Case Study #1
Kiera Roberson is 50 years old and thinks she is in menopause. She has had only two light
periods in the past 12 months and has occasional hot flashes. Kiera has frequent intercourse with
her boyfriend and has noticed mild discomfort, from vaginal dryness, during coitus. She makes
an appointment with her gynecologist to find out for sure if she truly is in menopause and to see
what she can do to help these symptoms while she goes through this hormonal transition.
1. Is Kiera in menopause?
Answer: Kiera is not in menopause because her symptoms more closely resemble
perimenopause, the period prior to menopause. Menopause can be diagnosed when a
woman doesn’t have her regular menstruation cycle for a full 12 months. Kiera has
had two light periods in the last 12 months, so her symptoms do not align with
menopause. Hot flashes are also a regular occurrence in perimenopause as well as
vaginal dryness.
2. How do you answer Kiera when she asks you about estrogen replacement therapy?
Answer: Estrogen replacement therapy is no longer a recommended intervention for
patients due to findings that estrogen use may be associated with breast cancer
development and cardiovascular disease. Estrogen replacement therapy is sometimes
used for short-term use for symptoms such as hot flashes, night sweats, and joint
pain. Any use of estrogen should be for a short period and closely monitored by the
patients’ health care provider. If possible, the patient may consider other options for
managing symptoms such as using a personal lubricant when engaging in sexual
activity.
Chao Yi, 25 years old, is at the high-risk clinic. She is a known drug user, has admitted to
multiple sexual partners, and has tested positive for chlamydia, herpes simplex virus (HSV), and
hepatitis B. She just completed a prescribed course of antibiotics for her chlamydia infection and
came today to be re-cultured. The nurse found this to be a perfect opportunity to council Chao on
infectious diseases and their impact on her health and that of her partner(s).
1. Discuss the details of hepatitis B. How does it differ from hepatitis A and C?
Answer: Hepatitis B is a virus that infects the liver and can lead to chronic liver
disease. Having unprotected sex and sharing needles between drug users are the
primary modes of transmission. Having multiple sexual partners is a risk factor for
this virus but it can be prevented through vaccination. Common symptoms of
hepatitis B occur after the prodromal stage and manifest as RUQ pain, jaundice,
fatigue, nausea, and vomiting. Hepatitis B differs from hepatitis A and C mostly in
the way that it is transmitted. While hepatitis B is primarily transmitted through
unprotected sex and “dirty needles” hepatitis A is transmitted through the oral-fecal
route and hepatitis C is transmitted through blood-to-blood contact.
2. Chao does not want her partner to know about her hepatitis B infection. What advice
should the nurse give to Chao regarding this request?
Answer: The best advice a nurse could give to Chao would be to be honest with her
partner(s) for the sake of protecting their health so that they can make decisions that
will protect themselves from becoming infected as well. The partner(s) should be
tested to see if they are infected with hepatitis B. If they aren’t infected, Chao could
encourage them to get the hepatitis B vaccine. The nurse should also encourage Chao
to engage in safe sexual practices such as using condoms and limiting the number of
sexual partners.
References
O'Meara, A. M. (2019). Chapter 27 Common Gynecologic Conditions. In Maternity, Newborn,
and Women's Health Nursing: A CASE-BASED APPROACH (pp. 641–642). Wolters
Kluwer Health.
O'Meara, A. M. (2019). Chapter 28 Infections. In Maternity, Newborn, and Women's Health
Nursing: A CASE-BASED APPROACH (pp. 675–677). Wolters Kluwer Health.