Case Overview Of Genitourinary Symptoms Discussion
Case Overview Of Genitourinary Symptoms Discussion
The patient is a 46years old female complaining of hot flushing, night sweats, and genitourinary symptoms. She has a history of hypertension, atypical squamous cells of undetermined significance ASCUS five years ago, and a family history of breast cancer. She is currently on HCTZ 25mg PO once daily and Norvasc 10mg PO once daily. she is up to date with her mammogram and pap smear tests which are normal. She has had a regular menstrual cycle and her LMP was one month ago. On examination, she is obese with 2130Ibs and her blood pressure is 150/90mmHg. Case Overview Of Genitourinary Symptoms Discussion
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Describe The Patient’s Health Needs
The patient is hypertension, she is obese, has a previous history of ASCUS, has a family history of breast cancer, and has pre-menopausal symptoms. Hypertension is a chronic disease characterized by persistently elevated blood pressure above 140/90 mmHg. Risk factors for secondary hypertension are too much stress, old age, genetics, obesity, lack of physical exercise, and increased dietary sodium (Mills, et al, 2020). During the visit, her blood pressure is not well controlled despite her being on treatment (HCTZ and Norvasc). The patient has 230Ibs which is an alarming weight for her age. Obesity and hypertension predispose this patient to hyperlipidemia, diabetes mellitus, and metabolic syndrome. She presents to the clinic with pre-menopausal symptoms. Pre-menopause is the period that leads to menopause. Its onset is from the age of 44years until the onset of menopause. The ovaries gradually reduce the production of estrogen hormone thus the patient presents with hot flushes, night sweats, vaginal dryness, insomnia, lower abdominal pain, and recurrent urinary tract infections. Case Overview Of Genitourinary Symptoms Discussion
Treatment Regimen
Pharmacological treatment
- Norvasc 10mg PO OD
- HCTZ 25mg PO OD
- Losartan 50mg PO OD
- Atorvastatin 20mg PO NOCTE
I would continue with Norvasc and HCTZ because they are effective in controlling hypertension. However, I added losartan because the blood pressure is still high. The reason for initiating triple therapy for treating hypertension is because the patient is at high cardiovascular risk (Rahman, et al, 2017). Atorvastatin reduces the risk of stroke or major coronary events in obese patients.
Non-pharmacological
Reduce dietary sodium to control hypertension, engage in regular physical exercise, and healthy eating to help her lose weight. To reduce the hot flushes and sweating, she should maintain a healthy weight, avoid caffeine and alcohol, and carry a portable fan to spike when hot flushes strike. She should use vaginal lubricants and creams to enhance moisturization. Reduced estrogen production leads to vaginal dryness that increases the risk for frequent urinary tract infections (Santoro, et al, 2021)Case Overview Of Genitourinary Symptoms Discussion . The patient should avoid hormone replacement therapy because they increase the risk for breast cancer and she has a positive family history.
Explain Patient Education Strategies
Patient education strategies help in instilling knowledge about their illness and health to follow-up appointments and learn self-management techniques. In this patient, I will assess her health literacy by asking questions about her symptoms and what she feels about them. For a patient who understands her health, it is easy to learn the self-management instructions. I will then explain the simple concept of her illness, the causes, and the consequences then ask the patient to repeat what they have understood. I will offer educational materials with graphics and demonstrations to allow easy understanding. Health technology offers patients convenience in accessing health education materials. This patient education strategy will involve her next of kin to support the patient in the treatment journey. The patient should take her medication as prescribed and monitor her vitals regularly. She should follow up with the physician to treat and prevent chronic diseases Case Overview Of Genitourinary Symptoms Discussion .
References
Mills, K.T., Stefanescu, A. & He, J. The global epidemiology of hypertension. Nat Rev Nephrol 16, 223–237 (2020). https://doi.org/10.1038/s41581-019-0244-2
Rahman, M.A., Halder, H.R., Yadav, U.N. et al. Prevalence of and factors associated with hypertension according to JNC 7 and ACC/AHA 2017 guidelines in Bangladesh. Sci Rep 11, 15420 (2021). https://doi.org/10.1038/s41598-021-94947-2
Santoro, N., Roeca, C., Peters, B. A., & Neal-Perry, G. (2021). The menopause transition: signs, symptoms, and management options. The Journal of Clinical Endocrinology & Metabolism, 106(1), 1-15 Case Overview Of Genitourinary Symptoms Discussion .
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) Case Overview Of Genitourinary Symptoms Discussion
Lunenfeld, B., Mskhalaya, G., Zitzmann, M., Arver, S., Kalinchenko, S., Tishova, Y., & Morgentaler, A. (2015). Recommendations on the diagnosis, treatment and monitoring of hypogonadism in men. Aging Male, 18(1), 5–15. doi:10.3109/13685538.2015.1004049
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.
Montaner, J. S. G., Lima, V. D., Harrigan, P. R., Lourenço, L., Yip, B., Nosyk, B., … Kendall, P. (2014). Expansion of HAART coverage is associated with sustained decreases in HIV/AIDS morbidity, mortality and HIV transmission: The “HIV Treatment as Prevention†experience in a Canadian setting. PLoS ONE, 9(2), e87872. Retrieved from https://doi.org/10.1371/journal.pone.0087872
This study examines HAART therapy and its sustainability and profound population-level decrease in morbidity, mortality, and HIV transmission.
Roberts, H., & Hickey, M. (2016). Managing the menopause: An update. Maturitas, 86(2016), 53–58. .https://doi.org/10.1016/j.maturitas.2016.01.007
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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.
Agency for Healthcare Research and Quality. (2014). Guide to clinical preventive services, 2014: Section 2. Recommendations for adults. Retrieved from http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/guide/section2.html
Please use them as resources Case Overview Of Genitourinary Symptoms Discussion