PATO CH 1 - 5

Schedule III Listing of drugs currently used in medical treatment that have less of a potential for abuse than drugs in schedules I and II.

Amphetamines Anabolic Steroids Ketamine

Direct or closed questioning

Asking questions that require a yes or no answer. Direct or closed questioning is used when it is not necessary for the patient to elaborate and only a short answer such as yes or no is desired to obtain specific facts. If the clinician is looking for certain details that may not have been answered during the interview or wants to regain control of the conversation, closed questioning is acceptable. During the interview it is also important to take the patient's body language into account. The patient may be indicating that they are in pain, which you can then direct your questions toward. See Figure 1-16.

Masks

Facial covering to protect a clinicians face, nose and mouth from body fluids and secretions. So, what do we use to protect our face? Masks should be worn to protect a clinicians face, nose, and mouth from body fluids and secretions generated from the patient care procedures. Masks also protect the patient from the clinician during invasive procedures. Some masks have shields attached to protect the eyes, which is a convenient form of eye protection. Always keep in mind that eye glasses are not a substitute for a face shield or googles.

Beta blockers

High blood pressure Tenormin (atenolol) Zebeta (bisoprolol)

Topical (TOP) Drug Forms

Topical agents are administered externally by applying a drug directly to the skin or mucosal membrane. These will produce a local affect at the site of application. Creams and ointments might seem as if they are the same thing, but actually they are not. Although both are topical and in a semisolid form, creams are thinner in consistency and have a more liquid base, making them absorb more quickly. Ointments are thicker and more concentrated with an oil base, giving them a stickier feeling. Not all ointments are used solely for treating skin conditions. Vicks VapoRub is a menthol oil-based ointment that is rubbed on the body and used in humidifiers to treat nasal congestion, Figure 4-15. Keep in mind it is important to use the medication as directed by your physician or pharmacist.

Diuretic

Increase urinary output Lasix (furosemide) Edecrin (ethacrynic acid)

Schedule I Listing of drugs not currently used in medical treatment that have a high potential for abuse.

Heroin Bath salts LSD Marijuana Ecstasy Quaaludes Peyote

Identifying Trade (Brand) and Generic Names

The list of drugs that are marketed keeps expanding. We see television and magazine advertisements for all that the pharmaceutical companies have to offer. Most people have seen commercials for drugs that will help you combat obesity, decreased libido, high cholesterol, risk of heart attack from blood clots, sleeplessness, and the list goes on and on. These marketing campaigns usually mention the drug by its trade name. What is the difference between a trade name and generic name? Why don't drugs have just one name? It can be daunting to new healthcare students to have to become familiar with all these different names. Learning drug names can be a "bitter pill to swallow," but the task can become easier when you understand the various types of names. Medications do not magically appear on the market for use. A company must first develop a promising drug and submit it to the FDA for approval. The new drug then must be given a name by which it can be tracked. This name is called the generic name. Generic names are provided by the United States Adopted Names (USAN) Council. A generic name is a nonproprietary name that is not owned by any particular pharmaceutical company. A trade name is a catchy name that is developed by pharmaceutical companies to market their creations to the public. A trade name often has a hidden meaning, or one that is not so hidden, as to what the medication does. Some examples include: Prevacid (prevents acid) Ambien (good morning) Plan B (an emergency backup plan to prevent pregnancy) Flomax (maxing urinary flow). Trade names and brand names are synonymous, and imply ownership. The trade or brand drug names are owned by the company, which has spent hundreds of millions of dollars and many years in researching and developing the drug to become effective and approved by the FDA. Just as you might recognize brand-name clothing with ease and might even associate it with quality, drug companies want you to recognize and to buy their medications. It is only fair that the company that first came out with the drug be allowed to profit from its work without competitors, who potentially could siphon away profits by selling the drug at a lower cost. Therefore, the developing drug company gives a catchy brand name to its officially approved generic named drug. The patent protection of a drug is 20 years, but many years go by while the company waits for final FDA approval to sell the drug on the market. After the patent expires, other companies are free to produce the same drug. Therefore, generic drugs will not be produced until the patent protection has expired. A generic drug is the bioequivalent or the same as a brand-name drug except it costs less money. How can we tell the difference between a brand name and generic name? Well, usually you can tell the difference just by looking at the drug name. A brand name will often have a registered trademark symbol after its name and usually begins with a capital letter. Generic names are always written in all lowercase letters (unless they begin a sentence) and always lack a trademark symbol. For example, acetaminophen is the generic name for Tylenol®. The label in Figure 3-8 shows both the brand name and generic name. In this MindTap, we will capitalize all trade names and will not use the trademark symbol. Trade name and generic name found on Percocet label. Note that the generic names on this label begin with capital letters but do not in texts or readings. Many states in the United States have generic substitution laws. These laws allow pharmacists to substitute prescriptions with generic drugs from other manufacturers. However, pharmacists are not permitted to change the strength of the medicine prescribed. If physicians do not wish for their patients to receive any generic substitutions for whatever reason, a "Dispense as written" or "Do not substitute" order must accompany the script.

total parenteral nutrition (TPN)

All nutrition is received through a vein.

1.5

1.5

Blood pressure Breathing Pulse Temperature

120/80 mm/Hg 12 to 20 breaths per minute 60 to 100 beats per minute 97.8 f to 99.1 f 98.6 f average

anthelmintics

A class of drugs used to treat worm infections. Pharmacological intervention is accomplished through a class of drugs used to treat worm infections called anthelmintics. Albedazole is an example of a drug used to rid the person of worms.

Secondary union or secondary intention

A large wound loaded with debris and/or bacteria making it difficult to heal. Secondary union or secondary intention are larger wounds loaded with debris and or bacteria, which make them difficult to heal. While the healing process is the same as in primary union, it takes longer. More inflammation must be resolved before healing can occur, and the larger surface area of the wound requires more capillaries, fibroblasts, and collagen, which ultimately causes a large scar. If the wound is too large, the body will not be able to properly heal over the area, resulting in the need for a skin graft as shown in Figure 2-27.

portal of exit

A point where pathogen leaves the body.

Cellulitis

A potentially serious bacterial skin infection. play audio Cellulitis is a potentially serious bacterial infection of the skin most commonly caused by Streptococcus or Staphylococcus bacteria. Cellulitis is an acute inflammation that presents as a red swollen area with a warm and tender sensation, Figure 2-25. This infection does not remain contained to a local area, and it can spread to anywhere in the body through the bloodstream, making it life-threatening. This bacterial infection is successfully treated with a regimen of antibiotics.

Rectal Drug Forms

A less-desirable way to receive and administer medication is the rectal route. Rectal drug forms do serve a purpose, however, such as for a patient who can take nothing by mouth (NPO). Infants and young children who can't swallow pills can be given rectal suppositories. Drugs that can be given this route are sedatives, laxatives, antipyretics, and analgesics. Even though the drug does not travel through the entire GI tract, it is still an enteral route drug because the rectum is part of the GI tract, and the drug is absorbed in the rich blood supply in that area. These methods of delivery include suppositories and enemas. A suppository (supp) is inserted directly into the rectum with a finger. The drug itself is suspended in a solid substance that resembles a bullet shape, Figure 4-3. The pointed end is inserted first, while the flat end is used as a surface to push the suppository into the rectum. Once inserted, the substance melts at body temperature, releasing the drug into the mucous membrane where it is absorbed. An enema is a liquid drug that might be either a solution where no shaking is needed or a suspension drug where the fluid must be shaken to mix the drug. The liquid is instilled into the rectum with an applicator bottle.

Other Oral Drug Forms

A lozenge (troche) is a tablet that is usually flavored to have a pleasant taste. The lozenge is held in the mouth where it slowly dissolves. To be effective, the patient should avoid drinking any fluids for 15 minutes after administration to prevent the effect from being washed away. Used for a sore throat, lozenges can have a soothing or even numbing effect, as seen with Chloraseptic lozenges. A suspension (susp) is a liquid form of a drug that must be shaken before use to suspend the drug in the fluid. The drug particles settle at the bottom of the bottle so they are not dissolved evenly throughout the liquid until it is shaken. An antibiotic given to children called cephalosporin (cephalexin) is an example of a liquid medication that has to be shaken to suspend the drug in the liquid. An emulsion is a type of drug preparation that is a liquid containing fats and oils in water. An elixir (elix) or fluid extract is a liquid drug mixed with an alcohol base, and should not be administered to alcoholics for that reason. Also, because alcohol evaporates quickly, the lid must be kept on the medication securely. A solution is a drug in a liquid form that is completely dissolved in the fluid. It is usually clear in appearance. A solution differs from suspension because the drug does not settle at the bottom of the bottle. A syrup is a sweetened, colorful liquid drug form often with palatable flavors such as orange, grape, or cherry (see Figure 4-2). An easy way to remember this is to think of maple syrup, which is also a sweet liquid. Codeine is a narcotic that is used in cough syrup to suppress a cough. This should be used only for a dry, nonproductive cough. If the patient has a productive cough, and it is stopped, the mucus could settle in his or her lungs and the patient might develop pneumonia.

neoplasm

A new growth called a tumor.

syndrome

A particular set of signs and symptoms that when grouped together is indicative or characteristic of a certain disease or disorder. Now, how are signs and symptoms related to a syndrome? A syndrome refers to a particular set of signs and symptoms that when grouped together is indicative or characteristic of a certain disease or disorder. Down syndrome results when an individual has an extra partial or extra whole chromosome 21. Symptoms seen in affected individuals include mental impairment, flat face, slanted eyes, a short neck, low set ears, flaccid muscles, and obesity to list a few similar qualities

Prescriptions

A prescription is a written order for a patient to receive a certain therapy or medication, Figure 3-7. Not all healthcare professionals are given the legal authority to write prescriptions. Prescriptions can be written by physicians, dentists, nurse practitioners, and veterinarians, as well as a few other practitioners, but not chiropractors, for example. After an authorized individual writes a prescription, the next step is for it to be filled at a pharmacy. The prescription, also called a script, has certain areas that must be filled out. The patient's name, address, and date prescribed The prescription (Rx), which is a written authorization by the prescriber for a certain medication or other therapy The name and quantity of the drug being prescribed Transcription, which is the information the pharmacist must put on the label as instructions to the patient, such as how much and how frequently to take the medication Signature of prescriber Name of prescriber DEA number Each pharmacy has a certain listing of drugs they keep in stock, and this is known as their formulary. The list of medications offered in a particular hospital or healthcare system also is called a formulary. Each healthcare setting will stock the most commonly needed and prescribed medications they encounter. If a drug is not in their formulary, they have access to a network to obtain that drug quickly.

death rate

A statistical measurement of deaths caused by a disease of a certain population over a specific time period.

Acute pain

A sudden onset of pain.

nasogastric tube (NG)

A tube that is passed through the nasal passage and into the stomach for a short-term feeding solution.

capsid

A virus's outer coating. The virus reprograms the host cell to replicate more virus cells, which in turn hijack even more host cells, continuing the process. Viruses can mutate and change over time, so more than one method is needed to fight them. Lymphocytes are a type of white blood cell that is the chief combatant against viruses

NKA

Abbreviation for no known allergies.

immunity

Ability to protect from illness.

Chromosomal disorders

Abnormality of a whole or partial chromosome. arise from an abnormality of a whole or partial chromosome. An example is Turner syndrome, which occurs when a female does not inherit an X chromosome from either the mother or father, resulting in one less X chromosome than normal

rectally (PR) or (R)

Administering a drug by inserting into the rectum.

enteral route

Administering substances through the GI tract, including oral, feeding tubes, and rectal routes.

Tissue Repair

After the body fights off a foreign invader or is physically injured, the body must then heal itself. The healing process begins after the macrophages remove debris from the area. The length of repair depends on the type of tissue cells affected. The regenerative cell growth or division to heal the damaged tissue can be categorized in three ways: Mitotic cells Facultative mitotic cells Nondividing cells.

