Download AANP Adult Gerontology Primary Care Nurse Practitioner AGPCNP Study Guide 100% Pass and more Exams Psychiatry in PDF only on Docsity!
AANP Adult Gerontology Primary Care
Nurse Practitioner AGPCNP Study Guide
100% Pass
Pheochromocytoma - Answer>> small vascular tumor of the adrenal medulla, causing irregular secretion of epinephrine and norepinephrine, leading to attacks of raised blood pressure, palpitations, and headache. Tx with Alpha blockers Rovsing's Sign - Answer>> Palpation in LLQ ilicits pain in RLQ indicates appendicitis NYHA classes of Heart Failure - Answer>> I No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea (shortness of breath). II Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea (shortness of breath). III Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnea. IV Unable to carry on any physical activity without discomfort. Symptoms of heart failure at rest. If any physical activity is undertaken, discomfort increases. Step-wise Approach to Asthma Diagnosis & Treatment - Answer>> Step 1- Mild Intermitten FEV1/PEF > 80% predicted. Symptoms <2 days/week. Albuterol as needed. Step 2- Mild presistent Asthma (FEV1/PEF > 80% predicted. Symptoms > 2 days/week. Albuterol as needed. Low dose ICS ex Flovent. Alt cromolyn, montelukast, nedocromil, theophylline. Step 3- Mod presistent (FEV1 or PEF 60-80% predicted. Daily Symptoms. SABA plus low dose ICS or med dose ICS or low dose with leukotriene inhibitor (singulair, theophylline, zileuton).
Step 4- Severe presistent asthma (FEV1/PEF <60% predicted. Symptoms most of day. High dose ICS plus long acting B agonist plus oral steroid daily (prednisone). Peak Expiratory Flow Rate (HAG): Green Yellow Red Zone: - Answer>> PEF based on Height Age Gender. Blow hard using spirometer highest value recorded. 80-100% expected volume Green Zone maintain or reduce meds 50-80% expected volume Yellow Zone increase maintenance therapy. Or Having exacerbation. Below 50% expected volume Red Zone call 911 give epinephrine inj. PPD - Answer>> Neg- No firm bump forms at the test site, or a bump forms that is smaller than 5 mm (0.2 in.). A firm bump that is 5 mm (0.2 in.) in size suggests a TB infection in people who are in a high-risk group. HIV, immunocompromise, exposed. A firm bump that is 10 mm (0.4 in.) in size suggests a TB infection in people who are in a moderate-risk group. healthcare workers, immigrants, homeless. A firm bump that is 15 mm (0.6 in.) in size suggests a TB infection in people who are in a low-risk group no risk for tb. Digoxin (Cardiac Glycosides) - Answer>> Therapuetic 0.5-2.
Aldosterone Antagonist - Answer>> causes a decrease in potassium excretion (spares K) and decreases Na reabsorption. (spironolactone) Hirsuitism, htn, sever heart failure. exp spironolactone. Adverse effects are galactorrhea and hyperkalemia. Spironolactone is rarely used to treat htn in primary care due to adverse effects and higher risk of certain cancer. Postassium Sparing Diuretics - Answer>> compete w/ aldosterone at receptor sites causing increase na and water excretion while conserving k and h ions Alt for Sulfa Allergy Pts to tx HTN. Triameterene (Dyrenium), Amiloride (Midamor). Combo HCTZ. Severe Hyperkalemia, Avoid renal pts, ace or arbs, do not give potassium supplement or salt subst. Monitor serum K+ 3.5-5. high risk elder, severe ill, dm. Ace Inhibitors, ACEI/ARBS - Answer>> ACTION: prevent the conversion of angiotensin I to angiotensin II in the lungs USES: CHF, HTN , usually end in PRIL Indicated for DM, HTN, CKD pts w/ HTN. Cat C & D. dont give in preg. excereted in breast milk. Dry Cough, angioedema, hyperkalemia. Captopril causes agrunolocytosis monitor cbc. switch from ace to arb if cough persist. Beta Blockers - Answer>> **** DO NOT give with ASTHMA, BRONCHIAL CONSTRICTIVE DISEASE!!!****
