Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal GENITALIA ASSESSMENT.

PLS, I WILL LIKE THIS (24 HRS)ORDER TO BE EXECUTED BY WRITER 1714 IF POSSIBLE. PLS FOLLOW THE SOAP FORMAT WHERE APPLICABLE. PLS FOLLOW THE RUBRIC

For this assignment, you will analyze an Episodic note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions. Please remember to pretend that this is an actual patient and gives as much detail as possible!Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal GENITALIA ASSESSMENT.

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Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal GENITALIA ASSESSMENT

Subjective: • CC: “I have bumps on my bottom that I want to have checked out.” • HPI: AB, a 21-year-old WF college student reports to your clinic with external bumps on her genital area. She states the bumps are painless and feel rough. She states she is sexually active and has had more than one partner during the past year. Her initial sexual contact occurred at age 18. She reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She reports one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed.Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal GENITALIA ASSESSMENT.

• PMH: Asthma •

Medications: Symbicort 160/4.5mcg •

Allergies: NKDA •

FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD •

Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)

Objective: • VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs •

Heart: RRR, no murmurs • Lungs: CTA, chest wall symmetrical • Genital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia • Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, negMcBurney •

Diagnostics: HSV specimen obtained

Assessment: • Chancre

RUBRICS

With regard to the SOAP note case study provided and using evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature:Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal GENITALIA ASSESSMENT.

1) Analyze the subjective portion of the note. List additional information that should be included in the documentation.

2)Analyze the objective portion of the note. List additional information that should be included in the documentation.

3) Is the assessment supported by subjective and objective information? Why or why not?

4) What diagnostic tests would be appropriate for this case, and how would the results be used to make a diagnosis?

5)· Would you reject or accept the current diagnosis? Why or why not?
· Identify three possible conditions that may be considered as a differenial diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal GENITALIA ASSESSMENT.

Proper history taking and physical examination is one of the most important skills that a clinician must acquire for success in clinical practice. This is true for nurse practitioners (NPs) as it is for other advanced practice registered nurses or APRNs. Assessment of the breasts, genitalia, prostate, and the rectum presents one of the biggest challenges for clinicians due to the intimate nature of the information that is involved. Of particular importance is the concern for confidentiality. This makes many patients feel reluctant to expose themselves and divulge intimate personal information to a healthcare professional. It should be noted that sexually transmitted infections or STIs are some of the conditions that affect these intimate areas. They necessitate meticulous history taking and physical examination of the genitalia to come up with the correct diagnosis and differential diagnoses. Young people aged 15-24 years are particularly vulnerable to STIs because of the likelihood of them having multiple sexual partners and practicing unsafe sex.Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal GENITALIA ASSESSMENT. Evidence shows that this group is disproportionately affected by STIs, despite the fact that they make just one quarter of the entire population. Cases of STIs are on the increase in the US, and young people aged between 15 and 25 years make up 50% of all the new cases every year (Shannon & Klausner, 2018). This is the case of a Caucasian female aged 21 years who is married and a mother of three children. She presents with a history of chlamydia (STI) two years ago and a chief complaint of painless genital lesions that feel rough and bumpy to the touch. This paper looks at her incomplete episodic SOAP note documentation with a view to filling in the missing information in the documentation; as well as discussing whether the diagnostic assessment is correct or not (i.e. whether supported by the history and physical examination findings or not). Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal GENITALIA ASSESSMENT.

Required Additional Information Missing from the Subjective Part of the Episodic SOAP Note

            By going through the documentation in the subjective part of the episodic SOAP note for patient AB, it is clear that the missing information in this section is the review of systems (ROS) from the patient’s perspective. The other required information in this section is already documented as follows:

1. The chief complaint (CC) which is the presence of raised lesions that are painless in the genital region.
2. The history of presenting illness or HPI of the symptom in terms of time of onset, location, duration, characteristics, aggravating factors, relieving factors, temporal factors, and severity on a scale of 1-10 (Ball et al., 2019).

• Allergies (which she does not have).

1. Past medical history (which is significant for asthma).
2. Current medications (she is on Symbicort MDI 160/4.5 mcg for her asthma).
3. Family history (which is significant for hypertension and gastroesophageal reflux disease or GERD in first degree relatives).

• Social history (which is significant for occasional alcohol use). She is married and a mother of three.

The missing ROS would be as follows:

ROS

General: The patient denies being febrile, weak, or fatigued.

