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Assignment Directions:  Case: Jane

For this Assignment, using the case information and best evidence, complete the chart below. Make sure to address all columns in the chart. 

  

Case #1: Jane 

Jane is a 42-year-old G4P2103. Jane is divorced and works long, hard hours as a real estate agent. Jane was having irregular and heavy menses for 6 months, and then they abruptly stopped 3 months ago.

Jane has been having nausea and vomiting for 6 weeks but attributed it to having the flu recently. She also admits to gaining about 10 pounds in the last few months and experiencing breast tenderness.

Jane comes to the clinic today to discuss menopause symptoms and treatment. During the visit, a urine pregnancy test came back positive. During the exam, you palpate a 16-week-size uterus and get fetal heart tones of 165. Jane is in disbelief. 

 

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The purpose of this unit is to focus on performing the necessary components of the women’s health exam and to learn to identify crucial exams and necessary age appropriate screenings for the women’s health client. 

Discuss how the age of the female patient, demographics, race, and lifestyle will drive your exam and plan of care. (Pap smear screening)

Give examples and support with evidence-based practice. (Create plan of care for a young African American women that is sexually active, use example of higher incidence rate of cervical cancer in African-American women, also mention the benefit of HPV vaccinations). 

 

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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. 

 

An adolescent’s concerns about privacy can prevent them from seeking primary health care, especially for specific sensitive health care services such as STI screening and family planning issues. Those with privacy concerns are also less likely to talk openly with a health care clinician about important health issues, such as substance use, mental health, and risky sex. Recognizing that confidentiality is critical to high-quality care for adolescent women, professional health care organizations have adopted policy statements and practice guidelines that support the provision of confidential services. 

Discuss these guidelines and the laws in your state that address adolescent confidential health care.

Peer Response 1

 

This is a great discussion topic, because I have often thought about adolescent care and confidentiality, but have never gotten the chance to thoroughly investigate the topic. I have worked with adult populations and therefore it has never been a big issue in my professional career. We all know that adolescent brains are not fully developed and they require teaching, support and valid resources when they encounter problems in their lives. This is why laws were enacted to allow adolescents to see a provider confidentially and seek medical help from a professional without the repercussions from their parents who may disapprove of their actions or situation.

            In my state of Idaho, mental health services are confidential for adolescents after the age of 14 and cannot be shared with the parents without written consent of the adolescent unless they need to disclose information in order to bill insurance, carry out a treatment plan or prevent harm to the child or others or if they are ordered to by a court of law (Children’s Mental Health Services, 2018). Therefore, the clinician does have quite a bit of wiggle room in the statue because a majority of mental health issues can result in harm to the child or others. Either way, it’s good to understand that the age of 14 is the deciding factor. After 18 though, it is all confidential and no parents have rights to the individual’s medical records.

            

As for medical information. Every state allows adolescents to be seen, screened and treated for sexually transmitted infections and diseases without release of information to the parents. This law was passed as research was conducted that indicated that adolescents were MUCH less likely to seek medical help for STD’s if they knew their parents would find out. Therefore, in an attempt to decrease the prevalence of STD’s, no parental consent or notification is necessary (Bornstein, 2000). Even though confidentiality is attempted in this population with sensitive sexual or reproductive issues, obstacles to patient privacy remain. Overall, from what I can find, the provider in Idaho has the discretion to notify parents of any medical information of an adolescent.

Peer Response 2

 

When it comes to healthcare, Patient’s confidentiality is paramount, a sensitive issue, and is part of the law in many states.  When caring for adolescent patients, care is not any different.  If a minor is seeking care and fears his or her information would be disclosed to their parents, it might prevent them from seeking preventative care such as contraceptives, pregnancy testing, sexually transmitted infection testing, or even psychological help if needed.  Unless, the provider suspects neglect or abuse, confidentially should always be provided to adolescents.  Judgement by the provider regarding the best medical interest and safety of the patient should prevail (AAFP, 2013). 

In the state of Florida, the Florida Legislature (2017) there are some cases a minor could consent for their own care without a parent’s consent.  For example, if the minor is not married and pregnant or a mother, she could consent for herself and for her child; if the minor is seventeen years-old he could consent for blood donation; also, contraceptives and services of a nonsurgical nature; confidential medical services and counselling related to substance abuse and mental health outpatient counselling and treatment to minors, that does not need medications and other somatic treatments or less than two outpatient visits.

