PHP Exam 3

Common Viral/Bacterial STIs

HIV/AIDS/Gonhorrea

Heb B/Syphilis

Genital Herpes/Chlamydia

Genital Warts/Bacterial Vaginosis

Cytomegalovirus/Vulvovaginal candidiasis

What is the highest at-risk group for STIs?

young adults ages 20-24

AIDS transmission

exchange of bodily fluids

AIDS symptoms

asymptomatic, flu like

AIDS diagnosis and treatment

blood test diagnosis

treat with antiviral

Hep B Transmission

sex, maternal/fetal, blood

Hep B diagnosis, symptoms, treatment

diagnosed by antibody test, no treatment but vaccine available

Genital Herpes transmission

HSV1 - non sex

HSV2 - sex

Genital Herpes symptoms, treatment, diagnosis

lesions, diagnosed by culture or viral test

treatment is Acyclovir

Genital Warts Transmission

sex

Genital Warts diagnosis, symptoms, treatment

swellings, vaginal discharge, dyspareunia

diagnosed by Pap smear or biopsy

treatment is Podophylin, trichloroacetic acid, cryotherapy, laser, valacyclovir, tamicicloyvir

Gonhorrea transmission

sexual

Gonhorrea symptoms, diagnosis, and treatment

diagnosed by culture, treat with antibiotics

Chlamydia transmission

Chlamydia symptoms, treatment, diagnosis

diagnosed y blood tests, treat with doxycycline, azythromycin

Syphilis transmission

sex, kissing, biting, maternal/fetal

How are STIs transmitted?

sex, biting, kissing, blood, maternal/fetal

What methods are used in primary and secondary prevention for STIs?

Primary - vaccination, protected sex, abstinence

Secondary - abstinence, medications

HIV effects on pregnancy and signs

depression of immune system, antiviral therapy during pregnancy, no breastfeeding

Hep B effects on pregnancy and signs

vaccinate before pregnancy, liver infection

Genital Herpes effects on pregnancy and signs

lesions, fevers, chills, malaise, dysuria, prescribe Acyclovir during pregnancy

Genital warts effects on pregnancy and signs

papillary swellings, vaginal discharge with itching, post coital bleeding, no treatment

Gonhorrea effects on pregnancy and signs

Chlamydia effects on pregnancy and signs

asymptomatic, screen

Syphilis effects on pregnancy and signs

screen

GBS effects on pregnancy and signs

screen 35-37w gestation, antibiotics during labor

Trichomoniasis effects on pregnancy and signs

metronidazole

Basic Recommendations in Dietary Guidelines for Americans

follow healthy dietary pattern at every life stage

customize and enjoy nutrient dense food and beverage choices to reflect personal preference, traditions, and budget consideration

focus on meeting food group needs with nutrient dense foods and beverages to stay within calorie limits

limit foods and beverages higher in added sugars saturated fat, and sodium, and limit alcoholic beverages

How often are the dietary guidelines for Americans updated?

every 5 years

What is the purpose of MyPlate?

personalized, stepwise, and flexible approach to healthy eating through 5 food groups, interactive

Carbs

45-65% daily, 4c/g, primary source of energy for CNS, kidneys, brain, and muscles, intestinal health and waste elimination

Proteins

needed for immune function, tissue growth, repair, and maintenance, complete proteins contain all AA needed like meats, eggs, milk, incomplete lack 1 or more AA like grains, nuts, seeds, 4c/g, 10-35%. daily

Fats

25-35% daily, normal growth and development, major source of energy, carry fat-soluble vitamins, cushioning for organs, makes things taste good, slows digestion, 9c/g

Water soluble vitamins

Vitamin C and B Complex

Fat soluble vitamins

A, D, E, K

Vitamin K

fat soluble, functions in blood clotting, from leafy green vegetables, at risk if taking warfarin because if too much, could be anticoagulation failure, deficiency causes hemorrhage and newborns are at risk, injection is given at birth to help them clot

Mirconutrients

required in small amounts, play unique role, balanced diet is best approach, water soluble and fat soluble

Macronutrients

nutrients that provide calories or energy

Vitamins and Minerals percent of daily calories

0

Why is it important to know if a patient is taking herbal medicines and dietary supplements or therapies?

because too many can cause toxicity, they’re unregulated by FDA

Food Assistance Programs

SNAP

Child Nutrition Programs like school lunch and breakfast programs

Supplemental nutrition for women infants children

Older adults programs like meals on wheels

BMI

not be all end all anymore, look at more factors

weight in pounds/height in inches/height in inches x 703

BMR

energy needed to maintain life-sustaining activities for specific period of time at rest

