AMBULATORY CARE NURSING CERTIFICATION STUDY GUIDE SOLUTION, Exams of Nursing

Download AMBULATORY CARE NURSING CERTIFICATION STUDY GUIDE SOLUTION and more Exams Nursing in PDF only on Docsity! AMBULATORY CARE NURSING CERTIFICATION STUDY GUIDE SOLUTION Apraxia - impaired ability to carry out motor activities despite intact motor function; decline in motor activities Aphasia - Difficulty expressing thought and emotions, as well as difficulty in understanding verbal messages Order of Physical Assessment - Inspection, palpation, percussion, and auscultation Order of Abdominal Physical Assessment - inspection, auscultation, percussion, palpation Primary care - Integrates primary services with other levels of care, continuity is a key characteristic Secondary care - Hospital services Tertiary care - Highly specialized, technological hospital services START - Simple triage and rapid treatment Red - Immediate, within 1 hour. Breathing by unconscious, RR >30, cap refill >2 sec or no radial pulse (control bleeding), unable to follow simple commands Green - Moving, walking, wounded Black - Diseased, no respirations after head tilt Yellow - Delayed, >30 RR, 0 to 2 seconds cap refill, follows commands Primary prevention - Health promotion (nutrition and sex education), specific protection (use of seat belts, avoidance of allergens, and immunizations); targets well populations or those already ill; does not exist for scoliosis Mammogram - Every 2 years for women 50 to 74 Secondary prevention - Early detection, diagnosis, and treatment l; mammography, colonoscopy Tertiary prevention - Recovery, rehabilitation, and specific measures to minimize disability and increase functioning (breast reconstruction) Pap smear - Every 3 years in women 21 to 65, screening before 21 not recommended regardless of sexual history If abnormal pap smear - Annually until 2 or 3 consecutive normal results Fecal occult blood test - Annually flexible sigmoidoscopy - every 5 years with high sensitivity fecal occult blood test every 3 years Colonoscopy - Every 10 years, begin earlier than 50 of at greater risk Colorectal Screening - Age 50 to 75 Depression screening - 12 to 18 years Normal bmi - 18.5 to 24.9 Overweight bmi - 25 to 29.9 Obese - 30 to 39.9 Extreme obesity - >40 Tetanus diphtheria - One every 10 years; after age 19 it is recommended to exchange a Tdap in place of one Td to boost the pertussis; Hpv - 3 doses through 26 starting at 11 to 12 years old Zoster - 1 dose greater than or equal to 60 years MMR - 2 doses prior to school entry, 1 dose by 2 years, 1 dose at 4 years Varicella - If no immunity by 12 mos, 2 doses Meningococcal - 1 or more doses as recommended by provider, pre teens and teens, first year college students living in dorms are at risk Pneumococcal polysaccharide - 2 doses between 19 to 64, after age 65 is one dose Hepatitis a - Can be given at 12 mos to adult; 2 doses Hepatitis b - Can be given 1 month to adult years; 3 doses by age 2 (early childhood immunizations) Live vaccine for childhood - Herpes zoster, varicella, MMR Low HDL High BP High Fasting blood sugar HTN Goal - <130/85 FBS goal - <100 HDL goal - >50 women >60 men LDL - <100 Triglycerides - <150 waist circumference - <35 women <40 men Emphysema - Abnormal enlargement of air spaces Chronic bronchitis - Airways that carry air in and out of lung are partly blocked by increased secretions; SX: constant and/or productive cough, smokers cough, excess sputum, sob, wheezing Asthma - Inflamed and narrows airways RAD - Airways react, swell, and cause chest tightness, SOB, and difficulty breathing; triggers: exercise pollen, cold, foods, or odors/smells Spiro - Measures how much air is inhaled, exhaled, and how quickly it is exhaled Pursed lip breathing - Pucker/purse lips (think of whistling) which conserves energy, calming, and helps control SOB. Use when changing position of when breathing is labored Nephrotic syndrome - Increased protein excretion in urine caused by damaged glomeruli. This leads to inability to filter waste and remove excess fluid Nephrotic syndrome symptoms and complications - Edema in ankles, feet, and around eyes Format urine Weight gain due to fluid retention Fatigue Loss of appetite Complications: blood clots, HTN, acute/chronic kidney disease Alzheimer's - Progressive, degenerative disorder that attacks the brain's nerve cells, or neurons, resulting in loss of memory, thinking and language skills, and behavioral changes. Commonly affects > 65 Alzheimer's facts - 80% of communication is nonverbal 6/10 Alzheimer's patients wander Visual field becomes narrower over time - 12X12 MS - Immune mediated process with unknown antigen Immune sys creates abnormal response against the central nervous system - nerve signals interrupted b/w brain and other parts of the body. More prevalent further from earth's equator which possibly means it is vitamin d related (more sunlight exposure could be a possibility). Risk factor - smoking (stoping smoking can slow progression of MS) Spine curvature - No cure Onset is 10 to 15 years Testicular CA - Come in men age 15 to 34 Curable Cryotorchidism - risk factor Two types: seminoma vs nonseminoma (grown and spread more rapidly) Common in white males Treatment leads to infertility (consider prior sperm bank) Testicular CA sx - Lump or swelling In Testicle Dull ache in lower abd Sudden fluid buildup in a rotor Scrotal pain or discomfort Graves' disease (hyperthyroidism) - Immune system disorder Overproduction of thyroid hormones Anxiety, irritability, fine tremors in hands or fingers, heat sensitivity, weight loss despite normal eating habits, enlarged thyroid gland (goiter), bulging eyes (exopthalmos), fatigue, palpitations, thick red skin on shins or top of feet Radioactive iodine uptake - A radioactive iodine uptake (RAIU) test uses a radioactive tracer and a special probe to measure how much tracer the thyroid gland absorbs from the blood. The test can show how much tracer is absorbed by the thyroid gland. The RAIU test often is done along with a thyroid scan, which shows if the tracer is evenly spread in the gland. This helps your doctor know if the thyroid gland is working properly. The radioactive tracer commonly used in this test is iodine. 