Theiss

Cotabato Medical Foundation College, Inc
Quezon Ave. Poblacion 8, Midsayap, Cotabato

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GONORREA DURING PREGNANCY
Submitted by
Quitor, Almira A.
Date Presented:
Date Submitted:
Semester SY: 1st Semester 2021-2022
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TABLE OF CONTENTS
Page
Cover Page
Introduction (Includes the Background and Rationale of the analysis) . . . . . . . . . . . 3
Scenario (if presented in a virtual progressive scenario, write the summary) . . . . . . . 5
Phenomenon (Series of incidents leading to the occurrence
of the main (health) problem) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
Concept Map (brief but concise graphical presentation of the phenomena) . . . . . . . . 12
Learning Objectives (SMART; includes the main parts of the Clinical
Case Analysis Worksheet; Nursing Process – Approached) . . . . . . . . . 15
Clinical Case Analysis Worksheet
Patient’s Personal Data
I. Family Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
II. Developmental Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
III. Chief Complaints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
IV. Health History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
V. Complete Diagnosis of the case chosen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
a. Definition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
b. Etiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
c. Symptomatology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
d. Anatomy and Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
e. Pathophysiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
VI. Medical Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
a. Laboratory Interpretation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
b. Drug Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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VII. Nursing Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . 29
a. Nursing Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
b. Nursing Care Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
VIII. Evaluation and Implication of the case to: . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . .
35
a. Nursing Practice (What might the case mean for other nurses?) . . . . . . . 35
b. Nursing Education (What might the case contribute to education).. .. . . . 35
c. Nursing Theory (applicable nursing theory in the care of the case) . . . . . 35
d. Nursing Research (any related issues that may need investigation) . . . . . 35
IX. Recommendations/Referrals/ Follow – ups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
X. Journal Reading Related to the Case . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
XI. APPENDIX (Any relevant documentation as long as it will
not violate the Intellectual Property Rights) . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . .41
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INTRODUCTION
Gonorrhea in pregnancy is associated with spontaneous miscarriage pre-term birth and
endometriosis in the postpartum period pregnant women cannot be administered doxycycline
because, it has the potential to be teratogenic. Instead, they are prescribed azithromycin. It is
important that gonorrhea is identified and treated during pregnancy because, if the infection is
present at the time o birth it can cause a severe eye infection which can lead to blindness in the
newborn. (Pilliterri, A., 2018). The worldwide pooled prevalence of gonorrhea in pregnant
women was estimated at 1.85% (95% CI 1.73-1.97%), with the highest rate in the African region
(3.53%) (2.84-4.29%) and the lowest rate in the European region (0.52%) (0.27-0.84%). (WHO,
2022). Nationally, the prevalence of Neisseria gonorrhea among women is 0.75%, and 0.7%
among female youth. 31% of female were asymptomatic for infection. (DOH, 2019).
This case study, A 30 years old pregnant women, gravida 2, para 1 was presented to the
emergency department of a local hospital with chief complaints of nausea, vomiting, myalgia,
and dysuria. Abdominal ultrasound confirmed an intrauterine pregnancy of 27weeks gestational
age (GA). Had not received prenatal care, citing lack of health insurance. She was screened with
sexually transmitted infection test. An endocervical swab was positive for both Neisseria
gonorrhea and chlamydia trachomatis. She was given with 1g of oral azithromycin in addition to
IV ceftriaxone, and cephalexin 500mg orally 4 times a day for 14 days to complete her
pyelonephritis treatment during her discharge after 2 days of being admitted. A reactive TP-PA
result returned after the patient was discharge. The patient presented for her prenatal visit 1 week
after discharge and began treatment for latent syphilis of unknown duration with benzathine
penicillin G 2.4 million units (mU) IM once a week for 3 weeks.
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As a nursing student, intention in this case study is to import knowledge to the learners
and especially the pregnant women about gonorrhea. That is known to lead an increase risk in
miscarriage and premature birth. This study can be used to educate the learners and other
individuals on how to take care of people with gonorrhea. Some of signs and symptoms of
gonorrhea are depicted in the scenario, as well as some of the measures that can be utilized to
avoid it. This case topic was given to me by the Dean of College of Nursing, Ma’am Lorna E.
Vallar, RN, MAN.
