Question

Sally Drake is a 54-year-old client who reports hot flashes and night sweats for the past few months. She has not had a normal menstrual period for about a year. She says she would like to start on hormone replacement therapy. She has several questions regarding the use of hormone replacement therapy.

Ms. Drake informs the nurse that she is worried about the risks of hormone replacement therapy. What can the nurse tell her?

What nursing implications are essential in identifying if the use of hormone replacement therapy is contraindicated for Ms. Drake?

Ms. Drake has been started on hormone replacement by her physician. What client teaching will she need?

Answer 1

Hormone therapy (HT):

- It refers to estrogen with or without progestins.

• Clinical evidence of efficacy of hormone therapy shows

a reduction in fracture, but an increase in breast cancer, CHD (during the first year), stroke, and DVT/PE. The benefit versus risk assessment has been altered in light of this newer evidence.

• Indications for hormone therapy is for women with

vasomotor symptoms (hot flushes and night sweats) and urogenital atrophy and prevention of osteoporosis.

• Contraindication:

> Endometrial cancer, breast cancer, undiagnosed vaginal bleeding, coronary heart disease, thromboembolism, stroke or transient ischemic attack and active liver disease.s

• Risk/ side effects:

bleeding, breast tenderness, bloating, and "premenstrual-like symptoms".

• Health teaching/ Nursing Interventions to decrease risk/side effects of HRT:

> Assessment of the Client undergoing hormone replacement therapy: General condition, Vital signs, patient's understanding & Knowledge level, risk/ side effects,etc.

> Reducing the dose or changing the regimen or the route of administration can minimize these effects.

> Instructions to report for any signs & symptoms of complications.

> Careful monitoring

> Lifestyle modification:

* Smoking cessation
* Layer clothing
* Maintain cool temperature

* Use fans
* Drink cold water
* Relaxation techniques and stress reduction
* Avoid triggers: alcohol, tobacco, hot environmental conditions and emotional stress.

> Teach them that Hormone therapy is the most effective treatment option for alleviating vasomotor and vaginal symptoms.