APANo plagirism
· You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts.
Formatted and cited in current APA style with support from at least 1 academic sources. Your reply posts are worth
2 points
(1 point per response.)
· All replies must be constructive and use literature where possible.
|
Response to Posts of Peers |
Distinguished – 2 points |
Fair – 1 point |
Poor – 0 points
|
2 points |
#1 – This week was great as I have completed the required clinical hours for this course. The patient that is being detailed in this discussion post was seen in the
prior weeks in the clinical setting. There was no challenges that was faced during this week, I have learned so much during this Women’s Health rotation, and now
feel more confident in seeing this population of patients in the future as a nurse practitioner.
Chief Complaint: “Decreased libido and amenorrhea”
HPI
KM is a 51 year-old Caucasian female presenting to the clinic for decreased libido and amenorrhea. KM reports that for the last two months she has not had
the urge to be intimate with her spouse. She reports that she feels fatigued all the time which is unusual for her as she is a devoted runner and exercises 7 days a
week. KM has noticed that she has not been exercising, as much, and correlates these changes as the same time as her change with her decreased sexual function.
Furthermore, KM reports that last week had three episodes of feeling hot suddenly and sweating profusely through her shirt, while other member in the household
was content with the temperature. KM has reported that her LMP was 12/12/2022 and has not had any spotting or breakthrough bleeding in this time frame.
Additionally, she took a pregnancy test which was negative during the first week in February. KM has started taking vitamin b12 supplements to help with her
symptoms, but she has not noticed a difference since taking the supplements.
ROS
General: admits fatigue, hot flashes, decreased sexual function
Dermatology: denies moles, rashes, pruritus
HEENT: denies headache, nasal congestion, earaches
Neck: denies painful swallowing, swelling, limited rom
Pulmonary System: denies cough, increased work of breathing, or breathlessness
Cardiovascular System (CVS): denies chest pressure, dizziness, irregular heartbeat
Breast: denies breast tenderness, breast discoloration, mass
Gastrointestinal (GI) System: denies constipation, abdominal pain, nausea and vomiting
Genitourinary (GU) System: denies polyuria, dysuria, incomplete emptying of bladder
Female Genitalia: admits decreased libido, vaginal dryness, pain with coitus LMP 12/12/22.
Musculoskeletal System: admits joint pain, joint stiffness, and difficulty bending,
Psychologic: denies suicidal ideation or feelings of wanting to harm others, anxiousness, sadness, and feeling overwhelmed
Assessment
Vitals: BP 148/62, RR 18, Temp 36.7, HR 87, O2 95% RA, Weight 132lb, Height 5ft 7nch, BMI 20.7 (normal weight)
General: Alert and oriented, in no acute distress, well groomed, behavior appropriate
HEENT: Head is normocephalic. Scalp clean without dandruff. Ears: Ear canal patent. Tympanic membrane without peroration. Eyes: PERRLA, EOM intact.
20/20 vision in both eyes. No nystagmus. No conjunctival irritation. Nose: Mucosa is pink. No bleeding. Throat: Moist oral mucosa
Cardiovascular: S1 & S2 auscultated. No abnormal heart sounds. JVD is negative. Carotid, radial and pedal pulses +2 bilaterally. No extremity edema present.
Respiratory: Respirations are even and unlabored. Respiratory rate 18. No SOB. Chest expansion equal. Clear lung sounds in all lobes.
GI: Normoactive bowel sounds. No abdominal distention. Abdomen nontender to palpation.
GU: Bladder is not palpable. Right kidney palpable. Left kidney not palpable. CVA without tenderness.
Female Genitalia: No vaginal discharge, no external vaginal lesions, mild vaginal wall tenderness, normal cervix appearance
Breast: breast size equal in size bilateral, no dimpling present, no mass palpated; breast is nontender, mild breast atrophy
Musculoskeletal: : No gait unsteadiness. Active ROM in all joints. Spine is without deformity. No muscle weakness noted.
Integumentary: Skin is intact. Skin tone is even. No jaundice present. Skin turgor is normal. Skin is warm to touch. Normal nail bed, no clubbing
Neuro: A/O X 3. Speech is slowed and clear. Sensation is intact in all extremities. Tendon reflexes are +2 bilateral. Cranial nerves not tested.
Hematologic: No active bleeding. No bruising present. No petechiae.
Psych: Normal and coherent thought processes. No signs of mania. No signs of depression.
Differential Diagnosis
Perimenopause (N95.9) is referred to the period before a woman transition into menopause. Changes in the duration and frequency of the menstrual cycle
are considered physiological during the perimenopausal period (Aggarwalet al., 2022). The main difference to with menopause, is that menopause is the absence of
menses consecutively for a year. Other symptoms can include hot flashes, joint pain, vaginal dryness, as changes in sexual function.
