State Exam Nursing New Zealand – Nursing Council of New Zealand (NCNZ) State Examination – 2026/2027 Edition – Verified Questions and Answer

State Exam Nursing New Zealand – Nursing Council of New Zealand (NCNZ) State Examination – 2026/2027 Edition – Verified Questions and Answers Q: What does Ambulatory mean? Answer Day surgery (max stay 23 hours) Q: What does inpatient surgical care mean? Answer Admitted to hospital (min 24 hours) Q: Surgery classifications? Answer Elective Diagnostic Acute Q: List 3 patient orientated goals post surgery? Answer Return to normal physical function Remain free from post op complications Achieve emotional and physical comfort Q: What is included in a pre-op assessment? (5) Answer Obtain history Physical assessment Determine patient understanding Identify emotional state and coping skills Check consent, pre anaesthetic form complete, other pre anaesthetic orders Q: What does atelectasis mean? Answer Collapse or closure of lung resulting in reduced or absent gas exchange Q: List 5 ways to safely care for post op patients? Answer Fluid balance input and output Pain management Assessing wound Vital signs every five minutes Checking IV site Q: What is meningitis? Answer A serious disease in which there is inflammation of the meninges Q: Signs and symptoms of meningitis? Answer Intense headache Fever Light sensitivity Muscular rigidity Q: Main cause of meningitis? Answer Bacterial: Streptococcus pneumoniae Viral: Enterovirus Q: Signs of raised intercranial pressure? (4) Answer Headache Nausea Increased bp Confusion Q: What is the purpose of the nursing council? Answer To protect the health and safety of members of the public by ensuring RNs are registered, fit to practise, and competent. Q: Signs of otitis? (Ear infection/inflammation) Answer Ear pain Fever Difficulty hearing Q: What would you do if prescribed medication was not signed by the doctor? Answer Do not give until a signature or verbal consent has been given with a witness Q: Signs of a patient on methamphetamine? (5) Answer Dilated pupils Agitation Increased bp Loss of appetite Paranoia Q: List 5 pieces of advice to give a patient following a total hip replacement? Answer Place a pillow between legs when lying on side Avoid bending past 90 degrees Avoid crossing legs Sit on chairs higher than knee height Take short frequent walks Q: What is airway obstruction caused by? Answer Tongue Laryngospasm Retained secretions Insufficient anaesthetic reversal Q: Treatment for airway obstruction? Answer Correct positioning o2 therapy Suctioning Close monitoring Viral signs Anti emetics Q: Manifestations of atelectasis? Answer Insidious onset Early s&s: cough, sputum, low grade fever Later s&s: respiratory distress, dyspnoea, tachycardia, pleural pain, cyanosis, anxiety What is a pulmonary embolism? Answer Occurs from a deep vein thrombosis, clot forms, travels to lungs or brain, life threatening Diagnosis of a pulmonary embolism? Answer Chest X-ray Ecg Abg Ultra sound Pulmonary angiography How to prevent a pulmonary embolism? Pre op weight loss Compression stockings Early animation Hydration Meds What causes a deep vein thrombosis? Occurs in leg veins due to inactivity, body positioning, and pressure Risk factors for DVTs? Elderly Poor nutrition Surgery over three hours Limited mobility Long haul flights Diabetes What is wound dehiscence? Disruption of previously joined wound edges due to an infection, too tight sutures, or injury to wound Risk factors for wound dehiscence? Elderly Poor nutrition Diabetes Abdominal surgery Immunosuppressant Smoking Signs of wound inflammation? Redness Warmth Malaise ( general discomfort) Tachycardia Febrile What are treatments for pain? Positioning Analgesia List some side effects of opioid use? Decreased bp Decreased LOC Vomitting Respiratory depression Constipation What would you assume if someone's temperature was slightly lower post surgery? This could be normal due to lack of muscle movement to keep body warm What would you assume if someone's temperature was slightly higher post surgery? This could be normal due to inflammation being the 1st sign of healing What would a temp above 38 4-5 days post op signify? Infection/sepsis What is autologous blood collection? Providing blood for oneself What fresh blood components are given in blood transfusions? Red cells- used to treat anaemia, severe bleeding. Platelets- to stop bleeding, used in ICU or cancer treatment Fresh frozen plasma or cryoprecipitate- used for replacing clotting factors and rarely other blood proteins. Used in ICU or liver disease patients Blood donations are always tested for? Infection Hep B & C HIV & AIDS Syphilis ABO group Rh type Blood group antibodies What cell is carefully checked before a blood transfusion for incompatibility? Red blood cells What is a blood crossmatch? When a sample of the patients blood is used along with the donors blood for a transfusion List some risks for blood transfusions? Mild fever Skin rash Kidney failure Dyspnoea Minor virus infection What type of burns are there? Thermal Electrical Caustic chemical injury Radiation exposure Inhalation of noxious fumes What occurs with a thermal burn? Proteins denature Irreversible cellular damage occurs Acute inflammatory response What is a 1st degree burn + what occurs? Superficial partial thickness burn Damage to epidermis Triggers vasodilation Increased capillary permeability Heals within a week Give an example of a 1st degree burn? Sunburn What is a 2nd degree burn and what occurs? Deep partial thickness burn Damage to epidermal skin layers Penetrates some dermal skin layers Epidermal and dermal layers seperate + Fluor accumulate between Blisters form Scars form Healing takes 2-4 weeks Give an example of a 2nd degree burn? Hot coffee spill What is a 3rd degree burn and what occurs? Full thickness burns Damage of the epidermis and dermis Can penetrate subcutaneous layers Destruction of blood vessels Scaring is extensive Give an example of a 3rd degree burn? Exposure to flame What is shock? A condition of circulatory failure and impaired perfusion to vital organs What commonly occurs to bp in shock? Hypotension List the different kinds of shock? Carcinogenic Hypovolemic Anaphylactic Septic Neurogenic What occurs during cardiogenic shock? Inadequate or inefficient cardiac pumping Causes low output & restricted movement of oxygenated blood throughout circulation Leads to systemic hypotension or pulmonary odema How to treat cardiogenic shock? Assess ECG & troponin levels Give aspirin, GTN, morphine, clopidogrel Give o2 What occurs during hypovolaemic shock? Inadequate blood/plasma volume Reduced circulation Multiple organ failure What causes hypovolemic shock? Severe haemorrhage, burns, diarrhoea, poluria How to treat hypovolaemic shock? Apply pressure to wound if bleeding Blood plasma, rbc, or platelet transfusion Iv crystalloids What occurs during anaphylactic shock? Result of massive immune hypersensitivity response Vasodilation and increased vascular permeability Fluid leaves vascular space=swelling Bp and circulation is reduced What is the treatment for anaphylactic shock? Adrenaline What is septic shock? Systemic infection Chemical mediators produce inflammatory response Damages endothelial cells What is the treatment for septic shock? ICU admission Iv abs What causes neurogenic shock? Result of brain or spinal injury, depressant action of certain