Nursethink® for Students NCLEX-RN Conceptual Review Guide
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Update on Challenging Disorders of Pigmentation in Skin of Color Heather Woolery-Lloyd, M.D
Update on Challenging Disorders of Pigmentation in Skin of Color Heather Woolery-Lloyd, M.D. Director of Ethnic Skin Care Voluntary Assistant Professor Miller/University of Miami School of Medicine Department of Dermatology and Cutaneous Surgery What Determines Skin Color? What Determines Skin Color? No significant difference in the number of melanocytes between the races 2000 epidermal melanocytes/mm2 on head and forearm 1000 epidermal melanocytes/mm2 on the rest of the body differences present at birth Jimbow K, Quevedo WC, Prota G, Fitzpatrick TB (1999) Biology of melanocytes. In I. M. Freedberg, A.Z. Eisen, K. Wolff,K.F. Austen, L.A. Goldsmith, S. I. Katz, T. B. Fitzpatrick (Eds.), Dermatology in General Medicine 5th ed., pp192-220, New York, NY: McGraw Hill Melanosomes in Black and White Skin Black White Szabo G, Gerald AB, Pathak MA, Fitzpatrick TB. Nature1969;222:1081-1082 Jimbow K, Quevedo WC, Prota G, Fitzpatrick TB (1999) Biology of melanocytes. In I. M. Freedberg, A.Z. Eisen, K. Wolff, K.F. Austen, L.A. Goldsmith, S. I. Katz, T. B. Fitzpatrick (Eds.), Dermatology in General Medicine 5th ed., pp192- 220, New York, NY: McGraw Hill Role of Melanin-Advantages Melanin absorbs and scatters energy from UV and visible light to protect epidermal cells from UV damage Disadvantages Inflammation or injury to the skin is almost immediately accompanied by alteration in pigmentation Hyperpigmentation Hypopigmentation Dyschromias Post-Inflammatory hyperpigmentation Acne Melasma Lichen Planus Pigmentosus Progressive Macular Hypomelanosis -
Melasma (1 of 8)
Melasma (1 of 8) 1 Patient presents w/ symmetric hyperpigmented macules, which can be confl uent or punctate suggestive of melasma 2 DIAGNOSIS No ALTERNATIVE Does clinical presentation DIAGNOSIS confirm melasma? Yes A Non-pharmacological therapy • Patient education • Camoufl age make-up • Sunscreen B Pharmacological therapy Monotherapy • Hydroquinone or • Tretinoin TREATMENT Responding to No treatment? See next page Yes Continue treatment © MIMSas required Not all products are available or approved for above use in all countries. Specifi c prescribing information may be found in the latest MIMS. B94 © MIMS 2019 Melasma (2 of 8) Patient unresponsive to initial therapy MELASMA A Non-pharmacological therapy • Patient education • Camoufl age make-up • Sunscreen B Pharmacological therapy Dual Combination erapy • Hydroquinone plus • Tretinoin or • Azelaic acid Responding to Yes Continue treatment treatment? as required No A Non-pharmacological therapy • Patient education • Camoufl age make-up • Sunscreen • Laser therapy • Dermabrasion B Pharmacological therapy Triple Combination erapy • Hydroquinone plus • Tretinoin plus • Topical steroid Chemical peels 1 MELASMA • Acquired hyperpigmentary skin disorder characterized by irregular light to dark brown macules occurring in the sun-exposed areas of the face, neck & arms - Occurs most commonly w/ pregnancy (chloasma) & w/ the use of contraceptive pills - Other factors implicated in the etiopathogenesis are photosensitizing medications, genetic factors, mild ovarian or thyroid dysfunction, & certain cosmetics • Most commonly aff ects Fitzpatrick skin phototypes III & IV • More common in women than in men • Rare before puberty & common in women during their reproductive years • Solar & ©ultraviolet exposure is the mostMIMS important factor in its development Not all products are available or approved for above use in all countries. -
The Key to Increasing Breastfeeding Duration: Empowering the Healthcare Team
