Nurs 6551 Week 11 Assignment ESSAY

Nurs 6551 Week 11 Assignment Paper

How can a nurse practitioner decide what is important to focus on in a 15- to 30-minute appointment with a woman seeking primary care? Students in this course gain opportunities to teach and promote wellness in women through the process of screening for commonly seen in gynecological disorders. Nurs 6551 Week 11 Assignment Paper .

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Students learn to analyze data to interpret results for the benefit of women seeking assistance with planning healthy lifestyle behaviors. They also gain clinical experience in a primary healthcare setting that provides opportunities to increase competence in diagnosis, treatment, referrals, or follow-up care with a concentration on improving patient outcomes. Note: This course requires a minimum of 144 practicum hours.Nurs 6551 Week 11 Assignment Paper.

How can a nurse practitioner decide what is important to focus on in a 15- to 30-minute appointment with a woman seeking primary care? Students in this course gain opportunities to teach and promote wellness in women through the process of screening for commonly seen in gynecological disorders. Students learn to analyze data to interpret results for the benefit of women seeking assistance with planning healthy lifestyle behaviors. They also gain clinical experience in a primary healthcare setting that provides opportunities to increase competence in diagnosis, treatment, referrals, or follow-up care with a concentration on improving patient outcomes. Note: This course requires a minimum of 144 practicum hours.Nurs 6551 Week 11 Assignment Paper

Society for Reproductive Endocrinology and Infertility (SREI, 2012) described abnormal uterine bleeding as bleeding that differs in quality and quantity from normal menstrual bleeding, such as women spotting or bleeding between the women’s menstrual periods; bleeding after sex; bleeding heavier or last more days than normal; and bleeding post menopause. According to SREI (2012), factors that can cause abnormal bleeding include structural abnormalities of the reproductive system, such as uterine polyps, fibroids, and adenomyosis. Furthermore, SREI (2012) explained that vaginal, uterine or cervical lesions, miscarriage, ectopic pregnancy, endometritis, adhesions in the endometrium, and use of an intrauterine device (IUD) can also cause abnormal bleeding. Johns Hopkins Medicine (2016) specified that early recognition of abnormal bleeding, and seeing a health care provider immediately for appropriate diagnosis and treatment increase the chance of successful treatment. Therefore, the author will focus on a single patient comprehensive evaluation, which includes the patient’s personal/health history; physical examination; laboratory/diagnostic tests; diagnosis; treatment/management plan; education strategies; and follow-up care. Comment by DeAllen B Millender: Good introduction.Nurs 6551 Week 11 Assignment Paper

General Patient Information

Age: 41-year-old

Race/Ethnicity: Hispanic American

Partner Status: Married Comment by DeAllen B Millender: This information is not in APA format.

Current Health Status

Chief Complaint: “I have heavy, prolonged menstrual bleeding with severe cramping for the past one year”.

History of Present Illness (HPI): RG is a 41-year-old Hispanic American female who presented to the clinic with complaint of heavy prolonged menstrual bleeding with severe cramping for the past one year. Patient reported sharp pelvic pain during menstruation, bleeding between periods, pain with intercourse, blood clots during periods.Nurs 6551 Week 11 Assignment Paper Abdominal pain/pressure and bloating. Patient suggested that these symptoms started after her second caesarean section surgery one year ago. Patient also reported that she takes over-the counter medication, such as ibuprofen to relieve the pain. she also suggested that she uses heating pad on her abdomen/pelvic for pain relief, and she stated that she soaks in a warm sitz bath to ease pelvic pain and cramping. Patient also reported fatigue and weakness. Patient further stated that she decided to see an obstetrician and gynecologist (OB/GYN) because the heavy prolonged bleeding with severe menstrual cramp interfere with her regular activities. Patient denied nausea, vomiting, diarrhea, fever, and chills.Nurs 6551 Week 11 Assignment Paper

Timing/Onset: Patient said one year ago.

Location: The location of the problem as stated by the patient is pelvic/uterus/vaginal.

Duration: 5 to7 days during periods for the past one year.

Quality/Characteristic: Patient reported heavy prolonged menstrual pain; severe, sharp lower abdominal/pelvic cramping/pain, and blood clots during periods.Nurs 6551 Week 11 Assignment Paper

Aggravating Factors: Monthly periods as stated by the patient.

Relieving/Alleviating Factors: Patient stated that ibuprofen pain medication, heating pad, and/or warm sitz bath help the pain/cramping.

Severity: The severity of the pain/cramping on a pain scale is 10/10 reported by the patient.

Treatments/Therapies: Patient stated that she had not undergone any treatment for the reported problems.Nurs 6551 Week 11 Assignment Paper

Last Menstrual Period: The last menstrual period reported by patient was 7/5/2016.

Sexual Activity Status: Patient reported being sexually active.

Barrier Prevention: Patient stated she uses natural barrier methods.

Sexual Preference: Patient sexual preference is monogamous/heterogeneous relationship.

Satisfaction with Sexual Activity: Patient reported that she is sexually satisfied with her partner.

Contraception Method: Patient denied using any contraception method.Nurs 6551 Week 11 Assignment Paper

Patient History

Past medical History (PMH): Anemia and C-section. Patient was delivered full term through vaginal delivery without complications. The birth weight was 8 pounds 10 oz.

Psychological/Mental Health: Patient denied depression, mood swings, anxiety, or mental health problem.Nurs 6551 Week 11 Assignment Paper

Medications: RG reported that she takes over the counter Motrin 200-400 mg orally every 4-6 hours as needed for pain and cramping.

Allergies: Patient reported no known allergies (NKA).

