STUDY - Technical - New Dacian's Medicine
Menorrhagia
(Classical / Allopathic Medicine)
Heavy, or
significantly heavier menstrual bleeding, menorrhagia may
occur as a single episode or a chronic sign. In menorrhagia,
bleeding is heavier than the patient's normal menstrual flow;
menstrual blood loss is 80 ml or more per monthly period. A
form of dysfunctional uterine bleeding, menorrhagia can result
from endocrine and hematologic disorders, stress, and certain
drugs and procedures.
ALERT:
If the patient is experiencing severe menorrhagia:
- take her vital signs
- assess her for signs of hypovolemic shocks, such as pallor, tachycardia, tachypnea, and cool, clammy skin
administer I.V. fluids
- prepare her for a pelvic examination.
If the patient's condition permits, perform a focused assessment.
If the patient is experiencing severe menorrhagia:
- take her vital signs
- assess her for signs of hypovolemic shocks, such as pallor, tachycardia, tachypnea, and cool, clammy skin
administer I.V. fluids
- prepare her for a pelvic examination.
If the patient's condition permits, perform a focused assessment.
HISTORY:
Ask the patient her age at menarche, the normal duration of her menstrual periods, and the normal interval between them.
Ask the patient the date of her last menses and about recent changes in her normal menstrual pattern. Ask her to describe the character and amount of bleeding.
Ask the patient about the development of other signs and symptoms before and during the menstrual period.
Ask the patient if she's sexually active and which type of birth control she uses, if any.
Obtain a pregnancy history, noting the outcome of each as well as pregnancy-related complications.
Find out the dates of the patient's most recent pelvic examination and Papanicolaou test and the details of previous gynecologic infections or neoplasms.
Ask the patient about previous episodes of abnormal bleeding and the outcome of treatment.
If possible, obtain a pregnancy history of the patient's mother and determine if the patient was exposed to diethylstilbestrol in utero.
Review the patient's medical history, noting especially surgical procedures; thyroid, adrenal, or hepatic disease; blood dyscrasias; and tuberculosis. Also, ask the patient about a family history of these disorders.
Ask the patient about her general health and if she's under emotional stress.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient her age at menarche, the normal duration of her menstrual periods, and the normal interval between them.
Ask the patient the date of her last menses and about recent changes in her normal menstrual pattern. Ask her to describe the character and amount of bleeding.
Ask the patient about the development of other signs and symptoms before and during the menstrual period.
Ask the patient if she's sexually active and which type of birth control she uses, if any.
Obtain a pregnancy history, noting the outcome of each as well as pregnancy-related complications.
Find out the dates of the patient's most recent pelvic examination and Papanicolaou test and the details of previous gynecologic infections or neoplasms.
Ask the patient about previous episodes of abnormal bleeding and the outcome of treatment.
If possible, obtain a pregnancy history of the patient's mother and determine if the patient was exposed to diethylstilbestrol in utero.
Review the patient's medical history, noting especially surgical procedures; thyroid, adrenal, or hepatic disease; blood dyscrasias; and tuberculosis. Also, ask the patient about a family history of these disorders.
Ask the patient about her general health and if she's under emotional stress.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
PHYSICAL
ASSESSMENT:
Take the patient's vital signs.
Inspect the skin, hair, and nails. Note color and texture.
Palpate and percuss the abdomen. Note areas of tenderness or masses.
Assist with a pelvic examination, as appropriate.
Take the patient's vital signs.
Inspect the skin, hair, and nails. Note color and texture.
Palpate and percuss the abdomen. Note areas of tenderness or masses.
Assist with a pelvic examination, as appropriate.
SPECIAL
CONSIDERATIONS:
Herbal remedies, such as ginseng, can cause postmenopausal bleeding.
Herbal remedies, such as ginseng, can cause postmenopausal bleeding.
PEDIATRIC
POINTERS:
Irregular menstrual function in young girls may be accompanied by hemorrhage and result in anemia.
Irregular menstrual function in young girls may be accompanied by hemorrhage and result in anemia.
AGING ISSUES:
In postmenopausal women, menorrhagia can't occur. In such patients, vaginal bleeding is usually caused by endometrial atrophy. Malignancy should be ruled out.
In postmenopausal women, menorrhagia can't occur. In such patients, vaginal bleeding is usually caused by endometrial atrophy. Malignancy should be ruled out.
PATIENT
COUNSELING:
Explain to the patient the need for a pelvic examination as well as the need for blood studies and a pregnancy test.
Explain to the patient the need for a pelvic examination as well as the need for blood studies and a pregnancy test.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common symptoms,
Edition V, McGraw - Hill, 2002.