ASE205 Phppc Test 2 Flashcards

Prevention of Unintended Pregnancy and Barrier Contraception

• Primary Objective: The main goal of contraceptive use is to prevent unintended pregnancy while ensuring the fewest possible adverse effects for the user.

• Selection Factors: Appropriate method selection depends on four major criteria:

  • Safety.

  • Effectiveness.

  • Accessibility.

  • Acceptability.

Male Condoms: Materials and Function

• Definition: A physical barrier sleeve designed to fit snugly over an erect penis before vaginal penetration.

• Primary Functions:

  • Prevention of pregnancy.

  • Prevention of sexually transmitted infections (STIs), including AIDS, hepatitis, and chlamydia.

• Materials:

  • Latex and Polyurethane: Protect against both pregnancy and STIs (viral and bacterial).

  • Lamb Cecum: Effective solely for pregnancy prevention; they do not provide an adequate barrier against viral or bacterial infections due to microscopic pores.

• Efficacy: When used correctly, the effectiveness rate ranges from $85\%$ to $95\%$.

Male Condom Usage and Maintenance Guidelines

• Integrity Checks: Users must only use fresh, unopened condoms that are within their expiration date. Inspect for discoloration, brittleness, or stickiness before use.

• Storage: Conditions must be dry and cool. Condoms should never be stored in environments subject to heat or friction, such as a wallet or a car's glove compartment.

• Handling: Care must be taken to avoid tears from long fingernails or jewelry.

• Application:

  • Pinch the top to leave a $0.5$ inch ($1/2$ inch) space at the tip to collect semen.

  • Unroll the condom to cover the entire length of the erect penis.

• Withdrawal: After ejaculation, the penis must be withdrawn immediately while holding the rim of the condom firmly to prevent slippage and semen spillage.

• Breakage Protocol: If a condom breaks during intercourse, a vaginal spermicide product should be inserted immediately.

• Lubrication: Only use water-based lubricants (e.g., K-Y Jelly, Duragel). Oil-based lubricants must be avoided as they weaken the integrity of the material.

• Adverse Effects: Potential side effects include decreased sensitivity of the glans penis and reduced sexual pleasure. Contact dermatitis may occur in those with latex allergies (either immediate itching/swelling or delayed eczematous reactions). Spermicide-treated condoms can exacerbate these effects.

Internal Barrier Devices: Femidoms, Diaphragms, and Sponges

Femidoms (Female Condoms)

• Description: A lubricated polyurethane tube, approximately $6.5$ inches long, designed for one-time use. Polyurethane is thin, soft, and odorless.

• Structure: Features a flexible inner ring at the closed end (for insertion and anchoring) and an outer ring that fits over the vaginal mucosa.

• Efficacy and Advantages:

  • $95\%$ effective when used correctly; however, the user-related failure rate is approximately $25\%$ in the first year.

  • Provides extensive barrier protection for the vagina, cervix, and external genitals.

  • Can be inserted up to $8$ hours before intercourse and does not require immediate removal after ejaculation.

  • Does not require a male erection and does not cause latex-related allergic reactions.

• Usage: Squeeze the inner ring into a long, narrow shape for insertion. Ensure the penis enters inside the pouch during intercourse. To remove, twist the outer ring and pull gently.

• Contraindication: Never use a male condom simultaneously with a Femidom, as friction can cause displacement or breakage.

• Adverse Effects: Vaginal irritation, decreased sensation, discomfort from the outer ring, and a "squeaking" noise during sex.

Diaphragms and Cervical Caps

• Mechanism: Flexible, cup-shaped rubber devices that cover the cervix. They provide a triple mode of action: mechanical barrier, semen absorption, and spermicide carrier.

• Effectiveness:

  • Cervical Cap: $86\%$ for nulliparous women (never given birth); $71\%$ for parous women.

  • Diaphragm: Ranges from $88\%$ to $94\%$.

• Requirements: Must be professionally fitted by a doctor or nurse to determine correct size.

• Usage: Apply spermicide to both sides of the cup. Insert up to $2 - 3$ hours before sex. They must remain in place for at least $6$ hours post-coitus but should not exceed a $24$-hour retention time.

The Contraceptive Sponge

• Description: A disposable polyurethane device ($2.5\,\text{cm}$ thick, $5.5\,\text{cm}$ diameter) permeated with nonoxynol-$9$ spermicide.

• Effectiveness: $88 - 90\%$ for nulliparous women; decreases to $76 - 80\%$ for those who have given birth.

• Usage: Moisten with $2$ tablespoons of water before insertion. The concave side must cover the cervix. Can be placed up to $24$ hours before intercourse. Must remain in place for $6$ hours after sex but must be removed within a $24$-hour total limit.

