Uterine Bleeding in Women
Comprehensive Patient Assessment: Dysfunctional Uterine Bleeding in Women
Instructions:
Conduct an internal and external environmental analysis, and a supply chain analysis for your proposed new division and its business model.
Create a SWOT table summarizing your findings. Your environmental analysis should consider, at a minimum, the following factors. For each factor, identify the one primary strength, weakness, opportunity, threat, and trend, and include it in your table.
External forces and trends considerations:
Legal and regulatory
Global
Economic
Technological
Innovation
Social
Environmental
Competitive analysis
Internal forces and trends considerations:
Strategy
Structures
Processes and systems
Resources
Goals
Strategic capabilities
Culture
Technologies
Innovations
Intellectual property
Leadership
Write a synopsis of no more than 1,050 words in which you analyze relevant forces and trends from the list above. Your analysis must include the following:
Identify economic, legal, and regulatory forces and trends.
Critique how well the organization adapts to change.
Analyze and explain the supply chain of the new division of the existing business. Share your plans to develop and leverage core competencies and resources within the supply chain in an effort to make a positive impact on the business model and the various stakeholders.
Identify issues and/or opportunities:
Identify the major issues and/or opportunities that the company faces based on your analysis.
Generate a hypothesis surrounding each issue and research questions to use for conducting analysis.
Identify the circumstances surrounding each issue; classify the circumstances; attribute the importance of each classification; and test the accuracy of the importance for each classification.
Format your paper consistent with APA guidelines.
Solution
Comprehensive Patient Assessment: Dysfunctional Uterine Bleeding in Women
Introduction
Dysfunctional uterine bleeding (DUB), also referred Abnormal Uterine Bleeding (AUB) is a type of bleeding that varies with the normal quality and quantity from normal menstruation (Bradley & Gueye, 2016). As such, such type of bleeding occurs when women spot or bleed between menstrual periods, bleeding after sexual intercourse, heavy bleeding, menstruation lasting for a longer period than normal, and bleeding past menopause (Bradley & Gueye, 2016). According to Brasic and Feldstein (2010), DUB is caused by abnormalities of the structures in the reproduction system such as fibroids, polyps in the uterus as well as endometriosis. Additionally, the Association of Reproductive Health Professionals (2008) report that DUB/AUB can be caused by adenomyosis, miscarriage, cervical lesions grips in the endothelium, and increased use of the intrauterine device. Regarding treatment, earlier recognition of DUB and seeking earlier treatment from health care providers who will appropriate diagnosis and treatment the will help in successful overall treatment. This paper will provide a comprehensive assessment of a single patient which will entail health and personal history, physical examination, diagnostic tests, treatment plans, patient education strategies as well as nurse follow-ups.
General Information
The patient is a 42-year old Latino female and married. The patient’s initials are BR.
Health Status
Chief Concern: The patient narrated for the past one and a half year she has been experiencing protracted menstruation accompanied by unadorned cramping.
History of Past Illness
BR reported that she has been experiencing extreme pain during menstrual cycles and these the episode was prolonged. As such, she reports of having heavy bleeding with severe cramping for the last one and a half years. Additionally, the patient had episodes of pain during sexual intercourse, severe abdominal pains, and blood clotting during menstruation.
The patient stated that she took OTC drugs such as Advil and Motrin relieve her of the severe pain. Additionally, the patient says that she utilized heating pad to relieve her of the pelvic pains and narrated that she soaks in a warm bath to ease cramping and pelvic pains. Additionally, the patient reported tiredness and feebleness. Also, she once visited a gynecologist and an obstetrician as a result of prolonged bleeding with painful cramps which tampered with her regular activities. The patient did not have any cases of nausea, diarrhea, fever, or vomiting.
OLDCART for BR
Onset: The patient asserts that this condition started one and a half year.
Location: The patient experience the problem in her pelvic region, uterus and vagina
Duration: Six to Seven Days during menstruation periods for the past one and a half years.
