Endometriosis

Endometriosis is when tissues similar to the lining of the uterus grow outside of the uterus and endometrial cavity and on other areas in your body which causes pain and other symptoms. According to the Office on Women’s Health (OWH 2019), endometriosis affects more than 11% of American women between the age of 15 and 44. It is especially common among women in their 30s and 40s. The most common symptoms are pain during and after sex, chronic low back pain and/or pelvic pain, bleeding or spotting between menstrual periods, infertility, diarrhea, constipation, bloating, or nausea, especially during menstrual periods. I would refer the patient to a gynecologist for follow up and additional treatment or procedures they may need. According to Johnston, Reid, and Hunter (2015), clinical suspicion should prompt referral. Women with severe endometriosis should be referred to a specialist and should be a part of the multidisciplinary team. The patient should have access to a gynecologist, urologists skilled in laparoscopic management, as well as specialist nurses, psychology services, and an active network of support groups. The patient can follow up with the NP to follow up with symptoms and birth control options. Endometriosis is chronic so long term management is needed. Patients can also discuss alternative therapies with their providers and ask for referrals. According to Epocrates (2020), therapy should focus on reducing recurring symptoms that may occur a few months after medical or surgical procedures.

Sample Solution

Parts of this symphony were composed during the actual siege during air raids and attacks.   During the first few weeks of the siege, Shostakovich refused to evacuate and continued writing.  He hoped that he would create a piece that would boost the morale of the Russian people. The Leningrad Symphony as a whole, while sharing some similarities with its earlier counterpart, is stylistically quite different and shows a slightly different side to Shostakovich’s writing. The Fifth Symphony contains melodies that are lush and flowing. It reflects Shostakovich’s transformation as a good Soviet composer. The overall mood of the Seventh Symphony can be viewed as more nationalistic, reflecting what was occurring at this time in Soviet history.  There are fewer flowing melodic lines, and he also plays with meter much more in this symphony, experimenting with more inconsistent meters like 7/4. Each movement of the symphony also contains a number of what can be described as battle scenes, no doubt reflecting the environment in which Shostakovich was composing at the time.  For example, in the first movement the music becomes more and more frantic until the trumpets loudly introduce the arrival of the Germans with scales that ascend and descend consecutively.  As the tempo increases the brass imitate the air raid sirens.  In addition, the repetition of themes and ostinatos in the first movement seem to represent the stupidity of war according to Sheinberg.    The statement of the first theme, which makes numerous appearances in various forms throughout the work, makes it clear that this is going to be a work representative of the Russian people as a whole: strong, resilient and united. The theme itself contains sev

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