NURS664B Week 1 | Nursing in Health Care - Westcoast university

1. A 58-year-old woman presents for her annual well-woman examination. She reports that she started having (vaginal) spotting about 3 months ago, “I thought maybe I was having one last period,” and has had increased urinary frequency over the past 2 to 3 months. She denies any constitutional symptoms, and denies pelvic pain. Her past medical history is notable for hypothyroidism, hypercholesterolemia, hypertension, and type II diabetes. Family history is notable for father with lung cancer, mother with uterine cancer, and maternal first cousin with colon cancer. She is obese but is exercising regularly. She reports one abnormal Pap smear about 15 years ago, which was worked up, and “normalized” after follow-up Pap smears without any surgery. Her last Pap smear was about 4 or 5 years ago and she recalls it was negative; she was told that she didn’t have to have any more Pap smears. She went through menopause at 54 years of age, used combination hormone replacement therapy (HRT) for 2 to 3 years, discontinued 2 years ago. Vital signs: Height 158 cm; Weight 78.0 kg; BMI 31.2; BP 148/88 mmHg; Pulse 84; Respirations 18; Temp 36.6°C. Physical exam notable for normal cardiovascular, respiratory, skin, musculoskeletal; abdomen obese, soft, non-distended, non-tender; pelvic exam notable for normal female genitalia, no lesions; vagina and cervix normal, no discharge or blood in vaginal vault; bimanual exam notable for no tenderness on exam; uterus somewhat globular, approximately 10 to 12 weeks size; ovaries non-palpable.

Which test/study will you want to obtain first? Which risk factor contributes most to this woman’s risk for endometrial cancer? The results of the endometrial biopsy return as endometrioid adenocarcinoma FIGO grade I to II. What will you want to do next? What suggestions can you give her to improve her successful post-hysterectomy adjustment?