Hypothyroidism (E03.9) is a disease where the thyroid produces insufficient amount of thyroid hormone. The thyroid gland located in the anterior neck
secretes thyroid hormones and is essential for multiple metabolic functions spanning almost every organ system (Patil et al., 2022). Symptoms of hypothyroidism
includes weight gain, excessive fatigue, decreased libido, constipation, and irregular periods.
Hyperandrogenism (E28.1) is the excessive amount f androgens hormones. Symptoms include acne, facial hair or hirsutism, irregular period, and weigh gain.
Polycystic ovary syndrome (PCOS) characterized by a chronic disorder in ovulation along with hyperandrogenism, and puts women with PCOS at risk for other
diseases such as insulin intolerance, diabetes type 2, metabolic syndrome, cardiovascular diseases, infertility and all kinds of reproductive system cancers (Samadi,
et al., 2019).
Plan of Care & Patient Education
· Labs: FSH, TSH, T3, T4, CBC, Testosterone, estradiol, CMP
· Patient should start taking Slynd (progesterin only mini pill) 4mg daily to help with symptoms of perimenopause.
· KM should be educated on consuming a balanced diet, adequate physical activity, and exposure to sunlight (Aggarwal et al., 2022).
· Education on limiting alcohol and avoiding smoking for overall health status
· Patient educated on the use of water-based lubricants to help with painful coitus.
Health Promotion
· Patient can take Vitamin D and Calcium supplements to promote bone growth.
· Promote continence by encouraging pelvic floor exercises (Aggarwal et al., 2022).
· Continue adequate physical activity to prevent bone deterioration.
· Avoiding caffeine and decreasing intake of dietary sodium to promote cardiovascular health
#2 – Did you face any challenges, any success? If so, what were they?
This week, I had my first taste of the challenges that come with treating gynecological problems during my clinical rotation. Making a prompt diagnosis despite the overlap in symptoms was one of the challenges faced, as was calming the fears of nervous individuals. But, there were also successes, such as improving patients’ quality of life via better treatment and health-promoting initiatives.
Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and at least 3 possible differential diagnosis with rationales.
A 35-year-old female visited the clinic complaining of acute pelvic discomfort, heavy monthly flow, and infertility. She also stated that she was unable to conceive. During the examination, the patient was uneasy, exhibiting discomfort in the lower abdomen and cervical motion tenderness.
Signs and Symptoms
· Extreme pelvic pain
· Heavy menstrual bleeding
· Infertility
· A soreness in the lower region of the abdomen
· Sensitivity caused by cervical motion
Diagnosis
According to the patient’s current symptoms and the results of the physical examination, some of the potential alternative diagnoses for this individual include the following:
Endometriosis is a persistent gynecological disorder defined by the proliferation of endometrial tissue outside of the uterus. Endometriosis can affect both women and men. Endometriosis can cause a wide range of symptoms, some of which include pelvic discomfort, painful periods, and excessive bleeding. These symptoms can range from moderate to severe.
Adenomyosis is a disorder in which the inner lining of the uterus develops into the muscular wall of the uterus. This condition can lead to complications such as infertility. Adenomyosis can cause various symptoms, including painful periods, excessive menstrual flow, and pain in the pelvic region.
Uterine fibroids are benign growths that can cause discomfort, excessive menstrual bleeding, and pressure on the bladder or rectum. Uterine fibroids are the most common cause of abnormal bleeding during menstruation.
Care Plan
The care plan for this patient may include prescribing pain medication for pelvic pain, hormone therapy to manage endometriosis or adenomyosis, or surgery to remove uterine fibroids. Further diagnostic tests may be required, such as an ultrasound or MRI.
Mention the health promotion intervention for this patient.
The health promotion intervention for this patient might consist of teaching her about the significance of keeping a healthy weight, exercising regularly, and eating a balanced diet to manage the symptoms of endometriosis or adenomyosis.
What did you learn from this week’s clinical experience that can beneficial for you as an advanced practice nurse?
I gained a better understanding of the significance of providing effective communication and emotional support to patients, as well as the importance of considering a broad range of differential diagnoses when dealing with gynecological issues, as a result of the clinical experience I had this past week. Also, it is essential to maintain familiarity with the most recent research standards for treating gynecological disorders.
Peer-Reviewed Research Guideline:
Endometriosis, adenomyosis, and uterine fibroids are all conditions managed according to specific protocols established by the American College of Obstetricians and Gynecologists (ACOG). In order to effectively manage the symptoms of endometriosis and adenomyosis, the American College of Obstetricians and Gynecologists (ACOG) recommends either hormone treatment or surgical surgery. The American College of Obstetricians and Gynecologists (ACOG) recommends that women with uterine fibroids monitor the progress of the fibroids and undergo surgical intervention if the fibroids cause severe complaints.
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