Nurs 6551 Week 9 Assignment Paper

Nurs 6551 Week 9 Assignment Paper

Nurs 6551 Week 9 Assignment Paper

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The Nursing Division of the Spiritual Care Association focuses on the spiritual dimension of professional nursing practice including registered nurses, advanced practice and specialty practice nurses from a wide variety of hospital and non-hospital-based settings.Nurs 6551 Week 9 Assignment Paper.

The Nursing Division of the Spiritual Care Association supports the advancement of the spiritual care component of nursing practice as an integral aspect of high-quality whole person care for all including the professional providing the care.Nurs 6551 Week 9 Assignment Paper

Mission:

Our mission is to support best-practice nursing spiritual care and self-care through education, mentoring, and resources for nursing professionals and nursing-related organizations.

Vision:

All nurses will have access to high quality, practical spiritual care information.
Nurses specializing in spiritual care as a component of whole-person care will be recognized for their expertise.
Nursing-related organizations will work in partnership with SCA to improve health outcomes and support the health of professional care providers.Nurs 6551 Week 9 Assignment Paper

Why Join?
If you are a nurse interested in incorporating spiritual care into your practice, the Nursing Division of the Spiritual Care Association is perfect for you.Nurs 6551 Week 9 Assignment Paper

Advance your career! Learn about the specialty practice of faith community nursing and spiritual care aspects of professional nursing through resources, courses, and presentations from national & international experts. As you develop knowledge of spiritual care and strengthen your understanding of other faiths and cultures, you will also start to discover your inner self as you strengthen your personal spirituality. As a member of the Nursing Division of SCA, you will discover opportunities to find fellowship with nursing colleagues and other allied health professions such as social workers and chaplains, work with a mentor or become a mentor to increase your confidence as a healthcare provider assisting hospitals and other healthcare organizations to integrate spiritual care back into health. Be a force in moving high-quality healthcare forward and support the future of nursing practice that improves outcomes by including steps to honor beliefs and aspects of faith that influence healthcare decisions for all faiths and perceptions of spirituality. You have a voice!

Benefits of membership include:

Belong to a supportive professional community that welcomes both novice and seasoned nurses
Access to current best-practice standards of spiritual care for those of all faiths and no faith preference. Be notified of new research publications related to spiritual care and the specialty practice of faith community nursing
Discounted price for online professional educational courses
Three free Spiritual Care Grand Round Webinars annually with CNE credit
Discounted registration for the Annual Westberg Symposium at the Caring for the Human Spirit® Conference
Free electronic subscription to the Journal of HealthCare Chaplaincy
Free subscription to the Caring for the Human Spirit® Magazine
Free Spiritual Care Tip of the Day emailed to you
Free newsletters
Membership directory and networking opportunities
Access to archived webinars and articles related to nursing & spiritual care
Faith community nurse practice information and mentoring
Faith Community Nurse leadership development
Opportunities to present at the national level and/or publish an article or be featured in our nursing spotlight column
Expand your professional value by adding a chaplain certification to your portfolio
Access to nursing expert
SCA Membership card will be mailed to you
How to Join?
To become a member, click the “Join now” button below. Membership is $95 annually and it includes all the member benefits listed above. During the registration process, select the “Professional – Nurse Membership” to be added to the Nursing Division of SCA.Nurs 6551 Week 9 Assignment Paper

Bethel U. Godwins

Walden University

NURS 6551, Section 8, Primary Care of Women

July 31, 2016

Abnormal Uterine Bleeding

Society for Reproductive Endocrinology and Infertility (SREI, 2012) described abnormal uterine bleeding as bleeding that differs in quality and quantity from normal menstrual bleeding, such as women spotting or bleeding between the women’s menstrual periods; bleeding after sex; bleeding heavier or last more days than normal; and bleeding post menopause. According to SREI (2012), factors that can cause abnormal bleeding include structural abnormalities of the reproductive system, such as uterine polyps, fibroids, and adenomyosis. Furthermore, SREI (2012) explained that vaginal, uterine or cervical lesions, miscarriage, ectopic pregnancy, endometritis, adhesions in the endometrium, and use of an intrauterine device (IUD) can also cause abnormal bleeding. Johns Hopkins Medicine (2016) specified that early recognition of abnormal bleeding, and seeing a health care provider immediately for appropriate diagnosis and treatment increase the chance of successful treatment. Therefore, the author will focus on a single patient comprehensive evaluation, which includes the patient’s personal/health history; physical examination; laboratory/diagnostic tests; diagnosis; treatment/management plan; education strategies; and follow-up care. Comment by DeAllen B Millender: Good introduction.Nurs 6551 Week 9 Assignment Paper

General Patient Information

Age: 41-year-old

Race/Ethnicity: Hispanic American

Partner Status: Married Comment by DeAllen B Millender: This information is not in APA format.

Current Health Status

Chief Complaint: “I have heavy, prolonged menstrual bleeding with severe cramping for the past one year”.

History of Present Illness (HPI): RG is a 41-year-old Hispanic American female who presented to the clinic with complaint of heavy prolonged menstrual bleeding with severe cramping for the past one year. Patient reported sharp pelvic pain during menstruation, bleeding between periods, pain with intercourse, blood clots during periods.Nurs 6551 Week 9 Assignment Paper Abdominal pain/pressure and bloating. Patient suggested that these symptoms started after her second caesarean section surgery one year ago. Patient also reported that she takes over-the counter medication, such as ibuprofen to relieve the pain. she also suggested that she uses heating pad on her abdomen/pelvic for pain relief, and she stated that she soaks in a warm sitz bath to ease pelvic pain and cramping. Patient also reported fatigue and weakness. Patient further stated that she decided to see an obstetrician and gynecologist (OB/GYN) because the heavy prolonged bleeding with severe menstrual cramp interfere with her regular activities. Patient denied nausea, vomiting, diarrhea, fever, and chills.Nurs 6551 Week 9 Assignment Paper

Timing/Onset: Patient said one year ago.

Location: The location of the problem as stated by the patient is pelvic/uterus/vaginal.

Duration: 5 to7 days during periods for the past one year.

Quality/Characteristic: Patient reported heavy prolonged menstrual pain; severe, sharp lower abdominal/pelvic cramping/pain, and blood clots during periods.

Aggravating Factors: Monthly periods as stated by the patient.

Relieving/Alleviating Factors: Patient stated that ibuprofen pain medication, heating pad, and/or warm sitz bath help the pain/cramping.Nurs 6551 Week 9 Assignment Paper

Severity: The severity of the pain/cramping on a pain scale is 10/10 reported by the patient.

Treatments/Therapies: Patient stated that she had not undergone any treatment for the reported problems.

Last Menstrual Period: The last menstrual period reported by patient was 7/5/2016.

Sexual Activity Status: Patient reported being sexually active.

Barrier Prevention: Patient stated she uses natural barrier methods.

Sexual Preference: Patient sexual preference is monogamous/heterogeneous relationship.Nurs 6551 Week 9 Assignment Paper

Satisfaction with Sexual Activity: Patient reported that she is sexually satisfied with her partner.

Contraception Method: Patient denied using any contraception method.

Patient History

Past medical History (PMH): Anemia and C-section. Patient was delivered full term through vaginal delivery without complications. The birth weight was 8 pounds 10 oz.Nurs 6551 Week 9 Assignment Paper

Psychological/Mental Health: Patient denied depression, mood swings, anxiety, or mental health problem.

Medications: RG reported that she takes over the counter Motrin 200-400 mg orally every 4-6 hours as needed for pain and cramping.

Allergies: Patient reported no known allergies (NKA).

Past Surgical/Hospitalization History: Patient reported history of C-section twice, and she was hospitalized for 3 days post the C-sections.Nurs 6551 Week 9 Assignment Paper

Preventive Screening: Patient reported that she had flu shot on 11/20/2015; last mammogram was 2/12/2015 and mammogram was normal; Pap smear was on 2/20/2015, which was also normal; patient also reported that she was up to date with her childhood immunization, but denied pneumococcal vaccination.

Family History: Both father and mother have history of diabetes mellitus type 2 and hypertension. Both parents are still living, and two siblings are still living and well.

Gynecological History: Patient is multipara with 2 pregnancy resulting in two viable offsprings. Patient had her first child at the age of 33 years. Menarche at age 13; periods last between 5 to 7 days. Patient reported heavy prolonged menstrual bleeding with severe cramping; sharp pelvic pain during menstruation; and bleeding between periods for the past one year. Denied vaginal discharge or sexually transmitted infection/disease.Nurs 6551 Week 9 Assignment Paper

Obstetric History: Gravida 2, Para 2, term 2, preterm 0, spontaneous abortion 0, and living 2 (G2T2P2A0L2). Gravida 1: Delivered at 39 weeks by C-section on 4/20/08 male; Gravida 2: Delivered at 40 weeks by C-section on 2/18/15 female. Patient denied therapeutic abortion (TAB) or spontaneous abortion (SAB); Patient denied preterm or low birth weight baby with no delivery complications. Patient also denied having sexual transmitted disease.Nurs 6551 Week 9 Assignment Paper

Personal/Social History: Patient is married with 2 children, and lives at home with the husband. Patient is a college graduate; works outside the house as a nurse at a nearby hospital. Patient’s husband works for a computer company. Patient family is a middle income family. Also, patient denied any physical or psychological abuse. Patient denied being exposed to any environmental or occupational health hazards. Patient also denied alcohol consumption, tobacco, or recreational drug use. Patient denied participating in any exercise or physical activity because she is tired after work, and prefers to rest. Patient reported that she eats healthy; she eats low fat, low carbohydrate meals, and she eats fruits and vegetable at least 3 to 4 times a week. Patient stated

that she sleeps well at night, and she usually goes to bed at 9 pm and wakes up at 6 am. Patient drinks a cup of coffee occasional, especially when she is at work to be awake.Nurs 6551 Week 9 Assignment Paper

Review of System (ROS)

General: RG admitted fatigue and weakness; denied fever /chills; and no weight loss.

Head and Neck: Patient denied headache or dizziness. Patient also denied lumps, neck injury, pain/tenderness or jugular vein distention.

