NR 602 DISCUSSION WEEK 4 PBL CASE STUDY DISCUSSION WOMEN'S HEALTH PART ONE (GRADED)

PBL Case Study Discussion: Women's Health Part One (graded) Overview: Kayla, a now 38-year-old Caucasian and Latino female, comes in the month after Riley’s last illness complaining of fatigue, right breast pain, and vaginal itching. HPI: The breast pain began in the right breast and is now into the right axilla. It is warm and tender to touch. She has not noticed any nipple discharge. She has also had mild myalgia. The vaginal itching began a few days before the breast pain. She reports a great deal of stress. She has not been monitoring for a fever. She denies diarrhea or constipation, abdominal pain, skin changes, cough, or chest pain. She has not had dysuria. LNMP was 6 weeks ago, 8 days in length, heavy for 5 days with clots. This was her first menses since her last visit with you. Menses are irregular, having only 5 to 6 per year. PMH: As previously given. Social History: She continues to live with her parents during a separation from her husband and is working part time at the children’s school library but has not been there for over a week. She now has no health insurance, but her children are covered by the State Medicaid HMO. Family History: Her paternal great grandmother died of breast cancer at the age of 50. Otherwise her family history has not had updates or changed since her last visit. Discussion Questions Part One What further historical questions are needed to properly care for her? What are your differential diagnoses? What is your rationale for these diagnoses? K.F., 38yo, F, Caucasian and Latino S. CC- fatigue, right breast pain, vaginal itching