NURS 6521 Week 9: ASSIGNMENT: CASE STUDIES
Walden University NURS 6521 Week 9: ASSIGNMENT: CASE STUDIES- Step-By-Step Guide
This guide will demonstrate how to complete the Walden University NURS 6521 Week 9: ASSIGNMENT: CASE STUDIES assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.
How to Research and Prepare for Walden University NURS 6521 Week 9: ASSIGNMENT: CASE STUDIES
Whether one passes or fails an academic assignment such as the Walden University NURS 6521 Week 9: ASSIGNMENT: CASE STUDIES depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.
After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.
How to Write the Introduction for Walden University NURS 6521 Week 9: ASSIGNMENT: CASE STUDIES
The introduction for the Walden University NURS 6521 Week 9: ASSIGNMENT: CASE STUDIES is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.
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How to Write the Body for Walden University NURS 6521 Week 9: ASSIGNMENT: CASE STUDIES
After the introduction, move into the main part of the Walden University NURS 6521 Week 9: ASSIGNMENT: CASE STUDIES assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.
Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.
How to Write the Conclusion for Walden University NURS 6521 Week 9: ASSIGNMENT: CASE STUDIES
After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.
How to Format the References List for Walden University NURS 6521 Week 9: ASSIGNMENT: CASE STUDIES
The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.
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Sample Answer for NURS 6521 Week 9: ASSIGNMENT: CASE STUDIES
Scenario 1
The scenario depicts Jamie, a 38-year-old homeless bipolar patient diagnosed with an acute psychotic episode. He has been on lithium and was recently initiated on Amitriptyline. In this case, I would continue Lithium as a maintenance mood stabilizer for Jamie since it is efficacious in the prevention and relapse of depressive and manic episodes (Goes, 2023). However, I would discontinue Amitriptyline since studies show that Tricyclic antidepressants can increase the risk of mania or rapid cycling and have the potential to cause heart rhythm problems (Irizarry et al., 2022). Amitriptyline can be hazardous and potentially fatal in overdose, and its use in bipolar patients is limited. I would add Olanzapine to the patient’s treatment since it is recommended as an adjunctive to lithium. The combination treatment has been efficacious in preventing the relapse of both depression and mania (Nierenberg et al., 2023). Olanzapine 10 mg/day orally initially; Maintenance dose- 20 mg/day orally. Lithium 450 mg twice daily orally.
Scenario 2
The case is about a 68-year-old woman with a history of rheumatoid arthritis who has been on nabumetone (Relafen) 1000 mg PO QID for 2 years. Lately, the arthritis pain has worsened, and she is requesting additional medication for her rheumatoid arthritis. An appropriate additional therapy for this patient would be Methotrexate 7.5 mg orally as a single weekly dose. The patient will also be prescribed Folic acid 5mg once a day orally to lower the risk of methotrexate adverse reactions (Salamoun et al., 2021). Methotrexate is indicated for managing severe, active rheumatoid arthritis with an insufficient response or intolerance to an adequate trial of first-line therapy, including full-dose NSAIDs (Rubio-Romero et al., 2024). This patient has been on a full dose of Relafen for two years but reports insufficient pain relief. The patient will be monitored closely for early signs of bone marrow suppression and renal or hepatic toxicity (Mustafa et al., 2022). Thus, monitoring will include renal function tests and liver function tests.
Scenario 3
The case concerns Sheila, a 26-year-old with a history of head injury and tonic-clonic seizures. She reports “funny” eye movements, feeling uncoordinated, blurred vision, and feeling lethargic. The patient’s symptoms are due to the current phenytoin (Dilantin) levels. Phenytoin levels between 10 and 20 are characterized by occasional mild nystagmus (Shah et al., 2023). The patient has nystagmus, which explains the reported symptoms. A Dilantin level of 11 confirms the diagnosis. Besides, the patient is on a high dose of Dilantin at 300 mg twice daily, which has contributed to the elevated Dilantin levels (Prasertsup et al., 2023). The treatment plan will be to lower the Dilantin dose to 300 mg once daily orally. In addition, the patient will be prescribed Diazepam 5 mg PO 8houlyr PRN for muscle spasms (Manoj et al., 2024).
