Adult/Gero Flashcards
Treatment for Acne Roscea
Metronidazole gel
Pernicious Anemia, Vitamin B-12 deficiency, Folic Acid deficiency, Liver disease, Hypothyroidsim, & Reticulocytosis are all considered as
Macrocytic Anemia (MCV > 100fL)
What is the cornerstone pharmacological therapy for COPD?
Anticholinergics (Ipratropium/Atrovent, Tiotropium/Spiriva) & L.A.B.A (Salmeterol, Formoterol, & Bambuterol)
Iron deficiency anemia, Lead Poisoning/Toxicity, Sideroblastic Anemia, & Thalassemia (Alpha & Beta) all are considered as
Microcytic Anemia (MCV
Treatment recommendation for Mild COPD include
- Reduction of risk factors (i.e smoking cessation),
- Get flu and PNA vaccines
- Add S.A bronchodilators/(Levabulterol[Xopenex], Proventil [ProAir], Ipratropium [Atrovent])
Treatment recommendation for Moderate COPD include
- Short acting bronchodilators, plus…
- Add one or more long acting bronchodilators (long acting beta agonists/salmeterol, formoterol or long acting anticholinergic/tiotropium [Spiriva])
What are the most common forms of COPD?
Emphysema and Chronic Bronchitis
Hemolytic Anemia, Bone Marrow disorders, Hyperspleenism, Acute Blood loss, & Anemia of Chronic disease, are all considered as
Normocytic Anemia (MCV 80 - 100)
Treatment for Very Severe COPD
Along with short acting, long acting bronchodilators, and inhaled corticosteroids…
- Add long term oxygen
- Possible surgical treatments
A systolic B/P of 140-159, and diastolic BP of 90-99 is consider as:
Stage I Hypertension
Treatment recommendation for Severe COPD include
Along with short acting & long acting bronchodilators, add Inhaled steroids/glucocorticoids
- A hemoglobin A1C > 6.5%
- A random glucose or 2 hour plasma glucose > 200mg/dL
- A fasting glucose > 126 mg/dL
- The above mentioned are all criteria to diagnose…
Diabetes
Heberden’s nodes and Bouchard nodes are found in this disease
Osteoarthritis/Degenerative Joint Disease
A progressive “ASYMETRIC” degeneration of the articular/hyaline cartilage layer on the ends of bones at the joints. Can be monoarticular or polyarticular
Osteoarthritis
Symptoms of osteoarthritis include:
- Pain or stiffness of one or more joints
* Pain is most prevalent upon arising and after prolonged activity and RELIEVED BY REST
Stage II Hypertension is diagnosed when:
- A systolic BP is > 160 or, …
* A diastolic BP > 100
Treatment for Stage II Hypertension
“Dual Therapy”, usually with a thiazide diuretic, and a CCB, ACE-I, or ARB. (ACE-I & ARB cannot be a combo therapy)
A normal TSH level is _______
1 to 4
A normal Free T4 is ______
10 to 27
s1/Systole, which is the “lub” sound, is considered the closure of what valves
Mitral and triscupid valves (Atrioventricular valves = 3 leaflets)
s2/Diastole, which is the “dub” sound, is considered the closure of what valves
Aortic and Pulmonic valves (Semilunar valves = 2 leaflets)
An audible s3 sound is suggestive of ________
Congestive Heart Failure (CHF)
This heart sound is made due to a stiffness of the left ventricle, usually indicating Left Ventricular Hypertrophy (LVH)
s4
A holosystolic or pansystolic murmur, best heard at the apex, and can possibly radiate to the axillae, is suggestive of _______
Mitral Regurgitation
A midsystolic murmur heard at the 2nd intercostal space, on the right side of the sternum, that can radiate to the neck is suggestive of _____
Aortic Stenosis
The “GOLD STANDARD” for diagnosing Hashimoto’s thyroiditis is _______
ELEVATED antimicrosomal antibodies
An elevated TSH, with a low free T4 is the classic lab finding for ______
Hypothyroidsim
The “GOLD STANDARD” radiography for injuries of the menisci, cartilage, tendons, ligaments, and joints is _____
MRI
- Fracture of the distal radius (with or without ulnar fracture) of the forearm, along with displacement of the wrist is what type of fracture?
- Dinner Fork Fracture
Colles Fracture
Colles fractures are associated with a history of what?
