Screening For Cervical Cancer Essay Assignment
This is a continuation of order ID# 248944. Reply to peer’s post: 1 to 2 paragraphs per pear response.
Note: Responses are directed to the peer, they are at a critical level means discussing things such as your opinion of the point mentioned, why you hold that opinion, what you see wrong with the point mentioned, how you see the point consistent/inconsistent with what you have learned so far, implications for the future, consistencies/inconsistencies within the article or reading itself, and so forth. Expand on their explanation and provide an example that supports their explanation or respectfully challenging their explanation and providing an example. Screening For Cervical Cancer Essay Assignment
Cite your reference(s) using APA 7 format.
– Responses are supported with at least 2 scholarly source per response
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Shasta P’ Post
Episodic/Focused SOAP Note
Patient Information:
AB, 45 years-old, Female, Caucasian
S.
CC (chief complaint): multiple vaginal bumps that appeared one week ago after intercourse
HPI: 45-years-old female presenting to the clinic today for multiple vaginal bumps that appeared one week ago after intercourse. She states she has a new boyfriend and they have been having unprotected vaginal intercourse. She reports multiple sexual partners in the past and denies ever having sexually transmitted diseases in the past. She denies any pain or pain during intercourse. She also reports vaginal itching and a white, milky discharge that began at the same time of symptom onset. She denies any associated symptoms such as nausea, vomiting, or abdominal pain. She denies any alleviating factors or trying any medications OTC to relieve symptoms. Reports a regular LMP 3-10-23. She reports her last pap smear was in August of 2022 and denies ever having an abnormal pap smear. She denies her partner having these symptoms. Screening For Cervical Cancer Essay Assignment
Current Medications: amlodipine 5 mg for hypertension
Allergies: Denies medication, food, or environmental allergies.
PMHx: UTD on all immunizations. History of hypertension.
Soc & Substance Hx: Pt reports social alcohol. Denies tobacco use and recreational drug use. She is a sixth-grade teacher at the local elementary school. She wears a seatbelt when riding in the car. She does not text while driving or drink while driving. She lives in an apartment alone and reports the she has a safe living environment.
Fam Hx:
- Mother – hypothyroidism, still living
- Father – Hypertension, diabetes type 2, hyperlipidemia, still living
- Paternal grandfather – hypertension, died at age 75 due to MI
- Paternal grandmother – died at age 25 during childbirth from unknown reason
- Maternal grandfather – no known medical issues, died of natural causes at age 82
- Maternal grandmother – hypertension, diabetes type 2, died at age 80 due to MI
- Patient has no children or brother or sisters
Surgical Hx: No prior surgical procedures.
Mental Hx: No history of anxiety or depression
Violence Hx: No concern or issues about safety (personal, home, community, sexual—current and historical).
Reproductive Hx: No contraception use, or history of contraception use. States she uses the withdraw method. LMP: 3-10-23. G0P0. No barrier contraception uses to prevent STI or STD. Type of intercourse: Oral and Vaginal. Identifies as female. Heterosexual. Screening For Cervical Cancer Essay Assignment
ROS:
GENERAL: No weight loss, fever, chills, weakness, or fatigue.
CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema.
RESPIRATORY: No shortness of breath, cough, or sputum.
GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood.
PSYCHIATRIC: No history of depression or anxiety.
GENITOURINARY/REPRODUCTIVE: Reports of vaginal bumps, vaginal itching, and white, milky vaginal discharge. LMP 3-10-23, G0P0. Denies vaginal pain, painful intercourse, or abnormal vaginal bleeding. Denies breast lumps, pain, or nipple discharge. Sexually active with one partner.
O.
Physical exam:
VS: BP: 140/80, HR: 70, T: 98.6, RR: 16, O2Sat: 100% on RA, HT: 5’10”, WT: 180 lbs, BMI: 25.8
Lungs/CV: Clear to auscultation bilaterally, normal respirations, rhythm, and depth. HR RRR
GU: Six small, single, soft papillary lesions located along the vulva and labia. White/milky discharge noted. Normal hair distribution of hair. No edema or clitoris or labia enlargement. No other lesions, scars, rashes, erythema, or discoloration noted.
Cervix: Firm, smooth, copious amounts of white/milky discharge seen on speculum exam.
