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Hgb
Male
Female
- male 13.5-18dg/dL
- female 12-16dg/dL
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Platelets
150,000-400,000
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crepitus
cracking sound from joints rubbing together
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Complication of joint replacement
- PE or fat embolus
- usually at day 5 post op
- OOB asap....sequentials/Teds, heparin, ROM
- Discharge teaching of S/S of this
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After surgery what are the fevers from??
- Day 1-2 respiratory infection
- Day 2-4 UTI
- Day 5- Wound infection
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What's normal temp in the elderly?
96.8F
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What are respirations like in the elderly? 85+
fast and shallow
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Why are elderly at risk for dehydration?
- decreased skin elasticity and turgor
- decreased thirst, perspiration and body fluids
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Why are elderly at risk for malnutrition?
- decrease taste sensation
- decreased gastric acid and motility
- impaired absorption, reduced saliva
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Who's the prevelance of pain twice as high in? Elderly or young adult?
Elderly are in pain more often than anybody....but have a higher pain threshold
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Why are psychoactive drugs more potent in the elderly?
cuz the brain receptors are more sensitive....which causes psychoactive drugs to be MORE POTENT
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Primary, Secondary and Tertiery in community health
- Primary-prevention(immun/stay healthy)
- Secondary-what to do when they are already sick
- Tertiary-take all meds and prevent reoccurrence
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Morbidity vs. mortality
- morbidity-incidence of disease
- mortality-number of deaths in a given period of time
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Gate control theory
a pain stim opens a neurological gate, allowing pain stimulus to proceed thru the nervous system to the brain and creat the sensation of pain. It also considers the emotional component of pain.
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What explains why pain is perceived differently from person to person?
enkephalins
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S/S of pain
- increased BP and HR
- diaphoresis
- N/V
- pallor
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Visceral pain
pain that is crampy and gnawing....may be referred pain
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somatic pain
sharp pain from skin, muscles, bones and joints
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Neuropathic pain
- caused by injury to nerve fibers in the PNS or CNS
- numbing, burning, shooting, stabbing
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Example of neurpathic pain
phantom limb or diabetic neuropathy
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adjuvant meds
- aka coanalgesics....they add pain relief, but are not classified as pain meds
- (antidepressants, muscle relaxers)
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Equinalgesia
helps to decrease addition potential
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What needs to be kept available for patient using a PCA?
Narcan
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Cells and hypertonic and hypotonic dehydration
- hypertonic=cell shrinkage
- hypotonic=cell swelling
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VS for dehydration
- Decreased BP
- Increased HR/RR and depth and Temp
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Aldosterone causes
sodium and water reabsorption
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ADH causes
water to be reabsorbed
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anasarca
accumulation of fluid in all body tissues
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IV for hyponatremia
0.9% NS(Sodium Chloride)
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If a patient has hypernatremia....what med might they get?
Lasix/Furosemide-Diuretics
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Primary prevention for TB
- ID high risk people and get them vaccinated
- people in close contact with infected should wear a mask
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Secondary prevention for TB
teach infected persons they must take prescription till it's done
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Tertiary prevention for TB
- Dont spend time in a stuffy enclosed room with anyone with active TB
- Wear a mask if you do
- help infected to take all meds till gone
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Side effects of INH
- hepatitis/liver issues
- Renal problems
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Rifampin side effects
- orange body fluids
- less effect BCP
- hepatitis
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Pyrazinamide side effects
renal and liver issues...hepatitis
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Ethambutol side effects
occular toxicity
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ptosis
droopy upper lid of eye
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chalzion
cyst caused by obstruction in the ducts of the sebaceous glands
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blepharitis
inflammtion of eye lid
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keratitis....and treatment for
- inflammation of cornea
- wear an eye patch and use atropine drops
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S/S of cataracts
- blurred vision/hazy
- NO PAIN
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Surgery for cataracts
- extracapsular extraction....only done when effects ADL's
- Contents of lens removed, but posterior capsule is left in tact for attachment of intraocular lens
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Patient teaching after extracapsular extraction...cataract surgery
Dont do anything to increase IOP...no straining, leaning over, valsalva or coughing
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Glaucoma
- increased IOP
- it impairs vision and causes damage to the optic nerve.
- Can cause blindness
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Open angle glaucoma
when aqueous humor is prevented from draining due to changes in the trabecular meshowrk, canal of schlemm and adjacent canals....causing IOP
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S/S or open angle glaucoma
- foggy and blurred vision
- tired eyes
- Gradual decrease in PERIPHERAL vision
- HALOS
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Treatment of Open angle glaucoma
cholinertic miotic-pilocarpine/physostigmine
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What's a medication contraindicated with glaucoma?
ATROPINE-causes pupils to dialate
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surgery for glaucoma
- trabeculectomy
- laser surgery that creates a fistula so aqueous humor can be absorbed
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Close ended glaucoma
sudden build up of IOP (1/2 to 1 hr) due to a complete blockage of the filtering angle caused by a bunching up of the iris
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What can cause CLosed angle glaucoma?
Mydriatic agents
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S/S of closed angle glaucoma
- Excruciating pain
- blurred vision with halos around light
Red eye and moderately dilated and non reactive pupil
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treatment for closed angle glaucoma
medical emergency...if not treated will be blind
Peripheral iredectomy-remove portion of iris leaving ahole for aqueous humor to get out
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S/S of retinal detachment
- flashing lights or floating spots
- curtain drawn over the eye
NO PAIN OR EYE REDNESS
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Treatment for retinal detachment
eye patch in hopes for the retina to go back in place prior to surgery
- Scleral Buckling
- sclera is shortened allowing for contact with choroid and retina
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What do you monitor during a nose bleed?
