...The Management of Hypertension Allison A. Torbert, Pharm.D. Roberta M. Skoronski, Pharm.D. Clinical Instructors UW School of Pharmacy Objectives • Explain the classification and goals of therapy in the treatment of hypertension based on JNC VI recommendations • Describe nonpharmacologic and pharmacologic treatment approaches • Recognize patients with hypertension and comorbid conditions in order to optimize therapy • Develop an approach to manage hypertensive patients Prevalence • Approximately 50-60 million Americans have HTN defined as: systolic BP (SBP) 140 mm Hg or > diastolic BP (DBP) 90 mm Hg or > • • • • Incidence increases with age Blacks > whites Men > women Greater in less educated, lower socioeconomic groups hard disk\course\728-721\htn.ppt 1 Classification of Blood Pressure for Adults Age 18 & Older* Category Optimal+ Normal High-normal Hypertension++ Stage 1 Stage 2 Stage 3 Systolic (mm Hg) < 120 < 130 130-139 140-159 160-179 > 180 & & & & & & Diastolic (mm Hg) < 80 < 85 85-89 90-99 100-109 > 110 *Not taking antiHTN drugs & not acutely ill. When SBP & DBP fall into different categories, highest classification should be used. Isolated systolic HTN defined as SBP > 140 and DBP < 90 and staged appropriately. In addition to classifying accordingly, clinicians should specify presence or absence of target organ disease & additional risk factors + Optimal BP with respect to CV risk is < 120/80; unusually low BP’s should be evaluated...
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...Lithium: Ther. class. mood stabilizers Indications Manic episodes of manic depressive illness (treatment, maintenance, prophylaxis) Therapeutic Effect(s): Prevents/decreases incidence of acute manic episodes S/E: CNS: SEIZURES, fatigue, headache,impaired memory, CV: ARRHYTHMIAS, ECG changes GI: abdominal pain, anorexia, bloating,diarrhea, nausea, GU: polyuria,Derm: acneiform eruption, folliculitis, Endo: hypothyroidism, Hemat: leukocytosis. MS: muscle weakness Neuro: tremors.S Lithium Toxicity: Assess patient for signs and symptoms oflithium toxicity (vomiting, diarrhea, slurred speech, decreased coordination, drowsiness, muscle weakness, or twitching). If these occur, report before administering next dose.The therapeutic range for lithium has been established at 0.6 - 1.2 mmol/L." Shellys list Block1 lithium: • Tx of Manic (opposite of depression) Depression • Monitor lithium lab level PP 24 • Tx of bipolar disorder involves variety of drugs used to stabilize mood. Lithium, valproate, divalproex, carbmazepine, olanzapine, oxcarbazepin, lamotregine, quetiapine, and risperidone are examples of drugs used. Only lithium is approved by FDA for use in those 12-18 years. Early treatment is key to preventing chronic, serious mental illness. Nurses are instrumental in identifying children with this disorder, providing info to families and monitoring drugs and psychotherapy. Nurses should observe for side effects to specific drug regimen used and assist parents to find...
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...------------------------------------------------- Overview[edit] Nutritional science investigates the metabolic and physiological responses of the body to diet. With advances in the fields of molecular biology, biochemistry, genetics, the study of nutrition is increasingly concerned with metabolism and metabolic pathways: the sequences of biochemical steps through which substances in living things change from one form to another. The human body contains chemical compounds, such as water, carbohydrates (sugar, starch, and fiber), amino acids (in proteins), fatty acids (in lipids), and nucleic acids (DNA and RNA). These compounds in turn consist of elements such as carbon, hydrogen, oxygen, nitrogen, phosphorus, calcium, iron, zinc, magnesium, manganese, and so on. All of these chemical compounds and elements occur in various forms and combinations (e.g. hormones, vitamins, phospholipids, hydroxyapatite), both in the human body and in the plant and animal organisms that humans eat. The human body consists of elements and compounds ingested, digested, absorbed, and circulated through the bloodstream to feed the cells of the body. Except in the unborn fetus, the digestive system is the first system involved in obtaining nutrition. In a typical adult, about seven liters of digestive juices enter the digestive tract.[citation needed] These break chemical bonds in ingested molecules, and modulate their conformations and energy states. Though some molecules are absorbed into the bloodstream...
