Nursing Case Study for PCOD

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This nursing case study for PCOD covers pathophysiology, diagnostic assessment, and pharmacological management of the disease. The document type is a case study and the assignment type is nursing. The subject is nursing and the course code, course name, and college/university are not mentioned.

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Running head: NURSING CASE STUDY FOR PCOD 1
Nursing Case study for PCOD
Student name:
Student ID:
Author’s note:

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NURSING CASE STUDY FOR PCOD 2
Table of Contents
Introduction......................................................................................................................................2
Pathophysiology..............................................................................................................................2
Diagnostic assessment.....................................................................................................................3
Pharmacological management.........................................................................................................4
Conclusion.......................................................................................................................................5
Reference list...................................................................................................................................7
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NURSING CASE STUDY FOR PCOD 3
Introduction
Polycystic ovary syndrome (PCOS) accounts for a major number of
hyperandrogenism and even anovulatory symptoms among women. The diagnosis of PCOS is
often associated with lifelong symptoms, coupled with increased risk relating to infertility.
Research study states the fact that PCOS may lead to chronic disorder such as cardiac issues and
even endometrial carcinoma (Rosenfield, & Ehrmann, 2016). The current assignment thus aims
to underline the pathophysiology of the disease, coupled with diagnosis and proper medical
intervention.
Pathophysiology
Pathophysiology of PCOD is inclusive of primary defects within insulin secretion,
hypothalamic–pituitary axis and ovarian function. Although the exact cause in regards to PCOS
is yet to be evaluated, PCOD is often linked with obesity and resistance to insulin. The link with
insulin function is expected; insulin is responsible for regulating function of ovary (Rosenfield,
& Ehrmann, 2016). Ovaries respond to high levels of insulin by producing androgens leading to
anovulation. In similar regards, it can be seen that follicular maturation arrest can be termed as
landmark sign that suggests existence of ovarian abnormality. It is due to ovarian abnormality
that Sharon is subjected to irregular menses
Clinical signs in regards to PCOS is often marked with increase in level of the following
hormones; gonadotropin–releasing hormone (GnRH) and luteinizing hormone (LH) (Rotstein,
2019). However, it should be noted that the levels of follicular stimulating hormone observe no
change. Due to the increase in level of GnRH, the thecal cells within female ovary responds with
high level of androgen production. Nevertheless, follicular arrest can be rectified by increasing
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NURSING CASE STUDY FOR PCOD 4
the levels of either endogenous or exogenous follicle stimulating hormones. A research based
study conducted by Arentz et al. (2017), suggests PCOS is often termed as a primary defect
among the younger girls during the onset of menarche, or among individuals who have a
previous history of similar disorder. It can be found out that, 25% individuals with PCOS exhibit
elevated levels of prolactin (Rotstein, 2019). In PCOS, a decrease in ovulatory system may lead
to decrease in circulating progesterone. In similar regards, exposure to androgens may decrease
inhibitory effect of progesterone and estrogen on the hypothalamus contributing to increase in
pulsatility
Diagnostic assessment
If there is a doubt regarding the symptoms of PCOS, it becomes important to find out the
previous medical history of the patient. As stated by Jacob et al. (2016), a blood test is often
recommended in case of patients suspected to suffer from PCOS as elevated level of hormones in
the blood stream can attest the prevalence of PCOS. As stated by Gonzalez, Considine Abdelhadi
& Acton (2016), a pelvic ultrasound is recommended for individuals suffering from PCOS. The
BMI for the mentioned case was found to be 32. Based on this information, it can be
conclusively stated Sharon is subjected to PCOS.
The male pattern hair growth and medical history of repeated miscarriage and even
prolonged periods of infertility can be termed as one of the leading symptoms of diagnosing
PCOS. The reason why pelvic ultrasound is carried out is to find the possible presence of ovarian
cysts. During the course of assessment, potential causes linked with metabolic, endocrine and
even reproductive dysfunctions are excluded. As pointed out by (), physicians should rule out the
possibility of adrenal hyperplasia and even Cushing syndrome before the diagnosis of PCOS.
Once, PCOS is diagnosed, study showed that 50% of the patients were exposed to diabetes or

