PART 2

referent

= MOTIVATES one person to communicate with another

= motivates the communication

intimate

0 to 18 inches proxemics

personal

18-48 inches proxemics

isometric exercise

= static or setting exercises for STRENGTHENING; exerting pressure against SOLID object

= ex. PLANKING

High or semi fowlers

What should the patient's position be when receiving NGT feeding?

spinal/neurogenic shock

What type of shock has all V/S DOWN?

120-129/

elevated or borderline BP

>140/

>90

stage 2 hypertension

alpha adrenergic blockers

a medication for stage 2-3 hypertension that VASODILATES the PERIPHERAL vessels, and is more potent in the ARTERIES than in veins

beta adrenergic blockers

What type of drugs are -olol drugs?

ACE Inhibitor

What class of drugs are -pril drugs?

ARBs, ACE inhibitors

What class of antihypertensive drugs are good for DM with HTN due to its nephroprotective action?

Clonidine (Catapres)

most potent and popular central-acting hypertensive

depends on expiry date

If nitroglycerine is still unopened, how long is it viable?

Insulin = by units (cc)

Tuberculin = by mL

What is the diff between insulin & tuberculin syringe?

right eye

OD means?

both eyes

OU means?

Glucose can't be consumed by the cells due to absence of insulin. So cells become hungry.

Why does weight loss occur as a late sign of DM?

increase of girth in extremity & pain

What is the hallmark sign of DVT?

surgery: grafting and clipping of arteries

What is the ULTIMATE mgmt for aneurysms?

Plain LR, PNSS

What IV fluids should we give for a hyperglycemic reaction?

Potassium & Sodium Bicarbonate

What supplements should we give for DKA?

result in the patient receiving too much K too quickly; can cause CARDIAC ARREST within minutes

Why is KCL not given BOLUS?

hypoglycemia

cold and clammy, need some candy

126 mg/dl

LOWEST fasting glucose suggestive of DM

DM

leading cause of CKD

social

48 inches to 12 feet proxemics

public

greater than 12 feet proxemics

personal (18-48 inches)

What proxemics should you apply when taking patient's history?

isokinetic exercise

= rehabilitative exercise WITH RESISTANCE; uses special machines

= ex. TREADMILL

isotonic exercise

= dynamic exercise; opposite of isometric

= ex. walking, cycling

Can raise foot 1 inch off the bed

Indicator that px has sufficient strength to walk after a week-long bed rest

x-ray

best method for checking correct position of NGT

>200 ml

abnormal gastric residual aspirate

Weight gain of 1 kg in 1 day

gold standard for fluid congestion/load/accumulation/excess

1 liter

1 kg of weight gain is how many L of water in the body?

dysphagia

difficulty swallowing

Maintain the head of the bed >30 degree angle.

How to prevent aspiration during tube feeding?

calcium

cardioprotectant electrolyte; prevents other electrolytes from entering the heart

Digibind/digifab

Antidote for digoxin toxicity

suppresses Na & K, retains Ca

MOA of digoxin

(-) Chronotropic

(-) Dromotropic

(+) Inotropic

Function of digoxin

Tachy

What type of arrhythmias is digoxin indicated?

0.5-2.0 ng/ml

safe level of digoxin

18 months (1.6 years old)

average age of bowel training

24 months (2 yrs old)

average age of bladder training

opioid

a class of drugs that is a 'downer,' or depressant, and affects the brain's pleasure systems

10-12 hours

How much sleep do 3-6 year olds need?

Wernicke's/receptive aphasia

type of aphasia when px is able to speak well and use long sentences, but what they say may NOT MAKE SENSE

Broca's/expressive aphasia

a type of aphasia wherein px struggles to form words

dysarthria

a motor speech disorder that makes it difficult to articulate words

hypertensive crisis

= >180 systolic and >120 diastolic

= associated with NEUROLOGICAL SYMPTOMS such as headache, confusion, altered LOC

110-120/

70-80

normal blood pressure

130-139/

80-89

Stage 1 hypertension

the heart is having a hard time pushing blood to other ORGANS (systemic circulation); problemado ang ORGANS

What does a high systolic BP mean?

the heart is not receiving adequate amount of blood; problemado ang HEART

What does a high diastolic BP mean?

ADA

Angiotensin-converting-enzyme inhibitors (ACE)

Diuretics

Angiotensin receptor blockers (ARBs)

What medications do we give for Borderline/Stage 1 hypertension?

ABC (+ optional ADA)

Alpha, beta, calcium blockers

What medications do we give for Stage 2-3 hypertension?

