Laura Wood Assessment 

Laura Wood Assessment/ Management Plan

Diagnostic Tests

1. Mammography (Repeat or Follow-up)
   • Essential due to her family history of breast cancer and fibrocystic breast disease. Early detection of malignant changes is crucial (Hong & Xu, 2022).
2. Breast MRI
   • Provides detailed evaluation, especially in high-risk patients and those with dense breast tissue, enhancing detection sensitivity (Hong & Xu, 2022).
3. Genetic Testing (BRCA1 and BRCA2)
   • Determines her risk more accurately, given her family history. Positive results affect screening, prevention, and familial implications (Hong & Xu, 2022).
4. Blood Pressure Monitoring
   • Confirms elevated BP with multiple readings due to her and family history of hypertension, guiding management (Whelton et al., 2022).
5. Lipid Panel
   • Evaluates cardiovascular risk due to elevated cholesterol, guiding interventions (Carson et al., 2020).
6. HbA1c and Fasting Glucose
   • Tracks blood sugar levels given her prediabetes status to prevent type 2 diabetes (Doyle-Delgado et al., 2020).
7. Pap Smear
   • For cervical cancer screening, detecting precancerous changes early (Hong & Xu, 2022).
8. CBC and CMP
   • Provides a broad health overview, including liver/kidney function and blood cell counts, identifying hidden conditions (Doyle-Delgado et al., 2020).
9. Bone Density Test (DEXA Scan)
   • Assesses bone health and osteoporosis risk due to age, early menarche, and estrogen exposure (Carson et al., 2020).
10. Electrocardiogram (ECG)
    • Detects underlying heart issues given elevated BP and family history of cardiovascular disease (Whelton et al., 2022).

Medications

1. Aspirin 81 mg daily
   • For cardiovascular disease prevention, given her elevated cholesterol and family history of hyperlipidemia and hypertension. Aspirin can help reduce the risk of heart attack and stroke (Whelton et al., 2022).
2. Atorvastatin 20 mg daily
   • To manage high cholesterol levels and reduce cardiovascular risk. Statins help lower LDL cholesterol and reduce plaque buildup in arteries (Carson et al., 2020).
3. Vitamin E 400 IU daily
   • Continued for fibrocystic breast disease management. Vitamin E can help reduce breast pain and cyst formation (Hong & Xu, 2022).
4. Lisinopril 10 mg daily
   • For managing elevated blood pressure and reducing the risk of cardiovascular events. Lisinopril is an ACE inhibitor that helps relax blood vessels and lower blood pressure (Whelton et al., 2022).
5. Calcium 600 mg with Vitamin D 400 IU twice daily
   • To support bone health, especially given her age and potential risk for osteoporosis. Calcium and Vitamin D are essential for maintaining bone density (Carson et al., 2020).
6. Lifestyle modifications (diet and exercise)
   • Dietary changes to reduce fast food intake and increase physical activity will help with weight management, blood pressure control, and reducing cardiovascular and diabetes risk (Doyle-Delgado et al., 2020).

7. Ibuprofen 200 mg as needed for headaches

• To Provide effective relief for occasional headaches

Suggested Consults/Referrals

1. Genetic Counselor

1. • To discuss the implications of her family history of breast cancer and the possibility of genetic testing (BRCA1 and BRCA2) (Hong & Xu, 2022).

2. Oncologist

1. • For further evaluation of her breast cancer risk and management plan, especially if genetic testing reveals a high-risk mutation (Hong & Xu, 2022).

3. Endocrinologist

1. • To manage her prediabetes and provide specialized care for her glucose metabolism and potential endocrine issues (Doyle-Delgado et al., 2020).

4. Cardiologist

1. • For comprehensive cardiovascular risk assessment and management, considering her elevated blood pressure, high cholesterol, and family history of cardiovascular disease (Whelton et al., 2022).

5. Nutritionist

1. • To develop a personalized nutrition plan to address her overweight status, prediabetes, and cholesterol levels, emphasizing a balanced diet and weight management (Whelton et al., 2022).
   • To create an exercise program tailored to her needs, promoting weight loss, improving cardiovascular health, and managing prediabetes (Doyle-Delgado et al., 2020).

