B234 Final Exam Study Guide
DISCLAIMER - This is only a guide: It is very thorough but may not necessarily cover specifically
everything you need to know.
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NEW MATERIAL (ABOUT 55 QUESTIONS)
Young and middle-aged adults (about 10)_________________________________________________
1. Young adults (readings)
● Know the leading causes of death (accidents/suicide/homicide)
○ accidents/seat belt use & MVAs
○ Unintentional injuries, homicide, suicide
○ Alcohol consumption
● Alcohol abuse, binge drinking
○ Binge drinking: causes an increased loss of control; increases risk of MVA
■ 4 or more drinks within 2 hours for women
■ 5 or more drinks within 2 hours for men
■ Very high in college-aged students → sexual assault on campus
○ Teens who work >10 hours a week
○ Most prevalent substance use disorder
○ 16.6 million adults struggle with alcohol use disorder (AUD)
○ Affects men 2x more than women
○ Women are more likely to abuse alcohol if relatives abuse alcohol
○ Screenings:
■ CAGE
● Cut down, annoyed, guilty, eye opener
■ Michigan Alcohol Screening Test (MAST)
● yes/no answers to 25 questions
● 0-3: absence of alcohol dependence
● 4: possible substance dependence
● 5+: likely alcohol dependence
■ Alcohol Use Disorders Identification Test (AUDIT)
● A 10-item screening tool that can quickly identify substance
abuse problems
● Developmental task (Erickson) for this age
○ Intimacy vs. Isolation (ages 18-25)
○ Success = fulfilling relationships
○ Struggle = feelings of loneliness, isolation, and self-absorption
○ Develop deeply personal relationships, marry, & begin families
2. Middle-aged adults (readings)
● Know how lifestyle affects morbidity/mortality-leading causes of death
○ Heart disease, cancer, accidents, hypertension, and obesity
○ Depression and anxiety - associated with increased morbidity, premature
mortality, and greater healthcare utilization
● Roles and relationship patterns, changes
○ Married people are healthier than divorced, widowed, or never married
individuals
● Developmental task (Erickson) for this age
○ Generativity vs. Stagnation/Self-Absorption (ages 25-65)
○ Strives to create and nurture things that will outlast them
○ Doing things to promote future generations
3. Know intimate partner violence (readings and presentation)
● Risk factors, protective factors
○ Risk Factor: condition whether an individual or community-wide, that makes a
person more vulnerable to a given kind of violence of harm
■ Ie. poor families, poverty, harmful norms, lack of nonviolent social
problem-solving skills, and bad family life
○ Protective Factor: a person, trait, skill, relationship, or resource that
insulates/protects a person from a particular kind of violence or harm; makes a
person less vulnerable
■ Ie. connection and commitment to school access to healthcare, good
connection to community and school, access to mental health, and
substance dependency treatment services
● Trauma-informed care, trauma, and memory
○ Trauma can result in memory being spotty or only in bits and pieces
○ Post-it note analogy → scattered, broken up memory
○ Be mindful of how we ask clarifying questions
■ Potential for influencing memory formation
○ Survivors deserve to be believed no matter how coherent their memory is
○ Trauma-Informed Care:
■ Recognize the impact of trauma on the development of coping
mechanisms and social development
■ Changes paradigm from “What’s wrong with you and how can we fix
it?” → “What’s happened to you and how can we help you cope with it?”
■ Emphasizes strengths and provides resources to build skills; the
collaborative relationship between survivor and service provide
● Screening for intimate partner violence/domestic violence
○ Domestic violence by a current or former spouse or partner in an intimate
relationship against the other spouse or partner includes physical, verbal,
emotional, economic, and sexual abuse
Older Adult (about 10 questions)
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●
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Know how the older adult can maximize their potential, regardless of life changes (healthy
aging)
○ Exercise and nutrition
○ Manage chronic conditions, education, & counseling
Know fall prevention
○ Move to a 1-story house
○ Remove rugs, cords, and any tripping hazards
○ Put up guard rails on stairs
○ Baby-proof hard corners if falling is really common
○ Make bathroom wheelchair accessible with chair in shower for more caution
○ Encourage tai chi and yoga
○ Check vision yearly
○ Avoid going barefoot or wearing slippers
○ Improve lighting in your home
○ Paint contrasting colors on the edge of all steps
○ Exercise regularly
○ Balance Impairment: impaired postural control, loss of muscle mass, changes in hearing
and vision functions, >30% of adults 65+ fall each year
Know measures to promote healthy sleep-rest pattern
○ Take medication to prevent pain while sleeping if a chronic condition is present
○ Drinking tea before bed helps too
○ Maintain a regular schedule
○ Avoid naps
○ Don’t stay awake in bed for more than 5-10 minutes
○ Don't watch TV or read in bed
○ Drink caffeinated drinks with caution
○ Avoid inappropriate substances that interfere with sleep
○ Exercise regularly
○ Have a quiet, comfy bedroom
○ Have a pre-bedtime routine
Cognitive function (normal/impaired)
○ Normal Function: forgets to make a monthly payment every once in a while, sometimes
makes bad decisions, losing things from time to time
○ Impaired Changes: poor judgment and decision-making, inability to manage a budget,
losing track of the date or season, difficultly having a conversation, misplacing things,
and being unable to retrace steps to find them
○ Know the difference between Alzheimer/dementia changes and typical age-related
changes
■ Dementia:
● Cognitive impairment in older people
● Progressive impairment of short-term memory, then long-term
● Functional ability diminished
● Impaired executive function
● Trouble finding words and naming things
● Trouble remembering to eat
● Decrease in weight
● Impairment in thinking
● Reasoning and ability to learn
■ Alzheimer’s:
● Most common cause of dementia
● Aging is the best-known risk for developing Alzheimer’s
● Likelihood of developing the disease doubles every 5 years after age 65
● Forgetfulness all the time
● Developmental task (Erickson) for this age
○ Ego Integrity vs. Despair (age 65-death)
■ Accepting that death is inevitable, accepting the aging process, and achieving an
identity apart from work
■ Triggered by life events like retirement, loss of spouse, loss of
friends/acquaintances, facing terminal illness, and other major changes
Sexually Transmitted Infections (about 5 questions)
●
●
Know management strategies
○ Use condoms!!
