal pain, changes in mood, and hot flashes. The woman suffers from nausea and lower abdominal pain. Besides, she has not observed her menses during the last 10 weeks. She feels tired and deals with several cases of myalgia. Her PMH identifies the cases of PCOS. The combination of PCOS and menopause can be observed in many women and lead to the development of numerous hormonal changes characterized by menstrual dysfunction (Schmidt, Brännström, Landin-Wilhelmsen, & Dahlgren, 2011, p. 2179).

Diverticular disease of intestine, part unspecified, without perforation or abscess (ICD-10: K57.9): is also known as diverticulitis (GI), a non-gynecological diagnosis for women, who suffer from pain in the lower side of the abdomen, fever, and nausea. The researchers admit that only 5%, maximum 10%, of American women under 40 years may have diverticula (Masoomi, Buchberg, Magno, Mills, & Stamos, 2011, p. 404). Still, the cases of diverticulitis among adults between 20 and 40 are possible, and people have to be ready to identify and treat it properly. Kayla has nausea and pain in her abdomen. The only two symptoms that she denies is a fever and diarrhea. Still, these symptoms could be treated or reduced by the fact that she takes Tylenol that may reduce fever.

Primary Diagnoses

Problems related to unwanted pregnancy (ICD-10: Z64.0): Unwanted or unintended pregnancies are observed among the 49% of pregnant women (Simmonds & Likis, 2011, p. 423). As a rule, women of different age from different socioeconomic groups discover their pregnancies in the most unexpected from them times. Kayla had one sexual intercourse with her estranged husband 8 weeks ago. She refused the idea of contraception. In addition to the positive urine pregnancy test, the rationale for her being in her first trimester of pregnancy could serve her continuous nausea, tearful behavior during the exam, and several cases of vomiting during the last two weeks.

Education

The patient should understand that her pregnancy is the result of her and her ex-husband’s actions and decisions. It is not an illness that could be treated and forgotten with time. She has a baby, and she should be ready to a number of responsibilities. Though the number of abortions among unintended pregnant women has decreased (Finer & Zolna, 2011, p. 479), Kayla should understand her options. There are no strict limitations as for abortions. Still, it is the end of her first trimester. It is her fifth gestation. She knows a lot about pregnancy and possible operative outcome (she had two cesarean sections).

Other fatigue (ICD-10: R53.83)

Is the condition when the patient fails to function properly because of lack of energy, personal concerns, generalized weakness, etc. Nowadays, chronic fatigue syndrome is observed in more than one million Americans and affects the healthcare system, economic costs, and the life of society as a whole (Boneva, Lin, & Unger, 2015, p. 826). Kayla complains of the developed fatigue as one of the complications of her frequent nausea and abdominal pain. She does not take physical experiences or other activities that could lead to her fatigue.

Education

The patient should be informed that fatigue may have a variety of reasons. Besides, the outcomes of fatigue vary indeed, and people should be very careful treating their fatigue independently. Menstrual abnormalities, pelvic pain, and early menopause may associate with fatigue (Boneva, Lin, & Unger, 2015, p. 826), and women should know that to take a rest is not the only way out. Appropriate diet, fresh air walks, and avoidance of stresses should be taken into consideration.

Nausea (ICD-10: R11)

Is the condition when a person feels uneasy in their stomach and want to vomit the substances without any reasons. Though nausea is not a disease, this condition is a threat to a human organism and serves as a serious symptom of many diseases. As a rule, more than 80% of women have nausea during pregnancies (Anderka et al., 2011, p. 22). Therefore, as soon as a woman feels nausea, the most frequent question she hears is “Are you pregnant?” Kayla admits that nausea has been present for about two weeks. She cannot stop it, and this condition leads to certain limitations in food and drinks.

Education

Nausea is not an ordinary condition people have to neglect. If the organism refuses something, it means that some abnormalities could be found. The patients should learn that it is better to choose fresh and healthy food, not to eat something unwanted, and to drink as much water as possible in order not to cause dehydration, especially among pregnant women (Becker, 2015, p. 781).

Differential Diagnoses

Urinary tract infection, site not specified (ICD-10: N.39.0)

Is one of the most common bacterial infections (Terpstra & Geerlings, 2016, p. 70), and the disease that bothers a number of people around the whole world. This infection can be brought to the organism as a result of unsafe relations (in this case, Kayla had one sex intercourse with her ex-husband, who could have a number of unsafe intercourses before), stress (in this case, Kayla has to change her style of life, survive the divorce with her husband, and raise her three children with her parents at their home), or even poor hygiene (Kayla does not provide information concerning this point).

Obesity complicating pregnancy, first trimester (ICD-10: 099.211)

Is the condition when the current BMI is greater than it is recommended even during the first trimester of pregnancy. Johansson et al. (2014, p. 66) inform that associations between maternal BMI in pregnancy and risks of infants cannot be neglected. The effects of weight during pregnancy are a serious issue for consideration. Kayla’s is 155 cm, and her weight is 73 kg. It means that her BMI is 30.4 Kg/m2. It is higher than it is expected anyway. Besides, she admits that she has certain food and drink limitations and the cases of vomiting. The reasons for her overweighting are hard to identify.

