Mark Corson

By Q. Hurit. Goucher College. 2018.

If patient exhibits ataxia or weakness or lack of coordination purchase zovirax 400mg line, when ambulating generic 400 mg zovirax with amex, provide supervision/assistance generic zovirax 800mg with visa. Use siderails once in bed and identify at risks for falls Note: any signs and symptoms of jaundice: nausea, diarrhea, upper abdominal pain, or the presence of high fever, check liver function tests 7. Report if yellowing of the eyes or skin, or mucous membranes (evident in the late stages of jaundice or a biliary tract obstruction), hold if overly sleepy/confused or becomes comatose 8. With suicidal tendencies, anticipate drug will be prescribed in small doses, report signs of increased depression immediately 9. If history of alcoholism or if taking excessive quantities of drugs, carefully supervise amount of drug prescribed and dispensed, assess for manifestations of ataxia, slurred speech, and vertigo (symptoms of chronic intoxication and that patient may be exceeding dosage) Note: any evidence of physical or psychological dependence, assess frequency and quantity of refills Patient/Family Teaching: 1. These drugs may reduce ability to handle potentially dangerous equipment such as cars or machinery 25 2. Take most of the daily dose at bedtime, with smaller doses during the waking hours to minimize mental/motor impairment 3. Arise slowly from a lying position and dangle legs over the side of the bed before standing, if feeling faint, sit/lie down immediately and lower the head 6. Allow extra time to prepare for daily activities, take precautions before arising, to reduce one source of anxiety and stress 7. Do not stop taking drug suddenly, any sudden withdrawal after prolonged therapy or after excessive use may cause a recurrence of the preexisting symptoms of anxiety, anorexia, insomnia, vomiting, ataxia, muscle twitching, confusion, and hallucinations, and may develop seizures and convulsions 8. Identify/practice relaxation techniques that may assist in lowering anxiety levels 9. These drugs are generally for shortterm therapy, follow up is imperative to evaluate response and the need for continued therapy 10. Available forms of Ativan are injectable: 2 mg/ml and 4 mg/ml; oral solution (concentrated): 2 mg/ml; tablets are in 0. The oral route of onset is in 1 hour with a peak of 2 hours and a duration of 12 – 24 hours. Nursing Considerations: Keep emergency resuscitation equipment and oxygen available. Pharmaceuticals, among other industries use it in preparations 27 for making some medications including Ativan (antianxiety). Nursing Considerations: Azole Antifungals may increase first pass metabolism of Buspar (antianxiety). Nursing Considerations: Contraindications are those with a hypersensitivity to Benzodiazepines, Acute Angle Closure Glaucoma, Psychosis. Concurrent Ketoconazole (Nizoral) or Itraconazole (Sporonox) both antifungals, therapy, and children younger than age 9. The oral route has an onset of 1 – 2 weeks with a peak of 2 – 4 weeks and the duration is weeks. Available forms: injection 5mg/ml; oral solution 5 mg/ml, 5 mg/5 mg; rectal gel twin packs 2. If not, inject slowly through infusion tubing as near to the insertion site as possible. Warn patient to avoid activities that require alertness and good coordination until effects of drug are known. To induce sleepiness and amnesia and to relieve apprehension before anesthesia or before and during procedures. Infants and children ages 6 months to 5 years or less cooperative, older children: 0. Additional doses to maintain desired level of sedation may be given by slow titration in increments of 25% of dose used to first reach the sedation end point. Additional doses to maintain desired level of sedation may be given by slow titration in increments of 25% of dose used to first reach the sedative end point. Contraindicated in patients hypersensitive to drug and in those with acute angle-closure glaucoma, shock, coma, or acute alcohol intoxication. Continuously monitor patient, including children taking syrup form, for life-threatening respiratory depression. Available forms: capsules - 10 mg, 25 mg and 50 mg; Injection - 25 mg/ml, and 50 mg/ml; Syrup - 10 mg/5 ml; and tablets - 10 mg, 25 mg, 50 mg, and 100 mg. Nursing Considerations: Anticholinergics may cause additive Anticholinergic effects. May cause false negative skin allergen tests by reducing or inhibiting the cutaneous response to histamine. Elderly patients may be more sensitive to adverse anticholinergic effects: monitor these 44 patients for dizziness, excessive sedation, confusion, hypotension, and syncope. Available in oral solution: 