NURS 6551 Midterm NURS 6551 Midterm Study Guide updated 2020(Works 100%) • • The USPSTF (2014a) assigns a “B” recommendation to screening all adults age 18 and older (including pregnant women) for alcohol misuse; screening adolescents younger than age 18 has been assigned an “I statement”. • Most of all recent research regarding effects of alcohol has been conducted on males • Smaller amounts of alcohol is associated with more severe damage to a women • Alcohol consumption is considered hazardous for a women who has either more than seven drinks per week ormore than three drinks per day. • Women who consume more than seven drinks per day are considered at risk for developing AUD • Alcohol misuse screening tools include the AUDIT or Abbreviated AUDIT -C instrument or asking single questions. • Ask patient, how many times in the past year have you had four or more drinks in a day? #2 Feminist Perspective • Feminist is a model of care that works with women as opposed to for women. • Uses heterogeneity as an assumption, not homogeneity. • Minimizes or exposes power imbalance. • Rejects androcentric models as normative • Challenges the medicalization and pathologizing of normal physiologic processes. • Seeks social and political change to address women’s health issues. • A feminist model supports egalitarian relationships and identifies the women as the expert on her own body. • The women is the center of this healthcare model • Acknowledges the broader context in which women live their lives and the subsequent challenges to their health as a result of living within a patriarchal society. #3 Cultural Perspectives of Women • Adolescents - Using a relational approach when providing care to adolescent females, which is how adolescent females often define themselves. By asking questions such as “Tell me about your friends or who you hang out with”. • Early adulthood - Women at this age are facing childbirth and contraceptive issues, intimate partner violence, substance abuse and stress. • Midlife - Clinicians providing care for women in midlife need to promote healthy sexual functioning and assess changes that may negatively impact desire. • Older women - Some women become isolated. Elderly women contend with ageism and sexism. • Problems faced by Mexican and Central American women include feeding their families, accessing formal health care. • Undocumented migrant women also face problems with obtaining assistance with food and health care due to the inability to seek assistance • Veterans have increased risk for having been sexually assaulted, have post-
traumatic stress disorder and traumatic brain injury • People who are assigned female sex at birth are natal females, those who are assigned as males are considered natal males. • Transgender woman is a natal male who has a female gender identity. • A transgender man is a natal female who has a male gender identity • Cisgender refers to someone whose gender identity matches their natal sex • LBQ women and TGNC (Transgender and gender non-confirming) experience interpersonal and institutional discrimination. • LBQ and TGNC people face rejection of their families, their communities and spiritual levels. • LBQ and TGNC face the risk of not being involved with their partners in times of health crises, or able to participate in medical decisions of their partners when incapacitated. • LBQ and TGNC people are less likely to have insurance or be able to afford healthcare. • TGNC persons are at higher risk for suicide and are 5 times at greater risk for depression • Clinicians must create environments that are welcoming and nonthreatening to patients of all gender identities and sexual orientations • EMR must be able to identify the patient with their physical sex as well as their identified sex • Use open-ended and gender -neutral language • Examinations must be based on anatomy and organs present, not the perceived gender of the patient • For Transgender men taking testosterone - provide a short course of vaginal estradiol prior to vaginal examinations, as well as topical anesthetic to reduce pain. • LBQ and TGNC youth are at an increased risk for violence, homelessness and substance abuse than others of their age. • Older adults of the LBQ and TGNC population are particularly vulnerable to abuse, neglect and poverty. • Some religions and restrictive family upbringings may alter a woman’s ideas about sexuality and their ability to enjoy their sexuality. • Black women experience menopause earlier than other women, an average age of approximately 50 years. • Caucasian and hispanic women have reported greatest number of psychosomatic symptoms of menopause (moodiness, headaches, palpitations), • African American women reported highest severity of vasomotor symptoms of menopause • Asian women reported problems with joint pain and stiffness, especially in the neck, shoulders and back. • Women who are migrant workers may not report IPV