—Lynn Goddess, Founder of the Hazel K. Goddess Fund for Stroke Research in Women

Stroke is among the leading causes of death for women in the United States (CDC, 2008b). This common health condition has severe implications for women, yet it is frequently misdiagnosed because the female presentation of stroke often differs from the typical recognized male presentation. Like stroke, many other common cardiovascular and neurologic health conditions also present differently and progress differently in women. As an advanced practice nurse providing care for women, you must be able to quickly identify the unique signs and symptoms of these common health conditions in women.

This week you examine common cardiovascular and neurologic conditions that impact women. You consider differential diagnoses, treatment and management plans, and patient education strategies for women with these conditions. You also examine the Women’s Health Initiative study and research current best practices for assessing and managing common health conditions in women.

Learning Objectives – Case Study: Elderly Patient with Intermittent Chest Pain

By the end of this week, students will:

• Assess patients with common cardiovascular and neurologic conditions
• Evaluate differential diagnoses for common cardiovascular and neurologic conditions
• Analyze treatment and management plans for patients with common cardiovascular and neurologic conditions
• Analyze strategies for educating patients on the treatment and management of common cardiovascular and neurologic conditions
• Compare the diagnosis and management of female and male patients with the same conditions
• Evaluate best practices for assessing and managing conditions related to women’s health
• Evaluate the impact of differences in best practices on women’s health
• Understand and apply key terms, principles, and concepts related to common health conditions with implications for women
• Evaluate body system conditions

Learning Resources

Required Readings

Tharpe, N. L., Farley, C., & Jordan, R. G. (2017). Clinical practice guidelines for midwifery & women’s health (5th ed.). Burlington, MA: Jones & Bartlett Publishers.

• • Chapter 8, “Primary Care in Women’s Health” (pp. 457-616)

This chapter explores health promotion and disease prevention in women’s health. It also describes the presentation, assessment, diagnosis, and management of various systemic conditions, including cardiovascular and neurologic conditions.

McSweeney, J. C., Pettey, C. M., Souder, E., & Rhoads, S. (2011). Disparities in Women’s cardiovascular health. Journal of Obstetric, Gynecologic & Neonatal Nursing, 40(3), 362–371.

This article explores health disparities in cardiovascular disease, including gender and racial disparities related to the diagnosis, treatment, and outcomes of patients with this disease.

Department of Health and Human Services, National Institutes of Health, & National Heart, Lung, and Blood Institute. (n.d.). Women’s Health Initiative: WHI background and overview. Retrieved March 20, 2013, from http://www.nhlbi.nih.gov/whi/background.htm

This website outlines details of the Women’s Health Initiative (WHI) and introduces the various health issues addressed by the WHI.

Optional Resources – Discussion: Diagnosing and Managing Common Cardiovascular and Neurologic Conditions

Centers for Disease Control and Prevention. (2012b). Women’s health. Retrieved from http://www.cdc.gov/women/

National Institutes of Health. (2012). Office of Research on Women’s Health (ORWH). Retrieved from http://orwh.od.nih.gov/

U.S. Department of Health and Human Services. (2012a). Womenshealth.gov. Retrieved from http://www.womenshealth.gov/

Discussion: Diagnosing and Managing Common Cardiovascular and Neurologic Conditions

Cardiovascular and neurologic conditions are among the leading causes of death and hospitalization of women in the United States (Centers for Disease Control and Prevention, 2008a). As an advanced practice nurse, you must routinely monitor patients at risk of these conditions and recommend the appropriate health screenings and preventive services. When assessing patients for these conditions, it is important to keep in mind that while some female patients might present with typical signs and symptoms, others might present with atypical signs and symptoms that are unique to women. For this Discussion, consider signs and symptoms presented by the women in the following case studies and develop differential diagnoses:

Case Study 1

A 48-year-old overweight African American female is in the clinic for a wellness visit. A routine fasting lipid panel returned with the following results:

• Total cholesterol: 305 mmol/L
• Low-density lipoprotein (LDL): 180 mg/dl
• High-density lipoprotein (HDL): 30 mg/dl
• Triglycerides: 165 mg/dl

Case Study 2

You are seeing a 63-year-old African American female for a two-week history of intermittent chest pain. The pain varies in intensity and resolves with rest. She does not believe it has increased over time. She is a nonsmoker with a history of hypertension treated with Lisinopril 10 mg once daily. She had an exercise stress test one year ago that was within normal limits. Her physical exam findings are as follows: HR–90, BP–150/92, R–22, O2Sat 98% RA; lungs: clear to auscultation bilaterally; cardiovascular: apical pulse of 90 RRR, no rubs, murmurs, or gallops. Chest wall mildly tender to palpation that reproduces her complaint of pain. Extremities include no clubbing, cyanosis, or edema. The remainder of the exam is within normal limits.

Case Study 3

A 32-year-old Asian American female is in the clinic for a history of recurrent headaches for the past year, occurring monthly, lasting up to 12–18 hours. The headaches are sometimes associated with photophobia, nausea, and vomiting. She takes either acetaminophen or ibuprofen for relief that is not always successful. She uses Ortho Tricyclin for birth control. Her physical exam is within normal limits.

To prepare:

• Review Chapter 8 of the Tharpe et al. text and the McSweeney et al. article in this week’s Learning Resources.
• Review and select one of the three provided case studies. Analyze the patient information.
• Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.
•  
• Reflect on the appropriate clinical guidelines. Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.
• Consider strategies for educating patients on the treatment and management of the disorder you identified as your primary diagnosis.

By Day 3

Post an explanation of the differential diagnosis for the patient in the case study you selected. Explain which is the most likely diagnosis for the patient and why. Then, based on the appropriate clinical guidelines, explain a treatment and management plan for the patient, including proper dosages for any recommended treatments. Finally, explain strategies for educating patients on the disorder.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who selected different case studies than you did. Keep in mind the conditions your colleagues identified as their primary diagnoses. Explain signs and symptoms of these conditions that are unique to women or are more commonly seen in women. Then, explain how the assessment, diagnosis, treatment, and management of female patients might differ from male patients with the same conditions.

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 “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit! Case Study: Elderly Patient with Intermittent Chest Pain.