Focus review for Term 2 Final

Question 1

Cell Mediated (delayed) Immunity

Answer 1

• A delayed immune response to injury or infection that does not involve antibodies.
• It involves the activation of phagocytes, T-lymphocytes, and the release of substancesthat enhance the immune response and influence the destruction of antigens.
• T cells include helper cells, supressor cells, and killer cells.
• Helper T cells enhance humoral immunity
• Suppresor T cells help to “turn off” the humoral response.
• Disease may occur when the normal ratio of helper to supressor cells (2:1) is altered.
• In AIDS, for instance, the number of helper T cellsis diminished.
• When the number of suppressor T cells is too high, infections, allergy, or immune disease develop.
• Killer T cells directly destroy antigens.
• Cellular immunity fights most viral or bacterial infections and hinders the growth of malignant cells.: This process also launches an attack on transplanted tissue or organs in the body.

Question 2

Respiratory Acidosis

Answer 2

• respiratory acidosis occurs when the respiratory system fails to eliminate the appropiate amount of carbon dioxide to maintain the normal acid base balance.
• Carbon dioxide retained, with resultant accumulation of carbonic acid and a decrease in blood PH
• The body responds to respiratory acidosis by stimulating respirations to eliminate excess carbon dioxide.
• If that mechanism cannot restore balance , renal compensation begins.
• The kidneys attempt to help by reabsorbing more bicarbonate to balance the amount of carbonic acid in the blood.

Question 3

Causesa of Acute Respiratory Acidosis

Answer 3

• Caused by respiratory disease such as, pneumonia, drug overdose, head injury, chest wall injury, obesity, asphyxiation, drowning, or acute respiratory failure.
• People with chronic pulmonary disease may have elecated carbon dioxide levels but a normal PH as a result of renal conpensation.
• Common clinical S/S: rapid HR, headache, sweating, lethargy and confusion.

Question 4

Arterial blood Gas Values with uncompensated rspiratory and metabolic acidosis and alkalosis

Answer 4

see attached

Question 5

Opioid Analgesics

Answer 5

• generaly used for moderate to severe acute pain, cancer pain, and some other types of pain.
• they vary in ptency and duration of action.
• Opioid agonists: Codeine, methadone (Dolophine), hydromorphone (Diludid), meperidine (Demerol), morphine and fentanyl.
• Opioid agonist-antagonists: buprenorphine ( Buprenex), nalbuphine, butorphanol, and pentazocine (Talwin).
• Both types relieve pain at the level of the CNS.
• Older ppl more sensitive due to delayed excetion and slower metabolism.
• Dose should be reduced 25% to 50% initially and titrated.
• Oral dosage should be larger then parenteral as it needs to pass the liver after absorption reducing the dose.

Question 6

Agonist Drugs

Answer 6

• Agonist drugs fit into receptor sites on the cell to “turn on” the site and produce the drug effect.
• Opioid agonist bind to opioid receptors to produce analgesia but also bind to other receptors to produce unwanted side effects such as: Decreased respirations, drowsiness, and nausea.
  *

Question 7

agonist-Antagonist Drugs

Answer 7

• Opioid agonist-antagonist are drugs designed to produce analgesia and block certain side effects.
• They block side effects in the same manner naxolone the effects of pure opioids.
• Drugs classified as as agonist antagonists are: pentazocine, nalbulphine, buprennorphine
• they can produce pain relieve but also block the effects of opioids such as morphine or meperidine.
• A patient receiving pure opioid agonist for pain should not be given opioid agonist antagonist because they may block analgesia, precipitate withdrawl symptoms, and increase pain.

Question 8

agonist Drugs

Answer 8

Are drugs that block side effects at the receptor sites.

Question 9

Demerol

Answer 9

• Demerol or Meperidine use for moderate to severe pain has declined.
• Mepedirine may cause CNS toxicity.
• normepedirine a CNS stimulant, when accumulated in the body pt exhibits: Anxiety, twitching, tremors, muscle jerking, and generalized seizures.

Question 10

When an ipioid is prescribed

Answer 10

• frank discussion w/ PT about realistic goal for pain relief.
• plan for monotoring opioid and illicit drug use.
• plan to reduce and time frame for discontinuation.
• no more than 3-7 days for acute pain.

Question 11

Side effects of opioids

Answer 11

• Consatipation
• Nausea
• Vomiting
• Sedation
• Respiratory depression
• Confusion
• Hypotension
• Dizziness
• Itchyness
• Urinary retention

Question 12

Sedation Scale

Answer 12

S Sleeping but easy to arouse when called or stimulated.

1. Awake and Alert.
2. Slightly drowsy but easily aroused.
3. Frequently drowsy, arousable but drifts off to sleep during conversation- alert the RN
4. Somnolent, minimal or no response to physical stimulation- Emergency

Question 13

Stages of shock

Pre Shock

Answer 13

• Compensatory mechanisms respond to decreased delivery of oxygen, inadequate extraction of oxygen or both, depending on the type of shock.
• Physiological responses such as tachycardia and peripheral; vasoconstriction may maintain anormal BP.
• mild to moderate elevations in lactic acid levels, tachycardia, and slight increases or decreases in BP may be the only clinical sign detectable.
• with prompt intervention, progressive deterioration may be prevented.

Question 14

Stages of Shock

Shock

Answer 14

• S/S of organ dysfunction become apparent as compensatory mechanisms become overwhelmed.
• Neural, endocrine and chemical compensatory mechanisms are activated in effort to overcome the conswquences of anaerobic metabolism and maintain blood flow to vital organs.

1. activation of baroreceptors in the carotid arteries and the aorta stimulates the sympathetic nervous system.
2. sympathetic stimulation causes increased HR, constriction of peripheral blood vessels and reduced blood flow to the kidneys, lungs, muscles, skin, and GI tract.
3. decreasing renal blood flow triggers the release of renin and a sequence of events that that produce angiotensin II, a potents vasoconstrictor.
4. the adrenal cortex secretes aldosterone, which promotes sodium reention by the kidneys.
5. antidiuretic hormone is released by the posterior pituitary, resulting in addiotional retention of water by the kidneys.
6. falling blood PH and increasing arterial carbon dioxide are detected by chemoreceptorsin the carotid arteriesthat stimulate the respiratory center. increasing RR and depth to help eliminate excess carbon dioxide and normalize blood PH.

