Combo with "Ambulatory Nursing Certification" – Flashcards
102 test answers
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HDL-C
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.40 - 7. Low = Lipid disorder
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LDL
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65 - 100 High = Lipid disorder
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Criteria for Dx of Diabetes
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Fasting BS >126 on 2 separate occasions or 2 hour BS > 200 during oral glucose test or Sx of diabetes + random BS >200
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Symptoms of diabetes
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Polyuria Polydipsia Hyperglycemia Unexplained weight loss
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Do not collect fecal occult blood if ...
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Rectal bleeding Hematuria Menstruation
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7 days prior to colonoscopy avoid ...
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ASA - NSAIDS - Steroids - iron supplements
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5 days prior to colonoscopy avoid ...
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Vitamin C, both dietary and supplements
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3 days prior to colonoscopy avoid ...
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Red meat - broccoli - cauliflower - black grapes - raw fruit and vegetables
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Triage / assessment of terminal illness
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Emotional Social support Perception of illness / disease ADL's Change in problem solving Change in lifestyle / financial S/sx depression and anxiety
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Psychosocial intervention for terminally ill patients
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Decrease anxiety Promote coping End-of-life choices Palliative care Hospice care
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COPD - chronic obstruction of airflow in and out Pulmonary emphysema Chronic bronchitis Asthma
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Treatment Nursing interventions Position, sit up, lean forward Frequent rest Nebulization Pulmonary toilet IPPB O2
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CHF
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Treatment Nursing interventions Reduce pain and anxiety Improve oxygenation Reduce congestion Improve Myocardial contraction
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MS Multiple Sclerosis Teaching Plan Readmission / Exacerbation
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Define readmission and exacerbation Safety precautions Medication including SEs and OTC interaction Exercise to promote strength and mobility Self manage bowel / bladder / catherization
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MS Exacerbation reasons
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Infection, trauma, immunization, childbirth, stress, climate changes
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MS community resources
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MS society, public health nurse, home health, support groups, vocational rehab service, Social workers, therapists, SNFs and financial counseling.
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MS safety precautions
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Consider : Decreased sensation, visual disturbances, motor deficits
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MS medications
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Corticosteroids, immunomodulators, cholinergics, anticholinergics, muscle relaxers
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MS excercises
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Prevent contractures and skin breakdown, transfer techniques, body mechanics and use of assistive devices
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MS bowel and bladder
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Risk for constipation, UTI and urinary retention
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HIV Transmission
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Sex, parenteral exposure to blood/blood products Perinatal exposure and breast milk
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Before 12 weeks of age
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Any fever over 101 is emergency
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Gout
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Apply cold
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Immunization site swelling and pain
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Apply cold
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Amoxicillin rash
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Side effect only, not an allergy, no treatment
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Hypertension
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140/90 Home care 150/100 See in 2 weeks 160/110 See in 3 days 180/120 See in 24 hours >180/120 ED
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Fever without cause
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No longer than 24 hours
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Fever with associated symptom
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...
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Patient needs are UNHEALTHFUL responses
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Unhealthy responses
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Patient strengths are HEALTHFUL responses
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Healthy responses
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Child and adolescent screening
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Newborn metabolic devlopment & behavior High BP Genetic anemia Blood lead level Vision Hearing Dental Lipid disorders Scoliosis Depression Chlamydia, STD's Alcohol use Tobacco use Violence Cervical Cancer Sickle Cell and PKU
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Sickle cell screening mandated in ____ states
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all 50
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Sickle cell affects 1 in ____ African American newborns
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375
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MDD - Major Depressive Disorder symptoms
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sadness, irritable, loss of interest, social isolation, anger, sleep and appetite disturbances, non-specific pain
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MDD present when sx cluster together and persist for ___ weeks or more
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2
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PHQ-A
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Patient Health Questionnaire for Adolescents
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BDI-PC
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Beck Depression Inventory - Primary Care Version
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Live, attenuated vaccine
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Cultured under conditions which disable their virulent properties or use closely-related but less dangerous organisms
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Inactivated vaccine
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Contain toxoids, protein subunits, conjugate bacteria polysaccharide outer coats or killed organsms.
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Immunization Early childhood Hepatitis B by age 2
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3
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Immunization Early childhood Rotovirus (live) by age 2
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3
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Immunization Early childhood Tdap by age 2
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by age two - 4 doses age four - 1 dose
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Immunization Early childhood Hib (Haemophilus influenza bype B) by age 2
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3-4
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Immunization Early childhood Pneumonia by age 2
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4
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Immunization Early childhood IPV (inactivated polio) by age 2
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by age two - 3 age four - 1 dose
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Early childhood immunization MMR (live) by age 2
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by age two - 1 age four - 1
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Immunization Early childhood Influenza (live or inactivated) by age 2
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Yearly after 6 months
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Immunization early childhood VZV (Varicella) live by age 2
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1
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Immunization Early childhood Hepatitis A by age 2
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2
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Immunization Early childhood given at age 4
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Tdap - Tet., Diphtheria, Pertussis IPV - Inactivated Polio MMR - Measles, Mumps, Rubella Varicella - Chicken Pox
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Immunization Late childhood given at age 7-10
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Tdap
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Immunization Late childhood given age 11-12 (females)
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HPV - 3 doses (female) Meningococcal - 1 dose Pneumonia - 1 (if high risk) Hepatitis A - 1 (if high risk) HepB, IPV, MMR, VZV catch up
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National Childhood Vaccine Injury Act of 1986
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Report adverse events to Dept of Health & Human Services If acquired through public purchase, report to local, county &/or states health departments
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Adult Screenings
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Depression Prostate Ca Obesity Breast Ca Osteoporosis Cervical Ca Dementia Blood Pressure Vision Lipids Hearing Diabetes Violence STD's Alcohol misuse
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BMI
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Weight in kg / Height ...
