Female Genitourinary, & Musculoskeletal

 

 

For this , you will take on the role of a clinician who is building a health history for :

Chief Complaint
(CC) “I have a tumor on my left breast”

History of Present Illness (HPI)A 55-year-old African American social worker presents to your clinic with a finding of a lump in her left breast while in the shower this past week.

Drug HxI took birth control pills for 10 years, starting when I was 20 I am not on hormone replacement

Family HxMy grandmother had breast cancer when she was 76 years old

Subjective
Denies any fever or chills. No changes in vision or hearing, no difficulty chewing or swallowing. Supple neck, states that she does self-breast-examinations on occasion. Menopause at 52
No skin changes or nipple discharge from the left breast

VStemperature 98.6°F; respiratory rate (RR) 16; heart rate (HR) 80, regular; blood pressure (BP) 130/84; height: 5′8″; weight 160 lbs; body mass index (BMI) 24

Generalwell developed, nourished, healthy-appearing female

HEENTAtraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear, nares patent, nasopharynx clear, edentulous.

BreastExamined in sitting and supine positions. In sitting position, no evidence of skin changes, right breast is slightly larger than the left, symmetrical movement with the arms above the head and at the side and with flexion of the pectoral muscles; 5-mm nonmobile, non-tender, firm mass felt at 10 o’clock position, 5 cm from the areola. Right breast without dominant masses or tenderness. Nipples without inversion or evidence of nipple discharge. Breast mass is palpated in the supine position in the same manner as in the sitting position

Lymphnegative axillary, infraclavicular, and supraclavicular lymphadenopathy

GUBladder is non-distended.

Integumentgood skin turgor noted, moist mucous membranes

MSMuscles are smooth, firm, symmetrical. Full ROM. No pain or tenderness on palpation.

 

 

answer the following questions:

What other subjective data would you obtain?
What other objective findings would you look for?
What diagnostic examination do you want to order?
Name 3 differential diagnoses based on this patient presenting symptoms?
Give rationales for your each differential diagnosis.
What teachings will you provide?

Sample Solution

In order to gain a more comprehensive understanding of the patient’s condition and better assess the lump on her left breast, additional subjective data should be obtained. This includes questions regarding her family history, such as if any other relatives have had or currently have breast cancer; specific details about when she started taking birth control pills and if she is currently taking any medications; and whether there have been any changes in her breasts such as nipple discharge or pain.

Additional objective findings should also be looked for beyond what was mentioned in the history of present illness that can further help diagnose potential issues with the lump found on the left breast. These may include looking at skin integrity as well as examining lymph nodes, especially those located near where the mass was felt. Additionally, a physical exam should be conducted to observe range of motion (ROM) in both arms (especially when raising them above their head) which may indicate any pain while performing these movements.

Given this information and based on presenting symptoms it would likely be beneficial to order diagnostic examinations like an imaging scan (such as mammography or ultrasound) which could provide more detailed insights into what type of mass is present along with its size and shape, allowing for appropriate treatment plans to be created accordingly. Further investigation through blood workup may also be useful to rule out underlying medical conditions that could cause similar findings (Algawi et al., 2019).

Likewise, Vittola communicates the degree of military strategies utilized, yet never arrives at a resolution regardless of whether it’s legitimate to continue these activities, as he continually tracked down a center ground, where it very well may be legitimate to do things like this yet never consistently (Begby et al (2006b), Page 326-31). This is upheld by Frowe, who estimates the genuine strategies as per proportionality and military need. It relies upon the extent of how much harm done to each other, to pass judgment on the activities after a conflict. For instance, one can’t just nuke the fear monger bunches all through the center east, since it isn’t just relative, it will harm the entire populace, a potentially negative side-effect. All the more significantly, the officers should have the right expectation in the thing they will accomplish, forfeiting the expenses for their activities. For instance: to execute all detainees of war, they should do it for the right expectation and for a noble motivation, corresponding to the mischief done to them. This is upheld by Vittola: ‘not generally legal to execute all warriors… we should consider… size of the injury caused by the foe.’ This is additionally upheld by Frowe approach, which is much more upright than Vittola’s view yet suggests similar plans: ‘can’t be rebuffed basically for battling.’ This implies one can’t just rebuff another in light of the fact that they have been a soldier. They should be treated as sympathetically as could really be expected. In any case, the circumstance is heightened on the off chance that killing them can prompt harmony and security, inside the interests, everything being equal. In general, jus in bello recommends in wars, damage must be utilized against warriors, never against the guiltless. However, eventually, the point is to lay out harmony and security inside the republic. As Vittola’s decision: ‘the quest for equity for which he battles and the guard of his country’ is the thing countries ought to be battling for in wars (Begby et al (2006b), Page 332). Consequently, albeit the present world has created, we can see not entirely different from the pioneer accounts on fighting and the traditionists, giving one more segment of the hypothesis of the simply war. By the by, we can in any case presume that there can’t be one authoritative hypothesis of the simply war hypothesis due to its normativity.

Jus post bellum
At long last, jus post bellum recommends that the moves we ought to make after a conflict (Frowe (2010), Page 208). Vittola, first and foremost, contends after a conflict, it is the obligation of the pioneer to judge how to manage the foe (Begby et al (2006b), Page 332).. Once more, proportionality is stressed. For instance, the Versailles arrangement forced after WWI is tentatively excessively cruel, as it was not all Germany’s problem for the conflict. This is upheld by Frowe, who communicates two perspectives in jus post bellum: Moderation and Maximalism, which are very contrasting perspectives. Minimalists recommend a more merciful methodology while maximalist, supporting the above model, gives a crueler methodology, rebuffing the foe both financially and strategically (Frowe (2010), Page 208). At the last occasion, notwithstanding, the point of war is to lay out harmony security, so whatever should be done can be ethically legitimate, on the off chance that it keeps the guidelines of jus promotion bellum. All in all, simply war hypothesis is entirely contestable and can contend in various ways. Be that as it may, the foundation of a fair harmony is pivotal, making all war type circumstance to have various approaches to drawing closer (Frowe (2010), Page 227). In any case, the simply war hypothesis contains jus promotion bellum, jus in bello and jus post bellum, and it tends to be either ethically dubious or reasonable relying upon the proportionality of the situation. Consequently, there can’t be one conclusive hypothesis of the simply war yet just a hypothetical manual for show how wars ought to be battled, showing normativity in its record, which responds to the inquiry to what a conflict hypothesis is.

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