NURS 6501 Knowledge Check Women’s and Men’s Health, Infections, and Hematologic Disorders 

NURS 6501 Knowledge Check Women’s and Men’s Health, Infections, and Hematologic Disorders 

NURS 6501 Knowledge Check Women’s and Men’s Health, Infections, and Hematologic Disorders 

	Scenario 1: Polycystic Ovarian Syndrome (PCOS) A 29-year-old female presents to the clinic with a complaint of hirsutism and irregular menses. She describes irregular and infrequent menses (five or six per year) since menarche at 11 years of age. She began to develop dark, coarse facial hair when she was 13 years of age, but her parents did not seek treatment or medical opinion at that time. The symptoms worsened after she gained weight in college. She got married 3 years ago and has been trying to get pregnant for the last 2 years without success. Height 66 inches and weight 198. BMI 32 kg.m2. Moderate hirsutism without virilization noted.  Laboratory data reveal CMP within normal limits (WNL), CBC with manual differential (WNL), TSH 0.9 IU/L SI units (normal 0.4-4.0 IU/L SI units), a total testosterone of 65 ng/dl (normal 2.4-47 ng/dl), and glycated hemoglobin level of 6.1% (normal value ≤5.6%). Based on this information, the APRN diagnoses the patient with polycystic ovarian syndrome (PCOS) and refers her to the Women’s Health APRN for further workup and management.   Question 1.     What is the pathogenesis of PCOS?
	Selected Answer: Polycystic Ovary Syndrome (PCOS) has an underlying genetic component that causes irregular ovulation, increased androgens, and ovaries with polycystic characteristics (McCance & Huether, 2019). Glucose intolerance and insulin resistance increase androgen secretion via the ovaries’ supportive structures and reduce sex-hormone-binding globulin (McCance & Huether, 2019). Elevated leptin levels act on the hypothalamus interfering with hormone production. Follicular growth and apoptosis alterations influence the absence of ovulation, creating inappropriate functioning of FSH and LH. Cortical thickening increases subcortical stroma, and hyperplasia occurs (McCance & Huether, 2019) Polycystic ovary syndrome (PCOS) is a hormonal disorder common among women of reproductive age. Women with PCOS may have infrequent or prolonged menstrual periods or excess male hormone (androgen) levels. The ovaries may develop numerous small collections of fluid (follicles) and fail to release eggs regularly. other factors that may contribute to the development of PCOS include: Excess insulin. Insulin is the hormone produced in the pancreas that allows cells to use sugar, your body’s primary energy supply. If your cells become resistant to the action of insulin, then your blood sugar levels can rise, and your body might produce more insulin. Excess insulin might increase androgen production, causing difficulty with ovulation. Low-grade inflammation. This term describes white blood cells’ production of substances to fight infection. Research has shown that women with PCOS have a type of low-grade inflammation that stimulates polycystic ovaries to produce androgens, leading to heart and blood vessel problems. Excess androgen. The ovaries produce abnormally high androgen levels, resulting in hirsutism and acne. Early diagnosis of PCOS and treatment and weight loss may reduce the risk of long-term complications such as type 2 diabetes and heart disease.  Complications of PCOS can include: Infertility, Gestational diabetes or pregnancy-induced high blood pressure, miscarriage or premature birth, Nonalcoholic steatohepatitis, Metabolic syndrome including high blood pressure, high blood sugar, and abnormal cholesterol or triglyceride levels that significantly increase your risk of cardiovascular disease, Type 2 diabetes or prediabetes, Sleep apnea, Depression, anxiety and eating disorders, Abnormal uterine bleeding, and cancer of the uterine lining (endometrial cancer). It is important to note that these complications are more severe in overweight women.  Correct Answer:   The pathogenesis of PCOS has been linked to altered luteinizing hormone (LH) action, insulin resistance, and a possible predisposition to hyperandrogenism. One theory maintains that underlying insulin resistance exacerbates hyperandrogenism by suppressing synthesis of sex hormone–binding globulin and increasing adrenal and ovarian synthesis of androgens, thereby increasing androgen levels. These androgens then lead to irregular menses and physical manifestations of hyperandrogenism. The hyperandrogenic state is a cardinal feature of PCOS but glucose intolerance/insulin resistance and hyperinsulinemia often run parallel to and markedly aggravate the hyperandrogenic state, thus contributing to the severity of signs and symptoms of PCOS. Response Feedback: [None Given]

