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Case Study #1

Discuss and described the pathophysiology and symptomology/clinical manifestations of AUB.

Abnormal uterine bleeding (AUB) refers to a wide range of anomalies in the menstrual cycle, including variations in flow volume, length, and frequency that don’t occur during pregnancy. One third of women experience abnormal uterine bleeding, and it most frequently seen at the start of menarche and during the beginning stages of menopause. The uterus receives blood from the uterine and ovarian arteries, which then supply blood to the endometrium. At the end of the menstrual cycle, progesterone levels drop, which causes the functionalis layer of the endometrium to enzymatically break down. Menstruation is the result of this breakdown, which causes blood loss and shedding. Blood loss is controlled by thrombin, functioning platelets, and vasoconstriction of the arteries to the endometrium. Menstruation can be affected, and abnormal uterine bleeding can result from any abnormality in the uterus’ anatomy (such as cancer, polyps, or hyperplasia), irregularities in the clotting pathways, or interruption of the hypothalamic-pituitary-ovarian axis (Davis & Sparzak, 2022). Clinical manifestations of AUB include weight loss, pain, discharge, bowel or bladder symptoms, symptoms of anemia, symptoms of a bleeding disorder, and symptoms of endocrine disorders.

Discuss three differential diagnoses for AUB with ICD 10 numbers for each.

Endometriosis (ICD10-N80) is a disorder in which the uterus’ lining, endometrium, or cells that resemble it, proliferate outside the womb. Endometriosis can enclose the ovaries and fallopian tubes and frequently affects the pelvic tissue. It may have an impact on neighboring organs including the intestine and bladder. Endometriosis is seen in about 10% to 15% of women in the reproductive years, but many frequently show no symptoms and receive no medical attention for the condition (Tsmantioti & Mahdy, 2022). Chronic pelvic pain and decreased fertility are the disease’s main clinical symptoms.

Pelvic Inflammatory Disease (N73.9) is an infection-related inflammation of the upper vaginal canal in females. The uterus, fallopian tubes, and ovaries are all affected by the illness and is often spreads from the lower vaginal tract. Pelvic Inflammatory Disease (PID) is most frequently associated with a sexually transmitted infection. Clinical manifestations include lower abdominal or pelvic pain and genital tract tenderness, dysuria, dyspareunia, unusual vaginal discharge that may be malodorous, abnormal vaginal bleeding during or after intercourse, and fever with chills (Jennings & Krywko, 2022).

Cervical Cancer (ICD10-C53.9) is a cancer that affects the cells of the cervix due to the Human Papillomavirus (HPV). The virus remains in existence for years and contributes to the process through which some cervical cells develop into cancer cells. In the early stages of the disease, many women are asymptomatic. Clinical manifestations of the disease include postcoital bleeding and pain during intercourse, abnormal bleeding, persistent vaginal discharge that may be watery and malodorous, irritation, and cervical lesions (Cohen et al., 2019).

Discuss patient education.

Patients who experience abnormal uterine bleeding should be informed about any necessary dietary adjustments, available treatments, and when to seek emergency care. Patient education should also include complications that can be caused by AUB such as anemia, infertility, and endometrial cancer. If urgent treatment and supportive care are not started, there may be acute abnormal uterine hemorrhage, severe anemia, hypotension, shock, and even death (Davis & Sparzak, 2022). Women should be educated on the importance of familiarizing themselves with their menstrual cycle, regularity, desire for fertility, contraception, and sexual health. Patients should be educated on the different options to manage the condition which include hormonal, non-hormonal, and surgical interventions.

Develop the management plan (pharmacological and nonpharmacological).

The treatment plan for AUB depends on many factors such as the desire for fertility, clinical stability of the patient, and other medical comorbidities. The first line treatment for AUB is hormones such as intravenous conjugated estrogen, combined oral contraceptive pills (OCPs), and oral progestins (Davis & Sparzak, 2022). Other options are tranexamic acid, tamponade of uterine bleeding with a foley bulb and Desmopressin. Some patients may benefit from a dilation and curettage. Some non-pharmacological interventions include exercise, rest, dietary modifications, and herbs such as Yarrow which is known as a uterine stimulant. Dietary modification should include consuming a healthy diet of vitamin C-rich and iron, such as red meat, seafood, eggs, beans, and leafy green vegetables as this can help with low iron levels caused by blood loss.

An effective health assessment incorporates not only physiological parameters; please suggest other parameters that should be considered and included on health assessments to reach maximal health potential on individuals.

Evaluation of a patient’s economic, social, and educational characteristics that can have an impact on their health is crucial in addition to taking physiological measurements of the patient. Patients with lower socioeconomic status, have an increased risk of health deterioration and are unable to reach maximal health potential. When combined with a lack of disease knowledge, low levels of education can have an influence on income and increase the likelihood that people would make hazardous health decisions.

Name the different family developmental stages and give examples of each one.

With lower socioeconomic status, the disorder’s likelihood also increases. After every member of the family successfully completes the tasks related to that stage, families move through the stages in a certain fashion throughout time. A person has attained the first stage of independence when they achieve adulthood without the financial, emotional, or social support of their parents. The second phase is coupling or marriage, which is the union of two people in love through matrimony or another type of commitment to start a family on their own. When a couple decides it’s time to establish a family and have children, it is the third stage of parenting. In the fourth stage, when children eventually leave the family, they are referred to as “launching adult children.”

Describe family structure and function and the relationship with health care.

