Female Genitourinary & Musculoskeletal
Female Genitourinary & Musculoskeletal
Bermadean Pratt-Mends
St Thomas University
NUR 504-AP2
Dr. Quintana
4/25/24
Case Study # 3
1. What other subjective data would you obtain?
When a patient is experiencing pain, it is vital to gather information such as when it started, how long it has been present, and its character and intensity. It is also helpful to identify any exacerbating or alleviating factors, the location of the pain, and any areas where it radiates. Inquiring about activities or movements that worsen or relieve the pain is also essential. Additionally, any accompanying symptoms, such as numbness, tingling, weakness, or changes in bowel or bladder function, should be noted, as these can indicate nerve compression or involvement that may require urgent attention (Vilella & Reddivari, 2023). Information about past injuries, surgeries, or medical conditions can also guide treatment.
2. What other objective findings would you look for?
Other objective information to gather includes a physical examination to check the spine, hips, and lower extremities for any physical signs of nerve involvement or structural abnormalities. Neurological assessment measures muscle strength, sensation, reflexes, and nerve function in the affected leg. Imaging studies, such as X-rays, MRI, or CT scans, help identify structural abnormalities such as disc herniation, spinal stenosis, or degenerative changes (Vilella & Reddivari, 2023). Laboratory tests, such as a CBC, ESR, or CRP, may be required to rule out infectious or inflammatory causes
3. What diagnostic exams do you want to order?
Imaging studies to order include X-rays, MRI, or CT scans of the lumbar spine. These provide detailed anatomical information to identify structural abnormalities such as disc herniation, spinal stenosis, or degenerative changes. (De Sire et al., 2022).
4. Name three differential diagnoses based on this patient’s presenting symptoms with rationales.
Three differential diagnoses can be concluded. Lumbar disc herniation occurs when the inner core of the intervertebral disc protrudes outward and compresses nearby nerves. Pain radiating from the lower back to the leg, often called sciatica, is a classic symptom of lumbar disc herniation. The pain typically follows a dermatomal pattern corresponding to the affected nerve root (Vilella & Reddivari, 2023). Physical examination findings may include decreased sensation, muscle weakness, and abnormal reflexes in the affected leg. Lumbar Radiculopathy (Sciatica): Irritation or compression of lumbar nerve roots causes pain that radiates from the lower back down the leg, often following a specific dermatomal distribution. Lastly, Facet Joint Syndrome (Lumbar Facet Arthropathy), Degeneration or inflammation of facet joints can lead to pain that may radiate to the buttocks and down the back of the thigh (Vilella & Reddivari, 2023).
5. What teachings will you provide?
Several self-management strategies can be followed for patients with muscular conditions to alleviate symptoms and improve function. These strategies include maintaining good posture, modifying activities, using heat and cold therapy, practicing relaxation techniques, and using over-the-counter medications and topical treatments (Bennie et al., 2020). Patients should be aware of “red flag” symptoms that may indicate a more serious underlying condition and require immediate medical attention, such as severe or worsening pain, loss of bowel or bladder control, or progressive leg weakness. Conservative treatments like physical therapy, chiropractic care, acupuncture, or epidural steroid injections may help alleviate symptoms (Bennie et al., 2020). Surgery may be considered if conservative treatments fail to provide relief or if there is significant nerve compression causing progressive weakness or loss of function. Patients should also adopt lifestyle modifications such as regular low-impact exercises like walking or yoga, maintaining a healthy weight, quitting smoking, staying hydrated, and incorporating nutritious foods into their diet (Bennie et al., 2020). Lastly, patients can connect with others experiencing similar challenges, share coping strategies through local or online support groups, and learn more about managing their condition through reputable sources of information.
Female Genitourinary, & Musculoskeletal Case Study One
Alexandra Collins
St. Thomas University
NUR 504 AP2 Advanced Health Assessment
Professor Geisly Quintana
April 21, 2024
Case Study
In case study one, a 55-year-old year old African American female presents with complaints of, “I have a tumor on my left breast”. She reports a familial history of breast cancer in her grandmother diagnosed at age 76. She reports taking hormonal birth control since the age of 20. However, she denies taking hormonal replacements. Physical examination reveals a 5mm nonmobile, non-tender, left breast nodule at the 10 o’clock position.
Subjective Data
Subjective symptoms of breast cancer include breast lumps, as noted I the patient in case study one. The discovery of new breast lumps is the most reported symptom in those diagnosed with breast cancer. Approximately 83% of breast cancer cases are discovered upon the discovery of a breast nodule. Non- breasts lump related symptoms of breast cancer include nipple abnormalities, breast pain, back pain, and weight loss. On in six women diagnosed with breast cancer present with symptoms other than breast lumps. Therefore, further emphasis on breast cancer symptom recognition signs is warranted (Ferguson, 2023).
Objective Data
When performing an exam for possible breast cancer, the examiner should have the patient lay in supine position. The examiner should inspect the breast for overall size, shape, texture, and color. Breast palpitation allows the examiners to assess the breast for lymph node abnormalities. Masses should be noted by number, location, texture, and mobility (Ferguson, 2023).
