NURS 6551 – Primary Care of Women Assignment Paper

NURS 6551 – Primary Care of Women Assignment Paper NURS 6551 – Primary Care of Women Assignment Paper Women’s Health Women’s health refers to the health of women, which differs from that of men in many unique ways. Women’s health is an example of population health, where health is defined by the World Health Organization as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Often treated as simply women’s reproductive health, many groups argue for a broader definition pertaining to the overall health of women, better expressed as “The health of women”. These differences are further exacerbated in developing countries where women, whose health includes both their risks and experiences, are further disadvantaged. NURS 6551 – Primary Care of Women Assignment Paper Permalink: nurs-6551-primar…assignment-paper / ? Although women in industrialized countries have narrowed the gender gap in life expectancy and now live longer than men, in many areas of health they experience earlier and more severe disease with poorer outcomes. Gender remains an important social determinant of health, since women’s health is influenced not just by their biology but also by conditions such as poverty, employment, and family responsibilities. Women have long been disadvantaged in many respects such as social and economic power which restricts their access to the necessities of life including health care, and the greater the level of disadvantage, such as in developing countries, the greater adverse impact on health. NURS 6551 – Primary Care of Women Assignment Paper Women’s reproductive and sexual health has a distinct difference compared to men’s health. Even in developed countries pregnancy and childbirth are associated with substantial risks to women with maternal mortality accounting for more than a quarter of a million deaths per year, with large gaps between the developing and developed countries. Comorbidity from other non reproductive disease such as cardiovascular disease contribute to both the mortality and morbidity of pregnancy, including Precambrian. Sexually transmitted infections have serious consequences for women and infants, with mother-to-child transmission leading to outcomes such as stillbirths and neonatal deaths, and pelvic inflammatory disease leading to infertility. In addition infertility from many other causes, birth control, unplanned pregnancy, un consensual sexual activity and the struggle for access to abortion create other burdens for women. While the rates of the leading causes of death, cardiovascular disease, cancer and lung disease, are similar in women and men, women have different experiences. Lung cancer has overtaken all other types of cancer as the leading cause of cancer death in women, followed by breast cancer, collector, ovarian, uterine and cervical cancers. While smoking is the major cause of lung cancer, among st nonsmoking women the risk of developing cancer is three times greater than among st nonsmoking men. NURS 6551 – Primary Care of Women Assignment Paper Despite this, breast cancer remains the commonest cancer in women in developed countries, and is one of the more important chronic diseases of women, while cervical cancer remains one of the commonest cancers in developing countries, associated with human papilloma virus (HPV), an important sexually transmitted disease. HPV vaccine together with screening offers the promise of controlling these diseases. Other important health issues for women include cardiovascular disease, depression, dementia, osteoporosis and anemia. A major impediment to advancing women’s health has been their under representation in research studies, an inequity being addressed in the United States and other western nations by the establishment of centers of excellence in women’s health research and large scale clinical trials such as the Women’s Health Initiative. At Primary Care Center, women’s health services focus on women’s health concerns and needs with unconditional positive regard. The health needs of today’s women cover a wide spectrum of healthcare services. The most basic service offered is a pelvic exam which is designed for doctors to look for and diagnose signs of illness in the reproductive organs of a woman’s body. A Pap smear is routinely performed during the pelvic exam, which is a screen for cervical cancer. Our doctors can discuss with you how often you should have this test performed. NURS 6551 – Primary Care of Women Assignment Paper Other women’s health issues we cover include menopause and a woman can be counseled on ways to cope with the many symptoms associated with menopause, including the benefits and risks of hormone replacement therapy. Because breast cancer is a primary concern of most women, you will be taught methods of breast self-examination. Our physicians can discuss your medical options and treatments which may include counseling on treatment and prevention of sexually transmitted diseases, including HIV, herpes, syphilis, gonorrhea, Chlamydia, hepatitis, and many more. If necessary, our primary care physicians will consult and refer to appropriate specialists, including but not limited to, gynecologists, infectious disease specialists, endocrinologists, psychologists, dermatologists, and genetic counselors. For more detailed information regarding women’s health issues, including pelvic exams, Pap