- Apply knowledge and theory related to the prevention, diagnosis, and management of select uncomplicated common acute and chronic health problems for individuals across the lifespan (FNP) or adolescent through end of life (AGPCNP).
- Develop differential diagnoses and plans of care based on evidence-based research and clinical practice guidelines.
Case Overview
A 31-year-old female presents to your primary care office with complaint of heavy, irregular menses for 3 or 4 years. She has not used any contraception for 5 months and wants to conceive. Since her menses is irregular, she sometimes does not get a menstrual cycle for 8 weeks and typically does a pregnancy test at that time. She has never had a pelvic exam and knows very little about her family history, except that she herself was a large baby weighing over 9 pounds.
Relevant assessment findings include:
Vital Signs: BP: 141/88; HR: 82; Resp: 16, Temp: 98.2; weight 240 pounds; height 64 inches
Genitourinary: Labial folds without lesions or erythema; non-tender and no swelling skene and Bartholin glands; Cervix pink with transition zone small white discharge
Bimanual exam neg CMT; non-palpable ovaries; uterus fundus smooth normal size; no masses or tenderness
Breast exam: Breasts large bilaterally with some enlarged darkened areolar areas; Skin without any rashes, dimpling, or erythema. Nipples without discharge. No masses or nodules palpated and no lymphadenopathy.
Skin: Stage 2 pustular acne noted face and upper back. Skin has some increased pigmentation in the neck area and small coarse dark hair stubble on chin noted.
Instructions
Compose Initial Response
Compose an evidence-based response to address the following:
- Outline any laboratory and diagnostic tests needed to assess this patient; include the rationale for ordering the tests.
- What is the significance of the assessment findings? Discuss the long-term health risks that the patient faces if the underlying diagnosis is left untreated.
- Outline 3 differential diagnoses for this patient and how you would rule them in/out.
- What is the final diagnosis for this patient?
- What teaching would you provide to the patient while awaiting diagnostic results?
- Outline the plan of care for the patient, including medications and referrals.
Your response should include sources in APA formatLinks to an external site..
Compose Follow-Up Response
Read the responses posted in the discussion by other members of the class. Consider the responses and compose an evidence-based response to the following items:
- Does your final diagnosis change?
- Would you make any changes to the diagnostic tests ordered?
- Would you make any other changes to the plan?
Include sources in APA formatLinks to an external site..
Task List
- Read through the Discussion Guidelines.Links to an external site. These guidelines must be followed throughout the course.
- By the due date indicated, post your initial response.
- By Sunday, post your follow-up response.