Discussion:Clinic for a Wellness Visit

Discussion week 7
Carolyn Cross 41 years old female came to the clinic for a wellness visit, She also like to discuss a few concerns, especially her risk for breast cancer. She stated that recently both her mother who’s 63 and her first cousin on her mother’s side were diagnosed with breast cancer, then now she wants to know whether that increases her risk and if so how much.

Provide a reference for your treatment plan (in APA format). The reference may come from a journal, a book, etc.
Cite all sources using APA format.
Include three differential diagnoses and support your diagnoses with supporting literature.
diagnosis:

1- hyperlipidemia

2- type 2 diabetes mellitus

differential diagnosis:

1- breast cancer risk (based on first degree family member, early menses and late pregnancies)

1- diabetes (based on the patient is considered a prediabetic beased on labs results)

3- cardiovascular disease (based on lipid panel results)

The patient had an encounter a year before, this was the history:

Chief complaint:

Yearly physical

Discussion:Clinic for a Wellness Visit

Discussion:Clinic for a Wellness Visit

Discussion:Clinic for a Wellness Visit

HPI:

Carolyn is an almost 40 y/o married female, G2P2 here for her yearly physical exam. She has no complaints.

PMH (previous medical history)

Other active problems:

None

Medical, surgical, obstetric, hospitalizations:

Medical: noneSurgical: G2P2; Bilateral tubal ligation following last delivery at age 35OB/Gyn: NSVD x two; breast fed both for 3 months; premenopausal; menses regular since age 10.5

Allergies:

None

Medications:

NoneIbuprophen occasionally for headaches

Preventive Health:

Pap smears in the past are negative; last one 3-4 years agoDiet: tries to eat a well-balanced dietExercise: Walks to and from the train 5 days a week; weekend gardening

Immunizations:

Up-to-date

FHx:

Father: hypertension, hyperlipidemiaMother: Hx of type 2 diabetesSisters: no sistersBrothers: healthy and very physically active

SHx:

Ethnicity: Hispanic-AmericanOccupation: Middle-school learning specialistMarital status: married x ~13 yearsChildren: 2 sons (5ish and 7ish)Tobacco: neverRecreational drugs: neverAlcohol: wine (one glass at dinner most days)

ROS (review of systems)

General/ Constitutional:

Normal energy levelNo sleep concernsWeight stable

Skin/Breast:

Negative except for lumpy breasts

HEENT & Neck:

Negative

Cardiovascular:

Negative

Respiratory:

Negative

Abdomen/ Gastrointestinal:

Negative

Genitourinary:

Negative

Musculoskeletal:

Negative

Allergic/Immunologic:

Negative

Lymphatic/Endocrine:

Negative

Hematologic:

Negative

Neurological:

Negative

Psychological:

Negative

Vitals

Temp:98.6 FPulse:72, rhythm: regularBP:left: 130/72Respiration:14, effort: normal
Physical Exam

Weight:

148.0 pounds

Skin/Breast:

No pallor, jaundice, ecchymoses, or rashNormal, symmetrical breast contourNo visible skin or nipple abnormalitiesNo spontaneous or expressed nipple discharge or bloodIrregular “lumpy bumpy” consistency through both breasts; no suspicious, discrete palpable lesionsSlight tenderness to exam reported

HEENT & Neck:

Good dentitionThyroid within normal limits for size and consistencyNo cervical lymphadenopathy or mass

Cardiovascular:

Regular rhythm and rateNo murmur or gallopNo peripheral edema

Respiratory:

Thorax normal to percussionBreath sounds equal/clear bilaterally

Abdomen/ Gastrointestinal:

Abdomen mildly obese, nondistendedNo hepatosplenomegaly, mass, or herniationSoft, nontender throughout

Genitourinary:

Normal external genitaliaParous introitusNormal vaginal mucosaSlight cervical eversion without friability; samples collected for Pap smear completedNo abnormal discharge

Musculoskeletal:

Normal muscle tone and bulk bilaterally

Allergic/Immunologic:

Normal

Lymphatic/Endocrine:

No adenopathyThyroid normal, no nodules

Hematologic:

No ecchymosis, no petechiae

Neurological:

Reflexes 2+ bilaterally throughoutCN II-XII intact

Management Plan

Ms. Cross is a healthy 40ish woman with no acute medical issues.

1) Preventative Health

Mammogram ordered
lipid panel ordered
Pap smear – pending results
Fasting blood sugar ordered
Then for this encounter this are the labs results, the ROS and PE are the same from the previous visit.

pap smear negative

mammogram pending

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

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ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.
Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
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Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.
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The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
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