AGACNP 106 Document Question and verified answers from Experts (A+)

What disease conditions do you see Telangiectasia in? Differential? Physical Exam? - -("spider veins") dilated or broken blood vessels located near the surface of the skin or mucous membranes. -Rosasea -Liver dx -Scleroderma -Lupus -Corticosteriod use -Raynauds -Basal cell Skin CA -Differential: PVD -PE: Hemosiderans deposition (staining) Type 1 Error - -False positive -Incorrectly rejecting the true null hypothesis (occurs if the null hypothesis is rejected when it is true) -Rejection of the null hypothesis when it is actually true. Type 2 Error - -False negative -Failing to reject a null hypothesis which is false (occurs if the null hypothesis is not rejected when it is false) National mandate to prevent VAP? - Elevate the HOB Credentials - 1. Encompass required education, licensure and certification 2. Establish minimal levels of acceptable performance 3. Necessary to: ensure the safe healthcare is provided by qualified individuals and comply with federal and state laws relating to advanced practice nursing 4. Scope of practice 5. Mandates accountability 6. Enforces professional standards of practice What is credentialing or priviliging? - -Process by which a NP is granted permission to practice in an inpatient setting -Credentialing with hospital privileges is granted by a Hospital Credentialing Committee comprised of MDs who hold privileges at the given hospital where the NP has made request -Privileges may be granted in part or full; stipulations regarding the allowance of future privileges may be made by the Credentialing Committee Licensure - -Establishes that a person is qualified to perform in a particular profession. -Granted as defined by rules and regulations set forth by a governmental regulatory body Who gives licensure? - State board of nursing What is sensitivity? - -True positives -The degree to which those who have a disease screen/test positive What is specificity? - -True negatives -The degree to which those who do not have a disease screen/test negative What is null hypothesis? What if the null hypothesis is rejected? - -There is no significant relation between the variables of the study -Results are due to chance and are not significant in terms of supporting the idea being investigated. Thus, the null hypothesis assumes that whatever you are trying to prove did not happen -It means the results of the study are not due to chance What is p-value? - -Number describing how likely it is that your data would have occurred by random chance (i.e. that the null hypothesis is true). -0.05 as the standard level of significance -The smaller the p-value, the stronger the evidence that you should reject the null hypothesis if P<0.05 it? - -Rejects null hypothesis -Statistically significant -A significant result and this would have only arose 5/100 times through chance -Experimental and control groups are considered to be significantly different if p>0.05? - -Fail to reject the null hypothesis -Not statistically significant and indicates strong evidence for the null hypothesis What is treatment for VAP? - Cover MRSA+ Double antipseudomonal coverage -Abs with MRSA activity = vanc or linezolid -Gram neg with antipseudomonal coverage: beta lactam-based agents = Zosyn or cefepime/ceftazidine or imipenem/meropenem or aztreonam -Gram neg with antipseudomonal coverage: non-beta lactam-based agents = levofloxacin/cipro or amikacin/gentamicin/tobramycin or colistin/polymyxin B Right flank pain radiating to the back could indicate? - Pancreatitis What is treatment for cardiac tamponade? - Pericardiocentesis to remove the blood and fluid from around the heart Scope of Practice NP - -Based on legal allowances in each state -According to and delineated by individual State Nurse Practice Acts -Provides guidelines for nursing practice; varies from state to state Vaccines after splenectomy most important? Others? - -Meningococcal: conjugate (MenACWY) and serogroup B (MenB) and pneumococcal conjugate (PCV13) and polysaccharide (PPSV23) -Hib -Influenza each year -Tdap -Zoster -HPV -MMR -Varicella Addisons Disease Addisons lab findings? Test to rule out Addisons? Treatment for hypotension and Addisons? - -Deficient cortisol, androgens and aldosterone (autoimmune) - too little -Hypoglycemia, hyponatremia, hyperkalemia, elevated ESR, lymphocytosis, plasma cortisol <5mcg/dl @ 0800 -Cosyntropin stimulation test -D5 NS at 500mL/hr Cushing's Disease Cushing's lab findings? Test to rule out Cushing's? - -Adrenocorticotropic hormone (ACTH) hypersecretion- too much steroid -Hyperglycemia, hypernatremia, hypokalemia, glycosuria, leukocytosis (WBC > 10), elevated plasma cortisol in the AM, serum ACTH elevated, elevated urine free cortisol (normal is 90) -Dexamethasone suppression test What ethnicity like to have DM and not seek treatment? - Hispanics Steps in the Research Process - 1. Formulating the research problem 2. Reviewing related literature 3. Formulating the hypotheses 4. Selecting the research design 5. Identifying the population to be studied 6. Specifying methods of data collection 7. Designing the study 8. Conducting the study 9. Analyzing the data 10. Interpreting the results 11. Communicating the findings Arcus Senilis - -A cloudy appearance of the cornea with a gray/white arc or circle around the limbus -Due to deposition of lipid material -No effect on vision -Permanent color change of the eye -Underlying issue = HLD Ventilatory settings for ARDS - -Peep = 10 (manage pulmonary shunting by adding PEEP) -Tidal volume 6-8 mL/kg ideal body weight (low tidal volume to prevent acute lung injury) Medicare Part A covers? - -Inpatient/hospitalization -Skilled nursing facility services -Home health services -Hospice (inpatient) Medicare Part B covers? - -Physician services -Outpatient hospital services -Labs and diagnostic procedures -Medical equipment -Some home health services Medicare Part C covers? - -Medicare A + B -HMOs, PPOs Medicare Part D covers? - -Limited prescription drug coverage Therapeutic Communication - -Listen more than talk -"Tell me" -Never ask "why" -Focus on feelings (mad, sad, glad, afraid, ashamed) -Do not mince words; no euphemisms (I am concerned about alcoholism, I'm sorry but she died) When do you transfer pts to tertiary facilities? - -Serious ill/injured pts if full range of services are not available -Assess all injuries, stabilize, assess the capabilities of your facility and the transfer as appropriate -Major maxillofacial injuries -Severe Le Fort fractures of the skull 1-floating pallete 2-floating maxilla 3-floating face What lab to assess to see if enteral feeding is beneficial? - Pre-albumin (earliest indicator of protein malnutrition) What is Refeeding Syndrome? - Complication enteral feeding -Hypokalemia -Hypophosphatemia ** -Hypomagnesemia -Hypocalcemia -Thiamine Def What labs do you check for with TPN? - -Albumin -Glucose? Pt says don't tell my daughter about my diagnosis, what ethical principle is this honoring? - Fidelity -The duty to be faithful ICU pt, 2 days post extubation fails swallow study. Keep in ICU or transfer to floor? - Transfer to step down Veracity - The duty to be truthful DNR with advanced directives, family asking for everything to be done? - We don't go against advanced directives Pt comes in with CHF and dementia, first thing NP should do? - Assess cognition Side effect Levothyroxine (Synthroid)? - Alopecia What pt most likely to have angioedema with ACE? - African American