The Key to Increasing Breastfeeding Duration: Empowering the Healthcare Team By Kathryn A. Spiegel A Master’s Paper submitted to the faculty of the University of North Carolina at Chapel Hill In partial fulfillment of the requirements for the degree of Master of Public Health in the Public Health Leadership Program. Chapel Hill 2009 ___________________________ Advisor signature/printed name ________________________________ Second Reader Signature/printed name ________________________________ Date The Key to Increasing Breastfeeding Duration 2 Abstract Experts and scientists agree that human milk is the best nutrition for human babies, but are healthcare professionals (HCPs) seizing the opportunity to promote, protect, and support breastfeeding? Not only are HCPs influential to the breastfeeding dyad, they hold a responsibility to perform evidence-based interventions to lengthen the duration of breastfeeding due to the extensive health benefits for mother and baby. This paper examines current HCPs‘ education, practices, attitudes, and extraneous factors to surface any potential contributing factors that shed light on necessary actions. Recommendations to empower HCPs to provide consistent, evidence-based care for the breastfeeding dyad include: standardized curriculum in medical/nursing school, continued education for maternity and non-maternity settings, emphasis on skin-to-skin, enforcement of evidence-based policies, implementation of ‗Baby-Friendly USA‘ interventions, and development of peer support networks. Requisite resources such as lactation consultants as well as appropriate medication and breastfeeding clinical management references aid HCPs in providing best practices to increase breastfeeding duration. The Key to Increasing Breastfeeding Duration 3 The key to increasing breastfeeding duration: Empowering the healthcare team During the colonial era, mothers breastfed through their infants‘ second summer. -
Breastfeeding Management in Primary Care-FINAL-Part 2.Pptx
Breastfeeding Management in Primary Care Pt 2 Heggie, Licari, Turner May 25 '17 5/15/17 Case 3 – Sore nipples • G3P3 mom with sore nipples, baby 5 days old, full term, Breaseeding Management in yellow stools, output normal per BF log, 5 % wt loss. Primary Care - Part 2 • Mother exam: both nipples with erythema, cracked and scabbed at p, areola mildly swollen, breasts engorged and moderately tender, mild diffuse erythema, no mass. • Baby exam: strong but “chompy” suck, thick ght frenulum aached to p of tongue, with restricted tongue movement- poor lateral tracking, unable to extend tongue past gum line or lower lip, minimal tongue elevaon. May 25, 2017, Duluth, MN • Breaseeding observaon: Baby has deep latch, mom Pamela Heggie MD, IBCLC, FAAP, FABM Addie Licari, MD, FAAFP with good posioning, swallows heard and also Lorraine Turner, MD, ABIHM intermient clicking. Mom reports pain during feeding. Sore cracked nipple Type 1 - Ankyloglossia Sore Nipples § “Normal” nipple soreness is very minimal and ok only if: ü Poor latch § Nipple “tugging” brief (< 30 sec) with latch-on then resolves ü LATCH, LATCH, LATCH § No pain throughout feeding or in between feeds ü Skin breakdown/cracks-staph colonizaon § No skin damage ü Engorgement § Some women are told “the latch looks ok”… but they are in pain and curling their toes ü Trauma from pumping ü § It doesn’t maer how it “looks” … if mom is uncomfortable Nipple Shields it’s a problem and baby not geng much milk…set up for low ü Vasospasm milk supply ü Blocked nipple pore/Nipple bleb § Nipple pain is -
Frequency of Different Types of Facial Melanoses Referring to the Department of Dermatology and Venereology, Nepal Medical Colle
Amatya et al. BMC Dermatology (2020) 20:4 https://doi.org/10.1186/s12895-020-00100-3 RESEARCH ARTICLE Open Access Frequency of different types of facial melanoses referring to the Department of Dermatology and Venereology, Nepal Medical College and Teaching Hospital in 2019, and assessment of their effect on health-related quality of life Bibush Amatya* , Anil Kumar Jha and Shristi Shrestha Abstract Background: Abnormalities of facial pigmentation, or facial melanoses, are a common presenting complaint in Nepal and are the result of a diverse range of conditions. Objectives: The objective of this study was to determine the frequency, underlying cause and impact on quality of life of facial pigmentary disorders among patients visiting the Department of Dermatology and Venereology, Nepal Medical College and Teaching Hospital (NMCTH) over the course of one year. Methods: This was a cross-sectional study conducted at the Department of Dermatology and Venereology, NMCT H. We recruited patients with facial melanoses above 16 years of age who presented to the outpatient department. Clinical and demographic data were collected and all the enrolled participants completed the validated Nepali version of the Dermatology Life Quality Index (DLQI). Results: Between January 5, 2019 to January 4, 2020, a total of 485 patients were recruited in the study. The most common diagnoses were melasma (166 patients) and post acne hyperpigmentation (71 patients). Quality of life impairment was highest in patients having melasma with steroid induced rosacea-like dermatitis (DLQI = 13.54 ± 1.30), while it was lowest in participants with ephelides (2.45 ± 1.23). Conclusion: Facial melanoses are a common presenting complaint and lead to substantial impacts on quality of life. -
