Mid Term Madness

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foxyt14
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202910
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Mid Term Madness
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2013-02-24 10:30:08
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Mid Term Key things to remember
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  1. Nursing Process, key things to remember for each:
    Assess
    Diagnose
    Plan
    Implement
    Evaluate
    • Assess-first time nurse is looking at subjective and objective data.
    • Diagnose-NANDA
    • Plan-"Patient will...."
    • Implement-"Nurse will....."
    • Evaluate-Did pt. respond and meet expected outcomes
  2. Maslows Hierarchy
    • Physiological needs-eat, sleep, sex, air, water
    • Safety and Security
    • Love and belongingness
    • Self Esteem
    • Self Actualization
  3. Overflow Incontinence
    • pressure of urine in overfull bladder overcomes sphincter control.
    • Leakage of small amounts throughout the day and night.
    • Bladder is distended and palpable
  4. How do you treat overflow incontinence
    • urinary catheterization to decompress the bladder
    • Crede
    • Valsalva
  5. Reflex Incontinence
    • No warning or stress precedes involuntary urination.
    • Moderate in volume
    • Brain issue
  6. How do you treat Urge Incontinence?
    • bladder retraining
    • decrease dietary irritants
    • Kegels
    • Calcium channel blockers
  7. How do you treat stress incontinence?
    Kegels
  8. How do you treat Reflex Incontinence?
    • Intermittent self catheterization
    • Valium
  9. Total Incontinence
    • Anatomical or functional absence of sphincters
    • Spina bifida, scoliosis, MS, Lou Gherigs, Pelvic Surgery
  10. Self Management strategies to reduce incontinence
    • stop smoking
    • lose weight
    • reduction of bladder irritants-caffeine
    • schedule voiding regimens
  11. Habit training for incontinence
    scheduled toileting with adjustments of voiding intervals, longer or shorter, based on the individuals voiding pattern
  12. Prompted voiding
    scheduled toileting that requires prompts to void from a caregiver every 3 hours....with a reward
  13. Causes of UTI
    • E Coli
    • Urinary stasis
    • stones
    • structural abnormalities
    • BPH
    • Females-proximity of urethra to anus
    • Low estrogen in post menopausal women
    • decrease in vaginal lactobacilli causing an increase in vaginal pH
  14. How do you treat a UTI?
    • Prevention is best by...
    • Good hygiene
    • Frequent voiding
    • Staying hydrated
  15. Complication of Cystitis and describe
    • Pyelonephritis
    • usually cuased by E coli, proteus, klebsiella and Enberobacter
    • Vesicoureteral Reflux (urine moves from lower to upper urinary tract
    • BPH
    • catheters
  16. What's a sign of pyelonephritis, that isnt present in cystitis?
    fevers, chills and flank pain
  17. #1 Cause of UTI
    Non sterile catheter insertion