Scenario 4
The case is about Xavi, a 44-year-old man complaining of low back pain following a motor vehicle accident that occurred 7 days ago. He rates his pain 8 out of 10. He was prescribed Lortab 5 / 325, which just barely makes him comfortable. The treatment plan for Xavi will be to increase the Lortab dose to 10mg/325mg orally every 4-6 hours. In addition, I will prescribe a skeletal muscle relaxant as an adjunct to Lortab. This will be Flexeril 10 mg orally TDS (Alorfi, 2023). Lortab has Hydrocone, an opioid, which exposes the patient to the risks of opioid addiction, abuse, and misuse. Therefore, the patient will be assessed and monitored for risk of opioid addiction. The patient will be educated that Lortab increases his risk of opioid addiction (Gudin et al., 2020). Thus, he must take it as per the prescribed dose. He will also be educated on other non-pharmacological pain management measures like physical therapy that can help relieve the pain (Steinmetz, 2022).
References
Alorfi, N. M. (2023). Pharmacological Methods of Pain Management: Narrative Review of Medication Used. International Journal of General Medicine, 16, 3247–3256. https://doi.org/10.2147/IJGM.S419239
Goes, F. S. (2023). Diagnosis and management of bipolar disorders. BMJ (Clinical research ed.), 381, e073591. https://doi.org/10.1136/bmj-2022-073591
Gudin, J., Kaufman, A. G., & Datta, S. (2020). Are Opioids Needed to Treat Chronic Low Back Pain? A Review of Treatment Options and Analgesics in Development. Journal of Pain Research, 13, 1007–1022. https://doi.org/10.2147/JPR.S226483
Irizarry, R., Sosa Gomez, A., Miles, S., & Tamayo Acosta, J. (2022). Managing Bipolar Disease Complicated with Psychosis in Conjunction with Polypharmacy, Parkinson’s Disease, and Multiple Comorbidities. Case Reports in Psychiatry, 2022, 3813929. https://doi.org/10.1155/2022/3813929
Manoj, R., Meher, A., & Winner G, J. (2024). Ataxia and Seizures despite Phenytoin: A Case Report Highlighting the Importance of TDM and Genetic Influences. Case Reports in Neurological Medicine, 2024, 2888895. https://doi.org/10.1155/2024/2888895
Mustafa, S. H., Ahmad, T., Balouch, M., Iqbal, F., & Durrani, T. (2022). Safety Profile of Methotrexate Therapy in Patients With Rheumatoid Arthritis. Cureus, 14(7), e27047. https://doi.org/10.7759/cureus.27047
Nierenberg, A. A., Agustini, B., Köhler-Forsberg, O., Cusin, C., Katz, D., Sylvia, L. G., Peters, A., & Berk, M. (2023). Diagnosis and Treatment of Bipolar Disorder: A Review. JAMA, 330(14), 1370–1380. https://doi.org/10.1001/jama.2023.18588
Prasertsup, W., Chomchai, S., Mekavuthikul, P., & Phuditshinnapatra, J. (2023). Phenytoin Intoxication in a Patient Receiving a Therapeutic Dose for Postoperative Seizure Prophylaxis: A Case Study. Therapeutic Drug Monitoring, 45(5), 573–575. https://doi.org/10.1097/FTD.0000000000001129
Rubio-Romero, E., Díaz-Torné, C., Moreno-Martínez, M. J., & De-Luz, J. (2024). Methotrexate treatment strategies for rheumatoid arthritis: a scoping review on doses and administration routes. BMC Rheumatology, 8(1), 11. https://doi.org/10.1186/s41927-024-00381-y
Salamoun, Y. M., Polireddy, K., Cho, Y. K., Medcalf, M. R., & Funk, R. S. (2021). Methotrexate Disposition, Anti-Folate Activity, and Metabolomic Profiling to Identify Molecular Markers of Disease Activity and Drug Response in the Collagen-Induced Arthritis Mouse Model. Metabolites, 12(1), 24. https://doi.org/10.3390/metabo12010024
Shah, K. C., Patel, N. S., Vasani, P., Khadela, A., Chavda, V. P., & Vora, L. (2023). Phenytoin-induced dyskinesia: a case report. Journal of Medical Case Reports, 17(1), 313. https://doi.org/10.1186/s13256-023-04033-6
Steinmetz, A. (2022). Back pain treatment: a new perspective. Therapeutic Advances in Musculoskeletal Disease, 14, 1759720X221100293. https://doi.org/10.1177/1759720X221100293
Sample Answer 2 for NURS 6521 Week 9: ASSIGNMENT: CASE STUDIES
Sickle cell anemia is an inherited disease where blood cells are sickle or crescent shape and are very sticky and ridged unlike regular blood cells which are round and flexible (Mayo Clinic, 2018).