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...Cirrhosis and Related Liver Disorders The liver is the largest gland and second largest organ in the human body. It is also the only internal organ capable of regeneration following injury. Located in the abdominal cavity, this reddish brown organ is divided into lobes of different size and shape. The liver plays a critical role in metabolism, digestion, elimination, and detoxification, among other processes. This organ performs a surprisingly large number of functions that influence virtually all other body systems. This is why diseases of the liver can be so devastating. One class of chronic diseases affecting the liver is cirrhosis. (Kasper, 2008) Cirrhosis is a condition in which normal liver cells are damaged and replaced by scar tissue. As the scar tissue accumulates, blood flow through the organ is obstructed which prevents the liver from functioning normally. Cirrhosis can be difficult to notice early because the preliminary stages rarely demonstrate any signs or symptoms. As liver function deteriorates, the effects of cirrhosis become evident. Complications include swelling of the legs and abdomen, weight loss, jaundice, bleeding from the gastrointestinal tract and intense inching. (Kasper, 2008) The most common causes of cirrhosis are hepatitis C, fatty liver, and alcohol abuse. Other causes include repeated bouts of heart failure, cystic fibrosis, antitrypsin deficiency, and Wilson’s disease. Once diagnosed, treatment depends on the cause of the disease and...
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...To me, compulsive overeating is a disease where a person has no control over their food intake. It's a constant eating, a wanting for a more and more. You can't get enough, sort of like a junkie looking for the next high. That is my relationship with food. And I have no control. People that suffer from Compulsive Overeating have what can be labeled not only as an eating disorder, but also as an addiction and even more so as an illness. There are many reasons why people become addicted to food, many using eating as a way to cope with problems or stress in their lives. Eating can also help them conceal their emotions, to fill the emptiness that they feel inside. Food is used as a narcotic to not deal with their feelings or emotions. The tendency for people with this eating disorder is overweight because of the abnormal eating habits. People that do not suffer from the epidemic can and won’t empathize with the victims because of the common stereotypes, stereotype such as greed, gluttony or lack of disciple. Simple suggestions to a sufferer such as “Just slow down or go on a diet” are equally insulting as telling a person suffering from Anorexia to “eat something”. Not only are the words hurtful, but this disorder will negatively bleed into the body and causes health risks. A sufferer with this Compulsive Overeating disorder is prone to high blood-pressure and cholesterol, can develop kidney disease or kidney failure, arthritis, deterioration of the bones, strokes, heart attacks,...
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...Courtesy of L E K A R SPECIAL EDITION Authors: Marino, Paul L. Title: ICU Book, The, 3rd Edition Copyright ©2007 Lippincott Williams & Wilkins ISBN: 0-7817-4802-X Authors Dedication Quote Preface to Third Edition Preface to First Edition Acknowledgments Table of Contents Section I - Basic Science Review Basic Science Review Chapter 1 - Circulatory Blood Flow Chapter 2 - Oxygen and Carbon Dioxide Transport Section II - Preventive Practices in the Critically Ill Preventive Practices in the Critically Ill Chapter 3 - Infection Control in the ICU Chapter 4 - Alimentary Prophylaxis Chapter 5 - Venous Thromboembolism Section III - Vascular Access Vascular Access Chapter 6 - Establishing Venous Access Chapter 7 - The Indwelling Vascular Catheter Section IV - Hemodynamic Monitoring Hemodynamic Monitoring Chapter 8 - Arterial Blood Pressure Chapter 9 - The Pulmonary Artery Catheter Chapter 10 - Central Venous Pressure and Wedge Pressure Chapter 11 - Tissue Oxygenation Section V - Disorders of Circulatory Flow Disorders of Circulatory Flow Chapter 12 - Hemorrhage and Hypovolemia Chapter 13 - Colloid and Crystalloid Resuscitation Chapter 14 - Acute Heart Failure Syndromes Chapter 15 - Cardiac Arrest Chapter 16 - Hemodynamic Drug Infusions Section VI - Critical Care Cardiology Critical Care Cardiology Chapter 17 - Early Management of Acute Coronary Syndromes Chapter 18 - Tachyarrhythmias Section VII - Acute Respiratory Failure Acute Respiratory Failure Chapter 19 - Hypoxemia...
