Reply To Jennifer

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Comprehensive exams in women’s health need to

As with any assessment, the chief complain is often what drives what our questions are and what clinical pathways we explore.  With women’s health that approach is not any different, as we need to explore the “what was”, “what is” and “what will be” for the patient.  The comprehensive assessment is one that is longer in nature and normally saved for the first visit, as if this patient will be a returning patient a more focused examine comes during their following appointments.  The follow is a “blanket” comprehensive assessment that can be tweaked for any patient (Elson, 2008);

  1. Chief complaint (is this a focused complaint or a first meeting or annual meeting)
  2. History of present illness
  3.  Menstrual History
    1.  Age at menarche
    2. Last menstrual period
    3. Menstrual characteristics
      1. Length
      2. How long is flow
      3. Amount of flow
  4. Other symptoms? (breast tenderness, pelvic pain, etc)5
  5. Pain?
  6. Intermenstrual bleeding
  7. Perimenopause/menopause
    1. Bleeding pattern
    2. Vasomotor symptoms
  8.  Contraception
    1. Current method; is it working?
    2. Previous method; any complications and reason for change
  9. Cervical and vaginal cytology
    1. Results and date of most recent pap
    2. Hx of abnormal paps? Why? Treatment?
  10.  Infections
    1. Hx of STD?
    2. Hx of vaginitis (types, frequency and treatment)
    3. Hx of PID
  11.  Fertility/infertility
    1. Any desire for future?
    2. Difficulty conceiving? Treatments in past?
  12. Sexual hx
    1. Type
    2. Concerns about libido, orgasm, dyspareunia
    3. Any hx of abuse? Assault?
  13. Obstetric hx
    1. Describe each pregnancy and outcome
    2. Any maternal, fetal or neonatal complications?
  14. Past medical history
    1. Current and past illnesses
    2. Hospital admissions
    3. Surgical hx
      1. GYN and Non-gyn
    4.  Medications/allergies
      1. OTC, prescribed, herbal
      2. Allergies to meds, food, environment and reactions?
  15. Family hx
    1. Significant illnesses of family
    2. Hereditary concerns
  16. Social hx
    1. Relationship status
    2. Level of education
    3. Occupation
  17. R.O.S.
  18. Abdomino-pelvic
    1. GYN
    2. GI
    3. GU
  19. Breast
  20. Others

18.Health Maintenance

  1. Smoking, alcohol use, drug use
  2. Diet
  3. Supplement intake
  4. Exercise
  5. Regular screenings (mammo, pap, colonoscopy)
  6. Immunizations and dates

Health maintenance is very important for all ages when related to women’s health.  The following are some ideas of health maintenance for each age group (Well-Woman Recommendations, 2018);

  1. Adolescents
    1. If sexually active the patient should have discussion with provider on sexually transmitted diseases and contraceptive use
    2. Drugs and alcohol use
    3. Peer pressure with sexual situations
  2. Childbearing
    1. Annual blood work to identify challenges in anemia, TSH, Cholesterol and minerals.
    2. Breast self-awareness
    3. Reproductive health plan
    4. Imitate partner violence
  • Peri-menopausal
    1. Hormone therapy
    2. Mammograms
    3. Advance directives
    4. Problems with sexual encounters (pain, dry, etc)
  1. Menopausal
    1. Sleep patterns
    2. Changes of the body (hair growth, hormonal changes, sexual changes)
    3. Breast self-awareness
  2. Geriatric Women
    1. Sexual function
    2. Injury prevention
    3. Neglect/abuse

Elson, N. B. (2008, July). The Gynecologic History and Examination. Retrieved from The Global Library of Womens Health: https://www.glowm.com/section_view/heading/TheGynecologicHistoryandExamination/item/3#3521

Well-Woman Recommendations. (2018, January 5). Retrieved from The American College of Obstetricians and Gynecologists: https://www.acog.org/About-ACOG/ACOG-Departments/Annual-Womens-Health-Care/Well-Woman-Recommendations?IsMobileSet=false

 
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Reply To Jennifer 2 Apa Citations Current Due In 6 Hours

