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Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 Discussion

Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 Discussion Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionWeek 9: Women’s and Men’s Health/Infections and Hematologic Systems, Part IAs an advanced practice nurse, you will likely encounter many disorders associated with women’s and men’s health, such as hormone deficiencies, cancers, and other functional and structural abnormalities. Disorders such as these not only result in physiological consequences but also psychological consequences, such as embarrassment, guilt, or profound disappointment for patients. For these reasons, the provider-patient relationship must be carefully managed. During evaluations, patients must feel comfortable answering questions so that you, as a key health-care provider, will be able to diagnose and recommend appropriate treatment options. Advanced practice nurses must be able to educate patients on these disorders and help relieve associated stigmas and concerns.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionThis week, you examine women’s and men’s health concerns as well as the types of drugs used to treat disorders that affect women’s and men’s health. You also explore how to treat aspects of these disorders on other health systems.Learning ObjectivesStudents will:Evaluate patients for treatment of complex health issuesEvaluate patients for treatment of infectionsEvaluate patients for treatment of hematologic disordersAnalyze patient education strategies for the management and treatment of complex comorbiditiesORDER A PLAGIARISM-FREE PAPER HERELearning ResourcesWomen’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionRequired Readings (click to expand/reduce)Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.Chapter 46, “Anticoagulant and Antiplatelet Drugs” (pp. 364–371)Chapter 47, “Drugs for Deficiency Anemias” (pp. 389–396)Chapter 50, “Estrogens and Progestins: Basic Pharmacology and Noncontraceptive Applications” (pp. 425–436)Chapter 51, “Birth Control” (pp. 437–446)Chapter 52, “Androgens” (pp. 447–453)Chapter 53, “Male Sexual Dysfunction and Benign Prostatic Hyperplasia” (pp. 454–466)Chapter 70, “Basic Principles of Antimicrobial Therapy” (pp. 651–661)Chapter 71, “Drugs That Weaken the Bacterial Cell Wall I: Penicillins” (pp. 662–668)Chapter 75, “Sulfonamides Antibiotics and Trimethoprim” (pp. 688–694)Chapter 76, “Drug Therapy of Urinary Tract Infections” (pp. 695–699)Chapter 78, “Miscellaneous Antibacterial Drugs” (pp. 711–714)Chapter 79, “Antifungal Agents” (pp. 715–722)Chapter 80, “Antiviral Agents I: Drugs for Non-HIV Viral Infections” (pp. 723–743)Chapter 82, “Drug Therapy of Sexually Transmitted Diseases” (pp. 763–770)Lunenfeld, B., Mskhalaya, G., Zitzmann, M., Arver, S., Kalinchenko, S., Tishova, Y., & Morgentaler, A. (2015). Recommendations on the diagnosis, treatment and monitoring of hypogonadism in men. Aging Male, 18(1), 5–15. doi:10.3109/13685538.2015.1004049This article presents recommendations on the diagnosis, treatment, and monitoring of hypogonadism in men. Reflect on the concepts presented and consider how this might impact your role as an advanced practice nurse in treating men’s health disorders.Montaner, J. S. G., Lima, V. D., Harrigan, P. R., Lourenço, L., Yip, B., Nosyk, B., … Kendall, P. (2014). Expansion of HAART coverage is associated with sustained decreases in HIV/AIDS morbidity, mortality and HIV transmission: The “HIV Treatment as Prevention” experience in a Canadian setting. PLoS ONE, 9(2), e87872. Retrieved from https://doi.org/10.1371/journal.pone.0087872Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionThis study examines HAART therapy and its sustainability and profound population-level decrease in morbidity, mortality, and HIV transmission.Roberts, H., & Hickey, M. (2016). Managing the menopause: An update. Maturitas, 86(2016), 53–58. .https://doi.org/10.1016/j.maturitas.2016.01.007This article provides an update on treatments on Vasomotor symptoms (VMS), genito-urinary syndrome of menopause (GSM), sleep disturbance, sexual dysfunction, and mood disturbance that are common during the menopause transition.Agency for Healthcare Research and Quality. (2014). Guide to clinical preventive services, 2014: Section 2. Recommendations for adults. Retrieved from http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/guide/section2.htmlWomen’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionThis website lists various preventive services available for men and women and provides information about available screenings, tests, preventive medication, and counseling.Required Media (click to expand/reduce)Laureate Education (Producer). (2019h). Pathopharmacology: Pharmacology and immunological disorders: Improvements in medications and drug administration [Video file]. Baltimore, MD: Author.Note: The approximate length of this media piece is 8 minutes.Nurse Manager, Bette Nunn discusses how technology has improved the practice of administering drugs and created new and improved drug therapies. The importance of using technology as well as a patient’s knowledge of their own drug history is also discussed.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionSpeed Pharmacology. (2018). Pharmacology – Antibiotics – Cell wall & membrane inhibitors (Made Easy) [Video]. https://www.youtube.com/watch?v=mMk6VWVpRpo&t=504sNote: This media program is approximately 16 minutes.Speed Pharmacology. (2018). Pharmacology – Antibiotics – DNA, RNA, folic acid, protein synthesis inhibitors (Made Easy) [Video]. https://www.youtube.com/watch?v=5HQmvQJWzNY&t=32sNote: This media program is approximately 16 minutes.Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic DisordersWomen’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionAs 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?Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionFor 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.Photo Credit: Getty ImagesTo PrepareReview the Resources for this module and reflect on the different health needs and body systems presented.Your Instructor will assign you a complex case study to focus on for this Discussion.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionConsider how you will practice critical decision making for prescribing appropriate drugs and treatment to address the complex patient health needs in the patient case study you selected.By Day 3 of Week 9Post a brief description of your patient’s health needs from the patient case study you assigned. Be specific. Then, explain the type of treatment regimen you would recommend for treating your patient, including the choice or pharmacotherapeutics you would recommend and explain why. Be sure to justify your response. Explain a patient education strategy you might recommend for assisting your patient with the management of their health needs. Be specific and provide examples.You will respond to your colleagues’ posts in Week 10.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionNote: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit! Rubric Detail Select Grid View or List View to change the rubric’s layout.ContentName: NURS_6521_Week9_Discussion_RubricWomen’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionGrid ViewList ViewExcellentGoodFairPoorMain PostingWomen’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionPoints Range: 45 (45%) – 50 (50%)Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.Supported by at least three current, credible sources.