No plagiarism please.

Will need minimum of 150 words for each response, APA Style, double spaced, times new roman, font 12, and and Include: (1 reference for each response within years 2015-2018) with intext citations. 

 Discuss a primary care-focused visit devoted to wellness and or disease affecting women and health-enhancing strategies that you would include in the visit. 

Peer 1 Response

 

 One primary care-focused visit devoted to wellness is the annual wellness visit (AWV). Components of this visit should include updating immunizations and suggesting needed immunizations, blood pressure checks to screen for hypertension, obesity counseling if needed, and any counseling for tobacco and alcohol use. Also important is doing a functional status review, screening for fall risk and cognitive abilities for seniors (Adler, 2017). If the patient were a senior with a chronic problem it would be good to do problem-focused physical exam and explore any patient concerns, if any. The Medicare Annual Wellness Visit is still an underutilized benefit for seniors, even though it can offer many benefits to increase a person’s preventive care. According to (Harvard Men’s Health Watch, 2017), this visit does not focus on a physical exam, but is instead a conversation with your health care provider about important health issues. This visit provides time for the patient to plan with their health care provider a healthy future. Other health-enhancing strategies focused on in this visit are a vision test, to detect if the patient needs glasses, a stronger prescription, or have signs of an eye disease. A balance test will be done to help gauge the risk for falls, as well as a hearing evaluation to see if the patient would benefit from a formal hearing test.

     Another part of the AWV is developing a personalized plan to address ways the patient can stay active and maintain their current health. One primary care assessment that should be done at every visit is a depression screening. This doesn’t have to be a long questionnaire, the Patient Health Questionnaire (PHQ-2) is a good screening tool. It consists of just 2 questions from the PHQ-9. If the patient screens positive with the PHQ-2, the full PHQ-9 can be completed. According (Fuchs, Haradhvala, & Uebelacker, 2015), the PHQ-2 has demonstrated strong validity and high sensitivity for detecting major depression in primary care.

Peer 2 Response

 Women’s health care is a detailed visit that is focused on many different aspects of care. For example, women need education on special topics at all ages of life. One of the major concerns for aging women is osteoporosis. Osteoporosis is a disease of the bones that occurs when there is bone loss, or the body makes too little bone, or both loss and decreased production (NOF, 2018). This conditon causes bones to become extremely fragile, which increases the risk of fracture. Fractures can occur following a fall or injury, or in severe cases even from a minor bump to the area (NOF, 2018). Osteoporotic bones have a honeycomb appears due to the loss in bone density. For women over 50, the risk of osteoporosis increases and the provider should order a bone density scan to monitor the structure of the bone. Bone density scans are the only diagnostic testing for osteoporosis prior to a broken bone (NOF, 2018). The diagnostic test for bone density is done through x-ray called a Dexa Scan. Dexa stands for dual energy x-ray absorptiometry. (NOF, 2018). Dexa scans should be conducted every 1-2 years depending on patient history and risk factors. The Dexa scan results are determined by a T-score. Normal T-score results are -1.0 and anything above -1.0 are mild to severe osteoporosis (NOF, 2018). One of the medications used to treat osteoporosis is Actonel. Actonel is an oral medication that is taken daily. The mediation is designed to slow bone loss and even help to prevent fractures. (Actonel, 2017). One of the side effects that needs to be discussed with patients is that is can cause GI upset, so it the patient has a history of GI issues, another medication is most likely the better option. 

 

"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"

No plagiarism please.

Will need minimum of 150 words for each response, APA Style, double spaced, times new roman, font 12, and and Include: (1 reference for each response within years 2015-2018) with intext citations. 