Distribution

After the drug has been given and is absorbed into the bloodstream, the substance must now travel via the circulatory system to the tissues and fluids where it is needed (see Figure 3-17). The regions where a drug can be distributed in the body is known as the volume of distribution (VD). What factors determine where a drug will be distributed? We already discussed a very important one. Drugs that are lipid- or fat-soluble have the ability to pass more easily through the phospholipid cell membrane. Therefore, lipid-soluble drugs can also have a greater effect in obese patients because of their higher fat content. Another variable to consider in drug distribution is selective distribution. Selective distribution is the term applied when drugs have a greater affinity to reach a certain area and target a specific cell or organ in the body. For example, the human chorionic gonadotropin hormone has selective distribution to the ovaries. This is quite advantageous since this is used as a fertility drug.

Factors affecting wound healing

Age Wounds heal quicker for younger individuals Size Smaller wounds heal faster Tissue Epithelial cells heal faster than other tissues Nutrition Protein and vitamin C and other nutrition aid the body in faster healing Immobility Wounds heal faster when kept immobile Circulation Whether the site can be reached with enough blood supply to allow the healing process to occur Pathogenicity Wounds take longer to heal when infected Steroids Suppress the body's ability to fight infection and delay the healing process

Centers for Disease Control and Prevention (CDC)

Agency responsible for recording and tracking diseases not only domestically but abroad. The Centers for Disease Control and Prevention (CDC) records and tracks diseases not only domestically but abroad in an effort to monitor possible threats. One aspect monitored by the CDC is epidemiology, which is the study of disease transmission, occurrence, distribution, and control for a population of people. You often hear in the news how the CDC is monitoring an epidemic or pandemic. Just what does that mean? It is easy to confuse endemic, epidemic, and pandemic due to their similar word appearances.

Schedule IV Listing of drugs currently used in the medical treatment but have a slight potential for abuse; less than schedules II and III.

Alprazolam Xanax Soma Darvocet Valium Ativan Ambien Tramadol

methicillin-resistant staphylococcus aureus, or MRSA

An antibiotic-resistant strain of bacteria. Some bacteria such as staphylococcus aureus, which is responsible for causing methicillin-resistant staphylococcus aureus, or MRSA, has developed in this manner. MRSA is a commonly found antibiotic-resistant strain, which makes it potentially dangerous. This is why hand hygiene and proper cleaning techniques are so important in the healthcare setting to prevent the spread of this type of infection. In upcoming modules, we will discuss specific antibiotics that are used to treat various bacterial diseases that can affect different body systems. Bacteria can come in various shapes that help identify the causative microorganism

Opportunistic infection

An example of an opportunistic infection seen in patients is the fungus known as Candida albicans. This organism is present in our mouths in small amounts. However, our normal flora keeps this fungus in check and prevents it from growing out of control in the mouth. Inhaled steroids, however, can suppress our normal flora, and if the balance is disturbed, the fungal infection known as thrush can take over, as seen in Figure 2-11. This is why it is critical that patients rinse their mouths after taking an inhaled steroid. Infection can occur from many different organisms, such as bacteria, viruses, fungi, protozoa, helminths (worms), and rickettsiae. We will cover these types of infection in greater depth in the following sections.

secondary infection

An infection developing as a result of another illness or injury. Bacteria are known to cause both primary and secondary infections. When a person is first exposed to a bacterial pathogen and becomes infected, it is known as a primary infection, and if the patient develops an infection as a result of another illness or injury, it is a secondary infection. For example, a bacterial pneumonia is a primary infection, but a bacterial pneumonia that develops after a viral pneumonia would be a secondary infection.

hyperplasia

An overgrowth of tissue in a response to a stimulus.

biological vector

Animal or insect that spreads pathogen to other hosts by a bite or injection. A pathogen can actually live inside a host such as an animal or insect. The host can then harbor the disease. The pathogen can then spread to other hosts by a bite or injection, as shown in Figure 1-11. A prime example is a tick infected with Lyme disease. The tick bites the victim to feed on the host's blood and in the process transmits Lyme disease through its saliva, symptoms illustrated in Figure 1-12. The tick in this example is the biological vector.

common vehicle

Any medium such as food or blood that acts as a vehicle to transport pathogens. We have discussed a lot of routes that pathogens can take to enter your body; however, there is yet another route. This route is called common vehicle. Just like a vehicle can transport passengers, a common vehicle can be used to transport pathogens. For example, any consumable item, such as food, can serve as a common vehicle for infection. You've probably heard on the news of food poisoning outbreaks that have occurred as a result of the spread of Salmonella or Escherichia coli (E. coli) from contaminated food or water sources. Common vehicles are not limited to food or water. Medical products such as blood, injectable medications, and IV solutions can cause a sudden spread of the same disease to many patients. Common vehicles do not happen only in health care, but from a consumer standpoint, such as consuming contaminated food products

The Cell Cycle

Apoptosis refers to cellular death; it is estimated that approximately 300 million body cells die every minute. Cell types have varying life spans. Certain white blood cells live for only a few hours, intestinal cells last two to three days, and muscles cells can last for up to 15 years. Nerve cells win the longevity contest, because they can last a lifetime. During its life span, a cell can divide many times and cycles back and forth between normal functioning and asexual reproduction. The total life span of eukaryotic cells can therefore be divided into two major phases known as the cell cycle. The majority of the cell cycle, known as the interphase portion, is spent on normal functioning and stockpiling needed materials in preparation for division and by copying DNA and making new organelles. Only a brief portion of the cell cycle, the mitotic phase, is devoted to actual cell division when the need arises. The mitotic phase is subdivided into two major portions, with mitosis being the division and sorting of the genetic material, and the final phase, cytokinesis, being the division of the cytoplasm. See Figure 5-3. Mitosis, or division of the genetic material in a eukaryotic cell, produces identical daughter cells with the exact number of chromosomes and same organelles as the original cell. The various phases of mitosis are based on the position of the chromosomes relative to the new cells.

Open-ended questioning

Asking the patient simple, broad questions that require more than a yes or no to answer. When interviewing a patient, the clinician may want the patient to elaborate on the condition being discussed. In this case, it is best to ask open-ended questions. Open-ended questioning is conducted by asking the patient simple, broad questions that require more than a yes or no to answer. For example, "So, what made you decide to visit us today?" and "Tell me about your knee pain." are simple and effective ways to get the patient to open up about their condition. However, if you are looking for less patient engagement and a direct answer, then closed questioning is used.

Principles and Rights of Administration

Before administering medications to your patient, you should be familiar with these important principles. Cleanliness The clinician should always wash his or her hands before and after making contact with a patient. This includes washing hands before preparing medication. Organization Drugs should be prepared in the medication room and any drugs used should be recorded to be sure they can be replenished. This has become easier because many facilities use automated dispensing machines, which keep track of amounts available and allow the pharmacy to restock used medications. Preparation area Medications should be prepared in a well-lit private area free from distractions to prevent errors. While these principles should be employed in preparing the medication, six rights are commonly cited to make sure potential errors are avoided. The Six Rights of Medication Administration is a guideline to use when administering medication to patients. Each of the six steps is used to prevent a medication error from occurring Right Drug It is your responsibility to make sure the medication and dosage are the same as ordered by the physician. Since many drugs look the same and begin or end in the same letters, be sure that the medication name is visible and not partially missing. If you are ever in doubt, you must question the pharmacist before administering. If someone asks you to give a dose he or she has prepared, it is in your and the patient's best interest to decline. If you dispense such a medication, and an issue occurs, you would be the one at fault. Right Amount When administering medication, it is crucial to be as accurate as possible and to double-check that the medication you have is the one ordered on the patient's medical records. If the dose does not seem correct, call the physician to verify the correct dosage. Right Time A drug should be given during the prescribed time to allow for the proper therapeutic drug range in the bloodstream. It is important to become familiar with drug frequency abbreviations to ensure accurate dosage times, since some drugs might be ordered to be given every 4 hours, before meals, on a full stomach, or before bed. The upcoming medical abbreviation section will help you with this. Before the patient is discharged home or leaves the office, it is important to educate him or her not only on how to take his or her medication, but when. Right Route Many drugs can be administered in numerous ways, each having a different effect on the drugs' absorption, possible side effects, and speed of onset. Again, if you are the person giving the medication, you are responsible to ensure the medication is given via the correct route. If you are concerned that the route chosen might not be best for the patient for any reason, or if there is a change in the patient's status such as if the patient is vomiting or nauseated, contact the physician. You cannot change the route on your own. If it needs changed, for whatever reason, a physician's order is required. Right Patient You MUST properly identify your patient before administering a drug. Your organization should have its own protocol about how to accurately identify a patient. Patient identification is done by asking the patient his or her name and date of birth, then checking the patient's wristband to verify the patient's name, date of birth, and medical record number. This is still done today even with the evolution of technology in health care. Currently, hospitals are converting to electronic medication administration records (MARS). Here the patient's ID wristband is scanned, then the medication is scanned, along with asking the patient's name, all of which must match exactly before the drug is administered. Right Documentation Every organization might have different methods governing a patient's charting, which should be followed. Once the dose has been given, you must accurately document the dose, time, route, and location (if it was given by an injection or dermal patch). Also, the MAR must be initialed and signed with the approximate time the drug was given. When documenting by hand, the clinician should always use either a black- or blue-colored ink pen. If an error occurs, never use whiteout, instead put one line through the mistake and write error and initial it. If something out of the ordinary occurs, such as an adverse effect or patient refusal, that too must be documented by annotating exactly what happened. It is important to be specific, because any documentation can be subpoenaed into a court of law. Therefore, what you documented might be very beneficial to the outcome of a malpractice lawsuit. Remember, if it was not documented, it did not happen.

Legal Terms Referring to Drugs

Before moving forward, we are going to further develop a few legal terms that we have previously mentioned. It is important to become familiar with these terms since they deal with the legal availability of medications. Over-the-counter medications can be purchased without a prescription. Even though these drugs are readily available, OTC drugs should be respected because they too can be hazardous, especially when too much is taken or if they are not taken as directed. Therefore, care should be taken when using these medications, just as if they were prescribed drugs. To stop the alarming epidemic of methamphetamine use in the United States, President George W. Bush signed the Combat Methamphetamine Epidemic Act of 2005. This law was integrated into the Patriot Act and limits how much a person can purchase of OTC medication that can be used to make illegal methamphetamine. Purchase of any OTC drugs containing pseudoephedrine such as Sudafed, as shown in Figure 3-6, is closely monitored and requires a photo ID and a signature in a logbook.

Glandular epithelium

Benign Neoplasm : adenoma Malignant Neoplasm: adenocarcinoma

Squamous epithelium

Benign Neoplasm : epithelioma Malignant Neoplasm: squamous cell carcinoma

Adipose (fatty tissue)

Benign Neoplasm : lipoma Malignant Neoplasm: liposarcoma

Complete Blood Count (CBC)

Blood sample analyzing types and numbers of cells within the bloodstream. Blood is a very valuable tool to assess the overall condition of the body. A play audio Complete Blood Count (CBC) is a blood sample analyzed to determine if any anomalies are present. An increase or decrease from the normal cell ranges assists in the identification, monitoring, and examination of a disease. A CBC also displays the effectiveness of the treatment and overall system analysis of all blood components. Table 1-2 illustrates the cell types and normal values.

The chain of infection

Chain-like illustration made up of a series of steps or links that demonstrate how pathogens infect others.

Noncancerous tumor.

Cancerous cell growth.

