Feb 23, 2024 NURS 6521 Women’s And Men’s Health, Infectious Diseases and Hematologic Disorders
NURS 6521 Women’s And Men’s Health, Infectious Diseases and Hematologic Disorders
A Sample Answer For the Assignment: NURS 6521 Women’s And Men’s Health, Infectious Diseases and Hematologic Disorders
Case Study
A 46-year-old, 230lb woman with a family history of breast cancer. She is up to date on yearly mammograms. She has a history of HTN. She complains of hot flushing, night sweats, and genitourinary symptoms. She had felt well until 1 month ago and presented to her gynecologist for her annual GYN examination and to discuss her symptoms. She has a history of ASCUS about 5 years ago on her pap; other than that, Pap smears have been normal. Home medications are Norvasc 10mg QD and HCTZ 25mg QD. Her BP today is 150/90. She has regular monthly menstrual cycles. Her LMP was one month ago.
Treatment Regimen
After analyzing the symptoms, I concluded that the patient is experiencing peri-menopausal symptoms. For many people, menopause begins around age 45 though the onset of symptoms varies across different people. She is undergoing the early stages of menopause which is a stage that begins with experiencing changes in the uterus, breasts, increased fat deposit, and the urogenital tract undergoing several changes such as a shrinking cervix, and reduced muscle tone in the pelvic area. At that age, the level of estrogen production is low hence, leading to hot flashes and night sweats. Therefore, her treatment regime will focus on taking into consideration the patient has Hypertension already.
Hormone therapy will be eliminated and prescribe vaginal cream that would help her manage genitourinary symptoms such as vaginal dryness and dyspareunia (Yoo et al., 2020). Mood changes and hot flashes are common symptoms of menopause hence the patient will be prescribed low-dose antidepressants such as venlafaxine and sertraline. Besides, herbal treatment has been proven to be effective in managing vasomotor symptoms hence the patient can be prescribed black cohosh which helps in reducing many menopausal symptoms (Mahady, et al., 2002).
As people continue to age, their bones become weak and this increases their chances of suffering born fractures. Therefore, the patient will be given vitamin D supplements to the increase production of estrogen which reduces with age and reduces cases of bone fractures.
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During the clinical interview, I realized that the patient is taking Norvasc 10 mg and hydrochlorothiazide (HCTZ) 25 mg. I would advise her to discontinue taking Norvasc since the drug acts as a calcium blocker hence leading to hypertension and besides, its side effects increase menopause symptoms. Since she has hypertension, I would recommend that she takes lisinopril 20 mg daily. This should help alleviate the flushing that the patient has been experiencing (Li et al., 2016). Additionally, the patient has a history of ASCUS, hence I will advise her to continue with her PAP smear exams. With her blood pressure being high currently, and the fact that she is taking Norvasc, she will be encouraged to stop Norvasc but increase the HTCZ dosage to 50mg daily. The patient is expected to come regularly for assessment and examination of the drugs and symptoms.
Patient Education Strategies
Patient education has become an effective strategy to influence patients’ behavior to start living a quality life. The patient will be educated on ways to maintain weight through diet modification, become physically active, and practice relaxation as one way to reduce the severity of menopause symptoms and chances of getting breast cancer (Paterick et al., 2017). The patient will be educated about things she needs to avoid such as the use of exogenous hormones to reduce getting breast cancer going to her family history (Stuenkel et al., 2015). All this information will be passed to the patient through her patient portal which is deemed the best instructional method for her as she can access the information from the comfort of her home.
References
Li, R. X., Ma, M., Xiao, X. R., Xu, Y., Chen, X. Y., & Li, B. (2016). Perimenopausal syndrome and mood disorders in perimenopause: prevalence, severity, relationships, and risk factors. Medicine, 95(32).
Mahady, G. B., Fabricant, D., Chadwick, L. R., & Dietz, B. (2002). Black cohosh: an alternative therapy for menopause?. Nutrition in Clinical Care, 5(6), 283-289.
