A J.D. is a 37 year old white woman who presents to her gynecologist complaining of a 2 month histor. Question
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A J.D. is a 37 year old white woman who presents to her gynecologist complaining of a 2 month history of menorrhagia, increased urinary frequency, mild incontinence, extreme fatigue, and weakness. Her menstrual period occurs every 28 days and lately have been 6 days of heavy flow and cramping. She denies abdominal distention, backache, and constipation. She has not had her usual energy levels since before her last pregnancy.
PMH: Three-year history of osteoarthritis of the left knee, probably the result of trauma from a MVA when she was age 9. She takes 3 Ibuprofen daily each day for the last 2.5 years to manage the pain. Due to progressive increase in pain and a loss of adequate pain relief, she has doubled the dose of ibuprofen in the last few months. Since chronic use of Ibuprofen can cause peptic ulcers, and upon the recommendation from her nurse practitioner, she began taking omeprazole on a regular basis to prevent gastrointestinal bleeding.
FH/SH: Born in the United States of Greek parents. Strict vegetarian x 5 years. Non-smoker, does not drink alcohol, no street drug use.
VS: BP: 100/40; P: 140 beats/minute and regular; RR: 17 breaths/min; T: 98.0 F
PE: Tired, pale, oriented x 3. No neuro deficits. Skin pale, cool with normal skin turgor, palpable peripheral pulses. Brittle, thin, concave finger nails. Breath sounds clear in all lung fields. Tachycardia with systolic murmur heard best at right sternal border. Red, beefy, sore tongue, no gingivitis.
Labs: Hgb 9.1 g/dL; Hct 27.5%; RBC 3.3 x106/mm3; MCV 71 fL; MCH 19 pg; MCHC 27 g/dL; WBC 7.9 x 103/mm3; Plt 623 x 103/mm3; Iron 35 mcg/dL; TIBC 706 mcg/dL; Transferrin sat 5.0%; Ferritin 9.7 ng/m; Vit B12 680 pg/mL; Folic acid 420 ng/mL. Peripheral blood smear: significant number of hypochromic, microcytic RBCs; mild anisocytosis and poikilocytosis.
Pelvic Ultrasound: Irregularly enlarged uterus with 5 distinct uterine masses visible. Findings are consist with uterine fibroids/leiomyomas.
What does this data indicate? What conclusions can you make? What is your preliminary diagnosis(es)?
Search the literature using the MCHS Library databases, and select a clinical practice guideline (CPG) to guide your prescribing for these diagnosis(es). Which CPG did you select? (Include the reference for the CPG). Why did you select it?
Based on the CPG you have selected, what non-pharmacologic and pharmacologic interventions will you use for your treatment plan? How does each intervention treat the pathophysiology of the diagnosis(es)? What is the priority for each intervention (which interventions are first versus later)?
What are the important prescribing considerations for the pharmacologic interventions? Write a prescription for each medication you would prescribe, including all elements of a prescription.
What outcomes would you anticipate – therapeutic effects and adverse effects? How will you evaluate for these outcomes?
SCIENCE
HEALTH SCIENCE
NURSING
NURS 520
A J.D. is a 37 year old white woman who presents to her gynecologist complaining of a 2 month histor