    But also, make sure cath connections are tight and NEVER put urine collection on the floor, or raise it above the level of the bladder
  18. Details of TURP
    • removal of prostate tissue without an incision
    • done under spinal or general anesthesia
  19. First 24 hours after TURP
    Lg. three way indwelling cath with a 30 mL balloon is inserted in to the bladder to provide hemeostasis and facilitate urinary drainage.  Bladder is irrigated continuously or intermittently to PREVENT obstruction from blood clots or mucus
  20. TURP post op complications
    • bleeding,
    • clot retention,
    • dilutional hyponatremia
  21. What's Tamponade?
    Traction on the catheter during CBI which provides counter pressure on the bleeding site decreasing bleeding
  22. CBI complications
    • bleeding
    • blood clots
    • WATER INTOXICATION
  23. Pt. teachig for TURP
    • no incision
    • no lifting, driving strenuous activity 2-3 weeks
    • no straining BM
    • Avoid bladder irritants
    • Acid Ash diet-NO cheese or dairy
  24. Assault vs. Batter
    • Assault is verbal....you need to take your med before I give you your lunch
    • Batter is an action....doing any procedure without their permission
  25. Negligence
    • unintentional action that doesnt meet the standard of care
    • Didnt check the 5 rights of med admin
    • Carelesness/taking short cuts
  26. Slander vs. Libel
    • Slander is said....stating your teacher is a B
    • Libel is written (letter)...writting on FB your teacher is a B
  27. 5 elements of malpractice
    • Nurse had a duty to the patient
    • That duty was breeched
    • Forseability of events was evident
    • The patient was injured
    • The injury was caused by the breach
  28. Who must HIV patients tell of their status?
    sexual partners only
  29. READS
    • Redness
    • Edema
    • Approximation
    • Drainage
    • Size
  30. What do you chart a red wound as?
    Granulating well....healing
  31. Healthy tissue looks like
    dark pink to beefy red....it is "revascularized"
  32. Eschar
    Thick leathery, dry and crusted dead tissue that must be debrided for granulation to occur
  33. What do you note about exudates?
    color, consistency and odor of drainage
  34. Dehiscence
    partial or complete separation of upper layers of a wound
  35. Evisceration
    total separation of layers and extrusion of internal organs or viscera through the open wound
  36. Autolytic wound healing
    Best...pack with appropraite dressing to provide a moist environment.  Allows  the bodys natural defense to clean the necrotic wound of debris
  37. Foundation of wound healing
    Adequate nutrition
  38. When do you give pain med prior to painful wound dressing change?
    30-45 min prior
  39. Hydrophillic wound care products
    • absorbent
    • cotton gauze
    • Best used on closed wounds or wounds free of drainage
  40. Hydrophobic wound care products
    • non absorbent
    • clear, occlusive and transparent.  Acts like a second skin
    • Duoderm
  41. Provides moist environment to assist in healing and debridement with limited absorption of exudates and requires secondary dressing
    Hydrogels
  42. Good for absorbing moisture and packing
    Alginates
  43. Holds large amounts of exudates and is non adhesive for easy removal
    Foams
  44. How do you perform sterile gloving?
    • hand hygiene
    • dominant hand gloved first
    • non dominant hand grasps sterile glove at cuff
    • stick non dominant hand in as you hold cuff
  45. Increased porosity of the bone from lack of use
    Disuse Osteoperosis
  46. Lung infection R/T retained secretions and inactivity
    Hypostatic Pneumonia
  47. Type of active, resistive ROM
    Foot or Hand Press
  48. Urinary stasis
    Stoppage of urine flow
  49. Diuresis
    Increased excretion of urine
  50. Release of calcium from bone
    Resorption
  51. Drop in systolic BP of 15 mm or greater when sitting or standing
    Postural Hypotension
  52. Permanent flexion or bending of a joint
    Flexion Contracture
  53. Inflammation of the vein wall with clot formation
    Thrombophlebitis
  54. Plantar Flexion contracture of the foot
    Foot Drop
  55. Decreased level of protein in the blood
    Hypoalbuminemia
  56. Collapse of lung alveoli R/T decreased air flow
    Atelectasis
  57. Simple substances synthesized
    Anabolism
  58. Breakdown of molecules to simple ones
    Catabolism
  59. What happens with anabolism and catabolism with immobility?
    Anabolism decreases and catabolism increases causing protein depletion

    Which leads to negative nigrogen balance...which leads to muscle wasting
  60. Immobile bones release calcium....what happens?
    Hypercalcemia...causing bone weakness which means osteoperosis and also renal calculi
  61. TPN being administered....what if it runs out and it is being delivered peripherally? Centrally?
    Hang D10 peripherally and D50 Centrally to prevent hypoglycemia
  62. Induration means
    Hard
  63. Infiltration....How do you prevent and treat it?
    • Change IV catheter every 72 hrs
    • secure device, suport limb, assess frequently

    • DC IV
    • Elevate extremity
    • Stop swelling with a warm or cold compress
  64. How do you treat an infected IV site?
    • DC IV
    • Call Dr
    • Monitor VS
    • Culture site (if ordered)
    • Meds (if ordered)
  65. Signs of Fluid Overload?  What causes it?
    Crackles in the lungs or more input than output

