Based on patient history and physical exam, this patient presents with multiple underlying medical conditions including obesity and high blood pressure. With the information provided and symptoms include night sweats and genitourinary issues and hot flashes.
According to Lehne’s et. al (2021) Estrogen is an endogenous hormone, its primary source is the ovaries in pre menopausal woman, another name for this hormone is estradiol. Pre menopause can occur starting at age 45 years old 55 years of age. Primary symptoms include sleep disturbance and genitourinary atrophy. Other major symptom in over 60% of pre menopausal women are hot flashes that occur at night.
Based on the patient symptomatology of night sweats, urinary symptoms and age, patient may be transitioning into pre menopause. The patient blood pressure seems elevated considering she is on dual drug therapy for hypertension. Duringpre menopause there is an increase in cardiac perfusion due to the production of nitric oxide, improvement in cholesterol levels may also occur Lehne’s et. al (2021). However, there should be concern and thought regarding evaluating treatment of high blood pressure in setting of new pre menopause diagnosis. There is ongoing research on best treatment of hypertension in pre and post menopausal state, the goal is effective long term treatment Brahmbhatt et. al (2019).
Treatment plan should be based on new diagnosis of pre menopause. Hormone therapy is most common treatment of pre menopause. Pre menopause is primary diagnosis, with secondary diagnosis of uncontrolled blood pressure due to primary diagnosis. One of the side effects of the use of estrogen in pre menopause is . This patient has a family history of breast cancer, this has to be considered in treatment choice and the pros and cons of use.
Non contracaptive hormone therapy is plan of choice. Considerations of drug therapy include possible off label medication use( not approved by the Food and Drug Administration(FDA). Educating the patient on off label medications should be included in treatment options, with full disclosure. Endocrine based therapy is another treatment option, considering the patient family history of breast cancer. There is ongoing research on the efficacy of hormone therapy for pre/peri menopause. At this point estrogen replacement therapy can be initialed, then reevaluated for effectiveness, side effects and underlying effects on patient symptoms Patterson et. al (2019). 2APA References
Case Study 1: Community-acquired Pneumonia
This Patient has been diagnosed with community-acquired pneumonia and is being treated with Ceftriaxone and azithromycin. Community-acquired pneumonia is a leading cause for hospitalizations and has a high mortality rate if not treated (Regunath & Oba, 2021). There are two pathogen types that normally cause community-acquired pneumonia. The first type of pathogen is group A streptococci, anaerobes, and gram-negative organisms, and the second type is atypical agents such as legionella, mycoplasma, chlamydia pneumonia, and c. Psittaci (Regunath & Oba, 2021). The most common pathogens that have been causing community-acquired pneumonia are human rhinovirus, influenza virus, and streptococcus pneumoniae (Regunath & Oba, 2021). When a patient is diagnosed with community-acquired pneumonia, a complete blood count with differentials should be drawn along with electrolytes, renal and liver function tests and a urinalysis. The patient should also have a chest X ray to help with diagnosis and as well. CURB 65 (Confusion, Urea greater than 20mg/dL, respiratory rate greater than 30/min, blood pressure systolic less than 90mmHg or diastolic less than 60mmHg), and PSI are tools used to assess the severity and treatment plan (Regunath & Oba, 2021).
The recommended therapy for pneumonia should last for 5 to 7 days and our patient is only on his 3rd day of antibiotics but is already showing to be beneficial. The patient should also be without fever for more than 48 to 72 hours, not needing supplemental oxygen, no tachycardia, tachypnea, or hypotension (Regunath & Oba, 2021). HH is already starting to state that his symptoms have improved. He has decreased oxygen requirements however he isn’t tolerating his diet well due to nausea and vomiting which could be from the antibiotics. The patient could be administered some Zofran to assist with this. Our patient is receiving 1gram of Ceftriaxone IV every day and this is an appropriate dosage because studies have been done to prove that 2grams did not result in an improved clinical outcome (Relles, Cieslinski, Gasparetto, & Tuon, 2019).
Our Patient HH was diagnosed with community-acquired pneumonia and has been admitted to the hospital to receive ceftriaxone and azithromycin via IV. Our patient has received 3 days of these medications and the recommendation for these medications is between 5 to 7 days. Our patient has shown some improvements but is still not completely better. I recommend that the patient needs to complete at least 5 days of these medications and should probably be administered something to help with the nausea and vomiting. The patient has other comorbidities that need to be monitored while he is admitted, but the patient does have diabetes and him not eating could affect this. Labs should be done to ensure that the patient has levels within normal range.