Question 15

Assessment Findings in shock stage

Answer 15

• Mental status: anxiety, restlessness
• BP: possibly normal initially, decreasing BP later
• Pulse: slight increase progressing to tachycardia: decreasing rate (bradycardia) that may be present in neurogenic shock as a result of sympathetic stimulation.
• Respirations: Increased rate and depth
• Urine output: decreased to less than 0.5 to 1.0 mL/kg/h
• Skin: cool and pale; exceptiom: warm and dry with septic shock.
• Abdomen: decreased bowel sounds; decreased perfussion and ischemic injury can result in movement of bacteria from the intestine to the circulation with subsequent development of sepsis.
• Blood glucose: Increased
• other: thirst

Question 16

Stages of shock

End organ dysfunction

Answer 16

• If the cause shock is not corrected or if compensatory mechanisms continue without reversing the shock, irreversible organ damage, multiple organ failure, and death ensue.
• Even though the neural, endocrine, and chemical compensatory functioned together in the earlier stages, they now begin to function independently and in opposition.
• In this decompensated stage of shock, the systemic circulation continues to constrict in the attempt to maintain blood flow to vital organs.
• The decrease of peripheral blood flow, however, leads to weak or absent pulses and ischemia of the extremities.
• As intravascular blood volume decreases, the blood becomes increasingly vicious causing clumping of red blood cells, platelets, and proteins.
• Deprived of adequate oxygen, cells resort to anaerobic metabolism, which produces lactic acid and results in metabolic acidosis, which has a depressant effects on myocardial cells.

Question 17

Typical assessment findings of end stage shock

Answer 17

• Mental status: listlessness, confusion, loss of consciousness.
• Blood pressure: hypotension
• Pulse:: weak and thready, tachycardia, dysrhythmias.
• Respirations: increased, deep, crackles on auscultation.
• Temperature: increased or sub normal.
• Your an output: decreased, renal failure.
• Skin: cold, pale, clammy, slow capillary refill, cyanosis.
• Other: dry mouth, thirst, sluggish pupillary response, peripheral edema, muscle weakness.

Question 18

Pneumonia and atelectasis in post sx

Answer 18

• Drug affect and immobility place the surgical patient at risk for pneumonia and atelectasis.
• Patients who are most prone to these complications are older adults, the obese, those with chronic pulmonary disease, and those who have undergone chest or abdominal surgery.
• General anesthetics and opioid analgesic depressed respiratory function.
• Anti-cholinergics cause pulmonary secretions to be drier and thicker than normal.
• Immobility limits lung expansion and allows fluid to pull in the lungs.
• Fluid provides a medium for infectious organisms to grow.
• An infection of the lungs associated with immobility is called hypostatic pneumonia.
• As a fluid accumulate, they begin to block off branches of the respiratory tree.
• When gas is Cano longer enter or leave the effect of the alveoli, they collapse.
• Atelectasis is a term used to describe collapsed Alvioli, which may affect a portion or an entire lobe of the long.

Question 19

Post op gastrointestinal disturbances

Answer 19

• The primary G.I. problems that follow surgery or nausea, vomiting, impaired peristalsis, and constipation.
• Nausea and vomiting are most common in the early post up period.
• Causative factors include anesthesia, pain, opioids, decrease peristalsis, and resuming oral intake to soon.
• Factors that cost peristalsis to be impaired after surgery include: anesthesia, immobility, opioid analgesics, and handling of the bell during surgery.
• Patients who develop metabolic and balances, respiratory problems, or shock are also at risk for G.I. disturbances.
• Gas pains typically occur on the second or third postoperative day.
• If peristalsis stops completely, the patient said to have a paralytic ileus.
• The patient with paralytic ileus has abdominal distention that may be severe enough to impaired lung expansion and decreased blood return from the legs, causing cardiac output to fall. Distention also causes strain on an abdominal incision.

Question 20

Inadequate oxygenation

post op

Answer 20

• Document the patient’s respiratory status every hour for the first 24 hours and once or twice per shift after that.
• The most important nursing measures to prevent pneumonia and atelectasis are frequent position changes and coughing and deep breathing exercises.
• Deep breathing inflates the lungs completely and coughing remove secretions.
• The incentive spirometer is a device used to promote lung expansion.
• It consist of a tube through which the air is inhaled and a cylinder containing a ball rises in the cylinder as a patient inales through the tube.
• The more air that is taken in, the higher the ball moves.
• Reasons why coughing is contra indicated are surgeries for hernias and cataracts as well as brain surgery.

Question 21

Cerebral angiography and digital subtraction angiography

Answer 21

• cerebral angiography provides images of the cerebral, carotid, and vertebral blood vessels.
• A catheter is inserted into an artery usually femoral and advanced to the carotid or vertebral arteries.
• A contrast dye is injected, and a series of radiographs are taken.
• Angiography is the most definite diagnostic test and the diagnosis of cerebral aneurysms or congenital vascular disorders, such as arterial venous malformation.
• Risk: severe allergy to contrast media, embolus, hematoma, hemorrhage, renal toxicity, transit ice cream at attack, infection, and loss of consciousness.
• Digital subtraction angiography DSA: is a complementary, computer assisted radiographic procedure for visualization of cerebral vessels.

Question 22

Calcium channel blockers

Answer 22

• nimodipine-Nimotop
• Prevents spasms and cerebral blood vessels after a hemorrhagic stroke.
• Side effects: headache, fatigue, depression, confusion, dysrhythmias, hypertension, MI, renal failure.
• Nursing interventions: monitor pulse and blood pressure, assess for edema, monitor urine output, count pulse before each dose; withhold if less than 60 bpm.

Question 23

other medication is used for CVA

Answer 23

• Osmotic diuretics such as mannitol and hyperventilation or sometimes used.
• phenytoin-Dilantin and phenobarbital are anticonvulsants that may be ordered if the patient has seizures.
• The efficacy and safety of heparin and heparinoid drugs have been challenged and are no longer routinely used as the first line treatment with a TIA or an acute ischemic stroke unless a cardioembolic stroke is suspected.
• Small doses of this medication subcutaneously or recommended and the prevention of DVT associated with acute stroke.
• Heparin may be given via IV followed by oral to warfarin.
• Later the regimen may be changed to aspirin, which decreases the risk of thrombus by preventing platelets from clumping.
• Newer drugs such as dabigatran (pradaxa) or rivaroxaban (XARELTO) may also be considered for long-term anticoagulation instead of warfarin.
• Drugs given to prevent strokes caused by thrombi are acetylsalicylic acid (aspirin), clopidogrel (pplavix) and extended release dipyridamole (agrennox)

Question 24

RT - PA

Answer 24

• It is important to remember that recombinant tissue plasminogen activator, which is used to dissolve clots, is most effective when given within three hours of the onset of stroke symptoms.

