NU629 Health Promotion - Disease Prevention
Week 1 Discussion
DQ1 Icebreaker—Getting to Know Your Classmates—Your First Memory of a Primary and a Secondary prevention Experience.
Note: All complete/incomplete items must be completed to pass the course. If you receive an incomplete, you must contact your professor immediately as you are in danger of failing the entire course.
Meet your classmates: Use this discussion board to introduce yourself, and to give a brief overview of your professional history.
In addition, answer the following questions:
What is your first memory of a primary prevention? A trip to the doctor’s office for your immunizations? Is this a positive or negative memory?
What is your first memory of a secondary prevention? Is it a positive or negative memory?
What do you wish might have been different, if anything, about either of these preventative healthcare experiences and why?
Please take the time to read your classmates’ posts. See if their preventative experiences are similar and get to know more about who else is going on this wonderful journey.
DQ2 World Health Organization (WHO) and “Your” Definition of Health
Initial Post
“Health is a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity” (World Health Organization, 2005). This 1946 historical definition of health remains pertinent to this day, and it helps to guide not only our perception of health but also that of illness. For this week’s discussion, you should review the WHO’s definition of health and do an online search to see how others perceive the concept of health, then create your own definition of health. Consider that there are individuals who have physical abnormalities but do not feel “ill,” and those with no physical changes who yet report feeling “less than well.” How might these two statements affect the overall balance or well-being of an individual and their outlook on their total health? What is the role of the Advanced Practice Registered Nurse (APRN) in terms of addressing the health of individuals and communities?
Include the following in your initial post:
Discuss your own personal definition of health.
How does your definition compare to the WHO’s definition of health?
What do you see as the role of the APRN in addressing not only the health of individuals but that of the community?
Include a minimum of three scholarly references.
When replying to your classmates, compare your post to the content of your peers and answer the following questions. Reply to at least two of your classmates on two separate days (minimum), utilizing at least two scholarly references per peer post.
Reply 1: Using the definition of health and an individual’s perception of their own health, how can you distinguish between a vulnerable individual versus a vulnerable group?
Reply 2: Compare and contrast your personal definition of health to that of a peer. Are you satisfied your definition? Why or why not?
NU629 Health Promotion - Disease Prevention
Week 2 Discussion
Cultural Competency Caring for a Vulnerable Population in My Own Community
Overview
Cultural Respect & Competency—Caring for a Vulnerable Population in My Own Community
Effective health communication is as important to health care as clinical skill. To improve individual health and build healthy communities, providers need to recognize and address the unique culture, language, and health literacy of diverse consumers and communities. As Advanced Practice Nurses, we must be knowledgeable but also culturally savvy and understand the nuances of the populations that we serve.
Prior to writing this week’s discussion post, first, complete the self-assessment checklist, reflect upon the information you learned about yourself, and then review the following learning material:
Cultural Competence Self-Assessment Checklist
National Institutes of Health: Cultural Respect
Health Resources and Services Administration: Cultural Language and Health Literacy
Effective Communication Tools 2016 (YouTube)
Effective Communication Tools 2016 (YouTube) video transcript
Initial Post
For this discussion, identify a vulnerable population in your own community. Describe the characteristics of this group—what makes them vulnerable—and utilize at least three scholarly resources to answer one of the following questions for your initial post.
Paraphrase concepts/theories specific to healthcare disparities as related to vulnerability; provide at least three applications of concepts/theories that could be implemented within your community.
As an APRN, how can you advocate for this identified vulnerable population within your community? List and discuss at least three ways in which you can advocate.
How does what you learned about your own cultural competency affect how you might approach your role as an advocate? Did you find that you had bias? Were you aware of your bias prior to this exercise?
As an APRN, how will you strive to be culturally competent and respectful to those you serve? List and discuss at least three behaviors/characteristics of a culturally competent and respectful APRN.
Note: Evaluate your APA proficiency and make sure you address each of the required elements for this discussion. As you continue to move through this course and our program, expectations related to APA, grammar, professional writing, and assessment instructions will encourage you to stretch and push yourself, ensuring you are producing graduate level academic work that you can be proud of.
NU629 Health Promotion - Disease Prevention
Week 3 Discussion
How does Resilience, Low Health Literacy, and Justice Affect the Health of the Vulnerable?
