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Ambulatory Nursing Certification
BUN -
5 - 20 Too high = renal failure CREATININE - .6 - 1.3. Too high = renal failure TSH adult level - .25 - 4.30 High - Hypothyroid Low - Hyperthyroid Cholesterol -
- = Hyperlipidemia HDL-C - .40 - 7. Low = Lipid disorder LDL - 65 - 100 High = Lipid disorder Criteria for Dx of Diabetes - Fasting BS >126 on 2 separate occasions or 2 hour BS > 200 during oral glucose test or Sx of diabetes + random BS > Symptoms of diabetes - Polyuria Polydipsia Hyperglycemia Unexplained weight loss Do not collect fecal occult blood if ... - Rectal bleeding Hematuria Menstruation 7 days prior to colonoscopy avoid ... - ASA - NSAIDS - Steroids - iron supplements 5 days prior to colonoscopy avoid ... - Vitamin C, both dietary and supplements 3 days prior to colonoscopy avoid ... - Red meat - broccoli - cauliflower - black grapes - raw fruit and vegetables
Triage / assessment of terminal illness - Emotional Social support Perception of illness / disease ADL's Change in problem solving Change in lifestyle / financial S/sx depression and anxiety Psychosocial intervention for terminally ill patients - Decrease anxiety Promote coping End-of-life choices Palliative care Hospice care COPD - chronic obstruction of airflow in and out Pulmonary emphysema Chronic bronchitis Asthma - Treatment Nursing interventions Position, sit up, lean forward Frequent rest Nebulization Pulmonary toilet IPPB O CHF - Treatment Nursing interventions Reduce pain and anxiety Improve oxygenation Reduce congestion Improve Myocardial contraction MS Multiple Sclerosis Teaching Plan Readmission / Exacerbation - Define readmission and exacerbation Safety precautions Medication including SEs and OTC interaction Exercise to promote strength and mobility Self manage bowel / bladder / catherization MS Exacerbation reasons - Infection, trauma, immunization, childbirth, stress, climate changes
Patient strengths are HEALTHFUL responses - Healthy responses Child and adolescent screening - Newborn metabolic devlopment & behavior High BP Genetic anemia Blood lead level Vision Hearing Dental Lipid disorders Scoliosis Depression Chlamydia, STD's Alcohol use Tobacco use Violence Cervical Cancer Sickle Cell and PKU Sickle cell screening mandated in ____ states - all 50 Sickle cell affects 1 in ____ African American newborns - 375 MDD - Major Depressive Disorder symptoms - sadness, irritable, loss of interest, social isolation, anger, sleep and appetite disturbances, non-specific pain MDD present when sx cluster together and persist for ___ weeks or more - 2 PHQ-A - Patient Health Questionnaire for Adolescents BDI-PC - Beck Depression Inventory - Primary Care Version Live, attenuated vaccine - Cultured under conditions which disable their virulent properties or use closely-related but less dangerous organisms Inactivated vaccine - Contain toxoids, protein subunits, conjugate bacteria polysaccharide outer coats or killed organsms. Immunization Early childhood
Hepatitis B by age 2 - 3 Immunization Early childhood Rotovirus (live) by age 2 - 3 Immunization Early childhood Tdap by age 2 - by age two - 4 doses age four - 1 dose Immunization Early childhood Hib (Haemophilus influenza bype B) by age 2 - 3- Immunization Early childhood Pneumonia by age 2 - 4 Immunization Early childhood IPV (inactivated polio) by age 2 - by age two - 3 age four - 1 dose Early childhood immunization MMR (live) by age 2 - by age two - 1 age four - 1 Immunization Early childhood Influenza (live or inactivated) by age 2 - Yearly after 6 months Immunization early childhood VZV (Varicella) live by age 2 - 1 Immunization Early childhood Hepatitis A by age 2 - 2 Immunization Early childhood given at age 4 - Tdap - Tet., Diphtheria, Pertussis IPV - Inactivated Polio MMR - Measles, Mumps, Rubella Varicella - Chicken Pox Immunization Late childhood given at age 7-10 -
Varicella - 2 doses if no immunity Meningococcal - 1st year in dorm
- others at risk Immunization Adult high risk - Pneumonia - max 2 in lifetime Hep A - not vaccinated, 2 doses Hep B - not vaccinated, 3 doses Adult Screening - Alcohol Misuse - Risky or Hazardous drinking Women >7/week, >4 per party Men >14/week, >4 per party Harmful drinking - physical, social or psych harm but not dependence Adult Screening Alcohol Risky/hazardous drinking - Women >7/week, >4 per party Men >14/week, >4 per party Adult Screening Alcohol Harmful drinking - Physical, social or psych harm but not dependence Adult Screening Alcohol Tools - National Institute on Alcohol Abuse and Alcoholism niaaa.nih.gov/Publications/AlcoholResearch/ Medical Emergencies - Staff roles Skills (BLS, ACLS, PALS) Competency assessment (drills) Age-specific equipment and meds Medical Emergency - CAB
- Chest compression
- Airway
- Breathing - Check responsiveness Check breathing Call for help Check for pulse 10 seconds only Give 30 chest compressions Open airway & give 2 breaths Resume compressions HIV Course of infection - Mono-like syndrome Asymptomatic seropositivity
Symptomatic seropositivity HIV Prognosis - Strong correlation w/CD4 cell count Inversely related to HIV load HIV Management - Anti-retrovirals Prevent opportunistic infection No live virus vaccines Counseling Normal test values HgB - Men 13.5 - 16.5 g/dL Women 12.0 - 15.0 g/dL Normal test values Hct - Men 41 - 50% Women 36-44% Normal test values Sodium - 135 - 145 mEq/L Normal test values Calcium - 8.5 - 10.5mEq/L Normal test values Magnesium - 1.7 - 2.3mEq/L Normal test values Potassium - 3.5 - 5.5 mEq/l EKG lead placement - ... Head circumference - ... Vision - Snellen chart - Snellen at 20 feet, anything >20/40 needs eye doctor Blood Pressure Measurement - Cuff encircles 80 - 100% of arm Width 40% of circumference Bare arm Pump to 30mm Hg above radial pulse disappearance Release pressure 2-3 mm Hg/sec First 2 consecutive sounds Systolic Disappearance of sounds Diastolic
Require clinic thinking Telephone Triage - Why use Protocols? Standardization and structure Provides safe, effective care and appropriate disposition Eliminates common practice errors Provided legal protection Ease of documentation, efficiency & retrievability Meets accreditation standards Telephone Triage Disposition - Emergent 911 or ED Urgent ASAP 1-8 hrs Acute 8-24 hrs or next day Non-acute Phone advice ERR ON SIDE OF CAUTION Telephone Triage Legal Issue - Formal Nurse-Patient Relationship Maintain scope of practice Safeguards - Protocols Documentation Quality Assurance Accountability Telephone Triage Legal Risk - 3 R's Right care, place, time Consistency Formal training Adequate resources and protocols Written assessment Documentation Quality Improvment program Compliance to License Compact Normal Lab values Chloride - 85 - 115 mEq/l Normal Lab values Bicarbonate - 22 - 29 mEq/l Normal Lab values WBC - 4.5 - 11/cu mm Normal Lab values RBC - Female 4.2 - 5.4 million / cu mm Male 4.6 - 6.2 million / cu mm
