Menopause Nursing Care Plans

Menopause is the cessation of menstruation. It results from a complex syndrome of physiologic changes caused by declining ovarian function. It occurs when the loss of ovarian function results in the permanent termination of menstrual periods. The transitional period leading up to this irreversible event is called the climacteric and is characterized by the decline in the number of ovarian follicles, which also becomes less responsive to gonadotropic hormonal stimulation, and by the decrease of estrogen production by the ovaries until there is not enough to cause the endometrium to grow and shed.

Nursing Care Plans

Nursing management of menopause is symptomatic. Estrogen replacement therapy is the most advantageous treatment for symptoms, but it’s not suitable for all patients as it has some adverse effects and risks.

Here are six (6) nursing care plans (NCP) and nursing diagnosis for patients with menopause:

  1. Disturbed Sleep Pattern
  2. Sexual Dysfunction
  3. Risk for Injury
  4. Stress Urinary Incontinence
  5. Risk for Infection
  6. Situational Low Self-Esteem

Disturbed Sleep Pattern

Disturbed Sleep Pattern: Time-limited disruption of sleep (natural periodic suspension of consciousness)

May be related to

Possibly evidenced by

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  • hot flashes
  • interrupted sleep
  • insomnia
  • nervousness
  • anxiety
  • depression
  • emotional mood swings
  • decreased REM sleep

Desired Outcomes

  • Patient will be able to sleep without interruption and will express feelings of being rested.
  • Patient will be able to perform techniques to promote sleep.
  • Patient will identify factors that prevent restful sleep or disrupt sleep.
  • Patient will be able to achieve and maintain an adequate amount of sleep to facilitate maximal functioning.
  • Patient will be able to establish a sound sleep pattern.
Nursing InterventionsRationale
Assess patient’s sleep pattern and changes, naps, amount of activity, awakenings and frequency, and patient’s complaints of lack of rest.Provides information to alleviate sleep deprivation in relation to age-related changes and identify and establish plan of care.
Monitor for complaints of pain or discomfort.Identification of causative factors of frequent awakenings helps facilitate changes in sleep pattern.
Provide calm, quiet environment, closing curtains, adjusting lighting, and so forth.Helps to promote conducive atmosphere for restful sleep. External stimulus may interfere with going to sleep and increase awakenings in elderly patient because sleep is usually of less intensity.
Administer medications to promote normal sleep patterns as ordered.Medications may be required to achieve rest during hospitalization. Hypnotics induce sleep, while tranquilizers reduce anxiety.
Instruct the patient to practice slow deep breathing whenever a hot flash starts; instruct also on other relaxation techniques.Relaxation and deep breathing may help alleviate the discomfort caused by a hot flash.
Provide warm drinks, extra cover, warm bath prior to bedtime and so forth.Ritualistic procedures may prevent breaks in established routines and promote comfort and relaxation prior to sleep.
Instruct patient to avoid stimulants like caffeinated drinks, stressful activity, and so forth prior to sleep.Overstimulation prevents patient from falling asleep.
Help patient in relaxation techniques, guided imagery, muscle relaxation, meditation, and so forth.Relaxation techniques frequently help promote sleep.
Instruct patient to avoid alcohol prior to bedtime.Although alcohol may cause sleepiness, it interrupts sleep later in the night.

Sexual Dysfunction

Sexual Dysfunction: The state in which an individual experiences, or is at risk of experiencing, a change in sexual function that is viewed as unrewarding or inadequate.

May be related to

  • changes in body structure and function from decreased estrogen secretion

Possibly evidenced by

  • thin, dry vaginal mucosa
  • dyspareunia
  • slight bleeding during intercourse
  • verbalization of problems with sexual function
  • avoidance of engaging in sexual intercourse
  • need for confirmation of desirability
  • decreased vaginal lubrication