Characteristics: BR asserts that she feels sharp lower pelvic cramping and substantial bleeding as well as pain during menstruation. Also, she reports blood clots during menstruation.
Aggravating Factors: Menstruation Periods
Alleviating Factors: As stated, the patient used painkillers such as a heating pad, ibuprofen, and warm sit baths to help in relieving her pain.
Severity Scale; According to the patient, her cramping pains is on a 9/10 scale.
Treatment: The patient indicated that she had not received any treatment intervention regarding her problems.
Additionally, the patient reported that she experienced her last menstrual periods on 4/3/2017. Furthermore, she states that she is sexually active and she prefers natural barrier prevention methods. More so, the patient reported that she has a heterogeneous relationship in regard to her sexual preferences and that her partner satisfies her sexually. Also, the patient reported that she does not use any contraceptives.
Patient History
BR had a successful birth through vaginal delivery and had a weight of 8.5 pounds 6 oz. She was anemic at some point, and she had also undergone C-section. Mental health reports suggest that the patient did not have any form of depression, mood swings, anxiety, or major psychological/mental health problem. BR’s medication reports that she took Advil 200-400 mg after every 5-7 hours as stipulated by the physician for the pain. The patient reported that she has no known allergies. Additionally, surgical reports suggest, as mentioned earlier that she performed C-section once and was hospitalized 4 days post the C-section surgery. In regards, patient screening, BR reported that she connected the flu on 4/12/2016 and had a normal mammogram when she screened last on 5/17/2016. Also, the Pap smear on the same date was normal. Furthermore, the patient reported that she was aware of child immunization and denied vaccination against pneumococcal infections.
Regarding family history, the patient reported that both her father and mother had heart problems, specifically she indicated they both had hypertension. Also, she reported that she had three siblings who are well. Also, she reported that her two parents are alive and well.
Gynecological history suggests that the patient is multipara 1 since she had only one pregnancy that resulted in a viable offspring. She had only one child at the age 30. Her menarche kicked off at the age of 14 and her periods lasted for 5-7 days. In the past one and a half years, the patient has reported substantially extended bleeding accompanied by severe cramping as well as sharp pelvic pains during menstrual cycles coupled with bleeding between her menstrual cycle. The patient denied any form of sexually transmitted infections/diseases or vaginal discharge.
Obstetric History suggests that she is Gravida 1, Para 1, term 1. Gravida 1: She delivered at 40 weeks through C-section on 11/4/2005. As such, the patient denied having any SAB or therapeutic abortion (TAB). The patient reported the absence of preterm or low weight for the baby as well as she had no complications during the birth of her baby.
Social and Personal History
As indicated earlier the patient is married with one child, and she dwells with her husband. BR is a Masters graduate and works at a corporate firm as an auditor. The husband works as a construction manager at a local firm. Family household income is moderate, middle-class. Correspondingly, BR reports that there was no case of psychological or physical abuse as well as she notes she has never been exposed to any chemical, environmental or occupational hazards. BR also reports that she does not indulge in substance abuse, alcohol intake or smoking tobacco. Additionally, the patient does not take on any exercises as she feels tired after work and resides to resting. Also, BR reports that she feeds on a healthy diet that entails low fat and low carbohydrates. Furthermore, she reports that she is keen on her diet and she feeds on fruits and vegetables at least 4-5 times a week. Markedly, she reports that her sleeping patterns are normal as she wakes up from bed at 5:50 am and goes to bed at 8:30 pm, but at times she occasionally watches movies up until 10:30 pm. Additionally, the patient reports that she does not believe in some of her cultural beliefs such as the tendency of Latinos seek medication. She is a Catholic Christian and believes in the existence of God and Jesus as the son of God.
