· Discuss the recommended screening tests, using the latest evidence-based guidelines that the nurse practitioner should perform on Janice:
The nurse practitioner’s goal when screening and initiating care for Janice should be holistic and inclusive of her complete health. Initially, a complete health and medical history should be performed to screen, identify and evaluate risk factors and which tests would be most appropriate for her individual needs (Schuiling & Likis, 2016). Along with identifying Janice’s individualized needs, it is important to utilize national and evidence-based guidelines as a framework for care (Schuiling & Likis, 2016).
According to the U.S. Preventive Services Task Force (USPSTF) (2016) guidelines on cervical cancer screening, screening for Janice should include a cytology (Pap smear) every 3 years starting at age 21. Because of higher infection rates of STD’s/STI’s in women younger than 24 years and Janice’s report that she is sexually active, the USPSTF (2016) recommends screening for chlamydia, gonorrhea and HIV (Schuiling & Likis, 2016). According to a recent study, 15-25-year olds are undertested and receive suboptimal screening for sexually transmitted disease despite the higher rates of STI’s in this population (Cuffe, Newton-Levinson, Gift, Mcfarlane & Leichliter, 2016). Many times, female patient’s seek care through obstetricians/gynecologists, so it is important for the NP to optimize this opportunity to include a comprehensive preventative screen (Ozer, Urquhart, Brindis, 2012). Aside from Janice’s reproductive screenings, the USPSTF (2016), recommends the following: depression, obesity/BMI, hypertension, substance abuse (tobacco recreational drugs and alcohol) intimate partner violence, nutrition/exercise, and cholesterol level (Cuffe et al., 2016).
· Discuss the recommended education and counseling that should be included in Janice’s care?
Based on Janice’s report that she is sexually active and uses “condoms most of the time”, the NP should provide counseling regarding STD and contraceptives. Discussing and offering various birth control options, as well as future fertility plans should be initiated (Hawkins, Roberto-Nicholas & Stanley-Haney, 2016). Janice should be educated on her increased risk for STD’s, safe sexual practices and behaviors (Hawkins et al., 2016). Gynecologic cancer counseling should also be discussed including risk factors, prevention/immunization through the use of the HPV vaccine, and remaining consistent with her pap smear recommendations (Meites, Szilagyi, Chesson, Unger, Romero, & Markowitz, 2019). The Advisory Committee on Immunization Practices (2019) recommends HPV catch up vaccinations through age 26 (Meites et al., 2019). Lastly, education and teaching regarding monthly self-breast exam (SBE) should be included in Janice’s care (Hawkins et at., 2016).
The U.S. Preventive Services Task Force (USPSTF) recommends screenings to be performed on Janice is a screening for cervical cancer and gonorrhea/chlamydia. Cervical cancer screenings for women ages 21 to 65 is recommended every three years and since Janice has never had a pelvic exam, she needs a cancer screening and to provide a base line for future examinations. Since Janice is sexually active and occasionally uses a condom she needs a chlamydia and gonorrhea screening. Women 25 years and older with risk factors such as new or multiple sex partners or a sex partner who has an STD should also be tested for gonorrhea and chlamydia every year. Being a young sexually active women puts her at a high risk for acquiring an STD or STI. They recommend screening for human immunodeficiency virus (HIV) infection in all patients 15 to 65 years of age regardless of risk, as well as in younger and older patients at increased risk of HIV infection. The USPSTF also recommends screening for hepatitis B virus infection and syphilis in persons at increased risk. (U.S Prevention Service Task Force, 2017).
The education and counseling that should be included for Janice is that she needs to be screened for cervical cancer every 3 years with cervical cytology recommended by the USPSTF. Education on vaccines such as HPV and hepatitis B can help reduce the risk or prevent these infections. Education on high risk behaviors and safe sex practices should be included since she states they do not use condoms each time they have sex. Education on how to use condoms properly and the importance of condoms which can reduce the risk for contracting other STD’s that do not have vaccines (Center for Disease Control and Prevention, 2016). Also education of not having multiple sexual partners and abstinence is the safest sex practice.