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Certified Nurse Midwife
Desire to participate in and make choices in one's own health care.
Omitting or committing an act that a reasonably prudent person would not omit or commit under the same circumstances. Need: Duty to provide care; Duty breached; Injury occurred; Breach caused the injury.
Standards of care
Establish minimum criteria for competent proficient delivery of nursing care
Negligent action of a professional person
Patient or legally designated decision maker has granted permission for a specific treatment or procedure based on full information about that specific treatment or procedure as it relates to that patient.
Self-supporting adolescent under 18 yrs, not subject to parental control
14 & 15 year olds able to understand treatment risks
TI - therapeutic insemination
Only sperm is handled - deposited into the woman.
ART - Assisted reproductive technology
Fertility treatment in which both the egg and sperm are handled.
- NOT: artificial insemination or fertility drugs.
- IS: IVF-ET (invitro fertilization and embryo transfer
Number live births per 1,000 people
Infant Mortality Rate
Number of deaths of infants under 1 yr of age per 1,000 live births in a given population.
Number of deaths of infants less than 28 days of age per 1,000 live births.
Maternal Mortality Rate
Number of deaths from any cause related to or aggrivated by pregnancy or its management during the pregnancy cycle including 42 days post-partum per 100,000 live births.
Group of two or more people related by birth, marriage, or adoption, residing together
The potential or actual ability to change the behavior of other family members
collection of data regarding the family's current level of functioning, support systems, sociocultural information, environmental information, type of family, family structure and needs.
Beliefs, values, attitudes and practices that are accepted by a population, community or individual.
Social identity that is associated with shared behaviors and patterns.
The process by which people adapt to a new cultural norm.
When a group completely changes their cultural identity to become part of the majority culture.
the conviction that the values and beliefs of my own culture are the best or only acceptable ones.
Any procedure or product that is used together with conventional medical treatment.
Used IN PLACE OF conventional medicine.
Approach that combines mainstream medicine with complimentary therapies for which there is evidence of safety and effectiveness.
Benefits of Complimentary Therapies
- Emphasis on prevention and wellness
- Emphasis on healing versus cure
- Cheaper and easier access
Risks of Complimentary Therapies
- Lack of regulation and standardization
- Lack of research
- Inadequate training and certification
- Financial and health risks of uproven methods
Traditional medicine - uses treatment or medicine that causes a different reaction in the body than the offending organism or event. I.e., anti-inflammatory prescribed for a person suffering from inflammation.
"The same": Uses like to cure like. Remedies are minute dilutions of substances that (if ingested in larger quantities) would produce effects similar to the symptoms of disorder being treated.
"Natural medicine": Focusses on body's natural healing power. May use diet, exercise botanical medicine, homeopathy, lifestyle modifications, and others.
TCM - Traditional Chinese Medicine
Yin and Yang balance.
Hindu medicine - "life, health, vitality", focusses on five elements: ether, wind, fire, water and earth.
White patchy areas r/t absence of melanin
- 40's and 50's women.
- White papules and plaques often with areas of bruising and redness
local irritation and inflammation of the vulvar vestibule, severe pain with vaginal penetration, burning, itching, urinary frequency or dysuria
- Acute inflammation of the cervix
- Usually from infection from Neisseria gonorrhoeae or Chlamydia trachomatis
- Yellow/white discharge, copious purulent, malodorous
- Screens for cellular abnormalities from cervix and endocervical canal.
- Prep: nothing in the vagina 24h pre-test
- Start at 21yrs
- Q2y 21-29yrs
standardized method of reporting cytologic pap smear findings.
Factors that increase risk of cervical cancer:
- Early age coitus (1st time before 16yrs)
- Hx multiple partners
- Partner with Hx multiple partners
- Exposure to STIs
- Hx HPV infection
- Hx immunosuppressive therapy
- Hx immunocompromised state (HIV)
- Long-term oral contraceptive use
- Hx dysplasia
Tx for abnormal cytology of cervix
Surgical: loop excision, cryosurgery, laser, conization
AUB - Abnormal Uterine Bleeding
- Bleeding outside the normal cycle
- Endometrium and cyclical hormones are not in sync
- Thyroid disorder, DM, Infection, Hormon Imbal
- Tx: control bldg & anemia, prev endomet. cx
- Oral contraceptives or other hormonal
- Excessive bleeding
- Regular intervals
- May have clots
- >80ml per cycle
- Bleeding at irregular intervals
- Between the menses
- AKA Intermenstrual bleeding
DUB - Dysfunctional uterine bleeding
Bleeding w/o cycles
- Endometrial-like tissue found outside the uterine cavity
- Pain increased with menses, may be chronic
- Pain abd, back, rectal or vaginal
- Diarrhea, nausea, urinary complaints, fatigue
- Chocolate cysts
- Laparoscopy or laparotomy(open), biopsy confirms
Anterior bulge in uterus d/t descended bladder
Posterior bulge d/t weakness in wall b/t rectum/vagina
TSS - Toxic Shock Syndrome)
- Staph aureus
- Fever, rash/sloughing skin on hands/feet/trunk, myalgia, n/v, cogn chgs to coma, inflamed mucosa
pathology involves 3 or more organ systems
TSS DX and TX
DX: Labs - elevated BUN, AST, ALT, Bili levels, DECR platelets (increased r/f bleeding)
TX: IVs (elevate BP), Vasopresors (elevate BP), Ventilatory support, Renal dialysis, Antibiotics - until septicemia ruled out
PID - Pelvic Inflammatory Disease
- S/t STI (chlamydia or GC) w/or w/o abscess formation
- S/S: pain, fever 102+, chills, discharge, malaise, n/v
- Salpingitis (fallopian tubes)
- Oophoritis (ovaries)
- Peritonitis (peritoneum)
PID = late infection. No s/s early, ignored.
PID DX & TX
- DX: tenderness & chandelier cervix, cervical cultures
- LABS: CBC, UA; r/o syphilis and HIV
- Elevated ESR & CRP (elevated w/inflammations)
- TX: multiple abx (parenteral & po) Rocephin
- Treat partner, follow-up care, education
- Abnormal chgs in cells of cervix
- Pre-cancerous, condition
- Early detection w/PAP smear
- Carcinoma in situ = severe dysplasia / will become cx
TX: conization, cautery, cryosurgery, laser, LEEP
Cervical CX = dysplasia undiagnosed and untreated
- Dysplaisa undiagnosed and untreated
- HPV LEADING trigger
- Prevention: delay sexual activity, monogamy, no smoke, incr folic acid in diet
- Vaccinate - Gardasil - series x3
Leiomyomas - Uterine Fibroids
- Estrogen Dependent
- Benign growths in uterus, atrophy in menopause
- More in women of color, obesity
- Sx: heavier bldg, bladder/bowel sx