Question 25

Traumatic chest injuries

Answer 25

• Traumatic chest injuries fall into two major categories: non-penetrating and penetrating.
• Common non-penetrating injuries: rib fractures, pneumothorax, pulmonary contusion, and cardiac contusion.
• Common penetrating injuries: results from gun shots or Stabwound to the chest. Some include pneumothorax and life-threatening tears of the aorta, vena cava, or other major vessel.

Question 26

Medical treatment of chest injuries

Answer 26

• Immediate care of a person with chest injury is directed at stabilization and prevention of further injury.
• Assess injury site and observe for other injuries such as bleeding.
• Immediately treat bleeding.
• Cover any open chest wound with an airtight dressing taped on three sides. This is called vented dressing.
• vented dressing prevents additional air from entering but permits air to escape through the chest wound.
• If you were to completely seal an open wound in the chest, air could continue to leak from the lungs into the plural space.
• With no exit, the leaki cumng air accumulate in the plural space and create a tension pneumothorax.
• If an airtight dressing has been applied, be alert for worsening respiratory status: increasing dyspnea, cyanosis, distended neck veins, trachea deviated from the midline, decreased breath sounds on the affected side, which requires removal of the airtigh dressing.
• Do not remove impaled object but stabilize them with a bulky dressing.
• Monitor vital signs and level of consciousness, keep in mind the potential for a shock.
• Oxygen may be administered by nasal cannula.
• To facilitate breathing, put the client in a semi Fowler position or on the injured side.

Question 27

Respiratory system medications

Answer 27

• Bronchodilators an anti-inflammatory drugs, are used to prevent or treat asthma symptoms.
• Asthma medication are classified as long-term control controllers, and those that relieve acute symptoms relievers.
• Controllers are anti-inflammatory drugs that include inhaled glucocorticoids, leukotriene modifiers, mast cell stabilizer’s, monoclonal antibodies, long acting inhaled beta adrenergic agonist (labas) such as someterol,and formoterol methylxanthines (oral theophylline) and inhaled anticholirgenics ipratropium, tiotropium, and aclidinium. Systemic cortical steroids may be used for asthma but does not respond to other controllers.
• Systemic cortical “steroids is limited to a use of two weeks some older adults are recommended to use instead of controllers.
• Relievers are primarily bronchodilators. They include inhaled short acting beta2 receptor agonist, anti-cholinergics, and the less commonly used methylxanthines.
• Anti-cholinergics enhance bronco dilator an action of beta 2 receptor agonist.
• Beta 2 receptor agonist are the most often used relievers, however, some anti-cholinergic medication or effective for this purpose.
• Patients with severe asthma and they also require other agents, such as aerosol cortical steroids.
• Some combination preparation’s are available.
• Advair contains both a cortical steroid and a bronchodilator, Combivent contains an anti-cholinergic and a bronchodilator, and dulera is a combination of mometasone and formalterol.

Question 28

Status asthmaticus

Answer 28

• A severe, life-threatening episode of asthma that does not respond to the patient’s usual treatment.
• It is treated with inhaled and intravenous bronchial dilator’s and oxygen therapy.
• Endotracheal intubation and mechanical ventilation or sometimes necessary.

Question 29

COPD drug therapy

Answer 29

• Many drugs used to treat asthma are also used to treat COPD.
• Bronchodilators, including better adrenergics and anticholinergics are order to decrease airway resistance and the work of breathing.
• A person with mild COPD may be prescribed a short acting inhaled better adrenergic agonist (SABA) or a short acting inhaled anticholinergic drugs for use only as needed.
• For moderate or severe COPD, a long acting bronchodilator may also be prescribed.
• Some evidence indicates that anti-cholinergic drugs such as ipratropium (atrovent) or tiotropia (spiriva) are more effective than better adrenergic agents for treating COPD and have fewer side effects.
• Oral theophylline is a rather weak bronchodilator, but it may be beneficial is given with inhaled bronchodilators.
• Inhaled corticosteroids are commonly used to reduce airway inflammation.
• These drugs reduce the frequency of exacerbations, especially when used in combination with LABA.
• Patient using inhale glucosteroids are at increased risk for pneumonia.
• Long term use of oral corticosteroids has adverse effects that include fluid and electrolyte disturbances, increased risk for infection, elevated blood glucose, osteoporosis, and suppression of the adrenal cortex.

Question 30

Theophylline

Answer 30

• Blood levels must be monitored because toxicity can cause seizures and fatal cardiac dysrhythmias.
• The therapeutic blood level is 5 to 16 ug/mL

Question 31

Oxygen therapy for COPD patients

Answer 31

• The goal of O2 therapy is to maintain the PA02 between 50 and 60 MMHG.
• The initial liter flow is 1 to 3 L/m
• The oxygen may be adjusted by increasing by 1 L at 15 minute increments into the O2 sats remained above 90%
• Periodically blood gas levels should be obtained.
• High levels of O2 are not administered because patients with COPD may rely on hypoxic drive to breathe.
• Since a patient with COPD has high levels of CO2 it relies on low PA O2 to stimulate breathing.
• O2 concentrator’s compressor and filter room air and deliver O2 to the patient doing nasal cannula.

Question 32

Gold standard for diagnosing TB

Answer 32

• The gold standard for diagnosing TB is culture on solid media or liquid media followed by drug susceptibility testing.
• This process takes 2 to 4 weeks.
• Blood test used to diagnose TB or interferon gamma release assays (IGRA’s) which include the quantiFERON-TB gold in-tube test, the QuantiFERON-TB gold test, and the T- spot.TB test.
• IGRA results are available in 24 hours.
• IGRA does not distinguish between active and past infections.
• Another option is the xpertrt MTP/RIf test (mycobacterium tuberculosis/resistance to rifampicin) which detects M. Tuberculosis and respiratory secretions and determine susceptibility to rifampin within two hours, but it’s very expensive.
• The acid fast bacilli AFB smears body fluid usually sputum to a ID TB but it may give you false positive results.
• Checks x-rays and CT’s help diagnose too

Question 33

Tuberculosis patient teaching

Answer 33

• Tuberculosis is spread by airborne droplets. Protect others by covering your mouth when coughing, laughing, or sneezing. Wash your hands often. Uses disposable tissues and discard them in bagged trash.
• Effective treatment requires taking drugs exactly as prescribed for the full course of therapy to prevent reinfection. Notify your physician of adverse effects of your drugs but do not stop taking them unless advised to do so by the physician.
• If you’re taking isoniazid (INH), you must avoid foods containing tyramine like aged cheeses, smoked fish and histamine like tuna, sauerkraut. These foods combined with iron age can make you very ill.
• Good hygiene, nutrition, and hydration can help you to recover.
• Rifampin causes body foods to become red orange and may stain soft contact lenses.