• Risks: High risk of Toxic Shock Syndrome (TSS), potential fragmentation, and lack of STI protection. Contraindicated during menstruation or for $6$ weeks postpartum.

Spermicidal Agents and Natural Contraceptive Methods

Spermicides

• Chemicals: Nonoxynol-$9$, octoxynol-$9$, and menfegol.

• Action: Immobilizes or kills sperm while the vehicle acts as a physical barrier to the cervix.

• Dosage Forms: Gels, foams, creams, films, and suppositories.

• Efficacy: Relatively low ($70 - 80\%$) when used alone, with a $25\%$ first-year failure rate. Efficacy improves when paired with barrier methods.

• Timing: Must be placed in the vagina at least $10 - 15$ minutes before intercourse and remains effective for only $1$ hour.

Natural Methods: The Calendar (Rhythm) Method

• Biological Assumptions:

  • The ovum is fertilizable for $24$ hours post-ovulation.

  • Sperm remains viable for up to $5$ days.

  • Ovulation occurs $9 - 16$ days before menstruation starts.

• Calculation (Day 1 = first day of bleeding):

  • First fertile day: $\text{Shortest recorded cycle} - 18$.

  • Last fertile day: $\text{Longest recorded cycle} - 11$.

• Example: For cycles ranging $29$ to $35$ days, the fertile period is Day $11$ ($29 - 18 = 11$) to Day $24$ ($35 - 11 = 24$).

Basal Body Temperature (BBT) and Cervical Mucus Methods

• BBT Method: Involves charting temperature daily with a digital thermometer calibrated to $0.01^\circ \text{C}$. Temperature drops $12 - 24$ hours before ovulation and rises by at least $0.2^\circ \text{C}$ during the thermal shift (caused by progesterone). The safe period starts $3$ days after the rise until menstruation.

• Cervical Mucus Method: Estrogen causes mucus to become clear, quantity-rich, and stretchy (raw egg white texture) $5 - 6$ days before ovulation. Progesterone makes it thick, sticky, and cloudy post-ovulation. The user is fertile from the first sign of mucus until $4$ days after the "peak symptom" (last day of clear mucus).

Detection of Pregnancy: Human Chorionic Gonadotropin (hCG)

• Biological Basis: hCG is produced by the trophoblast of the fertilized ovum. It is detectable in urine within $1$ to $2$ weeks after fertilization.

• hCG Progression: Concentration doubles every $2$ days, peaking between the $6\text{th}$ and $8\text{th}$ week of pregnancy. After peaking, it decreases over $10$ weeks and maintains a lower plateau until birth.

• Concentration Range: In normal pregnancy, levels can range from $0$ to approximately $55,000\,\text{IU/L}$.

Home Pregnancy Test (HPT) Mechanism

• Assay Type: Enzyme-linked immunoassay (the "sandwich" assay) using monoclonal or polyclonal antibodies.

• The Sandwich Complex: Urinary hCG binds to a mobile antibody-enzyme conjugate. This complex then binds to a second, immobilized antibody at the test site.

• Device Regions:

  • Sample Region: Urine is applied and hCG binds to the first anti-hCG antibody.

  • Test Region (T): Contains immobilized antibodies that trap the hCG sandwich, triggering a color change via the enzyme and a chromogen.

  • Control Region (C): Contains antibodies that bind to excess unbound antibodies to confirm the device is functioning correctly.

Accuracy and Factors Affecting Result

• Accuracy: Home tests are advertised at $97\%$, while clinical blood tests range from $97\%$ to $100\%$. Blood tests are the most sensitive and can distinguish ectopic pregnancies or impending miscarriages.

• False Positives: Caused by recent birth/miscarriage (within $8$ weeks), medications (Chorionic gonadotropin, Menotropins), ovarian cysts, or ectopic pregnancy.

• False Negatives: Caused by testing too early (on or before the first day of a missed period) or technical errors (using refrigerated urine before it warms or using soapy containers).

Fertility Timing, Infertility, and Ovulation Detection

• Medically Defined Infertility:

  • Under age 35: Inability to conceive after $1$ year of unsuccessful attempts.

  • Over age 35: Inability to conceive after $6$ months of unsuccessful attempts.

• Physiology of the Surge: The hypothalamus secretes GnRH, causing the pituitary to release FSH and LH. Ovulation occurs $20 - 48$ hours after a surge in Luteinizing Hormone (LH).

• Fertility Window: The ovum is viable for $12 - 24\,\text{hours}$. Sperm live for up to $5$ days. Peak conception probability occurs within $24$ hours of the LH surge.

