NURS 6521 Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

NURS 6521 Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

Sample Answer for NURS 6521 Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders Included After Question

As an advanced practice nurse, you will likely experience patient encounters with complex comorbidities. For example, consider a female patient who is pregnant who also presents with hypertension, diabetes, and has a recent tuberculosis infection. How might the underlying pathophysiology of these conditions affect the pharmacotherapeutics you might recommend to help address your patient’s health needs? What education strategies might you recommend for ensuring positive patient health outcomes? 

For this Discussion, you will be assigned a patient case study and will consider how to address the patient’s current drug therapy plans. You will then suggest recommendations on how to revise these drug therapy plans to ensure effective, safe, and quality patient care for positive patient health outcomes. 

RESOURCES 

 

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.  

WEEK 9 RESOURCES 

 

WEEK 10 RESOURCES 

To Prepare: 

  • Review the Resources for this module and reflect on the different health needs and body systems presented. 
  • Your Instructor will assign you a complex case study to focus on for this Discussion.Links to an external site. 
  • Consider how you will practice critical decision making for prescribing appropriate drugs and treatment to address the complex patient health needs in the patient case study you selected. 

BY DAY 3 OF WEEK 9 

Post a brief description of your patient’s health needs from the patient case study you assigned. Be specific. Then, explain the type of treatment regimen you would recommend for treating your patient, including the choice or pharmacotherapeutics you would recommend and explain why. Be sure to justify your response. Explain a patient education strategy you might recommend for assisting your patient with the management of their health needs. Be specific and provide examples. 

You will respond to your colleagues’ posts in Week 10. 

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 Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!  

BY DAY 6 OF WEEK 10 

Read a selection of your colleagues’ responses from Week 9 and respond to at least two of your colleagues on two different days who were assigned a different patient case study, and provide recommendations for alternative drug treatments to address the patient’s pathophysiology. Be specific and provide examples. 

A Sample Answer For the Assignment: NURS 6521 Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

Title: NURS 6521 Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

Case Study

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

Treatment Regimen

After analyzing the symptoms, I concluded that the patient is experiencing peri-menopausal symptoms. For many people, menopause begins around age 45 though the onset of symptoms varies across different people. She is undergoing the early stages of menopause which is a stage that begins with experiencing changes in the uterus, breasts, increased fat deposit, and the urogenital tract undergoing several changes such as a shrinking cervix, and reduced muscle tone in the pelvic area. At that age, the level of estrogen production is low hence, leading to hot flashes and night sweats. Therefore, her treatment regime will focus on taking into consideration the patient has Hypertension already. Hormone therapy will be eliminated and prescribe vaginal cream that would help her manage genitourinary symptoms such as vaginal dryness and dyspareunia (Yoo et al., 2020). Mood changes and hot flashes are common symptoms of menopause hence the patient will be prescribed low-dose antidepressants such as venlafaxine and sertraline. Besides, herbal treatment has been proven to be effective in managing vasomotor symptoms hence the patient can be prescribed black cohosh which helps in reducing many menopausal symptoms (Mahady, et al., 2002).

As people continue to age, their bones become weak and this increases their chances of suffering born fractures. Therefore, the patient will be given vitamin D supplements to the increase production of estrogen which reduces with age and reduces cases of bone fractures.

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: NURS 6521 Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

During the clinical interview, I realized that the patient is taking Norvasc 10 mg and hydrochlorothiazide (HCTZ) 25

NURS 6521 Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders
NURS 6521 Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

mg. I would advise her to discontinue taking Norvasc since the drug acts as a calcium blocker hence leading to hypertension and besides, its side effects increase menopause symptoms. Since she has hypertension, I would recommend that she takes lisinopril 20 mg daily. This should help alleviate the flushing that the patient has been experiencing (Li et al., 2016). Additionally, the patient has a history of ASCUS, hence I will advise her to continue with her PAP smear exams. With her blood pressure being high currently, and the fact that she is taking Norvasc, she will be encouraged to stop Norvasc but increase the HTCZ dosage to 50mg daily. The patient is expected to come regularly for assessment and examination of the drugs and symptoms.

