3114 :')
How can you stimulate the bone marrow to manufacture more red blood cells?
Erythropoietin (Epogen/ Procrit)- SC injection
Pain tolerance
maximum intensity or duration of pain that a person is willing to endure →Greater variation from person to person →Associated with slow pain pathway
Does aging mean disease?
**NO**
Main risks of Transfusion
-reaction -HIV ( about 1 in 2 million) -Hep B (1 in 205,000) -Hep C (1 in 2 million)
Storage of insulin
-room temperature -in hot (stored in cooler) -extra unopened insulin should be refridgerated
ITP treatment
-safe platelet count -IV immunoglobulin -Splenectomy
Erythropoiesis
-stimulated by hypoxia -controlled by ERYTHROPOIETIN -reticulocytes (baby RBCS) mature into RBCS= good production rates
Polycythemia
-too many RBC's. WBC's, and platelets •Hgb increases to >18 mg/dl, Hct > 55 % •Hypervolemia, hyperviscosity, engorgement of capillary beds
Iron-Deficiency Anemia DX studies
-Decrease hgb, hct, MCV,MCH, serum iron, ferritin, reticulocytes ,increase TIBC, small and pale RBCs -stool occult blood test -endoscopy and colonoscopy -bone marrow biopsy
Foods to help with RBC production
-Iron (Fe) -Vitamin B 12(coblamin) -Vitamin B 6(pyridoxine) -Folic Acid(Folate) -Vitamin B 2 (rivoflavin)
Anemia due to blood loss- Causes
-trauma -complications of surgery -gastric/duodenal ulcer -colon bleeding due to color cancer -menstrual bleeding
Immune Thrombocytopenic Purpura (ITC)
-acute in children -chronic in adults *women 15-40 years *older adults *gradual onset with transient remissions -autoimmune disorder PRIMARY- <100,000 platelet SECONDARY- autoimmune, viral infection, sulfa drugs
Self-monitoring of blood glucose (SMBG)
-before meals -two hours after meal -when hypoglycemia is suspected -during illness or stress -before, during, and after exercise
Anemia causes
-body not making RBC's -blood loss -body destroying RBC's faster than producing than
Aplastic Anemia
-bone marrow failure/ suppression **caused by cancer DIAGNOSIS- bone marrow biopsy *leukopenia, thrombocytopenia, anemia *bone marrow transplant
Heparin Induced Thrombocytopenia (HIT)
-complication of heparin therapy -HIT-I: most common (slight drop in platelets) -HIT-II: immune mediated disorder characterized by antibodies -bleeding is NOTT a sign -venous and arterial thrombosis occur before platelet count decrease
HIT treatment
-discontinue heparin -may recieve agatroban -transition to warfarin when: *platelet count is at least 150,000/ microL
Vitamin B12 deficiency anemia
-due to defective DNA synthesis -megaloblastic anemia (large cells, few cells) WHY? •autoimmune destruction of intrinsic factor (IF), GI surgery, Crohn's and other GI disorders that cause the loss of IF secreting gastric cells, strict vegetarianism
Nursing assessment: ANEMIA
-family history -social history -environmental/occupation exposures (arsenic & lead) -medications -chemo/radiation -GI Bleeding -diet
SIGNS of Anemia
-fatigue -pallor -weakness -palpitations -shortness of breath -tachycardia
B12 diagnosis & signs
-hgb/hct low -MCV high -B12 level low -folate level low -glossitis (enlarged red tongue) -numbness -gait disturbance -anorexia -abdominal pain -paresthesias and weakness of feet and hands
indication of injection
-increase in neutrophils -localized edema -tachycardia
Iron-Deficiency Anemia & clinical manifestations
-most common nutritional disorder in the world -normally due to bleeding *inflammation of tongue/lips *unusual cravings for non-nutritional substances (ice & dirt etc.)
