As you are questioning her she reports the pain is getting worse and going from intermittent to constant. She states she has no prior medical conditions, no allergies, she is taking oral birth control pills, ate a health breakfast, and begin feeling the dull pain just after lunch. She denies being pregnant. She is starting to guard and feels more comfortable laying right lateral recumbent in a fetal position.What additional history questions would you ask? Explain what assessment procedures you would perform in this situation. After some more questioning you find out she has never had appendicitis or appendectomy. She admits to being sexually active although she “takes precautions”. Her LMP was 4 weeks ago and she states she had decreased menstrual flow but doesn’t think that is out of the ordinary. Your abdominal assessment reveals a rigid abdomen with rebound tenderness over the right lower quadrant. You reassess vital signs and find a normal BP (128/76), elevated pulse rate (108), and slight increased respirations (28). She looks pale and diaphoretic. Is there any additional questions you would ask based upon this information? Based upon this new information, what is your current diagnosis? Has it changed? Who (or where) would you refer this athlete to in this situation? Upon further questioning you find out she started spotting vaginally a couple of hours ago. She also finally reports she was diagnosed with PID three years ago. She reports her pain is getting worse (10/10). What is your final diagnosis? Based upon this new diagnosis, what course of treatment/referral would you recommend (be thorough)?
