wk 7 discussion replies
1. Case Scenario 1
Table 1
Define: |
|
Perimenopause |
“Period preceding final menstrual period by 8–10 years, usually occurring between 48 and 55 years of age” (Alexander, 2027). |
Menopause |
“Point in time occurring 12 consecutive months after natural cessation of menses, 51 years” (Alexander, 2027). |
Postmenopause |
“Period following menopause, commonly associated with symptoms attributable to waning estrogen and progesterone levels” (Alexander, 2027). |
S/S menopause |
Cause -How does it occur/ how does it relate to menopause |
Recommendations |
Example: Decrease libido |
Lower levels of testosterone |
Having a conversation with partner, setting the mood |
Hot flashes |
An effort to dissipate heat by means of vascular dilation (Alexander, 2017). Increased FSH and estrogen that is lowered. |
Try to maintain a healthy weight, avoid spicy foods and alcohol, and dress in layers that can be easily removed (Alexander, 2017). |
Night sweats and Sleep Disturbance |
Estrogen and progesterone can cause unpleasant temperatures (Casper 2024). |
Wear loose fitting pajamas such as cotton, sip cold water through the night, exercise during the day (Casper, 2024). |
Irregular menses |
Inconsistent levels of estrogen (Welt, 2024) |
Hormone therapy such as estrogen or progesterone to balance the hormones (Welt, 2024). |
Mood swings or irritability |
Falling of estrogen and progesterone can also cause serotonin levels to fall (Barbieri, 2024). |
Exercise, diet, rest, and support from loved ones (Barbieri, 2024). |
Vaginal dryness |
The body does not produce enough estrogen (Bachmann, 2024). |
Vaginal moisturizers, lubricants, estrogen ring, and estrogen cream (Bachmann, 2024). |
Barbara is 48-year-old female who complains her menstrual cycle has recently become irregular, and she is experiencing hot flashes and vaginal dryness. She has also noticed a decrease in her desire for sex lately. She has been married to a man for 20 years, is in a stable relationship, and has two daughters ages 16 and 18. She is otherwise healthy with an unremarkable medical history. Her pregnancy test is negative. Her Pap smear and STI panel are all negative.
Case 1
Subjective:
Chief Complaint: 48 y/o menstrual irregularity, hot flashes, and vaginal dryness.
HPI: 48 y/o female presents to the clinic for menstrual irregularity, hot flashes, and vaginal dryness. She admits to have experiencing hot flashes x4 months. Admits that the vaginal dryness has been increasing. Reports that the menstrual irregularity includes frequency of menstrual cycle lasting 4-5 days every 22 days vs 7 days every 28 days. Now that cycles are irregular menstrual cramps are a factor. Reports that her desire in sexual activity is decreasing. Endorses that because of experiencing low libido vaginal dryness is not of much concern in that department, but it is uncomfortable. She states that in times her occupation as a teacher can be stressful due to dealing with both children and parents on a day to day. She is happily married of 20 years with 2 daughters. Denies mood swings and sleep disturbance.
PMH: Unremarkable
LMP: 01.2024
Age of Menopause:
Pregnancies: 2
Miscarriage: 0
Past Surgical Hx: No Surgical Hx
Allergies: NKA
Family Hx:
Daughter, 16, Alive
Daughter, 18, Alive
Husband, 49, Diabetes
Mother, 67, Alive, Hypothyroidism
Father, 69, Alive, HTN
Maternal Grandmother, 90, Alive, Breast Cancer
Maternal Grandfather, 91, Alive, CKD
Paternal Grandmother, 93, Alive, Liver Disease
Paternal Grandfather, 95, Alive, Parkinson’s
Social Hx:
Married – 20 years
Occupation – School Teacher
Alchohol – 1 glass of wine per week
Tobacco Use – No hx of smoking
Substance Abuse – No hx of substance abuse
Subjective Data:
- What other medical history questions should you ask? Have you been treated for menopause? No, I have not. What medications are you currently taking? I am not on any medications. Have you gotten a recent set of labs? I went to have my labs drawn by my PCP, but I don’t believe that my other labs got drawn. Do these labs include hormone levels? No. Have you utilized oral contraceptives? Yes, many years ago. I used to take an Oral Contraceptive.
- What other social history questions should you ask? Do you practice safe sex? Yes, condom use. Do you practice stress relieving exercises? Yes, I attend a weekly cycle class.
- What other family history questions should you ask? At what age did your mom start menopause? 44 Did she experience the same symptoms? Yes
- General/Constitutional:
- Admits to irregular menstrual cycle x4 months. Admits to hot flashes. Admits to low libido. Admits to vaginal dryness.Denies malaise, weakness, fever, or chills. Denies recent weight gains or losses of >20 pounds over the last 6 months.
- Cardiovascular:
- Denies chest discomfort, heaviness, or tightness. Denies abnormal heartbeat or palpitations. Denies shortness of breath, denies having to sleep elevated on 2 pillows or more, no swelling of the feet, no passing out or nearly passing out. Denies history of heart attack or heart failure.
- Respiratory:
- Denies cough, phlegm production, coughing up blood, wheezing, sleep apnea, exposure to inhaled substances in the workplace or home, no known exposure to TB or travel outside the country. Denies history of asthma, COPD/emphysema, or any other chronic pulmonary disease.
- Gastroinestinal:
- Denies nausea, vomiting, abdominal discomfort/pain. Denies diarrhea, constipation, blood in the stool or black stools. Denies hemorrhoids, trouble swallowing, heartburn or food intolerance. Denies history of liver or gallbladder disease. No recent weight gains or losses of > 20 pounds within the last year.
- Skin and Breasts:
- Denies rash, itching, abnormal skin, or recent injury. Denies breast pain, discharge, or other abnormality was reported by the patient.
- Genitourinary:
- Denies Abdominal pain/swelling. Denies Blood in urine. Denies Difficulty urinating. Denies Frequent urination. Denies Pain in lower back.Denies Painful urination
- Women Only:
- Admits to irregular menstrual cycle x4 months to 4-5 days every 22 days vs 7 days every 28 days. Admits to filling up 3 pads in 24 hours daily. Admits to hot flashes. Admits to low libido. Admits to vaginal dryness
- Mental Status/Psychiatric:
- Denies history of depression or anxiety. Denies difficulty sleeping, persistent thoughts or worries, decrease in sexual desire, abnormal thoughts, visual or auditory hallucinations. Denies history of psychosis or schizophrenia. Denies difficulty concentrating or change in memory.
- Up to date on all Immunization
- Endorses a male sexual partner of 20 years
Objective:
VS: BP: 108/72, HR: 67, RR: 18, Temp: 98.3,O2 Sat: 98%, HT 5’10 inches WT: 165lb
Physical Exam:
- General: Alert and Oriented x4, speaks clearly and comfortably throughout.
- RESP: lungs clear to auscultation bilaterally, no rales, wheezes, or rhonchi, nonlabored breathing, no use of accessory of muscles of respiration.
- CV: RRR
- BREAST: (-) erythema, (-) symmetric at rest, (-) symmetric with pectoral tension, (-) tender to palpation
- Urethral meatus: (-) lesions, (-) erythematous, (-) discharge, (-) tender
- Bladder: normal, (-) tender, (-) cystocele
- Vagina: (+) dryness, (-) moist (-) discharge, (-) lesions
- Cervix: (-) lesions, (-) discharge, (-) contact bleeding,
- Uterus: (-) enlarged (-) tender
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