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...TENNIS RECOVERY A Comprehensive Review of the Research Editors: Mark S. Kovacs, PhD Todd S. Ellenbecker, DPT W. Ben Kibler, MD A United States Tennis Association Sport Science Committee Project Tennis Recovery: A Comprehensive Review of the Research Copyright © 2010 United States Tennis Association Inc. ISBN 978-0-692-00528-6 Editors: Mark S. Kovacs, Todd S. Ellenbecker, W. Ben Kibler TENNIS RECOVERY A Comprehensive Review of the Research A United States Tennis Association Sport Science Committee Project Editors: Mark S. Kovacs, PhD Todd S. Ellenbecker, DPT W. Ben Kibler, MD Introduction In the last two decades, physical training and competitive opportunities have increased dramatically in junior, collegiate and professional tennis. This arose due to a multitude of factors, but much of it has stemmed from an increase in knowledge and understanding of scientifically based training programs focused on improving performance. As this focus on performance has increased, the area of recovery has received relatively limited focus. Recovery is a multi-faceted paradigm focusing on recovery from training—session to session, day to day and week to week. Recovery is also vitally important during training as well as in competition between matches and between days during multi-day tournaments. As more information is needed in the area of tennis specific recovery, the Sport Science Committee of the United States Tennis Association (USTA) sponsored an extensive evidence-based...
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...Electrolyte is a scientific term for salts, specifically ions. The term electrolyte means that this ion is electrically-charged and moves to either a negative or positive electrode. Ions that move to the negative which are called cations are positively charged and Ions that move to the positive which are called anions are negatively charged. They can be divided into acids, bases, and salts, because they all give ions when dissolved in water. Electrolytes are present in the human body, and the balance of the electrolytes in our bodies is essential for normal function of our cells and our organs. Electrolytes are important because they are what your cells, especially nerve, heart and muscle use to maintain voltages across their cell membranes and to carry electrical impulses such as nerve impulses and muscle contractions across themselves and to other cells. The major electrolytes that are in our body are as follows: sodium (Na+), potassium (K+), chloride (Cl-), calcium (Ca2+), magnesium (Mg2+), bicarbonate (HCO3-), phosphate (PO42-), sulfate (SO42-). Sodium is an abundant metallic element which is an important mineral for all living organisms. It is also widely used industrially to make an assortment of consumer goods. In a pure form, sodium is a soft, silvery gray, highly reactive metal. Pure sodium is usually stored in a nonreactive substance, as it oxidizes rapidly when exposed to air, quickly forming a thick coating. The soft metal appears in an abundance of compounds,...
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...NUR160 Ca Name: Jodi Wiak | Section: 160 | Instructor: Ms. Higgins | Dates of care: 4/1/14 | Week: 1st clinical | Name: Jodi Wiak | Section: 160 | Instructor: Ms. Higgins | Dates of care: 4/1/14 | Week: 1st clinical | General Survey | Age: 85 | Sex: F | Ethnicity: Caucasion | # of days since admission: 7d | Allergies: Latex PCN | Code Status: FULL CODE | Diet: TPN | Rationale: Small bowel obstruction and resection benefit TPN over tube feedings is that all the nutrition is delivered at a cellular level making it immediately available for the body to utilize rather than making the body breakdown and absorb nutrients in the GI tract. It makes it easier on the digestive tract by giving the GI a chance to rest and heal without causing more harm. The patient also has to expend energy to breakdown foods/nutrition through the GI tract. Getting it TPN conserves the much needed energy the patient needs to heal their tissues and gain strength. | Activity: bedridden w/slight mobility with a walker | Rationale: Post surgical abdominal surgery, pt age, weakness, and recent foot surgery limiting her mobility. | Behavior/Affect: My pt was anxious when I first arrived due to her elevated B/P, N&V, and pain intolerance. By the end of shift my patient was very calm and communicative. | Isolation: | Yes | No | Culture: ⦵ | Source: ⦵ | Type of Isolation: ⦰ ⦵ | Height: 5’ 7.5” | Weight: 133 | BMI: 20.5 (BSA 1.71) | General Survey | Age: 85 | Sex:...
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...PN MENTAL HEALTH NURSING EDITION . CO NT ASTERY SERI ES TM N E R EV MOD IE W LE U PN Mental Health Nursing Review Module Edition 9.0 CONtriButOrs Sheryl Sommer, PhD, RN, CNE VP Nursing Education & Strategy Janean Johnson, MSN, RN Nursing Education Strategist Sherry L. Roper, PhD, RN Nursing Education Strategist Karin Roberts, PhD, MSN, RN, CNE Nursing Education Coordinator Mendy G. McMichael, DNP, RN Nursing Education Specialist and Content Project Coordinator Marsha S. Barlow, MSN, RN Nursing Education Specialist Norma Jean Henry, MSN/Ed, RN Nursing Education Specialist eDitOrial aND PuBlisHiNg Derek Prater Spring Lenox Michelle Renner Mandy Tallmadge Kelly Von Lunen CONsultaNts Deb Johnson-Schuh, RN, MSN, CNE Loraine White, RN, BSN, MA PN MeNtal HealtH NursiNg i PN MeNtal HealtH NursiNg review Module editioN 9.0 intellectual Property Notice ATI Nursing is a division of Assessment Technologies Institute®, LLC Copyright © 2014 Assessment Technologies Institute, LLC. All rights reserved. The reproduction of this work in any electronic, mechanical or other means, now known or hereafter invented, is forbidden without the written permission of Assessment Technologies Institute, LLC. All of the content in this publication, including, for example, the cover, all of the page headers, images, illustrations, graphics, and text, are subject to trademark, service mark, trade dress, copyright, and/or other intellectual property rights or licenses...
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...Geriatrics Geriatrics Jennifer P. Dugan, Pharm.D., BCPS Clinical Assistant Professor University of Colorado Colorado, Denver Updates in Therapeutics: The Pharmacotherapy Preparatory Review and Recertification Course 31 Geriatrics Learning Objectives: The following case pertains to questions 2 and 3. J.T. is an 82-year-old community-dwelling woman with a history of stage III Parkinson disease, hypertension, and urinary incontinence (UI). She is receiving carbidopa/levodopa, pramipexole, selegiline, tolterodine, diazepam, metoprolol, and hydrochlorothiazide. When she comes to your pharmacy to get her prescriptions, she walks slowly with a cane, and she is stooped over. 1. Identify age-related pharmacokinetic and pharmacodynamic changes in older people. 2. Evaluate the pharmacotherapy regimens of older people to support the maintenance of optimal physical and mental function. 3. Identify inappropriate medication prescribing in older people. 4. Recommend appropriate pharmacotherapy for patients with dementia. 5. Evaluate the risks and benefits of the use of antipsychotics (APs) (including atypical APs) in older patients with dementia. 6. Recommend appropriate interventions for patients suffering from behavioral symptoms related to dementia. 7. Identify the types of urinary incontinence and recommend appropriate treatments. 8. Given a patient’s American Urology Association Symptom Index for benign prostatic hyperplasia, recommend...
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...A kid with Hepatitis A can return to school 1 week within the onset of jaundice. 2. After a patient has dialysis they may have a slight fever...this is normal due to the fact that the dialysis solution is warmed by the machine. 3. Hyperkalemia presents on an EKG as tall peaked T-waves 4. The antidote for Mag Sulfate toxicity is ---Calcium Gluconate 5. Impetigo is a CONTAGEOUS skin disorder and the person needs to wash ALL linens and dishes seperate from the family. They also need to wash their hands frequently and avoid contact. positive sweat test. indicative of cystic fibrosis 1. Herbs: Black Cohosh is used to treat menopausal symptoms. When taken with an antihypertensive, it may cause hypotension. Licorice can increase potassium loss and may cause dig toxicity. 2. With acute appendicitis, expect to see pain first then nausea and vomiting. With gastroenitis, you will see nausea and vomiting first then pain. 3. If a patient is allergic to latex, they should avoid apricots, cherries, grapes, kiwi, passion fruit, bananas, avocados, chestnuts, tomatoes and peaches. 4. Do not elevate the stump after an AKA after the first 24 hours, as this may cause flexion contracture. 5. Beta Blockers and ACEI are less effective in African Americans than Caucasians. 1. for the myelogram postop positions. water based dye (lighter) bed elevated. oil based dye heavier bed flat. 2.autonomic dysreflexia- elevated bed first....then check foley...
