Questions:
· Discuss the relevant assessments required for the patient in the selected case study. (500 words)
· Discuss the role of the sexual health team members involved in the care of the case study. (500 words)
· Outline the education needs for the patient within the case study XXXXXXXXXXwords)
· This question is based on the Sharon case study and you will need to engage with the case study information prior to commencing this assignment.
· Sharon Munroe, 26 year old caucasian female, has recently been diagnosed with Polycystic Ovarian Syndrome (PCOS). Medical history includes, i
egular menses for the past 5 years, 12 kg weight gain over the past 2 years, increasing hirsuitism, episodes of severe acne and infertility.
Sharon case study
Sharon is a 26-year-old woman who has presented to the sexual health clinic for evaluation of the i
egular menses she has experienced since menarche. You are working with Natalie, an experienced nurse and midwife, who has worked in the sexual health clinic for 18 years.
Taking Sharon’s history
Sharon is noticeably overweight. Upon taking Sharon’s history, you learn that:
· she has a period about every 6 months
· when she does have her period, she bleeds very heavily, passing large clots and has a lot of cramping
· she also complained about excessive facial hair, which requires her to shave at least once every several days, and a lot of hair on her abdomen and arms
· she denies any change in her voice or increase in the size of her muscles
· she has been mo
idly obese since she was a young teenage
· she denies any headaches, blu
ed vision, or discharge from her nipples
· she also denies any hype
hypothyroid symptoms
· she has never had any surgery and has never conceived, despite several years of trying with her partner of six years
· she is not cu
ently taking any medication and has never used any form of contraception
Sharon has problems with menstruation
Assessing Sharon
You begin a full physical assessment of Sharon. Here is some of the information you collect:
Sharon is 172 cm tall and weighs 98 kg, giving her a BMI of 32.
Observations
Her vital signs are:
· Blood pressure (BP) 128/76mmHg
· Heart rate (HR) 72 beats per minute (at rest, sitting on the examination table)
· Respiratory rate (RR) 16
eaths per minute
· Temperature 36.5oC
· Oxygen Saturation (SpO2) 98% on room ai
· Heart sounds are normal: S1 and S2 heard clearly
· Lung fields sound clear to bases
· Abdomen soft, no masses, bladder non-palpable
Natalie conducts a pelvic exam, which is unremarkable, including no evidence for clitoromegaly, but Sharon's uterus and adnexa are very difficult to assess because of her obesity. The rest of her physical exam is unremarkable.
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The doctor’s opinion
The clinic’s doctor writes Sharon a refe
al for laboratory studies (full blood examination, luteinizing hormone (LH) and follicle-stimulating hormone (FSH), fasting glucose and glucose challenge test) as well as a transvaginal scan (TVS) of her ovaries to further evaluate what problems might exist.
The follow up appointment
Sharon returns one week later for her follow-up appointment, to learn the results of her laboratory studies. Sharon gives you her consent to sit in on the appointment with the doctor.
Test results
Sharon's follicle-stimulating hormone (FSH) is normal, but her luteinizing hormone (LH) is elevated. Her thyroid-stimulating hormone (TSH), prolactin, chemistry panel, cholesterol, triglycerides, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) are all within normal limits. Her fasting insulin level is elevated; fasting blood sugar was 6.1mmol/L, and the 2-hour value on glucose tolerance test was 10.1mmol/L. Her total testosterone is normal, free testosterone mildly elevated, whilst her progesterone is normal, as is her dehydroepiandrosterone sulfate (DHEAS) levels (a test for elevated adrenal function). The TVS showed both ovaries had an increase in volume, with 12 ovarian follicles seen in the left ovary and 18 ovarian follicles seen in the right ovary.
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Diagnosis and treatment
The clinical and laboratory results were consistent with poly cystic ovarian syndrome (PCOS). Because Sharon desires a pregnancy, she is a candidate for metformin 500mg od for 7 days, then 500mg bd for seven days, and finally increasing to 500mg tds. She is also prescribed Clomid 50mg od on day 5 of her cycle each month to induce ovulation.
Several months late
Follow up
After being started on a diet, an exercise program for weight loss, and metformin, Sharon’s blood glucose levels respond well. After 6 months of blood glucose control, menstrual regularity, and increasing doses of clomiphene, she becomes pregnant.
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