Alzheimer's Case Study
1. Characteristics of the following: obsessive-compulsive disorder (OCD) – the client has intrusive thoughts of unrealistic obsessions and tries to control these thoughts with compulsive behaviors. · Clients who engage in constant ritualistic behaviors may have difficulty meeting self-care needs (i.e. personal hygiene, grooming, nutrition, fluid intake, elimination and sleep) · If rituals include constant handwashing or cleaning, skin damage and infection may occur. · Obsession - Recurrent thoughts that the client cannot control; often violent, fearful, or doubting on nature (fear of contamination). · Compulsion - Repeated performance of rituals or purposeless behaviors
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designated to prevent some event, divert unacceptable thought, and decrease anxiety. Client may not desire to perform behavior but is unable to stop, as this is the only relief from stress. General anxiety disorder – more than 6 months of uncontrollable, excessive worry. ü Causes significant impairment in one or more areas of functioning such as work-related duties. ü Symptoms: fatigue, restlessness, problems with concentration, irritability, increased muscle tension, sleep disturbances. 2. Effects of diazepam (Valium) – Increased tolerance which may lead to physical and physiological dependence or addiction. 3. Rationale why chlorpromazine (Thorazine) is given along with lithium carbonate – Lithium is used to stabilize mania (for bipolar disorder). It has a narrow therapeutic range, so serum therapeutic levels must be determined 8-12 hours after the first dose, then two or three times per week for the first month and then weekly to monthly. Because it may take 2-3 weeks for lithium carbonate to be effective, Thorazine and Haldol are given to decrease the initial level of hyperactivity. 4. Basic drive behind the pt’s ANOREXIA NERVOSA a. Basic drive: perfection, fear to get fat and sense of control. b. Others: peer pressure, depression
5. Classic behavior of BULIMIA – ü Binge eating ü Vomiting ü Tooth marks on knuckles to induce vomiting ü Dental carries due to gastric acid ü Heartburn ü Constipation ü Dehydration ü Electrolyte Imbalances
6. Defense mechanism: a. Repression – unconsciously blocking an unwanted thought or memory from open expression. (i.e. a student truly does not remember cheating on an important exam) b. Denial – a person ignores reality and absolutely refuses to be swayed by evidence. (i.e. an alcoholic states, “I do not have a problem with alcohol. I never drink before 5pm) c. Rationalization – a person unconsciously makes EXCUSES for behavior or feelings (i.e. a woman who just lost her job, because she frequently was LATE for work tells friends that it will be much better for her family if she stays home every day. d. Identification – modeling behavior after someone else.(i.e. a student starts dressing and talking like a popular schoolmate) 7. withdrawal signs 12 hours after alcohol intoxication: IRRITABILITY is the first sign 8. How is Korsakoff’s syndrome confirmed (what diagnostic exam?) – Korsakoff’s syndrome is a substance-induced persisting dementia, which is irreversible. If symptoms of confusion, ataxia and memory loss, WERNICKE’s encephalopathy is suspected. Grossly impaired MEMORY and GAIT disturbance. Confabulation or making up stories is seen as an attempt to communicate. BRAIN SCAN or MRI will show brain atrophy. 9. Cannabis (marijuana) effect – euphoria and expands senses. 10. Interventions for patient with HALLUCINOGENIC substance abuse - provide safety protect patients from injury.
11. pathophysiology of memory lapses seen in early stages of Alzheimer’s disease (AD) – ü Alzheimer’s disease: frontal lobe neuropathy — loss of neurons in the frontal lobe ü Brain of a patient with alzheimers – tangled nerve cells; abnormal buildup of protein. Hence nutrition\diet for person with alzheimers is low protein, high calorie diet. ü Alzheimer’s disease person putting his clothes – coach the patient.: preserve dignity and function. 12. appropriate intervention for ANOMIA(trouble remembering words) – wait for the patient to remember the right words to say. Words and its meaning: ü APHASIA – trouble verbally expressing himself/herself ü AGRAPHIA – unable to write down his thoughts. ü AGNOSIA – failure to recognize objects 13. differentiate vascular dementia from Alzheimer’s dementia ü VASCULAR dementia – dementia caused by clots on the blood vessels in the brain. Clots decrease blood circulation and may not distribute enough blood supply to brain tissues thus causing hypoxemia, ischemia and tissue necrosis (death). Death of tissues in the brain is …show more content…
non-repairable.
14. define AGNOSIA - failure to recognize objects 15. communicating with a patient with moderate Alzheimer’s dementia - how do you speak, how do you talk— · Identify yourself · Speak clearly and calmly and use short phrases and repeat as needed · Face the patient directly when you talk. · Use pictures to communicate · Be consistent in the approach and assign the same staff and maintain daily structure and routine. · Break down all tasks into simple steps and encourage completion of one step at a time. · Encourage reminiscing about the past.
16. AIDS dementia complex (ADC) - risk for injury – rationale – because of PERIPHERAL NEUROPATHY (disturbance in the function of peripheral nerves that results in numbness or muscle weakness) that’s why they are risk for injury. 17. Pathophysiology of depression – SEROTONIN deficiency. Signs and symptoms of major depressive disorder: indecisiveness
• Overwhelming feeling of sadness • Inability to feel pleasure or interest in daily activities • Sleep disturbances • Weight loss or gain • Loss of energy • Feeling of worthlessness • Difficulty in making decisions • Suicidal thoughts • PSYCHOMOTOR RETARDATION 18. Cluster B group of personality disorders } Antisocial personality- Characterized by disregard for others with exploitation, repeated unlawful actions, deceit, and failure to accept personal responsibility. } Borderline personality - Characterized by instability of affect, identity, and relationships; fear of abandonment, manipulative, and impulsiveness; often tries self-mutilation and may be suicidal. } Histrionic personality - Characterized by emotional attention-seeking behavior, in which the person needs to be the center of attention; often seductive and flirtatious. Narcissistic personality - Characterized by arrogance, grandiose views of self-importance, the need for consistent admiration, and a lack of empathy for others that strains most relationships; often sensitive to criticism 19. intervention related to probable perception of abandonment –
20. hormone that acts on bone to release calcium into the blood - CALCITONIN
21. Endocrine system – anatomy and physiology, focus on which organs release what hormones a. Pituitary gland- connects to hypothalamus; consists of 2 parts: anterior and posterior pituitary. It is often referred to as the “master gland” of the body.
Anterior lobe – growth hormone(GH)-most tissues of the body,thyroid-stimulating hormone(TSH)-thyroid gland, adrenocorticotropic hormone(ACTH)-adrenal cortex, follicle-stimulating hormone(FSH)-ovarian follicles in female and seminiferous tubules in male, luteinizing hormone(LH),prolactin-mammary gland.
Posterior lobe – antidiuretic hormone(ADH)-kidneys, Oxytocin-uterus and breast.
b.Thyroid gland- 2 lobes lies below the larynx; secretes the hormone thyroxine(T4), triiodothyronine(T3), and thyrocalcitonin.
c.Parathyroid glands -4 to 6 small glands located on the posterior surface of thyroid glands; secretes parathormone or parathyroid hormone(PTH).
d.Adrenal glands-located on the anterior upper surface of each kidneys(cortex and medulla).
Adrenal medulla secretes 2 hormones:epinephrine(prepares the body to meet stress or emergency situations and prevents hypoglycemia) and norepinephrine (as a pressor–causing BV constriction to maintain BP)- stimulated from Sympathetic NS.
Adrenal cortex secretes hormone adrenal corticosteroids(mineralocorticoids and glucocorticoids).
Mineralocorticoids (aldosterone) affect the electrolytes(potassium,sodium,chloride)w/c promotes conservation of water to retain sodium.
