The Problem Of Postmenopausal Bleeding Discussion

The Problem Of Postmenopausal Bleeding Discussion

Need Help Writing an Essay?

Tell us about your assignment and we will find the best writer for your paper

Write My Essay For Me

Hi, you have provided an extensive overview of the patient’s follow-up regarding COPD, hypertension, nicotine dependence, and the unexpected problem of postmenopausal bleeding in your SOAP note. I do appreciate the comprehensive information given, which provides a well-rounded picture of the case and includes the patient’s past medical history, social history, allergies, and current medications. It is praiseworthy that the patient was sent to a gynecologist for additional testing, which could include a transvaginal ultrasound and possibly a hysteroscopy as described by Jia et al. (2019). A careful approach to differential diagnosis can be seen in the consideration of uterine polyps, endometrial atrophy, and endometrial glandular hyperplasia as possible causes of postmenopausal bleeding. Also, the progesterone therapy or polyp removal plan is in line with accepted medical procedures for treating these ailments (American College of Obstetricians and Gynecologists, 2020)The Problem Of Postmenopausal Bleeding Discussion.

ORDER A PLAGIARISM-FREE PAPER HERE

According to Jia et al. (2019), it is appropriate for postmenopausal bleeding to be prioritized in the assessment. I agree that there is additional complexity brought about by the co-existence of hypertension, COPD, and the unanticipated gynecological issue. Given the patient’s medical history, the choice to prioritize continuous smoking cessation education in addition to the Chantix prescription is a reasonable and essential step. The student’s pragmatic recognition of the difficulties in this area of care is demonstrated by her realistic observation that patient compliance with quitting cannot be guaranteed.

Given the patient’s age and medical history, I would recommend ruling out endometrial cancer as a possible cause of postmenopausal bleeding, even though the selected differentials are appropriate. Talking about this possibility with the gynecologist and looking into suitable screening or diagnostic tests could improve the assessment overall and guarantee a comprehensive analysis of possible causes (American College of Obstetricians and Gynecologists, 2020)The Problem Of Postmenopausal Bleeding Discussion.

With regard to the treatment, the suggested transvaginal ultrasound and gynecologist referral are reasonable and compliant with accepted standards. However, given her medical history and current medications, a more thorough discussion about potential risks and benefits with the patient may be helpful when considering Progesterone therapy for endometrial hyperplasia (Wingo et al., 2018). In addition, complicated factors may need to be taken into account when removing a uterine polyp, and the gynecologist may investigate several options, such as hysteroscopic polypectomy or other treatments.

With the right differential diagnoses and treatment plans, your SOAP note successfully addresses the patient’s numerous health issues. Working together with a gynecologist is crucial to providing comprehensive care, and your records demonstrate that you have a firm grasp of the patient’s medical background and present conditions. To promote a comprehensive and patient-centered approach to care, I encourage continous diligence in taking into account all viable causes and treatment options. Well done for giving such a thorough and analytical analysis of the case.

References

American College of Obstetricians and Gynecologists (ACOG)Links to an external site.. (2020).  https://www.acog.org/

Jia, X., Rana, N., Crouss, T., & Whitmore, K. E. (2019). Gynecological associated disorders and management. International journal of urology : official journal of the Japanese Urological Association, 26 Suppl 1, 46–51. https://doi.org/10.1111/iju.13974

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.

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. The Problem Of Postmenopausal Bleeding Discussion

ORDER NOW

Patient Information:

BS, 54 y/o Caucasian Female

S.

CC (chief complaint): Pt presents for follow up on COPD, Nicotine dependence and hypertensive disorder. Pt also reports vaginal bleeding last month after no menstrual period for 9 years.

HPI: Follow up on COPD. Pt currently not taking Trelegy due to waking up with thrush 2 days after beginning. Follow up on labs, fasting glucose 165, A1C POC today was 6.8. Follow up nicotine dependence, just over ½ PPD, ready to quit. Follow up HTN, BP 118/82. Had vaginal bleeding last month after no period for 9 years.

