Women’s Health Issue: Osteoporosis
· Part 1: post a description of the issue
· Research this issue and include (be specific and provide examples):
o common symptoms
o recommended diagnostic tests
o common treatments
· Part 2: answer this question (in its own paragraph)
o What are your options for primary prevention? How would you educate someone on the treatment?
A 25-year-old female presents with a recent Hx of ammennorhea. Propose five questions you would want to ask her. Why? Identify two diagnostic tests that would be appropriate and explain why.
Reflect upon the selected national practice problem in Week 1(OBESITY) to address the following. You have to develop this national problem but in the Local Practice (Florida). I selected for the first week OBESITY and I attached the week 1 the Discussion Board that you have one example to develop this week. Remember you have to answer these questions below for OBESITY but in Florida where I live.
1-From a local perspective, how does the practice problem impact nurses, nursing care, healthcare organizations, and the quality of care being provided?
2-Identify the local key stakeholders related to the selected practice problem.
3-Describe one approach used at your unique setting to address this problem. From your perspective, is this intervention effective in addressing the problem? Why or why not? If this practice problem is not addressed at your workplace, propose an intervention that could be implemented on a local scale to address the problem.
Please answer these questions separated and use at least 3 sources no later than 5 years.
SOAO Note
Patient Initials: S.M
Pt. Encounter Number: 2
Date: 10/12/2020
Age: 61
Sex: Female
Allergies: NKA
Advanced Directives: No
SUBJECTIVE
Chief Complaint: “I have a lump on my right breast.”
HPI: S.M is a 61-year-old, Hispanic, female who presents to the office alarmed by a painful lump in her right breast that she discovered while showering. S.M reports the pain started 2 days ago while in the shower. The pain is felt when touching the right breast, and it felt on light touch. Current pain level is now 5/10. She does not report any skin changes. Patient denies any history of herbal medicine use and is currently on no medication. Pain gets worse with movement and with lifting weight. Pain is relieved with rest and medication. S.M gets some short relief with pain reliever ibuprofen 200mg that she takes twice a day for the past two days.
Past Medical History
Medication Intolerances: No known drug intolerance
Chronic Illnesses/Major traumas: The patient denies any history of major trauma.
Screening Hx/Immunizations Hx: last mammogram, which was normal, was 2 years ago.
OBGYN: Menarche at 10; LMP 2 weeks ago; last PAP 2019/Normal; GTPAL: 11001 score; no previous history of STDs. S.M is sexually active, have had 2 sexual partners in the past. S.M used condoms with previous partners. No previous gyn diagnoses or procedures done in the past.
Hospitalizations/Surgeries: Hospitalized once for delivery
Family History: There is no history of malignancy in first-degree relatives. She has one sister, age 58, who is in good health. Mother died at age 70; father died at age 64, from unknown causes.
Social History: S.M is married with one child. No use of alcohol; drinks wine socially; drinks one cup of coffee sometime to start her day at work. Never uses drugs.
Review of System
Constitutional: No significant gain/loss weight, no chills, no malaise or fatigue; no night sweats, no exercise intolerance. She does not report any skin changes. She has not experienced fever, weight loss, headache, nausea, vomiting, dizziness, or bone pain.
Skin: Denies rashes, pigmentation changes, lesions, or hair or nail changes.
Eyes: denies vision changes, diplopia, blurred vision, reports wearing eyeglasses.
Ears: Denies loss of hearing, ear pain, drainage, sensation of ears feeling full, ringing in the ear, or ear trauma.
Nose/Mouth/Throat: Denies sore throat, hoarseness, difficulty swallowing, postnasal
drip. No report of mouth or lips sore, bleeding gums, ulcerations or lesions of tongue or
mucosa; no dentures or dental appliances, or missing teeth reported.
Breast: Refers to right breast pain, or discomfort to right breast. Reports some brownish nipple discharges when squeezing the nipple and denies any breast trauma.
Heme/Lymph/Endo: Denies history of anemia, no bruising, no abnormal bleeding, and no swollen glands.
Cardiovascular: Denies chest pain, palpitations, orthopnea, edema, claudication, murmurs, or history of cardiac disease.
Respiratory: S.M reports no cough, sputum, wheezing, no recurrent URIs, hemoptysis,
bronchitis, pneumonia, or history of TB.
