This week, as you continue exploring common gynecologic conditions, you consider diagnosis, treatment, and management strategies for patients. You also explore ways to educate patients on these conditions.

Learning Objectives – NURS 6551: Week 5: Case Study: A Young Patient who has missed her Menstrual Period for 3 Months

By the end of this week, students will:

• Assess patients with common gynecologic conditions
• Evaluate differential diagnoses for common gynecologic conditions
• Analyze treatment and management plans for patients with common gynecologic conditions
• Analyze strategies for educating patients on the treatment and management of common gynecologic conditions
• Understand and apply key terms, principles, and concepts related to common gynecologic conditions
• Evaluate common gynecologic conditions in patients
• Analyze treatment modalities for common gynecologic conditions

Learning Resources 

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Schuiling, K. D., & Likis, F. E. (2017). Women’s gynecologic health (3rd ed.). Burlington, MA: Jones and Bartlett Publishers.

• • Chapter 24, “Normal and Abnormal Uterine Bleeding” (pp. 575-599)

This chapter differentiates normal uterine bleeding from abnormal and dysfunctional uterine bleeding. It also examines causes of abnormal bleeding and identifies assessment strategies for diagnosing and managing these conditions.

• • Chapter 25, “Hyperandrogenic Disorders” (pp. 603-618)

This chapter explores the etiology, clinical presentation, and impact of hyperandrogenic disorders. It also provides strategies for assessing, diagnosing, and managing patients with these conditions, including adolescents and pregnant women.

• • Chapter 26, “Benign Gynecologic Conditions” (pp. 621-652)

This chapter explains the incidence, presentation, assessment, and management of common benign gynecologic conditions. It also explores differential diagnoses for these conditions and types of treatment options.

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 7, “Care of the Woman with Reproductive Health Conditions”

• • • “Care of the Woman with Amenorrhea” (pp. 372-376)

This section differentiates between primary and secondary amenorrhea and describes treatment options for managing patients with this condition.

• • • “Care of the Woman with Abnormal Uterine Bleeding” (pp. 368-372)

This section explains the causes of dysfunctional uterine bleeding and recommends treatment options for managing this condition.

• • • “Care of the Woman with Endometriosis” (pp. 395-398)

This section identifies the prevalence of endometriosis in women. It also provides strategies for diagnosing, treating, and managing patients with this condition.

• • • “Care of the Woman with Fibroids” (pp. 398-401)

This section describes the classification of fibroids and their prevalence in women of childbearing age. It also presents methods for identifying, diagnosing, and treating this common benign tumor.

• • • “Care of the Woman with Polycystic Ovarian Syndrome” (pp. 433-437)

This section identifies the criteria for a polycystic ovarian syndrome diagnosis. It also presents treatment options for this disorder, including therapeutic options and alternative measures.

Optional Resources – NURS 6551: Week 5: Case Study: Patient bleeding in between her menstrual periods

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 Gynecologic Conditions

Gynecologic conditions can be difficult to diagnose for a variety of reasons, including overlapping symptoms, lack of patient knowledge, or even patient fear or embarrassment about sharing information. Your role provides you the opportunity to develop a relationship of trust and understanding with these patients so that you can gather the appropriate details related to medical history and current symptoms. When caring for this patient population, it is important to make these women an integral part of the process and work collaboratively with them to diagnose and develop treatment and management plans that will meet their individual needs. For this Discussion, consider diagnosis, treatment, and management strategies for the patients in the following four case studies:

Case Study 1:A 32-year-old African American female is concerned about increasing dysmenorrhea over the past three years. In the past year, this was associated with painful intercourse. She has been in a monogamous relationship with one male partner for the past five years. They tried to have children without success. Menarche was at age 10; menstrual cycles are 21 days apart and last for 6–7 days. The first day of her last menstrual period was 10 days ago and was normal. She denies vaginal itching or discharge. On gynecologic exam there was no swelling, external lesions, or erythema, urethral swelling, or vaginal discharge. Cervix is pink without lesions or discharge. Uterus was small, retroverted, and non-tender. Adnexa were small and non-tender. Nodules are noted along the cul de sac.

Case Study 2:A 42-year-old African American female is in the clinic for a routine gynecologic exam. When asked, she admits to noticing bleeding in between her menstrual periods for the past several months. She has been pregnant three times and has three children. She is sexually active with one male sex partner in a monogamous relationship. During her bimanual exam, you note an irregular intrauterine non-tender mass about 4 cm in diameter. The mass is palpable abdominally. The remainder of her gynecologic exam was normal.

Case Study 3:

A 48-year-old Caucasian female is in the clinic concerned about prolonged menstrual bleeding for three weeks now. Her prior menstrual periods have been irregular for the past eight months, lasting no more than three days each. There have been one to two months when she had no menstrual cycles at all. She reports occasional hot flushes and mood swings.