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NURSING CASE STUDY FOR PCOD 5
even pre-diabetes coupled with increased risk of myocardial infarction (Abdelhadi, Considine,
Acton & Gonzalez, 2016).
NIH criteria ESHRE criteria AES criteria
Anovulation
Hyperandrogenism
Anovulation
Hyperandrogenism
Polycystic ovaries
Anovulation
Hyperandrogenism
Polycystic ovaries
Exclusion of other possible
disorders related to the same
Table 1: Diagnostic Tools for PCOS
(Source: Ndefo, Eaton & Green, 2013)
Pharmacological management
Anovulation
Clomiphene: The mentioned drug can be used to induce ovulation among people like
Sharon who are subjected to PCOS. However, the precise mechanism is yet to be known, the
initial dose is for 5 days, of 50 mg/day (Arentz et al. 2017). If ovulation takes place and no
pregnancy occurs, then the same dosage is continued for the subsequent cycles. However, if
there is no indication of ovulation, the dose strength is increased to 100 mg daily for 5 days with
minimum 30 days after the previous course of therapy (Sever, Ferjan & Janez, 2017)
Furthermore, Clomiphene is not recommended after 3 courses. Evidence based study provide a
clear understanding that Clomiphene provided positive results in the course of pregnancy.
Nevertheless, adverse effects may include enlargement of the ovaries, multiple pregnancies,
gastrointestinal problems and even hot flashes.
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NURSING CASE STUDY FOR PCOD 6
Antidiabetic agents.
In the mentioned case study, it can be clearly seen that Sharon is prone to the risk of
diabetes. Based on that it would be fair enough to prescribe anti-diabetic medication to Sharon.
Clomiphene with anti-diabetic medication can worm on improving the favourable outcome
related to fertility and even ovulation (Taghavi, van Wely, Jahanfar & Bazarganipour, 2017).
Anti-diabetic drugs can be used to improve the chances of fertility while decreasing the levels of
insulin and even reducing the level of androgen in blood stream. However, it should be noted
that physiology of every individual is different and if combination of anti-diabetic drugs in
combination with clomiphene fails to provide suitable results then gonadotropins can be used
coupled with FSH to induce ovulation.
Nevertheless, gonadotropins may be termed as an effective way than clomiphene for
inducing incident of ovulation, the expense and ease of using clomiphene is often favoured
within the medical setting. In order to control androgenic symptoms, Spironolactone (Anti-
androgens) works against PCOS and aims to reduce the symptoms of acne with hirsutism
(Ndefo, Eaton, & Green, 2013). The anti-androgens are often seen to reported to improve the
lipid rates among PCOS individuals, which otherwise remain high.
Conclusion
Based on the study, it can be easily concluded that PCOS is a complex disorder that
needs multiple approaches for treatment. However, it should be taken into consideration that no
two individuals suffering from PCOS can have same response to one treatment. It can be easily
concluded, clomiphene exhibited best results in treating infertility and Sharon can obtain
expected results. In case Sharon fails to take immediate steps, then she may be prone to long
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NURSING CASE STUDY FOR PCOD 7
term consequences of PCOS, which includes, cardiovascular issues and even type two diabetes
that can be treated with statins and anti-diabetic medications

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NURSING CASE STUDY FOR PCOD 8
Reference list
Abdelhadi, O. A., Considine, R. V., Acton, A. J., & Gonzalez, F. (2016). Increased lipid-
stimulated interleukin-6 (IL-6) release from mononuclear cells
(MNC) is linked to excess ovarian androgen secretion in
polycystic ovary syndrome (PCOS). Fertility and
Sterility, 106(3), e33.
Arentz, S., Smith, C. A., Abbott, J., Fahey, P., Cheema, B. S., & Bensoussan, A. (2017).
Combined lifestyle and herbal medicine in overweight women
with polycystic ovary syndrome (PCOS): A randomized
controlled trial. Phytotherapy research, 31(9), 1330-1340.
Gonzalez, F., Considine, R. V., Abdelhadi, O. A., & Acton, A. J. (2016). Anti-inflammatory
therapy suppresses proinflammatory cytokine secretion from
mononuclear cells and reduces hyperandrogenism in lean
women with polycystic ovary syndrome (PCOS). Fertility and
Sterility, 106(3), e32.
Jacob, R., Ramachandran, C., Jude, C., Venkatachalam, U., & Rao, S. K. (2016). Peroxisome
proliferator activated receptor gamma polymorphism Pro12Ala
in polycystic ovary syndrome (PCOS) of South Indian
Population. Asian Pacific Journal of Reproduction, 5(3), 210-
213.
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NURSING CASE STUDY FOR PCOD 9
Ndefo, U. A., Eaton, A., & Green, M. R. (2013). Polycystic ovary syndrome: a review of
treatment options with a focus on pharmacological
approaches. Pharmacy and Therapeutics, 38(6), 336.
Rosenfield, R. L., & Ehrmann, D. A. (2016). The pathogenesis of polycystic ovary syndrome
(PCOS): the hypothesis of PCOS as functional ovarian
hyperandrogenism revisited. Endocrine reviews, 37(5), 467-520.
Rotstein, A. (2019). Polycystic ovarian syndrome (PCOS) | McMaster Pathophysiology Review.
Retrieved 5 August 2019, from http://www.pathophys.org/pcos/
Sever, M. J., Ferjan, S., & Janez, A. (2017). Incretin System: New Pharmacological Target in
Obese Women with Polycystic Ovary Syndrome. In Debatable
Topics in PCOS Patients. IntechOpen.
Taghavi, S. A., van Wely, M., Jahanfar, S., & Bazarganipour, F. (2017). Pharmacological and
non pharmacological strategies for obese women with
subfertility. The Cochrane database of systematic
reviews, 2017(4).
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