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

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

A Sample Answer For the Assignment: NURS 6521 Discussion 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.

During the clinical interview, I realized that the patient is taking Norvasc 10 mg and hydrochlorothiazide (HCTZ) 25 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. Medicine, 95(32).

Mahady, G. B., Fabricant, D., Chadwick, L. R., & Dietz, B. (2002). Black cohosh: an alternative therapy for menopause?. Nutrition in Clinical Care, 5(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 Med, 374(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 & Metabolism, 100(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 & Prevention, 29(7), 1341-1347.

In this Case study, a 46-year-old patient comes to the clinic with complaints of night sweats, hot flushing, and genitourinary problems. The patient presents with signs of menopause. Headaches sleep issues, mood swings, vasomotor symptoms including hot flashes and night sweats, and anxiety may occur throughout this time because of the decreased ovarian activity and fluctuations of hormone levels (Taebi et al., 2018).

Patient also presents a history of ASCUS, which is atypical cells found in the tissue lining the cervix’s outer portion. ASCUS can be a sign of low hormone levels, which may occur in menopausal women.  According to a 2018 study, the incidence of ASCUS was highest in women who were menstruation normally (Misra et al., 2018)

The diagnosis of perimenopause would be given to this patient. For women experiencing perimenopausal and menopausal symptoms, Hormonal Replacement Therapy (HRT) is thought to be an appropriate treatment option. However, the patient has hypertension as well as a family history of breast cancer. A treatment plan should be personalized based on the patient’s past medical history, Thus, HRT would not be beneficial for this patient as it increases the risk of breast cancer and increases blood pressure.

The treatment plan would be to manage the patient’s symptoms. Since we are avoiding HRT, antidepressants would be prescribed to reduce night sweats and improve vasomotor symptoms. SSRIs would be prescribed to help manage the patient’s symptoms, such as Citalopram. Non-hormonal medications such as clonidine, gabapentin, pregabalin, and antidepressants may be a significant effective therapy for vasomotor symptoms (Karanth et al., 2019).

To treat her genitourinary symptoms, transdermal estrogen therapy would be beneficial, which is applied directly on the skin and easily absorbs the hormone in systemic circulation. This would be a safer option for such high-risk patients as a transdermal patch bypasses the first pass effect and makes the blood estrogen levels lower than oral administration. A low dose of estrogen would suffice with topical administration.

Side effects and benefits should be discussed with the patient before prescribing the medications. Education on the side effects of Citalopram, such as dizziness, sleepiness, and headache, will be provided. Also, the patient would be educated on adhering to both medication regimens to improve her symptoms over time. The patient will also be educated on monitoring her blood pressure and reporting any adverse effects.

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Taebi, M., Abdolahian, S., Ozgoli, G., Ebadi, A., & Kariman, N. (2018, July 6). Strategies to improve menopausal quality of life: A systematic review. Journal of education and health promotion. Retrieved January 23, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6052783/

Misra, J. S., Srivastava, A. N., & Zaidi, Z. H. (2018). Cervical cytopathological changes associated with onset of Menopause. Journal of mid-life health. Retrieved January 23, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6332728/

Karanth, L., Chuni, N., & Nair, N. S. (2019, September 12). Antidepressants for menopausal symptoms. The Cochrane Database of Systematic Reviews. Retrieved January 24, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6739239

The Factors Affecting Fertility

The patient in the provided case study is recovering from a bad case of mononucleosis. This disease is normally caused by EBV and transmitted through saliva. EBV belongs to the herpes family and can be considered as an STI, but not all cases. Studies suggest that EBV may be associated with autoimmune ovarian failure, which can lead to infertility among women(Smolarczyk et al., 2021).

Consequently, the patient displayed signs of ITP, which is normally caused by EBV. IPT is also associated with infertility among women. Recent research findings revealed that pregnant women diagnosed with ITP may be at high risk of fetal loss, stillbirth, and premature delivery.