Forward falling with outstretched hands
The most common area of Colles fracture is ________
Wrist
An acute or sudden onset of “TEARING” severe low back/abdominal pain. Presents with abdominal bruit with abdominal pulsation. What is this indicative of?
Dissecting Aortic Anyeurysm
A diagnostic sign for a “torn or ruptured” ligament (AL or PCL). It is a test for “knee instability”. What is this test?
Drawer Test
Which orthopedic maneuver produces a “click” sound and knee pain, when performed?
McMurray’s test (suggest a medial meniscus injury)
The “Lachman’s” test screens for _______
Knee instability (more sensitive than Drawer test) suggests ACL damage.
Inflammation of the digital nerve of the foot, between the 3rd & 4th metatarsal (toe) is known as?
Morton Neuroma
Morton’s neuroma risk is increased by what?
Wearing high-heeled shoes, tight shoes, being obese, being a runner or dancer
This test is done by grasping the 1st and 5th toe, then squeezing the forefoot. It screens for Morton’s Neuroma
Mulder’s test
De’Quervain’s screen is considered “positive” when what happens?
Their is pain and tenderness at the wrist (on the thumb side)
The “Finklestein” test is a screening for what?
De’Quervain’s tenosynovitis (an inflammation of the tendon and its sheath, located at the base of the thumb).
Which is known to have longer joint stiffness, degenerative joint disease (osteoarthritis) or rheumatoid arthritis?
Rheumatoid Arthritis
A type of bursitis located behind the knee is called
Baker’s Cyst
Prolonged and painful erection of the penis (greater than 2 to 4 hours)
Priapism
- Risk factors for priapism include?
- Sickle cell
- Cocaine users
- High dose erectile dysfunction medication
- Quadriplegics
What effect does mitral regurgitation have on cardiac output
It can “DECREASE” cardiac output
Symptoms of “decreased” cardiac output includes?
Dypsnea on exertion, chest pain, orthopnea, syncope, and near syncope
This goal is to: Achieve normal or near normal lung function, and prevent symptoms. Controlling inflammatory process reduces airway remodeling
Asthma goal
One of the main causes of Mitral Stenosis is ______
Rheumatic infection (a “streptococcal infection”)
Which nerve is affected by the “fibular” bone
Peroneal nerve
Mean corpuscular volume (MCV) range
80-100 fL
Mean Corpuscular Hemoglobin Concentration (MCHC) range is
33-36 g/dL
Population who are at increased risk for Tuberculosis include (8 populations)
- Foreign born people
- Minorities
- Prisoners
- Nursing Home residents
- Indigents
- Healthcare Providers
- Migrant workders
- People with blood disorders or prolong steroid therapy use.
* Any population that is OVERCROWDED*
The nurse practitioner role was initially established to (3 things)
- Improve access to care and partially solve physician shortage.
- Provide accessible primary care services
- Illness prevention and health promotion
Standards of practice are
Authoritative statements used to measure quality
The knowledge base of the APRN is based on
Scientific content and theory
Indications for starting a person with diabetes on oral hypoglycemics include
Failure to control hyperglycemia with diet in a client with diabetes type 2
The goal of COPD is to:
Reduce the disease progression, reduce the symptoms and exacerbation, and improve exercise tolerance and quality of life
This insulin’s onset is 15-20 minutes, and peaks at 30 minutes to 2 hours.
Immediate (Lispro or Aspart)
This insulin’s onset is 30 minutes to 1 hour, and peaks at 2 to 3 hours.
Regular (Humulin R or Novolin R)
- HBsAg (negative)
- Anti-HBc (negative)
- Anti-HBs (negative)
What do these lab results mean?
Susceptible to Hepatitis B
This insulin’s onset is “UNKNOWN” (maybe 1 to 2 hours), and HAS NO PEAK
Long Acting (Lantus or Levemir)
They increase the release of insulin, increase the levels of incretin
Dipeptidyl peptidase-4 (DDP-4) Januvia
Metformin is contraindicated for which patient population
Reduced Kidney Function/Kidney Failure
They delay intestinal carbohydrate absorption by reducing post prandial digestion of starches
Alpha-Glucosidase inhibitors (Precose)
They increase peripheral insulin sensitivity and reduces insulin resistance, stimulates insulin production, slows gastric emptying. Used as an appetite suppressant for weight loss.
