Well woman exam and cervical cancer screening in a healthy patient

¶ … Woman Exam With Pap Smear

Subjective

The patient is a 28-year-old white Caucasian woman who is married with no children. She is a professional insurance adjustor and travels frequently throughout the year to settle claims, as she works for the disaster division of the insurance company that is her employer.

The patient is presenting for her annual Well Woman Exam with Pap smear. The patient is a healthy female with no issues. She discusses exercise, nutrition, smoking, alcohol consumption, sexual practices and menstrual cycles with her health care provider as is the custom with a Well Woman visit. A Pap smear is performed upon request.

The patient has no precipitating/alleviating factors, as there are no issues pertaining to health wellness that the patient describes. She does not smoke, abuse alcohol, or eat an improper diet. She exercises regularly in spite of her frequent travels and her sexual activity is healthy; she stated that she does not engage in extra-marital sexual intercourse. She demonstrates no associated symptoms of illnesses, and her Pap smear indicates no sign of cervical cancer.

The patient's quality of life is reported as being very high: she enjoys outdoor activities, has a healthy social life, easily makes friends everywhere she goes (and for this reason has friends in many cities around the world, due to her frequent travels); she is interactive with members of her community and church, expresses no symptoms of depression, has a good relationship with her husband, and the two of them are now considering having children. They feel financially secure at this point in their lives, their house is paid off, and their jobs are stable. She is comfortable with where she is in life and is looking forward to the next stage.

The issue of how children might effect her job situation was discussed and she stated that she can always move back to a position that allows her to work locally and that will not require travel if she and her husband do decide to have children. Currently, she is using birth control and a discussion of returning to a natural menstrual cycle was conducted.

Because she is under the age of 50 the patient is not determined to be at risk for breast cancer and she declined a mammogram, as she had received one in the prior year and it is only recommended that a mammogram be performed every three years for women over the age of 20. Once she is at 40 years of age, she was informed that the mammogram should be performed every year.

Patient discussed with the health care provider the subject of pubic hair grooming because she wanted to know what was "normal" for women her age and whether the provider had any advice on common practices. The provider told her that is now "more common than not for women to have groomed their pubic hair" (Demaria, Berenson, 2013).

Patient did express some concern over the usefulness of gynecologic exams -- the Pap smear -- as she had come into contact with misconceptions about cancers. The provider discussed the patient's beliefs and values regarding performing pelvic examinations and why it is important for the Pap smear (Stormo, Cooper, Hawkins et al., 2012).

Assessment

The patient is a healthy woman and her Pap smear indicated no signs of cervical cancer. Her emotional state is healthy and strong and her well woman exam proceeded with typical calmness.

The patient was instructed to have another well woman exam in a year and that a Pap smear should be conducted in another 3 years. A mammogram would be scheduled in a year so as to maintain a watch over the possibility of breast cancer.

Health risks assessment conducted for the patient indicated that her family history poses a risk for breast cancer, which means that she should be monitored carefully in the coming years. A preventive plan based on reducing the risk for developing cancer in both the breasts and in the cervix was discussed and that plan is outlined below for the patient.

Plan

Cervical cancer risk can be reduced by monitoring with HPV tests and Pap smear, and by not participating in risky sexual behavior. This patient does not engage in such activity and is not at risk for this. In terms of developing breast cancer, the risk is in the family history, but studies show that diet and exercise can help to reduce the risk of developing breast cancer (Scott et al., 2013; Alegre et al., 2013).

By promoting healthy living through good diet consisting of natural foods and through exercise, the patient will help to reduce the risk of developing cancer. These steps should be part of the prevention plan going forward. The plan should also include maintaining commitment to the well woman annual check-up so that monitoring can be continued for any cancerous developments.

The patient should also pursue inquiries into insurance coverage should she choose to leave her job so that well woman preventive medicine visits can continue, and discussion with her health provider about conceiving should also begin.