Past Surgical/Hospitalization History: Patient reported history of C-section twice, and she was hospitalized for 3 days post the C-sections.Nurs 6551 Week 11 Assignment Paper

Preventive Screening: Patient reported that she had flu shot on 11/20/2015; last mammogram was 2/12/2015 and mammogram was normal; Pap smear was on 2/20/2015, which was also normal; patient also reported that she was up to date with her childhood immunization, but denied pneumococcal vaccination.Nurs 6551 Week 11 Assignment Paper

Family History: Both father and mother have history of diabetes mellitus type 2 and hypertension. Both parents are still living, and two siblings are still living and well.Nurs 6551 Week 11 Assignment Paper

Gynecological History: Patient is multipara with 2 pregnancy resulting in two viable offsprings. Patient had her first child at the age of 33 years. Menarche at age 13; periods last between 5 to 7 days. Patient reported heavy prolonged menstrual bleeding with severe cramping; sharp pelvic pain during menstruation; and bleeding between periods for the past one year. Denied vaginal discharge or sexually transmitted infection/disease.

Obstetric History: Gravida 2, Para 2, term 2, preterm 0, spontaneous abortion 0, and living 2 (G2T2P2A0L2). Gravida 1: Delivered at 39 weeks by C-section on 4/20/08 male; Gravida 2: Delivered at 40 weeks by C-section on 2/18/15 female. Patient denied therapeutic abortion (TAB) or spontaneous abortion (SAB); Patient denied preterm or low birth weight baby with no delivery complications. Patient also denied having sexual transmitted disease.Nurs 6551 Week 11 Assignment Paper

Personal/Social History: Patient is married with 2 children, and lives at home with the husband. Patient is a college graduate; works outside the house as a nurse at a nearby hospital. Patient’s husband works for a computer company. Patient family is a middle income family. Also, patient denied any physical or psychological abuse. Patient denied being exposed to any environmental or occupational health hazards.Nurs 6551 Week 11 Assignment Paper Patient also denied alcohol consumption, tobacco, or recreational drug use. Patient denied participating in any exercise or physical activity because she is tired after work, and prefers to rest. Patient reported that she eats healthy; she eats low fat, low carbohydrate meals, and she eats fruits and vegetable at least 3 to 4 times a week. Patient stated

that she sleeps well at night, and she usually goes to bed at 9 pm and wakes up at 6 am. Patient drinks a cup of coffee occasional, especially when she is at work to be awake.Nurs 6551 Week 11 Assignment Paper

Review of System (ROS)

General: RG admitted fatigue and weakness; denied fever /chills; and no weight loss.

Head and Neck: Patient denied headache or dizziness. Patient also denied lumps, neck injury, pain/tenderness or jugular vein distention.

Chest: Patient denied chest pain, cough or shortness of breath.

Heart: RG denied irregular heartbeats, heart attack, or heart murmur.

Breasts: Patient denied nipple discharge, tenderness or swelling.

Gastrointestinal: Patient admitted lower abdominal pain, pressure, and bloating; denied constipation, nausea, vomiting, and diarrhea.

Genitourinary: RG denied urinary tract infection, urinary frequency or burning on urination.

Genital: Patient admitted heavy prolonged menstrual bleeding with severe cramping for one year. Patient admitted sharp pelvic pain during menstruation, bleeding between periods, pain with intercourse, and blood clots during periods. Patient denied vaginal discharge.Nurs 6551 Week 11 Assignment Paper

Musculoskeletal: RG denied varicosities or extremities problem.

Psychiatric: RG denied depression, anxiety, or any psychiatric problems.

Neurological: Patient admitted fatigue and weakness; denied confusion, seizures, or tingling.

Hematologic: Patient admitted history of anemia; denied blood transfusion or easily bruise or bleeding.Nurs 6551 Week 11 Assignment Paper

Physical Examination

General exam: Patient appeared well developed and pleasant with good hygiene. Patient also appeared pale and weak. Vital signs: Blood pressure 118/76, heart rate 80, respiration 18,

temperature 98.8, pulse ox 100% on room air. Weight 78.2 kg, height 67 inches, and body mass index (BMI) 27.

HEENT: The head is normaceplalic, atraumatic. The pupils are equal, round, and reactive to light and accommodation. Extraocular movements are intact. Tympanic membrane is gray bilaterally. Oral mucosa is dry. Oropharynx is clear. Nares are patient, no nasal or septal deviation noted. No pharyngeal erythema.Nurs 6551 Week 11 Assignment Paper

Neck: Noted to be supple without jugular vein distention (JVD), thyromegaly or lymphadenopathy.

Lungs: Noted to be clear to auscultation throughout the lobes; no wheezes or rhonchi noted.

Cardiovascular: Regular rate and rhythm on auscultation, S1 S2 present without murmurs. Palpable pulses noted without peripheral edema.

Gastrointestinal: Bowel sounds are active in all quadrant. Abdomen is soft and tender on palpation.

Breast: The size of the breasts, areolas, and nipples are round and symmetrical with no discoloration, rash, lesions, dimpling, or retraction bilaterally; no masses, lumps, or tenderness noted on palpation bilaterally; and axillary lymph nodes non-palpable.Nurs 6551 Week 11 Assignment Paper

Pelvic Examination:

Vulva: The hair distribution is normal; no lesion noted.

Vagina: Vaginal walls are pink, and pubic hair is shaven; no lesions, masses, inflammation or discharge noted.

Cervix: Intact cervix with closed os.

Uterus: Enlarged, asymmetrical, soft, boggy and tender.

Laboratory and Diagnostic Tests

Laboratory Test and Results: Pregnancy test: Result is negative. Hemoglobin and Hematocrit (H/H): Result showed H/H 8.7/26.7, which is positive for anemia.

Diagnostic:

Transvaginal ultrasonography of the uterus: Revealed uterine enlargement measuring 12 cm with no leiomyomata; uterine wall thickening; cystic anechoic spaces in the myometrium; heterogeneous echo texture; obscured endometrial/myometrial border; sub endometrial echogenic linear striations; and thickening of the transition zone measuring 12.8 millimeter. The transvaginal sonography is used to rule out possible uterine tumor (Sakhel & Abuhamad, 2012).Nurs 6551 Week 11 Assignment Paper

Magnetic Resonance Imaging (MRI): MRI is ordered to obtain a high resolution image of the uterus as well as verifying/confirming the suspected diagnosis. The MRI result revealed that the junctional zone of the uterus is thickened and measures 12.8 millimeter. Also, MRI revealed an ill-defined ovoid and diffuse region of thickening with striated appearance (Sakhel & Abuhamad, 2012).Nurs 6551 Week 11 Assignment Paper

Differential Diagnoses

The differential diagnoses of the patient clinical presentation as described by Schuiling and Likis (2013) include: Adenomyosis, uterine fibroids and endometrial hyperplasia. However, the primary diagnosis for the patient is Adenomyosis.

