Week 1 Discussion Forum

Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example, #1 Maria, 49-year-old female, annual exam.

Discuss what questions you would ask the patient, what physical exam elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals and other team members needed to complete patient care. 

Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas. 

In your peer replies, please reply to at least one peer who chose a different case study.

1. Maria, a 49-year-old female, presents to at the clinic for her annual physical exam.  Her history notes she is G5P5, all NSVDs without pregnancy or delivery complications. Her LMP was two months ago, but her periods have recently become irregular over the last year. She has been separated from her husband for two years and has not been sexually active since the separation. Maria had a bilateral bunionectomy at age 25. Maria’s mother is 67 years old and has HTN since age 55. Maria’s father died from colon cancer 10 years ago at age 57.  Maria’s VS are WNL   and her BMI is 28.  She reports no current health complaints or problems except for some mild right knee pain for which she occasionally takes ibuprofen with relief.  Her last Pap smear was negative seven years ago and she has never had a mammogram. 

• Based on this information, what will you perform and order today for Maria as part of her annual PE?
• What is your rationale for ordering those tests, and why?

Please refer to evidence-based guidelines to support your decision-making for this scenario.

2. Denise, a 19-year-old female presents to the clinic for an annual physical exam.  She is G0P0, and for six months has been using the  Mirena IUD for contraception and to help her manage her menorrhagia and dysmenorrhea.  She is now experiencing amenorrhea as a normal side effect of the Mirena IUD.  She and her boyfriend broke up four months ago and she has had two new male sexual partners since. She admits to not using condoms because she is using the IUD for contraception. She denies any significant medical or surgical health history and denies any current health problems.  She has never had a Pap smear or any pelvic exam tests before today. Her pregnancy test is negative and her vital signs are all WNL.

• What procedures and/or tests will you preform during this visit?
• What patient education is important to include for this patient?

Provide evidence from the research to support your decision-making.

3. Juliais a 37-year-old woman G2P2 who presents with a lump in her left breast. Her husband noticed it recently and she is concerned, because her aunt had breast cancer and she thinks that a great-grandmother or some other ancestor may have died of breast cancer as well.  Both of her children, who are ages 9 and 7, were delivered without complications and she breastfed “for well over a year” with each.  She has no other significant PMH or allergies.  She is 5’ 6” tall, weighs 144 pounds, and has a BMI of 22. Julia works as an office manager.  She is a non-smoker, considers herself to be a “meat lover,” and drinks 2 to 3 glasses of wine most evenings with dinner. Her last physical exam was over 10 years ago. Upon examination, a lump is discovered. It is firm and near the surface and no other masses are discovered. The lump is aspirated and an opaque liquid is removed. Following this procedure, the lump vanishes.

• What is Julia’s risk of developing breast cancer?
• What recommendations, preventative measures, and patient education would you discuss with this patient?

Please refer to evidence-based guidelines to support your decision-making.