W#14 Health Promotion (replies)

Reply separately to two of your classmates posts (See attached classmates posts, post#1 and post#2). 

INSTRUCTIONS:

For each of your peer’s posts, discuss other applicable preventative guidelines for one of the patients from the initial scenario. Provide a link to patient education relating to this additional guideline that your peer would find interesting and helpful.

Note: DO NOT CRITIQUE THEIR POSTS, DO NOT AGREE OR DISAGREE, just add informative content regarding to their topic that is validated via citations. 

– Utilize at least two scholarly references per peer post. 

Please, send me the two documents separately, for example one is the reply to my peers Post #1, and the second one is the reply to my other peer Post #2.

– Minimum of 250 words per peer reply.

Background: I live in Florida, I am currently enrolled in the Psych Mental Health Practitioner Program, I am a Registered Nurse, I work in a Psychiatric Hospital.

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 retrofitted as a primary care clinic. Headed downtown where there is a large homeless population, everyone is excited to see what the day brings.

Miss Eleanor is a 72-year-old African American female who 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 30 years since she’d had a breast exam and that she had never had a mammogram.

Finishing up your day on the mobile clinic, Sally, a 48-year-old female, is concerned that she has an STI. During Sally’s pelvic exam, you learn that she has been living in a tent under a bridge downtown for about a year. 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 bipolar disorder. You are concerned that Sally does have an STI and you ask about her medical history. After quite a story, Sally tells you she had a mammogram about two 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.

POST # 1 Douglas

Scenario C: Focus on Preventative Guidelines for Breast Cancer Screening
This week we are asked to consider two different patient scenarios and address each using the same preventative measure with both. First, we will consider the two patients and the difference is that may apply to each of them regarding the possibilities of breast cancer. Secondly, we will look at the commonality between the two patients and what preventative measure would be best suited for both situations. Most patients are encountered while working in a mobile medical clinic providing services to a rural underserved community.
The first patient that we encounter is a 72-year-old African American female. Patient has complaints of recent breast tenderness but also shares with the provider that she recently fell striking her chest on her shopping cart. Patient allows for physical examination to be done and an area of concern is identified by the practitioner. Patient herself explains it’s probably been more than 30 years since she’s had a breast exam.  
There are several factors to consider When dealing with an African American female especially regarding breast cancer screenings. Several roadblocks have been identified including fears, distrust, knowledge deficits, family responsibilities, insurance or financial status and some cultural issues (Orji,2020). The fact that this patient allowed the provider to do a physical examination Is a good start in the trusting relationship had a good time for the provider to start building on patient education. 
The second patient we will address from this mobile clinic is a 48-year-old who is reporting her concerns about a possible STI. The patient confides in her provider that she has been homeless for around a year after being diagnosed as bipolar and losing her job. After further discussion it is learned that the patient had a mammogram about two years prior with no follow-up even though there was an area of concern. Efficacy of mammograms and the reduction of breast cancer is greatly affected by delays in diagnostic follow up. Oftentimes these delays occur do too lack of insurance or financial resources for the follow up. The CDC does recommend follow-up after an abnormal mammogram be done within 60 days (Durham,2017).
The preventative measure that would suit both patients takes into consideration that both have limited access to medical care, financial resources, or insurance. One of the leading preventative measures regarding breast cancer is self-examination. Self-examination requires no special tools, nor does it require insurance. May be important for the provider to take time to teach each of these patients how to properly do self-examinations. The American Cancer Society states that it is important for all women to be familiar with their breasts how they look and how they feel. Is recommended these examinations be done a few days after menstruation is completed. The patient should do both a visual and physical examination of the breast noting any changing color shape discharge or any feelings of lumps or tenderness in the breast tissue. Hello there has become some controversy as to whether or not self-exams drastically reduced breast cancer for these two particular patients it’s a great start to get them engaged in their own care and to start them on the road to better health and self-efficacy (Albeshan,2020).
References
Orji, C. C., Kanu, C., Adelodun, A. I., & Brown, C. M. (2020). Factors that Influence Mammography Use for Breast Cancer Screening among African American Women. Journal of the National Medical Association. 

