"Abnormal Pap Smear" is an excellent example of a paper on symptoms. The differential diagnoses that can be considered, in this case, include a human papillomavirus (HPV) infection, cervical cancer, and menopause. An abnormal Pap smear can show an infection by HPV since it usually causes the cells in the cervix to appear abnormal. Although not all HPV infections can progress to cervical cancer, some of them do, and, as a result, cervical cancer can also be considered as a possible diagnosis. It can only be ruled out by performing further tests.
Another possible diagnosis is menopause. The symptoms presented by the patient, her age and FSH levels infer that she may be undergoing menopause. Working Diagnosis The most probable working diagnosis for this patient is menopause. Symptoms of menopause include hot flashes, difficulty sleeping, and vaginal itch. The most common psychological health effects of menopause include depression and anxiety, which affects 55% of women while 36% of them report experiencing insomnia (Patel, Koshy & Ravindra, 2014). Given the symptoms presented by the patient, the most appropriate diagnosis would be menopause. Her age and significantly high FSH levels also provide evidence towards the diagnosis.
Also, menopause is characterized by a cessation of the menstrual cycle. According to the National Institute on Aging (2015), the average age of a woman having her last period is 51 years, although some women may experience menopause in their forties or after fifty. Goals of Treatment The goals of treatment for menopausal women include relieving of symptoms and prevention of further deterioration of the patient’ s condition. Relieving the symptoms is important as it improves the quality of life of the patient.
Also, the treatment plan will address minimizing the risk of getting complications that the patient is likely to be predisposed to due to their condition. Further complications may make the treatment of the patient more expensive and impact their normal routines negatively. A follow-up plan is also essential in the management of this patient because the symptoms may proceed for some time before the patient is fully recovered. The nursing care plan will adopt a holistic approach involving both pharmacological and non-pharmacological treatment options. Management of the Patient The patient will be started on menopausal hormone therapy.
The loss of estrogen has got adverse effects on the health of the woman, including hot flashes and insomnia. Also, anxiety, difficulty concentrating and depression can result from the hormonal imbalance. Although hormone therapy can help significantly in relieving the symptoms of menopause, it is recommended that the woman uses the lowest possible dose for the shortest duration possible (National Institute on Aging, 2015). Estrogen therapy also helps to prevent the patient from getting osteoporosis and cardiovascular diseases. Depressive symptoms are usually common in women with a history of depression although they may occur without a history of depression (Freeman, Sammel, Boorman & Zhang, 2014).
In case the patient experiences depression, antidepressants may also be considered. Non-pharmacological approaches include a lifestyle change to incorporate regular exercise and a nutritious diet that is rich in vitamin D, calcium, and fibre, and low in fat and processed sugars. Maintaining a healthy weight is also important to minimize the risks for osteoporosis and cardiovascular diseases. Patient education and counselling are also important to help the patient deal with the transition period effectively without developing depression. Follow-up plan The patient will have to undergo further tests to confirm the cause of the abnormal Pap smear results, to determine if it is an HPV infection or cervical cancer.
If the HPV results are negative, immediate treatment of the abnormal cells is required (Center for Disease Control and Prevention, 2015). The follow-up plan will also include two-week intervals to monitor the progression of treatment and to determine if alternative treatment approaches may be required.
Center for Disease Control and Prevention. (2015) Making Sense of Your Pap & HPV Test Results. Retrieved April 9, 2015 from http://www.cdc.gov/std/hpv/pap/default.htm#sec5
Freeman, E. W., Sammel, M. D., Boorman, D. W., & Zhang, R. (2014). Longitudinal pattern of depressive symptoms around natural menopause. JAMA psychiatry, 71(1), 36-43.
National Institute on Aging. (2015) Menopause. Retrieved April 9, 2015 from http://www.nia.nih.gov/health/publication/menopause
Patel, V., Koshy, S., & Ravindra, H. N. (2014). Effectiveness of structured teaching programme on knowledge regarding menopausal symptoms and its management among women. IOSR J Nurs Health Sci, 3, 22-26.