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Executive Editor: Amanda Martin
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Composition: S4Carlisle Publishing Services
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Cover Image: © Gregor Buir/Shutterstock
Printing and Binding: Edwards Brothers Malloy
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Library of Congress Cataloging-in-Publication
Data
Names: Hackley, Barbara, editor. | Kriebs, Jan M.,
editor.
Title: Primary care of women/edited by Barbara K. Hackley and Jan M. Kriebs.
Description: Second edition | Burlington, Massachusetts: Jones & Bartlett
Learning, [2017] | Includes bibliographical references.
Identifiers: LCCN 2016014028 | ISBN 9781284045970
Subjects: | MESH: Primary Health Care | Women’s
Health | Midwifery | Nurse
Midwives | Nurse’s Role | United States
Classification: LCC RG950 | NLM W 84.6 AA1 | DDC 618.2/0233 dc23
LC record available at https://lccn.loc.gov/2016014028
6048
Printed in the United States of America 20 19 18 17 16 10 9 8 7 6 5 4 3 2 1
PREFACE ACKNOWLEDGMENTS
CONTRIBUTORS
1 Defining Primary Care
Jan M. Kriebs
Midwifery Scope of Practice
Women’s Health as Primary Care Practice
The Clinical Scope of Primary Care
Chronic Diseases and Cause of Death
Disparities in Health Care
Cultural Competence in Practice
Conclusion
References
2 General Health Examination
Barbara K. Hackley
Annual Health Exam
Screening Tests
Criteria for Successful Screening Programs
Accuracy of Screening Tests
Impact of Disease Prevalence
Biases in Screening Tests
Recommendations of Various Organizations
Immunizations
Immune Response
Types of Vaccinations
Vaccine Safety
Principles of Vaccination
Commonly Used Adult Vaccines
HPV Vaccines
Influenza Vaccines
Measles, Mumps, Rubella (MMR) Vaccines
Meningococcal Vaccine
Pneumococcal Vaccines
Tetanus, Diphtheria, Acellular Pertussis (Tdap) Vaccine
Varicella and Zoster Vaccines
Immunization in Special Populations
References
3 Environmental Health
Katie Huffling
Why Women’s Healthcare Professionals?
Scope of the Issue
Clinical Care
Assessment of Risk
History and Physical Examination
Laboratory
Diagnosis, Treatment, and Referral
Anticipatory Guidance
The Environment and Patient Care—Issues and Foundation
Breastfeeding
Breast Cancer
Common Environmental Risks
Molds Mercury
Polyvinyl Chloride Plastic, Phthalates
Lead
Flame Retardants
Bisphenol A
Pesticides
Climate Change
Conclusion
References
4 Sleep Disorders
Janet Beardsley, Jennifer G. Hensley, Julia Lange
Kessler
Introduction
Sleep Loss, Health, and Safety
Physiology of Sleep
Sleep-Wake Cycles
Sleep Stages
Metabolic Changes During Sleep
Thermoregulation
Respiratory and Cardiovascular
Endocrine
Common Symptoms of Sleep Disorders
Specific Sleep Conditions
Insomnia
Sleep-Disordered Breathing
Central Disorders of Hypersomnolence—
Narcolepsy
Circadian Rhythm Sleep-Wake Disorder
Parasomnias
Sleep-Related Movement Disorders— Restless Legs Syndrome/Willis-Ekbom Disease
Summary
Online Resources
References
5 Mental Illness in Primary Women’s Health Care
Barbara W. Graves
Gender and Mental Health
Presentations of Mental Illness Through the Life Cycle
Essential History, Physical, and Laboratory
Evaluation
History
Physical Examination
Laboratory Studies
Mental Disorders Commonly Seen in Primary Care
Mood Disorders
Anxiety Disorders
Stress Disorders
Adjustment Disorders
Eating Disorders
Personality Disorders
Substance-Related Disorders
Female Gender–Associated Mental Disorders
Menstrual Disorders
Perinatal Mood Disorders
Depression and/or Anxiety During Pregnancy
Postpartum Mood Disorders
Adjunctive Therapies for Mental Illness
Referral and Consultation with Mental Health
Clinicians
Conclusion
Online Resources
References
6 Substance Use
Christine L. Savage, Deborah Finnell
Substance Use Across the Continuum
Level of Risk
Types of Psychoactive Substances
Epidemiology of Substance Use in Women
Tobacco: Prevalence, Attributable Mortality
Alcohol: Prevalence, Attributable Mortality
Illicit Drugs: Prevalence, Attributable Mortality
Substance Use in Women by Age and Ethnicity
Emerging Issues
Nonprescription Use of Controlled Substances
Methamphetamine
Legalization of Marijuana
Neurobiologic Bases of Substance Use
The Brain Reward System
Genetics and Epigenetics
Application to Practice
Women-Specific Issues
Women-Specific Physiology and Exposure to Psychoactive Substances
Adverse Health Consequences
Women of Reproductive Age
Older Women
Substance Use and Comorbidity
