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A. You develop a fever with your bleeding. B. You have a gush of blood from your vagina that is more than a period. C. You pass blood clots or tissue from your vagina. D. Your vaginal bleeding has a foul odor. E. You experience abdominal pain or uterine cramping not relieved by taking acetaminophen. F. Other:_______________________________________________________________ Phone:_______________________________________________________________ 2266
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VAGINAL BLEEDING: SECOND AND THIRD TRIMESTERS PROBLEM Vaginal bleeding may occur during the second and third trimesters of pregnancy (more than 12 weeks). The bleeding may range from spotting of blood on your panties to bleeding like a menstrual period. CAUSE A small amount of bloody mucous discharge or spotting may occur for about 1 day following a pelvic examination or sexual intercourse. This is normal if it is not associated with cramping or contractions. Other causes of vaginal bleeding may be related to the location of the placenta (placenta previa) or premature separation (abruption) of the placenta from your womb. Placental abruption can be associated with cocaine use, cigarette smoking, and trauma (injuries from car wrecks or physical violence). PREVENTION/CARE There is no known way to prevent most types of vaginal bleeding. If you have been diagnosed with placenta previa, you may be able to prevent bleeding by avoiding sexual intercourse and maintaining bed rest. There is no known method of preventing placenta previa. Smoking has been associated with placental abruption and placenta previa. You should not smoke or at least you should try to cut down and stop smoking during pregnancy. When you stop smoking, it is also good for your baby's health after delivery. TREATMENT PLAN A. Treatment depends on the cause of your vaginal bleeding. You may be placed on bed rest. B. Stop smoking. Ask your provider for a handout on tips to stop smoking. C. You may need to be on a rest schedule. D. You may need to stop working. E. You need to arrange help for child care, grocery shopping, and housework. Activity: The checked activity restriction(s) are prescribed by the provider. Level 1: As tolerated, avoid heavy lifting above 20 lb. Level 2: Modified bed rest. You may be out of bed for breakfast; rest (lying down) for 2 hours in the morning with moderate activity until lunch; rest for 2 hours with moderate activity until dinner. 2267
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Go to bed by 8 p. m. Moderate activity consists of short periods of cooking and light housework. Level 3: Strict bed rest. You may be out of the bed only to go to the bathroom or to move to the couch. You may take a shower, use the toilet, and brush your teeth, but then return immediately to bed. No sexual intercourse. Perform range-of-motion (ROM) exercises as directed by your practitioner. Diet: Eat fresh vegetables, fruits, and bran cereal to avoid becoming constipated on bed rest. Drinking extra liquids (especially water) also helps to prevent constipation. Medications: Continue taking your prenatal vitamins every day. You Need to Notify the Office If You Have: A. Contractions or cramps, eight in 1 hour or four in 20 minutes B. Bloody, mucous discharge not associated with recent sexual intercourse or a pelvic examination C. Bright-red or dark-red vaginal spotting D. Bleeding like a period E. A gush of fluid or blood from your vagina F. Sharp, knifelike pain in your abdomen that does not go away G. Pelvic pressure or low backache not relieved with emptying your bladder and resting on one side H. Noticed decreased movement of the baby I. Other:_______________________________________________________________ Phone:_______________________________________________________________ 2268
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VAGINAL YEAST INFECTION PROBLEM You have been diagnosed with a vaginal yeast infection. This is an infection or inflammation of the vagina that is caused by a fungus known as yeast ( Monilia or Candida albicans). CAUSE Yeast cells ( Monilia) are normally present on the skin in healthy people. These cells may be found in the vagina or rectal area. However, due to a disturbance in the body's hormones and p H, an overproduction of these cells has occurred and has caused an infection. Several factors can cause this disturbance, which include menstrual periods, pregnancy, diabetes, antibiotics or other medications, increased dietary intake of sugars and alcohol, and an increase in moisture and warmth in the vaginal or rectal area by wearing tight, restrictive clothing. PREVENTION/CARE A. Keep the vaginal and rectal areas clean and dry. B. Shower daily and avoid tub baths. C. Avoid tight, restrictive clothing such as tight jeans and underwear. D. Wear cotton panties that allow air to circulate. At bedtime, do not wear underwear with your pajamas. E. Obesity can contribute to this problem, too. If you have gained an excessive amount of weight, try to lose these extra pounds. F. Avoid douching because this changes the normal flora and p H of the vagina, which can contribute to causing yeast infections. TREATMENT PLAN A pelvic examination may have been necessary to identify the source of your infection. Practice preventive tips to speed your recovery. Activity: Avoid excessive exercise and activities that produce excessive sweating; also avoid sexual intercourse until your infection is gone. Your partner may also need to be treated for this same infection. Diet: Drink plenty of water and other liquids. Avoid alcohol and excessive sugars. Increase the intake of yogurt and buttermilk in your diet. Medications: Antifungal medications may be prescribed for you. 1. Over-the-counter medications may include Monistat vaginal suppositories and cream. This is also 2269
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known as miconazole nitrate, which you may find in the drug store at a much lower price and which can be just as effective. 2. You must use the full days of the over-the-counter medication. If you stop too early, the yeast can regrow. If you have also been diagnosed with a bacterial infection of the vagina, other medications may also be prescribed. If your provider has prescribed Flagyl (metronidazole), please do not drink any alcohol while taking this medication and for the next 3 days following this medication. The combination of this medication and alcohol can make you very sick. You Have Been Prescribed: _______________________________________________________________ You Need to Take: _______________________________________________________________ You Need to Notify the Office If: A. Over-the-counter medications do not help your symptoms. B. You develop other symptoms. C. Other: _______________________________________________________________ Phone: _______________________________________________________________ 2270
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VARICOSE VEINS PROBLEM Varicose veins are caused when the valves inside of veins are damaged and allow blood to flow backward instead of toward the heart. This backflow of blood increases the pressure in the vein, leading to pain and swelling, and makes them more visible. Varicose veins can worsen and increase the risk of blood clots, infection, bleeding, and changes to the skin. CAUSE There are many factors that increase the chance of developing varicose veins. Some cannot be changed, like age and genetics. Some can be changed; these include prolonged standing, restrictive clothing, excessive weight, and smoking. PREVENTION/CARE A. Avoid prolonged standing. If prolonged standing is required, shift weight from one leg to the other. B. Do not sit with legs dependent. TREATMENT PLAN A. Raise the affected arm or leg whenever lying down to improve pain and swelling. B. Wear compression stockings. Put them on before getting out of bed in the morning. Take them off just before going to bed at night. C. Avoid standing or sitting for long periods of time. D. Follow up with your primary health care provider on a regularly scheduled basis. Activity: A. Get regular exercise. Discuss with your health care provider what type and frequency of exercise is safe for you. B. Exercise leg muscles by pumping ankles when sitting. Rocking in a rocking chair is another option. Diet: A. Discuss with your health care provider the type of diet that best suits your needs: Diabetic diet, low-fat diet, low-cholesterol diet, and/or low-sodium diet. B. If you are taking the blood thinner Coumadin, ask your health care provider about which foods are high in vitamin K and whether you should limit those foods in your diet. Medications: 2271
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You Have Been Prescribed: _______________________________________________________________ You Need to Take: _______________________________________________________________ You Need to Notify the Office If You Have: A. New pain, swelling, or warmth in an arm or leg B. Increased redness, pain, tenderness to touch, and/or warmth in the affected arm or leg C. Sudden shortness of breath D. Chest pain E. Other: _______________________________________________________________ Phone: _______________________________________________________________ RESOURCES Patient Education Center—Varicose Veins: patienteducationcenter. org/articles/varicose-veins Patient Handout—Varicose Veins: nursing. advanceweb. com/sharedresources/ADVANCEfornurses/Resources/Downloadable Resources/N1010504_p30handout. pdf 2272
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WARTS PROBLEM A wart is a raised, rough growth projecting from the skin, which can be contagious. CAUSE Warts are caused by a viral infection that stimulates the cells of the skin to multiply rapidly, which results in an outward growth. PREVENTION/TREATMENT PLAN A. Wash hands well. B. Avoid scratching or picking warts. Warts bleed easily. C. Some warts go away spontaneously after time without any treatment. D. Medications may be prescribed. To Enhance Destruction A. Soak the wart in warm water 10 to 15 minutes a day. B. After soaking, use an emery board to file the wart down. C. Apply over-the-counter medication as prescribed (Compound W) to the site. D. Duct tape may be applied over the wart. Perform these steps every night until resolved. E. Warts may reappear at the same spot or in other areas. F. Cryotherapy “freezing” is another treatment option. Discuss this with your health care provider. Activity: There are no activity restrictions for warts. Diet: There are no special diets for warts. Medications: You Have Been Prescribed: _______________________________________________________________ You Need to Take: _______________________________________________________________ You Need to Notify the Office If: A. You develop an infection at the site of the wart. 2273
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B. Other: _______________________________________________________________ Phone: _______________________________________________________________ 2274
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WOUND CARE: LOWER EXTREMITY ULCERS PROBLEM An ulcer on the body that lies on the lower extremities CAUSE Edema, trauma, ischemia, venous insufficiency PREVENTION/CARE A. Keep the area clean and free of foreign debris. B. Dressing changes: C. You may be prescribed antibiotics; if so, take all antibiotics until they are completely gone. TREATMENT PLAN Activity: Do not apply direct pressure to the site of the ulcer. You may be prescribed to elevate your lower extremities. Diet: Eat a well-balanced diet. Increase protein intake. Medications: You Have Been Prescribed: _______________________________________________________________ You Need to Take: _______________________________________________________________ You Need to Notify the Office If You Have: A. A reaction or cannot tolerate any of the prescribed medications B. A fever and a general ill feeling C. Any new or unexplained symptoms related to the ulcer 1. Increase in size 2. New odor 3. Increased drainage 4. Change in color of the drainage 5. Increased pain at the site D. Any questions or concerns 2275
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Phone: _______________________________________________________________ 2276
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WOUND CARE: PRESSURE ULCERS PROBLEM An ulcer on the body that lies over a bony surface CAUSE Prolonged periods of pressure to the area of ulcer causing a breakdown of skin integrity. PREVENTION/CARE A. Keep the area clean and free of foreign debris. B. You may be prescribed dressing changes. 1. Remove dressing. 2. Clean the ulcer with normal saline. 3. Apply prescribed medication (see the following). 4. Cover with dry dressing, change as ordered. C. You may be prescribed antibiotics; if so, take all antibiotics until they are completely gone. TREATMENT PLAN Activity: Do not apply direct pressure to the site of the ulcer. Diet: Eat a well-balanced diet. Drink 8 to 10 glasses of water per day. Increase protein intake. Medications: You Have Been Prescribed: _______________________________________________________________ You Need to Take: _______________________________________________________________ You Need to Notify the Office If You Have: A. A reaction or cannot tolerate any of the prescribed medications B. A fever and a general ill feeling C. Any new or unexplained symptoms 1. Increase in size 2. New odor 3. Increased drainage 4. Change in color of the drainage 5. Increased pain at the site D. Any questions or concerns 2277
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Phone: _______________________________________________________________ 2278
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WOUND CARE: WOUNDS PROBLEM A wound is a break in the external surface of the body. CAUSE Wounds are often due to an accidental or intentional injury. Wound infection is usually caused by bacterial contamination of the site. PREVENTION/CARE A. Prevent accidental or intentional injury. B. Immediately after injury, cleanse the wound well with soap and water. C. Remove all dirt and foreign material. D. You may be prescribed antibiotics; if so, take all antibiotics until they are completely gone. E. You may need a tetanus shot. TREATMENT PLAN Activity: No restrictions. If infection is present, you may need to increase rest. Diet: Eat a well-balanced diet. Drink 8 to 10 glasses of water per day. Medications: You Have Been Prescribed: _______________________________________________________________ You Need to Take: _______________________________________________________________ You Need to Notify the Office If You Have: A. A reaction or cannot tolerate any of the prescribed medications B. A fever and a general ill feeling C. A wound/infection that seems to worsen D. Any new or unexplained symptoms E. Any questions or concerns Phone: _______________________________________________________________ 2279