Question 34

Coagulation measures

Prothrombin time TP

Answer 34

• Normal: 11.0 to 12.5 seconds; 85% to 100%
• Full anticoagulation therapy:> 1.5 to 2.0
• Times control value; 20% to 30%
• INR:>5
• Significance of values
• Short: diet high in fat or leafy vegetables, some drugs.
• Prolonged: liver disease, oral anticoagulant therapy, biliary obstruction, some drugs.

Question 35

coagulation measures

Partial thromboplastin time, activator

aPTT

Answer 35

• APTT:30 to 40 seconds should not exceed 70 seconds.
• Significance of values
• Prolonged: hemophilia, biliary obstruction, liver disease, heparin and some other drugs including salicylates.

Question 36

Coagulation measures

Partial thromboplastin time

PPT

Answer 36

• PTT:60 to 70 seconds should not exceed 100 seconds
• On anticoagulant therapy: 1.5 to 2.5 times control value in seconds.

Question 37

Coagulation measures

Platelet count

Answer 37

• All adults: 150,000 to 400,000/MM3
• Significance of values
• Low: bone marrow failure; hemorrhage; platelet destruction by drugs, infection, antibodies; DIC
• High: estrogen’s, oral contraceptives, high altitude.

Question 38

Acquired immunity

Answer 38

• Acquired immunity is specific to a particular pathogen and is activated only when needed.
• The two types of acquired immunity or antibodies mediated and cell mediated.
• Antibody mediated immunity is initiated when the bodies immune system makes copies of the antigen so in the future it would recognize it really quick and fight off the infection and destroy it.
• Cell mediated immunity is aimed primarily at intracellular defects caused by viruses and cancer.
• Tell me rated immunity is also responsible for delayed hypersensitivity reactions and rejection of transplanted tissue.

Question 39

cell mediated immunity

Answer 39

• Aimed primarily at intracellular defects caused by viruses and cancer.
• Also responsible for delayed hypersensitivity reactions and rejection of transplanted tissue.
• Tc cells are the primary component of cell mediated immunity.
• When the Tc cells recognize forgein antigens in the cells they secrete cytotoxic substances that destroy the defective cells.
• Unfortunately, a transplanted tissue graft, such as a kidney transplant for a heart transplant, may be recognized by the Oregon recipients immune system has formed and is attacked by TC sells the same way.

Question 40

Hematopoietic stem cell transplantion

major Complications

Answer 40

• Major complications of bone marrow transplant Tatian and peripheral blood stem cell transportation include infection, thrombocytopenia, renal insufficiency, hepatic vina occlusive disease, and graft versus host disease.
• Infection is a risk because the patient have severe neutropenia for two weeks after transplant.
• The patient is severely neutropenic because of the chemotherapy and radiation.
• Renal insufficiency is a risk that can occur because of the high doses of nephrotoxic drugs from chemotherapy.
• Paddock Vino close of the seas happens if the liver is damaged again because of high doses of chemotherapy and radiation.
• Graft versus host disease is a complication of allergenic bone marrow transplant and which T lymphocytes and a transplant them about identify the patient says she has fortune and try to destroy the patience to shit like

Question 41

Bacillary angiomatosis

BA

Answer 41

• Manifestations: causative bacteria: Bartonella henselae And B Quintana.
• Primarily manifest and skin lesions: papules and plaques anywhere on the skin. Can affect other organs.
• Mode of transmission: usually transmitted by cats and their fleas. Most patients with BA have been bitten or scratched by a cat.
• Prevention: warn patients with HIV about the risk of being around cats; the patient should avoid rough play with cats and ensure that cats are treated for fleas.

Question 42

Medical diagnosis of HIV

Answer 42

• Fourth generation test for HIV test for both HIV antibodies and P24 antigen.
• The P 24 antigen is an HIV posting that is elevated in the first few weeks after infection. Newer test can detect it sooner than older ones some cat measure for as long as 12 weeks.
• The CDC criteria for diagnosing of aids: CD for cell count of less than 200 cells per MM3, a symptomatic.
• CD4 cell count of less than 200 cells per MM3, with category B symptoms which include BA, candidiasis, oropharyngeal, vaginal, and cervical dysplasia; herpes zooster shingles; ITP; listeriosis: 0HL; pelvic inflammatory disease and peripheral neuropathy.
• Category C symptoms regardless of the CD for cell count meaning you are screwed you have aids if you have cancer diocese of bronchi, trachea, or lungs, esophageal or cervical cancer; coccidial Adam mycosis; cryptococcosis; crypto portal seals; see Andy; and cephalopathy; herpes simplex virus; chronic ilcers of longer than 1 month duration. Bronchitis, pneumonia pneumonitis, or esophagitis; histoplasmosis; it was paralysis; KS;; M.AVM; and that tuberculosis; or P dural vessel in the Monia; pneumonia recurrent; progressive multiple focal leukoencephalopathy; salmonella; septicemia recurrent; toxoplasmosis; and wasting dang you about to die.

Question 43

Other fucking test you can take at home for your HIV

Answer 43

• The home access HIV-1 test system requires the patient to break a finger for a small blood sample, applied the sample to special card, and mailed a card to a laboratory for analysis.
• The results can be available by telephone and as little as one day.
• Oraquick advance is the home testing kit that detects HIV-1 and HIV-2 antibodies in 20 minutes using a cheek swab.
• False negative results occur in about 8% of infected persons using oraquick.

Question 44

Medication used to treat HIV

Nucleoside/nucleotide reverse transcriptase inhibitors NRTI’s

Answer 44

• abacavir (Ziagen), didanosine (videx), emtricitabine (Emtriva), lamivudine (Epivir), stavudine (Zerit), tenofovir (Viread) zidovudine (retrovir)
• numerous combo rx: Epzicom, truvada, Combivir
• Use and action: used to slow the progression of HIV infection by suppressing synthesis of viral DNA.
• Side effects: anemia, neutropenia, headache, confusion, nausea, diarrhea, fatigue, muscle damage, skin rash, lactic acidosis with in large liver and fatty liver, pancreatitis, peripheral neuropathy, and lipodystrophy.
• Nursing interventions: some of these drugs should be taken on an empty stomach while others can be taken with or without food; check manufactures direction.
• Neutrophil count and hemoglobin must be monitored as directed, usually every 2 to 4 weeks. Liver function will also be monitored.
• Multiple drug interactions are possible between an RTI’s and other drugs; therefore the prescriber must review the patient’s complete medication record before beginning these drugs or adding other drugs to the patient’s regimen.

