NURS 6551 – Primary Care of Women Assignment Essay

NURS 6551 – Primary Care of Women Assignment Essay

NURS 6551 – Primary Care of Women Assignment Essay

NURS 6551 Final Exam: Primary Care of Women: Walden University

• What has changed in terms of recommended antibiotic treatment for uncomplicated lower UTIs?

a. Seven-day regimens are now recommended.

b. Three times a day of oral antibiotics are now recommended.

c. Three-day regimens are now recommended.

d. A single dose is now recommended.

• What is considered to be a common trigger of psoriasis?

a. Stress b. Pregnancy c. Migraines d. Menstruation

• The clinician is seeing a 48-year-old woman for the first time. She is overweight and has a blood pressure of 120/92. She is on no medications and does not smoke or drink alcohol. Her family history is negative for heart disease. Her physical exam is unremarkable. The clinician should advise her as follows:
  

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a. Her blood pressure is high normal and does not require further follow-up at this time. NURS 6551 – Primary Care of Women Assignment Essay.

b. She has prehypertension.

c. She has stage 1 hypertension.

d. She needs two additional blood pressure checks on two separate occasions.

• What tends to cause acne in adolescence?

a. A decrease in estrogen b. Dietary changes c. Hormonal birth control use d. An increase in testosterone

• The onset of labor is indicated by regular uterine contractions and:

a. Complete dilation of the cervix b. Change in the position of the fetus c. Rupture of the membranes d. Progressive cervical change

• The onset of labor is indicated by regular uterine contractions and:

a. Complete dilation of the cervix

b. Change in the position of the fetus

c. Rupture of the membranes

d. Progressive cervical change

• Which of the following statements does not support the diagnosis of Alzheimer’s disease?

a. Crying every day

b. Forgetting where she puts things

c. Getting lost driving to the grocery store

d. Lost ability to balance a checkbook. NURS 6551 – Primary Care of Women Assignment Essay.

• A 23-year-old woman is seeing the clinician because of chronic headaches. These headaches are typically preceded by seeing flashing lights. These visual distortions spontaneously resolve followed by throbbing pain on either the right or left side of her head. Pain is associated with photophobia, nausea, and vomiting. The most likely diagnosis is:

a. Cluster headache b. Migraine headache c. Temporal arteritis d. Transient ischemic attacks (TIAs)

• When is round ligament pain most likely to occur in pregnant women?

a. Between 6–8 weeks’ gestation b. Between 24–28 weeks’ gestation c. Between 10–12 weeks’ gestation d. Between 16–20 weeks’ gestation

• Postpartum depression occurs in about what percentage of women who give birth?

a. 5–10% b. 25–30% c. 10–15% d. 1–5%

• About how many breastfeeding women are affected by lactation mastitis?

a. 10% b. 20% c. 15% d. 25%

• What is the most typical schedule of prenatal care in the first 28 weeks of pregnancy?

a. Visits scheduled every 2 weeks b. Visits scheduled every 3 weeks 3. Visits scheduled every week 4. Visits scheduled every 4 weeks

• About what percentage of pregnant women develop gestational hypertension, preeclampsia, or pregnancy-induced hypertensive disorder? NURS 6551 – Primary Care of Women Assignment Essay

a. 5–7% b. 10–12% c. 1–3% d. 12–15

• What is the term for a postpartum disorder in which bacteria ascend from the lower genital tract and infect the uterus?

a. Postpartum amenorrhea b. Postpartum endometritis c. Postpartum staphylococcus d. Postpartum lochia

• How does women’s anatomy make them more susceptible to UTIs?

a. Asymptomatic UTIs do not resolve themselves without treatment. b . Women tend to get UTIs when they are pregnant. c. There is a longer distance between the urethra and anus. d. Their urethras are shorter.

• A 60-year-old woman has a blood pressure of 144/86. This would be classified as:

a. Normal blood pressure b. Prehypertensive c. Stage 1 hypertension (per course hero) d. Stage 2 hypertension

• After how many weeks’ gestation is a pregnancy loss considered a fetal death or stillbirth?

a. 18 weeks b. 30 weeks c. 20 weeks d. 24 weeks

• What can be used as a space-filling device, replacing normal pressure on the vaginal walls when levator ani support is unreliable?

a. Diaphragms b. Tampons c. Kegels d. Sacral nerve stimulators

• All of the following symptoms are associated with chest pain and representative of coronary artery disease except:

a. Diaphoresis b. Jaw pain c. Pain with inspiration d. Shortness of breath

• Screening for hyperlipidemia is recommended to begin at what age for women with no risk factors

a. 35

b. 40

c. 45

d. 50

• What is the potential danger of a fetus born through meconium-stained amniotic fluid?

a. The infant will not be able to relax its anal sphincter. b. The infant can breathe meconium into the lungs. c. The infant can get meconium caught in the esophagus. d. The infant will be born with jaundice.

