Module 3 Flashcards
(146 cards)
1
Q
Alternative medicine definition
A
Medicine or treatments that are used in place of Western or conventional medicines/treatments
2
Q
Complementary medicine
-def
A
-medicine or treatments that are used in conjunction with Western or conventional medicines/treatments
*most patients choose complementary treatments rather than alternative (always exceptions though)
3
Q
Complementary medicine: biologically based therapies
A
-botanical medicines
-Fish oil
-probiotics
-essential oils
4
Q
Complementary medicine: biologically based therapies
-botanical medicines
*need proof of safety or efficacy?
*what do these usually promote?
*when would a product be taken off the market?
*what laws monitor botanical medicines?
A
-no; marketable without proof of safety or efficacy as there is a disclaimer that this product is not indicated for diagnosis, tx, cure, or prevention of disease
-may promote improvement of normal bodily functions or state
-a product must be proven as “unsafe” before it is taken off the market
-Dietary supplement and health education act (1994); united states pharmacopeia (USP)
5
Q
-DSHEA
-USP
A
-the dietary supplement health and education act (1994)
created to ensure the safety of dietary supplements by prohibiting false claims and the sale of adulterated supplements; gives FDA authority to regulate the dietary supplement industry
*limits FDA’s action to taking retroactive action after unsafe products have been sold
-united states pharmacopeia (USP)
*independent, scientific nonprofit organization sets quality standards for dietary supplements and food ingredients
*USP does not enforce its standards, but instead provides them for FDA and other government authorities to use
6
Q
Complementary medicine: mind-body medicine
-types/examples
A
-biofeedback
-tai chi
-hypnosis
-mindful meditation
-guided imagery
-yoga
7
Q
Complementary medicine: biofeedback
-type
-def
-med?
A
-mind-body medicine
-using your thoughts to control some of your bodily responses
-Resperate has been approved by FDA to reduce stress and lower BP
8
Q
Complementary medicine: Tai Chi
-type
-def
A
-mind-body medicine
-ancient Chinese tradition practiced as graceful form of exercise
*a series of movements performed in a slow, focused manner and accompanied by deep breathing
Requires continuous flow from one position to the next (gentle, smooth)
9
Q
Complementary medicine: mindful meditation
-type
-def
A
-mind-body medicine
-centering oneself and taking slow deep breaths, focusing on the moment
10
Q
Complementary medicine: guided imagery
-type
-def
A
-mind-body medicine
-meditation with focus on imagery
11
Q
Complementary medicine: manual medicine
-types
A
-osteopathy
-chiropractic
-massage therapy
-dry needling
12
Q
Complementary medicine: dry needling
-chiropractic care vs osteopathy
A
-chiropractor
*Doctorate of chiropractic degree
*No prescriptions
*more focused sessions
-osteopath
*MD
*Prescriptions
*includes manipulation of joint to treat whole systems of the body
13
Q
Complementary medicine: energy medicine
-types
A
-Reiki
-Therapeutic touch
14
Q
Complementary medicine: Reiki
-type
-def
A
-Energy medicine
-stress reduction and healing; flows through the affected areas and changes them with positive energy
15
Q
Complementary medicine: therapeutic touch
-type
-def
A
-energy medicine
-(developed by RN) hands held 2-6 inches above skin; has specific phases including centering, assessing, intervention, balancing/rebalancing, and evaluation/closure
*has had scientific research upholding positive effects
16
Q
phases of therapeutic touch
A
-centering
-assessing
-intervention
-balancing/rebalancing
-evaluation/closure
17
Q
Complementary medicine: whole systems
-types
A
-traditional Chinese medicine (acupuncture)
-Ayurveda
-homeopathy
18
Q
Complementary medicine: Traditional Chinese medicine
-type
-def
A
-whole systems
-acupuncture
*Meridians (energy pathways) are identified that are blocking the flow of Chi (energy); if pathways are blocked, it creates dis-ease
*Acupuncture points are stimulated with very fine acupuncture needles
*endorphins and enkephalins are released within the brain (functional MRI studies reveal different areas of brain are activated and deactivated during needling)
*used in combination (whole system) treatment along with Tai Chi, massage, and herbal medicines
19
Q
Complementary medicine: Ayurveda
-type
-2 guided main principles
A
-whole body
-the mind and body are inextricably connected; nothing has more power to heal and transform the body than the mind (freedom from illness depends upon expanding our own awareness, bringing it into balance, and then extending that balance to the body
*Deepak Chopra, M.D.