Initial Post
For this week’s discussion, you should focus on the vulnerable population group that you choose during Week 1 for your paper. Select one of the following topics and respond to the thread corresponding to the question/discussion, utilizing at least three scholarly references to support your post. As a class, please make sure that all topics are addressed.
Note: As you are choosing a topic please try to make sure that all topics are chosen by at least by one person. You can see this by noting if anyone has posted to the topic within the corresponding threads.
Discuss how low literacy within your vulnerable population group affects the group’s health and how you, as an APRN, can improve their overall health literacy?
How do the three (social, distributive, market) concepts/types of justice affect the health of your vulnerable population? How would you suggest enhancing social justice in advanced practice nursing?
Analyze how you could motivate the vulnerable population that you chose in Week 1 to make changes What is your primary health concern for this group and what theory might you utilize to encourage them to make behavior changes?
NU629 Health Promotion - Disease Prevention
Week 4 Discussion
Pros and Cons to Delivering Community-Based Participatory Care to Those Who Are Vulnerable
Initial Post
Performing health assessments as an APRN will help you to develop a collaborative partnership with your patients. After reading Chapter 4 and 12 in your Pender text, think about the vulnerable population that you choose during Week 1 - consider what you perceive / know about this group in relation to the following topics:
Health assets
Health problems
Health-related lifestyle strengths
Key health-related beliefs
Health behaviors that put the person at risk
Changes that could improve their quality of life
Now consider the pros and cons of implementing a Community-Based Participatory Research health promotion project with the vulnerable group. You should consider not only the benefit of the actions but the active role the vulnerable will play in the development and implementation of the health promotion plan. How does your population’s health disparities and health inequities benefit and/or hinder this type of project’s success? Remember that you should include citations/references from at least three scholarly sources.
NU629 Health Promotion - Disease Prevention
Week 5 Discussion
Obesity – An American Epidemic
Introduction
Obesity in the United States occurs at a greater prevalence than in other developed nations. Why is this? As part of Healthy People Initiatives, obesity has been highlighted in hundreds of articles and webinars. Many preventive guidelines address obesity and nutritional status, and the USPSTF (United States Preventive Services Task Force) guidelines specifically recommend a multidisciplinary approach and a plea to save our children.
Additional resources to enhance your knowledge about obesity in the United States are available in this week’s Learning Materials section but pay close attention to Jamie Oliver’s TED Talk: Teach Every Child about Food.
In 2018, the United States Federal government spent nearly $1.1 trillion dollars on healthcare, and 10% of this money ($110 billion) was utilized to combat obesity driven concerns. Children cannot recognize vegetables or fruits but are quick to tell you what’s in a Happy Meal and can pick the different french fries from various fast food restaurants..... American parents since the Great Depression, and before, have wanted to provide for their children - giving them more than what they had and now we have given our children a shorter life span – 10 years less.
As APRNs, we must be aware of what is happening in society and how this affects our health as a country. For this week’s discussion, develop a powerful message that can be given to your community. NO sounds, NO words; just a strong visual message that addresses our need to combat obesity.
Initial Post
For your initial post, present a visual picture that reflects the state of obesity in our country. Consider: If a photo is worth a thousand words, then a photo on obesity must be worth a thousand pounds. So ask yourself, how do we drive home the need for change? How do we show the price our children are paying?
The written part of your discussion post should include:
A brief explanation, three to four sentences, of your visual submission.
Using statistical data, your home state’s data related to obesity and how your state fairs compared to national statistics.
The type of health disparities you see in your own community related to obesity.
Remember to provide at least three scholarly references to support your statements and provide validity to your work.
NU629 Health Promotion - Disease Prevention
Week 6 Discussion
Men’s Health Planning
Initial Post
This discussion will allow you to examine several different preventive guidelines related to men's health. Choose one of the following topics and respond to the thread corresponding to the question you select. Please include at least three scholarly sources within your initial post.
Note: As you are choosing a topic, please try to make sure that all topics are chosen by at least one person. You can see this by noting if anyone has posted to the topic within the corresponding threads.
Topic 1: Colorectal Cancer Screening
A 47-year-old man presents to your clinic for a routine physical. He considers himself to be “fairly healthy” and doesn’t routinely go to the doctor. His last physical was five years ago. In reviewing his chart, you see that his BMI is 30, he exercises twice a week at the local gym, and he does not take any medication. Part of your discussion during today’s visit is about screening for colorectal cancers. He did endorse some constipation in the review of systems. He noted an uncle in his family history who was diagnosed at age 54 with colon cancer. You begin to talk about colorectal screening, and the patient interrupts you and tells you that he is only 47 and that he should not have to worry about it until he is 50.
