Clinical Laboratory Values and Pharmacology Concepts, Exams of Nursing

Download Clinical Laboratory Values and Pharmacology Concepts and more Exams Nursing in PDF only on Docsity!

AMCB CNM Board Review (NM717)

PRIMARY CARE STUDY QUIDE –

QUESTIONS AND ANSWERS.

Metronidazole big take aways - \Used to treat BV, Trich, PID, etc Taken PO or PV SE: GI (take with food), HA, mild leukopenia or neutropenia (prolonged high doses, seizures ( prolonged high doses), urine darker, metallic taste STOP ALCOHOL UNTIL 48hrs AFTER avoid with hx of kidney or liver problems considered safe in pregnancy, iffy with breastfeeding Fluconazole big take aways - \Used for yeast/fungal infections CYP450 interactions b/c it works by inhibiting fungal CYP Can cause HA, GI Avoid with hx of heart arrhythmia, liver/kidney disease lots of drug interactions Can use in pregnancy and lactation but ideally topical Acylcovir big take aways - \Used to treat herpes genitalia/simplex/zoster, and varicella crosses placenta and enters breastmilk most of metabolism is in liver and excretion in urine inhibits viral DNA sythesis Does not cure latent herpes virus SE: n/v, diarrhea, HA, skin rash, acute renal failure (rare with PO) Can use in pregnancy and lactation Take with full glass of water **Valacyclovir: prodrug Famciclovir: prodrug, both of these have better bioavailability than acylclovir Alendronate take aways - \Bisphosphonate used for prevention and treatment of osteoporosis 3-6 months till max absorption Dont take with food, coffee, calcium (wait 2hrs), or orange juice it inhibits the activity of osteoclasts, which reduces bone resportion SE: GI problems, esophageal ulcers/erosions, hypocalcemia, osteonecrosis of the jaw, Need to stay upright x30min after taking it avoid with renal impairment, hypocalcemia Take in the morning with 8oz of water, no other drinks, foods, meds for 30-60min

Oxybutynin take aways - \Antimuscarinic Anticholinergic Used for overactive bladder Can cause anticholinergic SE: dry mouth, blurred vision, constipation, tachycardia, urinary retention, drowsiness, impaired sweating, confusion Drug interactions with CYP3A4 inhibitors Take with full glass of water, can take with or without food, caution with overheating Caution with uncontrolled narrow-angle glaucoma, gastric or urinary retention, esophageal disease, liver/kidney disease, heart disease, HTN, older adults Atorvastatin take aways - \1st line treatment for reduction of LDL decreases cholesterol production in the liver and increases LDL reuptake in liver. AE: muscle pain, rhabdomyolysis: if they have severe muscle pain or weakness, or dark colored urine check creatinine kinase levels GI: abdominal pain, constipation, diarrhea, nausea Lots of drug interactions, including warfarin, digoxin, and CYP3A4 inhibitors Contraindicated in pregnancy or with liver disease Tamoxifen take aways - \Selective Estrogen Receptor Modulator (SERM) Used to treat and prevent estrogen receptor positive breast cancer primarily excreted in feces AE: VTE, endometrial cancer, hot flashes, nausea, vaginal dryness, menstrual irregularities, weight gain, bone loss if premenopausal Pitocin Take Aways - \Onset: 3-4min, steady state in 30-40min, half life in 6-10min IV: subsides in 1 hr after d/c IM: duration of action for 2-3hrs minimally crosses placenta Risk for water intoxication Nitrous Take aways - \50/50 nitrous and O crosses placenta but rapidly eliminated mostly breathed out can cause N/V, megaloblastic anemia with low B Betamethasone take aways - \promotion of fetal lung maturity two 12mg doses 24hrs apart if <34weeks AND first course was >7-14 days ago can give single rescue course Magnesium Sulfate take aways -

