NRP/563: Management Of Women’s Health Issues – Betty Burns iHuman Reflection

SOAP Note Template
Subjective

Identification

– First Name: Betty
– Last Name: Burns
– Gender: Female
– Age: 48

Chief Complaint

– Lump on the left breast for approximately one month.

History of Present Illness (HPI)

– Current Health Issues: Hypertension well managed with Hydrochlorothiazide. Asthma, diagnosed in childhood, occasionally requiring oral steroids. Seasonal allergies under control. Mild fibrocystic disease. Obstetric History: Two pregnancies, two live births, and no miscarriages. First child at age 36, second child at age 38. Surgical History: Appendectomy over 20 years ago. Tubal ligation after second childbirth. Hospitalizations for child deliveries, appendectomy, and tubal ligation. Preventive Measures: Yearly flu vaccination, recommended weight loss to achieve a BMI of 24.2. Yearly mammograms. Regular use of seat belts, no texting while driving. Up-to-date on immunizations. Family History: Mother had breast cancer at age 55, alive and well. Father’s medical history is unknown. No sisters. Both brothers are healthy. Grandparents’ causes of death are unknown. Social History: No tobacco use, minimal exposure to secondhand smoke. Occasional social alcohol use. No recreational drug use. Married with two daughters aged 8 and 10. College graduate, works as an elementary school principal. No recent travel. No pets. No guns at home. Eating/Exercise: Most meals at home, fast food once a week, exercises with 1-2 walks per week.

Review of Systems (general, skin, HEENT, neck, breasts, respiratory, cardiovascular, GI, peripheral vascular, urinary, genital/LMP, musculoskeletal, psychological, neurological, hematologic, endocrine)

General: No fever, chills, fatigue, malaise, night sweats, or unexplained weight changes. Skin/Breasts: No skin issues, rashes, bruising, jaundice, pruritus, acne, sores, or changes in moles, hair, or nails. No breast pain. Reports discovering a lump on the left breast during a self-breast exam. Discoloration near the nipple on the left breast. Lump on the left breast, with a thickened area and indentations. Occasional bloody discharge in the left breast’s cup of the bra. Last mammogram was 15 months ago and was normal. No mobility of the lump. Regular menstrual periods every 26-28 days.

76-year-old black male with disabilities living in an urban setting

HEENT/Neck: No vision changes, eye pain, discharge, ear issues, nasal problems, throat discomfort, swollen neck glands, or tooth pain. Cardiovascular: No chest pain, shortness of breath, palpitations, or ankle swelling.

Respiratory: No shortness of breath, wheezing, cough, chest pain, or hemoptysis.

Abdomen/GI: No appetite changes, swallowing difficulties, nausea, vomiting, heartburn, abdominal pain, diarrhea, constipation, or melena.

GU: No menstrual irregularities, dysmenorrhea, dyspareunia, or urinary issues.

MSK: No joint or muscle pain, stiffness, swelling, or limitations in movement. Neuro: No headaches, syncope, dizziness, weakness, numbness, tingling, or balance problems. Allergic/Immunologic: No food allergies, hives, or rashes.

Lymphatic/Endocrine: No polyuria, polydipsia, polyphagia, tremors, temperature intolerance, or hot flashes. Hematologic: No excessive bruising, bleeding, swollen glands, or lymphadenopathy.

Psychological: No mood changes, depression, manic behaviors, hallucinations, anxiety, insomnia, or thoughts of self-harm or harm to others.

Allergies

– Seasonal hay fever. No known drug allergies.

Current Medications

– Fluticasone (Flonase) – One spray in each nostril every morning for seasonal allergies.
– Fluticasone/salmeterol 250/50 – One puff twice a day for asthma.
– Hydrochlorothiazide (HCTZ) – 25 mg by mouth daily for hypertension.