Glucocorticoids(cortisol or hydrocortisone)acts to increase glucose levels in the blood and counteract the inflammatory response. Essential for proper utilization of carbohydrates,proteins, and fats.
Both aldosterone and cortisol are controlled by ACTH-releasing hormone from hypothalamus secreted by anterior pituitary.
e.Pancreas – Beta cells secrete hormone insulin found in islets of Langerhans.
And Glucagon.
f.Ovaries –estrogen (peaks during ovulation) and progesterone(for implantation of fertilized ovum).FSH(follicle-stimulating hormone) and LH(luteinizing hormone)stimulate the maturing of immature ova for fertilization. Oxytocin – for lactation and uterine contraction.
g.Testes or gonads secretes testosterone, Interstitial cell-stimulating hormone(ICSH) h.Pineal gland –is in the midbrain.secretes Melatonin.
i.Thymus gland – secretes thymosin.
22. corticoid that counteracts the inflammatory response - CORTISOL 23. The only gland that is both an endocrine gland and an exocrine gland - PANCREAS
24. endocrine glands vs exocrine glands } Exocrine glands – secrete through a series of ducts (sebaceous gland of the skin). Their secretions are protective and functional. } Endocrine glands – are ductless. They release their secretions directly into the blood stream. Their secretions have a regulatory function. 25. function of luteinizing hormone (LH) – for ovulation 26. fructosamine assay vs glycosylated hemoglobin
(HbA1c) fructosamine assay-another test to monitor control of glucose overtime or over a shorter time frame because it measures sugar attached to protein albumin- shorter life than hemoglobin. glycosylated hemoglobin (HbA1c) – measures bld. Glucose over a period of many weeks. Glucose in the bloodstream attaches itself to hemoglobin A molecule and remains there for the life span of the RBC.
27. pituitary adenoma – pathophysiology Is a benign tumor that secretes GH, leading to continued growth of bones and soft tissues. It also antagonizes the effect of hormone insulin, resulting in an increase in blood glucose and glucose intolerance.
28. hypophysectomy – what to monitor after surgery; surgical complications = diabetes insipidus -removal of pituitary gland done microsurgically and the usual approach is transsphenoidal via the nose. Post-op instructions: -Pt kept in semi-fowler’s position. -monitor VS and neurological status -note and communicate promptly any change in vision, mental status, or strength. Surgical Complications: -diabetes insipidus -Pt should not brush teeth,cough,sneeze, nose blowing, bend forward, because it will interfere w/ the healing process. -hourly deep breathing exercise to prevent pulmonary problems. 29. cause of central diabetes insipidus - because of TRAUMA or SURGERY. 30. imbalance caused by severe dehydration associated with diabetes insipidus - characterized by the production of copious amounts(>2.5L/day) of dilute urine.It occurs as a result of decreased production of ADH hormone. 31. simple goiter – pathophysiology - When the blood level of T3 is too low to signal the pituitary to decrease TSH secretion, the thyroid gland then responds by increasing the formation of thyroglobulin (colloid), which accumulates in the thyroid follicles and causes enlargement of the gland.
32. administering potassium iodide for the treatment of goiter – nursing considerations:
-Iodine preparations should be given well diluted and administered thru a straw as they can stain the teeth.
-Adverse effects : GI upset, metallic taste, skin rashes, allergic reactions, epigastric pain. 33. risk factor that doubles the probability of developing Graves’ disease(toxic goiter): -
-Medications containing iodine(amiodarone, antidysrhythmic )
-Smoking.
34. methimazole (Tapazole) – nsg considerations :
-Pt must take antithyroid drug at the prescribed time and strictly according to schedule.
-May be given for a period of 10-14 days b4 surgery of the thyroid to reduce the vascularity of the gland,minimizing the danger of releasing large amt. of thyroid hormone into the bloodstream during surgery and to decrease the risk of hemorrhage.
35. subtotal thyroidectomy – indication :
-Pt who do not respond well to antithyroid drug therapy, unable to take radioactive iodine, or have greatly enlarged thyroid glands.
36. type 1 diabetic (IDDM)– pathophysiology: -occurs when the body’s immune system destroys beta cells in the pancreas responsible for making insulin.
37. Why do people who have constant stress in their day-to-day lives at risk for type 2 diabetes :
-Emotional or physical stress can unmask an inherited predisposition to the disease, probably as a result of glucogenesis induced by increased production of hormones from the adrenal cortex especially glucocorticoids. 38. type 2 diabetes – client teachings
-importance of diet and exercise.
-diet is geared toward providing adequate nutrition w/ sufficient calories to maintain normal body weight.
-Muscular activity improves glucose utilization for energy and improves circulation. 39. what stimulates thirst experienced by diabetics? Hyperglycemia increases concentration of intravascular fluid, raising osmotic pressure and pulling water from the cells and interstitial fluid into the blood.This causes cellular dehydration and a resultant increased intake of water(polydipsia) and dieresis w/ increased urination(polyuria).
40. lab values from a patient in ketoacidosis
- BUN, ARTERIAL PH, GLUCOSE
41. Manifestation of ketoacidosis: - Increased thirst (polydipsia) - Increased urination (polyuria) - Acetone breath odor (fruity odor) - Dry mucus membrane and sunken eyeballs (dehydration) - Nausea and vomiting - Deep respirations (kussmaul’s respiration) - Abdominal pain and rigidity - Paresthesias, weakness, paralysis - Hypotension - Minimal urine output (oliguria) or none (anuria) late sign - Stupor or coma (late sign)
42. What is Mittelscherz?
-sharp pain in the right or lower quadrant, sometimes felt at the midcycle around the time of ovulation, and may last a few hours. Some women are sensitive to this phenomenon and others never experience it.
43. Purpose of normal acidic pH of the vaginal vault.
-the main line of defense against infection is lactic acid, which causes an acidic pH. Any change in this pH can result in infection.
44. Premenstrual syndrome (PMS) with its behavioral symptoms occurs when?
-(ovarian cycle syndrome) – occur between ovulation and menstruation, and regularly recur within the luteal phase of the menstrual cycle and significantly disappear during the remainder of the cycle.
45. Premenstrual dysphoric disorder (PMDD)- client teaching
-stress management
-lifestyle changes
-maintaining a healthy diet: limit consumption of refined sugar, salt, red meat, alcohol, and caffeinated beverages. Supplements of calcium, magnesium and VitB6.
-exercise to increase beta endorphin levels.
46. Primary dysmenorrhea may cause the young female to develop what?
-cause uterine contractions and vasoconstriction that results in abdominal cramps. Backache, weakness, decrease in appetite, and central nervous system symptoms such as dizziness, headache and poor concentration may also occur.
47. sildenafil (Viagra) – client teachings
-side effects: headache, dyspepsia
-contraindicated in patients taking nitrates and retinopathy
48. Interviewing techniques for a patient who has erectile dysfunction
-start with open ended questions: “tell me about..” or “when did you first notice..”
-relate his problem to the inconvenience it has caused in his daily life : “tenderness and discomfort in the scrotal area could make sitting at the desk or walking very difficult and interfere with assigned work”
-phrase questions differently or ask clarification if pt. does not understand the parts of the body the nurse is talking about.
49. Clinical definition of sterility
-Primary infertility – inability of the couple to conceive a child after at least 1 year of active, unprotected sexual relations w/o using contraceptives.
-Secondary infertility – inability to conceive after having once conceive, or to maintain a pregnancy long enough to deliver a viable infant.
50. male and female reproductive system – anatomy and physiology, esp. hormones
Ovaries – located near the end of each fallopian tube. Almond shaped glands excrete estrogen and progesterone into the bloodstream. At birth, the ovaries contain all the eggs the woman will ever produce.