\Anticonvulsant seizure prophylaxis with (pre)eeclampsia fetal neuroprotection if anticipating <32 week birth short term (<48h) tocolytic Usually IV: loading dose 4-6g in 100mL over 20-30min, then maintenance 2g/hr x 12- 24hrs can cause flushing, palpitations, warmth, lethargy, muscle weakness, dizziness, n/v, respiratory deproession pulmonary edema DONT USE WITH CALCIUM CHANNEL BLOCKERS DONT USE >5-7 days MONITOR FOR TOXICITY (reversed with calcium gluconate) RhoGAM take aways - \Give IM. Effective for 12 weeks after administration doses: 50mcg and 300mcg Give at 26-28 weeks and postpartum ideally postpone live vaccines until 12 weeks after giving it OLDCARTS - \Onset, Location, Duration, Character, Aggravating/Associated factors, Relieving factors, Temporal factors (timing), Severity HEADSS - \Home Education Activities Drugs Sex Suicide (topics to cover with adolescents) Components of menstrual history - \menarche, regularity, frequency, duration, amount of bleeding, LMP, pads/tampons/douching, PMS/PMDD, dysmenorrhea, perimenopausal symptoms, age at menopause, use of hormone therapy, postmenopausal bleeding Components of sexual history - \age at first intercourse (consentual/nonconsentual) Hx of sexual abuse or assault sexual orientation gender identity Current sexual relationships: frequency of sex, satisfaction or concerns with sexual relationship, dyspareunia, orgasmic or libido problems

STI risk assessmentL # of lifetime partners and # in past 3 months, types of sexual contact (vaginal , oral, anal), condoms/barriers, previous STI history, injection drugs or partner with injection drug history, sex with alcohol/drugs, HIV testing current and future desire for pregnancy contraceptives : current and historical, what works(s)/side effects, etc BMI - <18.5 = underweight 18.5-24.9= normal 25-29.9= overweight 30-39.9= obesity 40+= extreme obesity Malignant Melanoma ABCDEs - \Asymmetry Borders Irregular Color: blue/black or variegated Diameter >6mm Elevation Normal lymph nodes - \less than <1cm in size, nontender, mobile, soft, discrete presbyopia - \impaired near vision myopia - \impaired far vision Eye Exam: Opacity of lens suggests: - \cataracts Eye Exam: dysconjugate gaze suggests: - \diseases, injuries, or lesions affecting CN III, IV, VI Eye Exam: nystagmus suggests: - \cerebellar system disorders, vestibular disorders, drug toxicity Eye Exam: Lid Lag suggests: - \exopthalmos, hyperthyroidism Eye Exam: papilledema (swelling of optic nerve) suggests - \Increased intracranial pressure Eye Exam: AV nicking suggests: -

\HTN (Arteriovenous nicking, also known as AV nicking, is the phenomenon where, on examination of the eye, a small artery (arteriole) is seen crossing a small vein (venule), which results in the compression of the vein with bulging on either side of the crossing.) Eye Exam: Retinal hemorrhage and exudates suggests: - \diabetes, HTN Weber Test - \Test done by placing the stem of a vibrating tuning fork on the midline of the head and having the patient indicate in which ear the tone can be heard. Tests for lateralization of sound through bone conduction Rinne test - \hearing acuity test performed with a vibrating tuning fork that is first placed on the mastoid process and then in front of the external auditory canal to test bone and air conduction. Normally, AC is 2x as long as BC Tragus tenderness suggests ________________, while mastoid process tenderness suggests__________________ - \otitis externa, otitis media Conductive hearing loss - \sound transmission impaired through external or middle ear; exudate/swelling, perforated ear drum sensorineural hearing loss - \defect in inner ear distorting sound; loud noise exposure, aging, acoustic neuroma Signs of squamous cell carcinoma in the mouth - \white patch (leukoplakia) on side or underside of tongue Signs of Streptococcal Pharyngitis - \pharynx erythematous, tonsils 3+, white exudate, enlarged and tender anterior cervical nodes What conditions may decrease tactile fremitus? - \emphysema, asthma, pleural effusion What conditions may increase tactile fremitus? - \lobular pneumonia, pulmonary edema Lung sounds: possible causes of crackles - \air flowing by fluid: pneumonia, bronchitis, early heart failure crackles don't usually disappear with coughing heard during inspiration

