nsg 6020 Health assessment week 1 discussion
nsg 6020 Health assessment week 1 discussion
Discussion Question 1
Asking Racheal about breast lumps or discharge is a question I missed. Although she did not have nipple discharge, it is important to ask because most nipple discharge is caused by a benign medical condition. However, discharge can sometime be symptoms of some forms of breast cancer. Nipple discharge along with a lump or mass in the breast can be a sign of cancer (Goolsby, Grubbs, 2014).
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Discussion Question 2
I learned that completing a head to toe physical exam is not always warranted and can be frustrating for the patient. Research shows that most diagnoses are made from history alone than physical examination. For example, palpating and examining the legs or feet of a patient with complaints of breast lumps can be frustrating to the patient. Another error was not obtaining a complete set of vital signs on the patient. I was not able to read the blood pressure accurately or get a pulse due to lack of knowledge of using the virtual blood pressure cuff. Vital signs show how well our body is functioning and is a key indicator during a physical exam. I will review the tutorial to improve my skills on maneuvering on Ihuman. nsg 6020 Health assessment week 1 discussion.
Discussion Question 3
One key finding was the two palpable right breast lumps that was found during a breast examination. Performing a proper breast exam is important due to the patient’s self and family history. This is done by using the pads of the middle 3 fingers of one hand, press downward using a circular motion. During the breast exam it is important to apply steady pressure. This will allow palpation of three levels which include: superficial, medium, and chest wall (Bickley, 2016). Clinical breast exams and breast self-awareness are important methods of early breast cancer detection and should be performed along with mammography (Goolsby, Grubbs, 2014). All three of these methods provide complete breast cancer screening.
Discussion Question 4
I had a hard time fully understanding how to work this program. However, once the summary review occurred at the end and I was able to see it all together and it made sense. One category I missed was her history of atypical ductal hyperplasia.  Having this indication is imperative since it has been almost 3 years since follow up and she did not have a recheck post biopsy which was specified in her past medical history.  Although atypical ductal hyperplasia is benign, it increases the chance of breast cancer (Buttaro, Trybulski, Polgar-Bailey, & Sandberg-Cook, 2017). With a first degree relative with a history of breast cancer the patient is at a higher risk of developing breast cancer.
Discussion Question 5
I did not identify fibroadenoma as a differential diagnosis. Occurring mostly in women between the age of 15 and 35, fibroadenoma are solid, noncancerous breast lumps (Buttaro et al., 2017). A fibroadenoma is painless, moves easily when touched and can feel firm, rubbery, or hard. Fibroadenoma are usually well-defined shape. Healthcare providers should stress the importance of patients communicating new lump or change in breast tissue to their healthcare provider.
 
Reference
Bickley, L.S. (2016). Bates’ Pocket Guide to Physical Examination and History Taking (8th
Ed.). Philadephia, PA: Lippincott, Williams & Wilkins. ISBN: 9781496338488
Buttaro, T., Trybulski, J., Polgar-Bailey, P., & Sandberg-Cook, J. 2017. Primary nsg 6020 Health assessment week 1 discussion
Care: A Collaborative Practice, 5th Edition. [South University]. Retrieved fromhttps://digitalbookshelf.southuniversity.edu/#/books/9780323355018/cfi/6/8!/4/2/6/4@0:0
Goolsby, M., Grubbs, L. (2015). Advanced Assessment: Interpreting Findings and
Formulating Differential Diagnoses, 3rd Edition. F.A. Davis Company. ISBN: 9780803643635
 