Paterick, T. E., Patel, N., Tajik, A. J., & Chandrasekaran, K. (2017, January). Improving health outcomes through patient education and partnerships with patients. In Baylor University Medical Center Proceedings (Vol. 30, No. 1, pp. 112-113). Taylor & Francis.
Manson, J. E., & Kaunitz, A. M. (2016). Menopause management—getting clinical care back on track. N Engl J Med, 374(9), 803-6.
Stuenkel, C. A., Davis, S. R., Gompel, A., Lumsden, M. A., Murad, M. H., Pinkerton, J. V., & Santen, R. J. (2015). Treatment of symptoms of the menopause: an endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 100(11), 3975-4011.
Yoo, T. K., Han, K. D., Kim, D., Ahn, J., Park, W. C., & Chae, B. J. (2020). Hormone replacement therapy, breast cancer risk factors, and breast cancer risk: a nationwide population-based cohort. Cancer Epidemiology, Biomarkers & Prevention, 29(7), 1341-1347.
Scenario 3: Syphilis
A 37-year-old male comes to the clinic with a complaint of a “sore on my penis” that has been there for 5 days. He says it burns and leaked a little fluid. He denies any other symptoms. Past medical history noncontributory.
SH: Bartender and he states he often “hooks up” with some of the patrons, both male and female after work. He does not always use condoms.
PE: WNL except for a lesion on the lateral side of the penis adjacent to the glans. The area is indurated with a small round raised lesion. The APRN orders laboratory tests, but feels the patient has syphilis.
Question:
1. What are the 4 stages of syphilis
Your Answer:
Syphilis progresses through four distinct stages, each characterized by specific symptoms and clinical manifestations:
Primary Stage: This stage begins with the appearance of a painless sore called a chancre at the site of infection, typically within 3 weeks after exposure. The sore is firm, round, and often goes unnoticed. It can last for a few weeks and eventually heals on its own. The chancre is highly contagious and contains the bacterium Treponema pallidum.
Secondary Stage: After the chancre heals, the secondary stage emerges, usually a few weeks to a few months later. Symptoms during this stage can vary widely and may include a skin rash, mucous membrane lesions (e.g., in the mouth or genitals), fever, fatigue, sore throat, and muscle aches. The rash is typically non-itchy, red or brown, and may appear on the palms and soles. These symptoms can come and go over several weeks.
Latent Stage: This stage is characterized by the absence of visible symptoms. Syphilis remains present in the body, but there are no outward signs or symptoms. Latent syphilis is further categorized into early latent (within a year of initial infection) and late latent (more than a year after initial infection). During this stage, the infection can still be transmitted to others through sexual contact.
Tertiary Stage: If left untreated, syphilis can progress to the tertiary stage, which can occur years after the initial infection. Tertiary syphilis is rare due to the widespread use of antibiotics. However, it can lead to severe and potentially life-threatening complications, such as damage to the heart, blood vessels, brain, nerves, and other organs. Neurological complications can lead to significant disability.
your discussion was very insightful. Just to piggyback on what you said, the patient is probably experiencing premenopausal symptoms evident by hot flash, night sweats, and genitourinary symptoms. According to Smail et al. (2019), menopause is the period from when a woman has stopped menstruating for a period of twelve conservative months.
Smail 2019 explains that during this time there is drop in the production of the ovarian hormones’ estrogen and progesterone leading symptoms and diseases like vaginal infections, increased risk for osteoporosis and cardiovascular diseases, sleep disorders, mood alterations, hot flashes, depression, and urinary tract infections. Roberts & Hickey (2016) also discusses that during menopause common findings such as genitourinary syndrome of menopause, sleep disturbances, vasomotor symptoms (VMS), and mood disturbances are common.