Uterus: RV, mobile, non-tender Screening For Cervical Cancer Essay Assignment
Adnexa: Ovaries 2×2 cm, almond shaped, nontender to palpation, mobile.
Diagnostic results:
- Pap-smear to assess for abnormal cervical cells and human papillomavirus (HPV). The pap-smear was positive for HPV.
- Additional testing needs to be completed for HSV, chlamydia, gonorrhea, syphilis, and other STDs. Nucleic acid amplification tests (NAATs) are the gold standard for testing for gonorrhea, chlamydia, and HSV (Schumann & Plasner, 2022). These cultures were negative.
- Urine HCG completed to rule out a pregnancy. She is having unprotected sex and this needs to be ruled out. Pregnancy test negative.
- BV swab negative.
- Needle biopsy negative. Screening For Cervical Cancer Essay Assignment
A.
Primary and Differential Diagnoses:
Human Papillomavirus R87.810: Human papillomavirus often presents as genital warts. HPV is a common sexually transmitted virus, and it is expected that more than 80% of women will carry HPV at some point in their lifetime (Bhatla & Singhal, 2020). A low-risk variant of HPV can cause genital warts (Bhatla & Singhal, 2020). Greater than 70% of those carrying HPV can develop cervical screening (Bhatla & Singhal, 2020). HPV was confirmed with diagnostic testing.
Herpes Simplex Virus B00.9: HSV accounts for the majority of the patients who present with genital ulcers (Ljubojević Hadžavdić & Skerlev, 2022). HSV is another sexually transmitted viral disease (Ljubojević Hadžavdić & Skerlev, 2022). HSV testing was complted with NAAT. NAAT is the preferred testing for HSV (Ljubojević Hadžavdić & Skerlev, 2022). This result was negative.
Bacterial Vaginosis N77.1: 50% of women presenting with bacterial vaginosis experience symptoms such as white/milky discharge and vaginal itching (Coudray & Madhivanan, 2020). Bacterial vaginosis can increase the risk of contracting other STI’s as well (Coudray & Madhivanan, 2020). Even though the patient does present with bacterial vaginosis symptoms, the pap-smear confirmed HPV, and her vaginal swab was negative for BV.
Molluscum Contagiosum B08. 1: Molluscum contagiosum is another virus that can cause papillary lesions (Ljubojević Hadžavdić & Skerlev, 2022). In adults, this virus is considered a sexually transmitted infection and can present as genital warts (Ljubojević Hadžavdić & Skerlev, 2022). This could be a cause of the warts, but the patient was positive for HPV, so HPV is the primary diagnosis for this patient.
P. Screening For Cervical Cancer Essay Assignment
Diagnostic testing was completed. Results and explanations were addressed above. The patient does not require any referrals since the primary care provider or women’s health nurse practitioner can manage these symptoms.
The primary treatment for this patient is the removal or excision of the warts and not the eradication of HPV. The patient is agreeable to come to the office for multiple treatments every 1-2 weeks of cryotherapy with liquid nitrogen. This will be completed until the warts are resolved. It is not uncommon for these warts to reappear after 3 weeks following completed treatment.
Counseling for HPV should be given to the patient. This education would include, there is no treatment for HPV and most women clear the virus on their own overtime. In some cases, the virus can lead to cervical cancer. She should be encouraged to use condoms to prevent the spread of HPV. Since she did not have abnormal cells, put did test positive for HPV, she should repeat a pap-smear in one year (The American College of Obstetricians and Gynecologists, 2021).
Health promotion should include the use of condoms when having intercourse. Completing monthly annual self-breasts exam and annual mammograms for breast cancer screenings. Repeat pap-smear in one year. Follow a low sodium, cardiac diet due to hypertension and family history. She should be told to call the office if she has any new symptoms or concerns.