Chest: Patient denied chest pain, cough or shortness of breath.

Heart: RG denied irregular heartbeats, heart attack, or heart murmur.Nurs 6551 Week 9 Assignment Paper

Breasts: Patient denied nipple discharge, tenderness or swelling.

Gastrointestinal: Patient admitted lower abdominal pain, pressure, and bloating; denied constipation, nausea, vomiting, and diarrhea.

Genitourinary: RG denied urinary tract infection, urinary frequency or burning on urination.

Genital: Patient admitted heavy prolonged menstrual bleeding with severe cramping for one year. Patient admitted sharp pelvic pain during menstruation, bleeding between periods, pain with intercourse, and blood clots during periods. Patient denied vaginal discharge.Nurs 6551 Week 9 Assignment Paper

Musculoskeletal: RG denied varicosities or extremities problem.

Psychiatric: RG denied depression, anxiety, or any psychiatric problems.

Neurological: Patient admitted fatigue and weakness; denied confusion, seizures, or tingling.

Hematologic: Patient admitted history of anemia; denied blood transfusion or easily bruise or bleeding.Nurs 6551 Week 9 Assignment Paper

Physical Examination

General exam: Patient appeared well developed and pleasant with good hygiene. Patient also appeared pale and weak. Vital signs: Blood pressure 118/76, heart rate 80, respiration 18,

temperature 98.8, pulse ox 100% on room air. Weight 78.2 kg, height 67 inches, and body mass index (BMI) 27.

HEENT: The head is normaceplalic, atraumatic. The pupils are equal, round, and reactive to light and accommodation. Extraocular movements are intact. Tympanic membrane is gray bilaterally. Oral mucosa is dry. Oropharynx is clear. Nares are patient, no nasal or septal deviation noted. No pharyngeal erythema.Nurs 6551 Week 9 Assignment Paper

Neck: Noted to be supple without jugular vein distention (JVD), thyromegaly or lymphadenopathy.

Lungs: Noted to be clear to auscultation throughout the lobes; no wheezes or rhonchi noted.

Cardiovascular: Regular rate and rhythm on auscultation, S1 S2 present without murmurs. Palpable pulses noted without peripheral edema.

Gastrointestinal: Bowel sounds are active in all quadrant. Abdomen is soft and tender on palpation.

Breast: The size of the breasts, areolas, and nipples are round and symmetrical with no discoloration, rash, lesions, dimpling, or retraction bilaterally; no masses, lumps, or tenderness noted on palpation bilaterally; and axillary lymph nodes non-palpable.Nurs 6551 Week 9 Assignment Paper

Pelvic Examination:

Vulva: The hair distribution is normal; no lesion noted.

Vagina: Vaginal walls are pink, and pubic hair is shaven; no lesions, masses, inflammation or discharge noted.

Cervix: Intact cervix with closed os.

Uterus: Enlarged, asymmetrical, soft, boggy and tender.

Laboratory and Diagnostic Tests

Laboratory Test and Results: Pregnancy test: Result is negative. Hemoglobin and Hematocrit (H/H): Result showed H/H 8.7/26.7, which is positive for anemia.Nurs 6551 Week 9 Assignment Paper

Diagnostic:

Transvaginal ultrasonography of the uterus: Revealed uterine enlargement measuring 12 cm with no leiomyomata; uterine wall thickening; cystic anechoic spaces in the myometrium; heterogeneous echo texture; obscured endometrial/myometrial border; sub endometrial echogenic linear striations; and thickening of the transition zone measuring 12.8 millimeter. The transvaginal sonography is used to rule out possible uterine tumor (Sakhel & Abuhamad, 2012).Nurs 6551 Week 9 Assignment Paper

Magnetic Resonance Imaging (MRI): MRI is ordered to obtain a high resolution image of the uterus as well as verifying/confirming the suspected diagnosis. The MRI result revealed that the junctional zone of the uterus is thickened and measures 12.8 millimeter. Also, MRI revealed an ill-defined ovoid and diffuse region of thickening with striated appearance (Sakhel & Abuhamad, 2012).Nurs 6551 Week 9 Assignment Paper

Differential Diagnoses

The differential diagnoses of the patient clinical presentation as described by Schuiling and Likis (2013) include: Adenomyosis, uterine fibroids and endometrial hyperplasia. However, the primary diagnosis for the patient is Adenomyosis.

Adenomyosis: Schuiling and Likis (2013) described adenomyosis as a benign, common condition that involves the movement of endometrial tissue into the uterine muscles.Nurs 6551 Week 9 Assignment Paper The definitive cause of the adenomyosis is unknown, but the condition is common among women with elevated levels of estrogen; the condition usually ceases post menopause when estrogen levels are reduced. Risk factors explained by Taran, Stewart, and Brucker (2013) include multiparity; previous uterine surgery, such as C-section, dilatation/curettage, or fibroids

removal surgery; and women at reproductive age, especially between the age of 40s or 50s. furthermore, Taran et al. (2013) specified that the clinical presentation entails chronic pelvic pain, prolonged menstrual cramps, heavy menstrual bleeding, spotting between periods, abdominal tenderness, painful intercourse, longer periods than normal, blood clots during periods. Taran et al. (2013) also explained that finding during physical examination include enlarged, tender, soft and boggy uterus. According to Taran et al. (2013) diagnosis is made based on sonographic or MRI results, and treatment is not recommended for women with mild form of adenomyosis, except when the symptoms interfere with daily activities. Taran et al. (2013) further explained that treatment options include anti-inflammatory medications; hormonal treatments; endometrial ablation; uterine artery embolization, MRI-guided focused ultrasound surged or hysterectomy, which is the definitive treatment for adenomyosis.Nurs 6551 Week 9 Assignment Paper

Adenomyosis is selected as the primary diagnosis because the aforementioned patient’s clinical presentation, physical examination findings, and diagnostic tests results are synonymous with adenomyosis aforementioned associated signs and symptoms; risk factors; physical examination findings; and diagnostic test results.

Uterine Fibroids: Women’s Health (WH, 2015) described uterine fibroid to be muscular tumors that develop in the uterine wall, which can also be referred to as leiomyoma or myoma. Uterine fibroids are usually non-cancerous, and can be single or multiple tumors in the uterus. According to WH (2015), women risk for developing uterine fibroid are increased by age, such as women in their 30s and 40s until menopause when the fibroids commonly shrink. Other risk factors include family history, ethnic origin, obesity and eating habits. Symptoms of fibroids as explained by WH (2015) involve lower back pain; pain during sex; heavy bleeding; painful menses, enlarged lower abdominal, frequent urination; and lower abdominal/pelvic feeling of fullness. Physical examination shows reveal painless, firm, irregular pelvic mass. According to WH (2015), diagnosis is done using transvaginal ultrasound, MRI, hysteroslpingography, hysteroscopy, and endometrial biopsy. Fibroid is not selected as the primary diagnosis because there is no visualization of the fibroid during pelvic examination or on sonography test. Moreover, severe pain is noted during pelvic exam. Furthermore, sonographic result is more consistent with adenomyosis rather than fibroids.Nurs 6551 Week 9 Assignment Paper

Endometrial Hyperplasia: Cancer Research of United Kingdom (CRUK, 2014) described endometrial hyperplasia as thickening of the covering of the uterus due to excessive growth of the cells that covers the uterus, and endometrial hyperplasia can lead to womb cancer. Risk factors according to CRUK (2014) include- age over 35 years; white race; nulliparity; older age at menopause; obesity; cigarette smoking; family history of ovarian, colon, or uterine cancer; early menarche; and history of diabetes, polycystic ovary syndrome, thyroid disease and gallbladder disease. The CRUK (2014), explained that the condition is caused by imbalance of to the estrogen and progesterone. According to CRUK (2014), signs and symptoms of endometrial hyperplasia includes abnormal, prolonged, heavy periods; bleeding between periods; shorter than 21 days’ menstrual cycles; and bleeding after menopause. Also, diagnosis is established by vaginal ultrasound scan, dilatation and curettage, or hysteroscopy.Nurs 6551 Week 9 Assignment Paper

23rd ed. Philadelphia, PA: Lippincott Williams &.Wilkins; 2014presentation, physical findings during examination; and diagnostic results are not synonymous with the signs and symptoms; physical examination finding, risk factors and diagnostic

results associated with endometrial hyperplasia (American College of Obstetricians and Gynecologist, 2016).Nurs 6551 Week 9 Assignment Paper

Management Plan

Diagnosis: The only definitive diagnosis of adenomyosis is established after uterus is examined post hysterectomy. However, clinical findings that helped in the diagnosis of the patient includes enlarged, asymmetrical, soft, boggy and tender uterus during pelvic examination and aforementioned sonographic and MRI findings, which synonymous with the diagnosis of adenomyosis (Sakhel & Abuhamad, 2012).Nurs 6551 Week 9 Assignment Paper

Treatment: Treatment was considered based on the patient clinical presentations, and collaborative agreement with the patient, the author, and the preceptor for total hysterectomy after explanation of the treatment options to the patient. Patient selected hysterectomy because patient does not want to have another child. According to Schuiling and Likis (2013) explanations, patient was advised to continue with the over-the counter anti-inflammatory drug: Motrin 200-400 mg orally every 4-6 hours as needed for pain and cramping until hysterectomy is performed. Also, Ferrous sulfate 325 mg orally three times a day for anemia was prescribed. Patient was educated to take the medication on an empty stomach one hour before meal or 2 hours after meal for optimum absorption.Nurs 6551 Week 9 Assignment Paper

Patient Education: Patient was educated on the risk factors for adenomyosis, the causes, symptoms, diagnosis, and treatment options. Patient was educated that most women with adenomyosis does not have any symptoms, but adenomyosis is usually found after the tissue obtained from the uterus has been biopsied after pelvic surgery. Patient was also informed that the C-section she had twice during child birth may have put her at risk for adenomyosis. Patient was informed that the symptoms of adenomyosis goes away after menopause or after hysterectomy.Nurs 6551 Week 9 Assignment Paper Patient was educated that all options of treatment must be tried before hysterectomy, but patient opted for hysterectomy without trying all options of treatment. furthermore, patient was educated to continue the home remedy, such as continuation of the use of the heating pad, warm soak bath, and continuing with the over the counter Motrin to alleviate the pain associate with the condition. Finally, patient was educated on the psychological and emotional effects of adenomyosis and hysterectomy surgery because some women grieve on the loss of their womb, which may put them into depression as a result of that; the patient has to be completely sure that she really wants to do the surgery at her age now or wait and do the surgery in the future (University of Maryland Medical Center, 2016).Nurs 6551 Week 9 Assignment Paper

Follow Up Care: In consideration of the Schuiling and Likis (2013) discussion, patient was schedule to follow-up in 6 weeks for follow-up on the patient’s anemia and surgical work up labs, such as complete blood count, complete metabolic panel, prothrombin time and international normalized ratio(PT/INR). Also, an electrocardiogram (EKG) and chest x-ray was ordered to rule out any cardiac problem that would complicate the hysterectomy surgery. The patient’s H/H came up to 11.5/38.9 and all the other laboratory and diagnostic result was normal. The Total hysterectomy surgery was performed on 7/27/2016. Surgery was successful, and patient was schedule to follow up in six eek post-surgery.Nurs 6551 Week 9 Assignment Paper

Conclusion Comment by DeAllen B Millender: Level 1 headings are centered, in bold print, and in ‘Title Case’ (Chapter 3, 3.03, pp. 62-63; see Table 3.1 and Figure 2.1).

