TEST 3

S/S of conjunctivitis

redness in the white of the eye • eyelid swelling • itchiness in your eye • a gritty feeling, as if something is in your eye • discharge that may cause crusting on your eyelashes in the morning (most discharge is clear, but bacterial conjunctivitis causes a yellow/green discharge) • increased amount of tears.

Avoiding conjunctivitis

wash your hands frequently • don't touch your eyes • don't share eye makeup • don't use the eye makeup testers at cosmetic counters • don't wear your contact lenses longer than recommended and always clean them properly • don't share a facecloth, towel, or pillowcase with anyone.

After clients have chosen a method of contraception, it is important to address the following:

Emphasize that a second method to use as a backup is always needed. Provide both oral and written instructions on the method chosen. Discuss the need for STI protection if not using a barrier method. Inform the client about the availability of ECs.

BARRIERS TO CONDOM USE AND MEANS TO OVERCOME THEM: Decreases sexual pleasure (sensation) Note: Often perceived by those who have never used a condom

Encourage client to try. Put a drop of water-based lubricant or saliva inside the tip of the condom or on the glans of the penis before putting on the condom. Try a thinner latex condom or a different brand or more lubrication.

BARRIERS TO CONDOM USE AND MEANS TO OVERCOME THEM: Decreases spontaneity of sexual activity

incorporate condom use into foreplay. Remind client that peace of mind may enhance pleasure for self and partner.

BARRIERS TO CONDOM USE AND MEANS TO OVERCOME THEM: Allergy to latex

Polyurethane male and female condoms are available. A natural skin condom can be used together with a latex condom to protect the man or woman from contact with latex.

FTT causes

Poor nutritional intake Emotional deprivation Heart defect or disease Lung defect or disease Gastrointestinal disorders Metabolic disorders Endocrine system disorders Chronic infection Damage to the brain or central nervous system Exposure to infections, parasites, or toxins Ineffective feeding technique Risk factors Psychosocial stressors Congenital disorders or diseases Metabolic syndromes Prematurity Intrauterine exposures (eg, infection, alcohol) Poor parenting skills Disordered feeding techniques Psychopathology

Adult Haemophilus influenzae type b (Hib)

1 or 3 doses depending on indication

Cervicitis Nursing Interventions

Be sensitive Listen Give information Ways to prevent transmission Change behavior

Adult Pneumococcal 13-valent conjugate (PCV13)

1 dose

Adult Pneumococcal 23-valent polysaccharide (PPSV23)

1 dose

Adult

1 dose 60 and older

Adults Influenza*

1 dose annually

Adult Measles, mumps, rubella (MMR)

1 or 2 doses depending on indication

Adult Meningococcal 4-valent conjugate (MenACWY) or polysaccharide (MPSV4)

1 or more doses depending on indication

Adult Varicella

2 doses

Adult Hepatitis A

2 or 3 doses depending on vaccine

Adult Meningococcal B (MenB)

2 or 3 doses depending on vaccine

Adult Hep B

3 doses

Adult Human papillomavirus (HPV) Female and male

3 doses before 26

EARLY SIGNS OF COMPLICATIONS FOR OC USERS

A = Abdominal pain may indicate liver or gallbladder problems. C = Chest pain or shortness of breath may indicate a pulmonary embolus. H = Headaches may indicate hypertension or impending stroke. E = Eye problems may indicate hypertension or an attack. S = Severe leg pain may indicate a thromboembolic event.

SENSORY PROCESSING DISORDER (ALSO CALLED SENSORY INTEGRATION DYSFUNCTION)

A neurologic disorder in which the child cannot organize sensory input used in daily living Hyposensitivity or hypersensitivity to sensory input Results in overreaction to different textures, decreasing the child's ability to participate in the world Preterm and low-birthweight infants are at increased risk compared with typical infants. Occupational and other therapies may increase the child's ability to function.

Fertility awareness methods rely on the following assumptions

A single ovum is released from the ovary 14 days before the next menstrual period. It lives approximately 24 hours. Sperm can live up to 5 days after intercourse. The "unsafe period" during the menstrual cycle is thus approximately 6 days: 3 days before and 3 days after ovulation. Because body changes start to occur before ovulation, the woman can become aware of them and not have intercourse on these days or use another method to prevent pregnancy. The exact time of ovulation cannot be determined, so 2 to 3 days are added to the beginning and end to avoid pregnancy.

TREATMENT RECOMMENDATIONS FOR ACUTE OTITIS MEDIA

Age and Severity of Illness- Certainty of Diagnosis- Treatment Younger than 6 months old- Certain or possible- Antibiotics 6 months to 2 years- Certain- Antibiotics 6 months to 2 years with severe illness- Possible- Antibiotics 6 months to 2 years with non severe illness- Possible- May observe Older than 2 years with severe illness- Certain- Antibiotics Older than 2 years with non severe illness- Certain- Observe Older than 2 years- Possible- Observe

Additional supportive criteria that support a diagnosis of PID are:

Abnormal cervical or vaginal mucopurulent discharge Oral temperature above 101°F Elevated erythrocyte sedimentation rate (inflammatory process) Elevated C-reactive protein level (inflammatory process) N. gonorrhoeae or C. trachomatis infection documented (causative bacterial organism) White blood cells on saline vaginal smear Prolonged or increased menstrual bleeding Dysmenorrhea Dysuria Painful sexual intercourse Nausea Vomiting

CARING FOR GENITAL ULCERS

Abstain from intercourse during the prodromal period and when lesions are present. Wash hands with soap and water after touching lesions to avoid autoinoculation. Use comfort measures such as wearing nonconstricting clothes, wearing cotton underwear, urinating in water if urination is painful, taking lukewarm sitz baths, and air-drying lesions with a hair dryer on low heat. Avoid extremes of temperature such as ice packs or hot pads to the genital area as well as application of steroid creams, sprays, or gels. Use condoms with all new or noninfected partners. Inform health care professionals of your condition.

Contraceptives: Reversible Methods- Behavioral

Abstinence Fertility awareness-based methods Withdrawal (coitus interruptus) Lactational amenorrhea method (LAM)

PMD

According to the American Psychiatric Association, a woman must have at least five of the typical symptoms to be diagnosed with PMDD. These must occur during the week before and a few days after the onset of menstruation and must include one or more of the first four symptoms: Affective liability: sadness, tearfulness, irritability Anxiety and tension Persistent or marked anger or irritability Depressed mood, feelings of hopelessness Difficulty concentrating Sleep difficulties Increased or decreased appetite Increased or decreased sexual desire Chronic fatigue Headache Constipation or diarrhea Breast swelling and tenderness

explore the client's current and past medical health history for risk factors for PID, which may include:

Adolescence or young adulthood Non-White female Having multiple sex partners Early onset of sexual activity History of PID or STI Sexual intercourse at an early age Alcohol or drug use Having intercourse with a partner who has untreated urethritis Recent insertion of an intrauterine contraceptive (IUC) Nulliparity Cigarette smoking Recent termination of pregnancy Lack of consistent condom use Lack of contraceptive use Douching Prostitution

PREVENTING PELVIC INFLAMMATORY DISEASE

Advise sexually active girls and women to insist their partners use condoms. Discourage routine vaginal douching, as this may lead to bacterial overgrowth. Encourage regular sexually transmitted infection screening. Emphasize the importance of having each sexual partner receive antibiotic treatment.

Diaphragm Insertion/Removal Technique

Always empty the bladder prior to inserting the diaphragm. Inspect diaphragm for holes or tears by holding it up to a light source, or fill it with water and check for a leak. Place approximately a tablespoon of spermicidal jelly or cream in the dome and around the rim of the diaphragm. The diaphragm can be inserted up to 6 hours prior to intercourse. Select the position that is most comfortable for insertion: Squatting Leg up, raising the nondominant leg up on a low stool Reclining position, lying on back in bed Sitting forward on the edge of a chair Hold the diaphragm between the thumb and fingers and compress it to form a "figure-eight" shape. Insert the diaphragm into the vagina, directing it downward as far as it will go. Tuck the front rim of the diaphragm behind the pubic bone so that the rubber hugs the front wall of the vagina. Feel for the cervix through the diaphragm to make sure it is properly placed. To remove the diaphragm, insert the finger up and over the top side and move slightly to the side, breaking the suction. Pull the diaphragm down and out of the vagina.

Male Condom Insertion/Removal Technique and Counseling

Always keep the condom in its original package until ready to use. Store in a cool, dry place. Spermicidal condoms should be used if available. Check expiration date before using. Use a new condom for each sexual act. Condom is placed over the erect penis prior to insertion. Place condom on the head of the penis and unroll it down the shaft. Leave a half-inch of empty space at the end to collect ejaculate. Avoid use of oil-based products, because they may cause breakage. After intercourse, remove the condom while the penis is still erect. Discard condom after use.

Client teaching and counseling regarding the diaphragm

Avoid the use of oil-based products, such as baby oil, because they may weaken the rubber. Wash the diaphragm with soap and water after use and dry thoroughly. Place the diaphragm back into the storage case. The diaphragm may need to be refitted after weight loss or gain or childbirth. Diaphragms should not be used by women with latex allergies.