Cancer Metastasis

Carcinoma in situ refers to cancer that is "just sitting there" in the particular tissue and hasn't broken through the basement membrane and invaded other tissues or sites. Cancer first begins at the primary site as a local invasion of the surrounding tissue with its tentacle-like projections entangling normal tissue structures. As it grows, the malignant tumor can block blood flow and cause the death of healthy tissue, which is termed tissue necrosis. Cancer can then spread from this primary location to secondary sites through the process of metastasis. Often cancer spreads through the lymphatic system, where lymph nodes attempt to filter the abnormal cells. When the lymphatic system is overwhelmed by the cancerous cells, the filters can become blocked and spill out the cancerous cells into the bloodstream, which basically runs parallel to the lymphatic system. After cancerous cells are in the blood circulatory system, they can spread to secondary sites. This is why close proximity or sentinel lymph nodes are removed or biopsied to determine if the cancer has entered the lymphatic system. Cancer cells can also be seeded by invasion and implantation within serous (watery filled) cavities such as the pleural cavity. Hematogenous spread occurs when cancer cells invade the blood vessels. While all the body systems can be ravaged as shown in Figure 5-6, common secondary sites of cancer include the brain, lung, bone, and liver. Often it is unfortunate for the patient that the secondary site is discovered first.

1970 Controlled Substances Act (CSA)

Categorizes drugs by the acceptable medical uses, the potential for drug abuse, and/or potential for dependency; requires those with prescribing or distributing privileges to have a DEA registration number to prevent fraudulent dispensing of medication. The Controlled Substances Act schedules or categorizes drugs by the acceptable medical uses, the potential for substance abuse, and addiction or potential for dependency. The lower the number is, the greater will be the risk of abuse and dependence. For example, drugs that are schedule I have more risk of dependency than schedule II; while schedule II is more addictive than schedule III; and so on. The schedule can be illustrated as a C with a roman numeral after it indicating its schedule, Figure 3-4. Drugs with the greatest potential for psychological and physical dependence and considered the most dangerous are listed as schedule I narcotics. Table 3-1 lists the five drug schedules and examples of drugs included in each category.

Pregnancy Category X

Category of drugs showing adverse fetal effects and not to be used under any circumstances.

histamines

Chemical substances released to cause dilation of vessels in response to injury or irritation.

facultative mitotic cells

Cell division process used to replace cells. Next are facultative mitotic cells. These cells differ from mitotic cells by dividing only when it is necessary to replace damaged cells. These cells are found in certain organs, such as the liver and kidneys, which are repaired only when they are damaged.

Red blood cells (RBC)

Cells within blood that transport oxygen. Transport oxygen Men: 4.32-5.72 trillion cells/L or (4.32-5.72 million cells/mcL) Women: 3.90-5.03 trillion cells/L or (3.90-5.03 million cells/mcL)

White blood cells (WBC)

Cells within bloodstream that fights infection. Fight infection .5-10.5 billion cells/L (3,500 to 10,500 cells/mcL)

Platelets (PLT)

Cellular fragments that clots blood. Ratio of volume of red blood cells to total volume of blood Men: 38.8-50.0 percent Women: 34.9-44.5 percent

terminal

Condition or disease resulting in imminent death.

Personal Protective Equipment (PPE)

Clothing and equipment used to prevent bodily fluid contact. Personal Protective Equipment (PPE) is worn during specific procedures that greatly increase the odds of the provider coming into contact with body fluids. PPE consists of gloves, gowns, eye protection (goggles or face shields), and masks, or respirators, Figure 1-27.

enteric-coated tablet

Coated pill that prevents disintegration by gastric juices. An enteric-coated tablet is a coating on a pill that does not allow the tablet to be disintegrated by gastric juices. The drug can then pass though the stomach without being absorbed and will be broken down and absorbed farther down the GI tract. This coating is useful for drugs such as aspirin that can irritate the stomach. It is important to keep in mind that the coating will not be effective if it is damaged from chewing or crushing.

Cell-mediated immunity

Consisting of specialized white blood cells (WBCs), it is the body's main defender from foreign substances. is the body's chief defender from foreign substances. This is made possible by a certain type of white blood cell (WBC) known as T-cell lymphocytes. T-cell lymphocytes are developed in the thymus gland, hence the name T-cells. When responding to a foreign substance, T-cells release sensitized lymphocytes that travel to the area of invasion (where inflammation is occurring) and activate macrophages that also activate helper T-cells. Helper T-cells release antibodies and macrophages to destroy and ingest foreign microorganisms.

Communicable

Contagious and spread from one source to another whether it is person-person, animal-person or even an object-person via bacterial or viral microorganisms. diseases are contagious and spread from one source to another whether it is person-person, animal-person, or even an object-person via bacterial or viral microorganisms. For example, the virus Hepatitis C can be spread from one person to another via the exchange of bodily fluids or from an object such as a shared needle

Contraindications

Contra means against so obviously this section will look at reasons why a drug should not be administered or its play audio contraindications. Keep in mind that drugs are not the only therapy that might be harmful to a patient. If any surgeries, procedures, or other treatments might harm a patient if they were done, they also are considered to be contraindications. When a patient is taking a blood thinner such as Coumadin, it is contraindicated for the patient to take aspirin, which also thins the blood. Another commonly seen warning on drug labels is the consumption of alcohol while taking medication Contraindications can have different levels. For example, a relative contraindication means the drug should not be used in this situation UNLESS the benefits outweigh the risk. For example, a drug is contraindicated for people with heart disease because it might cause some irregular beats. In one case, however, the physician believes the patient will die if the drug is not taken. Obviously, although the drug is contraindicated, the benefits outweigh the risks. However, if the medication or procedure will be life-threatening, and the benefits do not outweigh the risk then it is an absolute contraindication, and it should not be given at all. For example, according to the FDA, children under 2 years of age should not take any OTC cold and cough medicines. Not only will these not help relieve symptoms in the child, but they can be dangerous and should be avoided. The active ingredients can cause an increased heart rate, convulsions, unconsciousness, and death.

Hormones and Hormone Modifiers

Corticosteroid hormones are used to suppress the immune system specifically in leukemia and lymphoma. They are also used in combination with other chemotherapeutic agents to prevent the severe allergic reactions that can occur with these powerful cytotoxic medications. The two corticosteroids most commonly used in cancer treatment are: prednisone dexamethasone. Side effects listing of steroid use are very long, but the most common are: Fluid retention and edema (Cushing's syndrome) Osteoporosis Steroid-induced diabetes Nausea, vomiting, and diarrhea Electrolyte imbalance. Another group of drugs can be used to modify the effects of hormones. Antiestrogens will block estrogen's effects that can cause cancer and even osteoporosis. Tamoxifen is a selective estrogen receptor modifier that treats breast cancer by blocking the effects of estrogen on breast tissue. Antiandrogens, which suppress the production and effects of testosterone and can be used to treat prostate cancer. Eligard and bicalutamide (Casodex) are examples of antiandrogens. Side effects include impotence and hot flashes.

pathogenesis

Creation or progression of disease development.

lesion

Damaged or defective area on the inside or outside of the body such as scabs, ulcers, and tumors. As its name implies, fibrinous exudate contains fibrinogen, which differs from serous fluid. Fibrinogen is a plasma protein required for the clotting process. This type of exudate shows that a large injury is present and has a greater amount of inflammation. The resulting wound can be seen in the form of a play audio lesion on the outside of the body known as a scab. A scab is a large mass-like lesion that forms from dried fibrinous exudate, Figure 2-22.

disorder

Describes disruption from the normal functioning of the mind or body. Typically used when a disease is not an appropriate term to describe condition. Although disease and disorder is frequently used interchangeably, a disorder is a term used to describe a disruption from the normal functioning ability of the mind or body. Typically, disorder is used when a disease is not an appropriate term to describe a condition. For example, post-traumatic distress disorder (PTSD) is not classified as a disease. The individual's bodily functions are not deviated from functioning properly as in disease states. PTSD has symptoms such as anxiety, which is caused from witnessing or experiencing a traumatic event. Sadly, society has a stigma against mental health disorders and many veterans see PTSD as a label and choose to not seek help with the disorder.

Investigational New Drugs

Developing a new drug is by no means a simple endeavor. However, once a new drug has been developed and passed through animal trials, it must prove itself to the FDA to be a safe medication before it goes to market. This process is very much involved and lengthy. Investigational new drugs (INDs) enter a three-phase process: Phase one: The drug is given to a small group of healthy human subjects. Phase two: The drug is administered to a small group of people suffering from the condition the drug is intended to treat. Phase three: The drug is given to a large group and a multicenter study is done, which means the study is done at more than one facility. After this three-step process is finished and the FDA concludes the drug is safe, the agency approves the drug for general clinical use and the manufacturer can complete a new drug application.

Syringe Types

Different syringes are used for certain purposes. The three most commonly used disposable syringes are tuberculin, hypodermic, and insulin. Hypodermic syringes, meaning under the skin, usually has a capacity of 2-3 mL. Outfitted with the proper needle gauge and length, this syringe is commonly used to inject medication subcutaneously or intramuscularly. All hypodermic needles are marked on the barrel in 10 calibrations per milliliter (mL), with each small line measuring 0.1 mL. Therefore, when preparing an injection, it should be measured to the closest 0.1 mL. Insulin syringes are used only to give insulin preparations to diabetics. Those administering insulin should have a great understanding about how to do so before attempting to deliver a dose. Insulin needles vary in size to fit a patient's body type, so an obese person might require a longer needle to properly penetrate to a suitable depth to administer the insulin efficiently. The most common insulin syringe is the U-100 (units per milliliters) syringe. When looking at this syringe, located on the side of the barrel are two sets of measurements. One side is measured in even numbers while the other is in odd numbers, Figure 4-22. (A) is an image of U-100 syringes from both sides to show even numbers on one side and odd numbers on the other. (B) shows Lo-dose 30-unit and Lo-dose 50-unit syringes. When preparing a dose of insulin for a child, another type of insulin needle is used, such as the Lo-Dose insulin syringe that comes in 50-unit and 30-unit syringes, as shown in Figure 4-22(B). These provide a more accurate measurement of smaller doses. It should also be pointed out that each calibration on a Lo-dose syringe is one unit. Ideally, before administering insulin, the dose should be double-checked before injecting. Other types of syringes are: Tuberculin (TB) syringes are calibrated in tenths of a milliliter (1 cc or 1 mL). Therefore, this syringe is used to deliver a small quantity of a substance via the intradermal route. This syringe is used for tuberculosis testing or to deliver an allergen during an allergy test. However, since only 1 mL can be held in this syringe, it can also be used to deliver small doses of medication subcutaneously to a neonate or pediatric patient. Prefilled syringes are used to deliver a premeasured amount of a substance, Figure 4-23. Prefilled cartridges consist of a premeasured dose that is in a cartridge that can be given through an IV line if the needle is not attached. Oral syringes deliver medication orally without a needle. These syringes come capped, prefilled with medication labeled by the pharmacy with "not for injection" or "for oral use only."

Schedule II Listing of drugs that have usage in medical treatment but with severe restrictions because of a high potential for abuse.