Objective

Vital Signs:

– Heart Rate: 80 beats per minute, regular rhythm
– Blood Pressure: 128/80 mmHg (lying/sitting), 126/72 mmHg (standing)
– Pulse Rate: 80 beats per minute, regular rhythm
– Respiratory Rate: 16 breaths per minute, unlabored
– Pain: No pain reported
– Height: 5 feet 6 inches
– Weight: 165 pounds (75 kg)
– Body Mass Index (BMI): 26.26
– Temperature: 98.6 degrees Fahrenheit (oral)
– Pulse Oximetry: 99% on room air

Physical Examination (general, HEENT, neck/lymph, breasts, chest/respiratory, cardiovascular, GI/abdomen, GU/rectal, back, musculoskeletal, skin, neuro, psychological)

– Weight: 165 pounds. Skin/Breasts: Skin is normal, good skin turgor, and no suspicious pigmented lesions. Left breast shows subtle skin dimpling (peau d’orange appearance). Normal symmetrical breast contour on both sides. No overt signs of inflammation. Left breast and axilla exhibit subtle skin dimpling, a firm and fixed 3 cm mass at the 9 o’clock position, and no other suspicious masses. Expressible bloody nipple discharge. Solitary, non-tender, mobile 2 cm left axillary lymph node. Right breast has small palpable nodules consistent with fibrocystic disease and no axillary adenopathy. No nipple discharge.

HEENT: Eyes, ears, nose, and mouth show normal findings. Neck is supple, with no lymph node enlargement, and thyroid is normal in size (25 g).

Cardiovascular: No jugular venous distention, murmurs, thrills, heaves, or lifts. Heart is regular with normal S1 and S2 sounds. No carotid bruits, abdominal aorta is normal, and peripheral pulses are present without edema or varicosities.

Respiratory: Chest shape is normal, and breath sounds are normal without wheezing, rales, or rhonchi. Abdomen/GI: Abdomen is flat, surgical scars are consistent with the appendectomy and tubal ligation, bowel sounds are normal, and there’s no tenderness. The liver edge is palpable below the costal margin, spleen is normal, and no organomegaly or masses are noted. GU: Genitalia appears normal with no signs of infection. Ovaries are normal to palpation. Pap smear has been done.

MSK: Normal range of motion and muscle tone throughout. Muscle strength and flexibility are normal. Neurological: Oriented to person, place, time, and situation. Normal attention and memory. Gait is normal. All cranial nerves are intact, reflexes are normal, and cerebellar exam shows no abnormalities.

Assessment

Problem List:

– Breast mass/lump, neoplastic
– Invasive ductal carcinoma, left breast,

ER/PR negative, HER2 positive
– Evidence of metastasis: 2 out of 2 left axillary lymph nodes positive for metastatic spread

Differential Diagnoses:
– Breast hamartoma
– Fibroadenoma
– Breast lipoma

Plan

– Medications: To be determined (chemotherapy, HER2 antagonist therapy).
– Non-pharmacological treatment: Modified radical left mastectomy and axillary dissection/removal of suspicious lymph nodes.
– Patient Education: Education on breast cancer, regular gynecological follow-up, lifelong cancer surveillance screening (clinical breast exam every 6-12 months, MRI/mammogram every 6-12 months).
– Diagnostic Tests: BRCA1 and BRCA2 genetic test (no mutation detected), diagnostic mammogram (left breast BI-RADS 5, right breast BI-RADS 1), left breast biopsy with lymph node biopsy (invasive ductal carcinoma with specific characteristics), breast ultrasound (identifies the mass and suspicious lymph node), and other labs.
– Referrals: Surgical referral for mastectomy and axillary dissection, radiation referral, oncology referral to discuss treatment options, and referral for education, counseling, supported decision making, and support groups.

EB, a 68-year-old African American woman with hypertension – Discussion on Diversity and Health Assessments

Overall Case Evaluation and Takeaways

– Improved history taking and physical exam skills are evident.
– The application of pathophysiology knowledge has enhanced clinical and diagnostic reasoning.
– Need for more focused history taking and physical exams for improved diagnosis.
– Integration of patient preferences, values, and beliefs through Watson’s theory.
– Continued self-improvement in clinical skills.

References

Dunphy, L. (2019). Primary care: The art and science of advanced practice nursing (5th ed.). F.A. Davis.

Pajnkihar, M., Štiglic, G., & Vrbnjak, D. (2017). The concept of Watson’s carative factors in nursing and their (dis)harmony with patient satisfaction. PeerJ, 5, e2940.

NRP/563: Management Of Women’s Health Issues – Betty Burns iHuman Reflection

SOAP Note Template

Subjective

ID

First Name Betty

Last Name Burns

Gender Female

Age 48

CC

Lump on left breast for about one month NRP/563: Management Of Women’s Health Issues – Betty Burns iHuman Reflection.

