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Week 14 Discussion 1: Preventative Guidelines – One Guideline and Two Scenarios Week 14 Discussion 1 Preventative Guidelines – One Guideline and Two Scenarios Week 14 Discussion 1: Preventative Guidelines – One Guideline and Two Scenarios In this scenario, one woman is 72 years old while the other is 48 years old. The 72 year old woman is African American and she is complaining of breast tenderness. It is also stated that she has never gotten a mammography before and her last breast exam was thirty years ago. The second woman is 48 years old and she is concerned that she has a STI. She also states that two years ago she had gotten a mammography and was referred to get an ultrasound, but never went. These women will be treated in a different manner as they are two different ages. When discussing mammography, it is important to understand that the risk of developing breast cancer increases with age (Reeves, 2021). Breast cancer is most commonly diagnosed in women 55 to 64 years old (Reeves, 2021). According to the American Cancer Society, women should start getting mammograms starting at age 45 however, they can start as early as 40 years old (“American Cancer Society Guidelines”, 2021). For Sally, the 48 year old, she had a mammogram at 46 years old that her doctor wanted to re-evaluate. For her plan of care, I would treat her for her STI and refer her to get re-evaluated to determine what her mammogram had shown two years ago. 17% of breast cancer is diagnosed in women who are younger than 50 years old (Seely & Alhassan, 2018). The sooner Sally gets re-evaluated the sooner she can start treatment and be cured if she does have breast cancer. For Eleanor, the 72 year old, I would discuss the benefits and risks of her getting her first mammogram at this age. Mammography can be done up to the age of 74 years old asz most places won’t perform them on those who are older due to not enough evidence (Schrager et al., 2020). Those who are 70 years or older are at increased risk as the incidence of breast cancer among this group is 28% (Seely & Alhassan, 2018). Since Eleanor has never gotten a mammogram and she also hasn’t had a breast exam in 30 years until now, she is more likely to have a higher stage of breast cancer if anything were to be detected on the mammogram. Therefore, it may not be beneficial to her if she is at that point since her survival rate will already be significantly reduced (Schrager et al., 2020). Getting a mammogram at her age could be beneficial if she is still in good overall health and has a life expectancy of 10 years or longer (Schrager et al., 2020). To determine her state of health, more information would need to be gathered. References American Cancer Society Guidelines for the Early Detection of Cancer. American Cancer Society. (2021, August 27). Retrieved November 30, 2021, from https://www.cancer.org/healthy/find-cancer-early/american-cancer-society-guidelines-for-the-early-detection-of-cancer.html. Reeves, R. (2021, July 31). Mammography. StatPearls. Retrieved November 30, 2021, from https://www.statpearls.com/ArticleLibrary/viewarticle/38665. Schrager, S., Ovsepyan, V., & Burnside, E. (2020). Breast cancer screening in older women: The importance of shared decision making. NCBI. Retrieved November 30, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7822071/. Seely, J. M., & Alhassan, T. (2018, June 13). Screening for breast cancer in 2018-what should we be doing today? NCBI. Retrieved November 30, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6001765/. NU 629 Week 14 Discussion 1: Preventative Guidelines – One Guideline and Two Scenarios Value: 100 points Due: Initial post by Day 3, Response by Day 7 Grading Category: Discussions Introduction Throughout this course, we have looked at health promotion and disease prevention and focused on various vulnerable populations. This week’s discussion will focus on applying one guideline to two patients. Please select ONE of the following scenarios and then answer the questions in your initial post. Please include at least three scholarly sources within your initial post. Scenario A: Focus on Preventative Guidelines for Childhood Immunizations You are working as an APRN in your local primary care office. The rural town of Maynard has 300 people, a post office, doctor’s office, and a gas station. The primary source of income is farming or driving 45 minutes to a somewhat larger town. With the blizzard coming, all your patients except two have cancelled for the morning. Jose is scheduled at 0900; he is a nine-year-old Hispanic male born in Mexico. He and his family (Mom, Dad, and six siblings, ages six months to 14 years) moved into the area just a few months ago. Jose’s mother reported that he had nearly died at two months after contracting pertussis. Your final patient of the morning is Irena, a 15-year-old teenage female who lives with her aunt in Maynard. Irena is Romanian and barely