Lung sounds: possible causes of rhonchi - \air passing over solid or thick secretions in large airways bronchitis, pneumonia heard during inspiration and expiration Lung sounds: possible causes of wheezes - \heard during inspiration and/or expiration air flowing through constricted passageways asthma, chronic emphysema Lung sounds: possible causes of pleural friction rub - \inspiration or expiration inflammation of plueral tissue pleuritis, pericarditis What migth broncophony, egophony, or whispered pectroriloquy indicate? - \fluid or a solid mass in lungs Where is the apical impulse? - \5th ICS MCL = 5th left intercostal space midclavicular line What are normal findings on a liver exam? - \edge smooth, sharp, nontender, no more than 2cm below the right costal margin liver span: 6-12cm at the right MCL normal findings when palpating the aorta - \slightly left of midline in upper abdomen, less than 3cm width Findings with abdominal peritonitis - \guarding, rigidity, rebound tenderness Appendicitis Physical Findings (6) - \1. RLQ guarding with rebound tenderness

2. **Psoas sign (Iliopsoas Test): pain with right thigh extension
3. **Obturator sign: pain with internal rotation of flexed right thigh
4. **Positive Rovsing's sign: RLQ pain when pressure is applied to LLQ and then withdrawn
5. Local abdominal tenderness: McBurney's point in RLQ
6. Low grade fever (high fever suggests perforation or another diagnosis) Cholecystitis findings - \Murphy sign sharp increase in tenderness and sudden stop in inspiratory effort when upward pressure under right costal margin while client takes a deep breath

Physiologic Split S2: where do you hear it? Best heard with _______? Heard during _________, Normal or Abnormal? - \base, best heard with the diaphragm heard during inspiration NORMAL these are 2 sounds that are merged during expiration Fixed Split S2 where do you hear it? Best heard with _______? Heard during _________, Normal or Abnormal? What's happening? - \base, best heard with the diaphragm heard during inspiration and expiration ABNORMAL Due to delayed closure of pulmonic valve caused by atrial septal defect, right ventricular failure Increased S3 (ventricular gallop) where do you hear it? Best heard with _______? Heard during _________, Normal or Abnormal? What's happening? - \Apex, heard best with bell, heard during early diastole, low pitched, increased on inspiration May be normal in young adults and late pregnancy Due to rapid ventricular filling caused by decreased myocardial contractility, heart failure, volume overload Increased S4 (atrial gallop) where do you hear it? Best heard with _______? Heard during _________, Normal or Abnormal? What's happening? - \Apex, best with bell, late diastole, low pitched, increased on inspiration may be normal in well trained athletes and older adults forceful atrial ejection into distended ventricle caused by aortic stenosis, hypersensitive heart disease, cardiomyopathy physiologic murmur where do you hear it? Best heard with _______? Heard during _________, Normal or Abnormal? What's happening? - \2nd to 4th ICS between left sternal border and apex, mid-systole, little radiation, grades 1-3, soft to medium pitched, usually disappears or decreases with sitting NORMAL, common in pregnancy Murmur of mitral stenosis where do you hear it? Best heard with _______? Heard during _________, Normal or Abnormal? What's happening? - \Apex, heard best with bell, early to late diastole, no radiation, grades 1-4, low pitched due to narrowed mitral valve restricting flow, forceful ejection into ventricle Systolic Click. where do you hear it? Best heard with _______? Heard during _________, Normal or Abnormal? What's happening? - \apex, heard best with diaphragm, mid to late systole, high pitched, increased with inspiration, happens with mitral valve prolapse

pericardial friction rub where do you hear it? Best heard with _______? Heard during _________, Normal or Abnormal? What's happening? - \variable location, usually best at 3rd ICS left of sternum, diaphragm, grating sound throughout cardiac cycle, high pitched, little radiation, due to pericarditis Cranial Nerve I - \Olfactory (smell) CN II - \Optic: Test visual acuity with snellen eye chart or hand-held card; inspect optic discs; peripheral vision CN II, IV, VI - \Oculomotor, Trochlear, Abducens: Observe for PERLLA, EOM function, ptosis (drooping or falling of the upper eyelid) CN V - \Trigeminal, palpate strength of temporal and masseter muscles, sharp/dull and light touch on forehead, cheeks, chin CN VII - \Facial, observe for any weaknesses, asymmetry, or abnormal movements of the face CN VIII - -acoustic -assess ears for hearing CN IX and X - \Glossopharyngeal & Vagus -"Ah-h-h"=symmetrical rise of uvula & stays midline -Gag reflex -Voice quality for hoarseness -Swallowing CN XI - \spinal accessory observe and palpate strength and symmetry of trapezius and sternocleidomastoid muscles CN XII - \Hypoglossal (tongue movement) Romberg test - \balance maintained while eyes closed Skene's glands -

