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The attitude of the doctor towards the woman is terribly important and can set the whole tone of the relationship mens health gay discount fincar 5 mg otc. The general practitioners of a given area look after their population of men and women usually with complete confidence on both sides man health news za exit buy fincar visa, but provision has been made for the rotation between practices of those who do not wish to accept the management and treatment protocols of a given practice androgen hormone young generic fincar 5 mg amex. When a woman has to be referred to hospital prostate radiation side effects effective fincar 5 mg, she may request that she goes to a certain unit. This 19 Clinical approach Doctors should remember the sensitive nature of gynaecological and obstetrical problems which are very personal to women. The attitude towards the obstetrician is mollified by the fact that women realize that there are Chapter 2 the woman as a patient applies mostly in the big towns, for in rural areas there is usually only one District General Hospital. There again the woman may request to see (or not see) any given consultant for her own reasons. In the out-patients this can usually be arranged but not at an emergency level where consultants work to a rota. The presence of junior doctors or medical students at teaching hospitals is being highlighted at the moment. Naturally women want privacy, but when it is explained to them that these are the doctors of the future, they usually understand and allow them to be present. This raises the complication of the inclusion of events of a sensitive nature such as previous terminations of pregnancy or sexually transmitted diseases. If the woman wishes to keep confidential essential pieces of information which may affect the clinical management then marks such as an asterisk or euphemisms should be recorded in her notes that will alert your colleagues. If the woman attends an antenatal clinic where she is not known, one has to start from the beginning. The history, examination and investigation of the woman are taken at the booking clinic when she attends for the first time in pregnancy (see Chapter 9). Ideally, this should be at 810 weeks of gestation but more often in Britain it has slipped to 1214 weeks, hence invalidating all the help that can be offered to the woman in the first trimester and passing the time when teratogenesis might have been avoided. Ethics Ethics is the science of morals but probably is better interpreted as the rules of conduct recognized in certain departments of human life. Those in the medical profession owe an ethical duty to do their best for those who seek their care. In latter years the subject has moved more towards the science and people have tried to lay down guidelines. Generally speaking, the ethics of medicine are covered by the General Medical Council, the British Medical Association and the Ethical Committees of the various Colleges including the Royal College of Obstetricians and Gynaecologists. Details proliferate but a central principal remains that you should do unto others as you would they should do unto you. Always imagine your mother or your daughter as the patient and how you would like them to be treated. The gynaecological patient the pregnant woman When a woman becomes pregnant she usually consults her family doctor first. There may be records going back many years and the doctor may know the woman from previous medical encounters. While many of the items needed in the antenatal record for the history are already in the practice records, it is wise to keep a pro forma especially for each pregnancy with summaries of 20 Most women in their lives will consult a doctor about gynaecological symptoms. Be it specialist or general practitioner, the same logical processes must be used to make a diagnosis and direct management. History this is best considered under systematic headings so that no important symptoms are omitted. Any treatment of present complaint so far All drugs taken recently must be noted, especially tranquillizers, oral contraceptives, hormones and antibiotics. History of past major illness or operations All admissions to hospital with approximate dates. Social history Home conditions (including nature and state of relationships with other people in the residence). Vaginal discharge Character of discharge: (a) mucoid; (b) purulent; 21 Chapter 2 the woman as a patient (c) colour; (d) quantity; (e) bloodstained. Palpation this is done lightly at first to test for any localized tenderness or rigidity. Deep palpation is used to confirm the presence of a tumour or enlargement, especially of uterus or ovaries. Percussion If there is a central tumour it will be dull to percussion with hollow sounds from the flanks.
The nurse plays an important role by encouraging older adults to participate in a regular exercise program prostate jalyn discount fincar 5 mg otc. Regular exercise increases the strength and efficiency of heart contractions prostate cancer psa scale purchase genuine fincar on line, improves oxygen uptake by cardiac and skeletal muscles prostate biopsy purchase fincar 5 mg without prescription, reduces fatigue prostate cancer kidney metastasis purchase 5mg fincar free shipping, increases energy, and reduces cardiovascular risk factors. Muscle endurance, strength, and flexibility-all outcomes of regular exercise-also help to promote independence and psychological well-being. Aerobic exercises are the foundation of programs of cardiovascular endurance conditioning. A physical examination by a physician or nurse practitioner is necessary before initiating an exercise program, and older persons should perform exercises in moderation and use short rests to avoid undue fatigue. Swimming and brisk walking are often recommended because they are managed easily and usually are enjoyed by the older person. This condition, presbyopia, usually begins in the fifth decade of life, and requires the wearing of reading glasses to magnify objects. In addition, the yellowing, cloudy lens causes light to scatter and makes the older person sensitive to glare. The pupil dilates slowly and less completely because of increased stiffness of the muscles of the iris, so the older person takes longer to adjust when going to and from light and dark environments or settings and needs brighter light for close vision. Although pathologic visual conditions are not part of normal aging, the incidence of eye disease (most commonly cataracts, glaucoma, diabetic retinopathy, and age-related macular degeneration) increases in older people. Age-related macular degeneration, in its most severe forms, is the most common cause of blindness in adults older than 55 years of age in the United States, and it is estimated to affect more than 10 million Americans. Risk factors include sunlight exposure, cigarette smoking, and heredity, and people with fair skin and blue eyes are much more prone to the disease. Yearly eye checkups ensure early detection, which makes surgical correction much more successful. Optical aids to magnify print and printed objects may help those already suffering from the effects of macular degeneration to continue to read (Friberg, 2000). Older people are often unable to follow conversation because tones of high-frequency consonants (letters f, s, th, ch, sh, b, t, p) all sound alike. Hearing loss may cause the older person to respond inappropriately, misunderstand conversation, and avoid social interaction. Wax buildup or other correctable problems may also be responsible for major hearing difficulties. A properly prescribed and fitted hearing aid may be useful in reducing hearing deficits. Blunted taste may contribute to the preference for salty, highly seasoned foods, but herbs, onions, garlic, and lemon should be encouraged as substitutes for salt to flavor food. Elderly people make up an extremely heterogeneous group, yet negative stereotypes are attributed to all of them. Fear of aging and the inability of many to confront their own aging process may trigger ageist beliefs. Retirement and perceived nonproductivity are also responsible for negative feelings, since the younger working person may see the older person as not contributing to society and draining economic resources. This negative image is so common in American society that the elderly themselves often believe it. Only through an understanding of the aging process and respect for each person as an individual can the myths of aging be dispelled. If the elderly are treated with dignity and encouraged to maintain autonomy, the quality of their lives will improve. Stress and Coping in the Older Adult Coping patterns and the ability to adapt to stress are developed over the course of a lifetime and remain consistent later in life. Experiencing success in younger adulthood helps a person develop a positive self-image that remains solid through even the adversities of old age. Losses may accumulate within a short period of time, however, and become overwhelming. The older person will often have fewer choices and diminished resources to deal with stressful events. Common stressors of old age include normal aging changes that impair physical function, activities, and appearance; disabilities from chronic illness; social and environmental losses related to loss of income and decreased ability to perform previous roles and activities; and the deaths of significant others.
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