HPI

History (including PMH, surgical, family, and social)

Other active problems: Hypertension – well controlled on Hydrochlorothiazide. Asthma – childhood diagnosis; occasional flares requiring oral steroids. Seasonal allergies – controlled. Mild fibrocystic disease. Obstetric History: Gravida 2, Para 2, Abortus 0. 1st child at age 36. 2nd child at age 38. Surgical History: 1. Appendectomy – > 20 years ago. 2. Tubal ligation after birth of second child. Hospitalizations: 1.  Births of children. 2.  Appendectomy. 3.  Tubal ligation. Preventive: Flu immunization recommended yearly. Weight loss recommended to 150 lbs. to bring her BMI to 24.2. Yearly mammograms. Seat belts – uses regularly. Texting while driving – never. Current on immunizations:1) up to date on Tdap. 2) up to date on influenza vaccination. 3) pneumovax administered at age 42 due to her asthma. Recommend shingles vaccination when turns 60. Family History: Mother – breast cancer age 55, alive and well. Father – medical history unknown. Sisters – none. Brothers – both alive and healthy. Grandparents – deceased unknown causes. Social History: Tobacco – none; secondhand smoke exposure minimal. Alcohol – social (once to twice monthly). Recreational drugs – none. Married – monogamous; two daughters, ages 8 and 10. Education – college graduate. Job – elementary-school principal. Travel – none recently. Pets – none. Home safety – no guns in household. Eating/Exercise:  eats most meals at  home, fast food only once per week, walks 1-2 times per week for exercise NRP/563: Management Of Women’s Health Issues – Betty Burns iHuman Reflection.

ROS (general, skin, HEENT, neck, breasts, resp, CV, GI, peripheral vascular, urinary, genital/LMP, MSK, psych, neuro, hematologic, endocrine)

General: No evidence of fever, chills, fatigue, malaise, night sweats, excessive or unexplained weight gain or loss. Skin/Breasts: No rashes, bruising, jaundice, pruritis, acne, sores, ulcers, changes in moles, hair loss or brittleness, nails. No pain from her breasts. Reports lump on left breast x 1 month. Found during self-breast exam last month. Discoloration near nipple on left breast. Lump on left breast thickened area over lump with indentations. Occasional bloody discharge in left breast cup of bra. Last mammogram 15 months ago and normal per patient. No movement with lump. Periods are regular every 26-28 days.

NRS 429VN: Topic 1 DQ 2 – Using Health Promotion Models to Encourage Behavioral Change

HEENT/Neck: Denies vision changes, blurred vision; eye pain, discharge, itching, or redness. Denies ear pain, ear discharge, hearing difficulty, vertigo, nasal congestion, epistaxis, sinus pain or pressure, sore throat, swollen glands in neck, tooth pain. Cardiovascular: No complaints of chest pain/pressure, dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, palpitations, ankle swelling. Resp: Denies shortness of breath, wheezing, cough/ sputum, hemoptysis, tightness in chest, pleuritic chest pain (pain with deep breath or cough). Abd/GI: No problems with appetite changes, dysphagia, nausea, vomiting, hematemesis, heartburn, abdominal pain, diarrhea, constipation, melena. GU: No menstrual irregularities, amenorrhea, dysmenorrhea, dyspareunia.  Denies dysuria, urinary frequency, nocturia, hematuria, incontinence, urgency, hesitancy, difficulty starting or stopping stream NRP/563: Management Of Women’s Health Issues – Betty Burns iHuman Reflection. MSK: No joint or muscle pains, joint stiffness and swelling, limitations in movement, functionality. Neuro: No problems with headaches, syncope, presyncope, dizziness, weakness, paralysis, numbness/tingling, or balance. Allergic/Immunologic: Denies food allergies, hives, or rashes. Lymphatic/Endocrine: Denies polyuria, polydipsia, polyphagia, tremor, heat or cold intolerance, hot flashes. Hematologic: Denies excess bruising or bleeding, swollen glands/lymphadenopathy. Psychological: No problems with mood changes, feeling depressed, manic behaviors, auditory or visual hallucinations, anxiety, insomnia, suicidal or homicidal ideations.

Allergies

Seasonal hay fever. NKDA. NKFA.

Current Medications

Fluticasone (Flonase) – one spray each nostril Q AM as needed for seasonal allergies. Fluticasone/salmeterol 250/50  – one puff BID for asthma. Hydrochlorothiazide (HCTZ) – 25 mg PO daily for hypertension.

Objective

Vital Signs:

HR 80 RRR

BP 128/80 mmHg – supine/sitting. 126/72 mmHg – upon standing.

