N512-19A Assignment 1: Genetic Disease and Neoplasia

N512-19A Assignment 1: Genetic Disease and Neoplasia Discussion 1

See Van, a 35-year-old married Hmong-American woman recently underwent an annual Papanicolaou test (Pap smear) at her Certified Nurse Midwife’s practice, and the results were abnormal. Her provider diagnosed her with low-grade cervical dysplasia. What alterations at the cellular level would you expect to see with this diagnosis? Provide and discuss with your colleagues S. V.’s prognosis. Support your discussion with citations from the textbook, external credible literature and/or reliable electronic sources.

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria.

Permalink: ‎

Example Discussion Approach

Cervical dysplasia is abnormal changes in cells on a cervix; these changes are not caner but considered precancerous (U.S. National Library of Medicine, 2020).

As a nurse practitioner (NP), especially a Certified Nurse Midwife, performing a Papanicolaou test (Pap smear) is a common task. After receiving the results of S. Van’s Pap smear, I would need to gather more history (if not already known) including any history of human papillomavirus (HPV) and number of sexual partners. S. Van is married; therefore, assumption of multiple sexual partners is low however, cannot be assumed. Having multiple sexual partners and/or being infected with HPV can lead to cervical cancer (Rebar, 2019). I would also need to know if S. Van has human immunodeficiency virus (HIV). HIV infected women have a higher incidence of HPV-related cervical dysplasia progressing to invasive cervical cancer (Hammer, 2019) which would change a treatment course.

Alterations expected to be seen at a cellular level for low-grade cervical dysplasia include changes in size and shape of intraepithelial cells (Kimmel, n.d.). According to Voltaggio et al. (2016), proliferation of basal‐like cells extend no more than one‐third of the way up the epithelial thickness. In the upper two‐thirds of an epithelium, cells differentiate, gain cytoplasm, and nuclear enlargement occurs. Nuclei are hyperchromatic, often have nuclear membrane irregularities, and cells frequently develop halo‐like vacuoles around the nucleus (Voltaggio et al. 2016).

Given S. Van’s age, marital status, and ethnicity my prediction is her chance of developing cervical cancer is low. According to Rebar (2019), Hispanic women are at the greatest risk of developing cervical cancer; S. Van is Hmong. In most cases, mild cervical dysplasia resolves on its own and no treatment is needed (Laughlin-Tommaso, 2020). However, S. Van may want to have further testing such as a colposcopy or biopsy for further determination (Rebar, 2019). I would also suggest testing S. Van for HPV in case she was unknowingly infected with a virus which could be the cause of an abnormal Pap smear.

Reference

Hammer, G., & McPhee, S. (2019). Pathophysiology of disease: An introduction to clinical medicine (8^th ed). McGraw-Hill

Laughlin-Tommaso, S. (27 June 2020). Cervical dyplasia: Is it cancer? Mayo Clinc.

Rebar, C., Heimgartner, N., & Gersch, C. (2019). Pathophysiology made incredibly easy (6^th ed). Wolters Kluwer

S. Kimmel Cancer Center. (n.d.). Cervical dysplasia. Johns Hopkins Medicine.

U.S. National Library of Medicine. (02 July 2020). Cervical dysplasia. MedlinePlus.

Voltaggio, L., Cimino-Mathews, A., Bishop, J., Argani, P., Cuda, J., Epstein, J., Hruban, R., Netto, G., Stoler, M., Taube, J., Vang, R., Westra, W., Montgomery, E. (06 June 2016). Current concepts in the diagnosis and pathobiology of intraepithelial neoplasia: a review by organ system. CA: A Cancer Journal for Clinicians, 66(5), 408-436.

493 words

Hello Amanda,

Your post is informative, and I think it is beneficial that you provided insight from a Nurse practitioners eyes. Gathering more history from S.V is the correct course of action, in order to make appropriate recommendations for follow up. I also agree with your prognosis for S.V. being good, because S.V. has few other risk factors for increasing chances of her developing cervical cancer.

69 words

Hi Amanda,

Thanks for the informative post. Gathering a more in-depth sexual history is a great idea, along with the utilization of other health screens such as HIV like you had recommended, and possibly syphilis, gonorrhea, and chlamydia as recommended by the USPSTF (2017). S. V.’s cervical dysplasia will most likely resolve on its own. According to Voltaggio et al. (2020), the resolution of lesions appears to be related to the formation of HPV antibodies, macrophage natural killer cells and activated CD4+ T-lymphocytes, and in most patients the infection remains latent or is suppressed quickly. According to a study by Thorburn et al., (2020), for Hmong women, cervical cancer mortality rates are higher than for all Asian American women (2.8 times higher) and for non-Hispanic whites (4.2 times higher). The Thorburn study also indicates that Hmong are diagnosed with later cancer disease stages than are all other Asian American subgroups. Thorburn et al. (2020) also notes that in areas where Hmong screening rates have been measured, the use of Pap tests were exceedingly low, and in separate small area studies, 27–74% of Hmong women reported ever having a Pap test. The results from the study suggested that family members often discouraged Hmong women from screening, and the women often felt a sense of shame and embarrassment over the discussion (Thorburn et al, 2013).

