Posted: December 20th, 2021

Wellness Case Study

cite your sources in your work and provide references for the citations (2013-2018) in APA format.

Case study

Name: Carolyn Cross
Age: 41 years
Sex: F
Height: 5′ 3″
Weight: 155 pounds (BMI 27.5)– gained =>5lbs recently

Temperature: 98.4 F (oral)
Pulse: 76 bpm – regular
Blood pressure: 134/74 mmHg
Orthostatic blood pressure: 122/72 mmHg upon standing
Respiratory rate: 16 bpm
SpO2: 98% on room air

Chief complaint:В IвЂTMm here today for a wellness visit. IвЂTMd also like to discuss a few concerns. Especially my risk for breast cancer. Just recently both my mother, whoвЂTMs 63 and my first cousin on my motherвЂTMs side were diagnosed with breast Cancer. I would like to know whether that increases my risk and if so how much.

Ms. Cross is a healthy 41-year-old G2P2 Hispanic-American female who presents for a well-woman examination. She has no active medical complaints, but is concerned about her risk of breast cancer as both her mother (age 63) and maternal first cousin (age 44) have been recently diagnosed with intraductal breast cancer. Additional risk factors include menarche age 10.5; first pregnancy age 33; she breast fed each of her two infants for only four months each. The patient, reports a normal baseline mammogram at age 40, (report not available) and a history of fibrocystic breast disease. She is overweight (BMI 27.5) with a FH of hypertension, hyperlipidemia (father) and type 2 diabetes (mother).

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.

I only Missed 1 question “Tell me about your diet, what you normally eat.вЂк

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.

You missed 2 key exams. They are:
1. HEENT: inspect mouth/pharynx
2. Genitourinary: genitourinary female exam

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.

one key finding : Personal history of cystic breast disease with periods on bilateral breast

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.

one missed/incorrect category is her being overweight (BMI=27.5) with recent weight gain

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.

Missed differential diagnosis is cervical neoplasm.

Support your responses with scholarly academic references using latest APA style format. Assigned course reading and online library resources are preferred.В

APA format use of primary peer-reviewed references.
Sources include course and text readings as well as outside sources that are academic and authoritative (e.g., journal articles, other text books, .gov websites, professional organization websites). at least one half of your references must be peer-reviewed – which means from the library.
Not older than 5 years (2013). No Direct quotations

Wellness
Question 1:
The only question missed was about diet. The understanding of the normal diet is important. A normal diet comprises of adequate fluids from fruits, vegetables, and carbohydrates meal that gives adequate calories. Unhealthy fat items are avoided to avoid the accumulation of unhealthy nutrients and items in the body (Bodai, & Tuso, 2015). The diet history of a person is important it helps in the diagnosis of the potential health condition and illness. It is important to gather information about the diet of a person to guide their health performance and productivity. Another missed question is on history of breast illness that would have been instrumental in formulating relevant diagnosis.
Question 2:
The two errors that were evident in the physical examination includes the failure to inspect mouth/pharynx (HEENT), and the failure to conduct genitourinary female exam (Schwartz, de Heer, & Bea, 2017). Both physical examinations are important being able to assess the condition of the female patients in relation to their health condition.
Question 3:
From the physical examination findings, the key finding included is that the patient had a personal history of cystic breast disease with regular periods on bilateral breast. The doctor would order a mammogram and conduction of breast ultrasound that would help in making judgement of the potential condition of the breast cysts and examining the lumps (Runowicz, et al., 2016).

Question 4:
One missed category is that the patient was overweight with a recorded BMI of 27.5 due to the recent gain of weight. The failure to record that the overweight status is a concern as the weight level of the patient is important in the deciding the relevant treatment plans (Husebø, et al., 2015). The correct differential diagnoses will benefit from understanding of the weight condition of the patient.
Question 5:
The assessment of the differential diagnoses had a missed differential diagnosis of cervical neoplasm. According to Giunti et al. (2018), cervical neoplasm comprises of cancerous cells that requires early screening to prevent it from spreading to other parts of the body. Proper differential diagnosis of cervical neoplasm is important.

References
Bodai, B. I., & Tuso, P. (2015). Breast cancer survivorship: a comprehensive review of long-term medical issues and lifestyle recommendations. The Permanente Journal, 19(2), 48.
Giunti, G., Giunta, D. H., Guisado-Fernandez, E., Bender, J. L., & Fernandez-Luque, L. (2018). A biopsy of Breast Cancer mobile applications: state of the practice review. International Journal of Medical Informatics, 110, 1-9.
Husebø, A. M. L., Allan, H., Karlsen, B., Søreide, J. A., & Bru, E. (2015). Exercise: a path to wellness during adjuvant chemotherapy for breast cancer?. Cancer Nursing, 38(5), E13-E20.
Runowicz, C. D., Leach, C. R., Henry, N. L., Henry, K. S., Mackey, H. T., Cowens‐Alvarado, R. L., … & Hurria, A. (2016). American cancer society/American society of clinical oncology breast cancer survivorship care guideline. CA: A Cancer Journal for Clinicians, 66(1), 43-73.
Schwartz, A. L., de Heer, F. H. D., & Bea, J. W. (2017). Initiating Exercise Interventions to Promote Wellness in Cancer Patients and Survivors: Page 3 of 3. Oncology, 31(10).

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