WestCoast NURS664B Week 1 Discussion Latest 2022 October

NURS664B Primary Care Women's Health Theory

Week 1 Discussion

Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example, #2 a post-menopausal 57-year old woman.

Discuss what questions you would ask the patient, what physical exam elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals, and other team members needed to complete patient care.

Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas. Please refer to evidence-based guidelines to support your decision-making.

In your peer replies, please reply to at least one peer who chose a different case study.

1.  A 29-year-old woman G0P0 comes to your clinic and complains of trying to conceive with her husband for over a year. She reports no prior health problems or surgeries. Her height is 5'6" and her weight is 165 lbs. with a BMI of 26.63. Her vital signs are WNL. Her LMP was 2 months ago, but she reports they have never really been regular since menarche (coming approximately every 6 weeks for the first 10 years), but have been irregular (coming at random intervals—sometimes 1 month, 2 months, or 3 months apart) for approximately 7 years. Her pregnancy test is negative. Upon physical examination, you note some acne and hirsutism on her face, as well as acanthoses nigricans on her neck. All other physical exam aspects are WNL.

What are your differential diagnoses?

What is your plan of care, and why?

What patient education is pertinent during this visit?

2.  A post-menopausal 57-year-old woman complains of intermittent, slight vaginal bleeding and vague pelvic pain unrelated to intercourse that has been occurring for approximately four months. She has been post-menopausal for five years and denies other health problems. Her vital signs are all WNL. She does not take any medications or hormones.

What additional information do you need to obtain?

What are your differential diagnoses?

What is your plan of care, and why?

3.  A 58-year-old woman presents for her annual well-woman examination. She reports that she started having (vaginal) spotting about 3 months ago, “I thought maybe I was having one last period,” and has had increased urinary frequency over the past 2 to 3 months. She denies any constitutional symptoms, and denies pelvic pain. Her past medical history is notable for hypothyroidism, hypercholesterolemia, hypertension, and type II diabetes. Family history is notable for father with lung cancer, mother with uterine cancer, and maternal first cousin with colon cancer. She is obese but is exercising regularly. She reports one abnormal Pap smear about 15 years ago, which was worked up, and “normalized” after follow-up Pap smears without any surgery. Her last Pap smear was about 4 or 5 years ago and she recalls it was negative; she was told that she didn’t have to have any more Pap smears. She went through menopause at 54 years of age, used combination hormone replacement therapy (HRT) for 2 to 3 years, discontinued 2 years ago. Vital signs: Height 158 cm; Weight 78.0 kg; BMI 31.2; BP 148/88 mmHg; Pulse 84; Respirations 18; Temp 36.6°C. Physical exam notable for normal cardiovascular, respiratory, skin, musculoskeletal; abdomen obese, soft, non-distended, non-tender; pelvic exam notable for normal female genitalia, no lesions; vagina and cervix normal, no discharge or blood in vaginal vault; bimanual exam notable for no tenderness on exam; uterus somewhat globular, approximately 10 to 12 weeks size; ovaries non-palpable.

Which test/study will you want to obtain first?

Which risk factor contributes most to this woman’s risk for endometrial cancer?

The results of the endometrial biopsy return as endometrioid adenocarcinoma FIGO grade I to II. What will you want to do next?

What suggestions can you give her to improve her successful post-hysterectomy adjustment?