HEENT: She denies defective vision as well as a sore throat. She does not have otorrhea or tinnitus. She also denies sneezing or having rhinorrhea.

Gastrointestinal: She had her last bowel movement the previous night and has regular bowel movements. She denies being nauseated, having diarrhea, or vomiting.

Cardiovascular: She denies having any chest pains or a fast heart beat.

Integumentary: She denies having rashes or itchy skin.

Respiratory: She denies coughing or dyspnea. She also denies ever seeing her feet swollen.

Genitourinary: She denies being pregnant. Her LMP was on 03/11/2020. She reports painless but raised and rough genital lesions which she describes as “bumps”. She denies frequency of micturition, dysuria, or cloudiness of urine.Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal GENITALIA ASSESSMENT.

Musculoskeletal: She does not suffer joint pains, back pain, or muscle pain.

Endocrinologic: She denies sweating a lot or having heat intolerance. She also does not pass a lot of urine and does not drink water excessively.

Neurological: The patient denies losing control of her bowels and bladder (incontinence of urine and/ or stool). She also denies paraesthesia.

Hematologic: She denies ever feeling faint or dizzy. She also denies any bleeding apart from her menses.

Psychiatric: She denies mental illness in any form apart from anxiety due to her condition which she admits.

Lymphatics: She denies swollen lymph nodes or a history of splenectomy.

Allergic/ Immunologic: She admits to suffering from asthma but denies hives, rhinitis, and eczema. She denies any allergies of drugs, food, or environmental irritants like dust and smoke.Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal GENITALIA ASSESSMENT.

Required Additional Information Missing from the Objective Part of the Episodic SOAP Note

Looking at the objective part of patient AB’s episodic SOAP note, the information discovered to be missing is constitutional assessment, HEENT, and exhaustive diagnostics. The missing general assessment information to be included is about her grooming, her general appearance, her mood and emotions, and her gait. Objective examination of the HEENT should also show that her head is normocephalic and atraumatic. It should also show abscence of otorrhea and intact tympanic membranes bilaterally. Both her pupils are also equal, round, and reactive to light and accommodation (PERRLA). Her nostrils are symmetrical without rhinorrhea and her throat is devoid of any exudate. The information on the missing diagnostics is given below as well as their appropriateness and usefulness in making the differential diagnoses. The presented documentation only shows the herpes simplex virus test (HSV) as performed (Sauerbrei, 2016). Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal GENITALIA ASSESSMENT.

Information on Missing Diagnostics, their Usefulness in Diagnosis and Appropriateness, and Choice of Diagnosis

1. Nucleic acid amplification test (NAAT) whereby a swab from the lesion is taken and tested for Chlamydia trachomatis which is the causative organism for lymphogranuloma venereum or LGV (Huether & McCance, 2017; Macpherson & Cameron, 2017).
2. Dermoscopy which involves viewing scrapings of the genital lesions under a microscope to see if there will be Donovan bodies or white lumps with a distinct central pore. This would be diagnostic of granuloma inguinale or Donovanosis and molluscum contagiosum (MC) respectively (Meza-Romero et al., 2019; Macpherson & Cameron, 2017; Huether & McCance, 2017).
3. Rapid plasma reagin test, serological testing for Treponema pallidum which causes syphilis (Ghanem et al., 2020; Huether & McCance, 2017).Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal GENITALIA ASSESSMENT.

The diagnostic assessment of a chancre (syphilis) is not fully supported by the subjective and objective information. This is because as much as a syphilitic chancre is not painful; it is normally flat and not raised as in the case of patient AB. This diagnosis is therefore rejected. The subjective and objective evaluation is found to support the diagnosis of molluscum contagiosum (MC) caused by the poxvirus. Its genital lesions are raised, “bumpy”, painless, and firm (Meza-Romero et al., 2019; Huether & McCance, 2017). Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal GENITALIA ASSESSMENT.

Differential Diagnosis

1. Syphilis (Ghanem et al., 2020; Huether & McCance, 2017): The chancre is characteristically painless but not “bumpy”.
2. Lymphogranuloma venereum or LGV (Macpherson & Cameron, 2017): Its genital papules are painless just like in the clinical presentation.
3. Granuloma inguinale or Donovanosis (Huether & McCance, 2017; Macpherson & Cameron, 2017): The difference is that its genital lesion easily bleeds to touch, but is also painless.Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal GENITALIA ASSESSMENT.