Primary Healthcare Program Among Women Assignment

Discussion Response

Menstrual health has been a primary healthcare program among women. Women often report various menstrual ill health conditions like dysmenorrhea, amenorrhea, and heavy menses. In the case of Gretchen Abernathy, she complains of anxiety, weakness, and weight gain following heavy menses. Her periods seem sporadic, lasting for about five days to ten. The rich and persistent bleeding has negatively impacted her quality of life, prompting her to seek medical attention (Wouk & Helton, 2019). Her medical history includes bilateral tubal ligation and discontinuing oral contraceptive pills (OCPs). Primary Healthcare Program Among Women Assignment

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For proper assessment and accurate diagnosis, collecting complete history and conducting an adequate physical examination is essential. The investigation process should the impact of heavy bleeding on the patient, such as those blood counts and blood components. Possible complications the patient presents include iron deficiency anemia (Wouk & Helton, 2019). Investigation procedures also involve evaluating various causes of heavy bleeding, such as dysfunctional uterine hemorrhage and endometrial polyps. For an accurate diagnosis, the patient needs a transvaginal ultrasound to look for structural abnormalities such as endometrial polyps or polycystic ovarian syndrome (PCOS) that might be causing her bleeding problems (Sarkisova & Xegay, 2022). Unlike evaluation procedures, an imaging test gives a more accurate diagnosis in patients with heavy bleeding. In addition, due to proximity to other systems, the patient may be suspected of having kidney or urinary tract disorders. It is, therefore, essential to have a comprehensive urinalysis to reveal other systemic diseases like cystitis, kidney stones, and renal tract tumors. The results of the diagnostic procedures often serve as the basis of the treatment strategy. Primary Healthcare Program Among Women Assignment

The treatment approach for the patient should aim and lowering the menstrual blood flow volume. For example, the Administration of hormonal therapy, such as oral progesterone or OCPs, may be used if the patient is diagnosed with dysfunctional uterine hemorrhage—hormonal therapy help in stabilizing the uterine endometrial thickening and possibly menstrual flow amount. Secondly, the Administration of oral iron supplements such as iron sulfate can help to restore iron levels in the blood and thus eliminate the risk of anemia and fatigue (Kho & Shields, 2020).

Patient education is crucial to assist in managing the disease. Education allows the patient to take charge of her health by possibly identifying the adverse effects of her drugs. Secondly, by understanding her condition, the patient can identify the danger signs of her disease and take precautionary measures before developing complications (Wouk & Helton, 2019).

For proper patient management, I must consider the patient’s medical history, symptoms, and concerns while formulating a treatment plan. Extensive patient evaluation helps direct me to a precise and individualized treatment plan, boosting the chance of achieving an excellent patient care plan. Secondly, by conducting a physical examination and evaluation, I can come up with valid differential diagnoses, which will help manage the condition presented by the patient (Elstrott et al., 2020). Finally, interprofessional consultation will help me develop a valid diagnosis that I could miss and a treatment plan for the patient. Primary Healthcare Program Among Women Assignment

Conclusion

It is crucial to adopt a holistic approach to Gretchen’s care. I agree with initial differential diagnosis and treatment approaches. The healthcare provider can create a more individualized and holistic treatment plan to improve the patient’s quality of life and address the underlying cause of the patient’s heavy menstrual bleeding by asking about the patient’s history of using contraception and lifestyle factors. The treatment process should not only involve a pharmaceutical approach by also support the patient’s mental health. Primary Healthcare Program Among Women Assignment

References

Elstrott, B., Khan, L., Olson, S., Raghunathan, V., Dougherty, T., & Shatzel, J. J. (2020). The role of iron repletion in adult iron deficiency anemia and other diseases. European journal of hematology, 104(3), 153–161.

Kho, K. A., & Shields, J. K. (2020). Diagnosis and management of primary dysmenorrhea. Jama, 323(3), 268-269.

Sarkisova, V., & Xegay, R. (2022). Causes, Diagnosis, Conservative And Operative Treatment Of Uterine Myoma. Science and innovation, 1(D8), 198-203.

Wouk, N., & Helton, M. (2019). Abnormal uterine bleeding in premenopausal women. American family physician, 99(7), 435–443.