5 days prior to FOB - Avoid vitamin C 3 days prior to FOB do not consume: - Red meats, broccoli, cauliflower, black grapes, and raw fruits or veggies Peak flow meter - Perform standing up x 3 (explains lungs) Green: 80 to 100% good control of asthma Yellow: 50 to 80% caution, take quick relieve medicine and seek PCP care Red: <50% danger, take quick relief med and seek emergency medical care if not returned to yellow or green immediately. Critical SaO2 level - <93% Disinfection - A process that eliminates many or all microorganisms, with the exception of bacteria spores, from inanimate objects Accomplished through liquid chemical or wet pasteurization Sterilization - Complete destruction of all forms of microbial life Via physical or chemical methods Pressurized steam Dry heat EtO has Hydrogen peroxide gas plasma Liquid chemicals High level disinfection - kills all microorganisms except large numbers of bacterial spores Low level disinfection - Can kill most vegetative bacteria, some fungi, and some viruses Steam sterilizer - Autoclaves Dry heat sterilizer - Hydrogen peroxide gas plasma Ethylene oxide gas - Requires aeration Chemical sterilants - Time sensitive, glutaraldehyde, peracetic acid 3 R's - Right care, right place, and right time Ginko biloba - Bleeding St. John's Wort - Gastrointestinal disturbances, allergic rxn, fatigue, dizziness, confusion, dry mouth, and photosensitivity Ephedra (ma huang) - Htn, insomnia, arrhythmia, nervousness, tremor, headache, seizure, cerebrovascular event, myocardial infarction, and kidney stones Kava - Sedation, oral and lingual dyskinesia, torticollis, oculogyric crisis, exacerbation of parkinson's disease, painful twisting movements of the trunk, rash Schedule I drugs - No currently accepted medical use in the US, high potential for abuse Heroin, LSD, marijuana (some states), ecstasy Schedule II - High potential for abuse which may lead to severe psychological or physical dependence Hydromorphone (dilaudid), methadone (dolophine), meperidine (Demerol), oxycodone (OxyContin, Percocet), and fentanyl (sublimaze, duragesic), Vicodin, morphine, opium, and codeine. Methylphenidate (Ritalin), and amphetamine (adderal) Schedule III - Less potential for abuse than schedule II but may lead to moderate or low physical dependence or high psychological dependence Tylenol with codeine, ketamine, anabolic steroids (Depo-testerone) Schedule IV - Lower potential for abuse than schedule III Alprazolam (Xanax), carisoprodol (Soma), colnazepam (Klonopin), diazepam (Valium), lorazepam (Ativan), midazolam (Versed), temazepam (Restoril), and triazolam (halcion) Schedule V - Low potential for abuse relative to substances listed in schedule IV and consist primarily of preparations containing limited quantities of certain narcotics. Cough preparations containing no more than 200 mg of codeine per 100 mL (Robitussin AC, Phenergan with Codeine) 2 mos milestones - Holds head up, begins to push up on arms when laying on stomach, smiles, looks toward faces, brings hands to mouth, follows items with eyes/watches things as they move, turns head toward sound, vocalizes with coos or gurgles 4 mos milestones - Rolls over, reaches for toy, mimics sounds and begins to babble, pushes with feet when next to hard surface 6 mos milestones - Sits briefly without support, recognizes name, strings vowels together, brings items to mouth, makes sounds to show happiness such as laughing or squealing sounds 9 mos milestones - Pulls to stand, crawls, picks up small objects like Cheerios with thumb and forefinger, transfers toys from one hand to the other, looks where someone points, plays games like peek a boo, says dada/mama 12 mos milestones - May stand alone, puts blocks in cup, says three words, waves bye bye, follows simple commands, searches for hidden objects, points to things 18 mos milestones - Walks alone, may walk up steps and run, helps undress self, uses cup and spoon, plays pretend like feeding doll, knows at least six words, points to object of interest 2 years milestones - Throws ball overhand, jumps upC builds tower of four or more cubes, combined two words together, points to pictures when named, follows two step instructions 3 years milestones - Walks up and down steps one foot at a time, dresses self, can name a friend, follows directions with two to three steps, separates easily from parents, can work buttons, levers can and moving parts, wants to play with other children and pretend make-believe 4 years milestones - Hops, draws a person with two to four parts, names some numbers and colors, start counting, play board or card games, tells parts of favorite story, understands words same and different, used me and you correctly 5 years milestones - Hops, might be able to skip, tells simple story using sentences, draws a person with six body parts, counts to 10, writes some letter and numbers, understands future tense, uses plural and past tense appropriately, knows difference between reality and make believe, can give first and last name and possible address Ideal date to set for quitting