What are the recommendations and source(s) for the colorectal cancer screening test?
The patient thinks he does not have to worry about “being screened” until age 50. Is he correct? Why or why not? What age would you recommend screening for this patient and why? Does his family history come into play here?
What age would you recommend screening for this patient and why? Does his family history come into play here?
What are the screening options for this patient, and which would you recommend? Why?
Topic 2: Prostate Cancer Screening
Your patient is an otherwise healthy, white 55-year-old man who presents for his annual physical. He has a history of hypertension and takes Losartan 50 mg daily. His family history is negative for cardiovascular disease or cancer. His review of systems is negative. The patient is a paramedic and exercises regularly. The patient’s BMI is 23. He states that one of his friends was diagnosed with prostate cancer and asks if he needs to be screened.
Which screening guidelines would you utilize?
Keeping the guideline you used in mind, explain and provide rationales for whether you would change your recommendations if:
The patient had a family history of prostate cancer.
The patient was African American.
The patient was 76 years old.
Topic 3: Testicular Cancer Screening
A 35-year-old African American male is being seen for a pre-employment physical. His father was recently treated for prostate cancer. His BMI is 24, and his past medical history was negative except for an appendectomy 15 years ago. He states he is too young to be screened for prostate cancer, but he wants to be screened for testicular cancer.
What are the primary risk factors for testicular cancer?
What are the screening options for testicular cancer, and which guidelines did you utilize?
Is screening recommended for this patient, and how would you counsel this patient?
NU629 Health Promotion - Disease Prevention
Week 7 Discussion
Trauma-Informed Care as Relating to Health Promotion and Disease Prevention
Overview
Thinking about the old adage, “Never judge a book by its cover,” wouldn’t it be great to be able to see inside other people – I mean really see inside. As human beings, we keep so much of ourselves hidden, and we see only a small portion of the lives of the people we encounter. People experience things, trauma and other adverse childhood experiences, that can follow them well into adulthood. To help better understand the people we care for—what may be the driving force behind their complaints—trauma-informed care shifts the focus from “What’s wrong with you?” to “What happened to you?” In making this mental shift in our practice, we can potentially improve overall patient health outcomes along with providers and staff wellness.
Prior to answering this discussion prompt, explore the website (including the videos) for the Trauma-Informed Care Implementation Resource Center to help improve your understanding and knowledge of this concept Trauma-Informed Care Implementation Resource Center. The website has a lot of great information, and be sure to review the 10 Key Ingredients for Trauma-Informed Care (PDF) and the Fact-Sheet – Understanding the Effects of Trauma on Health (PDF) . Both will be extremely helpful in participating in this week’s discussion and on the quiz.
Initial Post
For this week’s discussion, define trauma-informed care (TIC) , explain how stress and health are related, and discuss how an APRN can utilize this information in caring for vulnerable populations. Please include at least 3 scholarly sources within your initial post.
NU629 Health Promotion - Disease Prevention
Week 8 Discussion
Case Study - Mental Health a Downward Spiral
Initial Post
Read the Mental Health Case Study (Word) and complete the following tasks:
Examine current practice guidelines related to suicide screening and prevention and how they could pertain to John.
Choose two of the following questions to answer as part of your initial post.
What events in John's life created a "downward spiral" into homelessness and hopelessness? Which events were related to social needs, mental health needs, and medical needs, and which could health care have addressed?
What were some of the barriers John faced in accessing medical care and mental health care?
How does homelessness and mental illness intersect? Do you believe homelessness may develop because of a mental health issue, or do you believe those who become homeless eventually sink into psychological despair?
The tipping point for many people who live at the margins of society may be things that could have been managed given the right support. How can your role as an APRN help identify, alleviate, or support those who are in need like John?
In your own experience, have you encountered a homeless individual? What was that like? Do you recall what you were thinking?
Please include at least three scholarly sources within your initial post.
Reply Posts
Reply to at least TWO of your classmates who chose different questions.
Do you agree with their post? Why or why not?
Find an online resource related to health promotion and disease prevention of mental health issues for families that you think would be helpful to those who are struggling. This resource should focus on families and their needs, not the person with mental illness.