Pulse 80 RRR

RR 16 unlabored

Pain 0

Height 5’ 6”

Weight 165 lbs. (75kg)

BMI 26.26

Temp 98.6 oral

Pulse Ox 99% room air

Physical exam (general, HEENT, neck/lymph, breasts, chest/respiratory, CV, GI/abdomen, GU/rectal, back, MSK, skin, neuro, psych)

Weight:  165.0 pounds. Skin/Breasts: Atraumatic, good skin turgor, skin, and scalp normal, no evidence of suspicious pigmented lesions NRP/563: Management Of Women’s Health Issues – Betty Burns iHuman Reflection. Breast exam consistent with known mild fibrocystic disease, left breast with subtle skin dimpling (peau d’orange appearance). Normal symmetrical breast contour bilat. No overt inflammatory signs. No previous incisions or trauma. Left breast and axilla: subtle skin dimpling (peau d’orange appearance), firm fixed, 3 cm mass palpated at the 9 o’clock position. No other suspicious mass lesions; smaller palpable nodules consistent with prior exams and consistent with history of fibrocystic disease. Expressible bloody nipple discharge. Solitary, nontender, mobile, 2 cm left axillary lymph node. Right breast small palpable nodules consistent with prior exams and known fibrocystic disease. No axillary adenopathy. No expressible nipple discharge. HEENT: Eyes: Sclera and conjunctiva normal. Pupils and irises size symmetrical and shows normal reaction to light and accommodation bilaterally. Ears: no external scars or lesions. Otoscopic exam normal with only minimal wax, no masses or foreign bodies, good light reflex bilaterally.

Nose: External without abnormality. Normal nasal mucosa, septum, turbinate’s. Mouth: Good dental hygiene. Neck supple, no adenopathy, trachea midline, no carotid bruits, thyroid size 25 gm, no masses or tenderness.

Cardiovascular: No JVD. No thrills, heaves, or lifts. PMI normal size and location.  Heart RRR Normal S1 and S2, no murmurs appreciated. No carotid bruits, abdominal aorta normal size no bruits, pedal pulses present and symmetrical, no evidence of peripheral edema or varicosities. Respiratory: Normal chest shape, normal respiratory movement, no tenderness, and percussion normal. Auscultation found normal breath sounds throughout without wheezing, rales or ronchi. Abdomen/GI: Flat contour. Scars consistent with prior surgical history. Normal bowel sounds present. Soft to palpation without tenderness all 4 quadrants.  Liver edge felt below the coastal margin, span normal to percussion. Spleen normal size. No masses or organomegaly. GU: Normal genitalia, no evidence of infection. Normal ovaries to manual palpation. Pap smear done. MSK: Normal ROM and muscle tone throughout. Muscle strength and flexibility throughout axial and appendicular skeleton normal. Motor 5/5 all extremities. Neurological: A & O x 4, good attention, memory, normal gait, CN 2-12 intact, reflexes 4/4 throughout. Normal cerebellar exam with finger to nose (FTN), rapid alternating movements (RAM), heal to shin (HTS) bilaterally. Allergic/Immunologic: No worrisome preauricular, posterior auricular, anterior cervical, posterior cervical, submandibular, supraclavicular lymph nodes. Lymphatic/Endocrine: Thyroid normal to palpation, 25 gm, no masses or tenderness. Hematologic: Normal capillary refill. No evidence of anemia NRP/563: Management Of Women’s Health Issues – Betty Burns iHuman Reflection.

Assessment

Problem List:

• Breast mass/lump, neoplastic
• Invasive ductal carcinoma, left breast ER/PR negative, HER2 positive
• Evidence of metastasis: 2 out of 2 left axillary lymph nodes positive for metastatic spread

 

Differential diagnoses:

Differential Diagnoses	How Was This Diagnosis Ruled Out?
Breast hamartoma
Fibroadenoma
Breast lipoma

Plan

Include the following:

• Medications to be prescribed (drug-dose directions)
• Instructions to continue, discontinue, or start medications, including changes to routine medications.
• Diagnostic tests in the proper order and reason for the order (e.g., CT abdomen and pelvis with and without contrast, Dx, LLQ abdominal pain)
• Labs, including appropriate serum panels (e.g., BMP, CBC with diff., TSH, T4, UA, C&S)
• Patient education pertinent to health condition
• Follow-up plan
• Referrals

