LEIK FNP review

ANTIBIOTIC STUDY GUIDE

CEPHALOSPORINS (Category B)

1st Generation: cephalexin (Keflex)

2nd Generation: cefprozil (Cefzil), cefuroxime (Ceftin), cefaclor (Ceclor).

3rd Generation: IM ceftriaxone (Rocephin),

cefdinir (Omnicef), cefixime (Suprax)

 

NOTE:Penicillin-allergic patients may be allergic to cephs. (cross-sensitivity). All antibiotics can cause Clostridium difficile overgrowth, pseudomembranous colitis,CDAD. Used for: strep throat, cellulitis, pneumonia, sinusitis, otitis media, secondary infection COPD, GC (Suprax, Rocephin)

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PENICILLINS (Category B)

1st Generation: po penicillin V (Veetids), IM benzathine penicillin (Bicillin L-A). 2nd Generation: dicloxacillin (Dynapen)

NOTE: Penicillin-allergic, can use macrolides, cephalosporins, newer quinolones (age >18 years), preferred for strep throat. Also cellulitis, AOM, sinusitis

 

MACROLIDES (most are Cat. B and two are Cat. C)

*There are 2 macrolides that should be avoided during pregnancy (both are Cat. C)

1. erythromycin estolate (Ilosone) 2. clarithromycin

Category B macrolides:

Erythromycin (Ery-Tab, E-mycin), azithromycin (Zithromax, Z-Pack), clarithromycin (Biaxin)

Macrolides may: Increased risk of arrythmias, prolong the QT interval, nausea/GI upset, diarrhea, etc.

 

NOTE: This drug class has more drug-drug interactions compared with the other classes of antibiotics.

 

Warfarin (Coumadin – increase risk bleeding), theophylline, carbamezapine (Tegretol), benzodiazepines (alprazolam, midazolam – slows down clearance so last longer), cisapride (risk extrasystoles, prolongs QT interval), HMG-CoA reductase inhibitors (lovastatin, simvastatin -increased risk rhabdomyolysis ,quinidine (risk arrythymias) LEIK FNP review

 

Tetracyclines (Category D)

Tetracycline, doxycycline, minocycline (Minocin)

Stains actively growing tooth enamel. Used for: chlamydia STDs, atypical pneumonia, UTIs, otitis media, PCP in AIDs, Lyme disease

 

SULFONAMIDES (Cat. C 1st & 3rd trimester)

Trimethoprim-sulfamethazole (Bactrim, Septra),

sulfadiazine, sulfisoxazole. Nitrofurantoin also has sulfa and should be avoided in the last month of pregnancy (hyperbilirubinemia). Avoid sulfas with G6PD anemia (hemolysis/jaundice).

 

NOTE: Avoid combining sulfas with warfarin (increases INR).

Avoid sulfas in pregnant women in the 1st trimester (folate antagonist) and 3rd trimester (hyperbilirubinemia).

G6PD anemia (hemolysis). Rash (Stevens-Johnson syndrome). Monitor INR if on warfarin (bleeds). Used for: UTIs, pyelonephritis, toxoplasmosis, AOM, etc.

 

FLOUROQUINOLONES (Category D)

Older forms: ciprofloxacin (Cipro), ofloxacin (Floxin). For gram-negatives, pseudomonas, some atypical bacteria. Best antipseudomonal antibiotic is ciprofloxacin.

Newer forms: levofloxacin (Levaquin), gemifloxacin (Factive), gatifloxacin (Tequin).

 

NOTE: Careful, this drug class has a lot of drug interactions and causes prolongation of QT interval.

 

Warning: Achilles & other types of tendon rupture. Interacts with theophylline, phenytoin, anticoagulants.

Avoid using in pregnancy, lactation, & children <18 years (affects cartilage development) .

If on Coumadin (Cat. X), monitor INR.

 

Used for: UTIs, pyelonephritis, pneumonia, sinusitis, otitis media (newer forms), anthrax, bone infections, joint infections, GI, prostatitis, epididymitis

 

Stimulant/Sympathomimetic Contraindications

Examples: decongestants (Sudafe), cold meds, amphetamines (Ritalin, Adderall), cocaine

 

Avoid stimulants/sympathomimetics with:

Avoid with hypertension, arrhythmias, post-MI, etc.