Signs/symptoms
○ Chlamydia:
■ Most common STI
■ Often asymptomatic, can cause urethritis in men
■ Commonly causes infertility, scarring of the fallopian tube, and if UNTREATED
= PID
■ Women often re-infected if partner not treated
■ Treat with azithromycin or doxycycline
■ Sexually active women need yearly testing
■ No intercourse 7 days after treatment is completed
■ Can transmit to newborns as an eye infection or pneumonia
■ CGeye - treat to kill eye bacteria; 3 letters = 30% transmission chance
○ Gonorrhea:
■ Men: urethral discharge, urethritis
■ Women: asymptomatic, dysuria, vaginal discharge, PID
■ Diagnosis: gram stain, culture is thayer-martin media or chocolate agar, NAAT
on urine, urethral/cervical swab
■ Will transmit to infant during birth, by law treat all infants eyes after birth
■ Rescreen at 3-month visit to detect reinfection
○ Syphilis (Everyone Screened):
■ Treponema pallidum
■ Systemic disease
■ Primary: painless genital ulcer (chancre)
■
■
■
■
■
●
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Secondary: rash, sores in mouth, swollen lymph nodes
Latent: asymptomatic and without treatment can last for years
Tertiary: 10-30 years after initial infection, death and attack of organs/tissues
Diagnosis: two types of blood tests are available
Nontreponemal Tests (screening): RPR, VDRL, treponemal tests, FTA-ABS,
TP-PA, EIA
■ Infants can obtain through the placenta
■ If the mom gets infected during pregnancy, the baby is more likely to get disease
■ Most likely to affect fetus during first 9 weeks
■ Treated w/ antibiotics
■ Screened during 1st & 3rd trimester
■ Syphilis = genital ulcer
○ Acute HIV:
■ Fever, body aches, sore throat, swollen lymph nodes
■ Rash in 50% of patients
■ Most common ways to get HIV are sharing needles, unprotected sex,
transmission from mother to fetus, or from blood products
Expedited Partner Therapy (EPT)
○ Expedited Partner Therapy: patient informs the partner, and provides them with written
material for sex evaluation for symptoms or complications, patient-delivered
prescription or antibiotic for partners, not for men who have sex with men (until
March 2020) (partners need testing, significant rate of concurrent infections, such as HIV
and syphilis)
○ Most common for gonorrhea or chlamydia
Communicable disease reporting
○ Reportable vs. non-reportable
■ Reportable: HIV, chlamydia, gonorrhea, syphilis, neonatal HSV
● **How Come Guys Suck Nets**
■ Non-Reportable: herpes simplex virus (HSV) & human papillomavirus (HPV)
Reproductive Health (about 8 questions)
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●
●
Know risks associated with estrogen and who should use different delivery forms
○ Increases the risk of heart disease, stroke, and blood clots
○ Avoid If: you are a smoker, over 35, have DVT, have frequent migraines with auras, and
recent birth
Understand who is the best candidate for long-acting birth control
○ Women who do not want to become pregnant in the near future or ever
Understand the different types of birth control and nursing implications/teaching
○ Use the MEC chart when trying to find the best birth control method for your client
○ Grade 1: no risk
○ Grade 2: benefits outweigh the risks
○ Grade 3: risks outweigh the benefits
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○
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Grade 4: very dangerous
Behavioral methods (fertility awareness/breastfeeding etc...)
