46 year old woman with history of ASCUS and hypertension. The patient has been experiencing hot flushing, night sweats (VMS), and genitourinary symptoms. Patients’ blood pressure is 150/90 and the patient is currently taking Norvasc 10mg daily and HCTZ 25mg daily. Atypical Squamous Cells of Undetermined Significance (ASCUS) are not always precursors of squamous intraepithelial lesion of cervix, however the patient should follow up with OBGYN every six months to keep check on this. This history is important however it is unlikely that ASCUS is causing the current symptoms. The more probable diagnosis would be menopause. The ASCUS was found more common in the perimenopausal than in the postmenopausal patients (Srivastava, & Misra, 2019). The increase in SBP per decade was 5 mmHg greater in the peri- and postmenopausal women than in the premenopausal group (Agency for Healthcare Research and Quality, 2014).
Menopause is the final menstrual period and starts around the age of 47 and last for five to eight years (Roberts & Kickey, 2016). Managing menopause is based on the degree of “bother”. The patient should be assessed on how severe her symptoms are. The patients genitourinary symptoms (GSM) can effectively be treated with vaginal (topical) estrogens (Roberts & Kickey, 2016). Vaginal estrogens have been proven to help with GSM and painful intercourse. Treatment of moderate to severe VMS and their potential sequelae of sleep disturbance, difficulty concentrating and subsequent reduced quality of life, remains the primary indication for treatment (Roberts & Kickey, 2016). The patient should be asses on the extent of hot flushing and night sweats, and how they are affecting her ability to function in her daily activities. The patient should be educated on hormonal therapy risk and benefits. Transdermal estrogen can be started if the patient symptoms are severe enough. Where treatment is indicated, this should be reviewed within 3 months for efficacy then at least annually and should be adapted to the changing stages of menopause (Roberts & Kickey, 2016). Patient should be encouraged to decreases sodium intake, add an exercise regimen to her daily activity, eat a healthy diet with fruits and vegetables, reduce alcohol intake, and reduce stress as much as possible. The patients’ blood pressure medication should be increased if a three month follow up continues to show elevated pressures.
References
Agency for Healthcare Research and Quality. (2014). Guide to clinical preventive services, 2014: Section 2. Recommendations for adults. Retrieved from http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/guide/section2.html
Roberts, H., & Hickey, M. (2016). Managing the menopause: An update. Maturitas, 86(2016), 53–58. .https://doi.org/10.1016/j.maturitas.2016.01.007
Srivastava, A. N., & Misra, J. S. (2019). ASCUS (Atypical Squamous Cells of Undetermined Significance) in the Cervical Smears of Women from Rural Population of Lucknow West. Journal of obstetrics and gynaecology of India, 69(Suppl 2), 165–170. https://doi.org/10.1007/s13224-018-1160-2
Sample Answer 5 for NURS 6521 Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders
This individual is experiencing menopause. According to Roberts & Hickey, “Vasomotor symptoms (VMS); “hot flushes” or “night sweats” are normal during the menopause transition and affect around 80% of women [5]” (2016). This is also a very common age to start experiencing menopause. An individual’s quality of life can decrease drastically if they are continuing to have these signs and symptoms on an everyday basis. Therefore, she needs a new medication regimen to help her with these issues. According to Rosenthal & Burchum, “Menopausal HT, formerly known as hormone replacement therapy (HRT), consists of low doses of estrogen (with or without a progestin) taken to compensate for the loss of estrogen that occurs during menopause” (2021). This therapy also states that it is the best treatment for vasomotor symptoms, which is what this patient is experiencing. According to Mayo Clinic, “You can take estrogen in the form of a pill, patch, gel, vaginal cream, or slow-releasing suppository or ring that you place in your vagina. If you experience only vaginal symptoms related to menopause, estrogen in a low-dose98 vaginal cream, tablet or ring is usually a better choice than an oral pill or a skin patch” (2018). This is a good educational piece to know. Therefore, if one method is not working for you it is not the end of the road. There are multiple routes of administration to help decrease unwanted symptoms and increase the quality of life.
References
Roberts, H., & Hickey, M. (2016). Managing the menopause: An update. Maturitas, 86, 53–58. https://doi.org/10.1016/j.maturitas.2016.01.007
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Mayo Clinic Staff. (2018). Hormone therapy: Is it right for you? Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/menopause/in-depth/hormone-therapy/ART-20046372
Sample Answer 6 for NURS 6521 Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders
A 46-year-old, 230lb woman with a family history of breast cancer. She is up to date on yearly mammograms. She has a history of HTN. She complains of hot flushing, night sweats, and genitourinary symptoms. She had felt well until 1 month ago and presented to her gynecologist for her annual GYN examination and to discuss her symptoms. She has a history of ASCUS about 5 years ago on her pap; other than that, Pap smears have been normal. Home medications are Norvasc 10mg QD and HCTZ 25mg QD. Her BP today is 150/90. She has regular monthly menstrual cycles. Her LMP was one month ago.