6. Gynecologist

1. • For routine gynecological care, including the overdue Pap smear, and to address other reproductive health concerns (Hong & Xu, 2022).

7. Psychologist/Counselor

1. • To provide support for any anxiety or stress related to her health concerns and family history of breast cancer (Hong & Xu, 2022).

Patient Education

1. Breast Cancer Awareness

1. • Educate her on breast self-exams and the importance of regular mammograms and follow-up tests. Understanding her increased risk will encourage vigilant monitoring and early detection (Hong & Xu, 2022).

2. Healthy Diet

1. • Inform her about the benefits of a balanced diet rich in fruits, vegetables, whole grains, and lean proteins. Reducing fast food intake and moderating carbohydrates can help manage her weight, cholesterol, and prediabetes (Doyle-Delgado et al., 2020).

3. Regular Exercise

1. • Emphasize the importance of regular physical activity for weight management, blood pressure control, and reducing cardiovascular risk. Aim for at least 150 minutes of moderate exercise per week (Whelton et al., 2022).

4. Blood Pressure Monitoring

1. • Teach her how to monitor her blood pressure at home and understand her readings. Regular monitoring can help detect any changes early and guide treatment adjustments (Whelton et al., 2022).

5. Medication Adherence

1. • Explain the importance of taking prescribed medications as directed. Proper medication adherence ensures effective management of her conditions, including blood pressure, cholesterol, and prediabetes (Doyle-Delgado et al., 2020).

6. Stress Management

1. • Discuss techniques such as mindfulness, relaxation exercises, and counseling. Managing stress can improve her overall well-being and lower her blood pressure.

Follow-Up Plan

1. Initial Follow-Up Visit

1. • Time Interval: 3 months
   • To evaluate the effectiveness of lifestyle changes and medication adjustments on blood pressure, cholesterol, and prediabetes management. Assess adherence to recommendations and address any concerns (Doyle-Delgado et al., 2020).

2. Breast Health Monitoring

1. • Time Interval: Annual mammogram
   • Regular mammograms are crucial for early detection of breast cancer, especially given her increased risk (Hong & Xu, 2022).

3. Lipid Panel and HbA1c

1. • Time Interval: Every 6 months
   • Monitoring lipid levels and HbA1c will help track her progress and adjust treatment plans as necessary to prevent cardiovascular disease and diabetes (Doyle-Delgado et al., 2020).

4. Blood Pressure Monitoring

1. • Time Interval: Every 1-2 weeks at home
   • Regular home monitoring can detect changes early, allowing for timely intervention and better hypertension management (Whelton et al., 2022).

5. Pap Smear

1. • Time Interval: Every 3 years, unless otherwise indicated
   • Routine cervical cancer screening as per guidelines, ensuring early detection of any abnormalities (Hong & Xu, 2022).

6. Return Visit Triggers

1. • Specific Symptoms: New breast lumps, persistent breast pain, significant changes in blood pressure readings, unexplained weight loss or gain, symptoms of hyperglycemia (increased thirst, frequent urination), or any new concerning symptoms (Doyle-Delgado et al., 2020).
   • Prompt evaluation of these symptoms is essential to identify and manage potential complications or new health issues early.

References

Carson, J. A. S., Lichtenstein, A. H., Anderson, C. A., Appel, L. J., Kris-Etherton, P. M., Meyer, K. A., … & Van Horn, L. (2020). Dietary cholesterol and cardiovascular risk: a science advisory from the American Heart Association. Circulation, 141(3), e39-e53. https://doi.org/10.1161/CIR.0000000000000743

Doyle-Delgado, K., Chamberlain, J. J., Shubrook, J. H., Skolnik, N., & Trujillo, J. (2020). Pharmacologic approaches to glycemic treatment of type 2 diabetes: synopsis of the 2020 American diabetes association’s standards of medical care in diabetes clinical guideline. Annals of internal medicine, 173(10), 813-821. https://doi.org/10.7326/M20-2470

Hong, R., & Xu, B. (2022). Breast cancer: an up‐to‐date review and future perspectives. Cancer communications, 42(10), 913-936. https://doi.org/10.1002/cac2.12358