■ Fertility Awareness:
● Predicts fertile days with calendars, thermometers, checking vaginal
mucus, or charts
● Pros:
○ Cost-effective
○ No side effects
○ Helps know when to avoid or when to have sex
● Cons:
○ Does not protect against STI
○ Need to have self control
○ Not effective if bleed is irregular
○ Need contraceptives if have different partners or want to protect
against STI
■ Breastfeeding:
● Used after birth if no period is present and less than 6 months after
delivery
● Pros:
○ Does not affect hormone balance
○ Immediately effective
○ Reduces bleeding after delivery
○ Inexpensive
○ Only affective if you are not bleeding
○ 98% effective
● Cons:
○ Does not protect against STIs
○ Short-term, not effective forever
■ Abstinence:
● Only way to prevent pregnancy and STI’s 100%
● Costs nothing
● No effects
● May be difficult to stay abstain
● Usually are at risk due to a lack of knowledge
Estrogen/progestin combinations (pill, patch, ring)
■ Oral Birth Control:
● Progestin and estrogen combine into an oral pill you take every day at the
same time
● Pros:
○ Safe and effective
○ May have lighter, shorter period
○ Clearer skin
○ Lower risk of cancer
○ 93% effective
●
○
Cons:
○ Pain, swelling, weakness, weight gain, bad headaches, vision
problems, chest pain
○ Does not protect against STIs
○ Wait 21-42 days postpartum to use
■ Ring Birth Control:
● Inserted into vagina and changed every 3-5 weeks
● The hormones stop ovulation from happening
● Pros:
○ Period may be lighter, shorter, and more
regular
○ Clearer skin
○ Lowers risk of cancer
○ 99% effective
● Cons:
○ Pain, swelling, weakness, bad headache, vision problems, chest
pain
○ Does not protect against STI’s
○ Have to wait 21-42 days postpartum to
use
■ Patch Birth Control:
● Placed on stomach or arm, allowing hormones to
go in and prevent ovulation from happening
● Pros:
○ Period is lighter, shorter, and more
regular
○ Lowers risk of cancer
○ Can put the patch anywhere
○ Has enough hormones for 9 days
○ 93% effective
● Cons:
○ Pain, swelling, redness, weakness, headache, vision problems,
nausea, spotting, breast pain, weight change
○ Does not protect against STI’s
○ Have to wait 21-42 days postpartum to use
Progestin-only pill (POP), medroxyprogesterone injection (Depo-Provera), implants
■ Progestin-Only Pill:
● Hormone stops ovulation and thickens the mucus around the cervix
○ Pros:
■ Good if patient can not take estrogen
■ Safer for women who are over 35
■ Can use while breastfeeding
■ Take once a day
■ 93% effective
○
○
○
Cons:
■ Does not protect against STI’s
■ Irregular bleeding, acne, depression, cysts, decreased sex
drive, nausea, headaches, breast tenderness
■ Injection Birth Control:
● Progestin stops ovulation and thickens the mucus around the cervix
● Pros:
○ Highly effective
○ Decreases cramping
○ Lessens blood flow
○ Decreases risk of cancer
○ 96% effective
● Cons:
○ Easy to miss an appointment for an injection
○ Does not protect against STIs
○ Spotting, weight gain, headache, bloating, mood changes
■ Implant Birth Control:
● Progestin is released from an implant in your arm, which thickens the
mucus by your cervix and stops ovulation
○ Pros:
■ Long-lasting
■ May improve period
■ Lowers risk of cancer
■ 99% effective
○ Cons:
■ Side effects with injection side and similar side effects of
pregnancy
Emergency contraceptive pills.
■ Emergency Contraceptive (Plan B):
● Prevents ovulation from occurring 120 hours after intercourse
● Pros:
○ Convenient
○ Can take as needed
○ Over the counter
● Cons:
○ Does not work if you are over 175 lbs
○ Causes late/early period
○ Must be taken within 72 hours
○ Doesn’t work if already pregnant
○ May delay your period up to 1 week
○ Causes terrible period side effects (cramps, headache, breast
tenderness, etc.)
IUD (copper/progestin)
■ Copper IUD
●
●
○
Changes the way that sperm cells swim so they can not get to the egg
Pros:
○ 10-12 years long
○ Can be used during breastfeeding
○ 99% effective
● Cons:
○ Fever, chills, stomach pain, feelings of
being pregnant
○ Heavier periods
○ Very expensive
○ Does not prevent against STI’s
■ Levonorgestrel IUD
● Pros:
○ Lasts for 5 years
○ Most are covered by insurance
○ May reduce cramps
○ 99% effective
● Cons:
○ Painful insertion process
○ Takes 7 days to become effective
○ Perforation, expulsion, cysts, breast cancer, PID, spontaneous
abortion, sepsis
Barrier methods (male/female condom)
■ Condom:
● Should be put on and stay on during sex
● Helps prevent STIs
● Men share responsibility
● Don’t use if have latex allergy
● Ability to break or slip
■ Female Condom:
● Can use if latex allergy
● Can be used with lubricants
● No hormonal effects
● Reduces risk of STIs
● Do not reuse
● Can insert up to 8 hours prior
■ Diaphragm:
● Pros:
○ Reversible
○ Lasts years
○ May protect against STIs
● Cons:
○ Difficult to insert and use
○ 83% effective
■
○
○
Cervical Cap:
● Pros:
○
○
○
●
Must be left in for 6 hours after intercourse
Prescription needed
Reversible
Can use for up to a year
Doesn’t require ongoing use of hormones
or spermicide
Doesn’t affect fertility
○
Cons:
○ Can’t be used when bleeding
○ 71% effective
○ Prescription needed
Prenatal Care (about 11 questions)
●
Know what measures taken prenatally, during labor, or after birth
○ Chlamydia/gonorrhea
■ Acquired from GU (genitourinary) tract
■ Newborn: transmits as eye infection or pneumonia
● By law, treat all infants’ eyes for these after-birth
○ Syphilis (everyone screened)
■ Acquired from GU tract
■ Crosses by placenta
■ Baby: bone damage, nerve damage, death, enlarged liver/spleen, sickle cell
anemia????