The author selected a patient at the author’s clinical site, and obtained a complete health history following the patient care from the beginning of the clinical up to 9 weeks of clinical. The author also used the patient health information and clinical presentation to come up with a diagnosis of adenomyosis. The author developed an appropriate treatment plan with the patient in collaboration with the author’s preceptor incorporating the author’s classroom knowledge with the author’s chosen nursing theorist. Finally, the patient was educated on the condition and follow up care.Nurs 6551 Week 9 Assignment Paper

Reflect on your Practicum Experience and select a female patient whom you have examined with the support and guidance of your Preceptor.

Think about the details of the patient’s background, medical history, physical exam, labs and diagnostics, diagnosis, treatment and management plan, as well as education strategies and follow-up care.Nurs 6551 Week 9 Assignment Paper

To complete

Write an 8- to 10-page comprehensive soap Note paper on Abnormal Uterine Bleeding , that addresses the following:

Age, race and ethnicity, and partner status of the patient

Current health status, including chief concern or complaint of the patient

Contraception method (if any)

Patient history, including medical history, family medical history, gynecologic history, obstetric history, and personal social history (as appropriate to current problem)

Review of systems

Physical exam

Labs, tests, and other diagnostics

Differential diagnoses

Management plan, including diagnosis, treatment, patient education, and follow-up care.Nurs 6551 Week 9 Assignment Paper

PLEASE FOLLOW ASSIGNMENT CRITERIA AND SAMPLE PAPER ATTACHED WITH THIS ASSIGNMENT. 100% ORINALITY AND APA FORMATE IS REQUIRED. DO NOT COPY SAMPLE PAPER , JUST FOLLOW THE PATTERN.

References

Schuiling, K. D., & Likis, F. E. (2013). Women’s gynecologic health (2nd ed.). Burlington, MA: Jones and Bartlett Publishers.

Chapter 5, “Gynecologic Anatomy and Physiology” (pp. 81–101)

Chapter 6, “Gynecologic History and Physical Examination” (pp. 103–131)
Tharpe, N. L., Farley, C., & Jordan, R. G. (2013). Clinical practice guidelines for midwifery & Women’s health (4th ed.). Burlington, MA: Jones & Bartlett Publishers.Nurs 6551 Week 9 Assignment Paper

Chapter 6, “Care of the Well Woman Across the Life Span
“Preventive Health Care for Well Women” (pp. 263–265)
. Retrieved from http://www.womenshealth.gov/screening-tests-and-vaccines/screening-tests-for-women/Screening tests and vaccinesU.S. Department of Health and Human Services. (2012b). Care of the Well Woman: Health Assessment and Screening” (pp. 265–270)
Society for Reporoductive Endocrinology and Infertility. (2012). Abnormal uterine bleeding. Retrieved from http://www.socrei.org/BOOKLET_abnormal_uteine_bleeding/

Taran, F. A., Stewart, E. A., & Brucker, S. (2013). Adenomyosis: Epidemiology, risk factors, clinical phenotype and surgical and interventional alternative to hysterectomy. Geburtshilfe Frauenheilkunde, 73(9), 924-931.Nurs 6551 Week 9 Assignment Paper

Welcome to the School of Social Sciences and Education. Degree opportunities include the Associate in Arts, Associate in Science and Associate in Applied Science degrees, and one year certificate programs. As soon as you choose a degree program, you’ll begin to concentrate your studies in a specific area, and shape your education to increase depth and breadth of study.Nurs 6551 Week 9 Assignment Paper

How can a nurse practitioner decide what is important to focus on in a 15- to 30-minute appointment with a woman seeking primary care? Students in this course gain opportunities to teach and promote wellness in women through the process of screening for commonly seen in gynecological disorders. Students learn to analyze data to interpret results for the benefit of women seeking assistance with planning healthy lifestyle behaviors. They also gain clinical experience in a primary healthcare setting that provides opportunities to increase competence in diagnosis, treatment, referrals, or follow-up care with a concentration on improving patient outcomes.Nurs 6551 Week 9 Assignment Paper

How can a nurse practitioner decide what is important to focus on in a 15- to 30-minute appointment with a woman seeking primary care? Students in this course gain opportunities to teach and promote wellness in women through the process of screening for commonly seen in gynecological disorders. Students learn to analyze data to interpret results for the benefit of women seeking assistance with planning healthy lifestyle behaviors. They also gain clinical experience in a primary healthcare setting that provides opportunities to increase competence in diagnosis, treatment, referrals, or follow-up care with a concentration on improving patient outcomes.Nurs 6551 Week 9 Assignment Paper

Health has many definitions, but the Gospel leads us to view “human health” as the reconciling of relationships among God, our neighbor, Creation, and our self. Studying health sciences within a Christian liberal arts setting allows students to participate in this reconciliation-ministry by understanding how the skills and knowledge acquired through their education can be used to help others move toward optimal health, healing, and wholeness. Our students learn—through global health opportunities, local preventative medicine and clinical experiences, and classroom development—to articulate a clear theological framework for defining and improving human health.Nurs 6551 Week 9 Assignment Paper

While students interested in medical or health professional school are all required to take natural science classes, these students are not limited to “hard” science majors. Humanities and social and behavioral science majors can take the prerequisite MCAT classes in the Pre-Med curriculum; apply to PA, OT, PT, dentistry, veterinary, medical, and other healthcare schools; and be accepted. Discussing how undergraduate humanities or social and behavioral science classes play into the healthcare field could be a great addition to a graduate or professional school application.Nurs 6551 Week 9 Assignment Paper

All students interested in preparing for healthcare professional and graduate school programs are encouraged to take health psychology, motivation psychology, medical ethics, medical anthropology, public health, nutrition, exercise as medicine, sustainable agriculture, and environmental health courses.

If you are interested in a humanities or social science major and Pre-Med, talk to your Admissions Counselor about adding the MCAT-prep curriculum to your degree.Nurs 6551 Week 9 Assignment Paper

Health Science in Practice
At Taylor, we seek to shape you on and off campus for your goal of entering the health field. Through interdisciplinary programs, you will have the ability to gain top-of-the-line, hands-on experience in biology, chemistry, kinesiology, public health, and psychology. You can train clients in better health practices, assist in rehabilitation of hospital patients, or teach community members how to prevent and/or treat chronic disease.Nurs 6551 Week 9 Assignment Paper

Diabetes Prevention Program
Taylor’s newly minted adult diabetes prevention program brings Taylor student into the local health clinics for nutrition and exercise intervention sessions, as well as individual health education, provided by Taylor students. The curriculum, approved by the Center for Disease Control (CDC), is designed to help individuals at risk of diabetes or other chronic diseases. Participating students take a semester-long training course that covers nutrition education principles, behavior modifications and listening skills, exercise prescription, and medical ethics.Nurs 6551 Week 9 Assignment Paper
Cardiac Rehabilitation
In collaboration with Ball Memorial Hospital (part of IU Health), this program brings patients to campus for a sustained maintenance cardiac rehab program, which focuses primarily on exercise. Students work with a member of Ball Memorial’s cardiopulmonary team to provide patients with appropriately tailored exercise sessions. The students check patients’ vital signs and monitor them during exercise while creating patient-professional relationships with members of the community.
IU Health Ball & Blackford Internships
Our students intern in the IU Health Blackford and Ball hospitals, participating in valuable observations and experiences. You will assist cardiopulmonary teams in a variety of cardiac rehabilitation opportunities—including cardiovascular surgery, echocardiograms, heart catheterization, nutrition and chronic disease coaching, and bariatric and oncology services.Nurs 6551 Week 9 Assignment Paper
Research Opportunities
From assessing the genetics of fruit flies to studying the fitness levels of prison inmates, there are ample research opportunities for students in any of the sciences. Along with ongoing on-campus studies, students can apply for research fellowships at scientific institutions or earn academic credit conducting immersive public health research in international settings.Nurs 6551 Week 9 Assignment Paper
Fit into Health
A personal training program run by exercise science students, Fit into Health, brings fitness-minded students alongside adults looking to maintain and improve their health. Students assess their clients’ fitness and health and design workouts to help them reach their fitness and health goals. One-on-one exercise sessions take place on campus in the Kesler Student Activities Center (KSAC).
Global Opportunities
Building a deeper understanding of the health sciences means exploring how different cultures approach medical care and disease. Taylor offers both long- and short-term overseas experiences to expand students’ global awareness and understanding of how to use their healthcare skills in the real world. Read more about international opportunities specifically designed for those interested in healthcare fields.Nurs 6551 Week 9 Assignment Paper

Semester Programs
Universidad del Azuay: Spend a semester in Ecuador and gain hospital experience through Taylor’s program in partnership with Verbo Church and the Universidad del Azuay (UdA) School of Medicine.
Ugandan Christian University Honours College*: Study abroad in Uganda with a Global Health Emphasis and complete an international internship with a hospital, clinic, child development center, or public health organization.Nurs 6551 Week 9 Assignment Paper
J-Term Programs
Belize: Teach basic exercises and healthy habits in the children’s homes, churches, senior living facilities, and schools of Belmopan, Belize. Our multi-disciplined teams volunteer in the community and connect with the Belizean through spreading the news of health, exercise, and the Gospel.
HEART Program*: Spend your J-Term in Lake Wales, Florida, to work in simulated third-world village, learning nutrition and food preparation and primary health care to prepare to serve in developing third-world countries.Nurs 6551 Week 9 Assignment Paper
Spring Break Trips
Students International*: Travel to the Dominican Republic to serve in their dentistry ministry site, meeting both physical and spiritual needs of locals as you develop relationships and share God’s love through your interactions.
*Programs are not directly associated with the Health Science programs. Contact the Office of Off-Campus Programs for more information.Nurs 6551 Week 9 Assignment Paper

Choosing Your Major
Our many Health Science majors will help shape a broad understanding of human health as informed by the sciences, humanities, and social sciences. While many of these health majors may include similar classes, each has a unique target outcome for its students.

