History of breast cancer

A 46-year-old, 230lb woman with a family history of breast cancer. She is up to date on yearly mammograms. She has a history of HTN. She complains of hot flushing, night sweats, and genitourinary symptoms. She had felt well until 1 month ago and she presented to her gynecologist for her annual gyn examination and to discuss her symptoms. She has a history of ASCUS about 5 years ago on her pap, other than that, Pap smears have been normal. Home medications are Norvasc 10mg qd and HCTZ 25mg qd. Her BP today is 150/90. She has regular monthly menstrual cycles. Her LMP was 1 month ago.

• Write a description of the above patient’s health needs.
• Explain the type of treatment regimen you would recommend for treating this patient, including the choice or pharmacotherapeutics you would recommend, and explain why. Be sure to justify your response.
• Explain a patient education strategy you might recommend for assisting your patient with the management of their health needs. Be specific and provide examples.
• Discuss alternative therapies such as hypnosis, acupuncture, and mind-body exercises. What are your thoughts regarding complementary therapies and do you feel that you would utilize them in your practice?

Sample Solution

ntent, but comprehensive guidance on teaching the content – so that each learning resource comes with instructions and examples of ‘how to teach’. This is especially important in developing countries where the teachers’ knowledge and skills are low. Online teacher communities will continue to become more and more important as centres for the sharing of resources, practice and mutual support.
Subject-wise, although traditional emphasis has always been on STEM subjects, the overriding priority for education systems is, and will continue to be, literacy.
In most countries Technical and Vocational Education will become increasingly important, especially as economies move from the production of simple commodities (agriculture, raw materials) to complex (manufactured goods, technology and services). The biggest challenge for TVE from a teaching and learning perspective is assessment – how do we define competencies and skills in this sector, and how do we assess and certify them to international standards? Technology that allows for the assessment of complex skills both in the classroom and onsite (through mobile devices) would be extremely valuable. There is also an opportunity to use A.I. for this, as it will allow for the assessment of intricate tasks and projects beyond simple testing.
We are seeing a move away from high stakes international testing (such as PISA, TIMS etc.) and the use of statistics and Big Data in education. There has been little evidence to date that these systems are useful to course correct or inform policy and practice. Despite the efforts of bodies like the OECD these tests struggle to assess the complex competencies and skills that will increasingly be needed over the next few years. While they have certain political currency, the impact on classroom practice appears to be largely negative as teachers are under increasing pressure to compile data, which detracts from teaching itself, and teach to the test. National boards, like OFSTED in the UK, are now moving away from the statistical ‘evidence of progress’ towards inspections focussed on the quality of teaching and learning in the classroom and we are seeing similar trends worldwide.
In summary – for centralised and developing education systems the next three to five years will see:
1. The need for standardised and central administrative control over resources, content and the implementation of technology in the classroom.
2. An increasing focus on Technical and Vocational Education and a growing demand for ef

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