Adenomyosis: Schuiling and Likis (2013) described adenomyosis as a benign, common condition that involves the movement of endometrial tissue into the uterine muscles. The definitive cause of the adenomyosis is unknown, but the condition is common among women with elevated levels of estrogen; the condition usually ceases post menopause when estrogen levels are reduced. Risk factors explained by Taran, Stewart, and Brucker (2013) include multiparity; previous uterine surgery, such as C-section, dilatation/curettage, or fibroids

removal surgery; and women at reproductive age, especially between the age of 40s or 50s. furthermore, Taran et al. (2013) specified that the clinical presentation entails chronic pelvic pain, prolonged menstrual cramps, heavy menstrual bleeding, spotting between periods, abdominal tenderness, painful intercourse, longer periods than normal, blood clots during periods. Taran et al. (2013) also explained that finding during physical examination include enlarged, tender, soft and boggy uterus. According to Taran et al. (2013) diagnosis is made based on sonographic or MRI results, and treatment is not recommended for women with mild form of adenomyosis, except when the symptoms interfere with daily activities. Taran et al. (2013) further explained that treatment options include anti-inflammatory medications; hormonal treatments; endometrial ablation; uterine artery embolization, MRI-guided focused ultrasound surged or hysterectomy, which is the definitive treatment for adenomyosis.Nurs 6551 Week 11 Assignment Paper

Adenomyosis is selected as the primary diagnosis because the aforementioned patient’s clinical presentation, physical examination findings, and diagnostic tests results are synonymous with adenomyosis aforementioned associated signs and symptoms; risk factors; physical examination findings; and diagnostic test results.Nurs 6551 Week 11 Assignment Paper

Uterine Fibroids: Women’s Health (WH, 2015) described uterine fibroid to be muscular tumors that develop in the uterine wall, which can also be referred to as leiomyoma or myoma. Uterine fibroids are usually non-cancerous, and can be single or multiple tumors in the uterus. According to WH (2015), women risk for developing uterine fibroid are increased by age, such as women in their 30s and 40s until menopause when the fibroids commonly shrink. Other risk factors include family history, ethnic origin, obesity and eating habits. Symptoms of fibroids as explained by WH (2015) involve lower back pain; pain during sex; heavy bleeding; painful menses, enlarged lower abdominal, frequent urination; and lower abdominal/pelvic feeling of fullness. Physical examination shows reveal painless, firm, irregular pelvic mass. According to WH (2015), diagnosis is done using transvaginal ultrasound, MRI, hysteroslpingography, hysteroscopy, and endometrial biopsy. Fibroid is not selected as the primary diagnosis because there is no visualization of the fibroid during pelvic examination or on sonography test. Moreover, severe pain is noted during pelvic exam. Furthermore, sonographic result is more consistent with adenomyosis rather than fibroids.Nurs 6551 Week 11 Assignment Paper

Endometrial Hyperplasia: Cancer Research of United Kingdom (CRUK, 2014) described endometrial hyperplasia as thickening of the covering of the uterus due to excessive growth of the cells that covers the uterus, and endometrial hyperplasia can lead to womb cancer. Risk factors according to CRUK (2014) include- age over 35 years; white race; nulliparity; older age at menopause; obesity; cigarette smoking; family history of ovarian, colon, or uterine cancer; early menarche; and history of diabetes, polycystic ovary syndrome, thyroid disease and gallbladder disease. The CRUK (2014), explained that the condition is caused by imbalance of to the estrogen and progesterone. According to CRUK (2014), signs and symptoms of endometrial hyperplasia includes abnormal, prolonged, heavy periods; bleeding between periods; shorter than 21 days’ menstrual cycles; and bleeding after menopause. Also, diagnosis is established by vaginal ultrasound scan, dilatation and curettage, or hysteroscopy.Nurs 6551 Week 11 Assignment Paper

23rd ed. Philadelphia, PA: Lippincott Williams &.Wilkins; 2014presentation, physical findings during examination; and diagnostic results are not synonymous with the signs and symptoms; physical examination finding, risk factors and diagnostic

results associated with endometrial hyperplasia (American College of Obstetricians and Gynecologist, 2016).

Management Plan

Diagnosis: The only definitive diagnosis of adenomyosis is established after uterus is examined post hysterectomy. However, clinical findings that helped in the diagnosis of the patient includes enlarged, asymmetrical, soft, boggy and tender uterus during pelvic examination and aforementioned sonographic and MRI findings, which synonymous with the diagnosis of adenomyosis (Sakhel & Abuhamad, 2012).Nurs 6551 Week 11 Assignment Paper

Treatment: Treatment was considered based on the patient clinical presentations, and collaborative agreement with the patient, the author, and the preceptor for total hysterectomy after explanation of the treatment options to the patient. Patient selected hysterectomy because patient does not want to have another child. According to Schuiling and Likis (2013) explanations, patient was advised to continue with the over-the counter anti-inflammatory drug: Motrin 200-400 mg orally every 4-6 hours as needed for pain and cramping until hysterectomy is performed. Also, Ferrous sulfate 325 mg orally three times a day for anemia was prescribed. Patient was educated to take the medication on an empty stomach one hour before meal or 2 hours after meal for optimum absorption.Nurs 6551 Week 11 Assignment Paper