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WOUND INFECTION: EPISIOTOMY AND CESAREAN SECTION PROBLEM You have an infection of your episiotomy site or cesarean section incision. CAUSE The cause is one or more types of bacteria that invaded the tissue following your delivery. The bacteria may be from the vagina, the bowel, or the environment. TREATMENT PLAN A. Take your temperature if you have fever and chills. B. Episiotomy: 1. Wash hands before and after changing your sanitary pads and your baby's diaper. 2. Wipe or pat dry from front to back after every urination or bowel movement. 3. Apply and remove perineal pad from front to back. 4. Change perineal pad at least every 4 hours and after each void or bowel movement (BM). 5. Use a squeeze bottle: Position the nozzle between the legs, empty the entire bottle over the perineum, blot dry with toilet paper, and avoid contamination from the anal area. 6. Use a blow dryer on the lowest setting to “air dry” your stitches. 7. Wash the perineum with mild soap and warm water at least once daily. C. Cesarean section incision: 1. Wash hands before and after dressing change and wound care. 2. Follow all of the aforementioned directions (except 6) for your bleeding, too. 3. After showering, gently pat dry your abdomen. 4. If the wound is draining, cover it with a clean dressing and call the office for instructions. Otherwise, leave it open to air. 5. Cleanse the incision with hydrogen peroxide and cotton swab. Do not clean the same area more than once with the same swab. 6. If your incision opens, notify your practitioner for further instructions. Activity: Increased rest is recommended; try to lie down for a nap when the baby goes to sleep. Diet: There are no dietary restrictions; eat well-balanced meals. Increase your fluid intake with an infection. Drink at least 10 to 12 glasses of liquid a day. Medications: Continue your prenatal vitamins. You may take acetaminophen one to two tablets every 4 to 6 hours for your fever and/or discomfort. You Have Been Prescribed the Following Antibiotics: 2280
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You Need to Take: _______________________________________________________________ Take all of your antibiotics, even if you feel better, unless you have an adverse reaction to them. Then call the office. You Need to Notify the Office If You Have: A. Temperature that rises significantly or reaches 101°F B. Foul-smelling drainage from the incision or episiotomy site C. Increased pain or tenderness D. Separation of wound or incision E. Other: _______________________________________________________________ Phone: _______________________________________________________________ 2281
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XEROSIS (WINTER ITCH) PROBLEM Xerosis is severely chapped skin that becomes cracked, fissured, and inflamed. It can appear on skin anywhere on the body, but it is seen most commonly on the legs. CAUSE Xerosis is caused by insufficient oil on the skin's surface, which allows water to evaporate through the skin. Oil in the skin decreases with aging, excessive bathing, and excessive rubbing of the skin. An environment with low humidity also promotes dryness of the skin. PREVENTION/CARE A. Reduce water loss from the skin. 1. Decrease the frequency and duration of baths or showers; use tepid water. 2. Use soap sparingly. 3. Avoid detergent soaps. 4. Pat skin dry rather than rubbing. 5. Apply skin lubricants (Lac-Hydrin, Eucerin, etc. ) to dry skin before chapped areas become inflamed. 6. Use ultrasonic, cool-mist humidifiers if the air is very dry. 7. Clean the humidifier daily. 8. Oil (such as Nivea) in the bath water may be helpful. 9. Apply lubricants after bathing when possible to trap additional moisture before evaporation occurs. B. Apply hand cream four to eight times a day to hands and twice daily on the trunk and extremities. TREATMENT PLAN Activity: No restrictions. Avoid long-term exposure to drying environments. Diet: Eat a well-balanced diet; drink 8 to 10 glasses of water per day. Medications: You Have Been Prescribed: _______________________________________________________________ You Need to Take: _______________________________________________________________ You Need to Notify the Office If You Have: A. Severely chapped skin, and self-care does not relieve the symptoms in 1 week 2282
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B. Chapped skin that becomes inflamed or if you see any oozing C. Any questions or concerns Phone: _______________________________________________________________ 2283
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ZIKA VIRUS INFECTION PROBLEM The Zika virus is a virus that is transmitted to humans by infected mosquitoes. Symptoms of the virus include low-grade fever, hand and/or foot joint pain, skin rash, headache, and/or eye discomfort or pain. The virus can spread to other humans by sexual contact with someone who is infected with the virus. A pregnant woman infected with the virus can spread the virus to her unborn baby. CAUSE The disease is caused by a bite from a mosquito infected with the Zika virus. PREVENTION/CARE Avoid traveling to countries with known cases of the Zika virus. The outbreak of this virus has been documented in Central and South America, Mexico, the Caribbean, and the Pacific Islands. It has also been documented in the United States territories of Puerto Rico, the U. S. Virgin Islands, and American Samoa. There have been reported cases in the United States; however, the people diagnosed with the Zika virus had previously traveled to countries in which mosquitoes carry the virus. TREATMENT PLAN A. There is no medication or vaccination approved to treat the Zika virus. B. Prevention of the virus is the most important thing one can do to protect from getting the virus. Avoid traveling to areas in which the Zika virus is transmitted by mosquitoes. C. Medications, such as acetaminophen (Tylenol), may be given to improve symptoms if present such as headaches, fever, joint pain, eye pain, and muscle weakness. D. It is thought that the Zika virus can cause another condition called Guillain-Barré syndrome, in which symptoms of severe muscle weakness can occur and even lead to paralysis. Notify your health care provider if you have any of these symptoms. Activity: Avoid sexual contact with any person thought to have the Zika virus. A. Women: 1. If you have traveled to any of the countries at risk of the Zika virus you should use condoms with sexual activity or do not have sex for at least 8 WEEKS after your symptoms start. 2. If you have traveled to any of the countries at risk of the Zika virus and you DO NOT have any symptoms, you should use condoms with sexual activity or do not have sex for at least 8 WEEKS after returning. 3. Avoid becoming pregnant while traveling to high-risk areas and avoid becoming pregnant up to 2284
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8 WEEKS after travel. B. Men: 1. If you have traveled to any of the countries at risk of the Zika virus and you HAVE any of the above symptoms, you should use condoms with sexual activity or do not have sex for at least 6 MONTHS after your symptoms started. 2. If you have traveled to any of the countries at risk of the Zika virus and you DO NOT have any symptoms, you should use condoms with sexual activity or do not have sex for at least 8 WEEKS after returning. 3. If you have traveled to any of the countries at risk of the Zika virus and your PARTNER IS PREGNANT you should use condoms with sexual activity, or do not have sex, for the rest of your partner's pregnancy. C. Precautions to use if you travel to a country with the Zika virus: 1. Stay indoors. Mosquitoes infected with the Zika virus usually bite during the daytime, but precautions should also be taken for evening and nighttime hours. 2. If screens in windows are not available, use a bed net to cover you while sleeping. 3. Small children in strollers should also be covered with netting for protection. 4. Wear loose clothing to cover most of your body (light-colored clothing, long sleeves and pants, hat) to avoid mosquito bites. 5. Spray clothing with an insect repellant that contains permethrin when going outdoors. 6. Apply insect repellant that contains diethyltoluamide (DEET) or a chemical called picaridin to skin. Precautions should be used when using the insect repellant DEET on young children. 7. Insect repellent with DEET should not be used on children younger than 2 years old. 8. Apply insect repellent after sunscreen. 9. Avoid bodies of standing water such as pools, lakes, ponds, and so forth. Empty any containers with standing water such as buckets, plants, and so on. Diet: No special diet will prevent or improve the virus. You need to drink plenty of fluids to stay well hydrated. Medications: A. Acetaminophen (Tylenol) may be used for fever, body pain, and joint pain. B. Avoid aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs; ibuprofen, naproxen) because of the risks of bleeding if other conditions are present. C. Children younger than 18 years should not use aspirin because of the risk of Reye's syndrome. You Have Been Prescribed: You Need to Take: You Need to Notify the Office If: A. Muscle weakness occurs. Guillain-Barré syndrome is a condition that is thought to be triggered by the Zika virus. Symptoms include muscle weakness and can lead to paralysis of the muscles and even death. B. High fever, increased joint pain, severe headache, confusion, or any other new symptoms present. C. Other: _______________________________________________________________ 2285
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Phone: _______________________________________________________________ From FAMILY PRACTICE GUIDELINES, Fourth Edition. Copyright Springer Publishing Company, LLC. All Rights Reserved. 2286
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Appendices A. Normal Laboratory Values B. Diet Recommendations C. Tanner's Sexual Maturity Stages D. Teeth 2287
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A Normal Laboratory Values Normal laboratory values are presented here. However, ranges of laboratory value differ from laboratory to laboratory. They differ because of age and gender. Different values are presented; all normal values are listed under the Females column. Values for males and children are the same unless otherwise noted. Legend: 106 = 1,000,000; 103 = 1,000. Normal Laboratory Values 2288
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B Diet Recommendations 2291
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Bland Diet Cheryl A. Glass and Jill C. Cash You have been prescribed a bland diet. This diet provides adequate nutrition along with the treatment of gastrointestinal (GI) problems such as ulcerative conditions or inflammatory problems of the stomach and intestines. It is intended to decrease irritation in the lining of the stomach and intestines. Food Tips Foods to Avoid Garlic, onions, alcohol, fatty foods, fried foods, chocolate, cocoa, coffee (even decaffeinated), dried fruits, citrus fruit and juices (orange, pineapple, and grapefruit), tomato products, peppermint, whole-grain breads and cereals, prespiced foods such as processed lunch meats and ham, pepper, and chili powder. Avoid pepper, chili powder, and cocoa spices. General Instructions A. Eat at least three small meals a day. B. Avoid alcohol and beer. C. Avoid caffeinated drinks/colas. D. Avoid fried, greasy foods. E. Bake or broil your foods. F. Trim the fat from meats before cooking. G. Bake, broil, mash, or cream potatoes. H. Avoid raw fruits and vegetables, such as corn on the cob, and other gas-forming vegetables such as cabbage, dried beans, and peas. I. Avoid rich desserts. J. Avoid bedtime snacks—they may increase acid production and cause discomfort at night. K. Avoid eating 2 hours before you go to bed. L. Ask your health care provider if nutritional supplements are necessary. 2292
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Approved Foods by Food Group A. Dairy products 1. Whole milk 2. Low-fat or 2% milk 3. Skim milk 4. Evaporated milk 5. Buttermilk 6. Cottage cheese 7. Yogurt 8. Cheese B. Meat 1. Beef 2. Veal 3. Fresh pork 4. Turkey 5. Chicken 6. Fish (canned or fresh) 7. Liver 8. Egg (as a meat substitute) C. Breads/grains 1. Enriched breads (plain toast) 2. Oats 3. Cereal 4. Tortillas 5. English muffins 6. Saltine crackers 7. Pasta (all types) D. Fruits/vegetables 1. All vegetables 2. All fruits and juices (except citrus) E. Desserts 1. Custard 2. Pudding 3. Sherbet 4. Ice cream (except peppermint and chocolate) 2293
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5. Gelatin 6. Angel food cake 7. Pound cake 8. Sugar cookies 9. Jams and jellies 10. Honey F. Drinks 1. Decaffeinated tea 2. Juices (except citrus) 3. Caffeine-free sodas G. Spices 1. Salt 2. Thyme 3. Sage 4. Cinnamon 5. Paprika 6. Apple cider vinegar 7. Prepared mustard 8. Lemon and lime juices 2294
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DASH Diet: Dietary Approaches to Stop Hypertension Cheryl A. Glass and Jill C. Cash The Dietary Approaches to Stop Hypertension (DASH) diet is based on a combination of different types of foods and is recommended to help control high blood pressure (BP). It is a food plan that is based on foods that are low in cholesterol and high in dietary fiber, potassium, calcium, and magnesium; it is moderately high in protein. DASH eating has a reduction in lean red meats, added sugar, and sugar-containing sodas. The DASH diet's dairy food portions make the diet high in calcium and vitamin D. Overall, Americans, especially African Americans, are deficient in vitamin D. The DASH diet, along with weight loss and exercise, is used to control other health problems such as type 2 diabetes and heart disease. If your ethnic background is Hawaiian, American Indian, Eskimo, Hispanic, or African American, you are at higher risk for high BP. Following a DASH eating plan will also help lower the bad cholesterol, or low-density lipoprotein (LDL), which can reduce heart disease. A major way the DASH diet helps lower BP is to limit the amount of salt (sodium). The recommendations are limiting sodium to 2,300 mg a day or less. If you have high BP, you may be limited to 1,500 mg or less a day. One teaspoon of salt contains 2,000 mg of sodium. Foods high in sodium make you retain extra fluid. If you notice that your hands are swelling (rings are tight) or your feet and legs swell (sock rings or shoes feel tight), you are getting too much salt. Fluid retention is bad if you have heart failure. This diet is rich in potassium, which can help you get rid of the extra sodium and decrease the fluid retention. Sea salt, even though it may contain less sodium, is not low enough in sodium to use as a substitute for regular salt. Salt substitutes contain potassium chloride; this can cause more fluid retention. Potassium chloride salt substitutes may also interfere with your BP medications, so check with your health care provider before using them. 2295