Labia majora – two elongated, raised folds of pigmented skin that encloses the vulvular cleft. The pubic hair extends along these folds.
Labia minora – soft folds of skin within the labia majora. Soft and shiny and made up of fat tissue and glands, and have no hair follicles.
Clitoris- located on top of vulvular cleft, above the urethral opening. Made primarily of erectile tissue and is highly sensitive to touch.
Urethral meatus – external opening of the urinary bladder, is located below the clitoris w/in the folds of the labia minora.
Perineum – is the flat muscular surface lying between the vagina and the anus.
Vagina – muscular tube lined w/ membranous tissue with transverse ridges called rugae. Connects the external and internal female sexual organ.
Uterus – (womb) hallow pear shaped organ with a thick muscular wall. Lies at the upper end of the vagina. Lower opening of the uterus is the cervix, w/c dilates during labor to allow fore delivery of infant.
Fallopian tubes – branch outward from the right and left side at the top of the uterus. They form the pathway for the ovum (egg) from the ovary to the uterus.
Testes – the male gonads are oval shaped and are encased in the scrotum along with the epididymis, seminal vesicles and vas deferens. The seminiferous tubules within the testes produce the sperm. Testosterone also is produced in the testes.
Penis –cylindrical, erectile organ that hangs in front of the scrotum.
Prostate gland – shaped like a walnut, encircles the urethra, and is located belowand to the rear of the bladder. Produces thin, milky and alkaline secretions that contribute to the seminal fluid and enhance the motility of the sperm.
Scrotum – thin walled muscular sac, holds the testes, epididymis and vas deferens. Hangs from the pubic bone, suspends the testes outside the body where they remain several degrees cooler than the body.
Vas deferens – muscular tube that connects to the epididymis. Stores the sperm and then carries it to the ejaculatory duct.
Seminal vesicles – produc fluid that is thick and contains fructose to nourish the sperm and provide energy. The fluid also contains prostaglandins, which contribute to the motility of the sperm.
Bulboutheral (Cowper’s) glands are small pea sized glands located in the urethral sphincter posterior to the urethra. Secrete an alkaline mucus like fluid in response to sexual stimulation.
51. Why are women at a greater risk for contracting sexually transmitted infections (STIs)?
-young sexually active women have a large proportion of columnar epithelium lining the cervix and a vaginal pH that can be altered by frequent douching and bacterial vaginosis.
-male secretions and semen are in contact w/ female mucous membranes for a longer period of time.
-mucus plug in the cervix of women (protects upper genital tract) becomes more permeable around the menstrual period, w/c results in increased risk for infection including PID.
52. Syphilis - characteristics
-Primary : Chancre (hard painless sore) on the mucous membrane of the mouth or genitals, often unnoticed in women. Chancre teeming with spirochetes. May have bacteremia.
-Secondary : generalized skin rash.
-Tertiary : “Gumma” lesions (soft encapsulated tumor) appear on any organ.
53. PID – s/sx
-acute PID – severe abdominal and pelvic pain and fever, accompanied by purulent foul smelling vaginal discharge, and the women appears acutely ill.
-chronic PID – backache, feeling of pelvic heaviness, and disturbance in menstruation.
54. What is staining – how is it used to identify a gram positive gonococcus?
-staining differentiate organisms by using dyes that have been found to stain bacteria in a different way.
-Gram stain – bacteria is first stained w/ crystal violet, then treated w/ a strong iodine soln., decolorized w/ ethanol or ethanol acetone and then counterstained with a contrasting dye. Those maintaining the initial stain are considered gram positive.
55. Urethral swab from a male pt. suspected of having gonorrhea – nursing consideration
-urethral swabs should not be done within 1 hour of the last void as organisms will have been flushed away.
56. newly diagnosed with genital herpes – client teaching
-use of condoms w/ spermicide to help prevent spread
-avoidance of sex if lesions are present
-scrupulous hand hygiene
-if diagnosed w/ genital herpes and becomes pregnant : c section during birth if disease is active to prevent exposure.
57. gonorrhea – incubation period; s/sx male and female
-Incubation: 2-6 days after exposure. May be asymptomatic
-Male : dysuria with frequency; scant to copious purulent discharge from penis, unilateral testicular pain.
If untreated, discharge increase and may continue for months; may develop urethral stricture, epididymitis.
May advance to inflammation of prostate and testes.
-Female : Vaginal discharge, burning on urination. Untreated, results in PID. May involve rectum, eyes and oropharynx.
58. Teaching for pregnant patient who is human immunodeficiency virus (HIV)
-HIV may be transmitted from mother to newborn or to fetus via placenta.
-Avoid breast feeding.
-cesarean section for birth.
59. Treatment for a person with anxiety disorders:
*supportive therapy ➢ individual therapy ➢ Education about relaxation techniques ➢ Stress management
*anxiolytic (antianxiety) medication - Benzodiazepines ➢ Alprazolam (Xanax), Diazepam (Valium), Lorazepam (Ativan)
- use them with caution because tolerance and physical and [sychological dependency can occur.
-Nonbenzodiazepine ➢ Buspirone (BuSpar) - takes longer to reach therapeutic efficacy (3-4 weeks) - advantage of BuSpar is the decreased rosk of dependency and less sedation.
-SSRIs
➢ Citalopram (Celexa) and Sertraline (Zoloft)
-first line drugs for anxiety because they have fewer adverse effects
60. The signs and symptoms that characterize a major depressive: -over whelming feelings of sadness -inability to feel pleasure or interest in daily activities -weight gain or loss not attributed to dieting -Sleep disturbances -fatigue or loss of energy -feelings of worthlessness -Difficulty in making decisions or concentrating -suicidal thoughts -psychomotor retardation ➢ Speech, movements and thought process are slowed
61. Diagnostic criteria for the diagnosis of substance abuse:
- Repeated substance abuse that causes a failure to meet usual obligations
(e.g., frequently absent from school, unable to care for children, poor work performance) - Repeated substance abuse creating potential danger of physical harm
(e.g., driving under the influence of substances) - Repeated legal problems related to substance abuse
(e.g., arrest for possession) - Continued substance abuse despite disruption to interpersonal relationships
(e.g., physically fighting with co-workers)
62. Criteria for the diagnosis of alcohol dependency: - Presence of withdrawal - Significant impairment in family relationship and occupational productivity - Blackouts –temporary loss of recent memory that occurs while drinking - Drinking in spite of serious consequences to health or occupation - Evidence of tolerance
63. Schizophrenia – psychotic features: - Disordered thinking - Delusions - Hallucinations - Depersonalization (feeling of being strange, not one self) - Impaired reality testing (psychosis) - Impaired interpersonal relationship
64. Characteristics of personality disorders: - Poor impulse control - Inappropriate emotion response - Adapting to life’s event – maladapt 1. Inflexible and maladaptive response to life events 2. Serious difficulty in areas of personal work and relationships 3. Tendency to evoke interpersonal conflict 4. Tendency to evoke a negative emphatic response from others.
65. Rise in the number of sexually transmitted infections (STI) can be attribute - The incidence of STI continues to rise throughout the world - Sexually active people considered potentially at risk - People with multiple sexual partners are at very high risk for contracting an STI - The largest population group affected by STI is adolescents and young adults (Workowski & Berman 2006)
*Goals of Healthy People 2010 – to increase efforts to “promote responsible sexual behaviors, strength community capacity and increase access to quality services to prevent STI and their complications” and to “prevent HIV infection and its related illness and death.
