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Case Study For Patient With Menstruation Cycles Discussion

Case Study For Patient With Menstruation Cycles Discussion

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SOAP note discussion post response

M.R.’s case caught my attention, and I appreciate your carefully considered recommendations for potential causes of her symptoms. My aim is to offer an additional perspective on the diagnostic tests and available treatments, based on M.R.’s presentation and test findings. I understand that it is imperative to embrace various perspectives as this deepens our understanding and ensures that M.R.’s health issues are handled holistically. I am excited to add to your discussion of her case. I believe that this will establish a culture of mutual knowledge and thorough comprehension. I appreciate you initiating a fascinating discussion.

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Firstly, it is vital to acknowledge that M.R.’s symptoms may be peri-menopausal. This is essential considering that she presents with irregular menstrual periods, hot flashes, and night sweats. However, it becomes vital to take a look at underlying causes other than perimenopause when a person reaches 45. Hypothyroidism, a disorder more common in women, can present with symptoms similar to those of the perimenopause (Wilson et al., 2021)Case Study For Patient With Menstruation Cycles Discussion. Thus, an exhaustive examination is essential in order to exclude others. We can guarantee a more precise diagnosis and suitable course of treatment for M.R through a more comprehensive evaluation of potential causes, such as thyroid function. This approach encourages a complete grasp of each patient’s unique profile and is in line with age-specific factors in women’s health.

Taking this into account, I recommend a more thorough assessment of thyroid function that goes beyond the TSH measurement. Even though the TSH level given is within normal ranges, a more comprehensive evaluation that includes measurements of free T3 and free T4 can give a fuller picture of thyroid function. According to Frank-Raue and Raue (2023), hypothyroidism is more common in women and can present with symptoms that resemble those of the perimenopause. Thus, a more in-depth examination of thyroid function may contribute to a thorough comprehension of M.R.’s situation.

A complete examination, which should include a mammography, is necessary to rule out any possible breast-related conditions. This examination is imperative given the patient’s complaint of pain in the right breast. A thorough examination is necessary even in cases where no lumps or discharge have been reported. This highlights the importance of early identification in maintaining breast health. This approach is in conformity with preventative care practices, ensuring an early response to any possible issues and promoting general health. Case Study For Patient With Menstruation Cycles Discussion

Regarding the suggested course of treatment, specifically hormone replacement therapy (HRT) for M.R.’s perimenopausal symptoms, I agree that HRT may be beneficial. However, it is vital to have an in-depth conversation about the advantages and risks involved with the patient. Likis and Schuiling’s (2022) scholarly resource “Women’s Gynecologic Health” emphasizes how important it is to carefully consider warnings and contraindications related to hormone therapy before administering HRT. This entails carefully reviewing each patient’s medical history while taking into account their unique risk factors. A patient-centered approach like this promotes informed decision-making and maximizes the therapeutic outcome. It ensures that the treatment selected is in line with M.R.’s unique health profile. A collaborative relationship between the patient and the healthcare professional is fostered by open communication. This raises the standard of care overall.

In conclusion, I suggest a more thorough evaluation that includes a full thyroid function assessment and breast examination, even though peri-menopause is a legitimate explanation for M.R.’s symptoms. In order to ensure a customized and knowledgeable approach, talks regarding prospective treatment choices, such as hormone replacement therapy (HRT), should also include a thorough discussion of the patient’s unique health profile.

Thank you for the insightful contributions, and I look forward to further discussion and collaboration on M.R.’s case.

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References

Frank-Raue, K., & Raue, F. (2023). Thyroid Dysfunction in Peri-and Postmenopausal Women—Cumulative Risks. Deutsches Ärzteblatt International, 120(18), 311. https://doi.org/10.3238%2Farztebl.m2023.0069

Schuiling, K. D., & Likis, F. E. (2022). Gynecologic Health Care: With an Introduction to Prenatal and Postpartum Care: With an Introduction to Prenatal and Postpartum Care. Jones & Bartlett Learning.

Wilson, S. A., Stem, L. A., & Bruehlman, R. D. (2021). Hypothyroidism: Diagnosis and treatment. American family physician103(10), 605-613.

Respond to your colleagues’ posts and explain how you might think differently about the types of tests or treatment options that your colleagues suggested and why. Use your learning resources and/or evidence from the literature to support your position. NEED 2 Scholarly Resources APA format.

 

Patient Information:

M.R. 45y/o, Female, white

S.

CC (chief complaint): Pain on right breast for two weeks

HPI: M.R. is a 44-year-old female G2 P2, that came to the clinic with a CC variable menstruation cycle. Client indicates that her menstruation cycles are strange with variable and heavier flow. Client indicates that is been happening for the last six month with pre-menstrual symptoms, irregular menstrual cycles, hot flashes, night sweats, and she is always tired. Drink daily multivitamins. No other medical history. Case Study For Patient With Menstruation Cycles Discussion

Location: lower abdomen

Onset: six months

Character: heavy menstrual flows,

Associated signs and symptoms: abdominal pain, cramps, hot flashes, night sweats, and she is always tired.

