Case Overview
The patient is a 46years old female complaining of hot flushing, night sweats, and genitourinary symptoms. She has a history of hypertension, atypical squamous cells of undetermined significance ASCUS five years ago, and a family history of breast cancer. She is currently on HCTZ 25mg PO once daily and Norvasc 10mg PO once daily. she is up to date with her mammogram and pap smear tests which are normal. She has had a regular menstrual cycle and her LMP was one month ago. On examination, she is obese with 2130Ibs and her blood pressure is 150/90mmHg.
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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.
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Describe The Patient’s Health Needs
The patient is hypertension, she is obese, has a previous history of ASCUS, has a family history of breast cancer, and has pre-menopausal symptoms. Hypertension is a chronic disease characterized by persistently elevated blood pressure above 140/90 mmHg. Risk factors for secondary hypertension are too much stress, old age, genetics, obesity, lack of physical exercise, and increased dietary sodium (Mills, et al, 2020). During the visit, her blood pressure is not well controlled despite her being on treatment (HCTZ and Norvasc). The patient has 230Ibs which is an alarming weight for her age. Obesity and hypertension predispose this patient to hyperlipidemia, diabetes mellitus, and metabolic syndrome. She presents to the clinic with pre-menopausal symptoms. Pre-menopause is the period that leads to menopause. Its onset is from the age of 44years until the onset of menopause. The ovaries gradually reduce the production of estrogen hormone thus the patient presents with hot flushes, night sweats, vaginal dryness, insomnia, lower abdominal pain, and recurrent urinary tract infections.
Treatment Regimen
Pharmacological treatment
- Norvasc 10mg PO OD
- HCTZ 25mg PO OD
- Losartan 50mg PO OD
- Atorvastatin 20mg PO NOCTE
I would continue with Norvasc and HCTZ because they are effective in controlling hypertension. However, I added losartan because the blood pressure is still high. The reason for initiating triple therapy for treating hypertension is because the patient is at high cardiovascular risk (Rahman, et al, 2017). Atorvastatin reduces the risk of stroke or major coronary events in obese patients.
Non-pharmacological
Reduce dietary sodium to control hypertension, engage in regular physical exercise, and healthy eating to help her lose weight. To reduce the hot flushes and sweating, she should maintain a healthy weight, avoid caffeine and alcohol, and carry a portable fan to spike when hot flushes strike. She should use vaginal lubricants and creams to enhance moisturization. Reduced estrogen production leads to vaginal dryness that increases the risk for frequent urinary tract infections (Santoro, et al, 2021). The patient should avoid hormone replacement therapy because they increase the risk for breast cancer and she has a positive family history.
Explain Patient Education Strategies
Patient education strategies help in instilling knowledge about their illness and health to follow-up appointments and learn self-management techniques. In this patient, I will assess her health literacy by asking questions about her symptoms and what she feels about them. For a patient who understands her health, it is easy to learn the self-management instructions. I will then explain the simple concept of her illness, the causes, and the consequences then ask the patient to repeat what they have understood. I will offer educational materials with graphics and demonstrations to allow easy understanding. Health technology offers patients convenience in accessing health education materials. This patient education strategy will involve her next of kin to support the patient in the treatment journey. The patient should take her medication as prescribed and monitor her vitals regularly. She should follow up with the physician to treat and prevent chronic diseases.
References
Mills, K.T., Stefanescu, A. & He, J. The global epidemiology of hypertension. Nat Rev Nephrol 16, 223–237 (2020). https://doi.org/10.1038/s41581-019-0244-2
Rahman, M.A., Halder, H.R., Yadav, U.N. et al. Prevalence of and factors associated with hypertension according to JNC 7 and ACC/AHA 2017 guidelines in Bangladesh. Sci Rep 11, 15420 (2021). https://doi.org/10.1038/s41598-021-94947-2
Santoro, N., Roeca, C., Peters, B. A., & Neal-Perry, G. (2021). The menopause transition: signs, symptoms, and management options. The Journal of Clinical Endocrinology & Metabolism, 106(1), 1-15.