Resting energy expenditure

amount of energy needed in 24h for body to maintain working activities while at rest

Nutrients

substances needed for energy, growth, metabolism, and other

Hypoalbuminia

low blood protein, liver isnt producing it

Portion size

cup palm

Cardiovascular disease

portion control

more fruits and veggies

whole grains

limit unhealthy foods

choose low fat proteins

limit salt intake

DASH for HTN

Osteoporosis

calcium intake

avoid smojing

dairy

supplements

Type II Diabetes

monitoring

weight loss

physical activity

lower fat

HIV/AIDS

protein rich

well balanced

vitamins and mineraks

food saniutation

avoid breastfeeding

Obesity

BMI

counseling

balanced diet with appropriate serving sized

exercise

avoid fad diets

Sensorimotor stage

birth to 2 years, learning through senses, actions, object permanence

Preoperational stage

2 to 7, symbols and imagination, egocentric, lack understanding of conservation

Concrete operational

7 to 11, logical thinking about concrete events, understands conservation and rev

formal operational stage

12+, abstract, logical, hypothetical, can reason systematically

Preconventional mortality

by Kohlberg, authority is outside individual and reasoning is based on physical consequences of actions, obedience and punishment orientation, be good in order to not be punished

conventional mortality

Kohlberg, authority internalized but not questioned and reasoning based on norms of a group, good intentional relationships, good in order to be seen as good by others

Postconventional mortality

judgement based on self chosen principles and moral reasoning is based on individual rights and justice, universal principles and moral guidelines to fit law, person prepared to defend these even if it means going against society and having consequences

Trust vs Mistrust

birth to 1y, trust established when comfort, feeding, stimulation, and caring needs are met, Emotional attachment occurs in this stage, Mistrust occurs when needs are inadequately or inconsistently met.

Autonomy vs shame and doubt

1-3y, growing self control, wanting to choose and decide for self, encouraged by permitting reasonable free choice and not forcing or shaming child

Initiative vs Guilt

pre school, New sense of purpose expressed through make believe play, Promote initiative, nurture ideas, encourage behaviors for positive self-concept, Feelings of guilt, anxiety, and fear: May result from thoughts that differ from expected behavior

Industry vs Inferiority

school age, Sense of industry and capacity to work and play with others developed through praise and successes, Sense of inferiority develops through negative experiences in working and playing with others

Identity vs role confusion

adolescents, Need to answer questions “Who am I?” and “What is my place in society?, Must build consistent identity from self perceptions and relationships with others, self chosen values and vocational goals

Intimacy vs isolation

young adults, Increased sense of competency/self-esteem, Learns to develop reciprocal intimate relationships (requires mutual trust)

Generativity vs stagnation

middle adult, Generativity: Sense of productivity, creativity, desire to care for others, Stagnation: Lack of accomplishment, self-absorption

Ego integrity vs despair

older adult, Successful: Ego integrity Honest acceptance of life “at peace”,. Unsuccessful: Fear of death/despair, Feeling that life was “lived in vain”

physical changes over lifespan infant

• Length

  • First 6 months infant may grow ½ to 1 inch per month

  • From 6-12 months may grow 3/8 inch per month

• Weight

  • Immediately after birth lose 5-10% of birth weight, and by 2 weeks of age begin rapid weight gain of 5-7 oz per week

  • Birth weight should double by 5-6 months and triple by 12 months

• OFC (occipital-frontal circumference)

  • Head circumference increases about 1 cm per month for 1^st year 

• Fontanel

  • Posterior closes by 6-8 weeks, anterior closes by 12-18 months.

physical changes toddler

• Grows about 2-4 inches per year 

• Gains 4-6 pounds per year

• Continue to measure head circumference

physical changes pre school

• Growth slows but continues

  • ~5 pounds and 2 ½ - 3 ½  inches per year

• Bodies evolve away from wide stance and protruding abdomen of toddler in to a more graceful, posturaly erect, and sturdy physicality

physical changes school age

• Consistent growth

  • Slow and steady until the skeletal growth spurt right before puberty

  • 2 inches and 4-6 pounds per year

  • Weight almost doubles

• Improved coordination

• Fine motor development occurs

physical changes adolescent

• Accelerated growth spurt (final 20-25% of height achieved)

• Biological differences: sexual maturation

  • Male: Testicular enlargement, pubic hair growth, penile enlargement, axillary hair growth, facial hair growth, vocal changes. 