Plan	Rationale and/or results
Breast Cancer Susceptibility Genetic Test (BRCA1 and BRCA2).	No mutation detected.
Diagnostic mammogram.	Left breast BI-RADS 5, (3 cm irregular shaped mass in upper outer quadrant worrisome for malignancy). Right breast BI-RADS 1, normal.
Left breast biopsy with lymph node biopsy.	Invasive ductal carcinoma with nuclear pleomorphism. Mitotic counts: score 2. Estrogen receptor negative. Progesterone receptor negative. HER2 receptor positive.
Breast ultrasound.	Left breast solitary mass measuring 3 cm X 3.2 cm X 3.0 cm at 9 o’clock upper outer quadrant. Some skin thickening overlying the mass was also noted. In the left axilla 2.0 cm X 1.8 cm X 2.0 cm lymph node was identified. Suspicious for malignancy.
Surgical referral for modified radical left mastectomy and axillary dissection/removal of suspicious lymph nodes.
Radiation referral for therapy.
HER2 antagonist therapy (trastuzumab)
Oncology referral to discuss treatment options NRP/563: Management Of Women’s Health Issues – Betty Burns iHuman Reflection.
Referral for education, counseling, supported decision making and support groups. Life long cancer surveillance.
Lab to check lipid panel and BMP.

 

NRP/563: Management Of Women’s Health Issues

Wk 3 – Signature Assignment: iHuman Patient Betty Burns Reflection

1. See attached SOAP note for Betty Burns.
2. Write a 500-word summary regarding your patient encounter with Betty Burns.
3. Include the following in your summary:

• Explain how you arrived at your differential diagnoses.
• Explain the steps you used to determine the final diagnosis.
• Give examples of how you can integrate cultural preferences, values, health beliefs, and behaviors into the treatment plan using Watson’s theory.
• Describe the appropriate management (e.g. health maintenance, diagnostics, medications/treatment) and support with evidence.)
• Critique your overall case evaluation, highlighting takeaways to improve your clinical skills now that the diagnosis has been revealed.

4. Cite a minimum of 3 peer-reviewed journal references within the last 5 years supporting your responses according to 7^th edition APA guidelines.
5. Course Textbooks:

• Schuiling, K. D., Likis, F. E. (2017). Women’s gynecologic health (3rd ed.). Jones & Bartlett Learning.
• Dunphy, L. (2019). Primary care: The art and science of advanced practice nursing (5th ed.). F.A. Davis NRP/563: Management Of Women’s Health Issues – Betty Burns iHuman Reflection.

Management Of Women’s Health Issues Week 3 – Signature Assignment: iHuman Patient Betty Burns Reflection

Student’s Name

Institution

Course Code, Course Name
Instructor’s Name

Date

Explain How You Arrived At Your Differential Diagnoses

Diseases are characterized by patterns of symptoms reported by patients, the signs obtained during physical exam, and the results obtained from diagnostic tests. According to Dunphy (2019), determining the differential diagnoses is a process of distinguishing between diseases which present with the same symptoms. In Betty Burns’ iHuman case study, I arrived at   the differential diagnosis   using a systematic approach through the following steps; generating a list of Betty Burn’s medical issues through history taking, a physical exam, and evaluating  the  findings of the laboratory tests. Burns’ chief complaint was a lump on her left breast for about one month. The most common problems which present with this symptom among women aged 40 years or older are; fibroadenomas, breast lipoma, breast hamartoma, and breast adenocarcinoma. Using a local anatomic differential diagnosis framework and applying to it the pertinent positives and negatives resulted in the following differentials;

• Fibroadenoma-presents as a painless, benign and firm lesion
• Fibrocystic Breast Disease: it usually presents with changes in breast tissue such as lobular hyperplasia and cysts that are smooth and movable (Schuiling & Likis, 2017).
• For Betty Burns, the physical exam was also consistent with mild fibrocystic disease.
• Breast Cancer-Betty Burns’ breast biopsy findings was significant for an invasive ductal carcinoma with nuclear pleomorphism which is indicative of breast cancer NRP/563: Management Of Women’s Health Issues – Betty Burns iHuman Reflection.