Question 45

Medication is used to treat HIV

Protease inhibitors (PI’s)

Answer 45

• atazanavir (reyataz), darunavir ( Prezista), fosamprevanir (Crixivan), lopinavir and ritonavir (kaletra), nelfinavir (Norvir), saquinavir (Invarse), tripanavir (Aptivus)
• use and action: used to slow the progression and replication of HIV by blocking protease enzymes so that infected cells cannot produce HIV proteins.
• Side Effects: diarrhea, nausea and vomiting, kidney stones, jaundice, abdominal pain, headache, skin rash, numbness and tingling around the mouth, drooling, dizziness, sleepiness, sore throat, sweating, altered taste, and lipodystrophy.
• Nursing interventions: advice patient weather specific PEI should be taken on an empty stomach or with food.
• Multiple drug interactions are possible between PI and other drugs; therefore the patient’s complete medication record must be reviewed before beginning the strokes and before adding other drugs to the patient regimen after he or she is started on protease inhibitor.

Question 46

Medication is used to treat HIV

Fusion inhibitor

Answer 46

• enfuvirtide ( Fuzeon)
• uses and action: used in combination with other anti-retroviral drugs in treatment experienced patients. This drug prevents the HIV from entering CD4 T cells.
• Side effects: irritation at injection site, pneumonia, hypersensitivity, neutropenia, fatigue, nausea, and insomnia.
• Nursing interventions: reconstitute and store as directed. And check subcutaneously as ordered usually twice daily and rotate sites.

Question 47

Cultural and ethnic health disparities for hypertension.

Answer 47

• African Americans, as compared with other ethnic groups, have the highest prevalence of hypertension in the world.
• African-Americans develop hypertension at a younger age than Caucasians.
• African-American women have a higher incidence of hypertension than African-American men.
• Hypertension is more aggressive and African-Americans and results in more severe and organ damage.
• African-American have a higher mortality rate related to hypertension than Caucasians.
• African-Americans and Caucasians living in the south eastern United States have a higher incidence of hypertension than similar ethnic groups living in other parts of the United States.
• Mexican Americans tend to have lower levels of awareness of hypertension and its treatment than other ethnic groups.
• Mexican Americans are less likely to receive treatment for hypertension than Caucasians and African-Americans.
• Mexican Americans and Native Americans have lower rates of adequate blood pressure control than Caucasians and African-Americans.

Question 48

Age related changes in the cardiovascular system

Answer 48

• Heart muscle density increases and elasticity decreases.
• Cardiac contractility declines.
• Valve thicken, stiffen, and may not close properly.
• Cardiac output decreases.
• Pacemaker cells in the SA node decrease in number.
• Nerve fibers in the ventricles decrease in number.
• Heart takes longer to respond to stress or exercise and return to normal.
• Connective tissue and elastic fibers in arteries become stiffer, increasing peripheral resistance and impairing blood flow.
• After 60 years of age, peripheral vascular resistance increases by approximately 1% per year; systolic pressure rises in response to increased peripheral vascular resistance.
• Arterial pulse pressure increases.
• Vein stretch and dilate leading to Venus stasis and impaired venous return.
• Cardiovascular system adapts more slowly to changes in position, frequently resulting in postural hypotension.

Question 49

Heart rate calculation

Question 50

Cardiac catheterization: angiography, coronary arteriography

Answer 50

• Cardiac catheterization is a procedure in which a catheter is inserted into a vein or artery and is threaded into the heart chambers, coronary arteries, or both under fluoroscopy.
• The contrast dye is injected through the catheter and films are made of the visualize heart structures.
• ECG and vital signs are monitored during the procedure.
• When cathing the right side of the heart the Kath is inserted into a vein and threaded into the vena cava, RA, RV, and pulmonary artery.
• When caffeine of the left side of the heart the calf is inserted into an artery and threaded against the flow of the blood into the coronary arteries of the LV.
• Complications or bleeding, hematoma formation, infection, and embolus or thrombus formation.
• Angiography is invasive that requires the injection of dye into the vascular system, which makes the vessels visible on radiographs.
• There are arteriography and Venography
• The risks are hemorrhage at the IV site, die induce allergic reactions, thrombosis at insertion site, and emboli. And the patient exposed to radiation.

Question 51

Pressure measurements

Answer 51

• Plethysmography is a non-invasive study used to measure blood flow in the extremities.
• They put a whole bunch of blood pressure cuffs to the different parts of the extremities.
• If the pressure varies from one side to the other it can reveal vascular occlusion or obstructions.
• It’s not as accurate as an arteriography or a venography but it’s safer and it is good to use on patients who are too thick for the arteriography.

Question 52

Drugs that decrease the effectiveness of warfarin

Answer 52

• Antacids, barbiturates, oral contraceptives, and adrenal corticalsteroids.

Question 53

Cardioversion

Answer 53

• Is the delivery of a synchronous shock to terminate arterial ventricle Taki dysrhythmias.
• Like if your heart is racing like super quick and it’s going like fucking crazy they will shock the shit out of you kind of like when you seen Grey’s Anatomy that people say clear and then boom huey they fucking shock the shit out of you but it supposed to put your heart back in normal sinus rhythm don’t want to try it I will believe them.
• Digoxen does have to be stopped for 24 hours before
• Make sure they sign the procedure consent otherwise if they fucking die the wife can be like well he never consented to it ,bitch is he doing it but anyways make sure it signed.
• They will give the patient a short acting sedative and knock the shit out of them then I would not want to be awake for that shit either knock them out I agree.

Question 54

Patient teaching buerger Allen exercises

Answer 54

• No we are not teaching a patient named Alan how to exercise after eating a burger.
• These exercises allow gravity to fill an empty the blood vessels.
• Lay flat on your back and raise your legs above the level of your heart for two minutes or until they become very pale. You know like those scenes in the movie where the Horchata’s are trying to get pregnant so they put her legs up like on the wall yeah that’s how you want to do it.
• Lower the lakes to a dependent position and flex and extend your feet for three minutes or until color returns to your legs.
• Keep your legs flat for five minutes.
• Go through the entire process six times and each session if you can tolerate it. 3 to 4 sessions a day for the best results.
• Start the exercises immediately if you have pain or severe skin color changes.