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Unintended pregnancy is something I know very much about, I had an unintended pregnancy at the age of 19.  Never in my wildest dream did I think it would happen to me, I knew the consequences of an intimate relationship, but at my age, I was invincible.  While I was sitting with my OB/GYN my options were discussed, and at that time there weren’t all these different ways to deal with an unintended pregnancy, you either had the baby or had an abortion, but abortions were not as “easy” as they are today.  Pills were not given and 10 minute procedures were not around, there was intense bleeding and pain and there was a very real chance that the reproductive organs could be damaged and the patient could never have children later in life.                I chose to have my child and I bless each day that I have her, but not all young women can easily make that decision and with advances in medicine they have more options than ever before.  I was amazed over this past week when I went to Planned Parenthood with a staff member, who is alone, we went over the many options that she had and she was educated in the different ways she could choose her way.  I am not saying that I agree with her choice or the choices of the other women that were in the waiting room, but the idea that they had many options is what I was impressed with.                The contraceptives offered to young adults, presently allow for options based on what fits their needs.  Teen pregnancy is prevalent in the nation and with recently approved long acting contraceptives for adolescents there are ways to help teens be more responsible with intimate relationships.  Intrauterine devices and implants are the choice for the main line of contraception for all women including the young adults.  Currently prescriptions for contraceptives show that the main choice is pills for young adults, some feel it is due to barriers of knowledge and cost (K. McKellen, 2018).  Nurse practitioners will be at the forefront of providing education to their patients, helping reduce the number of teen pregnancies and ensuring that all their patients have access to them.  According to a 2015 survey, only 3.3% of adolescents are using LARC’s for their last sexual encounter.  What has been found through this study was that the type of contraceptive chosen by the patient was directly based on the type of provider they see (S. Dixon, 2018).  Again, this is where nurse practitioners will be vital in aiding how teens and their parents view the use of LARC’s. How do you personally feel about youth and LARC’s?ReferencesMcKellen, e. a. (2018). The Latest in Teen Pregnancy Prevention: Long-Acting Reversible       Contraception. The Journal of Pediatric Medicine, e91-e97.Dixon, e. a. (2018). What Do Parents Know and Believe About LARC Use in Teens?       Journal of Adolescent Health, S37-S140. 

 
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Reply To Hollie

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Question 1—Preconception Counseling

 Preconception care has been around since the 1980s, however, a recent push across many nationally recognized professional practices, including the American Academy of Family Physicians (AAFP), has been occurring (AAFP, 2015). This is largely due to the high rate of infant mortality, premature births, birth defects, and maternal deaths in the United States (AAFP, 2015). Preconception care refers is defined as: “individualized care for men and women that is focused on reducing maternal and fetal morbidity and mortality, increasing the chances of conception when pregnancy is desired, and providing contraceptive counseling to help prevent unintended pregnancies” (AAFP, 2015, para. 1). The AAFP is pushing for family practice health care providers to play a larger role in preconception care to help improve the current statistics.

 As a future family nurse practitioner, I do not anticipate seeing a large population of women seeking maternity care; however, as the AAFP points out, family practice providers are the most frequent providers of ambulatory primary care services to women aged 18 to 44 (AAFP, 2015). This puts family care providers in a prime position to do the majority of the preconception interventions. Preconception interventions can occur during routine well-woman examinations and should include identifying childbearing goals, screening for risks that can impact pregnancies, and assisting women in making healthy changes before becoming pregnant.

 There are a number of important topics to discuss during preconception counseling. I will utilize the most current, evidence-based guidelines available when providing preconception counseling to a woman who is planning a pregnancy. At this time, I would plan to discuss the following: reproductive and pregnancy goals; nutrition (especially folic acid); contraception; weight concerns; family and genetic history; management of chronic diseases; medication use; smoking cessation; avoiding alcohol; avoiding other drugs; eliminating toxin exposures; updating immunizations if needed; screening for sexually transmitted infections; and screening for abuse (Fowler & Jack, 2018). These are all important topics to discuss, because they have an impact on fetal and maternal health. For women in the interconception phase, it is important that they be counseled on healthy pregnancy intervals (Fowler & Jack, 2018). For instance, short interval pregnancies of less than 18 months are associated with high rates of preterm births, premature rupture of membranes, maternal morbidity and mortality, third trimester bleeding, anemia, and myometritis (Fowler & Jack, 2018).

