In the given case study, a 46-year-old elderly woman describes night sweats, hot flushing, and genitourinary side effects. Given her age and sex, and the fact that 95% of women enter menopause between the ages of 45 and 55, her side effects are consistent with menopause. By all accounts, the hot flashes and night sweats are vasomotor symptoms of menopause. Vasomotor symptoms are common during the transition to menopause and affect nearly 80% of women (Rosenthal & Burchum, 2017). Additionally, the patient provides genitourinary indications, which typically include vaginal dryness and urinary side effects. As estrogen levels decrease, the urethra and vaginal epithelium undergo degenerative changes, resulting in urge incontinence, urinary recurrence, dryness, urinary plot diseases, and vaginal contaminations. It is permissible to state that the customer is going through menopause. Menopause is common in women between the ages of 40 and 60. (Demler, 2019). Additionally, hereditary characteristics play a role in determining the onset of menopause. In light of her age and onset manifestations, she appears to be exhibiting the initial signs of menopause. The uterus, breasts, urogenital tract, skeletal system, and cardiovascular system all undergo changes during this cycle. The customer’s symptoms are caused by fundamental changes in the body called vasomotor flushes. Changes in the breast that happen include cell passing and tissue rebuilding of the breast, increment in greasy stores and connective tissue, decreased size, and immovability. In the urogenital region, changes in the vaginal pH balance decrease oil production, the cervix shrivels, and muscle tone in the pelvic zone deteriorates, increasing the likelihood of urinary incontinence, contamination, and criticality (Sholefield, Sebti, & Harris, 2015). Due to the decrease in estrogen levels, vasomotor frameworks manifest as hot blazes and perspiring (night sweats) as a result of expanding fringe veins. Other possible side effects include palpitations, wooziness, and migraines, as well as an increased risk of breast, uterine, and ovarian cancer (Demler, 2019).
Treatment may include estrogen replacement therapy, specific estrogen receptor modulators (SERMS), or progestin therapy. Burchum and Rosenthal present a decision tree for selecting an appropriate treatment regimen based on side effects. We recognize that the patient is experiencing night sweats and hot flashes and has been cured of breast cancer as a result of a routine mammogram. Additionally, she had her menses a month ago, indicating that she is not a candidate for hysterectomy. The following stage is to conduct a risk assessment for cardiovascular disease. In this patient, she has uncontrolled hypertension despite being on two circulatory strain prescriptions, and her most recent pap five years ago revealed atypical squamous cells of uncertain essentiality (Sholefield, Sebti, & Harris, 2015). The customer can begin hormone treatment with a transdermal course that is not intended for long-term use. Estradiol is an example of a formula that can be given in a shower structure, gel fix, or emulsion form. Training should be provided on the proper use of the formula. Another possibility is that the patient would be placed on an upper dose of an SSRI or SNRI due to the cardiovascular risk associated with a raised pulse, the conclusion of hypertension, and the results of a Pap smear. Providing education as an afterthought has adverse effects on SSRIs such as escitalopram, such as nausea, sleep disturbances, queasiness, and weakness.
Discussion Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521
References
Demler, T. L. (2019). Pharmacotherapeutics for Advanced Nursing Practice, Revised Edition. Jones & Bartlett Learning.
Rosenthal, L., & Burchum, J. (2017). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants – E-Book. Elsevier Health Sciences.
Sholefield, D., Sebti, A., & Harris, A. (2015). Pharmacology Case Studies for Nurse Prescribers. M&K Update Ltd.
D…,
Dietary habits and body composition are factors associated with women’s perimenopausal symptoms. Assessing the patient and
Discussion Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521
education on managing vasomotor symptoms through lifestyle changes should be done prior to prescribing menopausal hormone therapy. For example, physical activity, a healthy diet, yoga and homeopathy have been used to arrest menopausal symptoms. Women with severe and multiple symptoms need menopausal hormone therapy (MHT). MHT is the most effective therapy for women to control menopausal symptoms (Du, Xu, Huang, Zhu & He, 2020). Conjugated estrogen/bazedoxifene is a good option for the patient because it prevents estrogen-induced endometrial hyperplasia and a progestin is not needed (Martin & Barbieri, 2020).