Reflection on Experience
I learned a great deal about the assessment and treatment of genital warts for patients. Being honest with the patient and choosing a treatment plan that is best for the patient is needed to appropriately treat each patient. Genital warts can be treated in many different ways. The clinician needed to know if the patient would be able to return to clinic every 1-2 weeks to complete treatment. Due to the patient’s job, she is out by 3 pm and can make it to the clinic before the clinic closes for treatment. The clinician should not assume that the patient can be at the clinic every week. This is essential to know, because if she was not able to come in for treatment other options such as prescription creams, gels, or ointments could have been used. Screening For Cervical Cancer Essay Assignment
References
Bhatla, N., & Singhal, S. (2020). Primary HPV screening for cervical cancer. Best Practice & Research Clinical Obstetrics & Gynaecology, 65, 98-108. https://www.sciencedirect.com/science/article/pii/S1521693420300353?casa_token=yKvshnJriH4AAAAA:NBq7_vyDMS04z3GEiBEHwjc-i0gLIkK7rWPVVGXV70F8Z21kX0Cl2EBi1gDyxDsbwanFJrSSQoALinks to an external site.
Ljubojević Hadžavdić, S., & Skerlev, M. (2022). Viral sexually transmitted infections. Atlas of dermatology, dermatopathology and venereology: Cutaneous Infectious and Neoplastic Conditions and Procedural Dermatology, 147-157. https://link.springer.com/content/pdf/10.1007/978-3-319-53805-1_70.pdfLinks to an external site.
Schumann, J., & Plasner, S. (2022). Trichomoniasis. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK534826/Links to an external site. Screening For Cervical Cancer Essay Assignment
Morgan B T’ Post
Patient Information:
- 42-year-old Caucasian female
S:
CC: Vaginal bleeding for 1 month
HPI: R.W. is a 42-year-old Caucasian female who presents to the clinic with complaints of vaginal bleeding for 1 month. She states about 1 month ago she had abdominal cramps as if she were starting her cycle and then about 2 weeks later passed a large blood clot and has been bleeding ever since. Patient denies any aggravating/relieving factors.
Current Medications:
- Propranolol 10mg BID for POTS
Allergies: No known drug, food, seasonal allergies
PMHx:
- POTS
Soc & Substance Hx: Denies drug, alcohol, tobacco use.
Fam Hx: Unknown
Surgical Hx: Unknown
Mental Hx: Denies anxiety, depression
Violence Hx: Unknown
Reproductive Hx: G2P2002, both vaginal deliveries. Screening For Cervical Cancer Essay Assignment
ROS:
General: Denies weight loss/weight gain. No fever.
HEENT: Denies headaches. No blurry vision, photophobia. No ringing in ears, ear pain. No sore throat.
SKIN: Denies any rashes, abnormal appearing lesions
CARDIOVASCULAR: No chest pain. Denies palpitations
RESPIRATORY: No cough or shortness of breath
GASTROINTESTINAL: Denies nausea, vomiting, diarrhea, constipation. No abdominal pain
NEUROLOGICAL: Denies headaches. Admits to occasional dizziness and lightheadedness associated to her POTS
HEMATOLOGIC: Admits to vaginal bleeding X 1 month. No abnormal bruising
LYMPHATICS: Denies enlarged lymph nodes
PSYCHIATRIC: No anxiety or depression
ENDOCRINOLOGIC: Denies heat/cold intolerance
GENITOURINARY/REPRODUCTIVE: Vaginal bleeding for 1 month. No discharge or odor. No burning or pain with urination
O:
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Physical Exam:
VVBSU: No discharge noted.
CERVIX: Multiparous. No tenderness with palpation
Diagnostic Results:
CBC: To check hemoglobin and platelet level (This was already checked at a different providers office and was WNL)
Hormone levels: Abnormal hormone levels can cause bleeding. FSH, Estrogen, Progesterone checked at different provider office and were all WNL
Pregnancy test: Pregnancy test was negative Screening For Cervical Cancer Essay Assignment
Pap smear: To rule out any abnormal cell changes on cervix. Her pap was WNL. This also allowed for a visual inspection of the vaginal walls where you could asses for any trauma or abrasions. None were noted on exam.
Bi-Manual exam: To assess for any uterine or adnexal abnormalities or tenderness
Pelvic US: To check for anything that could be causing the bleeding such as fibroids, polyps, ovarian cysts. Completed in office and no abnormalities found
A:
- Menorrhagia, N92.0: Heavy cyclical bleeding (Jeanmonod et al., 2023).
- Abnormal Uterine Bleeding, N93.9: Irregularities in the menstrual cycle that involves frequency, duration, volume of flow, and regularity outside of pregnancy (Davis & Sparzak, 2022).
