Scenarios

Scenario  C

 Preventative Guidelines

This discussion aims to elaborate on preventatives guidelines and its application towards two homeless individuals: the first case is a 72-year-old African American female whom you have seen many times. Today she complained of some breast tenderness due to a fall she took with her grocery cart a couple of weeks ago. While examining Eleanor’s breast, you took the opportunity to do a manual breast exam. Eleanor said it had been at least 30 years since she had had a breast exam and never had a mammogram. The last one, a 48-year-old female, is concerned that she has an STI. During Sally’s pelvic exam, you learned that she lived in a tent under a bridge downtown for about a year. Sally is eager to talk to someone and tells you that she used to work in a medical office as a receptionist, but that was a long time ago before she diagnosed with bipolar disorder. You are concerned that Sally does have an STI, and you ask about her medical history. After quite a story, Sally tells you she had a mammogram about two years ago before she left Texas, and there was a place the doctor wanted to evaluate further, but she never went back for the ultrasound. By using the knowledge of preventatives guidelines, we will tempt to bring answers to the following questions:

1-Discuss the guidelines assigned to your scenario.

2-Will, both patients are treated in the same manner? Why or why not?

3-What would your treatment plan be for each of the individuals in your scenario

The United State prevention task force (2016) summarized its recommendation to prevent breast cancer in women as follow: Women between 50 to 74 year-0ld, biennial screening mammography is recommended. Before 50 years old, the decision to start the screening is individually based, the individual who decided to do so would focus more on the benefit than the potential harms and start a biennial screening between 40 to 49-year-old. Beside early screening before 50 of age increase the risk of over-diagnosis and overtreatment, women with a parent, sibling, or child diagnosed with breast cancer are at high risk; therefore, they benefit from early screening in their 40s. Women 75-year-old and more the evidence of benefit and harm for mammography are insufficient and not recommended at this age.

After fall, the 72-year-old African American presented for breast pain had her last mammography at 42 and never returned to the clinic for follow up. Based on the USPFTF guidelines after shared decision-making, she could benefit from a mammography today. On the other hand, the 48-year-old even did not come for breast cancer screening because her last mammography necessitated further evaluation, which she did not complete, leading to the obligation to have a mammography done for better understanding. Both cases will necessitate breast cancer screening, and their criteria for investigation vary based on their demography and clinical history.

The 48 year- old besides breast cancer screening could take the opportunity to screen for disease and education that would promote her health state and to prevent some diseases. According to Medline Plus (2020), This approach would be centered on four aspects:

1- Screening for medical issues (Hypertension, Diabetes, Hypercholesterolemia, cervical cancer, Sexually transmissible diseases such as syphilis, chlamydia, HIV, gonorrhea, hepatitis B and C and other infections

2- Access her risk for future medical issues (Bipolar evaluation and Management, dental and eyes evaluation)

3- Encourage healthy lifestyle (good eating Habit, exercise smoking, counseling alcohol and drug abuse, counseling avoid risky behavior)

4- Update vaccination

The 72-year-old would take advantage of this visit to be screened for hypertension, diabetes, hypercholesterolemia, colon cancer, bone density test, eye evaluation, fall prevention, hearing test, dental examination, vaccination for Flu, Pneumonia, shingles vaccine, and updated other vaccination. Education healthy lifestyle, exercises, avoiding alcohol, drug abuse (AAFP, 2017).

 

Scenario D

The purpose of this post is to discuss two women presenting for a cervical screening for different reasons. The first patient is a 31-year-old African American who is being seen before deployment and is reporting symptoms of enlarging bumps around her vagina after being sexually assaulted on board her ship six months ago. The second patient is a 67-year-old who has been married for 42 years and has a history of breast cancer with a mastectomy at the age of 52. Both of these women are at risk, but for different reasons, and therefor require individual plans of care. Guidelines that should be followed for both patients are cervical cancer screenings, For the first patient, sexually transmitted infection screening guidelines and breast cancer screening guidelines should also be followed due to her age and situation. This post will focus on the cervical cancer screening aspect.

There are two types of screening for cervical cancer prevention: the Pap smear and the human papillomavirus test (Centers for Disease Control and Prevention [CDC], 2019). Because there are different guidelines for each test and patient population, both patients will not likely receive the same plan of care regarding cervical cancer. According to the United States Preventive Services Task Force (2018), women aged 21 to 65 should receive cervical cancer screening every three years with cervical cytology, while women aged 30 to 65 should receive additional high-risk human papillomavirus screening every 5 years. For women over 65, there is not recommended cervical cancer screening, unless screening previously had be inadequate or a woman is at increased risk for developing cervical cancer (United States Preventive Services Task Force [USPSTF], 2018). Women at increased risk for developing cervical cancer include "HIV infection, compromised immune systems, in utero exposure to diethylstilbestrol, and previous treatment of high-grade precancerous lesion or cervical cancer" (USPSTF, 2018).

With this information, the plan of care for both patients is different, as the recommendation would be to screen the first patient and not the second patient. Because the first patient is 31, it is recommended that she gets screened every three years with cervical cytology and every five years with high-risk human papillomavirus testing (USPSTF, 2018). For the second patient, the recommendation is to not screen her, as she is over 65 years old and has no current risk factors. The plan of care for the first patient is much more extensive than the second patient at this time, because she is displaying symptoms, as well as recently experiencing something very traumatic.

For the first patient, I would first attempt to listen, I would tell her that I am not going to judge her and I am here with my only purpose to support her. I would educate her that unfortunately, what she experienced is something that is fairly common, and that she is not alone. "In 2018, about 20,500 service members had experienced sexual assault, which is an increase of 38% over the two years prior ([email protected], 2019). This is not a good thing, but it is the reality and it needs to be spoken about more often. I would then ask the patient if she would allow me to screen her for both cervical cancer, but also assess her symptoms and go from there. I would explain every single step of the way, and I would reassure her that she did the right thing by telling me. I would make sure she felt comfortable and supported.

For the second patient, I would simply educate her on the guidelines and on her situation of not needing to be screening. I would ask her if she was having any symptoms or concerns. I would support the patient any way that she needed, but in regards to cervical cancer screening, she would not need any at this time. Overall, both patients need to very different plans of care, but overall, offering support, a listening ear and providing education to both my patients would be priority at this time.

Two references each , APA format, atleast  7-8lines