Timing: menstrual cycle (every 26-40 days)

Exacerbating/relieving factors:

Severity: 5/10 pain scale

Current Medications: Multivitamins

Allergies: No allergies.

PMHx: immunizations are up to date. No previous medical history

Soc & Substance Hx: No smoke, no drink alcohol, never used illicit drugs. Client is a medical office operational manager.

Fam Hx: mother- HBP

Father- DM type 2

Sister- no medical hx

Daughters- no medical hx

Surgical Hx: Tonsillectomy when she was 8year old.

Mental Hx: No hx of depression or anxiety

Violence Hx: No Concern or issues

Reproductive Hx: LMP 2 weeks ago, Menarche start when she was 13 years. Her menstrual cycles are irregular, 26-49 days and last from 5-10 days. No other sexual concerns at the moment. She does not have a sexual partner right now.

ROS:

GENERAL: No weight loss, fever, chills. Client is feeling tired all the time. She is having a hard time trying to sleep at night. Night sweat, hot flashes

HEENT: Eyes: She went to the optometrist appointment 3 weeks ago, No visual changes, no blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, no sneezing, no congestion, no runny nose, or sore throat.

SKIN: No skin issue reported

CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema.

RESPIRATORY: No shortness of breath.

GASTROINTESTINAL: No abdominal pain or blood. No anorexia, nausea, vomiting, or diarrhea.

NEUROLOGICAL: Occasional headache before menstrual cycle starts, no dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities.

MUSCULOSKELETAL: No muscle pain, back pain, joint pain, or stiffness.

HEMATOLOGIC: No anemia, Heavy menstrual blood flow.

LYMPHATICS: No enlarged nodes. No history of splenectomy.

PSYCHIATRIC: No history of depression or anxiety.

ENDOCRINOLOGIC: Reports of night sweating, hot flashes. No polyuria or polydipsia.

GENITOURINARY/REPRODUCTIVE: No Burning on urination. Pregnancy. LMP: 12/12/23. No Breast-lumps, pain, discharge. No reports of vaginal discharge, Client is not sexually active now of the visit. Indicate last sexual encounter last year. Case Study For Patient With Menstruation Cycles Discussion

ALLERGIES: No history of asthma, hives, eczema, or rhinitis.

O.

H 5’4”, Weight 150lbs, B/P 124/86, P 90, R 22.

Physical exam: M.R. is a 44-year-old female G2 P2, that came to the clinic with a CC variable menstruation cycle. Client indicates that her menstruation cycles are strange with variable and heavier flow. Client indicates that is been happening for the last six month with pre-menstrual symptoms, irregular menstrual cycles, hot flashes, night sweats, and she is always tired. Drink daily multivitamins. No other medical history.

Diagnostic results:

CBC-

Pelvic examination-

Pelvic ultrasound-

Serum FSH, LH, estradiol, TSH and prolactin-

A.

Peri-Menopause (N95.1)- The menopausal transition is roughly divided into 2 phases, which were initially based solely on menstrual patterns, but these patterns appears to have endocrine correlations (Santoro et al,  2021, para 2)

Hypothyroidism (E03.9)- Thyroid disorders are significantly more common in women compared to men and increase in incidence with age (Frank-Raue & Friedhelm, 2023, para 3)

Anemia (D64.9)- Anovulatory cycles can be highly variable in their bleeding patterns. The definition of abnormal uterine bleeding (AUB) is ‘flow outside of normal volume, duration, regularity or frequency (Goldstein & Lumsden, 2017, para 3) Case Study For Patient With Menstruation Cycles Discussion

O.

Client has some irregular menses at age of 45 and should be evaluated to rule out any other medical condition.

CBC- Normal limits results. No anemia

HGB125g/L

Platelets 245×10/L

RBC 4.5×10/L

Pelvic examination- Vaginal dryness

Pelvic ultrasound- thickened and hyperechogenic endometrium and the ovaries are small, no evidence if follicular growth.

Serum FSH, LH, estradiol, TSH and prolactin-

FSH 35mIU/mL

LH 22mIU/mL

E2 80pg/mL

TSH 1.9mcIU/mL

Prolactin 18 ng/mL

  • These labs suggest that the patient is entering menopause.

P.

Reflection

This client is experiencing some life changes that can affect her mood, emotions, and mental health. This visit is an excellent opportunity to teach the client what to expect and what to do during these changes. Menopause can increase the risk of cardiovascular diseases and can also worsen some lipid profiles. Menopause can be diagnosed based on the clinical absence of menses for 12 consecutive months; in this case, the patient still has some irregular menses but has some pre-menopausal symptoms. The hot flashes, night sweats, and trouble sleeping are strongly associated with peri-menopausal dx.