Question 55

Cardiac disorders drug therapy

Answer 55

• Ace inhibitors, diuretics, better adrenergic blockers, and a tropic agents, cardiac glycosides, and nitrates.
• Some patients will benefit from BNP.
• Ace inhibitors decrease preload and afterload by blocking the RAA system, resulting in vital dilation, decrease in blood volume and lower blood pressure.
• Diuretics decree circulating fluid volume and decrease blood low. Loop diuretics like for a semi Lasix are usually use an HS. They make you pee shit load.
• Beta adrenergic blockers improve survival rates by decreasing HR, reducing the work of the heart, and lessening the O2 demand of myocardium.
• Inotropic agents like dopamine are prescribed initially short term to improve cardiac contractility, renal perfusion, and decrease fluid retention.
• Digoxin, a glycoside with an inotropic effects,is prescribing use long-term to improve pump function by increasing contractility and decrease in HR.
• Nitrates like nitroglycerin her basal dilator’s that reduce preload for patients with HS. This helps reduce the workload of the heart.
• Morphine is used to decrease anxiety, delete the vasculature, and reduce myocardial O2 consumption in the acute stage.

Question 56

Nursing care of the patient with chronic venous insufficiency

Answer 56

• When the patient has chronic venous insufficiency, inspect lower extremities for rubber and stasis dermatitis, palpate skin temperature, evaluate Adema, and determine the presence of pain in the affected extremity.

Question 57

BP stages and classification

Answer 57

• normal <120 and <80
• pre hypertension 120-139 and 80-89
• hypertension
• stage 1 140-159 and 90-99
• stage 2 >160 and >100
• Class A- no major risks, no target organ damage, and no clinical cardiovascular disease.
• Class B have one or more risk factors, not including diabetes; no target organ damage; and no clinical cardiovascular disease.
• Class C have target organ damage and clinical cardiovascular disease, diabetes, or all of these conditions, with or without others factors.

Question 58

Primary essential hypertension

Answer 58

• The most significant risk factors for primary hypertension or dyslipidemia, atherosclerosis, diabetes mellitus, tobacco use, HB on 35 years for men or 65 years for a woman, family history, diagnosed with heart disease before age 55, or mother before 65, and sedentary lifestyle.
• Obesity defined as weight 20% over ideal body weight, it’s also risk factor. The additional weight and fat cost increases the number of blood vessels, circulating blood volume, and cardiac workload.
• But the earth chlorosis decreases the elasticity of the arteries and ideologies, causing increased PVR.
• Nicotine in cigarettes constricts blood vessels and stimulates the release of FNF friend and norepinephrine.
• Harmons also constrict blood vessels and raise heart rate and BP.
• Lack of physical activity leads to pooling of blood in the extremities and increases the workload of the cardiovascular system.
• Otherwise factors include stress; stimulation overstimulation; and a family history of obesity, hypertension, or dyslipidemia.
  *

Question 59

Cultural considerations with antihypertensive drugs.

Answer 59

• Genes affect the way people metabolize drugs.
• Therefore ethnicity and race explain some variations and affects of antihypertensive drugs.
• Asians respond better to better blockers than caucasians.
• African Americans are best treated with thiazide diuretics and or a calcium channel blockers.

Question 60

Angiotensin converting enzyme inhibitors

Answer 60

• Captopril ( Capoten), enalapril (Vasotec), lisinopril (Zestril, Prinivil)
• Reduces aldosterone secretion and prevents the formation of angiotensin II, thus decreasing peripheral resistance and fluid volume.
• Side effects: skin rash, headache, dizziness, neutropenia, and cough. Renal failure can occur in patients with renal artery stenosis.
• Nursing intervention; monitor the patient’s blood cell count. Report any changes in your an output to the physician.

Question 61

Prothrombin time an international normalized ratio

PT and INR

Answer 61

• Measures clotting ability. Prolong with liver disease, vitamin K deficiency, anticoagulant therapy.
• Patient preparation: non-fasting, if patient is on warfarin, obtain specimen before daily dose. Those may be adjusted pending test results.
• Post procedure nursing care: monitor venipuncture site. Apply pressure, patient with liver disease may have prolonged clotting time. Check results: nurses should know these values: PT 11.0 to 14 seconds INR 0.8 to 1.1 seconds immediately report PT greater than 46 and INR greater than 5

Question 62

Greenstick fracture

Answer 62

• The greenstick fracture has been used to describe the incomplete fracture is most commonly seen in children. In this case, the bone is splintered on one side but only bent on the other.

Question 63

Complications of a fracture

Answer 63

• Can delay or impede healing and maybe even life-threatening.
• Short term complications include infection, fat embolism, deep vein from Boces, compartment syndrome, and shock.
• Long-term complications include joint stiffness and contractures, no union, nonunion, delayed union, posttraumatic arthritis, a vascular necrosis, and complex regional pain syndrome.
• Infection in the bone is called osteomyelitis. s/s: local pain, redness, purulent wound drainage, chills, and fever.
• Fat embolism is a condition in which flat gobbles are released from the marrow of the broken bone into the bloodstream. They might migrate to the lungs. s/S: respiratory distress, tachycardia, tachypnea, fever, confusion, and decreased level of consciousness. Another characteristic is Petechea
• DVT venous stasis, vessel damage, and altered clotting mechanisms contribute to the formation of blood clots, most commonly in the deep veins of the legs.
• Compartment syndrome it’s a serious complication that results from internal or X ternal pressure on the affected area. External pressure caused by cast or tight dressing can decrease blood flow to the area. Internal pressure can cause by Adema or bleeding into a compartment. Fluid trapped in a compartment puts pressure on the tissues, nerves, and blood vessels, decreasing blood flow and resulting in pain and tissue damage. Within 4 to 6 hours after the onset of compartment syndrome, irreversible muscle and nerve damage can occur. Paresis within 24 hours.

Question 64

Traction

Answer 64

• Is a pulling force on a fractured extremity to provide alignment of the broken bone fragments.
• It is also used to prevent or correct the foreman he, decreased muscle spasm, promote rest, and maintain the position of the disease or injured part.
• May be applied directly to the skin or attached directly to a bone by means of a metal pen or wire.
• Examples of skin traction, our buck traction, did use for hip and knee contractures, muscle spasms, and alignment of hip fractures.
• The weight used should be no more than 5 to 10 pounds.
• Skeletal traction provides a strong, steady, continuous pool and can be used for prolonged periods of time.
• Skeletal traction’s are gardener wells, Crutchfield, and vine key tongs and halo vest.
• Weights youth are 15 to 30 pounds.
  *

Question 65

Traction complications

Answer 65

• Impaired circulation, inadequate fracture alignment, skin breakdown, and soft tissue injury. Pin track infection and osteomyelitis.