The current treatment for sickle cell includes hydroxyurea which works by increasing the water content of red blood cells which increases the deformability of sickled cells and alters the adhesion of red blood cells to endothelium (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Side effects include upset stomach, nausea, vomiting, diarrhea, constipation, skin changes (color changes or peeling), flu like symptoms, hair loss, rash, headache, dizziness, drowsiness, and weight gain. Serious side effects include anemia, myelosuppression, and leukemia (Rxlist, 2017).
In July 2017 the FDA approved a new therapy for Sickle cell anemia called L-glutamine oral powder “in phase 3 of the trial patients taking this drug had 25% fewer hospital visits for sickle cell crisis, were hospitalized 33% less often, were discharged an average of 4.5 days sooner, and were 65% less likely to experience acute chest syndrome compared with the placebo group” (Karon, 2017). The way L-glutamine oral powder works is not totally understood but what is believed is it “may improve the NAD redox potential in sickle RBCs through increasing the availability of reduced glutathione” (Rxlist, 2017). The side effects if this medication are constipation, nausea, headache, abdominal pain, cough, pain in extremities, back pain, chest pain, indigestion, burning sensation, and hot flashes (Rxlist, 2017). Other drugs used to help control sickle cell attacks are short and long acting opioids and NSAIDs.
Sickle cell anemia is a genetic disease that not only effects adults but also children. About 10% of people from African decent have sickle cell anemia. Treatment for children include pain medications, a blood transfusion, drinking plenty of water, folic acid to help prevent anemia and sometimes a bone marrow transplant (Stanford Children’s Health, n.d.). Life expectancy has increase for individuals with Sickle cell anemia over the last 30 years.
References
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (2017). Pharmacotherapeutics for advanced practice: a practical approach. Philadelphia, PA: Lippincott Williams & Wilkins.
