As an advanced practice nurse, you will likely experience patient encounters with complex comorbidities. For example, consider a female patient who is pregnant who also presents with hypertension, diabetes, and has a recent tuberculosis infection. How might the underlying pathophysiology of these conditions affect the pharmacotherapeutics you might recommend to help address your patient’s health needs? What education strategies might you recommend for ensuring positive patient health outcomes?
FOR THIS DISCUSSION, YOU WILL BE ASSIGNED A PATIENT CASE STUDY AND WILL CONSIDER HOW TO ADDRESS THE PATIENT’S CURRENT DRUG THERAPY PLANS. YOU WILL THEN SUGGEST RECOMMENDATIONS ON HOW TO REVISE THESE DRUG THERAPY PLANS TO ENSURE EFFECTIVE, SAFE, AND QUALITY PATIENT CARE FOR POSITIVE PATIENT HEALTH OUTCOMES. STUDY 2
A 46-year-old, 230lb woman with a family history of breast cancer. She is up to date on yearly mammograms. She has a history of HTN. She complains of hot flushing, night sweats, and genitourinary symptoms. She had felt well until 1 month ago and she presented to her gynecologist for her annual gyn examination and to discuss her symptoms. She has a history of ASCUS about 5 years ago on her pap, other than that, Pap smears have been normal. Home medications are Norvasc 10mg qd and HCTZ 25mg qd. Her BP today is 150/90. She has regular monthly menstrual cycles. Her LMP was 1 month ago.
BY DAY 3 OF WEEK 9
Post a brief description of your patient’s health needs from the patient case study you assigned. Be specific. Then, explain the type of treatment regimen you would recommend for treating your patient, including the choice or pharmacotherapeutics you would recommend and explain why. Be sure to justify your response. Explain a patient education strategy you might recommend for assisting your patient with the management of their health needs. Be specific and provide examples.
Expert Solution Preview
Based on the provided patient case study, the patient is a 46-year-old woman with a family history of breast cancer. She is experiencing symptoms such as hot flushing, night sweats, and genitourinary symptoms. She has a history of hypertension (HTN) and is currently taking Norvasc 10mg qd and HCTZ 25mg qd for blood pressure control. Her blood pressure is currently 150/90 mmHg. Her last menstrual period (LMP) was 1 month ago.
Considering the patient’s health needs and coexisting conditions, it is important to address the symptoms of menopause and provide adequate blood pressure control. The treatment regimen recommendation should aim to manage hot flashes, night sweats, genitourinary symptoms, and blood pressure.
For the management of menopausal symptoms, hormone therapy (HT) can be considered. HT involves the use of estrogen alone or in combination with progestin. In this case, since the patient has an intact uterus, a combination therapy consisting of estrogen and progestin is recommended. This can help alleviate symptoms such as hot flashes, night sweats, and genitourinary symptoms. However, the decision to initiate HT should be made after a thorough evaluation of the patient’s risks and benefits, taking into consideration her family history of breast cancer and other risk factors.
In terms of blood pressure control, the current medications the patient is taking (Norvasc and HCTZ) may not be providing adequate control as her blood pressure remains elevated at 150/90 mmHg. Adjustments to the medication regimen should be considered to achieve blood pressure targets. Options for antihypertensive therapy could include adding or substituting another class of antihypertensive medication such as an ACE inhibitor, angiotensin II receptor blocker (ARB), or a thiazide diuretic. The specific choice would depend on the patient’s comorbidities, overall health status, and response to previous medications.
It is important to initiate patient education to enhance self-management and promote positive health outcomes. In this case, education strategies to address the patient’s health needs could include:
1. Lifestyle modifications: Encourage the patient to adopt a healthy lifestyle, including regular exercise, a balanced diet, weight management, stress reduction techniques, and smoking cessation.
2. Medication adherence: Emphasize the importance of taking medications as prescribed and explain the potential consequences of non-compliance, such as uncontrolled blood pressure and menopausal symptoms.
3. Blood pressure monitoring: Teach the patient how to measure and record her blood pressure at home using a home blood pressure monitor. Provide instructions on how to interpret the readings and when to seek medical assistance.
4. Menopause management: Educate the patient about the natural progression of menopause and the potential benefits and risks of hormone therapy. Discuss alternative non-pharmacological approaches for managing menopausal symptoms, such as lifestyle modifications, relaxation techniques, and over-the-counter remedies.
5. Regular follow-up: Stress the importance of regular follow-up appointments to monitor the effectiveness of the treatment regimen, assess for any adverse effects, and make necessary adjustments to the plan.
Overall, a comprehensive treatment regimen involving hormone therapy for menopausal symptoms and adjustments to the antihypertensive medication regimen can help address the patient’s health needs effectively. Patient education is crucial in empowering the patient to actively participate in managing her health and achieving positive outcomes.