References

American Academy of Family Physicians. (2015). Preconception care. Retrieved from https://www.aafp.org/about/policies/all/preconception-care.html

Fowler, J., & Jack, B. (2018). Preconception counseling. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK441880/

 
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Reply To Hollie Discussion

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The physical examination should include components that are relevant to the patient’s complaint and with the patient’s history in mind. Thyroid palpation and an abdominal assessment are appropriate for all individuals with complaints of painful menstruation. A pelvic examination and bimanual exam are appropriate tests for sexually active individuals (Osavande & Mehulic, 2014). Adolescents that are not sexually active with histories consistent with primary dysmenorrhea do not need to have a pelvic examination (Osavande & Mehulic, 2014). Laboratory tests may be used pending the relevance determined by the provider. Laboratory tests may include: pregnancy test, CBC, thyroid function tests, vaginal and endocervical swabs, erythrocyte sedimentation rate, and urinalysis (Osayande & Mehulic, 2014). Additional tests may be ordered as necessary.

Diagnosis and Differentials

Without more information, the initial diagnosis in this case would be unspecified dysmenorrhea (ICD-10: N94.6). Further information and evaluations may be needed to rule out secondary causes of dysmenorrhea, if clinical findings are suspicious for secondary dysmenorrhea. Differential diagnoses may be: primary dysmenorrhea, endometriosis, pelvic inflammatory disease, fibroids, or uterine cancer (Hackley & Kriebs, 2017).

Therapies

Pharmacological therapies for primary dysmenorrhea include NSAIDs or oral contraceptives (Osavande & Mehulic, 2014). Strong evidence supports the use of NSAIDs as the first line treatment for primary dysmenorrhea (Osavande & Mehulic, 2014). The choice of NSAID should be made on an individual basis, though over-the-counter ibuprofen, Aleve, or Midol are popular and effective choices (Osavande & Mehulic, 2014). The decision to use oral contraceptives should be made by the patient after thorough education and risks are explained to the patient.

The most effective non-pharmacological therapy used to treat primary dysmenorrhea is the topical application of heat (Osavande & Mehulic, 2014). Some dietary supplements, such as omega 3 fatty acids and B vitamins, have shown mixed effectiveness for controlling menstrual pain (Osavande & Mehulic, 2014). Lifestyle modifications can also assist in decreasing painful menstruation. Some evidence suggests low fat or vegetarian diets can decrease intensity and duration of menstrual cramps (Alsaleem, 2018). Obesity and smoking are other factors that can be modified to improve menstrual cramps, through weight loss and smoking cessation, respectfully (Hackley & Kriebs, 2017). Stress reduction techniques may also improve symptoms in stressed individuals (Osavande & Mehulic, 2014).

Follow-Up

If symptoms of primary dysmenorrhea improve with the pharmacological adjustments and non-pharmacological interventions, Osavande and Mehulic (2014) recommend continuing treatment and reassessing every six months. If symptoms are not relieved, the patient should return to the clinic for further evaluation after menstruation.  

References

Alsaleem M. A. (2018). Dysmenorrhea, associated symptoms, and management among students at King Khalid University, Saudi Arabia: An exploratory study. Journal of Family Medicine and Primary Care, 7(4), 769-774. https://dx.doi.org/10.4103%2Fjfmpc.jfmpc_113_18

Hackley, B. & Kriebs, J. (2017). Primary care of women. Burlington, MA: Jones & Bartlett Learning.

Osayande, A. & Mehulic, S. (2014). Diagnosis and initial management of dysmenorrhea. American Family Physician, 89(5), 341-346. Retrieved from https://www.aafp.org/afp/2014/0301/p341.html

 
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Reply To Discussion Board By Amanda

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The word metaphor I chose for this scenario is “actuality”, because a similar scenario likely unfolds in primary care offices around the country on a daily basis. During my most recent clinical rotation, it was expected that all providers schedule a patient every 15 minutes, and remain timely. This is common practice throughout primary care in the United States. Primary care institutions across the U.S strive to create value for their consumers (Budrevičiūtė et al, 2018), but at what cost? During my rotation, I struggled to identify what needs of the patient were most important to them. Often, I felt as though the patients could benefit from a little extra time with the provider.

            As nurses, it is engrained in our being to put the patient first, and address all needs. Being a nurse practitioner does not change our inherent desire to fix all of our patient’s problems. However, this does set us aside from other providers such as MDs, DOs, and PAs. From the time we are in nursing school to now – we are taught to address the whole patient. So, how I would address this issue? I would prioritize the patient’s most pressing health-care needs. I would follow this patient on a regular basis, even weekly if needed to put him on the right track.

