Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders As an advanced practice nurse, you will likely experience patient encounters with complex comorbidities. For example, consider a female patient who is pregnant who also presents with hypertension, diabetes, and has a recent tuberculosis infection. How might the underlying pathophysiology of these conditions affect the pharmacotherapeutics you might recommend to help address your patient’s health needs? What education strategies might you recommend for ensuring positive patient health outcomes?

Women's and Men's Health, Infectious Disease, and Hematologic Disorders Scenario With a history of breast cancer in her family, this 46-year-old lady is being treated for the disease. She weighs 230 lbs. Her mammograms are always up to date. Although this patient's blood pressure has been elevated in the past, it's currently at 150/90. She is experiencing hot flushes, night sweats, and genitourinary symptoms. It's been approximately a month since she started experiencing these issues. About five years ago, she had ASCUS on her pap smear; however, her pap smears have been clear of ASCUS since then. There has been a month since her previous menstrual period, which is normal for her. HCTZ 25mg and Norvasc 10mg daily are the medications she takes. Health needs and the treatment After 12 months without menstruation, a woman is considered to be in menopause (Warneret al., 2020). There are signs that my patient may be going through the early stages of menopause because she has a regular menstrual cycle, but she also has hot flashes, night sweats, and genital symptoms. She should consider hormone therapy if she wishes to alleviate her hot flashes and night sweats. Therapy with progestins may offer protection from endometrial cancer; therefore, this is an option for her. The risk of developing breast cancer is more than doubled in families where the disease has run in the family. Consequently, the patient's mammograms should be kept up, and she should be counseled on getting her breast cancer gene tested. There is a 72% chance that a woman with both BRCA1 and BRCA2 gene mutations will develop cancer (De Jongeet al., 2021). In light of my patient's family's cancerous history, I recommend that she have ASCUS on one of her regular pap tests. Because hormone therapy raises the risk of coronary heart disease and myocardial infarction in women, the patient's hypertension must be better controlled if she begins hormone therapy. Her blood pressure could be better controlled if she took more of her

3 current medicine, which would allow for additional drug interactions. HCTZ dosage should be increased to 50 mg daily with daily weight and blood pressure monitoring and recording following a thorough evaluation of the patient and the patient's increased fluid retention. HCTZ, a type of thiazide diuretic, can help reduce fluid retention and hence lower blood pressure by preventing the body from absorbing too much salt (De Jongeet al., 2021). Since Norvasc is already at its maximum daily dose, no dosage adjustment is possible. If the existing medicine increases, clonidine transdermal 0.1mg/dl can be used (De Jongeet al., 2021). The symptoms have not improved, but only after four weeks of follow-up and appropriate documentation of her blood pressure. For both breast cancer survivors and those without, clonidine reduced hot flushes with fewer adverse effects than an oral pill. Patient Education strategy It is critical to educate the patient. Because of her family history, she must undergo preventive health screenings. It is recommended that this patient receives instruction on alternative methods of treating symptoms associated with menopause. Inform her about the significance of performing monthly breast checks on herself and a yearly checkup to spot any abnormalities early (Warneret al., 2020). As a result of their hypertension, patients would benefit from being educated on maintaining a minimal sodium consumption to receive optimal healthcare. The patient's overall outcome while undergoing treatment for hypertension can be improved by a mix of proper nutrition and diet that results in weight loss, resulting in a reduction in her blood pressure

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