For This Assignment You Will Review The Latest Eviden 940746

For This Assignment You Will Review The Latest Evidence Based Guideli

For this assignment, you will review the latest evidence-based guidelines as they pertain to the case below. Discussion of the case is based on the course objectives and weekly content, which emphasize the core learning objectives for an evidence-based primary care curriculum. Throughout your nurse practitioner program, case study discussions are used to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills, and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.

Ms. Martin is a 55-year-old woman who has been on HRT for 4 years. HRT was prescribed because Ms. Martin was experiencing vasomotor symptoms associated with menopause. Her last mammogram was 2 years ago and last pap was 5 years ago. Ms. Martin made an appointment with her nurse practitioner to discuss discontinuing HRT after hearing and reading news reports about the dangers associated with the medication.

Except for the HRT, Ms. Martin is taking no medication other than a daily vitamin. She had a tubal ligation after the birth of her third child but has had no other surgeries or history of any medical conditions. Her father had cardiovascular disease and died of a myocardial infarction at 77 years of age. Her mother was diagnosed with breast cancer at 81 years of age.

Ms. Martin does not smoke and rarely drinks alcohol. She likes to work in her garden but is not involved in a formal exercise program. She has gained about 10 pounds since menopause. What evidence-based information will you provide to Ms. Martin regarding her concerns of HRT? Discuss the advantages and risks associated with HRT. What are your recommendations for Ms. Martin? Will you recommend continuing or discontinuing HRT and why? What alternative treatments for menopausal symptoms will you discuss with Ms. Martin? Discuss the recommended screening tests, using the latest evidence-based guidelines that Ms. Martin should have. What health promotion, maintenance, and prevention education would be important to provide to Ms. Martin?

Paper For Above instruction

Menopause marks a significant transition in a woman's life, characterized by the cessation of menstrual periods and a decline in ovarian estrogen production. Vasomotor symptoms such as hot flashes and night sweats are common, prompting many women to seek hormone replacement therapy (HRT) for relief. However, recent evidence-based guidelines have highlighted the importance of individualized patient assessment regarding the risks and benefits of HRT, especially for women like Ms. Martin who are considering discontinuation due to safety concerns.

HRT has proven effective in alleviating menopausal vasomotor symptoms, improving quality of life. According to the North American Menopause Society (NAMS, 2017), HRT is considered the most effective treatment for menopause-related vasomotor symptoms and genitourinary syndrome of menopause. Nevertheless, safety concerns have arisen regarding long-term use, particularly concerning increased risks of breast cancer, cardiovascular disease, stroke, and venous thromboembolism (VTE). The Women's Health Initiative (WHI) studies (2013) provided pivotal data, indicating an increased risk of breast cancer with combined estrogen-progestin therapy and cardiovascular events in older women (Chlebowski et al., 2013). However, younger women, closer to the onset of menopause, may experience a different risk profile, and the decision to start or continue HRT should be individualized.

Specifically for Ms. Martin, with her history and risk factors, shared decision-making is crucial. Her family history of breast cancer and cardiovascular disease necessitate a cautious approach. The benefits of HRT in her case include relief from vasomotor symptoms; the risks involve potential increased breast cancer risk and cardiovascular events, although data suggests these risks are lower in women under 60 or within ten years of menopause onset (Manson et al., 2017). Therefore, if she is contemplating stopping HRT, it is essential to discuss the potential for symptom recurrence and alternative management strategies.

Regarding discontinuation, current guidelines (NAMS, 2017) recommend personalized decision-making and gradual tapering of HRT to minimize withdrawal symptoms. For Ms. Martin, discontinuing HRT may be appropriate given her concerns about safety, provided alternative non-hormonal options are discussed and implemented. It's crucial to assess her menopausal symptom severity, impact on quality of life, and any contraindications before recommending cessation.

Alternative treatment options for menopausal symptoms include non-pharmacological modalities such as cognitive-behavioral therapy, mindfulness, and lifestyle modifications like regular exercise, weight management, and avoiding triggers for hot flashes (Santoro et al., 2015). Pharmacologic options include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), gabapentin, and clonidine, which may provide symptom relief with fewer risks compared to HRT (NAMS, 2017). Phytoestrogens and other supplements are less well-supported by clinical trials but may be discussed as supplementary options after evaluating evidence and patient preferences.

Screening recommendations based on the most recent guidelines emphasize routine breast and cervical cancer screening. Ms. Martin's last mammogram was two years ago, aligning with American Cancer Society (ACS, 2022) recommendations for women aged 50-74 to undergo screening every one to two years. She had her last pap smear five years ago, though recent guidelines suggest Pap smear screening every three years for women aged 21-65 unless HPV testing is included. Additionally, lipid profiles, blood pressure measurements, and blood glucose assessments should be performed periodically to screen for cardiovascular risk factors, especially given her weight gain and family history.

Health promotion and disease prevention counseling are vital. Ms. Martin should be encouraged to adopt a heart-healthy diet rich in fruits, vegetables, whole grains, and lean proteins; engage in regular physical activity; and maintain a healthy weight to reduce cardiovascular risks (Reimers et al., 2015). Smoking cessation and moderation of alcohol intake are necessary to lower her risk of chronic diseases. Bone health should be supported through adequate calcium and vitamin D intake and weight-bearing exercises, especially since postmenopausal women are at increased risk for osteoporosis (Sözen et al., 2017). Regular screening for osteoporosis with bone density scans and considering pharmacologic therapy if indicated are also essential.

In conclusion, Ms. Martin's management should be individualized, considering her symptoms, risk factors, and personal preferences. Discontinuing HRT is reasonable given her concerns, provided alternative therapies and lifestyle modifications are emphasized. Ongoing screening and preventive health measures remain critical components of her care plan, aiming to optimize her health and quality of life during and after the menopausal transition.

References

  • American Cancer Society. (2022). Breast cancer screening guidelines. Retrieved from https://www.cancer.org
  • Chlebowski, R. T., et al. (2013). Estrogen plus progestin and breast cancer risk: findings from the Women's Health Initiative Randomized Trial. Journal of the National Cancer Institute, 105(7), 533-542.
  • Manson, J. E., et al. (2017). Menopausal hormone therapy and health risks and benefits: Current evidence. Obstetrics & Gynecology, 130(2), 257-266.
  • Reimers, C. D., et al. (2015). Physical activity and cardiovascular health. Current Cardiovascular Risk Reports, 9(4), 462.
  • Santoro, N., et al. (2015). Managing menopausal symptoms: nonhormonal options. Menopause, 22(4), 385-390.
  • Sözen, T., et al. (2017). Osteoporosis development and management. Endocrinology and Metabolism Clinics of North America, 46(4), 771-786.
  • North American Menopause Society (NAMS). (2017). The 2017 hormone therapy position statement. Menopause, 24(7), 728-753.
  • Women's Health Initiative Investigators. (2013). Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women's Health Initiative randomized controlled trial. JAMA, 288(3), 321-333.
  • Global Consensus Position Statement on Menopause and Cardiovascular Risks (2018). Journal of Clinical Medicine, 7(12), 644.
  • American College of Obstetricians and Gynecologists (ACOG). (2020). Menopause hormone therapy: Practice bulletin no. 141. Obstetrics & Gynecology, 135(3), e122-e135.

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