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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Identify the signs and symptoms associated with endometriosis.

  • Compare and contrast the benefits and risks associated with various hormonal medications used for the treatment of endometriosis-associated pelvic pain.

  • Determine a treatment approach for this case taking into account other health issues and potential health benefits.

  • Discuss possible side effects associated with treatment for endometriosis.

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PATIENT PRESENTATION

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Chief Complaint

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“Although the pain associated with my menstrual period is better, the naproxen upsets my stomach, and I am still having pain in my lower abdomen at other times during the month.”

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HPI

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Lisbeth Anderson is a 30-year-old woman who was diagnosed with endometriosis 3 months ago based on a history of dysmenorrhea, intermittent pain with defecation, and past history of dyspareunia. She presents to the nurse practitioner today for evaluation and management of continued endometriosis-related pain despite treatment with naproxen.

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PMH

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  • S/P deep vein thrombosis 4 years ago after a flight to Southeast Asia; treated for 6 months with warfarin; no recurrence

  • G1P1A0; one healthy male child aged 2 years

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FH

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Mother (aged 57 years) has a history of endometriosis, no other health conditions; father (aged 58 years) has hypertension and elevated cholesterol; one female sibling (aged 25 years) is healthy

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SH

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Patient is a freelance photographer. She has one child. She is single; currently not sexually active. She does not smoke and consumes no more than two alcohol-containing beverages per week. She exercises 30 minutes most days of the week.

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Meds

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  • Naproxen 250 mg three times daily with food at first sign of menses for 5–7 days was begun at previous visit

  • Multivitamin one daily

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All

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NKDA

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ROS

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(+) For moderate pain in pelvic region, (–) for constipation, menstrual periods occur at regular intervals of 29 days

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Physical Examination

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Gen
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WDWN female in NAD

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VS
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BP 115/70 mm Hg, P 65 bpm, RR 15, T 37°C; Wt 72 kg, Ht 5′11″; patient has maintained same weight prepregnancy and postpregnancy

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Skin
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No lesions

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HEENT
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WNL

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Neck/Lymph Nodes
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Supple, no bruits, no adenopathy, no thyromegaly

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Lungs/Thorax
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CTA bilaterally

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Breasts
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Supple; no masses

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CV
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RRR, normal S1 and S2

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Abd
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Soft; patient states, ...

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