• What does rosacea describe?

a. Adult acne b. Nail fungus c. Swelling of the joints d. Pruritis

• Any woman with a complicated cystitis or symptoms of upper tract disease needs a urine culture and:

a. Sensitivity test b. Blood culture c. Urine dipstick d. Parenteral culture

• What is the definition of a primary headache?

a. A headache that occurs only before and during menstruation b. A headache is caused by a preexisting condition c. A headache that is not a symptom of, or caused by, another condition d. A headache that is characterized by muscle tension

• What is the leading cause of first-trimester maternal death? NURS 6551 – Primary Care of Women Assignment Essay

a. Ectopic pregnancy b. Complications from prior gynecologic surgeries c. Abortion d. Complications from unresolved STIs

• When considering a diagnosis of Alzheimer’s disease, the clinician should:

a. Interview her with a family member or close friend

b. Interview her separately (alone) then with a family member or close friend

c. Obtain the history from a family member or close friend

d. Rely on client observation without obtaining a history

• What is the most common cause of death in women in the United States?

a. Breast cancer b. Cardiovascular disease c. Cervical cancer d. Lung cancer What percentage of pregnant women in developed countries have iron-deficiency anemia? a. 20% b. 10% c. 15% d. 5%

• How does the third stage of labor end?

a. With the birth of the baby b. With the delivery of the placenta c. With the clamping of the umbilical cord d. With the complete dilation of the cervix

• What is a possible cause of abdominal pain during pregnancy?

a. Round ligament pain b. Diabetes c. Anemia d. Cytomegalovirus

• Type 2 diabetes includes insulin resistance and affects what percentage of those who have diabetes?

a. 75–80%

b. 65–70%

c. 55–60%

d. 90–95%

• The primary endocrine disorders affecting women are diabetes mellitus and:

a. Psoriatic arthritis b. Thyroid conditions c. Melanoma d. Polydipsia

• When can relief from pregnancy induces nausea and vomiting be expected?

a. 6–8 weeks’ gestation b. 12–14 weeks’ gestation c. 20–22 weeks’ gestation d. after 24 weeks’ gestation

• What is the term for the craving and purposeful consumption of nonfood items for more than one month? NURS 6551 – Primary Care of Women Assignment Essay

a. Anemia b. Toxemia c. Pica d. Torsion

• What significantly increases the risk of hypertension in women?

a. The onset of menopause b. Hormonal replacement therapy c. Depression d. Atherosclerosis

• Carbohydrate intolerance and increased insulin resistance first recognized in pregnancy is known as:

a. Overt diabetes b. Gestational diabetes c. Carbohydrate overload d. Iron-deficiency anemia

• A chronic skin disorder that is thought to be caused by an abnormal immune reaction in the skin is atopic dermatitis or:

a. Rosacea

b. Psoriasis

c. Cellulitis

d. Eczema

• What is a potential benefit of circumcision?

a. Decreased incidence of urinary tract infections b. Prevention of prostate cancer c. Increased immunity against herpes simplex virus d. Prevention of transmission of sexually transmitted bacteria

• Without treatment shortly after birth, as many as 90 percent of infants born to hepatitis B–infected mothers will:

a. Develop HIV b. Have cognitive difficulties c. Need blood transfusions d. Become infected

• Fever associated with pyelonephritis will usually resolve within how many hours of treatment with antibiotics?

a. 24 hours

b. 12 hours

c. 72 hours

d. 80 hours

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• What is more likely to occur in women with female genital cutting?

a. Low birth-weight babies b. Birth-related complications c. Miscarriages d. Premature births

• What is the general goal of surgical treatment for stress UI?

a. To increase the capacity of the bladder b. To increase pressure on the vaginal walls c. To support and strengthen the levator ani d. To support and stabilize the urethra

