AANP Adult gerontology primary care
nurse practitioner study guide
Pheochromocytoma - ANS -small vascular tumor of the adrenal medulla, causing irregular secretion of
epinephrine and norepinephrine, leading to attacks of raised blood pressure, palpitations, and
headache. TX with Alpha blockers
Roving’s Sign - ANS -Palpation in LLQ elicits pain in RLQ indicates appendicitis
NYHA classes of Heart Failure - ANS -I No limitation of physical activity. Ordinary physical activity does
not cause undue fatigue, palpitation, dyspnea (shortness of breath).
II Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue,
palpitation, dyspnea (shortness of breath).
III Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue,
palpitation, or dyspnea.
IV Unable to carry on any physical activity without discomfort. Symptoms of heart failure at rest. If any
physical activity is undertaken, discomfort increases.
Step-wise Approach to Asthma Diagnosis & Treatment - ANS -Step 1- Mild Intermittent FEV1/PEF > 80%
predicted. Symptoms <2 days/week. Albuterol as needed.
Step 2- Mild Persistent Asthma (FEV1/PEF > 80% predicted. Symptoms > 2 days/week. Albuterol as
needed. Low dose ICS ex Fluent. Alt commonly, montelukast, nedocromil, theophylline.
Step 3- Mod persistent (FEV1 or PEF 60-80% predicted. Daily Symptoms. SABA plus low dose ICS or med
dose ICS or low dose with leukotriene inhibitor (singular, theophylline, zileuton).
Step 4- Severe persistent asthma (FEV1/PEF <60% predicted. Symptoms most of day. High dose ICS plus
long acting B2 agonist plus oral steroid daily (prednisone).
Peak Expiratory Flow Rate (HAG):
Green Yellow Red Zone: - ANS -PEF based on Height Age Gender. Blow hard using spirometer highest
value recorded.
, 80-100% expected volume Green Zone maintain or reduce meds
50-80% expected volume Yellow Zone increase maintenance therapy. Or Having exacerbation.
Below 50% expected volume Red Zone call 911 give epinephrine inj.
PPD - ANS -Nag- No firm bump forms at the test site, or a bump forms that is smaller than 5 mm (0.2
in.).
A firm bump that is 5 mm (0.2 in.) in size suggests a TB infection in people who are in a high-risk group.
HIV, immunocompromised, exposed.
A firm bump that is 10 mm (0.4 in.) in size suggests a TB infection in people who are in a moderate-risk
group. healthcare workers, immigrants, homeless.
A firm bump that is 15 mm (0.6 in.) in size suggests a TB infection in people who are in a low-risk group
no risk for tub.
Digoxin (Cardiac Glycosides) - ANS -Therapeutic 0.5-2.0
Overdose toxicity GI upset, arrhythmias, confusion visual changes (yellow/green tinge vision- scotomas).
TX with Digi bind. order dig level, electrolytes, creatinine keg.
Thiazide Diuretics - ANS -Pt with both hen and osteoporosis have an extra benefit from thiazides.
thiazide diuretics decrease calcium excretion by the kidneys and stimulate osteoclasts formation.
Patients with serious sulfa allergies should avoid thiazide diuretics. Potassium sparing diuretics can be
used as alternative.
Chlorthalidone (hygroton), hydrochlororthiazide (esidrix, microzide), indapamide (lozol), metolazone
(zaroxolyn); indicated for decreased fluid volume, inexpensive, effective, useful in severe hypertension,
effective orally, enhances other antihypertensives; adverse reactions: hypokalemia symptoms,
hyperuricemia, glucose tolerance, hypercholesterolemia, sexual dysfunction; observe for postural
hypotension, caution with renal failure gout and client taking lithium; hypokalemia increases risk for
digitalis toxicity, administer postassium supplements.
nurse practitioner study guide
Pheochromocytoma - ANS -small vascular tumor of the adrenal medulla, causing irregular secretion of
epinephrine and norepinephrine, leading to attacks of raised blood pressure, palpitations, and
headache. TX with Alpha blockers
Roving’s Sign - ANS -Palpation in LLQ elicits pain in RLQ indicates appendicitis
NYHA classes of Heart Failure - ANS -I No limitation of physical activity. Ordinary physical activity does
not cause undue fatigue, palpitation, dyspnea (shortness of breath).
II Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue,
palpitation, dyspnea (shortness of breath).
III Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue,
palpitation, or dyspnea.
IV Unable to carry on any physical activity without discomfort. Symptoms of heart failure at rest. If any
physical activity is undertaken, discomfort increases.
Step-wise Approach to Asthma Diagnosis & Treatment - ANS -Step 1- Mild Intermittent FEV1/PEF > 80%
predicted. Symptoms <2 days/week. Albuterol as needed.
Step 2- Mild Persistent Asthma (FEV1/PEF > 80% predicted. Symptoms > 2 days/week. Albuterol as
needed. Low dose ICS ex Fluent. Alt commonly, montelukast, nedocromil, theophylline.
Step 3- Mod persistent (FEV1 or PEF 60-80% predicted. Daily Symptoms. SABA plus low dose ICS or med
dose ICS or low dose with leukotriene inhibitor (singular, theophylline, zileuton).
Step 4- Severe persistent asthma (FEV1/PEF <60% predicted. Symptoms most of day. High dose ICS plus
long acting B2 agonist plus oral steroid daily (prednisone).
Peak Expiratory Flow Rate (HAG):
Green Yellow Red Zone: - ANS -PEF based on Height Age Gender. Blow hard using spirometer highest
value recorded.
, 80-100% expected volume Green Zone maintain or reduce meds
50-80% expected volume Yellow Zone increase maintenance therapy. Or Having exacerbation.
Below 50% expected volume Red Zone call 911 give epinephrine inj.
PPD - ANS -Nag- No firm bump forms at the test site, or a bump forms that is smaller than 5 mm (0.2
in.).
A firm bump that is 5 mm (0.2 in.) in size suggests a TB infection in people who are in a high-risk group.
HIV, immunocompromised, exposed.
A firm bump that is 10 mm (0.4 in.) in size suggests a TB infection in people who are in a moderate-risk
group. healthcare workers, immigrants, homeless.
A firm bump that is 15 mm (0.6 in.) in size suggests a TB infection in people who are in a low-risk group
no risk for tub.
Digoxin (Cardiac Glycosides) - ANS -Therapeutic 0.5-2.0
Overdose toxicity GI upset, arrhythmias, confusion visual changes (yellow/green tinge vision- scotomas).
TX with Digi bind. order dig level, electrolytes, creatinine keg.
Thiazide Diuretics - ANS -Pt with both hen and osteoporosis have an extra benefit from thiazides.
thiazide diuretics decrease calcium excretion by the kidneys and stimulate osteoclasts formation.
Patients with serious sulfa allergies should avoid thiazide diuretics. Potassium sparing diuretics can be
used as alternative.
Chlorthalidone (hygroton), hydrochlororthiazide (esidrix, microzide), indapamide (lozol), metolazone
(zaroxolyn); indicated for decreased fluid volume, inexpensive, effective, useful in severe hypertension,
effective orally, enhances other antihypertensives; adverse reactions: hypokalemia symptoms,
hyperuricemia, glucose tolerance, hypercholesterolemia, sexual dysfunction; observe for postural
hypotension, caution with renal failure gout and client taking lithium; hypokalemia increases risk for
digitalis toxicity, administer postassium supplements.