○ HIV
■ Crosses placenta
■ Transmission from infected mother to fetus
■ Test 1st prenatal visit & 3rd trimester
■ Lesions and anemia
■ Too much amniotic fluid
■ Stillbirth
○ Herpes simplex virus (HSV)
■ Crosses by placenta
■ Acquired from GU tract
■ Neonatal herpes is most serious complication
■ Potentially fatal
■ Can cause spontaneous abortions or neuro damage
■ If infected during pregnancy, more likely to transfer to baby
■ At birth, can cause lesions, seizures, respiratory distress, hydrocephalus (water in
the brain)
○ Hepatitis B
■ All women in early pregnancy and those at risk should be screened
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●
●
●
■ Immunization may be given before or during pregnancy when seronegative
■ Affects maternal liver
■ Transmission = 40% → 90% of them are chronically infected for life
■ Screened at 1st prenatal
■ Can lead to liver cancer for fetus
○ Group B strep
■ Gram-positive beta-hemolytic bacteria
■ Commonly colonized the GU and GI tracts
■ Most common cause of sepsis and meningitis in neonates less than 3 months old
■ Screen all women at 35-37 weeks
■ Treat women with positive cultures with intrapartum IV antibiotics
■ Found in 25% of healthy women
■ Can cause respiratory distress in newborn
■ Cause serious infections like meningitis, pneumonia, and sepsis
○ Rubella
■ Vaccine
■ High transmission rate
■ No as common in US, but 100,000 born with congenital rubella
■ With nonimmune mom, risk of transmission is 90%
■ Rubella in 1st trimester can lead to improper baby development, especially in the
eyes, ears, and heart
■ No treatment for fetus
■ Pregnant women can receive vaccine
Know what screenings are done during pregnancy including
○ What risks do we look for?
■ Depression, suicidal thoughts, stress, smoking, history of infertility, previous
c-section, diabetes, & STI
○ What labs are done?
■ Hgb, Htc, WBC, blood type & Rh, Rh antibody screen, gonorrhea & chlamydia
cultures, serology, rubella, HIV, urine drug screen, hep B surface antigen, UA
Be able to calculate a due date using Nagelle’s rule
○ How to calculate pregnancy due date
○ Last Missed Period + 7 Days - 3 Months - Due Date
○ Ie. LMP (nov 1) + 7 days (nov 8) - 3 months = aug 8
Be able to read a pregnancy wheel
○ The first arrow should be lined up with the first day of your last period
○ Look at week 40 to see your estimated due date
■ Ie. if the first day of your last period was August 5th, day of conception would be
August 19th, and due date would be May 12th
○ If shows things like milestones, expected tests, weight, and length of baby
Know how to use GTPAL and GPA (gravida, para, abortion)
○ GTPAL
■ Gravida: # of pregnancies including current one
■ Term: birth over 38 weeks
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■ Para: births between 20-38 weeks
■ Abortion: pregnancies ending before 20 weeks
■ Living: # of current children alive
○ GPA
■ Gravida: # of pregnancies including current one
■ Para: births after 20 weeks
■ Abortion: pregnancies ending before 20 weeks
Know which developmental stage (zygote, embryonic, fetal) a baby is at most risk from
teratogen
○ Zygote:
■ When sperm and egg unionize, cells travel down the fallopian tube toward the
uterus
■ Division of zygotic cells results in more differentiated structures and eventually
produces an embryo
○ Embryonic:
■ Growing conceptus up to 8 weeks of age
■ Embryo is implanted in the uterine wall (most vulnerable)
○ Fetal:
■ Week 9 to birth
○ Teratogens:
■ An agent that causes either a functional or structural disability in the organism as
a result of exposure to that agent
■ Affects central nervous system of the fetus
■ This leads to impaired intelligence and performance later in life
■ Has the ability to affect fetus 10-14 days after conception (most vulnerable
during first 12 weeks)
What does a urine pregnancy test measure?
○ Tests for human chronic gonadotropin (hCG)
■ A hormone produced by the placenta that is found in the pregnant women’s blood
and urine
Know self-care interventions for a pregnant person; role of the doula
○ Self-Care Interventions:
■ Avoid overheating
■ Elevated feet when you can, but avoid sitting for long periods of time
■ Continue exercising (but avoid high-risk activities)
■ Avoid lying on your back after 4 months
■ Backaches respond to pelvic tilt exercises
■ Welcome support from others
○ Doula:
■ A professional labor assistant who provides physical and emotional support to
you and your partner during pregnancy, childbirth, and postpartum
For dietary counseling know:
○ How much weight an underweight, overweight, and normal weight patient should
gain during pregnancy
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○
○
■ Underweight women: 28-40 lbs
■ Normal women: 25-35 lbs
■ Overweight women: 15-25 lbs
What is a normal pattern of weight gain by trimester?
■ First trimester: gain 3-5 lbs/week
■ 2nd trimester: gain 1-2 lbs/week
■ 3rd trimester: gain 1-2 lbs/week
What foods should a pregnant person eat or avoid? How many calories are needed?
■ Calories:
● 1st trimester: 1800 total calories
● 2nd trimester: 2200 total calories
● 3rd trimester: 2400 total calories
● No alcohol & moderate caffeine
■ Avoid:
● High mercury fish
● Raw fish
● Undercooked, raw, or processed meat
● Raw eggs
● Organ meat
● Caffeine
● Raw sprouts
● Unwashed produce
● Unpasteurized milk & cheese
● Processed junk foods
● Fruit juice
● Alcohol
■ Eat:
● Dairy products
● Legumes
● Sweet potatoes
● Salmon
● Eggs
● Dark leafy greens
● Lean meats/proteins
● Berries
● Whole grains
● Avocados
● Dried fruits
● Fish liver oil
● Water
● **foods that supply heme iron, enhancers of iron absorption (vitamin
C-rich foods), 400 micrograms of synthetic folic acid a day
What interventions help with nausea?