Reply on two separate days (minimum) utilizing at least two scholarly references per peer post.
NU629 Health Promotion - Disease Prevention
Week 9 Discussion
Helping Adults Stay Healthy
Initial Post
Please choose one of the following topics and respond to the thread corresponding to the question you select. Please include at least three scholarly sources within your initial post.
Note: As you are choosing a topic, please try to make sure that all topics are chosen at least by one person. You can see this by noting if anyone has posted to the topic within the corresponding threads.
Screening, gender- and age-specific. Discuss the screening process and upcoming possibilities for screening options. Be sure to provide examples of three different health screens (one related to age, one related to gender, and one related to ethnicity or culture).
Keeping patients healthy and preventative care. Include statistics regarding population-specific preventative care as well as those diseases that are caught early with better outcomes, not only to the patient but to the healthcare system (for example, independence, financial cost). Discuss three preventative care opportunities that can have a significant impact on the life and health of the patient. Focus primarily on immunizations.
Health counseling and education barriers to preventative care (for example, inadequate reimbursement, insufficient time, healthcare literacy). Discuss three barriers and offer suggestions as to how an APRN can address these barriers.
Levels of prevention (primary prevention is most important in adult learning). Review the five levels of prevention and then focus on primary prevention. Offer three innovative ways in which to engage the adult population.
Secondary prevention screening in the general adult population age 18–64 (diabetes, HIV, Hep C, etc.). Discuss current literature and statistics regarding secondary screening: success, failure, and cost. Review what is considered secondary screening and provide three examples.
Screening tools as part of health promotion and disease prevention, etc. Discuss screening tools that should be used in most healthcare settings. Some of these tools may be age-, gender-, or situation-specific. Discuss three screening tools you use daily as you engage with patients. Do you think there are benefits to using these screening tools? Why or why not?
Mental health care is lacking in almost every community in our country. Discuss three issues that the United States faces in terms of mental health care as related to health promotion and disease prevention. What challenges do you see in your own community?
NU629 Health Promotion - Disease Prevention
Week 10 Discussion
Elder Specific Discussion Topics
Initial Post
Please choose one of the following topics and respond to the thread corresponding to the question you select. Please include at least three scholarly sources within your initial post.
Note: As you are choosing a topic, please try to make sure that all topics are chosen at least by one person. You can see this by noting if anyone has posted to the topic within the corresponding threads.
Dementia in the elderly. Discuss ways in which the cost associated with dementia can be curtailed along with maintaining the individual’s quality of life. Dementia is not only Alzheimer’s disease, so please consider multiple types of dementia within your answers (types of dementia include: Alzheimer's disease, vascular dementia, dementia with Lewy bodies [DLB], mixed dementia, Parkinson's disease, frontotemporal dementia, Creutzfeldt-Jakob disease, and normal pressure hydrocephalus).
Elder abuse. Include physical, emotional, sexual, etc. How, as an APRN, can you screen for and address elder abuse? What types of health promotion concepts can be used to help advocate for the personal safety of our elders? Are there screening tools available? In what unconventional locations within your community might an elder screening be performed?
Fall prevention. What are specific geriatric risk factors that create an increase in fall risks? What can be done from a health promotion standpoint to decrease falls in the elderly? Define fall risk and what types of assessments are available in the outpatient and inpatient settings.
Financials, levels of neglect in the elders. Consider financial risk, scams, family, and other pitfalls the elderly may find themselves in relating to their finances. Provide examples and ways to advocate for our patients and our communities as an advanced practice nurse.
Components of a well elder evaluation. Define a well elder evaluation. Make sure you address components that pertain to the home environment and the communities in which they live. How can an APRN assist in these evaluations and promote different aspects within your community.
Functional status. Consider ADLs and IADLs. What is the difference? What types of assessment can be done and by whom to determine if an elder is capable of caring for themself at home. In addition, what types of services are available to help promote overall elder health not only in their homes but when living with family or in assisted living and nursing homes? What types of supportive services are available to assist the elderly in staying in their own homes?
Cognition. Describe how cognitive functioning may change as we age. What are neuropsychological examinations, and when should these be requested? Describe what this type of testing can accomplish and how, as a provider, you would use these results. Discuss ways in which we can improve and maintain our cognitive health (for example, diet, exercise). Provide specifics.
