Posted: February 27th, 2023

WH D6 response

APANo plagirism

Submission Instructions:

· You will reply to

the other two case studies (One of each).

· You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Formatted and cited in current APA style with support from at least 1 academic source. Your reply posts are worth

2 points

(1 point per response.) 

· All replies must be constructive and use literature where possible.

Case Study 2:  LT 62-year-old female patient who consulted to the clinic for abdominal discomfort, vague abdominal pain in lower abdomen, constipation and low

to moderated pain with sexual intercourse.

Differential Diagnosis

         Ovarian Cancer (C56) is described as malignancy of the ovaries and can often be prominent in women who have undergone menopause and women of older

age. Symptoms include abdominal bloating and discomfort, indigestion, constipation, painful intercourse, vaginal bleeding, and a palpable abdominal or pelvic

mass (Schuiling & Likis, 2022). The disease is usually not confirmed until it has reached later stages as the symptoms can be confused with other illnesses or

disease.  The likelihood of a good prognosis is not high, as this is directly correlated to the late diagnosis and metastasis of the cancer.

         Uterine fibroids (D25.9) or leiomyomas are growths or tumor of the uterus that are nonmalignant. Fibroids can cause heavy and prolonged menstrual

bleeding, pelvic and back pain, anemia, and bulk symptoms such as increased urination, constipation, and abdominal distention

(Aninye & Laitner, 2021).  They can be prominent in younger women that can still have kids or women who had an earlier age of menarche. Treatment can be

directed towards symptomatic management such as the use of oral contraceptive or hormonal therapies. If the fibroids are very debilitating surgeries such as a

myomectomy may be warranted.

         Irritable Bowel Syndrome (IBS) (K58)  is a disorder of gut–brain interaction (previously referred to as a functional gastrointestinal disorder), characterized by

abdominal pain associated with a change in frequency or form of bowel habits (Farmer et al., 2020). Other common symptoms include abdominal distention,

weight loss, and gas. This illness can be triggered by dietary intake and eve stress. Treatment is directed at avoiding triggers and changing lifestyle measures such

as stress reduction. Pharmacological can include the use of laxatives or antidiarrheals based upon the patients’ symptoms.

Diagnostics

        Women with clinical signs of and symptoms suggestive of ovarian cancer and those with a pelvic mass should undergo a transvaginal ultrasound (Schuiling &

Likis, 2022). The ultrasound can provide specific characteristic of the ovary, which is beneficial in deciphering malignancy. In addition, more precise imaging is

needed to determine specifics of the pelvic mass, which can include a MRI or CT scan.  However, a CT scan may not be the first option as they may not show

smaller tumors, but may can show the invasion of other organs. Furthermore, the MRI can help with determining the staging of ovarian cancer.  Laboratory

specimens are also warranted and include tumor marker such as the CA-125 and the Carcinoembryonic Antigen (CEA). The CA- 125 is nonspecific, and levels

outside of the normal range can signify different cancers including the cancer inside of the peritoneum.  Fine needle aspiration is not needed as it may cause the

tumor cells to further disseminate into the peritoneal cavity (Schuiling & Likis, 2022).

Management plan (pharmacological & nonpharmacological)

        When there is a concern for a patient with ovarian cancer, the management plan should first start off with a referral to gynecologic oncology. Indicators for a

referral includes persistent signs and symptoms, elevated CA-125 levels, and a fixed or nodular mass (Schuiling & Likis, 2022).  Once ovarian cancer is confirmed,

pharmacological measures include the use of chemotherapy. Chemotherapy can be given via the intravenous or intraperitoneal route. Combination chemotherapy

medications such as carboplatin and paclitaxel is usually given every 3 to 4 weeks (Zhao et al., 2021). The patient may require up to six treatments of

chemotherapy for ovarian cancer.

       Nonpharmacological treatment measures include surgical options.  Surgical options can vary based on the exact staging of the cancer. Surgical options include

an open or laparoscopic laparotomy. This procedure allows for the visualization and examination of the abdominal cavity and organ. This surgical procedure

determines the presence and actual staging of the ovarian cancer.  Other surgical options include the complete removal of all the female or organs via a

hysterectomy, or by just removing the ovaries themselves. Patients with early ovarian carcinoma can achieve better therapeutic results through surgical resection

combined with chemotherapy (Zhao et al., 2021).

