Combo with "Ambulatory Nursing Certification"

5 – 20 Too high = renal failure

.6 – 1.3. Too high = renal failure

TSH adult level
.25 – 4.30 High – Hypothyroid
Low – Hyperthyroid

> 200. = Hyperlipidemia

.40 – 7. Low = Lipid disorder

65 – 100 High = Lipid disorder

Criteria for Dx of Diabetes
Fasting BS >126 on 2 separate occasions
2 hour BS > 200 during oral glucose test
Sx of diabetes + random BS >200

Symptoms of diabetes
Unexplained weight loss

Do not collect fecal occult blood if …
Rectal bleeding

7 days prior to colonoscopy avoid …
ASA – NSAIDS – Steroids – iron supplements

5 days prior to colonoscopy avoid …
Vitamin C, both dietary and supplements

3 days prior to colonoscopy avoid …
Red meat – broccoli – cauliflower – black grapes – raw fruit and vegetables

Triage / assessment of terminal illness
Social support
Perception of illness / disease
Change in problem solving
Change in lifestyle / financial
S/sx depression and anxiety

Psychosocial intervention for terminally ill patients
Decrease anxiety
Promote coping
End-of-life choices
Palliative care
Hospice care

COPD – chronic obstruction of airflow in and out
Pulmonary emphysema
Chronic bronchitis
Nursing interventions
Position, sit up, lean forward
Frequent rest
Pulmonary toilet

Nursing interventions
Reduce pain and anxiety
Improve oxygenation
Reduce congestion
Improve Myocardial contraction

MS Multiple Sclerosis Teaching Plan
Readmission / Exacerbation
Define readmission and exacerbation
Safety precautions
Medication including SEs and OTC interaction
Exercise to promote strength and mobility
Self manage bowel / bladder / catherization

MS Exacerbation reasons
Infection, trauma, immunization, childbirth, stress, climate changes

MS community resources
MS society, public health nurse, home health, support groups, vocational rehab service, Social workers, therapists, SNFs and financial counseling.

MS safety precautions
Consider : Decreased sensation, visual disturbances, motor deficits

MS medications
Corticosteroids, immunomodulators, cholinergics, anticholinergics, muscle relaxers

MS excercises
Prevent contractures and skin breakdown, transfer techniques, body mechanics and use of assistive devices

MS bowel and bladder
Risk for constipation, UTI and urinary retention

HIV Transmission
Sex, parenteral exposure to blood/blood products
Perinatal exposure and breast milk

Before 12 weeks of age
Any fever over 101 is emergency

Apply cold

Immunization site swelling and pain
Apply cold

Amoxicillin rash
Side effect only, not an allergy, no treatment

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

Fever without cause
No longer than 24 hours

Fever with associated symptom

Patient needs are UNHEALTHFUL responses
Unhealthy responses

Patient strengths are HEALTHFUL responses
Healthy responses

Child and adolescent screening
Newborn metabolic
devlopment & behavior
High BP
Genetic anemia
Blood lead level
Lipid disorders
Chlamydia, STD’s
Alcohol use
Tobacco use
Cervical Cancer
Sickle Cell and PKU

Sickle cell screening mandated in ____ states
all 50

Sickle cell affects 1 in ____ African American newborns

MDD – Major Depressive Disorder symptoms
sadness, irritable, loss of interest, social isolation, anger, sleep and appetite disturbances, non-specific pain

MDD present when sx cluster together and persist for ___ weeks or more

Patient Health Questionnaire for Adolescents

Beck Depression Inventory – Primary Care Version

Live, attenuated vaccine
Cultured under conditions which disable their virulent properties or use closely-related but less dangerous organisms

Inactivated vaccine
Contain toxoids, protein subunits, conjugate bacteria polysaccharide outer coats or killed organsms.

Immunization Early childhood
Hepatitis B by age 2

Immunization Early childhood Rotovirus (live) by age 2

Immunization Early childhood
Tdap by age 2
by age two – 4 doses
age four – 1 dose

Immunization Early childhood
Hib (Haemophilus influenza bype B) by age 2

Immunization Early childhood
Pneumonia by age 2

Immunization Early childhood
IPV (inactivated polio) by age 2
by age two – 3
age four – 1 dose

Early childhood immunization
MMR (live) by age 2
by age two – 1
age four – 1

Immunization Early childhood
Influenza (live or inactivated) by age 2
Yearly after 6 months

Immunization early childhood VZV (Varicella) live by age 2

Immunization Early childhood
Hepatitis A by age 2

Immunization Early childhood
given at age 4
Tdap – Tet., Diphtheria, Pertussis
IPV – Inactivated Polio
MMR – Measles, Mumps, Rubella
Varicella – Chicken Pox

Immunization Late childhood
given at age 7-10

Immunization Late childhood
given age 11-12 (females)
HPV – 3 doses (female)
Meningococcal – 1 dose
Pneumonia – 1 (if high risk)
Hepatitis A – 1 (if high risk)
HepB, IPV, MMR, VZV catch up

National Childhood Vaccine Injury Act of 1986
Report adverse events to Dept of Health & Human Services
If acquired through public purchase, report to local, county &/or states health departments

