Sample Answer for NU 629 Discussion 1: Preventative Guidelines – One Guideline and Two Scenarios Included After Question
Having discussed many guidelines throughout this term, consider the content you have explored. Using this knowledge, answer the following questions related to your chosen scenario. Note: please try to choose a topic for your initial post that you did not choose previously during the semester or aren’t as familiar with so you can gain additional knowledge as we finish up this course
- Discuss the guidelines assigned with your scenario.
- Will both patients be treated in the same manner? Why or why not?
- What would your treatment plan be for each of the individuals in your scenario?
Please include at least three scholarly sources within your initial post.
A Sample Answer For the Assignment: NU 629 Discussion 1: Preventative Guidelines – One Guideline and Two Scenarios
Title: NU 629 Discussion 1: Preventative Guidelines – One Guideline and Two Scenarios
Throughout this course, we have looked at health promotion and disease prevention and focused on various vulnerable populations. This week’s discussion will focus on applying one guideline to two patients. Please select ONE of the following scenarios and then answer the questions in your initial post. Please include at least three scholarly sources within your initial post.
Scenario A: Focus on Preventative Guidelines for Childhood Immunizations
You are working as an APRN in your local primary care office. The rural town of Maynard has 300 people, a post office, doctor’s office, and a gas station. The primary source of income is farming or driving 45 minutes to a somewhat larger town. With the blizzard coming, all your patients except two have cancelled for the morning. Jose is scheduled at 0900; he is a nine-year-old Hispanic male born in Mexico. He and his family (Mom, Dad, and six siblings, ages six months to 14 years) moved into the area just a few months ago. Jose’s mother reported that he had nearly died at two months after contracting pertussis.
Your final patient of the morning is Irena, a 15-year-old teenage female who lives with her aunt in Maynard. Irena is Romanian and barely speaks any English. Her aunt has been your patient for the past few years, and she told you that Irena had been abducted in Romania at the age of 10. Irena’s parents found her quite by accident when a sex trafficking ring dumped all their “product” in a refugee camp in Serbia just a few months ago. Irena’s parents are still in Romania, but they sent Irena here to live with her aunt.
Scenario B: Focus on Preventative Guidelines for Colorectal Cancer Screening
On a busy Thursday morning, you note on your schedule a couple of patients who routinely “take a long time” no matter what their complaint. Jimmy is a 62-year-old male who is mentally challenged and lives in a local group home. Both his parents passed away last year, and his sister has never really been in the picture. She lives at least eight hours away. Jimmy has a “genetic disorder” but actually his symptoms are more like autism that we are familiar with today.
Jimmy’s caregiver states he has been having some problems with constipation but otherwise he seems okay. Jimmy is nonverbal and hates to be touched. Approaching Jimmy can be difficult, and he has taken a swing at staff a couple of times because he doesn’t understand what is going on – especially if they try to touch him to check his pulse or blood pressure.
Having finished up with Jimmy, you move on to Marvin. Marvin is a 67-year-old male here for his annual physical. Marvin is pretty healthy despite a scare with colon cancer when he was 50. He is obsessed with his bowels and even brings charts to each of his appointments as he is always concerned that the cancer will return.
Scenario C: Focus on Preventative Guidelines for Breast Cancer Screening
Volunteering once a month for a mobile clinic, you head out this Saturday morning with two other providers and staff. The mobile RV is a large motorhome retrofitted as a primary care clinic. Headed downtown where there is a large homeless encampment, everyone is excited to see what the day brings.
Miss Eleanor is a 72-year-old African American female who you have seen many times. Today she is complaining 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’d had a breast exam and that she had never had a mammogram.
Finishing up your day on the mobile clinic, Sally, a 48-year-old female, is concerned that she has an STI. During Sally’s pelvic exam, you learn that she has been living 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 was 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.
Scenario D: Focus on Cervical Cancer Guidelines
Working near a naval base, you see a lot of patients who are somehow connected with the military. Today, Shelesha, a 21-year-old African American female, is requesting to be seen for her annual exam before she leaves for deployment. Shelesha seems really anxious today. She is usually so excited about being on board her ship, but today she is different. You complete her annual exam, but she refuses her cervical and breast exam. After leaving the room so she can get dressed, you return to find Shelesha crying. She finally tells you that she was attacked – sexually assaulted on board her ship six months ago – and she has these “bumps” that keep getting bigger around her vagina and she is worried.
