Peer 1

Menopause Treatment and Education

     Women’s health and yearly screenings are important part of early detection and treatment. Family history of breast cancer places a higher risk forwomen to develop breast cancer themselves. Women who have these risk factors need to begin screenings at an earlier age. Women between 40-50 years of age need to have a screening mammogram every year. Finding cancer early before any symptoms present, and before it increases in size and spreads to surrounding tissue (“ACS Breast Cancer Screening Guidelines,” n.d.). Screenings should begin Atypical squamous cells undetermined significance or ASCUS can be caused by a vaginal infection, or a virus caused by HPV. With this type of findings, and further work up should be considered. Cervical cancer was the third leading type of cancer in women. Since the discovery of the role HPV has in developing cervical cancer, there has been ways developed to prevent this type of infection (Ndifon & Al-Eyd, 2022). Our patient should continue to have yearly mammograms and cervical cancer screenings yearly. Menopause causes changes in women’s body the older we get. Although our patient is only 46, hormone levels and screening questioners need to begin around this age for menopause symptoms.

     The patient in this scenario has a concern about the new onset of flushing, night sweats, and genitourinary symptoms. The symptoms that she is experiencing is probably coming from a hormone imbalance (Santoro, Roeca, Peters, & Neal-Perry, 2020). At the age of 46, our patient could be experiencing early menopause, since menopause usually happens around the age of 47 and can last up to 8 years (Roberts & Hickey, 2016). Memory loss, mood swings, sleeping problems, irregular periods, and the inability to hold your urine is also some of the symptoms a woman may experience. When levels of FSH increase over two blood draws that are 4-6 weeks apart it is considered menopause (Dunneram, Greenwood, & Cade, 2019). Vasomotor symptoms like hot flashes, can place our patient at risk for present and future cardiovascular disease. Genitourinary symptoms are also a symptom of menopause. Although we are not aware of specific genitourinary symptoms, some that come with menopause involve the vulva and vagina, vaginal dryness, vaginal narrowing and shortening, uterine prolapse these would require a vaginal examination and questioners regarding to the patient (Roberts & Hickey, 2016). Treatment for menopause would depend on how much the symptoms are interfering with everyday life, and whether it is bothersome for the patient. Hormone Therapy treatments (HT) are the treatment of choice and most effective to relieve the hot flashes and vaginal dryness. HT can be estrogen alone, or estrogen along with progesterone (progestin). Progestin is prescribed with estrogen during menopause to counterbalance the estrogen affects to the endometrium and the increase risk of endometrial hyperplasia and cancer (Rosenthal & Burchum, 2020).  HT comes in varies forms, pills, patches, cream, implants, cream, or vaginal ring. Benefits of taking HT is the suppression of  vasomotor symptoms, urogenital atrophy, and prevention of osteoporosis. When this treatment is stopped the risk for stroke and VTE are decreased as well as complications with bone loss (Roberts & Hickey, 2016). Since our patient is free of cancer and all other contraindications for HT, starting Prempro 0.3/1.5mg daily. Rechecking patient and symptom relief at week 6.

     Education for women that maybe experiencing menopause begins with educating women on the signs and symptoms. So that they realize what to look for the older we become. Offer free classes at local community centers or hospitals would be a great start for education. Providers can counsel their patients on menopause and treatment options. Offering information pamphlets to newly diagnosed patients, information websites, as well as scheduling appointments with nurses at the clinic to help any unanswered questions.

References

ACS Breast Cancer Screening Guidelines. (n.d.). Retrieved from 

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Dunneram, Y., Greenwood, D. C., & Cade, J. E. (2019). Diet, menopause and the risk of ovarian, endometrial and breast cancer.  Proceedings of the

               Nutrition Society,  78(3), 438–448. 

Ndifon, C., & Al-Eyd, G. (2022). Atypical Squamous Cells of Undetermined Significance.  National Library of Medicine. Retrieved from

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Roberts, H., & Hickey, M. (2016). Managing the menopause: An update.  Maturitas,  86, 53–58. 