Patient Education Strategies

Patient education has become an effective strategy to influence patients’ behavior to start living a quality life. The patient will be educated on ways to maintain weight through diet modification, become physically active, and practice relaxation as one way to reduce the severity of menopause symptoms and chances of getting breast cancer (Paterick et al., 2017). The patient will be educated about things she needs to avoid such as the use of exogenous hormones to reduce getting breast cancer going to her family history (Stuenkel et al., 2015). All this information will be passed to the patient through her patient portal which is deemed the best instructional method for her as she can access the information from the comfort of her home.

 

References

Li, R. X., Ma, M., Xiao, X. R., Xu, Y., Chen, X. Y., & Li, B. (2016). Perimenopausal syndrome and mood disorders in perimenopause: prevalence, severity, relationships, and risk factors. Medicine95(32).

Mahady, G. B., Fabricant, D., Chadwick, L. R., & Dietz, B. (2002). Black cohosh: an alternative therapy for menopause?. Nutrition in Clinical Care5(6), 283-289.

Paterick, T. E., Patel, N., Tajik, A. J., & Chandrasekaran, K. (2017, January). Improving health outcomes through patient education and partnerships with patients. In Baylor University Medical Center Proceedings (Vol. 30, No. 1, pp. 112-113). Taylor & Francis.

Manson, J. E., & Kaunitz, A. M. (2016). Menopause management—getting clinical care back on track. N Engl J Med374(9), 803-6.

Stuenkel, C. A., Davis, S. R., Gompel, A., Lumsden, M. A., Murad, M. H., Pinkerton, J. V., & Santen, R. J. (2015). Treatment of symptoms of the menopause: an endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism100(11), 3975-4011.

Yoo, T. K., Han, K. D., Kim, D., Ahn, J., Park, W. C., & Chae, B. J. (2020). Hormone replacement therapy, breast cancer risk factors, and breast cancer risk: a nationwide population-based cohort. Cancer Epidemiology, Biomarkers & Prevention29(7), 1341-1347.

Your discussion was very insightful. Just to piggyback on what you said, the patient is probably experiencing premenopausal symptoms evident by hot flash, night sweats, and genitourinary symptoms. According to Smail et al. (2019), menopause is the period from when a woman has stopped menstruating for a period of twelve conservative months. Smail 2019 explains that during this time there is drop in the production of the ovarian hormones’ estrogen and progesterone leading symptoms and diseases like vaginal infections, increased risk for osteoporosis and cardiovascular diseases, sleep disorders, mood alterations, hot flashes, depression, and urinary tract infections. Roberts & Hickey (2016) also discusses that during menopause common findings such as genitourinary syndrome of menopause, sleep disturbances, vasomotor symptoms (VMS), and mood disturbances are common.

Treatment Regimen Choice or Pharmacotherapeutics Recommendation

To control the patient blood pressure and the patient’s obesity, I will encourage patient to keep to current medication prescription regimen, make lifestyle changes, and monitor blood pressure reading regularly. VMS treatments would be based on how disturbing the symptoms are (Roberts & Hickey, 2016). Currently the most effective treatment for VMS is moderate dose estrogen-containing hormone therapy (HT), and that also improves vaginal dryness (Roberts & Hickey). They also explain that to help reduce VMS, SSRI such as escitalopram is a reasonable first choice since it is well tolerated. I will prescribe transdermal estradiol patch, spray, or gel. The patch will be applied to the skin of the trunk, or the spray to apply once daily to the forearm or the gel to apply once daily to one arm, from the shoulder to the wrist or to the thigh (Rosenthal & Burchum, 2018). when used for VMS, escitalopram reduces the frequency, severity and improves quality of life, improves sleep, and does not cause sexual dysfunction (Rosenthal & Burchum). Transdermal formulations range of estrogen absorption is from 14 to 60 mcg/24 hr, depending on the product employed (Rosenthal & Burchum).