smear, menopause, hormone replacement therapy, osteoporosis, breast cancer, and ovarian cancer, please refer to the disease-specific links provided on this website. These days patient care in the primary care setting can be a daunting task. With the influx of patients who had, until the Affordable Care Act (ACA), been largely neglected and had gone untreated now presenting with a myriad of ailments and an array of complicated and muddled complaints, the Primary Care Provider (PCP) is being challenged like never before. NURS 6551 – Primary Care of Women Assignment Paper Confounding our critical time limitations, much of which is spent in efforts geared toward determining what will be covered by the patient’s insurance, is the challenge to implement the most progressive and effective standards of care given the complexity of judging the benefits and risks of modalities that may not be considered as traditional areas of focus for the PCP. Perhaps no other treatment modality has sparked more debate then that of Bio identical Hormone Replacement Therapy (BHRT). With the immense interest generated by popular media, social networking and internet based information, patients often turn to their PCP for evidence based information and education. For the PCP this presents a unique opportunity as this can often be a critical period to evaluate risk for future health problems, provide proactive preventive care guidelines, prevent morbidity and decrease mortality. The primary care setting is on the front line of healthcare services and often serves to facilitate a cascade of all future healthcare needs of the patient. Proper evaluation and diagnosis is essential in providing efficient and effective care. In a time when financial expenditure, budgets and profits are an unfortunate reality of healthcare the decisions made at the primary care level can impact not only the patient but the entire health care system. [1] NURS 6551 – Primary Care of Women Assignment Paper The aim of this paper is to specifically discuss BHRT in menopausal women and the unique role of the Primary Care Provider in assessment, evaluation, initiation and follow up of such patients in the primary care setting. Due to limitations in space and the reader’s time, this conversation will be restricted to discussion of basic protocols and guidelines that can be easily implemented in a primary care setting. The main goal is to familiarize the PCP with typical characteristics a patient may present with who may be an appropriate candidate for hormonal therapy that may otherwise, in less astute eyes, be incorrectly assessed thus leading to needless exposure to redundant diagnostic evaluation, inappropriate interventions and pointless therapeutic modalities. [2] ORDER A FREE PAPER HERE Women and the Physiology of Aging Aging is the natural change in structure and function that results from the passage of time in absence of known pathology and disease. During the transition from reproductive years through menopause and beyond women experience many physiological changes that are normal consequences of the aging process. Although the observed changes around the time of menopause are often due to the natural decline in hormone production, these signs and symptoms may often mimic and erroneously be mistaken for, signs of illness or disease. [3] NURS 6551 – Primary Care of Women Assignment Paper Menopause represents the permanent cessation of menses. Most women reach menopause between the ages of 45 and 55, with average onset in the Western world being at age 52. Due to the relatively wide age range for natural menopause, chronological age may not be an adequate indicator of the beginning or end of the transition process. Although menopause is perhaps the most obvious and expected physical event, general knowledge about the process, symptoms and effective management is often inadequate. [4] Thus this presents a unique opportunity for the primary care provider to effectively and efficiently manage what could potentially influence a woman’s perceived well being, overall quality of life and health status. Midlife Physiological Changes: Is this Disease or Menopause? All women will experience menopause. However, each will do so in a very individual and unique way. Although the majority of women will report experiencing common symptoms in relation to the physiologic hormonal changes associated with menopause (night sweats, hot flashes and menstrual irregularities) there are numerous other presenting entomology that may otherwise mimic alternate pathology and disease. Depression, anxiety, fatigue, muscle and joint pain, hair loss and/or growth, skin changes, dry eye syndrome, hearing impairment, onset of periodontal disease, memory changes, insulin resistance, cardiac palpitations and other cardiovascular related ailments are often generalized complaints patients present with in midlife. [5] Since such entomology may easily be attributed to an array of possible pathological including autoimmune disease, heart disease, diabetes and possible cancer related disorders, women and their primary care providers may be challenged to distinguish whether such symptoms are attributable to onset of midlife pathology or simply menopause related changes. The PCP, working in collaboration with the female patient, can be a vital influence in helping guide the female patient in evaluation of personal health practices, facilitate improvement