NURSING NURSING PROCESS FOR PROCESS FOR WOMEN GOING WOMEN GOING

THROUGH THROUGH MENOPAUSEMENOPAUSE

Catherine May L. Cruz, RN

The nurse can play an The nurse can play an important role in helping important role in helping

women cope with the women cope with the symptoms of menopause. symptoms of menopause.

The nurse can play an The nurse can play an important role in helping important role in helping

women cope with the women cope with the symptoms of menopause. symptoms of menopause.

Teaching and counseling about Teaching and counseling about menopause, its symptoms, and menopause, its symptoms, and

medical and alternative medical and alternative therapies are foremost in the therapies are foremost in the

arsenal of interventions arsenal of interventions available to nurses in this area.available to nurses in this area.

Teaching and counseling about Teaching and counseling about menopause, its symptoms, and menopause, its symptoms, and

medical and alternative medical and alternative therapies are foremost in the therapies are foremost in the

arsenal of interventions arsenal of interventions available to nurses in this area.available to nurses in this area.

NURSING DIAGNOSES NURSING DIAGNOSES RELATED TO THE RELATED TO THE SYMPTOMS OF SYMPTOMS OF MENOPAUSEMENOPAUSE

Anticipatory Grieving Anticipatory Grieving related to loss of related to loss of

childbearing abilitychildbearing ability

Anticipatory Grieving Anticipatory Grieving related to loss of related to loss of

childbearing abilitychildbearing ability

Self Esteem Disturbance Self Esteem Disturbance related to physical and related to physical and

emotional changes emotional changes associated with associated with

menopausemenopause

Self Esteem Disturbance Self Esteem Disturbance related to physical and related to physical and

emotional changes emotional changes associated with associated with

menopausemenopause

Knowledge Deficit related Knowledge Deficit related to normal changes and to normal changes and

symptoms.symptoms.

Knowledge Deficit related Knowledge Deficit related to normal changes and to normal changes and

symptoms.symptoms.

Altered Sexuality Patterns Altered Sexuality Patterns related to hormonal related to hormonal

changes and decreased changes and decreased vaginal lubricationvaginal lubrication

Altered Sexuality Patterns Altered Sexuality Patterns related to hormonal related to hormonal

changes and decreased changes and decreased vaginal lubricationvaginal lubrication

NURSING INTERVENTIONS

HOT FLUSHES AND NIGHT SWEATS

• Adequate hydration • Adjust the room

temperature.• Appropriate clothing• Avoid hot beverages like

coffee and hot tea• Avoid alcohol • Avoid direct sun exposure • Minimize stress.

• Adequate hydration • Adjust the room

temperature.• Appropriate clothing• Avoid hot beverages like

coffee and hot tea• Avoid alcohol • Avoid direct sun exposure • Minimize stress.

HOT FLUSHES AND NIGHT SWEATS

• Try paced respiration at the beginning of a hot flash. • Take slow, deep,

abdominal breaths in through the nose and release out through the mouth.

• Try paced respiration at the beginning of a hot flash. • Take slow, deep,

abdominal breaths in through the nose and release out through the mouth.

HOT FLUSHES AND NIGHT SWEATS

• Prescribed Hormone Therapy– Systemic Estrogen Therapy

• Non hormone ( prescribed medications)1. Gabapentin (Neurontin)2. Paroxetine (Paxil),Fluoxetine3. Methyldopa (Aldomet) and

Clonidine(Catapres) Dixarit• Herbal Remedies/ supplements– Isoflavones– Remifemin

• Prescribed Hormone Therapy– Systemic Estrogen Therapy

• Non hormone ( prescribed medications)1. Gabapentin (Neurontin)2. Paroxetine (Paxil),Fluoxetine3. Methyldopa (Aldomet) and

Clonidine(Catapres) Dixarit• Herbal Remedies/ supplements– Isoflavones– Remifemin

Non hormone ( prescribed medications)

1. Gabapentin (Neurontin) - a drug used to treat epilepsy and migraine,

2. Paroxetine (Paxil),Fluoxetine (Prozac), and Venlafaxine (Effexor) : drugs approved to treat depression

3. Methyldopa (Aldomet) and Clonidine

(Catapres) Dixarit : drugs used to treat high blood pressure,

1. Gabapentin (Neurontin) - a drug used to treat epilepsy and migraine,

2. Paroxetine (Paxil),Fluoxetine (Prozac), and Venlafaxine (Effexor) : drugs approved to treat depression

3. Methyldopa (Aldomet) and Clonidine

(Catapres) Dixarit : drugs used to treat high blood pressure,

Herbal Remedies/ supplements

Isoflavones• (weak, plant-derived estrogens),• most commonly found in soy foods

have been found to reduce mild hot flashes by about 15-30% in some studies.

