A 45-year-old Caucasian woman comes to the clinic and reports experiencinghot flushes (sometimes ass

A 45-year-old Caucasian woman comes to the clinic and reports experiencinghot flushes (sometimes associated with headache) that have been intensifying for the past 3-4 months. She has hot flushes several times each day and is frequently awakened at night with night sweats. Removing blankets from the bed and turning down the thermostat at night have not seemed to bring her any relief. She heard from several older friends that she can take medication for these symptoms, but she is most concerned about “getting her period back.”History and physical reveal her last regular menstrual period was 8-9 months ago after several months of erratic menstrual cycles.  Her menarche began at age 12 1/2 years.   She had a tubal ligation at age 24 years and a normal mammogram and Pap smear 3 years ago.  Her mother’s menopause occurred at age 46 years and her remaining family history is non-contributory.   The client denies ever having used recreational drugs, she works as a nursing assistant at a local nursing home and has no regular exercise program, stating “I get all the exercise I need running around at the nursing home everyday.”  She does not take calcium or vitamin supplements.   The client denies vaginal itching, burning, or abnormal discharge.  Her only medication is St. John’s Wort, 300 mg po TID for the last 2 months (purchased at Walmart; someone told her that it would “make her feel happier”).  She denies allergies to any drugs.The patient is a pale and thin white female who appears to be in no acute distress (NAD).  She is alert and cooperative. Lungs clear to auscultation and percussion.  The heart has normal S1 and S2 sounds.  Vital Signs BP 132/86 RR 18 HR 76 T 97.5°F.  The abdomen is soft, nontender, and nondistended with no masses palpated.  Ovaries are not palpable during the pelvic examination.  Normal female genitalia is noted and the pelvic exam is otherwise normal except for mild vaginal mucosal atrophy.Urinalysis Color: Yellow-orange Bilirubin: (-); Protein: (+); Appearance: Mildly cloudy; SG: 1.020; Blood: (+); Glucose: (-); pH: 5.5; Bacteria: (-); Ketones: (-); Nitrites: (-); Blood Work:  Na 140 meq/L; WBC 7.4 103/mm3; T bilirubin 0.4 mg/dL; K 4.1 meq/L; Plt 361 103/mm3; Alb 2.8 g/dL; Cl 100 meq/L; Ca 9.6 mg/dL; T protein 5.7 g/dL; HCO3 26 meq/L Mg 2.5 mg/dL T cholesterol 150 mg/dL BUN 55 mg/dL PO4 2.7 mg/dL LDL 128 mg/dL Cr 1.5 mg/dL; AST 13 IU/L; HDL 46 mg/dL; Glu, fasting 86 mg/dL; ALT 23 IU/L; Trig 140 mg/dL; Hb 12.0 g/dL; GGT 60 IU/L; TSH 2.2 µU/mL; Hct 37.1%; Alk phos 110 IU/L; FSH 43.7 mU/mL.   Mammogram is consistent with perimenopause without masses or abnormal calcifications.  DEXA scans are consistent with significant osteopenia bordering on osteoporosis    -What are the abnormal and their clinical significance?  -Prioritize the top 3 abnormal.  -List the 5 most important interventions for the top priority (from question #2) and provide the rationale for each intervention.  -What are 3 potential complications that could happen with this client?  -Based on the information provided above, can a diagnosis of menopause be definitively established?  -Identify all of the clinical symptoms above that are consistent with a diagnosis of menopause.  -Does this patient have any laboratory evidence of thyroid disease?  Health Science Science Nursing NURS MISC Share QuestionEmailCopy link Comments (0)

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