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Review Chapter 8 of the Tharpe

Discussion: Political, Social, and Sociocultural Influences on Women’s Health

As an advanced practice nurse, you must remain current on health issues that commonly impact women such as birth control, abortion, family planning, the human papillomavirus (HPV) vaccine, and human immunodeficiency virus (HIV). Many of these women’s health issues are heavily influenced by political, social, and sociocultural factors. These influences might not only affect a woman’s ability or desire to receive care, but also a provider’s ability or willingness to offer care. How might political, social, and sociocultural factors influence your personal perceptions of these women’s health issues?

To prepare:

Review this week’s media presentation, as well as Chapter 1 of the Schuiling and Likis text.

Select and research one of the following women’s health issues: birth control, abortion, family planning, human papillomavirus (HPV) vaccine, human immunodeficiency virus (HIV) in women, or another issue approved by the course Instructor.

Consider the impact of political, social, and sociocultural factors on the women’s health issue you selected.

Reflect on how the personal perceptions of providers might influence their ability or willingness to care for women in relation to this issue.

Week 2 discussion

Discussion: Guidelines on Screening Procedures

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.

Week 3 discussion

Discussion: Contraception Treatments

Considering the potentially negative consequences of unintended pregnancy for a woman’s health and well-being, effective contraceptive treatments are an important part of gynecologic care. There are a variety of contraceptive treatment methods available for women, including hormonal, barrier, and fertility awareness options. Each method has its own strengths and limitations, and each patient often has individual factors that might also impact appropriateness of use. In your role as the advanced practice nurse, it is important to keep in mind that while you may make contraceptive recommendations to patients, contraceptive selection is a joint decision between the patient and the provider. For this Discussion, consider which contraceptive treatments would be most appropriate for the patients in the following three case studies:

Case Study 1:

A 23-year-old Caucasian female presents with concerns about mood swings around the time of her menses. She believes she has PMS and wants to know if there is medication to control it.

Case Study 2:

A 25-year-old Latina female presents with menstrual cramping that has been getting worse over time. She has never been pregnant and she has one male sex partner. Her gynecologic exam is normal.

Case Study 3:

A 33-year-old Caucasian female is being seen in clinic for contraception. She is using birth control pills, but forgets to take them because her work schedule changes every week. She has been married for 14 years and has two children. She is looking for an effective method that will be easy to remember. She has a history of chronic headaches and hypertension during pregnancy. She has never been treated for a sexually transmitted infection and is in a mutually monogamous relationship. Family history is significant for an aunt with breast cancer. She smokes half a pack of cigarettes per day. She is 5 ft. 8 in. and 215 lbs. Her vital signs are: BP 120/78, p 72, reg.

To prepare:

Review Chapter 12 of the Schuiling and Likis text and the Dragoman et al. article in this week’s Learning Resources

Select one of the three provided case studies. Reflect on the patient information.

Consider an appropriate contraception treatment for the patient case study you selected.

Think about how you might facilitate the selection of contraception treatments with patients who do not agree with your recommendations.

Week 4 discussion

Discussion: Sexually Transmitted Infections

The Centers for Disease Control and Prevention estimates that there are 19 million new cases of sexually transmitted infections every year in the United States (CDC, 2010b). STIs may present serious health implications for infected patients—especially for those who are unaware of their health condition. Studies show that women are not only at greater risk of contracting these infections, but they also tend to have more severe health problems resulting from infections than men (U.S. Department of Health and Human Services, 2009b). As an advanced practice nurse, you must educate female patients and emphasize the importance of prevention and STI testing for all women regardless of marital status, race, ethnicity, or socioeconomic status. For this Discussion, consider STI education strategies for the three patients in the following case studies:

Case Study 1:

A 19-year-old Asian American female comes into the clinic for a well-woman checkup. She states that about three weeks ago she had a non-tender sore on her labia that resolved without treatment. Her gynecologic exam is normal but she has maculopapular lesions on her trunk, neck, palms, and soles of her feet. The remainder of her exam was unremarkable.