 
E,
You did an excellent job on your discussion post. I missed Fibroadenomas as a differential diagnosis too! Cyst are most common in women aged 35 to 50 years old, however fibroadenomas are seen more often in adolescents and young women (Buttaro, Trybulski, Polgar-Bailey, Sandberg-Cook, 2017). Fibroadenomas are the most common benign solid lesion of the female breast and are usually painless, well defined, and freely movable. In fact, ninety percent of breast masses are caused by benign lesions such as cyst, fibroadenomas, and fibrocystic changes (Buttaro et. al, 2017). Diagnostic mammography and ultrasonography are usually the initial tests for a palpable mass in women older than thirty-five years old. Management of a patient with breast masses is administered by the patient’s clinical history, findings, and the patients age. (Buttaro et. al, 2017).
Reference
Buttaro, T., Trybulski, J., Polgar-Bailey, P., & Sandberg-Cook, J. 2017. Primary
Care: A Collaborative Practice, 5th Edition. [South University]. Retrieved fromhttps://digitalbookshelf.southuniversity.edu/#/books/9780323355018/cfi/6/8!/4/2/6/4@0:0
S,
Good job on your discussion post. I missed the swollen lymph nodes during Rachel’s physical examination. The lymph nodes are essential to the lymphatic drainage system and provide filtration of foreign substances through the action of lymphocytes, monocytes, and macrophages. There are over six hundred lymph nodes exist in the human body. Lymph nodes enlarge due to many factors such as but are not limited to an allergy or hypersensitivity to drug or environmental pollutants, tissue injury, and autoimmune diseases. Lymph nodes should be characterized by size, firmness, tenderness, and mobility. It should be note that breast changes especially with axillary adenopathy can be threatening and needs further investigation.
Reference
Buttaro, T., Trybulski, J., Polgar-Bailey, P., & Sandberg-Cook, J. 2017. Primary
Care: A Collaborative Practice, 5th Edition. [South University]. Retrieved fromhttps://digitalbookshelf.southuniversity.edu/#/books/9780323355018/cfi/6/8!/4/2/6/4@0:0
 
 
RH is a 42-year-old female who presents with two self-detected breast lumps.  She had a breast biopsy three years ago that identified atypical ductal hyperplasia.  Her mother was diagnosed with breast cancer at 48.  Other pertinent information includes weight loss of 11 pounds over the last three months.
Discussion Question 1
One of the questions I miss was Do you have any breast lump or discharge? It is important to ask because most nipple discharge is either normal or caused by a benign medical condition. There are instances, though, when discharge from the breast may be a symptom of some forms of breast cancer. This likelihood is greater if your nipple discharge is accompanied by a lump or mass within the breast or if you have had an abnormal mammogram (Goolsby, Grubbs, 2014). Another question I miss is Have you had any trauma to your breast? This is important because we can differentiate any problems related to breast trauma. A breast injury can result in breast contusion (bruises), pain, and tenderness.
Discussion Question 2
One of my errors was not to do a complete physical exam. It is said that over 80% of diagnoses are made on history alone, a further 5-10% on examination and the remainder on investigation. Whether this adage is true or not may be open to debate but it is clear that history and examination skills remain at the very core of clinical practice. Another error was not to palpate all lymph nodes. Lymph nodes can increase in size in a number of conditions. Infections, cancer, and many immune diseases can affect lymph cells and cause an enlargement of lymph nodes (Goolsby, Grubbs, 2014). Enlarged lymph nodes are often the first sign of lymphoma, a cancer of lymph cells. But all enlarged nodes are not lymphoma.
Discussion Question 3
One key finding was the two palpable right breast lumps. An specific physical exam I can do is a breast examination. Breast exams are best performed soon after your menstrual period ends, because your breasts will not be as tender and swollen as during your period. This makes it easier to detect any unusual changes. Clinical exams and breast self-awareness are important methods of early breast cancer detection and should be performed along with mammography (Goolsby, Grubbs, 2014). All three of these methods provide complete breast cancer screening.
Discussion Question 4
None missed.
Discussion Question 5
Based on your performance and the expert feedback in your ASSESSMENT of differential diagnoses, describe one incorrect/missed differential diagnosis and use specific references from your text to support the inclusion of the diagnosis for this client.
I miss breast lipoma. Breast lipomas have many features that RH was experiencing.  Unilateral, painless, mobile mass were symptoms that were consistent with lipomas.  Her history of weight loss with axillary lymphadenopathy ruled out this diagnosis.  Breast cancer was my leading diagnosis because of the presence of a first-degree relative with breast cancer, prior diagnosis of atypical ductal hyperplasia, recent weight loss and axillary lymphadenopathy.
Reference
Goolsby, M., Grubbs, L. (2014). Advanced Assessment: Interpreting Findings and Formulating Differential Diagnoses, 3rd Edition. F.A. Davis Company. VitalBook file. nsg 6020 Health assessment week 1 discussion
 
