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Assignment: Practicum – Journal Entry
Reflect on a patient who presented with endometriosis, ovarian cysts, or amenorrhea during your Practicum Experience. Describe the patient’s personal and medical history, drug therapy and treatments, and follow-up care. Then, explain how treatment modalities differ for endometriosis, ovarian cysts, and amenorrhea, as well as the implications of these differences when diagnosing and treating patients. If you did not have an opportunity to evaluate a patient with this background during the last five weeks, you may select a related case study from a reputable source or reflect on previous clinical experiences.
Required Readings
- Schuiling, K. D., & Likis, F. E. (2013). Women’s gynecologic health (2nd ed.). Burlington, MA: Jones and Bartlett Publishers.( Course textbook. Pls include in the references).
- Chapter 25, “Normal and Abnormal Uterine Bleeding” (pp. 609–646)
This chapter differentiates normal uterine bleeding from abnormal and dysfunctional uterine bleeding. It also examines causes of abnormal bleeding and identifies assessment strategies for diagnosing and managing these conditions.
- Chapter 26, “Hyperandrogenic Disorders” (pp. 647–667)
This chapter explores the etiology, clinical presentation, and impact of hyperandrogenic disorders. It also provides strategies for assessing, diagnosing, and managing patients with these conditions, including adolescents and pregnant women.
- Chapter 27, “Benign Gynecologic Conditions” (pp. 669–699)
This chapter explains the incidence, presentation, assessment, and management of common benign gynecologic conditions. It also explores differential diagnoses for these conditions and types of treatment options.
Tharpe, N. L., Farley, C., & Jordan, R. G. (2013). Clinical practice guidelines for midwifery & Women’s health (4th ed.). Burlington, MA: Jones & Bartlett Publishers..
- Chapter 7, “Care of the Woman with Reproductive Health Problems”
- “Care of the Woman with Amenorrhea” (pp. 341–344)
This section differentiates between primary and secondary amenorrhea and describes treatment options for managing patients with this condition.
- “Care of the Woman with Dysfunctional Uterine Bleeding” (pp. 362–366)
This section explains the causes of dysfunctional uterine bleeding and recommends treatment options for managing this condition.
- “Care of the Woman with Endometriosis” (pp. 372–375)
This section identifies the prevalence of endometriosis in women. It also provides strategies for diagnosing, treating, and managing patients with this condition.
- “Care of the Woman with Fibroids” (pp. 375–378)
This section describes the classification of fibroids and their prevalence in women of childbearing age. It also presents methods for identifying, diagnosing, and treating this common benign tumor.
- “Care of the Woman with Polycystic Ovarian Syndrome” (pp. 409–414)
This section identifies the criteria for a polycystic ovarian syndrome diagnosis. It also presents treatment options for this disorder, including therapeutic options and alternative measures.
Optional Resources
| Subject | Nursing | Pages | 5 | Style | APA |
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Answer
Practicum: Journal Entry: Amenorrhea
Amenorrhea is a medical term that is associated with the absence of menstrual periods. It is often classified as either primary or secondary. Primary amenorrhea refers to a condition where menstruation fails to begin even at the age of 16. Secondary amenorrhea, on the other hand, is the absence of menstrual periods for a time period of about six months in a woman who was previously menstruating (Schuiling & Likis 2013). According to Schuiling & Likis (2013) this condition is often influenced by numerous factors such as transient variation in hormonal levels, illness, and stress in addition to other environmental factors. This journal captures Mrs. Johanna’s (who is suffering from secondary amenorrhea) personal and medical history. It also describes her therapy and treatment as well as follow-up care. What is more, a variety of ways in which treatment and follow procedures for amenorrhea differs from those of patients diagnosed with endometriosis and ovarian cysts. Additionally, the medical implications of these variations are equally explored.