drugs, anaesthesia, hypoglycaemia, or hypoxia What occurs during neurogenic shock? Neuronal transmission is altered Loss is sympathetic control of tension of blood vessels Unregulated vasodilation Decrease in vascular resistance, bp, and vital organ perfusion What is the treatment for neurogenic shock? Airway-jaw thrust manoeuvre Iv isotonic crystalloid solution Leg rolling onto a spine board What is a hip replacement? When the two parts of the hip- the acetabulum (hip socket) and the head of the femur (thigh bone) are removed and replaced with smooth artificial surfaces What are the pro's of using spinal anaesthetic? Provides better pain relief (no analgesia for 24 hours post) Less bleeding during surgery so lower risk of developing clots You remain in full control of your breathing so lower risk of chest infection Less v+n+drowsiness post operation Risks of spinal anesthesia? Headache Dizziness Bladder problems Aches & pains Bruising Risks of general anaesthetic? Headache Sore throat N+V Dizziness Bladder problems Damage to lips & tongue Temporary confusion & memory loss Aches & pains How long should a pt do exercises for following a total hip replacement? At least 12 weeks What should a pt be aware for at home following a total hip replacement? Chest pain Calf pain SOB Fever or chills N+V Bleeding or discharge from dressing What are the two parts that make up the bowel? Small bowel and large bowel What occurs in the bowel? Digestion of food and liquid Nutritional parts of food are absorbed into the blood through the small intestine Remaining food and liquid is passed through the large bowel and eliminated What is the large bowel made up of? The colon and the rectum What is the colon? The first one and a half metres of the large bowel. It removes liquid from digested food and turns it into solid waste What is the rectum? The last 12-15cm of the bowel, ending at the anus How common is bowel cancer? One of the most common cancers amongst both men and woman. It may occur at any age although 90% is over 50 years What causes bowel cancer? Bowel polyps A high fat and protein and low fruit and veg diet Alcohol consumption Weight gain Low physical activity Family history What is hereditary non-polyposis colorectal cancer? (HNPCC) A condition where the tendency to develop cancer is inherited What is familial adenomatous polyposis? (FAP) A condition that causes hundreds of polyps in the bowel and if left untreated, always turns to bowel cancer What is a disease of ten years that increase the chance of bowel cancer? Chrohns What is a colectomy? Surgery to remove part of the bowel What is a left/right hemicolectomy? When the left/right part of the bowel is removed What is a transverse colectomy? When the middle part (transverse colon) of the bowel is removed What is a sigmoid colectomy? When the lower part of the bowel (sigmoid) is removed What is anastomosis? The place where the colon is joined back together after surgically removing part of it What is a colostomy? If the bowel cannot be rejoined the upper end is brought out onto the skin of the abdominal wall What is an ileostomy? When the end of the small bowel (ileum) or loop of the ileum is brought out onto the right side of the abdominal wall What is removed during surgery for rectal cancer? Tumour Surrounding rectal tissue Fatty tissue Mesentery What is a low anterir resection? Removal of part of the rectum containing the tumour What is a colo anal anastomosis? When the tumour is in the middle of the rectum. Most of the rectum is removed and the colon is attached to the anus What is a abdoperineal resection? (AP resection) When the anus and rectum is removed completely What occurs during key hole bowel surgery? Several small cuts are made A long tube called a laparoscope is inserted This is used to look through during the operation Side effects of a loparoscopic bowel surgery? 4-6 weeks off work Unable to lift heavy objects Altered bowel habits (more frequent and loose) Pain What is tonsellitis? When the tonsils and pharynx which lie at the back of the throat become inflamed Causes of tonsillitis? Viruses (herpes simplex) Bacteria (streptococcus) Symptoms of tonsillitis? Sore throat Swollen tonsils Fever Difficulty swallowing Swollen lymph nodes Treatment of tonsillitis? Virus cannot be treated by AB's Bacteria may be treated by AB's Food and fluids Tonsillectomy (surgical removal) How long does it take to heal after a tonsillectomy? 10-14 days How much blood to expect following a tonsillectomy? If more than 1-2 teaspoons or if it continues for more than 5 minutes go to ED What is the pyramidal motor system? Extends from the sensorimotor areas of the brain to the motor neurone of the central horns of the spinal cord. Controls voluntary movement What is the extrapyramidal system? Basal ganglia. Fine tunes and stabilises movement Mechanisms of injury? Traumatic Ischaemic Pressure Excitation (electrolyte imbalance) What is neuronal injury? + 3 examples Anything that alters the stable neutron environment Sepsis Hypoxia Acidosis What is a traumatic brain injury? Traumatic force to the skull and brain What is a closed head injury? Skull is penetrated What is a open head injury? Brain tissue is exposed What is the pathophysiology of a traumatic brain injury? Disrupts intervertebral environment Altered brain function: neuron/axon injury Cerebral bruise, laceration, damage, haemorrhage may occur Damage to cerebral cortex lobes What is raised intracranial pressure? Decreased blood flow and displacement of brain tissue as well as increased pressure Signs of a traumatic brain injury? Decreased LOC Altered motor responses Signs of raised intracranial pressure? Headache N+V Increased BP Confusion Diagnostic criteria of a traumatic brain injury? Hx and physical examination GCS score, LOC score Vitals X-ray Treatment for a traumatic brain injury? Preserve brain function Prevent secondary complications Stabilise cardio-respiratory function to maintain cerebral blood flow Decrease increased intracranial pressure and haemorrhage Meds Rehab Risk factors for a stroke? Genetics and age Hypertension and AF IHD and hyperlipidaemia Smoking and alcohol intake Obesity and inactivity What is a stroke? A clinical event causing impaired cerebral circulation What are the 3 different strokes? Thrombotic Embolic Haemorrhage What occurs during a thrombotic stroke? Cerebral artery occlusion often from atherosclerosis, commonly the middle cerebral artery (sensory or motor issues) What occurs during an embolic stroke? Travelling clot, commonly to brain or lungs What occurs during a haemorrhagic stroke? Bleeding. Caused by hypertensive arterioparthies, aneurisms, tumours, vasculitis, illicit drugs. Blood vessel ruptures Recognising a TIA or stroke? F-face-check smile or one side droopy A-arms-raise both arms is one side weak S-speech-slurred speech T-time-orientated to time Is the onset quick for a stroke? Focal neurological deficits may have abrupt or slow onset's that may worsen or stabilise or improve What is agosias? When a patient can't recognise physical objects What is aphasia? loss of ability to understand or express speech, caused by brain damage. What is expressive aphasia (Broca's area) Problems formulating speech, thoughts, writing ability What is receptive aphasia (Wernickes area) Trouble with comprehension, can speak, may have word deafness or word blindness Characteristics of left sided brain lesion? Apasia Reading