PMS and PMDD Symptoms

A—anxiety: difficulty sleeping, tenseness, mood swings, and clumsiness C—craving: cravings for sweets, salty foods, chocolate D—depression: feelings of low self-esteem, anger, easily upset H—hydration: weight gain, abdominal bloating, breast tenderness O—other: hot flashes or cold sweats, nausea, change in bowel habits, aches or pains, dysmenorrhea, acne breakout

Menopause maintaining a healthy lifestyle

Balance energy expenditure with energy intake. Modify your diet to maintain ideal weight. Avoid excessive use of alcohol and mood-altering or sedative drugs. Avoid cigarette smoking. Identify areas of emotional stress and seek assistance to resolve them. Balance work, recreation, and rest. Maintain a positive outlook regarding the diagnosis and prognosis. Participate in ongoing care to monitor any medical conditions. Maintain bone density through: Calcium intake (1,200 to 1,500 mg daily) Vitamin D (1,000 International Units/daily) Weight-bearing exercise (30 min or more daily) Hormone therapy

Notes

Because there are no diagnostic tests that can reliably determine the existence of PMS or PMDD, the woman herself must decide that she needs help during this time of the month. The woman must embrace multiple therapies and become an active participant in her treatment plan to find the best level of symptom relief. Adolescents and women who experience more extensive emotional symptoms with PMS should be evaluated for PMDD, because they may require antidepressant therapy. Humans are virtually the only species to outlive their reproductive capacities. Sexual health is an important aspect of the human experience. By keeping an open mind, listening to women, and providing evidence-based treatment options, the nurse can help improve quality of life for menopausal women. It is estimated that before graduating from high school, 25% of adolescents will contract an STI The lifetime risk of HPV infection is estimated to be as high as 80% in sexually active people. If a child cannot speak in sentences by 30 months of age, does not have understandable speech 50% of the time by age 3 years, cannot sit still for a short story by 3 to 5 years of age, or cannot tie shoes, cut, button, or hop by 5 to 6 years of age, refer the child to be evaluated for a learning disability. Pathologic drooling is a problem for many children with cerebral palsy. It can lead to dehydration, dental enamel erosion, and maceration of the skin, and an odor can result, along with social stigmatization. Recent research has shown that intraglandular injection of botulinum toxin type A can improve drooling with few side effects in children with neurologic disorders Therapeutic horseback riding has been demonstrated to improve gross motor function in children with cerebral palsy. If available in the local area, refer the child and family to the North American Riding for the Handicapped Association Infants with FTT related to maternal neglect may avoid eye contact and be less interactive than other infants Evaluation of hearing is recommended when OME lasts 3 months or more if language delay, hearing loss, or a learning problem is suspected Children with PE tubes who swim in a lake must wear earplugs, as lake water is contaminated with bacteria and entry of that water into the middle ear should be avoided

assess the health history for significant risk factors for chlamydia, which may include:

Being an adolescent Having multiple sex partners Having a new sex partner Engaging in sex without using a barrier contraceptive (condom) Using oral contraceptives Being pregnant Having a history of another STI

common misconceptions include:

Breast-feeding protects against pregnancy. Pregnancy can be avoided if the male partner "pulls out" before he ejaculates. Pregnancy can't occur during menses. Douching after sex will prevent pregnancy. Pregnancy won't happen during the first sexual experience. Taking birth control pills protects against STIs. The woman is too old to get pregnant. Irregular menstruation prevents pregnancy.

Syphilis

Causative Organism- Treponema pallidum (spirochete bacteria) Transmission Mode- Sexual contact with an infected person Diagnostic Testing and Recommended Screening for Sexually Active Adolescent- Blood tests Venereal Disease Research Laboratory (VDRL), rapid plasma reagin (RPR), and treponemal tests (e.g., fluorescent treponemal antibody absorbed [FTA-ABS]) can lead to a presumptive diagnosis. Dark-field examination and direct fluorescent antibody tests of lesion exudate or tissue provide definitive diagnosis of early syphilis. New tests are in development such as enzyme immunoassay Screen based on epidemiology and personal risk factors Recommended Treatment- Penicillin G injection (if penicillin allergy, doxycycline, or erythromycin) Sexual partners need evaluation and testing

ADHD

Causes Underlying cause unknown Possible genetic link Hypothesis involving intrauterine exposure to toxic substances, exposure to food additives or colorings, or allergies Risk Factors Family history Comorbid conditions, such as learning disabilities, mood disorders, oppositional defiant disorder, or conduct disorder

Condom broke during sex

Check expiration date. Store condoms properly. Use only a water-based lubricant. Watch for tears caused by long fingernails. Use spermicides to decrease possibility of pregnancy. Seek emergency postcoital conception.

BACLOFEN PUMP: CHILD/FAMILY EDUCATION

Check the incisions daily for redness, drainage, or swelling. Notify the physician or nurse practitioner if the child has a temperature greater than 101.5ºF, or if the child has persistent incision pain. Avoid tub baths for 2 weeks. Do not allow the child to sleep on the stomach for 4 weeks after pump insertion. Discourage twisting at the waist, reaching high overhead, stretching, or bending forward or backward for 4 weeks. When the incisions have healed, normal activity may be resumed. Wear loose clothing to prevent irritation at the incision site. Carry implanted device identification and emergency information cards at all times.

approved autism screening tool

Checklist for Autism in Toddlers (CHAT) Modified Checklist for Autism in Toddlers (M-CHAT) Social Communication Questionnaire (SCQ) Pervasive Developmental Disorders Screening Test-II (PDDST-II)

Infections characterized by cervicitis

Chlamydia Gonorrhea

EMERGENCY POSTCOITAL CONTRACEPTION OPTIONS

Combined estrogen & progestin pills (Yuzpe regimen) OCSs are taken in various formulations to prevent conception. Interfere with the cascade of events that result in ovulation and fertilization Plan B One-Step 1.5 mg pill taken Can cause nausea & vomiting Copper-bearing IUS (ParaGard-TCu-380A) Inserted within 5 days after unprotected sexual episode Can be left in for long-term contraception (10 yr) Intrauterine

Contraceptives, Reversible methods: Barrier

Condom (male and female) Diaphragm Cervical cap Sponge

BARRIERS TO CONDOM USE AND MEANS TO OVERCOME THEM: Nonpenetrative sexual activity

Condoms have been advocated for use during fellatio; unlubricated condoms may prove best for this purpose due to the taste of the lubricant. Other barriers, such as dental dams or an unlubricated condom, can be cut down the middle to form a barrier; these have been advocated for use during certain forms of nonpenetrative sexual activity (e.g., cunnilingus and anolingual sex).

CAUSES OF CEREBRAL PALSY prenatal

Congenital malformation Hypoxia Maternal fever Maternal seizures Maternal bleeding Exposure to radiation Environmental toxins Genetic abnormalities Metabolic disorders Intrauterine growth restriction Intrauterine infection, such as cytomegalovirus and toxoplasmosis Nutritional deficits Preeclampsia Multiple births Prematurity Low birthweight Malformation of brain structure Abnormalities of blood flow to the brain Abdominal insults

Inconsistent use of contraceptive

Contraceptives must be used regularly to achieve maximum effectiveness. All it takes is one unprotected act of sexual intercourse to become pregnant. Two to 5% of condoms will break or tear during use.

Vaccine-preventable STIs

Hepatitis A Hepatitis B

Nursing Diagnosis for decision making process

Deficient knowledge related to: Methods available Side effects/safety Correct use of method chosen Previous myths believed Risk for infection related to: Unprotected sexual intercourse Past history of STIs Methods offering protection

Intrauterine contraceptives (IUCs)

Description- A T-shaped device inserted into the uterus that releases copper or progesterone or levonorgestrel Failure Rate- 1% Pros- It is immediately and highly effective; allows for sexual spontaneity; can be used during lactation; return to fertility not impaired; requires no motivation by the user after insertion Cons- Insertion requires a skilled professional; menstrual irregularities; prolonged amenorrhea; can be unknowingly expelled; may increase the risk of pelvic infection; user must regularly check string for placement; no protection against STIs; delay of fertility after discontinuing for possibly 6-12 mo STI Protection- none Danger-Cramps, bleeding, pelvic inflammatory disease; infertility; perforation of the uterus Instruct woman how to locate string to check monthly for placement.

Oral contraceptives (progestin-only minipills)

Description- A pill containing only progestin that thickens cervical mucus to prevent sperm from penetrating Failure Rate- 8% Pros- No estrogen-related side effects; may be used by lactating women; may be used by women with history of thrombophlebitis Cons- Must be taken with meticulous accuracy; may cause irregular bleeding; less effective than combination pills STI Protection- None Danger- Irregular bleeding, weight gain, increased incidence of ectopic pregnancy Women should be screened for history of functional ovarian cysts, previous ectopic pregnancy, and hyperlipidemia prior to giving prescription.

Oral contraceptives (combination)

Description- A pill that suppresses ovulation by combined action of estrogen and progestin Failure Rate- 8% Pros- Easy to use; high rate of effectiveness; protection against ovarian and endometrial cancer Cons- User must remember to take pill daily; possible undesirable side effects; high cost for some women; prescription needed STI Protection- None Danger Dizziness, nausea, mood changes, high blood pressure, blood clots, heart attacks, strokes Each woman must be assessed thoroughly to make sure she is not a smoker and does not have a history of thromboembolic disease.

Implant (Implanon)

Description- A time-release implant (one rod) of levonorgestrel for 3 yr Failure Rate- 0.05% Pros- Long duration of action; low dose of hormones; reversible; estrogen-free Cons- Irregular bleeding; weight gain; breast tenderness; headaches; difficulty in removal STI Protection- none Danger- If bleeding is heavy, anemia may occur. Before insertion, assess woman to make sure she is aware that this method will produce about 3-5 yr of infertility.

Depo-Provera injection

Description- An injectable progestin that inhibits ovulation Failure Rate- 3% Pros- Long duration of action (3 mo); highly effective; estrogen-free; may be used by smokers; can be used by lactating women Cons- Menstrual irregularities; return visit needed every 12 wks; weight gain, headaches, depression; return to fertility delayed up to 12 mo STI Protection- None Danger- If depression is a problem, this method may increase the depression. Inform woman that fertility is delayed after stopping the injections.

Postcoital emergency contraceptives (ECs)

Description- Combination of levonorgestrel-only pills; combined estrogen and progestin pills; or the copper IUS inserted within 72 hr after unprotected intercourse Failure Rate- 80% Pros- Provides a last chance to prevent a pregnancy Cons- Risk of ectopic pregnancy if EC fails STI Protection- none Danger- Nausea, vomiting, abdominal pain, fatigue, headache Inform woman that ECs do not interrupt an established pregnancy, and the sooner they are taken the more effective they are.