The Birth Sisters Program: a Model of Hospital-Based Doula Support to Promote Health Equity
The Birth Sisters Program: A Model of Hospital-Based Doula Support to Promote Health Equity Julie Mottl-Santiago, Kirsten Herr, Dona Rodrigues, Catherine Walker, Catherine Walker, Emily Feinberg Journal of Health Care for the Poor and Underserved, Volume 31, Number 1, February 2020, pp. 43-55 (Article) Published by Johns Hopkins University Press DOI: https://doi.org/10.1353/hpu.2020.0007 For additional information about this article https://muse.jhu.edu/article/747773 Access provided at 19 Feb 2020 19:43 GMT from University of California, Davis REPORT FROM THE FIELD Th e Birth Sisters Program: A Model of Hospital- Based Doula Support to Promote Health Equity Julie Mottl- Santiago, MPH, CNM Kirsten Herr, BA Dona Rodrigues, MPH, CNM Catherine Walker, MPH, CNM Emily Feinberg, ScD, CPNP Summary: Maternity care in the United States is characterized by racial and income disparities in maternal and infant outcomes. Th is article describes an innovative, hospital- based doula model serving a racially and ethnically diverse, low-income population. Th e program’s his- tory, program model, administration requirements, training, and evaluations are described. Key words: Doula, community health worker, maternal- child health services, low-income populations, obstetrics. acial and income disparities in maternity care outcomes in the United States are Rlarge and persistent. Non- Hispanic Black people and Hispanic people have higher rates of preterm birth,1,2 lower rates of engagement with prenatal care,3 lower rates of breastfeeding,4,5 and higher rates -
PLANNED OUT-OF-HOSPITAL BIRTH Approved 11/12/15
HEALTH EVIDENCE REVIEW COMMISSION (HERC) COVERAGE GUIDANCE: PLANNED OUT-OF-HOSPITAL BIRTH Approved 11/12/15 HERC COVERAGE GUIDANCE Planned out-of-hospital (OOH) birth is recommended for coverage for women who do not have high- risk coverage exclusion criteria as outlined below (weak recommendation). This coverage recommendation is based on the performance of appropriate risk assessments1 and the OOH birth attendant’s compliance with the consultation and transfer criteria as outlined below. Planned OOH birth is not recommended for coverage for women who have high risk coverage exclusion criteria as outlined below, or when appropriate risk assessments are not performed, or where the attendant does not comply with the consultation and transfer criteria as outlined below (strong recommendation). High-risk coverage exclusion criteria: Complications in a previous pregnancy: Maternal surgical history Cesarean section or other hysterotomy Uterine rupture Retained placenta requiring surgical removal Fourth-degree laceration without satisfactory functional recovery Maternal medical history Pre-eclampsia requiring preterm birth Eclampsia HELLP syndrome Fetal Unexplained stillbirth/neonatal death or previous death related to intrapartum difficulty Baby with neonatal encephalopathy Placental abruption with adverse outcome Complications of current pregnancy: Maternal Induction of labor Prelabor rupture of membranes > 24 hours 1 Pre-existing chronic hypertension; Pregnancy-induced hypertension with diastolic blood pressure greater than -
Improving Delayed Lactogenesis and Suppressed Lactation in At-Risk Mothers
