A woman presents with increasing lower abdominal pain, fever, and abnormal menses for several months, and she is aware that her husband has had multiple sex partners in the past two years. What is the most appropriate nursing intervention?

• A. Arrange to have the client referred for medical evaluation for pelvic inflammatory disease (PID) and appropriate intervention and treatment.
• B. Contact the health department to confirm the spouse's diagnosis of Chlamydia infection to determine the client's exposure, give the client antibiotics, and have her return to the clinic if symptoms worsen.
• C. Provide sexually transmitted disease (STD) prevention and treatment education and refer the client to the health department for STD screening for gonorrhea and/or Chlamydia infection.
• D. Provide nonsteroidal antiinflammatory drugs and discharge instructions.

Answer: (A)

Suspected pelvic inflammatory disease is the key issue here. When a patient has increasing lower abdominal pain, fever, and abnormal menses along with a history suggesting exposure to sex with multiple partners, an upper-genital tract infection must be considered. PID can ascend from the cervix to the uterus and fallopian tubes, and delaying treatment raises the risk of infertility, ectopic pregnancy, and chronic pelvic pain. The best nursing action is to arrange for the client’s medical evaluation for PID and ensure appropriate intervention and treatment are started promptly. This typically involves a pelvic exam with diagnostic testing and empiric antibiotics to cover common pathogens such as gonorrhea and chlamydia, with plans for ongoing management and partner notification as indicated.

Starting antibiotics or giving education or screening alone would not address the acute infection, and treating based on a partner’s status without the patient’s own evaluation could miss other conditions or delay needed care. NSAIDs and discharge instructions neglect the antimicrobial therapy needed to treat PID and prevent complications.