Case Study 2:

A 31-year-old African American female is concerned about a white vaginal discharge. She has self-treated in the past with over-the-counter vaginal creams with some success. She has had no relief thus far for this episode.

Case Study 3:

A 21-year-old nulligravida comes to see you concerned about vague lower abdominal pain for two days associated with a yellowish, nonodorous, vaginal discharge. Past history reveals regular menstrual periods and no previous surgeries or significant medical problems. Her last menstrual period was normal and ended two days ago. She had a similar episode about eight months ago for which she did not seek care because of lack of health insurance. She is currently sexually active with one partner and has had two partners in the past year. She is not using any type of contraception. On physical exam you note a temperature of 38º C, a regular pulse of 100, and a BP of 110/65. Her abdomen is diffusely tender in both lower quadrants. Pelvic exam reveals a yellowish cervical discharge with cervical motion tenderness and a tender fullness in both adnexa.

To prepare:

Review Chapter 20 of the Schuiling and Likis text and the Centers for Disease Control and Prevention article in this week’s Learning Resources.

Review and select one of the three provided case studies. Reflect on the patient information.

Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.

Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.

Consider strategies for educating patients on the treatment and management of the sexually transmitted infection you identified as your primary diagnosis.

Week 5 discussion

Discussion: Diagnosing and Managing Gynecologic Conditions

Gynecologic conditions can be difficult to diagnose for a variety of reasons, including overlapping symptoms, lack of patient knowledge, or even patient fear or embarrassment about sharing information. Your role provides you the opportunity to develop a relationship of trust and understanding with these patients so that you can gather the appropriate details related to medical history and current symptoms. When caring for this patient population, it is important to make these women an integral part of the process and work collaboratively with them to diagnose and develop treatment and management plans that will meet their individual needs. For this Discussion, consider diagnosis, treatment, and management strategies for the patients in the following four case studies:

Case Study 1:

A 32-year-old African American female is concerned about increasing dysmenorrhea over the past three years. In the past year, this was associated with painful intercourse. She has been in a monogamous relationship with one male partner for the past five years. They tried to have children without success. Menarche was at age 10; menstrual cycles are 21 days apart and last for 6–7 days. The first day of her last menstrual period was 10 days ago and was normal. She denies vaginal itching or discharge. On gynecologic exam there was no swelling, external lesions, or erythema, urethral swelling, or vaginal discharge. Cervix is pink without lesions or discharge. Uterus was small, retroverted, and non-tender. Adnexa were small and non-tender. Nodules are noted along the cul de sac.

Case Study 2:

A 42-year-old African American female is in the clinic for a routine gynecologic exam. When asked, she admits to noticing bleeding in between her menstrual periods for the past several months. She has been pregnant three times and has three children. She is sexually active with one male sex partner in a monogamous relationship. During her bimanual exam, you note an irregular intrauterine non-tender mass about 4 cm in diameter. The mass is palpable abdominally. The remainder of her gynecologic exam was normal.

Case Study 3:

A 48-year-old Caucasian female is in the clinic concerned about prolonged menstrual bleeding for three weeks now. Her prior menstrual periods have been irregular for the past eight months, lasting no more than three days each. There have been one to two months when she had no menstrual cycles at all. She reports occasional hot flushes and mood swings.

Case Study 4:

A 16-year-old Caucasian female comes to the clinic concerned because she has not had a menstrual period for three months. She’s a junior in high school and active in sports. She has lost about 10 lbs. in the past two months. She is currently 5 ft. 4 in. and weighs 100 lbs.

To prepare:

Review Chapter 26 of the Schuiling and Likis text and Chapter 7 of the Tharpe et al. text.

Review and select one of the four provided case studies. Analyze the patient information.

Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.

Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.

Consider strategies for educating patients on the treatment and management of the sexually transmitted infection you identified as your primary diagnosis.