• The clinician is ordering a lipid panel for a 50-year-old woman. The following advice should be given:

a. Eat a normal breakfast the morning of the blood draw b. Fast for 12 hours prior to the blood draw c. No dietary changes d. Eat a low-fat breakfast the morning of the blood draw

• All except which of the following are important historical questions for a 29-year-old woman in clinic for right-sided weakness?

a. Use of oral combined hormonal contraceptives b. Recent childbirth c. History of recent deep venous thrombosis d. History of pelvic inflammatory disease

• What is the initial symptom of Lyme disease, seen in approximately 70 to 80 percent of people infected with the bacterium?

a. Red facial patches b. A circular red rash c. Rough bumps on the skin d. Shortness of breath

• According to the CDC, what percentage of pregnant women continues to drink alcohol during their pregnancies?

a. 10%

b. 20%

c. 25%

d. 30%

• What is a contributor to the increased incidence of heartburn during pregnancy?

a. The increased incidence of hypertension during pregnancy b. The dilation of veins in the esophagus, due to increased blood flow c. The increased levels of magnesium and calcium in the blood d. The pregnancy hormone relaxin, which softens the lower esophageal sphincter

• Gender differences in heart disease can be found in:

a. Diagnosis b. Treatment c. Identification of symptoms d. All of the above

• What is the recommended amount of Kegel contractions per day for women whose pelvic muscles are weak?

a. 10 b. 50 c. 30 d. 7. NURS 6551 – Primary Care of Women Assignment Essay

• What is a common cause of leg cramps during pregnancy?

a. An imbalance of calcium and magnesium b. Dehydration c. An inability to sleep d. Poor nutrition

• What is the most common cause of medical complications in pregnancy?

a. Hypertension b. Gestational diabetes c. Hepatitis d. Anemia

• Which of the following is a predictor of impending preterm birth?

a. Positive fetal fibronectin testing b. Cervical length less than 15 mm c. Meconium-stained amniotic fluid d. Cord prolapse

• What is significant about cytomegalovirus (CMV)?

a. It cannot be transmitted by person-to-person contact. b. It can remain dormant within the body for life. c. It is the most dangerous virus that can be transmitted to a fetus. d. It is experienced by about 25 percent of childbearing-age women before pregnancy.

• A 30-year-old woman comes to clinic concerned about a headache that feels like a “rubber band squeezing her head,” which occurs nearly daily. It lasts several hours and is not associated with nausea or vomiting. She has no family history of migraine headaches. Her physical exam is within normal limits. The most likely diagnosis is Tension Headaches What is the percentage of all unintended pregnancies in the United States?

a. 5% b. 15% c. 25% d. 50%

• How often does breech presentation occur in singleton pregnancies?

a. 1–2%

b. 3–4%

c. 6–7%

d. 10–11%

• How are pregnancy-related DHA (docosahexaenoic acid) needs best met?

a. By consuming 2 servings of fatty low-mercury-content fish per week b. By taking a prenatal vitamin supplement c. By consuming 2 to 4 servings of fruit daily d. By consuming 3 to 4 servings of dairy products daily

• What should be considered in order to interpret the Mini-Mental State exam when considering the diagnosis of Alzheimer’s disease?

a. Education b. Family history of Alzheimer’s disease c. Medications that include estrogen d. Past history of concussion

• About how many infants born to mothers colonized with Group B streptococcus will become colonized as well?

a. 40% b. 25% c. 10% d. 50%

• What is an indication of the second stage of labor?

a. Complete dilation of the cervix b. Rupture of the membranes c. Emergence of the infant’s head d. Presence of bloody show

• Approximately how many reproductive-age women in the United States meet the BMI criteria for obesity? NURS 6551 – Primary Care of Women Assignment Essay

a. 1 in 5 b. 1 in 10 c. 1 in 4 d. 1 in 7

• What should be addressed during late postpartum maternal evaluation (weeks 2–6)?

a. The healing of the mother b. The need for birth control information or supplies c. The birth plan of the mother d. The latching-on response of the infant

• What is important to consider when vaginal bleeding occurs during the first trimester?

a. Uterine size b. Ectopic pregnancy c. Viral infection d. HIV

• Optimal weight gain during pregnancy is based on the woman’s prepregnant BMI and:

a. Age b. Height c. Nutritional assessment d. Caloric intake

• What is the most common disorder leading to hyperthyroidism?

a. Parkinson’s disease b. Graves’ disease c. Multiple sclerosis d. Epilepsy A 72-year-old woman is presenting with chest pain.

