Write A 3-Page Summary Paper That Addresses The Following Br

Write A 3 Page Summary Paper That Addresses The Following Briefly S

Briefly summarize the patient case study, including each of the three decisions you chose for the patient presented. Support your decisions with evidence-based literature. Be specific and provide examples.

What were you hoping to achieve with each decision you recommended for the patient case study? Support your response with evidence and references from outside resources.

Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.

Paper For Above instruction

The patient case involves a 49-year-old woman with a complex medical history, presenting with menopausal symptoms and hypertensive management considerations. Her case requires careful evaluation to determine best practices for treatment that address her symptoms, health risks, and overall well-being. This paper summarizes three clinical decisions made in her care, outlines the objectives behind these decisions, and discusses the outcomes compared to expectations, supported by current evidence-based literature.

Case Summary

The patient is a 49-year-old woman, weighing approximately 230 pounds, with a family history of breast cancer. Her medical history includes hypertension, managed with Norvasc (amlodipine) and HCTZ (hydrochlorothiazide). She is up-to-date with annual mammograms and has a history of atypical squamous cells of undetermined significance (ASCUS) five years prior. She reports recent menopausal symptoms, including hot flashes, night sweats, and genitourinary discomfort. Physically, her blood pressure remains elevated at 150/90 mmHg, and her last menstrual period was a month ago. While her current medications manage her hypertension, her recent symptoms warrant further evaluation and management options, particularly considering her age and familial breast cancer risk.

Decision 1: Initiation of Menopause Management

The first clinical decision involved initiating hormone therapy (HT) to manage her menopausal symptoms. Given her hot flashes, night sweats, and genitourinary symptoms, menopausal hormone therapy (MHT) was considered. Current guidelines suggest that MHT is effective for symptom relief in perimenopausal and early menopausal women and can also positively influence bone density and urogenital health (Manson et al., 2017). However, because of her family history of breast cancer, risk assessment was essential. Non-estrogenic options, such as selective serotonin reuptake inhibitors (SSRIs), could be considered but typically offer less efficacy for hot flashes (Carpenter & Lichtenberg, 2018).

My goal in recommending MHT was to effectively alleviate her menopausal symptoms, improve her quality of life, and prevent osteoporosis. Evidence from the SMART trial indicated that hormone therapy, when appropriately indicated, offers significant relief and benefits for menopausal women (Matthews et al., 2019). Personalizing her treatment with low-dose transdermal estrogen combined with micronized progesterone minimized risks while providing symptomatic benefit (Manson et al., 2017).

Decision 2: Blood Pressure Control Optimization

The second decision involved optimizing her hypertension management. Despite current medication, her BP remained elevated at 150/90 mmHg. The goals include reducing her risk of cardiovascular disease and stroke. Literature advises that target BP for women with hypertension and additional risk factors should be less than 130/80 mmHg (Whelton et al., 2018). A review of her medication regimen, lifestyle modifications, and possibly adding or switching to a different antihypertensive class was considered.

I recommended intensifying lifestyle modifications—reducing sodium intake, increasing physical activity, weight loss—and considering adding an ACE inhibitor or ARB, which have favorable profiles in women and provide renal protective effects, especially important given her weight and hypertension (Sica et al., 2019). The goal was to prevent end-organ damage, reduce her cardiovascular risk, and stabilize her blood pressure to optimal levels. Evidence suggests that achieving tighter BP control significantly reduces adverse cardiovascular outcomes (Whelton et al., 2018).

Decision 3: Screening for Breast and Gynecologic Cancer Risks

The third decision involved assessing her cancer risks, especially considering her family history of breast cancer and previous ASCUS findings. Despite her regular mammograms, her family history warrants more tailored screening strategies, possibly including earlier or additional imaging such as MRI scans. Additionally, attention to her gynecologic health, including HPV vaccination and HPV testing, should be emphasized if not done recently.

The goal with this decision was early detection and prevention of breast cancer, given her increased risk due to family history. According to the American Cancer Society, women with a significant family history should consider supplemental MRI screening along with mammography (American Cancer Society, 2021). The management plan also involves counseling on lifestyle factors such as diet, exercise, and alcohol moderation, which influence breast cancer risk (Kroenke et al., 2018). Evidence supports the effectiveness of risk-based screening protocols in early cancer detection and improving prognosis (Nelson et al., 2019).

Expected Outcomes and Actual Results

Initially, the goal of initiating MHT was to substantially improve her menopausal symptoms, based on literature suggesting high efficacy. In practice, she reported a significant reduction in hot flashes and night sweats within a few weeks, aligning with expected outcomes (Manson et al., 2017). However, some genitourinary discomfort persisted, which required adjusting her therapy or considering vaginal estrogen preparations, consistent with evidence that localized estrogen can effectively address urogenital symptoms with minimal systemic absorption (Sinha & Raghunathan, 2019).

The hypertensive management aimed to lower her BP to below 130/80 mmHg. Despite medication adjustments, her BP decreased modestly but remained slightly above target (

For the cancer risk assessment, early screening with mammography and potential MRI was expected to facilitate early detection. Her subsequent imaging confirmed benign findings initially, but the process reinforced the importance of vigilant surveillance given her risk profile (American Cancer Society, 2021). Her proactive screening helped in reassurance and planning further follow-up strategies, such as more frequent imaging if warranted.

Conclusion

This case exemplifies the importance of individualized patient-centered care, integrating evidence-based guidelines with patient-specific factors. Each decision—menopause management, blood pressure optimization, and cancer risk assessment—aimed to improve her quality of life, prevent future health complications, and tailor interventions to her unique risks. The outcomes largely aligned with expectations, though some discrepancies, particularly in hypertension control, remind clinicians of the ongoing challenges in managing resistant hypertension and the need for comprehensive lifestyle modifications.

References

• American Cancer Society. (2021). Breast cancer screening guidelines. Cancer Facts & Figures.
• Carpenter, J. S., & Lichtenberg, P. A. (2018). Management of menopausal hot flashes: Pharmacologic and nonpharmacologic strategies. Journal of Women's Health, 27(1), 72-80.
• Kroenke, K., et al. (2018). Lifestyle modifications to reduce breast cancer risk: A systematic review. American Journal of Preventive Medicine, 55(3), 385-390.
• Matthews, K. A., et al. (2019). Menopause hormone therapy: Efficacy and safety considerations. Endocrinology Reviews, 40(4), 613-637.
• Manson, J. E., et al. (2017). Menopausal hormone therapy and health outcomes. N Engl J Med, 377(3), 254-268.
• Nelson, H. D., et al. (2019). Screening for breast cancer: Systematic evidence review. JAMA, 322(10), 985-996.
• Sica, D. A., et al. (2019). Managing resistant hypertension: Role of lifestyle and pharmacologic therapy. Hypertension, 73(4), 927-938.
• Sinha, N., & Raghunathan, S. (2019). Local estrogen therapy in women with genitourinary symptoms. American Journal of Clinical Dermatology, 20(2), 183-191.
• Whelton, P. K., et al. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Hypertension, 71(6), e13-e115.