NURS 6551 Midterm Study Guide

NURS 6551 Midterm Study Guide

NURS 6551 Midterm Study Guide
#1 Alcohol Abuse Among Women

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 or more than three drinks per day. NURS 6551 Midterm Study Guide
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?

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#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:

Cervical mucus monitoring
Basal body temperature monitoring
Menstrual cycle charting
Ovulation sensations
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

Recommendation: The USPSTF recommends against screening for cervical cancer with HPV testing, alone or in combination with cytology, in women younger than age 30 years.

Age: Women Older than 65, who have had adequate prior screening

Recommendation: The USPSTF recommends against screening for cervical cancer in women older than age 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer.

Age: Women who have had a hysterectomy

Recommendation: The USPSTF recommends against screening for cervical cancer in women who have had a hysterectomy with removal of the cervix and who do not have a history of a high-grade precancerous lesion (cervical intraepithelial neoplasia [CIN] grade 2 or 3) or cervical cancer.

Chlamydia and Gonorrhea: Screening

Age: Sexually Active Women

Recommendation: The USPSTF recommends screening for chlamydia and gonorrhea in sexually active women age 24 years and younger and in older women who are at increased risk for infection.

 
 
#7 Preventable causes of death
*Cardiovascular disease is the leading causes of death in females. (CDC, 2015).
Preventable causes of death for women are related to:
Modifiable, behavioral risk factors:

Tobacco use with related illnesses (Lung Cancer)

Leading preventable cause of death
Risk of MI, CVA, lung cancer (and others)

Overweight or Obesity
Morbidity and mortality

Elevated Low-Density lipoprotein (LDL) cholesterol levels
Diabetes

CAD, CVA, DM, Kidney Disease, Respiratory problems
Risk of premature death
Disability
Poor diet
Physical inactivity

USPSTF recommendations:

Overweight or obese patients be referred for high-intensity behavioral counseling to promote a healthful diet and physical activity.
Counseling on interventions on smoking cessation.
Exercise
Healthy diet (manage cholesterol)

Provide education and resources for smoking cessation, healthy food choices, exercising 30 minutes a day
 

Common Health Issues

Dominant Breast Mass/Breast Cancer- Adult to older female with dominant mass on one breast that feels hard and irregular in shape and is immobile.  Common locations upper outer quadrants.  Skin changes may be evident- peau d’orange, dimpling and retraction.  Mass is painless and may be accompanied by serous or bloody nipple discharge.  Nipple may be displaced or fixed.
Ductal Carcinoma In Situ (Paget’s Disease)- Chronic scaly red-colored rash which bears similar appearance to eczema, starts on nipple and spreads to the areola on one breast.  May c/o itching, pain or burning.  Lesion slowly enlarges and evolves to include crusting, ulceration and/or bleeding of the nipple.
Inflammatory Breast Disease- Recent or acute onset of red, swollen and warm area in the breast of a younger woman, may mimic mastitis.  No distinct lump and symptoms develop quickly.  Skin may appear pitted (peau d’orange) or bruised.  More common with African Americans.  It is rare but very aggressive.
BRCA Associated Breast Cancer and Ovarian Cancer- High risk-family history of Breast ca before 50, male breast ca, triple negative breast ca before 60, or ovarian cancer and other types of gyn. Ca.  Men with BRCA mutation are higher risk for breast ca and prostate ca.  A patient reporting BRCA mutation should be followed by a breast specialist, and screened with both a mammogram and a breast MRI.  Screening should occur 10 years before the age of the earliest member diagnosed with breast cancer.  BRCA mutations are common among Ashkenazi Jews.  Should also be referred for genetic counseling
Fibrocystic Breast-When the monthly hormonal cycle causes the breast tissue to become engorged and painful; symptoms occurs about 2 weeks before menstrual period and at the worst right before the cycle starts.  Resolves after menses start, common to begin in women in their 30s.
Tx: Refrain from caffeine intake, Take Vitamin E and evening primrose capsules, wear bras with good support, monitor for skin changes
Polycystic Ovary Syndrome (PCOS)- Hormonal abnormality characterized by anovulation, infertility, excessive androgen production and insulin resistance.  High risk for DM2, dyslipidemia, metabolic syndrome, endometrial hyperplasia, obesity and OSA.  Common symptoms are excessive facial and body hair, bad acne and amenorrhea or infrequent periods.  Increased risk for CHD, DM2 and metabolic syndrome, breast and endometrial cancers, central obesity and infertility.
Assess: Transvaginal US to r/o enlarged ovaries, Bloodwork-serum testosterone, dehydroepiandrosterone (DHEA), androstenedione (these three are typically elevated), FSH normal or low), fasting glucose and 2 hr. oral GTT (glucoses are usually abnormal).
Tx: Low dose oral contraceptives, spironolactone, metformin, weight loss planning
Osteoporosis- Gradual loss of bone density secondary to estrogen deficiency and other metabolic disorders.  Most common-older women of white or Asian background with thin or small body frame, especially with family history.  Menopausal women with osteoporosis and those with hip or vertebral fracture history should be treated.  Other risk groups include: chronic steroid use, anorexia nervosa or bulimia, long-term use of PPIs, gastric bypass, celiac disease, hyperthyroidism, ankylosing spondylitis, and RA
Assess: DXA to measure bone mineral density.  Baseline, then every 1-2 years if on treatments, every 2-5 if not treated.  Evaluate T-scores for osteoporosis and osteopenia
Tx: Weight bearing exercises on most days of the week and Calcium with Vitamin D (1200mg), Vitamin D2 (50,000IU once weekly) and Vitamin D3 (800mg to 1000 IU/d).  Other medication options: Bisphosphonates (1st line- Ex: Fosamax 5-10mg/d or 70mg/wk, Actonel 5mg/d or 35mg/wk or 150mg/mon, Selective Estrogen Receptor Modulators (Ex: Evista, used for patients with contraindication of bisphosphonates), Tamoxifen (used in breast cancer patients), Parathyroid hormone analog (Ex: Teriparatide), Miacalcin and Calcitrol
Ovarian cancer- 5th most common cancer in US for women.  Rare to diagnose in early stages, often women c/o vague symptoms: abdominal bloating and discomfort, low-back pain, pelvic pain, urinary frequency and constipation for certain women with BRCA1 or BRCA2 mutations.  Some experts recommend bilateral salpingo-oopherectomy (BSO) between 35-40 for women with BRCA1 or BRCA2.  USPSTF doesn’t recommend routine screening in general population.  High risk women recommended for genetic screening.  Transvaginal US and CA-125 should be done with screening.   Begin screening at 30 or 5-10 years before earliest age of diagnosis in family member.
Bacterial Vaginosis – caused by an overgrowth of vaginal bacteria.  Risk factors: sexual activity, new or multiple sexual partners, and douching.  Fish-like odor, profuse milk-like discharge on the vaginal vault, not itchy and vulva not red
Assess: Clue cells and no or few WBCs on wet smear microscopy, whiff test (KOH application to discharge releases fishy odor) and vaginal pH (>4.5) are used to diagnose.
Tx: Metronidazole BID X 7D, abstain from sexual activity until completion of treatment
Candidal Vaginitis- Overgrowth of yeast (candida albicans) in the vulva/vagina.  High-risk: HIV, antibiotic use, immunosuppression. Cheesy or curd-like white discharge
Assess: Pseudohyphae and spores with many WBCs of wet smear microscopy
Tx: Miconazole or clotrimazole for 7 D (OTC) or Diflucan 100mg x 1 dose or terconazole vaginal cream/suppository.  If on antibiotics recommend daily yogurt or lactobacillus pill
Trichomonal Vaginitis- An infection involving a protozoan parasite.  Causes inflammation (itching, burning and irritation) of the vagina/urethra.  “Strawberry” cervix, bubbly discharge gray/green color.
Assess: Mobile unicellular organisms with flagella and large number of WBCs on wet smear microscopy
Tx: Metronidazole 2g PO x 1 dose or 500mg BID X 7D, avoid sexual contact, treat partner
Atrophic Vaginitis- chronic lack of estrogen in the urogenital tract.  Atrophic changes in the vulva and vagina of menopausal women.  C/O vaginal dryness, itching and pain with intercourse
Assess: atrophic labia with decrease rugae, vulva or vagina may have fissures, dry pale pink vagina, Pap smear
Tx: If Pap is mildly abnormal (atrophic changes) temporary topical estrogen vaginal cream for a few weeks and repeat Pap test.  Topical estrogens may be cream, suppository or cervical ring (Premarin, Extrace, Vagifem).
Amenorrhea-
Primary- Failure to begin menses by 16 years old with normal tanner stages.  Begin workup at 13 if no breast development of period.  May be caused by genetic relation or functional abnormality in reproductive structures
Secondary- Cessation of normal menses for 3 months and irregular menses for 6 months.  Common causes: PCOS, pregnancy, hypothalamic amenorrhea, primary ovulation insufficiency bulimia/anorexia and lifestyle.
 
#8 cont. Common Health Concerns for Women
– Endometriosis: The tissue that is normally found in the lining of the uterus grows in other places such as the ovaries, behind the uterus, on the bowel and the bladder.
– Uterine Fibroids: The most common noncancerous tumors found in women of childbearing age. Made of muscle cells and tissues that grow in and around the wall of the uterus. Exact cause is unknown. Affects African American and overweight women. Symptoms are heavy periods, frequent urination, painful sex, lower back pain, and infertility, miscarriages, or early labor.
– HIV/Aids: The virus can be spread through breast milk. Women contract the disease through unprotected sex with someone infected with the virus, or by sharing needles with an infected person. Minority women are affected the most.
– Interstitial Cystitis: A chronic bladder condition resulting in discomfort or pain in the bladder or surrounding pelvic region. The walls of the bladder are inflamed or irrated and can cause scarring and stiffening of the bladder. Can affect women more than men. Cause abdominal or pelvic pain, frequent urination, feeling of urgency to urinate, pelvic tenderness, or fullness, pain in bladder or pelvic area.
– Polycystic Ovary Syndrome (PCOS): Occurs when a woman ovaries or adrenal gland produce more male hormones than normal. Results in cysts developing on the ovaries. Obese woman is at a greater risk for developing. These women are also at a greater risk for developing diabetes and heart disease. Symptoms are infertility, pelvic pain, excess hair growth on face, chest, stomach, thumbs, and toes. Baldness, ache, oily skin, dandruff, or patches of thicken dark brown or black skin are also some of the symptoms of this disorder.
 

ACOG Recommendations:

Cervical cancer:
-Cervical cytology alone every three years from 21-29
-Co-testing with Pap test and HPV every five years for women 30-65 years old w/o cervical cancer history, not immunocompromised, negative for HIV and no history of diethylstilbestrol exposure
-Screening every 3 years with Pap alone is acceptable without risk factors
-Women with risk factors may require unique screening needs
-HIV positive cytology every 6 months after diagnosis and then annually after two consecutive normal results
-No screenings for hysterectomy patients for reasons other than carcinoma, women with history of CIN 2 or 3 should have routine age-based screening for 20 years following post-treatment monitoring
-No screenings for over 65 with no history of cervical cancer and adequate negative results prior to 65.
Breast cancer:
-CBE every 1-3 years for 20-39 and annually for 40 and older
-Annual mammogram for 40 and older
-BSE for all women high risk for breast cancer, breast self-awareness for all women regardless of risk
Elevated cholesterol
-Lipid profile every 5 years beginning at 45, Screening for 19-44 based on risk factors
Osteoporosis
-Screening of women 65 and older or younger women with history of fracture or having one or more risk factors
Colorectal cancer:
-Begin screening at 50 for average risk patients, 45 for African-American women
-Screening of younger women is based on risk factors
-Screen every 10 years with colonoscopy
-Discontinue screening at 75
Ovarian cancer:
-No techniques demonstrate effectiveness for screening asymptomatic low-risk women
-Monitor for signs and symptoms of disease
-Transvaginal US or CA 125 for certain at high risk for epithelial ovarian cancer
Intimate Partner Violence:
-Periodic screening for all adolescents and women
-Screen all women at first prenatal visit, throughout pregnancy and postpartum
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#10 Rape and Definition of Rape