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BMI normal
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18.5 - 24.9
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BMI overweight
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25.0 - 29.9
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BMI obese
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30.0 - 39.9
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BMI extreme obese
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>40
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Immunization Adult - 2010
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Tdap - one every 10 years Flu - all ages > 6 months Zoster - 1 dose 60 years HPV - 3 doses Females 13 - 26 years Males 9 - 26 years
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Immunization Adult Catch up
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MMR - during or after 1957 1 dose Varicella - 2 doses if no immunity Meningococcal - 1st year in dorm - others at risk
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Immunization Adult high risk
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Pneumonia - max 2 in lifetime Hep A - not vaccinated, 2 doses Hep B - not vaccinated, 3 doses
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Adult Screening - Alcohol Misuse
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Risky or Hazardous drinking Women >7/week, >4 per party Men >14/week, >4 per party Harmful drinking - physical, social or psych harm but not dependence
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Adult Screening Alcohol Risky/hazardous drinking
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Women >7/week, >4 per party Men >14/week, >4 per party
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Adult Screening Alcohol Harmful drinking
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Physical, social or psych harm but not dependence
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Adult Screening Alcohol Tools
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National Institute on Alcohol Abuse and Alcoholism niaaa.nih.gov/Publications/AlcoholResearch/
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Medical Emergencies
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Staff roles Skills (BLS, ACLS, PALS) Competency assessment (drills) Age-specific equipment and meds
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Medical Emergency - CAB 1. Chest compression 2. Airway 3. Breathing
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Check responsiveness Check breathing Call for help Check for pulse 10 seconds only Give 30 chest compressions Open airway & give 2 breaths Resume compressions
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HIV Course of infection
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Mono-like syndrome Asymptomatic seropositivity Symptomatic seropositivity
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HIV Prognosis
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Strong correlation w/CD4 cell count Inversely related to HIV load
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HIV Management
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Anti-retrovirals Prevent opportunistic infection No live virus vaccines Counseling
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Normal test values HgB
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Men 13.5 - 16.5 g/dL Women 12.0 - 15.0 g/dL
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Normal test values Hct
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Men 41 - 50% Women 36-44%
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Normal test values Sodium
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135 - 145 mEq/L
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Normal test values Calcium
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8.5 - 10.5mEq/L
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Normal test values Magnesium
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1.7 - 2.3mEq/L
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Normal test values Potassium
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3.5 - 5.5 mEq/l
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EKG lead placement
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...
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Head circumference
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...
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Vision - Snellen chart
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Snellen at 20 feet, anything >20/40 needs eye doctor
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Blood Pressure Measurement
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Cuff encircles 80 - 100% of arm Width 40% of circumference Bare arm Pump to 30mm Hg above radial pulse disappearance Release pressure 2-3 mm Hg/sec First 2 consecutive sounds Systolic Disappearance of sounds Diastolic
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Peak Flow Meter
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Green 80-100% good control Yellow 50-80% caution, take quick relief med and seek care Red <50% danger, take med and seek emergency care if not returned to yellow or green immediately
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Pulse Ox
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Arterial oxygen sat Leave on 75 seconds Normal >95% Critical <93%
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Mammogram
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Every 1-2 years age 50 - 74
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Pap smears
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Women with cervix - 3 years after becoming sexually active or age 21 Until 2-3 consecutive are normal, then every 3 years
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Colorectal screening
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Fecal Occult Blood test q 3 yrs Flex sigmoid q 5 years w/ high sensitivity Fecal Occult Blood test. Colonoscopy q 10 years
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Telephone Triage
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Interactive process between nurse and client involving id of the nature and urgency of the problem and determination of the appropriate disposition
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Telephone Triage Guideline
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Directs in developing individual plan of care. Flexible but retains a standard of care Practice that allows some discretion in interpretation, implementation or use. Allows for nursing judgement Disadvantage is potential lack of consistency in implementation Decision-support tools based on pattern recognition, encouraging RN to use critical thinking, context and pattern matching to determine disposition.
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Telephone Triage Protocol
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Plan for carrying out treatment. Actions are scripted, to be FOLLOW WITHOUT DEVIATION Best matches presenting problem Select the one that has highest likelihood of leading to appt. Ask patient what is most bothersome
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Telephone Triage Algorithm
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Rules for solving problem in finite number of steps. Flow chart of questions guiding decisions in step-by-step logical sequence.
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Telephone Triage Decision Making Tools
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Follow rigidly by yes/no answers to reach final disposition e.g. Protocols Require clinic thinking
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Telephone Triage
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Why use Protocols? Standardization and structure Provides safe, effective care and appropriate disposition Eliminates common practice errors Provided legal protection Ease of documentation, efficiency & retrievability Meets accreditation standards
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Telephone Triage Disposition
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Emergent 911 or ED Urgent ASAP 1-8 hrs Acute 8-24 hrs or next day Non-acute Phone advice ERR ON SIDE OF CAUTION
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Telephone Triage Legal Issue
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Formal Nurse-Patient Relationship Maintain scope of practice Safeguards - Protocols Documentation Quality Assurance Accountability
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Telephone Triage Legal Risk
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3 R's Right care, place, time Consistency Formal training Adequate resources and protocols Written assessment Documentation Quality Improvment program Compliance to License Compact
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Normal Lab values Chloride
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85 - 115 mEq/l
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Normal Lab values Bicarbonate
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22 - 29 mEq/l
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Normal Lab values WBC
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4.5 - 11/cu mm
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Normal Lab values RBC
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Female 4.2 - 5.4 million / cu mm Male 4.6 - 6.2 million / cu mm
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