One Guideline and Two Patients

Throughout this course, we have looked at health promotion and disease prevention and focused on various vulnerable populations. This week’s discussion will surround One Guideline and Two Patients. Please select one of the following scenarios and then answer the questions in your initial post.

Scenario A: Focus on Preventative Guidelines for Childhood Immunizations

You are working as a APRN in your local primary care office. The rural town of Maynard, Iowa has 300 people, a post office, doctor’s office and a gas station. The primary source of income is farming and 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 and he is a 9 y.o. Hispanic male born in Mexico. He and his family (Mom, Dad and 6 siblings, ages 6 months – 14 years) moved into the area when Louisa was born just a few months ago. Louisa had nearly died at 2 months when she contracted Pertussis.

Your final patient of the morning is Irena, a 15 y.o. 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. Knowing you have your work cut out for you, you work out a plan with your nurse to extract yourself from the room after 20 minutes and head in to see Mr. Jimmy James. Jimmy is a 62 y.o. 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 8 hours from Atlanta. Jimmy has a “genetic disorder” but actually his symptoms are more like Autism that we are familiar with today. Jimmy’s care giver states that he has been having some problems with constipation but otherwise he seems ok. Jimmy is non-verbal 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 y.o. male who is here today 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 that has been retrofitted as a primary care clinic. Headed to downtown Seattle where there is a large homeless population everyone is excited to see what the day brings.

Miss Eleanor is your first patient of the day. She is a 72 y.o. African American female that 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 20 years since had a breast exam and that she had never had a mammogram.

Finishing up your day with Sally. She is a 48 y.o. female that presents to the mobile clinic because she is concerned that she has a STD. During your pelvic exam of Sally, you learn that she has been living in a tent under a bridge in downtown Seattle for about a year. She had been traveling with her boyfriend and he took what money she did have and the car they had been living in and left her here in Seattle. 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 a Bipolar disorder. You are concerned that Sally does have a STD and you ask about her medical history. After quite a story, Sally tells you that she had a mammogram about 2 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 in Norfolk, VA, you see a lot of patients who are somehow connected with the Navy. Today, Shelesha, a 21 y.o. 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. Leaving the room so that she can get dressed, you return to find Shelesha crying. She finally tells you that she was raped on board her ship 6 months ago and she has these “bumps” that keep getting bigger around her vagina and she is worried.

Virginia arrives for her annual well women exam. Virginia is a 67 y.o. 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 as 52 but otherwise she is healthy, only taking one medication for her cholesterol.

Scenario E: Focus on Prostate Cancer Guidelines

Ivan is a 59 y.o. Caucasian male who is 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 that he smokes 2 packs of cigarettes a day and his only complaint is a chronic cough.

Chen is a 76 y.o. man of Chinese descent. He returns to the office for an annual exam and a recheck of his blood pressure. Chen tells you that he just heard from his brother that his PSA is really high, and his doctor is concerned that he may have prostate cancer. LiWen is from his father’s second marriage and he is only 59 y.o. Chen is asking to have his PSA drawn to make sure he doesn’t have prostate cancer.

Initial Post

Having completed case studies and pocket guides related to preventative guidelines, everyone should be familiar and comfortable with health promotion and disease prevention. Using this knowledge answer the following questions related to your chosen scenario:

1. Discuss the guideline assigned with your scenario.
2. Will both patients be treated in the same manner? Yes or No? Why?
3. What would your treatment plan be for each of the individuals within your scenario?