Scholarly Assignment

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Scholarly Assignment
Concept Map:
Polycystic Ovarian Syndrome
Mark Kevin D. Sadiamona
N01036081
NURS 252
Vasanthy Harananan
March 14, 2016

Scholarly Assignment

Case Study
The scenario is all about a 28 year old Female client that arrives at wellness clinic
complaining about amenorrhea. The client is anxious and states that she and her husband have
been married for two years and want to start a family. The client has a medical history of
Polycystic Ovarian Syndrome (PCOS). Vital signs taken: T-36.8, P-88, R-22, BP-112/62, O2 Sat
99% on room air and has a CBG of 9.3.
Introduction
There are many important information that are given in the scenario, as a nurse I must
identify the most relevant priority data for the client. The resident was complaining about having
amenorrhea and according to the case study, she has a past medical history of Polycystic Ovarian
Syndrome (PCOS). Due to having history of PCOS, amenorrhea could be one of its symptoms
(Wang, 2008). Another information that is alarming is the clients complete blood glucose level
of 9.3mmol/L. The normal range for blood glucose is between 4-7mmol/L (Lewis, 2014). A 9.3
mmol/L is high for a normal person. But Insulin resistance is also one of the clinical
manifestations for PCOS (Wang, 2008). This could be one of the reasons why her blood sugar is
higher than the normal range. Another concern of the client is she wanted to start a family after
her 2 years of marriage with her husband. In her situation, it is hard for them to start a family
because women with PCOS have difficulties in ovulation because of their irregular or sometimes
absent menstruation (Wang, 2008). Another main concern is the client being anxious. Anxiety
can be harmful if not treated or prevented but in my opinion, Polycystic Ovarian Syndrome has a
higher priority than anxiety.

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Body
Pathophysiology
The highest priority highlighted in my concept map is Polycystic Ovarian Syndrome
(PCOS). I chose it as a priority over anxiety because it has variety of clinical manifestations that
are very important such as insulin resistance, excess androgens in the body, and irregular or
absent menstruation. These manifestations of PCOS can lead into so many complications like
diabetes and deferred ovulation process. Polycystic Ovarian Syndrome is a common endocrine
disorder among women who are of reproductive age. It affects womans menstrual cycle, ability
to have children, hormones, heart, blood vessels, and physical appearance. According to
womens health Canada, 1 in 10 childbearing women in Canada has PCOS (Stein, 2006). It is
almost 10% of women population in Canada alone. It is a serious condition that leads into so
many complications. Hormonal balance is a main underlying problem in PCOS (Gardner, 2009).
Production of insulin is one of the biggest problems in PCOS. It is a hormone that controls sugar,
starches, and other food energy in our body. (Lewis, 2014). Patients with PCOS have excessive
amount of insulin in their bodies because they have problems using it. Producing too much
insulin appears to increase production of androgen. Androgen levels can lead to unnecessary hair
growth, problem in ovulation, and acne. The main complication that excessive production of
insulin causes is Diabetes.
Clinical Manifestation
There are so many manifestations of Polycystic Ovarian Syndrome (PCOS), but the main
important one is insulin resistance. As what I have said in the pathophysiology, hormonal balance
is the main underlying problem in PCOS. Women with PCOS do not have control in their insulin

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which causes uncontrolled sugar levels. Due to this, complications such as diabetes arises.
Diabetes is chronic and sometimes fatal disease which a persons body either cannot use the
insulin properly or cannot produce insulin. According to Canadian Diabetes Association, there
are more than 20 Million Canadians living with diabetes. I highlighted the risk of developing
diabetes in my concept map as the highest priority because the complete blood glucose level of
the client is higher than the normal range. It is an important piece of information because it gives
idea that she could develop diabetes mellitus type 2. Especially she is only 28 years old which is
the least age group of people having type 2 diabetes mellitus. According to Canadian Diabetes
Association, 45-64 years old are the most diagnosed age group for diabetes. It is important to
intervene the development of diabetes mellitus type 2 for the client as soon as possible. If the
development of diabetes continues, it will lead to so many complications such as; chronic kidney
disease, stroke, heart attack, and risk for infections. These diabetes-related complications are
serious and even life threatening. It is a priority and should be prevented.
Nursing Interventions
In order to prevent the development of diabetes, a nurse must plan interventions. I as a
nurse to the given scenario, I provided series of interventions. First intervention is to instruct the
client to monitor glucose levels with glucometer at regular intervals to identify and respond early
to fluctuation in glucose levels that occur outside the normal parameters (4-7mmol/L) (Sparks,
2014). This first intervention helps to monitor the sugar levels in timely manner so that if ever
sugar levels go high or low, actions such as providing orange juice for a low sugar level and
administering insulin for high sugar level will be implemented right away. Another intervention
is to assess for underlying cause of elevated serum glucose levels including PCOS, dietary
intake, and lifestyle(Sparks, 2014). It is important to do this to prevent future episodes and to

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know what triggers the high or low sugar levels. The third intervention is to assess the clients
knowledge of hypoglycemia or hyperglycemia to ensure adequate management and prevent
future episode. It is important if the client knows what and how to do if ever hyperglycemia or
hypoglycemia occurs. Assessing the clients knowledge give an idea to the nurse if the client has
a self-care deficit. If a client has lack of knowledge, she might have some problems taking care
of herself especially if administering insulin. The fourth intervention is to teach the patient to
follow a diet that is low in simple sugars, low in fat, and high in fiber and whole grains to control
cholesterol and triglycerides (Sparks, 2014). Following a healthy diet provides so many benefits
in the body. Controlling cholesterol and triglycerides in the body can prevent diabetes related
complications like myocardial infarction. Lastly, Promote exercise routine. Working muscles
more often improves insulin use and absorb glucose.
Conclusion
There are so many important information given in the case study and it is imperative to
use critical thinking. Polycystic Ovarian Syndrome is the main priority in the scenario because it
could trigger so many complications and one of them is diabetes. Diabetes is the most important
clinical manifestation of PCOS because it can be chronic or life-long disease. Interventions such
as monitoring sugar levels, assessing elevated serum levels, assessing patients knowledge
regarding diabetes, and maintaining a healthy diet are necessary to prevent the development of
diabetes.

Scholarly Assignment

References:
Azziz R., Carmina E., Dewailly D, et al. The Androgen Excess and PCOS Society criteria for the
polycystic ovary syndrome:the complete task force report. Fertil Steril. 2009
Feb.91(2):456-88
Wang JG, Lobo RA. The complex relationship between hypothalamic amenorrhea and
polycystic ovary syndrome. J Clin Endocrinol Metab. 2008 Apr. 93(4):1394-7.
Stein F., Leventhal M. Amenorrhea associated with bilateral polycystic ovaries
Am J Obstet Gynecol, 29 (1935), pp. 181191.
Lewis, S. L. (2014). Medical-Surgical Nursing in Canada, 3rd Edition.
[VitalSource Bookshelf Online]. Retrieved from
https://pageburstls.elsevier.com/#/books/978-1-926648-70-5/.
Gardner, J. (2011). Hormonal Imbalance in Polycystic Ovarian Syndrome.
Greenspan's Basic andClinical Endocrinology. 9th edition New York: McGraw-Hill.
Sparks, S. (2014). Risk for Unstable Blood Glucose Level. Nursing Diagnosis Pocket Guide 2nd
Edition. Sparks & Taylor, pp. 31-32.