speaks any English. Her aunt has been your patient for the past few years, and she told you that Irena had been abducted in Romania at the age of 10. Irena’s parents found her quite by accident when a sex trafficking ring dumped all their “product” in a refugee camp in Serbia just a few months ago. Irena’s parents are still in Romania, but they sent Irena here to live with her aunt. Scenario B: Focus on Preventative Guidelines for Colorectal Cancer Screening On a busy Thursday morning, you note on your schedule a couple of patients who routinely “take a long time” no matter what their complaint. Jimmy is a 62-year-old male who is mentally challenged and lives in a local group home. Both his parents passed away last year, and his sister has never really been in the picture. She lives at least eight hours away. Jimmy has a “genetic disorder” but actually his symptoms are more like autism that we are familiar with today. Jimmy’s caregiver states he has been having some problems with constipation but otherwise he seems okay. Jimmy is nonverbal and hates to be touched. Approaching Jimmy can be difficult, and he has taken a swing at staff a couple of times because he doesn’t understand what is going on – especially if they try to touch him to check his pulse or blood pressure. Having finished up with Jimmy, you move on to Marvin. Marvin is a 67-year-old male here for his annual physical. Marvin is pretty healthy despite a scare with colon cancer when he was 50. He is obsessed with his bowels and even brings charts to each of his appointments as he is always concerned that the cancer will return. Scenario C: Focus on Preventative Guidelines for Breast Cancer Screening Volunteering once a month for a mobile clinic, you head out this Saturday morning with two other providers and staff. The mobile RV is a large motorhome retrofitted as a primary care clinic. Headed downtown where there is a large homeless encampment, everyone is excited to see what the day brings. Miss Eleanor is a 72-year-old African American female who you have seen many times. Today she is complaining of some breast tenderness due to a fall she took with her grocery cart a couple of weeks ago. While examining Eleanor’s breast, you took the opportunity to do a manual breast exam. Eleanor said it had been at least 30 years since she’d had a breast exam and that she had never had a mammogram. Finishing up your day on the mobile clinic, Sally, a 48-year-old female, is concerned that she has an STI. During Sally’s pelvic exam, you learn that she has been living in a tent under a bridge downtown for about a year. Sally is eager to talk to someone and tells you that she used to work in a medical office as a receptionist but that was a long time ago, before she was diagnosed with bipolar disorder. You are concerned that Sally does have an STI and you ask about her medical history. After quite a story, Sally tells you she had a mammogram about two years ago before she left Texas and there was a place the doctor wanted to evaluate further but she never went back for the ultrasound. Scenario D: Focus on Cervical Cancer Guidelines Working near a naval base, you see a lot of patients who are somehow connected with the military. Today, Shelesha, a 21-year-old African American female, is requesting to be seen for her annual exam before she leaves for deployment. Shelesha seems really anxious today. She is usually so excited about being on board her ship, but today she is different. You complete her annual exam, but she refuses her cervical and breast exam. After leaving the room so she can get dressed, you return to find Shelesha crying. She finally tells you that she was attacked – sexually assaulted on board her ship six months ago – and she has these “bumps” that keep getting bigger around her vagina and she is worried. Virginia arrives for her annual well-woman exam. Virginia is a 67-year-old female who has been married for 42 years. Virginia and Harrold are still sexually active with the use of medications, and like clockwork, Virginia comes every year for her pelvic exam requesting a Pap smear. Virginia had breast cancer with a mastectomy when she was 52, but otherwise she is healthy, only taking medication for her cholesterol. Scenario E: Focus on Prostate Cancer Guidelines Ivan is a 59-year-old Caucasian male in your office today for his annual exam. He has been reading about prostate cancer and the need to have some lab work done. His wife really wants him to get his PSA drawn, but he’s not so sure. Your physical exam of Ivan is “all normal.” When reviewing Ivan’s health assessment form, you see he smokes two packs of cigarettes a day and his only complaint is a chronic cough. Chen is 76-year-old gentleman of Chinese descent. He is here today for an annual exam and a recheck of his blood pressure. Chen tells you he just heard from his brother that his PSA (Prostate Specific Antigen) is really high, and they are concerned he may have prostate cancer. Chen’s brother