■ Eat crackers before rinsing
■ Take prenatal vitamins at night
■ Eat more cool foods and less spicy foods
■ Avoid drinking fluids with meals
■ Avoid straws
■ Ginger snaps and tea are ok
Complementary and alternative medicine and stress (about 8 questions)
●
●
Stress Response: the physical and emotional reactions to a stressor
○ Stage 1: stimuli from one or more of the 5 senses
○ Stage 2: The brain decides if it is a threat or not
○ Stage 3: The body stays activated or aroused until the threat is over
○ Stage 4: returns to homeostasis (stage of physiological calmness), once threat is gone
Herbal supplements
○ Echinacea
■ Use: boost immunity and treat common cold
■ Avoid if taking Warfarin
■ Med interactions metabolized through liver, and immunosuppressants are
important to use precaution with
○ Melatonin
■ Use: sleep aid; may help with insomnia, jet lag, anxiety, sleep disorders in
children, and delayed sleep-wake phase disorder (DSWPD)
○ Valerian root
■ Use: insomnia, migraines, fatigue, anxiety, depression, PMS and
menopause symptoms and stomach cramps
■ Can increase effects of sedatives, alcohol, and anesthesia
■ Can interact with antihistamines. statins (for high cholesterol) and
antifungal drugs
○ Ginseng
■ Use: improve stamina, concentration, and memory; stimulate immune
functioning, slow aging process; can improve glucose metabolism
■ Decrease effectiveness of calcium channel blockers
■ Interacts with some chemo & HIV agents, antidepressants, and certain
antihypertensive & statin meds
○ Black kohosh
■ Use: menopausal symptoms; menstrual cramps and inducing labor
■ Combining with prescription meds may harm liver
■ Adverse reactions with statin medicines that reduce blood cholesterol
■ Can interfere with hormonal BC due to effect on hormone levels
○ Ginger
■ Use: mild nausea/vomiting (with pregnancy)
■ Can interfere with blood thinners
○ Ginkgo biloba
■ Use: anxiety, allergies, asthma, bronchitis, dementia, eye problems,
peripheral artery disease, tinnitus, kidney/bladder problems
■ May interact with coagulants (blood thinners)
○ Saw palmetto
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○
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○
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■ Use: urinary symptoms associated with an enlarged prostate gland
St. John’s Worts
■ Use: depression, menopause symptoms, ADHD, somatic symptom
disorder, and OCD
■ Can interact with antidepressants, BC pills, cyclosporine, some heart
meds, some HIV drugs, some cancer meds, warfarin, and certain statins
Garlic
■ Use: lowers cholesterol and BP
■ MAY interact with anticoagulant (warfarin) or effectiveness of some drugs
Glucosamine/chondroitin
■ Use: reduce symptoms of osteoarthritis and slow breakdown of cartilage
■ Increases effects of warfarin, causing bruising/bleeding
Omega-3 fatty acids
■ Use: improves heart health, reduce stroke risk, reduce triglycerides in
blood, relieve symptoms of dry eyes disease, relieve symptoms of RA,
important in infant development, reduce risk of cognitive decline
■ Interferes with meds affecting blood clotting meds
■ *Fish or shellfish allergies*
Feverfew:
■ Use: fever, headaches, arthritis, toothache, antiseptic and insecticide
The safety of CAM approaches in children
○ Dietary supplements result in 23,000 ER visits annually (20% of the visits are children,
most took vitamins or minerals when unsupervised)
○ Children are more vulnerable to having allergic or adverse reactions to dietary
supplements
○ CAM methods also may have not been tested on children
○ Homeopathic remedies are not evaluated by the FDA
○ Spinal manipulation is associated with rare but serious complications
The safety and efficacy of CAM approaches
○ Does not have to be tested in order to market the product
○ Based on many other factors, such as the individual’s health status, any underlying health
issues/diseases, what medications they are taking, etc.
○ Children are more vulnerable to having allergic or adverse reactions to dietary
supplements
Regulation of dietary supplements
○ Does not have to be FDA tested (must have a label stating this)
○ Regulations are much less strict than those for prescription or over-the-counter
medications
○ Safety and efficacy do not have to be proved before marketed, only monitory label claims
and inserts
○ May not have been tested on children or pregnant women
OLD MATERIAL (ABOUT 20)
Nutrition (about 5 questions)
●
Know what constitutes being underweight, overweight, obese, and normal weight (BMI
interpretation)
○ Underweight BMI: less than 18.5 (less than 5th percentile)
○ Normal BMI: 18.5 to 24.9 (5th to 85th percentile)
○ Overweight BMI: 25.0 to 29.9 (85th to 95th percentile)
○ Obese: more than 30.0 (greater than 95th percentile)
● Know how many calories are in carbohydrates, fats, and proteins. Be able to calculate
calories and percentages of macronutrients
○ Proteins: 4 calories
○ Carbs: 4 calories
○ Fats: 9 calories
○ Alcohol: 7 calories
● Know how to read a food label.
● Know the functions, food sources, risk factors, and key recommendations for the micro- and
macronutrients covered. Focus on the nutrients of public concern and those associated with
specific health risks/disease, and drug interactions with commonly prescribed medications:
Carbohydrates:
● Functions: provide fuel (an energy source for the brain), spare body protein, help prevent ketosis,
enhance learning and memory
● Food sources: bread, pastas, potatoes, corn, sugars, fibers, starches, vegetables, fruits
● Excess conditions: metabolic syndrome
● Deficiency conditions: hypoglycemia?
