regular gyn care
Type of service: Academic Writing
Work type: Discussion Essay
Format: APA
Pages: 1 pages ( 275 words, Double spaced
Academic level: Undergrad. (yrs 3-4)
Discipline: Nursing
Title: Response to a case
Number of sources: 3
Paper instructions:
Please respond to this write up with one page and three APA resources.
Gloria Smart is a 55-year-old female who presents to your office today for regular gyn care. You read her medical history and note she received a cardiac stent at age 50, has mild hypertension, and is on Zocor, Plavix, and lisinopril. Surgical history is remarkable for tonsils as a child and bunion surgery. She works full time, by choice, because it “makes me feel young.” She is up to date with colonoscopies. Gyn history normal pap history, last DXA within normal limits, normal mammogram. BMI is 26. First menses age 14 and menopause age 52. She works out at her local gym 5 days a week. Social history is negative for tobacco and recreational drugs. She has an occasional glass of wine. She has never married and has been with her current partner for 2 years and will be getting married in 2 months. She has never been pregnant, and her partner has never had a child. Gloria and her fiancé are seeking guidance as they are interested in having a child. After conferring with an infertility specialist, the couple becomes successful in getting pregnant. However, Gloria’s blood pressure becomes uncontrolled and presents back to the office for evaluation.
Differential Diagnosis
The differential diagnosis for Gloria would be High Risk Pregnancy of the Elderly Mother Primigravida. This differential diagnosis was chosen based upon the fact that her age is elevated at 55 years old, she has already gone through menopause, she has significant cardiovascular disease, and has a history of hypertension which has been proven to put both the mother and baby at risk (Christenbery, 2017).
Treatment Plan
To properly manage and treat the patient, the provider would look at multiple factors that place her in high risk such as obesity. Having a BMI of 26 is significant in that she is already 20% overweight. Also, she is on Zocor, which is a statin that is contraindicated in pregnancy, she had a cardiac stent at the age of 50, and she is on Lisinopril, an ACE inhibitor, which is also contraindicated in pregnancy, especially the second and third trimesters, as they can cause difficulties for the baby (Schuiling & Likis, 2020). As Gloria has hypertension, a heart healthy diet should be started immediately inclusive of a low sodium restriction with the goal to keep her BP controlled and to slowly bring her weight to the appropriate range (Buttaro et al., 2017). As for the medications, the statin should be stopped. The only medications currently acceptable during pregnancy are bile acid sequestrants (Arcangelo et al., 2017). The ACE Inhibitor may be replaced with a calcium channel blocker and the Plavix may be replaced with a low molecular weight heparin such as Lovenox (Podymow & August, 2008).
Evidence Based Research
Current evidence-based research shows that Hypertension is the leading cause of death and is a major cause of disability in the world (Butalia et al., 2018). The research shows that the prevalence of hypertension has remained among adults and relatively stable in Canada and that the measures to treat and control remain high.
Resources for Best Practice
Best practice guidelines for management of hypertension includes the utilization of blood pressure trackers (Ball RN DrPH CPNP, Jane W. et al., 2014). These simple devices, whether digital or paper based can be utilized to manage and track BP readings throughout the day and shared with collaborating physicians.
Issues
Ethical concerns for Gloria and her fiancé consist of the fact that Gloria is advanced in age and has never been a parent before and is now considering being a parent. Ethically the concern is whether it is correct to assist in Glorias quest to have a baby even though she has already been through menopause and has significant cardiovascular issues which may cause harm or death to her and/or her child.
A psychological issue is whether to assist Gloria and risk the possibility of her developing depression when she is informed of all the risks that could potentially happen to her based upon her age and cardiovascular status. Informing her of the risk may inhibit further treatment, trust, and health.
A physical issue that may develop is that Gloria works full time, and that work makes her happy. With her advanced age and the reality of an illness such as uncontrolled hypertension being plausible, this will possibly ensure that bedrest will happen which may lead to depression and inability to trust.
Financial issues may arise causing difficulties during the pregnancy. IVF, in itself, is very expensive as is the increase in medical provider attention.