and enhance an overall sense of well being and self-determination. NURS 6551 – Primary Care of Women Assignment Paper Baseline Diagnostic Hormonal Evaluation In addition to the general laboratory tests that are commonly performed as part of a complete health care evaluation (lipid panel, comprehensive metabolic panel, fasting blood sugar, etc.) hormonal evaluation can be an important component in compiling a complete profile of a woman presenting with a barrage of symptoms and complaints. Presently, a single test of ovarian function capable of predicting or confirming menopause does not exist. Therefore, a comprehensive history review (including a complete review of the patient’s medical and menstrual history) accompanied by a complete laboratory profile will be vital in confirming menopause status and for ruling out other causes of presenting symptoms. [6] For the PCP in the primary care setting, baseline levels of ovarian related function would be beneficial in helping attain a complete picture and analysis of the patient. The following are commonly included in the baseline hormonal panel: Estradiol, Testosterone, Progesterone, SHBG (sex hormone binding globulin), Thyroid panel (TSH, T3, T4, TPO) NURS 6551 – Primary Care of Women Assignment Paper Implementing Hormone Therapy in the Primary Care Setting The effective management of menopause related symptoms requires a collaborative approach between the patient and the PCP. A thorough discussion of entomology, goals, expectations and areas of concern is essential between the patient and health care professional. Based on the review of labs the PCP can effectively counsel the patient as to the basic guidelines for initiation of bio identical hormone therapy (BHT). This also serves as an opportunity for the PCP to determine whether to continue in the role of a primary coordinator of care or to better refer to someone more experienced in the treatment modalities. [7] Once again there is opportunity for a unique collaborative moment in the relationship between the patient and PCP that will extend into future interactions between the professional and the patient. NURS 6551 – Primary Care of Women Assignment Paper As it is beyond the scope of this article to discuss the specifics regarding precise individualized BHRT dosage it is left to the PCP to seek relevant evidence based approaches as to the nuances of prescribing BHRT regimens. Multiple references at the end of this commentary provide excellent guidelines that may be of interest and can help guide the provider in development of standardized institutional protocols for BHRT management. Basic guidelines for initiation and follow up recommend that first follow-up be scheduled 3 months post regimen initiation. At that visit the PCP needs to revisit the patient’s initial presenting symptoms, discuss progress in symptom management, and discuss any new or persistent concerns. Adjustments in dosage based on presenting symptoms should be done at that time. Lab tests to be performed at these follow up visits should correspond with the prescribed BHT regimen. [8] Routine labs should be checked annually. If changes in therapy are required a 3 month follow up is recommended. If no changes are needed follow up visits can be extended for 6 months. After that annual visits are appropriate and serve to continue the collaborative relationship between the patient and the PCP provider. [9] NURS 6551 – Primary Care of Women Assignment Paper Conclusion In consensus with the latest recommendations from the North American Menopause Society the objective of hormone therapy in women having gone through menopause is to provide relief of symptoms found to be disruptive of normal activities of living. While conventional medical therapies often provide a simple cookie cutter approach to patient management, BHRT is a more holistic, individualized approach that not only helps manage entomology but also provides a comprehensive and prevention based approach that encompasses medical, lifestyle and behavioral based therapies in effort to prevent initiation and progression of chronic disease associated with the aging process. BHRT is a unique tool that assists in caring for women not only during the transition years, where the PCP is first likely to encounter the patient in the primary care setting, but also into later years when age and menopause related symptoms progress into development of chronic age related disease.10 It is often in the primary care setting where non-experienced care providers may feel that their role is no more effective than merely the band aiding of superficial symptoms. In this setting there is often missed opportunity to treat the underlying cause and instead there exists a reliance on providing treatment to merely adequately mask the symptoms the patient presents with. How often has a middle aged female patient presented with complaint of headache? Depression? Weight gain? Fatigue or anxiety…and we quickly conclude that a prescription for an anti-depressant, or pain medication, or muscle relaxer, or an appetite suppressant is the appropriate prescription to write the patient after a 7 min conversation? Could it be that we as PCP’s are missing an opportunity to make a difference and are, instead, settling on providing only temporary and often ineffective resolutions? NURS 6551 – Primary Care of Women Assignment Paper The science of BHRT is constantly