QuestionAnswered step-by-stepPharmacology Made Easy 4.0: Repro/GU Problem-Based Scenario -…  Pharm

QuestionAnswered step-by-stepPharmacology Made Easy 4.0: Repro/GU Problem-Based Scenario -…  Pharmacology Made Easy 4.0: Repro/GU  Problem-Based Scenario – Infertility Clinical Scenario:  Jennifer P, 37-year-old female, and her 37-year-old husband, David, present with the complaint of a possible fertility problem. The couple has been married for 2 years. The patient has a 4-year-old daughter from a previous relationship. The patient used birth control pills until one-and-a- half-years-ago. The couple has been trying to conceive since then and report a high degree of stress related to their lack of success. Jennifer reports good health and no problems in conceiving her previous pregnancy or in the vaginal delivery of her daughter. She reports that her periods were regular on the birth control pill, but have been irregular since she discontinued taking them. She reports having periods every 5-7 weeks. Past history is remarkable only for mild depression. Imipramine 150 mg qhs for the last 8 months is her only medication. Jennifer works as a cashier, runs 12-24 miles each week for the last 2 years, and has no history of STDs, abnormal Paps, smoking, alcohol or other drugs. She has had no surgery.David also reports good health and reports no problems with erection, ejaculation or pain with intercourse. He has had no prior urogenital infections or exposure to STDs. He has had unprotected sex prior to his current relationship, but has not knowingly conceived. He has no medical problems or past surgery. David works as a long-distance truck driver and is on the road 2-3 weeks each month. He smokes a pack of cigarettes a day since age 18 and drinks 2-3 cans of beer 3-4 times a week when he’s not driving. He occasionally uses amphetamines to stay awake while driving at night. The couple has vaginal intercourse 3-5 times per week when he is at home. What is the definition of infertility?   What are some etiologies of infertility?      Complete the menstrual cycle process, filling in the correct endocrine glands and the target tissues – estrogen/progesterone, hypothalamus, ovary, pituitary, and uterus.  Noticing:  Evaluation of client’s medical history: Describe any abnormal findings/potential issues related to Jennifer/David’s infertility etiology and describe your thoughts about these findings.   Interpreting:What is the initial work-up for infertile couples and what tests would you add for this couple? Patient Partner                              Clinical Scenario Progression: It has been found that Jennifer has primary ovarian insufficiency. She is prescribed clomiphene 50 mg PO every day for five days, starting on day 3 of menstrual period. Interpreting: What contraindications should healthcare personnel screen for prior to the use of clomiphene? When discussing administration of clomiphene with the couple, what information should be included? Responding: When starting fertility treatment with clomiphene, it is important to discuss possible adverse reactions with Jennifer and David. Complete the following chart with information related to interventions and which reactions should be reported to the provider. Adverse drug reactions to clomiphene Patient and/or Nursing interventions Report to provider(yes/no)Breast engorgement    Nausea, abdominal discomfort     Vasomotor instability (hot flashes)    Ovarian hyperstimulation    Multiple gestation    Blurred vision, flashes of light, dizziness     Reflecting: Couples who are experiencing infertility issues often require other specific interventions and/or nursing considerations. In relation to Jennifer and David’s situation, what particular nursing care topics should be addressed?   Problem-Based Scenario – Benign Prostatic Hyperplasia (BPH)  Clinical Scenario: Mr. B.H. is a 52 year old white male who was referred to the urology clinic by his primary care physician after complaining of his inability to urinate, painful urination and incomplete bladder emptying. Mr. B.H. symptoms have been getting increasingly worse over the past 3 months. Most recently Mr. B.H. has noticed an increase in pain and unequal stream flow of urine while urinating. He indicates that his problems seem to be worse at night and that the pain is greater during urination after waking from sleep. Past Medical History:Hernia operation at birthLeft forearm break, age 14Right knee ACL repair, age 19Right shoulder rotator cuff repair, age 20Hypertension diagnosis, age 41UTI x 2, age 50 and 52  Pertinent Family History:Father alive, age 76 years, Smoker, CAD, HTN, COPD, BPH, prostate CAMother alive, age 76 years, Smoker, CAD, HTN, MI with cardiac stents at age 64Brother alive, age 46, HTNSister alive and well at age 39 yearsFather diagnosed with BPH at age of 57  Pertinent Social History:Marine Corps Veteran with 2 tours in Iraq, 1991-1998Has worked full-time as a real-estate agent for 15 yearsHobbies include woodwork, weight lifting, surfing and boatingFrequently spends time in the Pacific Ocean surfing, at least 3 times a weekSmoker x 20 yearsDrinks approximately 3 beers 2-3 times a weekDiet high in cholesterol  Allergies:                                                                                 NKA  Current Medications:Atenolol 25 mg PO BID  Focused Physical Assessment:            Vital Signs:T:   (oral) 98.2°FP:   (regular) 82 /minR:   (regular) 18 /minBP: 155/88 (sitting)02 sat: 98% (room air) Abdomen/Scrotum/RectumBladder