\glands located on the anterior wall of the vagina, around the lower end of the urethra Bartholin's glands - \Glands located on either side of the vaginal opening that secrete mucus for vaginal lubrication. Pederson speculum - \flat, narrow blades barely curved, works well for nulliparous women and postmenopausal women Graves speculum - (larger, wider blade) - use for multiparous women RBC count - \Normal female: 4.2-5.4 million/mm low: hemorrhage, hemolysis, dietary deficiencies, hemoglobinopathies, bone marrow failure, chronic illness, medications high: dehydration, diseases causing chronic hypoxia like congenital heart disease, polycythemia vera, medications Hematocrit normal values - \Hct: % of total blood volume that is made up of RBCs Non pregnant adult female: 37-47% 1st and 3rd trimesters: 33% + 2nd trimester: 32% + Black women: 1st/3rd Tri: 31%, 2nd tri: 30% Hemoglobin normal values - \total hemoglobin (which carries oxygen) in the blood Non pregnant adult female: 12-16 g/dL 1st/3rd trimesters: 11 g/dL (Black women 10.2) 2nd trimester: 10.5 g/dL (9.7 Black women) Possible causes of low Hgb/Hct - \anemia, hemoglobinopathies, cirrhosis, hemorrhage, dietary deficiencies, bone marrow failure, renal disease, chronic illness, some cancers Possible causes of high hgb/hct - \erythrocytosis, polycythemia vera, severe dehydration, severe COPD, smokers, living at high elevations MCV - \mean corpuscular volume-average volume or size of a single red blood cell Normal range: 80-95 (or 100?) High MCV, macrocytic (Vitamin B 12 or folate deficiency Low MCV , microcytic, IDA or thalassemia

Mean Corpuscular Hemoglobin (MCH) - \Average mass of hemoglobin per RBC Normal: 27-31 pg/cell High: Vitamin B 12 or folate deficiency Low: IDA or thalassemia Platelet Count - \Normal: 150,000-400,000/mm Low (Thrombocytopenia): autoimmune disorders, cirrhosis, sepsis, hypersplenism, hemorrhage, leukemia, cancer chemotherapy, viral infection, some medications High (Thrombocytosis): malignancy, polycythemia vera, leukemia, rheumatoid arthritis, myeloproliferative disesae PT and PTT - \prothrombin time/partial thromboplastin time Used to evaluate how well coagulation factors in coagulation cascade work together measures the # of seconds it takes for clot to form prolonged: blood clotting is taking longer than normal What could cause a prolonged PT with normal PTT? - \liver disease, vitamin K deficiency, chronic low grade DIC, defective factor VII, warfarin What could cause a normal PT with prolonged PTT? - \decreased/defective factor VIII, IX, XI, XII, von Willebrand disease, Lupus (SLE) What would cause prolonged PT and prolonged PTT? - \decreased or defective factors I, II, V, or X, severe liver disese, acute DIC, warfarin overdose Total WBC count - \5,000-10,000/mm Possible causes of low: Bone marrow suppression, autoimmune disorders, immunosuppressive disorders, overwhelming infection, cancer that spreads to bone marrow possible causes of high: dehydration, infection, inflammatory conditions, some malignancies, can be elevated in late pregnancy and during labor, traumatic injury Neutrophils - \Normal: 30-70% Low values: bone marrow suppression, autoimmune disorders, immunosuppressive disorders, overwhelming infection, cancer in bone marrow high: acute bacterial infection, inflammation or tissue necrosis, some malignancies, cushing syndrome,