Sponge with spermicide

Description- Disk-shaped polyurethane device containing a spermicide that is activated by wetting it with water Failure Rate- 25% Pros- Offers immediate and continuous protection for 24 hr; OTC Cons- Can fall out of vagina with voiding; is not form fitting in the vagina STI Protection- none Danger- Irritation, allergic reactions; toxic shock syndrome can occur if sponge left in too long Caution woman not to leave sponge in beyond 24 hr.

Permanent sterilization- female

Description- Fallopian tubes are blocked to prevent conception Failure Rate- less than 1% Pros- One-time decision provides permanent sterility; short recovery time; low long-term risks Cons- Procedures are difficult to reverse; initial cost may be high; chance of regret; some pain/discomfort after procedures STI Protection- none Danger-Postoperative complications: pain, bleeding, infection Counsel both as to permanence of procedure and urge them to think it through prior to signing consent.

Withdrawal (coitus interruptus)

Description- Man withdraws before ejaculation Failure Rate- 27% Pros- Involves no devices and is always available Cons- Requires considerable self-control by the man STI Protection- none Danger- none Places woman in trusting and dependent role.

Female condom

Description- Polyurethane sheath inserted vaginally to block sperm Failure Rate- 21% Pros- Use controlled by woman; eliminates postcoital drainage of semen Cons- Expensive for frequent use; cumbersome; noisy during sex act; for single use only STI Protection- Provides protection against STIs Danger- Allergy to polyurethane Couple must be instructed on proper use of condom.

Fertility awareness-based methods

Description- Refrain from sex during fertile period Failure Rate- 25% Pros- No side effects; acceptable to most religious groups Cons- High failure rate with incorrect use STI Protection- None Danger- None Requires high level of couple commitment.

Abstinence

Description- Refrain from sexual activity Failure Rate- None Pros- Costs nothing Cons- Difficult to maintain STI Protection- 100% Danger- None Must be joint couple decision.

Permanent sterilization- male

Description- Sealing, tying, or cutting the vas deferens Failure Rate- less than 1% Pros- One-time decision provides permanent sterility; short recovery time; low long-term risks Cons- Procedures are difficult to reverse; initial cost may be high; chance of regret; some pain/discomfort after procedures STI Protection- Danger-Postoperative complications: pain, bleeding, infection Counsel both as to permanence of procedure and urge them to think it through prior to signing consent.

Diaphragm with spermicide

Description- Shallow latex cup with spring mechanism in its rim to hold it in place in the vagina Failure Rate- 16% Pros- Does not use hormone; considered medically safe; provides some protection against cervical cancer Cons- Requires accurate fitting by health care professional; increase in UTIs STI Protection- None Danger- Allergy to latex, rubber, polyurethane, or spermicide. Report symptoms of toxic shock syndrome. May become dislodged in female superior position Woman must be taught to insert and remove diaphragm correctly.

Cervical cap with spermicide

Description- Soft cup-shaped latex device that fits over base of cervix Failure Rate- 24% Pros- No use of hormones; provides continuous protection while in place Cons- Requires accurate fitting by health care professional; odor may occur if left in too long STI Protection- None Danger Irritation, allergic reaction; abnormal Pap test; risk of toxic shock syndrome Instructions on insertion and removal must be understood by client.

Male condom

Description- Thin sheath placed over an erect penis, blocking sperm Failure Rate- 15% Pros- Widely available; low cost; physiologically safe Cons- Decreased sensation for man; interferes with sexual spontaneity; breakage risk STI Protection- Provides protection against STIs Danger- Latex allergy Couple must be instructed on proper use of condom.

Lactational amenorrhea method (LAM)

Description- Uses lactational infertility for protection from pregnancy Failure Rate- 1-2% chance of pregnancy in first 6 mo Pros- No cost; not coitus linked Cons- Temporary method; effective for only 6 mo after giving birth STI Protection- None Danger- None Mother must breast-feed infant on demand without supplementation for 6 mo.

Ring (NuvaRing)

Description- Vaginal contraceptive ring about 2 inches in diameter that is inserted into the vagina; releases estrogen and progestin Failure Rate- 8% Pros- Easy system to remember; very effective Cons- May cause a vaginal discharge; can be expelled without noticing and not offer protection STI Protection- none Danger- Similar to oral contraceptives Instruct woman to use a backup method if ring is expelled and remains out for more than 3 hr.

CLASSIFICATION OF CEREBRAL PALSY- Ataxic

Description: Affects balance and depth perception Characteristics: Rare form Poor coordination Unsteady gait Wide-based gait

CLASSIFICATION OF CEREBRAL PALSY- Athetoid or dyskinetic

Description: Abnormal involuntary movements Characteristics: Infant is limp and flaccid. Uncontrolled, slow, worm-like writhing or twisting movements Affects all four extremities and possible involvement of face, neck, and tongue Movements increase during periods of stress. Dysarthria and drooling may be present.

CLASSIFICATION OF CEREBRAL PALSY- spastic

Description: Hypertonicity and permanent contractures; different types based on which limbs are affected: Hemiplegia: both extremities on one side Quadriplegia: all four extremities Diplegia or paraplegia: lower extremities Characteristics: Most common form Poor control of posture, balance, and movement Exaggeration of deep tendon reflexes Hypertonicity of affected extremities Continuation of primitive reflexes In some children, failure to progress to protective reflexes

CLASSIFICATION OF CEREBRAL PALSY: Mixed

Description: combination of all Characteristics: Most common is spastic and athetoid.

Patch (Ortho Evra)

Description; Transdermal patch that releases estrogen and progestin into circulation Failure Rate- 8% Pros- Easy system to remember; very effective Cons- May cause skin irritation where it is placed; may fall off and not be noticed and thus provide no protection STI Protection- none Danger- Less effective in women weighing more than 200 pounds Instruct woman to apply patch every week for 3 wks and then not to wear one during week 4.

Common supplementary laboratory and diagnostic tests ordered for the diagnosis and assessment of cerebral palsy include:

Electroencephalogram: usually abnormal but the pattern is highly variable Cranial radiographs or ultrasound: may show cerebral asymmetry MRI or CT: may show area of damage or abnormal development but may be normal Screening for metabolic defects and genetic testing may be performed to help determine the cause of cerebral palsy.

Chlamydia

Disease- Curable STI Seen frequently among sexually active adoles-cents and young adults Sexually active adolescents should be screened at least annually. Causative Organism Chlamydia trachomatis (bacteria) Transmission Mode Vaginal, anal, oral sex, and by childbirth Diagnostic Testing and Recommended Screening for Sexually Active Adolescent- Culture fluid from urethral swabs in males or endocervical swabs for females. Noninvasive, nonculture- based testing is avail able using nucleic acid application and testing from urine-single test can test for Chlamydia and gonorrhea Conjunctival secretions in neonates Females: screened annually Male: Screen high-risk clients Female Symptoms- May be asymptomatic Dysuria, urinary frequency Vaginal discharge (mucus or pus) Endocervicitis May lead to pelvic inflammatory disease, ectopic pregnancy, infertility Can cause inflammation of the rectum and conjunctiva Can infect the throat from oral sexual contact with an infected partner Male Symptoms- May be asymptomatic Dysuria, urethral itching Penile discharge (mucus or pus) Urethral tingling May lead to epididymitis and sterility Can cause inflammation of the rectum and conjunctiva Can infect the throat from oral sexual contact with an infected partner Recommended Treatment- Azithromyc in (Zithromax) Doxycycline (Vibramycin) Erythromycin (EES) Ofloxacin (Floxin) Sexual partners need evaluation, testing, and treatment also Abstinence from sexual activity until therapy complete and symptoms no longer present Retesting in 3 to 4 months to rule out recurrence

Venereal warts (condylomata acuminata)

Disease- One of the most common STIs in the United States Could lead to cancers of the cervix, vulva, vagina, anus, or penis No cure; warts can be removed but virus remains Causative Organism- Human papillomavirus Transmission Mode - Vaginal, anal, oral sex with an infected partner Diagnostic Testing and Recommended Screening for Sexually Active Adolescent- Visual inspection Abnormal Pap smear may indicate cervical infection of HPV Female Symptoms- Wartlike lesions that are soft, moist, or flesh colored and appear on the vulva and cervix, and inside and surrounding the vagina and anus Sometimes appear in clusters that resemble cauliflower-like bumps, and are either raised or flat, small or large Male Symptoms- Wartlike lesions that are soft, moist, or flesh-colored and appear on the scrotum or penis. They sometimes appear in clusters that resemble cauliflower-like bumps, and are either raised or flat, small or large. Recommended Treatment- May disappear without treatment Treatment is aimed at removing the lesions rather than HPV itself No optimal treatment has been identified, but several ways to treat depending on size and location Most methods rely on chemical or physical destruction of the lesion: Imiquimod cream 20% Podophyllin antimitotic solution 0.5% Podofilox solution 5% 5-fluorouracil cream Trichloroacetic acid (TCA) Small warts can be removed by: Freezing (cryosurgery) Burning (electrocautery) Laser treatment Large warts that have not responded to treatment may be removed surgically Vaccination available and may lead to decrease in cancer associated with HPV Abstinence from sexual activity during treatment to promote healing

Herpes type II (genital herpes)