Current Medications:

Breztri Aerosphere 160mcg-9mcg-4.8mcg/actuation HFA inhaler- 2 puffs BID COPD

Duloxetine 20mg- 1 capsule BID Depression

Losartan 100mg/2.5mg HCTZ- 1 tab daily HTN

Ozempic 0.25mg (2mg/1.5ml)- 0.5mg weekly Obesity

ProAir HFA 90mcg/actuation inhaler- 2 puffs Q4hrs PRN COPD

Varenicline 0.5mg-1mg Dose Pack Nicotine Dependence

Allergies:

Gabapentin

Neosporin

PMHx:

Tobacco dependence, chronic laryngitis, edema of larynx, postmenopausal bleeding, severe obesity, major depressive disorder, joint pain, headache, hypertensive disorder, asthma, COPD

Soc & Substance Hx: + Tobacco Use ½ PPD, Denies alcohol or illicit drug use

Fam Hx:

Mother- Hypertensive disorder, Depressive disorder

Surgical Hx:

Cesarean Section- 1/1/87

Mental Hx: History of depressive disorder

Violence Hx: Denies history or verbal, emotional or physical abuse

Reproductive Hx: + history of postmenopausal bleeding

ROS:

GENERAL: No weight loss, fever, chills, weakness, or fatigue.

HEENT: Eyes: No visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat. The Problem Of Postmenopausal Bleeding Discussion

SKIN: No rash or itching

CARDIOVASCULAR: No chest pain

RESPIRATORY: No shortness of breath, history of COPD

GASTROINTESTINAL: No nausea, vomiting or diarrhea

NEUROLOGICAL: No headache, dizziness or syncope

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

HEMATOLOGIC: No anemia

LYMPHATICS: No enlarged nodes. No history of splenectomy.

PSYCHIATRIC: History of depressive disorder

ENDOCRINOLOGIC: No reports of sweating or cold or heat intolerance

GENITOURINARY: Denies burning on urination or increased urinary frequency

ALLERGIES: No history of asthma, hives or rhinitis

O.

Physical exam:

Heart RRR, no murmur noted

Lungs clear throughout to auscultation

Neck supple, without mass or bruit

External Genitalia, normal, vagina normal, cervix normal appearing, bimanual exam suboptimal due to obesity

Diagnostic results:

Pap, LB+ HR HPV- negative

A.

Primary and Differential Diagnoses (list a minimum of 3 differential diagnoses).

N85.8- Endometrium Atrophy- due to postmenopausal bleeding

N85.00- Endometrial glandular hyperplasia- due to postmenopausal bleeding

N84.0- Polyp of corpus uteri- due to post menopausal bleeding

Plan

Pt will be referred to Gyn for further evaluation and possible hysteroscopy due to postmenopausal bleeding. Pt will also be scheduled for transvaginal ultrasound for further evaluation.

Should endometrial hyperplasia be diagnosed, pt will be prescribed Progesterone therapy to trigger shedding of the uterine lining.

If it is determined that pt has a polyp of the corpus uteri, removal of the polyp may resolve the bleeding. This is why it is imperative to refer pt to GYN for further workup and treatment.

Pt was in clinic for routine follow up on chronic illnesses, she just happened to mention towards the end of visit with provider that she had experienced post menopausal bleeding.

Continued education should be provided to this patient regarding smoking cessation. The patient is willing to quit smoking at this point and Chantix was ordered, but that does not mean that the patient will quit. This needs to be an area of focus for the provider due to patient having COPD, HTN and now post menopausal bleeding. The patient will also complete a PHQ9 at least yearly to evaluate effectiveness of medication for depression. The Problem Of Postmenopausal Bleeding Discussion

References

Begum, J, Samal, R (2019); A Clinicopathological Evaluation of Postmenopausal Bleeding and its Correlation with Risk Factors for Developing Endometrial Hyperplasia and Cancer: A Hospital Based Study; Journal of mid-life health 10 (4), 179

Carugno, J (2020); Clinical Management of Vaginal Bleeding in Postmenopausal Women; Climacteric 23 (4), 343-349

Doll, K, Romano, S, Marsh, E, Robinson, W (2021); Estimated Performance of Transvaginal Ultrasonography for Evaluation of Postmenopausal Bleeding in a Simulated Cohort of Black and White Women in the US; JAMA Oncology 7 (8), 1158-1165

 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) The Problem Of Postmenopausal Bleeding Discussion

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?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 statement Links 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 Study Links 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 Handbook Links to an external site.. https://www.aanpcert.org/resource/documents/AGNP%20FNP%20Candidate%20Handbook.pdf The Problem Of Postmenopausal Bleeding Discussion
  

  ORDER HERE

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.).

• 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 careLinks to an external site.. https://www.nursingworld.org/
• Centers for Disease Control and Prevention. (CDC). (n.d.). CDC in actionLinks 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/

 The Problem Of Postmenopausal Bleeding Discussion