1 mg/ml (concentrate); orally disintegrating tablets: 0. Antiinfective drugs can be divided into those that are bacteriostatic, that is to arrest the multiplication and further development of the infectious agent, or bacteriocidal, which is to kill and thus eradicate all living microorganisms. Both lines of administration and length of therapy may be effective by this difference. Some antiinfectives halt the growth of or eradicate many different microorganisms and are termed broad spectrum antibiotics. Others affect only certain specific organisms and are narrow spectrum antibiotics. Penicillin’s cause more severe and more frequent hypersensitivity reactions than any other drug. Because of differences in susceptibility of infectious agents to antiinfectives, the sensitivity of the microorganism to the drug ordered should be determined before treatment is initiated. Certain antiinfective agents have marked side effects, some of the more serious of which are neurotoxicity, ototoxcicity, and nephrotoxicity. Care must be taken not to administer two antiinfectives with similar side effects concomitantly, or to administer these drugs to patients in whom side effects might be damaging (a nephrotoxic drug to a patient suffering from kidney disease).

B-2 2) Does the article relate to at least one step in the medication management process (prescribing/ordering buy zovirax 200 mg line, transmitting discount 200 mg zovirax with mastercard, order communication zovirax 800 mg without a prescription, administering, monitoring-patient or population, reconciliation or education)? If you have left a question unanswered and have not selected no or uncertain, the system will display an error and you will need to check for any unanswered questions. This intent may be explicitly stated in the text of the article or it may be bannered as a review, overview or meta-analysis in the title or in a section heading. If it’s about patients taking drugs or someone deciding what/how much or =when to take a drug, then include it. These correspond with the 5 Key Questions being addressed in the review a) Related to patient outcomes b) Deals with costs, benefits etc of the system c) Deals with values proposition to any of the users (value issues that users consider when deciding to use the system “what benefit is there for me? It contains data from a study, which can be numerical (quantitative) or text data from a qualitative study where focus groups, delphi method, interviews etc were conducted and transcribed. Does the study assess the values people consider when determining whether or not a particular application is useful to them? These will likely be survey or interview studies with people’s opinions, and can be patients, clinicians, pharmacists, hospital administrators etc. If yes, does it further describe the systems characteristics (such as proprietary, home-grown), or information about certification or conformity, or flexibility in the system (ability to customize) etc? Discussion of sustainability could include financial sustainability, maintenance and updating issues, adaptability of the system. It can relate to financial, technological, socio­ political or organizational factors. Does the study address the electronic communication between the clinician and the pharmacy? If you have an unusual measurement and you don’t know where it falls, make a note of it at the bottom of the assessment page: (see table on p 3 for guidance) i. Composite outcomes (are formed by combining individuals’ scores on a collection of singular measures-usually in trials with a range of treatment effects) b. This can be a different time-point, a before- after, a control group, another intervention group. This means that they will state in their introduction the effect they think they will see based on their intervention, or they will statistically analyze/compare the groups. Continue to the bottom of the page and make a note in the outcomes section and methodology box. Continue to the bottom of the page and make a note in the outcomes section and methodology box. Continue to the bottom of the page and make a note in the outcomes section and methodology box. B-6 Methods: Follow the methods algorithm to determine the methodology used in the study. Prescribing CheckBox The process of a clinician deciding and ordering a medication for a patient Transmission, order CheckBox The bi-directional communication of the communication prescription and it’s fine-tuning between clinician and pharmacist. Includes electronic data exchange Dispensing CheckBox The preparation of the prescription in the pharmacy and getting it to the patient Administering CheckBox The