20
Q
Complementary medicine: Ayurveda
-steps
A
- find your body type
- eat a colorful, flavorful diet
- Get abundant restful sleep
- Live in tune with nature
- Exercise: tune into your body
- Strengthen your digestive power
- Take it easy
21
Q
Complementary medicine: Ayurveda
-Finding body type
*types of doshas: Vata
A
-Vata: embodies energy of movement and is often associated with wind and air element
*linked to creativity and flexibility
*governs all movement - flow of breath, pulsation of heart, muscle contractions, tissue movements, cellular, mobility; movement of body
*communication
22
Q
Complementary medicine: Ayurveda
-Finding body type
*types of doshas: pitta
A
-represents the energy of transformation and is therefore closely aligned with the first element
-water is the secondary element
-neither mobile or stable, but spreads
-closely related to intelligence, understanding, and ingestion of foods, thoughts, emotions, and experiences
-governs nutrition and metabolism, body temp, and light of understanding
-governs nutrition and metabolism, body temperature, and light of understanding
23
Q
Complementary medicine: Ayurveda
-Finding body type
*types of doshas: Kapha
A
-lends structure, solidity, and cohesiveness to all things, and it therefore associated primarily with the earth and water elements
-embodies watery energies of love and compassion
Hydrates the cells and systems, lubricates the joints, moisturizes the skin, maintains immunity, and protects the tissues
24
Q
Complementary medicine: Ayurveda
-Finding body type
*types of doshas: Vata
~physical characteristics
A
-usually have thin, light frame, very agile, experience bursts of energy
-dry skin/hair, cold hands/feet
-sleep lightly and have sensitive bowels
-imbalances present with arthritis, IBS, weight loss, restlessness, weakness, and HTN
25
Complementary medicine: Ayurveda
-Finding body type
*types of doshas: Vata
~emotional characteristics
-love excitement/new experiences
-quick temper but also quick to forgive
-creative, flexible, and energetic when balanced
-anxious, worried, and experience insomnia when out of balance
-often blame themselves or ask "what did I do wrong" when out of balance
26
Complementary medicine: Ayurveda
-Finding body type
*types of doshas: pitta
~physical characteristics
-medium build/frame
-sometimes have bright red hair (often balding, thinning)
-excellent digestion and appetite/warm body temperatures
27
Complementary medicine: Ayurveda
-Finding body type
*types of doshas: pitta
~emotional characteristics
-powerful intellect/strong ability to concentrate
-good decision makers/teachers/speakers
-sleep soundly for short periods of time/strong sex drive
-beautiful complexion, lots of energy
28
Complementary medicine: Ayurveda
-Finding body type
*types of doshas: kapha
~physical characteristics
-strong build/excellent stamina
-large soft eyes, smooth skin, thick hair
-sleep soundly, good digestion systems
29
Complementary medicine: Ayurveda
-Finding body type
*types of doshas: kapha
~emotional characteristics
-naturally calm, loving, and thoughtful
-enjoy life and embrace routine
-strong, loyal, patient, steady, and supportive
-change/stubbornness
30
Commonly used herbal medicines:
-saw palmetto
-St John's Wort
-Ginkgo
-Ginseng
-Elderberry
-BPH
-Mild to moderate depression
-enhancing memory and cognitive function and improving circulation
-improving energy, brain function, and regulating blood sugar levels
-colds/flu, COVID 19??
31
Commonly used herbal medicines:
-echinacea
-turmeric
-garlic
-ginger
-peppermint
-soy
-common cold S/S
-rich in curcumin, it has strong anti-inflammatory and antioxidant properties
-HILD, HRN, CV disease
-treatment/prevention of N, pain, and inflammation
-IBS, nausea
-CV disease/osteoporosis
32
Commonly used herbal medicines
-Aloe vera
-feverfew
-milk thistle
-Ashwagandha
-chamomile
-popular for skin care, soothing burns, and aiding digestion
-prevent migraines and relieve arthritis pain
-supports liver health and is often used for detoxifying the body
-adaptogen that helps the body manage stress and boosts mental clarity
-inflammatory diseases
33
Vitamins C,D, and Zinc
-zinc: what system does it help? proven to decrease what? helps to lower what?
-immune function
-replication of common cold virus
-inflammation in the upper respiratory system
34
Magic mushrooms
-type of mushroom
-what kind of effect does it have on the body?
-microdosing
-psychedelic drug
-elevated BP, mild tachycardia, N/V, agitation, confusion, paranoia, fear
-Microdose is 0.1-0.2g (in comparison to 1.0-2.5g); at microdose, can cause mood elevation, increased focus, and increased energy.
35
Bioterrorism: what should we do first? (3 steps)
1. identify
2. report
3. refer
36
Bioterrorism:
-def
-what substances are included in bioterrorism?
-terrorism that utilizes release of biochemical agents
-viruses, bacteria, toxins, or other harmful agents
37
Bioterrorism: how many categories of agents?
3
38
Bioterrorism: high priority agents "A"
-can they be transmitted from person to person?
-high or low mortality rates?
-how it impacts CDC
-yes, easily
-high mortality rates/major public health impact
-requires special action for public health preparedness
39
Bioterrorism: second highest priority agents "B"
-can they be transmitted from person to person? If so, at what ease?
-high or low mortality? high or low morbidity?
-how it impacts CDC
-moderate ease of transmission
-moderate morbidity but low mortality rates
-requires surveillance of the disease(s) by the CDC
40
Bioterrorism: third highest priority agents "C"
-can they be transmitted from person to person? If so, at what ease?
