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Amenorrhea Practicum Journal Entry
During this practicum, a 25 year old female presented to the healthcare facility with complains of severe cramp pain that occurs about one week before her menses, during the menstrual cycle and a week after the cycle ends. The patient complains that her menstrual cycles is irregular, and gets heavy periods with some clots. The patient reported to the clinic due to sharp pain that radiated from the chest. The patient had lived with this condition for 12 years. She has been managing the disease using alternative tradition medicines, which has not been effective.
Review of the system was conducted and laboratory tests were performed (urinalysis, urine culture, pregnancy test and wet prep). The differential diagnosis identified included amenorrhea, endometriosis, and ovarian cysts without explanation. Ovarian cysts were suspected due to presence of pelvic pain before the onset of period. However, this is not likely because the patient did not complain of fever and vomiting. Amenorrhea is suspected due to presence of pelvic pain. However, this is not likely as the key indicator of amenorrhea is absence of menses (Domino, Baldor, Golding, 2014).
To make a definitive diagnosis physical test was performed. Under the supervision of my preceptor, I conducted a pelvic exam. This included palpating pelvis areas to check abnormalities such as cysts and scars. The pelvic exam was negative. An ultrasound was requested to capture the image of the reproductive organs. The results indicated that the patient was suffering from endometriosis (American Congress of Obstetricians and Gynaecologists, 2011).
Treatment made included pain relive medication to help manage the painful cramps. The patient was also given Lo Loestrin Fe which has been found to be effective in management of pain. The increase and decrease of hormones during the menstrual cycle makes the endometrial implants to thicken.
Using this hormone therapy, it slows down the growth which prevents the implantation of the endometrial tissue. However, the patient was educated that although these medications manage the pain, they are not a permanent fix for this health complication. The symptoms can reoccur after stopping the treatment (CDC, 2013).
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The patient was also advised on ways to manage pain using home remedies. This includes the use of heating pad to relax the pelvic muscles, which helps in reducing pain. OTC non-steroidal anti-inflammatory drugs such as Motrin IB. The patient is advised to eat health and exercise regularly as it helps improve the pain (Buttaro et al., 2013).
During this practicum, I have learnt that issue of endometriosis is poorly understood in the society. This is probably because of the common myth of “etiquette menstruation” where the society believes that menstruation is a private affair and must not be discussed in public. Most of women conceal their suffering, which makes them to suffer in silence. As advanced nurse practitioner, it is our responsibility to raise awareness on endometriosis to encourage the affected persons to speak up, and seek medication early (CDC, 2013).
During the research, I also realized the common modalities between ovary cysts, amenorrhea and endometriosis. This includes the similarity in the clinical manifestation, test and diagnosis procedures and treatment. In these three reproductive systems disorders, they are clinically manifested by presence of pelvic pain before the onset and after menstrual cycle.
The test diagnosis of these disorders includes ultrasound, Pregnancy tests, urinalysis and urine culture. In management of the disease, most of them are managed using OTC pain killers, hormone therapy or invasive methods. Therefore, I need to research more on these reproductive disorders to ensure that I deliver effective care when serving the affected community (American Congress of Obstetricians and Gynecologists, 2011).
References
American Congress of Obstetricians and Gynecologists. (2011). Guideline for adolescent health care (2nd ed.). Retrieved from http://www.acog.org
Buttaro, T., Trybulski, J., Bailey, P., & Sandberg-Cook, J. (2013). Primary Care, 4th Edition. Philadelphia, PA: Lippincott Williams & Wilkins.
Centers for Disease Control and Prevention (CDC). (2013). Incidence, prevalence, and cost of sexually transmitted infections in the United States. Retrieved from http://stacks.cdc.gov/view/cdc/13174
Domino, F. J.; Baldor, R.A.; Golding, J (Ed.). (2014). The 5-minute clinical consult standard 2015 (23rd ed, Kindle Edition). Philadelphia, PA: Lippincott Williams & Wilkins.
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