Gastrointestinal: Patient denies abdominal pain, nauseas, or vomiting. Denies bloating,
flatulence, diarrhea, constipation, changes in stools; black tarry stools, or bright rectal
bleeding after defecation. S.M reports normal appetite.
Genitourinary/Gynecological: denies dysuria, frequency, urgency, and urge to urine after she had emptied her bladder. Denies nocturia, or hematuria; denies genital discharge, or sensation of bladder fullness; no abnormal bleeding, and no history of STD.
Musculoskeletal: No muscular aches or weakness, no arthralgia, denies history of falls, no loss of balance.
Neurological: Denies changes in LOC, Denies history of tremors, seizure, weakness, numbness, dizziness, headaches, memory lapses or loss. Denies sleep disturbances.
Psychiatric: Denies hallucination, depression, or any thoughts to harm self or others. Also denies psychosocial, or emotional disorder at this point in time.
OBJECTIVE
Vital Signs: BP: 130/78, P: 74, R18; T: 97.3; O2 Sat: 99 %. Wt.: 170 lb. Ht. 5’5″, BMI: 28.29.
Physical Examination
General Appearance: S.M is awake, alert, and oriented to time, space, and person. Speaks clearly and follows simple commands. Well nourished, developed and dressed/groomed, pleasant demeanor. Appears to be without discomfort, does not look distressed.
Skin: Normal general appearance. Warm, moist, good skin turgor. No cyanosis, rashes, or lesions noted. No wound, no change in a mole, no unusual growth, no jaundice, no bruising, no bleeding.
HEENT: Head: Is normocephalic, atraumatic, and without lesions. No tenderness elicited on palpation with both temporal pulses being regular.
Eyes: Are normal with PERRLA; with pinkish conjunctiva and whitish sclera implying no jaundice or anemia.
Ears: There is mild cerumen on external auditory meatus; tympanic membranes are also intact and pearly gray in color, with presence of light reflex.
Nose and sinuses: The patient has moist nasal mucosa with no drainage and mid sagittal septum. External nares are patent, and frontal and maxillary sinuses non-tender on palpation.
Mouth: The patient has a good oral hygiene. The lips, gums, tongue, and hard palate are normal, with all teeth intact with no discolorations. The oropharynx is moist and pinkish with no apparent enlargement of the tonsils (Hollier, 2016).
Neck: The assessment depicts no apparent tracheal deviation, without thyroid and lymph nodes not palpable. All movements are normal.
Cardiovascular: The anterior chest wall is symmetrical with AP diameter less than lateral diameter. Both S1 and S2 heard on auscultation at all valve areas with no added sounds. The apex beat at fifth intercostal space, mid clavicular line, with neither heaves nor thrills. Capillary refill is 2 second, with pulses 3+ throughout and no edema.
Respiratory: Unlabored respiration, lungs are clear bilaterally to auscultation. Breath sounds are normal on auscultation.
Gastrointestinal: Abdomen is soft, no rebound tenderness, masses, scars, herniation, or guarding. Bowels sound present to all 4 quadrants, no organomegaly, or bruits. No sign of active GI bleed.
Breast: There are no visible abnormalities on sitting or supine exam. Left breast and axilla are normal. Right breast with about 2 cm tender hard, color changed, immobile lesion with irregular borders, in superior lateral quadrant approximately 6 cm from areola. There is no palpable axillary, or supra-clavicular lymph nodes.
Genitourinary: The kidney was bimanually not palpable and non-tender, no sign of costo-vertebral angle tenderness. The bladder was not distended and devoid of urine prior to examination (Hollier, 2016).
Musculoskeletal: Full range of motion in all extremities. No abnormalities in gait or movement.
Neurological: Alert, oriented to time, place and person, Neurologic grossly intact. Memory to recent and remote events preserved. Sensation intact and preserved strength to bilateral upper and lower extremities.
Psychiatric: Patient has good judgment; mood and affect are normal. No anxiety, or depression, no irritability, and no mood swing.
Lab Tests: U/A, and C/S, no growth, WBC 5.6 and H/H 9.5/31(July 2020).
Special Tests: Last mammogram 2019/ negative; Pap smear 2018/normal
Diagnosis
C50.9- Breast cancer– Patient presents to the clinic and alarmed by a painful lump in her right breast that she discovered while showering. The reported symptoms and signs noted on physical examination suggest findings of breast carcinoma which can be justified with a mammogram and other studies (Burstein, Lacchetti, & Griggs, 2016).