HTN, post myocardial infarction(first line), angina, arrhythmias, migraine prophylaxis. Adjunct tretment-hyperthyroidism/thyrotoxicosis (decrease HR, anxiety). Migrain prophylaxis-non-cardioselective(blocks beta 1 and beta 2) propanolo, timolol. Cardio Selective blocks beta-1 only atenolol, metoprolol. Toxicity of these agents include bradycardia, AV blockade, exacerbation of acute CHF; signs of hypoglycemia may be masked (tachycardia, tremor, and anxiety) Adveser effects, ED, Depression, fatigue, bradycardia. Loop Diuretics - Answer>> Examples a. Furosemide (Lasix) b. Bumetanide (Bumex) 2. Loop diuretics inhibit reabsorption of sodium and chloride at the proximal portion of the ascending loop of Henle, increasing water excretion. 3. Side effects / nursing care a. Hypokalemia, hypochloremic alkalosis, hyperuricemia (gout), hyperglycemia b. Teach high potassium foods to include in diet. c. Sulfonamide sensitive patients may have allergic reaction to furosemide. Ototoxicity, nephrotoxic. Hypovolemia, hypotension, pancreatitis, jaundice rash. Alpha Blockers - Answer>> Hypertension with coexisting BPH- Hytrin- Terazosin. -blockage of alpha 1 receptor leads to vasodilation, decrease peripheral resistance and venous return. Potent Vasodialator- causes diziness and hypotension. give at beditime low dose titrate up. Careful with frail elderly risk of syncope/falls. Calcium Channel Blockers - Answer>> Diltiazem (cardizem), nifedipine (procardia, adalat), verapamil HCL (calan, isoptin), nisoldipine (sular); inhibits calcium ion influx during cardiac
1st gen- active gram + bacteria Keflex tx cellulitis uti in preg. 2nd gen- broad spectrum tx gram + & - bacterial infections. Cefuroxime (ceftin), Cefprozil (cefzil), Cefaclor (ceclor). Sinusitis, AOM, CAP, chronic bronchitis, skin infections. 3rd gen- treats gram - less potent towards gram +. Ceftriaxone (Rocephin) STDs gonnorrhea, PID, urethritis. Cefixime (suprax) ENT OAM in children, acute sinusitis. Cefdinir (Omnicef) pyelonephritis, CAP. Penicillins - Answer>> beta lactams that inhibit bacterial ell wall synthesis by binding to one or more penicillin binding proteins, which in turn prevents the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls. Amoxicillin & Ampicillin extended spectrum effective against gram
- and some gram - bacteria. Tx otitis media, sinusitus. Penicillin V tx strep. Benzathine Penicillin G IM for syphillis. Dicloaxacillin for cellulitis,ersipelas. Adverse effects: Diarrhea, Cdiff, Vaginitis candida. Do not treat mono with amox tx with penicillin vk causes rash. Fluoroquinolones - Answer>> Gram - & Atypical bacteria. Ciprofloxacin, norfloxacin, levofloxacin, ofloxacin, moxifloxacin, gemifloxacin, enoxacin causes tendonitis, tendon rupture, tooth damage Tx Chlamydia, Mycoplasma, Legionella, utis, pylenephritis, pna, sinusitus. High risk achilles tendon rupture. Avoid use with QT prolong drugs (amiodorone, macrolides, TCA, Antiphsycotics). Risk sudden death from arrythmia (torsa de pointes). Coadministration
with antacids decreases effectiveness of drug. monitor INR on coumadin. C/I children less 18 yrs, preg, breast feeding, myasthenia gravis. Sulfonamides - Answer>> Trimethoprim-sulfamethoxazole (TMP-SMX) Bactrim DS BID- prophylaxis treatment of PCP, MRSA cellulitis, UTIs, pyelonephritis Uses 1. Urinary tract infections. 2. Ulcerative colitis and Crohn's disease. 3. Bowel prep before colon surgery to kill intestinal bacteria. B. Examples of Drugs (Note the Sulfa and Gant) 1. Sulfisoxazole (Gantrisin) 2. Sulfasalazine (Azulfidine) a. Sulfasalazine (Azulfidine)(contains salicylate) 3. Sulfamethoxazole (Gantanol) is given primarily in combination with Trimethoprim (Proloprim) as Septra or Bactrim. C. Side effects / nursing care 1. Photosensitivity- rash 2. Nausea and vomiting 3. Kidney stones- push fluids 4. Tell patients to avoid direct sunlight while taking sulfonamides. 5. Encourage fluids to avoid crystal formation and renal dysfunction. C/I G6PD anemia causes hemolysis, newborns <2 months, preg 3rd tri causes hyperbilirubenemia/ kernicterus. hypersen to sulfa drugs. skin rash steven jhonson syndrome, interacts with warfarin increases INR. NSAIDS - Answer>> Inhibit prostaglandin and other chemical mediator syntheses and other chemical mediator synthesis involved in pain; antipyretic activity through action on the hypothalamic heat-regulating center to reduce fever Mild/moderate pain, fever, arthritis, and blood thinner. Take with food will cause GI ulcers, Do not give this and aspirin together, stop taking 1 week before surgery.