66. Sexually transmitted infections (STIs) that must be reported: - Syphilis - Gonorrhea - Chlamydia - Chancroid - Lymphogranuloma venereum - Hepatitis B - PID - HIV infection - AIDs
67. Teaching for patient diagnosed with Chlamydia who is on doxycycline: - Must complete antibiotics to ensure effective treatment and prevent development of PID
68. If untreated gonorrhea can result in: MALE - Discharge increase and may continue for months - may develop urethral stricture epididymitis - can advance to inflammation or prospate and testes - can cause sterility
FEMALE - PID - May involve rectum, eyes, oropharynx
69. Assessment for complication – drowning - Usually aspirate water - Pulmonary edema - Bacterial or fungal pneumonia - Cardiac irregularities
70. Question by the nurse that would provide information about possible sexual abuse: 1. Have you been hit or hurt in any way in the past year? 2. Has it occurred before? 3. Are you afraid of anyone 4. Do you feel safe at home? 5. Does your partner use drugs or alcohol?
71. Intervention for a patient who has been in a motorcycle accident experiencing pain in his neck
- Neck and spine immobilization
- Keep the neck as straight as possible, preventing it from flexing or hyper extending - Cervical collar (when a cervical collar is not available and the victim must be move safety, the neck maybe immobilize with any material handy, such as a coat, shirt, or towel, rolled in the safe of a collar)
72. Differentiate the types of treatment that are appropriate for each type of shock. 1. Cardiogenic shock - infusion of volume, intra-aortic ballon pump through baseline assessment. 2. Hypovolemic shock - stop the source of volume loss, IV fluids, packed red cells fresh frozen plasma 3. Anaphylactic shock – airway management, administration of epinephrine 4. Neurogenic shock – blocking of sympathetic outflow from the vasomotor center of the brainstem, vasoconstriction medication 5. Insulin shock – hypoglycemia shock = IV push
73.difference between an emergency situation and disaster. • Emergency is an extraordinary event such as multivictim incident involving an explosion or a train crash • Disaster exists when the number of casualties exceeds the resource capabilities of the area.
74. intervention for impact stage of disaster • Survivor stunned, apathetic , disorganized • Need strong support and firm guidance • Difficulty following direction several hours after event
75. Provision of non- contaminated water in a disaster- possible sources? Disruption or contamination of the water supply is probable when a disaster occurs.
Flood water or storm water should not be used to wash dishes, brush teeth, was and prepare food, wash hands, make ice, or make baby formula. People have to be taught how to purify water.
Preparing Safe Water • Bringing it to a roiling boil for 3-5 mins let water cool before drinking. • Adding household liquid bleach 5.25% sodium hydrochlorite. 16 gtts of bleach to a gallon and let stand for 30 mins. • Distilling the water.
76. indication that chlorine gas is an imminent threat • Fog like or low-lying cloud suddenly appearing in the atmosphere • Many dead birds, domestic animals or insects within a particular area • Many dead dying or sick people in an area or downwind from a suspicious cloud or fog • An typical , unexplained odor for the location
77. tornado- what to do? • Choose ahead of time where you could go if evacuation is necessary. • Evacuate when you are told to do so. • Listen to a NOAA weather radio or local radio or television stations for evacuation instruction • Keep a road map because you may have to take unfamiliar routes
78. category B terrorism agents- how are they delivered? • Delivered through water and food sources
79. period of time during which there is the greatest chance that aerosolized anthrax could be inhaled. • During the first day after the event, before the particles hit the ground.
80. people who have plague and have been treated with appropriate antibiotics can be released from respiratory droplet precautions after - 48 hrs and treatment has been initiated.
81. plague caused by Yersinia pestis – organism can be destroyed by: • Antibiotics only effective it administered immediately • Drug of choice: streptomycin or gentamicin • Vaccine under development • Hospitalization • Isolation for containment
82. lesions- smallpox-characteristics- • The rash contains firm, deep seated vesicles or pustules. It start in the buccal and pharyngeal mucosa spreads to the face , hands and forearms and then spread to the rest of the body.
83. purpose of debriefing after a disaster plan for the health professionals • to help with the promotion of effective coping strategies
84. essential elements in a disaster plan – rationale • coordinate their services with each other and with other agencies in planning for essential such as shelter, transportation, communication, and welfare.
85. contents of disaster kits- • water • flashlights • boots • can opener • first aid kit • cash
86. how can water can be rendered safe for drinking in the event of disruption of service.- boiled water 87. What organisms may be released in a bioterrorism attack because of their high lethality - Anthrax (inhalation) – through direct contact with bacteria - Botulism – through air or food - Plague – direct person to person - Small pox (airborne/droplets)– person to person - Tularemia – (vector-borne) aerosol or intra-dermal - Hemorrhagic fever (E.g. Ebola virus) – person to person
88. Triage categories and examples of types of injuries of the disaster victims
1. RED TAG : EMERGENT - immediate threat to life – e.g. airway / hemorrhagic shock (tx: IMMEDIATE) 2. YELLOW TAG : URGENT -major injuries – open fractures, large wounds (tx: within 30 mins – 2 hours) 3. GREEN TAG : NONURGENT - walking wounded – closed fractures, sprains, strains, contusions, abrasions (tx: more than 2 hours) 4. BLACK TAG: TERMINAL - dead, imminently dying (tx: NONE)
89. Intervention for near-drowning victim who is semiconscious and breathing - She should be on her side in recovery position and covered with a blanket. - Head should be turned on the side to prevent aspiration when pt vomits
90. Memory prompt for emergency care (ABCDE – stands for?) Rapid assessment – should not take no longer than 60 seconds to perform. A- airway/ Cervical Spine B- breathing C- circulation D- disability E- exposure
91.Good Samaritan law
- Protects medical personnel from liability from rendering emergency medical care for victims of accidental injuries. Guards against liability for care given as long as medically trained individuals act in good faith and to the best of their ability.
92. Emergency care for abdominal wound with evisceration
- Cover with the piece with a non-adhering material such as plastic wrap or aluminum foil. This will keep the protruding contents moist and free of contamination. Clean folded towel or sheet is placed over it to retain body heat.
93. Intervention for a deep laceration pumping bright red arterial blood - Apply pressure to the wound or compress the artery above the wound.
94. Intervention for heat stroke and heat exhaustion S/S: Hyptension, tachypnea, tachycardia, anxiety, confusion, bizarre behavior, seizures and coma. - Patient should be placed in the shade and cooled immediately by being sprinkled with water and fanned.
95. Best explanation why the heart is being monitored on a hypothermic patient. - When the core (central) temperature drops even 2 or 3 degrees F, can lead to fatal cardiac disrhythmias and respiratory failure.
96. Assessment and intervention for frost bite – All degrees - 1st degree – reddened skin, swelling, waxy appearance, hard-white plaques, and sensory deficits - 2nd degree – redness and swelling, formation of blisters filled with or milky fluid. Within 24hours - 3rd degree – blisters or blood-filled and black eschar forms over several weeks - 4th degree – full-thickness damage affecting muscles, tendons and bone resulting in tissue loss.
98. Carbon monoxide poisoning
S/S: Excessive coughing, SOB, wheezing, and burning sensation of the nose and throat. Pale or bluish color to skin , dizziness, headache, nausea and vomiting and chest pain.
+ If carbon monoxide has been inhaled, mucous membranes will be CHERRY RED.
99. Choking interventions - Encourage to cough and breath as deeply as she can.
-When person can’t speak or cough & unable to remove foreign object in her throat on her own, help is needed and HEIMLICH MANEUVER is used - if person is conscious and able to cough or speak, she may not need assistance in expelling foreign object.
100. Stages of Shock Initial – no visible changes in client’s parameters, changes on the cellular level only
Compensatory – measures to increase cardiac output to restore tissue perfusion and oxygenation Progressive – compensatory mechanisms begin to fall Refractory – irreversible shock, total body failure.