Karon, A. (2017, December 15). A new drug and more on the way for sickle cell disease. Retrieved from https://acphospitalist.org/archives/2017/12/new-drug-and-more-for-sickle-cell-disease.htm
Mayo Clinic. (2018, March 8). Sickle cell anemia – Symptoms and causes. Retrieved from https://www.mayoclinic.org/diseases-conditions/sickle-cell-anemia/symptoms-causes/syc-20355876
Rxlist. (2017, July 14). Common Side Effects of Hydrea (Hydroxyurea) Drug Center – RxList. Retrieved from https://www.rxlist.com/hydrea-side-effects-drug-center.htm
Rxlist. (2017, July 19). Common Side Effects of Endari (L-glutamine Oral Powder) Drug Center – RxList. Retrieved from https://www.rxlist.com/endari-side-effects-drug-center.htm
Stanford Children’s Health. (n.d.). Sickle cell disease in children. Retrieved from https://www.stanfordchildrens.org/en/topic/default?id=sickle-cell-disease-in-children-90-P02327
NURS_6521_Week9_Assignment_Rubric
| Criteria | Ratings | Pts | |
|---|---|---|---|
| This criterion is linked to a Learning OutcomeScenario 1: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection. | 15 to >11.0 ptsExcellentMedication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.11 to >7.0 ptsGoodMedication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.7 to >3.0 ptsFairMedication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.3 to >0 ptsPoorMedication selected is inappropriate or would not be provided based on patient unique characteristics. | 15 pts | |
| This criterion is linked to a Learning OutcomeScenario 1: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate. | 3 ptsCompleteWritten medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.0 ptsPoorThe prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate. | 3 pts | |
| This criterion is linked to a Learning OutcomeScenario 1: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. | 4 ptsExcellentReferences for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.3 ptsGoodReferences for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.2 ptsFairReferences for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.0 ptsPoorNo references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors. | 4 pts | |
| This criterion is linked to a Learning OutcomeScenario 1: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation | 3 ptsExcellentUses correct grammar, spelling, and punctuation with no errors.2 ptsGoodContains a few (1 or 2) grammar, spelling, and punctuation errors.1 ptsFairContains several (3 or 4) grammar, spelling, and punctuation errors.0 ptsPoorContains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. | 3 pts | |
| This criterion is linked to a Learning OutcomeScenario 2: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection. | 15 to >11.0 ptsExcellentMedication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.11 to >7.0 ptsGoodMedication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.7 to >3.0 ptsFairMedication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.3 to >0 ptsPoorMedication selected is inappropriate or would not be provided based on patient unique characteristics. | 15 pts | |
| This criterion is linked to a Learning OutcomeScenario 2: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate. | 3 ptsCompleteWritten medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.0 ptsPoorThe prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate. | 3 pts | |
| This criterion is linked to a Learning OutcomeScenario 2: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. | 4 ptsExcellentReferences for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.3 ptsGoodReferences for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.2 ptsFairReferences for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.0 ptsPoorNo references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors. | 4 pts | |
| This criterion is linked to a Learning OutcomeScenario 2: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation | 3 ptsExcellentUses correct grammar, spelling, and punctuation with no errors.2 ptsGoodContains a few (1 or 2) grammar, spelling, and punctuation errors.1 ptsFairContains several (3 or 4) grammar, spelling, and punctuation errors.0 ptsPoorContains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. | 3 pts | |
| This criterion is linked to a Learning OutcomeScenario 3: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection. | 15 to >11.0 ptsExcellentMedication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.11 to >7.0 ptsGoodMedication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.7 to >3.0 ptsFairMedication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.3 to >0 ptsPoorMedication selected is inappropriate or would not be provided based on patient unique characteristics. | 15 pts | |
| This criterion is linked to a Learning OutcomeScenario 3: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate. | 3 ptsCompleteWritten medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.0 ptsPoorThe prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate. | 3 pts | |
| This criterion is linked to a Learning OutcomeScenario 3: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. | 4 ptsExcellentReferences for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.3 ptsGoodReferences for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.2 ptsFairReferences for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.0 ptsPoorNo references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors. | 4 pts | |