Reasons Behind A Rise In Inflammatory Markers In STD/PID

Persistent pathogens like latent herpesviruses including EBV can trigger an inflammatory response. Replication of EBV can induce the production of proinflammatory cytokines hence influencing systemic inflammation.

A study conducted by Ke et al., (2020) found out that higher EBV antibody titers in chronic mononucleosis were associated with increased levels of C-reactive protein (CRP), interferon-γ (IFNγ), interleukine-18(IL-18), and interleukine-6 (IL-6). The levels of these inflammatory markers depend on the severity of the patient’s condition, as they act as the body’s response mechanism against the viral infection.

Reasons behind Prostatitis and Associated Infections

Prostatitis normally occurs secondary to leakage of microorganisms such as viruses or bacteria into the prostate gland from the urinary tract. It may also occur as a result of the extension or spread lymphatic from the rectum. Microorganisms that might lead to prostatitis include EBV, HIV, Neisseria gonorrhoeae,and Chlamydia trachomatis among others (Dikov et al., 2020). Studies have reported cases of EBV among patients with prostate cancer. Consequently, patients diagnosed with prostate cancer are at a higher risk of developing ITP caused by EBV.

Reasons Behind Splenectomy Among Patients Diagnosed With Immune Thrombocytopenia

Splenectomy is normally recommended forsteroid-refractory or dependent immune thrombocytopenia (ITP). However, it is only advisable among adult patients who require second-line therapy as a result of the failure of steroids in managing the disorder (Chaturvedi et al., 2018). Splenectomy is effective in this case as it removes the main destruction site, and is the primary source of synthesis of antiplatelet antibodies.

Anemia and Its Classifications

The patient in the provided case study recorded a low platelet level which is an indication of aplastic anemia. Generally, anemia can be defined as a blood disorder associated with the production of few red blood cells (RBC) by the body, the destruction of too many RBC, or the loss of too many blood cells. An inadequate amount of red blood cells deprives the body tissues of adequate oxygen, for normal body functioning (Chaparro & Suchdev, 2019).

Based on the mean corpuscular volume (MCV) anemia can be classified into four categories, microcytic, macrocytic, normocytic, and non-hemolytic normocytic anemia. Other types of anemia based on the causative mechanism include iron deficiency anemia, aplastic anemia, hemolytic anemia, and sickle cell anemia. Several risk factors are associated with anemia such as race and ethnicity. For instance, blacks are more prone to anemia as compared to whites. This might be a result of socioeconomic advantages among other reasons.

Conclusion

The assigned case study presents an example of an adolescent suffering from ITP caused by EBV. This condition can be classified as an STI, can compromise the patient’s fertility given her childbearing age. ITP is also associated with low platelet count, which suggests possibilities of aplastic anemia.

References

Chaparro, C. M., & Suchdev, P. S. (2019). Anemia epidemiology, pathophysiology, and etiology in low-and middle-income countries. Annals of the New York Academy of Sciences, 1450(1), 15. https://doi.org/10.1111/nyas.14092

Chaturvedi, S., Arnold, D. M., & McCrae, K. R. (2018). Splenectomy for immune thrombocytopenia: down but not out. Blood, The Journal of the American Society of Hematology, 131(11), 1172-1182. https://doi.org/10.1182/blood-2017-09-742353

Dikov, D. I., Koleva, M. S., Boivin, J. F., Lisner, T., Belovezhdov, V. T., & Sarafian, V. (2020). Histopathology of nonspecific granulomatous prostatitis with special reference to eosinophilic epithelial metaplasia: Pathophysiologic, diagnostic and differential diagnostic correlations. Indian Journal of Pathology and Microbiology, 63(5), 34. https://doi.org/10.4103/IJPM.IJPM_568_18

Ke, X., He, H., Zhang, Q., Yuan, J., &Ao, Q. (2020). Epstein–Barr virus‐positive inflammatory follicular dendritic cell sarcoma presenting as a solitary colonic mass: two rare cases and a literature review. Histopathology, 77(5), 832-840. https://doi.org/10.1111/his.14169

Smolarczyk, K., Mlynarczyk-Bonikowska, B., Rudnicka, E., Szukiewicz, D., Meczekalski, B., Smolarczyk, R., & Pieta, W. (2021). The Impact of Selected Bacterial Sexually Transmitted Diseases on Pregnancy and Female Fertility. International Journal of Molecular Sciences, 22(4), 2170. https://doi.org/10.3390/ijms22042170

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.