and writing problems Labels emotions Diagnosis for a right/left sided brain lesion? Hx and physical examination Lab results CT scan Treatment for a brain lesion? Reduce cerebral oedema and increased intracranial pressure Rehab What can degenerative disease cause? Alterations in cognition, sensation, pain and motor responses Pathology of Parkinson's disease? A chronic, progressive, medical condition Degeneration of pigmented dopaminergic neutrons of basal ganglia What is neurotransmitter imbalance? Manifestations due to overactive cholingeric neurons and lewey bodies Cause of Parkinson's disease? Unknown. Might be inherited Signs and symptoms of Parkinson's disease? Impaired motor function: tremor, rigidity, bradykinesia Autonomic nervous system responses: urinary retention, constipation Cognitive and personality changes Insomnia What is the pharmacological treatment for Parkinson's? Dopamine replacement Anticholinergic agents Paillidotomy (deep brain stimulation) What causes Alzheimer's? Unknown but believed to be environmental factors, mutated late onset genes (chromosome 19) Patho if alzheimers? Amyloid plaques glue up the correct Ray proteins form neurofibrillary tangles Neurons degenerate Neurotransmitter imbalance Signs of Alzheimer's? Cognitive decline Decreased problem solving Language loss Confusion Treatment for Alzheimer's? Maximise quality of life and promote general health status What is multiple sclerosis? Central nervous system demyelination Demyelinated areas inflame and scarring develops Cause of multiple sclerosis? Genetics Autoimmunity Regional variation More common in females 20-40 years Signs of multiple sclerosis? Loss of coordination Tremor Fatigue Memory loss Treatment for multiple sclerosis? Treat symptoms Reduce frequency of relapse Prevent disability What is the main extracellular cation? Sodium What does sodium do? Regulates osmotic forces Regulated acid-base balance Where is sodium mainly excreted? Urine output What is hyponatremia? Deficiency in sodium in blood 135mmol/L What is the cause of hyponatraemia? Vomitting, diarrhoea, excessive sweating What are 3 main things hyponatraemia causes? Reduced extracellular circulating volume: hypotension, tachycardia, decreased urine output Osmotic swelling of cells: muscle twitching, weakness Altered neuronal function: nausea, vomitting, lethargy What is hypernatremia? Increased sodium in blood 145mmol/L. Water moves from intercellular fluid to extracellular fluid Signs of hypernatraemia? Thirst Decreased LOC hypertension or tachycardia Oedema What causes hypernatraemia? Water loss or sodium gain What is potassium and what does it do? It is a major intercellular cation It regulates intercellular electrical neutrality It is maintained by the sodium potassium pump It is essential for transmission and conduction of nerve impulses, cardiac rhythm, and skeletal smooth muscle contraction What is hypokalaemia? Potassium level of 3.5mmol/L Cause of hypokalaemia? Reduced intake of potassium Increased output of potassium usual through GI tract or urine Signs of hypokalaemia? Skeletal muscle weakness and leg cramps Cardiac arrythmia Nausea, anorexia, abdominal distension Hypitension What is hyperkalaemia? Potassium level of 5mmol/L (rare) Cause of hyperkalaemia? Increased IV intake Decreased renal excretion Cell trauma Signs of hyperkalaemia? Mild: tingling of lips and fingers, restlessness, intestinal cramping and diarrhoea Severe: muscle weakness, loss of muscle tone, flaccid paralysis, cardiac arrest What is the function of the kidneys? Regulates body fluid and composition Eliminates metabolic waste Synthesis, release, activates hormones such as erythropoietin: stimulates red bone marrow to produce RBC, renin, vitamin D Regulates BP What is a nephron? It is the functional unit of the kidney that filters blood to make urine. There are 1 million per kidney Components of the kidney? Glomerulus Proximal tubule Loops of henle Distal tubule Collecting duct What are the consequences of altered renal function? Blocking of urine flow Dilation of structures proximal to obstruction Injury to renal anatomy What is hydronephrosis? Prolonged obstruction of the ureter causes pressure to build up resulting in hydroureter and hydronephrosis Signs of altered urinary function? Altered volume of excretion Haematuria Pain-dull: stretching if renal capsule sharp: relates to ureters or lower urinary tract N+V Diagnosis of altered renal function? Hx + physical exam Blood bichem analysis Imaging studies What are kidney stones? Renal calculi in the renal system which are solid masses caused from filtrate Cause of renal stones? Urinary stasis Dehydration Elevated urinary levels of salt, protein, calcium What is renal failure? Sudden rapid decline in renal function, retention of metabolic waste, usually associated with neohrotoxicity or hypovolaemia Cause of renal failure? Prerenal (ischaemic) Intrarenal (acute tubular necrosis) Postrenal (obstructive) What is chronic kidney disease? Irreversible loss of renal function that affects nearly all organ systems Causes of chronic kidney disease? Diabetes Smoking Hypertension CVD Signs of chronic renal disease? Increased bp Increased serum urea Increase creatinine Anemia What is haemodialysis? Using special filters to remove waste that the kidneys can no longer do on their own mechanisms of diffusion, osmosis and ultrafiltration What is pyelonphretitis? Kidney infection Cause of kidney infection? When bacteria enters the urethra and travels up the bladder into the kidneys What is cystitis? infection of the bladder Who is at risk for kidney infections? Woman Children Pts with diabetes Pts with kidney stones Signs of a kidney infection? Infection Pain when urinating Nausea Lack of appetite Treatment for a kidney infection? Fluids Genital area clean ABs Pain relief What is insulin produced by? Beta cells in the pancreas What is insulin? Insulin is an anabolic hormone It is required for the uptake of glucose by many cells: liver, muscle, adipose It promotes protein synthesis and formation/storage for lipids It facilitates transport of potassium, phosphate, and magnesium into cells When does insulin increase? When blood glucose, amino acids, glucagon and gastric increase When does insulin decrease? When there is low blood glucose, high insulin levels, alpha cell stimulation What is diabetes mellitus? A disease in which the body does not produce or respond properly to insulin What is type 1 diabetes? the body's immune system destroys cells in the pancreas that produce insulin. What are the signs of type 1 diabetes? Polydipsia Polyuria Polyphagia Fatigue Diagnostic criteria for type 1 diabetes? Hx + physical exam Blood glucose levels:fasting and random Gycosylated haemoglobin Treatment for type 1 diabetes? Carbohydrates intake Exercise Insulin replacement therapy What is type 2 diabetes? Insulin resistance and decrease mass of B cells Risk factors for type 2 diabetes Overweight Unhealthy diet Metabolic syndrom Ethnicity Family hx Signs of type 2 diabetes? Often symptomatic but Visual changes Neohropathy Recurrent infection Neuropathy Diagnostic criteria for type 2 diabetes? Blood glucose level Presence of long term complications Treatment for type 2 diabetes? Weight control Oral glycaemic agents: metformin What are 3 acute complications of diabetes? Hypoglycaemia Diabetes ketoacidosis (only in DM type 1) Hyperglycaemia hyperosmolar nonketotic syndrome (HHNK, only in DM type 2) What are the sympathetic effects of hypoglycaemia? Neuroglycaemia Hunger Fatigue Tachycardia Increased BP Palpitations Tremor Clammy skin What are the neurological effects of hypoglycaemia? Confusion Slurred speech Headache Nightmares Sleep disturbance What is diabetes insipidus? Unrelated to DM type 1 and 2 Increased urine output but not increased glucose Caused by a lack of the anti diuretic hormone (ADH) Where is ADH (arginine vasopressin) made + what does it do? Hypothalamus, released into blood from pituitary gland Circulated the blood and produces concentrated urine from kidneys What occurs if your body does not produce enough ADH? The kidneys produce large amounts of dilute urine and you become thirsty What is the cause of diabetes insipidus? Almost any disease affecting the pituitary region of the brain eg Pituitary tumors Trauma What is nephrogenic diabetes insipidus? The abnormality of the pituitary function due to genetics How to diagnose diabetes insipidus? Blood and urine sample to see how concentrated they are What is a fluid deprivation test? Blood and urine is monitored when pt is not drinking ADH is then given to see if kidneys can respond to the hornone How is diabetes insipidus treated? Synthetic form of ADH hormone is given called DDAVP (Minirin) by nostril spray A tablet form of DDAVP is also available but is not as absorptive Is tuberculosis life threatening? Yes. It can cause haemorrhage from the lungs, although rare How is tuberculosis spread? Aerosolized droplets expelled during coughing by an individual with active disease What is latent tuberculosis? Inactive tb infection in the body that can rake many years to develop What are the symptoms of tb? Coughing for 3+ weeks often with thick phlegm Tiredness Night sweats Weight loss Swollen glands usually in neck How can tuberculosis be treated? Four antibiotics for 6 months and if not cured, another 2-3 months: Isoniazid Rifampin Ethambutol Purazinamide Who is NZ is able to have the fb vaccination? (BCG-Bacille Calmette-Guerin Babies living in a country with higher rates of tb Babies who may likely have contact with tb What is palliative care? Care that focuses on the resident being comfortable What is cancer and what does it do? A disease of the bodies cells Causes damage to genes that are involved in the process of replacing worn out or damaged cells Damaged genes cause cells to behave abnormally and they may grown into a tumour at a rapid rate What is benign? Not cancerous What is malignant melanoma? Rarest and most deadly form of skin cancer, brown spots that spread quickly What is benign prostatic hyperplasia? Enlargement of the prostate that occurs in the periurethral and transitional zones of the gland. What do malignant tumours do? They invade into surrounding tissue and form a secondary cancer or metastasis into another part of the body What is metastasis? cancer cells leaving a tumor and invading other parts of the body How is cancer treated? Chemo Surgery Immunotherapy Hormone treatment Radiation What is rheumatic fever? A disease that follows upper respiratory infection with Group A Beta haemolytic streptococci How does rheumatic fever start? With Group A strep throat What ethnicity has the highest risk of developing rheumatic fever? Maori and pacific islander How to diagnose rheumatic fever? Carditis Arthritis Chorea (jerky movements of the shoulders hips and face) Subcut nodules Erythema marginatum (rash) Fever Arthralgia (pain in joints) What is rheumatic fever arthritis? One of the earliest and most common signs of RF. Several joints such as the knees, ankles and elbows become inflamed in rapid time. This typically lasts up to 1 week and tends to overlap What is rheumatic fever carditis? Results from RF. The endocardium, myocardium, epicardium and pericardium becomes inflamed. For this to be diagnosed, a aortic or mitral valvular regurgitation must be auscultated along with correlated findings on an ecg What is rheumatic fever erythema marginatum? A non pruritic, erythemeous macular rash that appears on the trunk or limbs. It is a fleeting rash that is exacerbated by hot baths or showers What are rheumatic fever subcutaneous nodules? Firm, painless nodules that appear symmetrically over bony prominences What is rheumatic fever Sydenhams chorea? Consists of abrupt, involuntary movements, muscular weakness, emotional lability, facial grimacing, tongue fasciculation, speech changes, and obsessive compulsive disorder What occurs during rheumatic myocarditis? Acute phase: pathognomonic lesions called Aschoff bodies within the myocardium What are Aschoff bodies composed of? Fibrinoid necrosis (destroyed fragmented collagen) Lymphocytes and histiocytes and Aschoff cells (large mononuclear or multinuclear macrophages What occurs during rheumatic pericarditis? Acute phase: Aschoff bodies are formed accompanied by serofibrinous inflammation Chronic phase: Fibrosis and adhesions may occur between the visceral and the parietal layers of the pericardium What occurs during rheumatic endocarditis? It affects both the mural and valvular endocardium Mural endocardium (in the walls): Aschoff bodies develop in the endocardium and healing results in a white patch Valvular endocardium (in the valves): vegetation (thrombi) develop at the lines of contact of the chaos causing friction at the swollen cusps What occurs to the mitral and aortic valves with rheumatic fever? Thickening of the valve leaflet, especially along the lines of closure Fusion of commissures Result is mitral and aortic stenosis (hard and not flexible) How does rheumatic fever affect the brain? Rheumatic chorea. Due to inflammation of the basal ganglia. The condition is reversible How does rheumatic fever effect the skin? Subcutaneous nodules occurs over bony prominences and their structure is similar to Aschoff bodies How's does rheumatic fever effect the joints? Rheumatic arthritis. Effects large joints in a fleeting way but can cross over How does rheumatic fever effect the arteries? Affects the coronaries, renal, mesenteri , and cerebral arteries How to manage rheumatic fever? Admission to hospital Confirmation of diagnosis Treat with AB's Clinical follow up Commence long term preventative measures What are the long term measures of rheumatic fever? Give Bicillan every month to prevent reoccurrence until age 21 What are the risks following having rheumatic fever? HF AF Pulmonary hypertension Ineffective endocarditis Stroke Premature death What are 3 things NZ MOH does to decrease rheumatic fever in the prevention programme? Auckland-wide healthy homes initiative: systemically identifies children living in an area who are at risk of developing RH and offering a package of house related interventions to reduce the risks Community awareness raising about healthy communal living: improving healthy communal living for pacific families through home visiting and supporting church networks. Increase health literacy amongst professionals and the public: Delivering a communications campaign to raise awareness of sore throats and rheumatic fever among vulnerable communities and supporting them to take action to protect their children. Developing a training and resources such as online learning modules for professionals What can primary health care services in nz do to reduce rheumatic fever? Understand there is a problem Be aware of the nz guidelines and algorithms