NURS 6521 Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

NURS 6521 Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

HH is a 68 yo M who has been admitted to the medical ward with community-acquired pneumonia for the past 3 days. His PMH is significant for COPD, HTN, hyperlipidemia, and diabetes. He remains on empiric antibiotics, which include ceftriaxone 1 g IV qday (day 3) and azithromycin 500 mg IV qday (day 3). Since admission, his clinical status has improved, with decreased oxygen requirements. He is not tolerating a diet at this time with complaints of nausea and vomiting.

The 2010 IOM report had four key messages or recommendations for nurses to position themselves strategically in healthcare provision. Firstly, the report stresses the need for nurses to practice to the fullest level of their education and training without any hindrances imposed by state boards of nursing. The message influences nursing practice as it means that nurses should be barred from practicing what they have trained on in different specialties (Price & Reichert, 2018). Secondly, the report asserted that nurses should engage in lifelong learning to acquire higher levels of education and training based on a better education system. The message means that the nursing practice requires professional nurses to engage in continual professional de

NURS 6521 Discussion Women’s and Men’s Health, Infectious Disease and Hematologic Disorders

NURS 6521 Discussion Women’s and Men’s Health, Infectious Disease and Hematologic Disorders

velopment to attain the latest skills and knowledge in healthcare provision, especially the deployment of technology.

Allergies: Penicillin (rash)

Community acquired pneumonia is pneumonia that is obtained outside of the hospital; the most common symptom is a cough that makes sputum, also chest pain, chills, fever, and shortness of breath are also common.  Pneumonia is diagnosed by a provider, during a work up the provider listens to lungs with a stethoscope and by reading x-rays or CT scans of the chest (Sehti, at.el).  This patient is older in age and has multiple comorbidities.  I would request medical records from the primary care providers office to see what medications the patient is prescribed to control the comorbidities listed above.  I would ask the patient if home oxygen were ever used.  I would include the patient in the treatment plan.  I would ask the patient the name and schedule of the medications he takes daily.   Empiric antibiotics are medications that are given for an unknown cause of infection another phrase is called broad spectrum antibiotics.  A sputum sample would be obtained and once the results came back stating the type of infection then direct therapy would begin with the antibiotic that treats that specific infection.  With excluding penicillin since that patient has a documented allergy to this medication.  Weaning this patient completely off oxygen successfully with the goal between 88-93% room air would be a great start for a COPD patient.  Since this patient has a decreased appetite because of nausea and vomiting I would add an as needed medication Zofran intravenously to the medication list with a medication to help boost appetite for example Megace.  FYI Zofran side effect are dizziness, headache, and diarrhea (Rosenthal, L. D., & Burchum, J, R. 2021 pg. 605).  A consult would be ordered for dietary to consult with this patient for a healthy diet.  Obesity is a risk factor especially for this patient that has multiple health risks and currently has lack of energy to complete daily ADL’s.  The discharge plan for this patient would be to continue to take prior prescribed medications for HTN, HLD, and DM.  The new added medications would be to take azithromycin 500 mg daily by mouth with breakfast for 7 days.  Zofran by mouth as needed for nausea every 6 hours.  Encouragement to continue being active whether that means small brisk walks in the neighborhood or light cardio exercises at home.  Anything that gets the heart rate up to maintain healthy activity to help promote a healthy weight, healthy health.  

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Reference:

 

Sethi, Sanjay (2020). What is community acquired pneumonia? Retrieved from https://www.msdmanuals.com

 

 

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

Main Post

Advanced Pharmacology

The health needs of the patient include nutritional status, hydration status, and length of the IV antibiotic treatment.

NURS 6521 Discussion Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

NURS 6521 Discussion Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

The patient is not tolerating diet as indicated by nausea and vomiting. Nausea and vomiting may be due to side effects of the antibiotic (Mohsen et al., 2020) or due to undiscovered conditions. It is therefore important to further evaluate the patient to determine the cause of nausea and vomiting. Moreover, since the patient has been vomiting, it is essential to ensure that he is well hydrated to prevent hydration. Additionally, keeping him hydrated will loosen up secretions and thus ease breathing. The period of IV antibiotic treatment also needs to be addressed. According to Metlay et al (2019) patients with community-acquired pneumonia who are hospitalized should be treated with empiric antibiotics for five to seven days. By the 5th to the 7th-day patients being administered with empiric antibiotics need to be evaluated to determine the course of action.

For the treatment regimen, the patient should continue with the current antibiotic until the 7th day. He should be re-evaluated before discontinuing the antibiotics. The antibiotic needs not be changed because the patient is already improving. However, if he is unable to drink, he needs to be started on IV fluid replacement therapy with normal saline 0.9 at 75 ml/hr. The patient’s home medications should be reconciled, especially the COPD medication in order to prevent COPD exacerbation. Sliding-Scale Insulin (SSI) should be used to treat diabete. (Gosmanov et al., 2020).