evolving so it is important that the primary care provider stay informed and keep an open mind/perspective as the understanding of such agents expands and improves. Since a large percentage of menopausal women will suffer the consequences of age related disorders further innovative, evidence based research regarding the role of BHRT is needed. As primary care providers, we must not miss the opportunity to be in the forefront of care in coordinating the needs of the menopausal patient. PCP is the gatekeepers in the health care arena. We should not take this role casually. Women’s Primary Care Because women have unique health concerns, Bay front Health Seven Rivers offers specialized care to address the needs of women of all ages, from adolescence through menopause. Whether you need preventive care and annual screenings or need a specialist to manage osteoporosis, heart disease or another condition, we offer comprehensive services to meet all your health needs. NURS 6551 – Primary Care of Women Assignment Paper Bay front Health Seven Rivers offers a full range of services for women, including: Comprehensive gynecological care, including contraceptive counseling, care for urinary incontinence, menopause management and more Minimally invasive treatment options including laparoscopic and robotic gynecologic surgery Osteoporosis screening and treatment Preventive screenings and education on cancer, heart disease and other diseases that affect women Well-woman care, including Pap tests, and pelvic and breast exams NURS 6551 – Primary Care of Women Assignment Paper Women have a higher prevalence of depressive disorders compared to men. The current system of care for women with depressive disorders provides significant financial barriers for patients with lower incomes to access mental health services. Primary care systems are used extensively by women and have the potential to diagnose patients at early stages of mental illness and to provide evidence-based treatments, but this potential is largely unfulfilled because of significant system-level barriers inherent in primary care. Recent effectiveness research provides an excellent framework for cost-effectively improving care of depression using stepped care principles and strategies effective for improving care of other chronic conditions. Psychologists have the potential to help implement stepped care models by providing training, consultation and ongoing quality assurance, as well as by delivering collaborative care models of acute-phase treatment and relapse prevention interventions. NURS 6551 – Primary Care of Women Assignment Paper This discussion paper brings together evidence and experience from around the world focusing on making health systems more gender responsive. The paper uses a framework that combines WHO’s six building blocks for health systems and the primary health care reforms propounded in the World Health Report 2008 on primary health care. Furthermore, the paper provides examples of what has worked and how, and ends with an agenda for action to strengthen the work of policy-makers, their advisers and development partners as well as practitioners as they seek to integrate gender equality perspectives into health systems strengthening, including primary health care reforms. Facts on women’s health Women and men share many similar health problems, but women have their own health issues, which deserve special consideration. Women’s lives have changed over the centuries. Historically, life was particularly difficult for most women. Aside from the numerous dangers and diseases, women became wives and mothers often when they were just emerging from their own childhood. Many women had a large number of pregnancies which may or may not have been wanted. In the past, childbirth itself was risky and frequently, led to the death of the mother. Most women in the past did not live long enough to be concerned about menopause or old age. NURS 6551 – Primary Care of Women Assignment Paper In 1900, a woman’s life span was about 50 years. Now, in the new millennium, average life expectancy for American women is 82 years of age, and it is continuing to rise. Not only are women living longer, but they also can anticipate the possibility of enjoying a better quality of life throughout their span of years. In order to accomplish this, it is essential that women take charge of their own bodies and that they comprehend how they can maximize their personal health and fitness. It is also helpful that men understand and are supportive of the health concerns of the women. Gynecology is the primary branch of medical science concerned with women’s health issues. The word “gynecology” is a word consisting of “gyneco,” meaning “woman,” and “logic,” meaning “knowledge.” Taken together, it is “woman knowledge.” It is important that every woman has access to knowledge related to the spectrum of women’s health issues, not only about her reproductive system, but about all aspects of her body. Women’s general health and wellness There is credible information available to women not only on such problems as eating disorders, stress, alcoholism, addictions, and depression, but also on basic topics such as good nutrition, heart health, and exercise. For example, it is beneficial that a woman maintain her optimum weight. If a woman’s waist size measures more than 35 inches (89 cm), she is more likely to develop heart