Improving Delayed Lactogenesis and Suppressed Lactation in At-Risk Mothers Jean Rucks Rhodes, PhD, CNM, IBCLC High breastfeeding initiation rates show that most mothers in the U.S. want to breastfeed and are trying to do so. However, low breastfeeding rates among infants who are six and 12 months of age indicate that many mothers do not continue breastfeeding as recommended. These rates suggest that mothers, in part, may not be getting the support they need, such as from healthcare provid- ers, family members, and employers.... The early postpartum period is a critical time for establishing and supporting breastfeeding. CDC 2016 Breastfeeding Report Card 1 WHITE PAPER EXECUTIVE SUMMARY Although breastfeeding initiation is at an all-time high New evidence suggests babies’ feeding behaviors of 81%, rates of breastfeeding exclusivity and du- have an important role in determining lactation suc- ration lag behind national goals. Women who stop cess. These unique infant sucking patterns in the first breastfeeding before meeting their goals often report few days of life appear to program mothers’ breasts they did not have enough milk. for optimal milk production. New breast pump initia- tion technology that mimics early newborn sucking The ability to initiate, build and maintain breast milk is a potentially viable and safe intervention to provide volumes sufficient to meet an infant’s needs are de- at-risk mothers with additional breast stimulation for pendent on complex interwoven factors. Additionally, optimal milk production outcomes. there are multiple maternal risk factors for delayed milk production and suppressed lactation: In many lactation situations, interventions aren’t start- ed until a mother reports problems. -
Virginia Commonwealth University Volunteer Doula Program Training Manual Kathleen M
Virginia Commonwealth University VCU Scholars Compass School of Nursing Publications School of Nursing 2015 Virginia Commonwealth University Volunteer Doula Program Training Manual Kathleen M. Bell Virginia Commonwealth University, [email protected] Susan L. Linder Virginia Commonwealth University, [email protected] Follow this and additional works at: http://scholarscompass.vcu.edu/nursing_pubs Part of the Maternal, Child Health and Neonatal Nursing Commons Copyright © 2015 The Authors Downloaded from http://scholarscompass.vcu.edu/nursing_pubs/16 This Curriculum Material is brought to you for free and open access by the School of Nursing at VCU Scholars Compass. It has been accepted for inclusion in School of Nursing Publications by an authorized administrator of VCU Scholars Compass. For more information, please contact [email protected]. Virginia Commonwealth University Volunteer Doula Program Training Manual “Empowerment, advocacy and support for one of life’s greatest journeys.” 1 Reflection and Discussion Why are you here? Why did you decide to do this doula training? What experiences do you have with birth, and how have they shaped your desire to participate in this program? What does it mean to be a doula with the VCU School of Nursing? What other reflections do you have? 2 Table of Contents 1. An overview of birth: Statistics and trends………………page 4-6 2. Birth workers and their roles………………...……………pages 7-10 3. You are a doula! Your birth-bag and preparation………..pages 11-14 4. Anatomy and Physiology of birth………………………...pages 15-18 5. Hormonal regulation of labor and birth…………………..pages 19-21 6. Pharmacologic management of labor…………………….pages 22-26 7. -
And Double-Balloon Catheters for Cervical Ripening and Labor Induction
Comparison Between The Ecacy and Safety of The Single- (Love Baby) and Double-Balloon Catheters for Cervical Ripening and Labor Induction Meng Hou Xi'an Jiaotong University https://orcid.org/0000-0002-6510-886X Weihong Wang Xi'an Jiaotong University Medical College First Aliated Hospital Dan Liu Xi'an Jiaotong University Medical College First Aliated Hospital Xuelan Li ( [email protected] ) Xi'an Jiaotong University Medical College First Aliated Hospital Research article Keywords: cervix, balloon catheters, single- and double-balloon catheters, labor induction, cervical ripening Posted Date: July 16th, 2020 DOI: https://doi.org/10.21203/rs.3.rs-37246/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/23 Abstract Background: Induced labor is а progressively common obstetric procedure, Whether the specically designed double-balloon catheter is better than the single-balloon device in terms of ecacy, eciency and safety yet remains controversial. Methods: In our study We have performed a Retrospective study in which 220 patients with immature cervix were admitted for induction of labor either through single cervix balloon catheter (love-baby) (SBC) or double cervix balloon catheter (DBC). The comparison showed that the cervical bishop score was slightly higher for the SBC after removal or expulsion of the balloon. Results:This was a proof that SBC demonstrates slightly better ecacy for cervical ripening with a shorter time from balloon placement to spontaneous vaginal delivery than DBC. No signicant differences in the comparison between SBC and DBC following other parameters like spontaneous vaginal delivery, the initiate uterine contractions rate, the number of patients that needed oxytocin, the balloon spontaneous expulsion rate and others have been detected. -