Social Implications—Gender Bias
Advertising
Stigma
Cultural Shift
Prevention Models
The Institute of Medicine Prevention Model
Harm Reduction Model
Screening and Assessment
Screening for At-Risk Alcohol Use
Screening for Drug Use Including Nonmedical Use of Prescription
Medication
Screening for Tobacco Use
Screening for Substance Use During Pregnancy
The Use of Biomarkers and Toxicology to Screen for Substance Use
Physical Assessment
Brief Interventions
Referral to Treatment
Pharmacology
Smoking Cessation
Medications Used in the Treatment of Alcohol Abuse
Medications Used in the Treatment of Opiate Addiction
Mutual Self-Help Groups
Conclusion
References
7 Women and Violence—Issues for Primary Care Providers
Jenna A. LoGiudice, Jan M. Kriebs
Child Abuse and Neglect
Prevalence
Etiology
Sequelae and Prevention
Violence Against Women
Rape and Sexual Assault
Intimate Partner Violence (IPV)
Assessment and Care for Victims of Violence
Assessment
Reporting Abuse
Clinical Examination When Violence Is Suspected
Sexual Assault and Rape Evaluation
Documentation
Danger Assessment and Safety Planning
Working with Survivors of Abuse
Trauma-Informed Care
Abuse During Pregnancy
Sequelae
Prevention of IPV
Elder Abuse
Incarcerated Women
Health Concerns
Women’s Health Care
Programs Addressing These Challenges
A Final Note for Clinicians
References
8 Neurology
Lynn C. Simko
Introduction
Common Symptoms
General Approach to Investigating Neurologic
Problems
History
Abbreviated Neurologic Exam
Neurologic and Laboratory Testing
Headache
Essential History, Physical, and Laboratory
Assessment
Tension Headache
Migraine Headache
Chronic Headache
Cluster Headache
Syncope
History
Physical Examination
Laboratory
Management of Syncope
Complementary/Alternative Therapies
Patient Instructions
During Pregnancy and Lactation
Vertigo and Dizziness
Numbness and Paresthesia—Peripheral Neuropathy
History
Physical
Laboratory and Clinical Testing
Management of Numbness/Tingling/Paresthesia
Weakness
History
Physical
Laboratory
Management
Multiple Sclerosis
History
Physical Examination
Laboratory Evaluation
Medications
Complementary/Alternative Therapies
Pregnancy/Lactation
References
9 Common Conditions of the Eye
Melanie Cheung, Derek Hoare
Anatomy and Function
Essential History and Physical
History
Physical
Eye Conditions
Minor/Self-Limiting Conditions
Urgent and/or Chronic Ophthalmic
Conditions
Uveitis and Iritis
Eye Injury
Cellulitis
Herpes Infections
Glaucoma
Common Health Conditions Associated with
Visual Problems
Aging
Diabetes
Thyroid Disease
Pregnancy
References
10 The Ear
Holly Thomas, Deborah A. Hall, Matija Daniel
Introduction
Physiology
Outer Ear
Middle Ear
Inner Ear
Vestibulocochlear Nerve
Otologic Symptoms
Pain
Auditory Symptoms of Hearing Loss
Vestibular Symptoms
Tinnitus
Essential History, Physical Examination, and
Laboratory Data
History
Physical Examination
Referral Criteria
Diagnostic Clues
Specific Conditions
Outer Ear Conditions: Otitis Externa, Foreign Bodies, and Earwax
Middle Ear Condition: Otitis Media with Effusion
Inner Ear Conditions: Sensorineural Hearing Loss and Vertigo
Retrocochlear Condition: Vestibular Schwannoma
References
11 Oral Health
Barbara K. Hackley
Preventive Health Care
Personal Dental Health Practices
Screening and Early Treatment of Dental Health Conditions
Recognizing Dental Disease
Clinical Presentation
Essential History, Physical, and Laboratory
Evaluation
Management of Common Conditions
Caries
Abscess
Gingivitis and Periodontal Disease
Tooth Loss
Temporomandibular Disorders
Dental Trauma
Care of the Pregnant and Breastfeeding
Woman
References
12 Diabetes
Allison A. Vorderstrasse
Epidemiology
Course of Disease
Evaluation for Diabetes
History and Physical
Laboratory Testing
Differential Diagnosis
Management
Type 1 Diabetes
Type 2 Diabetes
Patient Education
Prevention of Type 2 Diabetes
Impact of Pregnancy and Breastfeeding
References
13 Thyroid and Other Endocrine Disorders
Barbara K. Hackley, Jan M. Kriebs
Thyroid Disease
Screening Recommendations
Thyroid Physiology
Clinical Presentation
History, Physical, and Laboratory
Evaluation
Hypothyroidism
Prevalence
Etiology
Presentation
Treatment
Hyperthyroidism
Etiology
Presentation
Treatment
Thyroid Nodule Pregnancy
Postpartum
Parathyroid Disease
Clinical Presentation
Management
Adrenal Gland Disorders
Adrenal Insufficiency
Cushing’s Syndrome
References
14 Hematology
Barbara K. Hackley
White Blood Cells
Granulocytes
Agranulocytes
Interpretation of WBC Abnormalities