  • Females: Breast bud development, pubic hair growth, axillary hair growth, menstruation 

physical changes young adult

• Full growth by age 20

• Healthiest period

• Optimal muscle strength (age 25-30)

• Manual dexterity peeks

• Stable period of physical development

  • Exception: Pregnancy related changes

• Usually quite active

• Tend to ignore symptoms

physical changes adult

• Visible changes have effects on self-esteem: graying hair, wrinkles, body shape

• Hormonal changes

  • Men: Testosterone decline = Sexual dysfunction (impotence, premature ejaculation, retrograde ejaculation)

  • Women: Estrogen decrease - Perimenopause and menopause

  • Mood swings, nervousness, fatigue, depression

  • Hormonal therapy: indications and controversy

  • Alternative products: little scientific data on benefit

physical changes older adult

• Functional status in older adults includes the day-to-day activities of daily living (ADLs) involving activities within physical, psychological, cognitive, and social domains.

• Changes are usually linked to illness or to disease and degree of chronicity.

• Performance of ADLs is a sensitive indicator of health or illness.Body changes such as: wrinkles, gray hair, loss of body mass in the extremities, and an increase of body mass in the trunk

• Skin

• Vision

• Hearing

• Taste/smell

• Cardio/Pulmonary

• GI

• GU

• Musculoskeletal

• Impaired heat/cold perception

psychosocial changes infant

• Attachment bond forms within the first month

• Purposeful smiling: 2-3 months

• Body Image, by 12 months - separation of self from others

• Solitary Play (stage 1): First stage of play from birth to around 2 years

psychosocial changes toddler

• Gaining a sense of Autonomy (Erikson)

  • Provide gradual increases in independence

• Still attached to their parents, fear separation

• Temper tantrums

• Parallel Play: Stage 2 of play

psychosocial changes pre school

• Expanding influence

  • Primary caregivers still most important, peers and older siblings gaining influence 

• Magical Thinking

  • Pretend play allows child to determine the difference between reality and fantasy. 

• Imaginary Friends

  • Controlled by child, not a threat

  • A way to practice social interactions 

• Play: the “work” of the child

  • Mimic others (adults)

  • Associative play (Stage 3)

  • Cooperative play (stage 4)

psychosocial changes school age

• Family provides sense of security

  • Also provide framework for socially accepted behaviors

• Increasing independence and maturity

  • Building peer group

  • Broaden interests outside of home

    • Clubs, sports

  • More responsibility in home and community

    • Pets, chores, earn allowance

psychosocial changes adolescent

• Changing roles—stressful family time

  • Increasing independence for adolescent

  • Parents try to learn to “let go”

  • May challenge authority 

• Peer groups

  • Strong influence & support system for adolescent

• Sexual Identity

• Self-perception and body image

• Personality developments and changes

psychosocial changes young adult

• Insecurity with home, work and life causes stress and rigidity in the early young adult period.  

• Maturing relationships and roles

  • Development of enduring friendships

  • Formation of intimate relationships

  • Decisions about life/career directions

  • Formation of family units

    • Multiple decisions related to child-bearing, finances, roles/relationships

    • Self and family development

• Adapting to parenthood is a major change for young adults

• Separation/Divorce

psychosocial changes adults

• Family

  • Multiple responsibilities and stresses

    • Children, aging parents, job and civic responsibilities

    • Single parent families, adult children at home

    • “Empty-nest syndrome”

  • Caring for aging parents

    • Additional demands of caring for parents and children (sandwich generation)

    • Midlife crisis”

      • Time of reassessment, turmoil, change

    Divorce

    • Multiple family member adaptations needed

    • Potential psychological effects on children

  • Death

    • Spouse: Grief for loss of companionship, loss of future

    • Increased awareness of finite nature of life

    • Midlife review common 

    • Work

      • Plays major role in level of wellness, self-esteem

      • 10 million work-related injuries yearly

psychosocial changes older adult

• Loss of former roles—child, sibling, spouse

• Grand parenting: New role

  • Frequently brings joy and happiness

  • Grandparents raising children

    • Stress issues

    • Retirement

      • Influences: Health, more time with family, wanting to do other things, not liking work

      • Challenges: Lower income, loss of friends, disease, disability, leaving home, widowhood

      • Resources: Federal/state programs; bereavement groups, volunteering opportunities, support groups, education may help coping

cognitive changes infant

birth to 1 month, Innate behaviors, reflexes, sensory functions

• Crying is primary means of communication

• Sensory stimulation helps develop cognitive function

• Exploration of environment with limited motor skills – head turning and sucking

• 1 month to 12 months, Exploration of environment with well coordinated reaching, grasping, swiping, and banging by 12 months

• All of the senses are developing rapidly to assist the infant in learning about the environment

cognitive changes toddler

• 12-18 months

  • Know what ordinary things are (phone, brush, spoon, etc.)

