Unit 5 Levels of Prevention. 4 references and intext citation. 1000w. due 3-31-23.

Unit 5 Levels of Prevention. 4 references and intext citation. 1000w. due 3-31-23.

A 32-year-old female presents for an evaluation of a lump in her right breast that she found on breast self-examination. The lump is found to be 2cm in size, firm, and mobile. No Adenopothy noted.

1. What are two questions you would ask this patient and why? Support each question with evidence-based research.

2. What are two risk factors would you want to assess for and why?

3. What are the levels of prevention in healthcare and provide example for each?

4. What are the levels of prevention for this patient? Provide rationale.

5. What role can nurse practitioners play in early detection at each level of prevention?

6. Summarize an article that speaks on the importance of patient and healthcare providers acting at each level of prevention.

Please include the information below in the essay.

Please be sure to validate your opinions and ideas with citations and references in APA format.

https://online.simmons.edu/blog/role-of-nurse-practitioners-in-preventive-health/#:~:text=Through%20one%2Don%2Done%20dialogue,that%20help%20prevent%20chronic%20disease.&text=The%20settings%20in%20which%20NPs,those%20who%20need%20it%20most.

How NPs Can Make an Impact on Disease Prevention

Nurse Practitioners  (NPs) have the potential to play a significant role in preventive care, which has traditionally been provided by primary care physicians. Most NPs — up to 90 percent — are prepared in primary care and can manage 80 percent to 90 percent of the care provided by physicians. 6  Moreover, while physician education focuses on diagnosis and treatment, NP training concentrates more on holistic care for individual patients, families and communities. NPs also play an important role in prevention and health promotion across the lifespan. This makes NPs uniquely positioned to influence patient behavior by developing strong, trusting, long-term relationships. Through one-on-one dialogue, NPs can empower individuals to make better health choices and make lifestyle changes that help prevent chronic disease. 5

The settings in which NPs practice can help expand preventive care to those who need it most. Research shows that Nurse Practitioners specializing in primary care are more likely than primary care physicians to practice in urban and rural areas. NPs are also more inclined to care for uninsured patients and other at-risk groups. 6  NPs work in a variety of settings, such as community health clinics and in-store or standalone urgent-care clinics, where patients can quickly be treated for an array of episodic illnesses. Other practice locations include college campuses, worksite health centers and independent clinical practice environments.

The role of NPs in preventing illness and disease can also extend beyond the exam room into the community, where they play a valuable part in health promotion, education, and advocacy. As an example, American Association of Nurse Practitioners member Lt. Meg Whelpley recently  discussed her trajectoryExternal link: open_in_new  with  Daily Nurse. Whelpley went from bedside nurse to officer in the Commissioned Corps of the U.S. Public Health Service. In her current role, she serves as an NP with the National Heart, Lung, and Blood Institute at the National Institutes of Health (NIH). Her responsibilities range from evaluating patients enrolled in research protocols to administering cardiac evaluations for underserved populations in surrounding areas

Two questions to ask this patient

When did the patient first notice the lump and for how long has it been there?

Has there been any changes in the size of the lump and is there any associated pain?

Although breast lump may be first evidence of breast cancer in approximately 90% of patients,

not all lumps are cancerous. Of all breast lumps, 60-80% are benign (Perry, 1990). It is important

to ask questions about the when the lump was first noticed and the initial symptoms, changes

during menstrual cycle, any skin discoloration, retraction, or nipple discharges to make an

accurate clinical decision regarding investigations and diagnosis.

Two risk factors to assess for

Family history of breast cancer.

Family history is an important breast cancer risk factor. Studies have shown that women with a

strong family history, especially first-degree relatives with breast cancer could inherit genetic

alterations and mutation of BRACA and BRCA2 genes that increases their risk of the

disease (Tazzite et al., 2013).

Any use of hormonal contraceptives.

Studies have shown that there is an increased risk of breast cancer when using therapies that

contain combinations of estrogens and progestins. Although this may be dependent on many

factors such as patient factors, hormonal formulations, and duration of use, exogenous estrogen

and progesterone has been classified as group I carcinogen due to estrogen and progestin’s

mitogenic actions and estrogen’s carcinogenic metabolites (Dorchak et al., 2018).

Level of prevention for this patient

The level of prevention for this patient is the secondary level of prevention which focuses on

early detection and prompt treatment of disease to prevent complications (Falkner, 2018). At this

level screening activities are implemented. For breast cancer, early detection is the of its

prevention. Therefore, for this patient, further screening such as mammography, breast

ultrasound, MRI or biopsy may be needed to obtain high resolution images of the breast to

confirm if the lump is benign or cancerous.

References.

