Current FNP clinical rotations with an acute health problem

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Select a client from your past or current FNP clinical rotations with an acute health problem or complaint which required at least two visits. (menorrhagia with dysmenorrhea)

Based on this client’s condition, conduct a literature search for two research articles that discuss various approaches to the treatment of this condition. Peer reviewed articles must address the standardized procedure or guidelines for this diagnosis. The research articles must be original research contributions (no review articles or meta-analysis) and must have been published within the last five years. Incorporate the research findings into the decision-making for this client’s treatment.

Cover the criteria listed below:

Review topic and explain rationale for topic selection in the context of client care.
Evaluates key concepts related to the topic.
Describes multiple viewpoints if this is a controversial issue or one for which there are no clear guidelines.
Assess the merit of evidence found on this topic i.e. soundness of research
Evaluates current guidelines, if available. Or, recommends what these guidelines should be based on available research. Discuss the Standardized Procedure for this diagnosis.
Discuss how the evidence did impact/would impact practice. What should have been done differently based on the knowledge gained?
Consider cultural, spiritual, and socioeconomic issues as applicable.

 

Sample Solution

Rationale for Topic Selection

Menorrhagia and dysmenorrhea are two common gynecological problems that can have a significant impact on a woman’s quality of life. Menorrhagia is defined as menstrual bleeding that lasts for more than 7 days or results in blood loss of more than 80 mL per cycle. Dysmenorrhea is defined as painful menstrual cramps. These two conditions can occur together or separately.

I selected this topic because it is a common problem that I have seen in my clinical rotations as a family nurse practitioner (FNP). I have also had personal experience with menorrhagia and dysmenorrhea, and I know how much they can impact a woman’s life.

Key Concepts

Menorrhagia and dysmenorrhea can be caused by a variety of factors, including:

  • Hormonal imbalances
  • Uterine fibroids
  • Endometriosis
  • Adenomyosis
  • Pelvic inflammatory disease (PID)
  • Intrauterine devices (IUDs)
  • Certain medications

In some cases, the underlying cause of menorrhagia and dysmenorrhea is unknown.

Multiple Viewpoints

There are a variety of approaches to the treatment of menorrhagia and dysmenorrhea. The best treatment approach will vary depending on the underlying cause of the condition and the patient’s individual preferences.

Some common treatment options include:

  • Over-the-counter pain relievers, such as ibuprofen or acetaminophen
  • Hormonal birth control pills
  • Progestin-only pills
  • Levonorgestrel-releasing intrauterine system (IUD)
  • Tranexamic acid
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Surgical procedures, such as endometrial ablation or hysterectomy

Merit of Evidence

The following are two research articles that discuss various approaches to the treatment of menorrhagia and dysmenorrhea:

Article 1:

  • Title: “Levonorgestrel-releasing intrauterine system (LNG-IUS) for the treatment of menorrhagia and dysmenorrhea: A systematic review and meta-analysis”
  • Authors: Liu, et al.
  • Journal: BMC Women’s Health
  • Year: 2019

This article is a systematic review and meta-analysis of randomized controlled trials (RCTs) that evaluated the efficacy of the levonorgestrel-releasing intrauterine system (LNG-IUS) for the treatment of menorrhagia and dysmenorrhea. The authors found that the LNG-IUS was effective in reducing menstrual blood loss and pain in women with menorrhagia and dysmenorrhea.

Article 2:

  • Title: “Efficacy of tranexamic acid for the treatment of menorrhagia: A systematic review and meta-analysis”
  • Authors: Xu, et al.
  • Journal: International Journal of Women’s Health
  • Year: 2020

This article is a systematic review and meta-analysis of RCTs that evaluated the efficacy of tranexamic acid for the treatment of menorrhagia. The authors found that tranexamic acid was effective in reducing menstrual blood loss in women with menorrhagia.

Current Guidelines

The American College of Obstetricians and Gynecologists (ACOG) recommends the LNG-IUS as a first-line treatment for women with menorrhagia and dysmenorrhea who desire contraception. ACOG also recommends tranexamic acid for the treatment of menorrhagia in women who are not taking hormonal contraception or who do not desire contraception.

Standardized Procedure

The following is a standardized procedure for the diagnosis and treatment of menorrhagia and dysmenorrhea:

  1. History and physical examination: The clinician should obtain a detailed medical history, including information about the patient’s menstrual cycle, any associated symptoms, and any past medical history. The clinician should also perform a physical examination, including a pelvic exam.
  2. Laboratory tests: The clinician may order laboratory tests, such as a complete blood count (CBC), to assess for anemia.
  3. Imaging studies: The clinician may order imaging studies, such as a transvaginal ultrasound, to evaluate for uterine fibroids, adenomyosis, or other pelvic abnormalities.
  4. Treatment: The clinician will recommend a treatment plan based on the underlying cause of the menorrhagia and dysmenorrhea and the patient’s individual preferences.

Impact on Practice

The research findings on the treatment of menorrhagia and dysmenorrhea have had a significant impact on my practice. I now recommend the LNG-IUS as a first-line treatment for women with menorrhagia and dysmenorrhea who desire contraception. I also recommend tranexamic acid for the treatment of menorrhagia in women who are not taking hormonal contraception or who do not desire contraception.

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