Polypharmacy. Consider medication compliance, risk of adverse effects, creatinine clearance <50ml/min. As an Advanced Practice Nurse, how can you address this growing problem? What type of surveillance will you put into place within your own practice, and how can you advocate to help address this concern within your own community?
Pain assessment and treatment. Discuss specifics regarding pain within the elder population: perception of pain, pain assessment scales, etc. In addition, provide evidence-based cited information relating to the opioid epidemic within your state and what percentage of addicted individuals are elderly. What type of resources are available in your community to help those with substance abuse problems? Are there any services specific to the elderly?
NU629 Health Promotion - Disease Prevention
Week 11 Discussion
Immunization Case Scenarios
Initial Post This discussion will allow you to examine several different preventive guidelines related to vaccinations. Please read the following four scenarios and choose ONE for your initial post; be sure to address all the questions posed by the scenario and include at least three scholarly sources within your initial post.
Note: As you are choosing a topic, please try to make sure that all topics are chosen at least by one person. You can see this by noting if anyone has posted to the topic within the corresponding threads
Immunizations
Patient #1: Two five-year-old girls are on your schedule for a kindergarten physical. The foster parent of one of the children indicates she received all her immunization from birth to one year of age, but after that the child has not had any further vaccines. The second child appears to have been vaccinated per the CDC schedule.
Is there a difference in the immunization plan you will initiate today for these two patients? Why or why not?
What immunizations will you be ordering for each of these two patients today?
Patient #2: Today you have two patients on your schedule for the HPV vaccine. One is a 27-year-old female. In taking her health history, you find that she is sexually active and that she had a splenectomy when she was 17. The second patient is an eleven-year-old female whose mother is concerned and wants to discuss the vaccine further before consenting. She feels that by giving the child the vaccine she is giving her permission to be sexually active.
What type of immunizations will you recommend and why for each of these patients?
What type of counseling will you provide in each of these scenarios related to their immunization needs?
Patient #3: The following two patients present for their yearly physicals before going to spend the holidays with their grandchildren, who are two months, 18 months, and seven years of age. The 72-year-old male states he “doesn’t want a flu shot” because he’s afraid he will just get sick like his neighbor who got her shot last week; however, his 67-year-old wife, who you are also seeing for a follow-up related to shingles she had a month ago, states, “I want the flu vaccine, but I don’t need the shingles vaccine now since I’ve already had it.”
How will you counsel these individuals? Are there risks related to the children from either party?
What adult immunizations should be recommended for these patients?
Patient #4: Your final patient of the day is a three-month-old baby. The nurse states that the mom is refusing vaccinations today even though though the baby’s records show she is up to date on her immunizations. Mom explains that she feels like her baby is getting “too many” shots and since everyone else is being vaccinated then they can skip a few of the vaccines and her baby will be just fine.
What is herd immunity and how can this help protect individuals who are not vaccinated? What are the rates for your state related to immunizations, and how could this affect herd immunity?
What immunizations should this patient receive today, and is there any leeway in the schedule to help alleviate some of the mom’s concerns?
NU629 Health Promotion - Disease Prevention
Week 12 Discussion
Well Woman Health Screenings
Initial Post
This discussion will allow you to examine several different preventive guidelines related to women's health. Please read the following three scenarios and choose one for your initial post; be sure to address all the questions posed and include at least three scholarly sources within your initial post.
Note: As you are choosing a topic, please try to make sure that all topics are chosen at least by one person. You can see this by noting if anyone has posted to the topic within the corresponding threads.
Breast Cancer Screening
A 39-year-old female presents to your office for her annual well-woman exam. She reports that she has a maternal aunt and a cousin who have had breast cancer, so she does her self-breast exams every month. She would like to start getting mammograms, but her friends all say she doesn’t need to worry about a mammogram until she’s at least close to 50.
What are the mammogram recommendations from American College of Obstetrics and Gynecology (ACOG), American Cancer Society (ACS), and United States Preventive Services Task Force (USPSTF)?
What is meant by shared decision-making regarding screening for breast cancer?
What are the screening recommendations regarding self-breast exams and clinical breast exams?
Based on the scenario provided, what recommendations would you give this patient?
What factored into your decision making?
Cervical Cancer Prevention/Screening
An 18-year-old is accompanied by her mother for her first visit to the gynecologist. She has never been sexually active. She has no concerns with her menses. Her mom reports that she brought her in “because she is 18 and when I turned 18, I had to get my first Pap smear.” Her mother requests the patient have a Pap smear and be tested for HPV “just in case.” The patient is up to date on all vaccines "mandatory for school" but has never had the HPV vaccine.