Insulin Administration
-no aspiration, massage, or rub
Blood Administration
-only normal saline -start slowly and speed up after 15 minutes -must monitor for first 15 minutes -baseline vitals -assess for symptoms of reaction (itching, hives, swelling, shortness of breath, fever, chills)
Types of blood/ blood product tranfusions
-whole blood -packed red blood cells -platelets and clotting factors -plasma transfusions
Nancy Reagan, RN
1. Add air to NPH 2. Add air to regular insulin 3. Regular insulin 4. NPH insulin (last because it is cloudy)
Neuropathic
pathophysiologic; ABNORMAL processing of sensory input by nervous system as a result of damage to PNS and/ or CNS (shooting pain or sharp pain) *Hard to treat *Caused by disease or injury
Preprandial capillary plasma glucose
80-130 mg/dL
Peak postprandial capillary plasma glucose
<180 mg/ dL
A1C
<7%
Blood
5 to 6 liters of blood in adults (7-10 percent of body weight) -Plasma (liquid portion) *91% water & 55% of blood volume -Blood Cells *45% of blood Plasma- 55% Platelets- 1% White blood cells-41% Red blood cells-41%
Young old
65-74 years old
Old Old
75 years or older; complications common
Life expectancy today
77.8 years olds
A nurse is caring for a client diagnosed with DM and observes mild hand tremors. Which of the following actions should the nurse take after obtaining a glucometer reading of 60 mg/ dL? A. administer 10-15 g of carbs B. retest the blood glucose C. administer 1 mg of glucagon (GlucaGen) IM D. call for emergency assistance
A
A nurse is caring for a client who has diabetes and reports an occasional loss of sensation in her feet. Which of the following complications is the client likely expriencing? A. Nephropathy B. Neuropathy C. Macroangiopathy D. Retinopathy
A
A nurse is caring for a client who has type I DM. The nurse finds the client lying in bed, sweating, tachycardic, and reporting lightheadedness and palpitations. Which of the following complications should the nurse suspect? A. Hypoglycemia B. Nephropathy C. Hyperglycemia D. Ketoacidosis
A
A nurse is completing a detailed health history and assessment in the electronic medical record (EMR) for a client with a disorder of the hematopoietic system. Which symptom is the most commonly reported in association with hematologic diseases? A. extreme fatigue B. severe headaches C. blurred vision D. dyspnea
A
A nurse is providing education for a client who has glaucome. Which of the following statements is appropriate? A. without treatment, glaucoma can cause blindness B. double vision is a common symptom C. glaucoma results from inadequate production of fluid within the eye D. you will need to treat glaucoma by instilling eye drops once a week
A
A nurse is providing education on site rotation for insulin injections to a client who is newly diagnosed with type I DM. Which of the following reasons should the nurse include in the teaching for site rotation? A. decrease risk for lipoatrophy with insulin injections B. includes administering injections within 1 inch of the umbilicus C. reduces the risk for infection associated with insulin injections D. minimizes the pain associated with insulin injections
A
Nurse is educating a client who is prescribed metformin for type II. Which of the following info should the nurse include? A. Take meds with meal B. You may crush or chew the medication C. Drinking alcohol allowed D. Monitor for hypoglycemia
A
The body responds to infection by increasing the production of white blood cells (WBCs). The nurse should evaluate the differential count for what type of WBCs, which are the first WBCs to respond to an inflammatory event? A. Neutrophils B. Monocytes C. Basophils D. Eosinophils
A
The nurse teaches a student nurse about managing chronic pain when caring for older patients. Which statement, if made by the student nurse, indicates an understanding of the teaching? A. "Chronic pain is not an inevitable part of aging" B. "Older patients who are confused do not experience pain" C. "Older patient tolerate pain better than younger patients" D. "Opioids should not be used for chronic pain in the older patients"
A
Which is a symptom of severe thrombocytopenia? A. petechiae B. inflammation of the mouth C. dyspnea D. inflammation of the tongue
A
Which of the following nursing interventions is appropriate for a patient with a platelet count of 31,000/mm3? A. Pad sharp services to avoid minor trauma B.Offer foods of the patient's preference to increase their calories C. Keep the room darkened D. Check for blood in the urine
A
A nurse is reinforcing teaching with a client who has DM. Which of the following should the nurse include in the teaching? (SELECT ALL) A. reduce cholesterol and saturated fat intake B. increase physical activity and daily exercise C. enroll in a smoking-cessation program D. sustain hyperglycemia to reduce deteriorate of nerve cells E. maintain optimal blood pressure to prevent kidney damage
A, B, C, E
When performing a respiratory assessment on an older adult patient, what age-related changes does the nurse expect to find? (Select all that apply.) A.Increased residual volume B.Decreased residual volume C.Loss of elastic tissue surrounding the alveoli D. Reduced vital capacity E. Decreased pulmonary resistance
A, C, D
