NURS 6521 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 she 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 1 month ago. Discussion: 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.
Case overview sample solution
A 46years old female has night sweats, hot flushing, and genitourinary symptoms. She is known to have hypertension and takes Norvasc 10mg and HCTZ 25mg. she has a positive family history of breast cancer. She goes for annual mammograms and pap smear tests with nothing abnormal. She has a history of ASCUS in her pap smear five years ago. She has had a regular monthly cycle with her LMP since one month ago. On examination, her blood pressure is at 150/90 mmHg and her weight is 230Ib.
Post a description of the patient’s health needs
The patient is 46 years old and presenting with symptoms of menopause transition; flushing, genitourinary symptoms, and night sweats. Menopause transition or premenopausal is the period that links a woman into menopause. The onset of menopause transition is from 45years and lasts about five years before menopause. Hormonal changes in menopause transition are decreased production of inhibin, progesterone, estrogen, and follicle stimulation hormone (Maki, P. M., & Thurston, R. C. 2020). These changes cause symptoms like changes in menstrual bleeding, hot flushes, vaginal dryness, hot flushes, dyspareunia, mood swings, and sleep disturbances. The patient’s symptoms; flushing, genitourinary symptoms, and night sweats are due to decreased estrogen production from the ovaries.
The patient is hypertensive and her blood pressure is not well controlled despite taking antihypertensives Norvasc and HCTZ. Hypertension is high blood pressure above 130/80mmHg. Causes of hypertension are obesity, old age, comorbidities like chronic kidney disease, and alcohol intake. Hormonal changes in the premenopausal period cause rapid weight gain and hence the increase in blood pressure. The patient is weighing 230Ib, which is way higher than the average weight of an adult female. Obesity is the accumulation of fat in the adipose tissues due to the body’s inactivity and unhealthy eating. Obesity increases the risk for chronic diseases like coronary heart disease, hyperlipidemia, kidney injury, diabetes mellitus, and osteoarthritis. She is at a higher risk for breast cancer because she has a positive family history of cancer. According to Maki, P. M., & Thurston, R. C. (2020), obesity increases the risk for cancer because of the presence of estrogen hormone in the fat tissue.
- Norvasc 10mg PO OD
- HCTZ 25mg PO OD
- Enalapril 5mg PO OD
- Aspirin 81mg PO OD
- Atorvastatin 40mg PO OD
The patient’s blood pressure is not well controlled despite taking a thiazide diuretic and calcium channel blocker. Therefore, I added an angiotensin-converting enzyme inhibitor which is cardio and renal protective to control the blood pressure (Morrow, et al, 2019). Aspirin is a non-steroidal anti-inflammatory drug that reduces the risk of cardiovascular events. Atorvastatin helps in reducing the risk of hyperlipidemia Zheng, S. L., & Roddick, A. J.(2019). In obese patients.
The patient should use vaginal moisturizers and lubricants to reduce urinary symptoms. Gels and sprays relieve night sweats and hot flushes. Lifestyle changes such as wearing light clothing, avoiding alcohol, and caffeine reduce hot flushing and night sweats.
My patient education strategy is one on one interviews and the use of diagrams to enhance easier understanding and ease to remember. I will explain the causes of the symptoms and others associated t menopause. I will explain the natural remedies to treat symptoms and what to prevent to reduce the risk of complications.
Maki, P. M., & Thurston, R. C. (2020). Menopause and brain health: hormonal changes are only part of the story. Frontiers in Neurology, 11, 562275.
Morrow, D. A., Velazquez, E. J., DeVore, A. D., Prescott, M. F., Duffy, C. I., Gurmu, Y., … & Braunwald, E. (2019). Cardiovascular biomarkers in patients with acute decompensated heart failure randomized to sacubitril-valsartan or enalapril in the PIONEER-HF trial. European heart journal, 40(40), 3345-3352.
Zheng, S. L., & Roddick, A. J. (2019). Association of aspirin use for primary prevention with cardiovascular events and bleeding events: a systematic review and meta-analysis.
Jama, 321(3), 277-287. JAMA. 2019;321(3):277-287. doi:10.1001/jama.2018.2057