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Tips for Reducing Sodium A. Slowly cut back on your salty foods and begin to use healthier products. Take the saltshaker off the table. B. Eat fresh foods. 1. Avoid prepackaged foods. 2. Eat fresh vegetables instead of canned vegetables. If you use canned vegetables, choose the low-sodium option and/or rinse the vegetables. C. Read food labels. 1. Sodium is in almost all processed foods, including milk. 2. Focus on the amount of sodium per food serving. 3. Do not forget to read labels on soda and sports drink bottles. 4. Choose your favorite food brand with low-salt or low-sodium labels on the package instead of the same product with more salt. D. Avoid salty snacks and foods, including: 1. Crackers, chips, and pretzels 2. Cheeses 3. Olives, pickles, pickled okra, and other foods 4. Processed foods, including jerky, hot dogs, bacon, deli meats, canned fish, and canned meats, which contain a large amount of sodium. E. Limit using soy sauce, seasoned salts, and meat tenderizers. F. Many seasonings, including ketchup and sauces, contain a lot of sodium. Substitute with other flavors such as fresh herbs (e. g., rosemary, thyme, oregano, cilantro, and basil). Use garlic powder, lemon and lime juice, and crushed red peppers, as well as ginger. G. Try making your own salt-free herb blend to use on your foods. Ingredients that can add flavor without adding salt include: 1. Peppers such as cayenne, black pepper, and lemon pepper 2. Dried herbs such as thyme 3. Garlic powder 4. Paprika 5. Celery seed H. Helpful websites for salt-free herb blend, products, and recipes are: 1. Salt-free seasoning recipes: a. busycooks. about. com b. www. tasteofhome. com/Recipes/Salt-Free-Seasoning-Mix 2296
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2. Websites with low-salt recipes: a. http://homecooking. about. com/library/archive/blhelp13. htm b. Mc Cormick: www. mccormick. com c. Mrs. Dash: www. mrsdash. com Tips on Eating the DASH Way A. Start small. Make gradual changes in your eating habits, such as eating smaller portions (see Tables B. 1 and B. 2). B. Center your meal around carbohydrates such as pasta, rice, beans, or vegetables. C. Treat meat as only part of a whole meal instead of the main focus of the meal. D. Use fruits or low-fat, low-calorie foods such as sugar-free gelatin for desserts and snacks. E. Choose “whole” grains in breads and cereals. F. Choose to eat vegetables without butter or sauce. G. Choose lean cuts of meat. Use fresh poultry, for example, skinless turkey and chicken. H. Choose ready-to-eat breakfast cereals that are lower in sodium. I. Eat fruits for dessert. Use fruits that are canned in their own juice. J. Add fruit to plain yogurt. K. To increase eating vegetables, stir-fry with 2 oz of chicken and use 11/2 cups of raw vegetables. L. Snack on vegetables, bread sticks, graham crackers, or unbuttered/unsalted popcorn. M. Drink water or club soda. N. Table B. 3 lists the number of servings suggested and Table B. 4 offers an example of the caloric adjustment for 2,000 calories a day using the DASH diet. TABLE B. 1 DASH Diet Serving Portion Sizes 2297
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TABLE B. 2 DASH Diet Daily Servings 2298
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TABLE B. 3 Total Number of Servings in 2,000 Calories per Day DASH Diet Food Group Servings Grains 6-8 Vegetables 4-5 Fruits 4-5 Fat-free or low-fat milk and dairy foods 2-3 Lean meats, poultry, and fish 2 (6 oz) Nuts, seeds, and legumes 1 (4-5/wk) 2299
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Fats and oils 2-3 Sweets and added sugars 1 (<5/wk) TABLE B. 4 DASH Example Menu (2,000 Calories) Food Amount Servings Provided Breakfast Orange juice 1% low-fat milk Corn flakes (with 1 tbsp sugar) Banana Whole-wheat bread (with 1 tbsp jelly) Soft margarine6 oz 8 oz (1 cup) 1 cup 1 medium 1 slice 1 tsp1 fruit 1 dairy 2 grains 1 fruit 1 grain 1 fat Lunch Chicken salad Pita bread Raw vegetable medley: Carrot and celery sticks Radishes Loose-leaf lettuce Part-skim mozzarella cheese 1% low-fat milk Fruit cocktail in light syrup¾ cup 1/2 large 3-4 sticks each 2 2 leaves 1. 5 slice (1. 5 oz) 8 oz (1 cup) 1/2 cup1 poultry 1 grain 1 vegetable 1 dairy 1 dairy 1 fruit Dinner Herbed baked cod Scallion rice Steamed broccoli Stewed tomatoes Spinach salad: Raw spinach Cherry tomatoes Cucumber Light Italian salad dressing Whole wheat dinner roll Soft margarine Melon balls3 oz 1 cup 1/2 cup 1/2 cup 1/2 cup 2 2 slices 1 tbsp 1 small 1 tsp 1/2 cup1 fish 2 grains 1 vegetable 1 vegetable 1 vegetable 1/2 fat 1 grain 1 fat 1 fruit Snacks 2300
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Dried apricots Mini-pretzels Mixed nuts Diet ginger ale1 oz (¼ cup) 1 oz (¾ cup) 1. 5 oz (1/2 cup) 12 oz1 fruit 1 grain 1 nuts 0 Resources DASH Diet Calorie Adjustments for 1,200, 1,600, 2,000, and 2,400 calorie diets: http://dashdiet. org/Images/calories. pdf The DASH Diet Eating Plan: http://dashdiet. org/dash_diet_recipes. asp DASH Diet Recipes: www. mayoclinic. com/health/dash-diet-recipes/RE00089 DASH for Health: www. dashforhealth. com/index. php 2301
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Foods to Avoid While Taking Warfarin (Coumadin, Jantoven) Cheryl A. Glass and Jill C. Cash Warfarin is a medication that thins the blood to prevent blood clots. Some nutrients and foods can interfere with warfarin and make the warfarin less effective or not work as well. Therefore, it is important to closely monitor the foods that you eat daily to make sure your medication is working for you the same way every day. One nutrient that causes this problem is vitamin K. Vitamin K interferes with the warfarin and can cause problems with thinning the blood. Therefore, it is important to avoid foods and nutrients that would cause this problem. It is suggested to eat foods that contain the same amount of vitamin K every day. This will help to prevent problems with thinning your blood. The recommended intake of vitamin K for the adult man is 120 mcg and for adult women is 90 mcg. The following is a list of foods that have a MODERATE to HIGH level of vitamin K and should be avoided: 1. Broccoli (cooked) 2. Brussels sprouts 3. Chard 4. Collard greens 5. Green tea 6. Kale 7. Mustard greens 8. Parsley 9. Spinach 10. Turnip greens Some drinks can also interfere with warfarin and should be avoided. These drinks include: 1. Cranberry juice 2. Alcohol 2302
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Foods that have a LOWER level of vitamin K and are safer to eat in moderate portions include: 1. Asparagus 2. Avocado 3. Blackberries/blueberries 4. Cabbage 5. Carrots 6. Cauliflower 7. Cucumbers 8. Lettuce, iceberg and romaine 9. Peas 10. Peppers 11. Potatoes 12. Prunes 13. Squash (summer and winter) 14. Sweet potatoes 15. Tomatoes 16. Tuna Medications (prescribed and over-the-counter [OTC] medications, multivitamins, supplements, and herbal supplements) may also interfere with warfarin and should only be taken after discussing the medication, vitamin, or supplement with your health care provider for safety. If you have questions about certain foods or medications, you need to discuss this with your health care provider. Foods Rich in Vitamin K If you are taking a blood thinner, you should be aware that certain foods are high in vitamin K. Vitamin K can interfere with how blood thinners work. You do not necessarily have to stop eating these foods, just be consistent and maintain your regular eating habits. Please discuss these foods further with your health care provider. These vitamin K-rich foods include the following: 1. Broccoli 2. Brussels sprouts 2303
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3. Collard greens 4. Endive 5. Kale 6. Mustard greens 7. Parsley 8. Swiss chard 9. Spinach 10. Turnip greens Foods that are low in vitamin K: 1. Asparagus 2. Avocado 3. Blackberries 4. Blueberries 5. Cabbage 6. Cranberry juice 7. Green tea 8. Lettuce (iceberg & leafy) 9. Liver 10. Peas 11. Prunes 12. Tuna 2304
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Gluten-Free Diet Cheryl A. Glass and Jill C. Cash Gluten-Free Diet Tips The symptoms from celiac disease are triggered from glutens in your diet. Three cereals that contain gluten are wheat, rye, and barley. Glutens are also present in other products, such as food additives, so it is very important to read all the ingredients on food labels (see Table B. 5). Dietary Recommendation for Celiac Disease A. You may also be told to follow a lactose-free diet for a short time to help your symptoms. B. Most bread sold in the grocery aisle is not allowed on a gluten-free eating plan. C. All vegetables and fruits are gluten-free. However, frozen and canned fruits and vegetables may contain an additive with gluten. D. Although you should not enjoy beer, wine is still on the menu when you go to dinner. E. Specialty bakeries are able to make gluten-free cakes for special occasions. Plain hard candy, marshmallows, and other candies are usually gluten-free. F. Caution should be taken when ordering any breaded foods such as chicken nuggets or breaded fish. G. Deli meats may also contain gluten. H. Gluten-free foods are often not fortified with vitamins and minerals. It is recommended to take a daily multivitamin. Resources Celiac Disease Foundation: www. celiac. org www. celiac. com www. chex. com/glutenfree www. Betty Crocker. com/glutenfree https://celiac. org/celiac-disease/understanding-celiac-disease-2/what-is-celiac-disease/ 2305
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Gluten-Free Recipes: http://allrecipes. com/Recipes/Healthy-Cooking/Gluten-Free/Main. aspx TABLE B. 5 Examples of Foods That Are Allowed and Avoided on a Gluten-Free Diet Allowed Avoid Fresh fruits and vegetables without any processing or additives Wheat, wheat berry, wheat bran, wheat germ, wheat grass, whole wheat berries Meat Flours, bread flour Soy, soybean, tofu Bulgur (bulgur wheat, bulgur nuts) Brown rice Rye Enriched rice/instant rice/wild rice Barley Buckwheat Barley malt/barley extract Millet Oats, oat bran, oat fiber Sorghum Cereals Alfalfa Matzo Almond Beer, ale, porter, stout Canola Farina Chickpea Croutons Corn, corn flour, cornmeal Bran Brown rice flour Tabbouleh Tapioca Soy sauce 2306
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High-Fiber Diet Cheryl A. Glass and Jill C. Cash Fiber is a plant cell-wall component that is not broken down by the digestive system. An old term for fiber is roughage because it absorbs fluid and moves waste faster through the intestines in a bulky mass. The Food and Drug Administration (FDA) defines as high-fiber those products that contain 20% of the daily fiber value. High-fiber diets are used to help prevent constipation as well as diarrhea. Fiber has been used to help several medical conditions such as diabetes, diverticulosis, irritable bowel syndrome (IBS), and high cholesterol, as well as weight loss. If you have a chronic health condition, check with your health care provider about starting any new dietary change. Fiber provides a full feeling that can help with spacing meals further apart (3-4 hours). Fiber recommendations change with your age (see Table B. 6). Tips for Increasing Fiber in Your Diet A. Read the Nutrition Facts food label for fiber content per food serving. 1. Cereals that provide 5 g of fiber per serving give you 20% of your daily fiber. 2. Look for “whole grain” on the label. Just because bread is brown does not mean it is whole grain. B. Increase fiber in your diet gradually to prevent gas. Adding too much fiber too quickly may give you abdominal pain, bloating, and constipation. Increase your fiber over several weeks so that it gives time for you to adjust. C. As you increase fiber, it is also important to increase the amount of fluids you drink up to six to eight glasses a day, including tea, milk, fruit juices, coffee, and even soft drinks. The extra fluids that you drink along with the extra fiber makes you feel fuller, which can help control snacking. D. Keep a food diary and review it periodically to decide on other diet adjustments that need to be made. E. Several fiber supplements are available over the counter (OTC) to help you get your daily recommendation of fiber. 2307
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Good Food Sources of Fiber A. Bran: Add 1 teaspoon of whole-grain bran to food three times a day, or take an OTC fiber supplement, such as psyllium (Metamucil), as directed. B. Whole-grain cereals and breads: Eat oat, bran, multigrain, light, wheat, or rye breads rather than pure white bread or breads that list eggs as a major ingredient. Grains are not only a good source of fiber but also contain vitamins and minerals. Folic acid has been added to breads and cereals to help reduce neural tube defects. C. Fresh or frozen fruits and vegetables: Citrus fruits are especially good sources of fiber. Eat raw or minimally cooked vegetables, especially squash, cabbage, lettuce and other greens, and beans. Leave the skin on fruits and vegetables; eating the whole fruit is better than drinking the juice. Whole tomatoes offer more fiber than peeling the skin off. The more colorful the fruit and vegetable (dark green, reds, blue, yellow), the better; they provide a good source of antioxidants that are good for the heart and the prevention of some cancers. Apples are a good source of both fiber and water. D. Legumes (pods): Peas and beans are a good source of fiber. Add chickpeas and kidney beans to salads for extra fiber and flavor. Add baked beans as a delicious side item to your meal. E. Coffee is another source of fiber. F. Nuts are an excellent source of fiber. They are considered nutrient-dense and are a good source of vitamins and folic acid. Sprinkle sunflower seeds on a salad to add flavor and fiber. The amount of nuts eaten should be limited to 1 to 2 oz because they are also high in calories. G. If you have diverticulosis: Avoid foods with seeds or indigestible material that may block the neck of a diverticulum such as nuts, corn, popcorn, cucumbers, tomatoes, figs, strawberries, and caraway seeds. TABLE B. 6 Fiber Recommendations by Age Group/Gender Age (Years) Fiber Recommendations (g of Fiber Each Day) Children 1-3 19 Children 4-8 25 Boys 9-13 31 2308