distendedAbdomen tender to palpation at lower quadrantsDigital rectal examination reveals enlarged, asymmetrical prostate gland; no tenderness; no masses; no nodules  Testing/Lab Results:  Basic Metabolic Panel (BMP) Result   Complete Blood Count (CBC) ResultSodium (135-145 mEq/L) 140   WBC (3.4-9.6 K/uL) 7.6Potassium (3.5-5.0 mEq/L) 3.9   RBC (4.35-5.65 M/uL) 5.22Chloride (95-105 mEq/L) 97   Hematocrit (38.3-48.6 %) 46.8Glucose (70-110 mg/dL) 106   Hemoglobin (13.2-16.6 g/dL) 14.7Calcium (8.4-10.2 mg/dL) 8.9   Platelets (135-317 K/uL) 290BUN (7-25 mg/dL) 24      Creatinine (0.6-1.2 mg/dL) 1.0        Urinalysis Result   Other Testing ResultColor (yellow) Yellow   Prostate Specific Antigen 5.2 ng/mLClarity (clear) Clear   Void with post void residual u/s  350mLSpecific Gravity (1.015-1.030) 1.026      Protein (neg) Neg      Glucose (neg) Neg      Ketones (neg) Neg      Bilirubin (neg) Neg      Blood (neg) Trace      Nitrite (neg) Neg                 Noticing:   When reviewing the client’s history and physical, what are the most significant findings and why?     Which lab and test results are most concerning and why?     Is there any other information (assessment data, testing, etc.) that would be helpful for determining the significance of the findings thus far?     Interpreting:   What is most likely occurring? What led you to this hypothesis?     What are the desired outcomes related to your hypothesis (give at least 2)?     What will happen if this condition is not treated?           Clinical Scenario Progression:  Mr. B.H. is diagnosed with benign prostatic hyperplasia. He is started on finasteride 5mg PO once a day. He is also started on doxazosin 1mg PO once a day.  Responding: What information is important for the nurse to know about the medications finasteride and doxazosin? Complete the following table:   Drug Name finasteride doxazosinDrug Classification       Pharmacologic Action       Adverse Effects       Administration      Nursing Considerations      Interactions        What other teaching should be included for the client about his condition?    Reflecting: What findings would demonstrate that the pharmacologic therapy is working? What follow-up data is needed?     If the pharmacologic therapy is ineffective, describe (2) procedures or surgical interventions that could be offered to Mr. B.H. for his condition.    Problem Based Scenario – Menopause Clinical Scenario: Zoila Lopez is a married, 55-year old woman living in suburban Los Angeles with her husband of 28 y+ears. She comes to the office today for her annual gyn/physical exam.  Her LMP was 12 months ago.  She smoked ½ pack of cigarettes daily from age 19-30 until she quit when she became pregnant with her first child.  Her OB history is: G3 T2 P0 A1 L2.  Her second and last child was born when Zoila was 35.  She breastfed both of her children for one year each.  Zoila’s past medical history is significant for arthroscopic knee surgery 10 years ago and migraines which she treats with good effect with ibuprofen 600 mg.  Family history is significant for Pulmonary Embolism (father) at age 60 and hypertension (mother) and breast cancer (mother) at age 70.  Her father is still living and her mother is deceased after a broken hip and pneumonia.  No history available for siblings or grandparents. Zoila reports some friction within her relationship with her husband as her sex drive has diminished over the last year or so.  She also reports an increase in anxiety and irritability.   What is the definition of menopause?    What are some of the health risks associated with menopause?   Describe some of the clinical manifestations a woman may experience related to perimenopause/menopause.   Noticing:   Evaluation of client’s medical history: Describe which of Zoila’s symptoms may be related to menopause.   What are some other symptoms that you should ask Zoila about relating to menopause?        Clinical Scenario Progression: Diagnostic labs confirm that Zoila is menopausal.  Interpreting:  What contraindications should healthcare personnel screen for prior to the use of (combined) medroxyprogesterone acetate and conjugated estrogen (Prempro)?   When starting HRT treatment with medroxyprogesterone acetate for symptoms of menopause it is important to discuss possible adverse reactions with the client.  Complete the following chart with information related to interventions and which reactions should be reported to the provider. Adverse drug reactions to (combined) conjugated estrogen and medroxyprogesterone acetate Patient and/or Nursing interventions Report to provider(yes/no)Nausea (estrogen)     Increased blood pressure (estrogen)    Increased risk for thromboembolism    Increased risk for MI or stroke    Increased vaginal bleeding      Responding: What are some of the benefits to beginning low-dose HRT soon after menopause?          Reflecting: Are there alternate options that may be offered to Zoila if she chooses to not use HRT that will help relieve her symptoms?  List some of the symptoms she may be experiencing and options for alleviating these symptoms:   Menopausal symptoms Zoila would like to relieve Alternative therapies                                         10.  What health promotion interventions will be a priority for the patient entering menopause?    11. What nutritional and exercise behaviors would you promote for the woman in menopause? Explain your answer. Health ScienceScienceNursingNURSING 2005Share Question

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