F/E & ABGs
What 2 patient populations are at a greater risk for F/E imbalances?
Pediatric & Geriatric
What would you include when educating your patient on bleeding precautions?
Use a soft bristle toothbrush, use an electric razor, avoid hard foods (such as chips), don't blow your nose too hard or scratch the inside of the nose, avoid falling and bruising self, avoid sharp objects, don't strain with BMs, avoid any trauma or injury that may cause bleeding, apply firm pressure to any area of bleeding at least for 5 min, etc.
Which of the following is NOT used to treat asthma? (Do you know why?)
1. Corticosteroids, 2. Leukotriene modifiers, 3. Bronchodilators, 4. NSAIDS, 5. Anticholinergics
4. NSAIDS
why??
What do Proton Pump Inhibitors treat and give an example.
GERD, PUD
Omeprazole (prilosec), Esomeprazole (Nexium), Lansoprazole (Prevacid), Rabeprazole (AcipHex), Pantoprazole (Protonix), Dexlansoprazole (Dexilant), Zegerid (omeprazole with sodium bicarbonate)
What is HIV wasting syndrome?
10%+ loss of body weight w/ diarrhea or weakness and fever that have lasted 30 days. Weight is difficult to regain.
What abnormal electrolyte is the opposite of hyperphosphatemia?
hypocalcemia
Increased Phos. (fat cat) = Decreased Ca (skinny cat)
Increased Ca (fat cat) = Decreased Phos. (skinny cat)
List at least 3 modifiable risk factors & 3 Non-modifiable risk factors for CAD.
Modifiable: Elevated serum lipid levels, HTN, DM, Smoking, Inactivity, Obesity, Psychological factors, Elevated homocysteine levels
Non-modifiable: Age, Gender, Ethnicity, Genetics
What is Cor Pulmonale?
Complication of COPD. Hypertrophy of the right side of the heart as a result of pulmonary HTN. Eventually causes Right-sided Heart Failure.
S/S: Dyspnea, crackles in lungs, JVD, hepatomegaly w/ RUQ tenderness, peripheral edema, wt gain.
Explain the steps of giving a SQ injection.
1. Gather all supplies (SQ needle, med, alcohol pad, gloves).
2. Sanitize hands and apply PPE.
3. Identify your 5 Rights (Right pt, drug, dose, route, time).
4. Find a SQ spot where you can pinch up at least 1 inch of fat (abdomen, thighs, love handles, back of the arm) and clean it with an alcohol pad.
5. Pinch skin and Inject med at 45-90 degrees.
6. Engage safety on needle and dispose in sharps container.
List the 7 warning signs of possible cancer.
(CAUTION)
1. Change in bowel/bladder
2. A sore that doesn't heal
3. Unusual bleeding
4. Thickening or lump
5. Indigestion w/ dysphagia
6. Obvious or worsening wart or mole
7. Nagging cough
List and describe the 2 hallmark signs of hypocalcemia.
Chvostek's - twitch in facial muscles that occurs when gently tapping the cheek in front of the ear
Trousseau's - involuntary contraction of the muscles in the hand and wrist that occurs after the BP cuff is inflated over SBP.
List the clinical manifestations of Right sided heart failure.
Backs up into body >> edema everywhere, JVD, ascites, anasarca, hepatomegaly, splenomegaly, ankle & sacral edema, testicular edema in men.
Identify and compare the 3 ways to acquire pneumonia?
1. Community acquired - occurs in patients who have NOT been hospitalized or in LTC w/i 14 days of onset of sx.
2. Hospital acquired - occurs 48hrs+ after hospitalization and no s/s upon admission.
3. Ventilator acquired - occurs 48hrs+ after endotracheal intubation
List at least 5 s/s of hypothyroidism.
Morbid Matilda, everything is low and slow
Decreased CO, dyspnea, wt gain, decreased appetite, thick nails, thin/coarse hair, decreased sweating, fatigue, lethargy, forgetfulness, prolonged DTRs, decreased menses, intolerance to cold.
(Hyperthyroidism = go getter Gertrude)
List an example of each type of potential airway/respiratory problem that might occur in the postoperative period?
