Older adults 2 exam 4

What STI's can cause cancer?

HPV, HBV, EBV

What are some long term health consequences of STI's?

Cancers, reproductive health problems

what are the bacterial STIs?

Gonorrhea, syphilis, chlamydia

Viral STIs

genital herpes, genital warts, HBV

protozoan STIs

Trichomoniasis

Parasitic STIs

scabies, pubic lice

5 P's for obtaining sexual history

partners, practices, protection from STIs, past history of STIs, pregnancy intentions

ways to prevent STDs

condom provision, Hep A and B vaccine, HPV vaccine, emergency contraception pills, STI/HIV prevention counseling, PrEP, Non-occupational post exposure prophylaxis, DoxyPEP

Nongonococcal Urethritis

inflammation of the urethra, not caused by gonococcal infection, mucoid or purulent urethral discharge, caused by chlamydia, mycoplasma (ureaplasma), trich

Treatment of STIs

Doxycycline 100 mg BID x 7 days, azithromycin 1 gm in a single dose or 500 mg in single dose and 250 mg for 4 days

Mucopurulent cervicitis

inflammation of the cervix, yellow endocervical exudate, usually caused by chlamydia or gonorrhea

management of sexual partners

patients should refer sex partners for evaluation and treatment, follow-up appointments important, promotion of safer sex

Chlamydia

bacteria, important cause of blindness and STD, most common STD, 1.8 million cases reported in 2018, very damaging and very preventable

symptoms of chlamydia in females

often few or no symptoms

mucosal infections of the lower reproductive tract: urethritis, cervicitis

Invasion of the upper reproductive tract: pelvic inflammatory disease (PID)

symptoms of chlamydia in males

sensation of heaviness in the testicles -unilateral, painful swelling at the bottom of the testicle, inflammation of the scrotal skin, painful urination, mucopurulent or purulent drainage at penile opening, can be asymptomatic

treatment of chlamydia

doxycycline - 100 mg BID x 7 days

Azithromycin - 1 gm in single dose

Levofloxacin - 500 mg per day x 7 days

Gonorrhea

lay terms "clap, GC"

estimated 1.5 million new infections occur each year

Gram negative diplococci

Simple growth requirements, prefers epithelial surfaces... therefore young girls at particular risk

local inflammatory reaction -> exudate

symptoms of Gonorrhea in men

typically occur in 1 to 5 days after infection, urethritis is the most common manifestation (bad smelling and cloudy discharge form the penis, burning sensation during urination) early symptoms may clear up on their own

symptoms of gonorrhea in women

urethra site to common, often unaware or have no symptoms, increased vaginal discharge, painful urination, painful intercourse, primary site of infection is usually the cervix

a PAP test does not test for it

other sites for gonorrhea

systemic infection, eyes, rectal mucosa, oropharynx

erythromycin drops used in infants

treatment of gonorrhea

single dose of antibiotic, usually given by injection, ceftriaxone IM (500 mg)

complications of gonorrhea

left untreated in early stages, symptoms may disappear, yet bacteria may move to other organs causing more serious infections and compilations , sterility

signs & symptoms of mastalgia

breast tenderness, breast heaviness or fullness, sharp or burning pain, pain that radiates, breast swelling, lumpiness or nodularity, pain that worsens with menstrual cycle, pain unrelated to cycle

signs and symptoms fibrocystic changes

breast lumps or areas of thickening, breast pain or tenderness, breast swelling or fullness, symptoms that worsen before menstruation, lumps that change size with the menstrual cycle, green or brown non-bloody nipple discharge, breast changes occurring in both breasts, generalized breast discomfort

signs and symptoms of fibroadenoma

painless breast lump, smooth firm or rubbery texture, well-defined, round or oval shape, highly mobile, usually small (1-3cm) but may grow, may enlarge during pregnancy or estrogen exposure, tenderness before menstruation, usually occurs in one breast, but can be multiple or bilateral

signs and symptoms of endometriosis

pelvic pain, dysmenorrhea, dyspareunia, pain with bowel movement or urination, heavy menstrual bleeding or spotting, infertility, lower back pain, gastrointestinal symptoms, fatigue

signs and symptoms of myomas

heavy or prolonged menstrual bleeding, pelvic pressure or fullness, pelvic pain or cramping, enlarged abdomen, frequent urination, difficulty emptying the bladder, constipation, lower back pain, pain during intercourse, reproductive issue,

signs and symptom of uterine prolapse

pelvic pressure or heaviness, feeling or seeing a bulge in the vagina, low back, difficulty inserting tampons, urinary symptoms, bowel symptoms, pain or discomfort during intercourse, worsening symptoms after standing or lifting

signs and symptoms of menopause

irregular periods, hot flashes, night sweats, vaginal dryness, mood changes, sleep disturbances, decreased libido, weight gain or body composition changes , thinning hair or dry skin, urinary symptoms

signs and symptoms andropause

low energy, decreased libido, erectile changes, mood changes, difficulty concentrating, loss of muscle mass and strength, increased body fat (abdomen), decreased bone density, sleep disturbances, hot flashes or sweating, reduce testicular size

S/sx of BPH

urinary frequency/nocturia/urgency, weak urine stream, hesitancy, straining to urinate, incomplete bladder emptying, dribbling at the end of urination

s/sx of syphilis

painless chancre, swollen lymph nodes, skin rash, mucous patches condyloma lata, fever, sore throat fatigue, muscle aches, hair loss

s/sx trichomoniasis

women: frothy, yellow-green vaginal discharge, strong vaginal odor, vulvar irritation or itching, pain during intercourse, dysuria, punctate red lesions on the cervix

men: urethral discharge, buring after urination or ejaclation, mild itching or irritation inside the penis

70% of cases are asymptomatic

TNM cancer stages

t = tumor - T0: no tumor, T1-T4: increasing size or local invasion

N = nodes - N0: no lymph node involvement, N1-3: increasing number or distance of affected nodes

M = metastasis - M0: no metastasis, M1: distant metastasis present

Stages of cancer

Stage 0 - abnormal cell present but not invasive, very early and highly treatable

Stage 1 - early stage, small, localized tumor, no lymph node involvement

Stage 2 - localized but larger, larger tumor and or limited lymph node involvement

stage 3 - locally advanced, more extensive lymph node involvement, tumor may invade nearby tissue

Stage 4 - metastatic, cancer has spread to distant organs

external radiation therapy

local cancer treatment in which a machine aims high-energy photons, protons or electrons at a tumor.

sealed radiation therapy

materials is sealed inside a capsule, seed, wire or applicator and placed in or near a tumor,

nursing safety: time- limit time spent near patient, distance: stay 6 feet away when possible, shielding - use lead shields, private room with radiation signage, no pregnant staff or visitors,

patient teaching: remain in bed if applicator is in place, report pain, burning or feeling of applicator displacement, after removal no radioactivity remains

unsealed

radioactive material is given orally intravenously or injected and circulates through the body, follow body-fluid, use gloves, gown and disposable equipment double flush toilet handle linens with tongs or gloves, separate laundry if required by protocol

NADIR

is the lowest level of bone marrow suppression after chemotherapy usually affecting: neutrophils, white blood cells, platelets, RBCs, highest risk for infection, bleeding, fatigue/anemia