for the management of ARF Assist in the raising community awareness and support early detection Continue to lobby for improvements and equality in socioeconomic factors What is angina? chest pain due to reduced blood flow to the heart What is angina caused by? Myocardial ischemia and atherosclerosis What is atherosclerosis? thickening of arteries due to plaque build up. This can cause a heart attack or stroke what do coronary arteries do? Feed blood to the heart Common signs and symptoms of angina? Heaviness and tightness in the chest Discomfort in the back, shoulders, neck and jaw What is the difference between heart disease, angina, and a heart attack? HD: Plaque builds up in artery A: it is harder for blood to get through the artery HA: plaque cracks and a blood clot blocks the artery What is the difference in symptoms between angina and a heart attack? With angina, the symptoms will ease after a few minutes of resting or taking GTN (glyceryl trinitrate) spray, with a heart attack, the symptoms will not ease after resting or taking medication How to manage angina? Slow down or take breaks if angina comes on with exertion Avoid large meals and rich foods Learn ways to deal with stress How does GTN work? By quickly relaxing the blood vessels allowing blood to flow more freely to the heart Adverse effects of GTN? Headaches Flushing Dizziness soon after use What other meds are used for angina other than GTN? Long acting nitrates Beta blockers Calcium channel blockers What are 2 examples of long acting nitrates? Isosorbide mononitrate Glyceryl trinitrate patches Can you use long acting nitrates to relieve angina symptoms? No Adverse effects of long acting nitrates? Headaches Flushing Dizziness What is COPD? Chronic obstructive pulmonary disease. An umbrella term for the diseases emphysema, chronic bronchitis, chronic asthma. In pts with COPD, the airway is permanently obstructed and the tissue inside the lungs is damaged making it hard to breath What occurs with emphysema? The air sacs in the lungs are gradually destroyed so pts have difficulty absorbing enough 02 What occurs with chronic bronchitis? The airways become narrower and have increased mucus production and inflammation Symptoms of COPD? Coughing Increased phlegm Breathlessnes Is COPD curable? No. It progresses over time but it can be controlled and prevent further damage What is the main cause for COPD? Smoking What is strep throat caused by? Streptococcal bacteria What are the signs of strep throat? Chills Fever Swollen lymph nodes in neck How can strep throat be treated? Antibiotics such as penicillin or amoxicillin If left untreated, what can strep throat cause? Rheumatic fever and kidney complications What are some causes of strep throat? Viruses, most commonly the cold and flu virus. Is a sore throat caused by bacteria worse than one caused by a virus? Yes it has higher chance of complication and requires more attention Is strep throat contagious? Yes it is spread by close contact with an infected person usually by inhaling airborne droplets from an infected person What is breast cancer? When the cells in the breast and body begin to grow out of control usually forming a tumour that can be seen on X-ray or felt as a lump. The tumour is malignant if the cells grow into invade surrounding tissue or spread/metastasize to distant areas of the body What are the aims of breast cancer surgery? To remove the tumour safely to reduce the risk of recurrence and maximise survival To achieve good cosmetic result and optimise quality of life To obtain tissue for pathological staging and to help determine further treatment What is a partial mastectomy? Involves removing a wedge of tissue from the breast around the cancerous area The aim of this is to remove the cancer but also leave the breast looking as natural as possible What is a total mastectomy? The removal of the full breast tissue along with the nipple, areola, and wedge of skin What is a prophylactic mastectomy? Removal of the breasts as a measure to reduce the risk. Not 100% guarantee of not developing breast cancer. Still need to be checked yearly What is lymph node surgery? Usually if breast cancer is invasive as the lymph nodes which drain from the breast lie in the armpit. This results in lymphoedema (swelling in the arm or hand) When can lymphoedema occur? Shortly after surgery or years later as it is caused by slow or blockage of lymph fluid resulting from lymph nodes or vessels being removed or damaged How can you avoid lymphoedema? By taking special care to avoid injury or infection by protecting the arm on the side you have surgery What is sentinel node biopsy? A biopsy of the first lymph node that drains the breast. (Usually in the armpit) How is the sentinel node located? Injecting a small amount of radioactive substance or blue dye into the area of the breast lump and surrounding area Changes to genital organs with pregnancy? Bluish purpleish discolouration of labia, vagina and cervix (chadwicks sign) Cervical softening with mucous plug (goodells sign) Abdominal enlargement Breast enlargement and vascular engorgment Colostrum secretion When would abdominal enlargement occur during pregnancy? Around the 12th week When would you expect colostrum secretion in pregnancy? Around the 16th week How to diagnose a pregnancy? Raised human chorionic gonadrotropin (hCG) 7-10 days (blood) and 3rd week (urine) after contraception Steadily increases to maximum levels between the 8-11th week (pee stick/bloods) What does an ultrasound see in pregnancy? Uterine enlargement Gestational sac Foetal pulse Foetal lie, presentation, position, size, number, death When would a pregnant patient have a foetal electrocardiography? 12th week Where would you feel for the uterine growth in the 12th week? Two fingers above the symphysis Where would you feel for the uterine growth in the 16th week? Midway between the symphysis and the umbilicus Where would you feel for the uterine growth in the 20th and 22nd week? Umbilicus Where would you feel for the uterine growth in the first foetal movement? 16th 18th week (quickening) When would you feel for the foetal body outlines palpated? 20th week How many bpm is a foetal heart? 120-160 What is a teratogen? an agent or factor that causes malformation of an embryo. Can cause birth defects or death List 4 examples of teratogens? Infectious disease like rubella STI's like syphilis Drugs like diet pills Environmental toxins like mercury What are the 2 main hormones in pregnancy and what do they do? Oestrogen: develops female sexual characteristics, maintains a healthy pregnancy, produced by the ovaries and placenta. Progesterone: relaxes smooth muscles, causes uterine lining to thicken. Produced in the placenta What are the 4 P's in labour? Powers: contractions and duration of labour Passage: size of pelvis, type of pelvis, ability of cervix to dilate Passenger: foetus, foetal head size, attitude, lie, positions, presentation Psyche: preparations, people, professionals, environment What duration of labour is typical for a primigravida? 12-20 hours What duration of labour is typical for a multigravida? 