Have you taken any other measures to become pregnant?

Use at least 2 scholarly sources other than your textbook to connect your response to national

guidelines and evidence-based research in support of your ideas.

Please reply with the case discussed below.

22yo female with irregular menses

Subjective data: The patient states that she has an irregular menstrual cycle, and that she has been trying to get pregnant for 18 months so far.

Additional questions to ask this patient:

1. What other past medical history do you have?

2. What medications do you take? Supplements?

3. Have you ever had an abortion?

4. When was the last time you had hormonal birth control?

5. How often have you had your menstrual cycle in the last year?

6. Describe irregular, is your cycle frequent or infrequent?

7. How heavy is your typical menstrual flow?

8. What symptoms do you experience when you have your cycle?

9. Do you have spotting in between cycles?

10. You state that you have been actively trying to get pregnant for the last 18 months, how often during this time frame have you been sexually active?

11. What is your diet typically like?

12. How active are you? Do you exercise regularly?

13. How much sleep do you typically get?

14. What is your job like?

15. Is your stress well managed?

16. Have you taken any other measures to become pregnant?

Objective data: patient is a 22 year old female who presents as significantly overweight with vital signs as follows: BP 138/91, Heart rate 94, Respirations 18, SpO2 94%, temperature 97.9*F. Patient denies pain at this time. Patient presents with significant acne on her face and facial hair. Abdomen is soft and non-tender on palpation, no lumps masses or distention noted. Bowel sounds present in all 4 quadrants.

Assessment:

Differential Diagnoses:

1. Endometriosis – pertinent positives include irregular menstrual cycle, spotting between cycles, infertility. Pertinent negative – patient reports no pain on urination/bowel movements and no nausea/vomiting associated with her cycle.

2. Pelvic Inflammatory Disease (PID) – pertinent positives include infertility. Pertinent negative includes no pain in her pelvic region, patient states she has only been sexually active with her partner in the last 24 months, patient has a normal temperature, no additional signs of infection.

3. Polycystic ovarian syndrome (PCOS) – pertinent positives include evidence of hormone disorders such as facial hair and acne, the risk factor of obesity, and irregular menstrual cycles causing infertility. Pertinent Negatives – none.

Working Diagnosis: PCOS

Plan: diagnostics to include a vaginal exam, transvaginal ultrasound and serum androgen, glucose tolerance test and triglyceride levels. If no recent pap smear has been performed that may be advisable to include in the vaginal exam. The plan for this patient would include encouraging weight loss as it is may improve her fertility if she reaches a normal goal weight. A weight loss and exercise plan of 1500-1800 kcal per day and moderate cardio exercise of 20-30 minutes every day should be outlined for the patient. Patient should be placed on Progestin and Clomid medication cycles to improve the patient’s menstrual cycle regularity and increase chances of her getting pregnant with regular cycles. Lastly, advise patient that it is important to engage in regular sexual activity in the weeks following her menstrual cycles as this is when she is most likely to get pregnant.

MayoClinic (2020) PCOS – Symptoms and Causes, Mayo Clinic. Retrieved April 15, 2020 from https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439

Womens Health (2020) Infertility, Women’s Health. Retrieved April 15, 2020 from https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439

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