Sexual abuse of children and adolescents is a serious and complicated issue that requires specialized training in interviews and physical examinations whenever abuse is suspected
Collaboration with agencies that are specific to children and adolescents should be the goal for this population in effort to avoid lifelong complications related to abuse
Older patients are also vulnerable because of age related illness and a decrease in physical strength
Older adults often sustain more injuries and specifically more genital injuries they may feel embarrassed or ashamed therefore recording goes unnoticed, risk factors for being sexually assaulted include impaired hearing, diminished physical strength, reliance on others for help, memory issues, and limited mobility
18% of sexual assault victims are people over the age of 60
The legal definition of rape according to the FBI is penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by sex organ of another person, without the consent of the victim
Rape is a form of sexual assault, but not all sexual assault is rape.
60% of sexual assaults are not reported to the police the incidence of rape is about 10 times higher for women than for men
If the patient does not desire to pursue an exam in the emergency department or if more than five days have passed since the assault medical care can be managed in an office setting
If a patient does disclose a sexual assault, the provider should differ a physical examination and refer the patient to the emergency department if the assault occurred within the past 5 days, preferably within 72 hours a referral to the emergency department will ensure that the appropriate measures are taken to collect evidence into comply with standardized protocol
There are no known absolute risk factors for becoming a victim of sexual assault

 
 #11 Genital Trauma and Rape

Can include external or internal genitalia
Can result in pain, structural damage, impaired genitourinary function, sexual dysfunction and infertility
After Rape or sexual assault, it’s important to complete a thorough physical exam, collect DNA, swabs and document the complete patient report and assessment

 
#12 Pneumonic EMPOWER

Empathetic listening
Making time to properly document
Providing information about domestic violence (including later in life)
Offering options and choices
Working with a domestic abuse specialist (including elderly domestic abuse)
Encouraging planning for safety and support
Referring to local services

Clinical interventions for IPV (intimate partner violence) patients should be based on four important principles: empowerment, childbearing cycle-stage specificity, abuse stage specificity, and cultural competence. Abusers take power and control away from victims by isolating them from the people and information that can help them make thoughtful choices. Therefore, it is crucial that clinicians use empowerment model of offering information, options and support. Clinicians must not judge an abused women’s choices, nor use any kind of tactics to get her to cooperate. An empowerment model should include the information given in the list above.

 
#13 World Health Organization

Women’s health matters not only to women themselves. It is also crucial to the health of the children they will bear. This underlines an important point: paying due attention to the health of girls and women today is an investment not just for the present but also for future generations. This implies addressing the underlying social and economic determinants of women’s health – including education, which directly benefits women and is important for the survival, growth and development of their children.
A life course approach emphases a temporal and social perspective, looking back across an individual’s or a cohort’s life experiences or across generations for clues to current patterns of health and disease, whilst recognizing that both past and present experiences are shaped by the wider social, economic and cultural context. In epidemiology, a life course approach is being used to study the physical and social hazards during gestation, childhood, adolescence, young adulthood and midlife that affect chronic disease risk and health outcomes in later life.  It aims to identify the underlying biological, behavioral and psychosocial processes that operate across the lifespan. It fosters a deeper understanding of how interventions in childhood, through adolescence, during the reproductive years and beyond, affect health later in life and across the generations.