6-12 hours What is involution? Uterus reduction to pre-pregnancy state. What is lochia? Vaginal discharge after delivery composed of endometrial tissue blood and lymph What is lochia rubra? Red discharge. Composed mainly of blood. Occurs for 3 days postpartum What is lochia serosa? Pinkish discharge. Composed of blood and mucus and can last from the 3rd to the 10th day postpartum What is lochia alba? Mostly mucus. Clear colourless or white and can last from the 10th to the 21st day postpartum What are 5 pieces of advice to give a pregnant woman? Stay smoke free Zero alcohol Folic scid and iodine intake Avoid listeria (food poisoning) Get blood and syndrome tests When should a pregnant woman take folic acid? Ideally once a day for 3 months prior to pregnancy and for the first 3 months of pregnancy When should a pregnant woman take iodine? One tablet per day throughout pregnancy What are the blood tests needed through out pregnancy? (8) Blood group or rhesus factor Haemoglobin or iron Antibodies Immunity to rubella Hep B Syphilis HIV Diabetes What antenatal screening is offered in NZ? Down's syndrome and other genetic conditions When can antenatal screening be done? First trimester combined screening or if less than 14 weeks, can be done with a blood test and ultrasound scan What does a antenatal screening look for? The thickness of the back of the neck, known as the nuchal thickness Symptoms of rubella? Rash Swollen neck glands Sore joints Feeling unwell Effects of rubella on an unborn child? Blindness Deafness Heart defects Brain damage What causes rubella immunity? Previous case of rubella Immunisation (MMR) What does the MMR vaccine cover? Measles, mumps, and rubella When can your child get the MMR vaccine? At 15 months, and at 4 years What is listeria? A common bacterium which can cause uncommon but potentially serious illness called listeriosis Where is listeria found? milk products, soft cheeses, and uncooked meats. also in soil, water, plants, and animal and human faeces How do people get listeriosis? Eating contaminated food, in particular, ready to eat products and food with a long refrigeration life Who is at risk of listeriosis? Pregnant woman and their foetus Newborns Weak immune system patients Elderly What are the symptoms of listeria? Takes days to weeks to show: Mild fever Headache Aches and pains Vomitting What can listeria lead to? Meningitis Sepsis Miscarriage Premature or still birth Severe infection of a newborn baby What does a baby need vitamin D supplement for? To maintain healthy levels of calcium and phosphorus which helps build bones and teeth What does low vitamin D put a baby at risk of? Rickets which can lead to deformed and broken bones Abnormal bone growth Delayed physical development Which food contains vitamin D? Fatty fish Eggs Liver (don't eat more than 100g p/w Milk and yogurt Who has high risk of low vitamin D? Dark skin No sun exposure Liver or kidney disease Anticonvulsant meds What are rickets? Bone disease ,Bowed legs no vit d and phosphorus Is breast milk a good source of vitamin D? No When should a baby start on solids? After 6 months How long does nz recommend breast feeding? Until the baby is over 1 years old List 5 benefits of breast feeding? Antibodies build babies immunity Helps with brain development Bonding Saves cost of formula Less likely to develop breast and cervical cancer for mother What illness does breastmilk help to protect babies from? Eczema Asthma Bowel disease Cancer Type 2 diabetes How does the breast produce milk? Bundles of glands in the breast produce milk What is colostrum? the substance that is released when a woman first begins to lactate, containing proteins and antibodies What is meconium? The dark green substance forming the first feces of a newborn infant. What hormone initiates lactation? Prolactin What is oxytocin? A hormone secreted by the posterior pituitary gland in the hypothalamus that causes increased contraction of the uterus during labour and stimulates ejection of milk into breast ducts What is the role of oxytocin during birth? Stimulates the uterine muscles to contract and increased production of prostaglandins which increases contractions What 5 things would you expect your 1 month old infant to be doing? Can't focus more than 8-12 inches away Black and white patterns draw attention Hearing is fully developed Can lift head briefly and turn it to the side when on stomach Jerky arm movements, can get them to the mouth List 5 red flags for a 1 month olds development? Doesn't suck well Doesn't focus with eyes Seems stiff or floppy Doesn't react to loud sounds Doesn't react to bright lights List 5 things to expect a 3 month old to do? Imitates facial expressions Mimicks mum and dads sounds Head doesn't need supporting Open and close hands Can lift head and chest What 5 things would you be concerned about if your 3 month old couldn't do? Can't support head Can't grasp objects Can't smile Doesn't react to loud sounds Ignores new faces What should you expect your 7 month old to do? Smiles and laughs Has babbling conversations Rolls onto tummy and back Can sit without help Can support weight well enough to bounce when being held What 5 things would you be concerned about if your 7 month old couldn't do? Seems stiff or floppy Can't hold head steady Can't sit on own Doesn't respond to noises or smiles Isn't affectionate to those close to her What would you expect your 8-12 old to be able to do? Explore Crawl Able to sit up Might walk First words What would you be concerned about in a 8-12 month old? Doesn't crawl Can't stand with support Doesn't say any words Doesn't use gestures Doesn't explore What would you expect a 13-24 month old to do? Go up and down stairs Stand on tip toes Kick a ball Run Short sentences What would you be concerned about in a 13-24 month old? Can't walk by 18 months Doesn't speak at least 6 words Loses skills previously had Can't follow simple instructions Can't understand use of familiar objects What would you expect in a 25-36 month old Imagination Speech Open doors and containers Draws a circle Develops friendships (empathy and affection) What would you be concerned about in a 25-36 month old? Struggles with separation anxiety Doesn't interact with others Avoids eye contact Doesn't use more than 3 words in a sentence Has trouble scribbling What are the 2 common types of middle ear problems? Acute otitis media (ear infection) Glue ear (ear infection with effusion or secretions) How can ear infections occur following a cold? Bacteria and virus travel to the eustachian tube which connects the space behind the ear drum to the back of the nose, the germs infect this space. This can cause swelling and blocking of the tube and fluid and pus in the ear drum What are s&s of an ear infection? Fever Pain in ear Unwell Reduced hearing How long does an ear infection usually last? Usually 24 hours What is the treatment for an ear infection? Pain relief Antibiotics What are complications of an ear infection? Hearing loss Fluid collection usually lasting 12 weeks A hole in the eardrum What immunisations are given to a child of 6 weeks? Rotavirus 1 oral vaccine (Rotateq) Diphtheria, tetanus, pertussis, polio, hepatitis B, haemophilus influenza type b 1 oral injection (infanrix) Pneumococcal 1 injection (prevenar 13) What immunisations are given to a 3 month old? Rotavirus 1 oral vaccine (rotateq) Diphtheria, tetanus, pertussis, polio, hepatitis B, haemophilus influenza type b 1 oral injection (infanrix) Pneumococcal 1 injection (prevenar 13) When is rotavirus vaccine given? 