References
Du, L., Xu, B., Huang, C., Zhu, L., & He, N. (2020). Menopausal Symptoms and Perimenopausal Healthcare-Seeking Behavior in Women Aged 40-60 Years: A Community-Based Cross-Sectional Survey in Shanghai, China. International Journal of Environmental Research and Public Health, 17(8). https://doi-org.ezp.waldenulibrary.org/10.3390/ijerph17082640
Martin, A. K., Barbieri, R. L. (2020). Treatment of menopausal symptoms with hormone therapy. Retrieved from https://www.uptodate.com/contents/treatment-of-menopausal-symptoms-with-hormone-therapy
Hi D….,
I agree with you in your thought that this patient may be experiencing the beginning stages of menopause. Because the patient still has regular monthly menses, she may be in perimenopause where the estrogen level is beginning to fall; she will have to be menstrual-free for 12 months to reach menopause (Mayo Clinic, 2019) officially. When women experience genitourinary syndrome secondary to menopause, they may suffer from urologic complications, including altering pH levels, which can cause urinary tract infections and vaginitis (Kagan, Kellogg-Spadt, & Parish, 2019). Due to the patient’s genitourinary symptoms, it may be beneficial to include in your care plan a urinalysis and urine culture to rule out a urinary tract infection. Your plan to start the patient with estrogen therapy aligns with the recommendation to treat using the lowest dose and frequency to help manage the symptoms (Kagan, Kellogg-Spadt, & Parish, 2019). It may also benefit the patient to increase a conversation of incorporating a heart-healthy diet to help decrease her blood pressure before making adjustments to any blood pressure medication. Included in the heart-healthy diet, it may be helpful to assess the patient’s caffeine intake as it has been seen not to increase blood pressure, but it can have a positive effect on the metabolism of estrogen as well (Sisti et al., 2015). Discussion Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521
References
Kagan, R., Kellogg-Spadt, S., & Parish, S. J. (2019). Practical treatment considerations in the management of genitourinary syndrome of menopause. Drugs & Aging, 36(10), 897–908. Retrieved from https://doi-org.ezp.waldenulibrary.org/10.1007/s40266-019-00700-w
Mayo Clinic. (2019). Perimenopause. Perimenopause – Symptoms and causes. Retrieved from https://www.mayoclinic.org/diseases-conditions/perimenopause/symptoms-causes/syc-20354666
Sisti, J. S., Hankinson, S. E., Caporaso, N. E., Gu, F., Tamimi, R. M., Rosner, B., Xu, X., Ziegler, R., & Eliassen, A. H. (2015). Caffeine, coffee, and tea intake and urinary estrogens and estrogen metabolites in premenopausal women. Cancer Epidemiology, Biomarkers & Prevention : A Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology, 24(8), 1174–1183. Retrieved from https://doi-org.ezp.waldenulibrary.org/10.1158/1055-9965.EPI-15-0246. Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521
Week 9: Women’s and Men’s Health/Infections and Hematologic Systems, Part I
As an advanced practice nurse, you will likely encounter many disorders associated with women’s and men’s health, such as hormone deficiencies, cancers, and other functional and structural abnormalities. Disorders such as these not only result in physiological consequences but also psychological consequences, such as embarrassment, guilt, or profound disappointment for patients. For these reasons, the provider-patient relationship must be carefully managed. During evaluations, patients must feel comfortable answering questions so that you, as a key health-care provider, will be able to diagnose and recommend appropriate treatment options. Advanced practice nurses must be able to educate patients on these disorders and help relieve associated stigmas and concerns.
This week, you examine women’s and men’s health concerns as well as the types of drugs used to treat disorders that affect women’s and men’s health. You also explore how to treat aspects of these disorders on other health systems.