• Which of the following statements best differentiates chest pain due to angina versus myocardial infarction?

a. Angina pain is frequently relieved by nitroglycerin. b. Angina pain is more substernal and does not radiate to other areas. c. Myocardial pain with an infarction is always associated with fatigue. d. Myocardial pain with an infarction is more severe.

• At what time during pregnancy does nausea typically occur?

a. At 3–6 weeks’ gestation b. At 6–8 weeks’ gestation c. At 12–15 weeks’ gestation d. At 1–3 weeks’ gestation

• What step can a clinician take to learn more about any chemicals used in a woman’s workplace?

a. Contact OSHA (Occupational Health and Safety Administration). b. Contact the woman’s workplace. c. Ask the woman to obtain her workplace MSDs (material safety data sheets). d. Conduct research on the OSHA website.

• Where does edema tend to occur in the pregnant woman’s body?

a. Hands b. Face c. Feet d. Abdomen

• What is the term for stimulation of the uterus by an external agent to enhance uterine contractions after labor has started?

a. Exteriorization b. Induction c. Augmentation d. Presentation

• Uncomplicated acute bacterial cystitis occurs in women who:

a. Are pregnant b. Have no signs of upper tract infection c. Have a high fever d. Have had recent antibiotics

• Chest pain associated with irritation of the myocardial nerve fibers (such as with angina pectoris or myocardial infarction) is due to an increase in:

a. Blood glucose b. Lactic acid c. Serum magnesium d. Serum potassium

• What was the reason that prenatal care began in the early 1900s?

a. To screen for preeclampsia b. To predict preterm births c. To assess women’s nutritional needs d. To test women for disease

• A common prenatal care model in which women have their first visit with one provider and then subsequent visits in a group setting is called:

a. Holistic Birthing b. Midwifery c. Centering Pregnancy d. Pathology Care

• Which of the following symptoms are suggestive of a cluster headache?

a. Bilateral, aching pain not associated with nausea or vomiting and not aggravated by physical activity

b. Pain in the left temporal area behind the left eye associated with fever and jaw claudication

c. Pulsating pain on the left side of the head associated with nausea, vomiting, and photophobia

d. Thirty-minute episodes of right-sided pain occurring 3–5 times daily associated with rhinorrhea and conjunctival injection.

NURS 6551 – Primary Care of Women Assignment Essay

Assignment:

As an advanced practice nurse, you must remain current on health issues that commonly impact women such as birth control, abortion, family planning, the human papillomavirus (HPV) vaccine, and human immunodeficiency virus (HIV). Many of these women’s health issues are heavily influenced by political, social, and sociocultural factors. These influences might not only affect a woman’s ability or desire to receive care, but also a provider’s ability or willingness to offer care. How might political, social, and sociocultural factors influence your personal perceptions of these women’s health issues?

To prepare for NURS 6551 – Primary Care of Women Assignment Essay:

·        Review this week’s media presentation, as well as Chapter 1 of the Schuiling and Likis text.

·        Select and research one of the following women’s health issues: birth control, abortion, family planning, human papillomavirus (HPV) vaccine, human immunodeficiency virus (HIV) in women, or another issue approved by the course Instructor.

·        Consider the impact of political, social, and sociocultural factors on the women’s health issue you selected.

·        Reflect on how the personal perceptions of providers might influence their ability or willingness to care for women in relation to this issue.

After identifying potential health risks for pregnant patients, providers often recommend behavior changes in lifestyle choices such as drug use, alcohol consumption, dietary habits, and environmental exposures. Even with provider recommendations and patient education programs, some patients still struggle to adhere to recommended lifestyle changes during pregnancy, posing health risks for both the mother and child. In your role as the provider, you must be able to recognize signs of nonadherence to recommended lifestyle changes because not all patients will be forthcoming with the struggles they may be experiencing. Management plans are only successful if patients’ individual needs are recognized and met, so provider-patient collaboration is essential for mitigating nonadherence issues. For this Discussion, consider implications of nonadherence to recommended lifestyle changes and potential management strategies for pregnant patients. NURS 6551 – Primary Care of Women Assignment Essay

To prepare FOR NURS 6551 Week 9 Discussion:

• Review the “During Pregnancy” article in this week’s Learning Resources.
• Think about the health promotion topic that you selected for the Week 8 Discussion (i.e., smoking, drinking, taking drugs, eating habits, and caring for pets).
• With the topic you selected in mind, consider early signs and symptoms that might indicate a patient’s nonadherence to recommended lifestyle changes during pregnancy. Think about the impact of nonadherence on the fetus and the patient.Reflect on treatment and management strategies for patients presenting with signs and symptoms of nonadherence to recommended lifestyle changes.