During the clinical interview, I realized that the patient is taking Norvasc 10 mg and hydrochlorothiazide (HCTZ) 25 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. Medicine, 95(32).

Mahady, G. B., Fabricant, D., Chadwick, L. R., & Dietz, B. (2002). Black cohosh: an alternative therapy for menopause?. Nutrition in Clinical Care, 5(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 Med, 374(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 & Metabolism, 100(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 & Prevention, 29(7), 1341-1347.

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.

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. 

Women and Men’s Health/Infections and Hematologic Symptoms

Community-acquired pneumonia (CAP) is acquired outside of the hospital, nursing home, or any other medical facility. Pneumonia is caused by infection of the lungs. CAP in the elderly has a different clinical presentation than CAP in other age groups. (Riquelme, 1997) Elderly patients have an increased risk of CAP with PMH of COPD, HTN, and diabetes. Elderly patients also present with fewer symptoms than younger patients. Delirium, falls and malnutrition are some of the symptoms that elderly patients present with. (Yoshikawa, 2000)

Presentation

Patient is a 68 year-old male that has been admitted to the hospital with a diagnosis of community-acquired pneumonia. PMH significant for COPD, HTN, hyperlipidemia and diabetes. Currently receiving empiric antibiotics, ceftriaxone 1 g IV q day x 3 days, and azithromycin 500 mg IV x 3 days. Clinical status has improved, with decreased oxygen use. Currently not tolerating a diet, with complaints of nausea and vomiting. Reported Allergies are Penicillin. Ht: 5’8” Wt: 89 kg

Treatment

Ceftriaxone in combination with azithromycin is one of the most common regimens used for the treatment of CAP because the therapy covers both standard organisms as well as atypical organisms. (Murter, 2019) Medications has been effective but there is an issue with patient not tolerating his diet. Zofran 4mg IV as needed with a max of 0.45 mg/kg/day IV. (Rosenthal, 2021) Liquid diet will be started until solid foods are able to be tolerated.  Blood sugars will be checked 4 times a day.

Education

Patient and family are instructed on how symptoms may present themselves in this age group, delirium, dizziness, and falls. Educate on the importance of finishing all medications prescribed and teach on antibiotic resistance and how it occurs. Order a consult for a dietician so the patient can be educated on diet and exercise.

Educate patient and family on the recovery process, explaining that it could take longer than most individuals due to his medical history. Also, educate on the importance of following up with primary care doctor to receive pneumococcal vaccine, to decrease the chances of catching pneumonia again.

References

Murter, F. D. (2019). Ceftriaxone Monotherapy vs. Ceftriaxone Plus Azithromycin for the Treatment of Community-Acquired Pneumonia in Hospitalized, Non-ICU Patients. Open Forum Infectious Diseases,, 6(Suppl 2), S748-S749.

Riquelme, R. T. (1997). Community-acquired pneumonia in the elderly: clinical and nutritional aspects. American journal of respiratory and critical care medicine, 156(6), 1908-1914.

Rosenthal, L. D. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants. St. Louis, MO: Elsevier.

Yoshikawa, T. T. (2000). Community-acquired pneumonia in the elderly. Clinical infectious diseases, 31(4), 1066-1078.

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

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

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. 

From a personal standpoint, being age 60, overweight and having a family history of breast cancer, and being hypertensive, I can relate to this case study. I take HRT daily. 

