Families Exam 2 Review PDF

Families Exam 2 review: Focus on: Herpes, teaching facts (no drugs) Painful genital lesions Type1: primarily oral-labial lesions Type 2: 90-95% genital lesions Outbreak: painful urination, burning vulvar, scrotal or penile pain, local swelling, erythema, fatigue, backache Typically grouped...

Families Exam 2 review: Focus on: Herpes, teaching facts (no drugs) Painful genital lesions Type1: primarily oral-labial lesions Type 2: 90-95% genital lesions Outbreak: painful urination, burning vulvar, scrotal or penile pain, local swelling, erythema, fatigue, backache Typically grouped vesicles, pustules & painful erosions or ulcers, sometimes vaginal dc - Lesions are unilateral - Recurrent discomfort is less than initial outbreak Activators: stress, illness, menstruation, pregnancy, trauma, heat, and hiv Risk of transmission from mother to baby is higher esp. When infection is acquired close to delivery, but lower in women who got it the 1st trimester - Male to female transmission is the biggest Differentiating vaginitis such as trich, yeast, & bv; teaching patients (know drugs) Vaginitis: Trich: - Diffuse, foul-smelling, moderate to copious thin yellow-green, white or gray dc with “strawberry cervix and possible fishy odor, petechial lesions on cervix - Tx- flagyl 2gm po x1 dose - Treat sex partners - Women can be symptomatic or asymptomatic and men are asymptomatic carriers - Microscopic - motile flagellated trich (little fish moving) on wet-mount Bacterial vaginosis - Moderate to white dc, fishy odor - Can be sexually related or not - Can be asymptomatic - Need a whiff test (mix vaginal secretions with 10% KOH (potassium hydroxide); do the whiff test to see if there is a fishy odor & presence of clue cells on wet-mount for confirmation - Could be d/t: douches, sex partners, IUD or BC, - Tx: can resolve on its own, but flagyl 500 BID X 7 DAYS, vaginal flagyl, clindamycin gel - No alcohol during tx & 3 days after with oral flagyl  - Can cause low birth weight, preterm birth, labor, and late miscarriages Vulvuoaginal candidiasis (yeast) - White curd like, thick vaginal dc, pruritus with escorations, vaginal soreness, burning, painful sex - Microscopic views show : hyphae and budding yeast - Tx- miconazole, fluconazole 150mg x 1 dose, monistat - If it keep happening, think of diabetes, immunosuppression, steroids and abx Confirmatory test- western blot, screening tests, etc A person takes the ELISA test then Western blot to confirm HIV Syphilis need a VDRL or RPR for screening & for follow up tX; confirmation test is treponemal test (FTA-ABS) Always remember that a biopsy is a confirmation test for cancer Syphilis: - Primary: painless ulcer or chancre, unilateral or bilateral with nontender lymphadenopathy - Secondary: rash, adenopathy, fever - Tertiary- cardiac, neuro, etc involvement TX: - Primary & secondary - benzathine penicillin G 2.4 million IM x 1 dose - Tertiary- benzathine penicillin 7.2 million units (3 doses of 2.4 million units at each 1-week interval) - Give IV PCN G for pt’s with ocular, otic, or neurologic syphilis REMEMBER TO DESENTIZE THE PT IF THEY HAVE ALLERGIES TO IF SKIN-POSITIVE, GIVE IN MONITORED TEST DOSES Titers: - When we treat syphilis, wait 12 weeks to repeat the titer should drop to 1.2 , 6 months- 12 months expect a fourfold (quarter) ¼ decrease What is the test used in Vaginitis Wet mounts are used to examine samples underneath a microscope - Ie. in BV use a wet mount to find clue cells - In trich, use a wet mount with saline to see motile flagellated trichomonas (looks like fish with tails moving) - Yeast infections: under the microscope you find hyphae or budding yeast Know Hiv (no drugs on the test): - Virus transmitted by bodily fluids such as semen, blood, and vaginal secretions - routes:  Sexual (anal, oral, vaginal) Blood (transfusions, infected needles) Perinatal (in utero, at delivery, breast feeding) asymptotic - no overt s/s, virus is replicating & infecting more cells & progressively destroying immunity Early symptomatic- cd4 count begins to drop and when cd4/cd8 ratio inverts Late symptomatic- cd4 cells count is western blot to confirm HIV Test anyone who asks to be tested, blood transfusion before 1985, partners thats HIV+, High risk of HIV or syphilis, anyone with “flu-like s/s” who is high risk, IV drug users, prostitutes, homosexuals, homeless people,people that have >1 sex partners Routine part of pregnant patients work-up 1st twin always at greater risk of becoming infected d/t exposure to cervical/vaginal secretions, any delivery complications increase fetal risk, & if membranes have been ruptured >4 hours Always refers esp if they are newly diagnosed patients Teach: have a good protein diet & calories, small meals and generous fluids, multivitamins, avoid unpasteurized milk, rare or raw meat, always safe sex & condoms, get TD every 10 years, pneumococcal vaccine, flu vaccine, avoid live vaccines except MMR Reporting: - HCP and health dept. Must report and find the pt’s partners list to inform them - Everyone with HIV needs to be reported Children 18 months need 1 positive test: +ELISA & Western Blot, PCR, P24, viral cultures or meets aids definition Same tx with kids, but get pneumococcal vaccine at 2 & second dose 3-5 years later Drugs for a few STDS: - Chlamydia: azithromycin gm x 1 dose or doxycycline 100 mg BID x 7 days (no sex for 2 weeks) TREAT THIS AS A SINGLE CASE - Gonorrhea: Cefriaxone 250mg im x1 dose + azithromycin 1 gm — ALWAYS TREAT GONORRHEA AND CHLAMYDIA TOGETHER Chlamydia  - Most common std cervicitis (women) and urethritis (men); cause conjunctivitis or pneumonia in newborns s/s; -mucopurulent dc, post-coital bleeding, suprapubic tenderness, dysuria, hesitancy, frequency Need a urinalysis & specimen swab to confirm Re-screen teens in 3-4 months Re-screen women in 12 months for annual pap smear Tx: - azithromycin gm x 1 dose or doxycycline 100 mg BID x 7 days Gonorrhea: - N. gonorrhoeae s/s- urethral dc (scant to profuse, clear to brown, yellow, white or green), meatal crusting, redness, dysuria, itching, & redness Need both urinalysis and specimen for dx; same as chlamydia - Complications can lead to PID, infertility, ectopic pregnancy, epididymis Tx: - Cefriaxone 250mg im x1 dose + azithromycin 1 gm — ALWAYS TREAT GONORRHEA AND CHLAMYDIA TOGETHER STDS that can cause PID (s/s) - Gonorrhea and Chlamydia is untreated s/s: - Lower abd tenderness, adnexal tenderness, cervical motion tenderness, temp>101, abnormal cervical or vaginal d/c, elevated ESR, presence of either GC or Chlamydia Can lead to infertility GU: Hematuria: - Blood in the urine (3 erythrocytes per high power field) (gross or microscopic) CAN BE D/T: - Runner’s hematuria- exercise induced - Flank pain- infection, calculus, & obstruction - Painless bleeding → cancer Foods: Beets, blackberries, rhubarb Meds: Rifampin, pyridium, anticoagulants - Check CVA tenderness, examine penial opening, bruising, prostate nodules, pain, bogginess US of kidneys and bladder - initial examination for pregnant women CT of abd & pelvis- renal anatomy, kidney stones, tumors, CT of abd & pelvis w/o contrast recommended if GFR50 y/o, tobacco use, pelvic irradiation, males, work in chemical plants, painters, printers, exposure to dyes, chronic UTIs, exposure to cyclophosphamide, chronic indwelling foreign body, hx of analgesic abuse, aristolochic acid —- REFER Age is a big factor in the test on what to complete on pt’s Always send urine for culture and sensitivity esp when its pertaining a UTI Enuresis- involuntary voiding of urine –kids don't have bladder control until 2 & 4 years of