Budrevičiūtė, A., ⨯ Ramunė Kalėdienė, & Petrauskienė, J. (2018). Priorities in effective management of primary health care institutions in lithuania: Perspectives of managers of public and private primary health care institutions.PLoS One, 13(12) doi:http://dx.doi.org/10.1371/journal.pone.0209816

 
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Report Issue Please Use The Two Sources Provide In The Attachment Plus 3 More Souses Of Your Choice For In Text Citation And References You May Use Numerous Forms Including Web Pages Journal Articles Text Books Inter

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Report Issue

Please use the two sources provide in the attachment  plus 3 more souses of your choice for in text citation and references 

You may use numerous forms including web pages journal articles, text books, interviews,Take time to look for professional resources who offer valid research and insight to your topic

Try to use a minimum of five current references

Include a (1) Introduction, (2) Body and (3) Conclusion

use for peer review that includes a type of Cohort, Quantitative or Qualitative research design and include in the introduction section of the paper include the outcome of the study

Example: A quantitative research study was conducted in Australia surveying 110 ER nurses to determine if the use of intraosseous insertion decreases the mortality rate of cardiac arrest patients. The conclusion of the research study conducted concluded that ……..

 
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Report And Summary

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FOLLOW THE INSTRUCTIONS TO GET TO THE WEBSITE 

 
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Research 19027237

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Assignment: This assignment has two parts

Part 1. EBP Research

Locate two research articles on the topic of your choice, but each article needs to use a different research method (quantitative, qualitative, or mixed methods). First, summarize both articles. Then answer the following questions…

  • Which type of research article did you find easier to understand? Explain
  • If you had to complete a research project which style would you choose and why?

This section should include 2 outside references and your book. This section should be at least 1000 words.

Part 2. Political Letter

Identify a current state or national healthcare or nursing issues that impact nurses or healthcare. Possible websites to locate an issue would be…

State Nursing Association

American Nursing Association

Specialized Professional Organizations

Once you have found your issue, write a letter to your governor, senator, or congress person. Your letter should be 500 words, in a block format and addresses should be included. Your first paragraph should state the issue. The second paragraph should state how the issue affects you personally as a nurse (avoid medical jargon). The third paragraph should state how the issue affects the community. Your fourth and final paragraph should restate the importance of the issue and thank the individual for their time and attention to the issue.

Your references for the letter should not be cited in your letter, but should be included on a separate reference page.

 
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Research 18992455

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– Follow instructions in the attached file carefully  
        – Avoid Plagiarism 
        – 1 page  not including the cover page and the references. 
        – follow APA style. 
        – provide in-text citation 3 articles

   Kindly stick to your price if you change I will dispute

 
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Research 18975079

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For this assignment, you are to select a target population with a specific health issue and research how social, cultural, and behavior factors of the target population contribute to health outcomes associated with the health issue. The 1,200-1,500 word Research Paper must including the following:

  1. Introduction: Provide a concise synopsis of the purpose of the paper and a general introduction to the target population and the health issue.
  2. Target Population: Provide a description about the target population that you have selected; provide demographic information about the population; and discuss relevant social, cultural, and behavior factors that affect this population.
  3. Health Issue: Provide information discussing the health issue that you have selected; include a history of knowledge and public health understanding regarding the health issue; how it has evolved; biological and epidemiological information related to the disease; and major social, cultural, and behavior factors that affect or relate to the health issue.
  4. Relationship Between Health Issue and Target Population: Analyze how social, cultural, and behavior factors in the target population contribute to the health issue; and identify what factors/characteristics are positive or negative and which behaviors/practices/beliefs serve as risk factors or protective factors.
  5. Current Strategies/Interventions: Discuss existing programming to prevent or reduce the health issue within the target population and challenges to interventions and programming.
  6. Recommendations/Conclusion: Make recommendations to resolve the health issue within the target population based on your review of current literature and what you have learned throughout the course.
  7. Minimum of Five References: Use the GCU Library to locate at least five resources, including at least two peer-reviewed articles.

Refer to the “Academic Writing Guidelines Resource.”

Use the completed “Peer Review Guide” from Topic 6 in making revisions and modifications to the final draft of your Research Paper.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

 
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