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Boys 14-18 38 Girls 9-13 26 Girls 14-18 26 Men Younger than 50 38 Women Younger than 50 25 Men Older than 50 30 Women Older than 50 21 Source: Adapted from the American Heart Association (2015). 2309
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Lactose-Intolerance Diet Cheryl A. Glass and Jill C. Cash Lactose is the sugar present in milk. Lactose intolerance is very common; it occurs when the body is not able to appropriately digest this milk sugar content and the result is diarrhea. You have been diagnosed as having difficulty digesting milk (lactose) products or you have problems with malabsorption. Lactose intolerance can cause gas, bloating, abdominal cramps, diarrhea, and nausea or vomiting. You may be able to eat small portions without problems, or you may be unable to tolerate any foods containing lactose (see Table B. 7). Tips for Following a Lactose-Intolerance Diet A. Limit or omit foods that contain milk, lactose, whey, or casein. B. Lactose-controlled diets allow up to 1 cup of milk per day for cooking or drinking, if you can tolerate it. C. Read labels carefully. If you cannot tolerate any lactose, choose lactose-free foods with lactate, lactic acid, lactalbumin, whey protein, sodium caseinate, casein hydrolysates, and calcium compounds. D. You may also choose kosher foods marked “pareve” or “parve,” which do not contain lactose. Read labels carefully. E. A low-fat diet is important if you have fat malabsorption. F. To help with diarrhea because of malabsorption, avoid more than one serving a day of caffeine-containing drinks. G. Beverages with high sugar content, such as soft drinks and fruit juices, may increase diarrhea. Juices and fruits with high amounts of fructose include apples, pears, sweet cherries, prunes, and dates. H. “Sugarless” sorbitol-containing candies and gums may cause diarrhea. TABLE B. 7 Fiber Recommended Foods for Lactose Intolerance 2310
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Foods Recommended Not Recommended Milk Soybean milk, milk treated with lactase, nondairy creamers, whipped topping; up to 1 cup/d of buttermilk, yogurt, sweet acidophilus milk, or whole, low-fat, or skim milk Milk products in excess of 1 cup/d, malted milk, milkshakes, hot chocolate, cocoa Meat and protein foods All meats, fish, poultry, eggs, peanut butter, tofu, or hard, aged, and processed cheese, if tolerated Sandwich meat, hot dogs that contain lactose, cottage cheese, any meat prepared with milk products Vegetables All fresh, frozen, canned, buttered, and/or breaded vegetables Any vegetable prepared with milk or milk products in excess of allowance (1 cup) Fruits All fresh, frozen, or canned fruits Any fruits processed with lactose Breads, cereal, and starchy food White, wheat, rye, or other yeast breads, crackers, macaroni, spaghetti, popcorn, dry or cooked cereals Commercial bread products (French toast, bread mixes, pancakes, biscuits), cakes/cookies containing milk or milk products Fats and oils Butter/margarine, salad dressing, mayonnaise, all oils, nondairy creamers, bacon Sour cream, salad dressings with milk products in excess of 1 cup allowance Soups Vegetable and meat soups, broth, and bouillon Dried soups, creamed soups made with milk Desserts Plain and fruit-flavored gelatins, sherbet, fruit pies, cakes, pudding, pastries, angel food cake, sponge cake Ice cream, ice milk, cream pie, puddings, custards, cakes, and pastries with milk (unless count as day's allowance) Beverages Coffee, tea, soft drinks, fruit juices, carbonated and mineral waters Beverages with milk over the 1 cup allowance Miscellaneous condiments Catsup, mustard, soy sauce, vinegar, steak sauce, Worcestershire sauce, chili sauce None Seasonings Salt, pepper, spices, herbs, and seasonings None Sweets Sugar, jelly, honey, molasses, preserves, marmalade,Cream or chocolate candies containing milk or milk 2311
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syrups, hard candy, baker's cocoa, carob powder, artificial sweetenersproducts (unless count as day's allowance), caramels, toffee, and butterscotch 2312
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Low-Fat/Low-Cholesterol Diet Cheryl A. Glass and Jill C. Cash The connection between fat in the diet and heart attack is cholesterol. Cholesterol is a fatlike substance produced by your liver and also found in many foods. Too much cholesterol causes heart attacks by clogging the arteries that deliver blood to your heart. Exercising and following a low-fat/low-cholesterol diet can help control your blood cholesterol and reduce your risk of heart attack. Tips A. Read food labels. Use the ingredient list on labels to identify products containing saturated fat. High-fat ingredients may have many names. Remember: Foods can say “no cholesterol” and still be high in saturated vegetable fat and calories. B. Train yourself to think “low fat” in your food and cooking methods. 1. Bake 2. Broil 3. Grill 4. Stir-fry C. Eat less fried food, fast food, and baked products. D. Eat more fruits and vegetables. E. Organize your shopping around low-fat foods. F. Add flavor to foods by using herbs and spices instead of butter and sauces. G. Choose coleslaw, sliced tomatoes, or a dill pickle instead of fries and chips. Foods to Avoid or Limit A. Proteins/meats 1. Shrimp 2. Fried meats, fish, or poultry 2313
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3. Fatty ground meat 4. Prime or heavily marbled meats 5. Bacon, sausage, high-fat deli meats, and cheeses 6. Liver and organ meats B. Breads/cereals 1. High-fat baked foods, such as Danish, croissants, and doughnuts 2. Fried rice, crispy chow mein noodles 3. Granola bars with coconut or coconut oil 4. Chips, cheese, or butter crackers 5. High-fat cookies and cakes C. Fruits and vegetables 1. Coconut 2. Fried vegetables such as onion rings and breaded fried pickles, mushrooms, and okra 3. Cream, cheese, or butter sauces on vegetables D. Milk/dairy products 1. Whole or 2% milk 2. Cream, half-and-half, nondairy creamers 3. Ice cream, whipped cream, nondairy whipped toppings 4. Whole-milk yogurt, sour cream 5. Cheeses: Cheddar, American, Swiss, cream cheese, Brie, Muenster E. Very high-fat foods 1. Butter or margarine made with partially hydrogenated oils 2. Lard, meat fat, and coconut or palm oils 3. Salad dressings made with sour cream or cheese 4. Chocolate 5. Beef tallow 6. Hydrogenated or partially hydrogenated vegetable shortening 7. Cream 8. Cocoa butter Foods That Are Allowed A. Proteins/meats 1. Fish and shellfish 2. Chicken and turkey cooked without the skin 3. Ground turkey 2314
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4. Eggs: Limited to two yolks per week 5. Dried beans, lentils, tofu 6. Small amounts of meat and seafood B. Breads/cereals 1. Plain bread and English muffins and bagels 2. Plain pasta, rice 3. Cereals, oatmeal 4. Pretzels, air-popped popcorn, rice cakes, Melba toast 5. Low-fat baked goods: Angel food cake, graham crackers, fruit cookies, and gingersnaps C. Fruits and vegetables 1. Eat several servings per day of high-nutrition, low-fat fruits and vegetables. 2. Prepare vegetables by steaming, broiling, baking, or stir-frying. D. Milk/dairy products 1. Skim or 1% milk 2. Low-fat milk, evaporated milk, nonfat dry milk powder 3. Frozen yogurt, ice milk, sherbet, sorbet 4. Low-fat yogurt 5. Low-fat cheeses: 1% cottage cheese, skim-milk ricotta, mozzarella, and American cheeses E. Allowed high-fat foods 1. Margarine made with liquid safflower, corn, or sunflower oils 2. Olive, canola, or peanut oils 3. Nut snacks in moderation (high fat and calories) 4. Salad dressings made with saturated oils 2315
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Nausea and Vomiting Diet Suggestions (Children and Adults) Cheryl A. Glass and Jill C. Cash For simple nausea and vomiting with an upset stomach, follow these steps: Step 1: Replace Lost Fluids A. Rest your stomach for 1 to 2 hours. B. Infants and small children: Pedialyte or Ricelyte are recommended because children become dehydrated quickly. C. Infants: Resume breast-or bottle-feeding as soon as possible. D. Young children: Give very small sips every 10 to 20 minutes until they keep the fluid down. E. Older children: Give Gatorade or Pedialyte. F. Older child and adults 1. After vomiting stops, take sips of clear liquids at room temperature, such as flat ginger ale, flat cola, or gelatin. 2. Suck on lollipops or Popsicles. 3. Gradually increase the amount of liquids. If 4 hours pass without vomiting, progress to Step 2. Step 2: Dry Diet The foods in this diet do not meet all daily food requirements and should be used only for a short period before adding foods or advancing to Step 3. A. Cheerios B. Crackers C. Cornflakes D. Graham crackers E. Rice Krispies F. Vanilla wafers G. Toast H. Dinner rolls 2316
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Step 3: More Advanced Carbohydrates A. Oatmeal B. Grits, unseasoned C. Rice, unseasoned D. Mashed potatoes E. Baked potato F. Noodles G. Peanut butter H. Pudding Step 4: Bland Foods With Limited Odors After you are able to eat dry and more complex carbohydrates, a trial of bland foods may be tried. Foods with little or no odors are more easily tolerated after experiencing nausea and vomiting (see Table B. 8). BRAT Diet You may be told to use a BRAT diet. This is a combination of foods that make up a bland diet and help with nausea and vomiting: Bananas, rice, applesauce, and toast as tolerated. TABLE B. 8 Bland Foods With Limited Odors Apple Juice Canned Pears Ice Cream Apple sauce Chicken noodle soup Iced tea Baked chicken Cottage cheese Low-fat milk Baked turkey Fresh apple Sherbet Canned peaches Fresh banana 1/2 turkey sandwich 2317
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Vitamin D and Calcium Handout Cheryl A. Glass and Jill C. Cash Vitamin D and Calcium Handout Food Source Serving Size Food International Units (IU) Fish liver oils, cod liver oil 15 m L 1,360 Mushrooms 3 oz 2,700 Fortified milk 8 oz 100 Herring 3 oz 1,383 Catfish 3 oz 425 Mackerel (cooked) 3. 5 oz 345 Salmon (cooked) 3. 5 oz 360 Sardines (canned in oil, drained) 1. 75 oz 250 Fortified orange juice 8 oz 100 Fortified cereal 1 serving 100 Fortified cheese 3 oz 100 Calcium-Rich Foods Food Source Serving Size Food International Units (IU) Yogurt 1 cup 448 Orange juice 1 cup 350 Fat-free milk 1 cup 316 Shrimp 3 oz 275 Salmon 3 oz 182 Instant oatmeal 1 packet 165 Tofu 1/2 cup 130 Broccoli 1 cup 94 2318
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Dried beans, cooked 1/2 cup 50 Cheddar cheese 11/2 oz 306 Turnip greens 1 cup 197 Cereal bars, snack bars (fortified) 1 bar 200 Sunlight exposure to the skin is also recommended for approximately 20 to 30 minutes without sunscreen. Sun exposure provides an adequate source of vitamin D. Care should be taken not to burn skin. 1. Vitamin D recommendations: a. Men and women age younger than 50: 400 to 800 IU/d b. Men and women 50 years and older: 800 to 1,000 IU/d 2. Calcium recommendations: a. Women 50 and younger: 1,000 mg/d; women age 51 years and older: 1,200 mg/d b. Men age younger than 70: 1,000 mg/d; men 70 years and older: 1,200 mg/d 3. Vitamin D assists with calcium absorption into the bones. 4. Research indicates that caffeine interferes with calcium absorption and lowers bone density. Carbonated beverages appear to be worse than coffee. 5. Vitamin D and calcium deficiency contribute to bone loss, and thus, osteoporosis. Bibliography American Dietetic Association Reports. (2008). Position of the American Dietetic Association: Nutrition guidance for healthy children ages 2 to 11 years. Journal of the American Dietetic Association, 108, 1038-1047. American Heart Association. (2015). Fiber and children's diets. Retrieved from http://www. heart. org/HEARTORG/Healthy Living/Healthy Eating/Nutrition/Fiber-and-Childrens-Diets_UCM_305981_Article. jsp#. WGagd Ln T8r M Banks, D. (n. d. ). Salt: Too much of a good thing. In University of Illinois extension: Thrifty living. Retrieved from http://urbanext. illinois. edu/thriftyliving/tl-salt. html Boyle, M., & Long, S. (2013). Personal nutrition (8th ed. ). Belmont, CA: Wadsworth Cengage. The DASH Diet Eating Plan. (n. d. a). Retrieved from http://dashdiet. org/default. asp The DASH Diet Eating Plan. (n. d. b). The DASH diet and African American heart health. Retrieved from http://dashdiet. org/dash_diet_and_african_american. asp 2319
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The DASH Diet Eating Plan. (n. d. c). DASH diet FAQ. Retrieved from http://dashdiet. org/dash_diet_faq. asp The DASH Diet Eating Plan. (n. d. d). Low salt, low sodium, and the DASH diet. Retrieved from http://dashdiet. org/low_salt_diet. asp Dietary Fiber Guide. (n. d. ). High fiber foods. Retrieved from http://dietaryfiberguide. com National Heart, Lung, and Blood Institute. (2013). Serving sizes and portions. Retrieved from: http://www. nhlbi. nih. gov/health/educational/wecan/eat-right/distortion. htm National Heart, Lung, and Blood Institute. (n. d. a). Tips for reducing sodium in your diet. Retrieved from www. nhlbi. nih. gov/hbp/prevent/sodium/tips. htm National Heart, Lung, and Blood Institute. (n. d. b). Tips on how to make healthier meals. Retrieved from www. nhlbi. nih. gov/hbp/prevent/h_eating/tips. htm National Heart, Lung, and Blood Institute. (2015). In brief: Your guide to lowering your blood pressure with DASH. Retrieved from http://www. nhlbi. nih. gov/files/docs/public/heart/dash_brief. pdf National Institute of Diabetes and Digestive and Kidney Diseases. (2015). Lactose intolerance. Retrieved from https://www. niddk. nih. gov/health-information/health-topics/digestive-diseases/lactose-intolerance/Pages/facts. aspx National Osteoporosis Foundation. (n. d. ). Calcium and vitamin D: What you need to know. Retrieved from www. nof. org/articles/10 The University of Chicago Celiac Disease Center. (n. d. ). Is a gluten-free diet similar to a diabetic diet? Retrieved from www. cureceliacdisease. org/?s=glutentfree+diet 2320