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionWritten clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.Points Range: 40 (40%) – 44 (44%)Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.At least 75% of post has exceptional depth and breadth.Supported by at least three credible sources.Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.Points Range: 35 (35%) – 39 (39%)Responds to some of the discussion question(s).One or two criteria are not addressed or are superficially addressed.Is somewhat lacking reflection and critical analysis and synthesis.Somewhat represents knowledge gained from the course readings for the module. Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionPost is cited with two credible sources.Written somewhat concisely; may contain more than two spelling or grammatical errors.Contains some APA formatting errors.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionPoints Range: 0 (0%) – 34 (34%)Does not respond to the discussion question(s) adequately.Lacks depth or superficially addresses criteria.Lacks reflection and critical analysis and synthesis.Does not represent knowledge gained from the course readings for the module.Contains only one or no credible sources.Not written clearly or concisely.Contains more than two spelling or grammatical errors.Does not adhere to current APA manual writing rules and style.Main Post: TimelinessPoints Range: 10 (10%) – 10 (10%)Posts main post by day 3Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionPoints Range: 0 (0%) – 0 (0%)Points Range: 0 (0%) – 0 (0%)Points Range: 0 (0%) – 0 (0%)Does not post by day 3First ResponsePoints Range: 17 (17%) – 18 (18%)Response exhibits synthesis, critical thinking, and application to practice settings.Responds fully to questions posed by faculty. Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionProvides clear, concise opinions and ideas that are supported by at least two scholarly sources.Demonstrates synthesis and understanding of learning objectives.Communication is professional and respectful to colleagues. .Responses to faculty questions are fully answered, if posed.Response is effectively written in standard, edited English.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionPoints Range: 15 (15%) – 16 (16%)Response exhibits synthesis, critical thinking, and application to practice settings.Responds fully to questions posed by faculty.Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.Demonstrates synthesis and understanding of learning objectives.Communication is professional and respectful to colleagues. .Responses to faculty questions are fully answered, if posed.Response is effectively written in standard, edited English.Points Range: 13 (13%) – 14 (14%)Response is on topic and may have some depth.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionResponses posted in the discussion may lack effective professional communication.Responses to faculty questions are somewhat answered, if posed. Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionResponse may lack clear, concise opinions and ideas, and a few or no credible sources are cited.Points Range: 0 (0%) – 12 (12%)Response may not be on topic and lacks depth.Responses posted in the discussion lack effective professional communication.Responses to faculty questions are missing.No credible sources are cited.Second ResponsePoints Range: 16 (16%) – 17 (17%)Response exhibits synthesis, critical thinking, and application to practice settings.Responds fully to questions posed by faculty. Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionProvides clear, concise opinions and ideas that are supported by at least two scholarly sources.Demonstrates synthesis and understanding of learning objectives.Communication is professional and respectful to colleagues. .Responses to faculty questions are fully answered, if posed.Response is effectively written in standard, edited English.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionPoints Range: 14 (14%) – 15 (15%)Response exhibits critical thinking and application to practice settings.Communication is professional and respectful to colleagues.Responses to faculty questions are answered, if posed.Provides clear, concise opinions and ideas that are supported by two or more credible sources.Response is effectively written in standard, edited English.Points Range: 12 (12%) – 13 (13%)Response is on topic and may have some depth.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionResponses posted in the discussion may lack effective professional communication.Responses to faculty questions are somewhat answered, if posed. .Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionPoints Range: 0 (0%) – 11 (11%)Response may not be on topic and lacks depth.Responses posted in the discussion lack effective professional communication.Responses to faculty questions are missing.No credible sources are cited.ParticipationPoints Range: 5 (5%) – 5 (5%)Meets requirements for participation by posting on three different days.Points Range: 0 (0%) – 0 (0%)Points Range: 0 (0%) – 0 (0%)Points Range: 0 (0%) – 0 (0%)Does not meet requirements for participation by posting on 3 different days Total Points: 100Name: NURS_6521_Week9_Discussion_RubricWeek 9 Initial Discussion PostCase StudyThis is a case of a 46/F complaining of hot flushing, night sweats, and genitourinary symptoms. She claims to have a regular menstrual cycle and her last menstrual period was a month ago. The patient has a family history of breast cancer and is up to date with her mammogram. Current pap smears are within normal limits, but she claims to have a history of atypical squamous cells of undetermined significance from her pap smear five years ago. Past medical history includes hypertension and is taking Norvasc 10mg daily and hydrochlorothiazide 25mg daily. The patient’s BP at this visit is 150/90.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionMenopausal Hormone TherapyThe patient on the above case study might still have a regular menstrual cycle; however, the presence of night sweats and genitourinary symptoms are an indication that the patient is starting to have the clinical manifestation of menopause. Perception of being warm, sweating, and skin flushing characterize the vasomotor symptom of menopause (Rosenthal & Burchum, 2021). Additionally, the patient is also complaining of genitourinary symptoms. According to Rosenthal and Burchum (2021), atrophic transformation at the vagina and urethra is caused by estrogen loss in menopause. Careful deliberation about giving menopausal hormone therapy is critical, and multiple factors should be considered. The first factor is the patient’s history of hypertension and current BP of 150/90. In menopause, distinct vasoconstrictive components like angiotensinogen and endothelin are produced due to decreased estrogen levels, particularly in the estrogen-to-androgen ratio (Anagnostis et al., 2020)Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 Discussion. Dosage adjustment or total revision of the patient’s current anti-hypertensive medications might be necessary. The second factor to consider is the patient’s history of breast cancer. According to Rosenthal and Burchum (2021), there is an incremented possibility of having breast cancer in women receiving estrogen and progestin therapy. The patient should be advised to continue undergoing regular mammograms as directed by her health care provider and teach the patient how to perform self-breast examination. The third factor to consider is whether to use estrogen alone or estrogen and progestin. There is no mention if the patient has undergone hysterectomy; hence the use of estrogen and progestin as menopausal hormone therapy is appropriate for this patient. Opposing the effects of estrogen in inciting the endometrium, causing endometrial hyperplasia and cancer can be accomplished by administering progestin; this is the sole indication of giving progestin with estrogen in menopausal hormone therapy (Rosenthal & Burchum, 2021). Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionPharmacotherapeutics            I will prescribe Estrogen/Progestin combination (Prempro) and start on a low dose. The patient’s Norvasc dosage of 10mg daily will be maintained, and the hydrochlorothiazide will be increased from 25mg to 50 mg daily to better control the patient’s hypertension. Utilizing hydrochlorothiazide alone in treating hypertension could be limited correlated to individual differences in patients; however, it is still the preferred medication in a combination of another medication for hypertension (Johnson et al. 2019). Labs will be ordered to screen for diabetes and hyperlipidemia, such as a lipid profile, fasting blood sugar, HBA1C, and liver function test. Oral hypoglycemic agents and statins will also be prescribed if indicated.Patient EducationThe patient should be taught what signs and symptoms need to be reported to her healthcare provider. Smoking cessation, exercise, avoiding eating saturated fats, and strict compliance with medications for hypertension, high blood sugar, and hyperlipidemia decrease the cardiovascular risk (Rosenthal & Burchum, 2021).            Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionReferencesAnagnostis, P., Theocharis, P., Lallas, K., Konstantis, G., Mastrogiannis, K., Bosdou, J. K., Lambrinoudaki, I., Stevenson, J. C., & Goulis, D. G. (2020). Early menopause is associated with increased risk of arterial hypertension: A systematic review and meta-analysis. Maturitas, 135, 74–79. ttps://doi.org/10.1016/j.maturitas.2020.03.006Johnson, R., Dludla, P., Mabhida, S., Benjeddou, M., Louw, J., & February, F. (2019). pharmacogenomics of amlodipine and hydrochlorothiazide therapy and the quest for improved control of hypertension: a mini review. Heart Failure Reviews, 24(3), 343–357. ttps://doi.org/10.1007/s10741-018-09765-yRosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.RE: Week 9 Initial Discussion PostResponse # 1     Thanks for the insightful post! Menopause begins one year after the menstrual period, but symptoms appear during the perimenopausal years (Rymer, 2000). The most common symptoms are hot flashes, night sweats, and genitourinary symptoms.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 Discussion       The case study presented a woman who still has a regular menstrual cycle, has a history of hypertension, a family history of breast cancer, and had ASCU five years ago. In my opinion, starting with hormonal therapy in the early part of the perimenopausal stage would pose a significant risk for the patient of all the side effects of hormone therapy. But I would still discuss this option with the patient, same as any other alternatives to hormone therapy that will help relieve menopausal symptoms and postmenopausal conditions. According to Women’s Health Initiative (WHI) studies about hormone therapy, findings said that there is an increased risk for breast cancer, stroke, heart attack, and blood clots in women on estrogen plus progestin (Menopausal Hormone Therapy Information, 2015). Before we put the patient in hormonal therapy, we should weigh first the benefits and the side effects. According to Rosenthal & Burchum (2021), women with multiple risk factors should consider alternative treatments. For women who opted for alternatives, escitalopram or Lexapro and desvenlafaxine or Pristiq can be prescribed to reduce those hot flashes, Rosenthal & Burchum, 2021. Since systemic estrogen carries significant risks, we can also prescribe topical estrogen formulation to treat genitourinary syndrome (Rosenthal & Burchum, 2021).       Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 Discussion                                                                  References Menopausal Hormone Therapy Information. (2015, October 6). National Institutes of           Health (NIH).           https://www.nih.gov/health-information/menopausal-hormone-therapy-information ‌Rosenthal, L. D., & Burchum, J.R. (2021). Lehne’s Pharmacotherapeutics for Advanced             Practice Nurse and Physician Assistants. (2nd ed.). Elsivier, Inc. Rymer, J. (2000). Extracts from “Clinical Evidence”: Menopausal symptoms. BMJ,            321(7275), 1516–1519. https://doi.org/10.1136/bmj.321.7275.1516‌Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionRE: Week 9 Initial Discussion PostReply 1 Hi , and thank you for your post discussing your treatment plan for the patient with menopausal symptoms in the case study. I appreciated your plan to still prescribe estrogen/progestin therapy (EPT) despite the history of family breast cancer and associated increased risk to develop breast cancer with this treatment. Your plan to prescribe the EPT while educating the patient of the increased risk and necessity to monitor herself for breast cancer is still an appropriate option. Usually, EPT would be the most effective at controlling both vasomotor and genitourinary symptoms (Rosenthal & Burchum, 2021). A suggestion would be to consider transdermal EPT, as this route is preferred with patients with hypertension and overall increased cardiovascular or thromboembolic risk (Holloway, 2018). Overall, whether it be EPT or alternative options such SSRIs, the patient should be well-informed of all of her options and the risks and benefits of each.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 Discussion References Holloway, D. (2018). Menopause Symptom Management in the United Kingdom. Nursing Clinics of North America, 53(2), 263–277. https://doi.org/10.1016/j.cnur.2018.01.004 Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionRE: Week 9 Initial Discussion PostThank you for your post, it was very informative and very interesting. In the study, women who used estrogen-only HRT in the first five years after they began menopause had a 43% higher risk of breast cancer than women who never used HRT. The extra risk dropped to 5% (which was not statistically significant) for women who began estrogen-only HRT therapy more than five years after the start of menopause. The additional risk was higher among women who received combination HRT: 104% for women within five years of menopause and 53% who started more than five years after menopause. . Some women can safely use MHT after cancer treatment but not those with hormone receptor-positive breast cancer, estrogen-dependent gynecological cancers, or a history of venous thromboembolic disease, (Szabo et al., 2021). Low-level evidence suggests that local (vaginal) estrogens are effective in dealing with symptoms of vaginal dryness in menopausal women. These drugs are generally not regulated by the therapeutic goods, drug, or equivalent administrations so manufacturing quality and dosage cannot be ensured, (Szabo et al., 2021). As part of a low dose hormonal treatment program, I would prescribe her Estradiol vaginal cream at a dose of  0.5 gram once a day.