101. Interventions : sucking chest wound - Wound should be covered at the end of a forceful expiration with an occlusive dressing – that is one made of plastic wrap, aluminum foil, Vaseline-covered gauze, or any other material that seals the wound and prohibits the flow of air into the pleural cavity, - O ne corner of the dressing is left unsealed to allow accumulated air to escape. - Place patient in semi-Fowler’s position if possible
designated to prevent some event, divert unacceptable thought, and decrease anxiety. Client may not desire to perform behavior but is unable to stop, as this is the only relief from stress. General anxiety disorder – more than 6 months of uncontrollable, excessive worry. ü Causes significant impairment in one or more areas of functioning such as work-related duties. ü Symptoms: fatigue, restlessness, problems with concentration, irritability, increased muscle tension, sleep disturbances. 2. Effects of diazepam (Valium) – Increased tolerance which may lead to physical and physiological dependence or addiction. 3. Rationale why chlorpromazine (Thorazine) is given along with lithium carbonate – Lithium is used to stabilize mania (for bipolar disorder). It has a narrow therapeutic range, so serum therapeutic levels must be determined 8-12 hours after the first dose, then two or three times per week for the first month and then weekly to monthly. Because it may take 2-3 weeks for lithium carbonate to be effective, Thorazine and Haldol are given to decrease the initial level of hyperactivity. 4. Basic drive behind the pt’s ANOREXIA NERVOSA a. Basic drive: perfection, fear to get fat and sense of control. b. Others: peer pressure, depression
5. Classic behavior of BULIMIA – ü Binge eating ü Vomiting ü Tooth marks on knuckles to induce vomiting ü Dental carries due to gastric acid ü Heartburn ü Constipation ü Dehydration ü Electrolyte Imbalances
6. Defense mechanism: a. Repression – unconsciously blocking an unwanted thought or memory from open expression. (i.e. a student truly does not remember cheating on an important exam) b. Denial – a person ignores reality and absolutely refuses to be swayed by evidence. (i.e. an alcoholic states, “I do not have a problem with alcohol. I never drink before 5pm) c. Rationalization – a person unconsciously makes EXCUSES for behavior or feelings (i.e. a woman who just lost her job, because she frequently was LATE for work tells friends that it will be much better for her family if she stays home every day. d. Identification – modeling behavior after someone else.(i.e. a student starts dressing and talking like a popular schoolmate) 7. withdrawal signs 12 hours after alcohol intoxication: IRRITABILITY is the first sign 8. How is Korsakoff’s syndrome confirmed (what diagnostic exam?) – Korsakoff’s syndrome is a substance-induced persisting dementia, which is irreversible. If symptoms of confusion, ataxia and memory loss, WERNICKE’s encephalopathy is suspected. Grossly impaired MEMORY and GAIT disturbance. Confabulation or making up stories is seen as an attempt to communicate. BRAIN SCAN or MRI will show brain atrophy. 9. Cannabis (marijuana) effect – euphoria and expands senses. 10. Interventions for patient with HALLUCINOGENIC substance abuse - provide safety protect patients from injury.
11. pathophysiology of memory lapses seen in early stages of Alzheimer’s disease (AD) – ü Alzheimer’s disease: frontal lobe neuropathy — loss of neurons in the frontal lobe ü Brain of a patient with alzheimers – tangled nerve cells; abnormal buildup of protein. Hence nutrition\diet for person with alzheimers is low protein, high calorie diet. ü Alzheimer’s disease person putting his clothes – coach the patient.: preserve dignity and function. 12. appropriate intervention for ANOMIA(trouble remembering words) – wait for the patient to remember the right words to say. Words and its meaning: ü APHASIA – trouble verbally expressing himself/herself ü AGRAPHIA – unable to write down his thoughts. ü AGNOSIA – failure to recognize objects 13. differentiate vascular dementia from Alzheimer’s dementia ü VASCULAR dementia – dementia caused by clots on the blood vessels in the brain. Clots decrease blood circulation and may not distribute enough blood supply to brain tissues thus causing hypoxemia, ischemia and tissue necrosis (death). Death of tissues in the brain is …show more content…
non-repairable.
14. define AGNOSIA - failure to recognize objects 15. communicating with a patient with moderate Alzheimer’s dementia - how do you speak, how do you talk— · Identify yourself · Speak clearly and calmly and use short phrases and repeat as needed · Face the patient directly when you talk. · Use pictures to communicate · Be consistent in the approach and assign the same staff and maintain daily structure and routine. · Break down all tasks into simple steps and encourage completion of one step at a time. · Encourage reminiscing about the past.
16. AIDS dementia complex (ADC) - risk for injury – rationale – because of PERIPHERAL NEUROPATHY (disturbance in the function of peripheral nerves that results in numbness or muscle weakness) that’s why they are risk for injury. 17. Pathophysiology of depression – SEROTONIN deficiency. Signs and symptoms of major depressive disorder: indecisiveness
• Overwhelming feeling of sadness • Inability to feel pleasure or interest in daily activities • Sleep disturbances • Weight loss or gain • Loss of energy • Feeling of worthlessness • Difficulty in making decisions • Suicidal thoughts • PSYCHOMOTOR RETARDATION 18. Cluster B group of personality disorders } Antisocial personality- Characterized by disregard for others with exploitation, repeated unlawful actions, deceit, and failure to accept personal responsibility. } Borderline personality - Characterized by instability of affect, identity, and relationships; fear of abandonment, manipulative, and impulsiveness; often tries self-mutilation and may be suicidal. } Histrionic personality - Characterized by emotional attention-seeking behavior, in which the person needs to be the center of attention; often seductive and flirtatious. Narcissistic personality - Characterized by arrogance, grandiose views of self-importance, the need for consistent admiration, and a lack of empathy for others that strains most relationships; often sensitive to criticism 19. intervention related to probable perception of abandonment –
20. hormone that acts on bone to release calcium into the blood - CALCITONIN
21. Endocrine system – anatomy and physiology, focus on which organs release what hormones a. Pituitary gland- connects to hypothalamus; consists of 2 parts: anterior and posterior pituitary. It is often referred to as the “master gland” of the body.
Anterior lobe – growth hormone(GH)-most tissues of the body,thyroid-stimulating hormone(TSH)-thyroid gland, adrenocorticotropic hormone(ACTH)-adrenal cortex, follicle-stimulating hormone(FSH)-ovarian follicles in female and seminiferous tubules in male, luteinizing hormone(LH),prolactin-mammary gland.
Posterior lobe – antidiuretic hormone(ADH)-kidneys, Oxytocin-uterus and breast.
b.Thyroid gland- 2 lobes lies below the larynx; secretes the hormone thyroxine(T4), triiodothyronine(T3), and thyrocalcitonin.
c.Parathyroid glands -4 to 6 small glands located on the posterior surface of thyroid glands; secretes parathormone or parathyroid hormone(PTH).
d.Adrenal glands-located on the anterior upper surface of each kidneys(cortex and medulla).
Adrenal medulla secretes 2 hormones:epinephrine(prepares the body to meet stress or emergency situations and prevents hypoglycemia) and norepinephrine (as a pressor–causing BV constriction to maintain BP)- stimulated from Sympathetic NS.
Adrenal cortex secretes hormone adrenal corticosteroids(mineralocorticoids and glucocorticoids).
Mineralocorticoids (aldosterone) affect the electrolytes(potassium,sodium,chloride)w/c promotes conservation of water to retain sodium.
Glucocorticoids(cortisol or hydrocortisone)acts to increase glucose levels in the blood and counteract the inflammatory response. Essential for proper utilization of carbohydrates,proteins, and fats.
Both aldosterone and cortisol are controlled by ACTH-releasing hormone from hypothalamus secreted by anterior pituitary.
e.Pancreas – Beta cells secrete hormone insulin found in islets of Langerhans.
And Glucagon.
f.Ovaries –estrogen (peaks during ovulation) and progesterone(for implantation of fertilized ovum).FSH(follicle-stimulating hormone) and LH(luteinizing hormone)stimulate the maturing of immature ova for fertilization. Oxytocin – for lactation and uterine contraction.
g.Testes or gonads secretes testosterone, Interstitial cell-stimulating hormone(ICSH) h.Pineal gland –is in the midbrain.secretes Melatonin.
i.Thymus gland – secretes thymosin.
22. corticoid that counteracts the inflammatory response - CORTISOL 23. The only gland that is both an endocrine gland and an exocrine gland - PANCREAS
24. endocrine glands vs exocrine glands } Exocrine glands – secrete through a series of ducts (sebaceous gland of the skin). Their secretions are protective and functional. } Endocrine glands – are ductless. They release their secretions directly into the blood stream. Their secretions have a regulatory function. 25. function of luteinizing hormone (LH) – for ovulation 26. fructosamine assay vs glycosylated hemoglobin
(HbA1c) fructosamine assay-another test to monitor control of glucose overtime or over a shorter time frame because it measures sugar attached to protein albumin- shorter life than hemoglobin. glycosylated hemoglobin (HbA1c) – measures bld. Glucose over a period of many weeks. Glucose in the bloodstream attaches itself to hemoglobin A molecule and remains there for the life span of the RBC.
27. pituitary adenoma – pathophysiology Is a benign tumor that secretes GH, leading to continued growth of bones and soft tissues. It also antagonizes the effect of hormone insulin, resulting in an increase in blood glucose and glucose intolerance.
28. hypophysectomy – what to monitor after surgery; surgical complications = diabetes insipidus -removal of pituitary gland done microsurgically and the usual approach is transsphenoidal via the nose. Post-op instructions: -Pt kept in semi-fowler’s position. -monitor VS and neurological status -note and communicate promptly any change in vision, mental status, or strength. Surgical Complications: -diabetes insipidus -Pt should not brush teeth,cough,sneeze, nose blowing, bend forward, because it will interfere w/ the healing process. -hourly deep breathing exercise to prevent pulmonary problems. 29. cause of central diabetes insipidus - because of TRAUMA or SURGERY. 30. imbalance caused by severe dehydration associated with diabetes insipidus - characterized by the production of copious amounts(>2.5L/day) of dilute urine.It occurs as a result of decreased production of ADH hormone. 31. simple goiter – pathophysiology - When the blood level of T3 is too low to signal the pituitary to decrease TSH secretion, the thyroid gland then responds by increasing the formation of thyroglobulin (colloid), which accumulates in the thyroid follicles and causes enlargement of the gland.
32. administering potassium iodide for the treatment of goiter – nursing considerations:
-Iodine preparations should be given well diluted and administered thru a straw as they can stain the teeth.
-Adverse effects : GI upset, metallic taste, skin rashes, allergic reactions, epigastric pain. 33. risk factor that doubles the probability of developing Graves’ disease(toxic goiter): -
-Medications containing iodine(amiodarone, antidysrhythmic )
-Smoking.
34. methimazole (Tapazole) – nsg considerations :
-Pt must take antithyroid drug at the prescribed time and strictly according to schedule.
-May be given for a period of 10-14 days b4 surgery of the thyroid to reduce the vascularity of the gland,minimizing the danger of releasing large amt. of thyroid hormone into the bloodstream during surgery and to decrease the risk of hemorrhage.
35. subtotal thyroidectomy – indication :
-Pt who do not respond well to antithyroid drug therapy, unable to take radioactive iodine, or have greatly enlarged thyroid glands.
36. type 1 diabetic (IDDM)– pathophysiology: -occurs when the body’s immune system destroys beta cells in the pancreas responsible for making insulin.
37. Why do people who have constant stress in their day-to-day lives at risk for type 2 diabetes :
-Emotional or physical stress can unmask an inherited predisposition to the disease, probably as a result of glucogenesis induced by increased production of hormones from the adrenal cortex especially glucocorticoids. 38. type 2 diabetes – client teachings
-importance of diet and exercise.
-diet is geared toward providing adequate nutrition w/ sufficient calories to maintain normal body weight.
-Muscular activity improves glucose utilization for energy and improves circulation. 39. what stimulates thirst experienced by diabetics? Hyperglycemia increases concentration of intravascular fluid, raising osmotic pressure and pulling water from the cells and interstitial fluid into the blood.This causes cellular dehydration and a resultant increased intake of water(polydipsia) and dieresis w/ increased urination(polyuria).
40. lab values from a patient in ketoacidosis
- BUN, ARTERIAL PH, GLUCOSE
41. Manifestation of ketoacidosis: - Increased thirst (polydipsia) - Increased urination (polyuria) - Acetone breath odor (fruity odor) - Dry mucus membrane and sunken eyeballs (dehydration) - Nausea and vomiting - Deep respirations (kussmaul’s respiration) - Abdominal pain and rigidity - Paresthesias, weakness, paralysis - Hypotension - Minimal urine output (oliguria) or none (anuria) late sign - Stupor or coma (late sign)
42. What is Mittelscherz?
-sharp pain in the right or lower quadrant, sometimes felt at the midcycle around the time of ovulation, and may last a few hours. Some women are sensitive to this phenomenon and others never experience it.
43. Purpose of normal acidic pH of the vaginal vault.
-the main line of defense against infection is lactic acid, which causes an acidic pH. Any change in this pH can result in infection.
44. Premenstrual syndrome (PMS) with its behavioral symptoms occurs when?
-(ovarian cycle syndrome) – occur between ovulation and menstruation, and regularly recur within the luteal phase of the menstrual cycle and significantly disappear during the remainder of the cycle.
45. Premenstrual dysphoric disorder (PMDD)- client teaching
-stress management
-lifestyle changes
-maintaining a healthy diet: limit consumption of refined sugar, salt, red meat, alcohol, and caffeinated beverages. Supplements of calcium, magnesium and VitB6.
-exercise to increase beta endorphin levels.
46. Primary dysmenorrhea may cause the young female to develop what?
-cause uterine contractions and vasoconstriction that results in abdominal cramps. Backache, weakness, decrease in appetite, and central nervous system symptoms such as dizziness, headache and poor concentration may also occur.
47. sildenafil (Viagra) – client teachings
-side effects: headache, dyspepsia
-contraindicated in patients taking nitrates and retinopathy
48. Interviewing techniques for a patient who has erectile dysfunction
-start with open ended questions: “tell me about..” or “when did you first notice..”
-relate his problem to the inconvenience it has caused in his daily life : “tenderness and discomfort in the scrotal area could make sitting at the desk or walking very difficult and interfere with assigned work”
-phrase questions differently or ask clarification if pt. does not understand the parts of the body the nurse is talking about.
49. Clinical definition of sterility
-Primary infertility – inability of the couple to conceive a child after at least 1 year of active, unprotected sexual relations w/o using contraceptives.
-Secondary infertility – inability to conceive after having once conceive, or to maintain a pregnancy long enough to deliver a viable infant.
50. male and female reproductive system – anatomy and physiology, esp. hormones
Ovaries – located near the end of each fallopian tube. Almond shaped glands excrete estrogen and progesterone into the bloodstream. At birth, the ovaries contain all the eggs the woman will ever produce.
Labia majora – two elongated, raised folds of pigmented skin that encloses the vulvular cleft. The pubic hair extends along these folds.
Labia minora – soft folds of skin within the labia majora. Soft and shiny and made up of fat tissue and glands, and have no hair follicles.
Clitoris- located on top of vulvular cleft, above the urethral opening. Made primarily of erectile tissue and is highly sensitive to touch.
