Please respond to discussion below using current APA edition and 2 scholarly ref

Please respond to discussion below using current APA edition and 2 scholarly references. Must be 150 words at least.
Case Study Essay
This case study explores appropriate diagnostic testing options as well as a treatment plan for a 43-year-old woman who experiences vaginal bleeding after sexual activity. The patient had previously tested positive for Human Papillomavirus (HPV) type 16 at her cervical cancer screening two years prior. She has been married for four years and has a history of various sexual partners. This paper examines the significance of HPV as the primary focus in cervical cancer screenings among patients who have tested positive. Furthermore, it discusses the guidelines provided by the United States Preventive Service Taskforce (USPSTF) for cervical cancer screening in average-risk women within the patient’s (O. P’s) age bracket. The heightened occurrence of post-coital vaginal bleeding creates concerns regarding potential underlying factors, ranging from sexually transmitted infections to gynecological malignancies like cervical cancer (Singh et al., 2018). In this particular case, the previous HPV diagnosis adds another level of complexity, thus choosing the right diagnostic procedures and creating an effective treatment strategy require careful consideration.
Diagnostic Testing
The patient’s chief complaint is that she is experiencing vaginal bleeding after sexual intercourse for a duration of two months. To identify the root cause of post-coital bleeding, a thorough examination of the patient is necessary. The following tests should be considered.
Performing a Colposcopy: A colposcopy involves visually examining the cervix and vagina using instruments for magnification, like a colposcope, in order to spot any unusual changes or lesions (Cooper, Dunton, 2020).
Performing a Cervical biopsy: During a cervical biopsy, tissue samples are taken from locations that show up abnormal or suspicious during a colposcopy. According to Cooper and Dunton (2020), in the event that anomalies are detected during a colposcopy, a cervical biopsy may be carried out in order to collect tissue samples from any questionable (suspicious) or atypical locations. These samples can then be analyzed under a microscope by pathologists to determine if there are any precancerous or cancerous changes present.
Carrying out Pap smear: The Pap smear, also known as a Pap test or Papanicolaou test, is a screening tool used to detect abnormal cells on the cervix that may be indicative of precancerous or cancerous changes (HPV (Human Papillomavirus) | American Cancer Society, n.d.). During this procedure, cells from the cervix are collected and examined under a microscope for any abnormalities. Several studies have demonstrated that pap smears have good overall accuracy in detecting cervical abnormalities when performed correctly and interpreted accurately by skilled professionals. However, false-negative results can occur due to various factors such as inadequate sampling techniques or errors during laboratory processing.
Carrying out Endocervical Curettage (ECC): This procedure involves scraping tissue samples from inside the endocervical canal using an instrument called a curette. ECC helps detect precancerous lesions that may not be visible through colposcopy alone.
Conducting Transvaginal ultrasound: Transvaginal ultrasound is a procedure where an imaging technique used to assess the structure of reproductive organs and identify any masses or irregularities present.
These diagnostic tests aim to assess potential causes such as gynecological malignancies like cervical cancer, the presence of sexually transmitted infections (STIs), or other factors contributing to vaginal bleeding in this patient with HPV history. Post-sexual bleeding can arise from various causes, including surface lesions in the genital tract such as cervical intraepithelial lesion (CIN), carcinoma, cervicitis, ectropion, and cervical polyps. In this case study, the patient has a history of type 16 HPV and is experiencing vaginal bleeding after sexual intercourse. Given these factors, a Pap smear would be an appropriate diagnostic test to assess for any abnormal cellular changes indicating precancerous or cancerous lesions.
Management Plan (Pharmacological and Nonpharmacological).
Based on the case study provided, the management plan for O.P., a 43-year-old female patient experiencing vaginal bleeding after sexual intercourse, should include both pharmacological and non-pharmacological interventions.
Pharmacological Management:
a) Treatment of HPV: Given her history of testing positive for HPV type 16 in her last cervical cancer screen, it is essential to address this infection. The recommended treatment options will depend on the extent and severity of any associated lesions or abnormalities identified during further diagnostic tests such as colposcopy or biopsy.
Topical agents: If superficial genital warts are observed during the examination, topical treatments like imiquimod cream or podophyllotoxin solution may be considered.
Surgical approaches: For more extensive cases with larger lesions that do not respond well to topical therapy, surgical procedures such as cryotherapy (freezing), laser ablation/fulguration (burning), electrocautery (burning using an electrical current), excisional surgery may be necessary.
b) Addressing potential infections: Since she has had multiple sexual partners in the past and currently experiences post-coital bleeding, it is crucial to rule out other possible sexually transmitted infections (STIs). Appropriate screening tests can help identify these infections so that targeted antibiotic therapy can be initiated if needed.
c) Hormonal therapies: Depending on additional findings from clinical assessment and further investigations like pelvic ultrasound or endometrial biopsy/endocervical curettage(based upon suspicion of underlying pathology e.g., polyps/fibroids/endometrial hyperplasia/cancerous growths, etc.), hormonal therapies might also have a role in managing abnormal uterine bleeding due to hormonal imbalances caused by conditions like adenomyosis/hyperplasia/intrauterine pathologies/polycystic ovarian syndrome(PCOS).