Week 6 discussion

Discussion: Breast Conditions

Throughout a woman’s life, her breasts go through many normal, healthy changes. However, patients do not always understand these changes and often visit health care providers for treatment. When examining these patients, you must be able to identify when a breast condition is the result of a safe and normal physiological change and when it is the result of an abnormal change requiring treatment and management. A diagnosis of a breast condition resulting from an abnormal change can be devastating for women, making emotional support as vital to women’s well-being as proper assessment, diagnosis, and management. For this Discussion, consider how you might diagnose, manage, and support the following two patients presenting with breast conditions:

Case Study 1:

You are seeing a 60-year-old Latina female, Gravida 4 Para 3104, who is concerned about a thick greenish discharge from her left breast for the past month. The discharge is spontaneous and associated with dull pain and burning. Upon questioning, she also tells you that she breastfed all her children and is currently not on any medications except for occasional Tylenol for arthritis. Her last mammogram, 14 months ago, was within normal limits. On exam, her left breast around the areola is slightly reddened and edematous. Upon palpation of the right quadrant, a greenish-black discharge exudes from the nipple. You note an ovoid, smooth, very mobile, non-tender 1 cm nodule in the RUIQ at 11:00 5 cm from the nipple. No adenopathy, dimpling, nipple discharge, or other associated findings. Her right breast is unremarkable. The patient expresses her desire to proactively decrease her risk for developing breast cancer.

Case Study 2:

You are seeing a 53-year-old African American female for a lump she found in her right breast two weeks ago in the shower. Her last mammogram was three years ago and she was told it was “benign.” She had two breast biopsies at ages 32 and 34 in her right and left breasts, respectively. At both times she had surgery for removal of fibroadenomas. She does not routinely do breast self-exams. Her mother had a mastectomy for breast cancer at age 63, and she heard that a paternal aunt had a breast removed for cancer when she was in her forties. Both mother and aunt are alive and well today. It was discovered on postmortem exam that her grandfather had prostate cancer. Menarche was at age 15 and she is still having monthly menses. She is Gravida 4 Para 3104 with her first childbirth at age 31. She was on oral contraception for 10 years, has no history of fertility treatments, and had a bilateral tubal ligation after the birth of her last child at age 35. Past medical history is noncontributory. She wants to know how likely it is that she will get breast cancer. Physical exam reveals breasts are symmetrical with no dimpling, retractions, or rash. Her right breast has a 2 cm non-tender, hard, fixed mass at 3:00 6 cm from her nipple. Left breast is non-tender without masses. No nipple discharge bilaterally. No anterior cervical, infra- or supraclavicular, or axillary adenopathy.

To prepare:

Review Chapter 15 of the Schuiling and Likis text.

Review and select one of the two provided case studies. Analyze the patient information.

Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.

Reflect on the appropriate clinical guidelines. Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.

Consider strategies for educating patients on the treatment and management of the disorder you identified as your primary diagnosis.

Week 7 discussion

Discussion: Care Plans for Pregnancy

After confirming and dating a pregnancy, you must collaborate with patients to develop a personalized care plan. These pregnancy care plans are integral to prenatal care as they help to ensure the mother and child’s well-being throughout the entire pregnancy. Pregnancy can be a wonderful, yet difficult time for women as a woman’s body goes through many physical, mental, and emotional changes that might be challenging or even overwhelming for some. Whether or not these women share their concerns, as the advanced practice nurse, you must routinely watch for signs and symptoms of any developing physical or mental health issues. By collaborating with patients and discussing concerns, you can modify care plans and often address potential issues before they become a significant health problem. For this Discussion, consider pregnancy care plans for the women in the following case studies:

Case Study 1:

On 1-15-13, you are seeing a 25-year-old Caucasian female in the clinic because she believes she’s pregnant. Her LMP was 12-1-12. Her home pregnancy test was positive, and she has been having nausea and breast tenderness.