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SCENARIO
A 30-year-old Micronesian woman, gravida 2, para 1, presented to the emergency
department (ED) of a local hospital with nausea, vomiting, myalgia, and dysuria. Abdominal
ultrasound confirmed an intrauterine pregnancy of 27 weeks gestational age (GA). She had not
received prenatal care, citing lack of health insurance. She reported a past history of chlamydia,
denied smoking, alcohol, or illicit drug use, and was currently living at a homeless shelter with
her young child. The patient was diagnosed with presumptive pyelonephritis, admitted, and
treated with ceftriaxone 1 g intravenously (IV) every 24 hours.
Of note, the patient was seen twice in the ED for nausea and vomiting earlier in
pregnancy. At her first visit at approximately 9 weeks GA, an intrauterine pregnancy was
diagnosed by pelvic ultrasound. No sexually transmitted infection (STI) screening was done. She
was treated symptomatically, discharged, and referred for prenatal care. The patient returned to
the ED 3 weeks later. She again was discharged without STI screening and referred for prenatal
care. She had no further follow-up until her ED visit and admission at 27 weeks GA.
Results of STI testing conducted upon her admission were reported the next day. An
endocervical swab was positive for both Neisseria gonorrhoeae and Chlamydia trachomatis; 1 g
of oral azithromycin was administered in addition to IV ceftriaxone. A nontreponemal syphilis
serology test (rapid plasma reagin [RPR]) was reactive with a titer of 1:32. In Hawaii, when an
RPR is reactive, an aliquot of serum is reflexed from the private laboratory to the Hawaii
Department of Health (HDOH) laboratory for a quantitative venereal disease research laboratory
(VDRL) titer and confirmatory Treponema pallidum particle agglutination (TP-PA) test.
Treatment for syphilis was held pending TP-PA test results.
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The patient's last documented syphilis serology was a nonreactive RPR performed more than 2
years earlier, during her last pregnancy. She denied recent rashes or genital lesions, and physical
examination revealed no skin rashes or genital, perianal, or oral lesions. She reported one sexual
partner over the previous 3 years, the father of her unborn child, and that he had other female
partners. She was discharged on hospital day 2 with cephalexin 500 mg orally 4 times daily for
14 days to complete her pyelonephritis treatment. Because her TP-PA results had not yet
returned, she was not treated for syphilis. She was referred to the hospital's prenatal care clinic.
A reactive TP-PA test result returned after the patient was discharged. Her quantitative
VDRL titer was 1:32. The patient presented for her first prenatal visit 1 week after discharge and
began treatment for latent syphilis of unknown duration with benzathine penicillin G 2.4 million
units (mU) intramuscularly (IM) once a week for 3 weeks. Retests for gonorrhea and chlamydia
were negative, but she was diagnosed with trichomoniasis. She missed her scheduled second
weekly prenatal clinic visit but returned without appointment 13 days later at 30 weeks GA, was
treated for trichomoniasis, and restarted on the syphilis treatment regimen with benzathine
penicillin G 2.4 mU IM. She did not return for treatment or prenatal care and was lost to follow-
up.
At 39 weeks GA, the patient presented to the hospital in labor. She delivered a female
infant, 2719 g (normal birth weight), Apgar score 8 and 9, via normal spontaneous vaginal
delivery. The infant was noted to have peeling skin on palms and soles bilaterally, facial
maculopapular rash, and hepatomegaly, was diagnosed with probable congenital syphilis, and
admitted to the neonatal intensive care unit. The infant's serum RPR titer was 1:2 with the
following cerebrospinal fluid results: nonreactive VDRL, protein, 104 mg/dL; glucose, 59
mg/dL; RBC, 9675/μL; and WBC, 6/μL. Long bone x-rays were within normal limits. The infant
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completed a congenital syphilis treatment regimen of aqueous crystalline penicillin G 50,000
units/kg/dose IV every 12 hours for 1 week, then every 8 hours for a total of 10 days. At
delivery, the patient was retested for syphilis, gonorrhea, chlamydia, and trichomoniasis. Her
RPR titer had declined to 1:4, but she tested positive for gonorrhea, chlamydia, and
trichomoniasis. She was retreated for gonorrhea, chlamydia, and trichomoniasis and scheduled to
restart syphilis treatment. Through the coordinated efforts of an assigned case worker, the patient
entered a family shelter and accessed transportation services to attend her appointments. The
infant's rash and hepatomegaly resolved with treatment and serum RPR at 4 months was
nonreactive. At the time of this report, the patient completed the 3-week treatment regimen and
provided written consent for her information to be published. The HDOH is attempting to access
her partner for evaluation and treatment.
The infant was born with symptomatic congenital syphilis. Both the number of
benzathine penicillin doses (2) and the spacing of doses (13 days apart) represent inadequate
treatment for syphilis of unknown duration. The Centers for Disease Control and Prevention
(CDC) recommends 3 weekly IM injections of 2.4 mU benzathine penicillin G.2 Although it
may be acceptable to have a 10- to 14-day gap between injections when treating syphilis of
unknown duration or late latent syphilis in nonpregnant patients, a delay between dosing
