NRNP 6552 WEEK 5 COMMON GYNECOLOGIC CONDITIONS, PART 2 Case # (1, 2, 3 or 4) and Description of the Case Chosen:

·         15-year-old female G0

·         Heavy bleeding during her periods, anxiety, and mood swings.

·         Symptoms in the past 4 months.

·         Symptoms occur a few days before the onset of menses and improve by day 3.

·         2 pads every 1-2 hours and sometimes need to double up on the pads.

·         Other symptoms: Severe bloating, pelvic pain, and back pain during periods.

·         Missed numerous days of school due to her symptoms

·         Lacks interest in usual daily activities, staying in bed all day.

·         Diagnosed with major depression 2 months ago and

·         started on sertraline 50mg OD

Objective findings.

·         VS: BP: 122/74, P: 64, RR: 16, T: 97.8

·         Weight: 146 lbs., Height: 63 inches, BMI 26.2

·         General Examination: Well developed, well nourished, in no acute distress.

·         Psych: alert and oriented, cooperative with exam appears frustrated.

·         Abdomen: Soft, NTND, no masses

·         Gynecological: EXTERNAL EXAM: normal, appropriate hair distribution, no erythema, no skin discoloration, no lesions.

·         SPECULUM/INTERNAL EXAM: Cervix: normal appearance, no lesions, no bleeding/discharge, no cervical movement tenderness, nulliparous.

·         UTERUS: normal size, shape, and consistency, normal mobility, nontender.

·         ADNEXA: no masses or tenderness bilaterally.

·         Laparoscopy to assess if the patient has endometriosis

·         Transvaginal Ultrasound to visualize the myometrium, endometrium, and ovaries.

Endometriosis

Symptoms of endometriosis in symptomatic women include

·         Dysmenorrhea

·         Heavy or irregular bleeding

·         Pelvic pain, lower abdominal, and back pain 

·         Dyspareunia

·         Dyschezia

·         Bloating, nausea, and vomiting

·         Inguinal pain

·         Pain on micturition and urinary frequency

·         Pain during exercise (Allaire et al., 2023).

·         The patient presents with complaints of heavy bleeding, severe bloating, pelvic pain, and back pain during periods.

Premenstrual Dysphoric Disorder (PMDD)

·         PMDD is a severe form of premenstrual syndrome. It occurs two weeks before the menstrual period (Itriyeva, 2022).

·         The DSM-5 criteria require at least five of the following symptoms during the final week before the menses begin :

·         Marked affective lability

·         Irritability

·         Depressed mood or self-deprecating thoughts

·         Anxiety,

·         Decreased interest, loss of concentration, insomnia, lack of energy, or change in appetite (Eccles & Sharma, 2023).

·         The patient reports having anxiety and mood swings a few days before the onset of menses.

·         She also lacks interest in usual daily activities and stays in bed all day.

·         The PMDD could have led to the diagnosis of MDD (Eccles & Sharma, 2023).

Menorrhagia

·         Menorrhagia is heavy menstrual flow with blood loss greater than 80 mls (Pouraliroudbaneh et al., 2024).

·         Patients with menorrhagia report soaking of one or more pads every hour, using double sanitary protection to control the menstrual flow and bleeding for more than one week.

·         This differential is based on the patient’s report of heavy menses.

·         She uses 2 pads every 1-2 hours and sometimes needs to double up on the pads.

Endometriosis

i.            Mefenamic acid 250 mg QID PRN to relieve painful menstruation (Allaire et al., 2023).

ii.            Combined oral contraceptives (COCs) for 90 days for ovarian suppression (Allaire et al., 2023).

PMDD

iii.            Prozac 20 mg OD.

iv.            Cognitive behavioral therapy (Itriyeva, 2022).

Menorrhagia

v.            Mefenamic acid: 500 mg  STAT then 250 mg QID  for 3 days; to reduce the mean menstrual blood loss and restore the menstrual blood loss to normal (Pouraliroudbaneh et al., 2024).

vi.            COCs for 1 week to reduce menstrual loss.

vii.            Iron supplements for 2 weeks; to increase hemoglobin level (Pouraliroudbaneh et al., 2024).

Social Determinants of Heath (SDoH) for your chosen case.

Endometriosis

·         Social determinants contribute to the long delays in endometriosis diagnosis (Drinkell et al., 2023).

·         They include lack of awareness and

·         knowledge of endometriosis, limited access to reproductive health services, and stigmas about women’s health issues (Drinkell et al., 2023).

·         The patient’s lack of knowledge about endometriosis could have led to delayed diagnosis.

Endometriosis

Referrals

Gynecologist to evaluate if laparoscopic surgery is necessary (Allaire et al., 2023).

Patient education

·         The patient will be advised to take a diet with low-fat content with plenty of vegetables and fats to help resolve symptoms of painful menstruation (Allaire et al., 2023).

·         She will be advised to engage in physical exercises during menstruation to improve blood flow to the pelvis and alleviate dysmenorrhea.