Treatment examples for a patient with a Stage IIB Ovarian Cancer

        Stage IIB ovarian cancer has invaded the ovaries (one or both) or fallopian tubes and has extended to other pelvic intraperitoneal tissues (Schuiling & Likis,

2022). Treatment can be a little more complicated as there are other structures or tissues involved such as combination therapy. Surgery such as removing as much

as the tumor and affected tissues as possible is usually a standard with stage II. After surgery, chemotherapy agents are then used to attack the nucleus of cancer

cells.  Lastly, the intravenous chemotherapy is given for six cycles.

Health assessment

       An effective health assessment incorporates not only physiological parameters, but multiple components.  Psychosocial needs are important, as mental health 

can have a significant impact on one’s health. For example, depression and anxiety can negatively affect and worsen health conditions. Furthermore, cultural needs 

should be included as well. Cultural needs include the beliefs of illness and wellness, complementary and alternatives to medicine, dietary preferences, as well 

other beliefs and values that are significant to the patient.  

Family Developmental Stages

       The family life cycle is the stages of life that begins in the early adulthood and extends to the later years of life. The first stage is family founding and starts 

with a marriage or union. The home environment is being established and along with the roles and responsibilities of each partner. The second role stage is the 

childbearing stage. This stage entails the pregnancy journey and the evolving relationship of the couple as parenthood is soon to begin. In addition, the third stage is 

raising children is centered upon the values and beliefs of the couple. This newfound role of parenting can be a quite challenging role, as rearing and navigating the 

child during each age transition can be tedious.  The fourth stage is child launching which can be described to launching the child into their adult role. The children 

can be leaving for school, starting careers, or getting married themselves. Finally, the last stage is the empty nest stage. This stage is the retirement years, children 

have built their own families, marriages are threatened with children being gone which can lead to the dissolution of marriage. The role of grandparents can be 

included in this last stage.

 Family Structure

       Family structure can be a dynamic structure and can be traditional or non-traditional. Traditional family structures include the immediate family such as 

parents and siblings living in the same household. Nontraditional family structures can include families of same sex, single household, or additional relatives or 

friends in the home. The uniqueness of all family structures should be accepted as the differences are what shape an individuals and their choices regarding

healthcare.

Case Study #3

Discuss and described the pathophysiology and symptomology/clinical manifestations.

Chronic pelvic pain (CPP) is a common complaint amongst women seeking gynecologic and primary care. One in seven women are affected by this chronic, incapacitating, constant discomfort in the pelvis. CPP seems to be part of the family of functional somatic pain syndromes, with fundamentals of intensified threat awareness and greater pain processing, although these chronic pain features are also present in many pain states with supposed identifiable causes. A history or physical exam is frequently used to make the diagnosis of chronic pelvic pain, which is supported by a number of additional symptoms or triggering causes. The diagnosis is made after three to six months of pelvic pain. Chronic pelvic discomfort is linked to conditions including interstitial cystitis, irritable bowel syndrome, major depressive disorder, posttraumatic stress disorder and other mental health conditions.

Depending on the source of the pain, the pathophysiology may vary. For instance, endometriosis causes cyclical discomfort due to frequent bleeding in the endometriotic implants. In pelvic congestion syndrome, enlarged and dilated pelvic veins result in pain, which causes decreased venous washout (Dydyk & Gupta, 2022). Pelvic pain can either be centralized in one area or spread out. The pain does not occur with menstruation and can be episodic or continuous. Pelvic discomfort, pain in several limbs, pain in the axial bone, and pain above the diaphragm are all signs broad pain. In addition to menstrual symptoms, clinical manifestations with chronic pelvic pain may also include gastrointestinal, urinary, sexual, psychological, and menopausal issues. Non-cyclic pelvic pain that lasts for three to six months or more is the defining symptom of women with CPP.

Give three examples with definition of Chronic Pelvic Pain (CPP) of: Gynecologic origin with ICD 10 numbers and non-gynecologic origin with ICD 10 numbers

Dysmenorrhea (ICD10-N94.6) refers to menstruation and painful bleeding experienced monthly. Dysmenorrhea is classified into primary and secondary dysmenorrhea. Primary dysmenorrhea is lower abdomen pain that occurs throughout the menstrual cycle and is unrelated to other illnesses. Secondary dysmenorrhea is associated with other illnesses or pathologies located inside or outside of the uterus (Nagy & Khan, 2022). Dysmenorrhea is a common complaint of chronic pelvic pain in women. Endometriosis (ICD10-N80.9) is a disorder in which the uterus’ lining, endometrium, or cells that resemble it, proliferate outside the womb. Up to 70% of referral populations of women and adolescents with pelvic pain have been found to have endometriosis (Ball & Khan, 2020). Pelvic Inflammatory Disease (ICD10-N73.9) is an infection-related inflammation of the upper vaginal canal. According to studies, about 30% of women with a prior history of pelvic inflammatory disease (PID) have developed CPP (Curry et al., 2019).