Rosenthal, L., & Burchum, J. (2020).  Lehne’s Pharmacotherapeutics for Advanced Practice  

            Providers. Maarssen, Netherlands: Elsevier Gezondheidszorg.                                  

Santoro, N., Roeca, C., Peters, B. A., & Neal-Perry, G. (2020). The Menopause Transition: Signs, Symptoms, and Management Options.  The Journal of

           Clinical Endocrinology &Amp; Metabolism,  106(1), 1–15. 

Peer 2

Patient Health Needs and Education

Health Needs

Among infectious diseases, community-acquired pneumonia (CAP) ranks high as a major killer. Clinical manifestations of CAP range from a relatively moderate illness with fever and persistent cough to a life-threatening condition with respiratory failure and septic shock (Ferreira-Coimbra et al.,2020). CAP is included in the clinical presentation of practically all respiratory disorders due to the vast range of related clinical symptoms. The 68-year-old male has a medical history of diabetes, hypertension, hyperlipidemia, and chronic obstructive pulmonary disease. Annually, 5832 chronic obstructive pulmonary diseases (COPD) cases are diagnosed per 100,000 people in the United States (Ferreira-Coimbra et al.,2020). This comorbidity puts patients at the highest risk for CAP hospitalization. Other chronic lung diseases (e.g., bronchiectasis, asthma), chronic heart disease (especially congestive heart failure), stroke, malnutrition, and diabetes mellitus have all been related to an increased possibility of CAP. As a result, the 68-year-old guy was at risk for developing CAPD.

Treatment

The most frequent and aggressive bacterial CAP pathogen, S. pneumonia, and atypical pathogens are empiric regimens' primary targets for all CAP patients (Ramirez et al.,2020). Beta-lactamase-producing H. influenza, methicillin-susceptible S. aureus, and M. catarrhal are covered, or at least better treated, for patients with comorbidities, smoking, and recent antibiotic usage. Enterobacteriaceae, including Escherichia coli and Klebsiella spp., are also covered for people with structural lung disease (Ramirez et al.,2020). Because the patient, in this case, has a penicillin allergy, it is not possible to prescribe amoxicillin.

In place of amoxicillin, one may try a combination of a cephalosporin and a macrolide, doxycycline, or lefamulin on its own. Omadacycline is a relatively novel drug effective against many CAP infections, including Enterobacteriaceae (Ramirez et al.,2020). It is a viable option for individuals who cannot tolerate beta-lactams (or other medicines) and want to forego fluoroquinolones, as is evident in this case study. Antibiotic allergies, medication combinations, individual patient exposures, and other variables may need adjustments to these regimens (Ramirez et al.,2020). In particular, antiviral medication may be necessary during flu season for individuals at high risk for severe flu complications.

Patient Education

            Given that the patient is positive for risk factors such as diabetes, he must employ lifestyle changes. Therefore, the patient is advised to exercise daily and eat food with the least amount of fats (Betancourt,2019). Additionally, the patient is recommended to incorporate healthy sleeping patterns and avoid smoking.

References

Betancourt, S. L. (2019). Community-Acquired Pneumonia. In S. L. Betancourt,  Chest Imaging (pp. 191–195). Oxford University Press. https://doi.org/10.1093/med/9780199858064.003.0034

Ferreira-Coimbra, J., Sarda, C., & Rello, J. (2020). The burden of Community-Acquired Pneumonia and Unmet Clinical Needs.  Advances in Therapy,  37(4), 1302–1318. https://doi.org/10.1007/s12325-020-01248-7

Ramirez, J. A., Musher, D. M., Evans, S. E., Dela Cruz, C., Crothers, K. A., Hage, C. A., Aliberti, S., Anzueto, A., Arancibia, F., Arnold, F., Azoulay, E., Blasi, F., Bordon, J., Burdette, S., Cao, B., Cavallazzi, R., Chalmers, J., Charles, P., Chastre, J., … Wunderink, R. (2020). Treatment of Community-Acquired Pneumonia in Immunocompromised Adults.  Chest,  158(5), 1896–1911. https://doi.org/10.1016/j.chest.2020.05.598