Patient Education: Patient was educated on the risk factors for adenomyosis, the causes, symptoms, diagnosis, and treatment options. Patient was educated that most women with adenomyosis does not have any symptoms, but adenomyosis is usually found after the tissue obtained from the uterus has been biopsied after pelvic surgery. Patient was also informed that the C-section she had twice during child birth may have put her at risk for adenomyosis. Patient was informed that the symptoms of adenomyosis goes away after menopause or after hysterectomy. Patient was educated that all options of treatment must be tried before hysterectomy, but patient opted for hysterectomy without trying all options of treatment. furthermore, patient was educated to continue the home remedy, such as continuation of the use of the heating pad, warm soak bath, and continuing with the over the counter Motrin to alleviate the pain associate with the condition. Finally, patient was educated on the psychological and emotional effects of adenomyosis and hysterectomy surgery because some women grieve on the loss of their womb, which may put them into depression as a result of that; the patient has to be completely sure that she really wants to do the surgery at her age now or wait and do the surgery in the future (University of Maryland Medical Center, 2016).Nurs 6551 Week 11 Assignment Paper

Follow Up Care: In consideration of the Schuiling and Likis (2013) discussion, patient was schedule to follow-up in 6 weeks for follow-up on the patient’s anemia and surgical work up labs, such as complete blood count, complete metabolic panel, prothrombin time and international normalized ratio(PT/INR). Also, an electrocardiogram (EKG) and chest x-ray was ordered to rule out any cardiac problem that would complicate the hysterectomy surgery. The patient’s H/H came up to 11.5/38.9 and all the other laboratory and diagnostic result was normal. The Total hysterectomy surgery was performed on 7/27/2016. Surgery was successful, and patient was schedule to follow up in six eek post-surgery.Nurs 6551 Week 11 Assignment Paper

Conclusion Comment by DeAllen B Millender: Level 1 headings are centered, in bold print, and in ‘Title Case’ (Chapter 3, 3.03, pp. 62-63; see Table 3.1 and Figure 2.1).

The author selected a patient at the author’s clinical site, and obtained a complete health history following the patient care from the beginning of the clinical up to 9 weeks of clinical. The author also used the patient health information and clinical presentation to come up with a diagnosis of adenomyosis. The author developed an appropriate treatment plan with the patient in collaboration with the author’s preceptor incorporating the author’s classroom knowledge with the author’s chosen nursing theorist. Finally, the patient was educated on the condition and follow up care.Nurs 6551 Week 11 Assignment Paper

Endocrine and musculoskeletal conditions, especially when left untreated, can have a significant impact on women’s health. Many of these conditions present unique challenges for women, making risk assessments and routine screenings an important part of primary care. As an advanced practice nurse, you must identify signs and symptoms of these conditions and educate at-risk patients so they can also monitor themselves. For this Discussion, consider how you would diagnose, treat, and educate the patients in the following three case studies:

Case Study 2 (diagnosis Polycystic Ovary Syndrome)
A 28-year-old Latina obese female presents to the clinic with increasing body hair and irregular menses. She now has coarse body hair on her chest and upper back. Her menstrual periods used to be fairly regular, but now she can skip three or four months before her next menstrual cycle. She has never been pregnant. She has one male sex partner.Nurs 6551 Week 11 Assignment Paper

Case Study 3 ( diagnosismultiple sclerosis)
A 28-year-old Caucasian female comes to clinic concerned about three episodes of urinary incontinence associated with difficulty walking. The first two episodes resolved spontaneously after a couple of days without residuals, but this current episode has lasted a week. Today she began to have some blurred vision. Physical exam is remarkable for mild edema of the optic disc and difficulty with heel-to-toe walking. Deep tendon reflexes are 2+ and there is no extremity weakness.Nurs 6551 Week 11 Assignment Paper

To prepare:

Review Chapter 8 of the Tharpe et al. text and the McSweeney et al. article in this week’s Learning Resources.

Review and select one of the three provided case studies. Analyze the patient information.

Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.

Reflect on the appropriate clinical guidelines. Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.Nurs 6551 Week 11 Assignment Paper

Consider strategies for educating patients on the treatment and management of the disorder you identified as your primary diagnosis.

Post 250 words (no introduction or conclusion)

1. explanation of the differential diagnosis for the patient in the case study you selected.
2. Explain which is the most likely diagnosis for the patient and why.
3. Then, based on the appropriate clinical guidelines, explain a treatment and management plan for the patient, including proper dosages for any recommended treatments.Nurs 6551 Week 11 Assignment Paper
4. Finally, explain strategies for educating patients on the disorder.

Cardiovascular and neurologic conditions are among the leading causes of death and hospitalization of women in the United States (Centers for Disease Control and Prevention, 2008a). As an advanced practice nurse, you must routinely monitor patients at risk of these conditions and recommend the appropriate health screenings and preventive services. When assessing patients for these conditions, it is important to keep in mind that while some female patients might present with typical signs and symptoms, others might present with atypical signs and symptoms that are unique to women. For this NURS 6551 Week 10 Discussion, Assignment 1, consider signs and symptoms presented by the women in the following case studies and develop differential diagnoses:

NURS 6551 Week 10 Case Study 1
A 48-year-old overweight African American female is in the clinic for a wellness visit. A routine fasting lipid panel returned with the following results:

Total cholesterol: 305 mmol/L
Low-density lipoprotein (LDL): 180 mg/dl
High-density lipoprotein (HDL): 30 mg/dl
Triglycerides: 165 mg/dl
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NURS 6551 Week 10 Case Study 2
You are seeing a 63-year-old African American female for a two-week history of intermittent chest pain. The pain varies in intensity and resolves with rest. She does not believe it has increased over time. She is a nonsmoker with a history of hypertension treated with Lisinopril 10 mg once daily. She had an exercise stress test one year ago that was within normal limits. Her physical exam findings are as follows: HR–90, BP–150/92, R–22, O2Sat 98% RA; lungs: clear to auscultation bilaterally; cardiovascular: apical pulse of 90 RRR, no rubs, murmurs, or gallops. Chest wall mildly tender to palpation that reproduces her complaint of pain. Extremities include no clubbing, cyanosis, or edema. The remainder of the exam is within normal limits. NURS 6551 Week 10 Discussion, Assignment 1.