CD (+optional ABC)

Central-acting hypertensives

Direct-acting vasodilators

What medications do we give for Stage 3 hypertension to hypertensive crisis?

alpha adrenergic blockers

What type of drugs are -zosin drugs?

peripheral vessels (distal extremities)

Where are alpha 1 receptors found?

alpha adrenergic blockers

a medication for stage 2-3 hypertension that has a DIURETIC effect and can be used to treat Benign Prostatic Hyperplasia (BPH)

Wait 3-5 mins before changing position

Management for orthostatic/postural hypotension

orthostatic hypotension

What is the primary reason for Alpha Adrenergic Blocker drug non-compliance?

B1 - cardiac muscles/blood vessels

B2 - lungs (bronchioles)

B3 - adipose tissue/GI tract

Where are the 3 beta receptors found?

Beta-adrenergic blockers

a medication for stage 2-3 hypertension that CONSTRICTS the vessels, and DECREASES HR and GI function

Non-selective beta antagonist

Cardioselective beta 1 antagonist

2 types of Beta-adrenergic blockers

Cardioselective beta 1 antagonist

= a type of beta blocker that blocks B1 only (heart only)

= SAFER than non-selective beta antagonist

= ex. Atenolol, Betaxolol, Metoprolol

Non-selective beta antagonist

= a type of beta blocker that blocks all B receptors but LESS ON B3

= STRONGER than cardioselective beta 1 antagonist

= ex. Carvedilol, labetalol, propranolol

Cardioselective beta 1 antagonist (does not attack B2 which may cause bronchoconstriction)

If px has asthma, what type of beta blocker can we give?

miotic

agent that CONSTRICTS the pupil

mydriatic

agent that DILATES the pupil

beta adrenergic blocker

Type of stage 2-3 hypertension drug that is also good for GLAUCOMA due to its OCULAR-CONSTRICTIVE effect?

10-21 mmHg

Normal intraocular pressure

tonometer

instrument used to measure IOP

40-59 bpm

How much bpm is bradycardia?

How much bpm is heart block?

SA node

= our natural pacemaker

= provides 60-100 electrical impulse

AV node

a bundle of conduction cells that produces 40-60 electrical impulse (bradycardia)

Purkinje fibers

fibers in the ventricles that produce 20-40 electrical impulse (heart block)

congestive heart failure

What is the adverse effect of beta blockers?

Weight gain of >1kg in 24H

golden standard of weight gain

glucagon

antidote for beta-blocker

erectile dysfunction

primary reason for BETABLOCKER drug non-compliance

cardiac muscles and blood vessels

Where are the calcium channel receptors found?

(-) Chronotropic

(-) Dromotropic

(-) Inotropic

function of calcium-channel blocker

Dihydropyridine

Non-dihydropiridine

2 types of calcium-channel blocker

Dihydropyridines

= ends with -dipine

= MORE POTENT sa BLOOD VESSELS (vasodilator); weak effect on cardiac muscles

= ex. Nifedipine, Amlodipine, Nicardipine

Non-dihydropyridines

= does NOT end with -dipine

= MORE POTENT sa HEART (depressant fx), less on blood vessels

= ex. Diltiazem, Verapamil (DiVe)

Reflex tachycardia

What should we always look out for during vasodilation (ex. giving dihydropyridine)?

bradycardia and heart block (atrioventricular block)

What should we look out for in giving non-dihydropyridines?

dihydropyridine = VASODILATOR

non-dihydropyridine = DEPRESSANT (lowers HR)

Key difference between dihydropyridine & non-dihydropyridine CCB?

ALPHA = VASODILATOR; blocks norepinephrine

BETA = DEPRESSANT (lowers HR); blocks epinephrine

Key difference between alpha adrenergic blocker & betablocker?

lungs

Where is ACE produced?

ACE Inhibitor

a type of drug for Stage 2-3 hypertension that affects RAAS, is a DIURETIC, and causes excessive DRY COUGH?

Vasodilator -> Antihypertensive, Diuretic

What is the function of ACE inhibitor?

ACE Inhibitors. ARBs are more safer, but weaker.

Between ACE inhibitors and ARBs, which is more potent?

Angiotensin 2 receptor blockers (ARBs)

this class of drug that is basically the same as ACE inhibitors except lung effect (hence no dry cough)

= suffix: -sartan

= ex. Losartan, Telmisartan, Candesartan, Irbesartan

Central-acting anti-hypertensives

= target the CNS by DEPRESSING it

= V/S "downer"

= affects hypothalamus & brain stem (v/s controllers)

= route: oral, parenteral, SL

Methyldopa (Aldomet)

= given for Pregnancy-Induced Hypertension (stage 2 htn)

= also given for pre-eclampsia, but paired w/ MagSo4