Treatment Regimen Choice or Pharmacotherapeutics Recommendation
To control the patient blood pressure and the patient’s obesity, I will encourage patient to keep to current medication prescription regimen, make lifestyle changes, and monitor blood pressure reading regularly. VMS treatments would be based on how disturbing the symptoms are (Roberts & Hickey, 2016). Currently the most effective treatment for VMS is moderate dose estrogen-containing hormone therapy (HT), and that also improves vaginal dryness (Roberts & Hickey). They also explain that to help reduce VMS, SSRI such as escitalopram is a reasonable first choice since it is well tolerated.
I will prescribe transdermal estradiol patch, spray, or gel. The patch will be applied to the skin of the trunk, or the spray to apply once daily to the forearm or the gel to apply once daily to one arm, from the shoulder to the wrist or to the thigh (Rosenthal & Burchum, 2018). when used for VMS, escitalopram reduces the frequency, severity and improves quality of life, improves sleep, and does not cause sexual dysfunction (Rosenthal & Burchum). Transdermal formulations range of estrogen absorption is from 14 to 60 mcg/24 hr, depending on the product employed (Rosenthal & Burchum).
Patient Education Strategy Recommendation
To help with the patient’s VMS, I will educate the patient on eating heart healthy food such as whole grains, vegetables, fruits, and maintain a normal level of vitamin D and Calcium (McCance & Huether, 2019). To manage the patient’s weight, I will encourage her to reduce the amount of processed foods, reduce salt intake, avoid or limit alcohol consumption, maintain a healthy weight, manage stress level and regular exercise weekly at least for thirty minutes daily (McCance & Huether).
NURS 6521 Women’s And Men’s Health, Infectious Diseases and Hematologic Disorders
Maintain good sleep pattern by avoiding caffeine, engage in bedtime relaxation rituals such as stay away from bright lights to reduce things that can cause excitement before bedtime and avoid eating large meals for at least two hours before bedtime (Fujimoto, 2017). Fujimoto also explains that keeping to regular health maintenance such as pap smear test, mammograms, breast self-examination, cholesterol screening. Also, I will encourage the patient to take flu shot annually.
References
Fujimoto, K. (2017). Effectiveness of coaching for enhancing the health of menopausal Japanese women. Journal of Women & Aging, 29(3), 216–229. https://doi-org.ezp.waldenulibrary.org/10.1080/08952841.2015.1137434
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’spharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.
Roberts H., & Hickey, M. (2016) managing the menopause: An update. Maturitas, 86(2016), 53-58. Retrieved from https://www-sciencedirect-com.ezp.waldenulibrary.org/science/article/pii/S037851221630007X?via%3Dihub
Smail, L., Jassim, G., & Shakil, A. (2019). Menopause-Specific Quality of Life among Emirati Women. International Journal of Environmental Research and Public Health, 17(1). https://doi-org.ezp.waldenulibrary.org/10.3390/ijerph17010040
What antibiotics have dietary precautions?
Antibiotics
Links to an external site. are a type of medication used to treat bacterial infections. They work by stopping the infection or preventing it from spreading. There are many different types of antibiotics. Some are broad-spectrum, meaning they act on various disease-causing bacteria. Others are designed to kill certain species of bacteria. While many foods are beneficial during and after antibiotics, some should be avoided. Some antibiotics require specific dietary precautions to ensure their effectiveness and prevent interactions or side effects(Huizen, 2021). The following are some common antibiotics and their dietary precautions.
Tetracyclines (e.g., doxycycline, minocycline): These antibiotics should not be taken with dairy products (milk, cheese, yogurt) or antacids containing calcium, magnesium, aluminum, or iron. These substances can bind to tetracyclines, reducing their absorption and effectiveness. Take tetracyclines at least 1-2 hours before or 4-6 hours after consuming dairy products or antacids.
Fluoroquinolones (e.g., ciprofloxacin, levofloxacin): Avoid taking fluoroquinolones with dairy products, calcium-fortified foods, or mineral supplements (calcium, magnesium, zinc) as they can reduce the absorption of the antibiotic. Take these medications at least 2 hours before or 6 hours after consuming such products.