  

Peer resp. #1

Fibrocystic change is categorized as a benign breast problem. Symptoms of fibrocystic change include breast tenderness, swelling, pain, or irregular menstrual cycles (Arslan Solmaz, 2018). Patients can feel lumps in their breasts. Movable lumps filled up with fluid are called cysts. The patients can find their breasts swollen or tender to touch. It happens when breast tissues become firm and rubbery like scar tissues. Fibrocystic change occurs mostly in women of child-bearing age, but they can affect any women (American Cancer Society, 2017). The changes in hormone related to menstruation can cause the lumps to get bigger and tenderer. Therefore, the symptoms are more noticeable just before the menstrual period starts. The patients may also feel a clear or cloudy nipple discharge. Hormonal abnormalities such as an excess of estrogen over progesterone or increased thyroid hormone activity are reported to be the cause of the fibrocystic change (Arslan Solmaz, 2018). A diagnosis is based on symptoms, history, and physical examination. A mammogram, ultrasound, or a biopsy will be needed to rule out cancer.

Treatment for fibrocystic change is necessary if the cysts cause discomfort. Medications include danazol, tamoxifen, hormonal therapies, or vitamin E (Talaei, Moradi, & Rafiei, 2017). The authors also mention that Metformin can help reduce the symptoms of fibrocystic change. Besides that, patients who take Metformin have a reduced mortality rate of cancer due to the medication’s antitumoral properties (Talaei, Moradi, & Rafiei, 2017). Another option is to have the cysts drained to reduce the pressure and pain, but the fluid can build up again (American Cancer Society, 2017). If that happens, the patients can choose surgery to remove the cysts. They can take pain medications such as ibuprofen or acetaminophen for pain relief as well. They need to avoid caffeinated drinks such as coffee, tea, sodas, or chocolate since they can stimulate the symptoms (American Cancer Society, 2017). It is still controversial regarding if fibrocystic change is associated with increased risk of breast cancer, so they need to have a routine mammogram screening to detect cancer early (Arslan Solmaz, 2018).

  

Peer resp. #2

Fibrocystic breast is considered to be a non-proliferative lesion. It generally affects women between the ages of 25 and 50 and rarely affects women under age 20 (Arslan Solmaz, 2018). According to the Center for Disease Control (2018), fibrocystic breasts can have symptoms of feeling lumpy, tender to touch and sore and have cysts that are fluid filled sacs within the breast. Patient education would include that fibrocystic breast disease is usually benign and and may be due to hormonal imbalance. Follow up care would include sonography, mammography and possibly biopsy to ensure that the cysts are not cancerous (Talaei, Moradi and Rafiei, 2017). Treatments can include a fine needle aspiration to drain the cysts, or surgical incision. Over the counter Tylenol and Ibprofen can be used for pain control. Oral contraceptives can be taken for women to lower hormone levels associated with breast changes (Talaei, Moradi and Rafiei, 2017). Self management would include pain management, breast self exams, warm compresses and monitoring any cysts for and change in texture, size and if they are causing further pain.

 

"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"

No plagiarism please.

Will need minimum of 150 words for each response, APA Style, double spaced, times new roman, font 12, and and Include: (1 reference for each response within years 2015-2018) with intext citations. 

Discuss the most common screening test and diagnostics used throughout pregnancy and the purpose of the tests. When during pregnancy are tests performed and what is the protocol when an abnormal test or diagnostic is found? 

Peer Resp#1

Health care provider may recommend a variety of screenings, tests and imaging techniques during a pregnancy. These tests are designed to provide information about the health of your baby and may help you optimize your child’s prenatal care and development (American Pregnancy Association, 2018). Genetic screening can help diagnose the potential for certain genetic disorders before birth. First-trimester screening is a combination of fetal ultrasound and maternal blood testing. This screening process can help determine the risk of the fetus having certain birth defects. Second trimester prenatal screening may include several blood tests called multiple markers. These markers provide information about the risk of having a baby with certain genetic conditions or birth defects. The ultrasounds can be performed at different times during the pregnancy to check for fetal growth, estimate the due date and look for any structural abnormalities in the baby. Additional testing during pregnancy may include amniocentesis, chronic villus, sample (CVS) and fetal monitoring glucose testing and Group B strep culture. Many genetic abnormalities can be diagnosed before birth (American Pregnancy Association, 2018) . Therefore, the PCP or midwife may recommend genetic testing during pregnancy in case there is a family history of genetic disorders. other reason may also be to have genetic screening when the fetus or baby has a genetic abnormality.