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C Tanner's Sexual Maturity Stages Sexual Maturity Stages in Females Sexual Maturity Stages in Males Stage Breasts Penis, Testes, and Scrotum 1 Preadolescent: Only papilla is elevated above the level of the chest wall Preadolescent: All are the size and proportion seen in early childhood (testes 1 cm) 2 Breast budding: Breast and papilla elevated as small mound; increased diameter of areola Slight enlargement, with alteration in color (more reddened) and texture of scrotum (testes 2. 0-3. 2 cm) 3 Continued breast and areola enlargement; no contour separation Further growth and enlargement (testes 3. 3-4. 0 cm) 4 Areola and papilla form secondary mound Penis significantly enlarged in length and circumference; further development of glands; enlargement of testes and scrotum with darkening of scrotal skin (testes 4. 1-4. 9 cm) 5 Mature: Nipple projects; areola is part of general breast contour Genitalia of adult size (testes 5. 0 cm) Stage Pubic Hair Pubic Hair 1 Preadolescent: None or vellus hair in pubis area Preadolescent: None or vellus hair in pubis area 2 Sparse, straight, lightly pigmented along medial border of labia Sparse, straight, lightly pigmented at base of penis 3 Darker, coarser, curlier, and in increased amount Darker, coarser, curlier, and in increased amount 4 Abundant, but has not spread to medial surface of thighs Abundant, but less quantity than adult type 5 Adult feminine, inverse triangle, spread to medial surface of thighs Adult distribution, spread to medial surface of thighs 2321
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Used with permission from the Child Growth Foundation ( www. childgrowthfoundation. org). 2322
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D Teeth DECIDUOUS (BABY) A, B: Incisors, 6 to 9 months C: Cuspid (eyetooth), 16 months D: First molar; 14 months E: Second molar; 26 months When they are lost: A: 6 to 8 years B: 7 to 9 years C: 9 to 13 years D: 8 to 12 years E: 8 to 12 years 6*: Sixth-year molar*, first permanent tooth 2323
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Expected number of teeth up to 24 months = age of child in months-4 (e. g., 18-month-old should have 14 teeth) PERMANENT 1, 2: Incisors, 7 to 9 years 3: Cuspid (eyetooth), 11 to 13 years 4: First bicuspid, 9 to 11 years 5: Second bicuspid, 10 to 12 years 6: Sixth-year molar, first permanent tooth 7: Second molar, 12 to 14 years 8: Third molar (wisdom), 16 to 20 years 2324
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Index abdominal aortic aneurysm (AAA), 242 abdominal hernias, 301-303 abdominal pain, 241-245 adults, 741 children, 742 patient teaching guide, 741, 742 ablation therapy, for atrial fibrillation, 203 abortion, 403-407 ABPM. See ambulatory blood pressure monitoring abruptio placentae, 405, 406, 493 abstinence, 430 acalculous cholecystitis, 251 Accolate. See leukotriene inhibitors acebutolol (Sectral), for atrial fibrillation, 202 ACE inhibitors. See angiotensin-converting enzyme inhibitors acetaminophen (Tylenol) for acute bronchitis, 159 for bacterial pneumonia, 178 for breast engorgement, 408 for cat-scratch disease, 478 for cholecystitis, 253 for common cold, 167 for croup, viral, 171 for erythema multiforme, 73-74 for febrile seizure, 608 for fibromyalgia, 652 for headache, 581 for herpes simplex, 76 for herpes zoster, 78 for influenza, 491 for lower back pain, 62 for mononucleosis, 503 for neck and upper back disorders, 561, 655 for osteoarthritis, 655 2325
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for otitis externa, 127 for pyelonephritis, 363 for restless legs syndrome, 601 for rheumatoid arthritis, 668 for roseola, 515 for rubella, 517 for sciatica, 563 for sprains, 565 for vaginal bleeding, 405 for viral pneumonia, 181 for wound infection, 418 for wounds, 99 for Zika virus, 533 acetaminophen, aspirin, and caffeine (Excedrin), for migraine, 582 acetaminophen, butalbital, and caffeine (Fioricet), for migraine, 581, 582 acetaminophen with codeine phosphate (Tylenol No. 3), for mastitis, 412 acetazolamide (Diamox), for glaucoma, 115 acetylcholine receptors (ACh Rs), 595 acid suppression, 283 Aciphex. See rabeprazole acne rosacea, 63-64 patient teaching guide, 743 acne vulgaris, 64-66 patient teaching guide, 744 acquired immune deficiency syndrome (AIDS), 541-545 reference resources for patients with, 840 toxoplasmosis and, 525 actigall (Ursodiol), for cholecystitis, 253 Actonel. See risedronate Acular. See ketorolac tromethamine acute angle-closure glaucoma, 115-116 acute bronchitis, 156-158 patient teaching guide, 778 acute cervicitis, 428-429 acute cholecystitis, 243 acute cystitis, 381-385 patient teaching guide, 940-941 acute diffuse otitis externa, 125 acute idiopathic demyelinating polyneuropathy. See Guillain-Barré syndrome acute inflammatory demyelinating polyradiculoneuropathy (AIDP), 575 acute motor axonal neuropathy (AMAN), 575 acute myocardial infarction (MI), 191-193 acute otitis media (AOM), 121-122 patient teaching guide, 745 acute pain, 55-56 acute pancreatitis, 243 acute respiratory tract infection (ARTI), 165-167 acute rheumatic fever (ARF), 508-511 2326
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acute sensorimotor axonal neuropathy (ASMAN), 575 acute sinusitis, 136 acute thyroidism, 643 acyclovir (Zovirax) for Bell's palsy, 566 for herpes simplex, 77, 429, 465, 470 for herpes zoster, 78 for mononucleosis, 503 for varicella, 528 for viral pneumonia, 181 Adalat CC. See nifedipine adalimumab (Humira) for Crohn's disease, 268 for rheumatoid arthritis, 668 for ulcerative colitis, 333 Adapin. See doxepin Adderall. See amphetamine-dextroamphetamine addiction, opioid, 59 Addison's disease, 619-621 patient teaching guide, 746 Adipex-P. See phentermine adjustment sleep disorder, 700 adolescent nutrition, 749 adrenal tumor, 632 adrenergic modulators, for depression, 692 Adult Risk Assessment Form, 15-16 adults health maintenance guide, 17 obesity in, 21-22 preventive health care for, 16 Adult Treatment Panel (ATP) III, 635 Advil. See ibuprofen aerobic exercise, 14 AF. See atrial fibrillation Afrin. See oxymetazoline hydrochloride; pseudoephedrine sulfate Aggrenox. See aspirin + dipyridamole AIDP. See acute inflammatory demyelinating polyradiculoneuropathy albendazole (Albenza) for hookworm, 309 for pinworms, 327 Albenza. See albendazole albumin-to-creatine ratio (ACR), 360 albuminuria, 358 albuterol (Proventil, Ventolin) for acute bronchitis, 159 for chronic bronchitis, 159 for emphysema, 173 for insect bites, 81 2327
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albuterol sulfate (Proventil, Ventolin, Pro Air), 161 alcohol, use, 34 during pregnancy, 391 alcohol and drug dependence, 750-751 Aldactone. See spironolactone Aldara. See imiquimod aldomet, for pregnancy-induced hypertension, 399 alemtuzumab (Lemtrada), for multiple sclerosis, 593 alendronate sodium (Fosamax), for osteoporosis, 658 Aleve. See naproxen alfuzosin (Uro Xatral), for benign prostatic hypertrophy, 341 Allegra. See fexofenadine allergic conjunctivitis, 106, 107 allergic contact dermatitis, 70, 71 allergic rhinitis, 131-133 patient teaching guide, 752 Alli, for obesity, 25 allodynia, 355 allopurinol, for gout, 653 almotriptan (Axert), for migraine, 587 alosetron (Lotronex), for irritable bowel syndrome, 313 alpha-adrenergic antagonists, for urinary incontinence, 381 5-alpha-reductase inhibitors, for benign prostatic hypertrophy, 342 alprazolam (Xanax) for anxiety, 679 for PMS, 461 for sleep disorders, 700 alprostadil (Muse Pellet), for erectile dysfunction, 370 alternative therapies, for chronic pain, 60 Alupent. See metaproterenol sulfate Alzheimer's disease, 563-565 AMAN. See acute motor axonal neuropathy amantadine (Symmetrel) for H1N1 influenza, 488 for multiple sclerosis, 594 for Parkinson's disease, 599 for viral pneumonia, 181 Ambien. See zolpidem amblyopia, 103 ambulatory blood pressure monitoring (ABPM), 223 ambulatory infusion pumps, 59 amenorrhea, 419-421 patient teaching guide, 753 Amerge. See naratriptan American Academy of Pediatrics (AAP), sports physical forms, 705 American Urologic Association Symptom Score (AUASS), 340 aminoglycosides, for conjunctivitis, 107 aminosalicylates (5-ASA) 2328
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for Crohn's disease, 266 for diverticulitis, 275 for ulcerative colitis, 332 aminotransferases, 960 amiodarone, for atrial fibrillation, 203 Amitiza. See naratriptan amitriptyline (Elavil, Endep) for chronic fatigue, 539 dosage, 692 for fibromyalgia, 652 for IBS, 312 for interstitial cystitis, 354 for migraine, 587 for neuropathic or spasticity-related pain, 594 for postherpetic neuralgia, 78 for postpartum depression, 417 amlodipine (Norvasc), 216-218 for Raynaud's phenomenon, 666 amniocentesis, 393 amoxicillin (Amoxil) for acute otitis media, 122 for avulsed tooth, 141 for bacterial pneumonia, 179 for diverticulitis, 275 for Lyme disease, 497 for murmurs, 227 for peptic ulcer disease, 326 for pharyngitis, 147 for rheumatic fever, 510 for scarlet fever, 522 for UTIs, 383 for wounds, 99 amoxicillin-clavulanate acid (Augmentin) for acute otitis media, 122 for chronic bronchitis, 161 for eczema, 73 for epiglottitis, 143 for impetigo, 80 for pyelonephritis, 363 for sinusitis, 138 for UTIs, 384 for wound infection, 418 Amoxil. See amoxicillin amphetamine-dextroamphetamine (Adderall, Adderall XR) amphetamines, 35, 38 ampicillin (Principen) for cholecystitis, 253 for Listeria, 500 2329
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for murmurs, 227 ampicillin-sulbactam (Unasyn), for epiglottitis, 143 anabolic steroids, 36 Anacin. See aspirin ANA-Kit, for insect bites and stings, 81 analgesics for chronic bronchitis, 161 for corneal abrasion, 109 for fibromyalgia, 652 for lower back pain, 62 for mild traumatic brain injury, 590 anaphylaxis, 81 Anaprox. See naproxen Ancef. See cefazolin ancylostoma duodenale, 308-309 Androgen Excess Society Screening and Treatment Requirements for IGT, 638 anemia, 346 iron-deficiency, 393-395, 548-550, 850 megaloblastic, 553-556 pernicious, 553-556, 888 in pregnancy, 393-395, 850 sickle cell, 391 angina, 204 angiotensin-converting enzyme (ACE) inhibitors for chronic kidney disease, 345-346 for diabetes mellitus, 626 for dry eyes, 112 for heart failure, 214 in pregnancy, 399 angiotensin II receptor blockers (ARBs), in pregnancy, 399 animal bites, mammalian, 66-68 ankle exercises, 754 ankle sprains, 564, 732 anorexia, 320 antepartum, 389-407, 943 anterior drawer test, 732 anterior septal bleeding, 134 anthralin (Dritho-Creme), for psoriasis, 87 antianxiety drugs, for PMS, 461 antibiotics. See also specific types for bacterial pneumonia, 179 for cat-scratch disease, 479 for cholecystitis, 253 for Crohn's disease, 268 for endometritis, 410 for gastroenteritis, 280-281 for meningitis, 500 for pyelonephritis, 363 2330
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for rheumatic fever, 510 for scarlet fever, 522 for ulcerative colitis, 333 for UTIs, 383, 384 for wounds, 99 antibody tests, 472 anticholinergics for asthma, 154 for cholecystitis, 253 for IBS, 312 for Parkinson's disease, 599 for urinary incontinence, 378, 379 anticipatory guidance tool, 7, 9-11 anticoagulants for atrial fibrillation, 202 for deep vein thrombosis, 211 for superficial thrombophlebitis, 234 anticonvulsants for menopause, 453 for neuropathic pain, 59 antidepressants, 687. See also selective serotonin-reuptake inhibitors; tricyclic antidepressants; specific types for chronic fatigue, 539 for depression, 690, 692 dosages for common antidepressant drugs, 691-692 for grief, 697 for headache, 582 for menopause, 451 for PMS, 461 for postpartum depression, 416, 417 antidiarrheals for gastroenteritis, 281 for IBS, 312 antiemetics for nausea and vomiting, 321 for pyelonephritis, 363 antiepileptics for migraine, 586 for seizures, 605 antifungals, for vulvovaginal candidiasis, 463 antihistamines for allergic rhinitis, 132 for atopic dermatitis, 72 for conjunctivitis, 108 for erythema multiforme, 74 for grief, 697 for insect bites, 81 for itching, 72 2331
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for lichen planus, 83 for nonallergic rhinitis, 136 for rubella, 517 for sinusitis, 136 for sleep disorders, 701 for xerosis, 100 antihypertensives, 216-218 for hypertension, 219 for menopause, 453 anti-Ig E monoclonal antibody, for asthma, 155 Antiminth. See pyrantel pamoate antiplatelet therapy for atrial fibrillation, 202 for transient ischemic attack, 611 antipyretics for chronic bronchitis, 161 for febrile seizure, 608, 609 antiretrovirals, for HIV, 542, 544 antisecretory therapy, for peptic ulcer disease, 325 antispasmodics for colic, 255 for IBS, 312 for malabsorption, 319 for urinary incontinence, 379 antithyroid drugs, for hyperthyroidism, 642 Antivert. See meclizine antivirals for H1N1 influenza, 488 for influenza, 491 anusol, for hemorrhoids, 289 anxiety, 677-679 aortic regurgitation, 227 aortic stenosis, 226 aphthous stomatitis, 148 patient teaching guide, 755 apixaban (Eliquis) for atrial fibrillation, 202 for deep vein thrombosis, 211 appendicitis, 243, 245-248 apremilast, for psoriasis, 87 Apresoline. See hydralazine apriso, for ulcerative colitis, 333 aquaphor for contact dermatitis, 71 for eczema, 72 for psoriasis, 87 Arava. See leflunomide Arbovirus. See Japanese encephalitis 2332
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Area Agencies on Aging (AAA), 14 arformoterol (Brovana), for asthma, 154 Aricept. See donepezil aripiprazole (Abilify), for bipolar disorder, 685 Aristocort. See triamcinolone acetonide arixtra, for deep vein thrombosis, 211 Armour thyroid. See desiccated thyroid arrhythmias, 193-196 Artane. See trihexyphenidyl HCl arterial blood gas volume, 961 arterial ulcer, 95 arthritis osteoarthritis, 654-656, 878 polyarthritis, 508 rheumatoid, 666-669 arthrotec, for osteoarthritis, 655 artificial tears, for dry eyes, 112 arylacetic acid derivatives, for dysmenorrhea, 435 5-ASA. See aminosalicylates Asacol. See mesalamine Ascaris lumbricoides, 328-330 Ascriptin. See aspirin asenapine (Saphris), for bipolar disorder, 686 ASMAN. See acute sensorimotor axonal neuropathy Asmanex. See mometasone furoate aspirin (Anacin, acetylsalicylic acid, Ascriptin, Bayer ASA, Bayer Buffered ASA) for diabetes mellitus, 626 for Kawasaki disease, 492 for myocardial infarction, 192 for peripheral artery disease, 232 for Raynaud's phenomenon, 666 for rheumatic fever, 511 for transient ischemic attack, 611 aspirin, butalbital, and caffeine (Fiorinal), for headache, 582 aspirin + dipyridamole (Aggrenox), for transient ischemic attack, 611 AST/ALT, 315 Astelin. See azelastine HCl asthma, 151-156 action plan and peak flow monitoring, 757-758 diary self-assessment, 758 medications for, 154-155 metered-dose inhalers, 152, 759 patient teaching guide, 756 Atarax. See hydroxyzine hydrochloride atenolol (Tenormin), for atrial fibrillation, 202 atherosclerosis, 196-200 patient teaching guide, 760 atherosclerotic cardiovascular disease (ASCVD), 623 2333
