Primary Care of the Woman II
History of Present Illness:
Jill is a 46-year-old, P2 presenting today as an urgent add on to your schedule. She reports that over the past six months she has had much heavier menses that come more frequent and have caused her to miss work. She also mentions recently seeing her FNP for her annual physical exam and she was diagnosed with iron deficiency anemia. She started on OTC ferrous sequel and feels a little better, but still has fatigue. She also reports mood irritability and occasional hot flushing. No sleep disturbances. She denies pain or pelvic pressure, no vaginal discharge, dyspareunia, or post-coital bleeding, and no urinary or bowel changes. She is happily married, no domestic violence concerns, and is s/p tubal ligation. She is a non-smoker and has healthy habits with diet and exercise.
- Remember that the case study needs to include a minimum of two evidence-based practice articles to support your work. All papers must conform to the most recent APA standards.
Answer the following questions:
- What additional subjective information would you ask this patient?
- What diagnostic test(s) would you order to further assess her concerns?
- Outline three treatment options for this patient, be sure to include all aspects of care and follow-up.
You have managed this patient well and she continues to see you on an annual basis. Her bleeding was well-controlled and eventually became irregular but light. She now presents for her annual exam and reports no bleeding over this past year, but is having uncontrolled hot flashes and night sweats, she is not sleeping and reports being “unbearable to be around.” She is requesting help with these symptoms as she is not functioning well and it’s affecting her work and social interactions. She has had no change in her medical/surgical history other than a recent fall where she broke her wrist. She also has borderline cholesterol levels.
Answer these questions:
- What additional subjective information would you ask this patient?
- What diagnostic test(s) would you order to further assess her concerns?
- Outline three treatment options for this patient, be sure to include all aspects of care and follow-up.
You have managed this postmenopausal patient well and she reports good control of her symptoms and feels herself again. She continues to present annually and now three years later reports two episodes of vaginal bleeding—very light, where she notices while wiping and it only requires a panty liner during the day. The patient presents no additional symptoms.
Answer these questions:
- What additional subjective information would you ask this patient?
- What diagnostic test(s) would you order to further assess these symptoms?
- Write up a comprehensive plan of care for this patient.