I recommend Compounded hormone therapy. According to Thompson, Ritenbaugh&Nichter (2017), this medication is a form of bioidentical hormone therapy that is individually formulated for patients by pharmacists. Popularly, the term “bioidentical” refers to prescription hormones that have “the same molecular structure as a hormone that is endogenously produced and circulates in the human bloodstream.”

Bioidentical hormone therapy may be manufactured in standard doses by drug companies and sold under brand names such as Vivelle (estradiol) and Prometrium (micronized progesterone). Alternatively, it may be individually formulated for patients by compounding pharmacists as CBHT. CBHT is available in an array of delivery methods (e.g., capsules, patches, creams, sublingual lozenges or “troches,” and vaginal suppositories) and dose strengths, although common compounded formulations include estriol alone, “bi-estrogen” or “bi-est” combinations (estradiol and estriol), or “tri-estrogen” or “tri-est” combinations (estrone, estradiol, and estriol)—as well as progesterone, testosterone, and dehydroepiandrosterone (DHEA).  

According to Dalal&Aganwal (2015), Systemic estrogen therapy is the most effective treatment available for vasomotor symptoms and the associated sleep disturbance. Healthy women in the perimenopausal transition who are experiencing bothersome hot flashes but still menstruating may benefit from oral contraceptives. 

I would recommend for the patient have yearly mammograms and pap tests, a weight program, and monitor blood pressure and heart rate at home. Follow up in 3 months for repeat blood work to see the efficacy of therapy. 

References: 

Dalal, P. K., & Agarwal, M. (2015). Postmenopausal syndrome. Indian journal of psychiatry, 57(Suppl 2), S222–S232. https://doi.org/10.4103/0019-5545.161483 Links to an external site. 

  Thompson, J. J., Ritenbaugh, C., &Nichter, M. (2017). Why women choose compounded bioidentical hormone therapy: lessons from a qualitative study of menopausal decision-making. BMC women’s health, 17(1), 97. https://doi.org/10.1186/s12905-017-0449-0

Manage Discussion Entry

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.

During the clinical interview, I realized that the patient is taking Norvasc 10 mg and hydrochlorothiazide (HCTZ) 25 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. Medicine, 95(32).

Mahady, G. B., Fabricant, D., Chadwick, L. R., & Dietz, B. (2002). Black cohosh: an alternative therapy for menopause?. Nutrition in Clinical Care, 5(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 Med, 374(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 & Metabolism, 100(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 & Prevention, 29(7), 1341-1347.

 

Women and Men’s Health/Infections and Hematologic Symptoms

Community-acquired pneumonia (CAP) is acquired outside of the hospital, nursing home, or any other medical facility. Pneumonia is caused by infection of the lungs. CAP in the elderly has a different clinical presentation than CAP in other age groups. (Riquelme, 1997) Elderly patients have an increased risk of CAP with PMH of COPD, HTN, and diabetes. Elderly patients also present with fewer symptoms than younger patients. Delirium, falls and malnutrition are some of the symptoms that elderly patients present with. (Yoshikawa, 2000)

Presentation

Patient is a 68 year-old male that has been admitted to the hospital with a diagnosis of community-acquired pneumonia. PMH significant for COPD, HTN, hyperlipidemia and diabetes. Currently receiving empiric antibiotics, ceftriaxone 1 g IV q day x 3 days, and azithromycin 500 mg IV x 3 days. Clinical status has improved, with decreased oxygen use. Currently not tolerating a diet, with complaints of nausea and vomiting. Reported Allergies are Penicillin. Ht: 5’8” Wt: 89 kg

Treatment

Ceftriaxone in combination with azithromycin is one of the most common regimens used for the treatment of CAP because the therapy covers both standard organisms as well as atypical organisms. (Murter, 2019) Medications has been effective but there is an issue with patient not tolerating his diet. Zofran 4mg IV as needed with a max of 0.45 mg/kg/day IV. (Rosenthal, 2021) Liquid diet will be started until solid foods are able to be tolerated.  Blood sugars will be checked 4 times a day.