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Ativan. See lorazepam atomoxetine (Strattera), for ADHD, 681 atonic seizures, 602 atopic dermatitis, 71-73 atovaquone, for HIV, 544 atrial fibrillation (AF), 193, 200-203 patient teaching guide, 761-762 atrioventricular, 193 atrioventricular reentrant tachycardia (AVRT), 193 atrophic rhinitis, 136 atrophic vaginitis, 421-423 patient teaching guide, 763 Atrovent. See ipratropium bromide attention-deficit hyperactivity disorder (ADHD), 679-682 coping strategies for teens and adults, 747 tips for caregivers, 748 atypical antipsychotics for bipolar disorder, 685 AUASS. See American Urologic Association Symptom Score augmentin See amoxicillin-clavulanic acid Aveeno. See oatmeal bath Aventyl. See nortriptyline avian flu, 489 Avodart. See dutasteride avulsed tooth, 141-142 Axert. See almotriptan Axid. See nizatidine azathioprine (AZA) (Imuran) for Crohn's disease, 268 for ulcerative colitis, 333 azelastine HCl (Astelin) for allergic rhinitis, 132 for conjunctivitis, 108 for nonallergic rhinitis, 136 azithromycin (Zithromax) for acute bronchitis, 159 for acute otitis media, 122 for bacterial pneumonia, 179 for blepharitis, 104 for cat-scratch disease, 479 for chlamydia, 466 for chronic bronchitis, 161 for gonorrhea, 467, 468 for murmurs, 227 for pharyngitis, 147 for rheumatic fever, 510-511 for scarlet fever, 522 Azmacort. See triamcinolone acetonide 2334
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Azulfidine. See sulfasalazine Babinski reflex, 530 baby blues, 415 bacitracin for blepharitis, 104 for corneal abrasion, 109 bacitracin zinc (Polysporin), for hordeolum, 116 back disorders, 559-561 back stretches, 765-766 baclofen, for multiple sclerosis, 594 bacterial conjunctivitis, 106, 107 bacterial pneumonia, 176-179 adult, 767 child, 768-769 patient teaching guide, 767, 768 bacterial vaginosis (BV), 423-425, 735 patient teaching guide, 770-771 Bactrim. See trimethoprim-sulfamethoxazole Bactrim DS. See trimethoprim-sulfamethoxazole Bactroban. See mupirocin balsalazide (Colazal) for Crohn's disease, 264 for ulcerative colitis, 332 barbiturates, 38 for chronic pain, 59 bariatric surgery, 176 barrier contraceptives, 430-431 bartholin cyst or abscess, 425-426 basal body temperature (BBT) measurement, 772 basal cell carcinoma (BCC), 68, 85 Bayer ASA. See aspirin Bayer Buffered ASA. See aspirin BBT. See basal body temperature BCC. See basal cell carcinoma Beck Depression Inventory, 58 beclomethasone (Qvar), for chronic bronchitis, 161 beclomethasone dipropionate (Beconase, Qnasl, Vancenase) for allergic rhinitis, 133 for sinusitis, 139 Beconase. See beclomethasone dipropionate bedside cystometry, 717 Beers criteria, 18 bees, insect bites, 80 behavior modification, and obesity, 23 Bell's palsy, 565-571 patient teaching guide, 773 2335
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Benadryl. See diphenhydramine benazepril (Lotensin), for hypertension, 217 benign paroxysmal positioned vertigo (BPPV), 708 benign prostatic hypertrophy (BPH), 339-342 American Urologic Association symptom score, 340 patient teaching guide, 901 benign skin lesions, 68 Bentyl. See dicyclomine benzathine penicillin G for pharyngitis, 147 for rheumatic fever, 510 for syphilis, 473 benzodiazepines, 38 for anxiety, 679 for chronic pain, 59 benzoyl peroxide, for acne vulgaris, 65 benzphetamine (Didrex), for obesity, 24, 26 benztropine mesylate (Cogentin), for Parkinson's disease, 599 beta 2 agonists, for emphysema, 173 beta-3 adrenergic agonists, for urinary incontinence, 381 beta blockers for arrhythmias, 195 for atrial fibrillation, 202 diabetes and, 626 for heart failure, 214 for hypertension, 221 for hyperthyroidism, 642 for migraine, 586 for myocardial infarction, 192 for syncope, 237 beta-lactam, for sinusitis, 138 betamethasone dipropionate (Diprolene) for eczema, 73 for lichen planus, 83 betamethasone valerate, for eczema, 72 betaxolol, for atrial fibrillation, 202 bethesda system, 454-455 bexsero vaccine, 501 Biaxin. See clarithromycin bilateral salpingo-oophorectomy, 442 bile acid sequestrants, for atherosclerosis, 198, 199 biliary colic, 243 biliopancreatic diversion with duodenal switch (BPD/DS), 27, 32 bilirubin, 960 bimanual examination, 710-711 biofeedback, for constipation, 260 biphosphonates, for osteoporosis, 658 bipolar disorder, 682-688, 774 2336
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types, 682 birth control pills. See oral contraceptives Bishop scoring, 710 bismuth subsalicylate (Pepto-Bismol), for gastroenteritis, 281 bisoprolol, for atrial fibrillation, 202 bites animal, 66-68 insect, 80-81, 846-847 bladder control diary, 379, 380, 939 bladder instillation, for interstitial cystitis, 354 bladder outlet obstruction (BOO), 339 bland diet, 963 bland foods, 972 blepharitis, 104-105 blood pressure, classification of, 219 blood sugar, signs of high and low, 848 Blues Questionnaire, 416 boceprevir (Victrelis), for hepatitis C, 301 body lice, 81-82 body mass index (BMI), 13, 636 Bontril PDM. See phendimetrazine bottle feeding, 842-843 botulinum toxin, for multiple sclerosis, 594 Bowen's disease, 85 BPH. See benign prostatic hypertrophy bradycardia, 192 bradykinesia, 597 brainstem vascular accident, 596 breast abscess, 412 breast engorgement, 408, 412 patient teaching guide, 895-896 breastfeeding, 842 breast pain, 426-428, 826 Brethaire. See terbutaline Brethine. See terbutaline bromocriptine, for Parkinson's disease, 598 bromocriptine mesylate (Parlodel), for PMS, 461 bronchiolitis, 156-158 bronchitis acute, 156-158, 778 child, 776-777 chronic, 159-162, 779 patient teaching guide, 776-777, 778, 779 bronchodilators for chronic bronchitis, 161 for respiratory syncytial virus, 182 Brovana. See arformoterol Brudzinski's sign, 485, 490, 530 2337
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budesonide (Entocort, Rhinocort Aqua) for allergic rhinitis, 133 for asthma, 153 for Crohn's disease, 268 for croup, viral, 171 for ulcerative colitis, 333 Buerger's disease, 230 bulk-forming agents for constipation, 260 for hemorrhoids, 289 bulk laxatives, 260 bullying, sports participation assessment, 706 BUN/creatinine-renal function tests, 960 bupropion (Wellbutrin, Zyban) for depression, 164, 692 for emphysema, 173 for substance abuse disorders, 40 Bu Spar. See buspirone buspirone (Bu Spar) for anxiety, 679 for PMS, 461 butoconazole nitrate, for vulvovaginal candidiasis, 463 BV. See bacterial vaginosis bypass patients, recommended annual laboratory monitoring for, 32 cadmium, 389 Calan. See verapamil calcipotriol, for psoriasis, 87 calcitonin, for osteoporosis, 658 calcium, food sources of, 12 calcium channel blockers (CCBs). See also specific agents for arrhythmias, 195 for asthma, 155 for diabetes mellitus, 626 for hyperthyroidism, 642 for Raynaud's phenomenon, 665 calcium deficiency, 28, 29 calcium polycarbophil (Fibercon), for hemorrhoids, 289 calcium-rich foods, 973 calcium supplements for Cushing's syndrome, 622 for malabsorption, 319 for osteoporosis, 658 caloric intake, 14 Campho-Phenique, for herpes simplex, 77 canalith repositioning procedure (CRP), 614, 708-709 cancer 2338
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cervical, 453-456 colorectal, 255-257 oral, 142-145 skin, 917-918 cancerous skin lesions, 85-86 Candida albicans, 146, 147, 149, 946 candidiasis, 69-70, 71, 147 vulvovaginal, 461-463, 735 cannabinoids, 35 capsaicin, for neuropathic pain, 59 capsule enteroscopy, 263 Carafate. See sucralfate carbamazepine (Tegretol, Inderal) for Guillain-Barré syndrome, 578 for neuropathic or spasticity-related pain, 59, 594 carbamazepine ER (Equetro), for bipolar disorder, 684-685 carbon monoxide, 390 cardiac medications, 216-218 cardiac-stable angina, 204 Cardio Smart Patient Education Portal, 221 carditis, 509, 511 Cardizem. See diltiazem Cardura. See doxazosin carisoprodol (Soma) for lower back pain, 62 for neck and upper back disorders, 561 carotid dissection, 581 carotid sinus massage, 236 carpal tunnel syndrome (CTS), 571-572 cataplexy, 700 cataracts, 105-106 category X drugs, 198 cat-scratch disease (CSD), 477-479 Ceclor. See cefaclor cefaclor (Ceclor), for emphysema, 174 cefadroxil (Duricef), for wound of the skin, 99 cefazolin (Ancef), for cholecystitis, 253 cefdinir (Omnicef) for acute otitis media, 122 for eczema, 73 for sinusitis, 138 cefixime (Suprax) for acute otitis media, 122 for gonorrhea, 467 cefotaxime (Claforan) for bacterial pneumonia, 179 for epiglottitis, 143 for meningitis, 500 2339
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cefotetan, for PID, 458 cefoxitin, for wound infection, 418 cefpodoxime (Vantin) for acute otitis media, 122 for sinusitis, 138 for UTIs, 384 cefprozil (Cefzil), for acute otitis media, 122 Ceftin. See cefuroxime ceftriaxone (Rocephin) for acute otitis media, 122 for chlamydia, 466 for endometritis, 410 for epiglottitis, 143 for gonorrhea, 429, 467, 468 for Lyme disease, 497 for meningitis, 500 for pharyngitis, 147 for sinusitis, 138 cefuroxime (Ceftin), for Lyme disease, 497 Cefzil. See cefprozil celebrex, for lower back pain, 62 celecoxib (Celebrex), for rheumatoid arthritis, 668 Celexa. See citalopram celiac disease, 248-251 Marsh Classification, 248 test results, 250 Centers for Disease Control and Prevention (CDC), 13, 17 cephalexin (Keflex) for dental abscess, 142 for endometritis, 412 for folliculitis, 75 for impetigo, 80 for murmurs, 227 for pharyngitis, 147 for pyelonephritis in pregnancy, 403 for UTIs, 384 for wounds of the skin, 99 cephalosporin-cefixime (Ceftin), for pyelonephritis, 363 certolizumab (Cimzia), for Crohn's disease, 268 cerumen impaction, 122-123 patient teaching guide, 780 cervarix vaccine, 471 cervical cancer, 453-456 cervical cap, 431 cervical cultures procedure, 735-737 cervical dysplasia, 454 cervical evaluation during pregnancy, 710-711 cervical mucus, checking, 772 2340
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cervicitis, 428-429 patient teaching guide, 781 cesarean section, 417-418, 952 cetirizine HCl (Zyrtec) for allergic rhinitis, 132 for eczema, 72 for sinusitis, 139 chalazion, 106, 116 Chantix. See varenicline cherry angioma, 68 chest pain, 203-208 comparison of etiologies, 204 chickenpox, 526-529 patient teaching guide, 782 Child Abuse Prevention Services (CAPS), 45 Childhood Nutrition website, 13 child neglect, 42 children abdominal pain in, 742 anticipatory guidance for, 9-11 bacterial pneumonia in, 768-769 bronchitis in, 776-777 dental care in, 15 disease in. See specific condition or disease growth charts for, 7 immunization schedule for, 17 normal hemoglobin and hematocrit values, 549 nutrition guidelines for, 12, 783-784 obesity in, 22 oral thrush in, 877 serving sizes for, 13 viral pneumonia in, 892 vision screening in, 15 chlamydia, 429, 465-466 patient teaching guide, 785 chloramphenicol (Chloromycetin), for Rocky Mountain spotted fever, 513 Chloromycetin. See chloramphenicol chlorpromazine (Thorazine), 687 Chlor-Trimeton. See diphenhydramine cholecystectomy, 253 cholecystitis, 251-253 cholesterol, 196, 197 cholinergic crisis, 596 cholinesterase inhibitors, for Alzheimer's disease, 564 chorea, 509, 510, 598 chorionic villus sampling (CVS), 393 chronic bronchitis, 159-162 patient teaching guide, 779 2341
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chronic cervicitis, 428-429 chronic conditions, sports participation assessment, 706 chronic fatigue syndrome, 537-539 chronic kidney disease (CKD), 342-346 patient teaching guide, 854-857 chronic obstructive pulmonary disease (COPD), 162-165 medications for, 154-155 patient teaching guide, 786 chronic otitis externa, 125 chronic pain, 56-60 patient teaching guide, 787 chronic sinusitis, 136 chronic venous insufficiency, 208-210 patient teaching guide, 788-789 cidofovir (Vistide), for cytomegalovirus, 482 Cimzia. See certolizumab Cipro. See ciprofloxacin ciprofloxacin (Cipro) for cyclosporiasis, 271 for diverticulitis, 275 for folliculitis, 75 for otitis externa, 127 for pyelonephritis, 363 for ulcerative colitis, 333 for UTIs, 384 for wounds of the skin, 99 ciprofloxacin extended-release (Cipro XR), for UTIs, 384 citalopram (Celexa, Lexapro) for anxiety, 679 for IBS, 312 for postpartum depression, 417 citalopram hydrobromide (Celexa), 691 Citrucel. See methylcellulose Civil Rights Act, Title VI, 3 CKD. See chronic kidney disease Claforan. See cefotaxime clarithromycin (Biaxin) for acute bronchitis, 159 for acute otitis media, 122 for bacterial pneumonia, 179 for cat-scratch disease, 479 for chronic bronchitis, 161 for emphysema, 174 for peptic ulcer disease, 326 for pharyngitis, 147 for rheumatic fever, 511 Claritin. See loratadine clavulanate, for impetigo, 80 2342
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Cleocin. See clindamycin Cleocin T. See clindamycin clindamycin (Cleocin, Cleocin T) for bacterial vaginosis, 424 for dental abscess, 142 for folliculitis, 75 for pharyngitis, 147 for PID, 458 for rheumatic fever, 511 clinically isolated syndrome (CIS), 591 clock-draw test (CDT), 712-714 Clomid. See clomiphene citrate clomiphene citrate (Clomid) for amenorrhea, 420 for PCOS, 638 clonazepam (Klonopin) for anxiety, 679 for dyspnea, 184 for neuropathic or spasticity-related pain, 594 clopidogrel (Plavix) for peripheral artery disease, 232 for transient ischemic attack, 611 Clostridium difficile, 271 clotrimazole (Gyne-Lotrimin, Lotrimin, Mycelex, Mycelex-G) for candidiasis, 69, 71 for pharyngitis, 147 for thrush, 149 for tinea corporis, 91 for tinea versicolor, 93 for vulvovaginal candidiasis, 463 club drugs, 35 clue cells, 736 cluster headaches, 578, 579, 582 CMV. See cytomegalovirus CNS depressants, 36 coagulation, 961 coal tar for psoriasis, 87 for seborrheic dermatitis, 90 cocaine, 35 codeine, 38 for dyspnea, 184 for hemorrhoids, 289 for rheumatic fever, 511 cognitive behavioral training, for chronic pain, 59 Colace. See docusate sodium Colazal. See balsalazide cold. See common cold 2343