6 weeks 3 months 5 months What vaccines are given at 5 months? Rotavirus 1 oral vaccine (rotateq) Diphtheria, tetanus, pertussis, polio, hepatitis B, haemophilus influenza type b 1 oral injection (infanrix) Pneumococcal (prevenar 13) What vaccines are given at 15 months? Haemophilus influenza type b 1 injection (ACT-HIB) Measles mumps rubella 1 injection (MMR) Pneumococcal 1 injection (prevenar 13) What immunisations are given at 4 years? Diphtheria, tetanus, pertussis, polio, hepatitis B, haemophilus influenza type b 1 oral injection (infanrix) Measesls mumps and rubella 1 injection (MMR) What vaccines are given at 11 years? Tetanus diphtheria pertussis 1 injection (boostrix) What vaccine is given at 12 years? Human papillomavirus 3 doses given over 6 months (GARDASIL) What vaccine is given at 45 years? Diphtheria tetanus 1 injection (ADT booster) What vaccine is given at 65 years? Diphtheria and tetanus 1 injection (ADT booster) Influenza What is naturally acquired active immunity? Exposed to a live pathogen, develops the disease and becomes immune as a result of a primary immune response What is artificially acquired active immunity? Can be induced by a vaccine a substance that contains the antigen What is passive immunity? Naturally acquired during pregnancy What is artificial passive immunity? Short term immunisation Is measles contagious? Yes it is highly contagious How is measles spread? Highly infections virus that spreads through the air, via breathing coughing and sneezing How long are you infectious for after measles? 5 days before and 5 days after the rash disapears What 5 complications can measles lead to? Ear infection Diarrhoea Pneumonia Seizure Swelling of the brain What risks are involved in a pregnant woman getting measles? Miscarriage Premature labour Low birth weight babies When does the illness start after measles? 7-18 days What are the symptoms of measles? A fever A cough Runny nose Pink eye Small white spots on the back inner cheeks of your mouth A rash How is meningitis transmitted? Difficult to spread as meningococcal bacteria doesn't live outside the body for very long. But can pass from one person to another through secretions from the nose or throat during close or prolonged contact eg coughing kissing sharing eating or drinking utensils Who is at most risk of catching meningitis? Babies Teenagers Weak immune system Respiratory infection Tobacco exposed Over crowded Is it possible to get meningitis more than once? Yes What is the bacteria from meningococcal? Bacteria neisseria meningitidis. There are several different groups of meningococcal bacteria including groups A B C Y and W135. In NZ the most common strains are group B and C Can people carry meningitis without being sick? Yes it can be carried in their nose and throat Can meningococcal be life threatening? Yes it can cause sepsis or meningitis which is infection of the brain 2 signs of head lice? Itchy scalp Scratch marks or rash on scalp How often should head lice be treated? 7-10 days after first treatment What comes under section 8A of the MHA? Application for assessment Application must be in writing What comes under section 9 of the MHA? Notice to the patient to attend an assessment examination Noticed is issued by a DAO What comes under section 10 of the MHA? Certificate of the preliminary assessment Done by a psychiatrist What comes under section 11 of the MHA? Notice recruited to the patient to undergo a 5 day further period of assessment and treatment. It is compulsory What comes under section 12 of the MHA? Certificate of further assessment What occurs under section 13 of the MHA? Notice requiring further assessment 14 days of compulsory assessment and treatment What happens under section 14 of the MHA? Certificate of final assessment Application for compulsory treatment order Completed up to 14 days after section 13 Patient now under section 15 What occurs under section 16 of the MHA? Application for judicial review Patient can apply for this What occurs under section 29 of the MHA? Compulsory community treatment order Patient is still considered mentally disordered but can be managed out in the community What occurs under section 29 (3A) of the MHA? Patient becomes mentally unwell and requires treatment in hospital for up to 14 days CTO still has effect What occurs under section 30 of the MHA? Compulsory inpatient treatment order What occurs under section 111 of the MHA? Notice of intention to detain on hospital grounds. Nurse can detain a patient for more than 6 hours from the time when a nurse first calls for a medical practitioner to examine the patient How is a mental disorder defined by the MHA? Abnormal state of mind characterised by delusions, disorders of mood or perception, volition or cognition of such a degree that poses a danger to the individual or others What are the patients rights under the MHA? Information Cultural identity Interpreter Appropriate treatment Informed regarding treatment Able to refuse video recording Independent psychiatric advice Legal advice Company and visitors Make calls Send and receive mail What is bipolar disorder? Bipolar disorder is a mood disorder with recurrent episodes of depression and mania. What ages is bipolar most common? Between 15 and 40 years What causes bipolar disorder? Unknown but may be genetic What is bipolar type 1 disorder? Bouts of mania and depression What is bipolar type 2? Bouts of mania and depression, however the mania is milder (hypomania). More common than type 1 S&S of bipolar? Mania Depression Irritable Rapidly changing moods Increased appetite for food and sex Loss of concentration Sleep problems Suicidal ideation What is schizophrenia? A psychotic disorder characterized by disorientation and disorganized patterns of thinking. What is schizoaffective disorder? Loss of contact with reality and bipolar symptoms S&S of schizoaffective disorder? Phsycosis Mood problems What are delusions? Firm, fixed, false beliefs, irrational What are thought disturbances? Inability to concentrate Disorganised train of thought Constant conversation change Distracted What are hallucinations? false sensory experiences, such as seeing something in the absence of an external visual stimulus What is a mood disorder? Dysregulation of one's mood state (depressive and bipolar disorders) Loss of motivation Every day tasks become difficult Social withdrawal What is a borderline personality disorder? A pattern of having very unstable relationships, self image and feelings and behaving recklessly What is paranoid personality disorder? A pervasive sense of mistrust of the motives of others. What is schizoid personality disorder? Avoid social relationships Does not express emotion or feelings What is schizotypal personality disorder? A pattern of being uncomfortable in close relationships, having distortions in thinking or sensation and behaving oddly Difficulty establishing and maintaining friendships and usually has eccentric tendencies in everyday behaviour What is antisocial personality disorder? A pattern of disregarding and violating the rights of others What is obsessive-compulsive disorder? preoccupied with orderliness, perfectionism, control, neatness, and the achievement of perfection Who is at risk of developing a personality disorder? Late adolescence or early childhood Can improve with increasing age Has the tendency to develop other mental health issues What is Risperidone? Atypical antipsychotic used to treat schizophrenia and bipolar disorder Adverse effects of risperidone? Akathisia Parkinsonims Insomnia Headache Gi upset