intervals is not acceptable during pregnancy.2 Of interest, the patient's nontreponemal antibody
titer demonstrated an 8-fold decrease (RPR, 1:32 to 1:4), which typically represents adequate
therapeutic response to treatment. If there is a delay between doses, the entire treatment series
should be restarted, even if maternal nontreponemal titers decline appropriately, as occurred in
this case.
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This case highlights challenges to treating syphilis during pregnancy, as coexisting social
factors, such as lack of insurance, unstable housing, substance use, and history of incarceration
of the patient or partner, may lead to lack of prenatal care, missed clinic visits, and barriers to
completing timely treatment.3,4 Racial/ethnic disparities have also been predictive factors.5,6 In
Hawaii, the Micronesian population has been at increased risk for adverse health outcomes,
including STIs, based on socioeconomic factors.7,8 Overcoming barriers requires collaborative
efforts to link patients to housing and medical/social services.
Adequate treatment of syphilis during pregnancy is an established evidence-based
approach to prevent congenital syphilis.9–11. Screening pregnant women for syphilis “as early
as possible when they first present for care” is a US Preventive Service Task Force "Grade A”
recommendation.
This case documents multiple missed opportunities for syphilis screening in pregnancy
and early intervention at a systems level. Our case-patient was seen twice in the ED before her
inpatient admission. No STI screening was done at either visit. If the ED visit is the first
presentation for care, pregnant women should be screened for syphilis in keeping with US
Preventive Service Task Force's recommendations.12 In addition, while hospitalized at 27 weeks
GA, syphilis treatment could have been initiated based on our patient's reactive RPR even though
the confirmatory TP-PA result was not available until after her discharge. The CDC treatment
guidelines note: “in populations in which receipt of prenatal care is not optimal, RPR test
screening and treatment (if the RPR test is reactive) should be performed at the time pregnancy is
confirmed.”
As Hawaii has seen a sharp increase in congenital syphilis, a health alert was issued in
August 2020 to clinicians caring for reproductive age and pregnant women. We recommend
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routine syphilis screening of all sexually active women aged 15 to 44 years, and more aggressive
screening of pregnant women; in addition to the first health care visit, screenings should be
performed at 28 to 32 weeks gestation, and delivery. We also recommend that infants of women
adequately treated for syphilis during pregnancy be treated for congenital syphilis with
benzathine penicillin G 50,000 units/kg per dose IM in a single dose, even if they appear normal
at birth, if their nontreponemal titer is equal to or less than 4-fold the maternal titer and the
mother has no evidence of reinfection or relapse, in keeping with CDC recommendations.2 For
consistency with the private laboratories, the HDOH will be transitioning to using the RPR to
follow titers pretreatment and posttreatment (replacing the VDRL), as RPR and VDRL titers
often differ and are not interchangeable.2 Finally, interdisciplinary provider learning
communities are planned as part of a multifaceted approach to address the growing threat of
syphilis to maternal and infant health.
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PHENOMENON
A 30 years old Micronesian pregnant woman
Upon admission:
Chief complaints
• nausea
• vomiting
• myalgia
• dysuria
Physical assessment
• Gravida 2, Para 1
•27 weeks GA
Past Medical History
• History of Chlamydia
9 weeks GA
• Nausea and vomiting
• Intrauterine pregnancy was diagnosed by pelvic ultrasound
• Treated symptomatically
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12 weeks GA
• Not screened with STI screening
• Referred for prenatal care
27 weeks GA
• Abdominal ultrasound confirmed an intrauterine pregnancy
• Diagnosed with presumptive pyelonephritis
• STI screening where reported an endocervical swab was positive for both Neisseria
gonorrhoeae and chlamydia trachomatis.
• Nontreponemal syphilis serology test [Rapid plasma reagin (RPR)] was reactive with a
titer of 1:32.
2 years earlier, during last pregnancy
• Syphilis serology was a non-reactive RPR
• Physical examination revealed no skin rashes, or genital, perianal, or oral lesions.
28 weeks GA
• Treponema pallidum particle agglutination (TP-PA) test result quantitative VDRL titer
was 1:32
• Began treatment for latent syphilis
• Diagnosed with trichomoniasis
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30 weeks GA
• Treated for trichomoniasis
• Restart in the syphilis treatment regimen
Present:
39 weeks GA
• Presented to the hospital in labor
• Delivered a female infant via SVD
• Retested for syphilis, gonorrhea, chlamydia, and trichomoniasis with RPR titer had
declined to 1:4
• Tested positive for gonorrhea, chlamydia, and trichomoniasis
• Retreated for gonorrhea, chlamydia, and trichomoniasis
3 weeks after delivery
• Pt. complete 3-week treatment regimen.
Management
• Azithromycin 1g PO
• Ceftriaxone IV
• Benzathine penicillin G 2.4 million units (mU) IM weekly for 3 weeks
• Cephalexin 500 mg PO QID for 14 days
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CONCEPT MAP
Woman, Micronesian, married, 3 years old
At Emergency Department of local