Differential Diagnoses–
N64.89- Galactocele– Patient presents to her clinic alarmed by a painful lump in her right breast that she discovered while showering (Burstein, Lacchetti, & Griggs, 2016).
N60.0- Breast cyst– The patient presents to her internist alarmed by a painful lump in her right breast. Tender breast lumps are a common presentation and could point out to a wide variety of diseases. As such, it is necessary to conduct a detailed history to come up with a detailed diagnosis. On the case of S.M, histology would be of great significance to come up with a definitive diagnosis. (Burstein, Lacchetti, & Griggs, 2016).
N64.4- Mastodynia- S.M shows sign and symptom of breast tenderness of unknown cause which requires further investigation.
PLAN and education
Test: Bilateral breast mammography and Right breast U-S
Ultrasound-guided ultrasonography for histology to confirm breast cancer
Medications: Ibuprofen 400mg PO as needed TID for pain for 10 days.
Non-pharmacological treatments: applied warm compress as tolerated daily; and practice aerobic exercise for at least 1 hour a day and three days in a week for overweight to manage weight. (Hollier, A. (2016)
Education: The patient is to be educated on taking the prescribed medication and the associated side effects (Burstein, Lacchetti, & Griggs, 2016).
Beware of Ibuprofen side effects: heartburn, stomach pain, nausea, gas, and constipation (Healthline.com)
Referrals: None for now, pending Mammogram and U-S results.
Follow: Patient to come back to the clinic in 1week for histological results.
References:
Burstein, H. J., Lacchetti, C., & Griggs, J. J. (2016). Adjuvant Endocrine Therapy for Women With Hormone Receptor–Positive Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update on Ovarian Suppression Summary. Journal of oncology practice, 12 (4), 390-393.
Hollier, A. (2016). Clinical guidelines in primary care. Scott, LA: Advanced Practice breastfeeding Associates
Mastitis (n.d). Miami Cancer Institute. Retrieved from
https://cancer.baptisthealth.net/miami-cancer-institute/cancer-care/treatments-and-
services/breast-cancer-prevention-clinic
Understanding How Ibuprofen works (n.d). Healthline. Retrieved from
https://www.healthline.com/health/pain-relief/ibuprofen-advil-side-effects
The RN to BSN program at Grand Canyon University meets the requirements for clinical competencies as defined by the Commission on Collegiate Nursing Education (CCNE) and the American Association of Colleges of Nursing (AACN), using nontraditional experiences for practicing nurses. These experiences come in the form of direct and indirect care experiences in which licensed nursing students engage in learning within the context of their hospital organization, specific care discipline, and local communities.
This assignment consists of both an interview and a PowerPoint (PPT) presentation.
Assessment/Interview
Select a community of interest in your region. Perform a physical assessment of the community.
Interview Guidelines
Interviews can take place in-person, by phone, or by Skype.
Develop interview questions to gather information about the role of the provider in the community and the health issues faced by the chosen community.
Complete the “Provider Interview Acknowledgement Form” prior to conducting the interview. Submit this document separately in its respective drop box.
Compile key findings from the interview, including the interview questions used, and submit these with the presentation.
describing the chosen community interest.
Include the following in your presentation:
While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA format ting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
Discussion Prompt #1
1) Minimum 3 full pages (Follow the 3 x 3 rule: minimum three paragraphs per page)
Submit 1 document per part
2)¨******APA norms, please use headers
All paragraphs must be narrative and cited in the text- each paragraphs
Bulleted responses are not accepted
Dont write in the first person
Dont copy and pase the questions.
Answer the question objectively, do not make introductions to your answers, answer it when you start the paragraph
3)****************************** It will be verified by Turnitin (Identify the percentage of exact match of writing with any other resource on the internet and academic sources, including universities and data banks)
********************************It will be verified by SafeAssign (Identify the percentage of similarity of writing with any other resource on the internet and academic sources, including universities and data banks)
4) Minimum 5 references not older than 5 years
5) Identify your answer with the numbers, according to the question.