Adult Screenings
Depression Prostate Ca
Obesity Breast Ca
Osteoporosis Cervical Ca
Dementia Blood Pressure
Vision Lipids
Hearing Diabetes
Violence STD’s
Alcohol misuse

Weight in kg / Height …

BMI normal
18.5 – 24.9

BMI overweight
25.0 – 29.9

BMI obese
30.0 – 39.9

BMI extreme obese

Immunization Adult – 2010
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

Immunization Adult Catch up
MMR – during or after 1957 1 dose
Varicella – 2 doses if no immunity
Meningococcal – 1st year in dorm
– others at risk

Immunization Adult high risk
Pneumonia – max 2 in lifetime
Hep A – not vaccinated, 2 doses
Hep B – not vaccinated, 3 doses

Adult Screening – Alcohol Misuse
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

Adult Screening Alcohol
Risky/hazardous drinking
Women >7/week, >4 per party
Men >14/week, >4 per party

Adult Screening Alcohol
Harmful drinking
Physical, social or psych harm but not dependence

Adult Screening Alcohol Tools
National Institute on Alcohol Abuse and Alcoholism

Medical Emergencies
Staff roles
Skills (BLS, ACLS, PALS)
Competency assessment (drills)
Age-specific equipment and meds

Medical Emergency – CAB
1. Chest compression
2. Airway
3. Breathing
Check responsiveness
Check breathing
Call for help
Check for pulse 10 seconds only
Give 30 chest compressions
Open airway & give 2 breaths
Resume compressions

HIV Course of infection
Mono-like syndrome
Asymptomatic seropositivity
Symptomatic seropositivity

HIV Prognosis
Strong correlation w/CD4 cell count
Inversely related to HIV load

HIV Management
Prevent opportunistic infection
No live virus vaccines

Normal test values HgB
Men 13.5 – 16.5 g/dL
Women 12.0 – 15.0 g/dL

Normal test values Hct
Men 41 – 50%
Women 36-44%

Normal test values Sodium
135 – 145 mEq/L

Normal test values Calcium
8.5 – 10.5mEq/L

Normal test values Magnesium
1.7 – 2.3mEq/L

Normal test values Potassium
3.5 – 5.5 mEq/l

EKG lead placement

Head circumference

Vision – Snellen chart
Snellen at 20 feet, anything >20/40 needs eye doctor

Blood Pressure Measurement
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

Peak Flow Meter
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

Pulse Ox
Arterial oxygen sat
Leave on 75 seconds
Normal >95%
Critical <93%

Every 1-2 years age 50 – 74

Pap smears
Women with cervix – 3 years after becoming sexually active or age 21
Until 2-3 consecutive are normal, then every 3 years

Colorectal screening
Fecal Occult Blood test q 3 yrs
Flex sigmoid q 5 years w/ high sensitivity Fecal Occult Blood test.
Colonoscopy q 10 years

Telephone Triage
Interactive process between nurse and client involving id of the nature and urgency of the problem and determination of the appropriate disposition

Telephone Triage Guideline
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.

Telephone Triage Protocol
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

Telephone Triage Algorithm
Rules for solving problem in finite number of steps. Flow chart of questions guiding decisions in step-by-step logical sequence.

Telephone Triage Decision Making Tools
Follow rigidly by yes/no answers to reach final disposition
e.g. Protocols
Require clinic thinking

Telephone Triage
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

Telephone Triage Disposition
Emergent 911 or ED
Urgent ASAP 1-8 hrs
Acute 8-24 hrs or next day
Non-acute Phone advice

Telephone Triage Legal Issue
Formal Nurse-Patient Relationship
Maintain scope of practice
Safeguards – Protocols
Quality Assurance

Telephone Triage Legal Risk
3 R’s Right care, place, time
Formal training
Adequate resources and protocols
Written assessment
Quality Improvment program
Compliance to License Compact

Normal Lab values Chloride
85 – 115 mEq/l

Normal Lab values Bicarbonate
22 – 29 mEq/l

Normal Lab values WBC
4.5 – 11/cu mm

Normal Lab values RBC
Female 4.2 – 5.4 million / cu mm
Male 4.6 – 6.2 million / cu mm

License vs. Certification License – government Certification – private, advance education of RN Nursing licensure As nursing programs proliferated, the need to demonstrate a certain level of nursing skill and knowledge evolved. Primary purpose was (still is) the protection of …

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Collaborative interventions interdependent interventions, therapies that require the knowledge, skill, and expertise of multiple health care professionals consultation Process in which the help of a specialist is sought to identify ways to handle problems in patient management or in planning …

In promoting health maintenance for prevention of strokes, the nurse understands that the highest risk for the most common type of stroke is present in a. African Americans b. women who smoke c.individuals with hypertension and diabetes d. those who …

Leading cause of perinatal admissions to the ICU Hemorrhagic disorders Percentage of deaths related to pregnancy related hemorrhages 17-25% WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR YOU FOR ONLY $13.90/PAGE Write my sample Most maternal …

A patient with type 1 diabetes has told the nurse that his most recent urine test for ketones was positive. What is the nurse’s most plausible conclusion based on this assessment finding? The patient’s insulin levels are inadequate. Ketones in …

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