Response to a peers discussion (Positive response please)

Week 9: Womens andMens Health/Infections and Hematologic Systems, Part I

As an advanced practice nurse, you will likelyencounter many disorders associated with womens and mens health, such ashormone deficiencies, cancers, and other functional and structuralabnormalities. Disorders such as these not only result in physiologicalconsequences but also psychological consequences, such as embarrassment, guilt,or profound disappointment for patients. For these reasons, theprovider-patient relationship must be carefully managed. During evaluations,patients must feel comfortable answering questions so that you, as a keyhealth-care provider, will be able to diagnose and recommend appropriatetreatment options. Advanced practice nurses must be able to educate patients onthese disorders and help relieve associated stigmas and concerns.

This week, you examine womens and mens healthconcerns as well as the types of drugs used to treat disorders that affectwomens and mens health. You also explore how to treat aspects of thesedisorders on other health systems.

You willneed to respond to 2 colleagues who were assigned a different patient casestudy, and provide recommendations for alternative drug treatments to addressthe patients pathophysiology. Be specific and provide examples 

This is my peers post!

Monique Walen 

Case study 2

Case Study 2

A 46-year-old, 230lb woman with a family historyof breast cancer.  She is up to date on yearly mammograms.  She has ahistory of HTN.  She complains of hot flushing, night sweats, andgenitourinary symptoms.  She had felt well until one month ago and she presentedto her gynecologist for her annual GYN examination and to discuss hersymptoms.  She has a history of ASCUS about 5 years ago on her pap. otherthan that, Pap smears have been normal.  Home medications are Norvasc 10mgQD and HCTZ 25 mg QD.  Her BP today is 150/90.  She has regularmonthly menstrual cycles.  Her LMP was 1 month ago.

The patient inthe case study presents with both vasomotor and genitourinary symptoms ofmenopause.  Her vasomotor symptoms are hot flushing and night sweats whilegenitourinary symptoms can include vaginal dryness, pain with intercourse(dyspareunia), incontinence, urinary frequency, and urinary tractinfections.  Although menopause with related estrogen loss usually startsaround age 51 and 52 years of age, 95% of women between the ages of 45 and 55years of age enter menopause around this time(Burchum & Rosenthal,2021)  The patient is hypertensive and takes Norvasc and HCTZ every day,she is overweight, and her BP is elevated at 150/90.

Thecontraindications for estrogens are that they can increase the risk for stroke,deep vein thrombosis, myocardial infarction, and pulmonary embolism(Burchum& Rosenthal, 2021)  The patient would have to be monitored to help herreduce her individual risk.  She already gets annual mammograms and Papsmears, so continuous education about diet, exercise, and adhering tomedication regimen should be standard at her wellness visits.  Lifestylemodification while on hormone therapy education should include smokingcessation, diet, exercise, and reduced alcohol consumption. Regarding her newsymptoms, which are common during the transition to menopause, taking hormonetherapy will help improve the vasomotor and genitourinary symptoms she hascomplaints of since she has no contraindications.  The dose, timing, androute of estrogen therapy should be individualized to the patient depending onthe problematic symptoms.  The delivery mode of estrogen is very importantas low-dose transdermal estrogen is connected to a lower risk of stroke, deep veinthrombosis, and cholecystitis, which is in contrast to oral estrogens(Newson,2016)

To keep thepatients risks low, hormonal therapy should be initiated at the lowest dosethat is needed for the shortest amount of time- duration can last up to 4years(Roberts & Hickey, 2016)  The patient still has her uterus, soshe could be prescribed combination therapy with estrogen and progesterone butunfortunately, she has a family history of breast cancer and the addition ofprogestogen increases her breast cancer risk.  I would have the patientstart on a low-dose estradiol transdermal patch, such as  Menostar 14 ug,once weekly.  Transdermal estrogen lowers the risk of thromboembolicevents and would help treat genitourinary symptoms.  For the vasomotorsymptoms, I would suggest the patient take an SSRI such as escitalopram (Lexapro)10mg/day.  Management of the patient would include baseline data such asVital signs to include weight, pregnancy test, and lab work: TSH, lipidpanel(Burchum & Rosenthal, 2021)  The decision to use hormone therapyis based on the patients perceived benefits, and treatment for less than 5years provides the greatest risk-benefit ratio in most patients(Roberts &Hickey, 2016)

References

Burchum, J.,& Rosenthal, L. (2021). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses andPhysician Assistants (2nd ed.). Elsevier, Inc.

Newson, L. R.(2016). Best practice for HRT: unpicking the evidence. British Journal of General Practice, 66(653), 597598. 

Roberts, H.,& Hickey, M. (2016). Managing the menopause: An update. Maturitas, 86, 5358. 

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