Review of Systems
BR was admitted to the hospital as she presented tiredness/fatigue and weakness, she had no fever or chills as well as no indications of weight loss. Furthermore, assessment of head and neck indicated that the patient had no headaches or dizziness as well she had no lumps or neck injuries. Chest assessment indicates that the patient had no cases of chest pains, coughing or dyspnea. The patient reports she had regular heartbeats and no cases of heart attack. Also, BR denied nipple discharge, soreness or inflammation. Furthermore, the patient reported that she had lower abdominal pains, bloating and she denied if cases of vomiting or diarrhea/constipation. In regard to a review of the genitourinary system, the patient denied burning on urination or urinary tract infection. Furthermore, the patient reported that most of her problems were on the genitals as she admitted that she had heavy protracted menstrual bleeding, severe cramping, sharp pelvic pains, sexual intercourse pains, blood clotting during menstruation and the patient denied leucorrheal discharge. The patient denied any case of varicosities. Neurologically, the patient admitted that she had fatigue and weakness and she denied any form of misperception and annexations. Last, the hematological review suggests that the patient admitted she had a history of anemia and she denied blood transfusion or bleeding
Physical Examination
First, general examination indicated that the patient had an excellent hygiene and was well developed, but she appeared weak and insipid. Vital signs indicated the following:
BP – 116/75
Heart Rate – 78
Respiration – 17
Temperature – 97.9
Pulse ox – 100 % on room air
Weight – 76.2 kg
Height – 65 inches
BMI – 28 Kg/m2
HEENT assessment suggests that the head of the was normal and atraumatic. BR’s pupils are equal, sensitive to light and accommodation as well as round. The oral mucosa is dry, and the oropharynx is clear. She has intact extraocular movements, and her tympanic membrane is bilaterally gray.
Neck Assessment suggests that her neck is flexible and without thyromegaly or JVD- jugular vein distention. Lungs assessment indicate that BR has a clear auscultation through the lobes as no wheezes or rhonchi noted. The cardiovascular assessment indicated that she had palpable pulses without any peripheral edema. Also, it was noted that BR had a steady rhythm and rate on auscultation. Also, gastrointestinal assessment indicated that the bowel sounds were active in all quadrant as the abdomen on palpitation, the abdomen is soft.
Breast assessment indicates that there are no lesions, dimpling or discoloration as the auxiliary lymph nodes are non-palpable. On the other hand, the Pelvic assessment shows that the Vulva’s hair distribution is normal with no lesions. Vagina has no inflammation or discharge as it is pink in color. The pubic hair is not shaven. The cervix is intact, and the uterus is soft, tender, asymmetrical and enlarged.
Diagnostic and Laboratory Tests
Lab Test and Results
A pregnancy test was performed, and the results were negative. Also, hemoglobin and hematocrit tests indicated H/H 8.5/26.5 indicating the presence of anemia.
Diagnostic
Transvaginal Ultrasonography
A transvaginal ultrasonography was contacted in order to rule out possibilities of a uterine tumor (van Nagell & Hoff, 2013). The diagnostic test indicated an obscured myometrial border, uterine wall thickening; the uterine enlargement measured 13 cm with no leiomyomata, a varied echo texture and the thickening of the zone of transition measured 12. 9 mm.
Magnetic Resonance Imaging
The purpose of the MRI focused on acquiring a high-resolution image of the uterus and authenticating any diagnosis suspected (Gardner, Jaffe, Hertzberg, Javan, & Ho, 2013). Results suggest that the intersectional region of the uterus is thickened and measures 12.9 mm. Additionally, the MRI revealed a diffuse area of the thickening with striated look/appearance.
Differential Diagnosis
The differential diagnosis for BR shows three diagnoses namely: uterine fibroids, adenomyosis, and endometrial hyperplasia.