Avoid with stroke/CVA or TIAs

Avoid if hx of seizures

LEIK FNP review

 

Caffeine will increase the effects of stimulants

Phenylephrine eye drops (mydriatic): avoid in

acute narrow- angle glaucoma

Be careful: BPH since may cause urinary retention

 

SAMPLE EXAM QUESTIONS

 

1) The Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination with meningococcal conjugate vaccine (Menactra) to all of the following groups except:

1. Entering college freshman who plan on residing in dormitories
2. Pre-teen to teenagers aged 11 and 18 years
3. Persons with sickle cell disease or splenectomy
4. Adults aged 65 years or older who reside in nursing homes

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2) The cones of the retina are responsible for what type of vision:

1. peripheral vision and night vision
2. central vision and 20/20 vision
3. peripheral vision
4. night vision
5. LEIK FNP review

 

3) All of the following are correct statements about G6PD anemia except:

1. It is classified as a hemolytic anemia
2. The intake of sulfa-containing drugs should be avoided
3. These patients are at higher risk of autoimmune disorders
4. Foods such as fava beans can precipitate hemolysis in these patients.

 

4) A 35 year old male with a BMI of 28 is seen for a routine PE. Vital signs are: BP 134/80, Pulse 80/min., Resp. 20/min. The lipid profile results are: HDL 35, LDL 120. FBS is 120 mg/dL. What is the best initial treatment plan to follow for this patient:

1) Advise the patient that he needs to loose 40 pounds

2) Recommend moderate exercise for at least 30 minutes for most days of the week

3) Initiate a prescription of Zocor 20 mg daily

4) Refer the patient to a cardiologist for a stress test

 

Answer Key: (1) 4; (2) 2; (3) 3; (4) 2

 

EXAM TIPS: Non-Clinical Topics

 

Licensure:

According to the U.S. Department of Health, Education

and Welfare (1971), what is the definition of licensure?

It is a process by which an agency of the state government grants permission to individuals accountable for the practice of a profession to engage in the practice of that profession and prohibits all others from legally doing so.

 

Certification:

Voluntary process by which a professional or

non-governmental agency (ie: ANCC, AANP) certifies that a practitioner has met predetermined standards specified by that profession. LEIK FNP review.

 

Per the ANCC – what is the value of certification?

Certification protects the public by enabling anyone to

identify competent people more readily

aids the profession by encouraging and recognizing professional achievement and enhances professionalism.

(http://www.nursecredentialing.org/Certification/Policies

Services accessed 9/1/10)

 

HIPAA

There will be several questions that address HIPAA on the ANCC exam. The questions will assess whether you

know how HIPAA rules are “applied” in the real world.

 

Updated/New Notes

Hospice 

Expected lifespan of 6 months or less. If patient does not want to participate in hospice care, can’t force. Patient does not fit criteria if refuses (even if terminally ill). LEIK FNP review.

 

Palliative Care

Follows palliative care model (quality of life is goal). Pain management, physical and psychological counseling if needed. Patient must agree not to pursue curative treatment

 

LEIK review

 

Diverse Populations and Age

Comment on the following Diverse Populations and Age paper;

Thing to Remember:

• Answer this discussion with opinions/ideas creatively and clearly. Supports post using several outside, peer-reviewed sources.
• 1 References, find resources that are 5 years or less
• No errors with APA format 6 Edition Diverse Populations and Age

 Diverse Populations and Age

Socioeconomic status, culture, gender, ethnicity and spirituality all affect both mental and physical health. These effects can change throughout the young, middle, and older adult life time.  Young adults (ages 18-35) can be affected by many different circumstances. Physical and emotional changes are occurring which presents both opportunities to learn and grow, but also for negative issues to impede on health ( (Edelman, Kudzma, & Mandle, 2014, p. 536). Young adult is generally the healthiest period for people. Their bodies are nearly fully grown, and the physical capabilities are in the topmost condition. (Edelman, Kudzma, & Mandle, 2014). However, many issues have detrimental effects on the health of young adults. Going out into the “real world” has its disadvantages. Ethnic minorities can encounter prejudice at any age, however, young adults are not sheltered by school rules and the comforts of home and parent lives. Prejudices and discrimination can occur for all of the afore mentioned reasons, SES, culture, gender, ethnicity and spirituality. Young adults must learn how to effective deal with these prejudices to prevent negative self-views, poor self-esteem, and excessive stress. Generalized anxiety disorder, depression and substance abuse problems often stem from not knowing how to effectively deal with these stressors.

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An additional stressor for young adults is created by the person not living at home, and becoming autonomous. The person may want to choose a different religion, or may have questions about their sexual orientation or preferences. This can create stress for the person when these new values go against his or her parent’s values. The parents may not want their child to date outside of their religion, SES or ethnicity. Again, these strenuous situations can lead to self-harming behaviors such as alcohol, drugs, unsafe sex, and unsafe actions such as staying out all night, or going to dangerous situations.

Middle-aged adults (35-64) have different responsibilities, different health concerns, and different stressors. Stress from death, caring for parents and children, jobs and careers, divorce, and declining health are major issues in middle adults mental and physical health. These stressors can increase diseases such as high blood pressure, and other heart diseases, anxiety and depression, and increase the chance of substance abuse.  They may be caring for a young or older child, in grade school or college. Dealing with the financial stressors of a less than perfect body, children, parents, and themselves can all place a lot of stress on a middle-aged person, Diverse Populations and Age

Lastly, the older adult. After age 65, its all downhill. At least that is what some think. Some people enjoy retirement, are free from being the caregiver to their children and/or their parents. They have their house and cars paid off, and can enjoy more from life. Others however, have to deal with little or no income, inability to buy medications, an aging and ill body, and more of the stress of death.

Let’s examine a fictional family, the Lopez’s. Mrs. Lopez’s parents immigrated from Cuba to America when she was three years old. She never went to college. She married George Lopez and had two children. Her father and his mother live nearby and they are called upon to care for them from time to time. George works in a factory. Angie has been a stay at home mom most of her young adult life, and now must go out and find a job. They are dealing with the financial constraints of college, and caring for their parents on a low-income budget. The constant stress of this life can be a bit over whelming and the temptation to drink alcohol is constant. They cannot afford a vacation and have little free time, or together time. Moreover, their daughter has just announced she is bisexual, which is a sin in their religion, and they are worried about her spiritual life, but don’t want to ruin their relationship with their daughter. They are needing to take care of their parents more and more frequently now and while many generations have had to care for both parents and children at the same time is hardly a new concept, improvements in geriatric care, and all health care and preventative care are resulting in people living longer. This means that this age group often carries this burden decades longer than their parents or grandparents did (Vitelli, 2015).

The children are young adults, going to college as first generation high school graduates. Carmen, the oldest daughter feels she is bisexual. This goes against her parents and grandparent’s beliefs. She is learning how to navigate the world, as a Hispanic American in a low socio-economic class. Her sexual preference makes everyday life harder, especially when she is at home. She feels stress when approaching the subject with her parents and prefers to avoid the situation which further strains her relationship. Max has found himself in dangerous relationships, drinking excessive alcohol on several occasions, and his grades are suffering. The college he goes to has very few Hispanic people attending so he feels like an outsider more than when he lived at home. Not having a great deal of money makes matters worse as he cannot afford a car as do most of his peers. Diverse Populations and Age

The grandparents are still working. They never had the chance to save for retirement or have a 401k because they were never employed in a place that offered these types of benefits. They have failing health, especially Benita, the grandmother who smokes and drinks nearly every day. They worry about being a burden to their children, so they do not ask for assistance when they need it which has led to not taking medications at the right time, or at all when they cannot afford to buy them.

Being able to deal with these stressors is important to both mental and physical health. All ages have unique stressors and events that may or may not affect them.

References

Edelman, C. L., Kudzma, E. C., & Mandle, C. L. (2014). Health Promotion Through the LIfeSpan(Eighth ed.). St. Louis: Elsevier.

Vitelli, R. (2015, January 26). Being in the Sandwich Generation. Retrieved from Psychology Today: https://www.psychologytoday.com/blog/media-spotlight/201501/being-in-the-sandwich-generation Diverse Populations and Age

 

Public policy that relates to nursing, healthcare, and/or the public that needs to be changed

The IOM Future of Nursing report calls for an increase in leadership from nurses at all levels. One way nurses demonstrate their role as a leader, is through public policy change. A leader does not always carry an official title or position, but demonstrates leadership through the work and the stance he/she takes to make a change for the good of others. Nurses have been noted by the Gallop poll year after year as the most trusted professionals.