increased immature forms (bands, stabs)= Left Shift, sign of acute bacterial infection Basophils - \Normal: 0-3% low: generally not medically significant High: hypersensitivity reaction, chronic inflammatory disorders, some leukemias, uremia Eosinophils - \normal: 0-5% Low: usually not medically significant High: allergic reaction, parasitic infection, chronic inflammatory disorders, some malignancies, Addison disease Lymphocytes - \Normal: 15-40% Low: Autoimmune disorders, debilitating illness, immunodeficiency syndromes, some malignancies, corticosteroids High: Acute viral infections, chronic bacterial infections, chronic inflammatory disorders, some malignancies Monocytes - \Normal: 2-8% Low: chronic disease (rare) High: chronic infections, recovery phase of infections, some malignancies CMP (Complete Metabolic Panel) - \Kidney, Liver, Metabolism Sometimes you need to be fasting x 10-12hrs Includes: glucose, calcium, albumin, total protein, Na, K, CO2, Chloride, BUN, creatinine, ALP, ALT, AST, bilirubin Fasting blood glucose - \no caloric intake for at least 8 hours Normal: <100mg/dL Impaired: 100- Diagnostic for DM: 126 2hr OGTT - \75g glucose drink, draw labs 2hrs later Normal: < Impaired: 140- Diagnostic for DM: 200mg/dL ADA Criteria for the Diagnosis of Diabetes - \1. Classic symptoms of hyperglycemia plus random non fasting glucose of 200mg/dL or higher

2. Fasting glucose of 126 or higher
3. 2hr OGTT of 200 or higher
4. Repeat testing on a subsequent day to confirm diagnosis HgbA1C - \Diabetes: 6.5% or higher Prediabetes: 5.7% to 6.4% Used for measurement of long term (60-90days) glycemic control in people with DM Good diabetic control: <7% Lipid Profile - \Fast for 12-14hrs prior to obtaining sample (?) Levels may be slightly elevated in pregnancy Total: <200mg/dL Triglycerides: 35- HDL: > LDL: < BUN - \blood urea nitrogen indirect measurement of renal and liver function Normal: 10-20mg/dL Elevated: hypovolemia, dehydration, reduced cardiac function, GI bleeding, starvation, sepsis, renal disease Decreased: liver failure, malnutrition, nephrotic syndrome Serum Creatinine - \Indirect measurement of renal function Normal: 0.5-1.1 mg/dL Increased: Renal disorders, dehydration Decreased: debilitation, decreased muscle mass Creatinine clearance - \uses 24-hour urine & serum creatinine levels to determine the rate that kidneys are clearing creatinine from the blood, reflecting the glomerular filtration rate normal creatine clearance: 0.5-1.1mg/dL normal 24hr urine creatinine: 500-2000mg Increased: increased muscle mass, exercise, pregnancy, diet high in meat, some meds Decreased: impaired renal function, reduced renal blood flow, heart failure, shock, some meds Urine Protein/Creatinine Ratio - \From a random urine sample Elevation can indicate kidney damage, preeclampsia, diabetes, multiple myeloma, kidney damage

TSH -

\Normal: 0.4 to 4.12 mU/mL elevated: primary hypothyroidism and thyroiditis decreased: secondary hypothyroidism, hyperthyroidism, suppressive doses of thyroid medication Pregnancy: upper limits change by trimester, <2.5-3.5 mU/mL Free thyroxine (FT4) - \0.58-1.64 ng/dL high: hyperthyroid and acute thyroiditis low: hypothyroid Total Thyroxine T4 - \4.5 to 12.0 ug/dL Impacted by changes in thyroid-binding globulin (TBG) Causes of increased TBG: pregnancy, OCPs, estrogen therapy anti-TPO antibodies - \Normal: negative antithyroid antibodies Positive: grave's disease, hashimoto's thyroiditis Bilirubin - \Normal adult: total 0.3-1.0mg/dL, direct (congugated) 0.1-0.3mg/dL, indirect (unconjugated): 0.2-0.8mg/dL elevated DIRECT: gallstones, obstruction of extrahepatic duct elevated INDIRECT: hepatoceullular dysfunction (hepatitis, cirrhosis) and hemolytic anemias Albumin - \Normal: 3.5- 5.0 g/dL increased: Dehydration decreased: liver disease, malabsorption syndromes, nephropathies, severe burns, malnutrition, inflammatory disease Alkaline Phosphatase (ALP) - \30-120 units/L elevated: liver disease, bone disease, myocardial infarction Aspartate aminotransferase (AST) - \0-35 units/L used to evaluate the cause of an elevated ALP