Non-pharmacological Management:
a) Education & Counseling Services: Provide comprehensive education about HPV infection, its transmission, prevention strategies (e.g., consistent condom use), and the importance of regular follow-up visits for Pap smears or other recommended screening tests. Counseling can also address any concerns related to sexual health and provide emotional support.
b) Lifestyle modifications: Encourage O.P. to adopt a healthy lifestyle that includes regular exercise, maintaining a balanced diet rich in fruits and vegetables, weight management if needed (as obesity is associated with hormonal imbalances like PCOS), and smoking cessation(if applicable).
c) Safe Sexual Practices: Promote the practice of safe sex by using barrier methods such as condoms during intercourse to reduce the risk of STIs including future re-infection due to multiple partners.
d) Regular Follow-Up: Emphasize the importance of periodic gynecological examinations for monitoring progress/recurring symptoms/early detection & treatment/interventions etc.
It is crucial for O.P.’s healthcare provider(s) to conduct further investigations based on their clinical judgment before finalizing and implementing an appropriate management plan tailored specifically according to her individual findings/symptoms/history/co-morbidities and preferences.
Critical Role of HPV Positivity in Cervical Cancer Screening
HPV (human papillomavirus) is the most important component of cervical cancer screening in patients who have tested positive for HPV due to its strong association with the development of cervical cancer. High Oncogenic Risk: Certain types of HPV, such as type 16 and 18, are classified as high-risk or oncogenic strains because they have a greater potential to cause cellular changes that can progress into cervical cancer. These specific types are responsible for approximately 70% of all cases of cervical cancer worldwide (Burd 2003). Persistent Infection: The presence of persistent HPV infection is considered a key factor in the progression from an initial HPV infection to precancerous lesions and ultimately invasive carcinoma (Schiffman et al., 2016). Long-term persistence increases the likelihood that abnormal cell growth will occur. Early Detection through Cytology Testing: Cervical cytology testing, commonly known as Pap smears, has been widely used for decades as part of routine screenings to detect abnormalities in cervix cells before they become malignant tumors. However, it relies on detecting cellular changes rather than directly identifying viral DNA or proteins associated with active infections. Improved Sensitivity with Primary HPV Screening: Recent studies have shown that primary high-risk HPV testing detects more pre-cancers compared to traditional Pap smear-based methods alone (Schiffman et al., 2016). This approach involves first conducting an HPV test followed by further evaluation if any high-risk genotypes are detected. Integrated Approaches Using Multiple Markers: Combining different biomarkers alongside conventional cytology enhances diagnostic accuracy and risk stratification among women infected with human papillomaviruses (Koliopoulos et al., 2017).
In general, considering the strong correlation between certain subtypes of HPVs and their role in causing cervical cancer along with advancements in primary HPV screening, it is crucial to prioritize testing for HPV in cervical cancer screenings. This approach allows for early detection of high-risk infections and the identification of individuals who may require further evaluation or treatment.
USPSTF Cervical Cancer Screening Recommendation
According to the USPSTF guidelines, for average-risk women aged 30 to 65 years, cervical cancer screening should be conducted every three years using cytology alone (Pap smear), or every five years using high-risk HPV testing alone (U.S Preventive Services Task Force, 2018). Another option is co-testing with both Pap smear and high-risk HPV testing every five years. Screening can be discontinued after age 65 if previous screenings have been negative.
O.P., a female patient who is 43 years old, meets the recommended age range for cervical cancer screening according to USPSTF guidelines. Therefore, until the age of 65, it is appropriate to recommend either a Pap smear every three years or a combination of Pap smear and high-risk HPV testing every five years. It is important to note that these recommendations may differ depending on personal preferences and risk profiles, among other individual factors. O.P. is therefore advised to have an assessment with her healthcare practitioner in order to evaluate her particular situation and decide on a cervical cancer screening plan.