Post  at least 250 words ( no introduction or conclusion)

•  an explanation of signs and symptoms that might indicate a pregnant patient’s nonadherence to recommended lifestyle changes related to the topic you selected. ( smoking in pregnancy is the topic we did last week)
• Explain the impact of non-adherence to these lifestyle recommendations on the fetus and the patient.
• Then, explain treatment and management strategies for patients presenting with signs and symptoms resulting from their non-adherence.

Post at least 250 words APA format (no introduction or conclusion)

1.     pick on subject from above

2.     explain the political impact of this women’s health issue,

3.     social factors of this women’s health issue

4.     sociocultural factors on this women’s health issue

5.     Explain how personal perceptions of providers might influence their ability or willingness to care for women in relation to this issue.

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

General Patient Information

Age: 41-year-old

Race/Ethnicity: Hispanic American

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

Current Health Status

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

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

Timing/Onset: Patient said one year ago.

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

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

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

Aggravating Factors: Monthly periods as stated by the patient.

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

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

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

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

Sexual Activity Status: Patient reported being sexually active.

Barrier Prevention: Patient stated she uses natural barrier methods.

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

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

Contraception Method: Patient denied using any contraception method.

Patient History

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

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

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

Allergies: Patient reported no known allergies (NKA).

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

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

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

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

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

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Personal/Social History: Patient is married with 2 children, and lives at home with the husband. Patient is a college graduate; works outside the house as a nurse at a nearby hospital. Patient’s husband works for a computer company. Patient family is a middle income family. Also, patient denied any physical or psychological abuse. Patient denied being exposed to any environmental or occupational health hazards. Patient also denied alcohol consumption, tobacco, or recreational drug use. Patient denied participating in any exercise or physical activity because she is tired after work, and prefers to rest. Patient reported that she eats healthy; she eats low fat, low carbohydrate meals, and she eats fruits and vegetable at least 3 to 4 times a week. Patient stated that she sleeps well at night, and she usually goes to bed at 9 pm and wakes up at 6 am. Patient drinks a cup of coffee occasional, especially when she is at work to be awake. NURS 6551 – Primary Care of Women Assignment Essay

Review of System (ROS)

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

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

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

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

Breasts: Patient denied nipple discharge, tenderness or swelling.

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

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

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

Musculoskeletal: RG denied varicosities or extremities problem.

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

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

Hematologic: Patient admitted history of anemia; denied blood transfusion or easily bruise or bleeding.

Physical Examination

General exam: Patient appeared well developed and pleasant with good hygiene. Patient also appeared pale and weak. Vital signs: Blood pressure 118/76, heart rate 80, respiration 18, temperature 98.8, pulse ox 100% on room air. Weight 78.2 kg, height 67 inches, and body mass index (BMI) 27.

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

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

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

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

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

Breast: The size of the breasts, areolas, and nipples are round and symmetrical with no discoloration, rash, lesions, dimpling, or retraction bilaterally; no masses, lumps, or tenderness noted on palpation bilaterally; and axillary lymph nodes non-palpable. NURS 6551 – Primary Care of Women Assignment Essay

Pelvic Examination:

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

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

Cervix: Intact cervix with closed os.

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

Laboratory and Diagnostic Tests

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

Diagnostic:

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

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

Differential Diagnoses

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

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

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

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

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

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

23rd ed. Philadelphia, PA: Lippincott Williams &.Wilkins; 2014presentation, physical findings during examination; and diagnostic results are not synonymous with the signs and symptoms; physical examination finding, risk factors and diagnostic results associated with endometrial hyperplasia (American College of Obstetricians and Gynecologist, 2016).

Management Plan

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

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

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

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

Conclusion Comment by DeAllen B Millender: Level 1 headings are centered, in bold print, and in ‘Title Case’ (Chapter 3, 3.03, pp. 62-63; see Table 3.1 and Figure 2.1). NURS 6551 – Primary Care of Women Assignment Essay.

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