The nurse is working in a long-term care facility. When assessing the patients, what body system dysfunction should the nurse look for as the leading cause of morbidity and mortality in the older adult population? A. Cardiovascular B. Genitourinary C. Gastrointestinal D. Respiratory
A. Cardiovascular
Blood type universal recipient
AB positive
While reviewing the results of the patient's complete blood count (CBC), which finding would be of greatest concern to the nurse? A. Hemoglobin of 11.4 g/dL B. Platelet count of 80,000/μL C. White cell count of 4500/μL D. Red cell count of 4.5×106/μL
B
Macroangiopathy
Arteriosclerosis
Nursing process (IMPORTANT)
Assess, diagnose, plan, implement, and evaluate
A client with pernicious anemia asks why she must take B12 injections for the rest of her life. What is the nurse's BEST response? A. The reason for your vitamin deficiency is an ability to absorb the vitamin because your stomach is not producing enough acid B. The reason for your vitamin deficiency is an ability to absorb the vitamin because the stomach is not producing sufficient intrinsic factor C. The reason for your vitamin deficiency is an excessive excretion of the vitamin due to kidney dysfunction D. The reason for your vitamin deficiency is an increased requirement for the vitamin because of rapid red blood cell production
B
A nurse is caring for a client who has type 1 DM. The nurse misread the client's morning glucose level as 210 mg/dL instead of 120 mg/dL. Based on this error, she administered the insulin dose appropriate for a reading over 200 mg/dL before the client's breakfast. which of the following is the nurse's priority action upon realizing the error. A. Give the client 15 to 20 g of carbohydrate B. Monitor the client for hypoglycemia C. Complete an incident report D. Notify the nurse manager
B
A nurse is caring for a client who is newly diagnosed with DM and is prescribed glipizide (Glucotrol). When instructing the client about this medication, the nurse should describe its method of action with which of the following statements. A. "Glucotrol absorbs the excess carbohydrates in your system." B. "Glucotrol stimulates your pancreas to release adequate insulin." C. "Glucotrol replaces insulin that is not being produced by your pancreas." D. "Glucotrol prevents your liver from destroying your insulin."
B
A nurse is caring for an older adult client who was alert and oriented. After four days of hospitalization, the client seems to be increasingly restless and intermittently confused. What is the most appropriate nursing intervention to address the safety needs of the client? A. call the family and ask them to stay with the client B. move the client to a room closer to the nurse's station C. apply wrist and leg restraints D. administer medication to sedate the client
B
A nurse is discussing the care of a client who has type 1 DM with the assistive personnel (AP). Which of the following situations should the nurse instruct the AP to report immediately? A. client reports dizziness when standing B. client refuses breakfast and requests to sleep C. client asks the AP to trim his broken toenail D. client reports urine that is dark yellow in color
B
A nurse is educating a client who is prescribed metformin (Glucophage) for type II DM. Which of the following information should the nurse include? A. take medication with meal B. you may crush or chew medication C. drinking alcohol is allowed when taking the medication D. monitor for hypoglycemia
B
A nurse is preparing to administer a prescribed dose of 10 units of regular insulin and 20 units of NPH insulin to a client who has diabetes. The nurse should take which of the following actions first when mixing the two types of insulin? A. inject 10 units of air into regular insulin B. inject 20 units of air into NPH insulin C. withdraw 10 units of air from regular insulin D. withdraw 20 units of air from NPH insulin bottle
B
A nurse is preparing to administer insulin lispro (Humalog) to a client who has type 1 diabetes mellitus. Which of the following nursing actions is appropriate. A. Assess for hypoglycemia 4 hours after the insulin injection. B. Inject the insulin 15 min before a meal. C. Monitor for polyuria. D. Administer with short-acting insulin
B
A nurse is providing discharge instructions for a client who has undergone outpatient cataract surgery with insertion of an intraocular lens. Which of the following should the nurse include? A. for discomfort, take aspirin B. Restrict lifting objects greater than ten pounds C. reduction of vision after surgery is normal D. apply warm compresses for discomfort
B
A nurse is teaching a client who has diabetes about which dietary sources should provide the greatest percentage of her calories. Which of the following statements indicates the client understands the teaching? A. Most of my calories each day should be from fats B. I should eat more calories from complex carbohydrates than anything else C. Simple sugars are needed more than other calories sources D. Protein should be my main source of calories
B
A nurse is teaching a client with a new diagnosis of DM how to administer his insulin and to eat a healthy and balanced diet. The client tells the nurse that his brother, who also has diabetes, has taught him what foods he can and cannot eat. Which client statement indicates to the nurse the need for further teaching? A. Rotate injection sites everyday B. eliminate bread and pasta from my diet C. roll the insulin rather than shaking it D. Wash feet everyday but won't soak them