Rebound abdominal tenderness (ICD-10: R10.82)

Is the condition when patients feel discomfort and pain in the area of their lower abdomen. As a rule, any kind of abdominal pain represents a serious diagnostic challenge for doctors and nurses (Thompson, Kudla, & Chisholm, 2014, p. 652). In Kayla’s case, she rates pain 4 on the scale from 1 to 10.

Education for the Patient

Topic: Presence of WBCs in Urine during Unintended Pregnancy

Definition: WBCs are the white blood cells of the immune system that aim at protecting a human organism against various infections or inflammation.

Specific Educational Points in Details

A urine test is a routine analysis that any woman has to pass for each prenatal visit and inform the doctor about the presence or absence of WBCs. As soon as the test shows positive results, and the presence of the WBCs in urine is high, a doctor informs about the possibility of inflammation in the body. As a rule, there are two main areas that can be infectious: the urinary tract infection or kidney inflammation. Still, a pregnant woman should not start panic but listen to her doctor carefully and consider the following points about the presence of the WBCs in the urine of a pregnant woman:

  1. WBCs (or leukocytes) in urine proves the presence of some infection in the body. Still, such infections are usually frequent results because of the presence of a new body in a female organism (Coad, Friedman, & Geoffrion, 2012, p. 275). The changes in the organism and the inability to empty the bladder can lead to the presence of leukocytes in the female urine.
  2. If WBCs prove the UTI (urinary tract infection), doctors can treat it in a short period, and women have just to listen to their prescriptions and follow the established treatment.
  3. Kidneys may be infected as well. The main symptoms are vomiting, nausea, and fever. In-time treatment is required to avoid possible complications. Sometimes, it is possible to treat this infection with the help of antibiotics.
  4. Finally, the WBCs may be present because of poor hygiene. A pregnant woman has to think about her future baby and the complications she could suffer from. Therefore, she has to follow such simple rule as to stay clean, avoid unsafe sex, and check the conditions of the vaginal area.

References

Anderka, M., Mitchell, A. A., Louik, C., Werler, M. M., Hernández‐Diaz, S., & Rasmussen, S. A. (2012). Medications used to treat nausea and vomiting of pregnancy and the risk of selected birth defects. Birth Defects Research Part A: Clinical and Molecular Teratology, 94(1), 22-30.

Becker, W. J. (2015). Acute migraine treatment in adults. Headache: The Journal of Head and Face Pain, 55(6), 778-793.

Boneva, R. S., Lin, J. M. S., & Unger, E. R. (2015). Early menopause and other gynecologic risk indicators for chronic fatigue syndrome in women. Menopause, 22(8), 826-834.

Coad, S., Friedman, B., & Geoffrion, R. (2012). Understanding urinalysis: clues for the obstetrician–gynecologist. Expert Review of Obstetrics & Gynecology, 7(3), 269-279.

Finer, L. B., & Zolna, M. R. (2011). Unintended pregnancy in the United States: Incidence and disparities, 2006. Contraception, 84(5), 478-485.

Johansson, S., Villamor, E., Altman, M., Bonamy, A. K. E., Granath, F., & Cnattingius, S. (2014). Maternal overweight and obesity in early pregnancy and risk of infant mortality: A population based cohort study in Sweden. BMJ, 349, 65-72.

Simmonds, K. & Likis, F.E. (2011). Unintended pregnancy. In K.D. Schuiling & F.E. Likis (Eds.), Women’s gynecologic health (pp. 423-442). Burlington, MA: Jones & Bartlett Publishers.

Terpstra, M. L., & Geerlings, S. E. (2016). Urinary tract infections: how new findings create new research questions. Current Opinion in Infectious Diseases, 29(1), 70-72.

Thompson, M. M., Kudla, A. U., & Chisholm, C. B. (2014). Appendicitis during pregnancy with a normal MRI. Western Journal of Emergency Medicine, 15(6), 652-654.

Masoomi, H., Buchberg, B. S., Magno, C., Mills, S. D., & Stamos, M. J. (2011). Trends in diverticulitis management in the United States from 2002 to 2007. Archives of surgery, 146(4), 400-406

Murray, A., Bennett, C. E., Perry, J. R., Weedon, M. N., Jacobs, P. A., Morris, D. H.,… & Swerdlow, A. J. (2011). Common genetic variants are significant risk factors for early menopause: Results from the Breakthrough Generations Study. Human molecular genetics, 20(1), 186-192.

Schmidt, J., Brännström, M., Landin-Wilhelmsen, K., & Dahlgren, E. (2011). Reproductive hormone levels and anthropometry in postmenopausal women with polycystic ovary syndrome (PCOS): A 21-year follow-up study of women diagnosed with PCOS around 50 years ago and their age-matched controls. The Journal of Clinical Endocrinology & Metabolism, 96(7), 2178-2185.

Thomas, A. (2012). Policy solutions for preventing unplanned pregnancy. Center on Children and Families, 47, 1-8. Web.