Interstitial Cystitis (IC) (ICD10-N30.1) is a chronic, non-infectious condition causing persistent pelvic or perineal pain, thinned bladder epithelium, and a variety of voiding symptoms such nocturia, increased frequency, and urgency (Lim & O’Rourke, 2022). Irritable Bowel Syndrome (IBS) (ICD10-K58.0) is described as the presence of abdominal pain or discomfort together with abnormal bowel habits in the absence of any other underlying disease. IBS is accompanied with symptoms of abdominal pain or discomfort, altered bowel habits along with constipation, diarrhea, or both, bloating, and distention. Fibromyalgia (ICD10-M79.7) is a clinical diagnosis defined by several tender sites on physical examination and widespread pain, usually in the muscles and joints. Chronic pelvic pain has been associated with IBS, IC, and Fibromyalgia.

Discuss patient education.

Patients with persistent pelvic pain discomfort should get in depth education about the complex nature of their problem. The patient should be motivated and educated on the importance of regular exercise, eating a healthy and balanced diet, and getting sufficient sleep, in order to improve their state of health. Additionally, it is important to educate the patient on the importance of maintaining an open line of communication with the provider and adhering to compliance with all prescribed medications, therapies, and treatment methods.

Develop the management plan (pharmacological and nonpharmacological). 

Treating CPP can be very limited as it must first be determined if the site of pain is known. In cases of persistent pelvic pain where the cause of the discomfort is known, treating the underlying disease process is the main goal of treatment with over-the-counter analgesics and/or hormonal contraceptives. If the pain is not relieved, or is suspected to be neuropathic, the patient should be evaluated and treated for a mood disorder with an antidepressant, selective serotonin reuptake inhibitors. If the pain is still persistent after various therapy attempts, the patient should be referred to a pain specialist. In addition, it is advised that the patient should undergo additional testing to identify the underlying illness if the cause of the discomfort is unknown.

Non-pharmacological treatments such as pelvic floor therapy and cognitive-behavioral therapy are options for patients suffering from chronic pelvic pain. These therapies have been shown to decrease pain, stress, and improve function. For patients with severe pelvic pain, it may be necessary to perform peripheral nerve blocks and neuromodulation of sacral nerves (Dydyk & Gupta, 2022). If all options fail, a last alternative for the patient would be to perform a hysterectomy.

An effective health assessment incorporates not only physiological parameters; please suggest other parameters that should be considered and included on health assessments to reach maximal health potential on individuals.

It’s critical to consider more than just a person’s physiological indicators to paint a complete picture of their health and wellbeing. Relationships, social networks, employment, and financial condition are a few examples of aspects that should be considered and addressed in a health evaluation. Additionally, it’s crucial to consider the accessibility of services like medical care, traditions, customs, lifestyle decisions like nutrition and exercise, and problems with substance misuse. For instance, some cultures have dietary standards that restrict people’s food options and have a negative impact on their health.

Name the different family developmental stages and give examples of each one.

Families move through different stages over a period, with each member accomplishing tasks associated with that stage. When a person enters adulthood, they do not have parental financial, emotional, or social support, and have reached stage one of independence. The second stage is marriage, in which two individuals unite and create their own family structure. The third stage of parenting is when a couple decides it’s time to expand and start a family of their own. Stage four involves the empty nest syndrome, when children move out and leave the home. The final stage is retirement, during which the parents have completed their parental duties, and are free to take pleasure in the fruits of their labor.

Describe family structure and function and the relationship with health care.

Family structure refers to the interdependencies and hierarchical arrangement of a family. It can refer to a wide range of family types, including nuclear, single-parent, and mixed families. Family function is frequently used to refer to the regular tasks and commitments that a family fulfills together. A happy family is a group of people who can collaborate to find solutions, make decisions, and offer one another emotional and practical support.

Family dynamics are closely related to health care. Family functioning is crucial when referring to how one member cares for another, and the effect that is has on the whole family. Throughout the medical process, family members can frequently offer valuable advice and support. Their interest in the well-being of a loved one can significantly contribute to the promotion of health and the avoidance of illness. Family dynamics, however, are not always an indifferent bystander, and healthcare professionals must take family dynamics into account while caring for patients. You can accomplish this goal by addressing family stressors, providing knowledge and tools to support healthy family functioning, and engaging with family members in a polite and sympathetic way.