Click on the name of any major below to learn more.
Human Physiology and Preventive Medicine
Designed specifically for students seeking to enter into professional schools related to healthcare, the Human Physiology and Preventive Medicine major first explores a basic foundation of health science, followed by in-depth chronic disease prevention and treatment and physiology courses. Students will gain a basic background in human nutrition, health psychology, and public health.Nurs 6551 Week 9 Assignment Paper
Biology Pre-Med
Pursue a Biology major as a foundation for a career in medicine, dentistry, and related fields. Your study of living organisms will be supplemented with hands-on medical experiences and the Pre-Med curriculum—a series of MCAT preparation classes in Biology, Chemistry, Physics, and Psychology that are necessary for graduate school applications.
Psychology Pre-Med
Apply your passion for psychology to a medical career. Develop your understanding of the mind and how it impacts behavior while adding the Pre-Med classes, the prerequisite science classes for medical school admission.Nurs 6551 Week 9 Assignment Paper
Chemistry Pre-Med
Add the Pre-Med curriculum to a rigorous Chemistry major. The MCAT-prep courses in the Pre-Med curriculum will give you the prerequisites for med school, and your Chemistry classes will challenge you to predict and characterize chemical properties and study the ways various substances act and react.
Health Science (Nursing 3+1 Program)
For students wanting to pursue a career in nursing, this program pairs with a neighboring university’s Nursing program and allows you to earn two degrees, a Bachelor’s in Health Science and a Bachelor of Science in Nursing (BSN).
Health Promotion & Wellness
The Health Promotion and Wellness major appeals to students interested in researching and educating people about preventing chronic health issues, such as diabetes and obesity. This major crosses Public Health with Kinesiology, giving students an interdisciplinary study to prepare for disease prevention research, analysis, and education.Nurs 6551 Week 9 Assignment Paper
Public Health
Students passionate about people, health, and social justice issues will find the Public Health major useful. Look past the basic biology of problems and diseases to identify societal issues that contribute to community health and develop solutions.Nurs 6551 Week 9 Assignment Paper
Exercise Science
Choose between our two extremely different Exercise Science tracks. Students interested in physical therapy, occupational therapy, or clinical exercise physiology commonly choose the Pre-Allied Health track to prepare them for graduate school. This track also suits students thinking about med school or PA school, allowing students to complete a core of Exercise Science classes in addition to the chemistry, biology, physics, and psychology necessary for graduate school acceptance. In contrast, students interested in athletic training, strengthening and conditioning, personal training, and corporate wellness will find the Health Science—Human Performance track well-suited to prepare them for careers or graduate school in these settings.Nurs 6551 Week 9 Assignment Paper
Preventive Medicine*
Students following the more traditional paths to professional schools in medicine and healthcare (i.e. biology or chemistry) or choosing majors that would not typically be associated directly with health care but related to human health (social work, music therapy, missions) may choose to complete a minor or certificate in preventative medicine, where they can still gain valuable experience working to prevent and treat chronic disease.Nurs 6551 Week 9 Assignment Paper

The Nursing Division of the Spiritual Care Association focuses on the spiritual dimension of professional nursing practice including registered nurses, advanced practice and specialty practice nurses from a wide variety of hospital and non-hospital-based settings.

The Nursing Division of the Spiritual Care Association supports the advancement of the spiritual care component of nursing practice as an integral aspect of high-quality whole person care for all including the professional providing the care.Nurs 6551 Week 9 Assignment Paper

Mission:

Our mission is to support best-practice nursing spiritual care and self-care through education, mentoring, and resources for nursing professionals and nursing-related organizations.Nurs 6551 Week 9 Assignment Paper

Vision:

All nurses will have access to high quality, practical spiritual care information.
Nurses specializing in spiritual care as a component of whole-person care will be recognized for their expertise.
Nursing-related organizations will work in partnership with SCA to improve health outcomes and support the health of professional care providers.Nurs 6551 Week 9 Assignment Paper

Why Join?
If you are a nurse interested in incorporating spiritual care into your practice, the Nursing Division of the Spiritual Care Association is perfect for you.

Advance your career! Learn about the specialty practice of faith community nursing and spiritual care aspects of professional nursing through resources, courses, and presentations from national & international experts. As you develop knowledge of spiritual care and strengthen your understanding of other faiths and cultures, you will also start to discover your inner self as you strengthen your personal spirituality. Nurs 6551 Week 9 Assignment PaperAs a member of the Nursing Division of SCA, you will discover opportunities to find fellowship with nursing colleagues and other allied health professions such as social workers and chaplains, work with a mentor or become a mentor to increase your confidence as a healthcare provider assisting hospitals and other healthcare organizations to integrate spiritual care back into health. Be a force in moving high-quality healthcare forward and support the future of nursing practice that improves outcomes by including steps to honor beliefs and aspects of faith that influence healthcare decisions for all faiths and perceptions of spirituality. You have a voice!

Benefits of membership include:

Belong to a supportive professional community that welcomes both novice and seasoned nurses
Access to current best-practice standards of spiritual care for those of all faiths and no faith preference. Nurs 6551 Week 9 Assignment PaperBe notified of new research publications related to spiritual care and the specialty practice of faith community nursing
Discounted price for online professional educational courses
Three free Spiritual Care Grand Round Webinars annually with CNE credit
Discounted registration for the Annual Westberg Symposium at the Caring for the Human Spirit® Conference
Free electronic subscription to the Journal of HealthCare Chaplaincy
Free subscription to the Caring for the Human Spirit® Magazine
Free Spiritual Care Tip of the Day emailed to you
Free newsletters
Membership directory and networking opportunities
Access to archived webinars and articles related to nursing & spiritual care
Faith community nurse practice information and mentoring
Faith Community Nurse leadership development
Opportunities to present at the national level and/or publish an article or be featured in our nursing spotlight column
Expand your professional value by adding a chaplain certification to your portfolio
Access to nursing expert
SCA Membership card will be mailed to you

Society for Reproductive Endocrinology and Infertility (SREI, 2012) described abnormal uterine bleeding as bleeding that differs in quality and quantity from normal menstrual bleeding, such as women spotting or bleeding between the women’s menstrual periods; bleeding after sex; bleeding heavier or last more days than normal; and bleeding post menopause. According to SREI (2012), factors that can cause abnormal bleeding include structural abnormalities of the reproductive system, such as uterine polyps, fibroids, and adenomyosis.Nurs 6551 Week 9 Assignment Paper Furthermore, SREI (2012) explained that vaginal, uterine or cervical lesions, miscarriage, ectopic pregnancy, endometritis, adhesions in the endometrium, and use of an intrauterine device (IUD) can also cause abnormal bleeding. Johns Hopkins Medicine (2016) specified that early recognition of abnormal bleeding, and seeing a health care provider immediately for appropriate diagnosis and treatment increase the chance of successful treatment. Therefore, the author will focus on a single patient comprehensive evaluation, which includes the patient’s personal/health history; physical examination; laboratory/diagnostic tests; diagnosis; treatment/management plan; education strategies; and follow-up care. Comment by DeAllen B Millender: Good introduction.Nurs 6551 Week 9 Assignment Paper

General Patient Information

Age: 41-year-old

Race/Ethnicity: Hispanic American

Partner Status: Married Comment by DeAllen B Millender: This information is not in APA format.

Current Health Status

Chief Complaint: “I have heavy, prolonged menstrual bleeding with severe cramping for the past one year”.

History of Present Illness (HPI): RG is a 41-year-old Hispanic American female who presented to the clinic with complaint of heavy prolonged menstrual bleeding with severe cramping for the past one year. Patient reported sharp pelvic pain during menstruation, bleeding between periods, pain with intercourse, blood clots during periods. Abdominal pain/pressure and bloating. Patient suggested that these symptoms started after her second caesarean section surgery one year ago. Patient also reported that she takes over-the counter medication, such as ibuprofen to relieve the pain. she also suggested that she uses heating pad on her abdomen/pelvic for pain relief, and she stated that she soaks in a warm sitz bath to ease pelvic pain and cramping. Patient also reported fatigue and weakness. Patient further stated that she decided to see an obstetrician and gynecologist (OB/GYN) because the heavy prolonged bleeding with severe menstrual cramp interfere with her regular activities. Patient denied nausea, vomiting, diarrhea, fever, and chills.Nurs 6551 Week 9 Assignment Paper

Timing/Onset: Patient said one year ago.

Location: The location of the problem as stated by the patient is pelvic/uterus/vaginal.

Duration: 5 to7 days during periods for the past one year.

Quality/Characteristic: Patient reported heavy prolonged menstrual pain; severe, sharp lower abdominal/pelvic cramping/pain, and blood clots during periods.

Aggravating Factors: Monthly periods as stated by the patient.

Relieving/Alleviating Factors: Patient stated that ibuprofen pain medication, heating pad, and/or warm sitz bath help the pain/cramping.Nurs 6551 Week 9 Assignment Paper

Severity: The severity of the pain/cramping on a pain scale is 10/10 reported by the patient.

