menopause dsm
A patient asks if apples and brown rice help with menopausal symptoms. Which response should the nurse provide to this patient?
"Foods such as brown rice and apples are mildly estrogenic and may improve vaginal dryness." Plant estrogens, found in food such as brown rice and apples, are mildly estrogenic and may improve vaginal dryness in menopause. They do not help prevent heart disease, control weight during menopause, or control blood sugar.
A patient experiencing menopause agrees to take hormone replacement therapy (HRT). Which information regarding HRT should the nurse provide?
"HRT will assist in alleviating severe symptoms when used on a short-term basis."
Plant estrogens are mildly estrogenic and may improve vaginal dryness. Foods in which these are found include the following:
Brown rice Sweet potatoes Carrots Apples Corn Green beans Tofu
Issues with HRT include:
Can be used to relieve hot flashes and vaginal dryness in most healthy, recently menopausal women (up to age 59 or within 10 years of menopause). Is the most effective treatment of menopausal hot flashes and vaginal dryness. Low-dose vaginal estrogen is preferred if vaginal dryness or dyspareunia are the only symptoms. Occurrence of blood clots in the legs and lungs is rare in women ages 50-59 years. Use of low-dose estrogen pills, transdermal patches, gels, or sprays further reduces the risk of clots. Risk of breast cancer increases when continuous EPT is used for 5 or more years or when estrogen only (ET) is used for 7 or more years. Risk for breast cancer ceases when the hormone is stopped.
Vasomotor instability
Clinical Manifestations Clinical Therapies Teach women to dress in layers, wear cotton underwear, and drink cool liquids. If instability is severe, hormone supplements may be prescribed.
Clinical manifestations and therapies for menopause include: Etiology Reduced vaginal lubrication
Clinical Manifestations Dyspareunia Injury Fungal infections Clinical Therapies Teach use of artificial water-based lubricants to reduce symptoms. Treat fungal infections.
Clinical manifestations and therapies for menopause include: Etiology Osteoporosis
Clinical Manifestations Fractures, increased bone fragility Kyphosis Clinical Therapies Teach the importance of calcium, vitamin D, and phosphorus intake. Suggest weight-bearing exercises.
Clinical manifestations and therapies for menopause include: Etiology Fluctuating estrogen levels
Clinical Manifestations Mood swings Irritability Depression Clinical Therapies Encourage adequate sleep and regular physical activity. Teach stress-management techniques. Refer the patient to a therapist, counselor, or support group. If severe, hormone supplements or antidepressants may be prescribed.
Clinical manifestations and therapies for menopause include: Etiology Increase in vaginal pH
Clinical Manifestions Risk of UTI; symptoms include burning, frequency, hesitancy, and urgency to urinate Vaginal infection; symptoms include vaginitis and vaginal drainage Clinical Therapies Medications (antibiotics or antifungals) may be prescribed. Encourage adequate fluid intake. Emphasize the importance of wiping from front to back. Teach patients to report symptoms of UTI and vaginal infection
A patient is experiencing an increase in facial hair and loss of skin elasticity due to menopause. The nurse should associate these manifestations to which hormone?
Decrease in estrogen As estrogen decreases during menopause, skin elasticity decreases and facial hair can increase. During menopause, progesterone decreases. A decrease in FSH is related to the feedback loop turning off due to loss of estradiol but is not responsible for the changes. Levels of the hormone androstenedione also decrease during menopause. As estrogen decreases, various tissues are affected. Breast tissue, body hair, skin elasticity, and subcutaneous fat decrease.
The nurse is teaching a female patient about the changes that occur during menopause. Which hormone change should the nurse state is responsible for menopausal symptoms?
Decreased estrogen
Hormone changes that occur with menopause include the following:
Decreased ovarian production of estradiol (E2) Estradiol is replaced by estrone (E1) as the major ovarian estrogen Progesterone production is reduced Androstenedione levels decrease FSH and LH levels increase
Which laboratory test result should the nurse identify as confirming a patient is experiencing menopause?
Decreased progesterone With decreased ovarian function, progesterone production is also markedly reduced. During menopause, ovarian production of estradiol (E2) decreases, and estradiol is replaced by estrone (E1) as the major ovarian estrogen. Estradiol is the most biologically active estrogen; estrone has only about one tenth the biological activity of estradiol and is produced in small amounts. FSH increases as it attempts to stimulate the ovaries.