Fertility Monitoring Tools

• Basal Thermometry: High resting BBT (rising by $0.2^\circ \text{C}$) indicates ovulation has happened. A sustained high temperature indicates pregnancy.

• Urinary LH Tests: Uses monoclonal antibodies to detect the surge in urine (usually $24 - 36$ hours before ovulation). Meds like clomiphene or menotropins can cause false positives.

• Salivary Tests: Detects changes in salivary electrolytes. During the fertile window ($3 - 4$ days before to $2 - 3$ days after ovulation), dried saliva forms a "fern" leaf pattern. Non-fertile periods show a dotted or bubble pattern.

Vaginal Hygiene and Douching Practices

• Definition: Rinsing the vagina by forcing water or solution into the cavity to flush discharge.

• Misconceptions: Douching is NOT an effective method for birth control or preventing STIs. It should not be used to mask odor, as this may delay treatment for infections.

• Adverse Effects:

  • Disruption of natural pH and flora (leads to anaerobe overgrowth).

  • Increased risk of Pelvic Inflammatory Disease (PID), preterm delivery, and ectopic pregnancy.

  • Reduced fertility and increased risk of cervical cancer.

• Self-Cleansing Nature: The vagina naturally regulates itself through a balance of microorganisms, mucus, and proteins.

• Guidelines: If douching is medically advised, wait $48$ hours before a gynecologic exam, $6 - 8$ hours after using spermicide, and $3$ days after antifungal meds. Never douche more than $2$ times per week.

The Menstrual Cycle and Pre-Menstrual Syndrome (PMS)

• Cycle Phases:

  • Menstrual Phase: Days $1 - 4$.

  • Proliferative (Follicular) Phase: Days $5 - 14$. Ends with the LH surge and ovulation.

  • Secretory (Luteal) Phase: Days $14 - 28$. Corpus luteum secretes progesterone and estradiol.

• PMS Definition: Cyclic disorder during the luteal phase characterized by physical/emotional changes (e.g., bloating, irritability, water retention). Severe disruption is termed PMDD.

• Cause: Fluctuating hormones lead to a biochemical decrease in serotonin levels.

• Pharmacologic Treatment:

  • Pyridoxine (Vit B6): Max $100\,\text{mg/day}$ to prevent peripheral neuropathy.

  • Calcium: $1200\,\text{mg/day}$ total ($600\,\text{mg}$ twice daily) to reduce emotional/physical symptoms.

  • Magnesium: $360\,\text{mg/day}$ during the luteal phase; side effect is diarrhea.

  • Others: Vitamin E ($400\,\text{IU}$) for breast tenderness; NSAIDs (Ibuprofen/Naproxen) for cramps; Diuretics (Pamabrom $200\,\text{mg/day}$ or Caffeine $100 - 200\,\text{mg}$) for bloating.

Enteral Nutrition and Feeding Tube Modalities

• Definition: Delivery of liquid nutrients via tube into the gastrointestinal tract (GIT). Indicated for patients with a functional GIT who cannot meet metabolic needs orally.

• Nasal Access (Short-term):

  • Nasogastric (NG): Easy insertion, suitable for thick feeds; risk of aspiration.

  • Nasoduodenal (ND) / Nasojejunal (NJ): Suitable for patients with reflux or gastroparesis; requires thinner feeds; higher risk of clogging.

• Abdominal Access (Long-term):

  • Percutaneous Gastrostomy (PEG): Direct to stomach.

  • Percutaneous Jejunostomy (PEJ): Direct to jejunum; suitable for reflux; lower risk of accidental removal; requires anesthesia.

• Sizing: Measured in French units ($Fr$). $1\,\text{Fr} = 0.33\,\text{mm}$.

  • Small bore: $5 - 12\,\text{Fr}$ (comfortable but clogs easily).

  • Big bore: $\ge 14\,\text{Fr}$ (used for suctioning; less comfortable).

Enteral Feed Formulations and Medication Administration

Product Classifications

• Polymeric (Standard): Energy density $1\,\text{kcal/mL}$. Examples: Isocal, Ensure, Jevity.

• Disease-Specific:

  • Pulmocare: Low carb-to-fat ratio to reduce $CO_2$; for COPD/Respiratory failure.

  • Nepro/Suplena: Low electrolytes (K, Na, P) and high density ($1.8 - 2\,\text{kcal/mL}$); for renal patients.

  • Glucerna: Low carb for diabetics.

• Elemental: Free amino acids/peptides for malabsorption (e.g., Alitraq).