- Uterine Leiomyoma, D25.2: Common benign neoplasm in women of reproductive age. Symptoms include abnormal uterine bleeding, pelvic pain, back pain, bowel and bladder issues (Barjon & Mikhail, 2022). This was ruled out with a pelvic US.
P:
This patient had several of her diagnostics that had already been completed at a different provider’s office and records sent over. Her CBC, hormone levels, and thyroid levels were all WNL. Her pregnancy test was negative. Her bimanual exam was unremarkable, and her pap smear came back with no abnormalities. Her pelvic US showed no abnormalities as well. Patient had been prescribed Provera X 6 weeks and Lysteda X 5 days by previous provider and had been on Provera X 1 week at time of appointment. Advised not to take both together. It was ultimately decided that due to no abnormalities noted with diagnostics, patient’s options are Hysterectomy or hysteroscopy/D&C/ablation. Patient opted for ablation and is currently scheduled to have procedure done. Screening For Cervical Cancer Essay Assignment
References
Barjon, K., & Mikhail, L. N. (2022). Uterine leiomyomata. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK546680/#_NBK546680_pubdet_Links to an external site.
Davis, E., & Sparzak, P. B. (2022). Abnormal uterine bleeding. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK532913/#_NBK532913_pubdet_Links to an external site.
Jeanmonod, R., Skelly, C. L., & Agresti, D. (2023). Vaginal bleeding. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK470230/#_NBK470230_pubdet_Links to an external site.
Discussion Response
- Shasta’s Post
I agree that it is important to be honest with the patient and choose the best treatment plan for them. It is important to emphasize that there is no one-size-fits-all approach and that the clinician should tailor the treatment plan to fit the patient’s needs best. For example, a different treatment plan may be needed if a patient cannot come in for treatment every 1-2 weeks. In this case, this patient could come in for treatment, so cryotherapy with liquid nitrogen was used. However, a prescription cream, gel, or ointment could have been used if the patient could not come for treatment (Thapa et al., 2022). This emphasizes the importance of tailoring the treatment plan to the patient. Additionally, it is important to provide counseling for HPV and health promotion for other sexual health topics. Chen et al. (2020) note that health education is essential for the patient to understand the risks and how to prevent the spread of HPV and other related infections and reduce the likelihood of complications. Screening For Cervical Cancer Essay Assignment
References
Chen, H., Zhang, X., Wang, W., Zhang, R., Du, M., Shan, L., Li, Y., Wang, X., Liu, Y., Zhang, W., Li, X., Qiao, Y., Ma, J., Zhou, J., & Li, J. (2020). Effect of an educational intervention on human papillomavirus (HPV) knowledge and attitudes towards HPV vaccines among healthcare workers (HCWs) in Western China. Human Vaccines & Immunotherapeutics, 17(2), 443–450. https://doi.org/10.1080/21645515.2020.1780093
Thapa, R., Gurung, S., Parat, M.-O., Parekh, H. S., & Pandey, P. (2022). Application of sol–gels for treatment of gynecological conditions—physiological perspectives and emerging concepts in intravaginal drug delivery. Gels, 8(2), 99. https://doi.org/10.3390/gels8020099 Screening For Cervical Cancer Essay Assignment
Morgan’s Post
I agree with your explanation of the patient’s diagnostics and care plan. It was important to rule out any underlying medical conditions causing the abnormal bleeding. The patient had a negative pregnancy test, CBC, hormone levels, and thyroid levels, all within normal limits. No abnormalities were found upon the pelvic US, and the patient had a normal pap smear. With all of these negative tests, the patient was likely experiencing menorrhagia due to an abnormality in her uterine cycle (Walker & Borger, 2019). To further assess the cause of the bleeding, a hysteroscopy, D&C, and ablation are necessary. It is good that the patient opted for the ablation and is currently scheduled for the procedure. Ablation is a minimally invasive procedure with a low complication rate and can often be done in an outpatient setting (Minalt et al., 2023). This procedure can effectively relieve excessive bleeding and restore a regular uterine cycle. This case study will provide a great learning experience for managing abnormal uterine bleeding and the diagnostic procedures for determining the underlying causes of the bleeding. Screening For Cervical Cancer Essay Assignment