 
I miss breast lipoma. Breast lipomas have many features that RH was experiencing.
Unilateral, painless, mobile mass were symptoms that were consistent with lipomas.
Her
history of weight loss with axillary lymphadenopathy ruled out this diagnosis.
Breast cancer
was my leading diagnosis because of the presence of a first-degree relative with breast cancer,
prior diagnosis of atypical ductal hyperplasia, recent weight loss and axillary
lymphadenopathy.
Reference
Goolsby, M., Grubbs, L. (2014). Advanced Assessment: Interpreting Findings and
Formulating Differential Diagnoses, 3rd Edition. F.A. Davis Company. VitalBook file nsg 6020 Health assessment week 1 discussion

Discussion Question 1
Based on your performance and the expert feedback in your HISTORY collection, describe two missed questions and your understanding of why they were important to collect for this case history. Use specific references from your text to explain.
Two questions that I did not ask specifically were: Do you now or have you had cancer, and do you drink alcohol? If so, what do you drink and how many drinks per day? I found in the textbook that these questions are important due to modifiable and non-modifiable risk factors of breast cancer. One non-modifiable risk factor of breast cancer is a personal history of breast cancer or lobular carcinoma in situ. A modifiable risk factor of breast cancer alcohol ingestion (Bickley, 2017, p.425).
Discussion Question 2
Based on your performance and the expert feedback in your PHYSICAL EXAM collection, describe two errors in your exam performance or documentation. Use specific references from your text to explain the importance of these findings in correct assessment of this client nsg 6020 Health assessment week 1 discussion.
I did not percuss or palpate the patient’s abdomen. Dull areas of percussion suggest an underlying mass or enlarged organ. This assessment could have revealed an enlarged liver if malignancy were an issue. Deep palpitation can also identify any masses (Brickley, 2017, p.473).
Discussion Question 3
Based on your performance on the PHYSICAL EXAM collection, describe one key finding that you included in your list and describe a specific physical exam that you can perform at the point-of-care to further evaluate the finding. Use specific references from your text.
The key finding included in my list was the two lumps in the patient’s right breast. One specific physical exam that can be performed at the point of care to further evaluate the finding is a clinical breast exam. During this exam you inspect skin changes, symmetry, contours, and retraction in four different views. These views are with arms at sides, arms over head, arms pressed against hips, and leaning forward. nsg 6020 Health assessment week 1 discussion. You also palpate the breasts during the exam. Palpation should be done in the rectangular area extending from the clavicle to the bra line, and from the midsternal line to the posterior axillary line and well into the axilla ensuring the tail of the breast is examined. The patient should be in the supine position for this portion of the exam. During the exam, any nipple discharge present is noted (Brickley, 2017).
Discussion Question 4
Based on your performance and the expert feedback in your ASSESSMENT identification of problem categories, choose one missed/incorrect category and use specific references from your text to explain the importance of this category in arriving at correct differential diagnoses for this client.
I didn’t identify the patient’s decreased appetite and unintentional weight loss of 11 pounds. On looking at the patient’s last visit three years ago, her weight is stated as 148 pounds and, on her visit today, her weight is 149 pounds, so this was not on my mind. It has been three years since her last visit, so she may have had some fluctuations in between. Many conditions, including cancer, can make you feel less hungry. Cancer can have this effect by changing your metabolism, the way your body turns food into energy (WebMD Medical Reference, 2017). This would make the missed category important in reaching the correct differential diagnosis. nsg 6020 Health assessment week 1 discussion.
Discussion Question 5
Based on your performance and the expert feedback in your ASSESSMENT of differential diagnoses, describe one incorrect/missed differential diagnosis and use specific references from your text to support the inclusion of the diagnosis for this client.
I did not specifically include fibroadenoma as a differential diagnosis. This should have been included because fibroadenomas are usually smooth, mobile, and nontender (Brickley, 2017, p. 423). This is very similar to the description given by the patient.
 