For patient education, he needs to be advised to take metoclopramide before eating to prevent nausea and vomiting. The patient will also be encouraged, educated, and shown how to use an incentive spirometer (IS). IS helps ease breathing (Sum et al., 2019). Additionally, since the patient is an older adult, he is venerable to community-acquired pneumonia and thus he should be advised to get a pneumonia vaccine before discharge and always ensure his pneumonia vaccine is up-to-date. This will reduce the risk of recurrent pneumonia (Quinton et al., 2018).

 

References

Gosmanov, A. R., Mendez, C. E., & Umpierrez, G. E. (2020). Challenges and Strategies for Inpatient Diabetes Management in Older Adults. Diabetes spectrum: a publication of the American Diabetes Association, 33(3), 227–235. https://doi.org/10.2337/ds20-0008

Metlay, J. P., Waterer, G. W., Long, A. C., Anzueto, A., Brozek, J., Crothers, K., Cooley, L. A., Dean, N. C., Fine, M. J., Flanders, S. A., Griffin, M. R., Metersky, M. L., Musher, D. M., Restrepo, M. I., & Whitney, C. G. (2019). Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. American journal of respiratory and critical care medicine, 200(7), e45–e67. https://doi.org/10.1164/rccm.201908-1581ST

Mohsen, S., Dickinson, J. A., & Somayaji, R. (2020). Update on the adverse effects of antimicrobial therapies in community practice. Canadian family physician Medecin de famille canadien, 66(9), 651–659.

Quinton, L. J., Walkey, A. J., & Mizgerd, J. P. (2018). Integrative Physiology of Pneumonia. Physiological Reviews, 98(3), 1417–1464. https://doi.org/10.1152/physrev.00032.2017

Sum, S. K., Peng, Y. C., Yin, S. Y., Huang, P. F., Wang, Y. C., Chen, T. P., Tung, H. H., & Yeh, C. H. (2019). Using an incentive spirometer reduces pulmonary complications in patients with traumatic rib fractures: a randomized controlled trial. Trials, 20(1), 797. https://doi.org/10.1186/s13063-019-3943-x

Week 9 Discussion

COLLAPSE

Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

From the presented case scenario, the 46-year-old female patient complains of hot flushing, night sweats, and genitourinary symptoms. She has a history of breast cancer and HTN. The patient also has a history of ASCUS about 5 years ago on her pap, other than that, Pap smears have been normal. Based on the presented description of symptoms and the patient’s age and sex, the possible diagnosis is menopause. Before recommending this diagnosis, it would be important for the provider to ask more questions concerning the symptoms and also conduct several diagnostic tests that would rule out other diseases that mimic menopause.

Menopause is a natural biological process that marks the end of a woman’s menstrual cycles. The condition mostly begins when a person in more than 45 years. According to the presented scenario, it illustrates that the patient is likely to be in the early stages of menopause since she is 46 years old. The treatment for this condition mainly focuses on relieving the symptoms as well as managing chronic conditions that may occur with aging. The recommended treatment, in this case, could include hormone therapy, low-dose antidepressants, gabapentin, clonidine, and vaginal estrogen. Estrogen therapy would be essential in relieving menopausal hot flashes (Fait, 2019). The dosage will be low to prevent severe side effects. Low-dose antidepressants related to SSRI would also decrease menopausal hot flashes (Johnson, Roberts & Elkins, 2019). Clonidine will be used to treat high blood pressure, considering that the patient has a BP of 150/90, which is considered high.

Concerning patient education, the patient should have adequate knowledge on the adherence of the recommended dosage to avoid the emergence of severe side effects. Besides, the patient should report back to the hospital within the recommended time for an effective follow up. Lastly, the patient should be educated on home remedies that would ease the symptoms. Such remedies include getting enough sleep, cooling hot flashes by drinking a cold glass of water, eating a balanced diet, and exercising regularly to attain the recommended body weight (Roberts & Hickey, 2016).

References

Fait, T. (2019). Menopause hormone therapy: latest developments and clinical practice. Drugs in context, 8.

Johnson, A., Roberts, L., & Elkins, G. (2019). Complementary and alternative medicine for menopause. Journal of evidence-based integrative medicine, 24, 2515690X19829380.

Roberts, H., & Hickey, M. (2016). Managing the menopause: An update. Maturitas, 86, 53–58. https://doi-org.ezp.waldenulibrary.org/10.1016/j.maturitas.2016.01.007

Initial Post

COLLAPSE

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

Week 9 Discussion

COLLAPSE

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 

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.

Response

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