Disease: Lifelong recurrent viral disease Most people have not been diagnosed. There is no cure. Causative Organism- Herpes simplex virus II (HSV II) Transmission Mode- Having sexual contact (vaginal, oral, or anal) with someone who is shedding the herpes virus either during an outbreak or during a period with no symptoms Can be transmitted through close contact such as close skin-to-skin contact Diagnostic Testing and Recommended Screening for Sexually Active Adolescent- Visual inspection and symptoms or culture from swabs taken from lesions (success depends on stage of lesion- optimum is during vesicular stage) Polymerase chain reaction is more sensitive than culture Serologic tests, such as antibody-based testing (Herpes Western blot assay is the most sensitive) Routine screening not recommended Female Symptoms- Initial symptoms include itching, tingling, and pain in genital area followed by small pustules and blisterlike genital lesions that then crust over and gradually heal. Recurrence episodes are usually milder than the initial episode Dysuria, dyspareunia, and urine retention Fever, headache, malaise, muscle aches Male Symptoms- Initial symptoms include itching, tingling and pain in genital area followed by small pustules and blisterlike genital lesions that then crust over and gradually heal. Recurrence episodes are usually milder than the initial episode Dysuria, dyspareunia, and urine retention Fever, headache, malaise, muscle aches Recommended Treatment- Antivirals used to treat first episode, recurrence, and suppression Acyclovir (Zovirax), famciclovir, and valacyclovir Does not cure; just controls symptoms Sexual partners benefit from evaluation and counseling. If symptomatic, need treatment If asymptomatic, offer testing and education

Nursing Assessment for contraceptives

Do your religious beliefs interfere with any methods? Will this method interfere with your sexual pleasure? Are you aware of the various methods currently available? Is cost a major consideration, or does your insurance cover it? Does your partner influence which method you choose? Are you in a stable, monogamous relationship? Have you heard anything troubling about any of the methods? How comfortable are you touching your own body? What are your future plans for having children?

Emergency contraceptive points

ECs do not offer any protection against STIs or future pregnancies. ECs should not be used in place of a regular birth control method, because they are less effective. ECs are regular birth control pills given at higher doses and more frequently. ECs are contraindicated during pregnancy

Vaginal Ring Insertion/Removal Technique and Counseling

Each ring is used for one menstrual cycle, which consists of 3 weeks of continuous use followed by a ring-free week to allow for menses. No fitting is necessary—one size fits all. The ring is compressed and inserted into the vagina, behind the pubic bone, as far back as possible. Precision placement is not essential. Backup contraception is needed for 7 days if the ring is expelled for more than 3 hours during the 3-week period of continuous use. The vaginal ring is left in place for 3 weeks, then removed and discarded. The vaginal ring is not recommended for women with uterine prolapse or lack of vaginal muscle tone

The prevention and control of STIs is based on the following concepts

Education and counseling of people at risk about safer sexual behavior Identification of asymptomatic infected people and of symptomatic people unlikely to seek diagnosis and treatment Effective diagnosis and treatment of infected people Evaluation, treatment, and counseling of sex partners of people who are infected with an STI Preexposure vaccination of people at risk for vaccine-preventable STIs

Chlamydia and effects on baby

Effects on Fetus or Newborn- Newborn can be infected during delivery Eye infections (neonatal conjunctivitis), pneumonia, low birthweight, increased risk of premature rupture of the membranes (PROM), preterm birth, and stillbirth

Syphilis and effects on baby

Effects on Fetus or Newborn- Can be passed in utero Can result in fetal or infant death Congenital syphilis symptoms include skin ulcers, rashes, fever, weakened or hoarse cry, swollen liver and spleen, jaundice and anemia, various deformations

Herpes type II (genital herpes) and effects on baby

Effects on Fetus or Newborn- Contamination can occur during birth. Newborn may develop skin or mouth sores Mental retardation, premature birth, low birthweight, blindness, death

Venereal warts

Effects on Fetus or Newborn- May develops warts in throat (laryngeal papillomatosis); uncommon but life-threatening

counseling and educating the client or couple about contraceptives:

Encourage the client/couple to participate in choosing a method. Provide client education. The client/couple must become informed users before the method is chosen. Education should be targeted to the client's level so it is understood. Provide step-by-step teaching and an opportunity for practice for certain methods (cervical caps, diaphragms, vaginal rings, and condoms). Obtain written informed consents, which are needed for intrauterine contraceptives, implants, abortion, or sterilization. Informed consent implies that the client is making a knowledgeable, voluntary choice; has received complete information about the method, including the risks; and is free to change her mind before using the method or having the procedure Discuss contraindications for all selected contraceptives. Consider the client's cultural and religious beliefs when providing care. Address myths and misperceptions about the methods under consideration in your initial discussion of contraceptives.

RISK FACTORS FOR ACUTE OTITIS MEDIA

Eustachian tube dysfunction Recurrent upper respiratory infection First episode of acute otitis media (AOM) before 3 months of age Day care attendance (increases exposure to viruses causing upper respiratory infections) Previous episodes of AOM Family history Passive smoking Crowding in the home or large family size Native American, Inuit, or Australian aborigine ethnicity Absence of infant breastfeeding Immunocompromise Poor nutrition Craniofacial anomalies Presence of allergies (possibly)

Education and counseling are important aspects of managing women with genital warts. Teach the woman that:

Even after genital warts are removed, HPV still remains and viral shedding will continue. The likelihood of transmission to future partners and the duration of infectivity after treatment for genital warts are unknown. The recurrence of genital warts within the first few months after treatment is common and usually indicates recurrence rather than reinfection

S/S OF AOM

Fever (may be low grade or higher) Complaints of otalgia (ear pain) Fussiness or irritability Crying inconsolably, particularly when lying down Batting or tugging at the ears (may also occur with teething or OME, or may be a habit) Rolling the head from side to side Poor feeding or loss of appetite Lethargy Difficulty sleeping or awakening crying in the night Fluid draining from the ear

Client teaching and counseling regarding the cervical cap

Fill the dome of the cap up about one third full with spermicide cream or jelly. Do not apply spermicide to the rim, since it may interfere with the seal. Wait approximately 30 minutes after insertion before engaging in sexual intercourse to be sure that a seal has formed between the rim and the cervix. Leave the cervical cap in place for a minimum of 6 hours after sexual intercourse. It can be left in place for up to 48 hours without additional spermicide being added. Do not use during menses due to the potential for toxic shock syndrome. Use an alternative method such as condoms during this time. Inspect the cervical cap prior to insertion for cracks, holes, or tears. After using the cervical cap, wash it with soap and water, dry thoroughly, and store in its container.

Infections characterized by genital ulcers

Genital herpes simplex Syphilis

Breast-feeding as a contraceptive method can be effective for 6 months after delivery only if a woman:

Has not had a period since she gave birth Breast-feeds her baby at least six times daily on both breasts Breast-feeds her baby "on demand" at least every 4 hours Does not substitute other foods for a breast-milk meal Provides nighttime feedings at least every 6 hours Does not rely on this method after 6 months

Nursing diagnoses applicable to the contraceptive would be:

Health-seeking behaviors related to: Perceived need for limiting number of children Overall health relative to contraceptives Risk for ineffective health maintenance related to: Not being familiar with the various contraceptive methods Being unaware of high-risk sexual behavior leading to STIs Fear related to: Not understanding the correct procedure to use Unintended pregnancy occurring if not used correctly General health concerning the long-term side effects

The most common complications of AOM include:

Hearing loss Expressive speech delay Tympanosclerosis (scarring of the tympanic membrane; usually has no effect on hearing) Tympanic membrane perforation (acute with resolution or chronic) Chronic suppurative otitis media (chronic drainage via perforation or tympanostomy tubes) Acute mastoiditis (infection of the mastoid process) Intracranial infections, including bacterial meningitis and abscesses

FOODS TO AVOID IN INFANCY

Honey Egg yolks and meats (until 10 months of age) Excessive amounts of fruit juice Foods likely to cause choking: Peanuts Popcorn Other small hard foods (e.g., raw carrot chunks) Grapes and hot dog slices (must be cut in smaller pieces) Foods likely to result in allergic reaction: Citrus Strawberries Wheat Cow's milk Egg whites Peanut butter

COMMON SYMPTOMS OF MENOPAUSE

Hot flashes or flushes of the head and neck Dryness in the eyes and vagina Personality changes Anxiety and/or depression Loss of libido Decreased lubrication Weight gain and water retention Night sweats Atrophic changes—loss of elasticity of vaginal tissues Fatigue Irritability Poor self-esteem Insomnia Stress incontinence Heart palpitations

CP S/S

Intrauterine infections Prematurity with intracranial hemorrhage Difficult, complicated, or prolonged labor and delivery Multiple births History of possible anoxia during prenatal life or birth History of head trauma Delayed attainment of developmental milestones Muscle weakness or rigidity Poor feeding Hips and knees feel rigid and unbending when pulled to a sitting position Seizure activity Subnormal learning Abnormal motor performance, scoots on back instead of crawling on abdomen, walks or stands on toes

Cervical Cap Insertion/Removal Technique

It is important to be involved in the fitting process. To insert the cap, pinch the sides together, compress the cap dome, insert into the vagina, and place over the cervix. Use one finger to feel around the entire circumference to make sure there are no gaps between the cap rim and the cervix. After a minute or two, pinch the dome and tug gently to check for evidence of suction. The cap should resist the tug and not slide off easily. To remove the cap, press the index finger against the rim and tip the cap slightly to break the suction. Gently pull out the cap. The woman should practice inserting and removing the cervical cap three times to validate her proficiency with this device.