Depending on the situation if an abnormal screening test comes the patient should be aware of and counsel the risk of having the baby and the percentage of survival of the fetus. It will be up to the parents of the unborn child to decide whether they should continue with the pregnancy. I have seen a patient who was advised to end the pregnancy because of the high risk of the death of the mother. depending on the situation, some parents may choose to abort the baby.  for example, this who recently found that she was 8—9 weeks pregnant via ultrasound for the fifth time, the patient who had 3 c sections 4 living children and was pregnant for the fifth her last baby was 10 months old. The physician had to explain the high risk of having a hysterectomy right after given birth and risk of bleeding to death.

Peer Resp#2

Pregnancy is a cascade of miracles occurring one after another.  The development of a growing embryo to a fetus to a full-term infant involves constant replication of cells and therefore any delivery of a healthy baby is truly a miracle.  Gestation typically last 40 weeks and is broken down into trimesters (i.e. 1st – 0-12 weeks, 2nd – 13-28 weeks, 3rd – 29 weeks to delivery).  Women typically request pregnancy testing, either at home or at their primary care provider’s office, when they have either missed a menstrual cycle or are having symptoms of pregnancy (i.e. nausea, breast tenderness, etc.).  These tests are designed to measure human chorionic gonadotropin (HCG), which is a hormone secreted by the placenta once a fertilized egg implants within the uterine lining (Mayo Clinic, 2018).

 Because pregnancy is not a benign condition, many screening tests can be completed in order to identify any potential issues with the growing fetus (i.e. birth defects, low weight, etc.) at the earliest possible stage. 

During the first trimester, the following tests can be ordered:

1. Maternal blood screen to test for HCG and pregnancy associated plasma protein A (PAPP-A).  If either of these results are elevated, there can be an increased probability for chromosomal disorders. Blood typing also occurs at this time and if the mother is RH negative will need a Rhogam injection at 28 weeks and immediately after childbirth.
2. Ultrasound in the first trimester can be used to look for anomalies such as fluid behind the fetus’ neck or presence of a nasal bone and is considered the most accurate method to determine estimated delivery date (EDD).  These two screening methods can accurately provide evidence of Trisomy 18 or 21 (Down Syndrome) (John Hopkins Medicine, 2016).

During the second trimester the following tests can be ordered:

1. Between 15-20 weeks, a Quad screen tests for the presence of 4 proteins (alpha-fetoprotein (AFP), HCG, Estriol and Inhibin-A.  
2. Between 18-20 weeks, an anomaly ultrasound can be completed to determine size of the fetus and identification of any birth defects (Centers for Disease Control and Prevention, 2017).

During the third trimester, the following tests can be ordered:

1. Oral glucose tolerance test (OGGT) to determine whether the patient has developed gestational diabetes (GDM) can be completed during the 24-28 weeks.  If found to have GDM, patient will need to be educated on diet changes and potentially get started on metformin.
2. Group beta strep (GBS) can be tested for during the 35-37 weeks.  If positive, IV antibiotics will need to be administered prior to delivery of the child.
3. Tdap for anyone who will be in contact with the infant to protect against pertussis and the influenza vaccine to protect against influenza.

If any of the genetic testing results in an anomaly, further diagnostic testing can take place.  These types of additional testing include amniocentesis and chorionic villus sampling (CVS) and can help differentiate between the exact genetic anomaly exists (Centers for Disease Control and Prevention, 2017).

 

"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"

No plagiarism please.

Will need minimum of 150 words for each response, APA Style, double spaced, times new roman, font 12, and and Include: (1 reference for each response within years 2015-2018) with intext citations. 