Virginia arrives for her annual well-woman exam. Virginia is a 67-year-old female who has been married for 42 years. Virginia and Harrold are still sexually active with the use of medications, and like clockwork, Virginia comes every year for her pelvic exam requesting a Pap smear. Virginia had breast cancer with a mastectomy when she was 52, but otherwise she is healthy, only taking medication for her cholesterol.
Scenario E: Focus on Prostate Cancer Guidelines
Ivan is a 59-year-old Caucasian male in your office today for his annual exam. He has been reading about prostate cancer and the need to have some lab work done. His wife really wants him to get his PSA drawn, but he’s not so sure. Your physical exam of Ivan is “all normal.” When reviewing Ivan’s health assessment form, you see he smokes two packs of cigarettes a day and his only complaint is a chronic cough.
Chen is 76-year-old gentleman of Chinese descent. He is here today for an annual exam and a recheck of his blood pressure. Chen tells you he just heard from his brother that his PSA (Prostate Specific Antigen) is really high, and they are concerned he may have prostate cancer. Chen’s brother is from his father’s second marriage and he is only 59 years old. Chen is asking to have his PSA drawn to make sure he doesn’t have prostate cancer.
In this scenario, one woman is 72 years old while the other is 48 years old. The 72 year old woman is African American and she is complaining of breast tenderness. It is also stated that she has never gotten a mammography before and her last breast exam was thirty years ago. The second woman is 48 years old and she is concerned that she has a STI. She also states that two years ago she had gotten a mammography and was referred to get an ultrasound, but never went.
These women will be treated in a different manner as they are two different ages. When discussing mammography, it is important to understand that the risk of developing breast cancer increases with age (Reeves, 2021). Breast cancer is most commonly diagnosed in women 55 to 64 years old (Reeves, 2021). According to the American Cancer Society, women should start getting mammograms starting at age 45 however, they can start as early as 40 years old (“American Cancer Society Guidelines”, 2021).
For Sally, the 48 year old, she had a mammogram at 46 years old that her doctor wanted to re-evaluate. For her plan of care, I would treat her for her STI and refer her to get re-evaluated to determine what her mammogram had shown two years ago. 17% of breast cancer is diagnosed in women who are younger than 50 years old (Seely & Alhassan, 2018). The sooner Sally gets re-evaluated the sooner she can start treatment and be cured if she does have breast cancer.
For Eleanor, the 72 year old, I would discuss the benefits and risks of her getting her first mammogram at this age. Mammography can be done up to the age of 74 years old asz most places won’t perform them on those who are older due to not enough evidence (Schrager et al., 2020). Those who are 70 years or older are at increased risk as the incidence of breast cancer among this group is 28% (Seely & Alhassan, 2018). Since Eleanor has never gotten a mammogram and she also hasn’t had a breast exam in 30 years until now, she is more likely to have a higher stage of breast cancer if anything were to be detected on the mammogram.
Therefore, it may not be beneficial to her if she is at that point since her survival rate will already be significantly reduced (Schrager et al., 2020). Getting a mammogram at her age could be beneficial if she is still in good overall health and has a life expectancy of 10 years or longer (Schrager et al., 2020). To determine her state of health, more information would need to be gathered.
American Cancer Society Guidelines for the Early Detection of Cancer. American Cancer Society. (2021, August 27). Retrieved November 30, 2021, from https://www.cancer.org/healthy/find-cancer-early/american-cancer-society-guidelines-for-the-early-detection-of-cancer.html.
Reeves, R. (2021, July 31). Mammography. StatPearls. Retrieved November 30, 2021, from https://www.statpearls.com/ArticleLibrary/viewarticle/38665.
Schrager, S., Ovsepyan, V., & Burnside, E. (2020). Breast cancer screening in older women: The importance of shared decision making. NCBI. Retrieved November 30, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7822071/.
Seely, J. M., & Alhassan, T. (2018, June 13). Screening for breast cancer in 2018-what should we be doing today? NCBI. Retrieved November 30, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6001765/.