Comprehensive Nursing Report: Sharon Munroe PCOS Case Study Analysis

This report presents a detailed analysis of a nursing case study involving Ms. Sharon Munroe, a 26-year-old patient diagnosed with Polycystic Ovary Syndrome (PCOS). The report begins with an introduction to the patient's medical history, including symptoms such as weight gain, cessation of menses, acne, hirsutism, miscarriages, and infertility. The pathophysiology of PCOS is then explored, focusing on the roles of elevated luteinizing hormone (LH) levels, insulin resistance, and their synergistic effects on ovarian growth and androgen production. The report highlights the impact of obesity, hyperandrogenism, and insulin resistance on the development of the syndrome, along with the characteristic symptoms like hirsutism, acne, and weight gain. Diagnostic assessments, including physical examinations, hormone level tests, and pelvic ultrasounds, are discussed. Finally, the report outlines pharmacological management strategies, particularly the use of Clomifene Citrate, along with lifestyle modifications like diet control, weight management, and psychological support. The conclusion summarizes the key findings and emphasizes the importance of a comprehensive approach to managing PCOS, encompassing both medical and lifestyle interventions.

Running head: NURSING
Nursing
Name of the Student:
Name of the University:
Author Note:

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Introduction:
The provided case scenario deals with the patient Ms. Sharon Munroe who is 26 years
old and has a medical history of Polycystic Ovarian Syndrome for the previous 6 years. The
provided medical history of the patient states that the patient had gained a body weight of 20
Kgs and her menstrual cycle had ceased several years ago. In addition to this, it has further
been stated that at present the patient suffers from problems of acne outburst, hirsutism,
miscarriages and infertility. This paper intends to make use of the evidence based practice in
order to devise an appropriate care plan for the patient.
Pathophysiology:
The endocrine abnormality of Polycystic Ovarian Syndrome initiates post menarche.
The two primary causes that lead to PCOs can be mentioned as a rise in the level of
Luteinizing hormone or the LH and insulin resistance. The genetic mechanism that could
possibly lead to a rise of the LH level is unknown. Research studies mention that the rise in
the level of LH or insulin resistance are not the individual causes that trigger the onset of
polycystic ovarian syndrome. As stated by Dokras et al. (2017), elevated level of LH and
hyperinsulinemia work synergistically and promote the ovarian growth which in turn
stimulates androgen production and formation of ovarian cysts. Research studies further
mention that obesity is one of the primary causes that attributes to 50% to 65% of the
Polycystic Ovarian Syndrome cases (Alchami et al., 2015). Obesity has been studied to
increase insulin resistance and cause hyperinsulinemia (Moran et al., 2017). However, the
evidence base also suggests that hyperandrogenism and insulin resistance is also found in
non-obese as well as obese women, which subsequently contradicts the assumption that only
obese woman would experience insulin resistance. The phenomenon of Insulin resistance can
be explained as the impaired action of insulin uptake and metabolism of glucose. The

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impaired functioning of the Insulin hormone leads to a rise in the insulin level which affect
the synthesis of 2 binding proteins that include sex hormone binding globulin (SHBG) and
Insulin like growth factor binding protein (IGFBP-1). The IGFBP-I protein binds with the
OGFBP-II protein and the SHBG protein binds to sex steroids such as Androgen (Moran et
al., 2017). Research studies mention that patients suffering from Polycystic Ovarian
Syndrome are affected with the conditions of hyperandrogenism, insulin resistance and
Acanthosis nigricans (Brennan et al., 2017).
Acanthosis nigricans can be explained as a dark, hyperpigmented hyperplasia of the
skin that manifests around the axilla as well as nape of the neck and is a characteristic clinical
symptom of insulin resistance. In addition to this, the symptoms of hyperandrogenism include
Hirsutism which refers to excess facial or body hair, emergence of acne and elevated blood
pressure (128/76mm Hg) which is characterised by the vital assessment documentation.
Another characteristic symptom of hyperandrogenism is excessive weight gain which leads to
obesity and is characterized by the documented BMI of the patient which is equivalent to 32.
Research studies define obesity as a condition where the body mass index of an individual
becomes equivalent to 30 or above (Kyrou et al., 2015). The provided case information
suggests that the patient’s height is equivalent to 172 cm and the body weight is equivalent to
96 kg. Based on the information the BMI can be calculated to be 32. In addition to this, the
case scenario also states that the patient has gained 20 kg body weight over the years.
Diagnostic assessment:
Physical assessment include high level of androgen hormone and excessive hair
growth and acne outburst on the surface of the skin. Other assessment tests include, body
weight and BMI examination and pelvic exam to check the ovaries (Teede et al., 2018). Other
assessment tests include, referral to blood tests for the estimation of hormone level in the

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body and a pelvic ultrasound to check the normal anatomy of the ovaries (Lebbi et al., 2015).
In addition to this, few questions related to the frequency of the menstrual cycle would also
help diagnose the condition of polycystic ovarian syndrome. Research studies state that
irregularity in the recurrence of the cycle especially if it is 35 days apart suggest problems
relation to ovulation (Kataoka et al., 2017) . Also, symptoms such as severe outbreak of acne,
excessive weight gain and excess hair on the skin surface suggests that the patient is possibly
suffering from polycystic ovarian syndrome.
Pharmacological management:
The evidence base suggests that the first line of pharmacological therapy for the
treatment of PCOs comprise of administering Clomifene Citrate (Kataoka et al., 2017). The
medication is prescribed largely in obese patients in order to manage infertility and PCOs.
Research studies further state that the second line of medication would comprise of ovulation
induction with the help of gonadotropins such as clomifene citrate-resistant medication,
laparoscopic ovarian drilling or metformin combines with clomifene citrate resistant
medication in women (Teede et al., 2018). A group of researchers also suggests the
effectiveness of prescribing aromatase inhibitor for PCOs management but the evidence base
does not provide sufficient studies to back the same (Kyrou et al., 2015). In addition to
pharmacological management, incorporating life style changes such as diet control, cessation
of smoking and alcohol as well as weight management can help in leading a healthy life.
Further, the patient would also be referred to a dermatologist for her skin and acne problems
and a fertility expert for possible options of adaption or other means of artificial conception.
The patient would also be referred to a nutritionist for planning an effective weight loss
program and a psychotherapist for coping with the associated symptoms of the disease.

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Conclusion:
Therefore, to conclude, it can be stated that the patient is diagnosed with Polycystic
Ovarian Syndrome which has led to the emergence of a number of symptoms such as acne
outbreak, excessive weight gain and excessive hair growth on the surface of the skin.
Pharmacological management such as administration of Clomifene Citrate along with
lifestyle changes such as body weight management through diet control and rigorous physical
exercise can help in controlling the intensity of the symptoms. In addition to this,
incorporation of other lifestyle changes such as cessation of smoking and alcohol
consumption can help in managing PCOs.

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References:
Alchami, A., O'Donovan, O., & Davies, M. (2015). PCOS: diagnosis and management of
related infertility. Obstetrics, Gynaecology & Reproductive Medicine, 25(10), 279-
282. DOI: https://doi.org/10.1016/j.ogrm.2015.07.005
Brennan, L., Teede, H., Skouteris, H., Linardon, J., Hill, B., & Moran, L. (2017). Lifestyle
and behavioral management of polycystic ovary syndrome. Journal of Women's
Health, 26(8), 836-848. DOI: https://doi.org/10.1089/jwh.2016.5792
Dokras, A., Saini, S., Gibson-Helm, M., Schulkin, J., Cooney, L., & Teede, H. (2017). Gaps
in knowledge among physicians regarding diagnostic criteria and management of
polycystic ovary syndrome. Fertility and sterility, 107(6), 1380-1386. DOI:
https://doi.org/10.1016/j.fertnstert.2017.04.011
Kataoka, J., Tassone, E., Misso, M., Joham, A., Stener-Victorin, E., Teede, H., & Moran, L.
(2017). Weight management interventions in women with and without PCOS: a
systematic review. Nutrients, 9(9), 996. DOI: https://doi.org/10.3390/nu9090996
Kyrou, I., Weickert, M. O., & Randeva, H. S. (2015). Diagnosis and management of
polycystic ovary syndrome (PCOS). In Endocrinology and Diabetes (pp. 99-113).
Springer, London. Retrieved from: https://link.springer.com/chapter/10.1007/978-1-
4471-2789-5_13
Lebbi, I., Ben Temime, R., Fadhlaoui, A., & Feki, A. (2015). Ovarian drilling in PCOS: is it
really useful?. Frontiers in surgery, 2, 30. Retrieved from:
https://www.frontiersin.org/articles/10.3389/fsurg.2015.00030/full
Moran, L. J., Brown, W. J., McNaughton, S. A., Joham, A. E., & Teede, H. J. (2017). Weight
management practices associated with PCOS and their relationships with diet and

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physical activity. Human Reproduction, 32(3), 669-678. DOI:
https://doi.org/10.1093/humrep/dew348
Teede, H. J., Misso, M. L., Costello, M. F., Dokras, A., Laven, J., Moran, L., ... & Norman,
R. J. (2018). Recommendations from the international evidence-based guideline for
the assessment and management of polycystic ovary syndrome. Human
Reproduction, 33(9), 1602-1618. DOI: https://doi.org/10.1093/humrep/dey256