• Modular: Single-nutrient (e.g., Promod, Polycose).

Medication Guidelines

• Flushing: Use $30\,\text{mL}$ of sterile water before/after medicine. Flush with $5\,\text{mL}$ between multiple drugs.

• Preparation: Dilute liquids with $60\,\text{mL}$ of water. Crush tablets to fine powder and mix with $15 - 30\,\text{mL}$.

• Prohibitions: Never crush carcinogenic, cytotoxic, or teratogenic drugs. Do not crush enteric-coated or certain extended-release beads.

• Timing: Stop feeding $15$ minutes before and after medication to avoid drug-nutrient interaction.

Nutritional Needs During Pregnancy and Lactation

• Weight Gain: Average $10 - 13\,\text{kg}$. Overweight individuals should gain $8 - 9\,\text{kg}$.

• Key Nutrients:

  • Folate: Prevents neural tube defects (Spina bifida); start $1$ month before conception.

  • Iron: Fetus stores maternal iron to last $4 - 6$ months after birth. Supplements needed in $2\text{nd}$ and $3\text{rd}$ trimesters.

  • Calcium: Requirements high for fetal bone calcification in the $3\text{rd}$ trimester.

• Lactation Energy: average extra $500\,\text{kcal/day}$ needed. At least $1800\,\text{kcal/day}$ total to produce milk. Water intake should be $3.8\,\text{L/day}$.

• Risk Factors: High mercury fish (Shark, Swordfish, King Mackerel, Golden Snapper) should be limited to $4$ servings per week ($90\,\text{g}$ per serving). Alcohol, smoking, and vegan diets (risk of B12 and Vit A deficiency) should be avoided.

Nutrition and Growth Indicators in Children

• Developmental Milestones:

  • 1 - 2 Years: Uses fingers/thumbs, walks alone, appetite decreases.

  • 2 - 3 Years: All $20$ baby teeth, self-feeding (spills often).

  • 3 - 6 Years: Preference for plain foods, growth secondary to language.

  • 6 - 12 Years: Loss of front teeth, permanent teeth appear, appetite increases.

• Energy and Iron:

  • $1$ year old: $800\,\text{kcal/day}$.

  • $6$ year old: $1600\,\text{kcal/day}$.

  • $10$ year old: $2000\,\text{kcal/day}$.

  • Iron DRI: $7\,\text{mg}$ ($1 - 3$ years); $10\,\text{mg}$ ($4 - 8$ years); $8\,\text{mg}$ ($9 - 13$ years).

Nutritional Management for the Elderly

• Metabolic Shift: Lower energy needs due to loss of lean body mass and reduced activity. Nutrient density is vital.

• Sarcopenia: Muscle wasting prevented by protein intake and physical activity.

• Vitamins/Minerals:

  • Vit B12: Risk of deficiency due to atrophic gastritis.

  • Vit D: Reduced skin efficiency and sunlight exposure.

  • Calcium: RDA is $1200\,\text{mg/day}$; non-dairy sources like fish with bones are recommended.

  • Zinc: Low intake causes dermatitis and reduced taste.

• Lifestyle: Aim for $6 - 8$ glasses of fluid daily and limit alcohol to $2$ glasses max.

Cardiovascular Health and Antioxidant Nutraceuticals

• Vitamin E: Lipid-soluble antioxidant (usually Alpha-tocopherol). Inhibits LDL oxidation and reduces CRP. Dosage: $300 - 800\,\text{IU/day}$.

• Coenzyme Q10 (Ubiquinone): Essential for ATP production in cardiac myocytes. Improves energy for the heart. Caution: May lower blood sugar and antagonize Warfarin.

• Policosanol: Derived from beeswax/sugar cane (active: octacosanol). Lowers LDL and increases HDL similarly to statins. Dosage: $10 - 20\,\text{mg}$ in the evening.

• PUFA (n-3): EPA and DHA. Reduce triglycerides, anti-inflammatory. Found in fish oils.

• Garlic (Allium sativum): Contains Alliin/Allicin. Inhibits platelet aggregation and delays cholesterol synthesis. Dosage: $4\,\text{g}$ fresh garlic or $18\,\text{mg}$ alliin.

Nutraceuticals for Immune, Brain, and Joint Support

• Echinacea: Immunostimulator for colds. Not for autoimmune patients (AIDS, MS, TB). Dosage: $3\,\text{g}$ divided every $2 - 3$ hours at onset.

• Ginkgo Biloba: Contains $24\%$ flavonoid glycosides and $6\%$ terpenoids. Enhances blood flow and memory. Contraindicated with TCAs, SSRIs, and MAOIs.

