Insulin
Fifteen percent of women with gestational diabetes require insulin therapy because of elevated blood glucose concentrations despite dietary therapy. Insulin should be initiated when the fasting blood glucose is greater than 90 mg dL and the one-hour postprandial blood glucose is greater than 120 mg dL on two or more occasions within a two-week interval despite dietary therapy. b. Preprandial blood glucose concentrations below 90 mg dL and one-hour postprandial concentrations below 120 mg dL...
Treatment of hypertension in preeclampsia
Severe hypertension should be treated. In adult women, diastolic blood pressures > 105 to 110 mm Hg or systolic pressures > 160 to 180 mmHg are considered severe hypertension. In adolescents, treatment is initiated at diastolic pressures of > 100 mm Hg. B. Intravenous labetalol is both effective and safe (beginning with 20 mg intravenously followed at 10- to 15-minute intervals by 40 mg, then 80 mg up to a maximum total cumulative dose of 220 mg). C. Occasionally, preeclamptic women...
Treatment regimens for yeast vaginitis
Clotrimazole vaginal tablets (Mycelex G), 500 mg hs** Fluconazole tablets (Diflucan), 150 mg Po Itraconazole capsules (Sporanox), 200 mg PO bid Tioconazole 6.5 vaginal ointment (Vagistat-1), 4.6 g hs** 5 g Butoconazole nitrate 2 vaginal cream (Femstat 3), 5 g hs 28 g Clotrimazole vaginal inserts (Gyne-Lotrimin 3), 200 mg hs** Miconazole vaginal suppositories (Monistat 3), 200 mg hs** Terconazole 0.8 vaginal cream (Terazol 3), 5 g hs Terconazole vaginal suppositories (Terazol 3), 80 mg hs...
High probability of endometriosis
Nonsteroidal anti-inflammatory medications should be prescribed at doses in the upper end of the dose range (eg, ibuprofen 800 mg orally every six hours). If the first NSAID tried is not effective, another should be given. 2. Oral contraceptive pills (OCPs) prescribed as monthly cycles. 3. OCPs prescribed as long cycles, with three to four months of continuous dosing of the active pill followed by one week off the pill are effective in women who fail cyclic therapy. 4. OCPs and NSAIDS can be...
Opportunistic Infections in HIVInfected Patients
-Fluconazole (Diflucan) 100-200 mg PO qd OR -Ketoconazole (Nizoral) 400 mg PO qd OR -Itraconazole (Sporanox) 200 mg PO qd OR -Clotrimazole (Mycelex) troches 10 mg dissolved slowly in mouth 5 times d. -Fluconazole (Diflucan) 200-400 mg PO qd for 14-21 days OR -Ketoconazole (Nizoral) 200 mg PO bid OR -Itraconazole (Sporanox) 200 mg PO qd for 2 weeks. -Caspofungin (Cancidas) 50 mg IV qd x 2 weeks. Primary or Recurrent Mucocutaneous HSV -Acyclovir (Zovirax), 200-400 mg PO 5 times a day for 10 days,...
History and Physical Examination
Identifying Data Patient's name age, race, sex. List the patient's significant medical problems. Name of informant (patient, relative). Chief Compliant Reason given by patient for seeking medical care and the duration of the symptom. List all of the patients medical problems. History of Present Illness (HPI) Describe the course of the patient's illness, including when it began, character of the symptoms, location where the symptoms began aggravating or alleviating factors pertinent positives...
New onset proteinuria hypertension and at least one of the following
Symptoms of central nervous system dysfunction Blurred vision, scotomata, altered mental status, severe headache Symptoms of liver capsule distention Right upper quadrant or epigastric pain Hepatocellular injury Serum transaminase concentration at least twice normal Severe blood pressure elevation Systolic blood pressure > 160 mm Hg or diastolic > 110 mm Hg on two occasions at least six hours apart Thrombocytopenia Less than 100,000 platelets per mm3 Proteinuria Over 5 grams in 24 hours or...
Clinical evaluation
Endometriosis should be considered in any woman of reproductive age who has pelvic pain. The most common symptoms are dysmenorrhea, dyspareunia, and low back pain that worsens during menses. Rectal pain and painful defecation may also occur. Other causes of secondary dysmenorrhea and chronic pelvic pain (eg, upper genital tract infections, adenomyosis, adhesions) may produce similar symptoms. Differential Diagnosis of Endometriosis Gastrointestinal tract (constipation, B. Infertility may be...
Transient Ischemic Attack
Diagnosis Transient ischemic attack 4. Vital Signs q1-4h with neurochecks. Call physician if BP > 160 90, < 90 60 P > 120, < 50 R> 25, < 10 T > 38.5 C or change in neurologic status. 7. Diet Dysphagia ground with thickened liquids or regular diet. 8. IV Fluids Heparin lock with flush q shift. 9. Special Medications -Aspirin 325 mg PO qd OR -Clopidogrel (Plavix) 75 mg PO qd OR -Aspirin 25 mg dipyridamole 200 mg (Aggrenox) 1 tab PO bid. -Heparin (only if recurrent TIAs or...
Absolute contraindications to OCs
Previous thromboembolic event or stroke b. History of an estrogen-dependent tumor e. Undiagnosed abnormal uterine bleeding g. Women over age 35 years who smoke heavily (greater than 15 cigarettes per day) 2. Screening requirements. Hormonal contraception can be safely provided after a careful medical history and blood pressure measurement. Pap smears are not required before a prescription for OCs. E. Efficacy. When taken properly, OCs are a very effective form of contraception. The actual...
Asthma
Vital Signs q6h. Call physician if P > 140 R > 30, < 10 T > 38.5 C pulse oximeter < 90 6. Nursing Pulse oximeter, bedside peak flow rate before and after bronchodilator treatments. 8. IV Fluids D5 NS at 125 cc h. -Oxygen 2 L min by NC. Keep O2 sat > 90 . Beta-Agonists, Acute Treatment -Albuterol (Ventolin) 0.5 mg and ipratropium (Atrovent) 0.5 mg in 2.5 mL NS q1-2h until peak flow meter 200-250 L min and sat 90 , then q4h OR -Levalbuterol...
Pubic scabies
This highly contagious infestation is caused by the Sarcoptes scabiei (0.2-0.4 mm in length). The infestation is transmitted by intimate contact or by contact with infested clothing. The female mite burrows into the skin, and after 1 month, severe pruritus develops. A multiform eruption may develop, characterized by papules, vesicles, pustules, urticarial wheals, and secondary infections on the hands, wrists, elbows, belt line, buttocks, genitalia, and outer feet. B. Diagnosis is confirmed...
No increased risk of breast cancer
Fibrocystic changes consist of an increased number of cysts or fibrous tissue in an otherwise normal breast. Fibrocystic changes do not constitute a disease state. 2. Fibrocystic disease is diagnosed when fibrocystic changes occur in conjunction with pain, nipple discharge, or a degree of lumpiness sufficient to cause suspicion of cancer. 3. Duct ectasia is characterized by distention of subareolar ducts. 4. Solitary papillomas consist of papillary cells that grow from the wall of a cyst into...
Definition and classification of breast cancer for staging
The definition for staging and the classification of stages for breast cancer follow the system of the International Union Against Cancer. This system is based on the tumor, nodes, and metastases (TNM) nomenclature. Definitions for Breast Cancer Staging Carcinoma in situ (intraductal carcinoma, Iobular) Tumor < 2 cm in greatest dimension Tumor > 2 cm but < 5 cm in greatest dimension Tumor > 5 cm in greatest dimension Tumor of any size with direct extension into chest wall or skin...
Other causes of vaginitis and vaginal discharge A Atrophic vaginitis
Reduced endogenous estrogen causes thinning of the vaginal epithelium. Symptoms include vaginal soreness, postcoital burning, dyspareunia, and occasional spotting. The vaginal mucosa is thin with diffuse erythema, occasional petechiae or ecchymoses, and few or no vaginal folds. There may be a serosanguineous or watery discharge with a pH of 5.0-7.0. 2. Treatment consists of topical vaginal estrogen. Vaginal ring estradiol (Estring), a silastic ring impregnated with estradiol, is the preferred...
Impetigo Scalded Skin Syndrome and Staphylococcal Scarlet Fever
Diagnosis Impetigo, scalded skin syndrome or staphylococcal scarlet fever 6. Nursing Warm compresses tid prn. -Nafcillin (Nafcil) or oxacillin (Bactocill, Prostaphlin) 100-200 mg kg day IV IM q4-6h, max 12 gm day OR -Dicloxacillin (Dycill, Dynapen, Pathocil) 25-50 mg kg day PO qid x 5-7days, max 2 gm day caps 125, 250, 500 mg elixir 62.5 mg 5 mL OR -Cephalexin (Keflex) 25-50 mg kg day PO qid, max 4 gm day caps 250, 500 mg drops 100 mg mL susp 125 mg 5 mL, 250 mg 5 mL tabs 500 mg, 1 gm OR...