Healthcare providers must be familiar with their federal and state laws related to adolescent consent and confidentiality.  Respecting adolescent patient’s rights and privacy is essential, but as a provider encouraging the adolescent seeking care to talk to their parents regarding their health could promote better communication between child and parents.  In some facilities, the provider may make a verbal contract with the parents and teenager regarding confidentiality.  This would assure the patient that any information obtain during the visit will remain in strict confidence unless the provider thinks it could pose a danger to the patient or if the patient themselves want to share the information with their parents. 

Ultimately as a healthcare provider, it is important to protect patient’s privacy and confidentiality but, at the same time, we must be aware that in all states, a person needing emergency medical treatment they may be treated without consent if securing a consent would delay treatment and places the patient’s life or health at risk (Olson and Middleman, 2018).  Patient care should not be delayed under any circumstances that will pose harm to the patient or cause death.   

 

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Sexuality affects individuals and society across a broad spectrum of activities through health, but also through factors at multiple levels, such as gender relations, reproduction, and economics. Physiologic, behavioral, and affective measurement of sexuality and sexual behavior is complicated by cultural values and norms but is essential to individual health (including happiness) as well as public health. Cultural or structural norms that stigmatize aspects of sexuality, such as sexual orientation, have adverse effects on individuals across their lifespan, with homophobia being a prominent example of such.

Discussion:

Discuss how one’s age, race, lifestyle, and demographics have an impact on your choice to complete a sexual history when working in the primary care setting with women across a lifespan. 

 Peer Post. I need Peer Response for this post: 

#1

 

Every person we interact with in practice is unique and requires unique attention in order to properly be treated for their medical problems. Small details of their life affect what we prescribe and how successful it will be for that individual. Making sure we are able to initiate and complete a full sexual history is important in addressing sexual health concerns, as most people do not willingly bring up sexual health issues unless there is an obvious issue such as infection or pain. The World Health Organization defined sexual health as, “a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity in all matters relating to the reproductive system and to its function and processes” (Ariin, 2015, p. 1).

In regards to my personal opinion on sexual history and health, I find it just as important as any other aspect of their life. While establishing a new patient, I try to ask every woman of childbearing age if they are sexually active in order to open up the conversation to potential questions or concerns they may have. As a majority of our job is education, this is the ideal time to talk about sexually transmitted infections/diseases (STI/STD’s) and help prevent significant comorbidities related to infections in adolescents and young women (Rosenthal et al., 1997). Sexually transmitted diseases cause a large amount of emotional distress and tend to be higher in certain populations such as low-income and undereducated.

Despite major public health efforts that address the varied diseased caused by sexually transmitted diseases, rates of infections are on the rise globally (Haghir et al., 2018).  Providers in the clinic should be focused on adolescents and young women who may partake in high-risk behaviors that are strongly associated with STD acquisition and spread. Educational pamphlets may be beneficial if time does not allow for in-depth conversations in the clinic.

#2

 

How age, race, lifestyle, and demographics impact the choice to complete a sexual history when working in the primary care.

Age

  One’s age play an important role in determining the kind of care that an individual receives. Adolescents for example if given a choice to make their own choices in performing certain gynecological exams. The age at which the patient first started the examination also plays an important role. Young children may refuse examination compared to older adult. On the other hand, geriatric patients with advanced age impact examination especially if the patients have debilitating and chronic conditions. On the other hand adolescence find it difficult to disclose their sexuality.

 Race and Lifestyle

According to Prather et al, 2016, racial needs varies when it comes to the health assessment of a female patient. Some cultures consider their sexuality sacred and do not feel comfortable performing sexual assessment and examination. Primary care providers need to be aware of patient cultures and belief in order to provide adequate care in a non-judgmental manner. Different race and cultures view sexual history differently. Some races are unable to disclose their sexual history because of fear of getting shunned in the community or the family.