is from his father’s second marriage and he is only 59 years old. Chen is asking to have his PSA drawn to make sure he doesn’t have prostate cancer. Initial Post Having discussed many guidelines throughout this term, consider the content you have explored. Using this knowledge, answer the following questions related to your chosen scenario. Note: please try to choose a topic for your initial post that you did not choose previously during the semester or aren’t as familiar with so you can gain additional knowledge as we finish up this course Discuss the guidelines assigned with your scenario. Will both patients be treated in the same manner? Why or why not? What would your treatment plan be for each of the individuals in your scenario? Please include at least three scholarly sources within your initial post. Reply Posts Reply to at least two of your classmates who chose two different scenarios. For each of your peer’s posts, discuss other applicable preventative guidelines for one of the patients from the initial scenario. Provide a link to patient education relating to this additional guideline that your peer would find interesting and helpful. Reply on two separate days (minimum) utilizing at least two scholarly references per peer post. Please refer to the Grading Rubric for details on how this activity will be graded.  Agnieszka, thank you for sharing your information for the case studies involving breast cancer screenings and mammograms.  The information you provided was helpful and informative.  Patient benefit from education and provided information so they can make an informed decision.  When the health care provider recommends a mammogram for a patient at certain age it should be the patient’s choice this concept is known as shared decision making.  Shared decision making is a a process where a patient and the healthcare provider share known or perceived information, express their preferences, and agree on a treatment or screening plan (ACOG, 2017).    The concept of shared decision making is important in the prevention of breast cancer because the process involves personal feelings about potential benefits and adverse consequences (ACOG, 2017).  Part of the process of shared decision making is education by the health care provider.  The patient should be provided with statistics and access to resources that outline the recommendations for screening for breast cancer.  For example, The U.S. Preventive Task Force (USPSTF) suggests that women ages 50-74 have a mammogram every two years (USPSTF, 2016).  They also suggest that it should be an individual choice for women ages 40-49 unless there are risk factors present (USPSTF, 2016). A patient can access this information at https://uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer- screening.  If the patient would like additional information or an opportunity to compare recommendations they can also be provided with the link to the American College of Obstetrics and Gynecology https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2017/07/breast-cancer-risk-assessment-and-screening-in-average-risk-women. Patient education the APRN’s responsibility so that the patient can make an informed decision that is the right decisions for her. Week 14 Discussion 1 Preventative Guidelines – One Guideline and Two Scenarios Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS:Week 14 Discussion 1: Preventative Guidelines – One Guideline and Two Scenarios References   American College of Obstetrics and Gynecology (2017) Breast Cancer Risk Assessment and  Screening in Average-Risk Women.  https://www.acog.org/clinical/clinical- guidance/practice-bulletin/articles/2017/07/breast-cancer-risk-assessment-and-screening- in-average-risk-women U.S. Preventive Services Task Force (USPSTF) (2016, Jan 11) Breast Cancer Screening.     https://uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer- screening Posting to the Discussion Forum Select the appropriate Thread. Select Reply. Create your post. Select Post to Forum. Discussion Question Rubric Note: Scholarly resources are defined as evidence-based practice, peer-reviewed journals; textbook (do not rely solely on your textbook as a reference); and National Standard Guidelines. Review assignment instructions, as this will provide any additional requirements that are not specifically listed on the rubric. Note: The value of each of the criterion on this rubric represents a point range. (example: 17-0 points) Discussion Question Rubric – 100 Points Criteria Exemplary Exceeds Expectations Advanced Meets Expectations Intermediate Needs Improvement Novice Inadequate Total Points Quality of Initial Post Provides clear examples supported by course content and references. Cites three or more references, using at least one new scholarly resource that was not provided in the course materials. All instruction requirements noted. 