Special Examinations—Breast, Genital, Prostate

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1. Case Study Assignment This week you will be reviewing another SOAP note and reflecting on the additional information that you would be needing. This is not in SOAP format, you will use headings for each section, and give me dialogue on what information is missing in each section. You will provide 5 differentials and reflect on the questions posed for the assignment. Be sure to support with scholarly references.

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.
•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, neg McBurney•Diagnostics: HSV specimen obtained
Assessment:•Chancre
PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future course

In summary, be sure to follow the rubric for this assignment. Tell me what is missing in each section…..and would you support or refute the diagnosis. Support that answer with rationale, and provide differential diagnosis with supported rationale. Utilize scholarly references to support your rationales. Remember….if you are doing a focused exam, which is what these case studies are…..be sure to really expand on the body systems that you are concerned about to hone in on your differential diagnosis. This will help you with your documentation completeness going forward.

To Prepare
• Review the Episodic note case study your instructor provides you for this week’s Assignment. Please see the “Course Announcements” section of the classroom for your Episodic note case study.
• Based on the Episodic note case study:
o Review this week’s Learning Resources, and consider the insights they provide about the case study. Refer to Chapter 3 of the Sullivan resource to guide you as you complete your Lab Assignment.
o Search the Walden library or the Internet for evidence-based resources to support your answers to the questions provided.
o Consider what history would be necessary to collect from the patient in the case study.
o Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
o Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

Using evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature.
• Analyze the subjective portion of the note. List additional information that should be included in the documentation.
• Analyze the objective portion of the note. List additional information that should be included in the documentation.
• Is the assessment supported by the subjective and objective information? Why or why not?
• Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis?
• Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.

 

Sample Solution

ntly, jus promotion bellum contains a few circumstances yet in particular: noble motivation and proportionality. This gives individuals an aide regardless of whether entering a war is legitimate. Nonetheless, this is just a single piece of the hypothesis of the simply war. By the by, it tends to be seen over that jus promotion bellum can be bantered all through, showing that there is no conclusive hypothesis of a simply battle, as it is normatively speculated.

Jus in bello
The subsequent area starts translating jus in bello or what activities might we at any point group as passable in wars (Begby et al (2006b), Page 323). To start with, it is never to kill honest individuals in wars, upheld by Vittola’s most memorable suggestion purposefully. This is generally acknowledged as ‘all individuals have a right not to be killed’ and in the event that an officer does, they have disregarded that right and lost their right. This is additionally upheld by “non-warrior resistance” (Frowe (2011), Page 151), which prompts the subject of soldier capability referenced later in the paper. This is validated by the besieging of Nagasaki and Hiroshima, finishing the Second World War, where millions were eagerly killed, just to get the point of war. In any case, here and there regular people are unintentionally killed through battles to accomplish their objective of harmony and security. This is upheld by Vittola, who infers proportionality again to legitimize activity: ‘care should be taken where evil doesn’t offset the potential advantages (Begby et al (2006b), Page 325).’ This is additionally upheld by Frowe who makes sense of it is legitimate to unexpectedly kill, at whatever point the warrior has full information on his activities and looks to finish his point, yet it would include some major disadvantages. In any case, this doesn’t conceal the reality the accidental actually killed blameless individuals, showing impropriety in their activities. In this way, it relies again upon proportionality as Thomson contends (Frowe (2011), Page 141). This prompts question of what meets all requirements to be a soldier, and whether it is legitimate to kill each other as warriors. Soldiers are individuals who are involved straightforwardly or by implication with the conflict and it is legitimate to kill ‘to protect the blameless from hurt… rebuff criminals (Begby et al (2006b), Page 290).However, as referenced above non military personnel can’t be hurt, showing soldiers as the main genuine focuses on, one more state of jus in bello, as ‘we may not utilize the sword against the people who have not hurt us (Begby et al (2006b), Page 314).’ likewise, Frowe proposed warriors should be recognized as soldiers, to keep away from the presence of hit and run combat which can wind up in a higher demise count, for instance, the Vietnam War. In addition, he contended they should be important for the military, carry weapons and apply to the guidelines of jus in bello. (Frowe (2011), Page 101-3). This proposes Frowe looks for a fair, simply battle between two members keeping away from non-warrior passings, yet couldn’t this prompt higher demise rate for soldiers, as the two sides have somewhat equivalent opportunity to win since both utilize comparable strategies? In any case, ostensibly Frowe will contend that soldier can legally kill one another, showing this is simply, which is likewise upheld by Vittola, who states: ‘it is legitimate to draw the blade and use it against transgressors (Begby et al (2006b), Page 309).’ moreover, Vittola communicates the degree of military strategies utilized, yet never arrives at a resolution regardless of whether it’s legal to continue these activities, as he continually tracked down a center ground, where it very well may be legal to do things like this however 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 greatness of how much harm done to each other, to pass judgment on the activities after a conflict. For ex

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