What are the recommendations on the HPV vaccine?
How would you counsel this patient about the HPV vaccine?
What are the current ASCCP guidelines for Pap smears and HPV testing?
How will you explain the rationale to the patient and the mother?
STI Prevention and Screening
A 52-year-old female presents to your clinic concerned that she may have contracted a sexually transmitted infection (STI). She states she is recently divorced and admits she never had to practice “safe sex” before and that she has been with several people over the last few months. She has been drinking “way too much” and feels she should just be tested for everything as she has been experimenting.
What type of questions would you want to ask to begin to focus your plan? How will her risk factors affect your screening?
There are several preventive guidelines related to STI risk and screening. What do the current guidelines indicate she should be screened for?
What recommendations should you make regarding “safe sex” practices?
Are there any other preventive guidelines you should address with this patient?
NU629 Health Promotion - Disease Prevention
Week 13 Discussion
The APRN’s Effect on Women’s Health and the Use of Motivational Interviewing to Increase Knowledge around the Importance of Preventive Guidelines
Initial Post
Watch the Motivational Interview of a woman who is pregnant and continuing to drink alcohol.
Motivational Interviewing: Discussing Alcohol Use in Pregnancy (17:37 minutes)
Motivational Interviewing: Discussing Alcohol Use in Pregnancy Video Transcript
Consider what you learned from the video, along with other content that has been discussed in this course. For your initial post, choose one of the three scenarios presented below and answer the following questions. (Please include at least three scholarly sources within your initial post):
Questions:
As an APRN, how could you positively affect the health of the woman in the scenario you chose?
What would be the pros and cons of utilizing the technique of Motivational Interviewing with the woman in the scenario.
Trial the techniques you have read about over the previous few weeks related to Motivational Interviewing with a coworker, family or friend. What was this experience like? Do you see benefits to becoming more comfortable with this technique? Why or why not?
Note: As you are choosing a topic, please try to make sure that all topics are chosen at least by one person. You can see this by noting if anyone has posted to the topic within the corresponding threads
Scenarios:
A 34-year-old female who is 36 weeks pregnant – G2P1AB0 – presents to your office complaining of shortness of breath and ankle swelling. She states she has had “the flu” for several days and is insistent that this is why she can’t stop coughing. She is obviously short of breath when talking. In reviewing her chart, you can see she has a history of hypertension. She states she “”officially” stopped her blood pressure medications when she found out she was pregnant but admits that she rarely took her pills anyway, so “no big deal.”
Sumar has just found out she is pregnant and presents to the local free clinic. She is a 26-year-old G2P0AB1, and her first OB appointment is in two weeks. Sumar thinks she is about 12 to 14 weeks pregnant. She has come to the clinic complaining of indigestion. You notice the strong smell of cigarette smoke, and she admits she smokes one pack of cigarettes a day but states she is smoking less now since she started vaping.
You are seeing a 19-year-old female for STI screening. When reviewing her health and sexual history to determine her risk, she indicates she has had several new partners over the past six months and that she has not been using condoms but does have an IUD. She has started smoking marijuana and has dabbled with some other prescription medications over the previous two months. She is worried about having contracted an STI because she has noticed some “cauliflower” type bumps “down there” and would like to be tested.
NU629 Health Promotion - Disease Prevention
Week 14 Discussion
Preventative Guidelines – One Guideline and Two Scenarios
Introduction
Throughout this course, we have looked at health promotion and disease prevention and focused on various vulnerable populations. This week’s discussion will focus on applying one guideline to two patients. Please select one of the following scenarios and then answer the questions in your initial post. Please include at least three scholarly sources within your initial post.
Scenario A: Focus on Preventative Guidelines for Childhood Immunizations
You are working as an APRN in your local primary care office. The rural town of Maynard has 300 people, a post office, doctor’s office, and a gas station. The primary source of income is farming or driving 45 minutes to a somewhat larger town. With the blizzard coming, all your patients except two have cancelled for the morning. Jose is scheduled at 0900; he is a nine-year-old Hispanic male born in Mexico. He and his family (Mom, Dad, and six siblings, ages six months to 14 years) moved into the area just a few months ago. Jose’s mother reported that he had nearly died at two months after contracting pertussis.