Clinical Presentation
Essential History, Physical, and Laboratory
Data
Management of Conditions Affecting the WBCs
Red Blood Cells (RBCs)
Physiology
Hemoglobinopathies
Classification of Anemia
Routine Screening
Clinical Presentation
Essential History, Physical Examination, and Laboratory Data
Management of Anemia
Platelets
Essential History, Physical, and Laboratory
Evaluation
Management of Common Conditions
Conclusion
References
15 Respiratory Conditions
Karen Stemler, Barbara K. Hackley
Common Respiratory Symptoms
Rhinitis
Fever
Wheeze
Cough
Physiologic Changes in Pregnancy
Management of Specific Respiratory Conditions
Common Cold
Essential History, Physical, and Laboratory
Assessment
Management
Influenza
Essential History, Physical, and Laboratory
Assessment
Management
Pneumonia
Essential History, Physical, and Laboratory
Assessment
Management
Allergies
Essential History, Physical, and Laboratory
Evaluation
Management
Patient Instructions
Rhinosinusitis
Essential History, Physical, and Laboratory Evaluation
Management
Chronic Rhinosinusitis
Management
Acute Bronchitis
Essential History, Physical, and Laboratory Evaluation
Management
Asthma
Essential History, Physical, and Laboratory Evaluation
Management
Chronic Obstructive Pulmonary Disease
Essential History, Physical, and Laboratory
Testing
Management of Stable COPD
Management of Exacerbations of Chronic Bronchitis and/or COPD
Tuberculosis
Essential History, Physical, and Laboratory Testing
Management of Tuberculosis
References
Carolynn Bruno, Barbara K. Hackley
Clinical Presentation
Essential History, Physical, and Laboratory
Findings
History
Physical
Laboratory/Imaging Testing
Cardiac Symptoms and Physical Findings
Chest Pain
Palpitations
Heart Murmur
Management of Cardiovascular Conditions
Hypertension
Physiology
Management
Management Issues Specific to Women
Alternative Therapies in the Management of Hypertension
Dyslipidemia
Physiology
Management
Medication Management
Alternative Therapies
Metabolic Syndrome
Dyslipidemia and Pregnancy
Venous Thromboembolism
Physiology
Assessment
Treatment
Pregnancy and Postpartum
Hypercoagulable States
Varicose Veins
References
17 Gastrointestinal
Diseases
Barbara K. Hackley, Elaine Leigh
Clinical Presentation
Nausea and Vomiting
Diarrhea
Dyspepsia and Heartburn
Dysphagia
Abdominal Pain
Constipation
Rectal Bleeding
Essential History, Physical, and Laboratory
Evaluation
History
Physical Examination
Laboratory Evaluation
Imaging/Diagnostic Procedures
Management of Common Gastrointestinal
Conditions
Conditions Associated with Nausea, Vomiting, and/or Diarrhea
Conditions Associated with Nausea and Vomiting
Conditions Associated with Diarrhea
Conditions Characterized Primarily by Dyspepsia and Heartburn
Conditions Characterized Primarily by Dysphagia
Conditions Characterized Primarily by Abdominal Pain
Conditions Characterized by Constipation
Conditions Characterized Primarily by Rectal Bleeding
Miscellaneous
References
18 Obesity and Weight Management
Diane Berry
Pathophysiology of Obesity
Office-Based Obesity Care
Measurement of Obesity
Associated Disease Risks
Management of Obesity
Dietary Interventions
Behavioral Modification Interventions
Exercise Interventions
Nonprescription Weight-Loss Products
Pharmacologic Therapy
Surgical Treatment
Weight-Loss Maintenance
Management of Obesity in Pregnancy
Dietary Interventions
Behavioral Modification Interventions
Exercise Interventions
References
19 Breast Health and Disease
Jan M. Kriebs
Breast Development and Anatomy
Epidemiology of Common Breast Conditions
Benign Breast Conditions
Breast Cancer
Essential History, Physical, and Laboratory
Evaluation
History
Physical Examination
Laboratory and Imaging
Evaluation of Breast Masses in Pregnancy
Classification and Management of Benign
Breast Conditions
Fibrocystic Breasts
Nonproliferative Changes
Proliferative Lesions Without Atypia
Proliferative Lesions with Atypia— Hyperplasia and Carcinoma In Situ
Other Symptoms and Conditions
Breast Cancer Screening
Risk Factors for Breast Cancer
Imaging in Breast Cancer Screening
Prevention of Breast Cancer
Invasive Breast Cancer
Hormone Receptor Status and Prognosis
Less Common Cancers
Psychosocial Aspects of Breast Cancer
Missed Diagnoses and Liability
Conclusion
References
Appendix 19-A: Breast Examination
Procedure for Breast Examination
References
20 Urinary System
Megan Sapp Madsen, Jan M. Kriebs
Basics of Anatomy and Physiology
Essential History, Physical Examination, and
Laboratory
History
