Please respond to your peer’s posts. To ensure that your responses are substantive, use at least two of these prompts:

• Do you agree with your peers’ assessment?
• Take an opposing view to a peer and present a logical argument supporting an alternate opinion.
• Share your thoughts on how you support their opinion and explain why.
• Present new references that support your opinions.

Please be sure to validate your opinions and ideas with citations and references in APA format. Substantive means that you add something new to the discussion, you aren’t just agreeing. This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion and should be correlated to the literature.

Dana Response

When a patient presents complaining of dysmenorrhea, more information needs to be acquired to make a differential diagnosis. Typically, painful menstruation pain is described as crampy or having spasmodic pain in the lower back, thighs, or pelvis. The onset of pain begins with the first day of the menstrual cycle. Therefore, I would ask the patient to describe the pain including onset, duration, etc. What does the discharge look like? Is there discharge present when the patient is not having menses? Additionally, I would want to know if there is a history of this pain. If the pain is new, I would want to rule out diagnoses such as miscarriage or ectopic pregnancy. The patient would need to be evaluated for the possibility of having a sexually transmitted diseases, pelvic inflammatory disease, and pregnancy. Birth controls methods would also need to be assessed. Some other symptoms to inquire about are diarrhea, nausea, vomiting, and dyspareunia (Dains, Baumann, & Scheibel, 2016).

Possible differential diagnoses for this patient include dysmenorrhea, pelvic inflammatory disease, endometriosis, miscarriage, and ectopic pregnancy. If there was more information provided there could be other diagnoses to consider such as irritable bowel syndrome, nephrolithiasis, or ovarian cysts (Carcio & Secor, 2015). The ICD-10 Code for unspecified dysmenorrhea is N94.6. The code for primary dysmenorrhea is N94.4. Secondary dysmenorrhea has a billing code of N94.5 (ICD-10 Coded website, 2019). I reviewed the ICD-10 Official Guidelines for 2019 and was unable to find information regarding V-codes as mentioned in the question (Centers for Medicare & Medicaid Services website, 2019). I am looking forward to learning from what others are find.

The treatment plan for uncomplicated dysmenorrhea includes taking non-steroidal anti-inflammatories such as ibuprofen beginning two days before the menstrual cycle begins until menses ends along with monophasic oral contraceptive pills. This therapy should be tried for three months. If the pain has not improved by the three-month follow up appointment, secondary causes should be investigated via gynecological referral. Some other therapies that can be recommended are heating pads, fish oil supplements, vitamin E supplements, toki-shakuyaku-san herbal remedy, or a daily dose of thiamine (Buttaravoli & Leffler, 2013).

References

Buttaravoli, P., & Leffler, S. (2013). Minor emergencies (3rd ed.). Philadelphia, PA: Elsevier.

Carcio, H., & Secor, R. M. (2015). Advanced health assessment of women (3rd ed.). New York, NY: Springer.

Centers for Medicare & Medicaid Services website. (2019). https://www.cms.gov

Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier.

ICD-10 Coded website. (2019). https://icd10coded.com

Jodi’s Response

Question

What clinical information would you obtain from an adolescent or adult female presenting with complaint of painful menstruation? What is your assessment and associated ICD-10 and V code(s) for this condition? What are your differential diagnoses? What pharmacologic and non-pharmacologic therapies would you recommend? What follow-up (RTC) timeframe, if any, would you recommend?

Assessment

Painful menstruation, or dysmenorrhea, usually occurs at the onset of menstruation. The patient might state that they are experiencing a crampy lower abdomen, that is sharp, aching and come and go. They may also present with back pain. Pain during menses is normal but a large amount of pain is not. Painful menstruation is the leading cause of lost time from school and work among women in their teens and 20’s. (U.S. Department of Health and Human Services, 2019). Assessment of the woman complaining of dysmenorrhea should include a through history and physical. History of her menses onset, duration, and characteristic should be obtained. It’s important to determine if this is something new for her or acute. The patient should have a physical assessment with a potential for a pelvic exam pending the answers to the history. A pelvic exam can be done to determine if the cervix is inflamed. A Pap smear can be done to rule out cancer. Blood test can be done to determine if hormonal imbalances are causing the dysmenorrhea. Urine or blood test can be done to rule out pregnancy. Other testing that can be done to rule out complications include endometrial biopsy, hysteroscopy, and ultrasound (Moore, 2016).

ICD-10 and V code

N94.6 v36.0

Differential Diagnosis

• dysmenorrhea
• fibroids
• pelvic inflammatory disease
• endometriosis
• sexually transmitted disease
• use of intrauterine devices (IUD)

Pharmacological and Non-pharmacological Interventions

The use of dietary supplements such as omega-3 fatty acids, and magnesium have been shown to reduce dysmenorrhea. The use of NSAIDS, Tylenol, oral contraceptives, progesterone have been shown to improve symptoms (Massachusetts General Hospital, 2019). The use of relaxation, exercise, and heat can help to decrease the pain. A study published in October 2017 in the Journal of Bodywork and Movement Therapies (Links to an external site.)Links to an external site.concluded that women who practiced yoga 30 minutes per day, two days a week, for 12 weeks at home had a significant improvement in menstrual pain and physical fitness over the control group (Davidson, 2019).

Follow Up

According to the American Congress of Obstetricians and Gynecologists, these cramps are caused by increased or imbalanced levels of prostaglandins (Links to an external site.)Links to an external site., hormone-like fatty acids that stimulate the uterus to contract during the period. Changes in prostaglandin levels can cause more intense and frequent uterine contractions, compressing nearby blood vessels and cutting off oxygen to the uterus, thus causing painful cramps and discomfort (Links to an external site.)Links to an external site. (Davidson, 2019). Explaining to the patient that some pain with menses can be normal and can be treated with the above recommendations. If the patient should experience severe pain she should immediate follow up. The patient should follow the recommended changes and follow up in 6 months or sooner if symptoms persist (Massachusetts General Hospital, 2019) (Massachusetts General Hospital, 2019).

References

Davidson, J. (2019). What Causes Menstrual Cramps and Period Pain? Retrieved from Everyday Health: https://www.everydayhealth.com/pictures/reasons-yo…

Massachusetts General Hospital. (2019, January). Dysmenorrhea. Retrieved from Massachusetts General Hospital: https://www.massgeneral.org/conditions/condition.a…

Moore, K. (2016, January 28). Menstrual Problems. Retrieved from healthline: https://www.healthline.com/health/menstrual-proble…

U.S. Department of Health and Human Services. (2019, January 07). Painful menstrual periods. Retrieved from U.S. National Library of Medicine : https://medlineplus.gov/ency/article/003150.htm