The nurse is preparing a teaching tool for patients experiencing menopause. Which activity should the nurse include that helps with mood swings?
Employ stress management techniques
A patient is experiencing symptoms of menopause. Which two laboratory tests should the nurse expect to be prescribed for this patient?
Estradiol (E2) and follicle-stimulating hormone (FSH) Estradiol and FSH levels are not routinely measured but may be used for the diagnosis of menopause. LH and progesterone are not the best options for laboratory work. Vitamin D can help diagnose bone issues associated with menopause but not aid in the diagnosis of menopause.
A young patient is experiencing hot flashes, dyspareunia, and vaginal dryness. Which laboratory test should the nurse expect to be prescribed for this patient?
Follicle-stimulating hormone (FSH) FSH levels are elevated in patients with premature ovarian failure (POF) or premature menopause. FSH levels may be the only symptom in some patients. Estradiol, progesterone, and estrogen would not be the best indicator of POF.
A 30-year-old patient shows signs of menopause. Which nonmodifiable risk factor for early menopause should the nurse suspect is causing this patient's reproductive change?
Genetics
Risks of early menopause include the following:
Genetics. Smoking. High altitude. Undernutrition.
A patient mentions having issues with menopausal symptoms. For which reason should the nurse encourage the patient to ingest an adequate amount of fluid?
Helps reduce vaginal dryness
A 54-year-old female patient is experiencing redness and swelling in the right lower leg. Which assessment should the nurse make to determine this patient's risk for blood clots?
Hormone replacement therapy (HRT) HRT has a rare risk of blood clots in the legs when used. Genetics, exercising, and sexual history will not identify the risk of developing blood clots. Risks for blood clots in the legs and lungs are increased with HRT, but occurrence is rare in women age 50-59 years.
A patient with a history of breast cancer asks for suggestions to help with symptoms of menopause. Which nonpharmacologic approach should the nurse recommend to help this patient?
Massage Massage is effective in decreasing menopausal symptoms. Hormone replacement therapy is a pharmacologic approach for symptoms of menopause. Acupuncture is not proven to be effective for symptoms of menopause. Vitamin D does not alleviate symptoms of menopause.
Nonpharmacologic therapy for menopause includes the following:
Massage Meditation Soy Ginseng Yoga Acupuncture Bioidentical hormones
A patient experiencing menopause is tense and has issues with stress and vasomotor symptoms. Which alternative therapy should the nurse suggest to this patient?
Meditation Research evidence suggests that mindful meditation relieves vasomotor symptoms of menopause. Diet changes with sweet potatoes can help with vaginal dryness. Although black cohosh has been a popular alternative to hormone replacement therapy for years, it does not decrease hot flashes and other symptoms. There is unclear or conflicting scientific evidence that ginseng alleviates hot flashes in menopausal women.
The nurse is reviewing the signs and symptoms of perimenopause and menopause with colleagues. Which psychological manifestation should the nurse emphasize is least likely to occur in patients experiencing this change?
Psychosis Psychosis is not an expected health problem in patients experiencing perimenopause or menopause. Forgetfulness, difficulty concentrating, mood swings, and anxiety are symptoms associated with this physiological change.
Information to support the older adult patient with menopause includes:
Referrals for dietary management, exercise, stress management, and cosmetic assistance to increase wellness and a positive sense of self. Encourage to describe body self-perceptions. Encourage verbalization of feelings of concern, anger, anxiety, loss, and fear over body changes to facilitate the grieving process and acceptance of change. Emphasize the importance of learning to recognize and appreciate one's own special strengths to gain acceptance and a realistic appraisal of self.
The nurse notes that a patient experiencing menopause has not met the expected outcomes. Which additional teaching should the nurse prepare for this patient?
Referring for dietary management due to weight gain Referring the patient to dietary management due to weight gain will help address an expected outcome that was not attained. Having the patient discontinue hormone replacement therapy does not address the outcomes. Explaining that the symptoms of menopause are short-lived does not address the outcomes. An exercise program helps with weight management and stress in addition to preventing cardiovascular disease.
The nurse reviews the different hormones that play a role in female reproduction. Which should the nurse identify as the function of luteinizing hormone (LH)?