• However, many other studies show no effect at all.

• Note: Eating 1 or 2servings of soy foods daily (25 grams of soy protein) may provide greater benefits than supplements.

• Examples : Low-fat varieties of tofu, soybeans, or roasted soy nuts

Isoflavones• (weak, plant-derived estrogens),• most commonly found in soy foods

have been found to reduce mild hot flashes by about 15-30% in some studies.

• However, many other studies show no effect at all.

• Note: Eating 1 or 2servings of soy foods daily (25 grams of soy protein) may provide greater benefits than supplements.

• Examples : Low-fat varieties of tofu, soybeans, or roasted soy nuts

Herbal remedies/ supplements

Remifemin • supplement pill containing the herb

“black Cohosh.” • Women taking a 20-mg tablet twice a

day for 8 to 12 weeks reported improvement in mild hot flashes, but not all studies show this positive effect.

• Side effects include gastrointestinal upset, typically with first time use.

• In rare cases, the use of black cohosh appears to cause liver damage.

• Note: Black Cohosh should not be taken if one is taking HRT.

Remifemin • supplement pill containing the herb

“black Cohosh.” • Women taking a 20-mg tablet twice a

day for 8 to 12 weeks reported improvement in mild hot flashes, but not all studies show this positive effect.

• Side effects include gastrointestinal upset, typically with first time use.

• In rare cases, the use of black cohosh appears to cause liver damage.

• Note: Black Cohosh should not be taken if one is taking HRT.

VAGINAL DRYNESS1. Water soluble vaginal lubicants

(such as K-Y Personal Lubricant,Astroglide, Lubrin, or Moist Again) decrease friction and ease discomfort during intercourse.

2. Vaginal moisturizers (such as Replens or K-Y Long-Lasting Vaginal Moisturizer) act directly on tissue to relieve dryness. Moisturizers may be preferred by women who have symptoms of irritation and burning that are not limited to sexual activity.Because moisturizers help maintain an acidic environment, there is a decreased risk for infection.

1. Water soluble vaginal lubicants (such as K-Y Personal Lubricant,Astroglide, Lubrin, or Moist Again) decrease friction and ease discomfort during intercourse.

2. Vaginal moisturizers (such as Replens or K-Y Long-Lasting Vaginal Moisturizer) act directly on tissue to relieve dryness. Moisturizers may be preferred by women who have symptoms of irritation and burning that are not limited to sexual activity.Because moisturizers help maintain an acidic environment, there is a decreased risk for infection.

MOODINESS/STRESS RELATED SYMPTOMS

1.Emotional health during perimenopause requires a balance between self-nurturing and the obligations of work and caring for others.

2. Regular Exercise3. Relaxation techniques: deep breathing,

massage4. Calcium carbonate supplements (TUMS) which reduced symptoms of food craving,

bloating, water retention and pain5.Diet that is low in fat, sodium, refined sugar,

alcohol, and caffeine. Snack on healthful, crunchy foods, such as apples

and raw carrots.6. Join support groups.7. Seek professional health when the usual

methods do not work anymore.

1.Emotional health during perimenopause requires a balance between self-nurturing and the obligations of work and caring for others.

2. Regular Exercise3. Relaxation techniques: deep breathing,

massage4. Calcium carbonate supplements (TUMS) which reduced symptoms of food craving,

bloating, water retention and pain5.Diet that is low in fat, sodium, refined sugar,

alcohol, and caffeine. Snack on healthful, crunchy foods, such as apples

and raw carrots.6. Join support groups.7. Seek professional health when the usual

methods do not work anymore.

MOODINESS/STRESS RELATED SYMPTOMS

8. Alternative remedy• St. John’s wort helps improve the

mood and decrease the level of depression. Caution : Do not use the herb with drugs that alter blood clotting such as aspirin or Coumadin)..Many practitioners avoid using this herb formore than 2 years.

• Another nutrient, omega-3 fatty acid, has alsobeen found to improve mood.

• Food sources include fatty fish (such as salmon and trout)

8. Alternative remedy• St. John’s wort helps improve the

mood and decrease the level of depression. Caution : Do not use the herb with drugs that alter blood clotting such as aspirin or Coumadin)..Many practitioners avoid using this herb formore than 2 years.

• Another nutrient, omega-3 fatty acid, has alsobeen found to improve mood.

• Food sources include fatty fish (such as salmon and trout)

INSOMNIA

• Reduction of stress• Sleep routine and sleep hygiene• Create an environment conducive to

sleep• Taking calcium supplements at night

instead of daytime to help relax muscles . Should be taken with magnesium ( ratio of 2:1 (Calcium: Magnesium,)

• Acupressure • Acupuncture• Massage therapy.