● Signs/Symptoms:
○ Excess: waist measurements of more than 40 in. for men and more than 35 in. for women,
high levels of triglycerides, high BP, insulin resistance or glucose intolerance, high
fasting blood glucose levels diagnostic of diabetes
○ Deficiency: fatigue, muscle aches, problems concentrating, nausea/loss of appetite,
lightheadedness, fruity breath, ketones in urine, very rapid weight loss
Fat:
● Functions: energy source, vehicle for fat-soluble vitamins, provides fullness, insulates organs,
thermal regulates, precursor for hormones, and builds cell membranes
● Food sources: butter, oils, margarine, salad dressings
Protein:
● Functions: source of nitrogen, provision of structure, maintenance and growth, regulation of body
processes, immunity, circulation, energy source
● Food sources: meat, poultry, fish, eggs, milk, cheese, peas, beans, lentils, peanuts
● Excess conditions: phenylketonuria - irreversible brain damage
● Deficiency conditions: marasmus (insufficient kilocalories and protein) and Kwashiorkor
(adequate kilocalories, insufficient protein)
○ Calcium
■ Mineral
■ Function:
● Makes up much of the structure of bones and teeth
● Allows normal bodily movement by keeping tissue rigid, strong, and
flexible
●
○
Mediates blood vessel contraction and dilation, muscle function, blood
clotting, nerve transmission, and hormonal secretion
■ Sources:
● Milk, yogurt, canned sardines, salmon w/ bones, kale, broccoli, bok choi,
grains (bread, pasta, unfortified cereals)
■ At Risk:
● Postmenopausal women, people who avoid dairy products, family history
of osteoporosis, history of long-term steroid use
■ Disorders:
● Lack of Calcium
○ Tetany, osteoporosis, rickets
○ Back pain, stooped posture, loss of height
○ People w/ underactive parathyroid glands, cancer patients,
kidney diseases, people taking lithium/diuretics/antacids
● Excess of Calcium - hyperthyroid (weak bones, kidney stones, heart and
brain dysfunction)
■ Key Recommendations:
● Important for adequate calcium intake for adults ages 19-30 - when peak
bone mass is actively occurring
● Calcium supplements during pregnancy for women w/ low calcium
intakes to reduce the risk of preeclampsia
● Post-menopausal women need adequate calcium b/c rapid bone
remodeling is occurring
● People who are lactose intolerant and vegans could consider supplements
due to a lack of dairy consumption
Vitamin D
■ Fat-soluble
■ Function:
● Provides calcium absorption in the gut
● Maintains adequate serum calcium and phosphate concentrations to
enable normal bone mineralization and prevent hypocalcemia tetany
■ Sources:
● Fatty fish, fish liver oil, fortified milk, ready-to-eat breakfast cereals,
some brands of yogurt, some brands of orange juice, cheese, some
margarine, lean meats, poultry, eggs, seafood, beans, peas, lentils, nuts,
seeds, soy products
■ Disorders:
● Lack of vitamin D - rickets (children - breastfed infants need
supplements), osteomalacia (adults)
● Excess of vitamin D - steroids, postmenopausal women, nausea,
vomiting, confusion, pain, dehydration
■ At Risk:
● Lack of vitamin D (rickets):
○ Most common among breastfed black infants and children
○
○
■
Overall:
○
○
Human milk alone does not ordinarily enable infants to meet
vitamin D requirements b/c it provides less than 0.6-2.0 mcg/L
Infants are also recommended to be out of direct sunlight
Older adults - skin’s ability to synthesize vitamin D declines w/
age
○ People w/ limited sun exposure - individuals who are
homebound, wear long robes/dresses/head coverings, people w/
occupations that limit sun exposure
○ People w/ dark skin - more melanin → reduced ability for skin to
produce vitamin D from sunlight
○ People w/ conditions limiting fat absorption - vitamin D is fat
soluble, so absorption depends on the gut’s ability to absorb
dietary fat
○ People w/ obesity - more subcutaneous fat → greater intake of
vitamin D to reach normal range
○ For people who have undergone gastric bypass surgery - vitamin
D is absorbed by the upper part of the small intestine, which is
bypassed in surgery
○ Signs/Symptoms - soft bones, skeletal deformities, failure to
thrive, developmental delay, hypocalcemic seizures, tetanic
spasms, cardiomyopathy, dental abnormalities
■ Key Recommendations:
● Include a variety of fruits and vegetables, low-fat and fat-free dairy
products
● Incorporate fatty fish into the diet
● Limit high-sugar foods, saturated fats, and sodium
● Limit alcoholic beverages
Potassium
■ Mineral
■ Function:
● Required for normal cell function b/c of its role in maintaining
intracellular fluid volume and transmembrane electrochemical gradients
● Has a strong relationship w/ sodium
■ Disorders:
● Hypokalemia (lack of potassium)
○ Sweating, diarrhea, dialysis, hypokalemia
○ At Risk:
■ People w/ inflammatory bowel disease, people who are
on laxatives, diuretics, or dialysis, people w/ heat
sweating, prolonged diarrhea or vomiting, and people w/
pica (a disorder of eating non-food items)
● Excess of potassium disorders
○
■
○
○
Hypertension and stroke, kidney stones, bone health, blood
glucose control, type 2 diabetes
Posessing your heart
● Excess - hyperkalemia → heart attack symptoms
● Deficiency - hypokalemia → hypertension, kidney stones
Vitamin B12
■ Water soluble
■ Function:
● Required for development, myelination, and function of the CNS
■ Sources:
● Beef, clams, tuna, nutritional yeast, salmon, meat, poultry, eggs, milk,
other dairy (animal products, fortified cereals/yeasts which have high
bioavailability
■ Disorders:
● Lack of B12 - pale skin, heart palpitations, weight loss, infertility
● Excess of B12 - no described UL due to low potential for toxicity
■ At Risk (megaloblastic anemia & GI cancer):
● Older adults (decreased ability to absorb nutrients w/ age and
medications can cause disruption), people w/ pernicious anemia, people
w/ GI disorders or had GI surgery, vegetarians, and infants of vegan
women
■ Key Recommendations:
● B12 may be a concern b/c it’s present only in animal-source food (fish,
meat, poultry, eggs, and dairy products)
● Human milk has sufficient vitamin B12 to meet infants’ needs unless the
mother’s vitamin B12 status is inadequate (a vegan mother may avoid
animal products for the child which puts the child at risk)
■ Blood (keeps healthy and makes DNA) & boat (water-soluble); only animal
producers
● Deficient - vegetarians & older adults
● Excess - heart disease & stroke
Vitamin K and Vitamin E
■ Vitamin E
● Fat Soluble
● Function:
○ Acts as an antioxidant helping to protect cells from the damage
caused by free radicals
○ Fight off invading bacteria and viruses, associated with diseases
where fat is not absorbed or digested
● Sources:
○ Nuts, green vegetables, vegetable oils
● Disorders:
○ Chron’s Disease (excess of Vitamin E)
○
■ Chronic inflammation of the intestinal tract
○ Hemorrhagic Stroke (lack of Vitamin E)
■ Occurs when a blood vessel in the brain leaks or ruptures
○ Muscle Aches
○ Double Vision
● Key Recommendations:
○ Eat a variety of foods like vegetable oils, nuts, green vegetables,
and inspect breakfast cereals or juices and other spreads for
Vitamin E
○ If one cannot meet the needs for some nutrients, it is possible to
take dietary supplements or fortified foods to meet the
requirement
■ Vitamin K
● Function:
○ Blood clotting
○ Helps maintain bone density
○ Prevents calcification of soft tissues, organs, and blood vessels
● Sources:
○ Green leafy vegetables, also synthesized in GI tract
● Disorders:
○ Anticoagulant treatment failure (excess condition)
■ Signs/Symptoms: international normalized ratio less than
2.0, PT (time it takes blood to clot) less than 13.5
seconds
○ Hemorrhage (deficiency condition)
■ Signs/Symptoms: petechiae, bleeding, shock
● Risk factors:
○ All newborns with malabsorption disorders (like cystic fibrosis)
and persons taking warfarin
● Key recommendations:
○ All newborns receive an intramuscular injection of vitamin K
○ People taking warfarin, keep intake of foods rich in vitamin K
about the same each day
Iron (know how to improve absorption)
■ Mineral
■ Fat-soluble
■ Function:
● Growth and development
● The body uses iron to make hemoglobin, myoglobin, and some hormones
■ Sources:
● Lean meat, seafood, poultry, white beans, lentils, spinach, kidney beans,
nuts, and some dried fruits
■ Key Recommendations:
● All iron should come from food and beverages
○
● Maintain a healthy dietary plan
● Lack of Iron: take iron supplements w/ food
■ Disorders:
● Lack of iron - anemia
○ Risks: women and teen girls w/ heavy periods, pregnant women,
infants, frequent blood donors, people w/ cancer, GI conditions,
or heart failure
○ Signs/Symptoms: anemia, smaller red blood cells, upset GI,
weakness, tiredness, lack of energy, problems w/ concentration
and memory
● Excess of iron - hemochromatosis, upset stomach, constipation, nausea,
vomiting, diarrhea
○ Signs/Symptoms: GI problems (constipation, diarrhea, nausea,
vomiting, gastric lesions or gastritis, multi-system organ failure,
coma or death
■ Risk factors: pregnant women, infants and young children, women with heavy
menstrual bleeding, frequent blood donors, people with cancer, people with GI
disorders, people who have had surgery or heart failure, and any person
consuming too much
Folic Acid
■ B12 Vitamin
■ Function:
● Make DNA/genetic material
● Tells cells to divide
● Prevents neural tube defects
■ Sources:
● Beef liver, vegetables, fruit, nuts, beans, peas, folic acid added to bread,
flour, pasta, breakfast cereals, corn flour
■ Key Recommendations:
● Take folic acid when pregnant or clid bearing age to prevent neural tube
defents (take 400 micrograms every day until pregnant and stop 12
weeks pregnant)
■ Disorders:
● Lack of folic acid - fatigue, trouble concentrating, irritability, headache,
rare in the USA
○ Megaloblastic Anemia
■ Signs/Symptoms: weakness, fatigue, trouble
concentrating, irritability, headache, heart palpations,
shortness of breath, open sores on mouth adn tongue
■ Risk: rare in USA, pregnant women or lactating women,
people w/ alcohol use disorder, child bearing women, GI
issues, people older than 65
● Excess of folic acid
○ Signs/Symptoms: worsen symptoms of B12 deficiency
○
Risk: men and women age 51-70 b/c of supplements, weakness,
fatigue
Population Health (about 4)
●
Understand levels of prevention
○ Primary:
■ Prevention before it happens
■ Ie. vaccines, personal hygiene, environmental sanitation, protection against
occupational hazards, protection from accidents, genetic screening
○ Secondary:
■ Early diagnosis
■ Prompt treatments
■ Disability limitations
■ SCREENINGS
○ Tertiary:
■ Restoration and rehabilitation
■ Recovery from accidents or illness
■ Managing disease and slowing production
■ Regular inspections after disease