• St John's Wort: Active components are Hyperforin/Hypericin. Inhibits serotonin reuptake. Induces CYP450, significantly reducing the effect of other drugs. Risk of Serotonin Syndrome.

• Bilberry: Contains anthocyanin pigments for eye health (macular degeneration, night vision). Dosage: $800 - 5000\,\text{mg}$.

• Glucosamine/Chondroitin: Glucosamine ($500 - 1500\,\text{mg}$) serves as a cartilage precursor. Chondroitin absorbs fluid into connective tissue to cushion joints.

• SAM-e: Increases cartilage thickness and chondrocyte count.

Ophthalmic Care and Contact Lens Technology

• Comparison (RGP vs. Soft Lenses):

  • RGP (Rigid Gas-Permeable): Smaller, inflexible, water content < 10\% (usually $1 - 3\%$). Excellent optical quality but requires days to adapt.

  • Soft (Hydrogel/Silicone Hydrogel): Flexible, water content > 10\%. Comfortable immediately, adapts in hours, but prone to tearing and deposit buildup.

• Oxygenation: Silicone hydrogel offers high oxygen permeability, preventing hypoxia which causes red eyes and infection risk.

• Contraindications: Lenses generally not advised for people with chronic conjunctivits, blepharitis, poor blink habits, or those in occupations with molten metals/heavy dust.

Contact Lens Maintenance, Disinfection, and Hygiene

Cleaning and Rinsing

• Multipurpose Solution (MPS): Cleans, rinses, disinfects, and stores. Contains surfactants and biguanides.

• Enzymatic Cleaners: Used weekly to hydrolyze protein deposits.

• Saline: For rinsing and storage only. NEVER for disinfection.

Disinfection Methods

• Chemical: Soak for $4 - 6$ hours.

• Hydrogen Peroxide ($3\%$): Uses a catalytic disc for neutralization to water/oxygen. Preservative-free. DANGER: Pain/damage if inserted before neutralization.

• Hygiene Tips: Discard RGP cleaners after $90$ days. Replace cases every $3$ months. No tap water or saliva (Acanthamoeba risk).

Ostomy and Stoma Management: Classifications and Care

• Ostomy: Surgical opening in the abdominal wall for waste elimination.

• Types:

  • Ileostomy: From the lowest small intestine. Discharge is dark green liquid/semisoft and non-odorous.

  • Colostomy: From the large intestine. Ascending is liquid/soft; Descending is semi-solid/formed.

  • Urostomy: Diverts urine via a conduit (ileum or cecum) the kidneys to a stoma.

• Stoma Characteristics: Should appear moist, red, and shiny.

Ostomy Pouching Systems, Accessories, and Patient Counseling

• Systems:

  • One-piece: Bag and base plate are one unit.

  • Two-piece: Skin barrier and bag connect via a plastic flange/click system. More versatile.

• Base Plates:

  • Flat: For stomas protruding > 1 inch.

  • Convex: For flat or retracted stomas (< 1 inch) to force output into the bag.

• Application: Measure stoma and cut barrier circle $1/8$ inch ($0.3\,\text{cm}$) larger than the stoma. Hold plate for $30$ seconds to $1$ minute to paste.

• Medication Absorption: Ileostomy patients should avoid time-release/enteric-coated meds (pass through unabsorbed). Solutions or uncoated tablets are preferred. Laxatives are contraindicated for ileostomy.

• Dietary Factors:

  • Blockage risk: Nuts, seeds, corn, celery.

  • Gas/Odor focus: Asparagus, beans, fish, onions, cabbage.

  • Odor reduction: Yogurt, parsley, cranberry juice.

Questions & Discussion

• True/False Concepts:

  • It is TRUE that Femidoms are made of polyurethane.

  • It is FALSE that a diaphragm prevents STDs effectively.

  • It is FALSE that the contraceptive sponge can be retained for more than $24$ hours total.

  • It is TRUE that estrogen increases cervical mucus quantity.

  • It is TRUE that hCG is produced by trophoblasts.

  • It is FALSE that ovulation occurs at the exact time as the LH surge ($20 - 48$ hours later).

  • It is TRUE that resting BBT is below normal in the early cycle phase.

  • It is FALSE that douching prevents pregnancy.

• Rhythm Method Math: A lady with cycles $29, 30, 31, 35$ days. Shortest ($29$) $- 18 =$ Day $11$. Longest ($35$) $- 11 =$ Day $24$. Fertile period: Day $11$ to Day $24$.

• Pregnancy Test Results: A negative result with no menses should be re-tested in $1$ week. Persistent negatives require a physician.