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1

Lymes is found mostly in Conneticut

Asthma and Arthritis--swimming best

2

Asthma has intercostal retractions--be concerned

Tardive Dyskinesia - irreversible - involuntary movements of the tongue, face and extremities, may happen after prolonged use of antipsychotics

3

Akathisia - motor restlessness, need to keep going, tx with antiparkinsons meds, can be mistaken for agitation.

When drawing an ABG, you need to put the blood in a heparinized tube, make sure there are no bubbles, put on ice immediately after drawing, with a lable indicating if the pt was on room air or how many liters of O2.

4

Remember to preform the Allen's Test prior to doing an ABG to check for sufficient blood flow

Before going for Pulmonary Fuction Tests (PFT's), a pt's bronchodilators will be with-held and they are not allowed to smoke for 4 hrs prior

5

For a lung biopsy, position pt lying on side of bed or with arms raised up on pillows over bedside table, have pt hold breath in midexpiration, chest x-ray done immediately afterwards to check for complication of pneumothorax, sterile dressing applied

For a lumbar puncture, pt is positioned in lateral recumbent fetal position, keep pt flat for 2-3 hrs afterwards, sterile dressing, frequent neuro assessments

6

EEG, hold meds for 24-48 hrs prior, no caffine or cigarettes for 24 hrs prior, pt can eat, pt must stay awake night before exam, pt may be asked to hyperventilate and watch a bright flashing light, after EEG, assess pt for seizures, pt's will be at increased risk

Diamox, used for glaucoma, can cause hypokalemia

7

Dexedrine, used for ADHD, may alter insulin needs, avoid taking with MAOI's, take in morning (insomnia possible side effect)

Cytovene, used for retinitis caused by cytomegalovirus, pt will need regular eye exams, report dizziness, confusion, or seizures immediately

8

INH, used to treat and prevent TB, do not give with dilantin, can cause phenytonin toxicity, monitor LFT's, give B6 along with, hypotension will occur initially, then resolve

Rifampin, for TB, dyes bodily fluids orange

9

If mixing antipsychotics (ie Haldol, Throazine, Prolixin) with fluids, med is incompatible with caffine and apple juice

Haldol preferred anti-psychotic in elderly, but high risk extrapyramidal side effects (dystonia, tarditive dyskinesia, tightening of jaw, stiff neck, swollen tongue, later on swollen airway), monitor for early signs of reaction and give IM Benadryl

10

Risperdal, antipsychotic, doses over 6mg can cause tarditive dyskinesia, first line antipsychotic in children

Levodopa, for parkinsons, contraindicated in pts with glaucoma, avoid B6

11

Sinemet, for parkinsons, contraindicated with MAOI's

Hydroxyurea, for sickle cell, report GI symptoms immediately, could be sign of toxicity

12

Zocor, for hyperlipidemia, take on empty stomach to enhance absorption, report any unexplained musle pain, especially if fever

Decorticate is toward the 'cord'. Decerebrit is the other way (out)

13

** BOTOX ** (Botulin Toxin) can be used with strabismus also to relax vocal cords in spasmodic dysphonia.

Thank you, I finally realize why a person shouldn't have cantaloupe before a occult stool test, because cantaloupe is high in vit c and vit c causes a false + for occult blood. Now I just need to figure out why they can't have fish.

14

is a psychiatric disorder that causes an individual to self-inflict injury or illness or to fabricate symptoms of physical or mental illness, in order to receive medical care or hospitalization. In a variation of the disorder -->

Munchausen Syndrome

15

an individual, typically a mother, intentionally causes or fabricates illness in a child or other person under her care. -->

Munchausen by proxy (MSBP)

16

is a chronic, progressive disease with demyelinating lesions in the CNS which affect the white matter of the brain and spinal cord. -->

Multiple Sclerosis

17

Motor S/S: -->

limb weakness, paralysis, slow speech

18

Sensory S/S: -->

numbness, tingling, tinnitus

19

Cerebral S/S: -->

nystagmus, ataxia, dysphagia, dysarthria

20

Huntington's Chorea: -->

50% genetic, autosomal dominant disorder

21

S/S: chorea -->

writhing, twisting, movements of face, limbs and body
-gait deteriorates to no ambulation
-no cure, just palliative care

22

WBC shift to the left in a patient with pyelonephritis (neutrophils kick in to fight infection)

Definitive diagnosis for abd. aortic aneurysm (AAA) --> CT scan

23

Don't use Kayexalate if patient has hypoactive bowel sounds.

Uremic fetor --> smell urine on the breath

24

Hirschsprung’s --> bile is lower obstruction, no bile is upper obstruction; ribbon like stools.

Pancreatic enzymes are taken with each meal! Not before, not after, but WITH each meal.

25

abnormality in which urethral meatus is located on the ventral (back) surface of the penis anywhere from the corona to the perineum (remember hypo, low (for lower side or under side)

Hypospadias:

26

opening of the urethra on the dorsal (front) surface of the penis

Epispadias:

27

painful erection lasting longer than 6 hrs

Priapism:

28

Anticholinergic effects--assessment
dry mouth==can't spit
urinary retention=can't ****
constipated =can't ****
blurred vision=can't see

1. When you see Coffee-brown emesis, think peptic ulcer
2.Anytime you see fluid retention. Think heart problems first.
3.An answer that delays care or treatment is ALWAYS wrong
4.For PVD remember DAVE (Legs are Dependent forArterial & for Venous Elevated) more to come..........

29

When choosing an answer, think in this manner... if you can only do ONLY one thing to help this 'patient' what would it be? Pick the most important intervention.

 If two of the answers are the exact opposite, like bradycardia or tachycardia...one is probably the answer.
 If two or three answers are similar or are alike, none is correct.
 When asking patients’ questions NEVER use “why” questions. Eliminate all “why?” answer options. If you have never heard of it...please don’t pick it!
 Never release traction UNLESS you have an order from the MD to do so
 Questions about a halo? Remember safety first, have a screwdriver nearby.
 Remember compartment syndrome is an emergency situation. Paresthesias and increased pain are classic symptoms. Neuromuscular damage is irreversible 4-6 hours after onset.
 Always deal with actual problems or harm before potential problems
 Always select a “patient focused” answer.
 An answer option that states "reassess in 15 minutes" is probably wrong.

30

Interpersonal model (Sullivan)
Behavior motivated by need to avoid anxiety and satisfy needs
1. Infancy 0-18 months others will satisy needs
2. childhood >6yrs learn to delay need gratification
3. juvenile 6-9 years learn to relate to peers
4. preadolescence 9-12 yrs learns to relate to friends of of opposite sex
5. early adolescence12-14yrs:learn independence and how to relate to opposite sex
6. late adolecence 14-21yrs: develop intimate relationship with person of opposite sex is this not about communication?....

Fetal alcohol syndrome
-upturned nose
-flat nasal bridge
-thin upper lip
-SGA