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Questions that would be important to include when interviewing the patient
The important questions to include when interviewing a patient with ovarian torsion must include the patient’s history and physical encounters. A complete medical history, allergies, and the current medications are key elements to include. Questions regarding the symptoms of the illness would also be essential in the determination of the severity of the diseases (Kawashima, Wada, Koizumi, Yamamoto, Minowa, Suzuki & Fujino, 2013. An family nurse practitioner can ask if there was the presence of adnexal mass, whether the patient has gynecological or obstetric diseases, is the patient pregnant, patient continuing with infertility treatment or on prior adnexal mass. A physical examination includes; examination of the abdomen and the pelvis on sexually active females, vital signs which include fever. Before undertaking the examinations, consent must be obtained.
Some examples of questions are:
·Why are you considering help at present time?
·Are you experiencing pain?
·Please describe your pain a scale of 0 to 10
·How you could define your pain?
·Did the pain radiate and if it is the case, where?
·When the pain started?
·Any triggers, anything that make it better or worse?
·Please describe other signs or symptoms that you are presenting
·Are you being involved in recent vigorous activity?
Possible clinical findings
Clinical findings that may be present in a patient with ovarian torsion include hypertension, tachycardia or hypotension. Out client has a right lower quadrant (RLQ) abdominal pain accompanied of abdominal tenderness, guarding, and nausea. Patient presented tachycardia and has history of treatment for sterility being treated at present time with hormonal-stimulation fertility injections. LMP three weeks ago. She is G0P0. Most of the clinical findings lead us to ovarian torsion that is characterized by unilateral pelvic pain, that usually start rapidly and often extents to the groin. Vomiting and nausea can be frequent. Other findings can include enlargement of the ovary (adnexal torsion) (Huchon, C., Dumont, A., & Fauconnier, A., 2014)
Diagnostic studies that should be ordered on the patient are:
– Laboratory testing such as CBC and pregnancy test to determine if the patient is gravid, check the hemoglobin level, white blood cell count, urinalysis and test for sexually transmitted infection.
– Radiology imaging using the Doppler flow to help in ruling out ectopic pregnancy, appendicitis, and ovarian cyst.
– CT and MRI used in determining causes of pelvic and abdominal pain and may show enlarged and edematous ovary, pelvic free fluid, lack of IV contrast due to blocking of the ovarian tube and abnormal location of the ovary. All these are signs consistent with ovarian torsion.
– Sonographic findings which include painful, rounded and enlarged ovary on the ipisilateral side, ovarian mass, and heterogeneous stroma always associated with ovarian torsion (Gerscovich, Corwin, Sekhon, Runner & Gandour-Edwards, 2014).
Primary and differential diagnoses
All these differential diagnoses are carried out to differentiate the mass present in the patients’ abdomen and rule out as life threats. That is, to broaden the differential diagnoses, gastrointestinal causes of pain, as well as gynecologic, are undertaken. On this patient these three were considered:
-Ectopic pregnancy because patient comes in with suddenly RLQ pain, and receiving treatment for infertility)
-Ruptured ovarian cyst because patient comes in with sudden-onset of abdominal pain and the US shows enlarged right ovary with no blood flow.
-Appendicitis is considered because patient comes in with RLQ pain, nausea and rebound tenderness.
The primary diagnosis for this patient was ovarian torsion. It is considered to be a situation that causes acute lower abdominal pain in a woman. The situation is always associated with the reduced return of venous form an individual ovary being a result of internal hemorrhage, hyper stimulation or stromal edema. Therefore, the major objective of this section is to indicate some important questions that can be asked in an interview with an individual who is considered to be suffering from ovarian torsion (Kawashima, A., Wada, S., Koizumi, A., Yamamoto, M., Minowa, K., Suzuki, Y., & Fujino, T., 2013)
Management plan for patients with ovarian torsion
Management of the ovarian torsion must be effective to help alleviate the effects of decreased blood flow to the ovary. This is to prevent complications such as sepsis and peritonitis and possible infertility (Azurah, Zainol, Zainuddin, Lim, Sulaiman & Ng, 2014). Treatment is done using broad-spectrum antibiotics; a possible surgical correction can also be a solution. Furthermore, medication of the patient as well as her diet is considered a vital aspect in the management of ovarian torsion. Therefore, an individual should always stick to prescribed medication and ensure that she eats a balanced diet thus effectively and efficiently managing this situation. In addition, it is advisable that individuals should always seek medical attention in case they see the signs of this ovarian torsion.
Azurah, A. G. N., Zainol,. A., Lim, P. S., Sulaiman,,& Ng, B. K. (2014). Update on the management of ovarian torsion in children and adolescents. World J Pediatr, 11(1), 35-40.
Gerscovich, E. O., Corwin, M. T., Sekhon, S., Runner, G. J., & Gandour-Edwards, R. F. (2014). Sonographic appearance of adnexal torsion, correlation with other imaging modalities, and clinical history. Ultrasound Quarterly, 30(1), 49-55.
Huchon, C., Dumont, A., & Fauconnier, A. (2014). Triage using a self-assessment questionnaire to detect life-threatening emergencies in gynecology. World Journal of Emergency Surgery, 9(1), 46.
Kawashima, A., Wada, S., Koizumi, A., Yamamoto, M., Minowa, K., Suzuki, Y., & Fujino, T. (2013). The clinical management of ovarian torsion: case series of 66 patients. Japanese of Gynecologic as Well as Obstetric Endoscopy, 29(1, 264-270)
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