severe rheumatoid arthritis, and autoimmune disorders; , temporal arteritis uveitis. asthma exacerbation 40-60 mg/day 3-4 days. Medrol dose pack x 7 days. adverse reactions: emotional liability, impaired wound healing, skin fragility, abnormal fat disposition, hyperglycemia, hirsutism, moon face, osteoporosis; wean slowly; monitor serum potassium, glucose and sodium; weigh daily and report >5lb/week; administer with antiulcer drugs; prevent injurys; monitor BP and HR. HPA supression, cushings disease, Topical Steroids Potency - Answer>> Class 1- Superpotent Class 1- Clobetasol (temovate) Potent- Halocinonide (Halog) Moderate- Triamcinolone (kenalog) Least Potent- hydrocortisone class 7. Biguanindes - Answer>> Metformin (Glucophage) decreases gluconeogenesis, increases glycolysis and peripheral glucose uptake (increases insulin sensitivity Sulfonylureas - Answer>> First generation: Tolbutamide (oranase), chlorpropamide (diabinase), second generation: Glyburide (micronase, diabeta), glipizide (glucotrol), glimeprode (amaryl); lowers blood sugar by stimulating the release of insulin by the beta cells of the pancreas + causes tissues to take up and store glucose more easily; first generation are low potency and short acting; second generation are high potency and longer acting; adverse reactions: first generations: hypoglycemia, nausea, heartburn, constipation, anorexia, agranulocytosis, allergic skin reactions; second generation reactions: weight gain, hypoglycemia; first generation: responsiveness may decrease over time; once daily with first meal; monitor blood sugar; hard to
detect hypoglycemia; second generation: less likely to interact with other medications Thiazolidinediones - Answer>> Rosiglitazone (avandia), pioglitazone (actos); lowers BS by decreasing insulin resistance of the tissues; adverse reactions: hypoglycemia, increased total cholesterol, weight gain, edema, anemia; skip dose if meal skipped; no known drug interactions; monitor liver function; caution with use in CAD; may precipitate HF Bile Acid Sequestrant - Answer>> Colesevelam (Welchol) reduces hepatic glucose production and may reduce intestinal absorption of glucose. Meglintinide - Answer>> Repaglinide (prandin) Nateglinide (starlix). Stimulates release of insulin in response to glucose load (meal) which lowers blood sugar, can cause hypoglycemia. Indicated for DM2 with posparandial hyperglycemia. Incretin Mimetic - Answer>> Byetta Liraglutide (Victoza®) stimulate insulin secretion;also inhibits glucagon secretion & delays stomach emptying Mitral Area - Answer>> (apex of heart)- located in the fifth left intercostal space, medial to the midclavicular line. Aortic Area - Answer>> second ICS to the right side of the upper border of the sternum. MR ASH - Answer>> Systolic Murmurs MITRAL REGURGITATION- radiates to axilla loud blowing high pitched.
