Peer Response to Ly

Peer Responses:

Relate to another journal reading

• As the patient shows clinical manifestation of secondary amenorrhea which is the “cessation of previously regular menses for three months”, her condition should be evaluated with physical examination and appropriate diagnostic tests including serum LH, FSH, TSH, prolactin level; as well as pelvic ultrasonography (to rule out outflow tract obstruction) (Klein, Paradise, & Reeder, 2019). When the diagnostic blood tests are normal, the nurse practitioner (NP) should screen patients for eating disorders, immoderate exercise habits, and nutritional conditions (Klein, Paradise, & Reeder, 2019). Moreover, according to the Advanced Fertility Center of Chicago, the Progesterone Withdrawal Test is an effective test to rule out the root cause of secondary amenorrhea (2020). During this test, the patient is required to take “medroxyprogesterone acetate (Provera) 10 mg orally daily for 5-10 days or one intramuscular injection of 100-200 mg of progesterone in oil.” (AFCC, 2020).  The AFCC advised that a positive test is indicated when the patient has bleeding (not spotting) within 2 weeks after the medication is completed and the diagnosis of anovulation is made; otherwise, the patient can experience hypoestrogenism (2020). The patient in the scenario has trouble interpreting the purpose of progestin in support of the diagnosis and treatment of choice for anovulation as hormonal therapy so the NP should explain the purpose of progestin by providing her high-level scholarly reference as written documents. 
• However, the NP should interpret the patient’s values, cultural beliefs, and religious practices in planning her treatments. Also, the NP should understand that the patient has the right to refuse the recommended treatment according to the principles of informed consent (Hilger, Raviele, & Hilgers, 2018). The NP can refer the patient to an obstetrics and gynecologist for a second opinion and quadrant her with more options.