Respond to colleagues’ posts and explain how you might think differently about the types of tests or treatment options your colleagues suggested and why. Use your learning resources and/or evidence from the literature to support your position.
Patient Information:

Initials, G, 38, female, Caucasian Primary Healthcare Program Among Women Assignment
S.
CC (chief complaint): “Frequent menstrual bleeding”
HPI: Gretchen Abernathy is a 38-year-old G2 P2 Caucasian female who presents to the clinic with complaints of frequent menstrual bleeding. Her menstrual calendar shows a bleeding frequency of 17-36 days, lasting 5-10 days in duration, and on her heaviest day, she needs to change her super tampon every 2 hours. She relates this has been getting worse since stopping her OCPs when she had a bilateral tubal ligation 4 months after having her second child 9 months ago. She is upset as no one told her that weight gain could happen after and relates she has gained
27 lbs. since her surgery. She states that all this bleeding is making her tired and she cannot
keep herself awake. Gretchen’s mother told her she probably just had “low iron” and if she took
vitamins, she would feel better.
Location: dysfunctional uterine bleeding
Onset: infrequent menstrual bleeding Primary Healthcare Program Among Women Assignment
Character: 5- 10 days duration with changes of tampons every 2 hours
Associated signs and symptoms: tiredness, sleep, and weak
Timing: bleeding frequency of 17-36 days, lasting 5-10 days
Exacerbating/relieving factors: Vitamins if taken per mother’s advice
Current Medications: Over-the-cover pills (OCPs)
Allergies: NKA
PMHx: Tubal ligation 4 months ago

Soc & Substance Hx: Have 2 children. Has her mother as a supporter. No information was provided on smoking and drinking.
Fam Hx: None
Surgical Hx: Tubal ligation after having her second child.
Mental Hx: Anxiety and stress
Violence Hx: None
Reproductive Hx: Her menstrual calendar shows a bleeding frequency of 17-36 days, lasting 5-10 days in duration, and on her heaviest day she needs to change her super tampon every 2 hours.
ROS: Primary Healthcare Program Among Women Assignment
GENERAL: weight gain, no fever, no chills, weakness, fatigue.
HEENT: Eyes: No visual loss, blurred vision, doubles vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.
SKIN: No rash or itching.
CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema.
RESPIRATORY: No shortness of breath, cough, or sputum. No tightness of the chest
GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood.
NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.
MUSCULOSKELETAL: No muscle pain, back pain, joint pain, or stiffness.
HEMATOLOGIC: frequent menstrual bleeding
LYMPHATICS: No enlarged nodes. No history of splenectomy.
PSYCHIATRIC: No history of depression or anxiety.
ENDOCRINOLOGIC: No reports of sweating or cold or heat intolerance. No polyuria or polydipsia.
GENITOURINARY/REPRODUCTIVE: G2 P2 Her menstrual calendar shows a bleeding frequency of 17-36 days, lasting 5-10 days in duration, and on her heaviest day, she needs to change her super tampon every 2 hours. Has normal vulvar vaginal Bartholin Skene’s urethra
ALLERGIES: NKA Primary Healthcare Program Among Women Assignment
O.
General: Have gained 27 pounds, denies fever, and chills
• HEENT: denies headache, no wnl, hair dry, neck supple without adenopathy.
• Cardiovascular: RSR without murmur or gallop
• Respiratory: Denies cough and has clear to p&a.
• Gastrointestinal: Have Abd soft, non-tender, BS all 4 quadrants.
• Genitourinary: VVBSU: WNL Has normal vulvar vaginal Bartholin Skene’s urethra
• Hematological: have heavy prolonged menstrual bleeding
• Cervix: firm, smooth, parous, w/o CMT
• Uterus: mid-mobile non-tender, approximately 10 cm
• Adnexa: without masses or tenderness
• Extremities: negative human, reflexes 2+ = bilaterally, no edema

