Discussion Question 5
Based on your performance and the expert feedback in your ASSESSMENT of differential diagnoses, describe one incorrect/missed differential diagnosis and use specific references from your text to support the inclusion of the diagnosis for this client. Mrs. Payne admitted that she has some worries and showing signs of anxiety of having a mammogram performed. For the question, “Which of the following is correct regarding breast self-examination”, I chose the answer, “It’s recommended to teach women breast self- examination” (Mushkbar & Tafelski, 2018). The correct answer was ‘Breast self-examination increase the number of biopsies performed” (Mushkbar & Tafelski, 2018). According to USPSTF, women of ages 40-49 should only have a mammogram if there are significant underlying causations (Siu, 2016). Women that undergo regular screening for mammograms at younger ages fall under the category of receiving over diagnosis and overtreatment that can lead to unnecessary biopsies. Women ages 50 to 74 are recommended to have mammography screenings every 2 years. USPSTF states that, “Of all the age groups, women aged 60-69 years are most likely to avoid breast cancer death through mammography screening” (Siu, 2016). During the history taking, Mrs. Payne stated that she has been doing self-breast exams occasional and had noticed from tenderness. Whenever a female has breast complaints, a provider should use the PQRST analysis to understand the underlying problem. PQRST stands for palliative/provoking, quality, radiation, severity, timing (Goolsby & Grubbs, 2015, p. 230). It seems as Mrs. Payne is experiencing cyclic mastalgia, which is the most common type of beast pain and is associated with premenopausal women. This was not one of the diagnosis educated to Mrs. Payne as a possibility of her pre-menopausal symptoms. Bickley, L. (2016). Bates’ guide to physical examination and history taking (12 th Ed.) Philadelphia, PA: Lippincott, William & Wilkins. Goolsby, M. J. & Grubbs, L. (2015). Advanced assessment: Interpreting findings and formulating differential diagnoses (3 rd Ed.) Philadelphia, PA: F. A. Davis Company. Mushkbar, S. & Tafelski, T. (2018). Family Medicine 01: 45-year-old female wellness visit [Case study]. Retrieved from - nur.meduapp.com/document_set_document_relations/30221 Siu, A. (2016). Screening for breast cancer: U.S. preventive services task recommendation statement. Annals of Internal Medicine , 164 (4), 279-296. Retrieved from
- Mnau_pZubaefDvUk Melissa, Thank you for your informative post this week. I too agree with you on the importance of Mrs. Payne’s smoking status and that she should quit as soon as possible. Quitting smoking is one of the most important, yet challenging steps a person can make to positively influence their health. According to an article I read recently, majority of smokers make several attempts at beginning to quit before that actually succeed (Sealock & Sharma, 2020). To most patients, their
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- Fall '16
- Physical examination, Medical diagnosis, Smoking cessation