Additional Parameters for Health Assessments
It is imperative to take into account a multitude of indicators or parameters that extend beyond physiological considerations while performing a full health examination. These additional considerations can help enhance a person’s capacity for optimal well-being and offer insightful information about their general health. These additional parameters include: Psychological Parameters: Because mental health has a big impact on physical health outcomes, it’s important to assess mental health (Ohrnberger et al., 2017). Incorporating measures such as self-reported mood, stress levels, anxiety, and depression screening tools can provide valuable insights into an individual’s emotional state. Social Parameters: Evaluating social determinants of health such as socioeconomic status, education level, employment status, living conditions, and support systems are essential in identifying potential barriers or facilitators to maintaining good health (Marmot et al., 2020). Understanding the patient’s social context helps tailor interventions that address specific needs. Lifestyle Behaviors: Examining lifestyle behaviors like diet quality (Kvaavik et al., 2018), physical activity levels (Kvaavik et al., 2018), and tobacco use (World Health Organization [WHO], n.d., alcohol consumption patterns, sleep patterns, and substance abuse provides insights into modifiable risk factors for chronic diseases. Environmental Factors: Considering environmental exposures including air pollution levels occupationalhazards/conditions-occupational exposure risks, and access to clean water and sanitation facilities aids in assessing their impact on overall health outcomes (World Health Organization [WHO],n.d.). Genetic/Family History: Gathering information about familial medical history helps identify genetic predispositions or hereditary conditions that may increase susceptibility to certain ailments (Bylstra et.al .2021). By incorporating these parameters alongside physiological assessments during healthcare evaluations we obtain more comprehensive knowledge regarding individuals’ current well-being thus allowing us to design a more personalized care plan.
Family Developmental Stages
In the context of family development, there are several stages that families typically go through as they progress and evolve over time. These stages can be categorized into different phases based on various factors such as age, relationship dynamics, and life events. Here are some examples of different family developmental stages: Formation Stage: This stage occurs when a couple decides to establish a committed partnership or marriage (Martin, 2018). For example, O.P.’s formation stage would have been four years ago when she got married. Childbearing Stage: This stage is characterized by the arrival and raising of children within the family unit (Martin, 2018). In this phase, couples may experience significant changes in their roles and responsibilities as they adapt to parenthood. Parenting Stage: Once children are born or adopted into the family unit, parents enter the parenting stage where they focus on nurturing and guiding their children’s growth (Kaakinen, 2018). Examples include providing emotional support to help navigate challenges during adolescence or assisting with educational decisions for school-age children. Launching Stage: The launching stage refers to when adult children begin leaving home to pursue higher education or start their careers (Martin, 2018)). Parents often face adjustments during this period as they transition from actively raising dependent offspring to having more independence themselves. Empty Nest Stage: During this phase after all children have left home permanently; individuals reestablish relationships with each other outside of parental roles (Martin, 2018). For instance, O.P. and her spouse will likely experience empty nest syndrome once their kids move out, and it could involve rediscovering shared interests. Retirement/Senior Years: This final life stage involves preparing for retirement while also navigating physical health changes associated with aging (Martin, 2018). O.P. and her partner will face the challenges of adjusting to retirement and perhaps relocating or downsizing their living arrangements. These are just a few examples of family developmental stages, and it’s important to note that each family’s journey is unique. Other factors such as cultural background, socioeconomic status, and individual preferences can also influence how families progress through these stages.
Impact of Family Structure and Function on Healthcare
Family structure and function play a crucial role in an individual’s health care. The family serves as the primary social unit that provides emotional support, access to resources, and assistance with decision-making related to healthcare (Kaakinen et al., 2018). In terms of family structure, O.P.’s case indicates that she has been married for the past four years. This suggests a nuclear family structure where she lives with her spouse. However, it is important to note that O.P. had multiple sexual partners in the past before getting married. The relationship between family function and healthcare can have significant impacts on individuals’ well-being(Kaakinen et al., 2018). In this case, O.P.’s positive history of HPV type 16 highlights the relevance of discussing sexual health within families. Open communication about sexual health issues can help facilitate early detection and prevention measures such as regular cervical cancer screenings or vaccination against specific types of HPV infections like type 16.
Given her complaint about vaginal bleeding after intercourse over two months now, it becomes vital for medical professionals to engage not only with O.P. but also consider involving her spouse if possible during discussions regarding diagnosis confirmation or treatment options (if needed). Including spouses or other close relatives/partners enhances their understanding of potential risks associated with sexually transmitted diseases (STDs), and reinforces joint responsibility towards preventive interventions like condom usage or regular screening examinations while promoting overall healthier behaviors within intimate relationships (Kaakinen et al., 2018). Furthermore, supportive family structures provide emotional backing during challenging times such as dealing with chronic illnesses or undergoing treatments that might be necessary in some cases like persistent symptoms reported by our patient.
In conclusion, recognizing how familial dynamics impact an individual’s healthcare journey is essential for designing comprehensive interventions targeting various aspects ranging from education and awareness campaigns at community levels up to providing tailored counseling services considering contextual factors tied directly into one’s living environment including cultural practices/values surrounding sexuality & reproductive topics which eventually influence seeking timely medical advice when concerns arise.