Clinical Oral Presentation Jessica Ward

 “I committed myself to the proactive stance of health promotion and disease prevention with the conviction that it is much better to experience exuberant well- being and prevent disease than let disease happen when it is avoidable and then try and cope with it.” Nola J. Pender, PhD, RN, FAAN

 Name: JA  Age: 38  Ethnicity: Caucasian  Chief complaint: follow-up of abnormal pap smear  HPI: Patient presented to office for f/u for abnormal pap smear results on 05/22/12.  LNMP: 06/13/12  Gravida: 0  Last pap smear 05/22/12 showed ASCUS high risk HPV  History: negative for STDs

 Neuro: alert/oriented x3, negative for mood disorder. Answers questions appropriately.  Endocrine: negative for thyromegaly, negative for lymph node enlargement  Respiratory: clear bilateral, equal lung expansion,RR= 16  Cardiovascular: negative for murmurs or gallops, no edema noted in lower extremity, denies palpations. b/p=114/86 HR=74  GI: no abdominal masses, bowel sounds present in all four quadrants, patient states she has regular bowel movements daily.  GU: unremarkable, negative for flank pain upon percussion of kidneys  Skin: non-raised moles on lower and upper back, negative for rashes, or lesions

 Inflammation of cervix  Dysplasia

(Pap Smear with ASCUS) 616 (Cervicitis)

 Pap Smear with HPV- helps to screen for abnormal precancerous cells

 Colposcopy biopsy taken from 2, 3, and 9 o'clock of external os  Specimens sent to pathology

 Abstain from sex for two weeks  Rest and exercise to help strengthening immunity  Do not use tampons, or douche for two weeks  Report any heavy bleeding, or foul smelling discharge

 Continue current birth control method Orthro Tri- Cyclen for pregnancy prevention

 Indications of HPV Screening and results  Colposcopy indication, side effects, and care after colposcopy  Risk for cervical cancer

 Continue to do monthly Self-Breast exams  STD Screening  Continue Pap Smear series as recommended for abnormal pap smear results  Abstain from unprotected sex

 Patient with abnormal cervical cytology require further evaluation, which include HPV testing, colposcopy, cervical biopsy, endometrial sampling, or a diagnostic excisional procedure, depending upon the severity of cytology results.  Cervical cancer screening can detect precancerous lesions and prevent cancer, as well as detect early stage disease and decrease cancer mortality

 Alligood, M. R., & Tomey, M. A. (2010). Nursing Theories and Their Work. In M. R. Alligood, & M. A. Tomey. Mosby Elsevier.  Arasi, T.-V. (2012). Cervicitis. Retrieved from emedicinehealth:  Feldman, S., Sirovich, B. E., & Goodman, A. (2012). Screening for Cervical Cancer. Retrieved from Up-to-date:  Fred, F. F. (2013). Ferri's Clinical Advisor. In F. F. Fred, Ferri's Clinical Advisor (pp ). Rhode Island: Elsevier Mosby.  WebMD. (2010). Colposcopy and Cervical Biopsy. Retrieved from WebMD: