Transdermal contraceptive patch
Ortho Evra is a transdermal contraceptive patch, which is as effective as oral contraceptives. Ortho Evra delivers 20 g of ethinyl estradiol and 150 g of norelgestromin daily for 6 to 13 months. Compliance is better with the patch. The patch is applied at the beginning of the menstrual cycle. A new patch is applied each week for 3 weeks week 4 is patch-free. It is sold in packages of 3 patches. Effectiveness is similar to oral contraceptives. 2. Breakthrough bleeding during the first two...
Delivery of the placenta
The placenta usually separates spontaneously from the uterine wall within 5 minutes of delivery. Gentle fundal massage and gentle traction on the cord facilitates delivery of the placenta. 2. The placenta should be examined for missing cotyledons or blind vessels. The cut end of the cord should be examined for 2 arteries and a vein. The absence of one umbilical artery suggests a congenital anomaly. 3. Prophylaxis against excessive postpartum blood loss consists of external fundal massage and...
Pharmacologic Therapy
Fluoxetine (Sarafem) and sertraline (Zoloft) have been approved for the treatment of PMDD. SSRIs are recommended as initial drug therapy in women with PMS and PMDD. Common side effects of SSRIs include insomnia, drowsiness, fatigue, nausea, nervousness, headache, mild tremor, and sexual dysfunction. B. Fluoxetine (Sarafem) 20 mg or sertraline (Zoloft) 50 mg, taken in the morning, is best tolerated and sufficient to improve symptoms. Fluoxetine or sertraline can be given during the 14 days...
Hormonal contraceptive methods other than oral contraceptives
Contraceptive vaginal ring (NuvaRing) delivers 15 g ethinyl estradiol and 120 g of etonogestrel daily. 1. Advantages of the ring include rapid return to ovulation after discontinuation, lower doses of hormones, ease and convenience, and improved cycle control. Benefits, risks, and contraindications to use are similar to those with combined oral contraceptive pills, except for the convenience of monthly administration. 2. In women who have not used hormonal contraception in the past month,...
Antibiotic Regimens for Endometritis
Clindamycin (900 mg IV Q 8 hours) plus gentamicin (1.5 mg kg IV Q 8 hours) Ampicillin-sulbactam (Unasyn) 3 grams IV Q 6 hours Ticarcillin-clavulanate (Timentin)3.1 grams IV Q 4 hours Cefoxitin (Mefoxin) 2 grams IV Q 6 hours Ceftriaxone (Rocephin) 2 grams IV Q 24 hours plus metronidazole 500 mg PO or IV Q 8 hours* .evofloxacin (Levaquin) 500 mg IV Q 24 hours plus metronidazole 500 mg PO or IV Q 8 hours* * Should not be given to breastfeeding mothers chlamydia infection is suspected, azithromycin...
Screening for osteoporosis and osteopenia
Normal bone density is defined as a bone mineral density (BMD) value within one standard deviation of the mean value in young adults of the same sex and race. B. Osteopenia is defined as a BMD between 1 and 2.5 standard deviations below the mean. C. Osteoporosis is defined as a value more than 2.5 standard deviations below the mean this level is the fracture threshold. These values are referred to as T-scores (number of standard deviations above or below the mean value). D. Dual x-ray...
Management of preeclampsia
The definitive treatment of preeclampsia is delivery. Delivery is recommended for women with mild preeclampsia at or near term and for most women with severe preeclampsia or severe gestational hypertension regardless of gestational age. Exceptions may be made for women remote from term (less than 32 to 34 weeks of gestation) who improve after hospitalization and do not have significant end-organ dysfunction or fetal deterioration. B. Fetal assessment consists of daily fetal movement counts...
Otitis Externa Pseudomonas gram negatives proteus
-Polymyxin B neomycin hydrocortisone (Cortisporin otic susp or solution) 2-4 drops in ear canal tid-qid x 5-7 days. otic soln or susp per mL neomycin sulfate 5 mg polymyxin B sulfate 10,000 units hydrocortisone 10 mg in 10 mL bottles) . The suspension is preferred. The solution should not be used if the eardrum is perforated. Malignant Otitis Externa in Diabetes (Pseudomonas) -Ceftazidime (Fortaz) 100-150 mg kg day IV IM q8h, max 12gm day OR -Piperacillin (Pipracil) or ticarcillin (Ticar)...
Sexually Transmissible Infections
Approximately 12 million patients are diagnosed with a sexually transmissible infection (STI) annually in the United States. Sequella of STIs include infertility, chronic pelvic pain, ectopic pregnancy, and other adverse pregnancy outcomes. Diagnosis and Treatment of Bacterial Sexually Transmissible infections Direct fluorescent antibody, enzyme immunoassay, DNA probe, cell culture, DNA amplification Doxycycline 100 mg PO 2 times a day for 7 days or Ofloxacin (Floxin) 300 mg PO 2 times a day...
Perimenopausal transition
Perimenopause is defined as the two to eight years preceding menopause and the one year after the last menstrual period. It is characterized by a normal ovulatory cycle interspersed with anovulatory cycles. Menses become irregular, and heavy breakthrough bleeding can occur. Some women complain of hot flashes and vaginal dryness. B. Chronic anovulation and progesterone deficiency in this transition period may lead to long periods of unopposed estrogen exposure and endometrial hyperplasia....
Treatment of menopausal symptoms with estrogen
Estrogen therapy remains the gold standard for relief of menopausal symptoms, and is a reasonable option for most postmenopausal women, with the exception of those with a history of breast cancer, CHD, a previous venous thromboembolic event or stroke, or those at high risk for these complications. Estrogen therapy should be used for shortest duration possible (eg, 6 months to 5 years). 2. Dose. A low-dose estrogen is recommended when possible (eg, 0.3 mg conjugated estrogens or 0.5 mg...
Clinical evaluation
Symptoms of vaginitis include vaginal discharge, pruritus, irritation, soreness, odor, dyspareunia and dysuria. Dyspareunia is a common feature of atrophic vaginitis. Abdominal pain is suggestive of pelvic inflammatory disease and suprapubic pain is suggestive of cystitis. B. A new sexual partner increases the risk of acquiring sexually transmitted diseases, such as trichomonas, chlamydia, or Neisseria gonorrheae. Trichomoniasis often occurs during or immediately after the menstrual period...
Risk Factors for Breast Cancer
Early menarche Nulliparity Delayed childbirth Increasing age Race Familial Risk Factors for Breast Cancer More than 50 of women in family have breast cancer Breast cancer present in more than I generation Multiple occurrences of breast cancer (> 3) in close relatives High rate of co-existing ovarian cancer B. Nulliparity and increased age at first pregnancy are associated with an increased risk for breast cancer. Nulliparity alone accounts for 16 of new cases of breast cancer each year. The...
Acute uncomplicated cystitis in young women
Sexually active young women are most at risk for UTIs. B. Approximately 90 percent of uncomplicated cystitis episodes are caused by Escherichia coli, 10 to 20 percent are caused by coagulase-negative Staphylococcus saprophyticus and 5 percent or less are caused by other Enterobacteriaceae organisms or enterococci. Up to one-third of uropathogens are resistant to ampicillin and, but the majority are susceptible to trimethoprim-sulfamethoxazole (85 to 95 percent) and fluoroquinolones (95...
Timing and indications for delivery
Timing of delivery is based upon the maternal and fetal condition and gestational age. 2. Women who develop severe preeclampsia at or beyond 32 to 34 weeks of gestation should be delivered. 3. Women with mild disease remote from term can be managed expectantly to enable fetal growth and maturation. 4. Women with mild disease and a favorable cervix or who are noncompliant may benefit from induction as early as 37 weeks otherwise, delivery by 40 weeks of gestation should be considered. 5. Women...
Treatment of acute uncomplicated cystitis in young women
Three-day regimens appear to offer the optimal combination of convenience, low cost and an efficacy comparable to that of seven-day or longer regimens. is the most cost-effective treatment. Three-day regimens of ciprofloxacin (Cipro), 250 mg twice daily, and ofloxacin (Floxin), 200 mg twice daily, produce better cure rates with less toxicity. 3. Quinolones that are useful in treating complicated and uncomplicated cystitis include ciprofloxacin, norfloxacin, ofloxacin, enoxacin (Penetrex),...
Normal serum prolactin and FSH concentrations with history of uterine instrumentation preceding amenorrhea
Evaluation for Asherman's syndrome should be completed. A progestin challenge should be performed (medroxyprogesterone acetate 10 mg for 10 days). If withdrawal bleeding occurs, an outflow tract disorder has been ruled out. If bleeding does not occur, estrogen and progestin should be administered. b. Oral conjugated estrogens (0.625 to 2.5 mg daily for 35 days) with medroxyprogesterone added (10 mg daily for days 26 to 35) failure to bleed upon cessation of this therapy strongly suggests...
Lower Urinary Tract Infection
Call physician if BP < 90 60 > 160 90 R > 30, < 10 P > 120, < 50 T > 38.5 C. Lower Urinary Tract Infection (treat for 3-7 days) -Trimethoprim-sulfamethoxazole (Septra) 1 double strength tab (160 800 mg) PO bid. -Norfloxacin (Noroxin) 400 mg PO bid. -Ciprofloxacin (Cipro) 250 mg PO bid. -Levofloxacin (Levaquin) 500 mg IV PO q24h. -Lomefloxacin (Maxaquin) 400 mg PO qd. -Enoxacin (Penetrex) 200-400 mg PO q12h 1h before or 2h after meals. -Cefpodoxime (Vantin) 100...
Theophylline Overdose
Admit to Medical intensive care unit. 2. Diagnosis Theophylline overdose 4. Vital Signs Neurochecks q2h. Call physician if BP > 160 90, < 90 60 P > 130 < 50 R > 25, < 10. 6. Nursing ECG monitoring until level < 20 mcg mL, aspiration and seizure precautions. Insert single lumen NG tube and lavage with normal saline if recent ingestion. 8. IV Fluids D5 NS at 125 cc h -Activated charcoal 50 gm PO round-the-clock, with sorbitol cathartic, until theophylline level < 20 mcg mL....
Pathophysiology
Simple hyperplasia without atypia is least likely to progress to endometrial carcinoma, whereas complex hyperplasia with atypia is most likely to progress to carcinoma. The presence of nuclear atypia is the most worrisome finding. Progression to endometrial carcinoma was more than tenfold higher in women with atypical hyperplasia (simple or complex) than in women with no atypia (23 and 1.6 percent, respectively). Approximately 25 percent of women with atypical hyperplasia have coexistent...
History of present pregnancy
Estimated date of confinement (EDC) is calculated as 40 weeks from the first day of the LMP. 2. Fetal heart tones are first heard with a Doppler instrument 10-12 weeks from the LMP. 3. Quickening (maternal perception of fetal movement) occurs at about 17 weeks. 4. Uterine size before 16 weeks is an accurate measure of dates. 5. Ultrasound measurement of fetal size before 24 weeks of gestation is an accurate measure of dates. 6. Prenatal history. Medical problems during this pregnancy should be...
Hepatitis A
IV Fluids D5NS IV at maintenance rate. 15 mg kg day IM PO PR q6-8h, max 100 mg dose if < 13.6 kg or 200 mg dose if 13.6-41kg. caps 100, 250 mg inj 100 mg mL supp 100, 200 mg . -Acetaminophen (Tylenol) 15 mg kg PO PR q4h prn temp > 38 C or pain. -Meperidine (Demerol) 1 mg kg IV IM q2-3h prn pain. -Hepatitis A immune globulin, 0.02 mL kg IM (usually requires multiple injections at different sites), when given within 2 weeks after exposure to HAV, is 85...
Diagnostic studies
Measurement of vaginal pH should always be determined. The pH of the normal vaginal secretions is 4.0 to 4.5. A pH above 4.5 suggests bacterial vaginosis or trichomoniasis (pH 5 to 6), and helps to exclude candida vulvovaginitis (pH 4 to 4.5). B. Saline microscopy should look for candidal buds or hyphae, motile trichomonads, epithelial cells studded with adherent coccobacilli (clue cells), and polymorphonuclear cells (PMNs). The addition of 10 potassium hydroxide to the wet mount...
Candida vulvovaginitis
Candida vulvovaginitis accounts for one-third of vaginitis. Up to 75 of women report having had at least one episode of candidiasis. The condition is rare before menarche. It is less common in postmenopausal women, unless they are taking estrogen replacement therapy. B. Microbiology and risk factors. Candida albicans is responsible for 80-92 of vulvovaginal candidiasis. Sporadic attacks of vulvovaginal candidiasis usually occur without an identifiable precipitating factor. 1....
Betaadrenergic receptor agonists
Maternal side effects include tachycardia, palpitations, and lowered blood pressure. Myocardial ischemia is rare. Common side effects include chest discomfort (10 percent), shortness of breath (15 percent), palpitations (18 percent), tremor (39 percent) and anxiety. Pulmonary edema is an uncommon maternal complication, occurring in 0.3 percent. 2. Beta-adrenergic-receptor agonists may cause hypokalemia (39 percent), hyperglycemia (30 percent), and lipolysis. Glucose and potassium should be...
If a normal vagina or uterus are not obviously present
On physical examination, pelvic ultrasonography should be performed to confirm the presence or absence of ovaries, uterus, and cervix. Ultrasonography can be useful to exclude vaginal or cervical outlet obstruction in patients with cyclic pain. a. Uterus absent (1) If the uterus is absent, evaluation should include a karyotype and serum testosterone. These tests should distinguish abnormal mullerian development (46, XX karyotype with normal female serum testosterone concentrations) from...
Step 5 Followup laboratory evaluation
Prolactin secretion can be transiently increased by stress or eating. Therefore, serum prolactin should be measured at least twice before cranial imaging is obtained, particularly in those women with small elevations (< 50 ng mL). These women should be screened for thyroid disease with a TSH and free T4 because hypothyroidism can cause hyperprolactinemia. 2. Women with verified high serum prolactin values should have a cranial MRI unless a very clear...
Normal or low serum gonadotropin concentrations and all other tests normal
This result is one of the most common outcomes of laboratory testing in women with amenorrhea. Women with hypothalamic amenorrhea (caused by marked exercise or weight loss to more than 10 percent below the expected weight) have normal to low serum FSH values. Cranial MRl is indicated in all women without an a clear explanation for hypogonadotropic hypogonadism and in most women who have visual field defects or headaches. No further testing is required if the onset of amenorrhea is recent or...
Aminophylline and theophylline
Concomitant drugs (e.g. erythromycin or carbamazepine) may increase serum theophylline levels by decreasing drug metabolism. -Aminophylline loading dose 5-6 mg kg total body weight IV over 20-30 min 1 mg kg of aminophylline will raise serum level by 2 mcg mL . -Aminophylline maintenance as continuous IV infusion (based on ideal body weight) 1-6 mth 0.5 mg kg hr 6-12 mth 0.6-0.75 mg kg hr 1-10 yr 1.0 mg kg hr 10-16 yr 0.75-0.9 mg kg hr > 16 yr 0.7 mg kg hr OR...
Secondline agents consist of one of the following
Medroxyprogesterone acetate (50 mg orally daily), norethindrone acetate (eg, Aygestin 5 mg orally daily), norgestrel (eg, Ovrette 0.075 mg orally daily), or norethindrone (eg, Micronor, Nor-QD 0.35 mg orally daily) for a two-month trial. 2. Danazol 200 to 400 mg day in two divided doses initially, may be increased to 800 mg day in two divided doses to achieve amenorrhea. Therapy may be continued up to nine months. 3. Empiric use of a gonadotropin-releasing...
Docusate sodium Colace
> 12y 50-400 mg day PO q6-24h caps 50,100, 250 mg oral soln 10 mg mL, 50 mg mL B. Magnesium hydroxide (Milk of Magnesia) 0.5 mL kg dose or 2-5 yr 5-15 mL 6-12y 15-30 mL > 12y 30-60 mL PO prn. C. Hyperosmotic soln (CoLyte or GoLytely) 15-20 mL kg hr PO NG. D. Polyethylene glycol (MiraLax) 3-6 yr 1 tsp powder dissolved in 3 ounces fluid PO qd-tid 6-12 yr tablespoon powder dissolved in 4 ounces fluid PO qd-tid > 12 yr one tablespoon powder dissolved in 8 ounces fluid PO qd-tid E. Senna...
Management of eclampsia
Maintenance of airway patency and prevention of aspiration are the initial management priorities. The patient should be rolled onto her left side and a padded tongue blade placed in her mouth, if possible. B. Control of convulsions. Magnesium sulfate, 2 to 4 g IV push repeated every 15 minutes to a maximum of 6 g. Maintenance dose of magnesium sulfate 2 to 3 g hour by continuous intravenous infusion. Diazepam may also be given as 5 mg IV push repeated as needed to a maximum cumulative dose...
Key Questions in Evaluating Patients for Urinary Incontinence
Do you leak urine when you cough, laugh, lift something or sneeze How often Do you ever leak urine when you have a strong urge on the way to the bathroom How often How frequently do you empty your bladder during the day How many times do you get up to urinate after going to sleep Is it the urge to urinate that wakes you Do you ever leak urine during sex Do you wear pads that protect you from leaking urine How often do you have to change them Do you ever find urine on your pads or clothes and...
Treatment of nausea and vomiting of pregnancy
Patients should avoid odors or foods that seem to be aggravating the nausea. Useful dietary modifications include avoiding fatty or spicy foods, and stopping iron supplements. Frequent small meals also may improve symptoms. Recommendations include bland and dry foods, high-protein snacks, and crackers at the bedside to be taken first thing in the morning. B. Cholecystitis, peptic ulcer disease, or hepatitis can cause nausea and vomiting and should be excluded. Gastroenteritis, appendicitis,...
Treatment Guidelines for Osteoporosis
Calcium supplements with or without vitamin D supplements or calcium-rich diet Weight-bearing exercise Avoidance of alcohol tobacco products Alendronate (Fosamax) Risedronate (Actonel) Raloxifene (Evista) 400 IU per day (800 IU per day in winter in northern latitudes) Prevention 5 mg per day or 35 mg once-a-week Treatment 10 mg per day or 70 mg once-a-week
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,...
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...
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...
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...
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...
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 ,...
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...
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...
Hormonal versus nonhormonal
Pelvic pain associated with severe dysmenorrhea and or pain at the time of ovulation is likely due to endometriosis or adenomyosis. Women with endometriosis report premenstrual spotting, dyspareunia, dyschezia, poor relief of symptoms with nonsteroidal anti-inflammatory drugs, progressively worsening symptoms, inability to attend work or school during menses, and the presence of pelvic pain unrelated to menses more often than women with primary dysmenorrhea. 2. Nonhormonally responsive...
Absence Seizure
-Divalproex Depakote 250-500 mg PO tid-qid 125, 250, 500 mg . -Clonazepam Klonopin 0.5-5 mg PO bid-qid 0.5, 1, 2 mg . -Lamotrigine Lamictal 50 mg PO qd, then increase to 50-250 mg PO bid 25, 100, 150, 200 mg adjunct therapy. 10. Extras MRI with and without gadolinium or CT with contrast EEG with photic stimulation, hyperventilation, sleep deprivation, awake and asleep tracings portable CXR, ECG. 11. Labs CBC, SMA 7, glucose, Mg, calcium, phosphate, liver panel, VDRL, anticonvulsant levels. UA,...
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...
