Health Medical Homework Help

Elizabeth Varona-Martin

Module 2

Before the patient is requested to undress, the healthcare provider should gather the gynecologic history in a quiet and confidential situation. In most cases, the patient should be interrogated alone. It is especially vital not to judge a patient’s history, such as being sexually active or heterosexual. Vaginal discharge, abnormal bleeding, discomfort, urinary issues, breast abnormalities, sexual dysfunction, and infertility are the most frequent gynecologic concerns. When a patient recognizes one of these problems, comprehensive questioning can help lead to further assessment and diagnosis (Carusi, 2021).

The external genitalia and internal pelvic organs are usually examined during a pelvic examination. The abdomen and breasts are frequently checked as well. The pelvic exam has typically been conducted in the dorsal lithotomy position best to expose the internal and external genitalia and pelvic palpation. When a patient complains of pelvic pain, the clinician should perform a gynecologic examination. Every regular cervical cancer screening test should include an assessment for asymptomatic women (Carusi, 2021). There is debate about whether an asymptomatic screening examination should be performed yearly or regularly, and patients and their healthcare providers should determine the recommended testing frequency.

The term GTPAL refers to a 5-digit method for tracking women’s obstetric history. GTPAL gives a fast summary of a person’s term and preterm pregnancies, abortions, and the number of live children .

Gravida: the total number of pregnancies, including the current pregnancy and all term, preterm, therapeutic abortions, and miscarriage (Rai, 2021).

Term: all births occurred at full term, after completion of 37wks of gestation.

Preterm births: all preterm births occur between the ages of 20 and 37 weeks of gestation.

Abortion: All miscarriages, therapeutic abortions, and surgical abortions before 20 weeks of gestation are considered abortions.

Living children: total number of living children, every child count, twins, triplets should be counted individually.

For G.R., a 66-year-old female patient who visits you at the office for the first time (last visit to her PCP 5 years ago) with only a positive health history of hysterectomy ten years ago due to fibroids, we should recommend the following screening:

Breast Cancer: Women between the ages of 50 and 75 are classified as grade B. Every two years, a screening mammogram should be performed (Schuiling & Likis, 2022).

Cervical Cancer:  Although G.R. had a hysterectomy ten years ago due to fibroids, the grounds for a pelvic examination are the same for hysterectomy patients as they are for other individuals. The exception is that most individuals who have had a complete hysterectomy do not need Pap testing. Many practitioners used to administer vaginal Pap tests on this patient population. However, the probability of vaginal intraepithelial neoplasia or vaginal cancer in individuals who have had a complete hysterectomy for benign illness is exceedingly low. According to screening standards, these individuals do not require post-hysterectomy vaginal cytology. Vaginal cancer screening is recommended for people who have risk factors for this condition (Carusi, 2021). 

Osteoporosis: All women 65 and older should have regular osteoporosis screening with bone density measurements. It may take up to two years to detect improvements in bone density, and it may take much longer to improve fracture risk prediction (Schuiling & Likis, 2022).

Colorectal Cancer: All individuals aged 50–75 years should be screened.

The recommended test is high-sensitivity guaiac-based fecal occult blood testing (gFOBT), fecal immunochemical test (FIT), flexible sigmoidoscopy every five years in conjunction with FIT every ten years, or colonoscopy every ten years are all tests (Schuiling & Likis, 2022).

Tobacco use: All adults should be screened. In 2017, 12.2 percent of American women smoked cigarettes (Schuiling & Likis, 2022). If G.R.  smokes, then interventions need to be aimed towards promoting smoking cessation.

Lung Cancer: It is not clear if G.R. smokes, but it is essential to mention that for all women aged 55-80 who smoke, the recommendation is to screen for lung cancer yearly with a low dose CT scan (Schuiling & Likis, 2022).

Depression: Screening for depression is an essential feature of women’s health care since women are more likely than males to acquire clinical depression (Schuiling & Likis, 2022).

Height and Weight: Obesity screening is graded B for all adults and adolescents. During the office visit, we should check G.R.’s body mass index(BMI); a patient is considered overweight if the BMI is between 25 and 29.9 (Schuiling & Likis, 2022). Obesity is defined as a BMI of 30 or higher. Healthcare providers should encourage a balanced diet and regular exercise.

Hypertension: All people over the age of 18 receive an A grade, 

G.R.’s blood pressure measurement should be performed during the office visit.

People should aim for 140/90; adults over 60 should aim for 150/90.

Lipid Disorders: The recommendation is no longer active for regular screening for lipid abnormalities. Although G.R.’s last visit to her PCP was five years ago, it is advisable to screen for lipid disorders. The USPSTF does guide for using statins to prevent cardiovascular disease in persons who are obese (Schuiling & Likis, 2022).

Hepatitis C Virus Infection: The USPSTF recommends hepatitis C infection screening (grade B) for all people born between 1945 and 1965 and those at high risk of infection. Infection risks for persons born between 1945 and 1965 are linked to blood transfusions obtained before the universal screening of donor blood (which began in 1992) or other infection risk factors (Schuiling & Likis, 2022).

Long-term COC users had an elevated risk of cervical cancer, albeit this risk returns to normal after cessation of usage. Cerebrovascular disease or coronary artery disease; a history of deep vein thrombosis, pulmonary embolism, or congestive heart failure; untreated hypertension; diabetes with vascular complications; estrogen-dependent neoplasia; breast cancer; undiagnosed abnormal vaginal bleeding; known or suspected pregnancy; active liver disease; and age older than 35 years and cigarette smoking are all contraindications to use (Casey, 2021).

Finally, drospirenone has antimineralocorticoid effects. It is not recommended for those who have kidney or adrenal gland insufficiency or who have liver difficulties. Potassium levels should be monitored throughout the first month of treatment, primarily if drospirenone is used with medications that might raise potassium levels, such as nonsteroidal anti-inflammatory drugs and ACE inhibitors (Casey, 2021).

Despite little research, there is no indication that any type of contraception is considerably less effective in obese women.

References

Casey, F. E. (2021, October 17). When are oral contraceptives contraindicated? Latest Medical News, Clinical Trials, Guidelines – Today on Medscape. Retrieved from https://www.medscape.com/answers/258507-109054/when-are-oral-contraceptives-contraindicated. 

Carusi, D. A. (2021, July 29). The gynecologic history and pelvic examination. UpToDate. Retrieved from https://www.uptodate.com/contents/the-gynecologic-history-and-pelvic-examination?search=Name+and+describe+the+components+and+rationale+of+the+gynecological+health+history&source=search_result&selectedTitle=9~150&usage_type=default&display_rank=9. 

Rai, U. (2021, September 29). Gravidity & Parity and GTPAL (explained with examples). Nurseship.com. Retrieved from https://nurseship.com/gtpal-gravidity-parity/. 

Schuiling, K. D., & Likis, F. E. (2022). Gynecologic Health Care: With an introduction to prenatal and postpartum care. Jones & Bartlett Learning.