PHARMACOLOGIC MANAGEMENT OF COMMON MUSCULOSKELETAL DISORDERS IN WOMEN

The range of musculoskeletal disorders encountered in primary care settings is broad, extending from simple injuries to complex chronic diseases. Assessment, management, referral, and pharmacologic intervention for many of these conditions may fall to certified nurse-midwives who increasingly are assuming primary care responsibilities.     

PHARMACOLOGIC MANAGEMENT OF COMMON LOWER RESPIRATORY TRACT DISORDERS IN WOMEN

In a primary care setting, nurse-midwives will collaboratively manage common lower respiratory conditions that require pharmacologic therapy. As such, they must maintain up-to-date knowledge about the indications, use, and potential side effects of these medications. This article reviews the drugs most commonly used for the out-patient treatment of pneumonia, asthma, tuberculosis, and bronchitis (both acute and chronic). Differences among common oral antibiotics recommended by the American Thoracic Society are described. Inhaled bron-chodilator and anti-inflammatory medications are covered, as well as systemic corticosteroids. The use of isoniazid preventive therapy for latent tuberculous infection is described in detail, with brief mention made of other drugs used for active tuberculosis. Adjunct treatments including immunotherapy, vaccines, oxygen supplementation, and nicotine replacement for smoking cessation also are discussed.     

PHARMACOLOGIC CONSIDERATIONS AND MANAGEMENT OF COMMON ENDOCRINE DISORDERS IN WOMEN

This article reviews the physiology and pathophysiology of selected endocrine glands. The common presenting clinical signs and symptoms are reviewed, and the initial laboratory tests that may establish the diagnosis are recommended. Diagnosis and management of hypothyroidism, hyperthyroidism, hyperparathyroidism, hypoparathyroidism, pituitary disorders, diabetes mellitus (types I and II), hypoglycemia, and disorders of the adrenal cortex are discussed. The clinical management of the most commonly encountered endocrine disorders seen in the primary care setting is described, and pharmacologic considerations are underscored.     

PRIMARY CARE FOR WOMEN: Comprehensive Dermatologic Assessment

This article identifies the components necessary for comprehensive dermatologic assessment, including the pertinent anatomy and physiology, appropriate health history, and physical examination strategies. An overview of common dermatologic conditions in women is presented, and the identification of and action needed for life-threatening dermatologic conditions are reviewed. This article is the first of two articles on primary care for women with dermatological complaints; the subsequent article will address primary care management of common dermatologic conditions.     

PRIMARY CARE FOR WOMEN: Comprehensive Cardiovascular Assessment

This article identifies the tools necessary for basic primary care assessment and evaluation of the cardiovascular system in women. Risk factors and abnormalities associated with cardiovascular problems are discussed. Guidelines are presented that will enable the primary care clinician to determine normal cardiovascular function in women, identify risk factors that indicate the need for preventive care, and discover abnormalities that may require referral and intervention.     

PSYCHOPHARMACOLOGIC MANAGEMENT OF WOMEN WITH COMMON MENTAL HEALTH PROBLEMS

This article reviews the essential aspects of the psychopharmacologic management of women with mental health problems, with particular emphasis on the role of the nurse-midwife as a primary care provider. The article also addresses the neurobiology of psychopharmacology, pharmakinetics, and the selection of pharmacologic treatments used for depression, bipolar disorders, anxiety disorders, eating disorders, and psychosis. Considerations for the timely and appropriate referral for psychiatric intervention for women with psychiatric or pharmacologic emergencies are discussed, and issues relating to pregnancy, lactation, and reproductive health are included. The importance of the nurse-midwife's role in ensuring women's access to and compliance with psychopharmacologic therapy is emphasized.     

PRIMARY CARE FOR WOMEN: Comprehensive Sexual Health Assessment

This article discusses the fundamentals of sexual functioning and describes the elements of a comprehensive, developmentally relevant sexual health assessment. Personal barriers that may prevent clinicians from comfortably addressing sexual issues are discussed, and useful strategies for facilitating effective, reciprocal communication during a sexual health history are presented. A therapeutic intervention model for counseling, referral, and sexual health assessment of women in the primary care setting is also included.     

PRIMARY CARE FOR WOMEN: Assessment of Hematologic Disorders

This article reviews hematopoiesis, the pathophysiology of selected hematological disorders, and the components of the health history and physical exam that are needed to make a complete assessment of women with a variety of hematological disorders. The laboratory testing and interpretation of tests that augment the assessment of women with signs and symptoms of hematological disorders are also included.     

PRIMARY CARE FOR WOMEN: The Art of Interviewing

This article focuses on the skills, attitudes, and goals required for effective history-taking during comprehensive health assessment in the primary care setting. The approach presented is characterized as “patient-centered” in that the woman is engaged in the problem-solving process. Specific communication skills are discussed, and attitudes and goals that enable primary care providers to adopt a patient-centered approach to relationship-centered care are included.     

