NURS 6512 Case study 2: A 46-year-old, 230lb woman with a family history of breast cancer
Last names beginning with N-Z please do Case study 2: 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.
Women’s Health: 49 y/o W
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Women’s Health
“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. Home medications are Norvasc 10mg qd and HCTZ 25mg qd. Her BP today is 150/90. She has regular monthly menstrual cycles”.
After meeting with this patient, addressing her new genitourinary symptoms would be a priority. With her last screening five years ago, I would want a pap smear, since the standard is every three years (Agency for Healthcare Research and Quality, 2014). With her presentation of vasomotor symptoms related to menopause such as the sleep disturbances, night sweats, and genitourinary symptoms, the topic of hormone therapy would need to be assessed (Roberts & Hickey, 2016). Estrogen affects the cardiovascular system through cholesterol, clot formation, and vascularity (Cleveland Clinic, 2019). Therefore a lipid panel and CBC would be good objective data to aid in decision making.
Continuing assessment, I would want to assess what she knows about her medications, if she is taking her medication, and when she is taking her medication. Her elevated blood pressure would suggest she is non-compliant with her current routine. Her sleep disturbances could be attributed to taking HCTZ before bed and being woken up by the urge to use the restroom. I would also want to know her A1C due to her weight.
During patient education, assessing what the patient knows is essential to effective teaching. Along with assessing a patient’s knowledge base, understanding what method of teaching the patient prefers improves communication. Using the patient’s preferred form of learning, teaching regarding weight loss (diet and exercise or medication if necessary), menopause (medication purpose and side effects), and cancer screenings (timing, risk factors, s/s to monitor) would be discussed. Educating patients about their medication and treatment helps promote safety and accountability which leads to better patient outcomes (Laureate Education, 2019).
References
Agency for Healthcare Research and Quality. (2014). Cervical Cancer.
Cleveland Clinic. (2019). Estrogen & hormones.
Laureate Education. (2019). Pathopharmacology: Pharmacology and immunological disorders: Improvements in medication and drug administration [Video file]. Baltimore, MD: Author.
Roberts, H., & Hickey, M. (2016). Managing the menopause: An update. Maturitas, 86(2016), 53-58.
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An undergrad physiology professor of mine once said “Many people say men and women are the same, but there is a Vas Deferens between us”
Students with last names beginning with A-M please do case study 1: HH is a 68 yo M who has been admitted to the medical ward with community-acquired pneumonia for the past 3 days. His PMH is significant for COPD, HTN, hyperlipidemia, and diabetes. He remains on empiric antibiotics, which include ceftriaxone 1 g IV qday (day 3) and azithromycin 500 mg IV qday (day 3). Since admission, his clinical status has improved, with decreased oxygen requirements. He is not tolerating a diet at this time with complaints of nausea and vomiting. Ht: 5’8” Wt: 89 kg, Allergies: Penicillin (rash)
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
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)
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.
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.
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.
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
