Explain why an advanced nurse provider needs to gather patient medical history including social, nutritional, and family history when prescribing HRT.
April 22, 2020 Comments Off on Explain why an advanced nurse provider needs to gather patient medical history including social, nutritional, and family history when prescribing HRT. Assignment Assignment help

Abidemis post, pls don’t criticize her work. each post require 2 reference each. ty The symptoms this patient presented in this scenario are pretty familiar with menopause. Sometimes, elevated follicle-stimulating hormone (FSH) levels are measured to confirm menopause in women Vahidroodsari, F., Ayati, S., Yousefi, Z., & Saeed, S. (2010). When a woman’s FSH blood level is consistently elevated to 30 mIU/mL or higher, and she has not had a menstrual period for a year, it is generally accepted that she has reached menopause. In the months or years leading up to menopause (perimenopause), one might experience some signs and symptoms Irregular periods, Vaginal dryness, Hot flashes, Chills, Night sweats, Sleep problems, Mood changes, Weight gain and slowed metabolism, Vahidroodsari et al,; (2010). This discussion will discuss the patient’s symptoms and the treatment adopted to minimize these symptoms. For this patient, a good treatment plan will be the hormone replacement surgery, the use of low-level anti-depressants, the use of Gabapentin, etc. The patient teaching strategy can include maintaining a balanced diet, optimizing sleep, exercising regularly, strengthening pelvic floor muscles, maintaining regular checkups, avoiding smoking, etc. Menopause occurs in women ages 40 to 50, approximately 12 months after the last menstruation; this signals the end of the menstrual cycles. Menopausal women exhibit infertility but are vital and still have sexual functions. They have physical symptoms, such as irregular periods, night sweats, hot flashes, and emotional symptoms (depression or anxiety), disruptive sleep, and, lower energy, Mayo Clinic, (2017). Menopause treatments may include hormone replacement therapy (HRT) or herbal. After menopause, hormone replacement therapy (HRT) is often prescribed to resupply the body with the hormones it no longer produces. HRT mostly consists of an estrogen/progestin supplement route of administration are orally or through a skin patch or gel. Estrogen is the component that treats hot flashes and vaginal dryness. Estrogen has increased risk of heart disease, endometrial or uterine cancer, and osteoporosis so it is recommended to be given in combination with a progestin, Pines et al,; (2008). However, progestin and estrogen both have negative side effects like irregular bleeding, headaches, bloating, and breast swelling and pain or might develop an artificial monthly period, depending on the dosage given WebMD, (2017). Estrogen may be used alone in women who have had a hysterectomy Arcangelo, Peterson, Wilbur, & Reinhold, (2017). Before the administration of hormonal therapy, alternatives treatment will be encouraged such as diet, exercise, and acupuncture. Foods high in plant estrogens such as soybeans and soy milk are encouraged to ease symptoms such as hot flashes. Nuts and seeds, fennel, celery, parsley, and flaxseed oil may also help. Increasing calcium intake to 1,000 to 1,500 mg a day and do regular weight-bearing exercise to avoid osteoporosis and maintain general good health WebMD, (2017). In conclusion, an advanced nurse provider needs to gather patient medical history including social, nutritional, and family history when prescribing HRT. After obtaining a complete history a risk analysis should be done when deciding on the HRT for the patient. It is as well beneficial to consider the patient’s drug of choice after a detailed explanation of the side effects, symptoms, benefits, and risk from taking the hormones. Patient follow up appointment needs to be communicated to know how effective the therapy is, and to promptly prevent exacerbation. References Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (2017). Pharmacotherapeutics for advanced practice: A practical approach (Vol. 4th ed.). Albler, PA: Lippincott Williams & Wilkins. Mayo Clinic, (2017). Menopause. Retrieved from: http://www.mayoclinic.org/diseases-conditions/menopause/basics/definition/con20019726 Pines, A., Sturdee, D. W., Birkhäuser, M. H., de Villiers, T., Naftolin, F., Gompel, A., Farmer, R., Barlow, D., Tan, D., Maki, P., Lobo, R., Hodis, H., & et al. (2008) on behalf of the International Menopause Society. HRT in early menopause: scientific evidence and common perceptions. Climacteric, 11(4), 267–272. https://doiorg.ezp.waldenulibrary.org/10.1080/13697130802226866 Vahidroodsari, F., Ayati, S., Yousefi, Z., & Saeed, S. (2010). Comparing Serum Follicle Stimulating Hormone (FSH) Level with Vaginal PH in Women with Menopausal Symptoms. Oman medical journal, 25(1), 13–16. https://doi.org/10.5001/omj.2010.4 WebMD, (2017). Understanding Menopause Treatment. Retrieved from http://www.webmd.com/menopause/guide/understanding-menopause-treatment Women’s health, (2019). Menopause basics. Retrieved from https://www.womenshealth.gov/menopause/menopause-basics#1 clotildas post The case scenario I was presented with is a 68-year-old male with a history of COPD, HTN, DM, and HLD, who is being admitted for community-acquired pneumonia that he developed three days ago. Chest x-ray revealed right lower lobe pneumonia, with sputum culture showing gram-positive cocci in pairs with a heavy growth of Streptococcus Pneumonia. The patient is going on day three of IV antibiotics, including azithromycin 500mg daily, and ceftriaxone 1gm daily. The patient’s clinical status is improving, including improvement in O2 status and fever, improvement in kidney function, and an overall decrease in WBC count. Only c/o patient has at this point is nausea and vomiting causing a decrease in oral intake. The patient’s only allergy is to Penicillin, which