Case studies provide the opportunity to simulate realistic scenarios involving patients presenting with various health problems or symptoms. Such case studies enable nurse learners to apply concepts, lessons, and critical thinking to interviewing, screening, and diagnostic approaches, as well as to the development of treatment plans.
CASE study scenario:
Case #4. Roberta.
History of Present Illness (HPI): Roberta, a 53-year-old mother of two children, presents to your clinic
with c/o vaginal dryness and low sexual desire. She went into surgical menopause at the time of a total
hysterectomy for leiomyomas 5 years ago. She took HRT for severe climacteric symptoms for 2 years,
which she discontinued 3 years ago due to breast pain and a fear of breast cancer. She states her sex life
before surgery was active and satisfying. After the hysterectomy, her desire diminished considerably,
although at first she was not too concerned about it. Lately, however, because of this lack of desire, she
now complains of quite a reduction in sexual activity which is also less satisfying. When she does have
intercourse, she experiences dyspareunia. She is now worried about it because it is affecting her quality
of life and negatively impacting her relationship with her husband.
Over this past year, she has had a mammogram and general blood tests which were all normal.
Prior medical history: Uterine fibroids. Prior surgical history: TAH 5 years ago
Current medications: None. Allergies: Sulfa.
OB- GYN History: NSVD x 2 (2014 and 2012). Menarche age 12, cycle length was 8 -10 days- frequency
every 21 days- heavy flow with clots – tampons 5-6/day.
LMP: 5 years ago. Contraception history: None
Social history: Lives with her husband and 2 children. Works as an attorney. Denies EtOH, smoking, or
recreational drug use.
Family history: Mother – osteoporosis, thyroid disease. Father – prostate cancer. MGM – breast cancer
diagnosed at age 81 yo.
Review of Systems (ROS): Unremarkable with exception of as noted in HPI.
Physical Exam (PE)
VS: BP: 134/78, P: 58, RR: 16, T: 98.8 Weight: 144 lbs., Height: 65 inches, BMI 24
General Examination: Well developed, well nourished, in no acute distress.
Psych: alert and oriented, cooperative with exam, appears frustrated.
Abdomen: Soft, NTND, no masses
Gynecological: EXTERNAL EXAM: sparse hair distribution, pale and shiny – dry labia, no lesions, Mild
introital stenosis noted. SPECULUM/INTERNAL EXAM: Vaginal lining is thin and dry. Cervix: surgically
absent. UTERUS: surgically absent. ADNEXA: surgically absent
To prepare:
Review the Learning Resources for this week and specifically review the clinical guideline resources specific to your chosen case study.
Use the Case Study Assignment Template found in the Learning Resources to support your assignment.
Resources:
Schuiling, K. D., & Likis, F. E. (2022). Gynecologic health care (4th ed.). Jones and Bartlett Learning.
Chapter 17, “Breast Conditions” (pp. 337-349)
Chapter 18, “Alterations in Sexual Function” (pp. 353-364)
Chapter 20, “Infertility” (pp. 383-398)
Chapter 21, “Gynecologic Infections” (pp. 401-432)
Chapter 22, “Sexually Transmitted Infections” (pp. 437-466)
Reproductive Health Access Project (2020). Your birth control choicesLinks to an external site.. https://www.reproductiveaccess.org/wp-content/uploads/2014/06/2020-09-contra-choices.pdf
Office of Women’s Health: Womenshealth.gov. (2017). Birth control methodsLinks to an external site.. https://www.womenshealth.gov/a-z-topics/birth-control-methodsLinks to an external site.
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