Review the latest evidence-based guidelines as they pertain to the case below and answer the questions. Use scholarly journal articles within 5 years and/or medical textbooks within 5 years (2016-2021). Ms. Martin is a 55-year-old woman who has been on HRT for 4 years. HRT was prescribed because Ms. Martin was experiencing vasomotor symptoms associated with menopause. Her last mammogram was 2 years ago and her last pap was 5 years ago. Ms. Martin made an appointment with her nurse practitioner to discuss discontinuing HRT after hearing and reading news reports about the dangers associated with the medication. Except for the HRT, Ms. Martin is taking no medication other than a daily vitamin. She had a tubal ligation after the birth of her third child but has had no other surgeries or history of any medical conditions. Her father had cardiovascular disease and died of a myocardial infarction at 77 years of age. Her mother was diagnosed with breast cancer at 81 years of age. Ms. Martin does not smoke and rarely drinks alcohol. She likes to work in her garden but is not involved in a formal exercise program. She has gained about 10 pounds since menopause. 1. What evidence-based information should a primary practitioner provide to Ms. Martin regarding her concerns of HRT? 2. Discuss the advantages and risks associated with HRT. 3. What alternative treatments for menopausal symptoms should a primary practitioner discuss with Ms. Martin? 4. Discuss the recommended screening tests, using the latest evidence-based guidelines that Ms. Martin should have. 5. What health promotion, maintenance, and prevention education would be important to provide to Ms. Martin?
is melting ice and the overall increased extent of thawing permafrost results in the removal of a critical water source. The change could force the relocation of one-sixth of Earth ́s population which critically depends the runoff of glaciers as drinking water source or on end-of-season snowpack (National Research Council 2010). It could also affect the water availability and quality through the release of pollutants and organics captured in the ice – these gases also contribute to climate change (Swann et al. 2009, Pfirman et al. 1995). Monitoring these changes is possible through measuring the vertical temperature profile of permafrost and the ice volume fraction. The changes are also revealed by observing the surface snow cover and temperature, vegetation and surface elevation change (National Research Council 2010). 3.5 Sea-level change The sea-level rise is another effect of climate change. The rate in the past 20 years (approximately 55 mm in 20 years) is nearly twice as high as the rise in the last century, which averaged to about 30 mm in 20 years (NASA 2013d). This can be seen in Figure 3. Where these changes in space and time lead to the loss of property through coastal erosion and/or floods, human and animal populations could be forced to relocate. Such an event would increase the potential for cultural conflicts (National Research Council 2010). Figure 3: The rise of the sea level (NASA 2013d) The sea-level rise can easily be tracked by monitoring the global sea level heights together with the seafloor morphology and glacial ice mensuration. This is due to the fact that sooner or later the glacial meltwater will end up in the oceans and due to the sped-up melting treated in 3.3 and 3.4, the rate will increase drastically in the future. It is also useful to create models of inundation, coastal erosion and potential storm damage in order to thwart these catastrophes since they are a predictable consequence of sea-level rise (National Research Council 2010, Chuvieco 2008). 3.6 Accumulating natural disasters The last point is the accumulation of extreme events. The USA experiences more and more record high temperatures every year, congruously the record low temperatures occur fewer than ever. However extreme events also include heat waves, droughts, floods, cyclones, and wildfires. Changes in the earth’s system diversity also follow as a response to weather and climate extremes. Species that prove unable to adapt to the new circumstances will ultimately disappear or have to surrender to more successfully adapted species. An increased number of strong blusters with mounting intensity is also an indicator for these extreme events, just like frequent insect infestations. Insects are the profiteers of global changes in wind patte>GET ANSWER