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NURSING CARE PLAN Needs/ Problems Cues I. Psychological a.

Deficit Cues Objective cues: Endocrine System Prolactin blood level test: 40 ng/mL (high prolactin level) Estrogen blood level test: 20 pg/mL (low estrogen level) LH blood level test: 3 IU/L (low LH level) FSH blood level test: 0.1 IU/L (low FSH level) MRI test: Presence of prolactinoma Reproductive Nursing Diagnosis Sexual Dysfunction: Sexual intercourse discomfort & loss of sexual desire related to dryness in the vagina secondary to galactorrhea Scientific Basis/ Significance Women with galactorrhea often develop hot flashes and vaginal dryness which causes discomfort with sexual intercourse, because of low estrogen levels. Source: Beers, M. (2003). The Merck Manual of Medical Information p. 946 Objectives of Care After 8 hours of ng. patient interaction, the patient will be able to: 1.) Verbalize that her sexual desire is returned to normal and able to function well during sexual intercourse Nursing Actions Rationale

Encourage and accept expressions of concern, anger, grief, and fear Discuss regarding the sexual anatomy /function and effects of current situation/conditio n

Clients needs to talk about these feelings t o begin resolution Individuals are often ignorant of anatomy of sexual system and how it works, impacting clients understanding of situation and expectations

To promote Provide factual informed decision information about making individual condition involved To reinforce the Provide sex knowledge of the education, patient explanation of normal sexual functioning To promote treatment Assist with treatment of It suppresses medical prolactin conditions production and

System Normal Spontaneous Vaginal Delivery of a baby boy on November 1, 2009 White yellowish nipple discharge Subjective cues: The husband complains about the loss of desire of sexual intercourse of her wife The mother verbalized that her vagina is dry The mother complains about the discomfort during sexual intercourse The mother stated that she is not menstruating The mother stated that her nipple discharges are persistent and continuing. The mother

Administer Bromocriptine as ordered by the physician

therefore stops galactorrhea and increase estrogen levels To control endometrial growth and reestablish a normal cyclic pattern of menstruation To stimulate ovulation, increase ovarian progesterone secretion during the second half of the cycle, and make menstrual cycle lengths more predictable to reduce chances of nipple discharge

High-dose estrogenprogestogen combination therapy as ordered by the physician Administer Clomiphene as ordered by the physician

Advice the mother to avoid stimulating the breast or avoid touching the nipples and avoid tight-fitting clothing or clothing that causes friction Advice to use breast pads

To absorb nipple discharge and prevent it from seeping through your clothing

stated that her breast is spontaneously flowing of milk The mother complains about a sudden headache, backache and abdominal pain which last for 15 30 mins. Doing stressful activities contributes pain while resting and taking analgesics can alleviate the pain. The mother complains also of blurred vision.

Sources: Doenges, M. (2008). Nurses Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales Beers, M. (2003). The Merck Manual of Medical Information