Primary Diagnosis: Adenomyosis
According to Levy et al. (2013), adenomyosis is a uterine pathology that occurs as a benign which entails endometrial tissue to move into the muscles of the uterine walls. Even though its cause has been unknown for years, the disorder is common with females who have elevated estrogen levels (Benagiano, Habiba, & Brosens, 2012). When estrogen levels decrease, this condition tends to fade away for women who are post-menopause. Its risk factors are multiparity; such as C-section, past uterine surgery, removal of fibroids through surgery, females at a reproductive phase, and those aged between 40-50 years (Benagiano et al., 2012). Clinical manifestation for adenomyosis entails severe pelvic pains, protracted menstrual cramping, heavy bleeding, tenderness in the abdomen, substantial bleeding during menstruation and pain during sexual intercourse (Struble, Reid, & Bedaiwy, 2016). According to Genc, Genc, and Cengiz, (2015) is suggest that adenomyosis can be detected physically when a patient depicts abdominal tenderness, wet and enlarged uterus. Furthermore Genc, Genc and Cengiz outline that its diagnosis is made on MRI results as well as sonographic results. Additionally, it is imperative to note that women with mild adenomyosis tend to have symptoms that alter their daily activities when treatment is administered to them (Taran, Stewart, & Brucker, 2013). As such, with all these risk factors, sign, and symptoms, as well as diagnosis, clearly relate to BR’s clinical presentation, making adenomyosis to be a primary diagnosis for the patient.
Endometrial Hyperplasia (EH)
Endometrial hyperplasia is a state where there is an excess growth of cells that cover the uterus that initiates the thickening of the uterus (Moore & Shafi, 2013). EH is linked to womb cancer (Sorosky, 2012). According to Moore and Shafi (2013), endometrial hyperplasia risk factors include women without children, women of age 35 years and above, mostly whites, family history of ovarian cancer or colon cancer. Obesity, tobacco smoking and history of diabetes. Hannemann, Alexander, Cope, Acheson, and Phillips (2010) indicate that conditioned is triggered by the imbalances between progesterone and estrogen. As such, it is indicated that its signs and symptoms entail prolonged, unusual periods: short than twenty-one days’ menstruation period and bleeding after menopause. Furthermore, they suggest that diagnosis is through dilatation and curettage, virginal ultrasound, and hysteroscopy. In regard to BR’s presentation and symptoms are not synonymous with the diagnostic results and risk factors.
Uterine Fibroids
According to Women’s Health U.S. (2017), uterine fibroids are referred to as muscular polyps that develop in the uterine wall. They are also referred to as myoma. These fibroids are non-cancerous and can either be single or more. For women, they stand a risk of developing uterine fibroids as they age to 35-40 years where the fibroids shrink. Other factors that can lead to the development of uterine fibroids include familial history, eating habits, and ethnicity. Uterine fibroids are characterized by lower back pains, painful sex, heavy bleeding, enlarged abdomen, and recurrent urination. Its physical examination entails irregular pelvic mass as well as a firm pelvic. According to Women’s Health U.S. (2017), diagnosis for uterine fibroids include transvaginal ultrasound, Magnetic Resonance Imaging, and endometrial-biopsy. The uterine fibroid was not selected as the main diagnosis because of the absence of fibroids during assessment of the pelvic as well as during sonography test. Additionally, sonography is more reliable with adenomyosis.
Care Management Plan
To establish a definitive diagnosis of adenomyosis, BR had to undergo post hysterectomy assessment. The clinical findings for this case indicated that the patient had enlarged, wet, asymmetrical, and tender uterus during the pelvic assessment, sonographic and MRI results are tantamount to the diagnosis of adenomyosis (Taran et al., 2013).
Intervention/Treatment Plan
The intervention plan was based on the clinical presentations and the collective agreement with BR. BR decided that she was satisfied with one child and opted for a hysterectomy. Additionally, due to anemia she was prescribed ferrous sulfate 325 mg, 3-times a day, taken orally. The patient was instructed and well made aware that the drug should be taken on an empty stomach an hour before a meal. Additionally, the patient was advised to continue with the OTC Advil 300 ng until the surgery was performed.
