Hello, I need to do my weekly discussion question for my nursing class. Here is the SOAP note and at the end there are 3 questions to answer. 

Name: X.X.                             Date:                                                   Age: 44

Gender: Female                       Marital Status: Married          Occupation: Bank Teller

Examiner: APRN-BC                     Time: 9:15 am

Subjective Data: 

HPI: Patient reports that after reading a recent article in Women’s Health magazine, she decided to do a self-breast exam.  This was the first time she had performed such an exam and is unsure of the results.  Patient reports that during the self-exam she felt a “marble-sized” mass in the upper, outer quadrant of her right breast.  Patient reports that the mass was movable and was not painful or tender to the touch.  Patient states that the self-breast exam occurred about ten days ago.  She is unaware of any changes in the mass. Also she reports some itching and burning sensation in vaginal area. Patient stated she is having regular monthly menstruation.

Objective Data: 

BP 128/82; T 98.1 F; P 64; R 25.  Patient is verbally responsive, demonstrates fluid coordination in large and small movements, and reports no pain or discomfort.  Patient is a non-smoker and an occasional drinker.  Patient states that she drinks approximately 3 alcoholic drinks per week with friends. Patient is slightly overweight with a BMI of 29.8.

PMH: Patient has no chronic illnesses.  Patient suffered from pneumonia for approximately four weeks in November 2007.

Family History: Patient is one of three children. Her siblings are both males.  Mother died in a car crash at the age of 69 and had no chronic conditions apart from mild arthritis.  Father is still alive and is undergoing treatment for lung cancer.

Sexual Health:  Married, but she believes her husband goes around and maybe have another sexual partner. She uses birth control pills to prevent pregnancy, but husband uses no condoms. She is afraid to confront husband regarding this issue. She is willing to talk to a therapist if it is need it.

Medications: use of contraceptives Altavera.

ROS: Patient has itching and burning sensation (vaginal area) showing some discomfort symptoms. Also patient present symptom is a marble-sized lump in right breast.

Allergies: NKA, immunizations current.

Physical Examination:

General: In no acute distress. Alert and oriented x 3. Appropriate and cooperative.

HEENT:  Head is normocephalic without lesions or masses. Pupils round and reactive to light accommodation. Extraocular movements intact.

Neck:  Supple.  Trachea is midline. No JVD, internal, Proper neck strength and movement.

Breast: symmetric, no lesion or discharge, palpation revels no masses or tenderness. Except for R breast lump.

Lungs:  Lung fields clear to auscultation bilaterally.  No acute respiratory distress, no accessory muscle use; No wheezing, rales or rhonchi.  Equal chest expansion bilaterally.

Cardiovascular:  Oral cavity lips moist and pink, no cyanosis.  Carotid pulses +2 palpable bilaterally, no JVD or bruit.  Upper extremities- capillary refills less than 2 seconds, no clubbing or cyanosis present.  Radial and brachial pulses +2 palpable bilaterally. Apical pulse palpable at the 5th and 6th intercostal spaces.  Apical rate and rhythm regular at 90 bpm. S1 and S2 are present without murmurs, rubs, or gallops.

Abdomen:  Flat, soft, no tender, non distended with positive bowel sounds x 4. No organs enlarged.

External Genitalia:  Redness, no lesions.

Internal Genitalia: showing redness and Gray-white color discharge with a fishy, foul rotten  odor. Vaginal walls erythematous and edematous. Cervix pink with no lesions. Specimens obtained

Bimanual: No tenderness to palpation, uterus and ovaries not enlarged.

Rectum: No masses or fissure. Stool brown test negative for occult blood.

Breast examination:  The lump the patient reports is indeed a marble-sized lump in the upper outer quadrant of the right breast.  The lump feels nodal, rather than smooth, has moderate density, and does not appear to give any discomfort to the patient when manipulated. Patient’s breast tissue is dense considering patient’s age.