Treatment Regimen
After analyzing the symptoms, I concluded that the patient is experiencing peri-menopausal symptoms. For many people, menopause begins around age 45 though the onset of symptoms varies across different people. She is undergoing the early stages of menopause which is a stage that begins with experiencing changes in the uterus, breasts, increased fat deposit, and the urogenital tract undergoing several changes such as a shrinking cervix, and reduced muscle tone in the pelvic area. At that age, the level of estrogen production is low hence, leading to hot flashes and night sweats. Therefore, her treatment regime will focus on taking into consideration the patient has Hypertension already. Hormone therapy will be eliminated and prescribe vaginal cream that would help her manage genitourinary symptoms such as vaginal dryness and dyspareunia (Yoo et al., 2020). Mood changes and hot flashes are common symptoms of menopause hence the patient will be prescribed low-dose antidepressants such as venlafaxine and sertraline. Besides, herbal treatment has been proven to be effective in managing vasomotor symptoms hence the patient can be prescribed black cohosh which helps in reducing many menopausal symptoms (Mahady, et al., 2002).
As people continue to age, their bones become weak and this increases their chances of suffering born fractures. Therefore, the patient will be given vitamin D supplements to the increase production of estrogen which reduces with age and reduces cases of bone fractures.
During the clinical interview, I realized that the patient is taking Norvasc 10 mg and hydrochlorothiazide (HCTZ) 25 mg. I would advise her to discontinue taking Norvasc since the drug acts as a calcium blocker hence leading to hypertension and besides, its side effects increase menopause symptoms. Since she has hypertension, I would recommend that she takes lisinopril 20 mg daily. This should help alleviate the flushing that the patient has been experiencing (Li et al., 2016). Additionally, the patient has a history of ASCUS, hence I will advise her to continue with her PAP smear exams. With her blood pressure being high currently, and the fact that she is taking Norvasc, she will be encouraged to stop Norvasc but increase the HTCZ dosage to 50mg daily. The patient is expected to come regularly for assessment and examination of the drugs and symptoms.
Patient Education Strategies
Patient education has become an effective strategy to influence patients’ behavior to start living a quality life. The patient will be educated on ways to maintain weight through diet modification, become physically active, and practice relaxation as one way to reduce the severity of menopause symptoms and chances of getting breast cancer (Paterick et al., 2017). The patient will be educated about things she needs to avoid such as the use of exogenous hormones to reduce getting breast cancer going to her family history (Stuenkel et al., 2015). All this information will be passed to the patient through her patient portal which is deemed the best instructional method for her as she can access the information from the comfort of her home.
References
Li, R. X., Ma, M., Xiao, X. R., Xu, Y., Chen, X. Y., & Li, B. (2016). Perimenopausal syndrome and mood disorders in perimenopause: prevalence, severity, relationships, and risk factors. Medicine, 95(32).
Mahady, G. B., Fabricant, D., Chadwick, L. R., & Dietz, B. (2002). Black cohosh: an alternative therapy for menopause?. Nutrition in Clinical Care, 5(6), 283-289.
Paterick, T. E., Patel, N., Tajik, A. J., &Chandrasekaran, K. (2017, January). Improving health outcomes through patient education and partnerships with patients. In Baylor University Medical Center Proceedings (Vol. 30, No. 1, pp. 112-113). Taylor & Francis.
Manson, J. E., &Kaunitz, A. M. (2016). Menopause management—getting clinical care back on track. N Engl J Med, 374(9), 803-6.
Stuenkel, C. A., Davis, S. R., Gompel, A., Lumsden, M. A., Murad, M. H., Pinkerton, J. V., & Santen, R. J. (2015). Treatment of symptoms of the menopause: an endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 100(11), 3975-4011.
Yoo, T. K., Han, K. D., Kim, D., Ahn, J., Park, W. C., &Chae, B. J. (2020). Hormone replacement therapy, breast cancer risk factors, and breast cancer risk: a nationwide population-based cohort. Cancer Epidemiology, Biomarkers & Prevention, 29(7), 1341-1347.