Recurrent cystitis in young women
Up to 20 percent of young women with acute cystitis develop recurrent UTIs. The causative organism should be identified by urine culture. B. Women who have more than three UTI recurrences within one year can be managed using one of three preventive strategies. 1. Acute self-treatment with a three-day course of standard therapy. 2. Postcoital prophylaxis with one-half of a trimethoprim-sulfa-methoxazole double-strength tablet (40 200 mg). 3. Continuous daily prophylaxis for six months with...
Management options for complicated or recurrent yeast vaginitis
Extend any 7-day regimen to 10 to 14 days Eliminate use of nylon or tight-fitting clothing Consider discontinuing oral contraceptives Consider eating 8 oz yogurt (with Lactobacillus acidophilus culture) per day Improve glycemic control in diabetic patients For long-term suppression of recurrent vaginitis, use ketoconazole, 100 mg ( of 200-mg tablet) qd for 6 months 5. Partner treatment is not necessary since this is not a primary route of transmission. 6. Pregnancy. Topical azoles applied for...
Step 2 Assess the history
Recent stress change in weight, diet or exercise habits or illnesses that might result in hypothalamic amenorrhea should be sought. 2. Drugs associated with amenorrhea, systemic illnesses that can cause hypothalamic amenorrhea, recent initiation or discontinuation of an oral contraceptive, androgenic drugs (danazol) or high-dose progestin, and antipsychotic drugs should be evaluated. 3. Headaches, visual field defects, fatigue, or polyuria and polydipsia may suggest hypothalamic-pituitary...
Noninfectious vaginitis and vulvitis
Noninfectious causes of vaginitis include irritants (eg, minipads, spermicides, povidone-iodine, topical antimycotic drugs, soaps and perfumes) and contact dermatitis (eg, latex condoms and antimycotic creams). 2. Typical symptoms, including pruritus, irritation, burning, soreness, and variable discharge, are most commonly confused with acute candida vaginitis. The diagnosis should be suspected in symptomatic women who do not have an otherwise apparent infectious cause. 3. Management of...
National Osteoporosis Foundation
All women should be counseled about the risk factors for osteoporosis, especially smoking cessation and limiting alcohol. All women should be encouraged to participate in regular weight-bearing and exercise. B. Measurement of BMD is recommended for all women 65 years and older regardless of risk factors. BMD should also be measured in all women under the age of 65 years who have one or more risk factors for osteoporosis (in addition to menopause). The hip is the recommended site of...
Nonpharmacologic therapy of osteoporosis in women
An optimal diet for treatment (or prevention) of osteoporosis includes an adequate intake of calories (to avoid malnutrition), calcium, and vitamin D. B. Calcium. Postmenopausal women should be advised to take 1000 to 1500 mg day of elemental calcium, in divided doses, with meals. C. Vitamin D total of 800 IU daily should be taken. D. Exercise. Women should exercise for at least 30 minutes three times per week. Any weight-bearing exercise regimen, including walking, is acceptable. E....
Gestational Diabetes Mellitus
Poorly controlled gestational diabetes is associated with an increase in the incidence of preeclampsia, polyhydramnios, fetal macrosomia, birth trauma, operative delivery, and neonatal hypoglycemia. There is an increased incidence of hyperbilirubinemia, hypocalcemia, and erythremia. Later development of diabetes mellitus in the mother is also more frequent. The prevalence of gestational diabetes is higher in black, Hispanic, Native American, and Asian women than white women. The prevalence of...
Oral contraceptive pills OCPs suppress LH and FSH
Combination OCPs alleviate symptoms in about three quarters of patients. Oral contraceptives can be taken continuously with no placebos or cyclically, with a week of placebo pills between cycles. The OCPs can be discontinued after six months or continued indefinitely. 4. Danazol Danocrine has been highly effective in relieving the symptoms of endometriosis, but adverse effects may preclude its use. Adverse effects include headache, flushing, sweating and atrophic...
Corticosteroid metered dose inhalers or nebulized solution
-Beclomethasone Beclovent, Vanceril MDI 1-4 puffs bid-qid with spacer and mask, followed by gargling with water. 42 mcg puff . -Beclomethasone Vanceril Double Strength MDI 2 puffs bid 84 -Budesonide Pulmicort Turbohaler MDI 1-2 puffs bid 200 -Budesonide Pulmicort 0.25-0.5 mg nebulized bid 0.25 mg 2mL, 0.5 mg 2mL -Flunisolide Aerobid MDI 2-4 puffs bid 250 mcg puff -Fluticasone Flovent MDI 1-2 puffs bid 44, 110, 220 mcg actuation -Triamcinolone Azmacort MDI 1-4 puffs bid-qid 100 mcg puff Cromolyn...