Desired Outcomes

  • Patient will have a satisfying sexual function.
Nursing InterventionsRationale
Assess presence of impotence, dyspareunia, feelings of inadequacy, or fear of sexual function and failure.Changes related to aging, such as slower arousal time, reduced lubrication of the vagina, and atrophy of the vaginal lining, results in painful intercourse, may be responsible for sexual problems. Chronic illness compromise sexual functioning due to fear of recurrence of symptoms.
Assess patient’s sexual interest, desire, affect of health status on sexuality, and psychosocial factors affecting sexual function.Several factors including chronic illness, drugs, lack of or an impaired relationship with partner, cultural belief can affect sexual function.
Include partner in discuss if appropriate.May be embarrassed to have partner present or even approach the subject. Patient may be more comfortable and open discussing the subject alone.
Discuss past sexual experiences and practices, interests, and satisfaction, and medications taken for control of chronic diseases that affect sexual function.Provides individual needs regarding sexual behavior based on history.
If patient is sexually active, tell her to remain sexually active.This helps in preserving vaginal elasticity. Water-based lubricants can be used during sexual interocurse to decrease dryness.
Instruct patient to perform Kegel exercises daily.Performing Kegel exercises can help strengthen the vaginal and pelvic muscles.
Discuss importance of maintaining sexual functioning by intercourse or masturbation.Maintains interest and sexual function.
Encourage to vary positions during intercourse.Pain and dyspnea may be exacerbated during exertion and a more passive position may promote participation in safe sexual activity.
Provide privacy.Elderly may lack the privacy needed.
Use exercise and pain tolerance in changes in VS caused by activity as guidelines for progressive sexual activity plan based on physical limits.Provide baseline to promote sexual activity without symptoms that create fear or interfere with sexual activity.
Suggest sexual or psychological therapy, if appropriate.Anxiety and reduced self-esteem resulting from altered sexuality are common problems that can be helped by counseling.
Instruct to void before and after intercourse.Clears meatus of infectious organisms that may cause bladder infection.
Instruct female patient to use water-soluble lubricant during intercourse.Lubricates the vagina to prevent pain and irritation during intercourse.

Risk for Injury

Risk for Injury: Vulnerable for injury as a result of environmental conditions interacting with the individual’s adaptive and defensive resources, which may compromise health.

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May be related to

  • menopause
  • perimenopause
  • abnormal bone density
  • estrogen level decrease
  • osteoporosis

Possibly evidenced by

  • osteoporosis
  • bone loss
  • decreased bone density
  • brittle bones
  • overproduction of interleukin-6
  • increased bone resorption
  • hyperthyroidism

Desired Outcomes

  • Patient will have no complications from trauma or fractures caused by falls.
  • Patient will have no accidental falls or injury.
  • Patient will exhibit no other fractures or tissue trauma.
Nursing InterventionsRationale
Assess type of medications, effect of medications, and number of medications being taken.Drug absorption, distribution, and excretion are altered in the aged, causing confusion, and forgetfulness leading to falls.
Assess patient’s accident proneness, presence of agitation, ambulatory status, interference with thinking, balance, and gait.Conditions may predispose falls. Menopause may induce atherosclerosis, and a decrease in estrogen level contributes to osteoporosis.
Maintain vigilance and supervision when needed.Accident prevention maintains safety of patient.
Reduce unsafe activities and behaviors, or modify, if appropriate.Reduces the risk for falls.
Assess patient’s pulses distal for fracture, presence of edema, or color changes.May indicate the presence of compartment syndrome, which requires emergency treatment to prevent necrosis and loss of tissue.
Tell patient to immediately report vaginal bleeding or spotting after menstruation has ceased.May indicate a different problem.

Stress Urinary Incontinence

Stress Urinary Incontinence: Sudden leakage of urine with activities that increase intraabdominal pressure.

May be related to

  • Aging
  • Uterine prolapse
  • Urinary incontinence
  • Degenerative changes in pelvic musculature and structural supports
  • Atrophic vaginitis

Possibly evidenced by

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  • Urinary urgency
  • Urinary frequency
  • Dribbling

Desired Outcomes

  • Patient will be able to resume normal activities and maintain continence of urine.
  • Patient will have an absence or reduction in urinary incontinence.
  • Patient will be able to perform exercises as instructed.
  • Patient will be able to prevent incontinence episodes associated with coughing, sneezing, or laughing.
Nursing InterventionsRationale
Assess patient for incontinence associated with signs that increased abdominal pressure: coughing, lifting, sneezing, or laughing.Increased intra-abdominal pressure causes involuntary loss of urine when the pelvic support organs are weakened by aging, frequent catheter use, childbirth, or with menopause.
Evaluate patient’s understanding of incontinence and diseases process.Provides information in establishing a baseline for teaching the plan of care. Most patients are hesitant to discuss incontinence thus a non-judgemental attitude may assist the patient to be less embarrassed and discuss the problem openly.
Identify patient’s current medication and evaluate medical regimen for drugs that could contribute to incontinence.Diuretics, CNS depressants, and anticholinergics may all cause urinary incontinence and may require medication alteration or change.
Provide patient with pads or leak-proof undergarments as appropriate.Prevents patient embarrassment by spoiling or wetting of clothing.
Administer estrogens are ordered.Estrogen loss during menopause affects the muscles that help maintain continence of urine. During perimenopause, the patient’s well-vascularized urethral mucosa is lost, resulting in loss of resistance to urinary flow and causing incontinence.
Instruct patient regarding potential reasons for urinary dribbling and incontinence.Menopausal changes can result in urinary incontinence, as can physiologic changes involved with aging.
Instruct patient in performing Kegel exercises.Exercises help strengthen perineal musculature and improve sphincter tone and control over urine loss.
Instruct patient to contract perineal muscles before coughing or sneezing to avoid or decrease chances of incontinence.Helps prevent increase in intra-abdominal pressure.

