Please reply to the following discussion with at least one reference. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates.
Janice is a 21-year old healthy female who presents for her yearly check-up. She is sexually attractive and uses condoms most of the time. She has never had a pelvic exam before.
Discuss the recommended screening tests, using the latest evidence-based guidelines that the nurse practitioner should perform on Janice.
The first screening test for Janice would be a pelvic exam. A pelvic exam is a way through which a healthcare provider examines the female organs to check for any gynecological problems. A pelvic exam is recommended when a person has symptoms such as discharge or pain or after turning 21 years. Other reasons for having a pelvic exam include having unexplained pain in the lower belly, vaginal discharge that causes itching or burning, foul smell, especially after engaging in sex, vaginal bleeding that lasts for more than 10 days, missed periods, and intense menstrual cramps (Echeverria-Beltran, n.d). A pelvic exam usually involves three parts. The first part involves looking at the outside of the vagina by the healthcare provider to see any signs of abnormalities. The second part involves the speculum exam, where the healthcare provider inserts the speculum into the vagina using a cool water-based lubricant to see the vaginal canal and the cervix (Wong & Lawton, 2021).
After checking the vagina and cervix, a Pap test may be recommended to check any early changes of the cervix before they can become cancer. A Pap test involves taking a sample of mucus cells from the cervix using a thin plastic stick and a special tiny brush. The best way to protect against cervical cancer is to protect against human papilloma virus (HPV), which is a sexually transmitted infection that can cause cervical cancer. However, the patient still need regular Pap tests since the vaccine does not protect against all types of HPV that can cause cancer.
If the patient has vaginal discharge, the healthcare provider can take another sample to check for yeast and other causes of discharge. Besides, if the patient is having sex, another sample from the cervix or vagina and urine may be taken to check for possible STI’s. The last part of the pelvic exam is done to check for female organs such as tubes, ovaries, and uterus. The provider may insert one or two gloved fingers into the vagina with the other hand gently applying pressure to the lower part of the abdomen. Sometimes the provider may perform a rectal exam (Rao, 2018). Other screening tests for her include blood pressure screening, cholesterol screening, dental exam, and immunization.
Discuss the recommended education and counselling that should be included in Janice’s care
Sexually active young females are known to be at increased risk of sexually transmitted illnesses (STIs) and unwanted pregnancies. Educating and counselling patients of her age requires a sensitive and nonjudgmental approach to obtaining a sexual history, dealing with issues of confidentiality, usage of oral contraception, and anticipating what is involved if she has to share her STI status with her partner. When completing sexual history, the provider should consider asking open-ended questions revolving around the 5Ps (partners, practices, prevention of pregnancy, protection of STIs and past history of STIs) (Rubin et al., 2018). When obtaining a sexual history, the provider should encourage her about risk reduction interventions and provide prevention counselling to the identified risks. Besides, the provider should reinforce positive behaviors, including consistent use of oral contraceptives and healthy-seeking behaviors such as making and keeping appointments for healthcare (Rubin et al., 2018). The education and counselling should be appropriate for the patient’s culture, sexual orientation, age, and healthy literacy levels.
Echeverria-Beltran, K. (n.d) The Pelvic Examination in Asymptomatic, Average-risk Women. https://www.acponline.org/system/files/documents/about_acp/chapters/fl/17mtgs/echeverria_beltran_the_pelvic_examination_in_asymptomatic_average_risk_women.pdf
Rao, S. S. (2018). Rectal Exam: Yes, it can and should be done in a busy practice!. American Journal of Gastroenterology, 113(5), 635-638.
Rubin, E. S., Rullo, J., Tsai, P., Criniti, S., Elders, J., Thielen, J. M., & Parish, S. J. (2018). Best practices in North American pre-clinical medical education in sexual history taking: Consensus from the summits in medical education in sexual health. The journal of sexual medicine, 15(10), 1414-1425.
Wong, K., & Lawton, V. (2021). The Vaginal Speculum: A Review of Literature Focusing On Specula Redesigns and Improvements to the Pelvic Exam. Columbia Undergraduate Research Journal, 5(1).