• Question 2

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	Scenario 1: Polycystic Ovarian Syndrome (PCOS) A 29-year-old female presents to the clinic with a complaint of hirsutism and irregular menses. She describes irregular and infrequent menses (five or six per year) since menarche at 11 years of age. She began to develop dark, coarse facial hair when she was 13 years of age, but her parents did not seek treatment or medical opinion at that time. The symptoms worsened after she gained weight in college. She got married 3 years ago and has been trying to get pregnant for the last 2 years without success. Height 66 inches and weight 198. BMI 32 kg.m2. Moderate hirsutism without virilization noted.  Laboratory data reveal CMP within normal limits (WNL), CBC with manual differential (WNL), TSH 0.9 IU/L SI units (normal 0.4-4.0 IU/L SI units), a total testosterone of 65 ng/dl (normal 2.4-47 ng/dl), and glycated hemoglobin level of 6.1% (normal value ≤5.6%). Based on this information, the APRN diagnoses the patient with polycystic ovarian syndrome (PCOS) and refers her to the Women’s Health APRN for further workup and management.   Question How does PCOS affect a woman’s fertility or infertility?
	Selected Answer: PCOS is the leading cause of infertility in women (McCance & Huether, 2019). Infertility results from alterations in androgen production, follicular disturbances, and an absence of ovulation. In other words, PCOS negatively impacts fertility because women with the condition do not ovulate or release an egg each month due to an overproduction of estrogen by the ovaries. Correct Answer:   Ovulation problems are usually the primary cause of infertility in women with PCOS. Ovulation may not occur due to an increase in testosterone production or © 2020 Walden University 2 because follicles on the ovaries do not mature. Due to unbalanced hormones, ovulation and menstruation can be irregular. A hyperandrogenic state is a cardinal feature in the pathogenesis of PCOS. Excessive androgens affect follicular growth, and insulin affects follicular decline by suppressing apoptosis and enabling follicle to persist. There is dysfunction in ovarian follicle development. Inappropriate gonadotropin secretion triggers the beginning of a vicious cycle that perpetuates anovulation Response Feedback: [None Given]

The case study concerns a 60-year-old man with complaints of urinary frequency and incontinence that started after having chemo and radiotherapy three years ago to treat prostate cancer. The patient is more worried about his low back and hip pain that started roughly one month ago, which he thought was caused by lifting heavy boxes. Lab results show a normal urinalysis and CBC, and PSA of 7.2. The prostate is enlarged and nodular on DRE. The purpose of this assignment is to discuss prostatitis as it relates to the patient case.

Why prostatitis and infection happen and causes of a systemic reaction.

Prostatitis occurs due to inflammation of the prostate gland. Bacterial prostatitis mainly occurs with urethritis or a lower urinary tract infection (UTI). It is commonly caused by Enterobacter, Escherichia coli, Group D streptococci, and Proteus (Pirola et al., 2019). The microbes reach the prostate through the urethra or bloodstream. The patient presents with symptoms of chronic bacterial prostatitis like urinary frequency and incontinence. This could have been caused by the inoculation of bacteria during therapy or microorganisms from a lower UTI spreading to the prostate (Pirola et al., 2019).

Furthermore, chronic prostatitis manifests with pain in and around the penis, testicles, anal area, lower abdomen, and lower back. It also presents with an enlarged or tender prostate on digital rectal examination (DRE). Therefore, the patient’s low back and hip pain, as well as findings of an enlarged, nodular prostate, can be pointed to chronic prostatitis. 

Benign prostatic hyperplasia (BPH) is a risk factor for prostatitis. The patient’s history of prostate cancer can be attributed to chronic bacterial prostatitis. The bacteria may have been inoculated to the prostate during the chemotherapy and radiotherapy. The patient has an elevated PSA level of 7.2 and an enlarged nodular prostate, which can be attributed to prostate cancer (McCance & Huether, 2019). Furthermore, the patient’s mild degenerative changes in the spine and cystic mass near the spine can be due to metastatic spinal cord compression (MSCC). MSCC occurs when cancer cells spread from the prostate and grow in or near the spine, pressing on the spinal cord (Patnaik et al., 2020).

A systemic reaction occurs in a patient with prostatitis when the causative organisms enter the circulation through the lymphatic or blood system and cause infection to other body organs. This results in systemic symptoms like fever, chills, malaise, tachycardia, tachypnea, and myalgia.

Conclusion

The patient has symptoms consistent with chronic bacterial prostatitis, like urinary frequency and incontinence. Chemotherapy may have caused prostatitis when pathogens are inoculated into the bladder. Besides, the patient has symptoms consistent with prostate cancer, like an enlarged, nodular prostate and elevated PSA levels. The degenerative changes and cystic mass near the spine are likely due to the spread of cancer cells from the prostate. A systemic reaction can occur when causative organisms migrate from the prostate to the circulation. 

References

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

Patnaik, S., Turner, J., Inaparthy, P., & Kieffer, W. K. (2020). Metastatic spinal cord compression. British journal of hospital medicine (London, England : 2005), 81(4), 1–10. https://doi.org/10.12968/hmed.2019.0399

Pirola, G. M., Verdacchi, T., Rosadi, S., Annino, F., & De Angelis, M. (2019). Chronic prostatitis: current treatment options. Research and reports in urology, 11, 165–174. https://doi.org/10.2147/RRU.S194679