 
#14 CDC HIV Testing recommendations

CDC recommends that everyone between the ages of 13 and 64 get tested for HIV at least once as part of routine health care. Knowing your HIV status gives you powerful information to help you take steps to keep you and your partner healthy. About 1 in 7 people in the United States who have HIV don’t know they have it.
You should be tested at least once a year if you keep doing any of these things. Sexually active gay and bisexual men may benefit from more frequent testing (for example, every 3 to 6 months).
If you’re pregnant, talk to your health care provider about getting tested for HIV and other ways to protect you and your child from getting HIV. If a woman is treated for HIV early in her pregnancy, the risk of transmitting HIV to her baby can be very low. Testing pregnant women for HIV infection and treating those women who have HIV have led to a big decline in the number of children infected with HIV from their mothers. The treatment is most effective for preventing HIV transmission to babies when started as early as possible during pregnancy. However, there are still great health benefits to beginning preventive treatment even during labor or shortly after the baby is born.
Before having sex for the first time with a new partner, you and your partner should talk about your sexual and drug-use history, disclose your HIV status, and consider getting tested for HIV and learning the results.
Even if you are in a monogamous relationship (both you and your partner are having sex only with each other), you should find out for sure whether you or your partner has HIV.
The time between when a person may have been exposed to HIV and when a test can tell for sure whether they have HIV is called the window period. The window period varies from person to person and depends on the type of test used to detect HIV.
A nucleic acid test (NAT) can usually tell you if you have HIV infection 10 to 33 days after an exposure.
An antigen/antibody test performed by a laboratory on blood from a vein can usually detect HIV infection 18 to 45 days after an exposure. Antigen/ antibody tests done with blood from a finger prick can take longer to detect HIV (18 to 90 days after an exposure). When the goal is to tell for sure that a person does not have HIV, an antigen/antibody test performed by a laboratory on blood from a vein is preferred.
Antibody tests can usually take 23 to 90 days to reliably detect HIV infection. Most rapid tests and home tests are antibody tests. In general, antibody tests that use blood from a vein can detect HIV sooner after infection than tests done with blood from a finger prick or with oral fluid.
Ask your health care provider about the window period for the test you’re taking. If you’re using a home test, you can get that information from the materials included in the test’s package. If you get an HIV test after a potential HIV exposure and the result is negative, get tested again after the window period for the test you’re taking to be sure. If your health care provider uses an antigen/antibody test performed by a laboratory on blood from a vein you should get tested again 45 days after your most recent exposure. For other tests, you should test again at least 90 days after your most recent exposure to tell for sure if you have HIV.
If you learned you were HIV-negative the last time you were tested, you can only be sure you’re still negative if you haven’t had a potential HIV exposure since your last test. If you’re sexually active, continue to take actions to prevent HIV, like using condoms the right way every time you have sex and taking medicines to prevent HIV if you’re at high risk.
If you use any type of antibody test and have a positive result, you will need to take a follow-up test to confirm your results. If your first test is a rapid home test and it’s positive, you will be sent to a health care provider to get follow-up testing. If your first test is done in a testing lab and it’s positive, the lab will conduct the follow-up testing, usually on the same blood sample as the first test.
After you get tested, it’s important for you to find out the result of your test so that you can talk to your health care provider about treatment options if you’re HIV-positive. If you’re HIV-negative, continue to take actions to prevent HIV, like using condoms the right way every time you have sex and taking medicines to prevent HIV if you’re at high risk.

 
#15 Gravida/Para/Abortus(GTPAL)
 
GTPAL system:

Gravidity: number of pregnancies
Term: Term deliveries (38 weeks or more)
Preterm: Preterm deliveries (up to 37 weeks)
Abortus/Miscarriages: Abortion (surgical or miscarriage)
Living: Living Children

 
Other terms:

P: para (number of births of viable offspring)
nulligravida gravida 0: no pregnancies
primigravida gravida 1, G1: 1 pregnancy
secundigravida gravida 2, G2: 2 pregnancies
nullipara para: 0 offspring

 
#16 Women’s health statistics
13.4% of women aged 18 and over are in fair or poor health
19.9% of women aged 18 and over have had four or more drinks in one day at least once in the past year
12.2% of women aged 18 and over currently smoke cigarettes
41.0% of women aged 20 and over are obese
33.6% of women aged 20 and over have hypertension (measured high BP and/or taking antihypertensives)
9.5% aged 65 and under are without health insurance coverage
Leading causes of death: heart disease, cancer (breast, lung, colorectal) (Ovarian Cancer is the leading cause of cancer deaths in women excluding breast cancer), stroke (cardiovascular disease)
 
#17 Pregnancy Statistics
A pregnancy is defined as the time between conception and birth and usually lasts 40 weeks. Nationwide pregnancy numbers and rates are difficult to survey because they also include abortions and miscarriages as pregnancy outcomes. In the United States, the latest figures report some 6.2 million pregnancies for 2010. Of this number, 4 million had a live birth outcome. On the other hand, approximately 1.1 million induced abortions and 1 million miscarriages at all gestational periods were reported.  (https://www.statista.com/topics/1850/pregnancy/)
For some women and their partners this may be a pleasant surprise, but for others the pregnancy may be mistimed or simply unwanted. Of the estimated 211 million pregnancies that occur each year, about 46 million end in induced abortion. Approximately 50 percent

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