Whelton, P. K., Carey, R. M., Mancia, G., Kreutz, R., Bundy, J. D., & Williams, B. (2022). Harmonization of the American College of Cardiology/American Heart Association and European Society of Cardiology/European Society of Hypertension blood pressure/hypertension guidelines: comparisons, reflections, and recommendations. European heart journal, 43(35), 3302-3311. https://doi.org/10.1093/eurheartj/ehac432

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Laura Wood Assessment

The patient is a healthy 41-year-old G2P2 Hispanic-American female who presents for a well-woman examination. She has no active medical complaints but is concerned about her risk of breast cancer as both her mother (age 63) and maternal first cousin (age 44) have been recently diagnosed with intraductal breast cancer. Additional risk factors include menarche at age 10.5, first pregnancy at age 33, and breastfed each of her two infants for only four months each. The patient reports a normal baseline mammogram at age 40 (report not available) and a history of fibrocystic breast disease. Physical exam reveals elevated blood pressure (134/74), increased body weight (BMI 27.5) with a FH of hypertension, hyperlipidemia (father) and type 2 diabetes (mother).

Case Findings

• Most significant active concern: risk of breast cancer
  

  Laura Wood Assessment

• Cystic breast disease
• Overweight (BMI = 27.5) with recent weight gain
• American fast food diet 2 x per week
• FH breast cancer mother and maternal cousin
• FH of HYperlipidemia
• FH of type 2 diabetes
• Due for pap smear
• Elevated BP 134/74

Test result:

• Glucose, 8-hour fasting 122: Fasting blood sugar from 100 to 126 mg/dL is considered prediabetes
• Hemoglobin A1C 6.4 %: Hemoglobin A1C between 5.7 and 6.4 indicates prediabetes
• Cholesterol 239
  • HDL 45
  • LDL 159
  • Triglycerides 40
    • Interpretation: Low HDL suggestive of sedentary lifestyle, Cholesterol is in the high moderate to high risk range.
• Mammography: result Pending
• Papanicolaou test: Result NORMAL
• No Allergies

Vitals

• Age 41, Sex F, Height 63”, Weight 155 lb, BMI 27.5
• Temp: 98.4 F (oral)
• Pulse 76 bpm, rhythm: regular, strength: normal
• BP 134/74 right arm, assessment: elevated, pulse pressure: Normal
• Respiration 16 bpm, rhythm: regular, effort: unlabored
• SpO2: 98% on room air

Medications:

• “I take Vitamin E for my cystic breast disease and occasional ibuprofen for rare
• Headache. This morning I took my vitamins” I always only take what it says on the bottle

Diagnosis

• Hypertension: The classic diagnosis of HTN requires a BP measurement x2 on 2 different occasions after the patient has rested for a period of time. Thus, this is a presumptive diagnosis in light of the patient’s weight and FH
• Breast cancer risk: The patient has an increased breast cancer risk due to first degree family members and early menses and late pregnancies, increased estrogen exposure to breast tissue, Mammogram results are pending.
• Prediabetes: Prior to test results, the reason prediabetes is one of the leading diagnosis is because she had no symptoms of hyperglycemia yet. Screening test identified that the patient is prediabetic. This would be the time to reduce her risk for progression to diabetes by increasing exercise, decreasing weight and discussing moderation in carbohydrates in diet.
• Cardiovascular Disease: Screeding test show the patient’s lipids are in high-moderate to high range for the risk of heart disease. This would be the time to discuss diet intervention

Please enter your assessment/management plan or SOAP note below
Management Plan: Use the expert diagnosis provided to create a pertinent, comprehensive, evidenced-based management plan. Address the following criteria in the plan:

1. Diagnostic tests;
2. Medications (write out a complete order, even for OTC meds);
3. Suggested consults/referrals;
4. Patient education;
5. Follow-up, including time interval and specific symptoms to prompt a return visit sooner;
6. Provide rationales for each intervention and include references to support your plan. Clinical practice guidelines should be utilized as applicable. (Evidence of Academic Integrity Issues will result in a grade of 0.)

This criterion is linked to a Learning Outcome.
References and Format: Current APA citations for references in management plan. Use of clinical practice guidelines when applicable.