NURS 6551 Week 10 Case Study 3
A 32-year-old Asian American female is in the clinic for a history of recurrent headaches for the past year, occurring monthly, lasting up to 12–18 hours. The headaches are sometimes associated with photophobia, nausea, and vomiting. She takes either acetaminophen or ibuprofen for relief that is not always successful. She uses Ortho Tricyclin for birth control. Her physical exam is within normal limits.Nurs 6551 Week 11 Assignment Paper

To prepare:
Review Chapter 8 of the Tharpe et al. text and the McSweeney et al. article in this week’s Learning Resources.
Review and select one of the three provided case studies. Analyze the patient information.
Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.
Reflect on the appropriate clinical guidelines. Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.Nurs 6551 Week 11 Assignment Paper
Consider strategies for educating patients on the treatment and management of the disorder you identified as your primary diagnosis. NURS 6551 Week 10 Discussion, Assignment 1.
Post at least 250 words

1. an explanation of the differential diagnosis for the patient in the case study you selected.Nurs 6551 Week 11 Assignment Paper
2. Explain which is the most likely diagnosis for the patient and why.
3. Then, based on the appropriate clinical guidelines, explain a treatment and management plan for the patient, including proper dosages for any recommended treatments.
4. Finally, explain strategies for educating patients on the disorder.

NURS 6551 Week 10 Assignment 1: Application – Best Practices
For over 20 years, the Women’s Health Initiative (WHI) study has conducted research trials to examine factors that impact risks and development of conditions that impact women such as heart disease, breast and colorectal cancer, and osteoporotic fractures in postmenopausal women. Health care providers use results from these trials to develop guidelines for delivering care to patients. In your role in clinical settings, you must be familiar with these guidelines, and you must be aware that through clinical practice, guidelines frequently evolve and change. Often, what is considered a best practice today might not be a best practice in the future. For this Assignment, you compare guidelines outlined in the WHI study to current best practices for assessing and managing conditions.Nurs 6551 Week 11 Assignment Paper

To Prepare:

Review the Women’s Health Initiative article in this week’s Learning Resources. Select one disorder presented in this study. https://www.nhlbi.nih.gov/whi/background.htm
Locate and select a research article that addresses current best practices for assessing and managing the disorder you selected. Be sure that the research article you select is from a reputable source.
Consider the similarities and differences between the best practices presented in the WHI study and the article you selected. Think about the potential impact of differences in best practices on women’s health. NURS 6551 Week 10 Discussion, Assignment 1.
Consider whether the best practices in the article you selected should be used in clinical practice.Nurs 6551 Week 11 Assignment Paper
To Complete:

Write a 2- to 3-page paper that addresses the following:

Describe the disorder you selected from the Women’s Health Initiative study.
Explain the current best practices for assessing and managing this disorder as suggested in the research article you selected. (support with current references)
Compare the best practices presented in the WHI study to the current best practices presented in the article.
Explain how the differences in best practices might impact women’s health.
Explain whether you think the current best practices in the article you selected should be used in clinical practice. Support your position with evidence-based research. NURS 6551 Week 10 Discussion, Assignment 1.
Note: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.Nurs 6551 Week 11 Assignment Paper

NURS 6551 Discussion – Week 11
NURS 6551 Discussion Diagnosing and Managing Common Endocrine and Musculoskeletal Conditions
Endocrine and musculoskeletal conditions, especially when left untreated, can have a significant impact on women’s health. Many of these conditions present unique challenges for women, making risk assessments and routine screenings an important part of primary care. As an advanced practice nurse, you must identify signs and symptoms of these conditions and educate at-risk patients so they can also monitor themselves. For this NURS 6551 Week 10 Discussion, Assignment 1, consider how you would diagnose, treat, and educate the patients in the following three case studies:Nurs 6551 Week 11 Assignment Paper

Case Study 2 (diagnosis Polycystic Ovary Syndrome)
A 28-year-old Latina obese female presents to the clinic with increasing body hair and irregular menses. She now has coarse body hair on her chest and upper back. Her menstrual periods used to be fairly regular, but now she can skip three or four months before her next menstrual cycle. She has never been pregnant. She has one male sex partner.Nurs 6551 Week 11 Assignment Paper

Case Study 3 ( diagnosismultiple sclerosis)
A 28-year-old Caucasian female comes to clinic concerned about three episodes of urinary incontinence associated with difficulty walking. The first two episodes resolved spontaneously after a couple of days without residuals, but this current episode has lasted a week. Today she began to have some blurred vision. Physical exam is remarkable for mild edema of the optic disc and difficulty with heel-to-toe walking. Deep tendon reflexes are 2+ and there is no extremity weakness. NURS 6551 Week 10 Discussion, Assignment 1.

To prepare:

Review Chapter 8 of the Tharpe et al. text and the McSweeney et al. article in this week’s Learning Resources.
Review and select one of the three provided case studies. Analyze the patient information.
Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.
Reflect on the appropriate clinical guidelines. Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.Nurs 6551 Week 11 Assignment Paper
Consider strategies for educating patients on the treatment and management of the disorder you identified as your primary diagnosis.
Post 250 words (no introduction or conclusion)

1. explanation of the differential diagnosis for the patient in the case study you selected.
2. Explain which is the most likely diagnosis for the patient and why.
3. Then, based on the appropriate clinical guidelines, explain a treatment and management plan for the patient, including proper dosages for any recommended treatments.Nurs 6551 Week 11 Assignment Paper
4. Finally, explain strategies for educating patients on the disorder. NURS 6551 Week 10 Discussion, Assignment 1.

Society for Reproductive Endocrinology and Infertility (SREI, 2012) described abnormal uterine bleeding as bleeding that differs in quality and quantity from normal menstrual bleeding, such as women spotting or bleeding between the women’s menstrual periods; bleeding after sex; bleeding heavier or last more days than normal; and bleeding post menopause. According to SREI (2012), factors that can cause abnormal bleeding include structural abnormalities of the reproductive system, such as uterine polyps, fibroids, and adenomyosis. Furthermore, SREI (2012) explained that vaginal, uterine or cervical lesions, miscarriage, ectopic pregnancy, endometritis, adhesions in the endometrium, and use of an intrauterine device (IUD) can also cause abnormal bleeding. Johns Hopkins Medicine (2016) specified that early recognition of abnormal bleeding, and seeing a health care provider immediately for appropriate diagnosis and treatment increase the chance of successful treatment.Nurs 6551 Week 11 Assignment Paper Therefore, the author will focus on a single patient comprehensive evaluation, which includes the patient’s personal/health history; physical examination; laboratory/diagnostic tests; diagnosis; treatment/management plan; education strategies; and follow-up care. Comment by DeAllen B Millender: Good introduction.Nurs 6551 Week 11 Assignment Paper

General Patient Information

Age: 41-year-old

Race/Ethnicity: Hispanic American

Partner Status: Married Comment by DeAllen B Millender: This information is not in APA format.