The client needs to be evaluated and educated about depression symptoms because the rate of new-onset depression is higher in peri-menopausal clients. The client will benefit from hormone replacement therapy. A follow-up visit will be held in three months to follow up on the patient’s symptoms. If any abnormal bleeding or other concerning symptoms occur, the client can contact the clinics for an early evaluation.

Treatment

As a result of low estrogen, client will need a vaginal lubricants or moisturizer and oral hormone therapy. Prior to prescribing HT, it is imperative that clinicians and their patients review any cautions or contraindications to hormone use (Likis &nSchuiling 2017 p. 283) Case Study For Patient With Menstruation Cycles Discussion

Recommendation to use a water-based lubricant and client will start with enjuvia 0.3mg daily. Follow up in three months.

 

References

Frank-Raue, K. &. (2023). Thyroid Dysfunction in Peri- and Postmenopausal Women-Cumulative Risks. Deutsches Ärzteblatt International, 120(18), 311-316.

Goldstein, S. R. (2017). Abnormal uterine bleeding in perimenopause. Climacteric, 20(5), 414-420.

Likis, K. D. (2017). Women’s Gynecologic Health. Burlington, MA: World Headquarters.

Santoro, N. R.-P. (2021). The Menopause Transition: Signs, Symptoms, and Management Options. Journal of Clinical Endocrinology & Metabolism, 106(1), 1-15.

 

CLASS Resources

  • Schuiling, K. D., & Likis, F. E. (2022). Gynecologic health care(4th ed.). Jones and Bartlett Learning.
    • Chapter 23, “Urinary Tract Infections” (pp. 469–478)
    • Chapter 24, “Urinary Incontinence” (pp. 479–492)
    • Chapter 23, “Menstrual-Cycle Pain and Premenstrual Syndrome” (pp. 495–510)
    • Chapter 26, “Normal and Abnormal Uterine Bleeding” (pp. 511–526)

RESOURCES FOR LGBTQ+

  • Aisner, A. J., Zappas, M., & Marks, A. (2020). Primary Care for Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning (LGBTQ) PatientsLinks to an external site.. The Journal for Nurse Practitioners, 16(4), 281–285. https://go.openathens.net/redirector/waldenu.edu?Case Study For Patient With Menstruation Cycles Discussion url=https://doi.org/10.1016/j.nurpra.2019.12.011
  • Office of Disease Prevention and Health Promotion (ODPHP). (2020, April 18). Lesbian, gay, bisexual, and transgender healthLinks to an external site.. https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health
  • Sadlak, C. A., Boyd, C. J., & Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ)
    Health Expert Panel (2016). American Academy of Nursing on Policy: Health care services for transgender individuals: Position statementLinks to an external site.. https://www.nursingoutlook.org/action/showPdf?pii=S0029-6554%2816%2930120-8
  • Wingo, E., Ingraham, N., & Roberts, S. C. M. (2018). Reproductive Health Care Priorities and Barriers to Effective Care for LGBTQ People Assigned Female at Birth: A Qualitative StudyLinks to an external site.. Women’s Health Issues, 28(4), 350–357. https://go.openathens.net/redirector/waldenu.edu?url=https://doi.org/10.1016/j.whi.2018.03.002

FNP RESOURCES

  • American Academy of Nurse Practitioners Certification Board (AANPCB). (2018). Welcome to the American Academy of Nurse Practitioners Certification BoardLinks to an external site.. https://www.aanpcert.org/
  • American Academy of Nurse Practitioners National Certification Board, Inc. (AANPCB). (2018). FNP & AGNP Certification Candidate HandbookLinks to an external site.. https://www.aanpcert.org/resource/documents/AGNP%20FNP%20Candidate%20Handbook.pdf Case Study For Patient With Menstruation Cycles Discussion

CLINICAL GUIDELINE RESOURCES

As you review the following resources, you may want to include a topic in the search area to gather detailed information (e.g., breast cancer screening guidelines; CDC for zika in pregnancy, etc.).

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  • American Cancer Society, Inc. (ACS). (2020). Information and Resources about Cancer: Breast, Colon, Lung, Prostate, SkinLinks to an external site.. https://www.cancer.org/
  • American College of Obstetricians and Gynecologists (ACOG)Links to an external site.. (2020).  https://www.acog.org/
  • American Nurses Association (ANA). (n.d.). Lead the profession to share the future of nursing and health care Links to an external site.. https://www.nursingworld.org/
  • Centers for Disease Control and Prevention. (CDC). (n.d.). CDC in action Links to an external site.. https://www.cdc.gov
  • Healthy People 2030. (2020). Healthy People 2030 Framework Links to an external site..  https://www.healthypeople.gov/2020/About-Healthy-People/Development-Healthy-People-2030/Framework
  • The American Association of Nurse Practitioners (AANP). (2020). What’s Happening at your association Links to an external site.. https://www.aanp.org/ Case Study For Patient With Menstruation Cycles Discussion

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