Hospital
Upon admission
Chief complaints:
Past Medical History • nausea
• vomiting
• Has chlamydia
• myalgia
 2 years earlier, during last
• dysuria
pregnancy
• syphilis serology was
non-reactive RPR
 9 weeks GA
• seen for nausea and Physical assessment

• Gravida 2, Para 1
vomiting earlier in
•27 weeks GA
pregnancy
• intrauterine pregnancy was

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diagnosed by pelvic exam
• treated symptomatically
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 12 weeks GA
• not screened with STI

After
screening delivery
• referred for prenatal care

Present
 27 weeks GA
• abdominal ultrasound  39 weeks GA
confirmed an intrauterine • presented to the hospital in

pregnancy labor
• diagnosed with
• delivered a female infant via
presumptive pyelonephritis
spontaneous vaginal delivery
• STI screening where
• retested for syphilis,
reported an endocervical
gonorrhea, chlamydia, and
swab was positive for both
trichomoniasis with RPR titer
Neisseria gonorrhoeae and
had declined 1:4
chlamydia trachomatis
Nontreponemal syphilis • tested positive for gonorrhea,
serology test [Rapid Plasma chlamydia, and trichomoniasis
Reagin (RPR)] was reactive
with a titer of 1:32
 28 weeks GA
• TP-PA test result
quantitative VDRL titer was
1:32
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• begun treatment for latent
syphilis
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• diagnosed with
trichomoniasis
 30 weeks GA
• treated for trichomoniasis
• restart in the syphilis
treatment regimen
Management
• Azithromycin 1g PO
• Ceftriaxone IV
• Benzathine penicillin G 2.4 mU IM
• Cephalexin 500 g PO QID
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LEARNING OBJECTIVES
After the presentation the learner improve knowledge, skills and attitude in giving appropriate
nursing care for the patient. Specifically, the learners will:
1. develop phenomenon and concept map leading to the development and treatment of diagnosis;
2. conduct a physical assessment to the patient to note other problems of the patient to the
manage;
3. discuss the developmental data based on the Erick Erickson’s life and developmental tasks;
4. determine the present chief complaints of the patient;
5. define the complete diagnosis of Anemia in pregnancy;
6. distinguish the basic etiology and symptomatology of Gonorrhea in pregnancy from other
types of Gonorrhea;
7. discuss the mechanism and process involved in the affected system;
8. review the anatomy and physiology of the affected system;
9. trace the pathophysiology of Gonorrhea in pregnancy;
10. explain and interpret the basic diagnostic procedure results;
11. present the drugs prescribed to the patient with Gonorrhea;
12. identify the present nursing problems and make nursing care plan to prioritized
problems of the patient with Gonorrhea;
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13. enumerate recommendation, referrals, and follow-ups, for the patients;
14. discuss an evidenced based practice journal related to Gonorrhea;
15. evaluate the effectiveness of nursing care rendered to Gonorrhea; and
16. list down all the references used in the study.
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CLINICAL CASE ANALYSIS WORKSHEET
MATERNAL, INFECTION
PATIENT’S PERSONAL DATA:
Name (optional): N/A Age: 30-years-old Sex: Female
Civil Status: N/A Religion: N/A
I. FAMILY BACKGROUND:
Occupation: N/A
Number of Siblings/Children: 1
Other Relevant Data: non-addict, live at a homeless shelter, husband that has STI
II. DEVELOPMENTAL DATA: Specify the Stage.
(Based on Havighurst’s and Erikson’s Life and Developmental Task/Psycho-Social).
The patient is a 30 years old pregnant woman who belongs to intimacy vs. isolation stage. This
stage covers the period of early adulthood when people are exploring personal relationships,
love, and maldevelopment in which individual forms close friendships or long-term partnership.
People develop close, committed relationships that are enduring and secure.
In relationship to my case analysis, intimacy is where it belongs because at this stage, the patient
will learn to develop a good relationship with the healthcare provider specially, in the
management provided to her. At her recent situation of having a gonorrhea, chlamydia, and
trichomoniasis, the patient had scheduled to have treatment of this disease that will lead the nurse
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to be more attach to her to provide management. Being open to share her relationship with her
husband where she gets the disease without hesitation is showing that the patient is willing to be
treated and that she is willing to build up good relationship with the healthcare provider. If the
nurse will meet the feeling of approach that the patient needs, sense of belongingness will grow.
Reference: Orenstein, G. and Lewis, L., (2021). Erikson’s Stages of Psychosocial Development:
Intimacy vs. Isolation. Available at https//www.ncbi.nlm.nih.gov/books/NBK536974/. Access on
March 27, 2023.
CHIEF COMPLAINTS:
Nausea, vomiting myalgia and dysuria
III. HEALTH HISTORY:
Pass Illness/Surgery:
Chlamydia
Intrauterine Pregnancy by Pelvic Ultrasound
Presumptive Pyelonephritis
Positive for both Neisseria gonorrhea and chlamydia trachomatis
Latent syphilis
Trichomoniasis
Inclusive Period of Hospitalization: 5
Present Illness:
She’s confirmed to be positive with gonorrhea, chlamydia, and trichomoniasis with RPR
titer had declined to 1:4
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IV. COMPLETE DIAGNOSIS OF THE CASE CHOSEN
a. Definition (at least 2 Definition with Bibliography)
1. Gonorrhea is a transmitted by Neisseria gonorrhea, a gram-positive diplococcus, which
thrives on the mucous membrane of the vagina or penis. Although symptoms of
gonorrhea in females are not as visible, there may be a slight yellowish vaginal discharge.
The Bartholin glands may become inflamed and painful. If left untreated, the infection
can spread to pelvic organs.
Reference:
Pilliteri, A. and Silbert-Flagg, J. (2018). Maternal and Child Health Nuraing: Care of
the Childbearing and Childrearing Family. Volume 2. Eighth Edition. Lippincott William
& Wilkins Publication.
2. Gonorrhea is one of the common and highly contagious STD caused by Neisseria
gonorrhoeae which differ in males and females in course, severity and ease of recognition
and can lead to different systemic complication if left untreated. It can grow easily in the
warm, moist area s of the reproductive tract, including the cervix, uterus, and fallopian
tubes in women, and in urethra in women and men.
Reference:
Kumar, A. (2020). Gonorrhea. Available at
https://www.dhss.delaware.gov/dph/dpc/gonorrhea.html. Access on March 28,2023.
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b. Etiology
List all the Basic Actual Etiology Rationale (Include the reference as endnote)
Etiology on the patient
Infection of the genital mucosa by N. gonorrhoeae involves attachment to and
Neisseria gonorrhoeae invasion of epithelial cells. Initial adherence of gonococci to columnar epithelial cells

is mediated by the type IV pili assemble from pilin submit PilE protein pilus tip-
associated PilC proteins. (Jarvis, G., Li, J., and Swason, K., 2019)
Risk Factor: Infected cervical and vaginal secretions contacting the baby’s mucosal surfaces during