Dilaudid Methadone Percocet OxyContin Fentanyl Morphine Codeine Cocaine Hydrocodone with Tylenol

Gender

Discrimination readily exists with disease, meaning some diseases affect more men than women, while other diseases affect women more than men. In women, multiple sclerosis, osteoporosis, and rheumatoid arthritis are more prevalent. Men have an increased risk of heart disease and Parkinson's disease. The reason for this may derive from hormones or genetics. Researchers are exploring potential causes of this phenomenon to gain a better understanding.

pandemic

Disease affecting the population of a vast geographic area such as a country or possibly worldwide. A disease affecting the population of a vast geographic area such as a country or possibly the globe is known as a play audio pandemic. A way to remember the meaning of this word is by associating it with a word you may be more familiar with—panoramic. A panoramic photograph is the widest picture one can take with a camera. A panoramic picture is used to photograph a very large area or a huge group of people. There was much fear that the Ebola virus (shown in Figure 1-6) might become a pandemic if not contained within West Africa. More about Ebola can be found

iatrogenic

Disease caused by medical intervention. This type of infection may also be called play audio iatrogenic, meaning the infection was caused by medical intervention. A HAI can occur in the healthcare setting but might not show symptoms until long after the patient is discharged. Figure 1-2 shows all the hiding places microorganisms lurk in plain sight According to the Centers for Disease Control and Prevention (CDC), in the United States, approximately 1 in 25 patients has at least one infection contracted during the course of their hospital care, adding up to about 722,000 infections in 2011. Figure 1-3 is an informative poster from the CDC on HAI.

endemic

Disease found in a certain region or specific population. A disease that is found in a certain region or specific population on a continual basis is an play audio endemic. Another way to remember this word is to think of it as never "ending". It will continually be in a certain location affecting a certain group of people, hence the word "end" in endemic. Ebola in West Africa is a prime example of an endemic disease. The deadly and highly contagious disease has been confined to Guinea, Sierra Leone, and Liberia for over a year and fortunately has not spread out of control considering its great potential. It has spread somewhat to Central Africa. Therefore, Ebola is an endemic disease because it is found in a certain region, in this case West Africa, and nowhere else. Figure 1-4 is a map that shows the region of West Africa where Ebola cases are found

Hereditary

Diseases are passed down from parents to their offspring. Unlike lifestyle, what is inherited cannot be avoided by healthy choices. Hereditary diseases are passed down from our parents. We are all born with certain traits and characteristics; however, some of these can increase the odds of getting a disease. Cystic fibrosis is passed on to a child and will be present at birth, drastically shortening the life-expectancy to 37.5 years of age. The BRCA or breast cancer gene is passed down the generations to children as well. Those with the BRCA gene are more susceptible to breast cancer. A blood test can be taken to examine DNA and determine if you are a carrier. Do you ever wonder why doctors ask you about your family history? Maybe you thought they were just nosey. However, physicians ask patients questions about their family history to identify if your relatives have been diagnosed with certain diseases that may have a tendency to run in the family. This gives the physician an idea of what disease you will be most likely to encounter, so it can be better prevented. For instance, heart disease is known to be inherited and if the patient's predecessors have heart disease they are at a greater risk of developing the disease themselves.

systemic effect

Effect of a drug on the entire body. A play audio systemic effect is when the drug has an effect on the entire body. An example is a drug that is taken to relieve pain, such as ibuprofen, which is taken by mouth and broken down by the body to reach the affected site via the bloodstream.

Patient Education: How to use an MDI

Ensure the patient is sitting in an upright position or standing Assemble the inhaler and dispense a waste dose if it has not been used within 24 hours to ensure consistent dosing Remove dentures if loose Check to ensure no debris is in the mouthpiece of the inhaler Exhale slowly to completely remove air form the lungs Place the mouthpiece between the lips to form a tight seal around the inhaler or mouthpiece of the spacer Push down on the canister while taking a slow deep breath, inhaling to full capacity Hold the breath for 5-15 seconds to give the aerosol time to deposit into the smaller airways Exhale through pursed lips to effectively remove all of the air inhaled Note: If the patient is ordered to take more than one puff, the patient should rest 1-2 minutes before the next dose. Also, if a patient is also ordered to take an inhaled corticosteroid at the same time, make sure to give the bronchodilator first. The patient must rinse out his or her mouth after the steroid to avoid getting an oral fungal infection commonly referred to as thrush. Thrush, which looks like white fuzz, causes painful sores in the mouth and throat. Believe it or not, many patients have difficulty self-administering their respiratory medication. This is another reason why patient education is so crucial, especially when sending a patient home with a drug. The reason behind this particular struggle is that both inhalers and nebulizers are effective only if they are properly administered. Unlike taking a pill or a teaspoon of cough syrup, a specific technique should be used when taking inhaled medication. Many patients complain that the medicine has not helped their condition. When this occurs and the patient does not require a dose, give the patient a placebo inhaler and ask him or her to demonstrate how he or she takes the drug at home. You might be surprised with what you see. One of the authors had an older patient who complained his MDI inhaler wasn't working. When asked to show how he used the inhaler, he activated the inhaler, and then blew into it. No wonder he did not feel any relief from the drug. Some patients, especially the elderly, require more attention and reinforcement, especially if the drug is newly prescribed.

Drug Enforcement Agency (DEA)

Established to enforce provisions of the 1970 Controlled Substances Act.

Genetic immunity

General ability of our body to respond to an invader based on genetic traits we are born with. is the general ability of our body to respond to an invader and depends on factors such as sex, race, and other genetic traits. We are born with an immune system to help us fight diseases. Have you ever wondered why physicians claim breastfeeding is better than formula feeding? In addition to personal preference, breast milk contains disease-fighting antibodies that strengthen a newborn's immune system

1983 Orphan Drug Act

Gives financial incentives to manufacturers that develop drugs to treat rare diseases. It is no secret that pharmaceutical sales are a multi-billion-dollar, profit-driven business. Common diseases affecting millions of people have an array of drugs produced by pharmaceutical companies that all want to get their share of the pie and make a significant profit. But, what about rare diseases that are contracted by only a few people? Do we just let them suffer because there is virtually no money to be made? By the time a drug is produced, from start to finish, a company spends millions and millions of dollars. So, what incentives can drug companies be given to pursue the development of medicinal products for these rare conditions? The 1983 Orphan Drug Act provides financial incentives for pharmaceutical companies to develop drugs for these otherwise poor money-making projects.

enteral route

Giving drugs by way of the GI tract.

The Importance of Information Gathering

Have you ever heard of the computer phrase, "garbage in, garbage out?" The same can be said for information gathering. If the information you collect is useless or inaccurate, the ability to properly diagnose and treat the patient will be compromised. The patient's information should be in chronological order, clear, correct, complete, and concise. We will start by discussing basic patient interview techniques because what better source to learn about the patient than the patient?

history of present illness (HPI)

History of the current condition or disease. A clinician is like a detective. To uncover the history of present illness (HPI), the clinician must use a line of questioning to help aid in determining the patient's diagnosis. It is important for the clinician to not only question the patient to gather information, but listen to the patient and not solely rely on tests to diagnose. The data listed in this section should only pertain to what recently happened in regards to the chief complaint, such as asking the patient when the issue first occurred and whether any other symptoms arose since then. Other details include, how long has this symptom been occurring? Has it been getting progressively worse or remaining constant? Has the condition improved at all since its first onset? Does anything alleviate or make the symptom(s) worse? For example, let's say a middle-aged woman named Jessica comes into the physician's office with complaints of shortness of breath (SOB). The doctor asks when she has trouble breathing. Jessica states that she has her breathing under control most of the time. However, the physician discovers that she has many cats in her apartment and she has trouble breathing when she vacuums the carpet. Then Jessica further explains she only has difficulty for about an hour or so and then her breathing returns to normal after she stops vacuuming. The doctor asks how often has this been happening, and finds it has started over that last few months. Based on this information the doctor has found probable cause for her SOB. Now further testing can be done to determine if the patient has an allergic asthma and if it is from the vacuum releasing cat dander, dust, or other irritants into the air

Indirect contact

Host coming into contact with a contaminated surface. occurs when a person comes into contact with a contaminated surface, such as a doorknob, and then touches a mucous membrane or wound. This is why it is so important to use new or sterilized medical instruments and equipment. It should also be noted that droplets can transmit disease via the indirect route. If a contaminated person sneezes in a doorway and particles land on a door knob and moments later another person opens the door, that person has come into indirect contact with a pathogen. Another method of indirect contact is by puncturing oneself with a dirty needle. A hollow needle has greater risk for transmitting disease than solid needles, due to the possibility of body fluids remaining inside the needle and releasing upon contact.

X-ray

Imaging technique utilized to determine any bone breaks and defects in the body. Let's begin by taking a look at X-rays. A play audio chest X-ray (CXR) is used to examine the thoracic cavity. An X-ray is also utilized to determine any bone breaks and defects elsewhere in the body. An X-ray has four main body densities, gas/air (black), water/blood (gray), tissue/fat (gray), and metal/calcium (white). The X-ray machine projects into the body a ray of electrons which are either scattered or deflected by body tissue. Some rays pass directly through the patient and reach the film, while others are absorbed by body tissues. A film is placed behind the targeted area and that film reflects the different contrasts of shades and shadows producing the image

chest X-ray (CXR)

Imaging used to examine the thoracic cavity.

Magnetic Resonance Imaging (MRI)

Imaging uses magnets and radio waves to produce high resolution images of organs and soft tissue with no radiation exposure to patient. uses magnets and radio waves to produce high-resolution images of organs and soft tissue; therefore, the patient is not exposed to any radiation. However, metal objects are contraindicated due to the magnetic field produced, this also includes pacemakers. Although not utilizing X-rays to produce images, MRIs have the capability to develop 3D images of the body at any desired plane. MRIs are widely used for making detailed images of ligaments, tendons, and other soft tissues such as the brain. However, an MRI can take up to two hours to complete

computerized tomography (CT or CAT) scan

Imaging utilizing x-rays and a computer to produce cross-sectional slices of the body. Another important tool is a CT scan. A computerized tomography (CT or CAT) scan has the ability to take a more detailed image of the patient than an X-ray. A CT produces cross-sectional slices of the body at various angles. It is capable of imaging bone, vessels, and organs such as the lungs. It is widely used to examine the extent of trauma such as a cranial hemorrhage. The scan uses a combination of an X-ray and computer making it more precise than a traditional X-ray and it is much faster and cheaper than an MRI, but not as detailed,

Acquired immunity

Immunity developed over time through pathogenic exposure. unlike genetic immunity, is developed over time as the body is exposed to pathogenic microorganisms and learns to combat them. Acquired immunity can be broken down into two types, active and passive

Active acquired immunity

Immunity occurring when the body is exposed to a pathogen and produces antibodies to defend itself against re-exposure. takes place when the body is exposed to a pathogen and makes antibodies to defend itself against re-exposure. This gives new meaning to the old adage, "what doesn't kill you, makes you stronger."

hyperemia

Increases blood flow to a certain area causing redness and warm sensation.

healthcare-associated infection (HAI)

Infection caused by medical intervention. A very important type of infection that everyone working in health care should be aware of is a healthcare-associated infection (HAI). The older term for this was nosocomial infection which meant a hospital-acquired infection. HAI is a much more inclusive term because patients are treated in other facilities besides a hospital

Patient education

Instructing patients in various aspects of their care such as how to properly perform treatments. Patient education in all aspects of their care is highly important. A patient should always understand the importance of each treatment and procedure. Instructing how to properly perform each treatment and explaining the purpose will greatly increase the chances of the patient continuing therapy on her or his own. It should be mentioned that including the patient's family members in patient education helps to reinforce proper technique, as well as ensure the likelihood of the patient continuing therapy once discharged.

electrocardiograph

Instrument used to record heart rhythms. How can we monitor the activity of the heart? An play audio electrocardiogram (ECG or EKG) is a quick, noninvasive, and painless technique used to record electrical impulses produced by special cells in the heart. These electrical impulses can be detected on the surface of the body as the impulse travels through the heart. The heart rhythms are recorded using an play audio electrocardiograph, while the actual display of the rhythms recorded is an electrocardiogram. If a patient has an arrhythmia, an irregular heartbeat, it can be identified and treated.

social history

Information obtained on the type of lifestyle the patient lives such as marital status, social or frequent drinking history, smoking history, or illicit drug use. The social history gives the caretaker an insight into the patient's lifestyle. Marital status, social or frequent drinking history, smoking history, or illicit drug use are important data findings. The social history obtained may aid in providing clues as to why the patient presents as is and can determine potential diseases the patient is at risk of developing. The patient may be living a risky lifestyle and may be more prone to certain ailments. For instance, if a patient states he smokes, the clinician can infer lung disease. Other factors included under this category are sexual and travel history as well as education level. Have you ever been asked if you recently traveled to Africa? Why do you think that happens? There are many diseases that can be acquired abroad, so it is best practice to know if the patient may have been exposed to those potential pathogens. For example, Africa is known for the Ebola virus, while South and Central America is known for the Zika virus