Bickley, L. (2017). Bates’ guide to physical examination and history taking. (12th ed.) [South University]. Retrieved from https://digitalbookshelf.southuniversity.edu/#/books/9781496354709/
WebMD Medical Reference. (2017). How to spot early warning signs of cancer. Retrieved from https://www.webmd.com/cancer/cancer-early-warning-signs#1
Amanda,
I didn’t notice that I missed auscultating the abdominal arteries, but I did as well. This is something that I will have to practice. I understand the importance of this step, but it is not something that I have done often in practice. Auscultation for abdominal bruits is a phase of the abdominal examination. Bruits are swishing sounds heard over major arteries most often during systole. The area over the aorta, both renal arteries. and the iliac arteries should be examined carefully for bruits (Goldberg, n.d.). We will continue to improve our assessment skills! Good job!
Goldberg, C. (n.d.). Abdominal exam. Retrieved from https://meded.ucsd.edu/clinicalmed/pe_abdominalexam.pdf
Mary,
I had a hard time navigating ihuman and almost missed the atypical ductal hyperplasia also. I did find it in the PMH section eventually. Atypical ductal hyperplasia (ADH) is a high-risk benign lesion found in approximately 1–10% of breast biopsies and associated with a variable incidence of carcinoma after surgical excision (Latronico et al., 2018). This information makes me think the patient was not educated properly on the severity of this finding. She states it has been six months since she first found these two lumps and just kept missing appointments. I feel that if she had known that ADH was associated with incidence of carcinoma she might not have waited so long to have it seen about. What are your thoughts?
Latronico, A., Nicosia, L., Faggian, A., Abbate, F., Penco, S., Bozzini, A., & … Cassano, E. (2018). Atypical ductal hyperplasia: Our experience in the management and long term clinical follow-up in 71 patients. The Breast, 371-5. doi:10.1016/j.breast.2017.10.003 nsg 6020 Health assessment week 1 discussion

 
NSG 6020 Week 1 Discussion Assignment Latest SU
Assignment 2: Discussion Questions
The discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered .
For this assignment, go to the Discussion Area and post a response to one question in the Discussion Area . You may respond to your classmates’ postings for either question .
To support your work, use your course and text readings and also use the South University Online Library .As in all assignments, cite your sources in your work and provide references for the citations in APA format.
Start reviewing and responding to the postings of your classmates as early in the week as possible .Respond to at least two of your classmates’ initial postings .Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion .Cite sources in your responses to other classmates
Discussion Question 1
Evidence-based practice will be the cornerstone of your advanced practice career .Choose a health disease process that is common in the adult population and post your choice to the discussion question area with the title “Health Disease Choice .” If a health disease is posted, pick another one so that there will be a discussion on a variety of health disease processes . nsg 6020 Health assessment week 1 discussion
Once you have decided on your topic, research two evidence-based articles .Cite your references in APA format .Do not look for less common and seldom-seen diseases; instead, look for the typical problems that you anticipate seeing in your practice as an advanced practice nurse .On the basis of the literature search and adult disease process, also discuss what parts of the complete health history would be essential in understanding a patient’s current health state and work-up completed to date .
Discussion Question 2
Differential diagnoses must be considered before choosing a final diagnosis .What criteria must be met before a final diagnosis can be made? Give an example of three differential diagnoses for a patient who complains of a sore throat .Support your differential diagnoses with a brief statement of reason .You do not have to have a final diagnosis for this patient; just work up the differential diagnoses .This is a common complaint for many patients nsg 6020 Health assessment week 1 discussion .