Discuss the CDC breastfeeding initiative and describe how you will support this when interacting with your pregnant and postpartum women in the primary care setting. 

Peer Resp#1

Our bodies are amazing at what they do, there’s no way to fully replace what the body does naturally. That is why organ donation is such a great gift and why we should use our bodies to the fullest in every aspect of life and respect the wonderful life we’ve been given. Breastfeeding is the most essential, dynamic and profitable way of providing an infant with the nutrients they need as they enter the world outside of the womb (Farhan, Das & Malik, 2018).

            Not only does breastfeeding benefit the infant, but it has important consequences for the mother as well. Breastfeeding can lower the risk for certain cancers including breast and ovarian as well as decrease the risk of developing type 2 diabetes (Grummer-Strawn et al., 2013). The CDC has started many initiatives to ensure that mothers in the United states have adequate access to lactation services and understand the best way to nourish their newborn. That being said, there are still many mothers who are unable to breastfeed but there is hope for those who desire to have breastmilk for their baby. Donor breastmilk is the milk of choice when a mother’s own milk is not available. Research clearly demonstrates that human milk decreases the rates of pediatric infections such as necrotizing Enterocolitis (NEC) and sepsis (Coutsoudis et al., 2011).

Encouraging mothers to research the benefits of breastfeeding and educating as the mother and family as they are willing is the goal of the nurse practitioner. Ultimately, it is the choice of the mother to partake in breastfeeding, but proper education and encouragement should be offered for new parents.

Peer Response#2

 

The CDC is currently on a mission to improve the breastfeeding in the nation by current, new, and prospective mothers. Nowadays the CDC is actively promoting and engaging with new and potential mothers and well as past mothers to gather information regarding their pregnancies, determining thoughts and practices and how to move forward with the promotion of breastfeeding (CDC, 2018).  From years 2011 to 2015, the CDC has been conducting a study to determine the difference in breastfeeding by demographic variables, which provided them with information regarding cultures and areas where improvement could be made, and where their advocacy needed to be expanded and promoted.  These areas have gained additional promotion regarding health benefits for both mom and baby, as well as the advantage of a cheaper alternative to formula (Anstey et al., 2017).  A variety of issues with moms were discovered in these areas concerning breastfeeding and its practice. Some of these new moms are unsure of breastfeeding and unfamiliar with the method. Some of the moms are interested in breastfeeding but then revert to formula.

The CDC has adopted the ten breastfeeding steps that are being successfully implemented by the WHO and UNICEF organizations; and has been used for promotion throughout hospitals and a variety of healthcare settings as a tool to promote and to make breastfeeding a successful and healthy experience for mom and baby (Sriraman, 2017).  This promotion could be critical as many mothers would attempt to breastfeed their baby as well. This guide and assistance gives new moms information and a guideline to help their newborns attach.  They could also meet with a support team that assists them and has the specialized experience to encourage and teach the mom with the proper practice of breastfeeding.

As practitioner one should encourage a mother to breastfeed if possible, because of the significant benefits of it, such as the decrease chance of the baby of having an allergy to the mother’s breast milk.  However, there could be contraindications to breastfeeding that must be looked at as well.  According to the CDC (2018), a mother who is addicted or who has a disease should not breastfeed, such as a mother with HIV because the disease or drug could pass to the baby through the breast milk. 

 

"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"

No plagiarism please.

Will need  APA Style, double spaced, times new roman, font 12, and and Include: Reference for each response within years 2015-2018 with intext citations. 

Directions: 

During your first 5 weeks of clinical, you have probably had patients with vaginal complaints and possible infections. For this Assignment, you will choose three STIs (e.g., bacterial vaginosis, HPV, chlamydia, HIV, trichomoniasis). Then fill in the chart for all columns including presenting symptoms, physical findings, laboratory/diagnostic findings, and management or treatment. Do not leave any section blank. 

 

"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"