Sample Answer 7 for NURS 6521 Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders
Hello Ruth! This is an in-depth and exceptional post about the case study. I agree with you that the patient is experiencing peri-menopausal symptoms. There are myriad treatment options for patients experiencing menopause, which usually depend on the seriousness of the symptoms. One of the treatment options that can be applied in this case is hormone replacement therapy to assist in replacing the lost estrogen and managing the symptoms of menopause (Cagnacci & Venier, 2019). Hormone replacement therapy is crucial in averting osteoporosis, lowering vasomotor symptoms, and preventing bone degeneration. It is important for the healthcare provider to collect a host of information before starting this treatment including data on BP, cardiovascular and breast screening, lipid panel, TSH, and HR. Reduction in estrogen is associated with bone degeneration and an increase in cardiovascular issues (Biglia et al., 2019). Therefore, the patient should be educated on the benefits of reducing weight, intake of sufficient calcium and Vitamin D, and avoidance of alcohol. The patient should also be educated on the benefits of consistently receiving mammograms due to her family history of breast cancer.
References
Biglia, N., Bounous, V. E., De Seta, F., Lello, S., Nappi, R. E., & Paoletti, A. M. (2019). Non-hormonal strategies for managing menopausal symptoms in cancer survivors: an update. ecancermedicalscience, 13. Doi: 10.3332/ecancer.2019.909
Cagnacci, A., & Venier, M. (2019). The controversial history of hormone replacement therapy. Medicina, 55(9), 602. https://doi.org/10.3390/medicina55090602
Sample Answer 8 for NURS 6521 Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders
This is an in-depth and exceptional post about the case study. Indeed, compounded hormone therapy is suitable for this patient. However, this treatment option should be administered with caution because the patient has a history of breast cancer. Prescription of hormones such as estrogen may lead to edema and the patient is already on HCTZ because she is experiencing HTN (Biglia et al., 2019). I would also suggest the use of antidepressants to address the issues of night sweats and hot flashes. Since the patient has a history of ASCUS, she should consider frequent PAP smear exams. The patient should also go for frequent checking of cholesterol to evaluate her risk of cardiovascular diseases, which is common among women experiencing menopause (El Khoudary et al., 2020). Controlling weight is crucial among overweight women and can potentially reduce incidences of hot flashes. Therefore, it is important to educate the patient about healthy nutrition, the need for physical activities and exercise, and the consumption of low sodium.
References
Biglia, N., Bounous, V. E., De Seta, F., Lello, S., Nappi, R. E., & Paoletti, A. M. (2019). Non-hormonal strategies for managing menopausal symptoms in cancer survivors: an update. ecancermedicalscience, 13. Doi: 10.3332/ecancer.2019.909
El Khoudary, S. R., Aggarwal, B., Beckie, T. M., Hodis, H. N., Johnson, A. E., Langer, R. D., … & American Heart Association Prevention Science Committee of the Council on Epidemiology and Prevention; and Council on Cardiovascular and Stroke Nursing. (2020). Menopause transition and cardiovascular disease risk: Implications for timing of early prevention: a scientific statement from the American Heart Association. Circulation, 142(25), e506-e532. https://doi.org/10.1161/CIR.0000000000000912
Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders
As an advanced practice nurse, you will likely experience patient encounters with complex comorbidities. For example, consider a female patient who is pregnant who also presents with hypertension, diabetes, and has a recent tuberculosis infection. How might the underlying pathophysiology of these conditions affect the pharmacotherapeutics you might recommend to help address your patient’s health needs? What education strategies might you recommend for ensuring positive patient health outcomes?
For this Discussion, you will be assigned a patient case study and will consider how to address the patient’s current drug therapy plans. You will then suggest recommendations on how to revise these drug therapy plans to ensure effective, safe, and quality patient care for positive patient health outcomes.
To Prepare:
- Review the Resources for this module and reflect on the different health needs and body systems presented.
- Your Instructor will assign you a complex case study to focus on for this Discussion.
- Consider how you will practice critical decision making for prescribing appropriate drugs and treatment to address the complex patient health needs in the patient case study you selected.
By Day 3 of Week 9
Post a brief description of your patient’s health needs from the patient case study you assigned. Be specific. Then, explain the type of treatment regimen you would recommend for treating your patient, including the choice or pharmacotherapeutics you would recommend and explain why. Be sure to justify your response. Explain a patient education strategy you might recommend for assisting your patient with the management of their health needs. Be specific and provide examples.
You will respond to your colleagues’ posts in Week 10.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!
By Day 6 of Week 10
Read a selection of your colleagues’ responses from Week 9 and respond to at least two of your colleagues on two different days who were assigned a different patient case study, and provide recommendations for alternative drug treatments to address the patient’s pathophysiology. Be specific and provide examples.