Discussion Question 1
EP is a fifty-year-old woman who reports experiencing two to three hot flashes per day, occasionally associated with insomnia. She also states she is awakened from sleep about two to three times per week, needing to change her bedclothes and linens due to sweating. Her symptoms began about three months ago, and over that time, her symptoms have worsened to the point where they have become very bothersome. She is concerned about starting any hormonal treatment because she has read news stories that the medication is not safe. She has been successfully treated for depression and is currently doing well on paroxetine. Her current medications include omeprazole 20 mg daily, paroxetine 20 mg, Synthroid 0.075 mg daily, and hydrochlorothiazide 25 mg daily. Her physical exam is normal; her blood pressure is 128/86, her pulse is 78, and her body mass index (BMI) is 30.5. Answer the following questions:
â€¢Is there any additional information you would want to collect?
â€¢What are the variables you would take into account before deciding how to help her?
â€¢What treatment will you recommend?
â€¢What nonpharmacological treatment would you suggest?
For medications, include dosages and schedules. Include highlights of patient teaching and/or lifestyle alterations. Support your decisions with at least one reference to a published clinical guideline and one peer-reviewed publication.
Please answer each question specifically.
Is there any additional information you would want to collect?
Evidence-based practice requires that patients are given holistic care considering all the aspects surrounding their wellbeing. Details on EP’s allergies to certain drugs should be obtained to guide the course of any treatment that will be selected. Information should also be obtained on her nutritional status and the level of physical activity so that appropriate plans can be made to educate her on how to maintain healthy life despite her age. Information on the factors that could have aggravated EP’s symptoms should be collected to assist in diagnosis. Sternfeld, Guthrie, Ensrud, LaCroix, Larson, Dunn, & Reed (2014) posit that insomnia, night sweats, mood disturbance, and hot flashes are the first line manifestations of menopause that usually occurs at an average age of 51. Therefore, EP could be experiencing symptoms of menopause. As such, information should be obtained on when she last experienced her menses and the regularity of her menstrual flow. Insomnia and diaphoresis are also common side effects of paroxetine and therefore, she should be asked the duration of persistent of the hot flashes to ascertain menopausal manifestations. Information on current use of over-counter-drugs should also be obtained. Lastly, the cause of her depression should also be identified for appropriate care planning and referrals.
What are the variables you would take into account before deciding how to help her?
The variables for consideration would include EP’s geriatric age, her current polypharmacy, her negative beliefs on hormonal therapies, ability to comply with medications, and her chief complaints. EP is 50 years old, and administration of several drugs concurrently could lead to drug interactions and she might also forget to take some medications or fail to adhere. Her belief in the adverse effects of hormonal therapies would necessitate education on the safe of such treatment options before they are recommended for her recovery. Her health status regarding weight, pulse, and blood pressure should also be considered. Finally, the course of treatment would take into account her chief complaints of night sweats, insomnia, and frequent hot flashes.
What treatment will you recommend?
EP is within the age bracket of women experiencing menopausal signs and symptoms. Therefore, the treatment plan would focus on alleviating the signs and symptoms of menopause she experienced. Despite her concern for starting any hormonal course of treatment, hormonal replacement therapy will be the first treatment choice in alleviating EP’s advanced menopausal symptoms. According to the clinical guidelines by Hauk (2014), vasomotor symptoms of menopause are best managed using systemic hormone therapy and several studies have proved its effectiveness. The chief complaints; hot flashes, diaphoresis, and insomnia are interlinked vasomotor symptoms that could be managed by hormonal therapy. The drug of choice would be 0.45mg/20mg per day bazedoxifene (Duavee) administered orally for four weeks. However, EP should be educated about the menopausal symptoms and given comprehensive information on the benefits and risks of the hormonal therapy.
What non-pharmacological treatment would you suggest?
Cognitive Behavioral Therapy (CBT) will be appropriate in helping EP change her lifestyle to practice regular physical exercises and eat a balanced diet. NICE (2015) opines that CBT alleviates psychological symptoms such as low moods due to menopause. Therefore, CBT could help EP overcome insomnia, eat balanced and healthy diet, and perform daily physical exercises. The CBT should focus on these lifestyle changes that could improve her health.
Hauk, L. (2014). ACOG Releases Clinical Guidelines on Management of Menopausal Symptoms. American family physician, 90(5), 338-340. Retrieved February 25, 2016, from http://www.aafp.org/afp/2014/0901/p338.html
NICE (2015). Menopause: diagnosis and management. Retrieved February 25, 2016, from http://www.nice.org.uk/guidance/ng23/chapter/Recommendations#managing-short-term-menopausal-symptoms
Sternfeld, B., Guthrie, K. A., Ensrud, K. E., LaCroix, A. Z., Larson, J. C., Dunn, A. L., … & Reed, S. D. (2014). Efficacy of exercise for menopausal symptoms: a randomized controlled trial. Menopause (New York, NY), 21(4), 330.