Journal Entry
Johanna is a 31-year-old white female. She is married with two healthy children, a boy and a girl aged 14 and 18 respectively. Johanna was born and raised in Texas and moved to Canada at the age of 20. Presently, she lives in a single bedroom apartment on the first floor of the building. She works as a high school teacher and together with the support of her husband she is able to meet most of her financial commitments. Psychosocially, Johanna is an active woman who is generally alert despite the fact that she has been diagnosed with amenorrhea. In regard to her family history, Johanna was brought up by her uncle since her mother had died at the age of 40 from kidney failure and her father had died at the age of 45 in a car accident. There is no known family history of primary or secondary amenorrhea. Johanna has occasional migraine that she says are mostly common late in the evenings. Presently, she takes Excedrin Migraine for the headaches. She has never been hospitalized and no surgeries have been performed on her. She also has no autoimmune disorders. Besides, no member of her family has ever been diagnosed with fertility problems. However, her late mother was diagnosed with premature menopause at the age of 35. Presently, Johanna reports the absence of her menses for more than six months.
Drug Therapy and Treatment
A detailed assessment on Johanna included pregnancy test as the initial step in evaluating the possibility of secondary amenorrhea. In order to rule out pregnancy, a measurement of serum beta subunit of hCG was conducted which gave a negative result. However, she revealed that lately, she has been experiencing a lot of stress as well as loss of weight. Physical examination was also carried out on Johanna that included measurements of both height and weight where her Body Mass Index (BMI) was found to be less than 18.5kg suggesting the presence of hypothalamic amenorrhea. The patient was also examined for hirsutism acne. Additionally, her breasts were examined for signs of galactorrhea and other signs of nitrogen deficiency. Since the treatment of secondary amenorrhea often depend on the cause of the amenorrhea and other patient concerns such as cosmetic issues and fertility, hypothalamic amenorrhea treatment involves lifestyle changes such as explaining the significance of adequate caloric intake in a manner that matches energy expenditure to help solve nutritional deficiencies. Also, Cognitive Behavioral Therapy (CBT) based on healthy eating as well as improving maladaptive behavior towards weight gain and eating was recommended for Johanna so as to help restore evolutionary cycles. Also, after confirming her low leptin levels, she was injected with recombinant methionyl human leptin (r-metHuLeptin, Amgen) at the rate of 0.08 mg per kilogram of body weight per day for a period of two months to correct hormonal abnormalities, and improve bone markers (Paz-Filho, Mastronardi, & Licinio, 2015) .
Patient's Follow-Up Care
Follow up activities that were recommended for Johanna included, offering her psychological support which in most cases involved contacting a professional psychologist who was contacted for a meeting with Johanna on monthly basis. Her family was also encouraged to give her both emotional and physical support. Besides, she needed to report at the healthcare facility at list once every month so as to check on her response to medication.
Comparison between Treatments for Ovarian cysts, Endometriosis, and Amenorrhea
Cysts refer to fluid-filled sacs that develop on the ovary. According to Schuiling & Likis (2013), ovarian cysts do not cause major symptoms unless they have grown large to block blood supply to the ovaries. Besides, unlike amenorrhea, their treatment in most cases is not necessary since they normally clear up on their own within a short period of time and do not impact fertility. Endometriosis, on the other hand, refers to abnormal growth of cells outside the uterus which are almost the same as the cells that form the inside of the uterus, studies show that unlike amenorrhea, there is no cure for Endometriosis. However, Giudice, Evers, & Healy (2012) observe that the condition can be managed by laparoscopic surgery. The medical implications imposed by the varying treatment techniques for the diseases implies that the health practitioners ought to conduct adequate diagnosis to ascertain the type of infection before prescribing any form of medication.
References
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Giudice, L. C., Evers, J. L. H., & Healy, D. L. (2012). Endometriosis: Science and Practice. New York, NY: John Wiley & Sons. Paz-Filho, G., Mastronardi, C. A., & Licinio, J. (2015). Leptin treatment: facts and expectations. Metabolism, 64(1), 146-156. Schuiling, K. D., & Likis, F. E. (2013). Women’s gynecologic health (2nd ed.). Burlington, MA: Jones and Bartlett Publishers.
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