Inhalation Drug Forms: The Metered Dose Inhaler

Inhalers are both portable and convenient for patients, but require good patient effort and coordination. The patient inhales an aerosolized form of a drug directly into the respiratory system. This route has a fast onset of action because the lungs have a large surface area and a tremendous blood supply. Drugs administered in this route are given to treat acute or chronic lung conditions that cause constriction of the airways such as asthma or COPD (chronic pulmonary obstructive disease). Several types of devices are used to generate aerosolized medication, and the most familiar one being the metered dose inhaler (MDI) as shown in Figure 4-11. MDI inhalers use a self-contained propellant to deliver a dose of medication. This device is convenient to use and carry, as it does not require any external gas sources. An MDI does require patient cooperation and coordination, in which case a reservoir or spacer (shown in Figure 4-12) can be added to an MDI to assist in administering the dose to the patient. A handy feature some spacers have is that they will whistle and sound like a harmonica if the patient inhales too fast. When the patient actuates the canister, the metered dose, commonly referred to as a "puff," moves into the reservoir, from which the patient can slowly and deeply inhale the drug, maximizing its distribution throughout the lungs. If prescribed to a pediatric patient, a mask can be added to the end of the MDI to help administer the dose. For MDI patient education, see Table 4-1.

family history

Interview to identify diseases the patient is susceptible to according to heredity. Why does a physician ask about your family history? A family history can help identify diseases the patient is susceptible to and likely to develop over his or her lifetime. As parents pass their physical traits on to their children, other characteristics are also inherited such as the predisposition to diseases. Heart disease and stroke are known to be hereditary. It is important to determine what illnesses a patient's parents or close relatives have or that caused their death. A family history of heart disease would make it more likely that a patient might develop heart disease. If a female patient's mother or grandmother had, or passed away from, ovarian or breast cancer, the odds of the patient encountering the disease is greatly increased. If this information is known, preventive measures can be taken to catch the disease in its earliest stage to increase the rate of survivability. For men, a cancer such as prostate cancer tends to run in the family. Therefore, men should be examined regularly when there is an increased chance of developing the disease.

opportunistic organisms

Invade regions of the body causing illness when given the opportunity. Sometimes drugs can wipe out the normal flora in our body and other microorganisms can seize this opportunity to occupy that space. These organisms are known as opportunistic organisms, and they can invade other regions of the body causing illness. Even though this is true, we do not fall ill every day because the body's defense mechanism or immune system constantly defends us from exposures. Although on occasion, as discussed in Module 1, a pathogenic organism can gain access to our body through portals of entry. When that happens, the inflammation process occurs in response to the invasion

Allergies

It is important to ask and make note of any patient allergies. Common patient allergies seen in the hospital are latex, dyes, and medications, all of which can cause a wide array of adverse effects. If the patient has no known allergies the abbreviation used in the chart is NKA. When a patient is first exposed to an allergen a mild reaction may present. Allergic reactions can occur within seconds, or hours after the initial exposure. An anaphylactic reaction results in a loss of blood pressure, making it the most serious and potentially life-threatening allergic reaction, requiring immediate medical intervention.

past medical history (PMH)

Listing of previous medical illnesses and procedures. The patient's past medical history (PMH) is a list of previous medical illnesses and procedures from the past. It is listed from the most relevant to the chief complaint to the least. The video demonstrates how questioning can be used to further gather information needed to treat a patient.

Official and Chemical Names

Just when you thought the same drug had enough names, there are even more. Medications also receive an official name given by the USP/NF, after the drug has been approved for use. The good news is that this name is usually the same as the generic name. Each drug also has a chemical name that is important in the drug manufacturing process. This name describes the molecular structure of a substance. These names are rarely, if at all, used in a clinical setting or marketing campaign because of their shear complexity. Can you imagine receiving a prescription or an order for 8-chloro-1-methyl-6-phenyl-4H-s-triazolo [4,3-α] [1,4] benzodiazepine? This chemical structure is for Xanax (alprazolam). Thankfully, we need only to know the brand and generic names, which does not seem too bad after considering the chemical names.

culture and sensitivity (C&S)

Laboratory sample from a patient that grows and identifies the pathogen and tests what drug will kill it. If a patient has an infection, it is important to determine if it is viral or bacterial. In order to identify the bug, a culture and sensitivity (C&S) needs to be completed. A C&S uses body secretion samples from a patient. The sample is placed in a sterile container designated for laboratory samples. Care must be taken to prevent contamination of the inside of the container and bottom of the lid, as this may cause an erroneous result. Once the sample is collected and properly labeled with the patient's information, it is promptly sent to the lab. The sample is grown (cultured) to determine the type of bacteria present and which antibiotics will destroy the microorganism. If the results show that it is viral microorganism, the patient can be treated with anti-viral medications.

Omnibus Budget Reconciliation Act (OBRA) of 1990

Legislation that mandates pharmacies to ask customers if they would like to be educated about their medication at time of purchase. Have you ever purchased prescription drugs from a pharmacy and had to check a box stating that you decline any and all drug counseling at this time? Have you ever wondered why you are asked if you need an overview of the medication? It is not just a common courtesy; it's the law. The Omnibus Budget Reconciliation Act (OBRA) of 1990 requires that pharmacies ask if people desire to be educated about their medication. This law also states that all nonprescribed or over-the-counter (OTC) drugs taken by a patient must be written down in the patient's medical record. OTC drugs, even though easily found and purchased, can still be dangerous if not used properly and have many interactions with prescribed drugs.

survival rate

Length of time a patient's lives after being diagnosed with a disease.

Less Common Injection Routes

Less commonly used parenteral injection routes are usually given by a physician and these forms are as follows: The intraosseous route was discovered in 1922. This form of injection is done by actually injecting medication into the marrow of the patient's long bones, where the drug can have an immediate systemic effect. It can be used to administer medications into systemic circulation when the patient's blood vessels would collapse or could not be found such as during a cardiac arrest. Intraventricular route route, which is used to inject medication into the brain, is not commonly used. Medications given by this route are delivered by a catheter called a ventriculostomy tube, which is placed into the brain ventricle. Intraspinal is an injection into the spinal cord. The drug is administered into the subarachnoid space and into the cerebral spinal fluid surrounding the spinal cord. This route is mostly used to give anesthetic agents that cause a loss of feeling in regions distal or away from the injection site. Intracapsular (intra-articular) is an injection used to decrease the inflammation of a joint. Anti-inflammatory agents are injected into the capsule of a joint such as a shoulder, elbow, wrist, knee, hip, or ankle to provide relief for those suffering from arthritis or bursitis.

Inflammatory Lesions

Let's start off by defining a lesion. A lesion is a tissue wound or abnormality that derives from a disease or physical trauma. Examples of lesions are tumors, ulcers, abscesses, blisters, wheals, vesicles, and the list goes on.

single-gene

Likely to be a recessive or an inherited disorder. abnormality is more likely to be a recessive or an inherited disorder. If both parents have abnormal genes, it is possible the child will have an abnormality. An example is cystic fibrosis, in which the individual will have pancreatic dysfunction resulting in the inability to properly absorb nutrients as well as pulmonary involvement causing excessive mucus production in the airways

medication history

Listing of all current prescriptions, over-the-counter (OTC) drugs, and herbal supplements and any adverse drug reactions. Obtaining a proper medication history is a very important component of the information and history gathering process. A proper medication history should include all current medications, including over-the-counter (OTC) drugs, and herbal supplements. Also, questioning the patient whether he or she takes all his or her medicines as prescribed or if any adverse drug reactions (side-effects) have ever occurred is critical. Gathering a list of medications will prevent the risk of medicine errors. The odds of an error occurring is increased in elderly patients prescribed different medications for the same ailment. Patients may self-medicate and take a variety of supplements to further treat a condition for which their doctor has already prescribed medication. The patient does not realize or consider the potential dangers that can occur from mixing over-the-counter drugs with prescribed medications. Elderly patients with multiple prescriptions can easily get their medications confused. Not only is this dangerous, but it can be frustrating for the patient

occupational history

Listing of what the patient does or did for a living. It is important to know what the patient does or did for a living. The patient's occupational history may aid in the understanding of what caused the patient to present to the emergency department or physician's office. A patient's work environment can have a significant impact on their overall health. A worker exposed to inorganic or organic dust can develop many possible diseases causing permanent destruction to the lungs and possibly lead to cancer. Individuals exposed to chemicals and radiation over periods of time can also develop long-term effects resulting in possible disability or death. This history, like others can be found within the forms given to the patient to fill out prior to being seen by the attending physician

Advantages of Inhalation Therapy

Local drug effect on the body (airways and lungs), not systemic; therefore, lower doses can be given to produce desired effect on lungs Rapid onset Painless/noninvasive Convenient Potent drugs can be given at lower doses to minimize side effects

Schedule V Currently used for medical treatment with less potential for abuse than drugs in schedule IV; have a slight possibility for abuse and might cause limited physical or psychological dependence.

Lomotil Motofen Lyrica Parepectolin Cheratussin AC Promethazine with codeine

Direct Contact

Making physical contact with another person or body fluids that spreads infection. Pathogens are spread by two common routes of transmission, or simply by direct and indirect contact. Direct contact is when a person carrying a pathogenic microorganism comes into physical contact with another person or when body fluids make contact with an open sore or mucous membrane. Infectious disease is most commonly spread through direct contact. For example, if an individual fails to wear gloves when dealing with contaminated body fluids and the fluid breaches the skin through a cut on a finger, the pathogen now can gain entry into the body. Kissing would be another form of potential direct contact transmission.

Cancer Treatment: Begin with Prevention

Many types of cancer can be prevented or managed with a healthy diet and exercise. Even genetic susceptibility to cancer can be lessened by preventative measures. Testing, such as mammograms (for breast cancer), colonoscopy (for colon cancer), and Pap tests (for cervical cancer), can improve survival rates by detecting cancers early, before they have metastasized, or even allowing the removal of abnormal cells before they become cancerous. Lifestyle changes should be considered key tools in cancer prevention. Since smoking is estimated to cause 30% of all cancers, the obvious lifestyle change is to never start smoking, and quit if you do. Also limit your alcohol consumption. A cancer-protective diet is low in fat and high in fiber-rich foods such as whole grains, fresh fruits, and vegetables. Moderate and regular exercise has been shown to be cancer protective. Protect your body from harmful environmental carcinogens. Get only needed X-rays, and make sure you are protected when having any imaging exam. Protect yourself around potentially harmful household products, such as insecticides, solvents, cleaners, pesticides and pool chemicals. Avoid harmful chemicals if possible, or wear proper masks to prevent breathing them in and wear proper clothing to prevent contact with your skin. Melanoma is one of the most widespread and deadliest forms of skin cancer, produced by hyperreproduction of the pigment-producing skin cells called melanocytes. Genetic factors also can cause melanoma, but high exposure to UV sunlight and sunburns are the key risk factors by far. That is why it is important to limit sun exposure and wear protective clothing and a sunblock SPF 15 or higher. Since prevention and screening are critical, review Table 5-2, which gives recommendations from the American Cancer Society. The prognosis of cancer is greatly enhanced by catching it early, before it becomes invasive and spreads. Other factors that can affect the prognosis are the type of cancer, age of patient, immune status, and efficacy of treatment.

Vital signs

Measured signs that are vital for life; heart rate, respiration rate, blood pressure, and body temperature. are all vital to life in the form of heart rate, respiration rate, blood pressure, and body temperature. Vital signs (listed in Table 1-1) vary according to patient age, sex, weight, and overall fitness level. To differentiate signs from symptoms, think of a road sign, more specifically a speed limit sign. A speed limit sign displays numbers showing how fast motorists can travel (Figure 1-21), and in health care a sign is measured numerically on a monitor or counted

sustained-release capsule or tablet

Medication with a coating to deliver a dose over an extended period time. A sustained-release capsule or tablet comes in many different coatings and colors and differ in the amount of time it takes for the coating to be dissolved. This type of coating is used to deliver a dose over an extended time period, thus decreasing the amount of times or frequency a drug has to be taken. Inside extended-release capsules are little round balls or pellets, which must not be crushed or altered. If they are, instead of the drug releasing in the body at certain time intervals, the drug will be absorbed all at once, potentially causing an overdose. Therefore, these types of capsules should remain intact or kept whole.