Elevated CPK levels Dyskinesia Points to tell patients after taking risperidone? Monitor for weight gain Hyperglycaemia Impact on mental alertness (driving, operating heavy machinery What class of drugs does chlorpromazine belong to? Phenothiazine antipsychotics What is chlorpromazine used to treat? Schizophrenia Psychotic disorders Manic phase of bipolar Prolonged hiccups Anxiety N+V Tetanus Effects of chlorpromazine? Think clearly Feel less nervous Reduced aggression Decreased hallucination Side effects of chlorpromazine? Dry mouth Blurred vision Tiredness Nausea Constipation Weight gain Extrapyramidal symptoms What is neuroleptic malignant syndrome? Life-threatening emergency; high fever, tachycardia, stupor, increased respiration, muscle rigidity Cause of neuroleptic malignant syndrome? Taking neuroleptic or antipsychotic medication What is serotonin syndrome? Group of symptoms following the use of some serotonergic medication. Symptoms include agitation ataxia increased sweating diarrhoea fever hyperreflexia What causes serotonin syndrome? Increased dose of Serotonergic medications MAOIs TCAs Tranadol St Johns Wort What are the effects of parkinsonia? Blank mask like expression Salivary drooling Noticeable tremor Muscle rigidity Shuffling gait Nursing interventions for parkinsonia? Reactions subside with time Anticholinergic medication (benztripine) What is akasthia? Restless legs Nursing interventions for akasthisia? Change medication Anticholinergic medication What is the main medication used as a mood stabiliser? Lithium. Treats mania symptoms and depression. Low doses are effective for depression and bipolar when used with another mood stabiliser Side effects of lithium? Polydipsia Polyuria Nausea Weight gain Lithium toxicity What is the normal lithium level? 0.8-1.2mmol What is lithium toxicity? When lithium levels are above 2.0mmol. Causes diarrhoea nausea vomitting weakness dizziness LOC tremors, psychosis, akasthisia, increased reflexes, slurred speech, tremors What is another medication used as a mood stabiliser? Sodium valporate. Treats bipolar Side effects of sodium valporate? Drowsiness, headache, weight gain, nausea, confusion What is a toxic level of sodium valporate? 850mg/L or greater What is the normal BSL? 4.0-7.8mmol What is the target level BSL for diabetics? Type 2: 4-8.5mmol Type 1: 4-9mmol What is type 1 diabetes? the body's immune system destroys cells in the pancreas that produce insulin. There for the patient is insulin dependant What is type 2 diabetes? caused by bad diet over time -- not enough insulin produced or not used properly What is hypoglycemia? BSL less than 4.0mmol. Shaking sweating tachy What is hyperglycemia? BSL more than 7.8mmol. Polyuria polydipsia blurred vision What is tardive dyskinesia? Bizarre facial & tongue movements, stiff neck, difficult swallow -- potentially irreversible What is a nursing intervention for tardive dyskinesia? Do not give antiparkinsinian drugs (benztropine) Lower dose of antipsychotics What is in the axis 1 for in diagnosing a clients condition? Axis 1: represents acute symptoms that need treatment diagnoses the most familiar mental illness eg major depressive disorder or schizophrenic episode What is in the axis 2 for in diagnosing a clients condition? Assessment of personality disorders and intellectual disabilities What is in the axis 3 for in diagnosing a clients condition? Medical or neurological conditions that may influence a psychiatric problem What is in the axis 4 for in diagnosing a clients condition? Identifies recent psychosocial stress eg death of a loved one that may affect the diagnosis treatment and prognosis of mental disorder What is in the axis 5 for in diagnosing a clients condition? Identifies the patients ability to function in everyday life. Scale of 0-100 What is the normal range for lithium in the blood, 0.5-1.5mmol What are some benzodiazapines and what do they treat? Anti anxiety meds Temazepam Lorazapam Oxazepam What are 2 atypical antipsychotics? Olanzapine tx schizophrenia mania and depression. Affects are weight gain and sedation Risperidone tx schizophrenia bipolar mania. Affects are akasthisia insomnia anxiety List 2 typical antipsychotics? Haloperidol tx schizophrenia phycosis. Affects are tachy fever insomnia Chlorpromazine tx schizophrenia mania bipolar. Affects are weight gain dry mouth dizziness List 2 antipsychotic depot injections? Zuclopenthixol (clopixol) take 2-4 weeks. IM. Causes drowsiness and sedation Palliperidone (invega sustenna) take 2-4 weekly. IM. Causes tremor sedation Guidelines for commencing clozapine? Must have trialled 2 other antipsychotics prior with no affect ECG ECHO FBC prior Begin with titration inpatient setting If dose is missed, retritate quick titration What is in the flu vac Michigan Brisbane Singapore Phuket Strains Who is the flu vac free for? Pts overs 65 Pts w poor immunity Pts w cardiac probs Pts resp probs What vacs would you get when pregnant? Boostrix Influenza What AB is most commonly used for UTI's? Trimethoprin What is decorticate posturing? characterized by flexion of the arms and extension of the legs What is decerebrate posturing? characterized by extension of the arms and legs worse than decorticate What medication would you avoid with a head injury? NSAIDS (increase bleeding) What is compartment syndrome? Large amounts of pressure in muscle compartment due to fascia not expanding with injured tissue blood vessels nerves. Can lead to cellular death by lack of 02 What to be aware of when giving opioids? Respiratory deoression What is erythromycin used to treat? Chest infections Acne STI's Most common side effect of erythromycin? N+V Main complication of shingles? Post herpatic nerve pain Who is at most risk for getting shingles? Adults who have had shingles Adults over 50 What is prednisone used to treat? Anti inflam cortico steroid Asthma Allergic reactions COPD Side effects of prednisone? High bp Fluid tetention Risk of catching tetanus? Having a cut and being in soil S+S of tetanus? Occurs 3-10 post infection Weakness Difficulty chewing and swallowing Muscle rigidity Respiratory muscle paralysis Which act affirms the TOW? Health and disability act 2000 When was the TOW signed? 6th feb 1840 List 4 nursing obligations w the TOW? Form partnership w Maori Be responsive to Maori needs Ensure equal opportunities Measure and evaluate the councils responsibilities to the TOW What is the vaccine for tetanus? Bacille calmette guerin causes of schizophrenia enlarged ventricles, decreased prefrontal cortex volume, blocked reuptake of dopamine Drug use Poor nutrition during pregnancy 3 positive symptoms of schiz? Delusions Disordered speech Hallucinations 3 negative symptoms of schiz? Flat expressions Lack of motivation Inability of experience pleasure List the bill of rights? Not be: Deprived of life Subjected to torture or cruel tx Subjected to medical or scientific experimentation To refuse tx Half life of lithium? 24 hr. 36 in the elderly What is whooping cough? Pertussis. A bacterial disease which causes a cough for 10+ weeks. Runny nose, N+V, spread through the air Tx for whooping cough? ABs such as azithromycin and clarithromycin. Boostrix vaccine What is asthma? an inflammatory disorder of the airway walls associated with a varying amount of airway obstruction 3 inhaled corticosteroids? Pulmicort Flixotide Beclazone List 3 combination inhalers? Seretide Symbicort Rexair