Question 66

Nursing considerations with traction patients

Answer 66

• Weights must always hang freely.
• Ensure that the amount of weight use is correct as ordered, clamps are tight, and ropes move freely over pulleys.
• Maintain good body alignment so that the line of the pole is correct.
• Use padding to prevent trauma to the skin or traction is applied. Report skin breakdown or irritation to the physician.
• Assess affected extremity’s for temperature, pain, sensation, motion, capillary refill time, and pulses.
• Which skeletal traction, assess pin sites for redness, drainage, odor, which may indicate infection.

Question 67

canes

Answer 67

• Are used to provide minimal support and balance and to relieve pressure on weight-bearing joints.
• The cane is placed on the unaffected side with the top of the cane even with the patience greater trochanter.
• The elbow should be flex to 30°.
• The cane should be held close to the body on the unaffected side and advance along with the affected leg.
• A two point or four point gate is used with a cane.
• When walking, it is better to lift the cane rather than slide it along to prevent catching the cane tip and tripping or falling.

Question 68

Amputation skin breakdown

Answer 68

• The residual limb is bandage to promote healing and to shrink and shape the residual them to a tapered, round, smooth and that will fit the prosthesis.
• Avoid a tourniquet like effect caused by pulling the bandage to tightly or unevenly.
• Shrinker socks are available that maintain compression; however, they are expensive, and it’s difficult to find the right size and length for many patients.
• Edema in the first 24 hours postop is very common.
• Elevated affect and lower extremities by raising the foot of the bed. Pillows can be placed under a below knee amputation, although the use of pillows is the screws with lower extremity amputation because it can cause contractures of the hip.
• Position the patient in low Fowlers rather than high Fowlers.
• After the 5th to 7th postop day the limb can be massage to promote circulation.
• It’s permitted, a patient with lower extremity amputation should lie prone for 30 minutes 3 to 4 times a day.

Question 69

Amputation knowledge deficit

Answer 69

• Pain or a phantom limb sensation is common. It is often described as a burning, stinging, or crushing pain. It tends to lessen with activity, weight-bearing, and exercise.
• Treatment for this type of pain include devotional activities, whirlpool, massage, injection of the residual limb with an anesthetic, or transcutaneous electrical nerve stimulation. A properly fitting dressing helps some patience.
• Dragons that are sometimes helpful include better blockers, anticonvulsants, neuroleptics, benzodiazepines, and antidepressants.

Question 70

Glycosylated hemoglobin A1c

Answer 70

• Provides a long-term index of the patient’s average blood glucose level.
• Patient preparation: non-fasting. General interventions. Tell the patient that the results indicate how well diabetes is being controlled. Target level is < 7%
• Post procedure care: general interventions.

Question 71

Type one diabetes glucose

Answer 71

• Insulin stimulates the active transport of glucose into the cells.
• When insulin is absent, glucose cannot enter most cells., So it remains in the bloodstream.
• The blood becomes thick with glucose, which increases the osmolality of the blood.
• Increase osmolality stimulates the thirst center, causing the patient to experience polydipsia and take an addition of fluid.
• The increase fluid does not pass into body tissues, however, because the high serum osmolality retains the fluid in the bloodstream.
• As a blood passes through the kidneys, some excess glucose is eliminated. The osmotic force created by glucose draws extra fluid and electrolytes with it, causing abnormally increase your an output polyuria
• Your storage fat is broken down to provide fuel heat and energy because cells need glucose without insulin no cells can’t do the glucose without the insulin.
• Because you’re fat tissue is breaking down and you lose like lean body mass your body gets Hella hungry because the hypothalamus good hunger signals and when you’re super hungry it’s not being a fatty is called polyphagia.
• Apparently if you have diabetes you are blessed with good metabolism because no matter how much you eat you still lose weight it sucks to have diabetes but I mean that’s a good little advantage there.
• Insulin is needed to transport glucose into resting muscle cells.
• If you’d like to exercise a lot and you have diabetes you probably should take a snack with you or inject yourself with the insulin right before exercising because muscle fibers are very pure mobile and in the absence of insulin your glucose levels will go down and you’re going to faint.
• Insulin regulates the rate in which glucose is metabolized so the more your insulin response to carbs been eaten the faster there are metabolized. This explains maybe why I gain weight see if it makes sense how the fuck do you lose weight then whatever.
• One black coal called racist insulin production is stimulated and the conversion of glycogen to glucose is inhibited this process used to maintain some blood glucose within a normal range however when someone is not what it is converted to glucose in attempt to no Schuylkill starfishes yeah hyperglycemia curious because south cannot use the glucose.

Question 72

Diabetic retinopathy

Answer 72

• Is a term used to describe pathological changes in the retina that are so shaded with DM.
• There are two types nonproliferative and proliferative.
• Both may be present at the same time.
• Nonproliferative disease include small hemorrhage is an aneurysms in the retina, heart lipid and protein exudate that leak from the blood vessels, and farted nerve fibers, and changes in retinal veins.
• Proliferative disease is characterized by the growth of abnormal capillaries on the retina and the optic disc.
• These fragile vessels can penetrate the vitreous humor and rupture. One hemorrhaging into the metro secures it becomes cloudy and vision is lost.
• The blood is eventually reabsorbed but the scars may remain which place is traction on the retina and may result in retinal detachment.

Question 73

Nephropathy

Answer 73

• 36% of people with DM will also have chronic kidney disease.
• African-Americans, Native Americans, and Mexican Americans have 4 to 6 times greater risk of developing ESRD.
• Factors that contribute to kidney issues is poor control of blood glucose, hypertension, long-standing diabetes, and genetic susceptibility,.
• High levels of glycosuria along with hypertension gradually destroy the capillaries that supply the renal glomeruli.
• No signs or symptoms and early stage once protein levels exceed 300 mg per day or albumin 500 mg per day the condition will likely progressed to ESRD.
• Signs of kidney failure: persistent protein urea, elevated BP and serum creatinine, hematuria, and only Gloria or anuria.

Question 74

Acute hypoglycemia

Answer 74

• Events that may trigger dangerous drops and blood glucose include taking too much insulin, not eating enough food, not eating at the right time, and an inconsistent pattern of exercise.
• Other variables are gastroparesis, renal insufficiency, certain drugs, like aspirin and better adrenergic blockers.
• Glucose levels between 50 and 70 or considered moderate hyperglycemia.
• S/S: adrenergic symptoms are first to appear shakiness, nervousness, irritability, tachycardia, anxiety, lightheadedness, hunger, tingling or numbness of the lips or tongue, and diaphoresis.
• beta adrenergic blockers might block the symptoms.
• neuroglucopenia or neuroglycopenia are the second symptoms that appear.
• The symptoms include drowsiness, irritability, impaired judgment, blurred vision, slurred speech, headaches, mood swings progressing to this orientation, seizures, and unconsciousness.
• Severe hypoglycemia progresses to loss of consciousness, convulsions, coma, and death.

