Essentials of Pediatric Nursing Pdf Download

  Premenstrual Syndrome 

Premenstrual syndrome (PMS) is a group of behavioral, psychological, and physical symptoms that include headache, irritability, depressed mood, breast tenderness, and abdominal bloating that are clearly related to the onset of menstruation.

Pathophysiology and Etiology 

1. Etiologic theories include hormonal imbalances, such as ovarian steroid interaction; dysfunction of neurotransmitters (such as serotonin), prostaglandins, or endorphins; psychological factors, such as attitudes and beliefs related to menstruation; and environmental factors, such as nutrition and pollution.

2. Most common in women in their 30s.

3. May occur in 20% to 32% of menstruating women. Up to 80% of women experience one or more of the symptoms during the luteal phase of their menstrual cycle.

Multiple Pregnancies and deliveries: Types, Diagnosis, Complications

Clinical Manifestations 

1. Symptoms may begin 7 to 14 days before the onset of menstrual flow; may diminish 1 to 2 days after menses begins.

2. Physical—edema of extremities, abdominal fullness, breast swelling and tenderness, headache, vertigo, palpitations, acne, backache, constipation, thirst, weight gain.

3. Psychological and behavioral—labile mood, irritability, fatigue, lethargy, depressed mood, anxiety, crying spells, changes in appetite, decreased concentration.

4. Diagnosis based on clinical manifestations; usually neither diagnostic laboratory nor radiological evaluation is necessary.

5. Usually self-limiting without complications.

Management 

1. First-line pharmacological therapy for severe PMS or PMDD includes selective serotonin reuptake inhibitors (SSRIs) such as citalopram, escitalopram, fluoxetine, and sertraline; and serotonin-norepinephrine reuptake inhibitors such as venlafaxine.

2. Drospirenone (a spironolactone derivative diuretic) combined with low-dose estrogen in oral contraceptives helps symptoms. Theoretically, longer cycles of oral contraceptives with shorter inactive phases would ameliorate symptoms by suppressing natural hormones.

3. Calcium supplementation of 1,200 mg elemental calcium per day has good evidence that supports decreased mood swings, irritability, depression, and anxiety.

4. Vitamin B6 supplements of 50 to 100 mg daily (should not exceed 100 mg/day).

 5. Cognitive-behavioral therapy has some limited evidence supporting the relief of symptoms.

 6. Healthy lifestyle changes, such as restriction of sodium, caffeine, tobacco, alcohol, and refined sweets, and inclusion of aerobic exercise, while are often recommended, have insufficient evidence to support their efficacy in the treatment of PMS symptoms.

 7. High-dose daily vitamin D intake is supported by some evidence.

 8. Prostaglandin inhibitors such as ibuprofen will decrease dysmenorrhea-related symptoms.

 9. Spironolactone, a diuretic with androgenic effect, may decrease fluid retention and weight gain.

 10. With great caution because of abuse potential, anxiolytic agents may be prescribed for use during the luteal phase for patients with anxiety symptoms.

 11. Chasteberry, an herbal supplement, 20 mg daily was shown to be effective in one randomized controlled trial.

Essentials of Pediatric Nursing Pdf Download 

Nursing Assessment

1. Ask patient to describe symptoms, their onset, and means of relief.

2. Assess patient’s diet, activity, and rest habits.

3. Assess patient’s emotional response to symptoms and methods of coping.

Nursing Diagnoses

1. Deficient knowledge related to self-care measures.

2. Anxiety related to symptoms and difficulty coping with condition.

Nursing Interventions

Increasing Knowledge and Coping Skills

Use patient education as a tool to help patient increase control over symptoms.

Reducing Anxiety

 1. Administer medications, as ordered; warn patient that diuretics will cause increased urination and anxiolytics may cause drowsiness or cognitive impairment.

 2. Provide emotional support for patient and significant others.

 3. Teach stress management and relaxation measures such as imagery and progressive muscle relaxation.

 4. Suggest counseling, as indicated.

Patient Education and Health Maintenance

 1. Encourage patient to keep a diary for several consecutive months, which includes dates, cycle days, stressors, symptoms, and their severity, to determine if therapy is effective.

 2. Instruct patient in the use and adverse effects of prescribed medications.

 3. Teach patient possible causes of syndrome and nonprescription methods to alleviate distress, such as calcium and vitamin B6 intake.

Evaluation: Expected Outcomes

1. Verbalizes increased knowledge and sense of control over the condition.

2. Reduced signs and symptoms of anxiety.

Reference Lippincott ManualNursing