Case Study 2:

You are seeing a 28-year-old African American female, G6 P 3115, who is currently on oral combined hormonal contraception. She’s here because she and her partner would like to have another child. She heard “it takes a while to become pregnant after being on the Pill,” so she discontinued them three months ago. They haven’t been using any contraception since then. Upon questioning, she states that on the Pill, sometimes her menstrual periods are very light and once she didn’t have one at all. Her urine pregnancy test in the clinic is positive. Her LMP was 7-14-12. You are seeing her on 12-3-12.

To prepare:

Review Chapter 30 of the Schuiling and Likis text and Chapter 2 of the Tharpe et al. text.

Review and select one of the two provided case studies. Analyze the patient information.

Consider how to date the pregnancy and estimate the date of delivery for the patient in the case study you selected.

Based on the dating of the pregnancy, reflect on the appropriate clinical guidelines for procedures and screenings. Think about the implications of any missed procedures or screenings.

Determine a plan of care for the patient. Identify procedures, screenings, diagnostic testing, pharmacologic and nonpharmacologic treatments (if appropriate), management strategies, and patient education.

Week 8 discussion

Discussion: Health Promotion During Pregnancy

When caring for pregnant women, it is important to care for the whole person. This means you not only manage the pregnancy and treat conditions, but you also promote healthy behaviors and good lifestyle choices. Through health promotion, you can help to ensure the safety of both the mother and the baby. Your role in health promotion is to identify health risks that might result in pregnancy complications, educate patients on these risks, and provide the necessary support to help patients mitigate these risks. In this Discussion, you examine implications of drug use, alcohol consumption, dietary habits, and environmental exposures during pregnancy, and you consider ways to educate pregnant women about such risks.

To prepare:

Review Chapter 2 of the Tharpe et al. text and the article from the Centers for Disease Control and Prevention in this week’s Learning Resources.

Consider lifestyle changes that pregnant women must make in relation to smoking, drinking, taking drugs (legal and illegal), eating habits, and caring for pets. Select one of these topics to be the focus of an educational media piece you would create for health promotion during pregnancy.

Think about the patient population that you treat within your practicum setting. Consider ways to educate these patients on health promotion as it relates to the topic you selected. Then, consider the types of educational pieces, such as flyers, posters, public service announcements, or other media, that might be most effective with your patient population.

Week 9 discussion

Discussion: Nonadherence to Lifestyle Changes During Pregnancy

After identifying potential health risks for pregnant patients, providers often recommend behavior changes in lifestyle choices such as drug use, alcohol consumption, dietary habits, and environmental exposures. Even with provider recommendations and patient education programs, some patients still struggle to adhere to recommended lifestyle changes during pregnancy, posing health risks for both the mother and child. In your role as the provider, you must be able to recognize signs of nonadherence to recommended lifestyle changes because not all patients will be forthcoming with the struggles they may be experiencing. Management plans are only successful if patients’ individual needs are recognized and met, so provider-patient collaboration is essential for mitigating nonadherence issues. For this Discussion, consider implications of nonadherence to recommended lifestyle changes and potential management strategies for pregnant patients.

To prepare:

Review the “During Pregnancy” article in this week’s Learning Resources.

Think about the health promotion topic that you selected for the Week 8 Discussion (i.e., smoking, drinking, taking drugs, eating habits, and caring for pets).

With the topic you selected in mind, consider early signs and symptoms that might indicate a patient’s nonadherence to recommended lifestyle changes during pregnancy. Think about the impact of nonadherence on the fetus and the patient.

Reflect on treatment and management strategies for patients presenting with signs and symptoms of nonadherence to recommended lifestyle changes.

