Question

’As the RN working in a family health clinic, you are providing education to a peri-menopausal woman who is seeking your guidance related to hormone therapy for management of hot flashes, mood swings and night sweats. this is the orginal problem we were given to write about .

state whether or not you agree with their position and explain why or why not

descscribe two (2) benefits and two (2) risks of hormone therapy?

Hormone replacement therapy is taken to compensate for loss of hormones, specifically estrogen. Loss of estrogen cause a person to experience hot flashes, sleep disturbances, urogenital atrophy, bone loss, and altered lipid metabolism. The benefit of hormone therapy is that is can either prevent or reduce these unwanted effects (Burchum & Rosenthal, 2016). However, hormone therapy does not come without risks. Two risks of hormone replacement therapy are the increased risk of endometrial hyperplasia and cancers. Cancers include those such as: breast, ovarian, and lung cancers. There is also an increased risk of CHD, MI, DVT, pulmonary embolisms and stroke (Burchum & Rosenthal, 2016).

Do the benefits of hormone therapy outweigh the risk? Provide rationale with evidence based data from the literature.

Does the risks outweigh the reward? Well, it depends. Short term uses are beneficial and are regulated in the smallest doses for the smallest amount of time. If hormone therapy is used long term to prevent chronic disorders then the benefits do not outweigh the risks. The WHI conducted studies where they found cardiovascular event and breast cancer exceeded any benefits (Burchum & Rosenthal, 2016). Another study found that it increased the risk of endometrial cancer by promoting favorable tumor characteristics such as stage, grade and tumor tubtypes (Felix et al., 2015).

What is one potential alternative to hormone therapy for this patient? Provide rationale to explain how this alternative may be beneficial for this patient.

Fortunately there are other routes this patient can take in managing her peri-menopausal symptoms she is experiencing. Effexor is one medication that can be prescribed by a physician to treat hot flashes (Hinkle & Cheever, 2014). Complimentary alternative medicines and treatments have also been used but it should be done so with caution because there is not much evidence of their safety and effectiveness. The nurse should inquire about any CAMs this patient has tried or is using. Exercise is one therapy that can be suggested that is proven to help in many ways and could help improve this patient’s moods. The WHO and CDC both advocate for regular aerobic exercise (Steven, Smith & Bryan, 2016). Exercising can help prevent bone tissue loss, muscle loss, reduce stress, and improve self-image (Hinkle & Cheever, 2014)

Describe how you will incorporate the QSEN pre-licensure Patient Centered Care competency into assisting this patient to make an informed decision on the most appropriate plan of care for her.

I would have the patient describe what symptoms she is experiencing and how it is affecting her in an attempt to see the patient situation through her eyes. I would ask her what information she already knows about what treatment options are out there for her and whether she is using any sort of alternative medicines. It is important to inquire whether she has any religious or cultural restrictions or considerations and what her goals are. With all of this in mind and collaboration with the physician then we can move forward with explanations of the treatment options available for her. Written material should also be given so that she has the option to take some time, ponder and maybe discuss with a significant other what the best route for her is. Whatever her decision is must be honored and the nurse and staff must be available to answer any other questions or concerns the patient might have.

Answer 1

Perimenopause is the time approaching menopause ( menopause is cessation of menstrual cycle) that begins when the ovaries begin to decline in function. It has been called 'change in life' or 'transition period'. Perimenopause has the potential to become a difficult period in a woman's life, as the ovaries begin to become depleted in eggs and produce hormones especially estrogen and progesterone in reduced amounts. It is important that each women attempt to understand the alterations that her body is undergoing and attempt to proactively manage these physiological changes. Moreover, she should not attempt to hide her feelings and symptoms from others involved in her life,as this may lead to misunderstooding and frustration.

Hormone therapy is the most effective tratment for perimenopausal symptoms. But this therapy has increased risk of cancer and stroke.

Hormone therapy is an acceptable option for the relatively young ( up to age of 59 or within 10 years of menopause) and healthy women who are bothered by moderate to severe menopause symptoms. Individualisation is key in the decision to use hormone therapy.consideration should be given to the woman's quality of life priorities as well as her personal risk factors such as age, time since menopause.