Regarding the role of family in illness and how illness affects the family system, one of the important concepts examined in contemporary health literature is family functioning. A strong family unit may support one another, be adaptable to stressors and changes, and be resilient. Clear duties and responsibilities, open communication, and a supportive and nurturing environment are all necessary for a healthy family to thrive. A healthy family can advocate for their needs and has access to healthcare resources. During treatment, family members can frequently provide helpful counsel and support. Their concern for a loved one’s health can make a big difference in the promotion of health and the prevention of illness.

Case 2

Discuss and described the pathophysiology and symptomology/clinical manifestations of Hyperandrogenism.

            According to Kanbour and Dobs (2022), a free/total testosterone, androstenedione, and/or DHEA-S level above the top 95th percentile in 98 healthy, non-hirsute eumenorrheic women is referred to as hyperandrogenemia. Hirsutism, acne, and androgenic alopecia are clinical signs of hyperandrogenemia (Kanbour & Dobs, 2022). Both men and women can be affected by hyperandrogenism, but it is more obvious in women since high levels of androgens in women frequently encourage virilization. In contrast to alopecia and acne, hirsutism is a more distinct aspect of hyperandrogenism (Kanbour & Dobs, 2022). Hirsutism is characterized as an overabundance of terminal hair in women that develops in a male pattern (Kanbour & Dobs, 2022).

Discuss three differential diagnoses for AUB with ICD 10 numbers for each.

Malignant neoplasm: Cervix uteri, unspecified (C53.9) – Abnormal, painless vaginal bleeding is the most important symptom that endometrial cancer may be present (Dlugasch & Story, 2019).

Endometriosis, unspecified (N80.9) – Endometriosis is a typical, benign condition, but ectopic endometrium-like tissue and the ensuing inflammation can lead to dysmenorrhea, dyspareunia, persistent discomfort, and infertility (Dlugasch & Story, 2019).

Malignant neoplasm, Endometrium (C54.1) – Postmenopausal bleeding, AUB in premenopausal women, abdominal or pelvic pain, pressure, and abdominal distention are the most typical signs (Dlugasch & Story, 2019).

Discuss patient education.

Treatment options might be addressed as soon as the doctor and you are able to identify the reason for your unusual bleeding. The initial line of treatment for AUB is frequently medication. Birth control pills –Uterine bleeding brought on by hormonal changes or abnormalities is frequently treated with birth control pills (Kaunitz, 2022). In women who do not ovulate frequently, the hormone progesterone, which is produced by the ovary, is useful in avoiding or managing heavy bleeding (Kaunitz, 2022). For women who experience abnormal uterine bleeding, an IUD that secretes progestin (such as Mirena, Liletta, Kyleena, or Skyla) may be advised (Kaunitz, 2022). Surgery – To eliminate aberrant uterine structures, surgery may be required (eg, fibroids, polyps) (Kaunitz, 2022). Women who have finished having children but still experience severe menstrual flow may want to think about having an operation like endometrial ablation (Kaunitz, 2022).

Develop the management plan (pharmacological and nonpharmacological).

Direct hair removal techniques and medication treatments that block androgen synthesis and action can be used to treat hirsutism (Kanbour & Dobs, 2022).  The standard treatment for PCOS to lower hyperandrogenism through several mechanisms is a combination of oral contraceptives (Kanbour & Dobs, 2022).  They boost the liver’s production of SHBG, which increases androgen binding and lowers serum-free androgen concentrations, while suppressing LH and, consequently, ovarian androgen secretion (Kanbour & Dobs, 2022).  Additionally, progestins boost testosterone elimination (Kanbour & Dobs, 2022).  Despite lowering blood testosterone levels by about 20 to 25 percent in PCOS-afflicted women, insulin-lowering medications and insulin sensitizers like metformin and thiazolidinediones are not any more effective than a placebo in treating hirsutism (Kanbour & Dobs, 2022).  Spironolactone may somewhat lower the level of testosterone in the blood, which could speed up the remission of hirsutism (Kanbour & Dobs, 2022). Insulin levels decrease along with weight loss. In overweight and obese patients with PCOS, weight loss of at least 5% of body weight reduces androgen levels (total and free testosterone, FAI, and DHEA-S), raises SHBG, enhances insulin sensitivity (OGTT, HOMA, fasting glucose, and insulin levels), and lessens hirsutism (Kanbour & Dobs, 2022).

An effective health assessment incorporates not only physiological parameters; please suggest other parameters that should be considered and included on health assessments to reach maximal health potential on individuals.

Other parameters apart from physiological treatments that should be incorporated in a health assessment for maximal health potential in patients include psychological, social, spiritual, economic, and even lifestyle parameters. The assessment of a patient in pain, for instance, is not only about how the pain manifests physically but also their psychological and social response to pain. Some patients, for instance, may experience negative emotions such as anger or even refuse to eat. The spiritual parameters may also be a key aspect of the patient’s life, and therefore, it is important to consider such factors during the assessment.

Name the different family developmental stages and give examples of each one.

The three main family developmental stages are the beginning stage, the expanding family, and the contracting stage. The beginning stage is the developmental stage, where the family is established. In this stage, two adults marry or come together to start a family. The stage continues until the first child has been born. The second developmental stage of a family is the expanding family, which takes a longer time. In this stage, children are born and include a number of sub-stages where children grow until the last child leaves their home to start their family. The final family developmental stage is the contracting stage, where the children start leaving home. The stage is marked by children departing as young adults.

Describe family structure and function and the relationship with health care.

The family structure is the genetic and legal relationships between members of a family (Lareau, 2018). The family function is how the family operates of works through the family structure relationships to support the needs of all the family members. The family structure and function can influence health as children who are raised in healthier and strong families will have better healthcare access. Such children may also have more behavioral and emotional stability as compared to children coming from families whose family structure and function are weak.

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