B
The nurse caring for a client receiving a transfusion notes that 15 minutes after the infusion of packed red blood cells (PRBCs) has begun, the client is having difficulty breathing and complains of severe chest tightness. What is the most appropriate initial action for the nurse to take? A. Notify the client's health care provider B. Stop the transfusion C. Remove the client's IV access D. Obtain vital signs
B
The nurse devises a teaching plan for the patient with aplastic anemia. Which of the following is the most important concept to teach for health maintenance? A. Eat animal protein and dark leafy green vegetables every day B. Avoid exposure to others with acute infections C. Practice yoga and mediation to help with anxiety D. Get 8 hours of sleep at night and take naps during the day as needed
B
A nurse is performing teaching with a client who has newly diagnoses type 2 DM. The nurse should recognize that the client undertsand the teaching when he identifies which of the following manifestations of hypoglycemia? (SELECT ALL THAT APPLY) A. polyuria B. vertigo C. Polydipsia D. Tachycardia E. Acetone breath F. Moist, clammy skin
B, D, F
A nurse at an ophthalmology clinic is caring for a client who has open-angle glaucoma. The client is started on a treatment regimen of timolol (Timoptic) and pilocarpine (Pilocar) eye drops. The nurse should understand that these medications will be administered... A. when experiencing eye pain B. until intraocular pressure returns to normal C. on a regular schedule for the rest of the clients life D. for approximately 10 days, followed by gradual tapering off
C
A nurse is administering an oral medication to an older client. The client states, "The pill I always take is green. I don't take an orange pill." Which of the following nursing responses is appropriate? A. Sometimes the same pill comes in a different color B. Let me explain the purpose of the medication C. I will check your medications orders again D. This is the medication that your doctor wants you to take
C
A nurse is caring for a client who is on a 2,000-calorie American Association (ADA) diet and substitutes the whole milk on his breakfast tray with skim milk. Because of this substitution, the nurse should know that the client can add which of the following items to the oatmeal on his breakfast tray? A. One 1/8 teaspoon B. One ounce of raisins C. One pat of butter D. One teaspoon of brown sugar
C
A nurse is caring for an older adult client who is hospitalized. At bedtime, the client says, "I am afraid that I may fall while walking to the bathroom during the night. I tend to get a bit disoriented in new surroundings." The nurse should: A. limit client's fluid intake in the evening B. obtain a bedside commode for the client's use C. leave a night-light on in the client's room D. put the side rails up and tell the client to call the nurse before voiding
C
A nurse is caring for an older adult client who provider will discharge him to an extended-care nursing facility the following morning. The client asks the nurse why he has to go to "that place." Which of the following is an appropriate nursing response? A. Your doctor feels this is the best place for you right now B. Why don't you ask your doctor about that when he comes in to see you? C. Did your doctor or anyone else talk to you about going to the nursing home? D. Your family cant take care of you at home, so you will need to go there.
C
A nurse is caring for an older adult client whom is suspected of being neglected. Which of the following statements by the caregiver should be of most concern to the nurse? A. We only have enough money for two meals a day B. We sit outside every afternoon C. We buy the prescriptions we can afford D. We cannot afford two new batteries for his hearing aid
C
A nurse is preparing a teaching plan for a client who has just found out that she has DM. What is the nurse's priority in preparing this plan? A. establish short-term goals for this client B. give her access to a video about diabetes C. determine what the client knows about managing her diabetes D. evaluate the effectiveness of the client's admission teaching plan
C
A nurse is reinforcing discharge teaching with an older adult client. Which of the following should be the nurse's priority action? A. ask the client to verbalize understanding of previous teaching B. observe ability to access info from the internet C. minimize distractions by closing the door to the room D. present learning activities from simple to complex tasks
C
A home health care nurse is visiting an older adult client who tells the nurse that she is feeling tired and is unable to shop for groceries. The client ass the nurse if she could pick up a few things for her at a local store. Which of the following is an appropriate nursing response? A. It is against policy for me to grocery shop for you B. I would be happy to do whatever I can to help you C. what I think you should do is wait for the days when you feel better and do your grocery shopping then D. It's unfortunate that you do not have someone to help you on the day you do not feel well. Let's talk about how we can solve that for you.