Viruses

Microorganisms smaller than bacteria and that require a host cell to reproduce. smaller than bacteria and spread differently. A virus needs a host to survive, and it cannot reproduce on its own. A virus must hijack a cell to use it as a host cell in order to replicate

electrolytes

Minerals dissolved in blood needed by the body to function properly, (calcium, potassium, sodium, phosphate, magnesium, and chloride). Another important component measured from a blood sample is play audio electrolytes. Electrolytes are highly important minerals (calcium, potassium, sodium, phosphate, magnesium, and chloride) that must to be maintained at a proper concentration level to enable the body to function efficiently. Each electrolyte plays a significant role in the way the body functions. When an imbalance occurs a disorder will present. Electrolyte imbalances may result from too much or not enough fluid in the body. Dehydration, vomiting, diarrhea, sweating, and burns cause decreases in electrolytes. Electrolyte increases may result from excess fluid intake from an intravenous (IV) solution. The severity of symptoms can vary greatly from nonlife threatening (muscle cramps) to a medical emergency (heart arrhythmias and organ failure).

nasogastric tube (NG)

Narrow tube passed through the nose to the stomach.

Nebulizers

Nebulizers are used to deliver an aerosol to the patient's airways. This can be done with a variety of different nebulizers. We will focus our attention on two types. A small volume nebulizer (SVN) is used to deliver an aerosol to a patient (Figure 4-14). To function, this device requires a gas source, which can be provided as piped-in oxygen in medical facilities or a portable air compressor unit for medication delivery at home. The patient must be instructed and coached to take in slow deep breaths with a breath hold. This will help prevent dizziness, which is a common side effect caused by patients inhaling too quickly (hyperventilating). Breath-actuated nebulizer (BAN) differs from SVNs by having the ability to be set on two different modes. This nebulizer can deliver a drug continuously like an SVN or it can be switched over to the breath-actuated setting so the nebulizer will give a breath only when the patient inhales through his or her mouth. Therefore, if the patient is on a face mask, the breath-actuated setting will not work. However, when used properly, this nebulizer prevents the drug from being wasted because it will nebulize on only inspiration and not continue to nebulize on exhalation. See Table 4-3 for more information about the advantages and disadvantages of aerosol medications.

Antacid

Neutralize stomach acidity Maalox (aluminum/magnesium) Mylanta (calcium carbonate/magnesium carbonate)

nothing by mouth (NPO)

No food, beverage, or medication to be given orally.

Health Care Practitioners and the Law

No matter what your profession, if you work around pharmaceuticals, you have a great responsibility, especially when dispensing drugs to patients or working in an environment containing vast quantities of medications. When administering medications, accurate records must be maintained for all controlled drug substances and kept available for two years. After that point, any old records must be shredded and properly disposed. It is also important to stay current with all news regarding FDA and DEA regulations. If you are employed at a physician's office, monitor the expiration date of the DEA registration number of the physician, to ensure everything is up-to-date. Some duties might include calling in prescriptions to pharmacies. If that is the case, we urge you to make an attempt establish a good relationship with the people who work there. Pharmacists can be invaluable sources of information when you face any uncertainties about a drug or if any legal responsibilities are in question. Also, an up-to-date drug reference should be kept on hand to help identify unknown medications. Keeping an organized inventory of all pharmaceuticals and supplies is essential. It might take some time getting organized, but knowing exactly how much of any drug is on hand or what is going to expire soon will save a lot of time in the long run. Any drugs that have expired must be properly discarded so they are not accidently dispensed to a patient or fall into the wrong hands. All controlled substances must be locked up, and, in most cases, require a double-lock, meaning a lock on the door to get into the "med room" and a lock on the cabinet or drawer in which they are stored (see Figure 3-5). Speaking of locking up items, all prescription pads must be kept out of the public's eye and in a locked drawer. This precaution will decrease the likelihood of any someone attempting to illegally write prescriptions to obtain a controlled substance.

Types of Acquired Immunity

Now that we have established some of the basics of the acquired immune system, let's break it down even further. The acquired immune system has two different types of protection: Cell-mediated immunity Humoral immunity.

Benign

Noncancerous Rarely fatal Encapsulated cell growth (enclosed in a capsule) Does not invade other tissues (noninvasive) but can interfere with body functions by compressing organs Slow cell growth

benign

Noncancerous tumor.

Rickettsiae

Nonmotile bacteria. are bacteria that are nonmotile, meaning they do not move on their own. That being said, rickettsia needs a host in order to live and spread, but how is this organism transferred to susceptible hosts? This bacterium spreads by way of types of insects called anthropods such as ticks, lice, fleas, and mites. Infections, which can be life-threatening, are treated with antibiotic therapy. Although Rocky Mountain spotted fever is a rare disease affecting less than 20,000 people a year, it is caused by rickettsia infection. This illness is often transmitted by a tick bite, which causes a rash that looks like spots on the patient's body as shown in Figure 2-15. Other symptoms are a loss of appetite, fever, muscle, and headaches. If addressed early with antibiotics, the illness lasts anywhere from days to a few weeks. However, if not treated during its early onset, serious damage can occur to the heart and kidneys.

Tissue Healing

Now that we covered tissue repair, we will discuss tissue healing. To get a better idea about this concept, we will draw on some of your own experiences. Have you ever had an operation where surgical incisions were made, or even had a paper cut? These cuts are very thin and clean, in other words, with no debris or jagged edges on the outside of the wound. When the tissue is "clean-cut" and has straight edges, the sides of the wounds stick together nicely and allow the wound to heal quickly. On the other hand, injuries resulting in the tearing of flesh will take longer to heal and will result in visible scarring because the edges don't fit "nicely" back together. The tissue healing process is based on how the wound heals, whether the edges of the wound come together to close the gap, or if the injury remains separated. In fact, healing is categorized based on the extent of separation from the edges of the wound. This is known as primary and secondary unions. Before discussing the primary and secondary unions, it is important to understand the process of how wounds are healed. The healing process has been broken down into a series of four steps.

Breaking the Chain of Infection

Now that you understand the links of the chain of infection, let's focus on ways to break the chain. It is important to remember that any break in the chain will prevent the spread of infection. The chain of infection shown in Figure 1-13 has subsections that break each link into smaller pieces. Each piece gives an example of how each link can be broken, stopping the pathogen before it has an opportunity to further grow and spread. For instance, following standard precautions will protect a clinician from a source of disease, such as an infected patient. Hand washing also breaks the chain of infection at the portal of exit and the mode of transmission links, preventing the pathogen from spreading to others. James, a 33-year-old outdoorsman went camping with his girlfriend, Lauren, in late July. The morning was very humid and sunny without a cloud in the sky. The couple decided to leave their campsite around 10 am to go hiking and picnic in the mountains. A few miles into the hike, Lauren noticed a black spot on the back of James' knee. The two stopped for a closer look and it was a tick embedded in James' skin. James removed the tick and the couple decided to picnic in a clearing. As they unpacked their food, Lauren noticed that the ice packs were no longer cold. Lauren told James that it was probably not a good idea to eat the potato salad because it was warm. James did not take the warning seriously and ate the potato salad anyway. The couple finished their meal and headed back to camp. Later in the evening, James did not feel well. Thinking he had food poisoning, the couple ended their camping trip early and went home. The next day, James was very nauseated and was experiencing abdominal cramps and pain. James vomited throughout the day and decided to go to the hospital. The physician confirmed that James did have food poisoning and was dehydrated from vomiting and not eating or drinking most of the day. The physician ordered a nurse to give James fluids via an intravenous (IV) route. The nurse, not using proper techniques, placed the needle into James' arm. At first there were no signs of infection, but later the injection site became very sore, swollen, and red, the results of a staph infection.

Signs

Objective measurements of body functions. are objective measurements such as height and weight that can be consistently obtained by different clinicians without bias and personal judgement

Symptoms

Observable subjective states or behaviors that rely on the patient to state how they feel. Symptoms are observable states or behaviors that are subjective. The diagnosis relies on the patient stating how she or he feels, and how the clinician interprets the patient. This is more difficult to measure, hence it is not a definitive measurement and is rather an estimation that is compared with other patients' answers to the same questions. For instance, when a patient is asked how nauseated or dizzy they feel, or how much pain is being experienced, there is no clear way to know, as a clinician, what the patient is actually experiencing. Everyone has different perceptions and tolerance levels.

Chronic inflammation

Ongoing inflammation of 7 to 10 days. . results from a foreign invader that has not been killed after 7 to 10 days. At this time, the immune system will release the "big guns" known as lymphocytes. In an effort to contain the foreign debris and prevent it from establishing itself in other areas of the body, the infected tissue surrounds the microorganism by encapsulating it in a granuloma

Oral Drug Forms

Oral medications are the easiest and, in most cases, the cheapest drug forms. They cannot be used in all situations, such as emergencies when the drug must bypass the GI tract and is injected directly into the blood for immediate action. Oral forms cannot be used if the patient has difficulty swallowing, or a physician has ordered, nothing by mouth (NPO). All forms discussed in this section can be seen in Figure 4-1.

helminths

Parasitic worms. Unlike most pathogenic organisms, helminths are large enough to be seen without the aid of a microscope. Helminths are parasitic worms that are broadly categorized as flatworms (tapeworms), roundworms (pinworms and hookworms), and flukes. Helminths are commonly found in third-world countries because of poor sanitation and are less likely seen in developed countries. These organisms can survive in both humans and nature, just as a protozoan. There are many different species of parasitic worms, and we will discuss a few that are most common

portal of entry

Pathogen point of entry to host such as by way of mouth, eyes, and nose or other mucous membrane.

mechanical vector

Pathogen transmitted by an animal or insect simply by coming into contact with a microorganism and then physically transporting it to the host. ow that we have discussed the various routes a pathogen can take, we need to take a closer look at the actual carriers that can assist the pathogen in entering the body. The carriers that assist pathogens are termed vectors. A vector is any living organism (person, plant, or animal) that carries and transmits disease to another living organism. A vector-borne exposure can occur in two ways, mechanical and biological. A mechanical vector is involved when a pathogen is transmitted by an animal or insect simply by coming into contact with a microorganism and then physically transporting it to the host, as shown in Figure 1-10. Imagine a fly landing on feces or a deceased animal that contains pathogens, then landing on an open sore. The carrier does not develop the disease but rather acts as the mechanical vector and transports the microorganisms from one location to another.

airborne transmission

Pathogenic transmission by way of coughing, sneezing, talking and laughing. There are other routes by which disease can be transmitted to a susceptible host. One of these routes is airborne transmission, which occurs when a pathogen is released into the air by way of coughing, sneezing, talking, and laughing. As seen in Figure 1-8, if an infected individual is in close proximity to a potential host the pathogen is transferred through droplets in the air

DPI Administration Technique

Patient Education: How to use a DPI Ensure the patient is sitting in an upright position or standing Break open the capsule inside the inhaler (this action varies per inhaler) Remove dentures if loose Check to ensure no debris is in the mouthpiece of the inhaler Exhale slowly to completely remove air form the lungs Place the mouthpiece between the lips to form a tight seal around the inhaler Inhale fast and deep to capacity Hold your breath for at least 5-15 seconds Exhale through pursed lips to effectively remove all of the air inhaled

inoculation period

Period of pathogen introduction without symptoms.

incubation period

Period of pathogen reproduction causing symptoms to occur within the host.

remission

Period where disease is treated successfully and the patient is free of symptoms.

