NURS 6551 Week 5 Discussion latest

NURS 6551 Week 5 Discussion latest

NURS 6551 Week 5 Discussion latest

Week 5 Discussion: Diagnosing and Managing Gynecologic Conditions

Gynecologic conditions can be difficult to diagnose for a variety of reasons, including overlapping symptoms, lack of patient knowledge, or even patient fear or embarrassment about sharing information. Your role provides you the opportunity to develop a relationship of trust and understanding with these patients so that you can gather the appropriate details related to medical history and current symptoms. When caring for this patient population, it is important to make these women an integral part of the process and work collaboratively with them to diagnose and develop treatment and management plans that will meet their individual needs. For this Discussion, consider diagnosis, treatment, and management strategies for the patients in the following four case studies:

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Case Study 1:

A 32-year-old African American female is concerned about increasing dysmenorrhea over the past three years. In the past year, this was associated with painful intercourse. She has been in a monogamous relationship with one male partner for the past five years. They tried to have children without success. Menarche was at age 10; menstrual cycles are 21 days apart and last for 6–7 days. The first day of her last menstrual period was 10 days ago and was normal. She denies vaginal itching or discharge. On gynecologic exam there was no swelling, external lesions, or erythema, urethral swelling, or vaginal discharge. Cervix is pink without lesions or discharge. Uterus was small, retroverted, and non-tender. Adnexa were small and non-tender. Nodules are noted along the cul de sac. NURS 6551 Week 5 Discussion latest

Case Study 2:

A 42-year-old African American female is in the clinic for a routine gynecologic exam. When asked, she admits to noticing bleeding in between her menstrual periods for the past several months. She has been pregnant three times and has three children. She is sexually active with one male sex partner in a monogamous relationship. During her bimanual exam, you note an irregular intrauterine non-tender mass about 4 cm in diameter. The mass is palpable abdominally. The remainder of her gynecologic exam was normal. NURS 6551 Week 5 Discussion latest

Case Study 3:

A 48-year-old Caucasian female is in the clinic concerned about prolonged menstrual bleeding for three weeks now. Her prior menstrual periods have been irregular for the past eight months, lasting no more than three days each. There have been one to two months when she had no menstrual cycles at all. She reports occasional hot flushes and mood swings. NURS 6551 Week 5 Discussion latest

Case Study 4:

A 16-year-old Caucasian female comes to the clinic concerned because she has not had a menstrual period for three months. She’s a junior in high school and active in sports. She has lost about 10 lbs. in the past two months. She is currently 5 ft. 4 in. and weighs 100 lbs.

To prepare:

Review Chapter 26 of the Schuiling and Likis text and Chapter 7 of the Tharpe et al. text.

Review and select one of the four provided case studies. Analyze the patient information.

Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.

Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.

Consider strategies for educating patients on the treatment and management of the sexually transmitted infection you identified as your primary diagnosis.

Week 6 Discussion: Breast Conditions

Throughout a woman’s life, her breasts go through many normal, healthy changes. However, patients do not always understand these changes and often visit health care providers for treatment. When examining these patients, you must be able to identify when a breast condition is the result of a safe and normal physiological change and when it is the result of an abnormal change requiring treatment and management. A diagnosis of a breast condition resulting from an abnormal change can be devastating for women, making emotional support as vital to women’s well-being as proper assessment, diagnosis, and management. For this Discussion, consider how you might diagnose, manage, and support the following two patients presenting with breast conditions:

Case Study 1:

You are seeing a 60-year-old Latina female, Gravida 4 Para 3104, who is concerned about a thick greenish discharge from her left breast for the past month. The discharge is spontaneous and associated with dull pain and burning. Upon questioning, she also tells you that she breastfed all her children and is currently not on any medications except for occasional Tylenol for arthritis. Her last mammogram, 14 months ago, was within normal limits. On exam, her left breast around the areola is slightly reddened and edematous. Upon palpation of the right quadrant, a greenish-black discharge exudes from the nipple. You note an ovoid, smooth, very mobile, non-tender 1 cm nodule in the RUIQ at 11:00 5 cm from the nipple. No adenopathy, dimpling, nipple discharge, or other associated findings. Her right breast is unremarkable. The patient expresses her desire to proactively decrease her risk for developing breast cancer.