This assignment requires thought about a public policy that is needed or needs to be changed that relates to nursing, healthcare, and/or the public. Policy changes can occur by working with members of your legislature, and state or national nurses associations, to introduce a new bill and/or change to a current law in your state or federal government. Public policy that relates to nursing, healthcare, and/or the public that needs to be changed

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Examples of public policy includes any component of the current legislation governing health care, Medicare part D, Medicaid, nursing regulation, medication technicians, etc.

In 750-1000 words, propose a health policy change (that is currently a bill, a law, or may not exist at all) at the state or federal level that you believe needs to change and why.

1. The policy must NOT be a clinical care policy for individual care. The policy involved may include public or community health, legislative or regulatory, professional organization (nursing-oriented), advanced nursing practice, health plan, or hospital plan.
2. Include a specific section for the exact wording for the bill or change in wording of the law.
3. Include the plan for the implementation of your policy development, to lobbying for passage, to next steps after passage.
4. Discuss who would be the champion for the bill/law change from your state advocates (legislators, federal legislators, local or national state nursing organizations). Are these individuals also influential in making changes occur? Did you vote for the individual in office that you want to help you make this change?

Resources:

1. Review different pieces of legislation for ideas on wording.
2. Visit your state’s legislative governmental affairs website site to understand the process your policy change could take if you wanted to introduce to into legislation.
3. Refer to the Nursing Leadership Health Policy Presentation Rubric.
4. Submit the assignment to the instructor by the end of Topic 2.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

You are required to submit this Public policy that relates to nursing, healthcare, and/or the public that needs to be changed assignment to Turnitin. Refer to the directions in the Student Success Center.

Public policy that relates to nursing, healthcare, and/or the public that needs to be changed

 

 

 

 

 

 

 

 

Evidence-Based Practice Proposal: Implementation Plan

In 500-750 words Evidence-Based Practice Proposal: Implementation Plan paper, provide a description of the methods to be used to implement the proposed solution. Include the following:

1. 1. Describe the setting and access to potential subjects. If there is a need for a consent or approval form, then one must be created. Although you will not be submitting the consent or approval form(s) in Topic 5 with the narrative, the consent or approval form(s) should be placed in the appendices for the final paper. Evidence-Based Practice Proposal: Implementation Plan
   

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2. 2. Describe the amount of time needed to complete this project. Create a timeline. Make sure the timeline is general enough that it can be implemented at any date. Although you will not be submitting the timeline in Topic 5 with the narrative, the timeline should be placed in the appendices for the final paper.
3. 3. Describe the resources (human, fiscal, and other) or changes needed in the implementation of the solution. Consider the clinical tools or process changes that would need to take place. Provide a resource list. Although you will not be submitting the resource list in Topic 5 with the narrative, the resource list should be placed in the appendices for the final paper.
4. 4. Describe the methods and instruments, such as a questionnaire, scale, or test to be used for monitoring the implementation of the proposed solution. Develop the instruments. Although you will not be submitting the individual instruments in Topic 5 with the narrative, the instruments should be placed in the appendices for the final paper.
5. 5. Explain the process for delivering the (intervention) solution and indicate if any training will be needed.
6. 6. Provide an outline of the data collection plan. Describe how data management will be maintained and by whom. Furthermore, provide an explanation of how the data analysis and interpretation process will be conducted. Develop the data collection tools that will be needed. Although you will not be submitting the data collection tools in Topic 5 with the narrative, the data collection tools should be placed in the appendices for the final paper. Evidence-Based Practice Proposal: Implementation Plan
7. 7. Describe the strategies to deal with the management of any barriers, facilitators, and challenges.
8. 8. Establish the feasibility of the implementation plan. Address the costs for personnel, consumable supplies, equipment (if not provided by the institute), computer related costs (librarian consultation, database access, etc.), and other costs (travel, presentation development). Make sure to provide a brief rationale for each. Develop a budget plan. Although you will not be submitting the budget plan in Topic 5 with the narrative, the budget plan should be placed in the appendices for the final paper.
9. 9. Describe the plans to maintain, extend, revise, and discontinue a proposed solution after implementation.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

Upon receiving feedback from the instructor, refine “Section F: Implementation Plan” for your final submission. This will be a continuous process throughout the course for each section. Evidence-Based Practice Proposal: Implementation Plan