Week 10 discussion

Discussion: Diagnosing and Managing Common Cardiovascular and Neurologic Conditions

Cardiovascular and neurologic conditions are among the leading causes of death and hospitalization of women in the United States (Centers for Disease Control and Prevention, 2008a). As an advanced practice nurse, you must routinely monitor patients at risk of these conditions and recommend the appropriate health screenings and preventive services. When assessing patients for these conditions, it is important to keep in mind that while some female patients might present with typical signs and symptoms, others might present with atypical signs and symptoms that are unique to women. For this Discussion, consider signs and symptoms presented by the women in the following case studies and develop differential diagnoses:

Case Study 1

A 48-year-old overweight African American female is in the clinic for a wellness visit. A routine fasting lipid panel returned with the following results:

Total cholesterol: 305 mmol/L

Low-density lipoprotein (LDL): 180 mg/dl

High-density lipoprotein (HDL): 30 mg/dl

Triglycerides: 165 mg/dl

Case Study 2

You are seeing a 63-year-old African American female for a two-week history of intermittent chest pain. The pain varies in intensity and resolves with rest. She does not believe it has increased over time. She is a nonsmoker with a history of hypertension treated with Lisinopril 10 mg once daily. She had an exercise stress test one year ago that was within normal limits. Her physical exam findings are as follows: HR–90, BP–150/92, R–22, O2Sat 98% RA; lungs: clear to auscultation bilaterally; cardiovascular: apical pulse of 90 RRR, no rubs, murmurs, or gallops. Chest wall mildly tender to palpation that reproduces her complaint of pain. Extremities include no clubbing, cyanosis, or edema. The remainder of the exam is within normal limits.

Case Study 3

A 32-year-old Asian American female is in the clinic for a history of recurrent headaches for the past year, occurring monthly, lasting up to 12–18 hours. The headaches are sometimes associated with photophobia, nausea, and vomiting. She takes either acetaminophen or ibuprofen for relief that is not always successful. She uses Ortho Tricyclin for birth control. Her physical exam is within normal limits.

To prepare:

Review Chapter 8 of the Tharpe et al. text and the McSweeney et al. article in this week’s Learning Resources.

Review and select one of the three provided case studies. Analyze the patient information.

Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.

Reflect on the appropriate clinical guidelines. Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.

Consider strategies for educating patients on the treatment and management of the disorder you identified as your primary diagnosis.

Week 11 discussion

Discussion: Diagnosing and Managing Common Endocrine and Musculoskeletal Conditions

Endocrine and musculoskeletal conditions, especially when left untreated, can have a significant impact on women’s health. Many of these conditions present unique challenges for women, making risk assessments and routine screenings an important part of primary care. As an advanced practice nurse, you must identify signs and symptoms of these conditions and educate at-risk patients so they can also monitor themselves. For this Discussion, consider how you would diagnose, treat, and educate the patients in the following three case studies:

Case Study 1

A 33-year-old Caucasian female presents with concerns about a four-month history of diffuse musculoskeletal pain and stiffness associated with fatigue and dry eyes. The pain varies with the weather and is worse in the morning. Her menstrual periods are irregular and she has frequent dyspareunia. Physical exam is remarkable for pain at different points all over the body, including neck, back, chest, elbows, hips, buttocks, and knees

Case Study 2

A 28-year-old Latina obese female presents to the clinic with increasing body hair and irregular menses. She now has coarse body hair on her chest and upper back. Her menstrual periods used to be fairly regular, but now she can skip three or four months before her next menstrual cycle. She has never been pregnant. She has one male sex partner.

Case Study 3

A 28-year-old Caucasian female comes to clinic concerned about three episodes of urinary incontinence associated with difficulty walking. The first two episodes resolved spontaneously after a couple of days without residuals, but this current episode has lasted a week. Today she began to have some blurred vision. Physical exam is remarkable for mild edema of the optic disc and difficulty with heel-to-toe walking. Deep tendon reflexes are 2+ and there is no extremity weakness.

To prepare:

Review Chapter 8 of the Tharpe et al. text and the McSweeney et al. article in this week’s Learning Resources.

Review and select one of the three provided case studies. Analyze the patient information.

Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.

Reflect on the appropriate clinical guidelines. Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.

Consider strategies for educating patients on the treatment and management of the disorder you identified as your primary diagnosis.

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