CAUSES OF CEREBRAL PALSY postnatal

Kernicterus (a type of brain damage that may result from neonatal hyperbilirubinemia) Asphyxia Head trauma (e.g., motor vehicle accidents, abuse) Seizures Toxins Viral or bacterial infection of the central nervous system (e.g., meningitis) Cerebral infarcts Intraventricular hemorrhage

FTT Symptoms

Lack of appropriate weight gain Irritability Easily fatigued Excessive sleepiness Lack of age-appropriate social response (i.e., smile) Does not make vocal sounds Delayed motor development Learning and behavior difficulties later in childhood

TREATMENT OPTIONS FOR PMS AND PMDD

Lifestyle changes- Reduce stress. Exercise three to five times each week. (2.5 hrs a week and strength 2-3 times a week) Eat a balanced diet and increase water intake. Decrease caffeine intake. Stop smoking and limit the intake of alcohol. Attend a PMS/women's support group. Vitamin and mineral supplements- Multivitamin daily Vitamin E, 400 units daily Calcium, 1,200 mg daily Magnesium, 200-400 mg daily Medications- NSAIDs taken a week prior to menses Oral contraceptives (low dose) Antidepressants (SSRIs) Anxiolytics (taken during luteal phase) Diuretics to remove excess fluid Progestins Gonadotropin-releasing hormone (GnRH) agonists Danazol (androgen hormone inhibits estrogen production)

Genital herpes Maternal Effects & Fetal Effects

Maternal Effects Spontaneous abortion, intrauterine infection, preterm labor, PROM, intrauterine growth restriction (IUGR) Fetal Effects- Birth anomalies; transplacental infection

Human papillomavirus (HPV) Maternal Effects & Fetal Effects

Maternal Effects- May cause dystocia if large lesions Fetal Effects- None known

Chlamydia Maternal Effects &fetal Effects

Maternal Effects- Postpartum endometritis, PROM, and preterm birth Fetal Effects-Conjunctivitis, which can lead to blindness Low birth weight; and pneumonitis

Syphilis Maternal Effects & Fetal Effects

Maternal Effects- Spontaneous abortion, preterm birth, stillbirth Fetal Effects- Congenital syphilis: multisystem organ failure, structural damage; mental retardation

Contraceptives history

Medical history: smoking status, cancer of reproductive tract, diabetes mellitus, migraines, hypertension, thromboembolic disorder, allergies, risk factors for cardiovascular disease Family history: cancer, cardiovascular disease, hypertension, stroke, diabetes OB/GYN history: menstrual disorders, current contraceptive, previous STIs, PID, vaginitis, sexual activity Personal history: use of tampons and female hygiene products, plans for childbearing, comfort with touching herself, number of sexual partners and their involvement in the decision Physical examination: height, weight, blood pressure, breast examination, thyroid palpation, pelvic examination Diagnostic testing: urinalysis, complete blood count, Pap smear, wet mount to check for STIs, HIV/AIDS tests, lipid profile, glucose level

Osteoporosis risk factors

Mild, prolonged negative calcium balance Declining gonadal adrenal function Faulty protein metabolism (caused by estrogen deficiency) Immobilization or sedentary lifestyle Increasing age Female gender White or Asian ethnicity Consuming more than two alcoholic drinks per day Smoking High caffeine intake Amenorrhea, late menarche, early menopause High doses of thyroid hormones, systemic steroids, anticonvulsants Corticosteroid drugs Diet low in calcium and vitamin D Family history of osteoporosis Previous fracture Weight less than 128 lb (58 kg) Chemotherapeutic drugs

Influences of a persons choice of contraceptives

Motivation Cost Cultural and religious beliefs Convenience Effectiveness Side effects Desire for children in the future Safety of the method Comfort level with sexuality Protection from STIs Interference with spontaneity

Chlamydia symptoms

Mucopurulent vaginal discharge Urethritis Bartholinitis Endometritis Salpingitis Dysfunctional uterine bleeding

Neck righting

Neck keeps head in upright position when body is tilted. Starts at 4-6 months

Screen all infants and toddlers for warning signs of autism:

Not babbling by 12 months Not pointing or using gestures by 12 months No single words by 16 months No two-word utterances by 24 months Losing language or social skills at any age

DISADVANTAGES OF ORAL CONTRACEPTIVES

Offer no protection against STIs Pose slightly increased risk of breast cancer Modest risk for venous thrombosis and pulmonary emboli Increased risk for migraine headaches Increased risk for myocardial infarction, stroke, and hypertension for women who smoke May increase risk of depression User must remember to take pill daily High cost for some women

Autism treatment

Nursing Interventions: Institute safety measures when appropriate. Provide positive reinforcement. Encourage development of self-esteem. Encourage self-care as much as possible. Prepare the child for a change by telling him about it. Assist the family in developing strong one-on-one relationships with the child. Reinforce behavioral techniques. Expected Outcomes: The child (or the family) will: as much as possible demonstrate age-appropriate skills and behaviors seek support systems and exhibit adequate coping behaviors develop alternative means of communication identify and contact available resources as needed practice safety measures and take safety precautions in the home refrain from harming self interact with family or friends.

NURSING INTERVENTIONS DURING THE CHILD'S HOSPITALIZATION FOR FAILURE TO THRIVE

Observe parent-child interactions, especially during feedings. Develop an appropriate feeding schedule. Provide feedings as prescribed (usually 120 kcal/kg/day is needed to demonstrate proper weight gain). Weigh the child daily and maintain strict records of intake and output. Educate parents about proper feeding techniques and volumes. Provide extensive support to alleviate parental anxiety related to the child's inability to gain weight.

Contraceptives, Reversible methods: Hormonal

Oral contraceptive Injectable contraceptive Transdermal patch Vaginal ring Implantable contraceptive Intrauterine contraceptive Emergency contraceptive

Growth and development, altered, related to speech, motor, psychosocial, or cognitive concerns as evidenced by delay in meeting expected milestones

Outcome Identification and Evaluation Development will be maximized: infant will make continued progress toward attainment of developmental milestones. Interventions: Maximizing Development Perform developmental evaluation of the infant to determine infant's current level of functioning. Offer age-appropriate play, activities, and toys to encourage further development. Carry out interventions as prescribed by developmental specialist, physical therapist, occupational therapist, or speech therapist (repeated exposure to the activities or exercises is needed to make developmental progress). Provide support to parents of infants with developmental concerns, as developmental progress can be slow and it is difficult for families to stay motivated and maintain hope.

NURSING DIAGNOSIS: Injury, risk for (risk factors: developmental age, infant curiosity, rapidly progressing motor abilities)

Outcome Identification and Evaluation Infant safety will be maintained: infant will remain free from injury. Interventions: Preventing Injury Encourage car seat safety to decrease risk of injury related to motor vehicles. Childproof home: as infant becomes more mobile, he or she will want to explore everything, increasing risk of injury. Parents should have the Poison Control Center phone number available: should an accidental ingestion occur, Poison Control can give parents the best advice for appropriate intervention. Never leave an infant unattended in the sink, bathtub, or swimming pool to prevent drowning. Teach parents first aid measures and infant CPR to minimize consequences of injury should it occur. Parents should watch the infant at all times (no amount of childproofing can replace the watchful eye of a caring parent).

NURSING DIAGNOSIS: Risk for altered growth pattern (risk factors: caregiver knowledge deficit, first infant, premature infant, or maladaptive feeding behaviors)

Outcome Identification and Evaluation Infant will demonstrate adequate growth and appropriate feeding behaviors: steady increases in weight, length, and head circumference; infant feeds appropriately for age. Interventions: Promoting Adequate Growth Observe mother/infant dyad breastfeeding or bottle-feeding to determine need for further education or identify infant difficulties with feeding. Educate mother about appropriate breastfeeding or bottle-feeding so that mother is aware of what to expect in normal feeding pattern. When infant is old enough, provide education about addition of solid foods, spoon and cup feeding: after 6 months of age breast milk or formula needs to be supplemented with a variety of foods. Determine need for additional caloric intake if necessary (premature infants and infants with chronic illnesses or metabolic disorders often need adjustments in caloric intake to demonstrate adequate or catch-up growth). Obtain daily weights if hospitalized (weekly if outpatient) and weekly length and head circumference to determine whether feeding pattern is sufficient to promote adequate growth.

NURSING DIAGNOSIS: Caregiver role strain, risk for (risk factors: first baby, knowledge deficit about infant care, lack of prior exposure, fatigue if premature, ill, or developmentally delayed infant)

Outcome Identification and Evaluation Parent will experience competence in role: will demonstrate appropriate caretaking behaviors and verbalize comfort in new role. Interventions: Preventing Caregiver Role Strain Assess parent's knowledge of newborn/infant care and the issues that arise as a part of normal development to determine parent's needs. Provide education on normal newborn/infant care so that parents have the knowledge they need to appropriately care for their new baby. Provide anticipatory guidance related to normal infant development to prepare parents for what to expect next and how to intervene. Encourage respite for parents (even a few hours away from the demands of an infant's care can rejuvenate the parents).

ADHD Assessment

Physical Findings Symptoms of Inattention Making careless mistakes Struggling to sustain attention Appearing not to be listening Failing to follow through or finish activities Difficulty with organization Avoiding tasks that require sustained mental effort Distractedness Often losing things necessary for activities or tasks Forgetfulness associated with appointments, social commitments, work deadlines; difficulty setting priorities Symptoms of Hyperactivity Restless, fidgety Difficulty relaxing Feeling "on edge" Excessive talking Symptoms of Impulsivity Interrupting Inability to wait patiently Socially inappropriate behavior; rude or insulting remarks Difficulties with executive functioning

NURSING DIAGNOSIS: Caregiver role strain related to long-term care of the child with a chronic mental health disorder as evidenced by fatigue, inattention to own needs, conflict, or ambivalence

Outcome Identification and Evaluation The child's caregiver will participate in the child's care, verbalizing the child's needs and treatment plan and demonstrating skills necessary for care. Interventions: Decreasing Role Strain Teach the parent or caregiver about the child's illness, treatments, and medications to clarify expectations for the child and parent. Role model appropriate interaction behaviors with the child so the parent can learn these techniques by watching. Encourage structure in daily routines to allow the parent to meet his or her own needs and allow for adequate rest. Gradually increase the parent's responsibility related to care of the child to help the parent feel less overwhelmed. Allow the parent to move at his or her own pace in assuming care to enhance the chances for success. Help the parent to identify a back-up caregiver so the parent has times of respite from constant involvement with the child.