Question 75

Glycosylated glucose levels

Answer 75

• AC1 levels should be checked every 2 to 3 months to check glycemic control.
• When the glucose level is elevated, a certain percentage of glucose molecules bind to the hemoglobin on the RBC cell. They stay on it the cell for life of the cell which is approximately three months.
• And a 1C result of 6.0% reflects an average blood glucose level of 126 where is the result of 9.0% reflects glucose of 212.
• The goal score is under 7%

Question 76

Pathophysiology of hypoglycemia

Answer 76

• Blood glucose level depends on insulin levels, available glucagon, and the secretion of catecholamines, GH, and cortisol.
• Hypoglycemia may occur to the abnormalities in these regulators or noted.
• If blood glucose level falls to less than 70 MG per DL it is considered hypoglycemia.
• The causes of hypo glycemia may be divided into three categories: Exogenous, endogenous, and functional.
• Exogenous hypoglycemia results from outside factors: insulin, oral hypoglycemic agents, alcohol, or exercise.
• Endogenous hypoglycemia occurs from internal factors these conditions may be related to tumors or genetics when there’s an excessive secretion of insulin.
• Functional hypoglycemia results from a variety of causes like gastric surgery, fasting, or malnutrition.

Question 77

Signs and symptoms of hypoglycemia

Answer 77

• Adrenergic symptoms are weakness, hunger, diaphoresis, tremors, anxiety, irritability, headache, Taylor, and tachycardia.
• Neuroglycopenic symptoms are confusion, weakness, dizziness, blurred or double vision, seizures, and in severe cases coma.

Question 78

Pathophysiology of psoriasis

Answer 78

• Psoriasis is an auto immune disorder characterized by abnormal proliferation of skin cells.
• The classic sign of psoriasis is the appearance of bright red lesions that may be covered with silvery scales.
• Onset is common in young adult hood, it can appear at any age.
• Psoriasis may affect a limited body area or be extensive.
• Some people have systemic effects of the disease, such as psoriatic arthritis.

Question 79

Medical treatment of psoriasis

Answer 79

• Can be treated topically or systemically.
• Patients with mild psoriasis are usually treated with topical medication: corticalsteroids, tazarotene, Estar, and vit D deratives (calcipotriene, Dovonex) Topical salicylic acid may be used with corticosteroids.
• Tazarotene stays on the skin longer= longer remission
• Anthralin (anthra-derm) removes heavy scales- apply to lesion only with gloves.
• After a specified period with tissues.
• It’s stains hair skin fingernails furniture and bathroom fixtures.
• Moderate to severe psoriasis may be treated with psoralen and ultraviolet A, a combination of methotrexate and UVA.
• Other oral drugs include oral retinoids like acid Treton and biologic agents intercept.
• Patients on most forms of systemic therapy require periodic liver testing and blood studies because of the adverse effects.
• Methotrexate and all that noise or contraindicated during pregnancy.
• Estar gel does not stain.
• Ultraviolet B may be used to enhance topical therapy with tar and anthralin.

Question 80

Therapeutic outcome of medication is used to treat high blood pressure

Answer 80

• The primary therapeutic outcome expected from calcium channel blocker’s therapy is reduction in blood pressure.

Question 81

Angiotensin converting enzyme inhibitors actions

Answer 81

• The ace inhibitors reduce afterload by blocking angiotensin II mediated peripheral vasoconstriction, and they help reduce circulating blood volume by inhibiting the secretion of aldosterone.
  *

Question 82

Ace inhibitor uses

Answer 82

• The ace in Hibbett her’s reduce blood pressure after load, preserve cardiac output, and increase renal bloodflow.
• They are preferred over to Jackson for treatment of mild to moderate systolic dysfunction heart failure.

Question 83

Bronchodilators

Answer 83

• Relax the smooth muscle of the tracheobronchial tree.
• This allows an increase in the opening of the bronchioles and alveolar ducts, which decreases the resistance to airflow into the alveolar sacs.
• Obstruction of the airway from asthma and bronchitis is reversible.
• Airway constriction from emphysema is somewhat reversible, depending on how severe and how long they’ve had the disease.
• *The primary bronchodilator** used are better adrenergic agonist and anti-cholinergic Aerosoles.
• Combining bronchodilators that have different mechanisms of action and duration of action may increase the degree of bronchodilation and lung function for equivalent or fewer side effects.

Question 84

Anti-inflammatory agents for the respiratory system

Answer 84

• Corticosteroids are the most effective agents in the main state of all asthma therapy.
• Usually by inhalation and in combo with beta adrenergic agonist.
• Systemic steroids, usually prednisone are used for 1 to 2 weeks only.
• Other agents used are leukotriene modifiers, cromolyn sodium, and Roflumilast.
• Leukotriene modifiers block leukotriene formation, which is part of the inflammatory pathway that causes bronchial constriction.
• Cromolyn acts as a mast cell stabilizer, preventing the release of histamine and other chemicals that activate the inflammation cascade.
• Roflumilast is the first of a new class of agents, the selective PDE 4 inhibitors.
• This agent inhibits the release of inflammatory mediators and inhibits immune cell activation.

Question 85

Therapeutic outcome of anti-cholinergic anti-emetics.

Answer 85

• The primary therapeutic outcome expected from the anti-cholinergic anti-emetics is relief of nausea and vomiting.

Question 86

How are antimicrobial agents chosen

Answer 86

• The selection of antimicrobial agents must be based on the sensitivity of the pathogen and the possible toxicity to the patient.
• If possible infecting organism should be first isolated and identified. Culture and sensitivity test should be completed to identify the effects of organism and determine the antibiotic to which the infecting organism is most sensitive.
• Bacterium is labeled as gram-negative micro organisms or gram-positive.

Question 87

Admitting a patient

Answer 87

• If it’s normal business hours the admission clerk is responsible for attaining like demographics, insurance, identification information emergency contacts privacy and confidentiality stuff and interpreter Hass to be used if they don’t speak English the nurse may have to do this if nobody else is available.
• Once all that is done and ID band will be placed on the patient’s wrist. And allergy bands will be placed if necessary.
• If the patient is unconscious than a family member or legal guardian will do the admission.
• Patient sign consent for general treatment. Hippo must be signed

Question 88

Typical assessment of ears

Answer 88

• Know if the ears are symmetric, variation in size is considered normal.
• Test for patency, press against one nostril and ask a patient to breathe. Air should flow through the nose. Assess both nostrils, observing for bleeding or drainage.
• Know if there’s a deviated septum.