Patient Education Strategy Recommendation

To help with the patient’s VMS, I will educate the patient on eating heart healthy food such as whole grains, vegetables, fruits, and maintain a normal level of vitamin D and Calcium (McCance & Huether, 2019). To manage the patient’s weight, I will encourage her to reduce the amount of processed foods, reduce salt intake, avoid or limit alcohol consumption, maintain a healthy weight, manage stress level and regular exercise weekly at least for thirty minutes daily (McCance & Huether). Maintain good sleep pattern by avoiding caffeine, engage in bedtime relaxation rituals such as stay away from bright lights to reduce things that can cause excitement before bedtime and avoid eating large meals for at least two hours before bedtime (Fujimoto, 2017). Fujimoto also explains that keeping to regular health maintenance such as pap smear test, mammograms, breast self-examination, cholesterol screening. Also, I will encourage the patient to take flu shot annually.

References

Fujimoto, K. (2017). Effectiveness of coaching for enhancing the health of menopausal Japanese women. Journal of Women & Aging29(3), 216–229. https://doi-org.ezp.waldenulibrary.org/10.1080/08952841.2015.1137434

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

Roberts H., & Hickey, M. (2016) managing the menopause: An update. Maturitas, 86(2016), 53-58. Retrieved from https://www-sciencedirect-com.ezp.waldenulibrary.org/science/article/pii/S037851221630007X?via%3Dihub

Smail, L., Jassim, G., & Shakil, A. (2019). Menopause-Specific Quality of Life among Emirati Women. International Journal of Environmental Research and Public Health17(1). https://doi-org.ezp.waldenulibrary.org/10.3390/ijerph17010040

Hey Ruth thanks for sharing this informative post.  Menopause is a complex period of life which is associated with many physical and psychological changes and hot flushes are one of the most common bothersome symptoms related to menopause which has affected 85% of menopausal women with various frequency, severity and duration that needs to be addressed. Hormone replacement Therapy is considered one of the most effective treatments of choice to treat or manage these menopausal associated symptoms however there are exceptions that prevents its use. One of the example is the patient condition in the given scenario is compatible with exceptions that could prevent its use from using this treatment regimen that is Hormonal Replacement Therapy as patient in the given scenario is at risk for developing breast cancer due to her family history of breast cancer and prescribing her with HRT could potentially make her more prone to developing breast cancer and hence non hormonal based treatment regimen should be considered. Some of the non-hormonal based options include use of antidepressants such as SSRIs (paroxetine) and SNRIs and other one is the use of Gabapentin and Clonidine can also be used. Looking back at the patient scenario patient has a history of high blood pressure and is currently on amlodipine and Hydrochlorothiazide however patient still is experiencing high blood pressure and hence I believe addition of clonidine in the patient’s current drug therapy regimen, along with amlodipine and hydrochlorothiazide can be beneficial in achieving effective blood pressure control and reduction in adverse reactions. Adding Clonidine (alpha adrenergic agonist) to the drug therapy will be useful in controlling blood pressure as well as treating symptoms such as hot flashes that are related to premenopausal symptoms.

I think a lot of women; about 51% seek complementary and alternative medicine (CAM) for managing the symptoms associated with menopause as they consider it as safe and effective option with no risk associated with it, as it’s natural. However the majority of the women using CAM do not discuss it with their health care provider. Hence it is very important to reconcile their current medication list at each visit and educate patient on importance of informing their health care provider if they are using any alternative or complementary treatments such as plant estrogens, bioidentical hormones, black cohosh etc in managing their symptoms of menopause to prevent any adverse effects resulting from drug interactions.

References

Johnson, A., Roberts, L., & Elkins, G. (2019). Complementary and Alternative Medicine for Menopause. Journal of evidence-based integrative medicine24, 2515690X19829380. https://doi.org/10.1177/2515690X19829380

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.