NURSING DIAGNOSIS: Deficient knowledge related to menopausal transition and its management

Outcome Identification and Evaluation- The client will demonstrate understanding of her symptoms as evidenced by making health-promoting lifestyle choices, verbalizing appropriate health care practices, and adhering to measures and complying with therapy. Interventions: Providing Client Education- Assess client's understanding of menopausal transition and its treatment to provide a baseline for teaching and developing a plan of care. Review instructions about prescribed procedures and recommendations for self-care, frequently obtaining feedback from the client to validate adequate understanding of information. Outline link between anovulatory cycles and excessive buildup of uterine lining in menopausal transition women to assist client in understanding the etiology of her bleeding. Provide written material with pictures to promote learning and help client visualize what is occurring to her body during menopausal transition. Inform client about the availability of community resources and make appropriate referrals as needed to provide additional education and support. Document details of teaching and learning to allow for continuity of care and further education, if needed.

WARNINGS FOR INTRAUTERINE SYSTEM USERS OF POTENTIAL COMPLICATIONS

P = Period late, pregnancy, abnormal spotting or bleeding A = Abdominal pain, pain with intercourse I = Infection exposure, abnormal vaginal discharge N = Not feeling well, fever, chills S = String length shorter or longer or missing

THE P-LI-SS-IT MODEL

P Permission—gives the woman permission to talk about her experience LI Limited Information—information given to the woman about STIs Factual information to dispel myths about STIs Specific measures to prevent transmission Ways to reveal information to her partners Physical consequences if the infections are untreated SS Specific Suggestions—an attempt to help women change their behavior to prevent recurrence and prevent further transmission of the STI IT Intensive Therapy—involves referring the woman or couple for appropriate treatment elsewhere based on their life circumstances

CHILDREN AT RISK FOR SPEECH, LANGUAGE, OR LEARNING DIFFICULTIES

Permanent hearing loss (without otitis media with effusion) Speech/language delay (suspected or diagnosed) Craniofacial disorder that may interfere with speech Any pervasive developmental disorder Genetic disorders or syndromes associated with speech or learning problems Cleft palate Blindness or significant visual impairment

Female Condom Insertion/Removal Technique and Counseling

Practice wearing and inserting prior to first use with sexual intercourse. Condom can be inserted up to 8 hours before intercourse. Condom is intended for one-time use. It can be purchased over the counter—one size fits all. Avoid wearing rings to prevent tears; long fingernails can also cause tears. Spermicidal lubricant can be used if desired. Insert the inner ring high in the vagina, against the cervix. Place the outer ring on the outside of the vagina. Make sure the erect penis is placed inside the female condom. Remove the condom after intercourse. Avoid spilling the ejaculate.

STI complications

Pregnancy complications (preterm, stillbirth, infection, blindness, ectopic) Arthritis Pelvic inflammatory disease Infertility Heart disease Certain cancers, such as HPV-associated cervical and rectal cancers Discomfort or pain in the genital area or pelvis Infertility Enhanced transmission of HIV Epididymitis

CAUSES OF CEREBRAL PALSY perinatal

Prematurity (<32 weeks) Asphyxia Hypoxia Abnormal fetal presentation Sepsis or central nervous system infection Placental complications Electrolyte disturbance Cerebral hemorrhage Chorioamnionitis (infection of the placental tissues and amniotic fluid)

Syphilis male symptoms

Primary infection: Chancre on place of entrance of bacteria (usually on penis but can develop in other parts of the body) Secondary, latent, and tertiary infections: All similar to female symptoms

Syphilis female symptoms

Primary infection: Chancre on place of entrance of bacteria (usually vulva or vagina but can develop in other parts of the body) Secondary infection: Maculopapular rash (hands and feet) Sore throat Lymphadenopathy Flulike symptoms Latent infection: No symptoms No longer contagious Many people if not treated will suffer no further signs and symptoms. Some people will go on to develop tertiary or late syphilis. Tertiary infections: Tumors of skin, bones, and liver Central nervous system symptoms Cardiovascular symptoms Usually not reversible at this stage

Parachute (forward)

Protective extension with the arms when held up in the air and moved forward. The infant reflexively reaches forward to catch himself or herself. starts at 6-7 months

Parachute (backward)

Protective extension with the arms when tilted backward starts at 9-10 months

Parachute (sideways)

Protective extension with the arms when tilted to the side in a supported sitting position starts at 6 months

SELECTED NURSING STRATEGIES TO PREVENT THE SPREAD OF STIs

Provide basic information about STI transmission. Outline safer sexual behaviors for people at risk for STIs. Refer clients to appropriate community resources to reduce risk. Screen asymptomatic persons with STIs. Identify barriers to STI testing and remove them. Offer preexposure immunizations for vaccine-preventable STIs. Respond honestly about testing results and options available. Counsel and treat sexual partners of persons with STIs. Educate school administrators, parents, and teens about STIs. Support youth development activities to reduce sexual risk-taking. Promote the use of barrier methods (condoms, diaphragms) to prevent the spread of STIs. Assist clients to gain skills in negotiating safer sex. Discuss reducing the number of sexual partners to reduce risk.

FTT Nursing interventions

Provide support to the child and family and answer questions as appropriate. Allow the child and family to verbalize their feelings and concerns. Assist with using positive coping strategies. Provide information about the disorder and the treatment plan. Obtain daily weight and anthropometric measurements, as indicated. Assist with nutritional measures; help ensure adequate intake by increasing the amount of protein, calcium, magnesium, vitamins, iron, and zinc; perform calorie counts, as indicated. Enlist the aid of a dietitian in planning nutritious meals. Enlist the aid of a speech therapist to address any problems with chewing and swallowing. Provide frequent feeding times to increase caloric intake; offer small, frequent meals with snacks throughout the day and offer nutritional supplements as indicated; encourage participation in family mealtime as appropriate. Institute safety and fall precautions. Institute energy-conservation measures; cluster activities to promote rest. Assist with feeding as necessary. Administer prescribed medications. Encourage the family and child to engage with peers and others to help the child reach developmental levels and norms.

CP health history should include questions related to:

Respiratory status: Has a cough, sputum production, or increased work of breathing developed? Motor function: Has there been a change in muscle tone or increase in spasticity? Presence of fever Feeding and weight loss Any other changes in physical state or medication regimen

ADVANTAGES OF ORAL CONTRACEPTIVES

Regulate and shorten menstrual cycle Decrease severe cramping and bleeding Reduce anemia Reduce ovarian and colorectal cancer risk Decrease benign breast disease Reduce risk of endometrial cancer Improve acne Minimize perimenopausal symptoms Decrease incidence of rheumatoid arthritis Improve PMS symptoms Protect against loss of bone density

BARRIERS TO CONDOM USE AND MEANS TO OVERCOME THEM: Requires prompt withdrawal after ejaculation

Reinforce the protective nature of prompt withdrawal and suggest substituting other postcoital sexual activities.

BARRIERS TO CONDOM USE AND MEANS TO OVERCOME THEM: Embarrassing, juvenile, "unmanly"

Remind client that it is "manly" to protect himself and others.

CP

Risk Factors Infection during pregnancy, especially varicella, rubella, cytomegalovirus, toxoplasmosis, syphilis Exposure to toxins during pregnancy, such as mercury Other conditions during pregnancy, such as seizures, thyroid problems Premature birth, low birth weight, breech delivery, multiple fetus delivery Infant illness, such as bacterial meningitis, untreated severe jaundice, viral encephalitis Incidence This disorder is slightly more common in males than in females. Cerebral palsy affects black children more commonly than white or Hispanic children.

Autism

Risk Factors: High-risk pregnancy; advanced maternal or paternal age Sibling with autism The disorder is five times more likely to occur in boys than girls Physical Findings: Delayed smiling response Impaired socialization skills; lack of reciprocal social interaction Language impairment Lack of imaginative play Not comforted by caregivers Repetitive behaviors Cognitive delay (more females than males have intellectual disabilities) Some children known as savants may excel in specific areas such as art, music, math, memory, or puzzle building History: Parental concerns about child's development and communication skills Seizure disorder Family history of autism Resistance to cuddling; lack of eye contact

SELECTED RELIGIOUS CHOICES FOR FAMILY PLANNING AND ABORTION

Roman Catholic—Abstinence and natural family planning; no abortion Judaism—Family planning and abortion accepted in first trimester Islam—Family planning accepted; abortion only for serious reasons Protestant Christianity—Firmly in favor of family planning; mixed on abortion Buddhism—Long experience with family planning and abortion Hinduism—Accept both family planning and abortion Native American religions—Accept both family planning and abortion Chinese religions—Taoism and Confucianism accept both

ADHD Nursing interventions

Set realistic expectations and limits to avoid frustrating the patient. Maintain a calm, consistent manner. Ensure a safe environment. Assess for signs of depression and suicidal ideation. Keep all instructions short and simple; make one-step requests. Provide encouragement, rewards, and positive feedback whenever possible. Provide diversional activities suited to a short attention span. Administer medications, as prescribed; give short-acting methylphenidate hydrochloride in the morning, at noon, and at 4 p.m.; give long-acting forms once daily in the morning; give dextroamphetamine sulfate and amphetamine extended-release once daily in the morning; give atomoxetine in the morning. Apply a methylphenidate patch to the hip 2 hours before the intended effect and remove 9 hours later; anticipate the dosage to be titrated upward every week, as needed. Administer antidepressants, as prescribed; institute safety measures to prevent injury from falls related to sedative effects of the medication. Assist with time-management skills, planning, and organizational skills as well as with ways to reduce distractions. Reinforce behavior modification and behavior therapy plans of care.

Vaccine for elderly

Shingles, Flu, pneumonia

BARRIERS TO CONDOM USE AND MEANS TO OVERCOME THEM:Poor fit (too small or too big, slips off, uncomfortable)

Smaller and larger condoms are available.