for fear of deportation. • Migrant workers commonly have the belief that the woman is subordinate to the man and not be aware of support services • Domestic Violence is the leading cause of homicide in women globally • Contraceptive considerations for couples that are part of cultural groups that prohibit contraceptives: • A. Cervical mucus monitoring • B. Basal body temperature monitoring c. C. Menstrual cycle charting • D. Ovulation sensations • E. Electronic hormonal fertility monitoring • Native American women have the highest rates of rape and assault in the U.S. (Leik) • Muslim women may refuse to undress and cannot be examined by a male practitioner without her husband or another male of her family present. #4 Tanner Stages • A commonly used scale for assessing sexual maturity and pubertal development is the Tanner scale, which for girls, relies on development of the breast and growth of pubic hair. It divides sexual physical maturity into five stages that extend from preadolescence to adulthood. • Tanner Stage 1 (Prepubertal) • Breast • Papilla elevation only • Pubic Hair • Villus hair only • No coarse, pigmented hair • Tanner Stage 2 • Breast • Breast buds palpable and areolae enlarge • Pubic Hair • Minimal coarse, pigmented hair mainly on labia • Tanner Stage 3 • Breast • Elevation of Breast contour; areolae enlarge • Pubic Hair • Dark, coarse, curly hair spreads over mons pubis • Other changes • Axillary hair develops • Acne Vulgaris develops • Tanner Stage 4: • Breast • Areolae forms secondary mound on the Breast • Pubic Hair • Hair of adult quality • No spread to junction of medial thigh with perineum • Tanner Stage 5: • Breast • Adult breast contour • Areola recesses to general contour of breast • Pubic Hair • Adult distribution of hair • Pubic hair spreads to medial thigh • Pubic hair does not extend up linea alba #5 Primary prevention versus secondary prevention • Primary Prevention: These services focus on preventing disease in susceptible populations. Examples of primary preventive efforts include health education and counseling, and targeted immunizations. • Secondary Prevention: These services focus on early detection of disease states and subsequent prompt treatment that will reduce the severity and limit the short - and long- term sequelae of the disease. Routine laboratory screening is an example of secondary prevention. • Tertiary Prevention: These services limit disability and promote rehabilitation form clinical disease states. #6 The US Preventative Services Task Force (USPSTF) recommendations: Mammography: • Age: All women • Recommendation: The USPSTF recommends against teaching breast self-
examination (BSE). • Age: 40 Years and Older • Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older. • Age: Women, Before the Age of 50 Years • Recommendation: The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms. • Age: Women, Age 50-74 Years • Recommendation: The USPSTF recommends biennial screening mammography for women 50-74 years. • Age: Women, 75 Years and Older • Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the benefits and harms of screening mammography in women 75 years and older. Cervical Cancer Screening: • Age: Women younger than 21 • Recommendation: The USPSTF recommends against screening for cervical cancer in women younger than age 21 years. • Age: Women 21 to 65 (Pap Smear) or 30-65 (in combo with HPV testing) • Recommendation: The USPSTF recommends screening for cervical cancer in women age 21 to 65 years with cytology (Pap smear) every 3 years or, for women age 30 to 65 years who want to lengthen the screening interval, screening with a combination of cytology and human papillomavirus (HPV) testing every 5 years • Age: Women younger than 30 years, HPV testing
traumatic stress disorder and traumatic brain injury • People who are assigned female sex at birth are natal females, those who are assigned as males are considered natal males. • Transgender woman is a natal male who has a female gender identity. • A transgender man is a natal female who has a male gender identity • Cisgender refers to someone whose gender identity matches their natal sex • LBQ women and TGNC (Transgender and gender non-confirming) experience interpersonal and institutional discrimination. • LBQ and TGNC people face rejection of their families, their communities and spiritual levels. • LBQ and TGNC face the risk of not being involved with their partners in times of health crises, or able to participate in medical decisions of their partners when incapacitated. • LBQ and TGNC people are less likely to have insurance or be able to afford healthcare. • TGNC persons are at higher risk for suicide and are 5 times at greater risk for depression • Clinicians must create environments that are welcoming and nonthreatening to patients of all gender identities and sexual orientations • EMR must be able to identify the patient with their physical sex as well