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colic, 253-255 patient teaching guide, 790-791 colitis. See irritable bowel syndrome colonoscopy, 256, 263 colorectal cancer screening, 255-257 combine estrogen/progesterone contraceptives, 432-433 combine oral contraceptives, for endometriosis, 440 Combivent. See ipratropium and albuterol common cold, 165-167 patient teaching guide, 792 community-acquired pneumonia (CAP), 176 community-based care, for homelessness, 20 Compazine. See prochlorperazine complete blood count (CBC), 959 complex partial seizures, 601 complicated grief, 696 Concerta. See methylphenidate concussion, 588 condoms, 430-431 conductive hearing loss, 123 congenital aganglionic megacolon, 306-308 congenital microcephaly, and Zika virus, 532 Congentin. See benztropine mesylate conjugated hyperbilirubinemia, 314 conjunctivitis, 106-108 patient teaching guide, 793 constipation, 257-261 drugs and classifications that cause and increase, 258 patient teaching guide, 794-795 tips to relieve, 794-795 contact dermatitis, 70-71 contraception, 429-434 emergency, 438-440, 815-816 how to take birth control pills, 796-797 patient teaching guide, 796-797 contraceptive implants, 432 COPD. See chronic obstructive pulmonary disease Corgard. See nadolol corneal abrasion, 108-110 coronary vascular disease (CVD), 196 corticosteroids for asthma, 154, 156 for atopic dermatitis, 72 for carpal tunnel syndrome, 572 for celiac disease, 250 for chalazion, 106 for Crohn's disease, 268 for croup, viral, 171 2344
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for emphysema, 173-174 for erythema multiforme, 74 for mononucleosis, 503 for osteoarthritis, 655 for pain, 60 for preterm labor, 401 for psoriasis, 87 for respiratory syncytial virus, 182 for seborrheic dermatitis, 90 for systemic lupus erythematosus, 671 for ulcerative colitis, 333 for varicella, 528 for xerosis, 100 Corynebacterium diphtheriae, 147 cough, 167-170 patient teaching guide, 798 Coumadin. See warfarin sodium Covera-HS. See verapamil CPS. See complex partial seizures cranial nerve function, 722-723 creatine kinase (CK), 192 Crede's method, 379 Crohn's disease (CD), 261-269 patient teaching guide, 799-800 cromolyn sodium (Intal), for asthma, 156 croup patient teaching guide, 801 viral, 170-172, 801 Westley scoring for, 171 cryptorchidism, 375-376 CSD. See cat-scratch disease CTS. See carpal tunnel syndrome cultural diversity, 3-4 cultural sensitivity, 3, 4 culture, 3 CURB-65 Severity Score, 176 Cushing's syndrome, 621-623, 632 patient teaching guide, 802 Cyanocobalamin. See vitamin B12 cyclobenzaprine (Flexeril), for neck and upper back disorders, 561 cyclobenzaprine HCl (Flexeril) for lower back pain, 62 for sciatica, 561, 563 cyclosporiasis, 270-271 cyclosporine (Neoral, Sandimmune) for interstitial cystitis, 354 for psoriasis, 87 2345
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for ulcerative colitis, 333 Cymbalta. See duloxetine cystic fibrosis, 389 cystometry, 715-716 Cystospaz. See hyoscyamine cytomegalovirus (CMV), 479-483 Cytotec. See misoprostol Cytovene. See ganciclovir dacryocystitis, 110-111, 113 dalfampridine, for multiple sclerosis, 594 Dalmane. See flurazepam danazol (Danocrine) for breast pain, 427 for endometriosis, 442 for PMS, 461 Danocrine. See danazol dantrium, for multiple sclerosis, 594 darifenacin (Enablex), for urinary incontinence, 379 DASH diet, 964 debrox, for cerumen impaction, 123 Decadron. See dexamethasone decongestants for common cold, 166, 167 for nonallergic rhinitis, 136 deep tendon reflex, 530, 560 deep tissue pressure injury (DTPI), 97 deep vein thrombosis (DVT), 210-212 patient teaching guide, 803-804 degenerative joint disease. See osteoarthritis Deltasone. See prednisone dementia, 572-575 patient teaching guide, 805 dental abscess, 142 dental care, 15 Depakene. See valproic acid Depakote. See divalproex sodium; valproic acid Depo-Medrol. See methylprednisolone acetate Depo-Provera, 432 depot medroxyprogesterone acetate (DMPA), 432 depressants, 38 depression, 688-693 Alzheimer's disease and, 569 postpartum, 415-417 screening tool, 58 sports participation assessment, 706 dermatitis 2346
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atopic, 71-73 contact, 70-71 diaper, 71 patient teaching guide, 806 seborrheic, 89-91, 569, 914 dermatosis papulosa nigra, 68 desiccated thyroid (Armour thyroid), 645 desipramine hydrochloride (Norpramin), 692 dosage, 692 for IBS, 312 desonide, for lichen planus, 83 Desquam E, for acne vulgaris, 65 desvenlafaxine (Pristiq), 691 Desyrel. See trazodone detoxification, 41 Detrol. See tolterodine tartrate dexamethasone (Decadron) for croup, viral, 171 for meningitis, 500 Dexilant. See dexlansoprazole dexlansoprazole (Dexilant, Kapidex), for peptic ulcer disease, 326 dextromethorphan (Actifed, Benylin DM, Dimetapp DM, Dimetane Extentabs, Entex, Humibid, Naldecon, Pediatric Drops, Robitussin, Triaminic, Vicks Formula 44, Zephrex), 36, 39 for common cold, 167 dextrose/fructose/phosphoric acid (Emetrol), for nausea and vomiting, 321 diabetes mellitus, 623-629 gestational, 395-397, 623, 831 medications for, 627-628 patient teaching guide, 807-809 screen, 396 diabetic foot ulcer, 94 diabetic ketoacidosis (DKA), 395 Diamox. See acetazolamide diaper dermatitis, 71 diaper rash, 71 diaphragm, 431 diarrhea, 271-273 organisms that cause, 272 patient teaching guide, 810-811 diastasis recti, 301 Diastat. See diazepam diastolic murmurs, 227 diazepam (Diastat, Valium) for sleep disorders, 700 for multiple sclerosis, 594 diclofenac potassium (Cataflam), for dysmenorrhea, 435 dicloxacillin (Dynapen) for dacryocystitis, 113 2347
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for folliculitis, 75 dicyclomine (Bentyl), for IBS, 312 Didrex. See benzphetamine diet bland, 963 DASH, 964-967 elderly, 13 gluten-free, 968 high-fiber, 969 lactose intolerance, 970 low-fat/low-cholesterol, 971 nausea and vomiting, 972 for obesity, 24 recommendations, 963-973 well-balanced, 7, 111 Dietary Approach to Stop Hypertension (DASH) diet, 964-966 diethylpropion (Tenuate), for obesity, 24 Diflucan. See fluconazole digitalis, for arrhythmias, 195 digital rectal exam (DRE), 341 digoxin (Lanoxin) for atrial fibrillation, 203 for heart failure, 214 for murmurs, 228 dihydroergotamine mesylate (Migranal), for migraine, 586, 587 Dilacor. See diltiazem Dilantin. See phenytoin diltiazem (Cardizem, Dilacor, Tiazac), for atrial fibrillation, 202 dimenhydrinate (Dramamine), for nausea and vomiting, 440 Dimetane Extentabs. See dextromethorphan Dimetapp DM. See dextromethorphan dimethyl fumarate (Tecfidera), for multiple sclerosis, 593 dioxin, 390 diphenhydramine (Benadryl, Chlor-Trimeton) for common cold, 167 for dyspareunia, 437 for herpes simplex, 77 for scabies, 89 for varicella, 528 for xerosis, 100 diphenhydramine Hcl (Benadryl), for eczema, 72 diphenoxylate and atropine (Lomotil), for Crohn's disease, 264 Diprolene. See betamethasone dipropionate dipyridamole (Persantine), for transient ischemic attack, 611 direct-acting antivirals (DAAs), for hepatitis C, 301 discoid lupus erythematosus (DLE), 669 disopyramide (Norpace) for atrial fibrillation, 203 2348
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for syncope, 237 dissociative drugs, 36 disulfiram (Antabuse), 41 Ditropan. See oxybutynin chloride diuretics. See also specific agents for breast pain, 427 for heart failure, 214 for Ménière's disease, 615 for murmurs, 228 for PMS, 461 Diuril. See hydrochlorothiazide divalproex sodium (Depakote, Depakote ER) for bipolar disorder, 684 diverticulitis, 273-276 diverticulosis, 273-276 Dix-Hallpike test, 613, 614 DLE. See discoid lupus erythematosus docusate calcium (Doxidan), for hemorrhoids, 289 docusate sodium (Colace), for hemorrhoids, 289 dofetilide, for atrial fibrillation, 203 domestic violence, sports participation assessment, 706 donepezil (Aricept) for Alzheimer's disease, 564 for dementia, 574 dopamine agonists, for Parkinson's disease, 598 dopaminergic agents, for restless legs syndrome, 601 double-control barium enema (DCBE), 256 dovonex, for psoriasis, 87 doxazosin (Cardura), for benign prostatic hypertrophy, 341 doxepin (Adapin, Sinequan), for chronic fatigue, 539 doxycycline (Vibramycin) for bacterial pneumonia, 179 for blepharitis, 104 for cat-scratch disease, 479 for cervicitis, 429 for chlamydia, 429, 466 for emphysema, 163 for Lyme disease, 497 for Rocky Mountain spotted fever, 513 for sinusitis, 138 DPI. See dry powder inhalers Dramamine. See dimenhydrinate Dramamine II. See meclizine Dritho-Creme. See anthralin dronabinol (Marinol), for nausea and vomiting, 322 dronedarone, for atrial fibrillation, 203 drop seizures, 602 drug-induced lupus, 669 2349
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dry eyes, 111-112 dry powder inhalers (DPIs), 153 dry skin. See xerosis duloxetine (Cymbalta) for anxiety, 679 for chronic pain, 59 for depression, 594, 692 for fibromyalgia, 652 dumping syndrome, 27, 31 Duo Neb. See ipratropium and albuterol Duricef. See cefadroxil dutasteride (Avodart), for benign prostatic hypertrophy, 342 DVT. See deep vein thrombosis Dyazide. See hydrochlorothiazide and triamterene Dyna Circ. See isradipine Dyna Circ CR. See isradipine Dynapen. See dicloxacillin dyslipidemia, 346 dysmenorrhea, 434-436 patient teaching guide, 812 dyspareunia, 436-438 patient teaching guide, 813 dyspnea, 183-185 early satiety, 320 earwax, 123 patient teaching guide, 780 Eaton-Lambert myasthenic syndrome, 596 echocardiogram, for syncope, 236 eclampsia, 602 ecthyma, 80 ectopic pregnancy, 244, 247, 403, 404, 405 ruptured, 243 eczema, 71-73 patient teaching guide, 814 eczematous otitis externa, 125 ED. See erectile dysfunction edoxaban (Savaysa), for deep vein thrombosis, 211 Effexor. See venlafaxine eflornithine (Vaniqa), for PCOS, 638 Elavil. See amitriptyline Eldepryl. See selegiline elderly nutrition for, 13 weight loss in, 13 electromyographic (EMG) studies, 570 eletriptan (Replax), for migraine, 587 2350
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elevated liver enzymes, 276-278 differential diagnosis for, 278 Eliquis. See apixaban ELISA, 524 ella, 439 Elmiron. See pentosan polysulfate sodium eltrombopag (Promacta), for purpura, 547 eluxadoline (Viberzi), for irritable bowel syndrome, 313 emergency contraception, 438-440 patient teaching guide, 815-816 emotional abuse, 42 emphysema, 172-174 patient teaching guide, 817-818 Enablex. See darifenacin Enbrel. See etanercept encephalitis, 483-486, 531 endocarditis, 205 endometriosis, 440-442 endometritis, 408-410 patient teaching guide, 819 enemas, for constipation, 260 Enterobacter species, 66 Enterobius vermicularis, 327-328 Entex. See dextromethorphan Entocort. See budesonide enzyme replacements, for malabsorption, 318 epididymitis, 346-349, 374 CDC recommendation regimens for, 348 patient teaching guide, 820 epigastric hernia, 301 epiglottitis, 143 epilepsy, 601 epinephrine, for insect bites, 81 epipen, 81 episiotomy, 417-418, 952 epistaxis, 133-135 epithelial cell, 736 Epstein-Barr virus (EBV), 479, 501-503 Epworth Sleepiness Scale, 175 erectile dysfunction (ED), 367-372 Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS), 367 Erectile Hardness Scale (EHS), 367 ergotamine tartrate, for migraine, 587 ergots, for migraine, 586, 587 erythema infectiosum, 506-508 erythema marginatum, 509 erythema multiforme, 73-74 patient teaching guide, 821 2351
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erythromycin for acne rosacea, 64 for acne vulgaris, 65 for acute bronchitis, 159 for acute otitis media, 122 for blepharitis, 104 for chlamydia, 466 for chronic bronchitis, 161 for conjunctivitis, 108 for contact dermatitis, 71 for corneal abrasion, 109 for dacryocystitis, 113 for folliculitis, 75 for gonorrhea, 468 for pharyngitis, 147 for rheumatic fever, 510 for scarlet fever, 522 for wounds, 99 erythroplakia, 144 erythropoietic agents, for chronic kidney disease, 346 Escherichia coli, 251 escitalopram (Lexapro) for anxiety, 679 dosage, 691 esomeprazole (Nexium), for peptic ulcer disease, 325 esophagitis, 205 esotropic strabismus, 117 establishing the date of delivery, 728-729 Estrace. See estradiol estradiol (Estrace, Estring) for atrophic vaginitis, 422 for female sexual dysfunction, 444-445 estradiol hemihydrate (Vagifem) for atrophic vaginitis, 422 for female sexual dysfunction, 444 estrogen therapy for atrophic vaginitis, 422 for female sexual dysfunction, 444 for headache, 582 for menopause, 451 for osteoporosis, 658-659 eszopiclone (Lunesta), for sleep disorders, 700 etanercept (Enbrel), for rheumatoid arthritis, 668 ethambutol (Myambutol), for tuberculosis, 187 ethmoid sinusitis, 138 evening primrose oil (EPO) for breast pain, 427 for premenstrual syndrome, 460 2352
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Evista. See raloxifene exanthem subitum, 514-515 Excedrin. See acetaminophen, aspirin, and caffeine excessive tears, 112-113 Exelon. See rivastigmine Exelon patch, for dementia, 574 exercise aerobic, 14 ankle exercises, 754 for chronic pain, 59 contraindications for, 14 for diabetes mellitus, 625 importance of, 14 knee exercises, 859 for lower back pain, 61-62 for obesity, 24 for osteoporosis, 658 patient education before, 14 patient teaching guide, 822 planning program, 14 during pregnancy, 14 in pregnancy, 391 therapy, 908 weight-bearing, 14 exotropic strabismus, 117 expectorants, for acute bronchitis, 159 Exsel. See selenium sulfide eye(s) dry, 111-112 instilling drops in, 110 medication administration, 823-824 pain, 113-114 Faces scale, 57 failure to thrive (FTT), 693-695 famciclovir (Famvir) for herpes simplex, 465 for herpes zoster, 78 Famvir. See famciclovir fasting plasma glucose, 624 fatigue, chronic, 537-539 febrile seizures, 607-609 patient teaching guide, 825 fecal occult blood test, 255 female condoms, 430-431 female hormone levels, 961 female infertility, 446-447 2353
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female sexual dysfunction, 442-445 female sterilization, 431 femoral hernias, 303 fentanyl, 38 fesoterodine (Toviaz), for urinary incontinence, 379 fetal heart tones (FHTs), 728 fever febrile seizures and, 607-609 of unknown origin, 539-541 fexofenadine HCl (Allegra) for allergic rhinitis, 131 for sinusitis, 139 Fibercon. See calcium polycarbophil fiber recommendations, 969 fibric acid, for atherosclerosis, 199 fibrinolytic therapy, for myocardial infarction, 192 fibrocystic breast changes, 826 fibromyalgia, 651-652, 827 patient teaching guide, 827 Fifth disease. See parvovirus B-19 filiform wart, 93-94 finasteride (Proscar), for benign prostatic hypertrophy, 342 fingolimod (Gilenya), for multiple sclerosis, 593 Fioricet. See acetaminophen, butalbital, and caffeine Fiorinal. See aspirin, butalbital, and caffeine fire ants, 81 flaccid paralysis, 530 Flagyl. See metronidazole flaxseed, for breast pain, 427 flea bites, 80-81 Flexeril. See cyclobenzaprine HCl flexible sigmoidoscopy, 255, 263 Flomax. See tamsulosin Flonase. See fluticasone Florinef acetate. See fludrocortisone acetate Flovent. See fluticasone Floxin. See ofloxacin flu. See influenza flublok, 491 fluconazole (Diflucan) for candidiasis, 69 for thrush, 149 for vulvovaginal candidiasis, 463 fludrocortisone acetate (Florinef acetate) for Addison's disease, 621 for syncope, 237 fluid overload, 346 Flunitrazepam, 35 2354