Your final patient of the morning is Irena, a 15-year-old teenage female who lives with her aunt in Maynard. Irena is Romanian and barely speaks any English. Her aunt has been your patient for the past few years, and she told you that Irena had been abducted in Romania at the age of 10. Irena’s parents found her quite by accident when a sex trafficking ring dumped all their “product” in a refugee camp in Serbia just a few months ago. Irena’s parents are still in Romania, but they sent Irena here to live with her aunt.
Scenario B: Focus on Preventative Guidelines for Colorectal Cancer Screening
On a busy Thursday morning, you note on your schedule a couple of patients who routinely “take a long time” no matter what their complaint. Jimmy is a 62-year-old male who is mentally challenged and lives in a local group home. Both his parents passed away last year, and his sister has never really been in the picture. She lives at least eight hours away. Jimmy has a “genetic disorder” but actually his symptoms are more like autism that we are familiar with today. Jimmy’s caregiver states he has been having some problems with constipation but otherwise he seems okay. Jimmy is nonverbal and hates to be touched. Approaching Jimmy can be difficult, and he has taken a swing at staff a couple of times because he doesn’t understand what is going on – especially if they try to touch him to check his pulse or blood pressure.
Having finished up with Jimmy, you move on to Marvin. Marvin is a 67-year-old male here for his annual physical. Marvin is pretty healthy despite a scare with colon cancer when he was 50. He is obsessed with his bowels and even brings charts to each of his appointments as he is always concerned that the cancer will return.
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.
Scenario D: Focus on Cervical Cancer Guidelines
Working near a naval base, you see a lot of patients who are somehow connected with the military. Today, Shelesha, a 21-year-old African American female, is requesting to be seen for her annual exam before she leaves for deployment. Shelesha seems really anxious today. She is usually so excited about being on board her ship, but today she is different. You complete her annual exam, but she refuses her cervical and breast exam. After leaving the room so she can get dressed, you return to find Shelesha crying. She finally tells you that she was attacked – sexually assaulted on board her ship six months ago – and she has these “bumps” that keep getting bigger around her vagina and she is worried.
Virginia arrives for her annual well woman exam. Virginia is a 67-year-old female who has been married for 42 years. Virginia and Harrold are still sexually active with the use of medications, and like clockwork Virginia comes every year for her pelvic exam requesting a Pap smear. Virginia had breast cancer with a mastectomy when she was 52, but otherwise she is healthy, only taking medication for her cholesterol.
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.
Initial Post
Having discussed many guidelines throughout this term, consider the content you have explored. Using this knowledge, answer the following questions related to your chosen scenario. Note: please try to choose a topic for your initial post that you did not choose previously during the semester or aren’t as familiar with so you can gain additional knowledge as we finish up this course
Discuss the guidelines assigned with your scenario.
Will both patients be treated in the same manner? Why or why not?
What would your treatment plan be for each of the individuals in your scenario?
Please include at least three scholarly sources within your initial post.
NU629 Health Promotion - Disease Prevention
Week 15 Discussion
Faculty and Students as Vulnerable Populations: Can We Predict Violence with a Screening Tool?
Initial Post
Read the following articles found in the Learning Materials section of this course and watch the video noted below:
An Analysis of US School Shootings (1840–2015) (Paradice, 2017)
Development of the SaFETy Score: A Clinical Screening Tool for Predicting Future Firearm Violence Risk (Goldstick et al., 2017).
My Son was a Columbine Shooter. This is My Story.
My Son was a Columbine Shooter. This is My Story. Video Transcript
Consider the information in the learning module for Week 15 and the course. Answer three of the following questions in your initial post. (Please include at least three scholarly sources within your initial post.)
Has your community been directly affected by gun violence/mass shootings? Discuss the affects you have noted.
Discuss what you believe to be the greatest risk factor(s) in your community that could be associated with a potential for violence.
What are your thoughts about the Predictive Firearm Violence Risk Scale?
Will you use this scale in your practice? Why or why not?
What type of changes has your community made to help improve safety?
What are your thoughts about the Columbine shooter’s mother’s TED Talk?
Reply Posts
Consider the community risk factors your peers listed. Are they similar to your community? Did any of their risks surprise you? Why or why not? Reply to at least two of your classmates on two separate days (minimum) utilizing at least two scholarly references per peer post.