Case Study 4:

A 16-year-old Caucasian female comes to the clinic concerned because she has not had a menstrual period for three months. She’s a junior in high school and active in sports. She has lost about 10 lbs. in the past two months. She is currently 5 ft. 4 in. and weighs 100 lbs.

To prepare:

• Review Chapter 26 of the Schuiling and Likis text and Chapter 7 of the Tharpe et al. text.
• Review and select one of the four 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.
• 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 sexually transmitted infection 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. Provide a minimum of three possible diagnoses and list them from highest priority to lowest priority. Explain which is the most likely diagnosis for the patient and why. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patients on the disorder.

Read a selection of your colleagues’ responses.

By Day 6 Case Study: A Young Patient who has missed her Menstrual Period for 3 Months

Respond to at least two of your colleagues on two different days in both of the ways listed below. Respond to colleagues who selected different case studies than you did.

• Explain how missing information from the patient history might change the diagnoses for the patients in the case studies your colleagues selected.
• Based on your personal and/or professional experiences, expand on your colleagues’ postings by providing additional insights or contrasting perspectives.

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! NURS 6551: Week 5: Case Study: A Young Patient who has missed her Menstrual Period for 3 Months.

ADDITIONAL INFORMATION;

Evaluate common gynecologic conditions in patients

Introduction

Gynecologic conditions can be divided into two categories: benign and malignant. Benign gynecologic conditions are those that are non-cancerous (ie, they do not spread to other parts of the body). Examples include normal vaginal bleeding and an abnormal uterine fibroid, which is not cancerous. Malignant conditions are cancerous diseases that spread to other parts of your body as well as causing symptoms such as pain, itching or swelling in different areas of your body.

Abnormal vaginal bleeding

Abnormal vaginal bleeding is a common gynecologic condition that can be a symptom of a serious condition. It can be caused by hormonal changes, infection or abnormal growths (lesions).

Vaginal bleeding may be bright red or brownish in color and may appear on the underwear or bed sheets. Bleeding often occurs in small amounts at first but becomes heavier over time until it becomes constant with little to no blood loss. This can be accompanied by pain during menstruation which is usually localized to the lower abdomen area where uterine tissue meets skin and muscle layers.

Amenorrhea

Amenorrhea is the absence of menstrual periods. There are many reasons why a woman may have amenorrhea, including pregnancy, menopause and stress. However, it’s important to remember that amenorrhea is not a disease itself it’s just one symptom of another condition. If your doctor suspects an underlying medical issue as the cause for your lack of menstruation (or regular periods), they’ll likely recommend testing for it instead of treating symptoms alone.

Dysmenorrhea

• Dysmenorrhea is painful menstrual periods.

• The pain can be anywhere from mild to severe, and it may last anywhere from a few hours to several days.

The pain may be felt in the lower abdomen, back, or thighs. The cramps also can make you feel nauseous and dizzy. You might vomit during a painful menstrual period.

You may have a fever during menstruation. You might also notice bleeding from your vagina that is heavy or light. It can be dark brown or bright red.

Dyspareunia

You may have experienced painful sexual intercourse (Dyspareunia) if you have ever experienced the following:

• Painful sex

• Pain during penetration of the vagina or anus during sex.

One condition that can cause Dyspareunia is vaginismus, which is a muscle spasm in your pelvic floor muscles that prevents vaginal penetration. This can be caused by an anxiety disorder, depression, low self-esteem and many other factors that make it difficult for you to be intimate with another person. If these conditions are present then there are several treatments available including physical therapy and counseling sessions based on your needs and preferences as well as medications such as SSRI antidepressants which help reduce the symptoms associated with these disorders such as depression and anxiety disorders.”

Vaginitis/vulvovaginitis

Vaginitis is an inflammation of the vagina. It can be caused by a variety of factors, including bacterial or fungal infections or allergies. Symptoms include itching, burning and discharge.

Vulvovaginitis refers to infections in your vulva (the area between your labia). Symptoms include redness around your external sex organs as well as vaginal discharge and pain during sex. Treatment depends on what caused it; if you have been exposed to staphylococcus bacteria on your skin then antibiotics may help reduce symptoms over time while antifungal medications are used if you have been infected by Candida albicans or Trichomonas vaginalis

Leukorrhea

Leukorrhea is a discharge of white or yellowish mucus from the vagina. It can be caused by hormonal changes, infections, and irritation. Leukorrhea isn’t a disease in itself; it’s merely a symptom of an underlying condition.

When you have leukorrhea, it can be helpful to know what’s causing it. If a doctor suspects a bacterial infection, he or she may prescribe antibiotics.

If you’re experiencing leukorrhea, it’s important to see a doctor as soon as possible. Your physician can determine the cause of your symptoms and recommend treatment options.

Conclusion

The purpose of this article was to provide you with a list of common gynecologic conditions that may be encountered in your practice and how to evaluate each. We hope this will help when assessing a patient, so they can get the right treatment.