Learning Objectives
Students will:
- Evaluate patients for treatment of complex health issues
- Evaluate patients for treatment of infections
- Evaluate patients for treatment of hematologic disorders
- Analyze patient education strategies for the management and treatment of complex comorbidities
Learning Resources
- Required Readings (click to expand/reduce)
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
- Chapter 46, “Anticoagulant and Antiplatelet Drugs” (pp. 364–371)
- Chapter 47, “Drugs for Deficiency Anemias” (pp. 389–396)
- Chapter 50, “Estrogens and Progestins: Basic Pharmacology and Noncontraceptive Applications” (pp. 425–436)
- Chapter 51, “Birth Control” (pp. 437–446)
- Chapter 52, “Androgens” (pp. 447–453)
- Chapter 53, “Male Sexual Dysfunction and Benign Prostatic Hyperplasia” (pp. 454–466)
- Chapter 70, “Basic Principles of Antimicrobial Therapy” (pp. 651–661)
- Chapter 71, “Drugs That Weaken the Bacterial Cell Wall I: Penicillins” (pp. 662–668)
- Chapter 75, “Sulfonamides Antibiotics and Trimethoprim” (pp. 688–694)
- Chapter 76, “Drug Therapy of Urinary Tract Infections” (pp. 695–699)
- Chapter 78, “Miscellaneous Antibacterial Drugs” (pp. 711–714)
- Chapter 79, “Antifungal Agents” (pp. 715–722)
- Chapter 80, “Antiviral Agents I: Drugs for Non-HIV Viral Infections” (pp. 723–743)
- Chapter 82, “Drug Therapy of Sexually Transmitted Diseases” (pp. 763–770)
Lunenfeld, B., Mskhalaya, G., Zitzmann, M., Arver, S., Kalinchenko, S., Tishova, Y., & Morgentaler, A. (2015). Recommendations on the diagnosis, treatment and monitoring of hypogonadism in men. Aging Male, 18(1), 5–15. doi:10.3109/13685538.2015.1004049
This article presents recommendations on the diagnosis, treatment, and monitoring of hypogonadism in men. Reflect on the concepts presented and consider how this might impact your role as an advanced practice nurse in treating men’s health disorders.
Montaner, J. S. G., Lima, V. D., Harrigan, P. R., Lourenço, L., Yip, B., Nosyk, B., … Kendall, P. (2014). Expansion of HAART coverage is associated with sustained decreases in HIV/AIDS morbidity, mortality and HIV transmission: The “HIV Treatment as Prevention” experience in a Canadian setting. PLoS ONE, 9(2), e87872. Retrieved from https://doi.org/10.1371/journal.pone.0087872
This study examines HAART therapy and its sustainability and profound population-level decrease in morbidity, mortality, and HIV transmission.
Roberts, H., & Hickey, M. (2016). Managing the menopause: An update. Maturitas, 86(2016), 53–58. .https://doi.org/10.1016/j.maturitas.2016.01.007
This article provides an update on treatments on Vasomotor symptoms (VMS), genito-urinary syndrome of menopause (GSM), sleep disturbance, sexual dysfunction, and mood disturbance that are common during the menopause transition.
Agency for Healthcare Research and Quality. (2014). Guide to clinical preventive services, 2014: Section 2. Recommendations for adults. Retrieved from http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/guide/section2.html
This website lists various preventive services available for men and women and provides information about available screenings, tests, preventive medication, and counseling.
- Required Media (click to expand/reduce)
Laureate Education (Producer). (2019h). Pathopharmacology: Pharmacology and immunological disorders: Improvements in medications and drug administration [Video file]. Baltimore, MD: Author.
Note: The approximate length of this media piece is 8 minutes.
Nurse Manager, Bette Nunn discusses how technology has improved the practice of administering drugs and created new and improved drug therapies. The importance of using technology as well as a patient’s knowledge of their own drug history is also discussed.
Speed Pharmacology. (2018). Pharmacology – Antibiotics – Cell wall & membrane inhibitors (Made Easy) [Video]. https://www.youtube.com/watch?v=mMk6VWVpRpo&t=504s
Note: This media program is approximately 16 minutes.