Treatments/Therapies: Patient stated that she had not undergone any treatment for the reported problems.

Last Menstrual Period: The last menstrual period reported by patient was 7/5/2016.

Sexual Activity Status: Patient reported being sexually active.

Barrier Prevention: Patient stated she uses natural barrier methods.

Sexual Preference: Patient sexual preference is monogamous/heterogeneous relationship.

Satisfaction with Sexual Activity: Patient reported that she is sexually satisfied with her partner.

Contraception Method: Patient denied using any contraception method.Nurs 6551 Week 9 Assignment Paper

Patient History

Past medical History (PMH): Anemia and C-section. Patient was delivered full term through vaginal delivery without complications. The birth weight was 8 pounds 10 oz.

Psychological/Mental Health: Patient denied depression, mood swings, anxiety, or mental health problem.

Medications: RG reported that she takes over the counter Motrin 200-400 mg orally every 4-6 hours as needed for pain and cramping.

Allergies: Patient reported no known allergies (NKA).

Past Surgical/Hospitalization History: Patient reported history of C-section twice, and she was hospitalized for 3 days post the C-sections.

Preventive Screening: Patient reported that she had flu shot on 11/20/2015; last mammogram was 2/12/2015 and mammogram was normal; Pap smear was on 2/20/2015, which was also normal; patient also reported that she was up to date with her childhood immunization, but denied pneumococcal vaccination.Nurs 6551 Week 9 Assignment Paper

Family History: Both father and mother have history of diabetes mellitus type 2 and hypertension. Both parents are still living, and two siblings are still living and well.

Gynecological History: Patient is multipara with 2 pregnancy resulting in two viable offsprings. Patient had her first child at the age of 33 years. Menarche at age 13; periods last between 5 to 7 days. Patient reported heavy prolonged menstrual bleeding with severe cramping; sharp pelvic pain during menstruation; and bleeding between periods for the past one year. Denied vaginal discharge or sexually transmitted infection/disease.

Obstetric History: Gravida 2, Para 2, term 2, preterm 0, spontaneous abortion 0, and living 2 (G2T2P2A0L2). Gravida 1: Delivered at 39 weeks by C-section on 4/20/08 male; Gravida 2: Delivered at 40 weeks by C-section on 2/18/15 female. Patient denied therapeutic abortion (TAB) or spontaneous abortion (SAB); Patient denied preterm or low birth weight baby with no delivery complications. Patient also denied having sexual transmitted disease.Nurs 6551 Week 9 Assignment Paper

Personal/Social History: Patient is married with 2 children, and lives at home with the husband. Patient is a college graduate; works outside the house as a nurse at a nearby hospital. Patient’s husband works for a computer company. Patient family is a middle income family. Also, patient denied any physical or psychological abuse. Patient denied being exposed to any environmental or occupational health hazards. Patient also denied alcohol consumption, tobacco, or recreational drug use. Patient denied participating in any exercise or physical activity because she is tired after work, and prefers to rest. Patient reported that she eats healthy; she eats low fat, low carbohydrate meals, and she eats fruits and vegetable at least 3 to 4 times a week. Patient stated

that she sleeps well at night, and she usually goes to bed at 9 pm and wakes up at 6 am. Patient drinks a cup of coffee occasional, especially when she is at work to be awake.Nurs 6551 Week 9 Assignment Paper

Review of System (ROS)

General: RG admitted fatigue and weakness; denied fever /chills; and no weight loss.

Head and Neck: Patient denied headache or dizziness. Patient also denied lumps, neck injury, pain/tenderness or jugular vein distention.Nurs 6551 Week 9 Assignment Paper

Chest: Patient denied chest pain, cough or shortness of breath.

Heart: RG denied irregular heartbeats, heart attack, or heart murmur.

Breasts: Patient denied nipple discharge, tenderness or swelling.

Gastrointestinal: Patient admitted lower abdominal pain, pressure, and bloating; denied constipation, nausea, vomiting, and diarrhea.

Genitourinary: RG denied urinary tract infection, urinary frequency or burning on urination.

Genital: Patient admitted heavy prolonged menstrual bleeding with severe cramping for one year. Patient admitted sharp pelvic pain during menstruation, bleeding between periods, pain with intercourse, and blood clots during periods. Patient denied vaginal discharge.Nurs 6551 Week 9 Assignment Paper

Musculoskeletal: RG denied varicosities or extremities problem.

Psychiatric: RG denied depression, anxiety, or any psychiatric problems.

Neurological: Patient admitted fatigue and weakness; denied confusion, seizures, or tingling.

Hematologic: Patient admitted history of anemia; denied blood transfusion or easily bruise or bleeding.Nurs 6551 Week 9 Assignment Paper

Physical Examination

General exam: Patient appeared well developed and pleasant with good hygiene. Patient also appeared pale and weak. Vital signs: Blood pressure 118/76, heart rate 80, respiration 18,

temperature 98.8, pulse ox 100% on room air. Weight 78.2 kg, height 67 inches, and body mass index (BMI) 27.

HEENT: The head is normaceplalic, atraumatic. The pupils are equal, round, and reactive to light and accommodation. Extraocular movements are intact. Tympanic membrane is gray bilaterally. Oral mucosa is dry. Oropharynx is clear. Nares are patient, no nasal or septal deviation noted. No pharyngeal erythema.Nurs 6551 Week 9 Assignment Paper

Neck: Noted to be supple without jugular vein distention (JVD), thyromegaly or lymphadenopathy.

Lungs: Noted to be clear to auscultation throughout the lobes; no wheezes or rhonchi noted.

Cardiovascular: Regular rate and rhythm on auscultation, S1 S2 present without murmurs. Palpable pulses noted without peripheral edema.Nurs 6551 Week 9 Assignment Paper

Gastrointestinal: Bowel sounds are active in all quadrant. Abdomen is soft and tender on palpation.

Breast: The size of the breasts, areolas, and nipples are round and symmetrical with no discoloration, rash, lesions, dimpling, or retraction bilaterally; no masses, lumps, or tenderness noted on palpation bilaterally; and axillary lymph nodes non-palpable.

Pelvic Examination:

Vulva: The hair distribution is normal; no lesion noted.

Vagina: Vaginal walls are pink, and pubic hair is shaven; no lesions, masses, inflammation or discharge noted.Nurs 6551 Week 9 Assignment Paper

Cervix: Intact cervix with closed os.

Uterus: Enlarged, asymmetrical, soft, boggy and tender.

Laboratory and Diagnostic Tests

Laboratory Test and Results: Pregnancy test: Result is negative. Hemoglobin and Hematocrit (H/H): Result showed H/H 8.7/26.7, which is positive for anemia.Nurs 6551 Week 9 Assignment Paper

Diagnostic:

Transvaginal ultrasonography of the uterus: Revealed uterine enlargement measuring 12 cm with no leiomyomata; uterine wall thickening; cystic anechoic spaces in the myometrium; heterogeneous echo texture; obscured endometrial/myometrial border; sub endometrial echogenic linear striations; and thickening of the transition zone measuring 12.8 millimeter. The transvaginal sonography is used to rule out possible uterine tumor (Sakhel & Abuhamad, 2012).Nurs 6551 Week 9 Assignment Paper

Magnetic Resonance Imaging (MRI): MRI is ordered to obtain a high resolution image of the uterus as well as verifying/confirming the suspected diagnosis. The MRI result revealed that the junctional zone of the uterus is thickened and measures 12.8 millimeter. Also, MRI revealed an ill-defined ovoid and diffuse region of thickening with striated appearance (Sakhel & Abuhamad, 2012).

Differential Diagnoses

The differential diagnoses of the patient clinical presentation as described by Schuiling and Likis (2013) include: Adenomyosis, uterine fibroids and endometrial hyperplasia. However, the primary diagnosis for the patient is Adenomyosis.Nurs 6551 Week 9 Assignment Paper

Adenomyosis: Schuiling and Likis (2013) described adenomyosis as a benign, common condition that involves the movement of endometrial tissue into the uterine muscles. The definitive cause of the adenomyosis is unknown, but the condition is common among women with elevated levels of estrogen; the condition usually ceases post menopause when estrogen levels are reduced. Risk factors explained by Taran, Stewart, and Brucker (2013) include multiparity; previous uterine surgery, such as C-section, dilatation/curettage, or fibroids

removal surgery; and women at reproductive age, especially between the age of 40s or 50s. furthermore, Taran et al. (2013) specified that the clinical presentation entails chronic pelvic pain, prolonged menstrual cramps, heavy menstrual bleeding, spotting between periods, abdominal tenderness, painful intercourse, longer periods than normal, blood clots during periods. Taran et al. (2013) also explained that finding during physical examination include enlarged, tender, soft and boggy uterus. According to Taran et al. (2013) diagnosis is made based on sonographic or MRI results, and treatment is not recommended for women with mild form of adenomyosis, except when the symptoms interfere with daily activities. Taran et al. (2013) further explained that treatment options include anti-inflammatory medications; hormonal treatments; endometrial ablation; uterine artery embolization, MRI-guided focused ultrasound surged or hysterectomy, which is the definitive treatment for adenomyosis.Nurs 6551 Week 9 Assignment Paper

Adenomyosis is selected as the primary diagnosis because the aforementioned patient’s clinical presentation, physical examination findings, and diagnostic tests results are synonymous with adenomyosis aforementioned associated signs and symptoms; risk factors; physical examination findings; and diagnostic test results.Nurs 6551 Week 9 Assignment Paper