●
Understand the social determinants of health
○ The condition in which people are born, grown, live, work, and age, shaped by the
distribution of money, power, and resources at global, national, and local levels
Vaccines (about 3)
●
●
Be able to use an immunization schedule
Know difference between live and inactivated vaccines and nursing implications
○ Live vaccine
■ Produced by modifying disease-causing microorganisms, such as viruses and
bacteria
○ Inactivated vaccine
■ Produced by growing bacteria or viruses in culture media, then inactivating them
with heat or chemicals
● Know the difference between active and passive immunity and how both are acquired
○ Active immunity: protection that is produced by the person’s own immune system
○ Passive immunity: protection by products produced by an animal or human, and
transferred to another human, usually by injection
Growth and development: Infant – adolescent (about 10)
●
Understand overall growth and development concepts unique to the infant, toddler,
preschooler, school-aged child, and adolescent
○ Infants:
■ 1 to 6 months: gains 5-7 oz and 1 in/month
■ 6 months to 1 yr: gains 3-5 oz and 1 in/month
■ 1 months: eyes follow bright objects, turns head, holds hand in fists
■
■
●
●
●
2 months: lists actively to sounds, lifts head, smiles and coos
4 months: babbles, primitive reflexes are gone, holds head steady, chews/bites,
rolls
■ 6 months: no head lag, rolls, sits unsupported, responds to name, puts things in
mouth
■ 9 months: crawls/scoots, better coordination, stranger anxiety
■ 12 months: pulls to stand, says mama/dada, waves bye, walk with hand held,
imitates vocalization
○ Toddlers/Preschoolers:
■ Ages 1-2: grow 2-4 inches, 4-6 lbs a year, walk by 15m, walk up stairs with help
at 18m, scribble by 18m, combine 2-3 words, parallel play, explore, imitate
■ Ages 2-3: jump in place, ride bike, use 3 word sentences, know name, age, and
gender, potty trained, parallel play
■ Age 4-preschool: grow 2 in and 4 lbs/year, draw a person, use scissors, name 4
colors, hop and balance on each foot, play cooperatively
○ School-Age Children:
■ Age 5-12: peer relationships, sexual identify, stress
○ Adolescent (ages 11/12-21 years)
■ Growth: height/weight increases during prepubertal growth spurt
● Girls: reach full height by 16-17 years
● Boys: reach full height by 18-20 years
■ Physical changes
● Sex-specific changes (menarche)
● Development of reproductive system
■ Psychosocial: search for person identity, development of ethical system,
consideration of future
■ Cognitive & communication: ability to think rationally, communication skills
Know Erikson for the infant through adolescent age groups
○ Trust vs. Mistrust (birth to 1 year)
○ Autonomy vs. Shame & Doubt (1 to 3 years)
○ Initiative vs. Guilt (3 to 6 years)
○ Industry vs. Inferiority (6 to 11 years)
○ Identity vs. Role Confusion (adolescents -11/12 to 21 years)
Know the leading causes of injury/death for each age
○ Infants: poisoning, drowning, motor vehicle accidents
○ Toddlers: drowning, poisoning, motor vehicle accidents, injury prevention, home safety
○ School age: accidents, bicycle injuries, infections, flue, child abuse
○ Adolescents: accidents, violence & homicide, suicide, subsstance abuse, eating disorders,
STIs, pregnancy
Know how to promote breastfeeding and prevent SIDS
○ Breastfeeding:
■ Reduces infection
■ Promotes optimal brain growth
■ Easier to digest
●
●
●
■ Anti-inflammatory properties
■ Reduces risk of childhood obesity, ear infections, and diabetes
■ Reduces risk of asthma and other respiratory viruses
○ SIDS Prevention:
■ Avoid prone/side sleeping; have baby sleep on back
■ Empty crib & firm mattress
■ Avoid overheating infants
■ Avoid commercial devices marked to reduce the risk of SIDS
Know S/S of eating disorders
○ Bulimia Nervosa:
■ Purging after meal or abuse of laxatives
■ Dehydration, heart problems, missed periods, depression, digestive problems,
teeth and gum problems from stomach acid
○ Anorexia:
■ Skipping meals, exercising a lot, underweight (doesn’t change drastically)
Review mild traumatic brain injury (mTBI) information
○ Pediatric brain is more susceptible to mTBI
■ Developing brain, body, curiosity
○ Categories of mTBI symptoms
■ Somatic
■ Cognitive
■ Sleep
■ Affect
○ Signs of intracranial injury or deteriorating neuro/cognitive symptoms = immediate
emergency care
○ Head CT if indicated by validated decision tool
○ If a child hits their head, has a headache, and “doesn’t feel right”...
■ Assess symptoms and concussion history and require observation at home for
24-48 hours for signs of deteriorating neurological function
○ mTBI symptom rating scales should assess changes from usual/baseline symptom
presentation
Know Tanner Stages
○ Pubic Hair Growth:
■ Stage I: Preadolescent - no sexual hair
■ Stage II: sparse, pigments, long, straight, mainly along labia and base of penis
■ Stage III: Darker, coarser, curlier
■ Stage IV: Adult, but decreased distribution
■ Stage V: Adult in quanity and type with spread to medial thighs
○ Breast/Male Genitalia Development:
■ Stage I: preadolescent
■ Stage II:
● Breast budding
● Enlargement, change in texture
■ Stage III:
■
■
● Continued enlargement
● Growth in length
Stage IV:
● Areola and papilla form secondary mound
● Further development of glans penis, darkening of scrotal skin
Stage V: Mature breasts/genitalia