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 Discussion ReferencesRosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier. Szabo, R. A., Marino, J. L., & Hickey, M. (2019). Managing menopausal symptoms after cancer. Climacteric : The Journal of the International Menopause Society, 22(6), 572–578. https://doi.org/10.1080/13697137.2019.1646718Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionStill, C. H., Tahir, S., Yarandi, H. N., Hassan, M., & Gary, F. A. (2020). Association of Psychosocial Symptoms, Blood Pressure, and Menopausal Status in African-American Women. Western Journal of Nursing Research, 42(10), 784–794. https://doi.org/10.1177/0193945919898477Initial PostScenario“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 she 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 1 month ago.”Clinical ConsiderationsGiven the very limited amount of information provided in the scenario, only an assumption can be made as to the etiology of the patient’s symptoms. An effective treatment plan should not be developed based only on assumptions. Many more very basic questions need to be asked. I would inquire about the patient’s height and BMI, type of “genitourinary symptoms” she is experiencing, complete medication history, exercise level, diet, etc. A brief physical examination would assess for fever, edema, or shortness of breath. A BMP and CBC would further assist in determining cause.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionUsing the limited information provided, I can see the patient is middle-aged and likely obese. Obesity is a major risk in developing and contributing to hypertension (Jiang et al., 2016). Her age tells me she may be in the early stages of menopause. 95% of women enter menopause between 45 and 55 years old (Rosenthal & Burcham, 2018). Also, even though the patient has an established history of HTN, menopause can exacerbate the condition. Women have higher rates of hypertension as they age, and this finding suggests that their sex hormones play a role in the pathogenesis of hypertension (Martins et al., 2001). Heat flushing and night sweats are very common symptoms related to the hormonal changes taking place during menopause.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionPlan of CareHormone Replacement Therapy (HRT) using Progesterone and/or Estrogen is a popular option among menopausal women and often ameliorates hypertension and helps to correct the vaginal dryness and other urinary symptoms, such as frequent UTIs and vaginal infections, that are seen more frequently in menopausal women. Pros and cons will need to be explained to the patient as she does have a family history of breast cancer and HRT can increase her risk of developing cancer herself. Combination HRT of Progesterone and Estrogen increases breast cancer risk by about 75%, even when used for only a short time, whereas Estrogen-only HRT increases the risk of breast cancer, but only when used for more than 10 years (Breastcancer.org, 2021).Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 Discussion            Menopause is transient and non fatal, but uncontrolled hypertension can have disastrous long-term outcomes. As such, it is my primary concern. I would offer the patient education on diet and exercise and the critical role both play in controlling hypertension. If the patient is willing to try lifestyle modification to address her hypertension, I would reassess her response once she has been established on an exercise and diet routine for several weeks, without a medication change initially. In the absence of a lifestyle change, I would add an ACE or an ARB to her antihypertensive medication regimen. Adding an ACE inhibitor or an ARB to a patient established on a CCB provides greater clinical benefit to cardiovascular outcome than monotherapy (Chi & Tai, 2015).Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionReferencesBreastcancer.org (2021). Using HRT (hormone replacement therapy). Breastcancer.org. https://www.breastcancer.org/risk/factors/hrtChi, C., & Tai, C. (2015). Whether ace inhibitor/ARB combined with CCB is superior to other combinations: Journal of Hypertension. LWW. https://journals.lww.com/jhypertension/Abstract/2015/06001/2A_04__WHETHER_ACE_INHIBITOR_ARB_COMBINED_WITH_CCB.52.aspxJiang, S. Z., Lu, W., Zong, X. F., Ruan, H. Y., & Liu, Y. (2016). Obesity and             hypertension. Experimental and therapeutic medicine, 12(4), 2395–2399.             https://doi.org/10.3892/etm.2016.3667Martins, D., Nelson, K., Pan, D., Tareen, N., & Norris, K. (2001). The effect of gender on age-            related blood pressure changes and the prevalence of isolated systolic hypertension   among older adults: Journal of Gender Specific Medicine. 2001; 4: 10–13, 20.Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice       nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionRE: Initial PostThanks for your informative post. Yes, I agree with you that the patient’s benefits and risks should be mentioned, since she does have a family history of breast cancer and HRT may raise her chance of getting cancer. When prescribing HRT, the practitioner should explain the most recent research and make an evaluation of the patient’s possible benefit and risk. Due to the known risk of endometrial cancer associated with estrogen-only formulations, the US Food and Drug Administration (FDA) currently recommends the use of estrogen-plus-progesterone HRT for the management of menopausal symptoms in women with an intact uterus, at the lowest effective dose for the shortest duration necessary to alleviate symptoms. At the moment, there are no specific recommendations for the use of HRT in high-risk breast cancer women (ie, women with a family history of breast cancer, a personal history of breast cancer, or benign breast disease)Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 Discussion. Only a few research have examined the impact of HRT after a breast cancer diagnosis. The biggest of these studies, HABITS (Hormonal Replacement Therapy After Breast Cancer—Is It Safe?), was prematurely discontinued due to unsatisfactory rates of breast cancer recurrence and contralateral illness after two years of HRT usage. Another randomized clinical study found no increase in the incidence of breast cancer recurrences in women who were followed for a median of 4.1 years. Intermittent use of progesterone-containing HRT was preferred to continuous exposure. Combination estrogen-progesterone formulations are contraindicated in women with a history of invasive illness, ductal or lobular carcinoma in situ, or a significant family history of breast cancer. When presented with a patient experiencing severe menopausal symptoms, this guideline presents a substantial issue (Chalasani, 2021).Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionTypically, gabapentin is used to treat epilepsy or persistent nerve pain. Additionally, it alleviates menopausal hot flushes. Gabapentin has been demonstrated to be equally effective as estrogen in reducing the severity and frequency of hot flushes when used in larger dosages. The National Cancer Institute of the United States of America supported the research (Public Health Service grant U10 CA37420). Pfizer, Inc. supplied the medicine and the placebo. The National Cancer Institute examined and approved the research. The results of the randomized, double-blind, placebo-controlled trial corroborate their pilot study of menopausal women, in which gabapentin 900 mg/day resulted in a 46% reduction in the hot-flash severity score, compared to a 54% reduction with placebo in postmenopausal women treated with gabapentin 900 mg/day for 12 weeks. They evaluated their data in two distinct methods, and in both cases, gabapentin 900 mg/day had a substantial impact on hot flashes, but gabapentin 300 mg/day was no better than placebo in either comparison. A dosage of gabapentin that is even greater may be more beneficial (Pandya et al., 2005).Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionReferencesChalasani, P.  (2021). Breast Cancerhttps://emedicine.medscape.com/article/1947145-overview#a6Pandya, K., Morrow, G., Roscoe, J., and Hickok, J. (2005). Gabapentin for hot flashes in 420 women with breast cancer: a randomized double-blind placebo-controlled trialhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1627210/ doi: 10.1016/S0140-6736(05)67215-7Response 1            Thanks for the additional information regarding alternative treatment in addressing the signs and symptoms of menopause, particularly “hot flashes.” My question strays a bit from topic, but I’d like your opinion on the off-label use of Gabapentin and any experience you have had in administering the drug.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionPsychiatry is my specialty and I’ve seen Gabapentin liberally prescribed for everything from anxiety to skin conditions. It is FDA approved for only two conditions: 1) postherpetic neuralgia in adults, and 2) Adjunctive therapy in the treatment of partial onset seizures (Food and Drug Administration, 2019). It seems to be used in psychiatry as a panacea drug to create an idea for the unknowing patient that an illness is being addressed…if only, in reality, for a placebo effect and response. In my own experience, I have seen good efficacy with Gabapentin, when prescribed for any illness, at a level of likely less than 10%. Even more compelling was a 2014 lawsuit when a court ordered Pfizer to pay $325 million to settle claims it marketed off-label uses of its epilepsy drug Neurontin. The decision ended a decade-old class-action lawsuit alleging Pfizer unit Warner-Lambert promoted Neurontin (gabapentin) for treatment of migraine headaches, depression and as a painkiller (Drug Industry Daily, 2014). None of those uses were approved by the FDA.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionWhat has your own experience been with the drug?ReferencesDrug Industry Daily. (2014). Judge approves Pfizer’s $325 million settlement of Neurontin off-label use lawsuit. FDAnews RSS. https://www.fdanews.com/articles/168559-judge-approves-pfizers-325-million-settlement-of-neurontin-off-label-use-lawsuit#:~:text=Judge%20Approves%20Pfizer’s%20%24325%20Million%20Settlement%20of%20Neurontin%20Off%2DLabel%20Use%20Lawsuit,-November%2017%2C%202014&text=A%20federal%20judge%20has%20finalized,of%20its%20epilepsy%20drug%20Neurontin.Food and Drug Administration. (2019). Serious breathing difficulties with gabapentin and pregabalin. U.S. Food and Drug Administration. https://www.fda.gov/drugs/drug-safety-and-availability/fda-warns-about-serious-breathing-problems-seizure-and-nerve-pain-medicines-gabapentin-neurontin#:~:text=Gabapentinoids%20are%20FDA%2Dapproved%20to,was%20first%20approved%20in%202004.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionRE: Initial Post #1Thank you for your post, it was very informative and very interesting. In the study, women who used estrogen-only HRT in the first five years after they began menopause had a 43% higher risk of breast cancer than women who never used HRT. The extra risk dropped to 5% (which was not statistically significant) for women who began estrogen-only HRT therapy more than five years after the start of menopause. The additional risk was higher among women who received combination HRT: 104% for women within five years of menopause and 53% who started more than five years after menopause. . Some women can safely use MHT after cancer treatment but not those with hormone receptor-positive breast cancer, estrogen-dependent gynecological cancers, or a history of venous thromboembolic disease, (Szabo et al., 2021)Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 Discussion. Low-level evidence suggests that local (vaginal) estrogens are effective in dealing with symptoms of vaginal dryness in menopausal women. These drugs are generally not regulated by the therapeutic goods, drug, or equivalent administrations so manufacturing quality and dosage cannot be ensured, (Szabo et al., 2021). As part of a low dose hormonal treatment program, I would prescribe her Estradiol vaginal cream at a dose of  0.5 gram once a day. ReferencesRosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionSzabo, R. A., Marino, J. L., & Hickey, M. (2019). Managing menopausal symptoms after cancer. Climacteric : The Journal of the International Menopause Society, 22(6), 572–578. https://doi.org/10.1080/13697137.2019.1646718 Still, C. H., Tahir, S., Yarandi, H. N., Hassan, M., & Gary, F. A. (2020). Association of Psychosocial Symptoms, Blood Pressure, and Menopausal Status in African-American Women. Western Journal of Nursing Research, 42(10), 784–794. https://doi.org/10.1177/0193945919898477Menopause – Main PostCase StudyThis patient is a 46-year-old female experiencing hot flushing, night sweats, and genitourinary symptoms. This patient is overweight at 230 lbs., history of hypertension, normal pap smears for five years, still has regular monthly menstrual cycles, and a family history of breast cancer. Her current medications are Norvasc 10mg qd and HCTZ 25mg qd. I believe this patient is presenting with menopausal symptoms. This patient’s specific factors, such as obesity, hypertension, and family history of breast cancer must be taken into consideration when developing a treatment regimen.Treatment regimenFirstly, this patient is still hypertensive, so her current HTN medications should be adjusted. Norvasc 10mg is the maximum daily dose (Drugs.com, 2021), so something else will need to be changed. Perhaps, increasing her HCTZ to 50mg qd and also encourage more exercise and proper eating habits would be helpful.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionHormone therapy (HT) is a common treatment for the symptoms of hot flashes, night sweats, and genitourinary syndrome caused by menopause (Rosenthal & Burchum, 2021).  Long-term and short-term therapy is available and there are risks involved.  