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Karen, age 40, has been married for 22 years. Karen started having menstrual cycles at age 12 and had her first

child at age 16. She has four children ages 16 to 24. Karen's menstrual periods have always been "heavy" but regular between 28 and 31 days apart. Over the last 6 months she has been experiencing severe menstrual bleeding with progressively worsening back pain and cramping. Karen was seen by her family doctor and a CBC revealed hemoglobin of 8.9. She was referred to an OB/GYN who after extensive diagnostic testing and a physical examination determined that she should recommend a complete hysterectomy.

A.   What common reproductive concern is the probable cause of Karen's symptoms including severe menorrhagia, progressively worsening dysmenorrhea, and anemia?

B.   What diagnostic tests do you think the OB/GYN ordered before concluding that a complete hysterectomy was in order?

C.   What is the nursing management that Karen will need in order to assist her in understanding the physiologic and psychological conditions she will experience after her surgical menopause?

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