https://doi.org/10.1016/j.jnma.2020.05.004

Durham, D. D. (2017). Insurance status and diagnostic follow-up disparities in breast cancer screening [ProQuest Information & Learning]. In Dissertation Abstracts International: Section B: The Sciences and Engineering (Vol. 77, Issue 11–B(E)).
Albeshan, S. M., Hossain, S. Z., Mackey, M. G., & Brennan, P. C. (2020). Can Breast Self-examination and Clinical Breast Examination Along With Increasing Breast Awareness Facilitate Earlier Detection of Breast Cancer in Populations With Advanced Stages at Diagnosis? Clinical Breast Cancer, 20(3), 194–200. 

https://doi.org/10.1016/j.clbc.2020.02.001

https://www.cdc.gov/cancer/breast/pdf/breastcancerscreeningguidelines

https://www.breastcancer.org/symptoms/testing/types/self_exam

Scenario E: Focus on Prostate Cancer Guidelines

Ivan is a 59-year-old Caucasian male 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 he smokes two packs of cigarettes a day and his only complaint is a chronic cough.

Chen is 76-year-old gentleman of Chinese descent. He is here today for an annual exam and a recheck of his blood pressure. Chen tells you he just heard from his brother that his PSA (Prostate Specific Antigen) is really high, and they are concerned he may have prostate cancer. Chen’s brother is from his father’s second marriage and he is only 59 years old. Chen is asking to have his PSA drawn to make sure he doesn’t have prostate cancer.

POST # 2 JAMIE

Prostate cancer is one of the most common types of cancer in men. Usually prostate cancer grows slowly and is initially confined to the prostate gland, where it may not cause serious harm. However other types can spread quickly and more aggressive (Mayo Clinic, 2019). Most prostate cancers are found as a result of screening with a prostate-specific antigen (PSA) blood test or a digital rectal exam (American Cancer Society, 2020).

In the first case scenario, Ivan is a 59-year-old Caucasian male in the office 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 is not sure. The physical exam of Ivan is “all normal.” While reviewing Ivan’s health assessment form, he smokes two packs of cigarettes a day and his only complaint is a chronic cough. According to the Prostate Cancer Foundation (2019), screening should begin at age 40 if the patient has a family history of it and age 55-69 to discuss with doctor. Because the patient is within the age range for prostate screening, he should be tested.     

In the second case scenario, Chen is 76-year-old gentlemen of Chinese descent. He is in the office for an annual exam and a recheck of his blood pressure. Chen states he heard from his brother that his PSA is really high, and they are concerned he may have prostate cancer. Chen’s brother is from his father’s second marriage and he is only 59 years old. Chen is asking to have his PSA drawn to make sure he does not have prostate cancer. As mentioned above, the Prostate Cancer Foundation does not recommend prostate screening for men above the age of 70, so Chen is not a candidate. Education needs to be provided to the patient in regard to family history. Chen’s brother is not biologically related to him, so the concern with genes are low in this situation. However, it would be recommended for Chen to find out if his father had any past medical history with cancer because the genes can correlate with one another.

Although diagnosing options are the same for both patients, each of them are presenting with different backgrounds and family history. Ivan is within the proper age range for screening and should have the PSA test done. However, Chen does not have a known biological family history of prostate cancer and is above the recommended age range for screening. In this situation, as the APRN, I would not screen the second patient but instead provide education on the topic.

References

Prostate cancer – Symptoms and causes. (2019, April 17). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/prostate-cancer/symptoms-causes/syc-20353087

Should I Be Screened? (2019, December 10). Prostate Cancer Foundation. https://www.pcf.org/about-prostate-cancer/what-is-prostate-cancer/the-psa-test/should-i-be-screened/

Tests to Diagnose and Stage Prostate Cancer. (2020). American Cancer Society. https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/how-diagnosed.html#:%7E:text=Most%20prostate%20cancers%20are%20first,Screening%20Tests%20for%20Prostate%20Cancer.)