Urethral meatus – external opening of the urinary bladder, is located below the clitoris w/in the folds of the labia minora.
Perineum – is the flat muscular surface lying between the vagina and the anus.
Vagina – muscular tube lined w/ membranous tissue with transverse ridges called rugae. Connects the external and internal female sexual organ.
Uterus – (womb) hallow pear shaped organ with a thick muscular wall. Lies at the upper end of the vagina. Lower opening of the uterus is the cervix, w/c dilates during labor to allow fore delivery of infant.
Fallopian tubes – branch outward from the right and left side at the top of the uterus. They form the pathway for the ovum (egg) from the ovary to the uterus.
Testes – the male gonads are oval shaped and are encased in the scrotum along with the epididymis, seminal vesicles and vas deferens. The seminiferous tubules within the testes produce the sperm. Testosterone also is produced in the testes.
Penis –cylindrical, erectile organ that hangs in front of the scrotum.
Prostate gland – shaped like a walnut, encircles the urethra, and is located belowand to the rear of the bladder. Produces thin, milky and alkaline secretions that contribute to the seminal fluid and enhance the motility of the sperm.
Scrotum – thin walled muscular sac, holds the testes, epididymis and vas deferens. Hangs from the pubic bone, suspends the testes outside the body where they remain several degrees cooler than the body.
Vas deferens – muscular tube that connects to the epididymis. Stores the sperm and then carries it to the ejaculatory duct.
Seminal vesicles – produc fluid that is thick and contains fructose to nourish the sperm and provide energy. The fluid also contains prostaglandins, which contribute to the motility of the sperm.
Bulboutheral (Cowper’s) glands are small pea sized glands located in the urethral sphincter posterior to the urethra. Secrete an alkaline mucus like fluid in response to sexual stimulation.
51. Why are women at a greater risk for contracting sexually transmitted infections (STIs)?
-young sexually active women have a large proportion of columnar epithelium lining the cervix and a vaginal pH that can be altered by frequent douching and bacterial vaginosis.
-male secretions and semen are in contact w/ female mucous membranes for a longer period of time.
-mucus plug in the cervix of women (protects upper genital tract) becomes more permeable around the menstrual period, w/c results in increased risk for infection including PID.
52. Syphilis - characteristics
-Primary : Chancre (hard painless sore) on the mucous membrane of the mouth or genitals, often unnoticed in women. Chancre teeming with spirochetes. May have bacteremia.
-Secondary : generalized skin rash.
-Tertiary : “Gumma” lesions (soft encapsulated tumor) appear on any organ.
53. PID – s/sx
-acute PID – severe abdominal and pelvic pain and fever, accompanied by purulent foul smelling vaginal discharge, and the women appears acutely ill.
-chronic PID – backache, feeling of pelvic heaviness, and disturbance in menstruation.
54. What is staining – how is it used to identify a gram positive gonococcus?
-staining differentiate organisms by using dyes that have been found to stain bacteria in a different way.
-Gram stain – bacteria is first stained w/ crystal violet, then treated w/ a strong iodine soln., decolorized w/ ethanol or ethanol acetone and then counterstained with a contrasting dye. Those maintaining the initial stain are considered gram positive.
55. Urethral swab from a male pt. suspected of having gonorrhea – nursing consideration
-urethral swabs should not be done within 1 hour of the last void as organisms will have been flushed away.
56. newly diagnosed with genital herpes – client teaching
-use of condoms w/ spermicide to help prevent spread
-avoidance of sex if lesions are present
-scrupulous hand hygiene
-if diagnosed w/ genital herpes and becomes pregnant : c section during birth if disease is active to prevent exposure.
57. gonorrhea – incubation period; s/sx male and female
-Incubation: 2-6 days after exposure. May be asymptomatic
-Male : dysuria with frequency; scant to copious purulent discharge from penis, unilateral testicular pain.
If untreated, discharge increase and may continue for months; may develop urethral stricture, epididymitis.
May advance to inflammation of prostate and testes.
-Female : Vaginal discharge, burning on urination. Untreated, results in PID. May involve rectum, eyes and oropharynx.
58. Teaching for pregnant patient who is human immunodeficiency virus (HIV)
-HIV may be transmitted from mother to newborn or to fetus via placenta.
-Avoid breast feeding.
-cesarean section for birth.
59. Treatment for a person with anxiety disorders:
*supportive therapy ➢ individual therapy ➢ Education about relaxation techniques ➢ Stress management
*anxiolytic (antianxiety) medication - Benzodiazepines ➢ Alprazolam (Xanax), Diazepam (Valium), Lorazepam (Ativan)
- use them with caution because tolerance and physical and [sychological dependency can occur.
-Nonbenzodiazepine ➢ Buspirone (BuSpar) - takes longer to reach therapeutic efficacy (3-4 weeks) - advantage of BuSpar is the decreased rosk of dependency and less sedation.
-SSRIs
➢ Citalopram (Celexa) and Sertraline (Zoloft)
-first line drugs for anxiety because they have fewer adverse effects
60. The signs and symptoms that characterize a major depressive: -over whelming feelings of sadness -inability to feel pleasure or interest in daily activities -weight gain or loss not attributed to dieting -Sleep disturbances -fatigue or loss of energy -feelings of worthlessness -Difficulty in making decisions or concentrating -suicidal thoughts -psychomotor retardation ➢ Speech, movements and thought process are slowed
61. Diagnostic criteria for the diagnosis of substance abuse:
- Repeated substance abuse that causes a failure to meet usual obligations
(e.g., frequently absent from school, unable to care for children, poor work performance) - Repeated substance abuse creating potential danger of physical harm
(e.g., driving under the influence of substances) - Repeated legal problems related to substance abuse
(e.g., arrest for possession) - Continued substance abuse despite disruption to interpersonal relationships
(e.g., physically fighting with co-workers)
62. Criteria for the diagnosis of alcohol dependency: - Presence of withdrawal - Significant impairment in family relationship and occupational productivity - Blackouts –temporary loss of recent memory that occurs while drinking - Drinking in spite of serious consequences to health or occupation - Evidence of tolerance
63. Schizophrenia – psychotic features: - Disordered thinking - Delusions - Hallucinations - Depersonalization (feeling of being strange, not one self) - Impaired reality testing (psychosis) - Impaired interpersonal relationship
64. Characteristics of personality disorders: - Poor impulse control - Inappropriate emotion response - Adapting to life’s event – maladapt 1. Inflexible and maladaptive response to life events 2. Serious difficulty in areas of personal work and relationships 3. Tendency to evoke interpersonal conflict 4. Tendency to evoke a negative emphatic response from others.
65. Rise in the number of sexually transmitted infections (STI) can be attribute - The incidence of STI continues to rise throughout the world - Sexually active people considered potentially at risk - People with multiple sexual partners are at very high risk for contracting an STI - The largest population group affected by STI is adolescents and young adults (Workowski & Berman 2006)
*Goals of Healthy People 2010 – to increase efforts to “promote responsible sexual behaviors, strength community capacity and increase access to quality services to prevent STI and their complications” and to “prevent HIV infection and its related illness and death.
66. Sexually transmitted infections (STIs) that must be reported: - Syphilis - Gonorrhea - Chlamydia - Chancroid - Lymphogranuloma venereum - Hepatitis B - PID - HIV infection - AIDs
67. Teaching for patient diagnosed with Chlamydia who is on doxycycline: - Must complete antibiotics to ensure effective treatment and prevent development of PID
68. If untreated gonorrhea can result in: MALE - Discharge increase and may continue for months - may develop urethral stricture epididymitis - can advance to inflammation or prospate and testes - can cause sterility
FEMALE - PID - May involve rectum, eyes, oropharynx
69. Assessment for complication – drowning - Usually aspirate water - Pulmonary edema - Bacterial or fungal pneumonia - Cardiac irregularities
70. Question by the nurse that would provide information about possible sexual abuse: 1. Have you been hit or hurt in any way in the past year? 2. Has it occurred before? 3. Are you afraid of anyone 4. Do you feel safe at home? 5. Does your partner use drugs or alcohol?