Stimulating the ovaries and uterus Luteinizing hormone (LH) works with follicle-stimulating hormone to stimulate the ovaries to ovulate and the uterus to prepare for an egg to be released. LH does not thin the vaginal wall, increase bone density, and increase LDL in the body.' As the ovaries age, they become less responsive to FSH and LH; this results in a shorter follicular phase and a shorter, less regular menstrual cycle. Over time, the number of viable follicles decreases, and the follicles that remain may not respond to hormonal stimulation.
The nurse plans care for a patient experiencing menopause. Which health problem can lead to urinary dysfunction?
Stress incontinence
A patient expresses concern about vaginal dryness during intercourse. Which food should the nurse encourage to help alleviate vaginal dryness?
Sweet potatoes Sweet potatoes have a plant estrogen that may help alleviate vaginal dryness. Chicken, white rice, and Brussels sprouts are not associated with plant estrogens.
A patient is receiving hormone replacement therapy (HRT) for the treatment of menopausal symptoms. For which adverse effect should the nurse evaluate this patient?
Swelling and warmth in lower extremities HRT has a rare risk of blood clots in the legs. Vaginal dryness, flushed appearance, and irregular menstrual cycle are signs of menopause. Risks for blood clots in the legs and lungs are increased with HRT, but occurrence is rare in women age 50-59 years.
A patient has taken estrogen-progestin combinations (EPT) for the last 10 years for treatment of menopause. Which intervention should the nurse identify as most appropriate for the patient?
Teaching self-examination of the breasts There is an increased risk of breast cancer when continuous EPT is used for 5 or more years. The patient would benefit from knowing how to self-examine the breasts. Mood swings, vaginal dryness, and cosmetic concerns are not as important as the risk of breast cancer.
Expected outcomes to evaluate the menopausal patient's progress toward goals include:
The patient demonstrates a positive sense of self as evidenced by stable weight, participation in a regular exercise program, and ability to manage stress. The patient verbalizes feelings related to changes that have occurred. The patient describes strategies for maintaining health.
A 38-year-old patient reports having irregular periods for the last 6 months. Which factor should the nurse consider that may put this patient at risk of early menopause?
Undernutrition Earlier menopause is associated with undernutrition. Osteoporosis and heart disease are health issues that increase after menopause. Obesity is not a risk factor.
Physiological changes caused by menopause include:
Vaginal dryness. Dyspareunia. Urinary stress incontinence, urinary tract infections, and vaginitis. Uncomfortable sexual intercourse. Hot flashes, palpitations, dizziness, and headaches. Insomnia, frequent awakening, and perspiration. Irritability, anxiety, and depression. Osteoporosis, leading to fractures and kyphosis. Increased risk for cardiovascular diseases in response to an increase in atherosclerosis.
A patient experiencing menopause asks what can be done for vaginal dryness. Which intervention should the nurse recommend?
Water-soluble gel Ways to increase vaginal lubrication include using water-soluble gels for vaginal lubrication. Sexual abstinence is not what the patient asked about. Oil-based lubricants should not be used. Accepting body changes will not help the patient's problem.
A 34-year-old patient reports not having a menstrual period in the past 14 months. Which data should the nurse obtain when performing a physical examination on the patient?
Weight and height When performing a physical examination on a perimenopausal patient, the nurse needs to obtain the patient's weight and height. The patient's sexual and menstrual history and use of alcohol and drugs are data obtained when performing the health history.
A patient is having difficulty with the changes related to menopause and states she is worried about the potential for heart problems and osteoporosis. Which activity would be best for the nurse to suggest to this patient?
Weight-bearing exercise Weight-bearing exercise reduces the rate of bone loss, helps maintain optimum weight, and reduces cardiovascular risk that increases in menopause. Swimming and isometric exercise are not the best choices for menopause, because they are not weight bearing. A healthy diet is important but should be combined with weight-bearing exercise.
The health history includes the patient observation and interview. Topics to be addressed in the health history include:
ddressed in the health history include: Sexual history. Dyspareunia or changes in sexual arousal. Menstrual history, including any changes. Past pregnancies, childbirth, and gynecologic surgeries. Urinary problems. Sleep patterns. Vasomotor symptoms. Changes in emotional responses. Alcohol, nicotine, and drug use. Diet, exercise, and vitamin or supplement use.