Uterine Fibroids: Women’s Health (WH, 2015) described uterine fibroid to be muscular tumors that develop in the uterine wall, which can also be referred to as leiomyoma or myoma. Uterine fibroids are usually non-cancerous, and can be single or multiple tumors in the uterus. According to WH (2015), women risk for developing uterine fibroid are increased by age, such as women in their 30s and 40s until menopause when the fibroids commonly shrink. Other risk factors include family history, ethnic origin, obesity and eating habits. Symptoms of fibroids as explained by WH (2015) involve lower back pain; pain during sex; heavy bleeding; painful menses, enlarged lower abdominal, frequent urination; and lower abdominal/pelvic feeling of fullness. Physical examination shows reveal painless, firm, irregular pelvic mass. According to WH (2015), diagnosis is done using transvaginal ultrasound, MRI, hysteroslpingography, hysteroscopy, and endometrial biopsy. Fibroid is not selected as the primary diagnosis because there is no visualization of the fibroid during pelvic examination or on sonography test. Moreover, severe pain is noted during pelvic exam. Furthermore, sonographic result is more consistent with adenomyosis rather than fibroids.Nurs 6551 Week 9 Assignment Paper

Endometrial Hyperplasia: Cancer Research of United Kingdom (CRUK, 2014) described endometrial hyperplasia as thickening of the covering of the uterus due to excessive growth of the cells that covers the uterus, and endometrial hyperplasia can lead to womb cancer. Risk factors according to CRUK (2014) include- age over 35 years; white race; nulliparity; older age at menopause; obesity; cigarette smoking; family history of ovarian, colon, or uterine cancer; early menarche; and history of diabetes, polycystic ovary syndrome, thyroid disease and gallbladder disease. The CRUK (2014), explained that the condition is caused by imbalance of to the estrogen and progesterone. According to CRUK (2014), signs and symptoms of endometrial hyperplasia includes abnormal, prolonged, heavy periods; bleeding between periods; shorter than 21 days’ menstrual cycles; and bleeding after menopause. Also, diagnosis is established by vaginal ultrasound scan, dilatation and curettage, or hysteroscopy.Nurs 6551 Week 9 Assignment Paper

23rd ed. Philadelphia, PA: Lippincott Williams &.Wilkins; 2014presentation, physical findings during examination; and diagnostic results are not synonymous with the signs and symptoms; physical examination finding, risk factors and diagnostic

results associated with endometrial hyperplasia (American College of Obstetricians and Gynecologist, 2016).Nurs 6551 Week 9 Assignment Paper

Management Plan

Diagnosis: The only definitive diagnosis of adenomyosis is established after uterus is examined post hysterectomy. However, clinical findings that helped in the diagnosis of the patient includes enlarged, asymmetrical, soft, boggy and tender uterus during pelvic examination and aforementioned sonographic and MRI findings, which synonymous with the diagnosis of adenomyosis (Sakhel & Abuhamad, 2012).Nurs 6551 Week 9 Assignment Paper

Treatment: Treatment was considered based on the patient clinical presentations, and collaborative agreement with the patient, the author, and the preceptor for total hysterectomy after explanation of the treatment options to the patient. Patient selected hysterectomy because patient does not want to have another child. According to Schuiling and Likis (2013) explanations, patient was advised to continue with the over-the counter anti-inflammatory drug: Motrin 200-400 mg orally every 4-6 hours as needed for pain and cramping until hysterectomy is performed. Also, Ferrous sulfate 325 mg orally three times a day for anemia was prescribed. Patient was educated to take the medication on an empty stomach one hour before meal or 2 hours after meal for optimum absorption.Nurs 6551 Week 9 Assignment Paper

Patient Education: Patient was educated on the risk factors for adenomyosis, the causes, symptoms, diagnosis, and treatment options. Patient was educated that most women with adenomyosis does not have any symptoms, but adenomyosis is usually found after the tissue obtained from the uterus has been biopsied after pelvic surgery. Patient was also informed that the C-section she had twice during child birth may have put her at risk for adenomyosis. Patient was informed that the symptoms of adenomyosis goes away after menopause or after hysterectomy. Patient was educated that all options of treatment must be tried before hysterectomy, but patient opted for hysterectomy without trying all options of treatment. furthermore, patient was educated to continue the home remedy, such as continuation of the use of the heating pad, warm soak bath, and continuing with the over the counter Motrin to alleviate the pain associate with the condition. Finally, patient was educated on the psychological and emotional effects of adenomyosis and hysterectomy surgery because some women grieve on the loss of their womb, which may put them into depression as a result of that; the patient has to be completely sure that she really wants to do the surgery at her age now or wait and do the surgery in the future (University of Maryland Medical Center, 2016).Nurs 6551 Week 9 Assignment Paper

Follow Up Care: In consideration of the Schuiling and Likis (2013) discussion, patient was schedule to follow-up in 6 weeks for follow-up on the patient’s anemia and surgical work up labs, such as complete blood count, complete metabolic panel, prothrombin time and international normalized ratio(PT/INR). Also, an electrocardiogram (EKG) and chest x-ray was ordered to rule out any cardiac problem that would complicate the hysterectomy surgery. The patient’s H/H came up to 11.5/38.9 and all the other laboratory and diagnostic result was normal. The Total hysterectomy surgery was performed on 7/27/2016. Surgery was successful, and patient was schedule to follow up in six eek post-surgery.Nurs 6551 Week 9 Assignment Paper

Conclusion Comment by DeAllen B Millender: Level 1 headings are centered, in bold print, and in ‘Title Case’ (Chapter 3, 3.03, pp. 62-63; see Table 3.1 and Figure 2.1).

The author selected a patient at the author’s clinical site, and obtained a complete health history following the patient care from the beginning of the clinical up to 9 weeks of clinical. The author also used the patient health information and clinical presentation to come up with a diagnosis of adenomyosis. The author developed an appropriate treatment plan with the patient in collaboration with the author’s preceptor incorporating the author’s classroom knowledge with the author’s chosen nursing theorist. Finally, the patient was educated on the condition and follow up care.Nurs 6551 Week 9 Assignment Paper

Endocrine and musculoskeletal conditions, especially when left untreated, can have a significant impact on women’s health. Many of these conditions present unique challenges for women, making risk assessments and routine screenings an important part of primary care. As an advanced practice nurse, you must identify signs and symptoms of these conditions and educate at-risk patients so they can also monitor themselves. For this Discussion, consider how you would diagnose, treat, and educate the patients in the following three case studies:Nurs 6551 Week 9 Assignment Paper

Case Study 2 (diagnosis Polycystic Ovary Syndrome)
A 28-year-old Latina obese female presents to the clinic with increasing body hair and irregular menses. She now has coarse body hair on her chest and upper back. Her menstrual periods used to be fairly regular, but now she can skip three or four months before her next menstrual cycle. She has never been pregnant. She has one male sex partner.Nurs 6551 Week 9 Assignment Paper

Case Study 3 ( diagnosismultiple sclerosis)
A 28-year-old Caucasian female comes to clinic concerned about three episodes of urinary incontinence associated with difficulty walking. The first two episodes resolved spontaneously after a couple of days without residuals, but this current episode has lasted a week. Today she began to have some blurred vision. Physical exam is remarkable for mild edema of the optic disc and difficulty with heel-to-toe walking. Deep tendon reflexes are 2+ and there is no extremity weakness.Nurs 6551 Week 9 Assignment Paper

To prepare:

Review Chapter 8 of the Tharpe et al. text and the McSweeney et al. article in this week’s Learning Resources.

Review and select one of the three provided case studies. Analyze the patient information.

Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.

Reflect on the appropriate clinical guidelines. Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.Nurs 6551 Week 9 Assignment Paper

Consider strategies for educating patients on the treatment and management of the disorder you identified as your primary diagnosis.

Post 250 words (no introduction or conclusion)
1. explanation of the differential diagnosis for the patient in the case study you selected.Nurs 6551 Week 9 Assignment Paper

2. Explain which is the most likely diagnosis for the patient and why.

3. Then, based on the appropriate clinical guidelines, explain a treatment and management plan for the patient, including proper dosages for any recommended treatments.Nurs 6551 Week 9 Assignment Paper

4. Finally, explain strategies for educating patients on the disorder.

How can a nurse practitioner decide what is important to focus on in a 15- to 30-minute appointment with a woman seeking primary care? Students in this course gain opportunities to teach and promote wellness in women through the process of screening for commonly seen in gynecological disorders. Students learn to analyze data to interpret results for the benefit of women seeking assistance with planning healthy lifestyle behaviors. They also gain clinical experience in a primary healthcare setting that provides opportunities to increase competence in diagnosis, treatment, referrals, or follow-up care with a concentration on improving patient outcomes.Nurs 6551 Week 9 Assignment Paper

Welcome to the School of Social Sciences and Education. Degree opportunities include the Associate in Arts, Associate in Science and Associate in Applied Science degrees, and one year certificate programs. As soon as you choose a degree program, you’ll begin to concentrate your studies in a specific area, and shape your education to increase depth and breadth of study.Nurs 6551 Week 9 Assignment Paper

As a future advanced practice nurse, it is important that you are able to connect your classroom experience to your Practicum Experience. By applying the concepts you study in the classroom to clinical settings, you enhance your professional competency. Each week you complete an Assignment such as Journal Entries or SOAP Notes that prompts you to reflect on your Practicum Experiences and relate them to the material presented in the classroom. This week you begin documenting your Practicum Experiences in your Practicum Journal.Nurs 6551 Week 9 Assignment Paper

To prepare for this course’s Practicum Experience, address the following in your Practicum Journal: This is a Women’s Health Course

· Select and explain a nursing theory or feminist perspective to guide your clinical practice.