Staging for Carcinoma of the Corpus Uteri
Invasion of less than one half of the myometrium Invasion of more than one half of the myometrium Invasion of serosa and or adnexa and or positive peritoneal cytologic results Metastases to pelvic and or para-aortic lymph nodes Invasion of bladder and or bowel mucosa Distant metastases including intra-abdominal and or inguinal lymph nodes --Carcinoma of the corpus is graded G according to the degree of histologic differentiation G1 5 percent or less of a solid growth pattern G2 6 to 50 percent...
Complicated UTI
A complicated UTI is one that occurs because of enlargement of the prostate gland, blockages, or the presence of resistant bacteria. B. Accurate urine culture and susceptibility are necessary. Treatment consists of an oral fluoroquinolone. In patients who require hospitalization, parenteral administration of ceftazidime Fortaz or cefoperazone Cefobid , cefepime Maxipime , aztreonam Azactam , imipenem-cilastatin Primaxin or the combination of an antipseudomonal penicillin ticarcillin Ticar ,...
Hyperemesis gravidarum
Hyperemesis gravidarum occurs in the extreme 0.5 to 1 of patients who have intractable vomiting. Patients with hyperemesis have abnormal electrolytes, dehydration with high urine-specific gravity, ketosis and acetonuria, and untreated have weight loss gt 5 of body weight. Intravenous hydration is the first line of therapy for patients with severe nausea and vomiting. Administration of vitamin B1 supplements may be necessary to prevent Wernicke's encephalopathy.
Ischemic Stroke
Vital Signs Vital signs and neurochecks q30minutes for 6 hours, then q60 minutes for 12 hours. Call physician if BP gt 185 105, lt 110 60 P gt 120, lt 50 R gt 24, lt 10 T gt 38.5 C or change in neurologic status. 6. Nursing Head-of-bed at 30 degrees, turn q2h when awake, range of motion exercises qid. Foley catheter, eggcrate mattress. Guaiac stools, inputs and outputs. Bleeding precautions check puncture sites for bleeding or hematomas. Apply digital pressure or pressure dressing to active...
Ventricular fibrillation and pulseless ventricular tachycardia
Apply cardiac monitor, administer oxygen, and ventilate. 2. Perform defibrillation using 2 J kg. Do not delay defibrillation. 3. If ventricular fibrillation persists, perform defibrillation using 4 J kg. 4. If ventricular fibrillation persists, perform defibrillation using 4 J kg. 5. If ventricular fibrillation persists, perform intubation, continue CPR, and obtain vascular access. Administer epinephrine, 0.1 mL kg of 1 10,000 IV or IO 0.01 mg kg or 0.1 mL kg of 1 1000 ET 0.1 mg kg . 6. If...
STSegment Elevation Myocardial Infarction
Diagnosis Rule out myocardial infarction 3 Condition 4. Vital Signs q1h. Call physician if pulse gt 90, lt 60 BP gt 150 90, lt 90 60 R gt 25, lt 12 T gt 38.5C. 5. Activity Bed rest with bedside commode. 7. Nursing Guaiac stools. If patient has chest pain, obtain 12-lead ECG and call physician. 8. Diet Cardiac diet, 1-2 gm sodium, low-fat, low-cholesterol diet. No caffeine or temperature extremes. 10. Special Medications -Oxygen 2-4 L min by NC. -Aspirin 325 mg...
NonST Segment Elevation Myocardial Infarction Nstemi and Unstable Angina
Diagnosis Acute coronary syndrome 4. Vital Signs q1h. Call physician if pulse gt 90, lt 60 BP gt 150 90, lt 90 60 R gt 25, lt 12 T gt 38.5C. 5. Activity Bed rest with bedside commode. 7. Nursing Guaiac stools. If patient has chest pain, obtain 12-lead ECG and call physician. 8. Diet Cardiac diet, 1-2 gm sodium, low fat, low cholesterol. No caffeine or temperature extremes. 10. Special Medications -Oxygen 2-4 L min by NC. -Aspirin 325 mg PO, chew and swallow...
New Onset Diabetes
2.Diagnosis New Onset Diabetes Mellitus 6.Nursing Record labs on a flow sheet. Fingerstick glucose at 0700, 1200, 1700, 2100, 0200 diabetic and dietetic teaching. 7.Diet Diabetic diet with 1000 kcal 100 kcal year of age. 3 meals and 3 snacks between each meal and qhs. 8.IV Fluids Hep-lock with flush q shift. 9.Special Medications -Goal is preprandial glucose of 100-200 mg dL -Divide 2 3 before breakfast and 1 3 before dinner. Give 2 3 of total insulin requirement as NPH and give 1 3 as lispro...