Risk for Infection

Risk for Infection: At increased risk for being invaded by pathogenic organisms.

May be related to

  • inadequate primary defenses due to aging or chronic illness
  • menopause
  • change in pH of secretions

Risk factors

  • change to alkaline secretions in vagina
  • decreased estrogen level secretion
  • thinning of vaginal mucosa
  • atrophy of vaginal mucosa

Desired Outcomes

  • Patient will have an absence of vaginal discomfort and/or infection.
  • Patient will correctly adhere to estrogen therapy.
  • Patient will be able to verbalize increased comfort and absence of symptoms of infection.
  • Patient will be able to demonstrate appropriate health practices with genitalia and perineal care.
  • Patient will exhibit no evidence of vaginal infection or tissue trauma.
  • Patient will comply with all instructions to decrease potential for infection.
Nursing InterventionsRationale
Assess patient’s vagina and genitalia for itching, burning, pain, lack of secretions, or foul-smelling secretions.Changes associated with aging predispose patient to easily traumatize mucosa and increased susceptibility to atrophic vaginitis.
Administer estrogen cream by vaginal applicator or suppository as ordered.Provides estrogen replacement and moisture to vagina to treat atrophic vaginitis.
Obtain vaginal smear for culture. Administer antimicrobial if culture is positive.Identities infectious organism, if present, and allows for eradication of causative organism.
Instruct patient to apply water soluble lubricant to genitalia and vagina as necessary.To treat dryness.
Instruct patient to avoid tight girdles or other tight clothing; instruct to wear cotton underwear.Tight clothing may irritate genitalia. Cotton is porous and prevents dampness resulting in less risk of infection.
Instruct to cleanse perineum frequently; wash genitalia from front to back.Promotes comfort and front to back technique prevents introduction of microorganisms.
Inform patient to avoid use of douches, sprays, or irritating soaps.Prevents alteration in pH of vagina and irritation of genitalia.
Recommend yearly gynecologic checks and Pap smear.Identifies presence of cancer and ensures well gynecologic health.

Situational Low Self-Esteem

Situational Low Self-Esteem: Development of a negative perception of self-worth in response to current situation.

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May be related to

  • biophysical factors
  • loss of reproductive capability
  • hormonal changes

Possibly evidenced by

  • self-negating verbalizations
  • verbalizations of loss of self-worth
  • expressions of guilt
  • depression
  • boredom
  • anxiety
  • insomnia
  • hot flashes
  • nervousness

Desired Outcomes

  • Patient will express feelings of reduce frustration, anxiety, nervousness, and enhanced feeling of self-worth during adjust to menopause.
  • Patient will express improved self-esteem and self-worth.
  • Patient will have reduced anxiety and nervousness.
  • Patient will be able to discuss concerns and develop a trusting relation with caregiver.
  • Patient will be able to verbalize adjustment to menopause and associated changes.
  • Patient will be able to access resources for counseling to improve chronic anxiety or depression.
  • Patient will exhibit improvement in comfort with hot flashes controlled and sleep pattern returned to normal.
Nursing InterventionsRationale
Assess patient’s expressions of negative feelings, self-worth, anxiety, and general complaints about present status in life.Menopause creates more difficulty for women who feel that childbearing is the main reason of existence and self-worth. Loss of reproductive ability then results in deeper emotional consequences.
Encourage expression of feelings in a nonjudgemental environment.Provides venting of concerns and reduces anxiety.
Inform patient that feelings and symptoms caused by decrease in hormone secretion are not unusual.Promotes understanding of problem for resolution and/or acceptance.
Suggest referral to counseling for chronic anxiety or depression if patient does not improve.Prevents prolonged depression and permanent emotional disability.

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