Nurses and Doulas: Complementary Roles to Provide Optimal Maternity Care Lois Eve Ballen and Ann J
CLINICAL ISSUES Nurses and Doulas: Complementary Roles to Provide Optimal Maternity Care Lois Eve Ballen and Ann J . Fulcher Staff in maternity-care facilities are seeing an doulas and hospital staff. The purpose of this article increase in doulas, nonmedical childbirth assistants, is to clarify the positive effects of doula support in who are trained to provide continuous physical, emo- labor, clarify some misconceptions about the doula ’ s tional, and informational labor support. The long- role, and discuss ways that nurses and doulas can term medical and psychosocial benefi ts are well work effectively together. documented. In this article, misconceptions about the doula ’ s role are corrected, and suggestions are of- Benefi ts of Continuous Labor Support fered on ways to improve communication between health care providers and doulas. Together, nurses A growing and unambiguous body of literature and doulas can provide birthing women with a safe demonstrates medical benefi ts and an increase in pa- and satisfying birth. JOGNN, 35, 304-311; 2006. tient satisfaction with continuous labor support to DOI: 10.1111/J.1552-6909.2006.00041.x both mother and infant and the cost savings to be Keywords: Birth outcomes — Childbirth — gained by the use of doulas ( Abramson, Altfeld, & Complementary roles — confl ict — Doula — Evidenced- Teibloom-Mishkin, 2000; Hodnett, Gates, Hofmeyr, based practice — Labor support & Sakala, 2003; Sauls, 2002 ). The Cochrane Library published an updated systematic review on continuous Accepted: October 2005 labor support in 2003, concluding “ Women who had continuous intrapartum support were less likely to To the relief of some busy nurses, and the conster- have intrapartum analgesia, operative birth or to re- nation of others, trained childbirth assistants called port dissatisfaction with their childbirth experiences. -
A Guide to Obstetrical Coding Production of This Document Is Made Possible by Financial Contributions from Health Canada and Provincial and Territorial Governments
ICD-10-CA | CCI A Guide to Obstetrical Coding Production of this document is made possible by financial contributions from Health Canada and provincial and territorial governments. The views expressed herein do not necessarily represent the views of Health Canada or any provincial or territorial government. Unless otherwise indicated, this product uses data provided by Canada’s provinces and territories. All rights reserved. The contents of this publication may be reproduced unaltered, in whole or in part and by any means, solely for non-commercial purposes, provided that the Canadian Institute for Health Information is properly and fully acknowledged as the copyright owner. Any reproduction or use of this publication or its contents for any commercial purpose requires the prior written authorization of the Canadian Institute for Health Information. Reproduction or use that suggests endorsement by, or affiliation with, the Canadian Institute for Health Information is prohibited. For permission or information, please contact CIHI: Canadian Institute for Health Information 495 Richmond Road, Suite 600 Ottawa, Ontario K2A 4H6 Phone: 613-241-7860 Fax: 613-241-8120 www.cihi.ca [email protected] © 2018 Canadian Institute for Health Information Cette publication est aussi disponible en français sous le titre Guide de codification des données en obstétrique. Table of contents About CIHI ................................................................................................................................. 6 Chapter 1: Introduction ..............................................................................................................