Estrogens

A patient of yours that is on estrogen therapy reports in their checkup that they believe they are now pregnant. What is your response?

You must confirm if they are pregnant; if they are pregnant, you must stop estrogen therapy because that is a contraindication in estrogen therapy.

A patient of yours is experiencing menopausal symptoms that is getting in the way of their daily life and would like to start estrogen therapy. What history assessments must you perform before you begin estrogen therapy?

Breast cancer hx/family hx, endometrial cancer hx/family hx, estrogen-dependent cancer hx/family hx, thromboembolic disease hx/family hx, smoking hx, stroke/MI hx/family hx

A patient of yours wants to begin estrogen therapy. You find through interviewing them that they have breast cancer family hx, but have never had it themselves.

Advise the patient that, while family hx of breast cancer is not necessarily a contraindication, it is something that they will want to keep an eye out for and to recommend annual PAP smears and mammograms.

A patient would like to begin estrogen therapy. They have a hx of smoking. What is your course of action?

Advise them that estrogen therapy is to be avoided in smokers because it can increase clot risk further, as estrogen therapy alone increases clot risk. You should teach smoking cessation as well.

On your floor there you have four patients, all on estrogen therapy, that are:
1) c/o nausea and vomiting

2) Experiencing breast tenderness

3) Need weight gain validation

4) Experiencing pain and swelling in their right leg

Which do you see first?

4) Pain and swelling in the leg(s) can be signs of DVT or clotting.

A 52-year-old patient is scheduled for an elective total hip arthroplasty in two weeks. During the pre-operative interview, the nurse notes the patient takes conjugated estrogens daily for vasomotor symptoms. Which action by the nurse is priority?

• A. Document the medication as a home med and continue administration.

• B. Advise the patient to double the dose the morning of surgery to manage stress.

• C. Notify the surgeon and anticipate an order to discontinue the medication.

• D. Instruct the patient to take the medication with a full glass of water.

C: Major surgeries involving long periods of immobility (especially orthopedic surgeries) significantly increase the risk of DVT. Estrogen should typically be held 4–6 weeks prior to such procedures to decrease the risk of thromboembolic events.

The nurse is providing discharge teaching for a patient starting a new prescription for an estradiol transdermal patch. Which statement by the patient indicates a need for further teaching?

• A. "I will rotate the site of the patch each week."

• B. "I will apply the patch to my breast area so it is absorbed quickly."

• C. "I should avoid smoking while using this medication."

• D. "I will call my doctor if I notice any sudden, blurry vision."

B: Estrogen should never be applied to the breasts or any area with skin irritation. It is typically applied to the trunk (abdomen, hips, or buttocks). Application to the breast increases the risk of local tissue hyperplasia and breast cancer.

The nurse is providing information to a patient about understanding the risks of taking estrogen therapy. Which statement by the patient would indicate a need for further teaching?

A. “Estrogen therapy may help me with my menopausal symptoms.”
B. “I should take my oral pills at the same time every day to ensure it is working effectively.”
C. “It is advisable that I seek out annual PAP smears and mammograms.”
D. “Smoking does not increase my risk of clots and I do not need to worry about continuing to do so.”

D. Smoking does increase risk of clots, which makes estrogen therapy more dangerous as estrogen alone increases clot risk.