age Defer tx until age 7 Always consider sexual abuse In kids over 5 y/o, usually from maturation or developmental delay Usually developmental and self-limiting - Primary enuresis - child has never gained bladder control & wets themselves frequently - Secondary- d/t a condition that develops after bladder control Teachings: - Night time alarm, counseling, hypnosis, limit fluid intake, nighttime awakening, trips to toilet, bladder stretching, positive reinforcement for little achievements Meds: -imipramine - desmopressin (DDAVP) Types of incontinence - stress,urge, overflow  - Stress- bladder leaks during activities that increase abd pressure (sneezing, coughing, and laughing ); TX- kegel exercises (10-20 contractions TID OR QID) - Urge- inability to delay urination with an abrupt desire to void d/t bladder hypersensitivity, detrusor instability; warning of seconds to minutes; “I HAVE TO PEE NOW” - Overflow: d/t overdistended bladder, frequent leakage of small amounts of urine, hesitancy, decreased flow, incomplete emptying Bacterial prostatitis: acute , decreased urine flow, dysuria, perineal & back pain, painful sex & pooing, fever, chills, malaise, UA chas pyuria & bacteria exams Swollen and boggy prostate, tender and irregular prostate Labs - UA, PSA (help detect or monitor prostate cancer) Meds: Bactrim, ampicillin, cipro, Teach: - No caffeine, decongestants, or spicy foods, normal sexual activity, warm sitz bath Benign Prostatic Hypertrophy: Hyperplasia of the prostate gland, begin around 40-60 y/o s/s from enlarged prostate: Hesitancy, straining, starting & stopping, dribbling, retention, frequency, urgency, nocturia, incontinence Exams - Enlarged rubbery smooth prostate; if it feels nodules or firmness in areas (malignancy) Labs: u/a - pyuria – infection, hematuria could be cancer, urine culture for r/o of uti, bun, crt, psa if >10 = cancer Tx & teaching: Avoid decongestants, antihistamines, use cardura, flomax, hytrin s/e hypotension Prostate Cancer: - Hard fixed prostate with a PSA>10 Normal 0-4, 4-10- means they have a problem, if the PSA is increasing they need to see a urologist, but it is greater than 10- they need to see a urologist & get tx options UA for UTI: Alkaline ph, nitrates, and leukocytes UA for Glompehrintis RBC casts UA for cystitis: Wbcs and bacteria UA for kidney stones (renal calculi) Crystals REFER ALL OTHER GU DISORDERS LIKE HYPOSPADIAS, HYDROCELE, VARICOCELE (KNOW WHAT IT LOOKS & FEELS LIKE) Hypospadias Urethral meatus on ventral surface of the penis; opening on the underside of penis rather than the tip Hydrocele - Scrotal swelling d/t collection of fluid (common in newborns)(swelling testicles) Varicocele - Venous dilation in the scrotum (“bag of worms”)(swollen veins in scrotum) Urology emergency Testicular Torsion: - Twisting of the spermatic cord can cause testicular gangrene Sudden unilateral pain of the scrotum, causing swelling REFER FOR IMMEDIATE SURGERY; sometimes can be reduced manually, but surgery is needed immediately within 6 hours to prevent testicular loss UTI: - Most common in female - E.COLI causative agent s/s Urgency, frequency, dysuria, low back pain, pelvic pain, suprapubic pain, hematuria (burning in urination, that's how you know it more lower urinary tract) Elderly Confusion, tachycardia, tachypnea Neonates  Fever, vomiting, hypothermia, abd distention, lethargy, irritability Dx- Urinalysis +nitrites leukocytes Uncomplicated - bactrim x 3 days & pyridium for pain Complicated- cipro 500 mg BID X 5-7 DAYS or Levaquin 750 mg daily for 5-7 days Teachings: - Increase fluid intake - Cranberry juice - Avoid diaphragm use, IUDS, void after sex, good hydration, avoid chemical irritants (bubble bath) Children suprax if allergic (gonorrhea), doxycycline or azithromycin (chlamydia), non gc- give cipro for 14 days