Writing Homework Help

Reply to Nancy

Describe your clinical experience for this week.

Did you face any challenges, any success? If so, what were they?

Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and possible differential diagnosis.

• What did you learn from this week’s clinical experience that can be beneficial for you as an advanced practice nurse?
• Support your plan of care with the current peer-reviewed research guideline.
• The last two weeks has been kind of difficult emotionally. Last week I had an older Hispanic woman come in with a lesion to her labia majora. She’s not sure how long is has been there. She was embarrassed about having something wrong ‘down there.” Before we went into the exam room, she sent a picture of her lesion to the doctor. She asked him if he could send me in by myself to do the exam because while she loved him, she was too embarrassed for him to see her sore. He agreed.
• I had met the patient before when she came in for blood pressure monitoring, so I had a rapport with her. I went in and reintroduced myself while the patient was fully clothed. I asked about her family and made some small talk. I asked her to describe the signs and symptoms that brought her in. I told her that I had seen the picture she had sent the doctor and explained to her that she needed to follow up with a gynecological surgeon who could biopsy the lesion and evaluate it for cancer.  She told me that she would prefer if I were to look at it before just to make sure. She has been treating it with olive oil and thinks that it is getting better (Markides et al.,1997). She feels like it could just be “a rough patch. I agreed and stepped out so she could take her bottoms off and cover up with a sheet (Juckett 2013). I returned shortly and examined the lesion. The lesion was midline along the labia majora. It was asymmetrical with abnormal borders, raised, and appeared calcified. The lesion was not open, it was not oozing and there was no foul odor. Once the exam was completed, I left the room, and she was given time to redress. While she was redressing, I consulted with my physician, and we agreed that she most likely had a cancerous lesion. I returned and sat on a stool next to her chair so I would be more at her level (Juckett 2013). I told her that the doctor and felt that she needed to go to a gynecologic oncologist. She asked what the process would be, I explained that the gynecologist would most likely biopsy or remove the lesion. A pathologist would then look at the tissue under a microscope to determine whether it was cancerous. She agreed to take the referral and see a specialist.

This week we received the pathology report, and the lesion was determined to be cancerous. The cancer has not been staged yet because the margins were not clean the report stated that further imaging tests and biopsy would be required. I felt so sad for my patient. I know she has a good support system and will be fine, however, it was sad to know that such a modest sweet person will have to go through cancer treatment of her vulva.

                                                           References:

Marc A Garcia, PhD, Brian Downer, PhD, Michael Crowe, PhD, Kyriakos S Markides, PhD, Aging and Disability Among Hispanics in the United States: Current Knowledge and Future Directions, Innovation in Aging, Volume 1, Issue 2, September 2017, igx020, https://doi.org/10.1093/geroni/igx020 (Links to an external site.)

Juckett G. Caring for Latino patients. Am Fam Physician. 2013 Jan 1;87(1):48-54. PMID: 23317025.

Markides KS, Rudkin L, Angel RJ, et al. Health Status of Hispanic Elderly. In: National Research Council (US) Committee on Population; Martin LG, Soldo BJ, editors. Racial and Ethnic Differences in the Health of Older Americans. Washington (DC): National Academies Press (US); 1997. 10. Available from: https://www.ncbi.nlm.nih.gov/books/NBK109838/

Signs and symptoms of vulvar cancers and pre-cancers. American Cancer Society. (2018, January 16). Retrieved September 23, 2021, from https://www.cancer.org/cancer/vulvar-cancer/detection-diagnosis-staging/signs-symptoms.html.