Posted: February 17th, 2021
Lauren Robbins Main PostCOLLAPSE
The patient is a 46-year-old female who presents with hot flashes, nights sweats and genitourinary symptoms. According to Rosenthal & Burchum, (2021) many women between the ages of 45 and 55 years old may experiences signs and symptoms of menopause. Menopause is a normal process that happens with women who are aging. The process develops as the number of ovarian quickly diminish, resulting in a decrease of estrogen production and menstruation. During this process there is change in the vagina also. The patient presents with genitourinary symptoms.
The vagina consists of several epithelial layers including the mucosa, muscularis, and adventitia. During menopause, the most superficial layer, the mucosa begins to atrophy because of lack of estrogen (Pérez-Herrezuelo, Aibar-Almazán, Martínez-Amat, Fábrega-Cuadros, Díaz-Mohedo, Wangensteen, & Hita-Contreras, 2020). This causes the cell layer to become dry and thin. In addition, blood pressure may be elevated from arterial vasoconstriction. Hormone therapy may be used in this case to treat vasomotor symptoms and prevent vaginal atrophy (Kotenko, Barashkov, Salamadina, & Borisevich, 2020). Assessment of the effectiveness of physiotherapeutic methods for management of early menopause disorders. Gynecology, Obstetrics & Perinatology / Voprosy Ginekologii, Akusherstva i Perinatologii, 19(4), 58–62. https://doi-org.ezp.waldenulibrary.org/10.20953/1726-1678-2020-4-58-62. Medication such as conjugated estrogens (Cenestin, Estrace, Estratab, Femtrace, Ogen, and Premarin) or estrogens-bazedoxifene (Duavee) may be prescribed for the [atients symptoms. For example, Cenestin 0.45mg PO daily may be prescribed. In addition, other forms such as a patch or vaginal creams may also works.
Kotenko, N. V., Barashkov, G. N., Salamadina, G. E., & Borisevich, O. O. (2020). Assessment of the effectiveness of physiotherapeutic methods for management of early menopause disorders. Gynecology, Obstetrics & Perinatology / Voprosy Ginekologii, Akusherstva i Perinatologii, 19(4), 58–62. https://doi-org.ezp.waldenulibrary.org/10.20953/1726-1678-2020-4-58-62
Pérez-Herrezuelo, I., Aibar-Almazán, A., Martínez-Amat, A., Fábrega-Cuadros, R., Díaz-Mohedo, E., Wangensteen, R., & Hita-Contreras, F. (2020). Female Sexual Function and Its Association with the Severity of Menopause-Related Symptoms. International Journal of Environmental Research and Public Health, 17(19). https://doi-org.ezp.waldenulibrary.org/10.3390/ijerph17197235
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Nick Daneri week9 discussion board initial postCOLLAPSE
Based on patient’s on going poorly managed hypertensions and presenting symptom related new onset of menopause, possibly a UTI, as well as poor absorption or clearance of htn meds. To confirm this the following labs would be ordered to confirm diagnosis: CBC, BMP, Thyroid, estrogen, testosterone. Additionally, ask how recently last pap was done, if not with in relate recommended timeline, order a pap-smear. The onset on menopause will usually occur between the ages of 40 to 60 years old, a hormonal process that that can trigger or exacerbate changes in the uterus, breast, cardiac, skeletal, and urinary track systems (Rosenthal & Burchum, 2017). The cardiac involvement compounded by a history of HTN increases the risk of a CVA (Rosenthal & Burchum, 2017). Additionally, the hormonal involvement in menopause increases the risk of cancer triggering patients with a familial history of breast cancer (Rosenthal & Burchum, 2017).
A change in BP med is recommended to the beta-blocker Metoprolol to reduce the risk of CVA, with education to check the heart rate and BP prior to administration because this med can contribute to brady cardia and hypotension (Manson, et. al., 2015). To address the early menopause, a hormone replacement medication such as Escitalopram (an SSRI) or Venlafaxine (an SNRI) if menopause symptoms worsen, as recommended by The North American Menopause Society (NAMS) (Di Angelantonio, et. al., 2016). Because of her genitourinary systems, she should be evaluated for UTI and another pap-smear for cancer development related to her ASCUS. If positive for UTI she should be treat with a broad-spectrum antibiotic such ceftriaxone; and if found to have cancerous uterine cells an oncology appointment should be made (Manson, et., al., 2015)
Di Angelantonio, E., Bhupathiraju, S. N., Wormser, D., Gao, P., Kaptoge, S., De Gonzalez, A. B., … & Hu, F. B. (2016). Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. The Lancet, 388(10046), 776-786.
Manson, J. E., Ames, J. M., Shapiro, M., Gass, M. L., Shifren, J. L., Stuenkel, C. A., … & Utian, W. H. (2015). Algorithm and mobile app for menopausal symptom management and hormonal/non-hormonal therapy decision making: a clinical decision-support tool from The North American Menopause Society. Menopause, 22(3), 247-253. https://doi-org.ezp.waldenulibrary.org/10.1177/1010539515586457
Rosenthal, L., & Burchum, J. (2017). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants-E-Book. Elsevier Health Sciences. https://books.google.com/books?hl=en&lr=&id=IPm9DwAAQBAJ&oi=fnd&pg=PP1&dq=Lehne%E2%80%99s+Pharmacotherapeutics+for+Advanced+Practice+Nurses+and+Physician+Assistants-E-Book&ots=rPV3leJySQ&sig=iYWkRJfqwwAFfSpBWKxJ7QVFCmU#v=onepage&q=Lehne%E2%80%99s%20Pharmacotherapeutics%20for%20Advanced%20Practice%20Nurses%20and%20Physician%20Assistants-E-Book&f=false
3 sources for each discussion, thanks.
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