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...The CrossFit Level 1 Training Guide is a collection of CrossFit Journal articles written since 2002 primarily by CrossFit CEO and founder Coach Greg Glassman (“Coach Glassman”) on the foundational movements and methodology of CrossFit. The Level 1 Certificate Course is CrossFit’s cornerstone seminar, which has allowed thousands to begin their careers as CrossFit Trainers. This Guide is designed to be used in conjunction with the Level 1 Course to develop the participant’s knowledge and trainer skills, as well as prepare him or her for the Level 1 test. This is an essential but not an exhaustive resource. Some of the knowledge required to pass the test comes from these articles; the other material comes directly from the two-day course. Some edits to the original articles have been made for the Training Guide to flow as a stand-alone reference, provide context for readers, as well stay current with the course format. All original works are preserved in the CrossFit Journal and hotlinks (noted by their blue color) are provided throughout. Copyright © CrossFit, Inc. All Rights Reserved. CrossFit is a registered trademark ‰ of CrossFit, Inc. V2.2-20150514R4.KW V2.3_ 20150525.KW Table of Contents Methodology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Medicine-Ball Cleans. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Understanding CrossFit. . . . . . . . . . . . . . . . ....
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...Practice Examination One Part One You will have two hours and 30 minutes to complete Part One. 1. The nurse is instructing an unlicensed assistant on how to collect a urine specimen from an indwelling catheter. Which of the following statements indicates that the assistant understands the instructions? A. "I will empty the catheter drainage bag, have the client drink some water, and an hour later collect the urine that drains into the bag. " B. "I will get a sterile syringe and remove urine from the catheter through the collection port to place in the specimen container. " C. "I should collect urine from the catheter drainage bag at the end of the shift and place it in the specimen container. " D. "I will disconnect the drainage tube from the catheter and let urine run from the catheter into the specimen container. " 2. Linda is a 19-year-old primipara who delivered a viable male neonate 2 hours ago. She has decided to breast-feed. Her 22-year-old husband supports her decision. She tells the nurse, "My mother breast-fed all of her children, but I'm going to need lots of help with breastfeeding. I'm worried that I won't be able to do this. " Which of the following should the nurse include when assessing the client? A. Determine the client's level of motivation to breast-feed. B. Perform a complete physical examination to determine her need for help. C. Assess her body-to-fat ratio and nutritional status before beginning...
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...General Psychiatry William a. Kehoe, Pharm.D., m.a., FCCP, BCPS University of the Pacific stockton, california © 2009 American College of Clinical Pharmacy 1-281 General Psychiatry Learning Objectives: 1. Describe pharmacotherapeutic options for managing the following psychiatric problems: depression, bipolar disorder, schizophrenia, anxiety disorders, insomnia, and alcohol withdrawal. Describe the drugs used to treat the above disorders in terms of unique pharmacological properties, therapeutic uses, adverse effects, and cognitive and behavioral effects. Formulate a pharmacotherapeutic treatment plan when presented with a patient having depression, bipolar disorder, schizophrenia, an anxiety disorder, or insomnia. Discuss the treatment of substance abuse using alcohol abuse as a model. 4. 2. C. Theophylline. D. Pseudoephedrine. Which one of the following antidepressants would be least likely to cause drug-disease or drug-drug interactions for T.N.? A. Venlafaxine. B. Fluvoxamine. C. Phenelzine. D. Fluoxetine. Which one of the following periods represents the continuation therapy phase for T.N.’s depression? A. 6–12 weeks. B. 12–16 weeks. C. 6–12 months. D. 2−3 years. T.N. will be seen initially at monthly intervals to assess antidepressant therapy. Which one of the following instruments is a patient-completed measure of depressive symptoms that could be used to assess his response? A. Hamilton Rating Scale for Depression. B. Montgomery-Åsberg Depression Rating Scale...
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