Perinatal transmission birth. (Kumar, A., 2020)
Unprotected sexual Spread of sexual fluids and semen inside the genitals. Gonococcus enter into the

contact vagina and somehow spread upward because of the extension that come off of
gonococcus.( Khan, A., 2017)
Age  Most often gonorrhea is found in younger people (ages 25-30) who are sexually
active. (DOH, 2020)
History of gonorrhea Women who had history of gonorrhea were 2.8 times more likely to be diagnosed with
gonorrhea, and infertile than those who did not have history of gonorrhea. (Bayu, D.,
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et al.. 2020)
Multiple partners Women who had multiple sexual partners had 5.3 times more chance of infertility that
those who did not have multiple sexual partners. (Bayu, D., Egata, G., and Jemere, t.,
2020)
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c. Symptomatology
List all the Basic Actual Rationale (Include the reference as endnote)
Symptomatology Symptomatology
on the patient
Urine comes in contact with the inflamed o urethral mucosal lining. This is
Dysuria exacerbated by and associated with detrusor muscle contractions and urethral

peristalsis, which then stimulates the submucosal pain and sensory receptors. (Meta,
P., Leslie, SW., Reddivari, AKR., 2023)
Dyspareuna Estrogen deficiency leads to decreased secretion of lubricant, resulting in various
unpleasant aftereffect to sex, pan during sex, such as soreness, burning after sex.
(Brenda, G., 2021)
Unusual Vaginal
Discharge
Pelvic pain N. gonorrhoeae move upward from a woman’s vagina or cervix into her reproductive
organ that cause pelvic inflammatory disease. (CDC, 2023)
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d. Anatomy and Physiology (Draw and Label the Organ or System Involved). Briefly
present the description and functions of parts of the system involved in the case.
Cervix
 Vagina
 a tubular, long fibromuscular canal lined with mucous membrane that extends
from the exterior of the body to the uterine cervix.
 Bartholin’s glands
 production of a mucoid secretion that aids in vaginal and vulvar lubrication.
 Vaginal mucosa
 most significant and adaptable structure in the female reproductive system and
is the surface upon which Candida species adhere to initiate infections.
 Cervix
 lower, narrow end of the uterus that forms a canal between the uterus and
vagina. A passage that allows fluid to flow inside and out of your uterus.
 Uterus
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 hollow, pear-shaped organ in a woman’s pelvis that is responsible for
implantation, gestation, menstruation, and labor.
 Urethra
 the tube through which urine leaves your bladder and body.
 Bladder
 a hollow organ, much like a balloon, that stores urine. Relax and expand to
store urine, and contract and flatten to empty urine through the urethra.
d. Mechanism or Process of the System involved in the Disease Process. Present a schematic
diagram or drawing to clearly explain the mechanism/process.
 Sexual contact
 Bartholin’s gland secrete fluid to lubricate the vagina
 Gonococcus enter into the vagina and somehow spread upward
 Pilus allow the gonococcus to grab on to the vaginal wall
 The pilus will work like a grappling hook, so it will snap the gonococcus upwards
towards the cervix
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 White blood cell will look for the gonococcus and swallow it.
 Lot of gonococcus or gonococci will be inside the white blood cell
 Gonococcus will latches on to WBC with the receptor called O-P-A receptors.
 These receptors help kick off the process of developing immunologic memory
 Opa protein will bind the opa receptors that prevent it from working.
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e. Pathophysiology (Schematic Diagram as applied to your patient)
Predisposing Factor Precipitating Factor
 Age  N. gonorrheae
 Sex
Neisseria Gonorrheae
Gonococcus enter to the vagina
Pilus come off from gonococcus
Gonococcus will grab on to the wall
Pilus snap the gonococcus upwards

towards the cervix
WBC will try to swallow gonococcus

the gonococcus
Oppa receptor kick off the process
No immunologic memory
Tissue damage will happen
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Expudation of purulent material
Puss will be found
Expudation of puss outside to the

lumen
Reaction of inflammation
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V. MEDICAL MANAGEMENT
a. Laboratory Interpretation
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b. Drug Study (All drugs indicated for the Patient’s Illness)
Generic Classification Dosage and Pharmacologic Indication and Side Effects Nursing Responsibilities
Name
Route of Effects / Mechanism Contraindication
(Brand
Administration of Action
Name)
Antibiotic PO: 1 g Azithromycin binds Indication CNS: fatigue,  Obtain history of
Generic to the 235 Rna of the headache,
 Urethritis and cervisitis hypersensitivity to
Name:
bacterial 505 dizziness Azithromycin prior to
Azithromycin ribosomal subunit. It Contraindication CV: chest pain, administration.
stops bacterial  Patient hypersensitivity palpitations  Give 2 max 1 hour
protein synthesis by to drug GI: diarrhea, before or 2 hours after
inhibiting the  Pt. with pneumonia abdominal meal tablets and single-
Brand name: assembly of the 50s  Pt with hepatic function pain, nausea, dose packets for oral
Zithromax
ribosomal subunit vomiting suspension can be taken
GU: nephritis, with or without food.
vaginitis Don’t give with
Skin: jaundice, antacids.
rash, pruritus  Monitor patient for
superinfection. Drug
may cause overgrowth
of nonsusceptible
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bacteria.
 Warn patient to seek,
immediate medical care
for diziness and
fainting.
 Assess bowel function
for constipation or
diarrhea
 If pt. vomits within 60
min of taking Zmax,
notify prescriber;
additional or deffirant
therapy may be needed.
 Let the patient report
severe or watery
diarrhea, severe nausea
or vomiting, rash or
itching, mouth sores,
vaginal sores.
 Monitor patient for
jaundice. Discontinue if
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s/s (yellowing of skin,