smoking - At least 2 weeks out Whistle blower laws - Have provisions to protect employees from retaliation by their employer for reporting violations of laws/regulations or refusing to engage in any action which is unlawful Title seven of the civil rights act of 1964 - Prohibits employment discrimination based on race, color, religion, sex, or national origin Equal pay act of 1963 (EPA) - Protects men and women who perform substantially equal work in the same establishment from sex based wage discrimination New York heart Association functional classification's class III - Less than ordinary activity results and symptoms of fatigue and dyspnea chest pain or about the Tatian's therefore patient has a marked limitation of physical activity Takes a break before completing a walk up one flight of 12 steps, must take breaks or stop to rest or catch a breath and usual daily activities such as walking small distances, dressing, bathing, changing sheets, or washing clothes New York heart Association functional classifications class two - Comfortable at rest but has symptoms like fatigue dyspnea and chest pain or palpitations with the ordinary exercise which causes a slight limitation of physical activity. Can walk up one flight of steps before stopping to rest, Ken fox trot or a walk on level terrain but not carry out strenuous boards or walk uphill New York heart Association functional classifications class four - Has discomfort with any physical activity or has symptoms arrest. Fatigue dyspnea chest pain or palpitations with simple activity such as moving from bed to chair Stage A heart failure - At high risk for developing heart failure and does not have heart failure currently. Pre-heart failure. Conditions such as hypertension diabetes coronary disease and family history of cardiomyopathy increased risk of the developing heart failure as does smoking history. Primary prevention strategies are the focus of care like lifestyle modification and drugs. Stage B heart failure - Hey symptomatic left ventricular dysfunction, hypertrophy, or geometric chamber distortion; does not have heart failure currently and is still considered pre-heart failure Has structural heart disease like valve dysfunction previous myocardial infarction and left ventricular remodeling including left ventricular hypertrophy and low ejection fraction. Has not experienced symptoms associated with heart failure. Primary prevention strategies are the focus of care like lifestyle modification drugs and ICD when indicated (implantable cardioverter defibrillator) Stage D heart failure - End stage heart failure, Management strategies no longer relieve symptoms Myocyte, neurohormonal, and other changes escalate or are associated with disabling symptoms and poor quality of life. In addition to stage C strategies, palliative, end of life care, cardiac transplantation, ventricular assist or other mechanical circulatory support device, or Other advanced care or treatment strategies may be warranted Stage c heart failure - Developed clinical syndrome of heart failure and currently has signs and symptoms or has a history of symptoms Can span from New York heart Association functional classifications class one through four. Treatments like drugs and devices that revise or attention we left ventricular remodeling and neurohormonal activation predominate as well as secondary prevention strategies, lifestyle modification, and symptom management Angiotensin two receptor blockers - Rather than lowering levels of angiotensin II (as ace inhibitors do) angiotensin two receptor blocker's prevent this chemical from having any effects on the heart and blood vessels. This keeps blood pressure from rising. Anticoagulants - Decreases the clotting ability of the blood. Sometimes called blood thinners although they do not actually thin the blood. They do not dissolve existing blood clots. Used to treat certain blood vessel heart and lung conditions. Antiplatelet agents and dual antiplatelet therapy - Keeps blood clots from forming by preventing blood platelets from sticking together Ace inhibitors (angiotensin converting enzyme) - Expands blood vessels and decreases resistance by lowering levels of angiotensin II. Allows blood to flow more easily and makes the heart's work easier or more efficient Angiotensin receptor neprilysin inhibitors (ARNIs) - Neprilsyn is an enzyme that breaks down natural substances in the body that open narrowed arteries. By limiting the effect of Neprilysin, it increases the effects of the substances and improves artery opening and blood flow, reduces sodium (salt) retention, and decreases strain on the heart Beta blockers - Decreases the heart rate and cardiac output which lowers blood pressure and makes the heartbeat more slowly and with less force Calcium channel blockers - Interrupts the movement of calcium into the cells of the heart and blood vessels. May decrease the hearts pumping strength and relax blood vessels. Cholesterol Lowering medications - Various medications can lower blood cholesterol levels but drugs other than statins should only be used for patients in whom statins are not effective enough or who have serious side effects due to Statin therapy. Digitalis preparations - Increases the force of the hearts contractions which can be a beneficial in heart failure and for irregular heartbeats Diuretics - Causes the body to read it self of excess fluid and sodium through urination. Helps to relieve the hearts workload. Also decreases the buildup of fluid in the lungs and other parts of the body such as the ankles and legs. Different diuretics remove fluid at varied rates and through different methods,