Case Study 2:

You are seeing a 53-year-old African American female for a lump she found in her right breast two weeks ago in the shower. Her last mammogram was three years ago and she was told it was “benign.” She had two breast biopsies at ages 32 and 34 in her right and left breasts, respectively. At both times she had surgery for removal of fibroadenomas. She does not routinely do breast self-exams. Her mother had a mastectomy for breast cancer at age 63, and she heard that a paternal aunt had a breast removed for cancer when she was in her forties. Both mother and aunt are alive and well today. It was discovered on postmortem exam that her grandfather had prostate cancer. Menarche was at age 15 and she is still having monthly menses. She is Gravida 4 Para 3104 with her first childbirth at age 31. She was on oral contraception for 10 years, has no history of fertility treatments, and had a bilateral tubal ligation after the birth of her last child at age 35. Past medical history is noncontributory. She wants to know how likely it is that she will get breast cancer. Physical exam reveals breasts are symmetrical with no dimpling, retractions, or rash. Her right breast has a 2 cm non-tender, hard, fixed mass at 3:00 6 cm from her nipple. Left breast is non-tender without masses. No nipple discharge bilaterally. No anterior cervical, infra- or supraclavicular, or axillary adenopathy.

To prepare:

Review Chapter 15 of the Schuiling and Likis text.

Review and select one of the two provided case studies. Analyze the patient information.

Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.

Reflect on the appropriate clinical guidelines. Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.

Consider strategies for educating patients on the treatment and management of the disorder you identified as your primary diagnosis.

Week 7 Discussion: Care Plans for Pregnancy

After confirming and dating a pregnancy, you must collaborate with patients to develop a personalized care plan. These pregnancy care plans are integral to prenatal care as they help to ensure the mother and child’s well-being throughout the entire pregnancy. Pregnancy can be a wonderful, yet difficult time for women as a woman’s body goes through many physical, mental, and emotional changes that might be challenging or even overwhelming for some. Whether or not these women share their concerns, as the advanced practice nurse, you must routinely watch for signs and symptoms of any developing physical or mental health issues. By collaborating with patients and discussing concerns, you can modify care plans and often address potential issues before they become a significant health problem. For this Discussion, consider pregnancy care plans for the women in the following case studies:

Case Study 1:

On 1-15-13, you are seeing a 25-year-old Caucasian female in the clinic because she believes she’s pregnant. Her LMP was 12-1-12. Her home pregnancy test was positive, and she has been having nausea and breast tenderness.

Case Study 2:

You are seeing a 28-year-old African American female, G6 P 3115, who is currently on oral combined hormonal contraception. She’s here because she and her partner would like to have another child. She heard “it takes a while to become pregnant after being on the Pill,” so she discontinued them three months ago. They haven’t been using any contraception since then. Upon questioning, she states that on the Pill, sometimes her menstrual periods are very light and once she didn’t have one at all. Her urine pregnancy test in the clinic is positive. Her LMP was 7-14-12. You are seeing her on 12-3-12.

To prepare:

Review Chapter 30 of the Schuiling and Likis text and Chapter 2 of the Tharpe et al. text.

Review and select one of the two provided case studies. Analyze the patient information.

Consider how to date the pregnancy and estimate the date of delivery for the patient in the case study you selected.

Based on the dating of the pregnancy, reflect on the appropriate clinical guidelines for procedures and screenings. Think about the implications of any missed procedures or screenings.

Determine a plan of care for the patient. Identify procedures, screenings, diagnostic testing, pharmacologic and nonpharmacologic treatments (if appropriate), management strategies, and patient education.

 

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