week 1 discussion response
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Please respond to these two discussions separately written by my peers. Please add intext reference for the two
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1) discussion written by Geneveive: First of all, the USPSTF, per our text recommends that at age 21, the patient should undergo women’s health screening every three years (Schuiling & Likis, 2016). This includes a pap smear, breast exam, physical and health history to rule out breast, ovarian, and cervical cancer and its precursor HPV. If the first pap smear is normal, then she will not need another routine screening for three years. If the pap is abnormal, then she will need a screening in just one year if it is squamous cell abnormality (Hawkins, Roberto-Nicholas, & Stanley-Haney, 2016).
If it is HPV positive, then they look for the specific type, as this can tell the practitioner how likely the patient will develop cervical cancer or how likely it will just cause genital warts. 90 percent of genital warts are caused by HPV types 6 and 11, which come with a lower risk at developing into neoplasias (Schuiling & Likis, 2016). The high-risk types of HPV are 16 and 18, and they cause 70 percent of all cervical cancer. Age 65 is when the cervical cancer screenings will no longer be medically necessary (Hawkins, Roberto-Nicholas & Stanley-Haney, 2016).
The FNP should also ask questions about sexual activity, number of partners, use and type of contraceptives, and history of prior STI’s and treatment. The patient should also be asked about all hygiene practices, specifically douching, as this can sometimes be a common practice with some women who are not educated to know the harmful risks it can carry, and use this opportunity to teach the patient to refrain from such practices. The FNP should also teach about recommended hygiene practices such as: urinating after intercourse, washing the perivaginal area with mild PH balanced soaps (Schuiling & Likis, 2016). I have also found, after working 12 years in the ED that many women believe it is okay to use a peri spray bottle to wash inside their vagina with water only, and that this practice will not harm their PH or normal bacterial growth.
The FNP should also do a manual breast exam at the bedside, but mammogram is not recommended until age 40 years. We should also ask if any first degree relatives have been diagnosed with breast cancer in order to ascertain her risk. Obesity, menarche prior to age 12, sedentary lifestyle, and drinking more than 1 alcoholic drink each day, and use of oral birth control are all factors that increase the patient’s risk for breast cancer (Schuiling & Likis, 2016).
At this visit, the FNP should also ask questions to screen for domestic partner abuse or violence. A good general and non-accusatory way to start that conversation might include questions like the following: Do you feel safe in your current living situation? Is anyone in your life trying to hurt or abuse you in any way? These questions are the domestic abuse screening questions that we ask every female patient in the Emergency Department.
Schuiling, K. & Likis, F. (2016). Women’s Gynecologic Health (3rd ed.). Sudbury, MA: Jones & Bartlett.
Hawkins, J., Roberto-Nicholas,D. & Stanley-Haney, J. (2016). Guidelines for Nurse Practitioners in Gynecologic Settings (11th ed.). New York, NY: Springer Publishing
2) Discussion written by Lauri: A complete physical exam should take place after a thorough history and the physical exam should be
age appropriate (Hawkins, Roberto-Nichols, & Stanley-Haney, 2016) The history will guide the direction
of the physical exam and testing. ACOG (2018) has recommended guidelines for women between the
ages of 19-39 for what screening should include, but with specific age criteria under each test. For a 21
year-old female, cervical cancer screening by PAP should be done every 3 years, chlamydia and
gonorrhea testing should be done annually if under 24 and sexually active (ACOG.org, 2018). Clinical
breast exam should be done every 1-3 years and the human immunodeficiency virus (HIV) at least once
during lifetime and then risk factors reviewed annually for guidance (ACOG.org, 2018). Vaginal cultures
will be as indicated based on history and exam as well as basic hematologic screening (Hawkins et al.,
2016). Obtaining rectal swabs is based on history and indication (Hawkins et al., 2016). Blood pressure
should be assessed for HTN (Hawkins et al., 2016). Tobacco usage should be assessed in all patients.
Syphilis is assessed if increased risk or if pregnant and this patient does not qualify (Hawkins et al.,
Janice should be educated or taught on self-breast exam, reproduction and the risk of pregnancy as well
as STD’s and the increased risk of cancer or infertility associated with these. Birth control options and
disease prevention should also be discussed. ACOG (2018) also recommends women 19-39 years should
also recommends the following immunizations tdap, td, HPV, flu, MMR and varicella. Teaching should be
appropriately based on physical exam and history findings to include diet, exercise, vaccines, smoking
cessation, alcohol use, safe sex, STI testing, PAP smear guidelines and general safety (Hawkins et al.,
ACOG.org. (2018, Nov). Retrieved Nov 2, 2018, from ACOG.org: https://www.acog.org/AboutACOG/ACOG-Departments/Annual-Womens-Health-Care/FOR-PATIENTS/Pt-Exams-and-Screening-TestsAge-19-39-Years
Durnell Schuiling, K., & Likis, F. E. (2017). Women’s gynecologic health. Burlington: Jones and Bartlett Learning.
Hawkins, J. W., Roberto-Nichols, D. M., & Stanley-Haney, J. L. (2016). Guidelines for nurse practitioners in gynecologic settings edition 11. New York: Springer Publishing.