Thorburn, S., Jennifer, K., Keon, K. L., & Zukoski, A. (2013) “We don’t talk about it” and other interpersonal influences on Hmong women’s breast and cervical cancer screening decisions. Health Education Research, 28(5), 760–771. https://doi.org/10.1093/her/cys115

U.S. Preventive Services Task Force., & United States. (2017). U.S. Preventive Services Task Force (USPSTF). Rockville, MD: U.S. Dept. of Health & Human Services, Agency for Healthcare Research and Quality. https://www.ahrq.gov/prevention/guidelines/guide/section1.html

Voltaggio, L., Cimino-Mathews, A., Bishop, J. A., Pedram, A., Cuda, J. D., Epstein, J. I., Hruban, R. H., Netto, G. J., Stoler, M. H., Taube, J. M., Vang, R., Westra, W. H., & Montgomery, E. A. (2016). Current concepts in the diagnosis and pathobiology of intraepithelial neoplasia: A review by organ system. CA: A Cancer Journal for Clinicians, 66(5), 408-436. https://doi.org/10.3322/caac.21350 N512-19A Assignment 1: Genetic Disease and Neoplasia

372 words

Assignment 1

The purpose of this paper is to address the following clinical scenario with the use of your textbook, external credible literature, and/or reliable electronic sources. Use the guide below to draft your paper and review the rubric to ensure you have met the assignment criteria. The expected length of the paper is approximately 4-5 pages, which does not include the cover page and reference page(s).

Lisa Anderson, a 22 y.o., Caucasian single parent, is referred for genetic counseling by her pediatric Nurse Practitioner. She has a 3-year-old boy with developmental delay and small joint hyperextensibility. The pediatric Nurse Practitioner has diagnosed fragile X-associated mental retardation. She is currently pregnant with her second child at 14 weeks of gestation. The family history is unremarkable.

Please use the following headings/subheadings as a guide to draft your paper:

Introduction (including a brief purpose statement)
Identify the genetic mutation responsible for fragile X-associated mental retardation.
Describe and discuss how it causes the clinical syndrome of developmental delay, joint hyperextensibility, large testes, and facial abnormalities.
Identify which parent is the probable carrier of the genetic mutation?
Explain why this parent and the grandparents are phenotypically unaffected.
Discuss the likelihood that the unborn child will be affected?

VII. Conclusion

In regards to APA format, please use the following as a guide:

Include a cover page and running head (this is not part of the 4-5 page limit)
Include transitions in your paper (i.e. headings or subheadings)
Use in-text references throughout the paper
Use double space, 12 point Times New Roman font
Spelling, grammar, and organization are appropriate
Include a reference list (this is not part of the 4-5 page limit)
Attempt to use primary sources only. That said, you may cite reliable electronic sources (i.e. ANA)

Assignment 1 Rubric

Criteria	60 Points	55 Points	50 Points	40 Points	Earned Points
Content: Application & Analysis	Responds correctly and/or appropriately to all questions and criteria. Content is excellent. Demonstrates a high level of critical thinking, shows significant insight or creative thought about the topic, and does not merely recite the text/resources. Uses concepts and terminology correctly. Detail rich and specific. N512-19A Assignment 1: Genetic Disease and Neoplasia	Responds correctly and/or appropriately to all questions and criteria. Content is good. Demonstrates some critical thinking throughout the paper and may also show some insight or creative thinking about the topic. Mostly uses concepts and terminology correctly (1-2 issues). Minor detail inconsistencies (1-2).	Responds correctly and/or appropriately to at least one question OR if only one question, partially responds to question. Does not address all criteria. Content is minimal. Demonstrates at least one critical thinking skill in the paper. Attempts to use concepts and terminology correctly. Several detail inconsistencies (3-5).	Paper is unclear and does not address the questions and/or criteria. Content does not meet requirements. Many inconsistencies and conflicting information (6+).	/60
Criteria	20 Points	16 Points	14 Points	12 Points	Earned Points
Quality: Supporting Research & Sources	All work is accurately cited (where applicable) and appropriately supports content with research, text, multimedia, and/or other resources. References are relevant and enhance the topic.	Most of the work is accurately cited (where applicable) and adequately supports content with research, text, and/or resources. One issue with reference or use of one inappropriate reference. References are relevant to the topic.	2-3 issues with references, including the use of inappropriate references to support content. May fail to provide references to support content. 1-2 references are not relevant to the topic and/or distract from the topic at hand.	4 or more issues with references, including the use of inappropriate references to support content OR failure to include references (where applicable). No supporting references are used OR they are used but 3+ references are not relevant to the topic.	/20
Criteria	10 Points	8 Points	7 Points	6 Points	Earned Points
Organization	Paper is well-organized. Ideas are clear and arranged logically. Transitions are smooth, no flaws in logic.	Paper is organized. Ideas are usually clear and arranged in an acceptable sequence (1-2 issues). Transitions are usually smooth (1-2 issues), good support.	Paper lacks organization. There are many problems with the approach (3-5 issues with organization). Some difficulty understanding ideas. Issues with support and transitions (3-5).	Paper is poorly organized and difficult to understand. Many issues with support and transitions (6+). Ideas are arranged illogically and do not make sense.	/10
Accuracy & Basic Writing Mechanics	Error-free, including APA formatting, reflecting clear understanding of various forms of expression and careful editing.	Very few (less than 3) errors in spelling, grammar, syntax, and/or punctuation. Very few (less than 3) issues with APA formatting. Occasional poor choice of word.	4-5 errors in spelling, grammar, syntax, and/or punctuation. 4-5 issues with APA Formatting. Writing may be difficult to understand at times.	More than 5 errors in spelling, grammar, syntax, and/or punctuation. Many (6+ issues with APA formatting. Writing is difficult to understand in many instances.	/10

N512-19A Assignment 1: Genetic Disease and Neoplasia

N512-19A Assignment 1: Genetic Disease and Neoplasia