D
A nurse is teaching an older adult client who has DM about preventing long-term complications of retinopathy and nephropathy. Which of the following instructions should the nurse include? A. have an eye exam once per year B. examine your feet carefully everyday C. wear compression stockings daily D. maintain stable blood glucose levels
D
A nurse working for a home health agency is assessing an older adult male client. Which of the following findings is the priority for the nurse to address? A. swollen gums B. pruritis C. urinary hesitancy D. dysphagia
D
The physician performs a bone marrow biopsy from the posterior iliac crest on a client with pancytopenia. What intervention should the nurse perform after the procedure? A. elevate the head of the bed to 45 degrees B. pack the wound with half-inch sterile gauze C. administer a topical analgesic to control pain at the site D. apply pressure over the site for 5-7 minutes
D
Blood transfusion most common reaction
Febrile Nonhemolytic Reaction
Do males or females live longer?
Females
Anterior pituitary
Great Pizza Makes Tummy All Full Later WORRY ABOUT G,T, A G=growth hormone T= thyroid stimulating hormone A= adrenocorticotropic hormone
Heparin
IV; intrinsic pathway
What do steroids cause?
Immunosuppression!!!
Acute hemolytic Reaction
LIFE THREATENING!!! -cause: incompatible blood -STOP infusion & grab emergency cart
Red Blood Cells normal values
MEN: 4-5 million/mL WOMEN: 4.2-5.4 million/mL
Blood type universal donor
O negative
Long acting Glargine (Lantus) Detemir (Levemir)
Onset- 0.8 to 4 hrs Peak- no pronounced peak Duration- 24+ hrs
Intermediate NPH (Humulin N, Novolin N)
Onset- 1.5-4 hrs Peak- 4 to 12 hrs Duration- 12 to 18 hrs
Rapid acting Lispro(Humalog) Aspart (NovoLog) Glulisine (Apidra)
Onset- 10-30 minutes Peak- 20 minutes- 3 hrs Duration- 3-5 hrs within 15 minutes of mealtime
Short Acting Regular (Humulin R, Novolin R)
Onset- 30mins- 1 hr Peak- 2-5 hrs Duration- 5- 8 hrs -injected 30 to 45 minutes before meal -only one to be given IV
Posterior pituitary
PEE!!!
Spleen
RBCs go to be broken down; hyperactive-will destory all types of cells, major organ of immunity
What is an indicator of erythropoiesis?
Reticulocytosis (over 1% of total number of red blood cells)
Blood Type
Type A- (anti- B antibodies) Type B-(anti- A antibodies) Type O- (both anti A/B antibodies) Type AB-(no antibodies)
CVD non-modifiable risk factors
age, race, gender, family history
Stroke volume (SV)
amount of blood ejected along with each heart beat
Cardiac output
amount of blood pumped by each ventricle 1 minute (SV x HR) *normal= 4-8 L/min
Basal
background insulin or base; intermediate or long acting
Bolus
before meal; rapid or short acting
Hematologic System
blood and blood forming sites (bone marrow and reticuloendothelial system) -Blood *Plasma & Blood Cells -Hematopoiesis
Dawn phenomenon
blood sugar level normal or high between 2-4 AM
Coagulation Labs
blue tube
Ecchymosis
bruise
Pituitary glands not able to secrete ADH
loss of fluids
Neuropathy
loss of sensation
Leukoctopenia
low WBC
Neutropenia
low neutrophils (common in cancer patients)
Hematopoiesis
complex process of the formation and maturation of blood cells
Systole
contraction of myocardium
Prednisone
causes glucose intolerance/ hyperglycemia
Red vs. Yellow bone marrow
children- red bone marrow as we get older it becomes yellow bone marrow RED-contains stem cells that form blood cells YELLOW- fat storage
Thrombocytopenia
low platelet count; bleeding tendency *prevent injury *avoid IM injections, IV sticks *prolonged pressure on puncture sites *no razor blade use (electric razor ok)
Hypoglycemia
decreased blood sugar from insulin reactions, inadequate intake of glucose, or increased exercise; vertigo, tachycardia, moist & clammy skin, anxiety, hunger, lightheadedness, tremors
How does lack of ADH affect the body?