Diagnostic Exams
Diagnostic testing for breast cancer begins with preventive mammography. Diagnostic mammograms reveal both benign and malignant breast abnormalities. Mammograms can detect early signs of breast cancer before the onset of symptoms occur, allowing for early diagnosis and treatment. The American Cancer Society recommends mammography screenings every one to two years for women ages 40 and over. Breast ultrasonography can be used to assess breast lesions and can identify lesions missed in a mammogram. An MRI can be used in conjunction of mammography to examine neoplasms of the breast. Along with diagnostic imaging studies, a ctDNA blood test is among the most studied test proven to be successful in the identification of breast cancer. Other certain breast cancer biomarkers include HER2 genetic markers, ESR1 genetic markers, PD-L1 status, genomic testing, and PIK3CA mutation status (Souri, 2022).
Differential Diagnosis
Differential diagnosis for breast cancer includes breast abscess, fat necrosis, and fibroadenoma. Breast abscess are a common diagnosis in women’s medicine. Breast abscess present with symptoms of a newly discovered breast lump and possible nausea, pain fever, breast warmth, and edema. Fat necrosis of the breast can mimic the breast cancer in symptomology and in diagnostic imaging studies. Features of breast necrosis include an irregular breast mass, skin tethering, and necrosis of tissue and skin (Garza, 2024). Fibroadenomas mimic signs and symptoms of breast cancer, as the condition presents as a glandular tissue mass. These tumors are typically well defined, mobile, and distinct of surrounding breast tissue (Sandeep Reddy Ramala, 2023).
Patient Teaching
According to Ferguson (2023), breast cancer education focuses on early detection and prevention. Mammograms are recommended every two years for women over the age of fifty. However, those at increased risk for breast cancer should begin receiving mammograms at an earlier age. Women should be taught how to perform monthly regular self-breast exams to assist in early detection. Lifestyle factors that reduce breast cancer risk include consuming a healthy diet, maintaining a healthy weight, regular exercise, avoiding smoking, and only consuming alcohol in moderation.
Health Promotion & Middle-Aged Adults: Case Study 1
Ana Miller
St. Thomas University
NUR-601-AP2: Health Promotion & Disease Prevention
Dr. Molin
April 22, 2024
Health Promotion & Middle-Aged Adults
Migrant workers are often at a higher risk of health issues due to engaging in strenuous manual labor, frequently working in poor conditions, or lacking access to healthcare services (Long et al., 2024). There are many health hazards associated with the migrant population in general and the one referred to in the case study. A list of these health hazards includes:
Limited access to healthcare
Limited access to food
Poor living conditions
Workplace hazards
Violence
Mental health challenges
These health hazards are associated with low economic status commonly encountered by migrant populations. This population may struggle to afford healthcare services, including preventative care like vaccines. They may lack health insurance and face financial barriers that delay needed treatment. Migrants with a low economic status may struggle to afford nutritious foods and rely on cheap, unhealthy options. This can lead to health issues such as obesity, diabetes, and nutrient deficiencies. Poor living conditions can increase the risk of infectious diseases and contribute to overall poor health. Migrant workers are exposed to workplace hazards such as working with heavy machinery or exposed to hazardous chemicals. Migrants are also at increased risk for exposure to violence including physical or sexual violence, human trafficking, and exploitation. All these health hazards can cause mental health challenges such as anxiety, stress, depression, and thoughts of suicide.
Recommendations to the migrant population to prevent injuries related to those hazards would include providing resources and education for them. Nurse practitioners can provide resources that help with accessing healthcare services. Nurse practitioners can help migrants enroll in health insurance programs and help them find affordable healthcare services. Health education should be given to these individuals to discuss preventative care, nutrition, hygiene, and infectious disease prevention. Migrants should be taught about their rights in their workplace and to report workplace hazards or injuries. If an individual is facing any type of violence, the nurse practitioner can provide resources for support for migrants that include legal services and safe housing options. An interpreter can be used during this teaching to ensure effective and sensitive communication.
Contraceptive Methods for Young Adults
Nurse practitioners need to advise young adults in selecting contraceptive methods. I do not have any personal religious reservations or discomforts that would interfere with my ability to advise clients on selecting contraceptive methods. The nurse practitioner should first assess the individual’s medical history and contraindications to certain contraceptive methods. Education would be provided on contraceptive options including emergency contraception options. All concerns and preferences would be addressed regarding contraceptive methods. The patient’s choice of contraception will decide the plan of care. The nurse practitioner will educate the patient on the contraception option, discuss preventing sexually transmitted infections (STIs), and follow up with the patient.