PRIMARY CARE FOR WOMEN: Assessment and Management of Headache

Headache is the seventh leading presenting complaint for ambulatory care encounters in the United States, which accounts for 18.3 million, or 43.2 per 1,000, outpatient visits per year Headache disorders have historically been difficult to track and study. This problem has been greatly ameliorated since the development, in 1988, of the international headache classification of the International Headache Society Tension-type headache and migraine headache predominantly affect women, whereas cluster headache predominately affects men. Advances both in diagnosis and in treatment modalities such as prophylactic treatments, stress reduction and biofeedback, and the use of sumatriptan, have helped to make the management of headache appropriate for nurse-midwives in the primary care setting.     

PRIMARY CARE FOR WOMEN: Management of Common Respiratory Problems

This article reviews the clinical management of common respiratory illnesses that primary care providers encounter in an outpatient setting. The latest recommendations from the American Thoracic Society, the National Heart, Lung, and Blood Institute, and the Centers for Disease Control and Prevention are summarized. The article discusses the causative organisms and antibiotics of choice for community-acquired pneumonia, and how to determine which patients require hospitalization. The appropriate use of asthma medications is described in detail, along with strategies for reducing aeroallergen exposure and for educating patients. An extensive section covers the interpretation of tuberculin skin tests and use of prophylactic isoniazid for preventive therapy of latent tuberculous infection, as well as the treatment of active tuberculosis. Controversies regarding antibiotics for both acute and chronic bronchitis are discussed, along with other treatment options including over-the-counter medications, bronchodilators, and non-pharmacologic interventions. Finally, a strategy for dealing with the complaint of chronic cough is outlined. Although many of these conditions require active comanagement by collaborating physicians, the nurse-midwife will be better able to communicate with and advocate for her clients if she possesses expanded and current knowledge of treatment strategies.     

PRIMARY CARE FOR WOMEN: Management of Common Musculoskeletal Disorders

This article provides a review of common adult musculoskeletal disorders including diagnosis and treatment guidelines to assist certified nurse midwives in their role as primary care providers. Disorders requiring referral as well es signs and symptoms indicating potentially serious underlying problems are emphasized.     

PRIMARY CARE FOR WOMEN: Comprehensive Assessment of Gastrointestinal Disorders

This article summarizes the anatomy and physiology of the gastrointestinal system, reviews physiologic changes that occur with normal development, and discusses considerations for the primary care provider in gathering health history information and conducting the physical exam. The use of diagnostic testing during the evaluation of women with gastrointestinal complaints is reviewed. A case study is used to illustrate an integrated approach to diagnosis and management of gastrointestinal disorders of women in the primary care setting.     

CULTURAL COMPETENCE IN THE CARE OF ABUSED WOMEN

This article explains the concept of cultural competence, adding advocacy to models of culturally competent health care already in the literature and demonstrating how it relates to domestic violence. Abuse stages according to Landenburger's model of entrapment and recovery are presented with applicable cultural differences and specificities. Cultural issues related to specific childbearing-stage abuse interventions are also discussed. The principles of cultural competence, abuse- and childbearing-stage specificity, and empowerment are used as the basis for this model of clinical intervention with abused women.     

PRIMARY CARE FOR WOMEN: Comprehensive Assessment of the Neurologic System

This article reviews the essential neuroanatomy and neurophysiology, and summarizes the components of the health history, physical exam, and laboratory tests required for an assessment of the neurologic system within the primary care setting. Brief case studies illustrate the wide range of symptoms associated with neurologic disorders in women and the manner in which the pattern of symptoms can be used to locate the site of pathology and indicate the need for referral and follow-up.     

PRIMARY CARE FOR WOMEN: Comprehensive Assessment of the Respiratory System

This article reviews the anatomy and physiology of the respiratory system and provides techniques for the physical assessment and data collection for common respiratory complaints in women. The pertinent historical, physical examination, and laboratory data for asthma, pneumonia, bronchitis, cough, and tuberculosis are also presented. This article is the first of two articles on primary care for women with respiratory complaints; the subsequent article will address primary care management of common respiratory conditions.     

PRIMARY CARE FOR WOMEN: Cultural Competence in Primary Care Services

The assessment of cultural competence in providing primary care services (or women is addressed Emphasis is placed on the ways in which cultural competency attainment can ensure the availability of key primary care components to all women, especially those from certain vulnerable populations and those who have specific primary health care needs, A cultural competence continuum is described that will assist providers in an assessment of their own cultural competency levels, as well as those of the service settings in which they practice. Six scenarios are provided, describing experiences at each level of the continuum that may hinder the development and delivery of effective primary care service interventions. Examples of ways in which nurse-midwives can provide leadership in the area of cultural competence in women's primary care are also included.     

PRIMARY CARE FOR WOMEN: Screening Tests and Preventive Services Recommendations

This article reviews public health prevention principles and screening test requirements and discusses current guidelines that underlie widely used preventive services recommendations. The reasons and rationales that govern the screening of healthy asymptomatic women for certain diseases are reviewed. This update will prepare nurse-midwives for enhanced roles in health promotion, an important aspect of the scope of primary care services for women.