dehydration, loss of electrolytes
CVD modifiable risk factors
diet(high sodium), sedentary lifestyle, smoking, alcohol consumption, chronic stress, obesity/adiposity, diabetes/impaired blood glucose
Leukocytosis
elevated WBC
Polydipsia
excessive thirst
Polyuria
excessive urination
Coumadin
extrinsic pathway; PT and INR
Retinopathy
eye complication
Oral iron (iron-deficiency)
ferrous sulfate/ ferrous gluconate -typically 325 mg -heart burn -constipation -diarrhea -black tarry stools *best absorbed with orange juice (1 hour before) -liquid iron should be diluted and drank through straw
What does an anti-diuretic hormone cause?
fluid retention
Pain threshold
lowest intensity of a painful stimulus that is perceived by a person as pain. Associated with fast pain pathway. *lowest threshold individuals will experience more pain if given the same stimulus as another person with high threshold
Lymph nodes
lymphocytes maturation site
Neutrophils: Segmented
mature neutrophils; come out first during infection
leading causes of death
heart disease, malignant neoplasms, COPD, stroke, Alzheimer
Purpura
hemorrhage into skin, muscle, organs
Thrombocytosis
high platelet count; increased clotting
Neutrophils: Bands
immature neutrophils
Hyperglycemia
increased blood sugar; polyuria & polydipsia, dry skin, rapid respiration, changes in consciousness
Leukocytes (WBC)
infection protection INCLUDE: monocytes(become macrophages), eosinophils, neutrophils (first to show up), basophils, defend the body against pathogens, lymphocytes (b/t cells)
Visceral Pain
internal organs
Nephropathy
kidney dysfunction; hypertension, lethargy, drowsiness, headache, and dry mucous membranes
Anemia
lack of sufficient RBCs (low hgb, hct) *symptom of problem happening in the body *know WHY!!!
Complete blood count
lavender tube Hgb/Hct/MCV,MCH,MCHC, # of WBCs, Platelets Men- hgb=14-18/Hct 42-52% Women- Hgb 12-16/Hct 37-47%
Idiopathic
no organic or psychological processes found
Exogenous insulin
outside source; SQ or IV; required for type I and prescribed for type II
Erythrocytes (RBC)
oxygen transportation *contain hemoglobin to carry O2 *120 day life span *maintain acid-base balance
Placebo effect
pain relief caused by expectation of a substance *studies show increased endorphins, etc. when patient expects relief, regardless of substance given *If placebo effect works, it DOES NOT mean that the patient does not have real pain
Referred Pain
pain that is felt in a site that is distant to the stimulus *when an individual has a heart attack and has a toothache, jaw or in shoulder (not what you expect)
Thymus
producer of T cells; degenerates with age
Thrombocytes (platelets)
promote coagulation -5- 10 day lifespan normal range- 150,000-400,000
Nociceptive
receptors; physiologic function (surgical incision, burn, broken bone) *NORMAL function of system that leads to perception of tissue damage as pain
Diastole
relaxation of myocardium
Hemolysis
removes old RBCs from circulation
Suffering
severe distress
Postprandial glucose measurements
should be made 1-2 hours after the start of the meal
Bone marrow aspiration
site-iliac crest indication- assess for abnormal cells/ evaluate response to treatment risks- bleeding and infection *long wide bore needle *pain relief difficult to obtain *patient feels "pressure" *bed rest for 1 hour after
Somatic Pain
skin, bones, muscles, and soft tissues
Petechia
small, pinpoint hemorrhages under skin
Gerontology
study of aging and getting old
Psychogenic
sustained due to psychological factors
Ketoacidosis
tachycardia, dry mucous membranes, altered consciousness, seizures, and hypotension
Somogyi Effect
too much insulin; high doses of insulin causes decreased glucose during the night; blood sugar low between 2-4 AM
Breakthrough Pain (BTP)
transient, moderate to severe pain that occurs in patients whose baseline persistent pain is otherwise mild to moderate and fairly well controlled *sudden and brief flare up of chronic condition
If ADH causes someone to hold onto water, what does it cause an increase in?
urine output
Polypharmacy
use of multiple medications interactions
Pain
what patient says it is (highly subjective in nature)
Polycythemia Vera
•Sx= headache, vertigo, tinnitus, nosebleeds, bleeding gums, dyspnea, chest pain, itchiness after shower, Venous and arterial thrombosis, enlarged liver & spleen, ruddy complexion, Increased levels of URIC ACID from RBC destruction>>>gout •Tx = phlebotomy and may need chemotherapy to reduce cell proliferation in bone marrow, may need iron supplements, anti-coagulants -PREPARE FOR PHLEBOTOMY -Education