Education

Patient and family are instructed on how symptoms may present themselves in this age group, delirium, dizziness, and falls. Educate on the importance of finishing all medications prescribed and teach on antibiotic resistance and how it occurs. Order a consult for a dietician so the patient can be educated on diet and exercise. Educate patient and family on the recovery process, explaining that it could take longer than most individuals due to his medical history. Also, educate on the importance of following up with primary care doctor to receive pneumococcal vaccine, to decrease the chances of catching pneumonia again.

References

Murter, F. D. (2019). Ceftriaxone Monotherapy vs. Ceftriaxone Plus Azithromycin for the Treatment of Community-Acquired Pneumonia in Hospitalized, Non-ICU Patients. Open Forum Infectious Diseases,, 6(Suppl 2), S748-S749.

Riquelme, R. T. (1997). Community-acquired pneumonia in the elderly: clinical and nutritional aspects. American journal of respiratory and critical care medicine, 156(6), 1908-1914.

Rosenthal, L. D. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants. St. Louis, MO: Elsevier.

Yoshikawa, T. T. (2000). Community-acquired pneumonia in the elderly. Clinical infectious diseases, 31(4), 1066-1078.

HH’s health needs include dietary needs, risk of infection, and risk of diabetes and hypertension complications. The patient’s dietary needs are secondary to inadequate dietary intake as evidenced by intolerance to food.  HH has symptoms of a respiratory infection probably caused by bacteria from the clogged mucus in the airways (Martinez-Garcia & Miravitlles, 2022). The patient has COPD which puts him at risk of hypoxia due to airflow limitation. In addition, HH is at risk for diabetes, microvascular and macrovascular complications as well as HTN complications like heart failure, stroke and kidney failure.

The recommended medication therapy will include continuing IV Ceftriaxone 1 g OD for up to five days. However, I would stop Azithromycin since the patient is resistant to Erythromycin, and thus likely resistant to Azithromycin since they are in the same drug class. I would recommend adding IV Levofloxacin 750 mg OD to treatment because it minimizes antibiotic resistance (Olson & Davis, 2020). 

HH has hyperlipidemia and  at risk of cardiovascular events owing to a history of diabetes and hyperlipidemia. Thus, I would recommend Lipitor 20 mg/day orally to manage cholesterols levels and lower cardiovascular risk (Hadjiphilippou & Ray, 2019). Furthermore, I would recommend Metoclopramide 10 mg orally for nausea and vomiting, thus increasing food tolerance. 

The “Teach-back” method is the recommended patient education strategy. The strategy is employed to confirm a patient’s understanding of the provided health education by asking them to explain what they have learned using their own words (Yen & Leasure, 2019). Thus, the Teach-back” strategy can be used to educate HH about his chronic illnesses and the lifestyle interventions he should adopt to prevent associated complications and prevent disease progress.

Discussion

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 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’.

The first step to managing this patient’s treatment regime includes, firstly, conducting a physical assessment, from head to toe, to guide in making appropriate diagnosis of the current illness. Further, the physical examination can help discover other symptoms not shared by the patients that can support the type of patient’s plan of care.

Secondly, determining the cause of the hot flushing, night sweats, and genitourinary symptoms that are priority for the patient. Thirdly, determine any of her current health risks that can contribute to the presenting symptoms such as age; 46 years; family history of cancer; past undermined Pap smear report; and, elevated body weight.

These health risks can likely contribute to pre-menopausal symptoms and/or cancer illness. If determined the symptoms are premenopausal related, then, reassure the patient and treat genitourinary symptoms if interfere with the patient’s quality of life (Rosenthal & Burchum, 2021). If symptoms are related to possible cancer, plan to investigate further via a cervical colposcopy procedure to determine any precancerous signs (Sachan et al., 2018).