Patient Education
BR was educated on the pathophysiology of adenomyosis, and she was able to understand the risk factors that made her be predisposed to adenomyosis. Additionally, the patient was well-educated on the different types of treatment regarding adenomyosis, and she opted for a hysterectomy. Furthermore, after her choice, she was educated of the psychological. Emotional effects of conducting a hysterectomy since most of the women turn to the grief of losing their womb that can lead to depression. Furthermore, she was advised to continue with her methods of relieving pain as mentioned earlier
Patient Follow-Up Care Plan
A pre-surgical test was performed before
conducting hysterectomy to examine the metabolic panel, complete blood count,
and prothrombin as well as INR -international normalized level. Additionally,
an electrocardiogram and x-rays of the chest
were performed to rule out any cardiovascular disease that would complicate
surgery. All lab results were normal with H/H 11.4/38.8. Total hysterectomy was
performed on 8/24/2016. Th hysterectomy was successful,
and the patient was given a six-week follow-up of post -surgery.
References
Association of Reproductive Health Professionals. (2008). Clinician Fact Sheet: Abnormal Uterine Bleeding. Retrieved April 29, 2017, from http://www.arhp.org/Publications-and-Resources/Clinical-Fact-Sheets/Abnormal-Uterine-Bleeding
Benagiano, G., Habiba, M., & Brosens, I. (2012). The pathophysiology of uterine adenomyosis: An update. Fertility and Sterility. https://doi.org/10.1016/j.fertnstert.2012.06.044
Bradley, L. D., & Gueye, N. A. (2016). The medical management of abnormal uterine bleeding in reproductive-aged women. American Journal of Obstetrics and Gynecology. https://doi.org/10.1016/j.ajog.2015.07.044
Brasic, N., & Feldstein, V. A. (2010). Dysfunctional uterine bleeding: Diagnostic approach and therapeutic options. Ultrasound Clinics. https://doi.org/10.1016/j.cult.2010.03.007
Gardner, C. S., Jaffe, T. A., Hertzberg, B. S., Javan, R., & Ho, L. M. (2013). The incarcerated uterus: A review of MRI and ultrasound imaging appearances. American Journal of Roentgenology. https://doi.org/10.2214/AJR.12.9473
Genc, M., Genc, B., & Cengiz, H. (2015). Adenomyosis and accompanying gynecological pathologies. Archives of Gynecology and Obstetrics, 291(4), 877–881. https://doi.org/10.1007/s00404-014-3498-8
Hannemann, M. M., Alexander, H. M., Cope, N. J., Acheson, N., & Phillips, A. (2010). Endometrial hyperplasia: a clinician’s review. Obstetrics, Gynaecology and Reproductive Medicine, 20(4), 116–120. https://doi.org/10.1016/j.ogrm.2010.01.002
Levy, G., Dehaene, A., Laurent, N., Lernout, M., Collinet, P., Lucot, J. P., … Poncelet, E. (2013). An update on adenomyosis. Diagnostic and Interventional Imaging, 94(1), 3–25. https://doi.org/10.1016/j.fertnstert.2009.03.012
Moore, E., & Shafi, M. (2013). Endometrial hyperplasia. Obstetrics, Gynaecology & Reproductive Medicine, 23(3), 88–93. https://doi.org/10.1016/j.ogrm.2013.01.002
Sorosky, J. I. (2012). Endometrial cancer. Obstetrics and Gynecology, 120(2 Pt 1), 383–97. https://doi.org/10.1097/AOG.0b013e3182605bf1
Struble, J., Reid, S., & Bedaiwy, M. A. (2016). Adenomyosis: A Clinical Review of a Challenging Gynecologic Condition. Journal of Minimally Invasive Gynecology. https://doi.org/10.1016/j.jmig.2015.09.018
Taran, F., Stewart, E., & Brucker, S. (2013). Adenomyosis: Epidemiology, Risk Factors, Clinical Phenotype and Surgical and Interventional Alternatives to Hysterectomy. Geburtshilfe Und Frauenheilkunde, 73(9), 924–931. https://doi.org/10.1055/s-0033-1350840
van Nagell, J. R., & Hoff, J. T. (2013). Transvaginal ultrasonography in ovarian cancer screening: current perspectives. International Journal of Women’s Health, 6, 25–33. https://doi.org/10.2147/IJWH.S38347 Women’s Health U.S. (2017). Uterine fibroids. Retrieved April 29, 2017, from https://www.womenshealth.gov/a-z-topics/uterine-fibroids#c