Dorchak, J. A., Maria, S., Guarinoni, J. L., Duensing, A., Somiari, S., Cavanaugh, J., Deyarmin,

B., Hu, H., Iida, J., Shriver, C. D., & Witt-Enderby, P. A. (2018). The Impact of Hormonal

Contraceptives on Breast Cancer Pathology. Hormones & cancer, 9(4), 240–253.

https://doi.org/10.1007/s12672-018-0332-y

Falkner, A. (2018). Health promotion in nursing care. Retrieved from

https://lc.gcumedia.com/nrs429vn/health-promotion-health-and-wellness-across-thecontinuum/

v1.1/#/chapter/2

Perry, M. C. (1990). Breast Lump.

https://www.ncbi.nlm.nih.gov/books/NBK279/

Tazzite, A., Jouhadi, H., Saiss, K., Benider, A., & Nadifi, S. (2013). Relationship between family

history of breast cancer and clinicopathological features in Moroccan patients. Ethiopian

journal of health sciences, 23(2), 150–157.

What are two questions you would ask this patient?

1. Have you noticed any changes in the lump throughout your menstrual

cycle?

According to Bickley (2021), “the female breast is a hormonally sensitive

tissue, responsive to the changes of monthly cycling and aging” (p. 594). The

nodularity may become more prominent before menses, when the breasts

expand and become tender, if not painful (Bickley, 2021).

2. When did you first notice the lump and where is the precise location?

It is important to note when the patient first noticed the lump and the exact

location so the exam can focus on that area of the breast (Bickley, 2021).

What are two risk factors would you want to assess for?

1. Has anyone in your family had a history of breast or ovarian cancer?

Women with a known family history of breast and/or ovarian cancers, as well

as those with known genetic susceptibility to breast cancer, are at a higher

risk of developing the disease (Bickley, 2021).

2. Are you currently taking birth control?

Using estrogen and progestin-containing hormones for birth control has been

linked to an increased risk of breast cancer, according to research (Dorchak

et al., 2018). Oral contraceptives expose women to excess estrogen and

progestin and can produce genomic changes in breast tissue which increases

the risk of getting breast cancer (Dorchak et al., 2018).

What are the levels of prevention for this patient?

1. For this patient, the primary prevention of breast cancer would be

reducing or removing factors that put the patient at risk for breast

cancer. These include limiting alcohol consumption, smoking cessation,

increasing physical exercise, and eating a diet rich in fruits and

vegetables.

Physical activity, eating a diet heavy in fruits and vegetables, and limiting

alcohol use are all healthy behaviors that may reduce the risk of breast

cancer (Bickley, 2021).

This

2. Secondary prevention is aimed at early detection activities to reduce

mortality.

The main strategies adopted to achieve early detection of breast cancer are mammography and physical

examination of the breasts via clinical breast examination and breast self-examination (Bickley, 2021).

Women who screen positive for a family history of ovarian, breast, tubal, or peritoneal cancers should be

referred to genetic counselors and considered for BRCA testing (Bickley, 2021).

3. The goal of tertiary prevention is to minimize or reduce disability

and/or suffering.

If the lump would be cancerous, tertiary prevention would focus on the patient undergoing

chemotherapy, radiation, and/or mastectomy in order to minimize the cancer from spreading and

causing further disability.

Reference

Bickley, L.S. (2021). Overview: Physical examination and history taking. Bates’

guide to physical examination and history-taking, 13th ed. New York: Lippincott,

Williams, & Wilkins. ISN-13:9781496398178

Dorchak, J. A., Maria, S., Guarinoni, J. L., Duensing, A., Somiari, S., Cavanaugh, J., Deyarmin, B., Hu, H.,

Iida, J., Shriver, C. D., & Witt-Enderby, P. A. (2018). The impact of hormonal contraceptives on breast

cancer pathology. Hormones & Cancer, 9(4), 240–253. https://doi.org/10.1007/s12672-018-0332-y

Primary Prevention

*Aims to prevent disease or injury before it ever occurs. This is done by preventing exposures to hazards that cause disease or injury, altering unhealthy or unsafe behaviors that can lead to disease or injury, and increasing resistance to disease or injury should exposure occur.

Primary Prevention Examples

*Legislation and enforcement to ban or control the use of hazardous products or to mandate safe and healthy practices (i.e. seatbelt, bike helmets)

* EDUCATION about healthy and safe habits (eating well, exercise daily, not smoking)

*Immunizations against infectious diseases

Secondary Prevention

*Aims to reduce the impact of a disease or injury that has already occurred. This is done by detecting and treating disease or injury as soon as possible to halt or slow the progress, encouraging personal strategies to prevent reinjury or recurrence, and implementing programs to return people to their original health and function.

Secondary Prevention Examples

*Regular exams and screening tests to detect disease in its earliest stages (mammograms for breast cancer)

* Daily low-dose aspirin and/or diet and exercise to prevent further heart attacks or strokes

* Suitably modified work so injured or ill workers can return safely to their jobs

Tertiary Prevention

*Aims to soften the impact of an ongoing illness or injury that has lasting effects. This is done by helping people manage long-term, often complex health problems and injuries in order to improve as much as possible their ability to function, their quality of life and their life expectancy.

Tertiary Prevention Examples

*Cardiac or Stroke rehabilitation programs, chronic disease management programs

*Support groups that allow members to share strategies for living well

* Vocational rehabilitation programs to retain workers for new jobs when they have recovered as much as possible