On Old Olympus Towering Tops A Finn And German Viewed Some Hops - Answer>> CN 1: Olfactory: Smell CN2: Optic (vision) CN3: Oculomotor (eye movement) CN4: Trochlear (eye movement superio oblique muscle of eye) CN5: Trigeminal (Facial Sensation) opthalimic, maxillary and mandibular branches. CN6: Abducense ( lateral muscle of eye movement) CN7: Facial (expressions of face) CN8: Acoustic (hearing) CN9: Glossopharyngeal ( swallowing speech worsk with vagus) CN10: Vagus (speech, heart rate) CN 11: Spinal Accessory (shoulders shrugging together) CN12: Hypoglossal (tongue movements, speech swallowing). kernig's sign - Answer>> This is a positive sign of meningitis that is when there is pain in the lower back or posterior(Back of) thigh that occurs when knee is extended while pt is lying in supine position and the hip is flexed at a right angle (pt can not straighten leg out if bent at knee when raised) Brudzinski's sign - Answer>> meningeal sign- neck stiffness causes a patients hips and knees to flex when the neck is flexed Turner's Sign - Answer>> Bruising on either flank that may indicate retroperineal bleeding into the abdominal wall Cullen's Sign - Answer>> Ecchymosis (edema and bruising) around the umbilicus (may indicate internal bleeding or major organ injury) Tinel's Sign - Answer>> This test is done in carpel tunnels syndrom. Tap over the median nerve and it is positive if tingling occurs
Phalen's sign - Answer>> test for carpal tunnel syndrome: flex wrists by putting hands back to back Navicular Fracture - Answer>> fracture of navicular/scaphoid bone of the wrist. has lim blood supply so poor healing. if not diagnosed quick, arthritic changes can occur. pain over snuffbox, fell forward. original x-ray wil be wnl- do a repeat in 2 weeks to show scaphoid fracture due to callous bone formation. Splint wrist- thumb spica cast Colles fracture - Answer>> the break of the distal end of the radius at the epiphysis often occurs when the pt has attempted to break his/her fall. fractured distal radius with dinner fork appearance. Lachman's Sign - Answer>> knee joint laxity is positive. suggest ACL damage of the knee. More sensitive than the anterioir drawer test for ACL damage. McMurray's Test - Answer>> knee pain and a "click" sound upon manipulation of the kneee is positive. Suggests injury to the medial meniscus. gold standard test for joint damage is the MRI Drawer Sign - Answer>> a test for knee instability. A diagnostic sign of a torn or ruptured ligament. The positive anterior drawer sign is the test for the anterior cruciate ligament (ACLS). the posterior drawer sign is the test for the posterior cruciate ligament(PCL) Finkelstein's Test - Answer>> De Quervains tenosynovitis is caused by an inflammation of the tendon and its sheath, which is located at the base of the thumb. The screening test is finkelsteins , which is positive if there is pain and tenderness o the
Thyroid Cancer - Answer>> a single large nodule(>2.5 cm)on one lobe of the thyroid gland. The 24 hour radioactive iodine uptake(RAIU) test will show a cold nodule Type 1 Diabetes - Answer>> form of diabetes mellitus that is an autoimmune disease; results in the destruction of beta islet cells and a complete deficiency of insulin on the body; usually occurs before age 30. Type 2 Diabetes - Answer>> Diabetes of a form that develops especially in adults and most often obese individuals and that is characterized by high blood glucose resulting from impaired insulin utilization coupled with the body's inability to compensate with increased insulin production. fasting glucose 100- A1C 5.7-6. 2 hr ogtt 140- Dawn Phenomenon - Answer>> A nocturnal release of growth hormone, which may cause blood glucose level elevations before breakfast in the client with diabetes mellitus. Treatment includes administering an evening dose of intermediate acting insulin at 10 pm. Somogyi Effect - Answer>> Rebound HYPERglycemia in AM in response to counterregulatory hormone release after episode of hypoglycemia in middle of the night Insulin Categories - Answer>> Humalog Rapid acting covers one meal at a time Short Acting Regular covers from meal to meal NPH long acting last from breakfast to dinner Lantus 24hrs.
Medicare part A - Answer>> The part of the Medicare program that pays for hospitalization, care in a skilled nursing facility, home health care, and hospice care. Medicare part B - Answer>> The part of the Medicare program that pays for physician services, outpatient hospital services, durable medical equipment, and other services and supplies. Medicare part C - Answer>> Medicare Managed Care Plans (formally Medicare Plus (+) Choice Plan) was created to offer a # of healthcare services in addition to those available under Part A & Part B. The CMS contracts w/ managed care plans or PPO's to provide Medicare benefits. A premium similar to Part B may be required for coverage to take affect Medicare part D - Answer>> Also known as the Medicare prescription drug benefit. Only individuals who are enrolled (or eligible) for Medicare Part A and/or Part B are eligible. One type of Part D coverage is called the Medicare Advantage plan (MA) Medicade Title 19 - Answer>> the government insurance program for low-income individuals & familys that is funded both by the federal government & each individual state Advanced Directives - Answer>> Communicates a client's wishes regarding and end-of-life care should the client become unable to do so. PSDA requires that all health care facilities ask if a patient has advanced directives upon admission. Living Will - Answer>> A document that indicates what medical intervention an individual wants if he or she becomes incapable of expressing those wishes.