Example:
Q 1. Nursing is XXXXX
Q 2. Health is XXXX
Case Study 1: Disorders of Hepatobiliary and Exocrine Pancreas Function
Robert is a 68-year-old who has dealt with alcoholism for over 30 years. He has cirrhosis and is anemic. His appetite has declined, and he regularly complains of abdominal pain. Recently, while preparing himself a sandwich, he cut his finger deeply with a knife. The wound bled profusely, and he used a kitchen towel to stop the flow. Refusing to go and seek medical assistance, he put ice on his finger and wrapped the towel around it. He sat down in his recliner with his hand over his head and fell asleep.
1.Anemia and clotting disorders are common features of alcoholic liver disease. What are the mechanisms that cause these hematologic disorders?
2.What gastrointestinal bleed is associated with a high mortality rate in those with advanced cirrhosis? What is the pathophysiology of this condition?3
3.Acute pancreatitis is sometimes seen in alcoholics, particularly after binge drinking. Why are tachycardia and hypotension indications of this condition?
4.Why are women more predisposed to alcoholic liver disease than men?
Name two different methods for evaluating evidence. Compare and contrast these two methods.
In your Case Study Analysis related to the scenario provided, explain the following:
A 58-year-old obese white male presents to ED with chief complaint of fever, chills, pain, and swelling in the right great toe. He states the symptoms came on very suddenly and he cannot put any weight on his foot. Physical exam reveals exquisite pain on any attempt to assess the right first metatarsophalangeal (MTP) joint. Past medical history positive for hypertension and Type II diabetes mellitus. Current medications include hydrochlorothiazide 50 mg po q am, and metformin 500 mg po bid. CBC normal except for elevated sedimentation rate (ESR) of 33 mm/hr and C-reactive protein (CRP) 24 mg/L. Metabolic panel normal. Uric acid level 6.7 mg/dl.
In your Case Study Analysis related to the scenario provided, explain the following:
Describe the selected problem from two of the three system levels (micro, meso, macro).
The healthcare system is a complex and high risk; therefore, the Joint Commission recommends creating high-reliability organizations within every healthcare facility. Building a high-reliability organization is about creating a culture of high quality, high safety, and patient-focused. Using my facility as an example, the culture within each of the departments at the hospital is the microsystems level. This is the location of patient communication and hands-on patient care. The problem exists in reporting near misses to avoid bigger safety events in the future. The culture across the Mercy Health St. Rita’s including the hospital, home care/hospice, primary care, and specialty offices would be the mesosystem level. Here continuity of care is provided across this environment. Having an environment that promotes communication and reporting is the problem. The culture among the entire BonSecour Mercy Health healthcare system would be the macrosystems level. They govern the overall healthcare being provided according to the standards and expectations (Alam, 2020). The problem would be to establish the expectations around creating a high-reliability organization.
Explain how the outcomes of one system level effect the other levels?
The culture of one system-level reflects the values and beliefs of team members across all levels. The expectations from the macrosystem reflection down to the microsystem. Like with Joint Commission setting an expectation for healthcare systems to become high-reliability organizations, the regulatory team members from the macro to meso to micro enforce these expectations. The mesosystem level receives most of the attention related to the culture embedded within their organization good or bad. However, the training and education to create a culture of high safety and quality happen at the microsystem level. It includes providing an environment where front line team members feel safe to speak about the problems and offer solutions on how to solve them without the fear of repercussion. The microsystem level needs to know the macrosystem and mesosystem levels will trust and support them (Manley & Jackson, 2019).
How is a systems approach beneficial in improving healthcare quality and safety?
All workers want to be apart of an organization that promotes high quality and safety no matter the system level they are associated with. Continuing the focus of creating a culture of high quality and safety, all levels have a different view. The macrosystem level can see when environments do not promote this culture leading to risk and harm caused to patients. They see patterns for success and opportunity across various facilities. Learning from one another can be promoted. This level is visionary, big picture. At the mesosystem level has the view to see the expectations and see the details specific to the facility to create the process around developing the culture. Middle managers at this level are strategically valuable. They can effectively influence change through educating and encouraging team members to speak out. From here they can voice concerns or needs up to the macrosystem level (Gutberg & Berta, 2017). The microsystem level can implement a culture of high quality and safety. With training, development, and support, they can carry out the vision set forth by the macrosystem level (Manley & Jackson, 2019). All system levels are important for advancing the healthcare system. Neither level could function independently effectively or efficiently.
I need a comment for this post at least 2 paragraphs with 2 sources no later than 5 years.