| This criterion is linked to a Learning OutcomeScenario 3: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation | 3 ptsExcellentUses correct grammar, spelling, and punctuation with no errors.2 ptsGoodContains a few (1 or 2) grammar, spelling, and punctuation errors.1 ptsFairContains several (3 or 4) grammar, spelling, and punctuation errors.0 ptsPoorContains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. | 3 pts | |
| This criterion is linked to a Learning OutcomeScenario 4: Appropriate medication is prescribed or changed. Rationale provided and includes current literature to support decision. All aspects of the patient history are considered in making the medication selection. | 15 to >11.0 ptsExcellentMedication selected is appropriate and considers all of the unique patient characteristics. Rationale for selection is clear, complete, and appropriate.11 to >7.0 ptsGoodMedication selected might be appropriate but conflicts with the unique patient characteristics. Rationale for selection is clear but lacks discussion about potential prescribing issues.7 to >3.0 ptsFairMedication selected is not appropriate for this patient unique characteristics. Rationale provided is not correct or is flawed in applying the medication to this patient.3 to >0 ptsPoorMedication selected is inappropriate or would not be provided based on patient unique characteristics. | 15 pts | |
| This criterion is linked to a Learning OutcomeScenario 4: Written medication orders include all 5 aspects required for a valid order. The order is complete, accurate, and appropriate. | 3 ptsCompleteWritten medication orders includes all 5 aspects required for a valid order. The order is complete, accurate, and appropriate.0 ptsPoorThe prescription is incomplete. Aspects of a complete order are missing. The order is either incomplete, inaccurate, or inappropriate. | 3 pts | |
| This criterion is linked to a Learning OutcomeScenario 4: References for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. | 4 ptsExcellentReferences for the scenario are within past 5 years and include the appropriate clinical practice guideline if applicable. Correct APA format is used.3 ptsGoodReferences for the scenario are within past 5 years but do not include the appropriate clinical practice guideline if applicable. Contains a few (1 or 2) APA format errors.2 ptsFairReferences for the scenario are not from within the past 5 years or do not reflect the content of this scenario and do not include the appropriate clinical practice guideline if applicable. Contains several (3 or 4) APA format errors.0 ptsPoorNo references are included. References do not reflect the content of this scenario. Appropriate clinical practice guideline is not include. Contains many (≥ 5) APA format errors. | 4 pts | |
| This criterion is linked to a Learning OutcomeScenario 4: Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation | 3 ptsExcellentUses correct grammar, spelling, and punctuation with no errors.2 ptsGoodContains a few (1 or 2) grammar, spelling, and punctuation errors.1 ptsFairContains several (3 or 4) grammar, spelling, and punctuation errors.0 ptsPoorContains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. | 3 pts | |
| Total Points: 100 | |||
NURS 6521 Discussion Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders Walden
Based on the symptoms the patient is presenting with, I would say that she is entering menopause. Rosenthal & Burchum (2021) state that “95% of women enter menopause between the ages of 45 and 55.” The symptoms of hot flushes, night sweats, and genitorurinary symptoms, under normal circumstances, would be treated with hormone therapy (HT). However, this patient’s family history of breast cancer makes treating the symptoms of menopause much riskier.
Before discussing treatment options with the patient, I would ask her to whether the symptoms are tolerable or extremely bothersome. Determining whether she wants treatment for the symptoms would be my first step. If yes, then we would have to discuss the risks and benefits of treatment with either HT or an SNRI such as Effexor. In their article, Roberts & Hickey (2021) state that SNRIs reduce vasomotor symptoms (hot flushes & night sweats) of menopause by 50-60%. If this is acceptable for the patient, this would be the treatment plan that I would recommend. If she didn’t think that a 50-60% decrease in her symptoms was sufficient, or if her genitorurinary symptoms were more troublesome, I would recommend a low dose estrogen only HT. Estrogen only HT does increase the risk of breast cancer, but only when used long-term (Breastcancer.org, 2021).
It is important to discuss the severity of the symptoms, whether they are tolerable, and possible length of time that symptoms persist with the patient. These factors may determine whether she wants the symptoms treated or not. Then we must discuss the risks and benefits of treatment, and educating the patient on the increased risk for breast cancer that HT presents for her is imperative. Again, if relieving the vasomotor symptoms by about half is acceptable for the patient, then I would recommend treatment with Effexor because it would not increase her risk of developing breast cancer.
References
Breastcancer.org. (2021). Using HRT (Hormonal Replacement Therapy). https://www.breastcancer.org/risk/factors/hrt
Roberts, H., & Hickey, M. (2016). Managing the menopause: An update. Maturitas, 86, 5-58.
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s phamacotherapeutics for advanced practice nurses and physician assistants (2nd ed). Elsevier, Inc. .