disease, high blood pressure, and diabetes. Eating sensible meals, eliminating after-dinner snacks, and making physical activity a part of daily life are significant ways to help control weight and lower the risk of a long list of health problems. NURS 6551 – Primary Care of Women Assignment Paper Smoking is detrimental to anyone’s health, as well as the health of those around them. Unfortunately, women continue to smoke despite the known health risks. Even though the number of female smokers is declining, still about 16% of women in the U.S. continue to smoke. Women are smoking in spite of the well-publicized risks including cancer, heart disease, and innumerable other health issues. Drinking an excessive amount of alcohol is also harmful to health. Although women typically begin drinking at a later age than men and tend to drink somewhat less, lower doses of alcohol are required for women to develop alcohol-related medical problems including alcohol toxicity, cirrhosis, and hepatitis. Women should be aware that they metabolize a number of drugs differently than men. In some cases and for some medications, the rate of metabolism may be slower, and in other cases, faster. It is, therefore, essential that women are well informed about the kinds and correct dosages of any drugs they are taking. Here are ten of the main issues regarding women’s health that keep me awake at night: Cancer : Two of the most common cancers affecting women are breast and cervical cancers. Detecting both these cancers early is key to keeping women alive and healthy. The latest global figures show that around half a million women die from cervical cancer and half a million from breast cancer each year. The vast majority of these deaths occur in low and middle income countries where screening, prevention and treatment are almost non-existent, and where vaccination against human papilla virus needs to take hold. NURS 6551 – Primary Care of Women Assignment Paper Reproductive health : Sexual and reproductive health problems are responsible for one third of health issues for women between the ages of 15 and 44 years. Unsafe sex is a major risk factor – particularly among women and girls in developing countries. This is why it is so important to get services to the 222 million women who aren’t getting the contraception services they need. Maternal health : Many women are now benefiting from massive improvements in care during pregnancy and childbirth introduced in the last century. But those benefits do not extend everywhere and in 2013, almost 300 000 women died from complications in pregnancy and childbirth. Most of these deaths could have been prevented, had access to family planning and to some quite basic services been in place. HIV : Three decades into the AIDS epidemic, it is young women who bear the brunt of new HIV infections. Too many young women still struggle to protect themselves against sexual transmission of HIV and to get the treatment they require. This also leaves them particularly vulnerable to tuberculosis – one of the leading causes of death in low-income countries of women 20–59 years. Sexually transmitted infections : I’ve already mentioned the importance of protecting against HIV and human papillary (HPV) infection (the world’s most common STI). But it is also vital to do a better job of preventing and treating diseases like gonorrhea, chlamydia and syphilis. Untreated syphilis is responsible for more than 200,000 stillbirths and early fetal deaths every year, and for the deaths of over 90 000 newborns. NURS 6551 – Primary Care of Women Assignment Paper Violence against women : Women can be subject to a range of different forms of violence, but physical and sexual violence – either by a partner or someone else – is particularly invidious. Today, one in three women under 50 has experienced physical and/or sexual violence by a partner, or non-partner sexual violence – violence which affects their physical and mental health in the short and long-term. It’s important for health workers to be alert to violence so they can help prevent it, as well as provide support to people who experience it. Mental health : Evidence suggests that women are more prone than men to experience anxiety, depression, and somatic complaints – physical symptoms that cannot be explained medically. Depression is the most common mental health problem for women and suicide a leading cause of death for women under 60. Helping sensitize women to mental health issues, and giving them the confidence to seek assistance, is vital. Noncommunicable diseases : In 2012, some 4.7 million women died from noncommunicable diseases before they reached the age of 70 —most of them in low- and middle-income countries. They died as a result of road traffic accidents, harmful use of tobacco, abuse of alcohol, drugs and substances, and obesity — more than 50% of women are overweight in Europe and the Americas. Helping girls and women adopt healthy lifestyles early on is key to a long and healthy life. NURS 6551 – Primary Care of Women Assignment Paper Being young : Adolescent girls face a number of sexual and reproductive health challenges: STIs, HIV, and pregnancy. About 13 million adolescent girls (under 20) give birth every year. Complications from those pregnancies and childbirth are a leading cause of death for those young mothers. Many suffer the consequences of unsafe abortion. Getting older : Having