The second step is to manage her current medications since her blood pressure is elevated at 150/90. By gathering information from the patient to determine adherence to the medication directions. If the patient followed the guidelines correctly, then, consider adjusting the medication doses for either Norvasc (amlodipine)- a calcium channel blocker, or HCTZ 25 mg (Thiazide) a diuretic. In this case, in a few of the body weights, I would increase HCTZ from 25 mg to 50mg daily or 25 mg 12 hours a day.

After that, I will follow up with the patient in two weeks to find out the progress. The current patient’s weight could indicate fluid accumulation in the body. Further, suggests testing the patient for cholesterol levels, and electrolytes such as potassium, especially with daily intake of HTCZ which can induce hypokalemia, increased uric acid and glucose (Rosenthal & Burchum, 2021).

The third step would be reviewing health maintenance concerns such as diet and weight concerns. Concerning the elevated body weight, if not related to the fluid retention, it is likely related to the diet or reduced body exercises. Determine how active the patient is and the current diet intake. Teach the patient how to ensure accomplishing body exercises daily or weekly such as walking for 20-30ins a day; diet intake suitable to her current health status such as low fat, low salt, and high fiber such as brown rice, legumes, to name a few (Swift et al., 2018).

Further, suggests testing the patient for cholesterol levels, and electrolytes such as potassium, especially with daily intake of HTCZ daily which can induce hypokalemia, and increase uric acid and glucose (Rosenthal & Burchum, 2021).

References

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants (2nd ed.). Elsevier Inc.

Sachan, P. L., Singh, M., Patel, M. L., & Sachan, R. (2018). A study on cervical cancer screening pap smear test and clinical correlation. Asia-Pacific Journal of Oncology Nursing, 5(3), 337–341. Retrieved October 23, 2023, from https://doi.org/10.4103/apjon.apjon_15_18Links to an external site.

Swift, D. L., McGee, J. E., Earnest, C. P., Carlisle, E., Nygard, M., & Hohannsen, N. M. (2018). The effects of exercise and physical activity on weight loss and maintenance☆. Progress in Cardiovascular Disease, 61(2), 206–213. Retrieved October 23, 2023, from https://doi.org/10.1016/j.pcad.2018.07.014Links to an external site.

Scenario 3: Syphilis

A 37-year-old male comes to the clinic with a complaint of a “sore on my penis” that has been there for 5 days. He says it burns and leaked a little fluid. He denies any other symptoms. Past medical history noncontributory. 

SH: Bartender and he states he often “hooks up” with some of the patrons, both male and female after work. He does not always use condoms.

PE: WNL except for a lesion on the lateral side of the penis adjacent to the glans. The area is indurated with a small round raised lesion. The APRN orders laboratory tests, but feels the patient has syphilis.  

Question:

1.     What are the 4 stages of syphilis 

Your Answer:

        Syphilis progresses through four distinct stages, each characterized by specific symptoms and clinical manifestations:

          Primary Stage: This stage begins with the appearance of a painless sore called a chancre at the site of infection, typically within 3 weeks after exposure. The sore is firm, round, and often goes unnoticed. It can last for a few weeks and eventually heals on its own. The chancre is highly contagious and contains the bacterium Treponema pallidum.

        Secondary Stage: After the chancre heals, the secondary stage emerges, usually a few weeks to a few months later. Symptoms during this stage can vary widely and may include a skin rash, mucous membrane lesions (e.g., in the mouth or genitals), fever, fatigue, sore throat, and muscle aches. The rash is typically non-itchy, red or brown, and may appear on the palms and soles. These symptoms can come and go over several weeks.

        Latent Stage: This stage is characterized by the absence of visible symptoms. Syphilis remains present in the body, but there are no outward signs or symptoms. Latent syphilis is further categorized into early latent (within a year of initial infection) and late latent (more than a year after initial infection). During this stage, the infection can still be transmitted to others through sexual contact.