Macrolides (e.g., erythromycin, clarithromycin, azithromycin): Macrolides should generally be taken on an empty stomach, about 1 hour before or 2 hours after meals. However, some forms of macrolides, such as azithromycin, can be taken with or without food.
Linezolid: Avoid foods rich in tyramine while taking linezolid. Tyramine-rich foods include aged cheeses, cured meats, fermented, or pickled foods, soy products, and alcoholic beverages. Linezolid can interact with tyramine and lead to a potentially dangerous increase in blood pressure.
Metronidazole: Alcohol should be avoided while taking metronidazole and for at least 72 hours after completing the course of the antibiotic. Combining alcohol and metronidazole can cause severe nausea, vomiting, and flushing.
Sulfonamides (e.g., sulfamethoxazole/trimethoprim): The patient needs to drink plenty of fluids while taking sulfonamide antibiotics to prevent crystal formation in the urine, which can lead to kidney problems.
Cephalosporins: Cephalosporins generally are not associated with significant dietary restrictions, but it’s always best to follow the specific instructions your healthcare provider or pharmacist gives.
Patients should always read the medication label and follow the instructions provided by their healthcare provider or pharmacist.
What antibiotics cause photosensitivity?
Certain antibiotics can cause photosensitivity, a condition in which the skin becomes more sensitive to sunlight and may result in an exaggerated sunburn-like reaction. Exposure to sunlight while taking these antibiotics can lead to skin rash, redness, itching, and even blistering. The following antibiotics are known to cause photosensitivity:
Tetracyclines (e.g., doxycycline, minocycline):
Tetracyclines are well-known for causing photosensitivity reactions. If you are prescribed a tetracycline antibiotic, taking precautions and avoiding excessive sun exposure is essential. Wearing protective clothing, using sunscreen with high SPF, and staying out of direct sunlight during peak hours can help reduce the risk of photosensitivity reactions.
Fluoroquinolones (e.g., ciprofloxacin, levofloxacin): Some fluoroquinolone antibiotics have been associated with photosensitivity reactions. Protecting your skin from excessive sunlight is essential when taking antibiotics like tetracyclines.
Sulfonamides (e.g., sulfamethoxazole/trimethoprim): Sulfonamides, especially sulfamethoxazole, can cause photosensitivity in some individuals. Take necessary precautions and avoid direct sunlight as much as possible when on this medication.
Macrolides (e.g., erythromycin, clarithromycin): While macrolides are not as strongly associated with photosensitivity as tetracyclines and fluoroquinolones, some cases of photosensitivity have been reported with these antibiotics.
Doxycycline and Retinoids Combination: It’s worth noting that taking doxycycline along with certain retinoids used for acne treatment can increase the risk of photosensitivity.
Use sunscreen with a high sun protection factor (SPF), wear protective clothing like hats and long sleeves, and seek shade to minimize the risk of photosensitivity reactions. Educate patients to Contact healthcare providers for guidance if they experience skin changes or reactions while on antibiotics (Kowalska et al., 2021)
What patient counseling would you provide?
Doctors provide patient counseling when prescribing antibiotics to ensure safe and effective medication use. Here are some common points that a doctor may cover during antibiotic counseling:
Indication: Explain the reason for prescribing the antibiotic. Discuss the specific infection or condition it is meant to treat.
Dosage and Schedule: Provide clear instructions on how and when to take the antibiotic. Emphasize the importance of taking the medication as prescribed and completing the full course, even if the patient feels better before finishing.
Administration: Instruct the patient on whether to take the antibiotic with or without food and if any specific dietary restrictions or precautions are necessary.
Potential Side Effects: Discuss common side effects of the antibiotic and what to do if they occur. Also, inform the patient about severe or rare side effects requiring immediate medical attention.
Allergies and Adverse Reactions: Ask the patient about known allergies to antibiotics or other medications. Inform them of possible allergic reactions and what to do in case of an adverse reaction.
Drug Interactions: Inform the patient about any potential drug interactions with the prescribed antibiotic and other medications they may be taking. This includes over-the-counter medications, herbal supplements, and recreational drugs.