Smoking Cessation Plan
Developing a smoking cessation plan for a client would include performing an assessment. The client’s smoking history needs to be obtained to understand the frequency of smoking, how much is smoked a day, how long the client has smoked, previous attempts at quitting, and triggers for smoking. The client’s readiness to quit needs to be assessed and encouraged. A date should be set with the client to quit smoking. Information can be provided that explains the benefits of smoking. The combination of behavioral therapy, such as motivational interviewing, and pharmacotherapy (nicotine replacement therapy, varenicline, and bupropion) can double or triple longer-term abstinence rates and should be offered to all patients (Lampridou, 2023). Coping skills can be identified to help the client with cravings. Support groups should be offered to encourage other individuals who have stopped smoking. Follow-up appointments need to be scheduled to monitor the client’s progress.
Impact of Poverty on Older Adults
Poverty impacts older adults by limiting their access to healthcare. This impacts their access to preventative care, current care, medications, and healthcare services. Older adults who cannot afford their medications will experience poor health outcomes. Higher rates of chronic diseases are associated with poverty such as diabetes, hypertension, heart disease, and arthritis. Poverty also affects the nutritional status of older adults which can cause malnutrition, obesity, and nutrient deficiency. The financial burden and limited access to healthcare cause mental health issues in older adults. The nurse practitioner should provide healthcare resources so older adults can use programs that assist in providing healthcare services. Resources for food insecurity can be set up for these individuals such as Meals on Wheels who would deliver food to their homes. Transportation services can be arranged to take older adults to their appointments. Mental health services can be arranged through telehealth services, community-based clinics, and outreach programs.
Karileida Medina
Thomas University
NUR601: Health Promotion and Disease Prevention
Professor: Ruth C. Dassas-Molin
April 23, 2024
Case 2: Advising Young Adults on Contraceptive Methods
Contraceptive advice to young adults should be informative, unbiased, and personalized to their needs and desires (Jain & Muralidhar, 2011). As a nurse practitioner, I would highly emphasize open discussions and respect for clients’ autonomy while making them feel empowered to make their own independent choices on matters of their sexual health with expertise and skill. Multi-religious culture may raise some personal, religious doubts and psychological resistance, but as for the counselor’s work, he/she is to give clear guidance and support based only on scientific findings (Jain & Muralidhar, 2011). Firstly, I need to remain unbiased and create a secure space for dialogue during my consultation process. That way, I can appropriately address the concerns and conflicts of my clients by letting them explore all the contraceptives in an objective manner that reflects their values and ulterior objectives while adhering to the principles of patient-centered care.
Smoking Cessation Plan for a Client
Developing a smoking cessation plan tailored to each client’s distinct approach to nicotine addiction is a process that involves considering both the physiological and psychological aspects of nicotine addiction. The assessment phase of the nurse practitioner’s role entails a patient’s history of smoking, tobacco use patterns, triggers, and factors contributing to the cessation. Through promoting two-way communication and cooperation, nurse practitioners support the clients in establishing feasible and specific individualized objectives so they can relate their readiness to quit to their precise situations (Giulietti et al., 2020). Education is a significant component of this process, as clients understand that smoking has negative effects on their health, including lung dysfunction, heart disease, and cancer. Also, clients learn that quitting is associated with multiple benefits, such as the improvement of respiratory work and reduced risk of developing cardiovascular and cancer diseases. With this information, customers can now make the informed decisions they need that rely on highly personalized care and support.
Besides, the successful plan further includes a range of behavioral interventions that deal with aberrations like cravings, transitional coping mechanisms, and stress management strategies. Through discovering cues and developing methods to cope, clients can cruise difficult moments without resorting to tobacco. Pharmacotherapy alternatives, which could include nicotine replacement therapy or prescription medications, are also considered for every individual (Giulietti et al., 2020). Additionally, this is on a person’s medical history and preference, thus providing options that will help in overcoming nicotine addiction. Besides, the continuance of support and motivation during the cessation plan are great contributors to an environment that is benevolent and ambient for sustained repudiation. Clients are also referred to smoking cessation programs and counseling services, which become the bridge to a long-term commitment. This is the extra assistance necessary to provide what is relevant to their specific requirements (Giulietti et al., 2020). Through their cooperative and comprehensive approach, nurse practitioners take a front stage in empowering patients by giving them a new lease on life by ensuring smoking cessation and recovery in health and happiness.
Impact of Poverty on Older Adults
Poverty plays a major role in the lives of the elderly, affecting all domains of their health, physical and mental. The poor older adults living in the slums usually encounter barriers in accessing services, healthcare, and screening of preventive and necessary medications, causing them to suffer treatable chronic conditions as well as much worse health outcomes (Attafuah et al., 2023). Besides, it is worth emphasizing that financial insecurity, accommodation instability, and lack of social support are among the dominant factors that worsen health status and lead to such consequences as stress, depression, and social loneliness among older adults. These complexities need a multicomponent approach, such as the policy of advocate programs, which enhance health care opportunities, nutrition assistance, housing affordability, social support programs, and mental health support services for impoverished older adults (Attafuah et al., 2023). By looking into the underlying reasons for poverty and old age jointly, healthcare professionals can strive for the elim
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