Alanine aminotransferase (ALT) - \4-36 units/L Lactic dehydrogenase (LDH) - \100-190 IU/L Gamma-glutamyl transferase (GGT) - \8-38 U/L Type of hypersesnitivity: TB test - \cell mediated Norepinephrine in stress response - \increased BP, increased sweat, piloerection Geriatrics total lung capacity - \remains the same What does the hypothalamus do? - \maintains homeostasis, metabolism Inherited thrombophilia - \Protein S deficiency Protein C deficiency Factor V Leiden Antithrombin Deficiency renin-angiotensin-aldosterone system - \compensatory process that leads to increased blood pressure and blood volume to ensure perfusion of the kidneys; important in the continual regulation of blood pressure increases both preload and afterload Triploidy - \when an organism has three copies of every chromosome instead of two, 69 total Type 1 hypersensitivity - \IgE mediated hypersensitivity Ex: Allergies Type 2 hypersensitivity - \Cytotoxic ANTIBODY mediated cell destruction Ex: Autoimmune hemolytic anemia Type 3 hypersensitivity - \Immune Complexes of Antigen and Antibody Ex: Serum sickness, Glomerulonephritis after strep

Type 4 hypersensitivity - \Delayed type hypersensitivity reactions. T-cell and Macrophage mediated. Ex: Tuberculosis What cardiac defect are you listening for in the left lateral decubitus position? - \mitral stenosis Should be able to visualize an IUP with beta hcg of - \1500- What is the best position for hearing aortic regurgitation? - \upright, leaning forward When can a urine pregnancy test detect pregnancy? - \as early as 28 days from LMP Types of colon polyps - \1)pseduopolyps/inflammatory -d/t IBD NOT cancerous 2)hyperplastic -LOW risk of malignancy -90% of ALL polyps 3)adenomatous - will become cancer in 10-20yrs -tubulous adenoma - nonpedunculated - M/C -tubulovillus -villous adenoma- HIGH risk of become maligant - tend to be sessile role of estrogen in osteoporosis -
Antibiotics that cover gram positive -
Antibiotics that cover gram negative -
Impacts of pregnancy on drug absorption -
Pregnancy Drug Categories -
Adult immunization schedule - \

Stages of smoking cessation -
Starting dose of nicotine gum -
How to use nicotine gum -
ACE inhibitor contraindications - \hypotension, pregnancy, bilateral renal artery stenosis (anything else?...) beta blocker contraindications - \2nd/3rd degree heart block cardiogenic shock sinus sick syndrome sinus bradycardia effects of ACE inhibitors on kidneys, liver, heart, lungs -
effects of beta blockers on kidneys, liver, heart, lungs -
HTN meds for Black population - \Choose thiazide diuretics or calcium channel blockers No ACEI/ARB If taking HTN meds but not meetin goals - \Add another medication Don't change from one med to another When treating HTN, how long should you wait for lifestyle changes to work? - \Not very long, you want to aggressively pursue goal BP (don't wait around for very long for just lifestyle changes to work) What are the RED FLAGS for low back pain being dangerous? -
If red flags aren't present, what do you need to do or not do for patients with low back pain? -
Describe normal hemorrhoids (That can be treated with just supportive care) -
Describe thrombosed hemorrhoids - \

Can midwives manage thrombosed hemorrhoids? - \No, not within scope of practice TB risk factors - \close contact with someone who has active TB, immunocompromised status, IV drug user, person who lives in institutions, lower socioeconomic group, incidence increasing in immigrant populations, poverty areas, elderly, alcoholics, drug abusers, and people with AIDS Most common cause of IDA in reproductive aged women vs postmenopausal women - \kids: poor nutrition reproductive: menses postmenopausal: chronic GI bleed, maybe cancer TB asessment -
TB Diagnosis -
When do you add ICS for someone with asthma? - \Step 2 (elaborate) cardiac vs. non cardiac-origin chest pain -
costochondritis diagnostics -
What does it mean if you can point to where the chest pain is and reproduce it with palpation? -
diagnostic criteria for major depressive disorder (MDD) -
normal grieving vs MDD -
IDA: MCHC, MCV, and MCH -
Migraine preventative meds - \

migraine abortive therapy -
Presentation of acute otitis media - \TM erythematous and bulging if there's pain with palpation of tragus/pinna, that's otitis externa treatment for acute otitis media - \systemic abx (Amoxicillin), drops wont work Which is safer for older adults: NSAIDs or acetaminophen? - \acetamminophen, NSAIDs increase risk for GI bleed/ulcers

\