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Posted: July 30th, 2023
Case Study 1 - Students with the first letter of the last name A-K
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.
Resources
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
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Roberts, H., & Hickey, M. (2016). Managing the menopause: An updateLinks to an external site.. Maturitas, 86(2016), 53–58. https://doi.org/10.1016/j.maturitas.2016.01.007
Comprehensive Assessment of a Middle-Aged Female Patient Exhibiting Menopausal Symptoms and Risk Factors for Breast Cancer
Introduction
This case study revolves around a 46-year-old woman with a familial history of breast cancer. As an expert in the field, we will explore the patient's clinical presentation, medical history, and pertinent findings, aiming to provide a comprehensive assessment of her health status. This analysis will be guided by recent scholarly sources, including Lehne's Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants (2021) and Roberts and Hickey's publication "Managing the Menopause: An Update" (2016).
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Clinical Presentation and Medical History
The patient is a 230lb woman with a family history of breast cancer, making her susceptible to the condition due to her genetic predisposition. However, she remains proactive in her health, being up to date on yearly mammograms, which is commendable given her elevated risk. Additionally, she presents a history of hypertension (HTN), a factor that demands careful monitoring and management.
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The patient's primary complaints include hot flushing, night sweats, and genitourinary symptoms, all indicative of menopausal transition. Menopause is a complex physiological process that marks the cessation of menstruation due to the decline in ovarian function, typically occurring between the ages of 45 and 55. As the patient experiences regular monthly menstrual cycles and her last menstrual period (LMP) was one month ago, it is reasonable to infer that she is currently in the perimenopausal phase.
Her gynecological history reveals an atypical squamous cells of undetermined significance (ASCUS) result from her pap smear about five years ago. Nevertheless, her subsequent Pap smears have been normal, a reassuring indication of her overall gynecological health.
The patient is under pharmacotherapy, taking Norvasc (Amlodipine) 10mg once daily, and HCTZ (Hydrochlorothiazide) 25mg once daily for her hypertension management. However, her blood pressure today is elevated at 150/90, warranting a closer examination of her cardiovascular health.
Discussion
The patient's family history of breast cancer necessitates ongoing monitoring and preventive measures. Regular mammograms are crucial for early detection and improved outcomes in individuals with increased breast cancer risk. However, the patient's menopausal symptoms warrant further evaluation to alleviate discomfort and ensure a smooth transition. For this, hormone replacement therapy (HRT) could be considered, but it should be weighed against the potential risks and benefits based on her individual medical history. Roberts and Hickey (2016) discuss the latest insights into managing menopause, highlighting the importance of personalized approaches to treatment.
Furthermore, the patient's HTN requires optimized control to mitigate cardiovascular risks. Pharmacotherapy may need to be adjusted or supplemented with lifestyle modifications, such as dietary changes and exercise, to attain a more desirable blood pressure range. Lehne's Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants (2021) offers a comprehensive resource for medication management in hypertensive patients.
Conclusion
In conclusion, this case study demonstrates the significance of a comprehensive assessment of a middle-aged female patient exhibiting menopausal symptoms and risk factors for breast cancer. Through a thorough analysis of the patient's clinical presentation and medical history, we emphasized the importance of regular mammograms, personalized menopausal management, and optimized control of hypertension. By combining evidence-based practices and the latest research, healthcare providers can effectively address the unique needs of patients in similar clinical scenarios.
References:
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Roberts, H., & Hickey, M. (2016). Managing the menopause: An update. Maturitas, 86(2016), 53–58. https://doi.org/10.1016/j.maturitas.2016.01.007
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