ANA Continuing Education | Menopause Health Educators Program: Monograph 3, page 11

Case Study 1

Asymptomatic Perimenopause

A 48-year-old African American woman presents for a routine examination. She is married and multiparous. She is in general good health but complains of minor changes in concentration.

Assessment

She has a family history of hypertension, diabetes, and macular degeneration. She has regular menstrual cycles that have not changed substantially. This patient has no remarkable features on physical exam or routine laboratory analysis.

Nursing Management

At this point, the most important aspect of the nursing interaction is anticipatory guidance. That is, by beginning a proactive discussion now that will be repeated in the future several times, this patient may make healthier choices as she ages. It is important to review her profile, particularly her family history of disease and the long-term consequences of these conditions. It is also a good time to begin a discussion of menopause and the changes that occur with estrogen loss. The fact that women have an increased risk of cardiovascular disease after menopause is a significant factor for this patient. She needs to understand her health risks, and the likely consequences of them if she makes no effort to modify them.

Next, it is equally imperative to discuss what the patient can do to modify her disease risk. Diet, exercise, and lifestyle changes are the first issues to discuss. The patient needs to understand that these are measures she can take now to prevent chronic disease in the future. It is also important to introduce the concept of hormone replacement therapy and how it can modify her risk. Her minor concentration problems may or may not reflect the early symptoms of estrogen loss. But she should be given the information that estrogen can ameliorate the short-term symptoms of menopause as well as confer long-term benefits for osteoporosis and cardiovascular disease. And although the data are preliminary, there may be some suggestion that estrogen provides benefit in terms of diabetes and vision disorders.

The sooner and more often this discussion takes place, the better equipped patients are to make informed healthy choices that are right for them. When patients are learning complex information, it is helpful for nurses to repeat it several times and let patients absorb the message. For this reason, a discussion of menopause and HRT should begin early.

Case Study 2

Mild Dementia and Depressive Symptoms

This 65-year-old white woman, who is in for a routine visit, complains of insomnia, difficulty concentrating, and frequent misplacing of items. She is a retired widow who lives alone with no pets, and has limited social activities. She has never used HRT. Her daily functional ability is good.

Assessment

Using questions that help differentiate depression and dementia on a continuum, the patient is determined to have some dementia with mild depressive symptoms (dysphoria, isolation, and insomnia).

Nursing Management

The diagnosis of depression vs dementia is difficult to make, and, often, patients have both. It is important to explain that her mood is low, she is having trouble with her memory, and the interrelationship of her symptoms with depression. Instead of telling this patient at this point that she has mild dementia, it may be better to explain it as memory problems. When an individual is depressed, the memory scores automatically go down, and antidepressant therapy can improve memory. It is important for this patient to understand the relationship of estrogen loss to cognition and memory. It would be advisable to initiate HRT and refer the patient for neuropsychiatric evaluation and treatment of her dementia.

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