as their identified sex • Use open-ended and gender -neutral language • Examinations must be based on anatomy and organs present, not the perceived gender of the patient • For Transgender men taking testosterone - provide a short course of vaginal estradiol prior to vaginal examinations, as well as topical anesthetic to reduce pain. • LBQ and TGNC youth are at an increased risk for violence, homelessness and substance abuse than others of their age. • Older adults of the LBQ and TGNC population are particularly vulnerable to abuse, neglect and poverty. • Some religions and restrictive family upbringings may alter a woman’s ideas about sexuality and their ability to enjoy their sexuality. • Black women experience menopause earlier than other women, an average age of approximately 50 years. • Caucasian and hispanic women have reported greatest number of psychosomatic symptoms of menopause (moodiness, headaches, palpitations), • African American women reported highest severity of vasomotor symptoms of menopause • Asian women reported problems with joint pain and stiffness, especially in the neck, shoulders and back. • Women who are migrant workers may not report IPV for fear of deportation. • Migrant workers commonly have the belief that the woman is subordinate to the man and not be aware of support services • Domestic Violence is the leading cause of homicide in women globally • Contraceptive considerations for couples that are part of cultural groups that prohibit contraceptives: • A. Cervical mucus monitoring • B. Basal body temperature monitoring c. C. Menstrual cycle charting • D. Ovulation sensations • E. Electronic hormonal fertility monitoring • Native American women have the highest rates of rape and assault in the U.S. (Leik) • Muslim women may refuse to undress and cannot be examined by a male practitioner without her husband or another male of her family present. #4 Tanner Stages • A commonly used scale for assessing sexual maturity and pubertal development is the Tanner scale, which for girls, relies on development of the breast and growth of pubic hair. It divides sexual physical maturity into five stages that extend from preadolescence to adulthood. • Tanner Stage 1 (Prepubertal) • Breast • Papilla elevation only • Pubic Hair • Villus hair only • No coarse, pigmented hair • Tanner Stage 2 • Breast • Breast buds palpable and areolae enlarge • Pubic Hair • Minimal coarse, pigmented hair mainly on labia • Tanner Stage 3 • Breast • Elevation of Breast contour; areolae enlarge • Pubic Hair • Dark, coarse, curly hair spreads over mons pubis • Other changes • Axillary hair develops • Acne Vulgaris develops • Tanner Stage 4: • Breast • Areolae forms secondary mound on the Breast • Pubic Hair • Hair of adult quality • No spread to junction of medial thigh with perineum • Tanner Stage 5: • Breast • Adult breast contour • Areola recesses to general contour of breast • Pubic Hair • Adult distribution of hair • Pubic hair spreads to medial thigh • Pubic hair does not extend up linea alba #5 Primary prevention versus secondary prevention • Primary Prevention: These services focus on preventing disease in susceptible populations. Examples of primary preventive efforts include health education and counseling, and targeted immunizations. • Secondary Prevention: These services focus on early detection of disease states and subsequent prompt treatment that will reduce the severity and limit the short - and long- term sequelae of the disease. Routine laboratory screening is an example of secondary prevention. • Tertiary Prevention: These services limit disability and promote rehabilitation form clinical disease states. #6 The US Preventative Services Task Force (USPSTF) recommendations: Mammography: • Age: All women • Recommendation: The USPSTF recommends against teaching breast self-
examination (BSE). • Age: 40 Years and Older • Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older. • Age: Women, Before the Age of 50 Years • Recommendation: The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms. • Age: Women, Age 50-74 Years • Recommendation: The USPSTF recommends biennial screening mammography for women 50-74 years. • Age: Women, 75 Years and Older • Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the benefits and harms of screening mammography in women 75 years and older. Cervical Cancer Screening: • Age: Women younger than 21 • Recommendation: The USPSTF recommends against screening for cervical cancer in women younger than age 21 years. • Age: Women 21 to 65 (Pap Smear) or 30-65 (in combo with HPV testing) • Recommendation: The USPSTF recommends screening for cervical cancer in women age 21 to 65 years with cytology (Pap smear) every 3 years or, for women age 30 to 65 years who want to lengthen the screening interval, screening with a combination of cytology and human papillomavirus (HPV) testing every 5 years • Age: Women younger than 30 years, HPV testing
