Question

_{^{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.}}

Post 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.

Answer 1

The patient has present compliant of hot flushing, night sweats, genitourinary symptoms. it needs immediate attention. the patient is 46 years old and has a history of hypertension and today BP is 150/90 there is elevated blood pressure. patient LMP is one month back. the patient had ASCUS in pap 5 years back, which causes no problem in the late period. patient present symptoms indicate the patient is in the perimenopausal period. when women menopausal period starts it causes a hot flush, night flush, depression, and high blood pressure and genitourinary changes. the patient needs to manage her symptoms and avoid further complications.
Type of treatment:
Hormone therapy -estrogen therapy avoid the symptoms and avoid the risk of cancer.
Vaginal estrogen avoid the genitourinary problem
A low dose of antidepressants like SSRIs decrease the symptoms and stabilize the mood disorder
Gabapentin reduces night sweats and hoit flush
clonidine treat high blood pressure
Vitamin D and calcium supplements help strengthen the bones.
Patient education:
-advise the patient to wear loose and comfortable clothes
-advice to increase the fluid intake
-advice aerobic activity, weight-bearing and stretching activity
-Take good calcium diet
-Increase fiber intake, eat 5 portions of food ad limit the salt intake
-avoid alcohol, tea, coffee and smoking that trigger the hot flush
-do pelvic floor exercise
-avoid saturate fats and high-calorie diet and take omega 3fatty acids for a healthy heart.
-Have regular screening that helps avoid breast and cervical cancer.

Answer 2

Health care needs of patient:As given in above case study patient is hypertensive,had atypical squamous cells of undetermined significance and history of of breast cancer.so patient requires pharmacological management of hypertension along with lifestyle modification and routine follow ups and checkups .

Treatment regimen :The treatment regimen will include.

. Diagnosis

. Regular monitoring of B.P.

.Discuss patient concerns and clarify misunderstanding.

.Inform patient B.P levels.

.Inform patient about recommend treatment.

.Teach self monitoring skilla.

.include patient in decision making.

.Modify dosage and change the medication as in above case patient is experiencing hot flushes and genitourinary symptoms which are side affects of amlodipine and hydrochlorothiazide used for lowering BP.

I will decrease there frequency of administration from Qid to Bd. Even then if symptoms persist I will substitute them with some other antihypertensive drugs.

.For ASCUS I will recommend:

Repeated cytology

Pap smear yearly

.for family history of breast cancer ...yearly mammography is recommended.

Patient education strategy for health management:

.Assess patient understanding and acceptance of being in care.

. Inform patient about his B.P levels, recommended treatment and it's outcomes.

. Patient motivation for taking medication on time.

. maintain normal weight,reducing extra weight in a healthy way.

.Eat a diet rich in fruits and vegetables ,low in fat.

. reducing salt intake less than 2.5 g.

.30 minutes of exercise daily.

.providing follow-up and reinforcement by telephone or regular visits.