Alterations during Menopause - Case Study Example

 Alterations during Menopause Total Number of Words: 1,129 Q.1 What would you like to ask this patient about her symptoms? Erratic menstrual cycle which is characterized by more than two months skipped periods with an interval of amenorrhea of >60 days is a sign of late menopausal transition (Brashers, 2006, p. 350). In relation to the patient’s initial history, I would like to ask her whether or not she has experienced any form of vaginal infection. Basically, the presence of vaginal infection caused by staphylococcus aureus could explain the presence of perivaginal itching. It is also necessary to ask the patient the description of her vaginal discharge. It is also important to ask whether or not she could sleep properly at night since sleeplessness could explain why she has been feeling tired lately. If she has been exercising, what kind of exercises does she perform. This particular question could also answer why she is feeling tired all of a sudden. Likewise, asking her whether or not she can tolerate heat is also necessary because of the possible presence of thermoregulatory center dysfunction (p. 351). Q.2 What would you like to ask about her medical history? The patient’s initial history which includes her age and complaints of fatigue, hot flashes, perivaginal itching, dyspereuria, and vaginal discharge with several months of erratic cycles are signs of menopausal transition. Late menopausal transitions is often characterized by more than two skipped periods with an interval of amenorrhea of >60 days. This explains why the patient had erratic cycles even though her menstrual period stopped 15 months ago (p. 350). To confirm the possibility that the patient is going through menopausal transition, I would like to ask the patient is she has a history of smoking since the habit of smoking could lead to early menopausal even though menopausal can occur between the age of 40 to 60 years old. Likewise, it is necessary to determine the length of her menstrual cycle in the past, whether or not she has been using non-contraceptive hormone, the presence of osteoporosis, and whether or not she has an Asian descent since these factors could equally contribute to the early cessation of menstruation (p. 349). It has been noted that menstrual cycle shorter than 26 days is a significant indicator wherein the patient could have an early menopausal. Other than altered sleeping patterns, health care professionals should ask the patient whether she is experiencing any forms of cognitive defects like dementia or mood alterations since these are symptoms that dysregulation in some neurotransmitters like norephinephrine, dopamine, and serotonin which is common side effects of estrogen deficiency (p. 350). Since the onset of symptoms of perimenopausal can take place before the actual cessation of menses (p. 349), knowing these questions will enable the health care professionals determine whether or not there is a possibility that the signs and symptoms the patient is experiencing which includes fatigue, hot flashes during the day time and frequently awakening at night, and vaginal symptoms without abdominal pain or dysuria is related to signs of alterations during menopausal stage. Q.3 What would you like to ask her about her life-style? With regards to the patient’s life-style, it is necessary to ask the patient about her sexual history such as the number of sexual partner(s) she had in her lifetime and when was the first time she had sexual encounter since vaginal discharge suggest the presence of sexually transmitted diseases (STDs). Knowing her life-style could somehow provide the physician an idea whether or not there is a possibility of her being infected with sexually transmitted diseases (STDs). Since the patient has a long history of hypercholesterolemia (high blood cholesterol), it is equally important to know about her eating habits such as the type of food she normally consumes. Having a history of hypercholesterolemia increases the possibility that the patient would have a high risk of developing atherosclerotic cardiovascular disease like coronary and cerebrovascular disease right after menopause (p. 351). Therefore, it is very important to learn about the patient’s eating habit since failure to control the intake of bad cholesterol could lead to the development of serious heart problems. In relation to the patient’s low calcium diet, the health care professional should instruct her to take more calcium and exercise more since osteoporosis and skeletal muscle contractility is part of the alterations during menopause (p. 351). Q.4 What are the pertinent positives and negatives on examination? Positives Negatives T = 37OC orally P = 80 bpm Pharynx clear Good chest excursion, lungs clear to auscultation and percussion Cardiac with RRR without murmurs or gallops Abdomen soft, non-tender, w/out organomegaly or masses. Extremities with full pulses w/out edema Breasts symmetric w/out masses, tenderness, or nipple discharge. Axillae w/out adenopathy No uterine or adnexal masses Strength and sensation normal and symmetric DTR2+ and symmetric Gait normal Mild kyphosis at the upper thoracic spine BP = 142/75 RR = 15 breaths per minute Skin is dry Pelvic w/ dry perivaginal and vaginal tissues. Decreased estrogen effect, pap pending. Oriented 4x Q.5 What laboratory test would you order? Laboratory Test FSH level increased Electrochemiluminescent Immunoassay; Blood Test Chemistries, including calcium and phosphate levels, normal Comprehensive Metabolic Panel (CMP); Basic Metabolic Panel (BMP) CBC including HCT, normal Blood Test Liver function normal Comprehensive Metabolic Panel (CMP) Lapid profile shows increased LDL and decreased HDL Blood Test Mammogram consistent with postmenopause without masses or abnormal calcifications Mammography Screening through X-ray Test Dual energy x-ray absorptiometry (DEXA) consistent w/ decreased bone mineral density Dual energy x-ray absorptiometry (DEXA); CT Scan Q.6 What recommendations for management should be made for this patient? The fact that the patient’s FSH level is increased suggests that the patient’s ability to produce eggs has declining, has poor ovarian reserve or has ovarian failure. Therefore, there is a strong need to administer 100 mg of clomiphene citrate from Day 5 to Day 9 as prescribed by the physician. It is also possible to try other intervention methods like attending yoga to improve the patient’s pelvic blood flow and acupuncture to improve ovarian blood supply (Malpani Infertility Clinic, 2010). Significant decreased in the HDL level could lead to coronary problems. For this reason, it is necessary to teach the patient how to control the levels of cholesterol through dietary reduction of cholesterol intake, exercise regularly, stop smoking, and administer medication as prescribed when necessary (Johnson, 2004, p. 270). Since the patient’s dual-energy x-rayabsorptiometry (DEXA) result shows a decreased in the bone mineral density, it is necessary to encourage the patient to increase her calcium intake together with vitamin D in order to increase the absorption rate of calcium. This strategy will help minimize the risk of osteoporosis. *** End *** References Brashers, V. (2006). Clinical Applications of Pathophysiology. An Evidence-based Approach. 3rd Edition. Mosby Inc. Johnson, J. (2004). Medical-Surgical Nursing. 10th Edition. Lippincott Williams & Williams. Malpani Infertility Clinic. (2010). Retrieved June 6, 2010, from Oopause - poor ovarian response : http://www.drmalpani.com/oopause.htm. Read More