Current Health Status

Chief Complaint: “I have heavy, prolonged menstrual bleeding with severe cramping for the past one year”.

History of Present Illness (HPI): RG is a 41-year-old Hispanic American female who presented to the clinic with complaint of heavy prolonged menstrual bleeding with severe cramping for the past one year. Patient reported sharp pelvic pain during menstruation, bleeding between periods, pain with intercourse, blood clots during periods.Nurs 6551 Week 11 Assignment Paper Abdominal pain/pressure and bloating. Patient suggested that these symptoms started after her second caesarean section surgery one year ago. Patient also reported that she takes over-the counter medication, such as ibuprofen to relieve the pain. she also suggested that she uses heating pad on her abdomen/pelvic for pain relief, and she stated that she soaks in a warm sitz bath to ease pelvic pain and cramping. Patient also reported fatigue and weakness. Patient further stated that she decided to see an obstetrician and gynecologist (OB/GYN) because the heavy prolonged bleeding with severe menstrual cramp interfere with her regular activities. Patient denied nausea, vomiting, diarrhea, fever, and chills.Nurs 6551 Week 11 Assignment Paper

Timing/Onset: Patient said one year ago.

Location: The location of the problem as stated by the patient is pelvic/uterus/vaginal.

Duration: 5 to7 days during periods for the past one year.

Quality/Characteristic: Patient reported heavy prolonged menstrual pain; severe, sharp lower abdominal/pelvic cramping/pain, and blood clots during periods.Nurs 6551 Week 11 Assignment Paper

Aggravating Factors: Monthly periods as stated by the patient.

Relieving/Alleviating Factors: Patient stated that ibuprofen pain medication, heating pad, and/or warm sitz bath help the pain/cramping.

Severity: The severity of the pain/cramping on a pain scale is 10/10 reported by the patient.

Treatments/Therapies: Patient stated that she had not undergone any treatment for the reported problems.

Last Menstrual Period: The last menstrual period reported by patient was 7/5/2016.

Sexual Activity Status: Patient reported being sexually active.

Barrier Prevention: Patient stated she uses natural barrier methods.

Sexual Preference: Patient sexual preference is monogamous/heterogeneous relationship.Nurs 6551 Week 11 Assignment Paper

Satisfaction with Sexual Activity: Patient reported that she is sexually satisfied with her partner.

Contraception Method: Patient denied using any contraception method.

Patient History

Past medical History (PMH): Anemia and C-section. Patient was delivered full term through vaginal delivery without complications. The birth weight was 8 pounds 10 oz.Nurs 6551 Week 11 Assignment Paper

Psychological/Mental Health: Patient denied depression, mood swings, anxiety, or mental health problem.

Medications: RG reported that she takes over the counter Motrin 200-400 mg orally every 4-6 hours as needed for pain and cramping.

Allergies: Patient reported no known allergies (NKA).

Past Surgical/Hospitalization History: Patient reported history of C-section twice, and she was hospitalized for 3 days post the C-sections.

Preventive Screening: Patient reported that she had flu shot on 11/20/2015; last mammogram was 2/12/2015 and mammogram was normal; Pap smear was on 2/20/2015, which was also normal; patient also reported that she was up to date with her childhood immunization, but denied pneumococcal vaccination.Nurs 6551 Week 11 Assignment Paper

Family History: Both father and mother have history of diabetes mellitus type 2 and hypertension. Both parents are still living, and two siblings are still living and well.

Gynecological History: Patient is multipara with 2 pregnancy resulting in two viable offsprings. Patient had her first child at the age of 33 years. Menarche at age 13; periods last between 5 to 7 days. Patient reported heavy prolonged menstrual bleeding with severe cramping; sharp pelvic pain during menstruation; and bleeding between periods for the past one year. Denied vaginal discharge or sexually transmitted infection/disease.Nurs 6551 Week 11 Assignment Paper

Obstetric History: Gravida 2, Para 2, term 2, preterm 0, spontaneous abortion 0, and living 2 (G2T2P2A0L2). Gravida 1: Delivered at 39 weeks by C-section on 4/20/08 male; Gravida 2: Delivered at 40 weeks by C-section on 2/18/15 female. Patient denied therapeutic abortion (TAB) or spontaneous abortion (SAB); Patient denied preterm or low birth weight baby with no delivery complications. Patient also denied having sexual transmitted disease.Nurs 6551 Week 11 Assignment Paper

Personal/Social History: Patient is married with 2 children, and lives at home with the husband. Patient is a college graduate; works outside the house as a nurse at a nearby hospital. Patient’s husband works for a computer company. Patient family is a middle income family. Also, patient denied any physical or psychological abuse. Patient denied being exposed to any environmental or occupational health hazards. Patient also denied alcohol consumption, tobacco, or recreational drug use. Patient denied participating in any exercise or physical activity because she is tired after work, and prefers to rest. Patient reported that she eats healthy; she eats low fat, low carbohydrate meals, and she eats fruits and vegetable at least 3 to 4 times a week. Patient stated

that she sleeps well at night, and she usually goes to bed at 9 pm and wakes up at 6 am. Patient drinks a cup of coffee occasional, especially when she is at work to be awake.Nurs 6551 Week 11 Assignment Paper

Review of System (ROS)

General: RG admitted fatigue and weakness; denied fever /chills; and no weight loss.

Head and Neck: Patient denied headache or dizziness. Patient also denied lumps, neck injury, pain/tenderness or jugular vein distention.

Chest: Patient denied chest pain, cough or shortness of breath.

Heart: RG denied irregular heartbeats, heart attack, or heart murmur.

Breasts: Patient denied nipple discharge, tenderness or swelling.

Gastrointestinal: Patient admitted lower abdominal pain, pressure, and bloating; denied constipation, nausea, vomiting, and diarrhea.

Genitourinary: RG denied urinary tract infection, urinary frequency or burning on urination.Nurs 6551 Week 11 Assignment Paper

Genital: Patient admitted heavy prolonged menstrual bleeding with severe cramping for one year. Patient admitted sharp pelvic pain during menstruation, bleeding between periods, pain with intercourse, and blood clots during periods. Patient denied vaginal discharge.Nurs 6551 Week 11 Assignment Paper

Musculoskeletal: RG denied varicosities or extremities problem.

Psychiatric: RG denied depression, anxiety, or any psychiatric problems.

Neurological: Patient admitted fatigue and weakness; denied confusion, seizures, or tingling.

Hematologic: Patient admitted history of anemia; denied blood transfusion or easily bruise or bleeding.Nurs 6551 Week 11 Assignment Paper

Physical Examination

General exam: Patient appeared well developed and pleasant with good hygiene. Patient also appeared pale and weak. Vital signs: Blood pressure 118/76, heart rate 80, respiration 18,

temperature 98.8, pulse ox 100% on room air. Weight 78.2 kg, height 67 inches, and body mass index (BMI) 27.

HEENT: The head is normaceplalic, atraumatic. The pupils are equal, round, and reactive to light and accommodation. Extraocular movements are intact. Tympanic membrane is gray bilaterally. Oral mucosa is dry. Oropharynx is clear. Nares are patient, no nasal or septal deviation noted. No pharyngeal erythema.Nurs 6551 Week 11 Assignment Paper

Neck: Noted to be supple without jugular vein distention (JVD), thyromegaly or lymphadenopathy.

Lungs: Noted to be clear to auscultation throughout the lobes; no wheezes or rhonchi noted.

Cardiovascular: Regular rate and rhythm on auscultation, S1 S2 present without murmurs. Palpable pulses noted without peripheral edema.

Gastrointestinal: Bowel sounds are active in all quadrant. Abdomen is soft and tender on palpation.

Breast: The size of the breasts, areolas, and nipples are round and symmetrical with no discoloration, rash, lesions, dimpling, or retraction bilaterally; no masses, lumps, or tenderness noted on palpation bilaterally; and axillary lymph nodes non-palpable.Nurs 6551 Week 11 Assignment Paper

Pelvic Examination:

Vulva: The hair distribution is normal; no lesion noted.

Vagina: Vaginal walls are pink, and pubic hair is shaven; no lesions, masses, inflammation or discharge noted.

Cervix: Intact cervix with closed os.

Uterus: Enlarged, asymmetrical, soft, boggy and tender.

Laboratory and Diagnostic Tests

Laboratory Test and Results: Pregnancy test: Result is negative. Hemoglobin and Hematocrit (H/H): Result showed H/H 8.7/26.7, which is positive for anemia.Nurs 6551 Week 11 Assignment Paper

Diagnostic:

Transvaginal ultrasonography of the uterus: Revealed uterine enlargement measuring 12 cm with no leiomyomata; uterine wall thickening; cystic anechoic spaces in the myometrium; heterogeneous echo texture; obscured endometrial/myometrial border; sub endometrial echogenic linear striations; and thickening of the transition zone measuring 12.8 millimeter. The transvaginal sonography is used to rule out possible uterine tumor (Sakhel & Abuhamad, 2012).

Magnetic Resonance Imaging (MRI): MRI is ordered to obtain a high resolution image of the uterus as well as verifying/confirming the suspected diagnosis. The MRI result revealed that the junctional zone of the uterus is thickened and measures 12.8 millimeter. Also, MRI revealed an ill-defined ovoid and diffuse region of thickening with striated appearance (Sakhel & Abuhamad, 2012).Nurs 6551 Week 11 Assignment Paper

Differential Diagnoses

The differential diagnoses of the patient clinical presentation as described by Schuiling and Likis (2013) include: Adenomyosis, uterine fibroids and endometrial hyperplasia. However, the primary diagnosis for the patient is Adenomyosis.Nurs 6551 Week 11 Assignment Paper

Adenomyosis: Schuiling and Likis (2013) described adenomyosis as a benign, common condition that involves the movement of endometrial tissue into the uterine muscles. The definitive cause of the adenomyosis is unknown, but the condition is common among women with elevated levels of estrogen; the condition usually ceases post menopause when estrogen levels are reduced. Risk factors explained by Taran, Stewart, and Brucker (2013) include multiparity; previous uterine surgery, such as C-section, dilatation/curettage, or fibroids

removal surgery; and women at reproductive age, especially between the age of 40s or 50s. furthermore, Taran et al. (2013) specified that the clinical presentation entails chronic pelvic pain, prolonged menstrual cramps, heavy menstrual bleeding, spotting between periods, abdominal tenderness, painful intercourse, longer periods than normal, blood clots during periods. Taran et al. (2013) also explained that finding during physical examination include enlarged, tender, soft and boggy uterus. Nurs 6551 Week 11 Assignment PaperAccording to Taran et al. (2013) diagnosis is made based on sonographic or MRI results, and treatment is not recommended for women with mild form of adenomyosis, except when the symptoms interfere with daily activities. Taran et al. (2013) further explained that treatment options include anti-inflammatory medications; hormonal treatments; endometrial ablation; uterine artery embolization, MRI-guided focused ultrasound surged or hysterectomy, which is the definitive treatment for adenomyosis.Nurs 6551 Week 11 Assignment Paper

Adenomyosis is selected as the primary diagnosis because the aforementioned patient’s clinical presentation, physical examination findings, and diagnostic tests results are synonymous with adenomyosis aforementioned associated signs and symptoms; risk factors; physical examination findings; and diagnostic test results.