Trauma

Physical injury or a disturbing experience. results from either a physical injury or a disturbing experience (mental trauma). In this text, we will focus only on physical injury. A physical trauma can occur in many different ways, including motor vehicle accidents (MVAs), gunshot wounds (GSWs), stabbings, burns, and falls. Secondary to a traumatic physical injury, many diseases, such as acute respiratory distress syndrome (ARDS), severe chest trauma, pulmonary embolism, and traumatic brain injury (TBI), can occur, further damaging the body's tissues and complicating the patient's well-being. If trauma is not managed correctly, infection is likely to occur.

malnutrition

Poor nutrition. Proper nutrition is vital to maintain a healthy body. Nutrition follows the concepts of, "good in, good out" and "garbage in, garbage out." If you put diesel fuel in a car that uses unleaded gasoline, its function will be greatly impaired. In a person, poor nutrition or malnutrition will result in poor body development and decreased cognitive ability and, in severe cases, death can occur It is important to recognize that malnutrition can happen in different ways. A disease can impair the body's ability to break down and absorb nutrients. Also, what people consume can have a direct effect on their body's nutrition. Those most likely to be affected by poor nutrition are children and senior citizens.

gowns

Protective garment used to protect clothing and skin from infectious exposures. Occasionally, blood and other body fluids may potentially splash or spray. In these situations, gowns are used to protect clothing and skin from exposures. Gowns are worn like a backwards robe and should be tied to remain secure and prevent falling during a procedure. Gowns should only be used once and should be discarded after the procedure.

Hemoglobin (Hgb)

Protein in the red blood cell that carries oxygen. Protein in the red blood cell that carries oxygen Men: 13.5-17.5 grams/dL or (135-175 grams/L) Women: 12.0-15.5 grams/dL or (120-155 grams/L)

contagious

Potential to cause infection and spread rapidly. disease is also communicable; however, it is differentiated by "rapidly" spreading from person to person by direct or indirect contact. For example, a fungal infection such as athlete's foot is certainly communicable but not highly infectious. On the other hand, the flu, or influenza, is highly contagious and spreads rapidly through the population.

Antiemetic

Prevent vomiting Emend (aprepitant) Inapsine (droperidol)

chronic pain

Prolonged pain. Analgesics or painkillers are very addicting and should be taken only as prescribed by the physician. Pain is any hurtful discomfort, and it is not a normal process of aging. Two types of pain are acute and chronic. Acute pain is a warning signal that something is not normal with our body. Acute pain occurs suddenly, lasting only a day or two. Acute pain can be associated with an infection, procedure, inflammation, etc. Once the cause of pain has been identified, it can be treated and relieved in a relatively timely fashion. However, chronic pain is prolonged pain, lasting much longer than its acute stage. What do we do when we are in pain? We want to take a pill to make it go away, right? It is common practice for people to rush to their physician's office for a pain pill prescription. It is vital to treat the underlying cause of the pain to prevent the patient from masking it with analgesics. Opioids are narcotics used to treat pain, but they can be addicting when they are used to produce an intoxicating high and reduce anxiety. This drug classification is one of the most abused drug classes in the United States.

physical examination

Process of physically examining a patient in a systematic manner. After the clinician reviews the patient's medical history, the next step is examining the patient. Now we will discuss the physical examination process in more depth. Commonly performed by the clinician at the beginning of a physical exam is the HEENT, which stands for Head, Eyes, Ears, Nose, and Throat. The physician will visually inspect the head for any abnormalities such as facial symmetry and palpate, or feel using their fingers, to search for any irregularities. The examination will proceed downwards to the neck to assess lymph nodes and thyroid. The eyes are checked to note the patient's ability to track a moving object to determine the movement ability, pupil dilation, contraction in response to light as well as equal and overall condition of the eyes. The ears are examined for hearing acuteness, redness, and inflammation with the use of an otoscope. An examination of the lungs and chest use four general principles, inspection, auscultation, palpation, and percussion.

The Patient Interview

Process where clinician gathers patient information. How can we get the patient to open up and explain how they are feeling in detail? During the patient interview process the clinician has the opportunity to make the patient feel comfortable and build a relationship. The clinician should maintain an open body posture by not crossing their arms or avoiding eye contact. It is also recommended to avoid standing in or near the door. It makes it appear as though the clinician is ready for the quickest possible exit. Another pointer is to avoid using medical jargon; the complicated, foreign sounding words will alienate the patient and only cause confusion. A patient is more likely to open up to questioning and elaborate on current and past history if she or he feels comfortable. We will further explore open and closed questioning, but first let's watch a short video to actually see how open questioning is done.

Hematocrit (HCT)

Ratio of total cellular volume to total volume of blood. Ratio of volume of red blood cells to total volume of blood Men: 38.8-50.0 percent Women: 34.9-44.5 percent

relapse

Reappearance of the disease or condition.

electrocardiogram (ECG or EKG)

Recorded display of electrical impulses produced by the heart.

Nonsteroidal anti-inflammatory drugs (NSAIDS)

Reduce inflammation Motrin (ibuprofen) Naprosyn (naproxen)

Disadvantages of Inhalation Therapy

Requires patient cooperation Can cause bronchoconstriction or airway irritation if not given correctly Patients with chronic lung diseases might become dependent on inhalation therapy Because of the quick onset of action, adverse effects can occur rapidly Device must be cleaned or replaced regularly to prevent possible infection

Risk Factors

Risk factors, or predisposing factors, increase the risk of an individual becoming affected by an illness. Predisposing factors can be grouped into different categories. Let's discuss each in more depth.

Standard precautions

Set of steps and procedures that protects not only the clinician, but the patient from exposure to infectious microorganisms. To ensure total protection for both patient and clinician, it is assumed that every patient has an infectious disease. Standard precautions are a basic form of protection that protects not only the clinician, but the patient from exposure to infectious microorganisms. These precautions are used whether or not a patient has a confirmed or suspected disease Hand hygiene is a simple, yet highly effective way to prevent the spread of infectious diseases. Even if gloves were worn, hand washing is done before and after patient contact. Another way to cleanse hands is by using an alcohol hand rub. Hand sanitizer is a temporary method of cleaning hands before and after coming in contact with a patient. That being said, it is important to remember that hand sanitizer does not replace proper hand washing with soap and water. Also, there are situations when hand washing is not enough and personal protective equipment should be donned. It is also important to keep in mind that proper hand washing techniques should be done before and after putting on personal protective equipment.

Needle Lengths and Uses

Short 3/8 inches Standard injections Medium 1-1½ inches Standard injections Long 2-5 inches 2-5 inches used for intra-articular injections 5 inches intraspinal and intraosseous

Side Effects

Side effects or play audio adverse reactions are not only undesirable experiences, but possible deadly events. Side effects are classified as mild, moderate, severe, or life-threatening. These adverse events can occur quickly or over time, and the patient should stop taking the medication and notify his or her physician if any adverse reactions occur. Side effects are found not only in prescription drugs but also in over-the-counter pharmaceuticals. Since all drugs have some possible side effects, why does the FDA approve drugs that are potentially deadly? Well, think of it this way. Why do we do open-heart surgeries or place stents in closed arteries during a cardiac catheterization, when these procedures can kill the patient? The answer is that the benefits have to outweigh the risks. Some drugs are known to be carcinogenic, or cancer-causing. For example, the drug Tamoxifen is used to treat breast cancer; however, it has been discovered that it can cause uterine cancer. Again, the benefit has to outweigh the risk. Side effect warnings are listed in medication inserts. Take a look at the many possible side effects of Lipitor, a commonly prescribed pill used to lower high cholesterol: tenderness confusion problems with memory fever dark-colored urine increased urination little or no urinating jaundice clay-colored stools diarrhea swelling increased thirst dry mouth dry skin itching sweet fruity-like breath muscle pain weakness drowsiness blurred vision weight loss nausea upper stomach pain loss of appetite hunger weight gain

Bacteria

Single-celled microorganisms. play audio Bacteria are single-celled microorganisms that are the major causes of infection. Bacteria, which are larger than viruses, replicate by splitting in half and grow at a very quick rate, in some cases doubling in as little as a half-hour. Therefore, one cell becomes two, then four, then eight, etc. A bacterium does not need a living host to survive. Some bacteria are beneficial and vital for the body to function properly. For example, our intestines have many different bacteria that call that area home, but if it finds its way to another region, an infection will occur.

Primary union or first intention

Small wounds with no debris or bacteria present, allowing a quick healing time. Primary union or first intention is when the edges of the wound are clean and result in minimal damage to the tissue. These wounds are small and do not have any debris or bacteria present, which allow for a quick healing time.

respirator

Specialized mask used for droplet airway infections. To protect our lungs, we can wear a respirator. A respirator is utilized when dealing with droplet airway infections and a regular mask will not be enough. Tuberculosis is an example of a time when this type of device is needed.

metastasize

Spread of disease. Once a disease is established, several terms can be used to describe the progression or current status. Disease status can worsen when "complications" arise such as an unexpected fever or coughing up blood. Sometimes the worsening of the disease may indicate it is spreading. For example, if a patient has prostate cancer, there is potential for it to play audio metastasize, or spread, to other regions of the body such as the bones, further complicating the patient's disease process.

drug legend

Statement warning that any distribution without a prescription is prohibited by federal law. Drug legend Bob Marley... wait, wrong topic. A drug legend is a cautionary label stating "federal law prohibits dispensing without a prescription." The term drug legend means that the drug is approved by the FDA and requires a person with appropriate licensing, such as a physician, to prescribe the medication, and another licensed person, such as a pharmacist, to dispense it to the public.

mortality rate

Statistical measurement of deaths caused by a disease of a certain population over a specific time period; also known as death rate.

Morbidity rate

Statistical measurement of how often a disease occurs in a certain time-frame within a population.

epidemiology

Study of disease transmission, occurrence, distribution and control for a population.

parenteral route

Substance given by an injection.

epidemic

Sudden spread of illness to large amount of people. Ebola is a devastating contagious disease with very high mortality rates. Therefore, it is very important to monitor for an Ebola epidemic that can spread and kill many people. An play audio epidemic is a sudden spread of illness to a large number of people. This occurred in West Africa when the endemic Ebola virus re-emerged in, and spread throughout, the population, killing thousands. A learning strategy to assist in recalling the meaning of epidemic is to think of an EpiPen. Epidemic and EpiPen both have "epi" in the word. Even though the meanings of the two words are totally different, it will assist you in remembering the meaning of epidemic. When someone has a sudden allergic reaction an EpiPen is used for immediate relief of sudden symptoms. The key word both have in common is sudden. In early 2016, the Zika virus was declared an epidemic and global emergency. A sudden occurrence of microcephaly, a small head and mental retardation was found in many newborns. At that time, it was thought to be caused by the mother being exposed to the Zika virus while pregnant. It was also thought the virus is transmitted to humans via mosquitos and can then be transmitted to other humans via contaminated body fluids. To further the alarm, the virus has become a pandemic moving throughout the Americas. A lot is yet to be discovered in regards to this virus

Blood glucose

Sugar found in the bloodstream used for energy. (blood sugar) is sugar found in the bloodstream. Glucose is transported throughout the body to provide energy to cells. Blood sugar levels are maintained by the body to sustain normal function. Glucose levels can be monitored with a glucose meter, which requires a very small blood sample. A lancet or small needle sticks the patient to draw a drop of blood. The blood sample is collected with a test strip, which is then placed into the meter where the sample is read. Another method used to measure blood sugar levels is with urine.

Environment

Surrounding in which one lives. The environment in which one lives can play a major role in whether or not an individual is at a greater risk of encountering a particular disease. From the way we live at home to where we work, the environment can play a major role in our overall health. At home, we may be exposed to mold, pollen, or dust from a local cement plant. Exposures at work can also increase the odds of developing a disease as a result of prolonged exposure. Imagine the dust breathed into the lungs of a coal miner. Before knowing the disastrous effects, miners would work in the mines with no masks, resulting in black lung disease. Coal dust can be seen on the miner's face

the oral route (PO)

Taken by mouth.

The Importance of Diagnostic Accuracy

Technology today, allows clinicians to take a multifaceted approach to ensure an accurate diagnosis. If an incorrect diagnosis is made, it will delay proper treatment and increase the odds of an adverse outcome, not to mention the possible legal action taken by the patient if he or she is wrongfully diagnosed. Could you imagine being diagnosed with cancer only to find out it was a mistake? It would take an emotional toll on the patient and their family members. Therefore, diagnostic labs and tests are performed to ensure accuracy at all times.