71. Intervention for a patient who has been in a motorcycle accident experiencing pain in his neck
- Neck and spine immobilization
- Keep the neck as straight as possible, preventing it from flexing or hyper extending - Cervical collar (when a cervical collar is not available and the victim must be move safety, the neck maybe immobilize with any material handy, such as a coat, shirt, or towel, rolled in the safe of a collar)
72. Differentiate the types of treatment that are appropriate for each type of shock. 1. Cardiogenic shock - infusion of volume, intra-aortic ballon pump through baseline assessment. 2. Hypovolemic shock - stop the source of volume loss, IV fluids, packed red cells fresh frozen plasma 3. Anaphylactic shock – airway management, administration of epinephrine 4. Neurogenic shock – blocking of sympathetic outflow from the vasomotor center of the brainstem, vasoconstriction medication 5. Insulin shock – hypoglycemia shock = IV push
73.difference between an emergency situation and disaster. • Emergency is an extraordinary event such as multivictim incident involving an explosion or a train crash • Disaster exists when the number of casualties exceeds the resource capabilities of the area.
74. intervention for impact stage of disaster • Survivor stunned, apathetic , disorganized • Need strong support and firm guidance • Difficulty following direction several hours after event
75. Provision of non- contaminated water in a disaster- possible sources? Disruption or contamination of the water supply is probable when a disaster occurs.
Flood water or storm water should not be used to wash dishes, brush teeth, was and prepare food, wash hands, make ice, or make baby formula. People have to be taught how to purify water.
Preparing Safe Water • Bringing it to a roiling boil for 3-5 mins let water cool before drinking. • Adding household liquid bleach 5.25% sodium hydrochlorite. 16 gtts of bleach to a gallon and let stand for 30 mins. • Distilling the water.
76. indication that chlorine gas is an imminent threat • Fog like or low-lying cloud suddenly appearing in the atmosphere • Many dead birds, domestic animals or insects within a particular area • Many dead dying or sick people in an area or downwind from a suspicious cloud or fog • An typical , unexplained odor for the location
77. tornado- what to do? • Choose ahead of time where you could go if evacuation is necessary. • Evacuate when you are told to do so. • Listen to a NOAA weather radio or local radio or television stations for evacuation instruction • Keep a road map because you may have to take unfamiliar routes
78. category B terrorism agents- how are they delivered? • Delivered through water and food sources
79. period of time during which there is the greatest chance that aerosolized anthrax could be inhaled. • During the first day after the event, before the particles hit the ground.
80. people who have plague and have been treated with appropriate antibiotics can be released from respiratory droplet precautions after - 48 hrs and treatment has been initiated.
81. plague caused by Yersinia pestis – organism can be destroyed by: • Antibiotics only effective it administered immediately • Drug of choice: streptomycin or gentamicin • Vaccine under development • Hospitalization • Isolation for containment
82. lesions- smallpox-characteristics- • The rash contains firm, deep seated vesicles or pustules. It start in the buccal and pharyngeal mucosa spreads to the face , hands and forearms and then spread to the rest of the body.
83. purpose of debriefing after a disaster plan for the health professionals • to help with the promotion of effective coping strategies
84. essential elements in a disaster plan – rationale • coordinate their services with each other and with other agencies in planning for essential such as shelter, transportation, communication, and welfare.
85. contents of disaster kits- • water • flashlights • boots • can opener • first aid kit • cash
86. how can water can be rendered safe for drinking in the event of disruption of service.- boiled water 87. What organisms may be released in a bioterrorism attack because of their high lethality - Anthrax (inhalation) – through direct contact with bacteria - Botulism – through air or food - Plague – direct person to person - Small pox (airborne/droplets)– person to person - Tularemia – (vector-borne) aerosol or intra-dermal - Hemorrhagic fever (E.g. Ebola virus) – person to person
88. Triage categories and examples of types of injuries of the disaster victims
1. RED TAG : EMERGENT - immediate threat to life – e.g. airway / hemorrhagic shock (tx: IMMEDIATE) 2. YELLOW TAG : URGENT -major injuries – open fractures, large wounds (tx: within 30 mins – 2 hours) 3. GREEN TAG : NONURGENT - walking wounded – closed fractures, sprains, strains, contusions, abrasions (tx: more than 2 hours) 4. BLACK TAG: TERMINAL - dead, imminently dying (tx: NONE)
89. Intervention for near-drowning victim who is semiconscious and breathing - She should be on her side in recovery position and covered with a blanket. - Head should be turned on the side to prevent aspiration when pt vomits
90. Memory prompt for emergency care (ABCDE – stands for?) Rapid assessment – should not take no longer than 60 seconds to perform. A- airway/ Cervical Spine B- breathing C- circulation D- disability E- exposure
91.Good Samaritan law
- Protects medical personnel from liability from rendering emergency medical care for victims of accidental injuries. Guards against liability for care given as long as medically trained individuals act in good faith and to the best of their ability.
92. Emergency care for abdominal wound with evisceration
- Cover with the piece with a non-adhering material such as plastic wrap or aluminum foil. This will keep the protruding contents moist and free of contamination. Clean folded towel or sheet is placed over it to retain body heat.
93. Intervention for a deep laceration pumping bright red arterial blood - Apply pressure to the wound or compress the artery above the wound.
94. Intervention for heat stroke and heat exhaustion S/S: Hyptension, tachypnea, tachycardia, anxiety, confusion, bizarre behavior, seizures and coma. - Patient should be placed in the shade and cooled immediately by being sprinkled with water and fanned.
95. Best explanation why the heart is being monitored on a hypothermic patient. - When the core (central) temperature drops even 2 or 3 degrees F, can lead to fatal cardiac disrhythmias and respiratory failure.
96. Assessment and intervention for frost bite – All degrees - 1st degree – reddened skin, swelling, waxy appearance, hard-white plaques, and sensory deficits - 2nd degree – redness and swelling, formation of blisters filled with or milky fluid. Within 24hours - 3rd degree – blisters or blood-filled and black eschar forms over several weeks - 4th degree – full-thickness damage affecting muscles, tendons and bone resulting in tissue loss.
98. Carbon monoxide poisoning
S/S: Excessive coughing, SOB, wheezing, and burning sensation of the nose and throat. Pale or bluish color to skin , dizziness, headache, nausea and vomiting and chest pain.
+ If carbon monoxide has been inhaled, mucous membranes will be CHERRY RED.
99. Choking interventions - Encourage to cough and breath as deeply as she can.
-When person can’t speak or cough & unable to remove foreign object in her throat on her own, help is needed and HEIMLICH MANEUVER is used - if person is conscious and able to cough or speak, she may not need assistance in expelling foreign object.
100. Stages of Shock Initial – no visible changes in client’s parameters, changes on the cellular level only
Compensatory – measures to increase cardiac output to restore tissue perfusion and oxygenation Progressive – compensatory mechanisms begin to fall Refractory – irreversible shock, total body failure.
101. Interventions : sucking chest wound - Wound should be covered at the end of a forceful expiration with an occlusive dressing – that is one made of plastic wrap, aluminum foil, Vaseline-covered gauze, or any other material that seals the wound and prohibits the flow of air into the pleural cavity, - O ne corner of the dressing is left unsealed to allow accumulated air to escape. - Place patient in semi-Fowler’s position if possible