• Reduction of stress• Sleep routine and sleep hygiene• Create an environment conducive to

sleep• Taking calcium supplements at night

instead of daytime to help relax muscles . Should be taken with magnesium ( ratio of 2:1 (Calcium: Magnesium,)

• Acupressure • Acupuncture• Massage therapy.

BLADDER PROBLEMS• AVOID BLADDER IRRITANTS. Certain

foods and beverages can contribute to overactive bladder by irritating the bladder; these include chocolate, tea, coffee, soft drinks, citrus fruits, fruit juices, honey, sugar, tomato-based products, spicy foods, and alcohol.

• NO SMOKING. Apart from the damage that smoking causes, nicotine can irritate the bladder. So smokers are urged to quit.

• FLUID RESTRICTION. Limit fluid intake to about 64 ounces per day, but don’t over-restrict below that level, as concentrated urine may irritate the bladder and also contribute to constipation.

• AVOID BLADDER IRRITANTS. Certain foods and beverages can contribute to overactive bladder by irritating the bladder; these include chocolate, tea, coffee, soft drinks, citrus fruits, fruit juices, honey, sugar, tomato-based products, spicy foods, and alcohol.

• NO SMOKING. Apart from the damage that smoking causes, nicotine can irritate the bladder. So smokers are urged to quit.

• FLUID RESTRICTION. Limit fluid intake to about 64 ounces per day, but don’t over-restrict below that level, as concentrated urine may irritate the bladder and also contribute to constipation.

Bladder Problems

• WEIGHT LOSS. For obese women, weight loss can reduce incontinence by up to 60%.

• GOOD HYGIENE. Keep genitals clean. Avoid exposure to urine for long periods.

• PADS. With severe incontinence, use absorbent pads instead of menstrual pads, as they provide better absorbency and better skin protection.

• KEGEL EXERCISES. Urogenital muscle exercises that are sometimes helpful for stress incontinence.

• VAGINAL CONES. Small cone-shaped device held in the vagina have been shown to help a woman determine which muscles to contract and relax for Kegel exercises

• WEIGHT LOSS. For obese women, weight loss can reduce incontinence by up to 60%.

• GOOD HYGIENE. Keep genitals clean. Avoid exposure to urine for long periods.

• PADS. With severe incontinence, use absorbent pads instead of menstrual pads, as they provide better absorbency and better skin protection.

• KEGEL EXERCISES. Urogenital muscle exercises that are sometimes helpful for stress incontinence.

• VAGINAL CONES. Small cone-shaped device held in the vagina have been shown to help a woman determine which muscles to contract and relax for Kegel exercises

Bladder Problems• ELECTRICAL STIMULATION. Painless

therapy that retrains the pelvic floor muscles used in urination.

• BIOFEEDBACK. A technique that teaches a woman to mentally isolate and control a bodily function (in this case, to contract the pelvic floor muscles).

• TIMED VOIDING. A technique for overactive bladder in which a woman schedules times to go to the bathroom and gradually increases the length of time between trips, thereby training the bladder to hold more and empty less often.

• MEDICATIONS. A variety are available for different causes and types of incontinence.

• SURGERY

• ELECTRICAL STIMULATION. Painless therapy that retrains the pelvic floor muscles used in urination.

• BIOFEEDBACK. A technique that teaches a woman to mentally isolate and control a bodily function (in this case, to contract the pelvic floor muscles).

• TIMED VOIDING. A technique for overactive bladder in which a woman schedules times to go to the bathroom and gradually increases the length of time between trips, thereby training the bladder to hold more and empty less often.

• MEDICATIONS. A variety are available for different causes and types of incontinence.

• SURGERY

OSTEOPORISIS

• ERT• Allendronate (Fosamax) – Prevents

bone resorption.– Instructions :– take in the morning with plenty

of water, 30 minutes before eating

– Instruct patient to stay upright for 30 minutes after talking to avoid reflux and other GI symptoms

• Calcitonin - causes calcium to go to the bones

• Calcium – 1500 mg daily• Vitamin D - 400 to 800 units daily

• ERT• Allendronate (Fosamax) – Prevents

bone resorption.– Instructions :– take in the morning with plenty

of water, 30 minutes before eating

– Instruct patient to stay upright for 30 minutes after talking to avoid reflux and other GI symptoms

• Calcitonin - causes calcium to go to the bones

• Calcium – 1500 mg daily• Vitamin D - 400 to 800 units daily

HEART DISEASE

• Emotional counselling,• Lifestyle changes • Avoid smoking and alcohol• Stress Reduction • Nutritional Management• Annual physical

examination and Blood cholesterol determination

• Emotional counselling,• Lifestyle changes • Avoid smoking and alcohol• Stress Reduction • Nutritional Management• Annual physical

examination and Blood cholesterol determination