Photosensitivity (if applicable): If the antibiotic is known to cause photosensitivity, advise the patient to protect their skin from sunlight and ultraviolet (UV) light exposure.
Pregnancy and Breastfeeding: If the patient is pregnant or breastfeeding, discuss the safety of the antibiotic and whether there are any potential risks.
Storage: Provide instructions on how to store the antibiotic properly, including temperature requirements and keeping it out of reach of children.
Missed Doses: Advise the patient on what to do if they miss a dose. It’s essential to avoid doubling up on doses but to take the next scheduled dose and continue the course as prescribed.
Follow-Up: Schedule a follow-up appointment to assess the patient’s progress and ensure the treatment works effectively.
Reference
Huizen, J. (2021, December 17). What are the side effects of antibiotics? https://www.medicalnewstoday.com/articles/322850
Kowalska, J., Rok, J., Rzepka, Z., & Wrześniok, D. (2021). Drug-Induced Photosensitivity—From light and chemistry to biological reactions and clinical symptoms. Pharmaceuticals, 14(8), 723. https://doi.org/10.3390/ph14080723
NYSDOH NY. (2016, October 28). Educating patients about antibiotic use [Video]. YouTube. https://www.youtube.com/watch?v=YHYmb2OKoMU
Based on the symptoms the patient is presenting with, I would say that she is entering menopause. Rosenthal & Burchum (2021) state that “95% of women enter menopause between the ages of 45 and 55.” The symptoms of hot flushes, night sweats, and genitorurinary symptoms, under normal circumstances, would be treated with hormone therapy (HT). However, this patient’s family history of breast cancer makes treating the symptoms of menopause much riskier.
Before discussing treatment options with the patient, I would ask her to whether the symptoms are tolerable or extremely bothersome. Determining whether she wants treatment for the symptoms would be my first step. If yes, then we would have to discuss the risks and benefits of treatment with either HT or an SNRI such as Effexor. In their article, Roberts & Hickey (2021) state that SNRIs reduce vasomotor symptoms (hot flushes & night sweats) of menopause by 50-60%.
If this is acceptable for the patient, this would be the treatment plan that I would recommend. If she didn’t think that a 50-60% decrease in her symptoms was sufficient, or if her genitorurinary symptoms were more troublesome, I would recommend a low dose estrogen only HT. Estrogen only HT does increase the risk of breast cancer, but only when used long-term (Breastcancer.org, 2021).
It is important to discuss the severity of the symptoms, whether they are tolerable, and possible length of time that symptoms persist with the patient. These factors may determine whether she wants the symptoms treated or not. Then we must discuss the risks and benefits of treatment, and educating the patient on the increased risk for breast cancer that HT presents for her is imperative. Again, if relieving the vasomotor symptoms by about half is acceptable for the patient, then I would recommend treatment with Effexor because it would not increase her risk of developing breast cancer.
References
Breastcancer.org. (2021). Using HRT (Hormonal Replacement Therapy). https://www.breastcancer.org/risk/factors/hrt
Roberts, H., & Hickey, M. (2016). Managing the menopause: An update. Maturitas, 86, 5-58.
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s phamacotherapeutics for advanced practice nurses and physician assistants (2nd ed). Elsevier, Inc. .
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Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders
As an advanced practice nurse, you will likely experience patient encounters with complex comorbidities. For example, consider a female patient who is pregnant who also presents with hypertension, diabetes, and has a recent tuberculosis infection. How might the underlying pathophysiology of these conditions affect the pharmacotherapeutics you might recommend to help address your patient’s health needs? What education strategies might you recommend for ensuring positive patient health outcomes?
For this Discussion, you will be assigned a patient case study and will consider how to address the patient’s current drug therapy plans. You will then suggest recommendations on how to revise these drug therapy plans to ensure effective, safe, and quality patient care for positive patient health outcomes.
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To Prepare
Review the Resources for this module and reflect on th
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