(Obstruction, Hypoxemia, and Hypoventilation)
1. Obstruction: blockage of the airway by the patient's tongue, retained thick secretions, laryngospasm, laryngeal edema
2. Hypoxemia: atelectasis, pulmonary edema, PE, aspiration, bronchospasm
3. Hypoventilation: depression of central respiratory drive, poor respiratory muscle tone, mechanical restriction, mechanical restriction, pain
What are the normal ranges for each electrolyte?
Na, K, Calcium, Phosphorus, Mag.
Na 135-145
K 3.5-5
Ca 8.6-10.2
Phos 2.4-4.4
Mag 1.5-2.5
Give an example of a medication in each of the following drug classes.
1. Loop diuretic, 2. Potassium sparing diuretic, 3. ACE inhibitor, 4. Beta Blocker, 5. Calcium Channel Blocker
1. Furosemide, -thiazide
2. Spironolactone
3. -pril
4. -lol
5. Diltiazem, Verapamil, Amlodipine, Nifedipine (DVAN)
Differentiate between COPD & Asthma.
COPD: airflow limitation NOT fully reversible, usually progressive, abnormal inflammatory response of lungs primarily caused by cigarette smoking and other harmful particles/gases. Emphysema (pink puffers) & Chronic Bronchitis (blue bloaters).
Asthma: Diverse disease characterized by combination of CM with reversible expiratory airflow limitation or bronchial hyperresponsiveness (narrow airways blocked w/ mucus).
List & Describe the 4 different types of incontinence.
1. Stress: in women, increased intraabdominal pressure, sneeze, cough, jump
2. Urge: in women, no warning, no intraabdominal pressure, on the way to the bathroom and can't hold it
3. Overflow: in men, involuntary loss of urine w/ overdistention of bladder, associated w/ BPH or prostate CA
4. Functional: pt is aware of need to urinate, but for one or more physical or mental reasons they are unable to get a bathroom
Differentiate between the following side effects following a stroke: Aphasia, Dysphasia, Dysarthria.
(Can you also list and define the 3 types of aphasia, and 2 types of dysphasia, and 3 areas of dysarthria.)
Aphasia: stroke damages the dominant hemisphere and affects language. Receptive = loss of comprehension. Expressive = loss of production of language. Global = total inability to communicate.
Dysphasia: impaired ability to communicate. Nonfluent = minimal speech activity w/ slow speech. Fluent = speech is pressure but contains little meaningful communication.
Dysarthria: disturbance in muscular control of speech. Pronunciation. Articulation. Phonation.
Interpret the following ABG.
pH 7.46, PaCO2 32, PaO2 59, HCO3 25
uncompensated respiratory alkalosis with hypoxia
Compare and contrast the following symptoms of arterial and venous disease.
Peripheral pulses, edema, hair, ulcers, pain, skin color, skin temp, skin texture, etc.
Arterial: decreased or absent pulses, edema only present if in dependent position, loss of hair on legs, ulcers rounded and smooth w/ black eschar or pale pink granulation, intermittent claudication, dependent rubor, elevation pallor, thin/shinny/taut skin texture.
Venous: present pulses, lower leg edema, hair present or absent, ulcers irregularly shaped w/ yellow slough or dark red "ruddy" granulation, dull ache or heaviness in calf, ulcers often painful, warm skin temp w/ no gradient, thick/hardened/indurated skin texture,
What precautions would you take & what PPE would you apply for the following medical diagnosis?
1. C.diff
2. Influenza
3. TB
1. Contact - gown, gloves
2. Droplet - gown, gloves, surgical mask
3. Airborne - gown, gloves, N95 respirator, goggles
Name the 4 types of insulin therapy and give an example for each.
1. Rapid acting (-log, Apidra)
2. Short acting (Regular - Humulin R)
3. Intermediate acting (NPH - Humulin N)
4. Long acting (Lantus, Levemir)
Define each of the following Musculoskeletal disease processes.
1. Fractures, 2. Fat Emboli, 3. VTE, 4. Compartment syndrome.
1. Fractures: disruption or break in continuity of structure of bone from trauma or secondary to disease process.
2. Fat emboli: presence of systemic fat globules from fracture that are distributed into tissues and organs after traumatic skeletal injury.
3. VTE: venous thromboembolism, blood clots that form in veins. DVT and PE.
4. Compartment syndrome: swelling and increased pressure w/i a confined space, compromises neuromuscular function of tissues w/i that space, from decreased compartment size or increased compartment contents.