abdominal pain, nausea,
vomiting) occur.
 Tell patient to report
adverse reaction
 Instruct patient to avoid
scartching the skin
 Document findings
Generic Classification Dosage and Pharmacologic Effects / Indication and Side Effects Nursing Responsibilities
Name
Route of Mechanism of Action Contraindication
(Brand
Administration
Name)
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Antibiotic PO: 500 mg, Cephalexin is a first Indication: CNS: dizinness,  Obtain history of
Generic Name: QID for 14 days generation cephalosporin headache,
 Skin and skin hypersensitivity to
Cephalexin antibiotic. Cephalosporins structure fatigue, Cephalexin prior to
contain a beta lacram and infections hallucinations administration
dehydrothiaside. Unlike caused by GI: anorexia,  Give drug with meals;
Brand name: penicillins, cephalospirins susceptible diarrhea, if GI complications
Keflex are more resistant to the isolates of abdominal pain, occur.
action of beta lactamase. Gram-positive anal pruritus,  Explain therapeutic
Cephalexin inhibits bacterial bacteria. oral candidiasis value of medication
cell wall synthesis, leading Contraindication: GU: geniral prior to administration
breakdown and eventually  Hypersensitivity prurirus, to enhance the effect.
cell death.  Pregnancy or vaginitis,  Monitor patient for
lactation candidiasis superinfection and
 Renal failure Hematologic: diarrhea, especially if
eosinophilia, patient is high risk
anemia  Monitor fluid intake
Muscuskeletal: and output; decreasing
arthritis, joint urine output may
pain indicate nephrotoxicity
Skin: rashes  If anemia develops
Other: during or after therapy,
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hypersensitivity obtain a diagnostic

ractions work-up for drug-
induced hemolytic
anemia, discontinue
drug, and institute
appropriate therapy.
 Tell patient to take
drug exactly as
prescribed, even if
feeling better.
 Tell patient to report all
adverse reactions and
to immediately report
rash and sign of
superinfection or
diarrhea.
 Tell patient that she
may experience side
effects such as stomach
upset, loss of appetite,
nausea, diarrhea,
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headache, dizinesss.
 Document findings
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Generic Name Classification Dosage and Pharmacologic Indication and Side Effects Nursing Responsibilities
(Brand Name)
Route of Effects / Mechanism Contraindication
Administrati of Action
on
Indication: CNS: neuropathy  Observe 15 rights of
Generic name: Antibiotic IM: 2.4 mU  Decreases fever by  GI: nausea, vomiting
Latent syphilis drug administration
Benzathine a hypothalamic GU: neuropathy  Assess for
penicillin G effect leading to Contraindications: Hematologic: hypersensitivity to
sweating and  Pt. with hemolytic anemia drugs
vasodilation hypersensitivity Skin: hypersensitivity  Educate the pt. About
Brand name:
 Inhibits CNS to drugs skin reactions the side effects of the
Bicillin L-A prostaglandins  Drug may Other: anaphylaxis, drug
synthesis with cause CDA sterile abscess at  Stay with pt. throughout
minimal effects on injection site whole duration of
peripheral administration.
prostaglandin  Monitor the client for
synthesis atleast 30 minutes after
administerion
 Instruct to report
difficulty of breathing,
rashes, severe pain at
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injection site, mout

sores, unusual bleeding
or bruising
 Monitor patient for
diarrhea and severe skin
reactions.
 Tell patient to report
adverse reactions
promptly
 Advice patient that
watery and bloody
stools with or without
stomack cramps and
fever may occur during
and up to two months or
more after antibiotic
use. Instruct the patient
to report these
symptoms as soon as
possible.
 Warn patient that IM
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injection may be painful

but that ice applied to
the site may ease
discomfort
 Tell patient to take
entire quantity of drug
exactly as prescribed,
even if feeling better.
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VI. NURSING MANAGEMENT
a. Nursing Diagnosis (Write five according to priority needs)
1. Acute pain r/t mucositis possibly evidenced by verbal reports of genital irritation, perineal or
pelvic pain, destructive and guarding behavior.
2. Impaired urinary elimination r/t urethritis as evidenced by verbalization of painful urination
and present of yellowish discharge.
3. Deficient knowledge regarding disease cause, transmission, therapy and self-care needs r/t
lack information, misinterpretation, denial exposure possibly evidenced by verbal statement of
concern questions, misconception, and inaccurate follow-though of instruction, developmental of
preventable complication.
4. Risk for infection r/t dissemination of bacteria (Neisseria gonorrhoeae)
5. Risk for impaired skin integrity r/t invasion of and irritation by pathogenic organisms.
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b. Nursing Care Plan (Develop 3 NCP from the 5 Nursing Diagnosis)

Data/Cues Needs Nursing Diagnosis Objective of Nursing Actions with Rationale Evaluation
Care
Subjective: P Acute pain r/t mucositis Within 1 day of Dependent Goal met
 Nausea H NI, the patient  Administer azithromycin as
After 1 day of NI, the
 Vomiting Y possibly evidenced by will be able to
prescribed
 Myalgia S report a relief of patient was able to report
 Dysuria I verbal reports of genital pain from the R- Azithromycin binds to the 235 Rna of the a relief of pain from the
O scale rating of
bacterial 505 ribosomal subunit. It stops
L irritation, perineal or 5 to 10 using scale rating of 1-10 to 10
Objective: O scale rating 0- bacterial protein synthesis by inhibiting the
 30 years old G pelvic pain, destructive 10
assembly of the 50s ribosomal subunit Goal Partially met
 2nd I
Trimester C and guarding behavior.  Administer cephalexin as After 1 day of NI, the
COMFORT
 GA: 27 wks prescribed patient was able to
R- Cephalosporins contain a beta lacram and report a relief of pain
Lab Results: Rationale:
dehydrothiaside and more resistant to the from the scale rating of
 STI test
• N. Tissue injury activates action of beta lactamase. Cephalexin inhibits 1-10 to 7
gonorrheae
nociceptive receptors bacterial cell wall synthesis, leading
• Chlamydia
trachomatis breakdown and eventually cell death. Goal Not me
 RPR test creating pain that
Within 1 day of NI, the
• titer of
1:32 resolves with Independent patient be able to report a
 TP-PA  Assess the degree of discomfort
underlying tissue relief of pain from the
• titer of
1:32 using verbal scaling of pain from 1- scale rating of 5
damage.
10
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R- It will help as a support of clues to the