-high or low mortality? high or low morbidity?
-can be mass produced easily
-potential for high morbidity and mortality
41
Bioterrorism: examples of category A
-Anthrax
-Botulism
-Plague
-Smallpox
-Tularemia
-Viral hemorrhagic fevers (VHF)
42
Bioterrorism: examples of category B agents?
-brucellosis
-Epsilon toxin of clostridium perfrigens
-food safety threats
-Ricin toxin
-viral encephalitis
-water safety threats (Vibrio cholesa, cryptosporidium parvum)
43
Bioterrorism: examples of category C agents?
-Hanta virus (cotton rat, deer mouse, rice rat, white footed mouse)
-Nipah virus (NIV infections) (pigs, flying fox bat; Malyasia/Singapore)
44
Bioterrorism: Anthrax
-what category?
-what kind of precautions?
-can this be transmitted to humans?
-how can this enter human's body? (by means of...?)
-category A
-droplet
-yes, animal to human (zoonotic disease)
-inhaled, ingested, topical
45
Bioterrorism: Anthrax
-cutaneous anthrax
*how is this transmitted?
*host does it get into the body?
*most common places this is found?
*likely source of bioterrorism?
*high or low dose required for illness?
-contaminated animal to humans
-spores/bacterium enter body through open wound, sore, or abrasion
*most often through contaminated hide
-Africa, Asia (uncommon in US)
-not likely source of bioterrorism
-requires high dose of anthrax exposure to cause illness
46
What is the most common type of anthrax?
cutaneous anthrax
47
Bioterrorism: gastrointestinal anthrax
-where is this found (countries)?
-can this be a likely method of bioterrorism?
-what are spores resistant to?
-what percent mortality rate? and how fast?
-sx
-Africa/Asia, undercooked meats
-Has been utilized as weapon by several countries already
-spores are resistant to heat and disinfectants
*can be mass produced quickly/low cost
-80% mortality rate; almost half of all deaths occur within 24-48 hours
-first sx: large number of cases in a focused area: acute flu-like sx followed by brief period of improvement
*severe resp distress, dyspnea, diaphoresis, stridor, and cyanosis; widened mediastinum with pleural effusions (no infiltrates)
48
Bioterrorism: inhalation anthrax
-treatment (med - first and second line)
-treatment (timeline)
-what treatment is used in pediatrics
-is there a vaccine?
-Ciprofloxacin = first line!
*levaquin (levofloxacin) is considered second line agent in ages 18 years and older
*doxycycline if allergic to cipro or levaquin
-post exposure treatment should last for 60 days at least (longer if sx warrant)
-penicillin for peds IF anthrax strain is sensitive
-vaccination should be given prior to exposure (not routinely given in US; military personnel receive this vaccine - 5 series injections (post exposure 3 series injections)
49
Types of anthrax?
Cutaneous
GI
Inhalation
50
Plague
-how does it spread?
-what type of plague is most common?
-progression of plague
-infected fleas that bite; artificial aerosols
-bubonic plague
-bubonic --> septicemia plague --> pneumonic plague --> transferable between humans
51
Plague: pneumonic plague
-human to human transmission?
-does this plague progress slowly or quickly?
-does pneumonic plague always result from bubonic plague?
-yes! now risks escalate for human to human transmission
-quickly - results in death within a few days
-can be primary and not a results of bubonic plague
52
Plague:
-what category?
-sx
-incubation
-category A
-high fever, HA, malaise, fatigue, adenopathy (cervical, axillary, or inguinal)
*inguinal nodes are the MOST common sx of plague
*diagnosed through lymph node aspiration, sputum, blood, or CSF
-2-6 days
53
Plague:
-how is it diagnosed?
-inguinal nodes are the MOST common sx of plague
-diagnosed through lymph node aspiration, sputum, blood, or CSF
54
Plague: TX
-first and second line
-course of treatment (acute vs post exposure)
-what kind of precautions?
-Doxycycline is first line; Ciprofloxacin is second line
-10 day treatment for acute, 7 day treatment for post exposure
-drainage and secretion
55
Smallpox
-what category?
-what virus is responsible?
-how does it spread?
-when was it eradicated?
-when does this virus shed?
-category A
-Variola virus
-spreads through respiratory, saliva, and other direct contact
-1980 worldwide; 1949 in US
-variola virus sheds during days 10-14 (unlike other viruses)
56
Smallpox:
-When does this virus shed?
-Incubation?
-Who gets vaccinated?
-days 10-14 (unlike other viruses)
-1-4 days
-Military personnel
57
Smallpox:
-phases
-prodrome
-acute
58
Smallpox: prodrome
-sx
-abrupt onset of fever 101-105 degrees AND at least 1 of the following:
*prostration
*severe (splitting) headache (90%)*****
*backache (90%)*****
*chills (60%)*****
*vomiting
*Delirium
*abdominal colic
*diarrhea
*convulsions
59
Smallpox: Acute phase
-onset of sx occurs how many hours prior to appearance of rash?