  • Points to get the attention of others

  • Points to one body part

  • Scribbles on his own

  • Can follow 1-step verbal commands (sits when you say sit down

  • By 2 years

    • Finds things even when hidden under two or three covers 

    • Begins to sort shapes and colors 

    • Completes sentences and rhymes in familiar books

    • Plays simple make-believe games

    • Builds towers of 4 or more blocks

    • Might use one hand more than the other 

    • Follows two-step instructions such as “Pick up your shoes and put them in the closet.” 

    • Names items in a picture book such as a cat, bird, or dog

cognitive changes pre school

• By 3 years

  • Can work toys with buttons, levers, and moving parts

  • Copies a circle with pencil or crayon

  • Turns book pages one at a time

  • Plays make-believe with dolls, animals, and people

  • Builds towers of more than 6 blocks

  • Does puzzles with 3 or 4 pieces 

  • Screws and unscrews jar lids or turns door handle

  • Understands what “two” means 

• By 4 years

  • Names some colors and some numbers 

  • Draws a person with 2 to 4  body parts 

  • Understands the idea of counting 

  • Uses scissors

  • Starts to understand time 

  • Starts to copy some capital letters

  • Remembers parts of a story 

  • Plays board or card games

  • Understands the idea of “same” and “different” 

  • Tells you what he thinks is going to happen next in a book 

• By 5 years old: 

  • Counts 10 or more things 

  • Can draw a person with at least 6 body parts 

  • Can print some letters or numbers 

  • Copies a triangle and other geometric shapes 

  • Knows about things used every day, like money and food 

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cognitive changes school age

• Overall capacity for knowledge expands and becomes more organized 

• Thinks in organized, logical fashion about concrete information

• Can use these skills to solve problems

cognitive changes adolescents

• Overall capacity increases at slower pace

• Memory strategies improve

• Knowledge continues to expand and become more organized

• Able to think rationally

  • Solve problems, make decisions

• Time orientation

  • Ability for future orientation

  • Able to delay immediate gratification

cognitive changes young adults

• Piaget: Formal Operations

• Critical thinking skills improve

• Optimal time for both formal and informal educational experiences

• Memory peaks in the 20s

cognitive changes middle adult

• Piaget = Formal Operations

• Continues to accumulate “learning” intelligence

• Abilities for complex problems of reasoning

cognitive changes older adults

• Older adults can continue to learn!

• Keeping active and engaged in daily life can help keep cognitive function.  

• Mild cognitive impairment

  • Memory loss

  • Language difficulties

  • Impaired judgment/reasoning

middle age biological changes

• Examples of general body changes

  • Thinning, graying hair

  • Skin drier, wrinkles, coarsening facial features

  • Fat disposition, decreased muscle mass/bone density, osteoarthritis

  • Hormonal changes

• Mortality

  • Leading causes: Heart disease, cancer, and accidents

  • Morbidity and mortality: Influenced by lifestyle behaviors

• Sex and marital status

  • Heart disease: a leading cause of death

  • Men: Higher mortality rate from heart disease

  • Life expectancies—Female: 81.1; Male: 76.3

  • Married people generally report better health 

• Genetics

  • Middle adult at higher risk for genetics-associated conditions

middle age psychological and spiritual changes

Normal aging changes in older adult

Risks factors for older adults

poverty, substance abuse, homelessness, aids, Obesity, Declining Physical Activity, Diabetes, Poor Cardiovascular Health, Hypertension, Head Injury, Lower Education Level, Smoking, Heavy Alcohol Use, air pollution, Hearing Impairment (Hearing aids being a protective factor), Depression, Minimal Social Contact

Social issues influencing well being of older adults

bereavement, isolation, alcohol abuse, illness

Risk factors injuries related to development

infant injury sources

• Aspiration of foreign objects

• Bodily Harm

• Burns

• Drowning

• Falls

• Poisoning

• Motor vehicle injuries

• Suffocation 

• Abuse/Neglect

  • Shaken Baby syndrome (SBS)

toddler injury sources

• Aspiration of foreign objects

• Bodily Harm

• Burns

• Drowning

• Falls

• Motor vehicle injuries

• Poisoning

• Suffocation 

• Abuse/Neglect

pre school injury sources

• Bodily Harm

• Burns

• Drowning

• Motor Vehicle Injuries

• Child Abuse/Neglect