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Preventive Medicine is a practice focusing on protecting, promoting, and maintaining people’s health while reducing morbidity and mortality. The present paper overviews recommendations for a nurse practitioner advising preventative screening for Janice, a 21-year-old female. The woman is sexually active and uses condoms most of the time, and she has never had a pelvic examination before. The paper encourages the nurse practitioner (NP) to offer Janice routine inspections for breast cancer and STDs tests while avoiding pelvic examination.
First, breast-cancer observations should be added to yearly checkups. Breast cancer is the most frequent cause of death among women; therefore, clinical breast examinations are pivotal for reducing mortality and morbidity among younger females (Lauby-Secretan et al., 2015). On the one hand, it would also be beneficial for Janice to learn self-examination technics for breast cancer; therefore, the nurse may provide information about self-diagnosis methods.
On the other hand, observational studies have not shown significant reduction in mortality rates among women who self-examined themselves of breast cancer. Although this may be due to insufficient evidence, there might be a rationale in not teaching these methods to Janice, as clinical diagnosis is simple and inexpensive and reduces mortality from breast cancer by 10% (Lauby-Secretan et al., 2015). In brief, the nurse should advise yearly clinical breast examinations and provide information about the risks of the omission of such checkups.
Second, NP may also encourage yearly HIV and other STDs observations. Even though Janice claims that she is sexually active only with her boyfriend, she is in the age when people often have multiple sexual partners.
As Janice claims that she uses condoms only most of the time, therefore, it is more than natural for her and her boyfriend to be vulnerable to HIV and other STDs. Lanier et al. (2014) encourage nurse practitioners to collect sexual history in a more detailed manner and offer sexual education about STDs and unwanted pregnancy. Overall, the efforts combined with yearly HIV and STDs tests considerably decrease mortality and morbidity from the infections; therefore, the NP should perform such practices.
A few words must be said about the pelvic examination. Janice has not yet had such a procedure, and evidence shows that there might be no need in the test. American College of Physicians recommends against pelvic exams in asymptomatic non-pregnant women (Qaseem, Humphrey, Harris, Starkey, & Denberg, 2014). Currently, such observations are used for early diagnosis of ovarian cancer and inflammatory infections; however pelvic examinations show low diagnostic accuracy (Qaseem et al., 2014). Instead, it may cause shame, fear, pain, and discomfort. In short, the NP should advise Janice to avoid routine pelvic checkups and provide information about the symptoms that may encourage the woman to apply for the pelvic examination.
Nurses are front liners of American medicine; therefore, it is of great importance to apply preventative examinations and counseling through nurse practitioners. Even though Janice is a healthy female who does not fall into many risk groups, some recommendations are to be considered by the NP. These recommendations include routine tests for sexually transmitted diseases, such as HIV and chlamydia, and yearly clinical breast examinations.
The nurse practitioner should also inform Janice that pelvic exams are considered redundant according to evidence-based practice; therefore, the woman should avoid the procedure until symptoms appear. In conclusion, the nurse practitioner should take blood samples for STDs tests and perform breast examinations, while providing counseling about the relevance of such tests.
References
Lauby-Secretan, B., Scoccianti, C., Loomis, D., Benbrahim-Tallaa, L., Bouvard, V., Bianchini, F., & Straif, K. (2015). Breast-Cancer Screening — Viewpoint of the IARC Working Group. New England Journal of Medicine, 372(24), 2353-2358. Web.
Lanier, Y., Castellanos, T., Barrow, R., Jordan, W., Caine, V., & Sutton, M. (2014). Brief sexual histories and routine HIV/STD testing by medical providers. AIDS Patient Care and STDs, 28(3), 113-120. Web.
Qaseem, A., Humphrey, L., Harris, R., Starkey, M., & Denberg, T. (2014). Screening pelvic examination in adult women: A clinical practice guideline from the American college of physicians. Annals of Internal Medicine, 161(1), 67. Web.
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