Initial Post:

1-What further questions do you have for this patient at this visit? (ROS) 
(This questions will help you to narrow your differential diagnosis) 

2-What is your differential (ICD-10 Codes) diagnosis list for this visit? include at least 2 (Assessment)

3. What would be your plan for this patient ? (diagnostic work-up, Medications, Referrals, Conservative measures, Patient education, Follow-up plan, etc) 

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Week 2: Common Screenings for Women

Many screening procedures are often recommended and routinely used with women to detect diseases in the earliest stages possible. Consider Cindy, who was 28 years old when she received the results of her annual pap smear. The results of the test were abnormal, leading to a diagnosis of human papillomavirus (HPV). While Cindy’s type of HPV did not require treatment, subsequent annual pap smears were highly recommended due to risks associated with the disease. Five years later, after another round of abnormal screening results, Cindy was diagnosed with aggressive cervical cancer, which was then successfully treated (Tamika & Friends, Inc., 2011). For diseases like cervical cancer, screenings and early detection can save patients’ lives, as it did in Cindy’s case. As an advanced practice nurse caring for women, you must be able to provide recommendations for screening tests, interpret test results, and develop care plans that meet the unique needs of patients.

Learning Objectives

By the end of this week, students will:

• Evaluate strengths and limitations of guidelines for screening procedures
• Analyze the influence of guidelines on clinical decision making
• Analyze the impact of advanced practice nurses on issues related to screening guidelines
• Evaluate diagnoses for patients
• Evaluate treatment and management plans
• Understand and apply key terms, principles, and concepts related to clinical guidelines on screening procedures
• Analyze differences between common screenings for younger women and common screenings for older women

Discussion: Guidelines on Screening Procedures

“THYROID DISEASE”

The goal of health promotion and education is to help prevent disease in patients. However, this is not always successful, and disease it not always preventable. With disease, early detection is ideal, often making screening procedures a routine part of clinical care. Unfortunately, many patients do not utilize these health services. This can be attributed to lack of awareness or access to care, financial concerns, or even levels of comfort with health care providers. In your role as the advanced practice nurse, you must be aware of potential obstacles for patients and implement strategies to ensure patients receive necessary screenings. Although a variety of screening procedures are recommended for women at various stages of life, not all screenings are appropriate for all patients. Understanding the strengths and limitations of each screening, as well as current guidelines for use is essential to effectively facilitate patient care. For this Discussion, the course Instructor will assign a specific topic for you to research.

To prepare:

• Review this week’s media presentation, as well as Chapters 6 and 8 of the Tharpe et al. text and the U.S. Department of Health and Human Services article in the Learning Resources.
• Research guidelines on screening procedures for the topic assigned to you by the course Instructor (e.g., guidelines on screening for domestic violence, safety, nutrition, osteoporosis, heart disease, mental health, eating disorders, thyroid disease, pap smear, mammogram, cancer, and sexually transmitted infections). Note: The course Instructor will assign a topic to you by Day 1 of this week.
• Reflect on strengths and limitations of the screening guidelines.
• Consider how the guidelines might support your clinical decision making.

By Day 3

Post an explanation of the guidelines on screening procedures for the topic assigned to you “THYROID DISEASE”. Include an explanation of strengths and limitations of the guidelines. Then, explain how the guidelines might support your clinical decision making.

By Day 6

Respond to at least two of your colleagues on two different days who were assigned different topics than you. Explain a patient scenario in which your colleague’s guidelines might not be appropriate. Then, explain how you would provide care for the patient in the scenario. Finally, explain how you, as an advanced practice nurse, might be able to impact issues related to these screening guidelines.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

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 You are admitting a 19-year old female college student to the hospital for fevers.  Using the patient information provided, choose a culture unfamiliar to you and describe what would be important to remember while you interview this patient. Discuss the health care support systems available in your community for someone of this culture. If no support systems are available in your community, identify a national resource. 

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Prompt: Your reflective journal for this week is your response to the session with Dr. Craigie with incorporation of the content of Chapter 4 in the Craigie book.

Summary:
The purpose of the reflective exercises is to allow for analysis, synthesis and evaluation of nursing theory using guided questions. Reflection has been referred to as a process that happens internally, privately or in isolation (Hill & Watson, 2011). Also, reflection has been referred to as the examination of an issue of concern, as a consequence of experience, creating clarity and meaning in terms of self, and which results in a change of perspective ( Boyd & Fales, 1983).

Boyd, E. M., & Fales, A. W. (1983). Reflective learning: Key to learning from experience, Journal of Humanistic Psychology, 23(2), 99-117.
Hill, M. & Watson, J. (2011). Creating a Caring Science Curriculum. New York, NY: Springer Publishing.

Directions:
The Reflective Exercise Questions will follow your Craigie (2010) readings.

• A dropbox will become available Monday, 0:01 am PST of the week it is due.
• Submissions are due by Sunday, 11:59 pm PST
• this book is for reflections:
• https://mgh.sharefile.com/share/view/sfa5f50e104f4ac8a

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