-what does rash look like and where does it tend to be located?
-what does it mean if patient has dense rash?
-onset approx 24 hours prior to rash appearance
-tiny red spots (enanthem) on tongue and soft palate; herald spots; proximal extremities/trunk, then whole body rash!
*Centrifugal (circular) distribution
*small deep seated well circumscribed vesicles that later become umbilicated
-the denser the rash, the worse the prognosis (lesions are always thicker on face and extremities than trunk)
60
Smallpox: treatment
-vaccine (live vaccine) is best hope!
*two prolonged bifurcated needles dipped in vaccinia virus; keep site dry and covered; not able to touch site with bare hands or have clothing touch it
-current antivirals have not been tested for treatment; Cidofovir (Vistide) has been used to treat human smallpox in animals
-supportive care
61
Smallpox: when is patient no longer contagious?
not until scabs drop off completely - so about 3 weeks (21 days)
62
Monkeypox:
-category of Bioterrorism
-sx
-category A
-rash located on or near the genitals (penis, testicles, labia, vagina) and anus; other areas: hands, feet, chest, face, or mouth
-rash will go away through several stages before healing
-rash can look like pimples or blisters initially but may be painful or itchy
-other sx: fever, chills, swollen lymph nodes, exhaustion, muscle aches, backaches, HA, resp sx
63
Monkeypox:
-duration
-sx usually start within 3 weeks of exposure to the virus
*pts with flu-like sx usually develop rash 1-4 days later
64
Monkeypox:
-when is patient contagious?
-how long does illness last?
-from the first flu-like sx until rash has healed, all scabs have fallen off, and fresh layer of skin formed (illness typically lasts 2-4 weeks)
65
Viral hemorrhagic fever (VHF) --> Ebola
-prevention
-treatment
-prevent transmission by keeping rodents out, keep rooms/homes clean and free of droppings/fleas
*vaccine (VSV-EBOV)
-supportive care, vaccine
66
Viral hemorrhagic fevers (VHF)
-how long can it take after exposure to develop symptoms?
-how is Ebola passed?
-21 days
-through body fluids
67
Ricin toxin
-category
-how is this made?
-sx of oral ingestion
-sx of inhaled ingestion
-tx
-B agents
-protein extract from castor pallet bean (byproduct from castor oil production) can be made into aerosol (powder or liquid form)
-abd pain, emesis, GI bleed, hypotension, tachycardia, and organ failure
-rapid onset of chest pain, fever, dyspnea and cough
*pulmonary edema and respiratory distress may develop --> leads to death
-supportive treatment
68
Hanta Virus
-how is it spread?
-where is most of the positive population located?
-cotton rat, deer mouse, rice rat, white footed mouse
-96% West of Mississippi
69
Nipah Virus (NiV infections)
-common locations
-how is this spread?
-how long is onset after exposure?
-tx
-Malaysia/Singapore
-pigs; flying fox bat; human to human transmission
-5-14 days --> encephalitis
-supportive tx
70
Human Trafficking:
-def
-difference in definition when under age 18 and over age 18
-types of trafficking
-recruitment, harboring, transportation, provisioning or obtaining of a person by means of force, fraud or coercion for the purposes of labor or services or sexual exploitation
-exploitation = <18yrs; sexual services >18yrs
-sex, child soldiering, baby trafficking, labor, organ harvesting
71
Human Trafficking:
-why is it so profitable?
-who are the traffickers?
-people can be sold over and over again
-individuals, families, organized criminal groups (most likely) - local or international gangs, violence and crime interwoven
72
Human Trafficking:
-how does internet and social media help traffickers?
-forms of sex trafficking
-forms of labor trafficking
-target victims, locate buyers, coordinate activities, evade police/arrest
-prostitution, pornography, phone sex, strippers/live sex shows, truck stops, mail order brides
-underground, wage violations, domestic, service industry, small businesses, agricultural (huge!), door to door sales, panhandling
73
Human Trafficking: labor trafficking
-def
-difference between labor trafficking and labor exploitation
-recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud or coercion, for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery
-both have unfair wages, theft of wages (employee not receiving their full pay), and poor living conditions
*exploited labor is able to leave and has freedom of movement
*trafficked laborer is forced to work in order to live
74
Human Trafficking:
-def of child soldiering
-Any person under 18yrs of age who takes a direct part in hostilities as a member of governmental armed forces, police, or other security forces
-Any person under 18 years of age who has been compulsorily recruited into governmental armed forces, police, or other security forces
-Any person under 15 years of age who has been voluntarily recruited into governmental armed forces, police, or other security forces
-Any person under 18 years of age who has been recruited or used in hostilities by armed forces distinct form the armed forces of a state
-The term “child soldier” includes any person descried in clauses II, III, IV who is serving in any capacity, including in a support role such as a cook, porter messenger medic guard
75
Human Trafficking:
-when is it defined as human trafficking?
-forced
-fraudulent
-coerced
-not associated with known/respected school/organization
76
Human Trafficking:
-sex trafficking definition
-the recruitment, harboring, transportation, provision, or obtaining of a person for a commercial sex act in which a commercial sex act is induced by force, fraud, or coercion, or in which a person induced to perform such an act has not attained 18 years of age
77
Human Trafficking:
-at what age are people most vulnerable to take part in domestic minor sex trafficking?
ages 11-14
78
Human Trafficking: hotel worker awareness
-things to observe regarding sex trafficking
-pays for room in cash or with pre-paid card
-hourly stay or extended stay with few possessions
-requests room overlooking parking lot
-excessive foot traffic in/out of hotel
-frequently requests new linens, towels, restocking of fridge
-exhibits fearful, anxious, submissive behavior (requests info on local sex industry)
79
Human Trafficking: hotel worker awareness
-sex or labor trafficking
-no control of money, cell phone, or ID
-restricted or controlled communications
-no knowledge of current or past whereabouts
-signs of poor hygiene, malnourishment, fatigue
-no freedom of movement, constantly monitored
-presence of excessive drugs, alcohol, sex paraphernalia
80
Human Trafficking: hotel worker awareness
-labor trafficking
-prevented from taking adequate breaks
-doing different work than was contracted
-living and working on-site
-forced to meet daily quotas
-exorbitant fees deducted from paychecks
-not paid directly or forced to turn over wages
-number of guests in hotel room exceeds its occupancy
81
Human Trafficking:
-where are potential victims targeted?
-mall/shopping center, group homes, arcades or other play areas, homeless shelters, local parks
-"Kindly woman" requesting assistance
-"Romeo" offer compliments, gifts, attention
-online dating sites, chat rooms, Facebook, Snapchat, social media
-false advertising - modeling, offers of a job, educational opportunities/travel, meeting others, marriage
-sold: by family, boyfriends, other relatives
-abduction
82
Human Trafficking: why do they stay?
-physical violence, beatings, rape, torture, starvation, forced drug use (dependent on drugs)
-traumatic bondings: perpetrator creates fear but also gratitude form the victim for allowing them to live
-coercion
83
Human Trafficking: trauma bonding
-similar to what syndrome?
-def
"Stockholm Syndrome"
-Stockholm syndrome: a bond that develops between victim and abuser
*emotional connection is reciprocal, with both the victim and abuser developing emotional bond
*often associated with shorter-term hostage situations or situations involving power imbalance
*the power imbalance is more externally imposed due to physical captivity
*more of a primitive feeling toward captor (primitive gratitude for food; unable to speak or go to the toilet without permission)
-Trauma bonding: bone that develops between victim and abuser
*the victim is emotionally attached to abuser, but the abuser doesn't reciprocate the feelings
*occurs in context of ongoing abuse or mistreatment in a relationship
*power imbalance is usually one-sided
84
Human Trafficking: as a medical professional, red flags?
-lack of legal identification
-no idea of last medical exam
-pays with cash
-"just visiting" but cannot tell you where they are staying
-numerous inconsistencies to story
-another person accompanies patient to "speak for them"
-exhibits paranoia, fear, anxiety, and/or hypervigilance
-loss of time/space, avoids eye contact, not in control of own money
85
Human Trafficking: differential diagnoses
-domestic violence
-addiction (alcohol/drugs)
-homelessness
-rape (once or recurrent)
-sexual abuse (once or recurrent)
-elder abuse
-illegal immigrant status without trafficking
-lack of insurance/knowledge/healthcare disparities
86
Human Trafficking: DO NOT...
1. confront patient in a hostile/accusatory manner
2. confront the 'handler' or trafficker/person with the patient
3. follow or otherwise interfere in the situation as it puts everyone at risk
87
LGBTQ:
-culture def
-what kinds of things can by impacted by a patient's culture?
-the blending of knowledge, experiences, behaviors, and beliefs
*integrated pattern of human behavior that includes the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, political, geographic, or social groups
-can identify with many different cultures
-health, health care decisions, attitudes toward health care providers
88
LGBTQ:
-cultural competence def
The capacity of an individual or an organization to be respectful of, and responsive to, the cultural and linguistic beliefs, behaviors, practices, and needs of diverse patients and their communities
89
LGBTQ:
-diversity def
A mix of individuals who have both differences and similarities due to many factors, including, but not limited to: age, gender, sexual orientation, race, religion, socioeconomic status, geography, etc.
90
LGBTQ:
-health disparity def
A difference or gap in health outcomes between populations that is linked to social, economic, and/or environmental disadvantage
91
LGBTQ:
-types of diversity within a subculture
-gender and sexual minority population
-ethnic
-racial
-cultural
-income
-education
-location: urban versus suburban vs rural
92
LGBTQ:
-LGBTQ def
usually refers to lesbian, gay, bisexual, transgender and questioning/queer people
-may be used to represent all gender or sexual minorities such as asexual or intersexual subgroups
-in some cases, the letter ! (in the LGBTQ community) can be "queer" or "questioning," as a reference to someone who is exploring their sexuality or gender identigy
93
LGBTQ:
-bisexual def
-asexual def
-homosexual def
-attracted to a person of same genders/partners
-not attracted to either gender; often these patients do not identify as a gender either
-attracted to a person of same gender
94
LGBTQ:
-intersex def
-lesbian def
-pansexual def
-neither male or female; having sexual organs (two or more) that are both genders (at birth)
-women attracted to women
-attracted to any gender, any sexual orientation
95
LGBTQ:
-transgender def
-gender fluid def
-identifies with a gender that is not the one assigned at birth
*may identify as heterosexual, homosexual, bisexual, or asexual
*transgender male - assigned female at birth - identifies as male (with or without surgery)
*transgender female - assigned male at birth - identifies as female (with or without surgery)
-neither male or female; flowing between male and female depending on the day
96
LGBTQ:
-non-binary def
-questioning def
-cisgendered def
-a term that encompasses all genders that are not binary
-uncertain of gender and or sexual orientation
-identifies with the gender assigned at birth
97
LGBTQ: health disparities
*higher risk of _______ disease, especially in what population?
-pre-existing barriers/disparities
-childhood physical abuse in the hone
-childhood sexual abuse
-substance abuse including ETOH and tobacco abuse
-higher risk for STIs
RISK for sexual assault
*higher risk for cardiovascular disease, especially in minority women
98
LGBTQ: what diseases/tendencies does this community have higher risk of developing?
-cardiovascular disease (esp in minority women)
-addiction (ETOH, tobacco, prescription and illicit drugs)
99
LGBTQ: Lesbians
-increased risk for:
-heart disease - obesity/sedentary lifestyle/co-morbidities such as HTN/DM2
-cancers - less likely to have well-womens exams; pap smears/mammograms; inc risk for HPV
-obesity
-injury/violence: family members, bullying, IPV
-mental health: inc risk of MDD, PTSD, phobias; women who are "out" experience more suicidal ideations; women who are not "out" are 2.5 times more likely to attempt suicide
-substance abuse
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LGBTQ: homosexual men
-increased risk for...
-heart disease: exacerbated by tobacco use and ETOH abuse
-cancers: prostate, testicular, colon cancer; HPV (inc risk in receptive anal intercourse)
-injury/violence: criminal violence and IPV
-body image: altered perception with associated eating disorders - much higher compared to heterosexual males
*depression and anxiety at disproportionate rates compared to hetero; early screening and tx necessary
*suicide: verbal/physical harassment, estrangement from family, substance abuse, negative experiences in 'coming out', all inc risk for suicide
*substance abuse: rate or ETOH, tobacco use, illicit drug use higher in gay men compared to hetero; influenced by age, affiliation with gay culture, level of stress, how 'out' someone is
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LGBTQ:
-HIV/AIDs incidence
*MSM
*race
-syphilis, gonorrhea, chlamydia, genital/anal warts (HPV), pubic lice
*where are escalated cases recently?
*which hepatitis' are of concern for contraction?
-4% of males population in US; 44% of new HIV infections every year
-African American MSM 2x as likely to be diagnosed with HIV/AIDS
-large cities (NY, San Fran, Chicago, Miami, Seattle, Southern California)
-hep A, B, C (mainly B and C)
102
LGBTQ: bisexual women
-more likely to use what when having sex?
-more likely to report what?
-ETOH/Drugs
-higher number of partners, vaginal infections (BV, HSV, trich)
103
LGBTQ: bisexual men
-less likely to participate in what?
-more likely to participate in what?
-may high higher incidence of what?
-anal sex/receptive sex
-anal sex with women and utilize female prostitutes
-mental health/substance abuse - close to slightly more than LGQ group
104
LGBTQ: healthcare disparities
-access to care
-less likely to have health insurance
-less likely to fill prescriptions
-more likely to use the ER or delay getting care
-more likely to be refused health care services and be harassed by health care providers
105
LGBTQ: healthcare disparities
-why do we have disparities?
-LGBT people are minority
-lack of specific education and training for health care workers
-lack of clinical research on LGBT health-related issues
-restrictive health benefits
-limited role models
-fear due to stigma, discrimination, institutional bias in the health care system
106
LGBTQ:
-how much more likely are LGBT youth likely to attempt suicide?
-more or less likely to be homeless?
-lesbians are more or less likely to get preventative services for cancer?
-are gay or straight men at higher risk for HIV and other STDs
-does race play a role in increasing risk for certain STDs/HIV?
-2 to 3
-more
-less
-gay
-yes, young communities of color
107
LGBTQ:
-what do Lesbians and bisexual females have in common?
-transgenders
*insurance
*HIV/STD incidence
-what culture of LGBT individuals face additional health barriers?
-what does the LGBT population have the highest rates of?
-they are both more likely to be overweight or obese
-less likely to have health insurance
-more likely to have HIV/STD
-Elderly LGBT
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what bacteria causes the bubonic plague?
Yersinia pestis (Y pestis)
109
what carries the bubonic plague?
rodents and their fleas
110
can people spread the bubonic plague?
