Assessment and Care of Patients With Adrenal and Urogynecologic Conditions Essay Assignment Papers
Week 9: Assessment and Care of Patients With Adrenal and Urogynecologic Conditions
Symptoms related to adrenal and urogynecologic issues, such as severe abdominal pain, urinary frequency, incontinence, sexual health concerns, and hormone overproduction, often lead to frustration and embarrassment for patients. These feelings may cause patients to withhold information, complicating the assessment and diagnosis of adrenal and urogynecologic conditions. Establishing trust with patients and asking questions carefully to accurately assess complaints become crucial, especially considering that some patients may require surgery to alleviate the impact of these conditions on their daily lives.
Learning Objectives
By the end of this week, students will:
- Evaluate medical and surgical patients with adrenal and urogynecologic conditions.
- Develop differential diagnoses for medical and surgical patients with adrenal and urogynecologic conditions.
- Develop treatment plans for medical and surgical patients with adrenal and urogynecologic conditions.
Learning Resources
Required Readings
- Colyar, M. R. (2015). Advanced practice nursing procedures (1st ed.). Philadelphia, PA: F. A. Davis Company.
- Chapter 42: Breast Biopsy (Fine Needle Aspiration)
- Chapter 44: Colposcopy (Endocervical Curettage and Cervical Biopsy)
- Chapter 45: Endometrial Biopsy
- Chapter 49: Bartholin Cyst Abscess (Incision and Drainage)
- Chapter 51: Cervical Lesions—Cryotherapy
- Chapter 52: Circumcision and Dorsal Penile Nerve Block
- Chapter 58: Paracervical Nerve Block
- Chapter 61: Vasectomy
- Doherty, G. M. (2015). Current diagnosis and treatment: Surgery (14th ed.). New York, NY: McGraw Hill.
- Chapter 17: Breast Disorders
- Chapter 33: Adrenals
- Chapter 38: Urology
- Chapter 39: Gynecology
- Weber, E. C., Vilensky, J. A., & Fog, A. M. (2013). Practical radiology: A symptom-based approach. Philadelphia, PA: F. A. Davis Company.
- Chapter 7: Breast
- Chapter 9: Male and Female Urinary Tract and Male Genital Tract
- Chapter 10: Female Pelvic Imaging
- American Cancer Society. (2014). American Cancer Society guidelines for the early detection of cancer. Retrieved from link.
Required Media
- i-Human Patient Cases. (2014). Retrieved from link
Optional Resources
- Massad, L. S., Einstein, M. H., Huh, W. K., Katki, H. A., Kinney, W. K., Schiffman, M. … Lawson, H. W. (2013). 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Journal of Lower Genital Tract Disease, 17(5), S1–S27.
Discussion Part I: Assessment and Care of Patients with Adrenal and Urogynecologic Conditions
Assessment and Care of Patients With Genitourinary Disorders
Case Study 1: Alicia
Differential Diagnosis:
Alicia’s symptoms and laboratory findings suggest rhabdomyolysis, a condition characterized by muscle breakdown and release of myoglobin into the bloodstream. The elevated CK levels, along with myoglobinuria and acute kidney injury (elevated BUN and creatinine), support this diagnosis.
Likely Diagnosis: The most likely diagnosis for Alicia is exertional rhabdomyolysis, triggered by her recent intense weightlifting for softball season.
Treatment and Management Plan:
- Fluid Resuscitation: Immediate intravenous hydration to prevent kidney damage and flush out myoglobin from the kidneys.
- Electrolyte Correction: Treatment of hyperkalemia with calcium gluconate, insulin with dextrose, and/or potassium binders like sodium polystyrene sulfonate.
- Pain Management: Analgesics such as NSAIDs for pain relief.
- Monitoring: Continuous monitoring of renal function, electrolytes, and fluid balance.
- Avoidance of Further Muscle Injury: Rest from strenuous activities until CK levels normalize.
Education Strategies:
- Exercise Modification: Educate Alicia and her family on the importance of gradual progression in exercise intensity to prevent recurrence.
- Hydration: Emphasize the importance of adequate hydration before, during, and after strenuous exercise.
- Recognizing Symptoms: Teach Alicia and her family to recognize symptoms of rhabdomyolysis, such as muscle pain, weakness, and dark urine, and to seek prompt medical attention if they occur.
Discussion: Cultural Considerations:
- In certain cultural contexts, there may be pressure to excel in sports, leading to increased risk of overexertion and muscle injury.
- Cultural beliefs about hydration practices during exercise may influence the likelihood of developing rhabdomyolysis.
Additional Insights:
- Encouraging open communication between Alicia, her family, and healthcare providers can facilitate early recognition and management of symptoms.
- Collaborating with Alicia’s sports coach to develop a safe exercise regimen tailored to her fitness level and goals can prevent future episodes of exertional rhabdomyolysis.
Discussion Part II: Pharmacology
Discussion: Option 2 – Fentanyl
Evidence-Based Drug Search on Fentanyl
Fentanyl is a potent opioid analgesic commonly used for pain management in the hospital or ICU setting. A thorough literature search reveals several important considerations:
Drug Interactions:
- Fentanyl may interact with other central nervous system depressants such as benzodiazepines, barbiturates, and alcohol, leading to additive sedative effects and respiratory depression. Clinicians should exercise caution when co-administering these medications and monitor patients closely for signs of respiratory depression.
- Additionally, concurrent use of fentanyl with serotonergic medications (e.g., selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors) may increase the risk of serotonin syndrome, characterized by symptoms such as agitation, hyperthermia, and autonomic instability.
Black Box Warnings:
- Fentanyl carries a black box warning regarding the risk of respiratory depression and death, particularly when used in opioid-naive patients or in high doses. Clinicians should carefully titrate fentanyl dosage based on individual patient factors, such as pain intensity and opioid tolerance, to minimize the risk of respiratory depression.
Patient Selection:
- Fentanyl is appropriate for patients experiencing moderate to severe acute pain, such as postoperative pain or pain associated with trauma. It is particularly useful in patients who cannot tolerate oral medications or require rapid pain relief.
- However, fentanyl should be used with caution in opioid-naive patients, elderly patients, and those with compromised respiratory function, as they may be more susceptible to adverse effects.
Conclusion: While fentanyl is an effective analgesic for managing acute pain in the hospital or ICU setting, clinicians must be vigilant for potential drug interactions and adverse effects, particularly respiratory depression. Careful patient selection and dose titration are essential to ensure safe and effective pain management.
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