causes a rash. The patient’s age and comorbidities have put him at a greater risk factor for developing drug-resistant streptococcus pneumonia (File, 2019). Treatment Regimen and Pharmacotherapeutics Since the patient is more advanced in age and has a few co-morbidities, it is important to make sure the choices of antibiotics to be given will not interact with any of his home medications or morbidities. Amoxicillin is typically the first-line drug for the treatment of streptococcus pneumonia; however, since this patient has an allergy to penicillin’s, Azithromycin would be the next best choice. I have seen in several instances when a patient has a mild allergy, and in this patient instance, a rash can be pre-treated with Benadryl to help relieve and protect against such adverse effects, which could be an option for this patient. Azithromycin comes from the Macrolide family of antibiotics, which are considered a broad-spectrum antibiotic, and is active against most gram-positive bacteria. Azithromycin is a derivative of Erythromycin, which is the most commonly used antibiotic. Azithromycin is considered one of the safer antibiotics to use and does not seem to have any adverse effects with certain disorders that this patient already has, nor does it seem to have any interactions with certain medications that this patient might be taking for his co-morbidities. However, nausea and vomiting are a couple of GI disturbances that can be noted with Azithromycin (Rosenthal & Burchum, 2018). The patient has resistance to Erythromycin but is susceptible to Vancomycin, therefore Azithromycin may or may not be beneficial to his treatment. However, I would go ahead and continue to keep the patient on this antibiotic or try Vancomycin. Vancomycin is used to treat only gram-positive bacteria and is used as an alternative for those with an allergy to Penicillins. With either choice, I would also administer an antiemetic such as Phenergan 25mg IV every 4-6 hours to help with nausea and vomiting. I would not suggest Zofran, as both Zofran and Azithromycin have the potential to prolong QT intervals, therefore posing a risk for cardiac dysrhythmias (Rosenthal & Burchum, 2018). Ceftriaxone is a member of the Cephalosporins, which work to disrupt the cell wall synthesis which activates autolysins, resulting in cell wall death by lysis (Rosenthal & Burchum, 2018). Ceftriaxone is a third-generation cephalosporin, meaning they have a broad spectrum of antimicrobial activity and are effective in treating gram-positive bacteria such as streptococcus pneumonia, which is what this patient is presenting with. Because cephalosporins act in the same way as Penicillin’s, they are a good second choice for someone with a Penicillin allergy like this patient (Rosenthal & Burchum, 2018). However, if the patient had a severe allergy to Penicillin’s, there is a good chance the patient would have an allergy to Cephalosporins as well. The patient has a susceptibility to Ceftriaxone and Cephalosporins are typically well tolerated with minimal adverse effects, therefore I would continue to keep the patient on this medication while in the hospital. Along with the IV antibiotics, it would be important to make sure the patient is getting a good cough medicine to help decrease the cough but not diminish completely, as it is important for the patient to be able to cough up sputum to help alleviate the infection. I would also make sure there is a PRN order for ibuprofen or Tylenol as needed for pain or elevated temperature. IV fluids would be acceptable if the patient is not able to keep any food down, and since he is a diabetic, I would suggest D5 Normal Saline to make sure his blood sugars stay stable and the patient does not become hypoglycemic. Adequate blood sugar checks, probably every 6 hours should be done also with a sliding scale to maintain appropriate blood glucose levels during the patient’s hospital stay. It is important to try and keep the patient on his normal medication regimen as best as possible, which would include COPD medications, as well as nebulizer treatments with albuterol and Ipratropium scheduled and PRN, as the patient is more likely to be in respiratory distress and at more of a risk for COPD exacerbation (Huether & McCance, 2017). Patient Education Strategies Some important information to teach the patient about treatment and management of pneumonia would include proper hand hygiene to help prevent the spread of germs and infection, prevention of aspiration, so making sure the patient is able to cough up secretions properly on his own as well as swallowing food and liquids without difficulty, as not to aspirate any contents back into the lungs, therefore causing further progression of pneumonia (Huether & McCance, 2017). Proper ventilation and oxygenation is important to ensure the patient is not having any difficulties with breathing, and to ensure he will be able to get around okay on his own after leaving the hospital. Deep breathing and coughing are important not just in the hospital but also after going home to help properly dispose of secretions that are further causing the infection, as well as proper hydration because this will help thin the secretions making it easier to cough up the secretions, as well as helping to flush out the system of bad toxins (Huether & McCance, 2017). The patient will more than likely be sent home on an oral antibiotic for an additional 5-7 days; therefore, it is imperative to educate the importance of taking his medications at the time prescribed and to make sure he takes the entire does so as not to build up a resistance to the antibiotic (File, 2019). References File, M. (2019). Treatment of community-acquired pneumonia in adults who require hospitalization. UpToDate. Retrieved from https://www.uptodate.com/contents/treatment-of0community-acquired-pneumonia-in-adults-who-require-hospitalization#H32 Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier