Response to Roselle

Please respond to the following post of my colleague.You can agree and make more suggestion.

Based on this post.

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  • Define what you believe is the most important diagnosis. Be sure to include the first priority in conducting your assessment.
  • Explain which diagnostic tests and treatment options you would recommend for your patient and explain your reasoning.


Common Gynecological Conditions Part 2


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My case is about AG, who is a 44-year-old, P3G3L3, Hispanic, female patient who came into the office for a visit with complaints of having heavy vaginal bleeding for 15 days now.  She says she thought it was only regular menstruation but until now it’s still heavy.  She denies pain and dizziness as of this time.

Examining this patient is remarkably interesting since her age is already in the premenopausal age.  I would have diagnosed it as part of premenopausal bleeding but my preceptor thinks otherwise.  She diagnosed it as the following (in corresponding order):

  1. Complete or Unspecified Spontaneous Abortion Without Complication (O03.9) (Magill’s Medical Guide, 2020)
  2. Excessive and Frequent Menstruation with Regular Cycle (N92.0)
  3. Excessive Bleeding in The Premenopausal Period (N92.4)
  4. Endometrial Hyperplasia (N85.00)

The plan would include the following to help diagnose her condition correctly:

  1. Urine Pregnancy Test
  2. CBC, CMP, TSH
  3. HCG
  4. Vitamin D Level
  5. US Pelvis Complete with Transvaginal Non-Ob




I would include spontaneous abortion basing on her signs and symptoms.  The symptoms of a threatened spontaneous abortion may include spotting of blood, which may turn into heavier bleeding; cramping, possibly accompanied by lower back pain; and vaginal discharge of tissue, clots, or pinkish fluid (Magill’s Medical Guide, 2020). 

Endometrial Hyperplasia can be a differential diagnosis also basing on her symptoms. Abnormal uterine bleeding (AUB) is the most common presenting symptom of endometrial hyperplasia (EH). EH is clinically important as it can progress to endometrial carcinoma or occur concurrently with it. EH is typically diagnosed by endometrial biopsy or curettage during normal evaluations for AUB in perimenopause and post menopause women. Hysteroscopic evaluation is the gold standard for AUB, and endometrial sampling is a preferred procedure for diagnosis of the endometrial pathology (Nigerian Medical Journal, 2015).

I would also like to include Endometrial biopsy or curettage also to help diagnose Endometrial Hyperplasia. EH is typically diagnosed by endometrial biopsy or curettage during normal evaluations for AUB in premenopausal and postmenopausal women. Hysteroscopic evaluation is the gold standard for AUB, and endometrial sampling is a preferred procedure for diagnosis of the endometrial pathology (Nigerian Medical Journal, 2015).

Basing on her age, AG is in her premenopausal period.  Menopause usually occurs in a woman’s forties or fifties, with the average age being about fifty-one (Salem Press Encyclopedia of Health, 2019). 


Resources: Please use one or two of these resources for your reference.


Schuiling, K. D., & Likis, F. E. (2017). Women’s gynecologic health (3rd ed.). Jones and Bartlett Publishers.

  • Chapter 21, “Urinary Tract Infections” (pp. 513-521)
  • Chapter 22, “Urinary Incontinence” (pp. 525-543)
  • Chapter 23, “Menstrual-Cycle Pain and Premenstrual Conditions” (pp. 549-570)
  • Chapter 24, “Normal and Abnormal Uterine Bleeding” (pp. 575-599)

Resources for LGBTQ+

Aisner, A. J., Zappas, M., & Marks, A. (2020). Primary Care for Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning (LGBTQ) Patients. The Journal for Nurse Practitioners, 16(4), 281–285.

Office of Disease Prevention and Health Promotion (ODPHP). (2020, April 18). Lesbian, gay, bisexual, and transgender health. 

Sadlak, C. A., Boyd, C. J., & Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ)

Health Expert Panel (2016). American Academy of Nursing on Policy: Health care services for transgender individuals: Position statement.

Wingo, E., Ingraham, N., & Roberts, S. C. M. (2018). Reproductive Health Care Priorities and Barriers to Effective Care for LGBTQ People Assigned Female at Birth: A Qualitative Study. Women’s Health Issues, 28(4), 350–357.

FNP Resources 

American Academy of Nurse Practitioners Certification Board (AANPCB). (2018). Welcome to the American Academy of Nurse Practitioners Certification Board.

American Academy of Nurse Practitioners National Certification Board, Inc. (AANPCB). (2018). FNP & AGNP Certification Candidate Handbook.

Clinical Guideline Resources 

As you review the following resources, you may want to include a topic in the search area to gather detailed information (e.g., breast cancer screening guidelines; CDC for zika in pregnancy, etc.).

American Cancer Society, Inc. (ACS). (2020). Information and Resources about Cancer: Breast, Colon, Lung, Prostate, Skin.

American College of Obstetricians and Gynecologists (ACOG). (2020). 

American Nurses Association (ANA). (n.d.). Lead the profession to share the future of nursing and health care.  

Centers for Disease Control and Prevention. (CDC). (n.d.). CDC in action.  

HealthyPeople 2030. (2020). Healthy People 2030 Framework.

The American Association of Nurse Practitioners (AANP). (2020). What’s Happening at your association. 


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