Uterine Fibroids: Women’s Health (WH, 2015) described uterine fibroid to be muscular tumors that develop in the uterine wall, which can also be referred to as leiomyoma or myoma. Uterine fibroids are usually non-cancerous, and can be single or multiple tumors in the uterus. Nurs 6551 Week 11 Assignment PaperAccording to WH (2015), women risk for developing uterine fibroid are increased by age, such as women in their 30s and 40s until menopause when the fibroids commonly shrink. Other risk factors include family history, ethnic origin, obesity and eating habits. Symptoms of fibroids as explained by WH (2015) involve lower back pain; pain during sex; heavy bleeding; painful menses, enlarged lower abdominal, frequent urination; and lower abdominal/pelvic feeling of fullness. Physical examination shows reveal painless, firm, irregular pelvic mass. According to WH (2015), diagnosis is done using transvaginal ultrasound, MRI, hysteroslpingography, hysteroscopy, and endometrial biopsy. Fibroid is not selected as the primary diagnosis because there is no visualization of the fibroid during pelvic examination or on sonography test. Moreover, severe pain is noted during pelvic exam. Furthermore, sonographic result is more consistent with adenomyosis rather than fibroids.Nurs 6551 Week 11 Assignment Paper

Endometrial Hyperplasia: Cancer Research of United Kingdom (CRUK, 2014) described endometrial hyperplasia as thickening of the covering of the uterus due to excessive growth of the cells that covers the uterus, and endometrial hyperplasia can lead to womb cancer. Risk factors according to CRUK (2014) include- age over 35 years; white race; nulliparity; older age at menopause; obesity; cigarette smoking; family history of ovarian, colon, or uterine cancer; early menarche; and history of diabetes, polycystic ovary syndrome, thyroid disease and gallbladder disease. The CRUK (2014), explained that the condition is caused by imbalance of to the estrogen and progesterone. According to CRUK (2014), signs and symptoms of endometrial hyperplasia includes abnormal, prolonged, heavy periods; bleeding between periods; shorter than 21 days’ menstrual cycles; and bleeding after menopause. Also, diagnosis is established by vaginal ultrasound scan, dilatation and curettage, or hysteroscopy.Nurs 6551 Week 11 Assignment Paper

23rd ed. Philadelphia, PA: Lippincott Williams &.Wilkins; 2014presentation, physical findings during examination; and diagnostic results are not synonymous with the signs and symptoms; physical examination finding, risk factors and diagnostic

results associated with endometrial hyperplasia (American College of Obstetricians and Gynecologist, 2016).

Management Plan

Diagnosis: The only definitive diagnosis of adenomyosis is established after uterus is examined post hysterectomy. However, clinical findings that helped in the diagnosis of the patient includes enlarged, asymmetrical, soft, boggy and tender uterus during pelvic examination and aforementioned sonographic and MRI findings, which synonymous with the diagnosis of adenomyosis (Sakhel & Abuhamad, 2012).Nurs 6551 Week 11 Assignment Paper

Treatment: Treatment was considered based on the patient clinical presentations, and collaborative agreement with the patient, the author, and the preceptor for total hysterectomy after explanation of the treatment options to the patient. Patient selected hysterectomy because patient does not want to have another child. According to Schuiling and Likis (2013) explanations, patient was advised to continue with the over-the counter anti-inflammatory drug: Motrin 200-400 mg orally every 4-6 hours as needed for pain and cramping until hysterectomy is performed. Also, Ferrous sulfate 325 mg orally three times a day for anemia was prescribed. Patient was educated to take the medication on an empty stomach one hour before meal or 2 hours after meal for optimum absorption.Nurs 6551 Week 11 Assignment Paper

Patient Education: Patient was educated on the risk factors for adenomyosis, the causes, symptoms, diagnosis, and treatment options. Patient was educated that most women with adenomyosis does not have any symptoms, but adenomyosis is usually found after the tissue obtained from the uterus has been biopsied after pelvic surgery.Nurs 6551 Week 11 Assignment Paper Patient was also informed that the C-section she had twice during child birth may have put her at risk for adenomyosis. Patient was informed that the symptoms of adenomyosis goes away after menopause or after hysterectomy. Patient was educated that all options of treatment must be tried before hysterectomy, but patient opted for hysterectomy without trying all options of treatment. furthermore, patient was educated to continue the home remedy, such as continuation of the use of the heating pad, warm soak bath, and continuing with the over the counter Motrin to alleviate the pain associate with the condition. Finally, patient was educated on the psychological and emotional effects of adenomyosis and hysterectomy surgery because some women grieve on the loss of their womb, which may put them into depression as a result of that; the patient has to be completely sure that she really wants to do the surgery at her age now or wait and do the surgery in the future (University of Maryland Medical Center, 2016).Nurs 6551 Week 11 Assignment Paper

Follow Up Care: In consideration of the Schuiling and Likis (2013) discussion, patient was schedule to follow-up in 6 weeks for follow-up on the patient’s anemia and surgical work up labs, such as complete blood count, complete metabolic panel, prothrombin time and international normalized ratio(PT/INR). Also, an electrocardiogram (EKG) and chest x-ray was ordered to rule out any cardiac problem that would complicate the hysterectomy surgery. The patient’s H/H came up to 11.5/38.9 and all the other laboratory and diagnostic result was normal. The Total hysterectomy surgery was performed on 7/27/2016. Surgery was successful, and patient was schedule to follow up in six eek post-surgery.Nurs 6551 Week 11 Assignment Paper

Conclusion Comment by DeAllen B Millender: Level 1 headings are centered, in bold print, and in ‘Title Case’ (Chapter 3, 3.03, pp. 62-63; see Table 3.1 and Figure 2.1).

The author selected a patient at the author’s clinical site, and obtained a complete health history following the patient care from the beginning of the clinical up to 9 weeks of clinical. The author also used the patient health information and clinical presentation to come up with a diagnosis of adenomyosis. The author developed an appropriate treatment plan with the patient in collaboration with the author’s preceptor incorporating the author’s classroom knowledge with the author’s chosen nursing theorist. Finally, the patient was educated on the condition and follow up care.Nurs 6551 Week 11 Assignment Paper

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