· Develop goals and objectives for the Practicum Experience in this course. When developing your goals and objectives, be sure to keep women’s health guidelines and best practices in mind.Nurs 6551 Week 9 Assignment Paper

Reflect on a patient who is beyond 20 weeks gestation and presented with a health problem that commonly arises during pregnancy. Describe the patient’s personal and medical history, drug therapy and treatments, and follow-up care. Then, explain the implications of the patient’s health problem. If you did not have an opportunity to evaluate a patient with this background during the last eight weeks, you may select a related case study from a reputable source or reflect on previous clinical experiences.Nurs 6551 Week 9 Assignment Paper

In the era of mass emigration and eldering society nursing is a very valuable and desirable profession. Student on this course must possess specialist knowledge about organization of patients’ healthcare process, therapeutic procedures and techniques, emergency rescue, rehabilitation process, preventive treatment, education and promotion of healthy lifestyle.
Professional nurse should be prepared to make quick decisions during their day-to-day work.Nurs 6551 Week 9 Assignment Paper

The Nursing programme is designed to implement theory into practice. Huge amount of programme hours is dedicated to nursing practice in hospitals and clinics. Our programme will
provide you with a solid grounding in all the key areas necessary for successful completion of your studies. To operate effectively within the healthcare environment, nurses are required to be able to implement and evaluate change by contributing to the ongoing development on their field.Nurs 6551 Week 9 Assignment Paper

Total didactic hours: 4790.
Over 3700 hours in core study programmes group, including:

Midwifery, Gynaecology and Gynaecological Nursing
Paediatrics and Paediatrics Nursing
Internal Diseases and Internal Medicine Nursing
Surgery and Surgical Nursing
Rehabilitation and Nursing of the Disabled
Geriatrics and Geriatric Nursing
Neurology and Neurological Nursing
Psychiatry and Psychiatric Nursing
Anaesthesiology and Nursing in a Threat to Life
Palliative Care
Principles of Medical Rescue
Dietetics
Research in Nursing
Benefits to You
High Salary – being a nurse means being well paid
The program is adjusted to the job market – nurses are most wanted on job market in EU
The study in English gives you a better chance for a career and overcomes the boundaries opening global job market for you
Professional staff – teachers with practice
Certification Opportunities

Nursing is my passion. Thanks to the studies I expanded and updated my knowledge. Modern teaching methods at the university made me aware that in this profession you must develop the knowledge all the time.Nurs 6551 Week 9 Assignment Paper

Society for Reproductive Endocrinology and Infertility (SREI, 2012) described abnormal uterine bleeding as bleeding that differs in quality and quantity from normal menstrual bleeding, such as women spotting or bleeding between the women’s menstrual periods; bleeding after sex; bleeding heavier or last more days than normal; and bleeding post menopause. According to SREI (2012), factors that can cause abnormal bleeding include structural abnormalities of the reproductive system, such as uterine polyps, fibroids, and adenomyosis.Nurs 6551 Week 9 Assignment Paper Furthermore, SREI (2012) explained that vaginal, uterine or cervical lesions, miscarriage, ectopic pregnancy, endometritis, adhesions in the endometrium, and use of an intrauterine device (IUD) can also cause abnormal bleeding. Johns Hopkins Medicine (2016) specified that early recognition of abnormal bleeding, and seeing a health care provider immediately for appropriate diagnosis and treatment increase the chance of successful treatment. Therefore, the author will focus on a single patient comprehensive evaluation, which includes the patient’s personal/health history; physical examination; laboratory/diagnostic tests; diagnosis; treatment/management plan; education strategies; and follow-up care. Comment by DeAllen B Millender: Good introduction.Nurs 6551 Week 9 Assignment Paper

General Patient Information

Age: 41-year-old

Race/Ethnicity: Hispanic American

Partner Status: Married Comment by DeAllen B Millender: This information is not in APA format.

Current Health Status

Chief Complaint: “I have heavy, prolonged menstrual bleeding with severe cramping for the past one year”.

History of Present Illness (HPI): RG is a 41-year-old Hispanic American female who presented to the clinic with complaint of heavy prolonged menstrual bleeding with severe cramping for the past one year.Nurs 6551 Week 9 Assignment Paper Patient reported sharp pelvic pain during menstruation, bleeding between periods, pain with intercourse, blood clots during periods. Abdominal pain/pressure and bloating. Patient suggested that these symptoms started after her second caesarean section surgery one year ago. Patient also reported that she takes over-the counter medication, such as ibuprofen to relieve the pain. she also suggested that she uses heating pad on her abdomen/pelvic for pain relief, and she stated that she soaks in a warm sitz bath to ease pelvic pain and cramping. Patient also reported fatigue and weakness. Patient further stated that she decided to see an obstetrician and gynecologist (OB/GYN) because the heavy prolonged bleeding with severe menstrual cramp interfere with her regular activities. Patient denied nausea, vomiting, diarrhea, fever, and chills.Nurs 6551 Week 9 Assignment Paper

Timing/Onset: Patient said one year ago.

Location: The location of the problem as stated by the patient is pelvic/uterus/vaginal.

Duration: 5 to7 days during periods for the past one year.

Quality/Characteristic: Patient reported heavy prolonged menstrual pain; severe, sharp lower abdominal/pelvic cramping/pain, and blood clots during periods.Nurs 6551 Week 9 Assignment Paper

Aggravating Factors: Monthly periods as stated by the patient.

Relieving/Alleviating Factors: Patient stated that ibuprofen pain medication, heating pad, and/or warm sitz bath help the pain/cramping.Nurs 6551 Week 9 Assignment Paper

Severity: The severity of the pain/cramping on a pain scale is 10/10 reported by the patient.

Treatments/Therapies: Patient stated that she had not undergone any treatment for the reported problems.Nurs 6551 Week 9 Assignment Paper

Last Menstrual Period: The last menstrual period reported by patient was 7/5/2016.

Sexual Activity Status: Patient reported being sexually active.

Barrier Prevention: Patient stated she uses natural barrier methods.

Sexual Preference: Patient sexual preference is monogamous/heterogeneous relationship.Nurs 6551 Week 9 Assignment Paper

Satisfaction with Sexual Activity: Patient reported that she is sexually satisfied with her partner.

Contraception Method: Patient denied using any contraception method.

Patient History

Past medical History (PMH): Anemia and C-section. Patient was delivered full term through vaginal delivery without complications. The birth weight was 8 pounds 10 oz.

Psychological/Mental Health: Patient denied depression, mood swings, anxiety, or mental health problem.Nurs 6551 Week 9 Assignment Paper

Medications: RG reported that she takes over the counter Motrin 200-400 mg orally every 4-6 hours as needed for pain and cramping.

Allergies: Patient reported no known allergies (NKA).

Past Surgical/Hospitalization History: Patient reported history of C-section twice, and she was hospitalized for 3 days post the C-sections.

Preventive Screening: Patient reported that she had flu shot on 11/20/2015; last mammogram was 2/12/2015 and mammogram was normal; Pap smear was on 2/20/2015, which was also normal; patient also reported that she was up to date with her childhood immunization, but denied pneumococcal vaccination.Nurs 6551 Week 9 Assignment Paper

Family History: Both father and mother have history of diabetes mellitus type 2 and hypertension. Both parents are still living, and two siblings are still living and well.

Gynecological History: Patient is multipara with 2 pregnancy resulting in two viable offsprings. Patient had her first child at the age of 33 years. Menarche at age 13; periods last between 5 to 7 days. Patient reported heavy prolonged menstrual bleeding with severe cramping; sharp pelvic pain during menstruation; and bleeding between periods for the past one year. Denied vaginal discharge or sexually transmitted infection/disease.Nurs 6551 Week 9 Assignment Paper

Obstetric History: Gravida 2, Para 2, term 2, preterm 0, spontaneous abortion 0, and living 2 (G2T2P2A0L2). Gravida 1: Delivered at 39 weeks by C-section on 4/20/08 male; Gravida 2: Delivered at 40 weeks by C-section on 2/18/15 female. Patient denied therapeutic abortion (TAB) or spontaneous abortion (SAB); Patient denied preterm or low birth weight baby with no delivery complications. Patient also denied having sexual transmitted disease.Nurs 6551 Week 9 Assignment Paper

Personal/Social History: Patient is married with 2 children, and lives at home with the husband. Patient is a college graduate; works outside the house as a nurse at a nearby hospital. Patient’s husband works for a computer company. Patient family is a middle income family. Also, patient denied any physical or psychological abuse. Patient denied being exposed to any environmental or occupational health hazards. Patient also denied alcohol consumption, tobacco, or recreational drug use. Patient denied participating in any exercise or physical activity because she is tired after work, and prefers to rest. Patient reported that she eats healthy; she eats low fat, low carbohydrate meals, and she eats fruits and vegetable at least 3 to 4 times a week. Patient stated

that she sleeps well at night, and she usually goes to bed at 9 pm and wakes up at 6 am. Patient drinks a cup of coffee occasional, especially when she is at work to be awake.Nurs 6551 Week 9 Assignment Paper

Review of System (ROS)

General: RG admitted fatigue and weakness; denied fever /chills; and no weight loss.

Head and Neck: Patient denied headache or dizziness. Patient also denied lumps, neck injury, pain/tenderness or jugular vein distention.

Chest: Patient denied chest pain, cough or shortness of breath.

Heart: RG denied irregular heartbeats, heart attack, or heart murmur.

Breasts: Patient denied nipple discharge, tenderness or swelling.

Gastrointestinal: Patient admitted lower abdominal pain, pressure, and bloating; denied constipation, nausea, vomiting, and diarrhea.

Genitourinary: RG denied urinary tract infection, urinary frequency or burning on urination.Nurs 6551 Week 9 Assignment Paper

Genital: Patient admitted heavy prolonged menstrual bleeding with severe cramping for one year. Patient admitted sharp pelvic pain during menstruation, bleeding between periods, pain with intercourse, and blood clots during periods. Patient denied vaginal discharge.

Musculoskeletal: RG denied varicosities or extremities problem.

Psychiatric: RG denied depression, anxiety, or any psychiatric problems.

Neurological: Patient admitted fatigue and weakness; denied confusion, seizures, or tingling.

Hematologic: Patient admitted history of anemia; denied blood transfusion or easily bruise or bleeding.Nurs 6551 Week 9 Assignment Paper

Physical Examination

General exam: Patient appeared well developed and pleasant with good hygiene. Patient also appeared pale and weak. Vital signs: Blood pressure 118/76, heart rate 80, respiration 18,

temperature 98.8, pulse ox 100% on room air. Weight 78.2 kg, height 67 inches, and body mass index (BMI) 27.

HEENT: The head is normaceplalic, atraumatic. The pupils are equal, round, and reactive to light and accommodation. Extraocular movements are intact. Tympanic membrane is gray bilaterally. Oral mucosa is dry. Oropharynx is clear. Nares are patient, no nasal or septal deviation noted. No pharyngeal erythema.