Signs and symptoms of STI's

Sores or bumps on the genitals or in the oral or rectal area Painful or burning urination Discharge from the penis Unusual or odd-smelling vaginal discharge Unusual vaginal bleeding Pain during sex Sore, swollen lymph nodes, particularly in the groin but sometimes more widespread Lower abdominal pain Fever Rash over the trunk, hands or feet

CP Nursing interventions

Speak slowly and distinctly, making sure to face the patient. Give all care in an unhurried manner. Allow participation in care decisions. Foster the patient's sense of control over the situation. Provide a diet with adequate calories; enlist the aid of a nutritionist or dietitian to help with appropriate food selection. If the patient has difficulty swallowing, consult with a speech therapist for appropriate measures, such as stroking the throat when swallowing and adding thickeners to facilitate swallowing. Auscultate lung sounds for changes. Administer prescribed medications such as baclofen to reduce spasticity. Provide frequent mouth and dental care. Provide meticulous skin care, especially to areas of pressure, such as under braces or splints. Assist with the application of braces or splints or the use of assistive devices, as necessary. Perform prescribed exercises to maintain muscle tone. Care for associated hearing and vision disturbances, as necessary. Prepare the patient and family for possible surgery; postoperatively, give analgesics for pain relief, as ordered. Institute safety precautions to provide a safe physical environment. Consult with physical and occupational therapy as appropriate to maximize the patient's functional capacities.

Treatment for failure to thrive

Specific treatment for failure to thrive will be determined by your child's physician based on: Your child's age, overall health, and medical history Extent of your child's symptoms Cause of the condition Your child's tolerance for specific medications, procedures, or therapies Expectations for the course of the condition Your opinion or preference

Adult Tetanus, diphtheria, pertussis (Td/Tdap)*,3

Substitute Tdap for Td once, then Td booster every 10 yrs

TIPS FOR INDIVIDUALS ALLERGIC TO LATEX

Symptoms of latex allergy include: Skin rash, itching, hives Itching or burning eyes Swollen mucous membranes in the genitals Shortness of breath, difficulty breathing, wheezing Anaphylactic shock Use of or contact with latex condoms, cervical caps, and diaphragms is contraindicated for men and women with a latex allergy. If the female partner is allergic to latex, have the male partner apply a natural condom over the latex one. If the male partner experiences penile irritation after condom use, try different brands or place the latex condom over a natural condom. Use polyurethane condoms rather than latex ones. Use female condoms; they are made of polyurethane. Switch to another birth control method that isn't made with latex, such as oral contraceptives, intrauterine systems, Depo-Provera, fertility awareness, and other nonbarrier methods. However, these methods do not protect against sexually transmitted infections.

Not following instructions for use of contraceptive correctly

Take pill the same time every day. Use condoms properly and check condition before using. Make sure diaphragm or cervical cap covers cervix completely. Check IUD for placement monthly.

Decrease otitis media in children and adolescents.

Teach children and families the importance of hand washing to avoid the common cold (often a precursor to otitis media). Teach families the importance of appropriate follow-up for eradication of otitis media. Educate families about the importance of using antibiotics only for true bacterial infections (in order to decrease the development of resistant organisms, many of which cause otitis media).

PMS

The ACOG diagnostic criteria for PMS consist of having at least one of the following affective and somatic symptoms during the 5 days before menses in each of the three previous cycles: Affective symptoms: depression, angry outbursts, irritability, anxiety Somatic symptoms: breast tenderness, abdominal bloating, edema, headache Symptoms relieved from days 4 to 13 of the menstrual cycle

Permanent Methods

Tubal ligation for women Vasectomy for men

To communicate more effectively with children with OME who have hearing loss:

Turn off music or television. Position yourself within 3 feet of the child before speaking. Face the child while speaking. Use visual cues. Increase the volume of your speech only slightly. Speak clearly. Request preferential classroom seating.

Use of antibiotics or other herbs taken with OCs Belief that you can't get pregnant during menses or that it is safe "just this one time"

Use alternative methods during the antibiotic therapy, plus 7 additional days. Implement on day 1 of taking antibiotics. It may be possible to become pregnant on almost any day of the menstrual cycle

PROPER CONDOM USE

Use latex condoms. Use a new condom with each act of sexual intercourse. Never reuse a condom. Handle condoms with care to prevent damage from sharp objects such as fingernails and teeth. Ensure condom has been stored in a cool, dry place away from direct sunlight. Do not store condoms in wallet or automobile or anywhere they would be exposed to extreme temperatures. Do not use a condom if it appears brittle, sticky, or discolored. These are signs of aging. Put condom on before any genital contact. Put condom on when penis is erect with rolled side out. Ensure it is placed so it will readily unroll. Hold the tip of the condom while unrolling. Ensure there is a space at the tip for semen to collect (about ½ inch), but make sure no air is trapped in the tip (air bubbles can cause breakage). Ensure adequate lubrication during intercourse. If external lubricants are used, use only water-based lubricants such as KY jelly with latex condoms. Oil-based or petroleum-based lubricants, such as body lotion, massage oil, or cooking oil, can weaken latex condoms. If you feel the condom break, stop immediately, withdraw, remove broken condom, and replace. Withdraw while penis is still erect, and hold condom firmly against base of penis. Remove carefully to ensure no semen spills out. Dispose of properly.

To avoid choking, recommend the following to parents:

Use only toys recommended for children 0 to 12 months of age. Avoid stuffed animals with eyes or buttons that can be dislodged by the persistent infant. Keep the floor free of small items (accidentally dropped coins, paper clips, straight pins). Avoid feeding popcorn, nuts, carrot slices, grapes, and hot dog pieces to infants.

Vaccines contraindicated in pregnancy and immunocompromised

Varicella Zoster Measles, mumps, rubella (MMR)

Infections characterized by vaginal discharge

Vulvovaginal candidiasis Trichomoniasis Bacterial vaginosis

BARRIERS TO CONDOM USE AND MEANS TO OVERCOME THEM:Fear of breakage may lead to less vigorous sexual activity

With prolonged intercourse, lubricant wears off and the condom begins to rub. Have a water-soluble lubricant available to reapply.

Screening

Yearly gonorrhea screening for at-risk sexually active women (e.g., those with new or multiple sex partners, and women who live in communities with a high burden of disease). Syphilis, HIV, chlamydia, and hepatitis B screening for all pregnant women, and gonorrhea screening for at-risk pregnant women at the first prenatal visit, to protect the health of mothers and their infants. Trichomoniasis screening should be conducted at least annually for all HIV-infected women. Screening at least once a year for syphilis, chlamydia, gonorrhea, and HIV for all sexually active gay men, bisexual men, and other men who have sex with men (MSM). MSM who have multiple or anonymous partners should be screened more frequently for STIs (e.g., at 3 to 6 month intervals). In addition, MSM who have sex in conjunction with illicit drug use (particularly methamphetamine use) or whose sex partners participate in these activities should be screened more frequently

Determine the child's response to any treatments used thus far. Explore the child's current and past medical history for risk factors such as:

Young age Day care attendance Previous history of AOM or OME Antecedent or concurrent upper respiratory infection

Which of the following combination contraceptives has been approved for extended continuous use? A Seasonale B Triphasil C Ortho Evra D Mirena

a. Seasonale is one of several FDA-approved long term oral contraceptives that is packaged to provide 84 days of continuous protection. Although any oral contraceptive can be taken continuously, the FDA has not approved this, and it would be considered an "off-label" use. B is incorrect: this product has not gained FDA approval for continuous use; it is to be left in 3 weeks and then removed for 1 week to create monthly cycles. C is incorrect response: the FDA has not given approval to use this transdermal patch on a continuous basis; it is placed on the skin for 3 weeks and removed for 1 week. D is incorrect: this implantable device is protective for 5 years, but it is not a combination contraceptive; it releases synthetic progesterone only, not estrogen.

Throughout life, a woman's most proactive activity to promote her health would be to engage in: A Consistent exercise B Socialization with friends C Quality quiet time with herself D Consuming water

a. exercise is heart-healthy, weight-healthy, and emotionally healthy. The motto "Keep moving" is the basis for a healthy lifestyle, since it will help maintain an ideal weight, improve circulation, and improve moods. B is incorrect: socialization does not necessarily involve physical activity and would not be proactive in preserving health. C is incorrect: quiet time alone, although needed to reduce stress, reduces movement and may result in depression and weight gain. D is incorrect: water, although needed to hydrate the body, will not maintain circulation, prevent weight gain, or improve one's emotional mindset. Exercise will accomplish all three.

In teaching about HIV transmission, the nurse explains that the virus cannot be transmitted by: A Shaking hands B Sharing drug needles C Sexual intercourse D Breastfeeding

a. the HIV virus is not spread through casual contact between individuals. HIV is spread through unprotected sexual intercourse, breastfeeding, blood contact, or shared needles or sex toys. B is incorrect: HIV can be spread by sharing injection equipment because the user can come into contact with HIV-positive blood. C is incorrect: sexual intercourse (unprotected vaginal, anal, or oral) poses the highest risk of HIV transmission. D is incorrect: the newborn can receive the HIV virus through infected breast milk. HIV-positive women are advised not to breastfeed to protect their offspring from getting a HIV infection.

Preventing STI's

abstaining from sex reducing the number of sexual partners, consistently and correctly using condoms Safe, effective HBV vaccines STI screening and prompt treatment (if infected) All adults and adolescents should be tested at least once for HIV. Annual chlamydia screening for all sexually active women age 25 and under, as well as older women with risk factors such as new or multiple sex partners. .