Oral estrogen can increase the vasoconstrictive action in women with hypertension. “In women with underlying hypertension, a transdermal route of estrogen administration is preferable due to avoidance of first-pass hepatic metabolism, particularly in the presence of comorbidities such as obesity or diabetes” (Kapoor et al., 2021, p. 4). In women under the age of 60 years, HT is appropriate for the short-term use (Kapoor et al., 2021).This patient’s family history of breast cancer should also be taken into consideration. A study by Fagerholm et al. suggests that hormone therapy predisposes patients with a breast cancer history to a more aggressive phenotype of breast cancer or worse prognosis compared to no family history (2018). Again, the risks and benefits are to be discussed between the patient and healthcare provider.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionHormone therapy is used for three indications: treatment of vasomotor symptoms, genitourinary syndrome, and prevention of postmenopausal osteoporosis. “With the first two indications, duration of treatment is relatively short (typically 3 to 4 years), and hence the risk for harm is relatively low” (Rosenthal & Burcham, 2021, p.432). With this patient, I think hormone therapy would be a good option for short-term treatment of her vasomotor and genitourinary symptoms.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionEducation StrategyThis patient would be educated on the importance of a healthy diet and exercise to reduce any cardiovascular risks. The patient should be educated to take hormone therapy oral medications with food to reduce nausea and if there is nausea – it should lesson over time. This patient should continue her regular mammograms, as there is a risk of endometrial and breast cancer. The patient should monitor for persistent vaginal bleeding (Rosenthal & Burcham, 2021). Some symptoms may be embarrassing for a patient to report to their healthcare provider. The patient and healthcare provider should be able to have an open conversation about any symptoms, so that they can be properly treated or addressed.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionReferencesDrugs.com. (2021). Norvasc dosage. Retrieved from https://www.drugs.com/      dosage/norvasc.htmlFagerholm, R., Faltinova, M., Aaltonen, K., Aittomaki, K., Heikkila, P., Halttunen-Nieminen,M., Nevanlinna, H., & Blomqvist, C. (2018). Family history influences the tumor characteristics and prognosis of breast cancers developing during postmenopausal hormone therapy. FAMILIAL CANCER, 17(3), 321–331. https://doi.org/10.1007/s10689-017-0046-2Kapoor, E., Kling, J. M., Lobo, A. S., & Faubion, S. S. (2021). Menopausal hormone therapy inwomen with medical conditions. Best Practice & Research. Clinical Endocrinology & Metabolism, 35(6), 101578. https://doi.org/10.1016/j.beem.2021.101578Rosenthal, L.D. & Burchum, J.R. (2021) Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.RE: Menopause – Main PostIt is important to consider each patient’s risk factors and potential for benefit when determining if HRT is appropriate.  It is also important to determine which products may be best for a patient.  Numerous HRT products, dosage forms, and regimens are on the market (FDA, 2018).  Which of these products is the best?  How might you decide which product is appropriate for any given patient?Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionReference:FDA. (2018).  Menopause- Medicines to Help You.  Retrieved from https://www.fda.gov/forconsumers/byaudience/forwomen/ucm118627.htmRE: Menopause – ReplyOpen communication with your healthcare provider is essential when considering hormone therapy. A complete medical history helps determine which product would be appropriate. There is not one product that stands out from the rest, this treatment is personalized and should be geared towards specific patient symptoms. For example, does the patient still have a uterus? Have they had certain kinds of cancer? Do they have liver disease? Do they have or have had blood clots? (FDA, 2019).  Multiple products from oral medications to transdermal patches to sprays are available in different doses. Generally, the lowest dose is prescribed first and the patient will be monitored for it’s effectiveness.ReferencesFDA. (2019). Menopause & Hormones. Common questions. Retrieved fromhttps://www.fda.gov/media/130242/downloadWomen’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionRE: Menopause – Main PostI enjoyed reading your post Meghan. According to Mattina, M.D (2017), menopause itself put women at risk for hypertension. Nitric Oxide relies heavily on estrogen to help arteries stay dilated, decreasing the work of the heart. This loss of estrogen, in turn causes arteries to naturally constrict which may cause hypertension in women who have never had an issue before or increase the blood pressure in women who are already suffering from hypertension. I agree with you that while supplemental estrogen may help, the safer option for this particular patient may be increasing her antihypertensives. Additionally, often times symptoms of high blood pressure, such as palpitations and hot flashes, are blamed on menopause when those symptoms are actually associated with hypertension (Preidt, 2021). The patient should be educated that those two symptoms could be hypertension that is critically high as well and should she experience other symptoms, such as headache and chest pain, she needs to follow up with a provider. Thank you for your post.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 Discussion Mattina, D. (n.d.). 3 reasons menopause changes your blood pressure. Henry Ford LiveWell. Retrieved February 5, 2022, from https://www.henryford.com/blog/2017/03/3-reasons-menopause-changes-blood-pressurePreidt, R. (2021, December 5). High blood pressure often mistaken for menopausal symptoms in women. HealthDay. Retrieved February 5, 2022, from https://consumer.healthday.com/b-1-27-high-blood-pressure-often-mistaken-for-menopausal-symptoms-in-women-2650129065.htmlWomen’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionRE: Menopause – Main PostResponse 2Hello , thank you for the great post. I agree with you saying that the patient needs to give exercising and a healthy diet more emphasis as due to the various body changes, the body needs to be revived and this can be achieved through taking part in physical activities. Both men and women are found to take part in activities that expose them to greater disease burden like of the cardiovascular. These could come from smoking, one’s age, obesity (like our patient), poor diet and depression, most of which are inevitable for a patient experiencing cancer. Physical activity as a therapy can help reduce risks to certain diseases. However women are reported to exercise less often than men, though it varies according to age groups (Mayra Buvinić, André Medici, Elisa Fernández, 2006).Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionWe understand that the patient being in her 40s is undergoing perimenopause leading to her last menstrual days as the body tends to lessen on the production of hormones needed for the menstrual cycle. However, we are aware that sudden symptoms of menopause come as a result of cancer treatments and where it persists, the patient is advised to seek medical assistance and maybe have their medication changed (ASCO, 2020).ReferencesASCO. (2020). Menopausal Symptoms Due to Cancer Treatment Cancer. https://www.cancer.net/coping-with-cancer/physical-emotional-and-social-effects-cancer/managing-physical-side-effects/menopausal-symptoms-due-cancer-treatmentWomen’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionMayra Buvinić, André Medici, Elisa Fernández, and A. C. T. (2006). Gender Differentials in Health – Disease Control Priorities in Developing Countries – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK11729/RE: Discussion – Week 9Brief description and identification of the disorder In my case, a forty-six-year-old woman presents herself in the hospital facility with multiple healthcare issues. The patient informed the healthcare personnel that she is experiencing genitourinary symptoms and signs, night sweats, and hot flushing; based on the symptoms, women between the age of forty-five and fifty-five present symptoms that are menopausal. Based on the patient’s age, it is clear that she is facing the first signs of menopause. For instance, the symptoms of night sweats and hot flashes are common among women experiencing menopause and thus are vasomotor signs of menopause. Based on various medical research, vasomotor symptoms affect more than eighty percent of women experiencing menopause. The 46-year-old woman also has genitourinary symptoms associated with urinary and vaginal dryness. Genitourinary cases among menopause women reduce the level of estrogen level, which increases the vulnerability to vaginal infections, urinary tract infections, dryness, and urinary frequencies.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionThe patients with menopausal symptoms present themselves to hospitals since they prevent them from normally handling their daily activities. Therefore, the patient should access hormone therapy (HT) interventions to cope with the situation (Spratt, Dess, Zumsteg, Lin, Tran, Morgan & Feng, 2018). Women who access HT interventions early enough can improve their quality of life by reducing symptoms such as genitourinary and vasomotor symptoms. However, patients should understand that they are various risks associated with HT. For instance, the therapy is not administered to patients with cancer and heart disease cases. Therefore, the HT intervention is not recommended for the patient since she has a case of breast cancer.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionType of treatment regimen Based on the patient’s medical history, the HT medical intervention is not appropriate for the patient due to the case of breast cancer. The alternative options for the treatment are SNRIs or SSRIs since it has shown positive outcomes for patients with menopause, particularly in relieving vasomotor symptoms. However, various medical researchers have noted that the medication has not been effective. In my case, I would use escitalopram to reduce the effects of vasomotor symptoms (Strawn, Mills, Schroeder, Mossman, Varney, Ramsey & DelBello, 2020). Additionally, I will treat genitourinary symptoms using topical estrogen. SSRI is the best choice for the first intervention since it will reduce vasomotor symptoms by sixty percent. The rationale for using topical estrogen is that it enables the blood estrogen of the patient to remain low throughout the medication process. The other reason is that it is more effective than oral medication.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionEducation strategy The first strategy will be to develop a strategy to ensure the patients remain in adherence to the medication prescriptions. The education strategy will promote the quality of health since the patient will be able to escape advanced side effects that occur when a patient skips or use excess drugs against the doctor’s prescriptions. The other strategy is to provide a written document to the patient concerning the side effects and non-medical measures to reduce the effect of the medicine side effect. The use of escitalopram causes many side effects such as nausea, insomnia, headache, drowsiness, and diarrhea (Zhu, Chung, Dobson, Pandeya, Brunner, Kuh & Mishra, 2020). For instance, in the case of diarrhea and headache, I would advise the patient to take a lot of water regularly. The education programs will also consider the application of software to track menopause. For instance, I will teach the patient to use Caria, software that will enable her to track various menopause symptoms.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionReferencesSpratt, D. E., Dess, R. T., Zumsteg, Z. S., Lin, D. W., Tran, P. T., Morgan, T. M., … & Feng, F. Y. (2018). A systematic review and framework for the use of hormone therapy with salvage radiation therapy for recurrent prostate cancer. European urology, 73(2), 156-165.Strawn, J. R., Mills, J. A., Schroeder, H., Mossman, S. A., Varney, S. T., Ramsey, L. B., … & DelBello, M. P. (2020). Escitalopram in adolescents with generalized anxiety disorder: a double-blind, randomized, placebo-controlled study. The Journal of Clinical Psychiatry, 81(5), 0-0.Zhu, D., Chung, H. F., Dobson, A. J., Pandeya, N., Brunner, E. J., Kuh, D., … & Mishra, G. D. (2020). Type of menopause, age of menopause and variations in the risk of incident cardiovascular disease: pooled analysis of individual data from 10 international studies. Human Reproduction, 35(8), 1933-1943. Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionReply Post 1Your post is very well written, and I like your treatment plan. In addition to the SSRI you recommended, an SNRI is an option.  Desvenlafaxine (Pristiq) is a SNRI that can significantly reduce the frequency and severity of hot flashes (Rosenthal & Burchum, 2021). These options are for women defined to be at too high risk for hormone therapy.Transdermal estradiol has been associated with many advantages: improved blood pressures, lower myocardial infarction rates, and lower rates of overall cardiovascular diseases (L’Hermite, 2017). Furthermore, “the total dose of estrogen is greatly reduced (because the liver is bypassed)” (Rosenthal & Burchum, 2021, p.428). L’Hermite, M. (2017). Bioidentical menopausal hormone therapy: registered hormones (non-oralestradiol ± progesterone) are optimal. Climacteric : The Journal of the International Menopause Society, 20(4), 331–338. https://doi.org/10.1080/13697137.2017.1291607Rosenthal, L.D. & Burchum, J.R. (2021) Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionRE: Discussion – Week 9Week 10 Response # 2Thank you for your post! I appreciate how you brought up the use of technology to track menopausal symptoms. This would help the patient see if the pharmacological and nonpharmacological approaches are effective. That will help the patient take an active role in her healthcare and will help her stay motivated and well informed.The other interesting fact that I learned this week is the effects of several vitamins in reducing menopausal symptoms. Although there are effective pharmaceutical options to reduce hot flushes, as APRNs we should be aware of more natural means to control those bothersome symptoms. One study showed a significant decline in the frequency of hot flushes after a short time of Vitamin E supplementation (Ziaei et al., 2007).Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionVitamin E can be found in many foods including seeds, nuts, and soybean. Please know that while vitamin E has a positive influence on several biological functions in the human body, too much of it can increase the risk of bleeding, so we should be always assessed if the patient has any other bleeding risk factors (Ziaei et al., 2007).Vitamin B12 is believed to not only increase levels of energy in menopausal women, but at the same time, it decreases the occurrence of hot flushes (Milart et al., 2018). Folic acid is particularly important as it is found to effectively decrease the frequency, duration, and severity of hot flushes (Bani, 2013).While Vitamin C is not as effective in reducing bothersome symptoms, higher levels of it are associated with bone health due to its properties in reducing bone turnover to loss ratio (Milart et al., 2018).Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionReferencesBani, S. (2013). The Effect of Folic Acid on Menopausal Hot Flashes: A Randomized Clinical Trial. Journal of Caring Sciences, 2(2), 131-140. doi: 10.5681/jcs.2013.016Milart, P., Woźniakowska, E., & Wrona, W. (2018). Selected vitamins and quality of life in menopausal women. Przeglad menopauzalny = Menopause review, 17(4), 175–179. https://doi.org/10.5114/pm.2018.81742Ziaei, S., Kazemnejad, A., & Zareai, M. (2007). The effect of vitamin E on hot flashes in menopausal women. Gynecologic and obstetric investigation, 64(4), 204–207. https://doi.org/10.1159/000106491Case Study on Women’s Health     The patient in our case study is a 46-year-old obese woman complaining of hot flushes, night sweats, and genitourinary symptoms for a month before the annual GYN visit. The patient has a family history of breast cancer and has been up to date on yearly mammograms. The patient had a history of ASCUS five years ago, and Pap smears have been normal. She has a regular menstrual period, and LMP was a month ago. She has a history of Hypertension which she is regularly taking Norvasc 10mg daily and HCTZ 25mg daily. Today’s BP is 150/90.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 Discussion     With the symptoms presented, we assume the patient has Urinary Tract Infection (UTI). Since the patient is coming in for an annual GYN visit, we would still do the regular test like the IEs, Pap smear, and Breast Examination. Before initiating any kind of treatment, we would take samples for culture to determine the identity and sensitivity of the infecting organism to optimize antibiotic therapy, Rosenthal & Burchum, 2021, p.655. We would do lab work like Urine Analysis and Culture & Sensitivity, CBC, BMP, Lactic acid, and Blood Culture. We would include swabs for STDs not to miss out on any infection-causing PIDs even though the patient is middle-aged and not typical for this age group. A diagnostic procedure can also be done, such as CT Abdomen and Pelvis, which can reveal if there is any pyelonephritis since the patient has been having genitourinary symptoms for a month.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 Discussion      We would recommend starting an antibiotic for UTI. According to Rosenthal & Burchum, 2021, p.655, in severe infections, we can initiate empiric therapy before identifying the organism based on the clinical evaluation and knowledge of which microbes are most likely to cause infection at a particular site (Rosenthal & Burchum, 2021,p. 656). The treatment goal is to prevent the spread of infection into the kidneys or develop into upper tract disease/pyelonephritis, which can cause the destruction of the delicate structures in the nephrons and lead to hypertension (Bono et al., 2021). UTIs and pyelonephritis are usually caused by gram-negative bacilli like E. coli (Rosenthal & Burchum, 2021,p.656). Ceftriaxone, a broad-spectrum cephalosporin, is active against gram-negative uropathogens can be started (Sanders, 1991). Once we get the results from cultures, we can switch to a more selective antibiotic, Rosenthal & Burchum, 2021, p.658. It achieves very high urine and relative tissue levels following single daily doses (Sanders, 1991). Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 Discussion       A strategy in patient education to manage their health needs is by involving them in the process of care (Hammoud et al., 2020). Patient involvement, partnership, and patient-centered care go with patient empowerment, permitting patients to achieve the information and build the needed skills to make decisions and contribute to their care process by educating and encouraging them to participate in all aspects (Hammoud et al., 2020). Patient education would include an instruction to finish the course of treatment and not to discontinue prematurely as it may cause recurrence of infection and increase drug resistance (Rosenthal & Burchum, 2021, p,659)Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 Discussion. Encourage the patient to drink plenty of fluids, stay well hydrated and explain that it flushes the bacteria out of the system. Explain the importance of practicing good personal hygiene and emptying the bladder frequently. Providing them with some flyers or reading materials about UTIs and how to prevent them will likely increase their compliance with treatment.                                                           References Bono, M. J., Reygaert, W. C., & Doerr, C. (2021, June 23). Urinary Tract Infection (Nursing).           Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK568701/Hammoud, S., Amer, F., Lohner, S., & Kocsis, B. (2020). Patient education on infection           control: A systematic review. American Journal of Infection Control, 48(12),           1506–1515. https://doi.org/10.1016/j.ajic.2020.05.039‌Rosenthal, L. D., & Burchum, J.R. (2021). Lehne’s Pharmacotherapeutics for Advanced             Practice Nurse and Physician Assistants. (2nd ed.). Elsivier, Inc.Sanders, W. E. (1991). Urinary Tract Infections. Hospital Practice, 26(sup5), 48–51.              https://doi.org/10.1080/21548331.1991.11707744Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionRE: Case Study on Women’s Healthpersonal health history is an essential aspect of healthcare. It plays a significant role in guiding healthcare practitioners on the most appropriate and effective medication procedures and treatment. Medical history also helps diagnose possible illnesses and understand hereditary and possible diseases in one’s family. A symptom is an indication of a condition apparent to the patient. Symptoms represent the patients, which drives them to health practitioners (Ecin et al., 2020). The symptoms presented by the 46-year-old woman helps in identifying the health problem she is having.Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 DiscussionPatient education plays a crucial role in making informed decisions. Educating the patients about their care and possible treatment options helps them identify the best way to receive their healthcare. Patient education allows patients to have a say in their care and prepare to care for themselves at home (Yeh et al., 2018). Your recommendation on a treatment regimen is also crucial in helping the patient recover and improve her health condition.ReferencesEcin, S. M., Sandal, A., Koyuncu, A., & Öz, Ş. G. (2020). Importance of The Medical History in The Diagnosis of Hypersensitivity Pneumonitis: A Case Report. Acta Medica, 51(3), 50-56.DOI: 10.32552/0.ActaMedica.438Yeh, M. Y., Wu, S. C., & Tung, T. H. (2018). The relation between patient education, patient empowerment and patient satisfaction: A cross-sectional-comparison study. Applied Nursing Research, 39, 11-17.DOI: 10.1016/j.apnr.2017.10.008. Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521 Week 9 Discussion

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