patient taking the drug. Monitoring including CheckBox Monitoring of patient taking drug for adverse patient adherence and events, reactions, compliance, adherence, compliance and efficacy. Education of patients and CheckBox Pre-professional education includes nursing, clinicians but not pre­ medical, dental etc students learning their professional education profession--they are excluded. Need to include the issue of medication as well as education around taking and reviewing medications. Reconciliation can go here as well where clinicians and patients check that lists of drugs for a particular patient is complete and up to date. Internal funding Radio--start off This would be a statement that the division or group provided funding or if the study says things like “no external funding was used”. External funding by Radio--start off Funding section will indicate funding agency grants, projects, name contracts External funding by Radio--start off Funding section will indicate sponsoring industry, companies company name Both internal and external Radio--start off B-8 Version 10-07-09 Question General Study Options Instructions Information Not specified Radio--start off Use this when no funding information is provided in the paper. If this studies or the evidence article is not about an original study, and it on their question? Usual care Checkbox Pre-implementation or baseline would be considered usual care, where care has not changed from the usual A control group Checkbox This does not include the ‘before’ for a pre- post implementation study or baseline in a time series study. Both groups followed forward in time to determine if the outcomes of interest develop. Case control Checkbox A study where groups of people are formed, one of which has the outcome of interest (e. Often members in the groups are “matched” in relation to things like age or experience. Time series Checkbox A study in which periodic measurements are obtained prior to, during, and following the introduction of an intervention or treatment in order to reach conclusions about the effect of the intervention. If only 2 points, 1 pre- and 1 post-implementation, then it is a before-after study. Before-after Checkbox A type nonrandomized study where data are collected before and after patients receive an intervention. Before-after studies can have a single arm where the before group is usual care or it can include a control group. Cross-sectional Checkbox involve observation of some subset of a population of items all at the same time, in which, groups can be compared Qualitative Checkbox Research that derives data from observation, interviews, or verbal interactions and focuses on the meanings and interpretations of the participants. Must say they are doing qualitative work-words like qualitative, themes, narrative, ethnography, phenomomology.

Mucus mistaken for casts hemoglobin purchase 800 mg zovirax mastercard, cytoplasmic blebs and an asymmetrical Body fluids/Evaluate laboratory data to determine membrane distinct from crenation cheap zovirax 800 mg with visa. The cytoplasm possible inconsistent results/Urinalysis/3 may be extruded from the cell and may aggregate at 13 order zovirax 800mg with visa. Intravascular hemolytic phenomenon is most often caused by: anemia causes hemoglobinuria rather than hematuria. Severe dehydration with extravascular hemolysis or hepatocellular Body fluids/Correlate clinical and laboratory data/ liver disease. A freshly voided specimen is needed Hematuria/2 to detect urobilinogen because it is rapidly photooxidized to urobilin. Urobilin does and turns brown after storage in the refrigerator not react with 2,4 dimethylaminobenzaldehyde or overnight. Te technologist requests a new 4-methoxybenzene diazonium tetrafluoroborate, specimen. Which test result would the urobilinogen test in the first sample will be normal, differ between the two specimens? Ketones and nitrites do not alter Body fluids/Apply knowledge to recognize sources of the pigment of the urine sample. Leukocytes cause the error/Urobilinogen/3 urine to be turbid but do not cause abnormal color. A patient’s random urine consistently contains These three tests are stable for 24 hours when urine is a trace of protein but no casts, cells, or other refrigerated within 30 minutes of collection. C Protein and other constituents of urine will often be sample is consistently negative for protein. A normal first-voided findings can be explained by: sample makes glomerular disease highly unlikely. Normal diurnal variation in protein loss Orthostatic albuminuria is a benign condition B. Orthostatic or postural albuminuria bent posture that puts back pressure on the kidneys. Microalbuminuria The quantity of albumin excreted into the urine is Body fluids/Evaluate laboratory data to determine small. Diagnosis is made by demonstrating a positive possible inconsistent results/Urinalysis/3 test after the person is erect for several hours, and the absence of proteinuria when the person is recumbent. Microalbuminuria seen in diabetic persons is usually accompanied by a positive test for urinary glucose. An error was made in the microscopic Answers to Questions 16–19 examination Body fluids/Evaluate laboratory data to determine 16. A urine sample has a negative blood reaction and test is significantly less sensitive. As a result, a trace to 5–10 cells per high-power field that resemble red small positive blood and negative protein test are blood cells. If a yeast infection Body fluids/Apply knowledge to recognize sources of is present, then the leukocyte esterase test will likely error/Microscopic/3 be positive; therefore, the leukocyte esterase test cannot be used to determine the identity of the cells. A pleural fluid submitted to the laboratory is Answers to Questions 20–23 milky in appearance. However, chylous effusions are odorless and have a twofold higher triglyceride than the Body fluids/Select test/Pleural fluid/2 plasma. A cerebrospinal fluid sample from an 8-year-old Pseudochylous effusions are foul smelling, usually child with a fever of unknown origin was tested have a mixed cellularity, and an elevated cholesterol. What is the most glucose, but may be somewhat lower in a diabetic likely cause of these results? A Bloody, exudative fluids with a preponderance of a several clusters of these cells were observed and singular cell type are suggestive of malignancy. The that the majority of the cells contained many cellularity in malignancy is variable but lymphocytosis vacuoles resembling paper-punch holes. They may be resting cells, reactive, degenerated, macrophages or phagocytic in nonmalignant conditions. Adenocarcinoma from a metastatic site inflammatory conditions, they are often increased C. Nodular sclerosing type Hodgkin’s disease of such cells and paper-punch vacuoles throughout Body fluids/Apply knowledge to recognize inconsistent the cytoplasm and over the nucleus are characteristics results/Serous fluids/3 of malignant mesothelial cells. Given the following data for creatinine clearance, gross appearance of this fluid suggests malignancy. Repeat the urine creatinine; results point to a greater than the upper physiological limit. Request the patient’s age and sex Body fluids/Evaluate laboratory data to recognize problems/Creatinine clearance/3 6. Te 2-hour timed blood D-xylose is Te technologist also noted that a urine amylase 15 mg/dL (lower reference limit 30 mg/dL). Request a new specimen; do not report results sample of the stat sample Body fluids/Apply principles of special procedures/ D. Report the result and recommend repeating the delayed and an L/S ratio of 2:1 may be associated L/S ratio in 24 hours with respiratory distress syndrome. Perform scanning spectrophotometry on the correlates with an L/S ratio of 2:1 or higher and rules fluid to determine if blood is present out a falsely increased result caused by blood C. The best course of action is to wait an those results additional 24 hours and perform another L/S ratio on D. Report results as invalid a fresh sample of amniotic fluid because an L/S ratio Body fluids/Correlate laboratory data to verify test of 3:1 would indicate a high probability of fetal lung results/L/S ratio/3 maturity.

Te most municipal water supply zovirax 800mg low cost, the most likely causative likely combination of disease and diagnostic agent is: procedure is: A trusted zovirax 200mg. Paragonimiasis and wet preparation Microbiology/Apply knowledge of life cycles and Microbiology/Apply knowledge of pathogenesis and epidemiology/Parasitology/2 diagnostic procedures/Parasitology/3 Answers to Questions 56–61 57 purchase zovirax 800mg fast delivery. After returning from a 2-year stay in India, a patient has eosinophilia, an enlarged left spermatic 56. B The fact that the patient has received a transplant, is cord, and bilateral inguinal lymphadenopathy. Tick blood films—microfilariae perform is the preparation and examination of thick blood films for the recovery and identification of Microbiology/Apply knowledge of pathogenesis and microfilariae. Patients with severe diarrhea should use immediately infective when passed in stool, and “enteric precautions” to prevent nosocomial nosocomial infections have been well documented infections with: with this coccidian. Cystoisospora belli and the amastigote in the striated muscle (usually Microbiology/Apply knowledge of pathogenesis and life cardiac muscle and intestinal tract muscle). A 60-year-old Brazilian patient with cardiac return to the United States (primary versus relapse irregularities and congestive heart failure suddenly case), and history of antimalarial medication and dies. Examination of the myocardium revealed illness (severe illness, few organisms on smear) are numerous amastigotes, an indication that the very important questions to ask. Without this cause of death was most likely: information, a malaria diagnosis can be missed or A. Trypanosomiasis with Trypanosoma gambiense through contaminated municipal water supplies. Fever patterns, travel history, diet Microbiology/Apply knowledge of pathogenesis and life cycle, and epidemiology/Parasitology/3 7. Plasmodium vivax and Plasmodium ovale are of diarrheal disease have been associated with the similar because they: ingestion of strawberries, raspberries, fresh basil, A. Exhibit Schüffner’s dots and have a true relapse mesclun (baby lettuce leaves), and snow peas. Cystoisospora belli Microbiology/Apply knowledge of life cycles and Microbiology/Apply knowledge of life cycles and morphology/Parasitology/2 epidemiology/Parasitology/2 Answers to Questions 62–67 63. Te microfilariae are in the blood during the late evidence strongly implicates various berries, basil, evening hours mesclun, and snow peas as likely causes. Te diagnostic test of choice is the skin snip outbreaks are very sporadic and tend to occur D. Te most prevalent helminth to infect humans is: under the outer layers of skin; thus, the appropriate A. Enterobius vermicularis, the pinworm diagnostic test is the microscopic examination of skin B. Ascaris lumbricoides, the large intestinal snips for the presence of microfilariae. Taenia saginata, the beef tapeworm parasitic helminth infection throughout the world, D. Schistosoma mansoni, one of the blood flukes and the eggs are infective within just a few hours. Microbiology/Apply knowledge of life cycles and Some have said, “You either had the infection as a epidemiology/Parasitology/1 child, have it now, or will have it again when you 65. These ascarid eggs of the Microbiology/Apply knowledge of organism dog can infect humans; the eggs hatch and the larvae morphology/Parasitology/1 wander through the deep tissues, occasionally the 66. Microbiology/Apply knowledge of life cycles/ Parasitology/2 474 Chapter 7 | Microbiology 68. Parasite stages that are immediately infective for with the following parasites: humans on passage from the gastrointestinal tract A. Microsporidia have been identified as causing severe diarrhea, disseminated disease in other body 74. Routes of infection fifth human malaria, Plasmodium knowlesi, have been identified as: resemble those of: A. Plasmodium vivax Microbiology/Apply knowledge of life cycles/ Microbiology/Apply knowledge of organism morphology/ Parasitology/2 Parasitology/3 70. An immunocompromised patient continues Answers to Questions 68–74 to have diarrhea after repeated ova and parasites (O&P) examinations (sedimentation 68. Taenia solium and Endolimax nana been confirmed as ingestion and inhalation of the D. Sporozoites within the spore trichrome stains for the microsporidial spores are C. Organisms stained with modified acid-fast stains Microbiology/Apply knowledge of life cycles and 71. C Confirmation of an infection with microsporidial diagnostic procedures/Parasitology/3 spores can be achieved by seeing evidence of the polar tubule within the spores (horizontal or diagonal 72. Plasmodium vivax infectious when passed in the stool, regardless Microbiology/Apply knowledge of organism morphology/ of the stool consistency (formed—liquid). A The older developmental stages of Plasmodium knowlesi (trophs, schizonts) resemble those seen in infections with P. Loss of Schüffner’s dots, poor adherence of the Microbiology/Apply knowledge of organism morphology blood to the glass slide, and parasites beginning and diagnostic procedures/Parasitology/3 the vector cycle within the tube of blood C. All of these options knowlesi include: Microbiology/Apply knowledge of specimen collection A. D Autofluorescence requires no stain and is often disease recommended for confirmation of Cyclospora D. A An infection with microsporidia can be confirmed stains using modified trichrome stains (10X the normal dye C. Electron microscopy and modified acid-fast content found in routine trichrome stains) and light stains microscopy. Fluorescence microscopy and hematoxylin stains within some of the spores; this will serve as Microbiology/Apply knowledge of organism morphology confirmation of the infection.