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fluoroquinolones for conjunctivitis, 108 for UTIs, 384 fluoxetine (Prozac) for anxiety, 679 dosage, 691 for headache, 582 for migraine, 587 for PMS, 461 fluoxetine hydrochloride (Prozac), 691 flurazepam (Dalmane) for grief, 697 for sleep disorders, 700 fluroquinolones, for sinusitis, 139 fluticasone (Flonase, Flovent HFA, Flovent Diskus) for chronic bronchitis, 161 for nonallergic rhinitis, 136 fluticasone furoate (Veramyst), for allergic rhinitis, 133 fluticasone propionate (Flonase, Flovent), for allergic rhinitis, 133 folate, food sources of, 12 folate deficiency, 28, 29 folic acid supplements, for malabsorption, 319 folliculitis, 74-76 patient teaching guide, 828 food guide servings, 12 food pyramid, 13 food sources, for vitamins and minerals, 12-13 forced vital capacity (FVC), 152 foreign body removal, from nose, 718 Fosamax. See alendronate sodium foscarnet (Foscavir), for cytomegalovirus, 482 fosfomycin (Monurol), for UTIs, 384 fragmin, for deep vein thrombosis, 211 Frova. See frovatriptan frovatriptan (Frova), for migraine, 587 functional incontinence, 377, 381 gabapentin (Neurontin) for fibromyalgia, 652 for Guillain-Barré syndrome, 578 for interstitial cystitis, 354 for neuropathic or spasticity-related pain, 59, 594 for postherpetic neuralgia, 78 galactorrhea, 629-630 galantamine (Razadyne) for Alzheimer's disease, 564 for dementia, 574 2355
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gallbladder disease, 251-253 ganciclovir (Cytovene), for cytomegalovirus, 482 gardasil vaccine, 471 gardnerella, 423-425 gastric sleeve (GS), 26, 27, 30, 32 gastroenteritis bacterial, 278-281 viral, 278-281 gastroesophageal reflux disease (GERD), 282-285 patient teaching guide, 829 GBS. See Guillain-Barré syndrome GDM. See gestational diabetes mellitus generalized anxiety disorder (GAD), 677-679 generalized seizures, 602 genetic screening, 393 genital warts. See human papillomavirus gentamicin for cat-scratch disease, 479 for PID, 458 gentian violet aqueous solution, for candidiasis, 69 GERD. See gastroesophageal reflux disease German measles, 515-517 gestational diabetes mellitus (GDM), 395-397, 623, 629 patient teaching guide, 831 GHB, 35 giardiasis intestinalis, 285-287 GI-esophageal spasm, 205 Gilbert syndrome, 315 gingivitis, 147 glatiramer acetate (Copaxone), for multiple sclerosis, 593 glatopa, for multiple sclerosis, 593 glaucoma, acute angle-closure, 115-116 Global Initiative for Chronic Obstructive Lung Disease (GOLD), 161 glomerular proteinuria, 358 glucagon-like peptide-1 (GLP-1) receptor agonist, 25 glucocorticoids for Kawasaki disease, 494 for nonallergic rhinitis, 136 for rheumatoid arthritis, 668 glucose, 960 glucose tolerance test (GTT), 396 gluten, 248, 250 gluten-free diet, 968 glycerin suppositories, for constipation, 260 GOLD. See Global Initiative for Chronic Obstructive Lung Disease golimumab (Simponi), ulcerative colitis, 333 gonadotropin-releasing hormone (Gn-RH), 419, 442 gonorrhea, 429, 466-468 2356
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patient teaching guide, 832 gout, 652-654, 833 patient teaching guide, 833 grand mal seizures, 602, 604 Graves' disease, 639-643 grief, 696-698 patient teaching guide, 834 griseofulvin, for tinea corporis, 91 group A beta-hemolytic streptococcal (GAS), 508 growth charts, 7 GTT. See glucose tolerance test Guillain-Barré syndrome (GBS), 575-578 gynecomastia, 630-631 Gyne-Lotrimin. See clotrimazole H1N1 influenza A, 486-489 H2 receptor antagonists, for peptic ulcer disease, 325 HAART (highly active antiretroviral therapy), for HIV, 542, 545 Haemophilus influenzae, 489 hallucinogens, 36 hand, foot, and mouth syndrome, 76 Hashimoto's disease, 643, 645 hashish, 35 HAV. See hepatitis A HBV. See hepatitis B HCV. See hepatitis C headache, 578-582 classification of, 579 migraine, 582-586, 870-871 head injury, 586-591, 835-836 head lice, 81 health maintenance, during life span, 6 cultural diversity and sensitivity, 3-4 history form, 5-7 over life span, 6-15 hearing loss, 123-125 heart failure, 212-219 antihypertensives and cardiac medications for, 216-218 functional classification of, 213 heart murmurs, 225-228 heart palpitations, 228-229 heart rate, 14 heart rate control therapy, 202 heart rhythm control therapy, 203 heat exhaustion, 14 heavy metals, 389 Helicobacter pylori, 323, 324 2357
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HELLP (hemolysis [H], elevated liver enzymes [EL], low platelets [LP] syndrome), 277 hemabate, for hemorrhage, secondary postpartum, 411 hematocrit, normal values for children, 549 hematuria, 349-351 hemoglobin, normal values for children, 549 hemorrhage, secondary postpartum, 410-411 hemorrhoids, 287-289 internal and external, 298 patient teaching guide, 837 severity of, 287 heparin, for deep vein thrombosis, 211 hepatitis, 83 serologic tests for, 276 hepatitis A (HAV), 289-293 vaccine, 291-292 hepatitis B (HBV), 293-298, 961 diagnostic tests for, 295 vaccine, 296 hepatitis C (HCV), 298-301 heptavalent pneumococcal vaccine, 178 herbal products for chronic pain, 60 for menopause, 453 for PMS, 460 hernia reduction, 719 hernias abdominal, 301-303 bowel, 350 diastasis recti, 301 epigastric, 301 femoral, 303 incisional, 301 inguinal, 303 obturator, 301 pelvic, 303-306 umbilical, 301 heroin, 35 herpangina, 77, 147 herpes simplex keratitis, 108 herpes simplex virus type 1 (HSV-1), 76-77, 429 herpes simplex virus type 2 (HSV-2), 468-470 patient teaching guide, 838 treatment in pregnancy, 465-470 vaccines, 471 herpes zoster, 78-79 patient teaching guide, 839 herpes zoster ophthalmicus, 108 herpetic otitis externa, 126 2358
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HHV-6, 514 high-density lipoproteins (HDLs), 624 high-fiber diet, 969 highly active antiretroviral therapy (HAART), 542, 545 Hirschberg's test, 117 Hirschsprung's disease (HD), 306-308 hirsutism, 631-633 histamine-2 receptor antagonists, for GERD, 284 history form, 5-7 HIV. See human immunodeficiency virus homelessness, 19-21 hookworm, 308-309 hordeolum (Stye), 116-117 hormone replacement therapy (HRT), 452 for amenorrhea, 420 for menopause, 451 for osteoporosis, 658 hornets, insect bites, 80 H. P. Acthar Gel (ACTH) for multiple sclerosis, 593 HPV. See human papillomavirus HRT. See hormone replacement therapy HSV. See herpes simplex virus type 1; herpes simplex virus type 2 human bites, 66-68 human diploid cell vaccine (HDCV), 67 human immunodeficiency virus (HIV), 541-545 and herpes simplex, 465 laboratory values, 961 reference resources for patients with, 840 human metapneumovirus (HMPV), 158 human papillomavirus (HPV), 470-472, 726 patient teaching guide, 841 Humatin. See paromomycin Humibid. See dextromethorphan Humira. See adalimumab hydralazine, for heart failure, 214, 399 hydrocele, 351-352 hydrochlorothiazide (Diurel, Hydro Diuril) for chronic venous insufficiency, 209 for hypertension, 217 for Ménière's disease, 615 for murmurs, 228 hydrochlorothiazide and triamterene (Dyazide), for vertigo, 615 hydrocortisone for Addison's disease, 620, 621 for contact dermatitis, 71 for Cushing's syndrome, 623 for eczema, 72 2359
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for seborrheic dermatitis, 90 for xerosis, 100 Hydro Diuril. See hydrochlorothiazide hydroxychloroquine (Plaquenil), for rheumatoid arthritis, 668 hydroxychloroquine sulfate, for systemic lupus erythematosus, 671 hydroxyzine hydrochloride (Atarax) for contact dermatitis, 71 for eczema, 72 for grief, 697 for insect bites, 81 for interstitial cystitis, 354 for lichen planus, 83 for sleep disorders, 701 hydroxyzine pamoate (Vistaril) for grief, 697 for sleep disorders, 701 hyoscyamine (Levbid, Levsin), for IBS, 312 hyperglycemia, 848 hyperkalemia, 346 hyperlipidemia, 196-200 patient teaching guide, 760 hypertension, 219-224 exercise and, 14 JNC 8 Guidelines, 222 JNC VII classification of blood pressure, 219 medications by medical condition, 222 modifiable and nonmodifiable risk for, 221 pregnancy induced, 397 hyperthyroidism, 638-642 hypertrophic cardiomegaly, 204 hypertrophic cardiomyopathy, 227 hypnagogic hallucinations, 700 hypochromic anemia. See iron-deficiency anemia hypoglycemia, 27, 31, 848 hypogonadism, 633-634 hypothalamic amenorrhea, 419 hypothyroidism, 632, 643-646 hysterectomy, 442 Hytrin. See terazosin IBS. See irritable bowel syndrome ibuprofen (Advil, Motrin, Nuprin) for common cold, 167 for dental abscess, 142 for dysmenorrhea, 435 for febrile seizure, 608 for headache, 582, 608 2360
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for neck and upper back disorders, 561 for otitis externa, 127 for plantar fasciitis, 562 for rheumatoid arthritis, 668 idiopathic peripheral facial palsy, 565-571 idiopathic thrombocytopenic purpura (ITP), 546-548 IFN-alpha, 301 IG (Gamastan, Gammar-P), for hepatitis A, 291 ileocolitis, 262 imipramine (Tofranil) for chronic fatigue, 539 2361
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for urinary incontinence, 381 imiquimod (Aldara) for HPV, 471 for wart, 94 Imitrex. See sumatriptan immunizations schedules, 17 for travel, 17 immunoglobin (Ig) for measles, 520 purpura, 547 immunomodulatory agents, for Crohn's disease, 268 immunosuppressive agents, for systemic lupus erythematosus, 671 Imodium A-D. See loperamide impaired glucose tolerance (IGT), 624 impetigo, 77, 79-80 Imuran. See azathioprine incisional hernia, 301 incontinence, urinary, 376-381 Inderal. See carbamazepine Index of Premature Ejaculation (IPE), 367 Indocin. See indomethacin indomethacin (Indocin), for vaginal bleeding, 407 infant disease in. See specific condition or disease nutrition, patient teaching guide, 842-843 infectious hepatitis. See hepatitis A infertility, 445-449 pathogenesis of, 446-447 inflammatory bowel disease (IBD). See Crohn's disease inflammatory pain, 57, 59 infliximab (Remicade) for Crohn's disease, 268 for rheumatoid arthritis, 659 for ulcerative colitis, 333 influenza (flu), 486-492 avian, 489 Haemophilus influenzae, 489 patient teaching guide, 844-845 influenza vaccine, 174, 345, 488, 491 inguinal hernias, 303 inhalants, 36 inhaled corticosteroid (ICS), for asthma, 153, 154 injury prevention, sports participation assessment, 706 insect bites and stings, 80-81 patient teaching guide, 846-847 insomnia, 698-701 patient teaching guide, 921-922 2362
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insufficient sleep syndrome, 700 insulin action times of, 626 for diabetes mellitus, 625 for gestational diabetes, 396-397 during pregnancy, 848-849 requirement during pregnancy, 396-397 insulin resistance syndrome, 634-636 Intal. See cromolyn sodium interferon (IFN) for hepatitis B, 293 for hepatitis C, 300 for multiple sclerosis, 593 interferon beta-1a (Avonex, Betaseron, Extavia, Rebif) for multiple sclerosis, 593 intermittent claudication (IC), 230 International Headache Society classification of headaches, 579 classification of migraines, 583 International Index of Erectile Function (IIEF), 367 interstitial cystitis, 352-355 intimate partner violence (IPV), 45-49 intramuscular IG, for rubella, 517 intrauterine device (IUD), 434, 441 insertion, 720-721 ipratropium and albuterol (Combivent, Duo Neb), for asthma, 154 ipratropium bromide (Atrovent) for emphysema, 173 for nonallergic rhinitis, 136 iron deficiency, 27, 29 food sources of, 12 iron-deficiency anemia, 548-550 patient teaching guide, 850 in pregnancy, 393-395, 850 iron-replacement therapy, for hookworm, 309 iron supplements for anemia, 346, 394, 550 for malabsorption, 319 for pernicious anemia, 555 irritable bowel syndrome (IBS), 309-313 diagnostic criteria, 312 differential diagnosis for, 312 patient teaching guide, 851 irritant contact dermatitis, 70, 71 ischemic ulcer, 94, 95 isolated diastolic hypertension (IDH), 219 isolated systolic HTN (ISH), 219 2363
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isoniazid (Laniazid, Nydrazid), for tuberculosis, 187 isotretinoin (Accutane), for acne rosacea, 64 ITP. See idiopathic thrombocytopenic purpura itraconazole (Sporanox) for onychomycosis, 91 for otitis externa, 127 IUD. See intrauterine device ivermectin (Stromectol), for scabies, 89 IVIG, for Kawasaki disease, 494 Japanese encephalitis (JE), 483 Jarisch-Herxheimer reaction, 474, 497 jaundice, 313-317 classification of, 314 drugs and herbs associated with, 314 patient teaching guide, 852-853 Kapidex. See dexlansoprazole Kaposi sarcoma, 514 Kawasaki disease (KD), 492-495 Keflex. See cephalexin Kegel exercises, 354, 379, 593 Kenalog. See triamcinolone acetonide keratoacanthoma, 68 keratolytic agents, for psoriasis, 87 Kerlone. See betaxolol Kernig's sign, 485, 487, 490, 531 ketamine, 36 ketoacidosis, 243 ketoconazole (Nizoral) for Cushing's syndrome, 622-623 for seborrheic dermatitis, 90 for tinea corporis, 91 for tinea versicolor, 93 for vulvovaginal candidiasis, 463 ketorolac tromethamine (Acular), for conjunctivitis, 108 kidney functions of normal, 854 calculus, 364-367 chronic disease, 342-346, 854-857 knee exercises, 859 knee sprains, 564-566, 732 Koplik's spots, 518 Kwell. See lindane LABA. See long-acting beta 2 agonist labor, preterm, 389-401, 899-900 2364
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labyrinthectomy, 615 lactase, 255 lactobacilli, 737 lactose intolerance diet, 970 patient teaching guide, 860 lactulose, 313 Lamisil. See terbinafine lamivudine, 297 lamotrigine (Lamictal), for bipolar disorder, 685 Landry-Guillain-Barré-Stroll syndrome. See Guillain-Barré syndrome Laniazid. See isoniazid Lanoxin. See digoxin lansoprazole (Prevacid), for peptic ulcer disease, 325, 326 laparoscopic adjustable gastric band (LAGB), 26-27, 28, 29-30, 31 laxatives, 260 for constipation, 260 for IBS, 312 lead, 389 leflunomide (Arava), for rheumatoid arthritis, 669 Lennox-Gastaut syndrome (LGS), 602 Leriche syndrome, 230 leucovorin calcium (folinic acid), for toxoplasmosis, 525 leukoplakia, 142-145 leukotriene inhibitors (Accolate, Singulair) for asthma, 153 for sinusitis, 139 leukotriene modifiers, for asthma, 154 Levbid. See hyoscyamine levocetirizine dihydrochloride (Xyzal), for allergic rhinitis, 132 levocetirizine HCl (Xyzal), for sinusitis, 139 levodopa, for Parkinson's disease, 598 levofloxacin (Levaquin) for bacterial pneumonia, 179 for chlamydia, 466 for pyelonephritis, 363 for UTIs, 384 levofloxin, for sinusitis, 138 levonorgestrel (Mirena, My Way, Next Choice, Plan B One-Step), for contraception, 431, 439 levothyroxine (Synthroid, Levoxyl, Levothroid, Unithroid), for hypothyroidism, 645 Levsin. See hyoscyamine Lialda for Crohn's disease, 268 for ulcerative colitis, 333 lice (pediculosis), 81-82 patient teaching guide, 861 lichen planus, 83-84 patient teaching guide, 862 2365
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