Demographics

Patient demographics is one factor that plays an important in the choice of examination to be done. Multiculturalism affects the kind of illnesses as well as mortality and morbidity and as a result it forces people to adapt different cultures impacting the examination to be performed.(Ferguson,& Chor,2018). Patients from certain regions do not accepts some examination and are less likely to allow healthcare professionals to perform certain tests based on nationality. The United States is one of the country that is more accepting different sexuality. Approaching human sexuality needs understanding

 

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Peer Resp.#1

 

When it comes to women’s health, pelvic pain is a serious condition that needs to be examined carefully and seriously.  Pelvic pain is a common problem among women and in primary care office, and it is seen in approximately in one to two percentage of women (Dunphy et al., 2015).  The nature and intensity of the pain may fluctuate, and its cause is often unclear.  According to Dunphy et al., (2015) pelvic pain is characterized as acute, chronic or recurrent and reported in both pelvic or lower abdomen.  Speer, Mushkbar, & Erbele (2016) define Chronic Pelvic Pain (CPP) as a persistent, noncyclic pain perceived to be in structures related to the pelvis, lasting more than six months, and does not show any signs of improvement with treatment.  Due to the multiple possible causes to develop CPP, the diagnosis could be difficult and must be done with care.  The cause of the pelvic pain might stem from genitourinary, gastrointestinal, musculoskeletal system disease or dysfunction which could cause sudden acute pain. (Dunphy et al., 2015).  CPP is not a direct diagnosis, but rather a condition that is caused by numerous factors or another medical disease.   The most prevalent and medically significant causes are cancers, sexually transmitted diseases (STDs), and general medical issues with the intestines and reproductive organs (Passavanti, Pota, & Sansone, 2017).  Ovarian cancer, chlamydia, and ovarian cysts are all potential causes that could be extremely serious for the patient and could even be life threatening.  On the other hand, it could be simple ache or pain caused by relatively benign reasons (Speer, Mushkbar, & Erbele, 2016).  Chronic or recurrent pelvic pain is less urgent; and recurrent pain could be associated or not with menstruation (Dunphy et al., 2015).  The origin of CPP could be related to benign or malignant neoplasms or characterized as psychogenic. (Dunphy et al., 2015). 

 

            Pain is a subjective symptom, and healthcare professionals cannot experience the pain that the patient is experiencing.  However, there are procedures that can help with assessment and diagnosis.  First, when assessing pelvic pain, a solid interview with the patient should be conducted, including the use of pain scales, questionnaires, and direct statements from the patient (Passavanti, Pota, & Sansone, 2017).  Severe persisting pain that has been present for an extended period should be evaluated and taken as a potential cause for professional diagnosis.  Due to the sheer amount of potential conditions that could cause pelvic pain, being able to narrow down possible causes is extremely important.  Therefore, other factors must be put into consideration to make a good differential diagnosis.  Lifford & Barbieri (2002) state that evaluating potential pre-existing conditions such as depression, narcotic dependency, and physical, sexual, or emotional abuse is crucial when diagnosing pelvic pain.   In the case that patients state that the pain is unbearable and severely affects their everyday life, referral to emergency department must be recommended to get promptly treatment.  Overall, the diagnosis and evaluation of pelvic pain cannot be taken lightly and should be done with caution to implement an adequate treatment with good health outcomes, which could give to the patient a better quality of life.  The determination when and why one would refer a patient for diagnostics and second opinions is based upon by the physical exam and tests, treatments might include medicines, surgical procedures, physical therapy and pain management techniques.

References

Peer Resp.#2

 

There are many different causes of pelvic pain in women. Pelvic pain is defined as pain that is felt in the lower part of the abdomen or pelvis and can be caused from urinary, reproductive/sexual, musculoskeletal, or digestive issues (Mayo Clinic, 2018). One of the causes can be due to uterine fibroids. Uterine fibroids, also referred to as leiomyomas, are noncancerous growths in the uterus that can cause pain, abnormal bleeding, pelvic pressure, constipation, and back aches (Mayo Clinic, 2018). Uterine fibroids are most commonly seen in patients who are in child bearing years and they can vary in size, shape, and symptom severity. Fibroids do not generally interfere with conceiving; however, they can lead to placental abruption, preterm delivery, and fetal growth restriction if not managed properly. (Mayo Clinic, 2018).

This patient would be referred to a GYN specialist and surgeon, have a pelvic ultrasound obtained with results sent to both the primary and GYN. The GYN specialist, surgeon, and patient can discuss a treatment plan such as expectant management, laparoscopic myomectomy, or hysterectomy. (Mayo Clinic, 2018)

The steps to writing a referral involve the diagnosis and chief complaint, plan of care such as the ultrasound, and the NP should plan to see the patient in 2 weeks for ultrasound review and to discuss the patient’s plan going forward.

 

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