2023 Carolyn Cross 41 years old female came to the clinic for a wellness visit She also like to discuss
2023 Nursing Discussion week 7
Carolyn Cross 41 years old female came to the clinic for a wellness visit She also like to discuss 2023
Carolyn Cross 41 years old female came to the clinic for a wellness visit, She also like to discuss a few concerns, especially her risk for breast cancer. She stated that recently both her mother who’s 63 and her first cousin on her mother’s side were diagnosed with breast cancer, then now she wants to know whether that increases her risk and if so how much.
- Provide a reference for your treatment plan (in APA format). The reference may come from a journal, a book, etc.
- Cite all sources using APA format.
- Include three differential diagnoses and support your diagnoses with supporting literature.
diagnosis:
1- hyperlipidemia
2- type 2 diabetes mellitus
differential diagnosis:
1- breast cancer risk (based on first degree family member, early menses and late pregnancies)
1- diabetes (based on the patient is considered a prediabetic beased on labs results)
3- cardiovascular disease (based on lipid panel results)
The patient had an encounter a year before, this was the history:
Surgical: G2P2; Bilateral tubal ligation following last delivery at age 35
OB/Gyn: NSVD x two; breast fed both for 3 months; premenopausal; menses regular since age 10.5
Ibuprophen occasionally for headaches
Diet: tries to eat a well-balanced diet
Exercise: Walks to and from the train 5 days a week; weekend gardening
Mother: Hx of type 2 diabetes
Sisters: no sisters
Brothers: healthy and very physically active
Occupation: Middle-school learning specialist
Marital status: married x ~13 years
Children: 2 sons (5ish and 7ish)
Tobacco: never
Recreational drugs: never
Alcohol: wine (one glass at dinner most days)
No sleep concerns
Weight stable
| Temp: | 98.6 F |
| Pulse: | 72, rhythm: regular |
| BP: | left: 130/72 |
| Respiration: | 14, effort: normal |
Normal, symmetrical breast contour
No visible skin or nipple abnormalities
No spontaneous or expressed nipple discharge or blood
Irregular “lumpy bumpy” consistency through both breasts; no suspicious, discrete palpable lesions
Slight tenderness to exam reported
Thyroid within normal limits for size and consistency
No cervical lymphadenopathy or mass
No murmur or gallop
No peripheral edema
Breath sounds equal/clear bilaterally
No hepatosplenomegaly, mass, or herniation
Soft, nontender throughout
Parous introitus
Normal vaginal mucosa
Slight cervical eversion without friability; samples collected for Pap smear completed
No abnormal discharge
Thyroid normal, no nodules
CN II-XII intact
Ms. Cross is a healthy 40ish woman with no acute medical issues.
1) Preventative Health
- Mammogram ordered
- lipid panel ordered
- Pap smear – pending results
- Fasting blood sugar ordered
Then for this encounter this are the labs results, the ROS and PE are the same from the previous visit.
pap smear negative
mammogram pending
| Name | Value | Units | Reference Range |
|---|---|---|---|
| Hemoglobin A1c | 6.4 | % | normal 4-5.6, elevated risk 5.7-6.4, diabetes >6.7 |
| Name | Value | Units | Reference Range |
|---|---|---|---|
| Glucose, 8 hour fasting | 122 | mg/dL | <126 |
| Name | Value | Units | Reference Range |
|---|---|---|---|
| Cholesterol | 239 | mg/dL | low risk <200, moderate 200-239, high >239 |
| High-density lipoprotein (HDL) | 45 | mg/dL | maj risk <40, neg risk >59 |
| Low-density lipoprotein (LDL) | 159 | units/L | low risk <130, moderate 130-159, high >159 |
| Triglycerides | 40 | mg/dL |
(♀) 35-135, (♂) 40-160 |
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