Neck: Noted to be supple without jugular vein distention (JVD), thyromegaly or lymphadenopathy.Nurs 6551 Week 9 Assignment Paper

Lungs: Noted to be clear to auscultation throughout the lobes; no wheezes or rhonchi noted.

Cardiovascular: Regular rate and rhythm on auscultation, S1 S2 present without murmurs. Palpable pulses noted without peripheral edema.

Gastrointestinal: Bowel sounds are active in all quadrant. Abdomen is soft and tender on palpation.

Breast: The size of the breasts, areolas, and nipples are round and symmetrical with no discoloration, rash, lesions, dimpling, or retraction bilaterally; no masses, lumps, or tenderness noted on palpation bilaterally; and axillary lymph nodes non-palpable.

Pelvic Examination:

Vulva: The hair distribution is normal; no lesion noted.

Vagina: Vaginal walls are pink, and pubic hair is shaven; no lesions, masses, inflammation or discharge noted.

Cervix: Intact cervix with closed os.

Uterus: Enlarged, asymmetrical, soft, boggy and tender.

Laboratory and Diagnostic Tests

Laboratory Test and Results: Pregnancy test: Result is negative. Hemoglobin and Hematocrit (H/H): Result showed H/H 8.7/26.7, which is positive for anemia.Nurs 6551 Week 9 Assignment Paper

Diagnostic:

Transvaginal ultrasonography of the uterus: Revealed uterine enlargement measuring 12 cm with no leiomyomata; uterine wall thickening; cystic anechoic spaces in the myometrium; heterogeneous echo texture; obscured endometrial/myometrial border; sub endometrial echogenic linear striations; and thickening of the transition zone measuring 12.8 millimeter. The transvaginal sonography is used to rule out possible uterine tumor (Sakhel & Abuhamad, 2012).

Magnetic Resonance Imaging (MRI): MRI is ordered to obtain a high resolution image of the uterus as well as verifying/confirming the suspected diagnosis. The MRI result revealed that the junctional zone of the uterus is thickened and measures 12.8 millimeter. Also, MRI revealed an ill-defined ovoid and diffuse region of thickening with striated appearance (Sakhel & Abuhamad, 2012).Nurs 6551 Week 9 Assignment Paper

Differential Diagnoses

The differential diagnoses of the patient clinical presentation as described by Schuiling and Likis (2013) include: Adenomyosis, uterine fibroids and endometrial hyperplasia. However, the primary diagnosis for the patient is Adenomyosis.

Adenomyosis: Schuiling and Likis (2013) described adenomyosis as a benign, common condition that involves the movement of endometrial tissue into the uterine muscles. Nurs 6551 Week 9 Assignment PaperThe definitive cause of the adenomyosis is unknown, but the condition is common among women with elevated levels of estrogen; the condition usually ceases post menopause when estrogen levels are reduced. Risk factors explained by Taran, Stewart, and Brucker (2013) include multiparity; previous uterine surgery, such as C-section, dilatation/curettage, or fibroids

removal surgery; and women at reproductive age, especially between the age of 40s or 50s. furthermore, Taran et al. (2013) specified that the clinical presentation entails chronic pelvic pain, prolonged menstrual cramps, heavy menstrual bleeding, spotting between periods, abdominal tenderness, painful intercourse, longer periods than normal, blood clots during periods. Taran et al. (2013) also explained that finding during physical examination include enlarged, tender, soft and boggy uterus. According to Taran et al. (2013) diagnosis is made based on sonographic or MRI results, and treatment is not recommended for women with mild form of adenomyosis, except when the symptoms interfere with daily activities. Taran et al. (2013) further explained that treatment options include anti-inflammatory medications; hormonal treatments; endometrial ablation; uterine artery embolization, MRI-guided focused ultrasound surged or hysterectomy, which is the definitive treatment for adenomyosis.

Adenomyosis is selected as the primary diagnosis because the aforementioned patient’s clinical presentation, physical examination findings, and diagnostic tests results are synonymous with adenomyosis aforementioned associated signs and symptoms; risk factors; physical examination findings; and diagnostic test results.Nurs 6551 Week 9 Assignment Paper

Uterine Fibroids: Women’s Health (WH, 2015) described uterine fibroid to be muscular tumors that develop in the uterine wall, which can also be referred to as leiomyoma or myoma. Uterine fibroids are usually non-cancerous, and can be single or multiple tumors in the uterus. According to WH (2015), women risk for developing uterine fibroid are increased by age, such as women in their 30s and 40s until menopause when the fibroids commonly shrink. Other risk factors include family history, ethnic origin, obesity and eating habits.Nurs 6551 Week 9 Assignment Paper Symptoms of fibroids as explained by WH (2015) involve lower back pain; pain during sex; heavy bleeding; painful menses, enlarged lower abdominal, frequent urination; and lower abdominal/pelvic feeling of fullness. Physical examination shows reveal painless, firm, irregular pelvic mass. According to WH (2015), diagnosis is done using transvaginal ultrasound, MRI, hysteroslpingography, hysteroscopy, and endometrial biopsy. Fibroid is not selected as the primary diagnosis because there is no visualization of the fibroid during pelvic examination or on sonography test. Moreover, severe pain is noted during pelvic exam. Furthermore, sonographic result is more consistent with adenomyosis rather than fibroids.Nurs 6551 Week 9 Assignment Paper

Endometrial Hyperplasia: Cancer Research of United Kingdom (CRUK, 2014) described endometrial hyperplasia as thickening of the covering of the uterus due to excessive growth of the cells that covers the uterus, and endometrial hyperplasia can lead to womb cancer. Risk factors according to CRUK (2014) include- age over 35 years; white race; nulliparity; older age at menopause; obesity; cigarette smoking; family history of ovarian, colon, or uterine cancer; early menarche; and history of diabetes, polycystic ovary syndrome, thyroid disease and gallbladder disease. The CRUK (2014), explained that the condition is caused by imbalance of to the estrogen and progesterone. According to CRUK (2014), signs and symptoms of endometrial hyperplasia includes abnormal, prolonged, heavy periods; bleeding between periods; shorter than 21 days’ menstrual cycles; and bleeding after menopause. Also, diagnosis is established by vaginal ultrasound scan, dilatation and curettage, or hysteroscopy.Nurs 6551 Week 9 Assignment Paper

23rd ed. Philadelphia, PA: Lippincott Williams &.Wilkins; 2014presentation, physical findings during examination; and diagnostic results are not synonymous with the signs and symptoms; physical examination finding, risk factors and diagnostic

results associated with endometrial hyperplasia (American College of Obstetricians and Gynecologist, 2016).Nurs 6551 Week 9 Assignment Paper

Management Plan

Diagnosis: The only definitive diagnosis of adenomyosis is established after uterus is examined post hysterectomy. However, clinical findings that helped in the diagnosis of the patient includes enlarged, asymmetrical, soft, boggy and tender uterus during pelvic examination and aforementioned sonographic and MRI findings, which synonymous with the diagnosis of adenomyosis (Sakhel & Abuhamad, 2012).Nurs 6551 Week 9 Assignment Paper

Treatment: Treatment was considered based on the patient clinical presentations, and collaborative agreement with the patient, the author, and the preceptor for total hysterectomy after explanation of the treatment options to the patient. Patient selected hysterectomy because patient does not want to have another child. According to Schuiling and Likis (2013) explanations, patient was advised to continue with the over-the counter anti-inflammatory drug: Motrin 200-400 mg orally every 4-6 hours as needed for pain and cramping until hysterectomy is performed. Also, Ferrous sulfate 325 mg orally three times a day for anemia was prescribed. Patient was educated to take the medication on an empty stomach one hour before meal or 2 hours after meal for optimum absorption.Nurs 6551 Week 9 Assignment Paper

Patient Education: Patient was educated on the risk factors for adenomyosis, the causes, symptoms, diagnosis, and treatment options. Patient was educated that most women with adenomyosis does not have any symptoms, but adenomyosis is usually found after the tissue obtained from the uterus has been biopsied after pelvic surgery. Patient was also informed that the C-section she had twice during child birth may have put her at risk for adenomyosis. Patient was informed that the symptoms of adenomyosis goes away after menopause or after hysterectomy.Nurs 6551 Week 9 Assignment Paper Patient was educated that all options of treatment must be tried before hysterectomy, but patient opted for hysterectomy without trying all options of treatment. furthermore, patient was educated to continue the home remedy, such as continuation of the use of the heating pad, warm soak bath, and continuing with the over the counter Motrin to alleviate the pain associate with the condition. Finally, patient was educated on the psychological and emotional effects of adenomyosis and hysterectomy surgery because some women grieve on the loss of their womb, which may put them into depression as a result of that; the patient has to be completely sure that she really wants to do the surgery at her age now or wait and do the surgery in the future (University of Maryland Medical Center, 2016).Nurs 6551 Week 9 Assignment Paper

Follow Up Care: In consideration of the Schuiling and Likis (2013) discussion, patient was schedule to follow-up in 6 weeks for follow-up on the patient’s anemia and surgical work up labs, such as complete blood count, complete metabolic panel, prothrombin time and international normalized ratio(PT/INR). Also, an electrocardiogram (EKG) and chest x-ray was ordered to rule out any cardiac problem that would complicate the hysterectomy surgery. The patient’s H/H came up to 11.5/38.9 and all the other laboratory and diagnostic result was normal. The Total hysterectomy surgery was performed on 7/27/2016. Surgery was successful, and patient was schedule to follow up in six eek post-surgery.Nurs 6551 Week 9 Assignment Paper

Conclusion Comment by DeAllen B Millender: Level 1 headings are centered, in bold print, and in ‘Title Case’ (Chapter 3, 3.03, pp. 62-63; see Table 3.1 and Figure 2.1).

The author selected a patient at the author’s clinical site, and obtained a complete health history following the patient care from the beginning of the clinical up to 9 weeks of clinical. The author also used the patient health information and clinical presentation to come up with a diagnosis of adenomyosis. The author developed an appropriate treatment plan with the patient in collaboration with the author’s preceptor incorporating the author’s classroom knowledge with the author’s chosen nursing theorist. Finally, the patient was educated on the condition and follow up care.Nurs 6551 Week 9 Assignment Paper

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