often worked in the home, older women may have fewer pensions and benefits, less access to health care and social services than their male counterparts. Combine the greater risk of poverty with other conditions of old age, like dementia, and older women also have a higher risk of abuse and generally, poor health. Primary Care of Refugee Women Refugees flee their country because of persecution, war, and violence; thus, all have well-founded fears for their safety should they return. To become a legal refugee, an individual must first apply to the United Nations High Commissioner for Refugees. Those who are referred to the U.S. begin the screening and vetting process, which takes 18 to 24 months. The health of refugee women is largely framed by their culture and the nature of their trauma. The shock of deprivation, persecution, and forced migration occurs throughout the path to resettlement: It begins before women are forced to leave their homes and continues during migration, at refugee camps, and after resettlement. Factors such as language barriers, health literacy, and beliefs about women’s roles all influence refugees’ health status and ability to access and engage in U.S. medical systems (see EthnoMed). 1, 2, 3 NURS 6551 – Primary Care of Women Assignment Paper Cultural Influences Language differences and lack of health literacy can impair a refugee’s capacity for self-care. Routines such as filling a prescription can be confusing if one does not understand the language and has never received a prescribed medication. What to do with the piece of paper, where to go to the pharmacy, and how to manage prescription refills are common issues. Moreover, not understanding the U.S. healthcare system makes use of services less likely. 2 Communication barriers can negatively affect care, so bilingual health educators, case managers, and patient navigators are all beneficial. Vetted female interpreters can increase refugees’ comfort, knowledge, and participation. 3 Refugee women have unique competing concerns. The process of resettlement itself is stressful and time consuming as women and their families prioritize housing, transportation, and finances. Thus, undergoing screening evaluations such as mammograms or Pap smears in the absence of symptoms is often difficult for refugee women to comprehend, especially in the context of their culture. 1, 4 While some providers may feel uncomfortable downward adjusting their goals to promote screening, putting the patient’s cultural background as well as her psychological and physical suffering first can actually lead to more-frequent screening and better outcomes. NURS 6551 – Primary Care of Women Assignment Paper Nature of Trauma Pr emigration trauma can take many forms. Healthcare resources might have been inadequate in the country of origin — and war, deprivation, and persecution leave lasting physical and psychological marks. Furthermore, the impact and sequel of torture predict multiple physical and psychological problems. 5, 6 A 2015 meta-analysis suggests that up to 44% of all refugees and asylees have been tortured (see CVT). Rape was reported in almost one third of female torture survivors, 80% of whom experienced at least two forms of torture. 7 Refugees may have also experienced other abuses including concussive trauma, witnessing torture and executions, cutting, asphyxiation, forced postures, and electric shock. 7, 8 Documenting a woman’s torture history can prevent the triggering of re-dramatization while helping her provider understand many of her complex physical and mental health issues, ultimately augmenting her adherence to healthcare. 9 NURS 6551 – Primary Care of Women Assignment Paper The sequelae of torture are severe both physically and mentally. Physical condition often varies based on the severity of the trauma and the methods used. Even in the absence of any visible deformities, there may be complaints of unexplained complex pain. A comprehensive plan of care that includes physical and occupational therapies as well as psychological and psychiatric support can be beneficial. 9 The process of migration itself is heterogeneous; while some refugee women locate resettlement camps easily, others may not. Because they may be forced to flee with only what they can carry, women might leave essential medications behind or be separated from their families (including small children). While they are displaced, they may experience limited nutrition, hygiene, sanitation, and safety. They are often exposed to extreme environmental conditions and their health is further threatened by infectious diseases. The healthcare available in refugee camps may be difficult to access, leading to — or worsening — anemia, dental issues, eosinophilic, vitamin deficiencies, parasites, abnormal cervical cytology, hepatitis, and HIV infection. 10 Because chronic health issues also often go neglected, refugee women should be checked for associated complications and provided with culturally specific interventions to achieve and maintain health. NURS 6551 – Primary Care of Women Assignment Paper At the Intersection of Trauma and Culture Female genital cutting (FGC; removing parts of the external female genitalia) is practiced in over 30 countries in Africa, the Middle East, and Asia. The procedures can cause severe bleeding, infection, and chronic problems with urina

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