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

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

NURS 6521 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.

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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. Medicine95(32).

Mahady, G. B., Fabricant, D., Chadwick, L. R., & Dietz, B. (2002). Black cohosh: an alternative therapy for menopause?. Nutrition in Clinical Care5(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 Med374(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 & Metabolism100(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 & Prevention29(7), 1341-1347.

Response 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. ecancermedicalscience13. Doi: 10.3332/ecancer.2019.909

Cagnacci, A., & Venier, M. (2019). The controversial history of hormone replacement therapy. Medicina55(9), 602. https://doi.org/10.3390/medicina55090602

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.

Resources

 

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEK 9 RESOURCES

WEEK 10 RESOURCES

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.

 

 

In this Case study, a 46-year-old patient comes to the clinic with complaints of night sweats, hot flushing, and genitourinary problems. The patient presents with signs of menopause. Headaches sleep issues, mood swings, vasomotor symptoms including hot flashes and night sweats, and anxiety may occur throughout this time because of the decreased ovarian activity and fluctuations of hormone levels (Taebi et al., 2018). Patient also presents a history of ASCUS, which is atypical cells found in the tissue lining the cervix’s outer portion. ASCUS can be a sign of low hormone levels, which may occur in menopausal women.  According to a 2018 study, the incidence of ASCUS was highest in women who were menstruation normally (Misra et al., 2018)

The diagnosis of perimenopause would be given to this patient. For women experiencing perimenopausal and menopausal symptoms, Hormonal Replacement Therapy (HRT) is thought to be an appropriate treatment option. However, the patient has hypertension as well as a family history of breast cancer. A treatment plan should be personalized based on the patient’s past medical history, Thus, HRT would not be beneficial for this patient as it increases the risk of breast cancer and increases blood pressure.

The treatment plan would be to manage the patient’s symptoms. Since we are avoiding HRT, antidepressants would be prescribed to reduce night sweats and improve vasomotor symptoms. SSRIs would be prescribed to help manage the patient’s symptoms, such as Citalopram. Non-hormonal medications such as clonidine, gabapentin, pregabalin, and antidepressants may be a significant effective therapy for vasomotor symptoms (Karanth et al., 2019). To treat her genitourinary symptoms, transdermal estrogen therapy would be beneficial, which is applied directly on the skin and easily absorbs the hormone in systemic circulation. This would be a safer option for such high-risk patients as a transdermal patch bypasses the first pass effect and makes the blood estrogen levels lower than oral administration. A low dose of estrogen would suffice with topical administration.

Side effects and benefits should be discussed with the patient before prescribing the medications. Education on the side effects of Citalopram, such as dizziness, sleepiness, and headache, will be provided. Also, the patient would be educated on adhering to both medication regimens to improve her symptoms over time. The patient will also be educated on monitoring her blood pressure and reporting any adverse effects.

 

Taebi, M., Abdolahian, S., Ozgoli, G., Ebadi, A., & Kariman, N. (2018, July 6). Strategies to improve menopausal quality of life: A systematic review. Journal of education and health promotion. Retrieved January 23, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6052783/

Misra, J. S., Srivastava, A. N., & Zaidi, Z. H. (2018). Cervical cytopathological changes associated with onset of Menopause. Journal of mid-life health. Retrieved January 23, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6332728/

Karanth, L., Chuni, N., & Nair, N. S. (2019, September 12). Antidepressants for menopausal symptoms. The Cochrane Database of Systematic Reviews. Retrieved January 24, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6739239/

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