-yes, once infected - people spread disease with close contact
111
what bacteria cause pneumonic plague?
-Y pestis
112
what bacteria causes bubonic plague and pneumonic plague? same bacteria or different bacteria?
same bacteria - Y pestis
113
Pneumonic plague
-is this spread from animal/fleas to person or person to person?
-how disease spread?
-sx
-person to person
-transmitted when person breathes in Y pestis particles in the air - DROPLET
-NO BUBOES; fever, weakness, rapidly developing pneumonia with SOB, chest pain, cough, sometimes bloody or watery sputum; nausea, vomiting, abd pain
114
Pneumonic plague
-without early treatment, what can happen?
-resp failure, shock, and rapid death
115
Pneumonic plague:
-if treated in certain window for certain length of time, patient can avoid becoming sick with illness
-what abx are suggested (oral, IV)
-when does onset of sx usually occur?
-can treat within 7 days exposure for 7 days antibiotics; abx should be given w/i 24 hours of first sx
-oral: tetracycline (doxycycline) or fluoroquinolone (ciprofloxacin); IV: streptomycin or gentamycin
-1-6 days after exposure
116
Pneumonic plague:
-how is it diagnosed?
-bloodwork, sputum, lymph node aspirate
*results take about 2 hours; confirmation will take longer (24-48 hours)
117
Bubonic plague:
-can this be transmitted person to person?
-how is this disease transmitted?
-sx
-what occurs if left untreated?
-yes
-bite of infected flea or exposure to infected material through a break in the skin
-swollen, tender lymph glands = boboes
-if left untreated, bacteria can spread through bloodstream and infect lungs, causing secondary case of pneumonic plague
118
-how is smallpox transmitted?
-what is more infectious? scab or respiratory secretions?
-when is patient infectious?
-inhalation of large virus-containing airborne droplets of saliva from infected person --> infectious virus particles are released from sloughing off of oropharyngeal lesions
-respiratory secretions are more infectious
119
Smallpox:
-when is the most infectious time period?
-R/F
-how many types?
-from the time of first oropharyngeal lesions appear, throughout course of disease, until last scab falls off body
-prolonged, close contact with infectious smallpox patient
-4 main chains
120
Smallpox:
-what are the four main chains?
1. Ordinary smallpox (Variola Major)
2. Modified-type smallpox (mild and occurring in previously vaccinated persons)
3. Flat-type (malignant) smallpox
4. Hemorrhagic smallpox
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Smallpox: Ordinary smallpox
-incubation period
-prodrome
*sx
*how long does this phase last?
-eruptive stage
*def
*progression of rash
-10-14 days (7-19d): no sx, not contagious
-fever, malaise, prostration, HA, backache, vomiting, severe abd pain, chills, anorexia, pharyngitis
*lasts about 4 days
-as fever subsites, rash lesions develop
*first in oropharynx, then face, then extremities, leading to trunk, palms, soles
*lesions develop uniformly throughout disease and process from macules to papules to vesicles in 4-5 days (vesicles umbilicate and evolve to pustules that are round, tense, firm, deep-seated within dermis); crusting and scabbing typically begins by ninth day, crusts slough off around 14 days after rash onset
122
Smallpox: Sequelae
-def
-where does scarring occur worst?
-pockmarks and scarring are most common sequelae; consequence of virus-mediated necrosis and destruction of sebaceous glands
-most profuse on face (highest concentration of sebaceous glands)
123
Smallpox:
-immunity?
-gives patients prolonged immunity to re-infection with variola virus; virus does not persist in body after recovery
124
Smallpox: Modified-type smallpox
-who does this occur in?
-prodrome sx
-is this a slowly or quickly evolving disease? explain timeline.
-previously vaccinated individuals
-HA, backache, fever; may last as long as ordinary type; fewer, more superficial lesions; do not tend to have fever during evolution of rash
-quickly evolving - crusting of skin lesions within 10 days as opposed to 14 days (with ordinary smallpox)
125
Smallpox: flat-type (malignant) smallpox
-common or rare?
-what is this characterized by?
-appearance of lesions suggests what?
-fatal or survive?
-protected by?
-rare
-intense toxemia; skin lesions develop slowly, merge together, and remain flat and soft (velvety to touch) --> never progress to pustular stage
*occurs more frequently in children
-appearance of lesions suggests a deficient cellular immune response to variola virus
-majority of cases are fatal
*if survive, lesions gradually disappear without forming scabs
-prior vaccination appears to protect against flat-type smallpox
126
Smallpox: hemorrhagic smallpox
-more common in children or adults?
-vaccination protective?
-characteristics
-when does death tend to occur?
-adults; pregnant women appear to be more susceptible
-prior vaccination not protective
-shorter incubation period; more severe prodroma sx: high fever, severe HA, abd pain; development of dusky erythmea after illness onset followed by petechiae and skin/mucosal hemorrhages
-death usually occurs by 5th or 6th day of rash, often before characteristic smallpox lesions develop
*death results from significant toxemia, leading to multi-organ failure
127
Smallpox:
-infection control
-differential dx
-dx
-tx
-airborne infection isolation room (AIIR); notify infection control dept.