Urine Analysis (UA)

Testing a urine sample for abnormalities. A Urine Analysis (UA) may also be indicated to further explain a medical condition. Urine is a waste product of the body's metabolism. Assuming an individual takes in normal amounts of fluid, about 2 liters of urine is produced a day. The kidneys act as a filter and remove dissolved waste in the bloodstream. Urine is secreted from the body to maintain homeostasis. A lot of information can be learned from a urine specimen. Color, consistency, and odor can indicate certain body dysfunctions.

Infectious

The ability to cause disease. disease has the ability to be communicable, but that is not always the case. It can also be spread from a food source to a person or animal. Botulism is caused by an infectious bacterium called botulinum. This bacterium enters the body from ingesting spoiled food products, and the results are better known as food poisoning. Therefore, an individual may become ill from the infected food, but will not pass the infection to another. We will discuss more about routes of transmission later in this module.

percutaneous endoscopic gastrostomy (PEG) tube

The actual tube used to administer fluids, medications, and nutrition.

passive acquired immunity

The body acquires antibodies for a specific disease from a vaccine. is achieved by vaccinations. A vaccination administers weakened or dead strains of an antigen that the body recognizes as a threat and develops antibodies for without causing such a disturbance that the individual becomes sick. This is why physicians tell their elderly patients to make sure they receive pneumonia and influenza vaccines so they will be unlikely to become infected with the actual disease. It also should be noted that many vaccinations are a temporary form of immunity. Some vaccines need to be given only once and protect the person for life. Other vaccines are good only for so long, so a booster is needed to remind the body to enable ongoing protection. Some illnesses, such as influenza, are always mutating and have a variety of different strains, which makes it necessary for vaccinations to be given yearly.

Drug Actions

The interactions between a drug and body at the cellular level. Drug actions are defined as how a drug interacts with the body at the cellular level. In simpler terms, it is how a drug does what it is supposed to do. Drugs can increase and decrease the body's ability to slow down or speed up certain processes. For example, we can give Lasix to remove fluid from the body by increasing urination. Another example is Flomax, which is used to relax muscles in the neck of the bladder and prostate to make it easier for men to urinate.

pinworms

The most common parasitic intestinal worm infection in the United States. The most commonly caused parasitic intestinal worm infection in the United States is caused by pinworms. Pinworms are white, small, and thin, with a maximum length of about a half-inch, Figure 2-18. Pinworms are transmitted by ingesting contaminated food or water and are most commonly seen in children. The most common symptom is an itchy anus. A simple test is performed by pressing cellophane tape against the anal area, which is then removed and examined for the presence of any eggs. If the patient is positive for worms, the individual is given an anthelmintic such as Albedazole.

percutaneous endoscopic gastrostomy procedure

The procedure for inserting a feeding tube through the abdomen and into the stomach.

Age

The risk of disease is not only for the elderly. Upon entering the world, newborn infants are at greater risk of infection. The newborn has not fully developed an immune system that will deter illness. On-the-other-hand, as the body ages it becomes more susceptible to heart disease, coronary artery disease, pneumonia, and, as the brain ages, decreasing cognitive ability. In fact, even though we may not feel any different from year to year our bodies are aging. Some people dread their birthdays and maybe for good reason. Did you know we lose 1% of our body function at age 30? So, Happy 30th Birthday!

maternal immunity

The strengthening of a baby's immune system by receiving antibodies from the mother's breast milk. This is known as maternal immunity. If newborns are fed formula, those antibodies will not be present, so the babies will have to develop them on their own, which take about one month

host

The susceptible individual who can harbor pathogen.

Dosage

The type of dosage depends on the desired therapeutic effect in regards to the drug's onset, duration, and effect on the body. Too little or too much of a drug will not give the patient the desired effect. If too much of the substance is given, it can become toxic and be deadly. Since a drug is a poison and foreign substance in the body, the body tries to eliminate it as soon as possible. The half-life (T 1/2) of a drug is the time it takes for the dosage of a drug to decrease by half after it is administered. Some drugs have a short half-life so they will not stay in the body long, while drugs with long half-lives will stay in the body for a long time. Ideally, the drug dosing is monitored to achieve a steady state of drug delivery, meaning that the same amount of a drug is eliminated as administered so the drug can have a consistent and predicable effect. There are several dosing types depending on the given patient's condition or needs. Table 3-3 contrasts these various dosing strategies.

mode of transmission

The way a pathogen is transported from the source of infection to the host.

lifestyle

The way in which an individual lives his or her life. The way in which an individual lives his or her life is their lifestyle. A person has control over how he or she chooses to live. Poor decision making can have an everlasting impact on an individual's lifespan. Poor nutrition can lead to deficiencies of the vitamins and minerals that the body needs to function correctly. If a poor diet and lack of portion control is present, the person will gain excess weight, causing strain on the body's systems. Obesity is a major problem in our society and can be avoided with proper eating habits and routine exercise. Smoking is another poor choice one can avoid. Smoking has been known to significantly increase the risk of cancers and is the number one cause of chronic obstructive pulmonary disease. Stress is also known to wreak havoc on the body. Although easier said than done, it is important to set aside time to relax and rest. Increased stress levels can cause one to burn out, suffer increased memory loss, and become more susceptible to illnesses. Figure 1-15 illustrates healthy choices that you can control.

step 1 step 2 step 3 step 4

The wound starts to fill with serum fluid and then forms a visible scab on top of the wound. Occurring within the next two days after the injury, the edges of the cut are connected together again with the formation of new capillaries. The cut develops fibroblasts, which fill in the deep area of the wound and forms play audio collagen. This new tissue is called granulation tissue and has a pink or paler appearance. The edges of the wound begin to be pulled together by the newly formed collagen, forming a scar.

Contact Transmission

There are many different routes a disease can take to enter your body. Some are fairly "straightforward" and some more "indirect."

ointments

Thick semisolid drug form applied on skin or mucosal membranes.

serous exudate

Thin watery fluid that exudes or escapes from blood vessels into the surrounding tissue. The fluid in serous exudate is clear and consists of small amounts of protein. This fluid is reabsorbed by the body after the healing process starts and the inflammatory process ends. This type of exudate is associated with little tissue damage that has occurred suddenly or acutely. For example, when you touch a hot stove and get a second-degree burn, you get a fluid-filled blister at the affected area. The blister is filled with serous fluid, the clear substance we just mentioned. Now, if you do not pop the blister, the fluid will be reabsorbed by the tissue and the wound will heal on its own.

Transmission of Disease

This section will further explain the different methods by which disease can be transferred. Many terms are used to describe the characteristics of disease. Before understanding how diseases are transmitted, let's discuss the meaning of the terms communicable, contagious, and infectious diseases.

tissue degeneration

Tissues cannot replace the cells as efficiently with old age. Another factor that can be a source of disease is age because as we get older our body has more difficulty maintaining homeostasis. As a person ages, tissue degeneration that occurs makes it difficult to fight infection and repair itself as efficiently. Bone density peaks around age 35; after that, it decreases in both men and women. More precisely, 1% of bone density is lost every year from ages 55 to 75. Also occurring as we age is a decrease in lean body mass. Our body fat increases, particularly accumulating in the abdominal region between 25 and 45 years of age, peaking at age 40. Even though this sounds terrible, there is still a light at the end of the tunnel. On a much lighter note, in spite of the accumulation of fat and slowing of reflexes that accompanies aging, people are living longer lives now than any time in history. Thanks to advances in research and technology, we have a growing older population.

Tablet and Syrup Dispensing Supplies

To administer drugs, you must be familiar with the supplies used to administer them. One common supply is the medicine cup. Medicine cups come in two different forms, both of which are used in the healthcare setting. Paper medicine cups are used to hold pills such as tablets and capsules Plastic medicine cups are used to orally administer liquid medications Pill crushers are not used for any sustained-release pills because it would alter the pharmacokinetic ability of a drug. However, if authorized by a physician, nonsustained-released tablets and capsules can be crushed. A few common reasons why a drug might be crushed are to administer the drug through a feeding tube or to mix it in food or a beverage if a patient has difficulties swallowing a pill. To crush a drug, simply place the pill within the device and push down until the pill is sufficiently crushed, Figure 4-18A. A pill splitter is used if a scored table is required to be split in half, Figure 4-18B. Mortar and pestle, shown in Figure 4-19, is another method used to crush pills. The tablets are placed in the glass bowl or cup, known as the mortar, while the pestle is the cylindrical glass tool with a rounded bottom used to crush the medicine. This device can also be seen in kitchens, although commonly constructed from marble or wood.

Hookworms

Type of parasitic worms found in tropical regions of the world that enter the body through the bare feet of those walking on contaminated soil. Hookworms are not commonly seen in the United States and are more prevalent in tropical regions of the world, Figure 2-19. Hookworms lay eggs in soil, and the larvae gain access to the body by entering through the bare feet of those walking on contaminated soil. Once in the body, the worm feeds on the host tissues and depletes the body of nutrients and blood by establishing itself in the mucosa of the intestinal wall. Common symptoms that result from this infection are vomiting, nausea, diarrhea, and anemia. Again, anthelmintic agents are used to treat this infection.

Medication Errors

Unfortunately, sometimes healthcare professionals experience the strain of fatigue from working long hours, understaffing, misinterpretation of illegible handwritten orders, but they are not an excuse for medication errors. A medication error is a preventable mishandling of medication regardless of whether harm has occurred. When an error occurs, it must always, always, always be reported to the individual in charge, so the proper steps can be done to correct the mistake, which will be discussed further in this section. Remember, it is better to come clean immediately and own your mistake than to cover it up or place blame on someone else. If not, the patient's well-being might be jeopardized, as well as your future in health care. The possible types of error include: Administering a drug to the wrong patient Administering the wrong drug Administering the drug via the wrong route Administering a drug at the wrong time Wrong documentation on a patient's chart

inspection

Visually looking for anything out of the norm. The inspection is done by visually looking for anything out of the norm. A few examples are accessory muscle use while breathing which is an indicator of respiratory distress, any scars that may be a result of a previous trauma or surgery, distention of veins and edema (swelling) in the extremities.

Inflammation Process

What causes inflammation? Infection from pathogenic microorganisms and physical injury will cause inflammation to occur in the body. The suffix used in medical terminology to express inflammation is -itis. For example, tonsillitis means inflammation of the tonsils. What would appendicitis mean? Can you think of more terms that end with -itis? In brief, blood vessels in the affected area are dilated, allowing cells to leave the bloodstream to combat the invasion. As more blood flow enters the tissue, it causes redness and warmth at the affected site. With swelling or edema, pressure increases on the nerve endings, causing pain and loss of function.

Inflammation and Associated Processes

While inflammation was discussed in previous sections, there is a lot more to the story. Let's dive a little deeper into what happens when the body gets injured or attacked. Keep in mind that the inflammatory response is needed and activated to help fight infection and prepares the body for the eventual healing process. Only when the inflammatory response goes too far can it be harmful.

Components of Needles and Syringes

ow, when you think of a needle, you might think about only a piece of sharp metal used to pierce flesh, but there is more to it. There are actually three parts to a needle. Beveled tip Shaft Hub Let's start at the tip and work our way up the needle. The tip of a needle is the "business" end and has a slanted portion called a bevel, making the needle into a point. The shaft, or body of the needle, comes in different lengths and is connected to the hub. The hub connects the needle to the syringe Syringes come in many different varieties, all of which consist of a hollow tube or barrel that has a tip on one end where a needle hub can be connected and an opening on the other end where the plunger is inserted. Syringes are usually made of disposable plastic, but some syringes are glass and are reused after sterilization. Before delving into the different types of syringes, we will discuss the three parts of a syringe, Figure 4-21. The tip is the end of the barrel that seats the needle hub. While some tips are plain, others have a Luer-Lok, which is a screw-on tip that is used to lock the needle in place. The barrel is a hollow tube used to hold medication or blood, if a sample is being taken. On the outside of the barrel, there are numbers used to measure the contents being held in the tube. The plunger is a solid, inner shaft with a rubber tip that fits tightly into the barrel. The plunger is pulled back away from the needle to draw or "suck in" fluid and pushed toward the needle to evacuate the contents.