Speed Pharmacology. (2018). Pharmacology – Antibiotics – DNA, RNA, folic acid, protein synthesis inhibitors (Made Easy) [Video]. https://www.youtube.com/watch?v=5HQmvQJWzNY&t=32s
Note: This media program is approximately 16 minutes.
Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders
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.
Photo Credit: Getty Images
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.
- 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 “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!
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 9 Discussion Rubric
Post by Day 3 of Week 9 and Respond by Day 6 of Week 10
To Participate in this Discussion:
Week 9 Discussion
What’s Coming Up in Week 10?
Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images
Next week, you will continue working on your Discussion assigned in Week 9, as you examine the types of drugs used to treat infections and disorders of the hematologic system.
Next Week
To go to the next week:
Week 10
Initial post Week 1 Week 9
COLLAPSE
The patient in case study 1 was hospitalized for community acquired pneumonia. The most common culprits of CAP are streptococcus pneumoniae, haemophilus influenzae, and mycoplasma pneumoniae(Thiem, 2011). His co-morbidities included COPD, HTN, hyperlipidemia and diabetes. Recommendations for his treatment plan are aimed at treating the underlying infection while stabling his other medical conditions. Treating the pneumonia can be accomplished by obtaining sputum and blood cultures to make sure the current treatment of ceftriaxone (Kefzol) and azithromycin (Zithromax) can eradicate the microbes (Franco, 2017). Although the patient reposts an allergy to PCN that caused a rash, studies have shown that Ceftriaxone (Kefzol) is the safer option (Thiem, 2011). CAP can exacerbate the patient’s COPD, so after an initial chest ray is done to first confirmed the diagnosis and can also be reviewed to determine the severity of patient’s COPD. Obtaining an alpha-1-antitrylpsin deficiency sample show if the patient has a genetic disorder that predisposes individuals to COPD (Thiem, 2011). This conditions also increases the risk of contracting haemophilus influenzae, leading to more infections and opportunities for antibiotic resistance. Use of peak flows, followed nebulized ipratropium (Atrovent) treatments can help to keep airways open. Atrovent opens air way to allow in haled steroids to get to terminal bronchioles (Rosenthal, 2021). Beclomethasone (Qvar) 40 mcg twice per day, is a good choice of an inhaled steroid to help reduce inflammation in the airway and allow the patient to continuing to wean down on supplemental oxygen.
The patient is overweight with a BMI 29.8 so a Heart Healthy ADA diet is appropriate. COPD patients have increased work of beathing that can result in an increase caloric needs. Providing 4-6 smalls meals thought out day that are high protein or Ensure/ Glucerna oral supplement between meals provides required nutrition. Blood sugars should be monitored before meals. Insulin therapy with Humulin 70/30 (Novolin 70/30) with side scale coverage for meals with lispro (Novolog). Atorvastatin (Lipitor) 40 mg at bedtime would be ordered for cholesterol monitor with monitoring of liver function with lab draws. Ondansetron (Zofran) 4 mg Q6 can help with symptoms of nausea and vomiting, which are most likely a side effect of the IV antibiotics (Rosenthal, 2021. When selecting antihypertensive medications for the client some considered is given to the fact that Beta blocker should be avoided in diabetics and COPD patients because they increase blood sugars and can exacerbate acute bronchospasms. Thiazide can also increase hyperglycemia (Rosenthal, 2021). A good drug choice for blood pressure control in this client can be a calcium channel blocker such as amlodipine (Norvasc) 10 mg daily. Educational points for the patient include, pulmonary toilet to encourage expectoration of mucus and clearing of large airways, mouth rinsing after inhaled steroids, encourages regular home use with peak flow, regular hand washing, avoidance of sick contact
References
Franco, J. (2017). Community-acquired Pneumonia. Radiologic Technology, 88(6), 621–639.
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Thiem, U., Heppner, H.-J., & Pientka, L. (2011). Elderly Patients with Community-Acquired Pneumonia Optimal Treatment Strategies. Drugs & Aging, 28(7), 519–537. https://doi-org.ezp.waldenulibrary.org/10.2165/11591980-000000000-00000