The father of a 2-month-old girl is expressing concern that his infant may be getting spoiled. The nurse's best response is: A "She just needs love and attention. Don't worry; she's too young to spoil." B "Consistently meeting the infant's needs helps promote a sense of trust." C "Infants need to be fed and cleaned; if you're sure those needs are met, just let her cry." D "Consistency in meeting needs is important, but you're right, holding her too much will spoil her."

b. Infants need to have both their physical needs (e.g., feeding, changing, clothing) and their emotional needs (e.g., attention, holding) met consistently so that they can develop a sense of trust, which is the basis for the later development of self-esteem.

A 9-month-old infant's mother is questioning why cow's milk is not recommended in the first year of life as it is much cheaper than formula. What rationale does the nurse include in her response? A It is permissible to substitute cow's milk for formula at this age as he is so close to 1 year old. B Cow's milk is iron poor and does not provide the proper balance of nutrients for the infant. C As long as the mother provides whole milk, rather than skim, she can start cow's milk in infancy. D If the mother cannot afford the infant formula, she should dilute it to make it last longer.

b. Though whole milk contains a sufficient quantity of fat, cow's milk is inappropriate for use in infancy as it does not provide the appropriate balance of nutrients (especially iron) and may overload the infant's renal system with inappropriate amounts of sodium, protein and minerals. Cow's milk use should be delayed until one year of age. Infant formula should always be reconstituted according to the manufacturer's recommendations.

Which of the following activities will increase a woman's risk of cardiovascular disease if she is taking oral contraceptives? A Eating a high-fiber diet B Smoking cigarettes C Taking daily multivitamins D Drinking alcohol

b. because smoking cigarettes causes vasoconstriction of the blood vessels, increasing peripheral vascular resistance and thus elevating blood pressure. These vascular changes increase the chances of CVD by placing additional pressure on the heart to pump blood with increasing vessel resistance. A is incorrect since fiber would be a positive diet addition and assist with elimination patterns and prevent straining, which stresses the heart. C is an incorrect response because vitamins do not cause narrowing of the vessel lumen, which places an additional burden on the heart. D is an incorrect response since alcohol produces vasodilation and reduces blood pressure. Alcohol in moderation is said to be good for the heart.

A couple reports that their condom broke while they were having sexual intercourse last night. What would you advise to prevent pregnancy? A Inject a spermicidal agent into the woman's vagina immediately. B Obtain emergency contraceptives and take them immediately. C Douche with a solution of vinegar and hot water tonight. D Take a strong laxative now and again at bedtime.

b. if EC is taken within 72 hours after unprotected sexual intercourse, pregnancy will be prevented by inhibiting implantation. The next morning would still afford time to take EC and not become pregnant. A is incorrect: it would be too late to use a spermicidal agent to prevent pregnancy, since the sperm have already traveled up into the female reproductive tract. C is incorrect: douching with vinegar and hot water 24 hours after unprotected sexual intercourse will not change the course of events; by then it is too late to prevent a pregnancy, and this combination would not be effective anyway. D is incorrect: a laxative will stimulate the gastrointestinal tract to produce defecation but will not disturb the reproductive tract, where fertilization takes place.

A couple is considered infertile after how many months of trying to conceive? A 6 months B 12 months C 18 months D 24 months

b. the definition of infertility is the inability of a couple to conceive after 12 months of unprotected sexual intercourse. A is incorrect: 6 months is not long enough to diagnose infertility in a couple not using birth control. C is incorrect: 18 months is 6 months beyond the time needed to diagnose infertility based on the definition. D is incorrect: 24 months is double the time needed to diagnose infertility.

A woman with HPV is likely to present with which nursing assessment finding? A Profuse, pus-filled vaginal discharge B Clusters of genital warts C Single painless ulcer D Multiple vesicles on genitalia

b. the human papillomavirus (HPV) causes warts in the genital region. HPV is a slow-growing DNA virus belonging to the papilloma group. Types 6 and 11 usually cause visible genital warts. Other HPV types in the genital region (16, 18, 31, 33, and 35) are associated with vaginal, anal, and cervical dysplasia. A is incorrect: a pus-filled discharge is not typical of an HPV infection, but rather a chlamydial or gonococcal STI. C is incorrect: a single painless ulcer would be indicative of primary syphilis rather than an HPV infection. D is incorrect: multiple vesicles would indicate a herpes outbreak, not an HPV infection. The woman would also experience tingling, itching, and pain in the affected area.

Parents of an 8-month-old girl express concern that she cries when left with the babysitter. How does the nurse best explain this behavior? A Crying when left with the sitter may indicate difficulty with building trust. B Stranger anxiety should not occur until toddlerhood; this concern should be investigated. C Separation anxiety is normal at this age; the infant recognizes parents as separate beings. D Perhaps the sitter doesn't meet the infant's needs; choose a different sitter.

c. As the infant realizes she is separate from her parents, it may distress her when the parents leave, as she understands they are no longer with her.

The nurse is providing anticipatory guidance to the mother of a 6-month-old infant. What is the best instruction by the nurse in relation to the infant's oral health? A "Start brushing her teeth after all the baby teeth come in." B "Use a washcloth with toothpaste to clean her mouth." C "Clean your baby's gums, then new teeth, with a washcloth." D "Rinse your baby's mouth with water after every feeding."

c. The infant's mouth should be cleansed with a damp washcloth as should the baby's new teeth. It is important to clean the mouth and teeth in order to prevent dental caries. Toothpaste is unnecessary in infancy. Rinsing the infant's mouth would present a safety hazard.

The nurse is preparing to teach a class to a group of middle aged women regarding the most common vasomotor symptoms experienced during menopause and possible modalities of treatment available. Which of the following would be a vasomotor symptom experienced by menopausal women? A Weight gain B Bone density C Hot flashes D Heart disease

c. The only two vasomotor symptoms listed are night sweats and hot flashes. The remainder of the symptoms listed (fatigue, confusion, forgetfulness, irritability, loss of libido and appetite) can be symptoms of menopause, but are not classified as vasomotor ones.

Which of the following contraceptive methods offers protection against sexually transmitted infections (STIs)? A Oral contraceptives B Withdrawal C Latex condom D Intrauterine contraceptive (IUC)

c. it creates a mechanical barrier so that bacteria and viruses cannot gain access to the internal reproductive tract and proliferate. A is incorrect: there is no barrier or protection offered by taking an oral pill. Oral contraceptives offer protection against pregnancy by preventing ovulation, but none against STIs. B is incorrect: since an infected partner can still transmit the infection through preejaculate fluids, which may contain an active STI. D is incorrect: an IUD offers no barrier to prevent entrance of bacteria or viruses into the internal reproductive tract. Because it is an internal device, the string emerging from the external uterine os can actually enhance STI infiltration into the uterus in susceptible women.

To confirm a finding of primary syphilis, the nurse would observe which of the following on the external genitalia? A A highly variable skin rash B A yellow-green vaginal discharge C A nontender, indurated ulcer D A localized gumma formation

c. the classic chancre in primary syphilis can be described as a painless, indurated ulcer-like lesion at the site of exposure. A is incorrect: a highly variable rash is characteristic of secondary syphilis, not primary. B is incorrect: this is more descriptive of a trichomoniasis vaginal infection rather than primary syphilis, which manifests with a chancre on the external genitalia. D is incorrect: a localized gumma formation on the mucous membranes, such as the lips or nose, is characteristic of late syphilis, along with neurosyphilis and cardiovascular syphilis.

The mother of a 3-month-old boy asks the nurse about starting solid foods. What is the most appropriate response by the nurse? A "It's okay to start puréed solids at this age if fed via the bottle." B "Infants don't require solid food until 12 months of age." C "Solid foods should be delayed until age 6 months, when the infant can handle a spoon on his own." D "The tongue extrusion reflex disappears at age 4 to 6 months, making it a good time to start solid foods."

d. As the tongue extrusion reflex disappears, the infant is better able to accept the spoon and learn to take solid foods.

8. What comment by a woman would indicate that a diaphragm is not the best contraceptive device for her? A "My husband says it is my job to keep from getting pregnant." B "I have a hard time remembering to take my vitamins daily." C "Hormones cause cancer and I don't want to take them." D "I am not comfortable touching myself down there.

d. This vaginal barrier contraceptive device is a dome-shaped rubber cup with a flexible rim that needs to be inserted into the woman's vagina before sexual intercourse. The dome of the diaphragm covers the cervix and the spermicidal cream or jelly applied to the rim prevents sperm from entering the cervix. Women who use this method of contraception must be able to insert the device in their vaginas before each sex act for it to be effective. If the woman is uncomfortable "touching" herself, this is not going to be a successful method and another method should be utilized.

The nurse's discharge teaching plan for the woman with PID should reinforce which of the following potentially life-threatening complications? A Involuntary infertility B Chronic pelvic pain C Depression D Ectopic pregnancy

d. a ruptured tubal pregnancy secondary to an ectopic pregnancy can cause life-threatening hypovolemic shock. Without immediate surgical intervention, death can result. A is incorrect: involuntary infertility may be emotionally traumatic, but it is not life-threatening. B is incorrect: chronic pelvic pain secondary to adhesions is unpleasant but typically isn't life-threatening. C is incorrect: depression may be caused by the chronic pain or involuntary infertility but is not life-threatening.

Which of the following measures helps prevent osteoporosis? A Supplementing with iron B Sleeping 8 hours nightly C Eating lean meats only D Doing weight-bearing exercises

d. weight-bearing exercise is an excellent preventive measure to preserve bone integrity, especially the vertebral column and hips. Walking strengthens the skeletal system and prevents breakdown that leads to osteoporosis. A is incorrect: iron does not prevent bone breakdown; while iron supplementation will build up blood and prevent anemia, it has a limited effect on bones. B is incorrect: being in the horizontal position while sleeping is not helpful to build bone. Weight-bearing on long bones helps to maintain their density, which prevents loss of bone matrix. C is incorrect: protein gained from eating lean meats helps the body to build tissue and muscles but has a limited effect on maintaining bone integrity or preventing loss of bone density.