Incretin Mimetic (Byetta)
Hemoglobin A1c gives an indication of glucose control over the past?
60 to 90 days (Usually 3 months, but never less than 2 months)
Rheumatoid arthritis is often associated with
Systemic symptoms
Principle of therapy in rheumatoid arthritis include
Early treatment with disease-modifying therapy to minimize joint damage
The most common “METABOLIC” bone disease in the U.S. is
Osteoporosis
They decrease glucose production in the liver, decrease intestinal glucose absorption & they are insulin sensitizers (increase insulin action)
Biguanides [METFORMIN]….1st Line Recommended therapy for diagnosis of Type II Diabetes
Post-traumatic Stress Disorder is marked by which triad of findings?
Intrusive thoughts, nightmares, flashbacks
The diagnostic Xray for Osteoarthritis will show what?
Joint space narrowings
In diabetics, at what BP should pharmacological treatment begin
140/80
What is the preferred pharmacological therapy for patients with confirmed hypertension and DIABETES?
- Ace-Inhibitors (Kidney protection)
- Angiotensin Receptors Blockers (ARBs)
- Beta-Blocker (Kidney protection)
For diabetics, what are the targets goal levels of a lipid profile
- LDL 40-45 (Men) > 50-55 (Women)
* Triglyceride
How often should a fasting lipid profile be done in person with diabetes
- Annually
* For patients with levels at or under goal, every 2 years if fine
This insulin’s onset is 1 to 2 hours, and peaks at 6 to 14 hours
NPH (Humulin N or Novolin N)
Diabetics with increased risk for CVD, should be placed on what, as a primary prevention
- Aspirin (ASA) 75mg – 162mg per day
* For ASA allergy: clopidegrel (Plavix) 75mg
When should a Type I diabetic have an eye exam by the ophthalmologist or optometrist
Within 5 years of onset
When should a Type II diabetic have an eye exam by the ophthalmologist or optometrist
Shortly after the diagnosis of Type II diabetes
In diabetics, when should a foot examination be done
Annually
Signs and Symptoms of “Hypothyroidism” include
Dry skin Flat Mood or Affect Slowed/Retard mentation Cold Sensitivity Fatigue Voice Hoarseness/Changes Muscle cramps Constipation
When should hypothyroidism be treated
TSH above 10mIU/L
When a goiter is present
TSH above 5mIU/L in the present of antibodies
Medications that can cause Hypothyroidism
Post-radioactive iodine
Lithium
Amiodarone
The overproduction or excess release of thyroid hormone is known as
Hyperthyroidism
The most common cause of hyperthyroidism is
Grave’s Disease
Medications that can cause Hyperthyroidism include
Amiodarone
Interferon
Hyperthyroidsim signs and symptoms include
Tachycardia Heat sensitivity Racing thoughts Loose stools Insomnia Smooth Skin Hyperreflexia
Treatment of hyperthyroidism includes
Beta-Blockers (propranolol)
Anti-thyroid meds (propylthiouracil/PTU, methimazole/Tapazole)
Radioiodine therapy
Possible Ablation
An autoimmune disease that over stimulates the thyroid.
A hyperthyroid state
Hyperfunction of the thyroid
Grave’s Disease
Patient with high risk of Grave’s Disease includes
Rheumatoid Arthritis (RA)
Pernicious Anemia
Osteoarthritis
It is the movement of gastric contents from the stomach to the esophagus or beyond, into the oral cavity or lungs.
The most common disease of Gastroenterology
G.E.R.D
Treatment of Giant Cell Arteritis includes
Corticosteroids
Get to E/R immediately
Common Signs and Symptoms of G.E.R.D include
Heartburn Chest Pain Wheezing Post-prandial fullness Hoarseness Regurgitation Chronic Cough (especially at night) Post nasal drip Bloating & Belching Dyspepsia Epigastric Pain
1st line treatment for G.E.R.D includes
Lifestyle modifications which include: Weight loss Smoking cessation ↓ caffeine, spicy foods, ETOH, chocolate Limit NSAID use H.O.B on 4-6 inch blocks Do not lie down for 2-4 hours after a meal
2nd line treatment for G.E.R.D include
Antacids ( for immediate symptoms relief)
H2 receptor blockers (Zantac, Tagamet)
PPI (Prilosec, Protonix = superior at suppressing post prandial acid surges)