Comprehensive Wellness Assessment - Case of a Caucasian Woman

Mary M.

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Comprehensive Wellness Assessment - Case of a Caucasian Woman

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Healthcare, women, disease, family history, covid-19, examination, patient, immunization, symptoms, appearance, pharmacology, treatment, education, vaccination, pregnancy, violence, caucasian woman, wellness

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Abstract

The comprehensive wellness assessment enables the caregiver and the patient to deliberate on existing and new health issues. A well-woman assessment is a proactive method for screening likely issues associated with women's health (Tong et al., 2021). This evaluation is vital for the health of all women. This reflection offers a detailed discussion of a comprehensive wellness clinic visit, gives diagnoses pertinent to the patient, and reflects diverse aspects concerning domestic violence or pregnancy that may impact the patient.
As mentioned by Medvescek et al. (2023), a well-woman visit offers a great opportunity to offer counseling to patients regarding the need to maintain a healthy lifestyle and curtail health risks.

Patient's information
1. Subjective data
2. Objective data
3. Assessment
Plan
1. Pharmacological Treatment
2. Non-pharmacological Treatment
3. Recommendations and Preventative Care
4. Pregnancy and postpartum implications
5. Domestic Violence Implications

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Extract

[...] There is a need to discuss J.M.'s comprehensive wellness visit thus and identify the factors influencing her normal life. C. Recommendations and Preventative Care In the healthcare setting, caregivers play a significant role in offering comprehensive care and offer support to women across various life phases (Cantor & Nelson, 2021). The "United States Preventive Services Task Force" recommends the well-woman chart in outlining preventive services on the basis of health status, age, and risk factors (Cantor & Nelson, 2021). Women's preventive care ought to encompass different services like breast exams and pelvic assessments to aid in evaluating the reproductive organs' health and identify any signs of infections or abnormalities. [...]

[...] There are no instances of acid reflux or constipation. - Breast: all normal. No lumps upon assessing - Musculoskeletal: No joint stiffness or pains were noted during her physical assessment. - Neurological: J.M.'s speech is flawless and affluent, and she adheres to all commands accordingly. - Psychiatric: Her primary evaluation doesn't show any instances of anxiety, mood disorders, or depression. - Genitourinary: she doesn't have CVA tenderness. Her urethral meatus is normal. The patient's vagina appears normal without any lesions or discharge. [...]

[...] Comprehensive Wellness Assessment - Case of a Caucasian Woman I. Patient's information Patient Initials: J.M. Age:46 Years Gender: Female Race: Caucasian A. Subjective data: CC: "Yearly examination." HPI: J.M. is a female Caucasian aged 42 years who visits the facility for her yearly pap smear assessment. The patient indicates that her last pap smear, taken three years ago, came out negative. She, however, mentions getting heavy menstrual periods. Her last period was 03/21/2024, which was accompanied by painful period cramps, compelling her to take painkillers (Advil 400mg), which she says is effective in pain management. [...]

[...] Non-pharmacological Treatment Massage and physical therapy are advised to enhance J.M.'s muscle tone and minimize pain and stress. Education Given J.M.'s history with STI and multiple sexual partners, she must adhere to the use of condoms when having sex to prevent STIs. She should also inform her sex partners to get full treatment for STIs. If possible, the patient should stick to one sex partner. Reflection The comprehensive wellness assessment enables the caregiver and the patient to deliberate on existing and new health issues. [...]

[...] was not pregnant at the time of the visit. However, should she have been, her pregnancy care would have comprised prenatal appointments, tracking the development of the fetus, complications management, educating her on prenatal nutrition, and preparing her for childbirth. Postpartum care would entail evaluating physical recovery, dealing with breastfeeding issues, and assessing the mother's emotional wellness (Lopez-Gonzalez & Kopparapu, 2022). During pregnancy, women should adopt and maintain healthy lifestyles. Physical exercise and activity during pregnancy are vital, given their minimal risks. [...]

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