293 Nursing Care of the Postmenopausal Woman, 3rd Edition
PATIENT EDUCATION Nurses are well positioned to help women keep current with screenings and immunizations. Women can find trying to follow current guidelines confusing, especially because recommendations differ depending on the organization or governing body that proposes them. The nurse can assist by confirming the wom - an’s risk factors for the various conditions.
Nurses in primary healthcare settings can assist by staying current on the ev- er-evolving guidelines for screenings and immunizations. As new guidelines are in- troduced, they can be incorporated into the practice setting. The nurse can pro- vide any counseling women might need when considering screening or vaccina- tion.
CASE STUDY 2-1
A 62-year-old woman presents to your office for a well-woman gynecologic visit. She relates that her last menstrual period was more than ten years ago. She had initially used hormone therapy (HT), but she was weaned off the HT about five years ago. She is doing well off the HT and is not having any hot flashes or other troubling symptoms. She has not been in to see the healthcare provider in three years. She states that she has not had any problems since her last visit.
Question : What screening tests would be reasonable to do or request during this visit? Commentary : On the basis of the limited information acquired, and because this woman has not been seen by a healthcare provider for three years, several screenings could be performed. Depending on the findings of the history and physical examination, the following preventive measures may be needed: ● Weight: It is important to determine if the patient is normal weight, overweight, or obese. ● Height: By using height and weight, a BMI can be calculated. ● Blood pressure: This test will assess if the patient has hypertension. ● Urinalysis: This test determines if there is sugar (a potential sign of diabetes) or blood (a possible sign of bladder cancer) in the urine, or if there is any sign of infection. ● Pap test: This test can determine if there are any abnormal cervical cells present. Because it has been three years since the woman has presented, it is time to offer a Pap test. The nurse would need to verify that she has not had a Pap test done anywhere else in the past three years. ● Blood work that could be offered includes: ○ Hemoglobin: To determine if the woman might have anemia. ○ Hemoglobin A1C: To screen for type 2 diabetes. ○ Lipid profile: To screen for hyperlipidemia. ○ TSH: Using shared decision making, the provider and patient can determine if this test is needed, since there is no universal screening recommendation for this test. ● Screening mammogram: To screen for breast cancer; should be done every one to two years. ● Dual-energy x-ray absorptiometry scan (DEXA): Not recommended until age 65 unless there is something in the woman’s history or physical examination that would warrant its request. ● Colonoscopy: Should be done if the patient has not had one within the past 10 years.
Powered by FlippingBook