NR 602 Discussion Week 4 PBL Case Study Discussion: Women's Health Part One (GRADED)

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NR 602 NRDiscussion Week 4 PBL Case Study Discussion: Women's Health Part One (graded) Overview: Kayla, a now 38-year-old Caucasian and Latino female, comes in the month after Riley’s last illn... ess complaining of fatigue, right breast pain, and vaginal itching. HPI: The breast pain began in the right breast and is now into the right axilla. It is warm and tender to touch. She has not noticed any nipple discharge. She has also had mild myalgia. The vaginal itching began a few days before the breast pain. She reports a great deal of stress. She has not been monitoring for a fever. She denies diarrhea or constipation, abdominal pain, skin changes, cough, or chest pain. She has not had dysuria. LNMP was 6 weeks ago, 8 days in length, heavy for 5 days with clots. This was her first menses since her last visit with you. Menses are irregular, having only 5 to 6 per year. PMH: As previously given. Social History: She continues to live with her parents during a separation from her husband and is working part time at the children’s school library but has not been there for over a week. She now has no health insurance, but her children are covered by the State Medicaid HMO. Family History: Her paternal great grandmother died of breast cancer at the age of 50. Otherwise her family history has not had updates or changed since her last visit. Discussion Questions Part One What further historical questions are needed to properly care for her? What are your differential diagnoses? What is your rationale for these diagnoses? K.F., 38yo, F, Caucasian and Latino S. CC- fatigue, right breast pain, vaginal itching HPI- The breast pain is in the right breast and now into the right axilla. It is warm and tender to touch. She has not noticed any nipple discharge. She has also had mild myalgia. The vaginal itching began a few days before the breast pain. She reports a great deal of stress. She has not been monitoring for a fever. She denies diarrhea or constipation, abdominal pain, skin changes, cough, or chest pain. She has not been sleeping well, due to having to stay with her daughter in the hospital. No recent physical or well woman exam since the birth of her son. She has not had dysuria. LNMP was 6 weeks ago, 8 days in length, heavy for 5 days with clots. Menses are irregular, having only 5 to 6 per year. PMH- No surgical history other than cesarean sections; no trauma history; 10 year 1PPD smoker, smoking cessation 2 years ago; gestational diabetes with last pregnancy; history of PCOS Social History- She continues to live with her parents during a separation from her husband and is working part time at the children’s school library but has not been there for over a week. She has no health insurance, but her children are now covered by the State Medicaid HMO. Family History- Her paternal great grandmother died of breast cancer at the age of 50. Her mother has hypertension, hyperlipidemia, and type 2 diabetes. Her father has hypertension, hyperlipidemia, and cardiovascular disease. What further historical questions are needed? Breast Pain: O- When did the breast pain start? Was there any trauma or event that started the pain? L- Exactly where is the pain at, point at it with one finger? D- Is the pain constant or intermittent? C- What are the characteristics of the pain? (Sore, achy, pin prick, stabbing) A- Is there anything that makes the pain worse? R- Is there anything that makes the pain better? T- Have you tried any treatments for the pain and discomfort? S- What is your pain on a scale of 1-10? Have you ever had a mammogram? If so what were the results? Family history of breast or ovarian cancer? Do you drink a lot of caffeine or fatty foods? Vaginal Itching: O- When did the vaginal itching start? L- Where exactly is the itching located? D- Is it constant or intermittent? C- Is there any vaginal discharge or odor? Color, smell? A- Does anything make the itching worse? R- Does anything make the itching better? T- Have you tried any treatments for the itching? S- What is the severity of the itching? When is the last time you had sex? Do you have multiple sexual partners? Have you ever had a STD? Is there a chance you can be pregnant? When did the fatigue and myalgia start? Have you felt you may have been feverish? When was your last pelvic exam with Pap smear? Where the results normal? What are your differential diagnosis with rational? Mastodynia (N64.4) - Breast pain is usually associated with a benign breast condition; it is rarely a sign of breast cancer. Pain may be felt in one or both breasts, or just in part of one breast. Pain may also be felt in the armpit or upper arm. Breast pain may be described as: sharp, stabbing or shooting pain, feeling of heaviness or fullness in the breast, aching, tenderness, burning, or pinching. (Canadian Cancer Society, 2016) Kayla is having right breast tenderness that is now spreading to the axilla. Cysts of right breast (N60.01) - A woman can have one or many breast cysts. The signs and symptoms of a breast cyst may include: Lump(s) in the breast that feel smooth, soft and moveable, the edges of the cyst are very distinct from the surrounding breast tissue or lump(s) that becomes larger, tender and painful before or during a woman’s period. The lump and pain may decrease after the period. (Canadian Cancer Society, 2016) Kayla is having right breast tenderness that is now spreading to the axilla. Contusion of right breast (922.0) - A breast contusion occurs from a blow to the breast resulting in injury to the small blood vessels that are plentiful throughout the breast. Symptoms include breast pain redness, swelling, tenderness, with discoloration progressing from red, to black and blue, to green and then to yellow. A significant bruise can result in a hard breast lump within the breast that doesn't always go away. (Canadian Cancer Society, 2016) Kayla is having right breast tenderness that is now spreading to the axilla. Malignant neoplasm of right breast (C50.911) - According to the American Cancer Society, any of the following unusual changes in the breast can be a symptom of breast cancer: swelling of all or part of the breast, skin irritation or dimpling, breast pain, nipple pain or the nipple turning inward, redness, scaliness, or thickening of the nipple or breast skin, a nipple discharge other than breast milk, or a lump in the underarm area. (BreastCancer.org, 2016) Kayla is having right breast tenderness that is now spreading to the axilla and her paternal grandmother died of breast cancer at age 50. Acute vaginitis (Vulvovaginitis) (N76.0) -The symptoms of vulvovaginitis vary and depend on their cause. In general, symptoms can include: Irritation of the genital area, itching, inflammation around the labia and perineal areas, an increased, strong-smelling vaginal discharge, or discomfort while urinating. (Schuiling & Likis, 2013). Kayla complains of vaginal itching. Herpes viral infection of urogenital system, unspecified (A60.00) – The symptoms include itching, pain and the appearance of small sores (Schuiling & Likis, 2013). Kayla complains of vaginal itching. [Show More]

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