Diagnostic results: What testing do you want to order?
• Complete Blood Count- The CBC can evaluate the patient’s overall health and detect a variety of diseases and conditions, such as infections and anemia. The CBC also can show unusual increases or decreases in cell counts and also can help find the cause of swelling and pain, bruising, or bleeding (MayoClinic, 2023).
• Transvaginal Ultrasound: A procedure used to examine the vagina, uterus, fallopian tubes, ovaries, and bladder that can help to rule out endometrial polyp, PCOS. Primary Healthcare Program Among Women Assignment
• Complete Urinalysis: A complete urinalysis consists of three components or examinations: physical, chemical, and microscopical. Physical examination describes the volume, color, clarity, odor, and specific gravity. Chemical examination identifies pH, red blood cells, white blood cells, proteins, glucose, urobilinogen, bilirubin, ketone bodies, leukocyte esterase, and nitrites (Milani and Jailal, 2023).
A: What is your differential Diagnosis?
Primary and Differential
• Dysfunctional Uterine Bleeding: ICD 10 code:9- it’s a term that describes irregularities in the menstrual cycle involving frequency, regularity, duration, and volume of flow outside of pregnancy. Patients who experienced this have been very disturbed due to the heaviness and prolonged bleeding. According to Davis and Sparzak, 2022, “Up to one-third of women will experience abnormal uterine bleeding in their life, with irregularities most commonly occurring at menarche and perimenopause. A normal menstrual cycle has a frequency of 24 to 38 days and lasts 2 to 7, with 5 to 80 milliliters of blood loss “( Davis and Sparzak, 2022). This patient has a long bleeding frequency and longer duration which is not normal for her.
• Endometrial polyp ICD 10 code: N4.0- Endometrial polyps are the most frequently observed pathological finding in the uterus and are usually benign lesions (Nijkang et al, 2019). Endometrial polyps are relatively common and may be accompanied by abnormally heavy bleeding at menstruation which is what the patient is seeking help from after giving birth to her second child. Having an irregular menstrual cycle can be very depressing along with the risk of being overweight of 27lbs.
• Iron deficiency Anemia: the patient is at risk for Iron deficiency anemia due to the heavy flow causing her to lose so much blood. According to Benson et al 2021, “Menstrual loss, abnormal uterine bleeding, and pregnancy put women at risk of developing iron deficiency which can result in severe fatigue, reduced exercise capacity, and poor work performance” (Benson et al, 2021). Primary Healthcare Program Among Women Assignment

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Treatments: What are the next steps for treatments?
Patients can continue taking the OCPs as it was helping with their cycle before stopping the medications. Davis and Sparzak 2022. Stated that “Treatment of abnormal uterine bleeding depends on multiple factors, such as the etiology of the AUB, fertility desire, the clinical stability of the patient, and other medical co-morbidities” (Davis and Sparazk, 2022). The patient can also be treated with oral progesterone such as Medroxyprogesterone acetate (MPA Provera) 10mg oral daily for 14 days along with patient education on side effects of the medications such as changes in breast sizes, hives, hair growth, acne, and changes in the menstrual cycle. Medroxyprogesterone is used to treat abnormal menstruation (periods) or irregular vaginal bleeding. (MedlinePlus, 2023). Another medication I can recommend for this patient is to take daily Iron supplements, Ferrous Sulfate 325mg daily orally to help with the anemia. Teaching such as constipation is the side effect of the medication so a patient should increase fluid intake. The patient should also follow up with her OBGYN for proper treatments and other evaluation and further laboratory work.
Reflection:
I am sure most women can relate to this patient’s issues of blood loss. I dealt with a prolonged menstrual cycle last month. Mainly Ibuprofen 800 mg oral has been my only release to help me feel better. I had these issues 14 years ago before my son was born, I recently release that the pain has come back. I made an appointment with my OBGYN and am looking forward to that. Taking the Iron Supplement 325 mg orally daily has also helped me because the prolonged and heavy flow has caused me to be very anemic and can cause me to be very fatigue Therefore the iron supplement has been very helpful. The contraceptive Mirena was never a great thing for me. I had it for 6 months and due to excessive dizziness was taken out due to it was recommended to help regulate my period. Primary Healthcare Program Among Women Assignment

References:
Benson, C. S., Shah, A., Stanworth, S. J., Frise, C. J., Spiby, H., Lax, S. J., Murray, J., & Klein, A. A. (2021). The effect of iron deficiency and anemia on women’s health. Anaesthesia, 76 Suppl 4, 84–95. https://doi.org/10.1111/anae.15405
Davis E, & Sparzak P.B.(2022). Abnormal Uterine Bleeding. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK532913/
Mayo Clinic. (2023). Complete blood count. Retrieved from https://www.mayoclinic.org/tests-procedures/complete-blood-count/about/pac-20384919
Links to an external site.
Milani, Q D.A, & Jialal I.(2023) Urinalysis. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK557685/
Links to an external site.
MedlinePlus. (2023). Medroxyprogesterone. Retrieved from https://medlineplus.gov/druginfo/meds/a682470.html

Nijkang, N. P., Anderson, L., Markham, R., & Manconi, F. (2019). Endometrial polyps: Pathogenesis, sequelae, and treatment. SAGE open medicine, 7, 2050312119848247. https://doi.org/10.1177/2050312119848247 Primary Healthcare Program Among Women Assignment