40 points Components are accurate and thoroughly represented, with explanations and application of knowledge to include evidence-based practice, ethics, theory, and/or role. Synthesizes course content using course materials and scholarly resources to support importantpoints. Meets all requirements within the discussion instructions. Cites two references. 35 points Components are accurate and mostly represented primarily with definitions and summarization. Ideas may be overstated, with minimal contribution to the subject matter. Minimal application to evidence-based practice, theory, or role development. Synthesis of course content is present but missing depth and/or development. Is missing one component/requirement of the discussion instructions. Cites one reference, or references do not clearly support content. Most instruction requirements are noted. 31 points Absent application to evidence-based practice, theory, or role development. Synthesis of course content is superficial. Demonstrates incomplete understanding of content and/or inadequate preparation. No references cited. Missing several instruction requirements. Submits post late. 27 points 40 Peer Response Post Offers both supportive and alternative viewpoints to the discussion, using two or more scholarly references per peer post. Post provides additional value to the conversation. All instruction requirements noted. 40 points Evidence of further synthesis of course content. Provides clarification and new information or insight related to the content of the peer’s post. Response is supported by course content and a minimum of one scholarly reference per each peer post. All instruction requirements noted. 35 points Lacks clarification or new information. Scholarly reference supports the content in the peer post without adding new information or insight. Missing reference from one peer post. Partially followed instructions regarding number of reply posts. Most instruction requirements are noted. 31 points Post is primarily a summation of peer’s post without further synthesis of course content. Demonstrates incomplete understanding of content and/or inadequate preparation. Did not follow instructions regarding number of reply posts. Missing reference from peer posts. Missing several instruction requirements. Submits post late. 27 points 40 Frequency of Distribution Initial post and peer post(s) made on multiple separate days. All instruction requirements noted. 10 points Initial post and peer post(s) made on multiple separate days. 8 points Minimum of two post options (initial and/or peer) made on separate days. 7 points All posts made on same day. Submission demonstrates inadequate preparation. No post submitted. 6 points 10 Organization Well-organized content with a clear and complex purpose statement and content argument. Writing is concise with a logical flow of ideas. 5 points Organized content with an informative purpose statement, supportive content, and summary statement. Argument content is developed with minimal issues in content flow. 4 points Poor organization and flow of ideas distract from content. Narrative is difficult to follow and frequently causes reader to reread work. Purpose statement is noted. 3 points Illogical flow of ideas. Prose rambles. Purpose statement is unclear or missing. Demonstrates incomplete understanding of content and/or inadequate preparation. No purpose statement. Submits assignment late. 2 points 5 APA, Grammar, and Spelling Correct APA formatting with no errors. The writer correctly identifies reading audience, as demonstrated by appropriate language (avoids jargon and simplifies complex concepts appropriately). Writing is concise, in active voice, and avoids awkward transitions and overuse of conjunctions. There are no spelling, punctuation, or word-usage errors. 5 points Correct and consistent APA formatting of references and cites all references used. No more than two unique APA errors. The writer demonstrates correct usage of formal English language in sentence construction. Variation in sentence structure and word usage promotes readability. There are minimal to no grammar, punctuation, or word-usage errors. 4 points Three to four unique APA formatting errors. The writer occasionally uses awkward sentence construction or overuses/inappropriately uses complex sentence structure. Problems with word usage (evidence of incorrect use of thesaurus) and punctuation persist, often causing some difficulties with grammar. Some words, transitional phrases, and conjunctions are overused. Multiple grammar, punctuation, or word usage errors. 3 points Five or more unique formatting errors or no attempt to format in APA. The writer demonstrates limited understanding of formal written language use; writing is colloquial (conforms to spoken language). The writer struggles with limited vocabulary and has difficulty conveying meaning such that only the broadest, most general messages are presented. Grammar and punctuation are consistently incorrect. Spelling errors are numerous. Submits assignment late. 2 points 5 Total Points 100 Order Now