severity of the pain , the necessity for the
effectiveness of intervention
 Monitor pt. vital sign
R- To monitor treatment progress
 Perform a comprehensive
assessment of pain to include
location, characteristics,duration,
frequency, quality, and severity.
R- To assess etiology/precipitating
contributory factor.
 Observe nonverbal cues like walks,
holds body, and sit
R- To evaluate patient’s response to pain
 Provide comfort measures like
change of position, relaxation, and
backrub.
R- to provide nonpharmacological
management
 Identify specific signs/symptoms and
changes in pain requiring medical
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follow-up.
R- To assist pt. to explore methods for
alleviation control of pain.
Teaching
 Educate and demonstrate to the
patent on how to properly clean the
perineal area
R- This will help with early identification to
provide necessary intervention and
prevention of any possible infection
 Educate the family for the importance
healthier lifestyle with the patient
R- to improve the patient’s diet , to include
nutrients needed to improve healing
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Care
Subjective: P Impaired urinary After 4 hours of Independent Goal met
 Nausea H
 Monitor rinary elimination After 4 hours of NI, the
 Vomiting Y elimination r/t urethritis NI, the patient
 Myalgia S including consistency odor, volume patient was able to report
 Dysuria I as evidenced by will able to
and color. improvement on urine
O
L verbalization of painful report R- These parameter help determine adequacy elimination
Objective: O
of urinary tract function.
 30 years old G urination and present of improvement in
 2nd I  Monitor pt. vital sign Goal Partially met
Trimester C yellowish discharge. urine After 4 hours of NI, the
COMFORT R- To monitor treatment progress
 GA: 27 wks
elimination  Limit ingestion of bladder irritant patient was able to report
like coffee, tes, alcohol, and slightly improvement on

Lab Results: Rationale:
 STI test chocolate urine elimination
• N. Bacteria that enter to
R- It has a natural diuretic effect and a
gonorrheae
the body causing sexual Goal Not met
• Chlamydia bladder irritant
trachomatis After 4 hours of NI, the
transmitted disease  Emphasize important of having
 RPR test
patient was not able to
• titer of good perineal hygiene
1:32 report improvement
R- To reduce the risk of infection
 TP-PA urine elimination
• titer of  Perform a comprehensive
1:32
assessment of pain to include
location, characteristics,duration,
frequency, quality, and severity.
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R- To assess etiology/precipitating
contributory factor.
 Observe nonverbal cues like walks,
holds body, and sit
R- To evaluate patient’s response to pain
 Provide comfort measures like
change of position, relaxation, and
backrub.
R- to provide nonpharmacological
management
 Identify specific signs/symptoms and
changes in pain requiring medical
follow-up.
R- To assist pt. to explore methods for
alleviation control of pain.
Dependent
 Administer azithromycin as
prescribed
R- Azithromycin binds to the 235 Rna of the
bacterial 505 ribosomal subunit. It stops
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bacterial protein synthesis by inhibiting the

assembly of the 50s ribosomal subunit
 Administer cephalexin as
prescribed
R- Cephalosporins contain a beta lacram and
dehydrothiaside and more resistant to the
action of beta lactamase. Cephalexin inhibits
bacterial cell wall synthesis, leading
breakdown and eventually cell death.
Teaching
 Educate and demonstrate to the
patent on how to properly clean the
perineal area
R- This will help with early identification to
provide necessary intervention and
prevention of any possible infection
 Educate the family for the importance
healthier lifestyle with the patient
R- to improve the patient’s diet , to include
nutrients needed to improve healing
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Care
Subjective: L Deficient knowledge After 3-4 hours Independent
 Nausea O regarding disease of NI, the  Provide physical comfort for the
 Vomiting V cause, transmission, patient will
 Myalgia E learner.
therapy and self-care identify risk
 Dysuria &
needs r/t lack factors of the R- This allows pt. to concentrate on what is
B
E information, disease process being discussed or demonstrated. According
Objective: L misinterpretation, and how to
to Maslow’s theory, basic physiological
 30 years old O denial exposure prevent
 2nd N possibly evidenced by worsening of needs must be addresses first.
Trimester G verbal statement of symptoms
I  Provide quite atmosphere without
 GA: 27 wks concern questions,
N interruption
G misconception, and
N inaccurate follow- R- This allows pt. to concentrate more
Lab Results:
 STI test E though of instruction, completely
• N. S developmental of
S  Provide an atmosphere of respect,
gonorrheae preventable
Intimacy
• Chlamydia complication. openness, trust, and collaboration.
trachomatis
R- This is especially important when
 RPR test Rationale:
• titer of providing education to patients with different
1:32 Lack of prenatal care, values and beliefs about health and illness.
 TP-PA
• titer of and lack of exposure to  Establish objectives and goals for
1:32
learning at the beginning of the
learn about the disease
session.
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R- This allows learner to know what will be

