Agency for Healthcare Research and Quality Essay
Agency for Healthcare Research and Quality
Case overview
Agency for Healthcare Research and Quality The patient is a 55years old female who came for a regular gynecological review at the clinic. She had a cardiac stent at the age of 50 years and mild hypertension, currently on lisinopril, Zocor, and Plavix. Agency for Healthcare Research and Quality Essay
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She has a past surgical history of tonsillectomy and bunion removal. She is up to date with her colonoscopies and has a history of normal pap smear tests and mammograms with diagnostic investigations. Her menarche was at the age of 14 years and menopause at 52years. She has never been married nor had a child. She has been with her current partner for two years and they will get married in two months. The patient needs guidance because her partner would want a child. The patient has a medical history of hypertension and cardiac disease that she needs to consider before conception. Moreover, she is on drugs contraindicated in pregnancy. However, despite her medical condition, she is on preconception care folate supplementation. She conceives during the second cycle and returns to the clinic after 12 weeks complaining of high blood pressure, facial puffiness, pitting edema, and epigastric pain. Agency for Healthcare Research and Quality
What Are Your Differential Diagnoses?
- Gestational hypertension
- Preeclampsia
- Eclampsia
Gestational hypertension is the elevated blood pressure of more than 140/90 mmHg in patients at less than 20 weeks gestation. It is common in pre-existing hypertension, mother age above 40 years, twin pregnancies, and kidney diseases. The presenting symptoms are high blood pressure, edema, pain in the right upper quadrant, and absence of protein in the urine (Lo, et al, 2020). It is the primary diagnosis because the patient is only twelve weeks pregnant, is 55years old, and has had pre-existing hypertension.
Preeclampsia is an endothelial malfunction disorder that presents with proteinuria ad hypertension in patients above 20 weeks gestation age. The symptoms are high blood pressure of more than 140/90 mmHg, persistent epigastric pain, visual disturbances, progressive renal insufficiency, thrombocytopenia, and pulmonary edema (Rana, et al, 2019). The risk factors are nulliparity, chronic hypertension, age of above 40years, and obesity. However, this is not the patient’s diagnosis despite similar symptoms because she has no proteinuria and is less than 20 weeks gestation. Eclampsia is the presence of convulsions in a patient with preeclampsia.
Why Did You Make This Diagnostic Decision?
Gestational hypertension is the patient’s diagnosis because she has high blood pressure, epigastric pain, lower limb edema, and facial puffiness. Additionally, her gestation age is 12 weeks, she is over 40years, and has never had children.
What Is Your Treatment Plan?
Diagnostic tests: according to Duhig, et al, (2018), renal function tests, liver function tests, urinalysis, and platelet levels help rule out preeclampsia and eclampsia.
Pharmacological treatment
- Nifedipine 20mg PO once daily for hypertension
- Magnesium sulfate for prophylaxis of preeclampsia and eclampsia
Non-pharmacological
Bed rest and fetal monitoring to check the health status of the fetus.
Ethical dilemma in this case study
The ethical dilemma in this situation is the respect for autonomy versus beneficence. Beneficence is having the best interests of patients when selecting a treatment method (Bester, J. C. 2020). In this case, the patient will have a difficult pregnancy due to her advanced age and the presence of chronic diseases like heart failure. Therefore, IVF or child adoption is the best option for the patient to have a child. This is contradicting the patient’s decision regarding the physical conception, pregnancy, and delivery. Autonomy is respect for a patient’s decisions.
Psychological issues in this case study
The patient is at risk of having depression and anxiety because she has pre-existing chronic diseases that would threaten her pregnancy. Moreover, hormonal fluctuations in pregnancy cause high and low mood changes. Agency for Healthcare Research and Quality
Physical issues in the case study
The patient has chronic diseases like hypertension and heart disease that would physically affect her during the pregnancy. Chronic hypertension increases the risk for stroke and placenta abruption that would threaten the survival of her pregnancy.
Financial issues in the case study
The patient requires financial resources to help her in consulting a specialist, regular follow-up, and treatment. Agency for Healthcare Research and Quality Essay
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.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.
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Chapter 46, “Anticoagulant and Antiplatelet Drugs” (pp. 364–371)
Chapter 47, “Drugs for Deficiency Anemias” (pp. 389–396)
Chapter 50, “Estrogens and Progestins: Basic Pharmacology and Noncontraceptive Applications” (pp. 425–436)
Chapter 51, “Birth Control” (pp. 437–446)
Chapter 52, “Androgens” (pp. 447–453)
Chapter 53, “Male Sexual Dysfunction and Benign Prostatic Hyperplasia” (pp. 454–466)
Chapter 70, “Basic Principles of Antimicrobial Therapy” (pp. 651–661)
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Chapter 71, “Drugs That Weaken the Bacterial Cell Wall I: Penicillins” (pp. 662–668)
Chapter 75, “Sulfonamides Antibiotics and Trimethoprim” (pp. 688–694)
Chapter 76, “Drug Therapy of Urinary Tract Infections” (pp. 695–699)
Chapter 78, “Miscellaneous Antibacterial Drugs” (pp. 711–714)
Chapter 79, “Antifungal Agents” (pp. 715–722)
Chapter 80, “Antiviral Agents I: Drugs for Non-HIV Viral Infections” (pp. 723–743)
Chapter 82, “Drug Therapy of Sexually Transmitted Diseases” (pp. 763–770)
Lunenfeld, B., Mskhalaya, G., Zitzmann, M., Arver, S., Kalinchenko, S., Tishova, Y., & Morgentaler, A. (2015). Recommendations on the diagnosis, treatment and monitoring of hypogonadism in men. Aging Male, 18(1), 5–15. doi:10.3109/13685538.2015.1004049
This article presents recommendations on the diagnosis, treatment, and monitoring of hypogonadism in men. Reflect on the concepts presented and consider how this might impact your role as an advanced practice nurse in treating men’s health disorders.
Montaner, J. S. G., Lima, V. D., Harrigan, P. R., Lourenço, L., Yip, B., Nosyk, B., … Kendall, P. (2014). Expansion of HAART coverage is associated with sustained decreases in HIV/AIDS morbidity, mortality and HIV transmission: The “HIV Treatment as Prevention” experience in a Canadian setting. PLoS ONE, 9(2), e87872. Retrieved from https://doi.org/10.1371/journal.pone.0087872
This study examines HAART therapy and its sustainability and profound population-level decrease in morbidity, mortality, and HIV transmission.
Roberts, H., & Hickey, M. (2016). Managing the menopause: An update. Maturitas, 86(2016), 53–58. .https://doi.org/10.1016/j.maturitas.2016.01.007
This article provides an update on treatments on Vasomotor symptoms (VMS), genito-urinary syndrome of menopause (GSM), sleep disturbance, sexual dysfunction, and mood disturbance that are common during the menopause transition.
Agency for Healthcare Research and Quality. (2014). Guide to clinical preventive services, 2014: Section 2. Recommendations for adults. Retrieved from http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/guide/section2.html
Please use them as resources Agency for Healthcare Research and Quality Essay
