DISCUSSION CASE STUDY HA. – nursing homework essays

DISCUSSION CASE STUDY HA.

DISCUSSION CASE STUDY HA.

You are working at an outpatient family medicine clinic with Dr. Hill. She has asked you to interview and examine Savannah, a 16-year-old who has come in for a routine sports physical before the softball season begins. Her mother, Leslie, accompanies her.

Dr. Hill informs you, “This is one of the special aspects I love about family medicine: I have cared for Savannah and her entire family since I helped Leslie deliver Savannah 16 years ago!”

She continues, “Today, in addition to performing a pre-participation physical examination, I would like to use this opportunity to perform prevention screening and counseling. Perhaps the most important ‘screening’ issue is the medical interview and developing a safe and trusting doctor-patient relationship. Since this can sometimes be challenging with adolescents, I have found it helpful to organize my interview around the adolescent interviewing mnemonic, HEEADSSS.”

Logistically, you both decide that it would probably be best to begin the history with Savannah’s mother present and then delve into more of the interview after she has been invited to the waiting room during the conclusion of the visit.

TEACHING POINT

HEEADSSS Adolescent Interview

Pre-participation exams are a great opportunity for prevention and counseling, as otherwise healthy adolescents may not come in for this routinely.

HEEADSSS covers the following issues:

· Home

· Education / Employment

· Eating

· Activities

· Drugs

· Sexuality

· Suicide / Depression

· Safety / Violence

Remember that in caring for adolescents, every effort should be made to encourage the patient to involve parents in their health care decisions. Nevertheless, teens have a right to be interviewed and examined without a parent or guardian in the room.

 

Dr. Hill reminds you, “Along with the psychosocial medical interview, we will want to consider prevention screening. First, you need to decide whether a screening test is worth ordering.  The U.S. Preventive Services Task Force (USPSTF)  has taken the qualities of a good screening test into account when they make recommendations of what screening tests we should do. Let’s take chlamydia for example and look online together and see what they have to say about chlamydia screening in a 16-year-old, such as Savannah.”

TEACHING POINT

Chlamydia: Epidemiology, Course of Disease, and Screening Recommendations

Epidemiology

Chlamydial infection is the most common sexually transmitted bacterial infection in the United States. In 2007, more than 1.1 million chlamydia cases were reported to the CDC. It is thought that another million cases of chlamydia remain unreported.

Course of disease

Chlamydia is often insidious and asymptomatic. In women, genital chlamydial infection may result in urethritis, cervicitis, pelvic inflammatory disease (PID), infertility, ectopic pregnancy, and chronic pelvic pain. Chlamydial infection during pregnancy is related to adverse pregnancy outcomes, including miscarriage, premature rupture of membranes, preterm labor, low birth weight, and infant mortality.

Screening recommendations

The USPSTF found fair evidence that nucleic acid amplification tests (NAATs) can identify chlamydial infection in asymptomatic men and women, including asymptomatic pregnant women, with high test specificity. In low prevalence populations, however, a positive test is more likely to be a false positive than a true positive, even with the most accurate tests available.

TEACHING POINT

Qualities of a Good Screening Test

ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS 

1. The condition should be an important health problem and the condition screened for must have a high prevalence in the population.

2. There should be a latent stage of the disease.

3. There should also be effective treatment for the condition being screened.

4. Facilities for diagnosis and treatment should be available.

5. There should be a test or examination for the condition.

6. The test should be acceptable to the population and the total cost of finding a case should be economically balanced in relation to medical expenditure as a whole. The potential benefits of early detection and treatment of a condition need to be weighed against many factors, including adverse side effects of the screening test, time and effort required (of both the patient and the health care system) to take the test, financial cost of the test, potential psychological and physical harm of false positive results (such as labeling and overtreatment), and adverse effects of the treatment.

7. The natural history of the disease should be adequately understood.

8. There should be an agreed policy on whom to treat.

9. Case-finding should be a continuous process, not just a “once and for all” project.

10. An effective screening test should have very good sensitivity (identify most or all potential cases) and specificity (label incorrectly as few as possible as potential cases). Even a test with a sensitivity of 95% will lead to many false positives when the prevalence of the condition is very low.

Question

According to USPSTF, of the groups listed below, who should be screened for chlamydia? Select all that apply.

All sexually active women under 25 years AND All sexually active women 25 years or older who are at high risk

 

After discussing preventive screening, you and Dr. Hill review the sports pre-participation questionnaire that Savannah filled out in the waiting room.

Get a 10 % discount on an order above $ 100
Use the following coupon code :
NURSING10