anice is a 21-year-old who presents for her annual check-up. She would need to have her history update with any new information since her last visit. There are currently no specific guidelines developed for young adults regardless of the definition of age range for young adulthood (Neinstein, 2016). The most comprehensive set of guidelines that intersect with the age group of 18 to 26 years are AAP’s Bright Futures (Neinstein, 2016). Due to her age, it is now time for a complete physical which includes a pelvic and pap examination. At age 21 a young woman should have a pap smear along with cervical screening then every 3 years (Hawkins, 2015). According to ACOG (2017), speculum examinations for cervical cancer screening should begin at age 21 years, irrespective of sexual activity of the patient. STIs and HIV screening is warranted at this visit. Because she is sexually active GC/Chlamydia should be completed.        There are recommended education and counseling that Janice should have at her visit. A woman should be taught how to properly exam her breast. According to Neinsten (2016), ACOG guidelines recommend BSE but it is not recommended under the USPSTF guidelines. Education that I would provide about BSE is to encourage getting in the habit of doing a breast self-examination once a month to familiarize herself with how her breasts normally look and feel. Reinforce examining several days after their period ends because the breasts are least likely to be swollen and tender (National Breast Cancer Foundation, 2016). In the United States, only 20% of women who have a suspicious lump biopsied turn out to have breast cancer (National Breast Cancer Foundation, 2016). Encouragement to start a journal where she can record the findings of her breast self-exams. This can be like a small map of her breasts, with notes about where she feels lumps or irregularities. This may help her remember, from month to month, what is “normal” for her breasts (National Breast Cancer Foundation, 2016). It is not unusual for lumps to appear at certain times of the month, but then disappear, as body changes with the menstrual cycle.       Janice also need an update with her vaccinations, but ensure she is vaccinated with the HPV vaccination if not already. HPV vaccine is recommended for young women through age 26 (CDC, 2016). She is a candidate for Gardasil or Cervarix in a 3 dose schedule. Alcohol misuse and smoking screening should be discussed. Blood pressure, diabetes, and cholesterol screenings are recommended. The NP should review obesity and diet screening and counseling. Immunizations should be reviewed to ensure up to date. If it is flu season, then the flu vaccine should be offered and if the last Tdap was given at age 11 then the Td booster vaccine needs to be administered. Lastly, a discussion about safe sexual practices is warranted. Janice is sexually active and does not always uses condoms and the NP should explore birth control options if she wants to avoid pregnancy if she is not already on any form of birth control (Hawkins, 2015). 

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