*wear standard, airborne, and contact precautions
-monkeypox (monkeypox causes swelling in lymph nodes, smallpox does not)
-lab diagnostic testing for variola virus: PCR identification of variola DNA
-no proven tx of smallpox; supportive care, vaccine
128
Acute Radiation Syndrome:
-who does this occur in?
-occurs in patients exposed to radiation in high dose
*radiation was able tor each internal organs (penetrating); the person's entire body (or most of it) received the dose; the radiation was received in a short time, usually within min.
129
Acute Radiation Syndrome:
-sx
-start min to days after exposure and can last min up to several days, may come and go
-after initial sx, pts usually look and feel healthy for period of time; but become sick again with variable sx and severity depending on radiation dose that he or she received
130
Acute Radiation Syndrome:
-tx
focuses on reducing and treating infections, maintaining hydration, and treating injuries and burns
-the lower the radiation dose, the more likely it is that person will recover from ARS
131
Acute Radiation Syndrome:
-what is the usual cause of death?
-how long is the recovery process for survivors?
-syndromes associated with ARS?
-destruction of person's bone marrow, which results in infections and internal bleeding
-recovery process may last from several weeks up to 2 years
-bone marrow syndrome, GI syndrome, cardiovascular/CNS syndrome
132
Acute Radiation Syndrome:
-what are the stages of ARS?
1. prodromal stage
2. latent stage
3. Manifest illness stage
4. recovery or death
133
Acute Radiation Syndrome: cutaneous radiation syndrome
-when does this occur?
-what does it cause?
-when does MD suspect this?
-with exposure to a large dose of radiation
-causes injury to skin
-when skin burn develops in person who was hot exposed to a source of heat, electrical current, or chemicals
134
Acute Radiation Syndrome:
-skin damage? when would this occur?
-sx
-how long for complete skin healing?
-yes; few hours after exposure
-swelling, itching, redness of skin (like a bad sunburn); can also be hair loss
-skin may heal for short time; followed by return of swelling, itching, redness days or weeks later
-complete healing: may take several weeks to few years depending on the radiation dose the person's skin received
135
Norovirus:
-def
-typical sx
-when do sx typically appear after exposure?
-group of non-enveloped, single stranded RNA viruses that cause acute gastroenteritis; belong to family calciviricae that includes sapoviruses, which cause acute gastritis
-acute-onset of vomiting, water, non-bloody diarrhea with abdominal cramps
-24-48 hours after exposure
136
Norovirus:
-how contagious?
-vaccine?
-VERY contagious
-no
137
Care for the Poisoned Patient: activated charcoal
-absorbs or adsorbs?
-how the activated charcoal functions?
-how does charcoal-drug complex leave the body?
-adsorbs
-adsorbs drugs or toxins in the gut and it can also interrupt their enterohepatic and enteroenteric recirculation
-excreted in stool, absorbed by macrophages, or dissociated slowly enough so drug does not cause harm
138
Care for the Poisoned Patient:
-what drugs/chemicals cannot be adsorbed by activated charcoal?
-acids, alkalis, alcohols, iron, and lithium
139
what is the recommended tx for poisoned patients?
activated charcoal
140
when is the best time/most effective time to give activated charcoal?
-<1hr prior was ingestion
141
Care for the Poisoned Patient: activated charcoal
-contraindications
-ingestion of non-toxic dose
-ingestion of drug or toxin not absorbed by activated charcoal (alcohols, acids, alkalis, iron, lithium, foreign body)
-Ingestion that occurred more than 1 hr before arrival
-lack of a normal, functioning GI tract
-there is or may be risk for aspiration
-patient who is not fully conscious or whose level of consciousness may become impaired
-endoscopic procedure may be needed
142
Care for the Poisoned Patient: activated charcoal
-adverse effects
-most common: vomiting
*increases risk for aspiration; may develop adult resp distress syndrome (ARDS) and pneumonitis
*serious resp complications caused by activated charcoal are uncommon
-abdominal pain, constipation, diarrhea, nausea
143
Care for the Poisoned Patient: activated charcoal
-dose
-mixing? impact on potency?
-multi-dose?
-10:1 ration of activated charcoal to drug
-yes, can be mixed; decreases absorptive strength
-can utilize multidose; no proof of clinical benefit
*can be helpful in extended release medications or extremely high doses of med/substance
144
Care for the Poisoned Patient: Antidotes
-do pit vipers (rattlesnakes) or copperhead snacks require antidote treatment?
-pit vipers require.
145
-what has replaced crotanilae as the antidotes?
-name of snake venom
-Crotadlidae polyvalent immune (FAB) (CroFab) antibenom
146
when should antivenom be given to patients who are symptomatice?
-envenomation by a pit viper (pain, swelling, coagulopathies, hypotension, and neurologic signs/symptoms
*CroFab contraindicated in persons with sensitivity to sheep or sheep products or papayas or papain