discussed and expected during the session.
 Allow learner to identify what is
most important to him or her.
R- This clarifies learner expectations and
helps the nurse match the information to be
presented to the individual’s needs.
 Explore attitudes and feelings
about changes
R- This assists the nurse in understanding
how learner may respond to the information
and possibly how successful the patient may
be with the expected changes
 Assist the learner in integrating
information into daily life.
R- This helps learner make adjustments in
daily life that will result in the desired
change in behavior.
 Encourage repetition of
information or new skill.
R- This is to assists in remembering.
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 Provide positive, constructive

reinforcement of learning.
R- A positive approach allows learner to feel
good about learning accomplishments, gain
confidence, and maintain self-esteem while
correcting mistakes.
 Document progress of teaching and
learning.
R- This allows additional teaching to be
based on what the learner has completed,
thus enhancing the learner’s self-efficacy and
encouraging most cost-effective teaching.
Teaching
 Educate the patient about the
condition se have
R- To provide information
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VII. EVALUATION AND IMPLICATION OF THE CASE TO:
a. Nursing Practice
This case analysis will help student nurse and staff nurse identify what managements or
interventions that are needed for the mother that serves as basis top priorities, and assess nursing
actions regarding those priorities.
b. Nursing Education
It will help the learners determine specifically, why gonorrhea in pregnancy associated with
spontaneous miscarriage pre-term birth. It will serve as a guide for the learners to gain
knowledge on how to identify the nursing management of the situation or gain knowledge about
the condition which is gonorrhea in pregnancy.
c. Nursing Theory
Callista Roy’s Adaptation Model is the theory that is applicable in this case. This model sees the
person as a biopsychological being in continuous interaction with a changing environment to
promote physiological integrity. In relation to this case, patient is in constant interaction with a
changing environment like how she will interact with nurses to relate in the management
provided to her.
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VIII. RECOMMENDATION/REFERRALS/FOLLOW-UPS
A. The Patient
 Educate
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Cotabato Medical Foundation College, Inc

Quezon Ave. Poblacion 8, Midsayap, Cotabato

GONORREA DURING PREGNANCY

Semester SY: 1st Semester 2021-2022

Gonorrhea in pregnancy is associated with spontaneous miscarriage pre-term birth and

endometriosis in the postpartum period pregnant women cannot be administered doxycycline

and dysuria. Abdominal ultrasound confirmed an intrauterine pregnancy of 27weeks gestational

penicillin G 2.4 million units (mU) IM once a week for 3 weeks.

Vallar, RN, MAN.

A 30-year-old Micronesian woman, gravida 2, para 1, presented to the emergency

treated with ceftriaxone 1 g intravenously (IV) every 24 hours.

of oral azithromycin was administered in addition to IV ceftriaxone. A nontreponemal syphilis

Treatment for syphilis was held pending TP-PA test results.

completed a congenital syphilis treatment regimen of aqueous crystalline penicillin G 50,000

her partner for evaluation and treatment.

(CDC) recommends 3 weekly IM injections of 2.4 mU benzathine penicillin G.2 Although it

should be restarted, even if maternal nontreponemal titers decline appropriately, as occurred in

including STIs, based on socioeconomic factors.7,8 Overcoming barriers requires collaborative

efforts to link patients to housing and medical/social services.

Adequate treatment of syphilis during pregnancy is an established evidence-based

Preventive Service Task Force's recommendations.12 In addition, while hospitalized at 27 weeks

syphilis to maternal and infant health.

A 30 years old Micronesian pregnant woman

Past Medical History

• Nausea and vomiting

• Intrauterine pregnancy was diagnosed by pelvic ultrasound

• Not screened with STI screening

• Referred for prenatal care

• Abdominal ultrasound confirmed an intrauterine pregnancy

• Diagnosed with presumptive pyelonephritis

2 years earlier, during last pregnancy

• Syphilis serology was a non-reactive RPR

• Physical examination revealed no skin rashes, or genital, perianal, or oral lesions.

• Began treatment for latent syphilis

• Diagnosed with trichomoniasis

• Treated for trichomoniasis

• Restart in the syphilis treatment regimen

• Presented to the hospital in labor

• Delivered a female infant via SVD

• Tested positive for gonorrhea, chlamydia, and trichomoniasis

• Retreated for gonorrhea, chlamydia, and trichomoniasis

3 weeks after delivery

• Pt. complete 3-week treatment regimen.

• Benzathine penicillin G 2.4 million units (mU) IM weekly for 3 weeks

• Cephalexin 500 mg PO QID for 14 days

Woman, Micronesian, married, 3 years old

At Emergency Department of local

Past Medical History • nausea

• syphilis serology was

• seen for nausea and Physical assessment

• intrauterine pregnancy was

• not screened with STI

• referred for prenatal care

• abdominal ultrasound  39 weeks GA

confirmed an intrauterine • presented to the hospital in

Nontreponemal syphilis • tested positive for gonorrhea,

serology test [Rapid Plasma chlamydia, and trichomoniasis

Reagin (RPR)] was reactive

with a titer of 1:32

• TP-PA test result

quantitative VDRL titer was

• treated for trichomoniasis

• restart in the syphilis