ABC's
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Odd interventions for epitaxis
- monitor CBC, PT/APTT
- Analgesia
- IV FLUIDS for increased blood loss
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Overweight
BMI of 25 and it doesnt necessarily mean excessive body fat (muscle, bone...)
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Obesity
BMI of 30....related to excessive amount of body FAT
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What should calories come from in our diet?
complex carbs and proteins
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Serving of vegetables/fruit
- size of a womans fist or a baseball
- 1/2 cup
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Serving of meat
- size of your palm or a deck of cards
- 3-5 oz
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A serving of cheese?
size of a thumb or 6 die
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What should be on my plate?
- 2/3 plant source foods
- 1/3 animal protein
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Xenical
- blocks fat absorption and digestion
- side effects-abdominal cramps
- loose stool
- vitamin deficiency
- anal leakage
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Meridia
- appetite suppressant and increases metabolic rate
- side effects: increase BP, HR
- constipation and insomnia
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Where is food dumped when you've had gastric bypass?
directly in to the jejunum
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HOB for NG tube...
Insertion
after insertion
- High fowlers
- low to mid fowlers
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2 ways to check placement of NG tube
- X ray and aspirate fluid (should be >4...acidic. make sure you calculate amount of aspirate)
- or
- add 20-30 mL of air and auscultate
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Prior to feeding a pt with NG tube what do I do?
check for residual (>200)
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When feeding a person with NG tube what do I do prior and after feeding?
- flush with 20-30mL of WATER
- RECORD INTAKE
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Where do you feel pain if you have gallbladder issues?
RUQ
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Hepatitis A
acute onset and has a higher fever than the other 100-104
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What causes jaundice?
obstruction of bile channels causing an increase in concentration of billirubin in the blood
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S/S of Icteric phase of Hepatitis
- jaundice
- elevated billirubin
- Dark amber/foamy urine
- clay colored stools
- pruritis
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Which hepatitis can become chronic?
Caused by?
- B,C,D
- alcohol intake and increased physical exertion
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What can chronic active hepatitis cause?
liver damage...hepatic necrosis and cirrhosis
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Which hepatitis cause liver cancer?
B and C
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Ribavirin
treats Hep C
do a pregnancy test prior to giving
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Precautions for Hepatitis A and E
Standard and contact....gown and gloves, private toilet, bag and label contaminated linens, isolate tools
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Precautions for Hepatitis, B, C, D and G
- Standard...wash hands
- watch for cuts on self and mucous membranes
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Pt teaching for pt with Hep BCDG
- avoid sex till LFT are normal, then use condom
- teach friends/family how to be safe and not isolate pt
- no sharing of razors, tooth brushes
- repeat blood tests often
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Prophylaxis for Hepatitis A
Havrix
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Prophylaxis for Hepatitis B
Recombicax....e injections in deltoid
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Kubler-Ross stages of grief
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
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Whats an example of bargaining?
go to get accupuncture
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Delayed grief response
stuck in denial; go on after a major loss as if nothing has happened
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impeded grief reaction
suddenly stop grieving....instead shop a lot, work alot, drugs, alcohol
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Chronic /Patholigic grief
normal patterns that persist for very long periods of time
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Exaggerated grief
self destructive behaviors....suicide
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Death...what goes firs? Last
respirations first and hearings last
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Breathing pattern for dying
cheyne stokes and agonal
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Left CVA effects
- Right side....
- analytical thinking
- math skills
- personality
- receptive and expressive language
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Which side of the brain causes problems with agnosia, alexia, agraphia?
Left side CVA
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Rt CVA effects
- left side....
- visual/spatial awareness and proprioception
- altered perception of deficits (overestimation of abilities)
- Poor judgement and impulse control
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Which side of the brain CVA causes problem with neglect syndrome?
Rt side CVA
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Glascow coma scale looks at...
- if patient opens eyes
- has normal verbal responses...can converse
- obeys commands with motor responses
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Meds for embolic CVA
- anticoagulant...prevents development of additional emboli
- aspirin, heparin, lovenox, warfarin
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Meds for thrombolytic CVA pt
- antiplatelets....prevents extension of the CVA
- Ticlid/Plavis
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Clot buster medication
Activase, tPA
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What drug is given to a patient with a CVA and develops seizures
- Antiepileptic....
- dilantin, Neurontin
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Blood tests for Warfarin
Heparin
- Warfarin-PT
- Heparin-PTT and APTT
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Normal temp is...
97-100.4
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Pulse deficit
apical minus radial
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euypnea
regular respirations
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cheyne stokes
gradual increase in rate and depth followed by apnea
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kassmaul
rapid, deep, gasping
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agonal
gasping, irregular and infrequent breathing
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How far do you stick enema in?
how high do you hold it?
- 3-4 inches toward umbillicus
- 18 inches above rectum
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TWE causes
hypotonic condition
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What do you put in an enema for a child/infant?
normal saline
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Catheter insertion....
- it is advanced till you get urine....then-
- female advance to more inches
- male advance to the hub
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How often do you change a catheter?
5-7 days
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What do you do if your catheter is clogged?
pinch off and flush with 50mL of NS
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How often do you change an IV?
48-72 hours
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How often do you change a TPN tube?
every day
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IM needles
21-23 gauge and 1-1.5 inches long
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SQ needles
25-27 gauge and 1/2 to 5/8 inches long
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ID needles
26-27 gauge and 3/8-5/8 inches
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When do you replace a ostomy bag?
every 3-7 days or when it starts to detach from the skin
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When a person has a colostomy what are they at risk for?
F&E imbalances
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Which skin cancer can metastasize?
squamous cells....look for it on lip and ears
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How often do you apply sun screen?
what is a large mole?
how often do you examine the skin?
- every 2 hours
- larger than 5 cm
- every month
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