Steps Used To Determine the Final Diagnosis

• To determine the final diagnosis, I identified the disease that accounted for all of Betty Burn’s problems from the initial list of differential diagnoses and was supported by the diagnostic test findings. The most appropriate diagnosis that met this criterion was breast mass/lump, neoplastic. Betty Burns was 48 years old and had a family history of breast cancer (mother). The risk of breast cancer increases in women aged 40 years and older (Schuiling & Likis, 2017). . She reported discoloration near the left breast nipple, an immobile lump on the left breast with thickening and indentations over the area with the lump. She also reported occasional bloody discharge in the cup of bra of the left breast. The physical exam findings were consistent with dimpling of the skin of the left breast, a fixed and firm mass (3cm) palpated at the 9 o’clock position, and bloody nipple discharge. The diagnostic breast biopsy was positive for an invasive ductal carcinoma, HER2 positive with evidence for metastasis (2 out of 2 left axillary lymph nodes positive for metastatic spread).

How To Integrate Cultural Preferences, Values, Health Beliefs, and Behaviors Into the Treatment Plan Using Watson’s Theory

Watson bases her theory of caring on seven major assumptions starting with the notion that caring can only happen at an interpersonal level between nurses and patients. Oher assumptions posit that caring   leads to growth of the patient and family, patient satisfaction, needs acceptance, is the core of nursing, and creates an environment where individuals make wide decisions (Pajnkihar, Štiglic & Vrbnjak, 2017). Basing on the aforementioned assumptions, she mentions  10 Carative factors  that nurses can implement in practice to; instill hope, develop trust, develop values, incorporate science to address  issues, support  a positive mental,  physical, social, and spiritual environment, continuous learning, and  help with physical needs (Pajnkihar, Štiglic & Vrbnjak, 2017). Applying this theory to the care of Betty Burns, I will develop a helping-trusting relationship and allow her to share both her positive and negative feelings, being authentic to, engage Betty Burn in genuine teaching-learning experience about her health status, and try to address her spiritual and physical needs by being open to discussions and matters spirituality NRP/563: Management Of Women’s Health Issues – Betty Burns iHuman Reflection.

Appropriate Management (Health Maintenance, Diagnostics, Medications/Treatment)

• Non-pharmacological treatment: refer for modified radical left mastectomy and axillary dissection/removal of suspicious lymph nodes.
• Pharmacological treatment: refer for radiation or/and chemotherapy (HER2 antagonist therapy (trastuzumab) (Schuiling & Likis, 2017).
• Patient Education: breast cancer and gynecological follow up in six months, lifelong cancer surveillance screening (clinical breast exam every 6-12 months), MRI/mammogram every 6-12 months.
• Diagnostics:
  • Genetic Testing (BRCA)-No mutation detected.
  • Left breast biopsy with lymph node biopsy- Invasive ductal carcinoma with nuclear pleomorphism. Mitotic counts: score 2. Estrogen receptor negative. Progesterone receptor negative. HER2 receptor positive.
  • CT of abdomen and chest
  • Diagnostic mammogram- Left breast BI-RADS 5, (3 cm irregular shaped mass in upper outer quadrant worrisome for malignancy). Right breast BI-RADS 1, normal.
  • Breast ultrasound-Left breast solitary mass measuring 3 cm X 3.2 cm X 3.0 cm at 9 o’clock upper outer quadrant. Some skin thickening overlying the mass was also noted. In the left axilla 2.0 cm X 1.8 cm X 2.0 cm lymph node was identified, suspicious for malignancy.
  • BMP
  • Lipid Panel
  • Referral to an oncologist for further evaluation and management

Overall Case Evaluation and Takeaways

In my next assessments, I will be keener to conduct a more focused history taking and physical exam based on a patient’s presenting complaint. A focused history using focused questions and a focused physical exam will provide more comprehensive and direct clues of a patient’s most probable diagnosis. When compared to past assessments, I must admit that my history taking and physical exam techniques have tremendously improved. Besides, I can effortlessly incorporate pathophysiology knowledge that I have obtained in class in clinical and diagnostic reasoning to determine the appropriate tests to order and make appropriate diagnoses NRP/563: Management Of Women’s Health Issues – Betty Burns iHuman Reflection.

References

Dunphy, L. (2019). Primary care: The art and science of advanced practice nursing (5th ed.). F.A. Davis.

Pajnkihar, M., Štiglic, G., & Vrbnjak, D. (2017). The concept of Watson’s carative factors in nursing and their (dis)harmony with patient satisfaction. PeerJ, 5, e2940. https://doi.org/10.7717/peerj.2940

Schuiling, K. D., Likis, F. E. (2017). Women’s gynecologic health (3rd ed.). Jones & Bartlett Learning NRP/563: Management Of Women’s Health Issues – Betty Burns iHuman Reflection.