        Tertiary Stage: If left untreated, syphilis can progress to the tertiary stage, which can occur years after the initial infection. Tertiary syphilis is rare due to the widespread use of antibiotics. However, it can lead to severe and potentially life-threatening complications, such as damage to the heart, blood vessels, brain, nerves, and other organs. Neurological complications can lead to significant disability.

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 medicine, 24, 2515690X19829380. https://doi.org/10.1177/2515690X19829380

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

The treatment regimen for community-acquired pneumonia (CAP) depends on the severity of the disease and the patient’s risk factors. CAP can be treated empirically with ceftriaxone 1g IV qday and azithromycin 500 mg IV qday. This regimen is effective against a broad range of bacteria that can cause pneumonia. Given HH’s comorbidities and age, he is at high risk for complications from CAP. A thorough medication reconciliation is required to have a complete dosages of medication HH has been taking. This would guide the clinician on well informed decision of parameters and set dosages appropriately. The reconciliation would ensure medication interactions, potentiating effects etc are avoided, by evaluating prior meds bioavailability in the patient’s system. Education to HH on utilizing two different antibiotics to target the bacteria from different perspective for optimal care is paramount, (Dineen-Griffin et al., 2019).

In addition to pharmacotherapy, HH’s education is an essential component of CAP management by advising HH to complete the full course of antibiotics as prescribed by their healthcare provider, even if they start feeling better before completing the course and also be informed about potential side effects of antibiotics such as diarrhea and instructed to report any adverse reactions to their healthcare provider. HH should be advised to rest and avoid strenuous activities until they have fully recovered from CAP. Encouraged adequate hydration by drinking plenty of fluids such as water or juice.

Since HH is experiencing nausea and vomiting, he may benefit from antiemetic therapy such as ondansetron or promethazine with advise to avoid foods that may exacerbate symptoms such as spicy or greasy foods. Instead, he should consume small frequent meals consisting of bland foods such as crackers, toast, or rice. Education on how to prevent future episodes of pneumonia, such as getting the flu vaccine and quitting smoking, (Werfalli et al., 2020).

Patient education is an essential component of CAP management. HH should be advised to complete the full course of antibiotics as prescribed by his healthcare provider and informed about potential side effects of antibiotics. He should also rest and avoid strenuous activities until he has fully recovered from CAP. Antiemetic therapy may help alleviate his nausea and vomiting symptoms. Provide HH with a list of resources, such as support groups and websites, where he can learn more about pneumonia and COPD. Encourage HH to talk to his family and friends about his health needs and how they can support him. Help HH to develop a plan for self-management of his health conditions. Review HH’s COPD management plan and make sure he understands how to use his inhalers and other medications.

It is also important to assess HH’s understanding of the information that is being provided and to answer any questions he may have. Patient education should be an ongoing process, and HH should be encouraged to ask questions and seek clarification whenever needed. Provide HH with written instructions on how to take his medications, including the dose, frequency, and side effects to watch for, (Yadav, et al., 2020).

                                                                                              References

Dineen-Griffin, S., Garcia-Cardenas, V., Williams, K., & Benrimoj, S. I. (2019). Helping patients help themselves: a systematic review of self-management support strategies in primary health care practice. PloS one, 14(8), e0220116. https://doi.org/10.1371/journal.pone.0220116

Werfalli, M., Raubenheimer, P. J., Engel, M., Musekiwa, A., Bobrow, K., Peer, N., … & Levitt, N. S. (2020). The effectiveness of peer and community health worker-led self-management support programs for improving diabetes health-related outcomes in adults in low-and-middle-income countries: a systematic review. Systematic Reviews, 9(1), 1-19. https://doi.org/10.1186/s13643-020-01377-8

Yadav, U. N., Lloyd, J., Hosseinzadeh, H., Baral, K. P., Bhatta, N., & Harris, M. F. (2020). Self-management practice, associated factors and its relationship with health literacy and patient activation among multi-morbid COPD patients from rural Nepal. BMC Public Health, 20(1), 1-7. https://doi.org/10.1186/s12889-020-8404-7

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