    • Caused by:
    • Excessive amounts of saline
    • Infusion rate too high
    • Infusing too many solutions
    • Pt with CHF or renal disease
  66. Signs of localized infection
    • inflammation
    • exudate
    • heat at site
  67. Signs of systemic infection
    • tachycardia
    • tachypenia
    • malaise
    • chills
    • elevated WBC
    • FUO is FIRST SIGN!!!
  68. How do you prevent fluid overload?
    • Assess frequently
    • Monitor infusion rates
    • ID high risk pt
    • Weigh at risk pt
    • Accurately measure I & O
  69. How do you treat fluid overload?
    • Slow or D/c IV...but dont take it out
    • call Dr.
    • High fowlers
    • Monitor Vs q15-30
    • Prepare to give lasix
  70. How do you treat an air embolism from an IV site?
    • Clamp tubing
    • Turn on left
    • Trendelenberg
    • Admin O2
    • Call Dr.
    • Valsalva
  71. How do you prevent extravasation?
    • teach high risk pt to report any pain or burning
    • use a central line for severly irritating drugs
  72. How do you treat Extravasation
    • Stop infusion
    • Disconnect tubing but dont remove IV
    • Aspirate Drug
    • Call Dr.-Antidote?
    • Ice therapy
  73. Serious complication from Heparin
    HIT Heparin Induced THrombocytopenia
  74. What do you do if CBG is below 65mg/dL?
    Dont give insulin, give milk or crackers and recheck in 10-15 min.
  75. What do Narcotics, hypnotics and sedatives cause?
    • Depressed respirations
    • Constipation
  76. Digoxin
    Where do you want your serum K levels to be?
    Serum Dig panic level?
    • Serum K normal is 3.5-5.5
    • Hold Digoxin if Serum Dig is 2.0 or higher

    Hold if Apical is below 60 beats/min
  77. What do you monitor with diuretics?
    I&O, lytes and BP
  78. It serum potassium is above ?? hold and call Dr.
    5.5
  79. 3 checks for drugs
    • MAR
    • Drug to Mar in med room
    • Pt room with Mar and patient
  80. When you are teaching a patient....how do you deal with illiteracy?
    • Ask how do you like to learn?
    • Provide info in simple terms
    • Give pt. credit for life experience
  81. Steps to patient teaching
    • Assess
    • Identification of learning needs
    • Plan goals and objectives
    • Implementation of teaching strategies
    • Evluation of learners progress and teaching efficacy
  82. How do you evaluate of you taught your patient well?
    Can they verbalize understanding of what I presented or demonstrate what was taught?
  83. How can you obtain a sterile urine sample?
    catheterization...straight cath
  84. Whens best urinalysis sample taken?
    • Morning
    • 20 mLs
    • Get to lab within 1 of collecting
  85. What do you test stool for?
    • Fecal fat
    • occult blood
    • ova and parasites
  86. When do you take a throat culture?
    Prior to eating....or if ate or drank, wait 1 hour
  87. If you need a wound sample...what are the rules?
    • Remove old exudate.
    • Take anaerobic (inner) sample first
    • Take aerobic (outer) sample second
  88. Procedures you need to be NPO for 8 hours prior?
    • Angiogram (angiography)
    • Bronchoscopy
    • Endoscopy
  89. Which end is an endoscopy from?  What do you need to watch for?
    Rear End....bleeding
  90. Lumbar puncture details: (looking at CSF)
    Position during procedure
    Position post procedure
    Common assessments
    • During, side lying, knees bent
    • Post flat on back 4-8 hrs
    • Assess....CSF leaks, headaches, change in neuro condition
  91. Paracentesis does what?
    Considerations during procedure?
    Post procedure position
    Common Assessments
    • Removal of fluid from peritoneal cavity...tappin the melon
    • void before and after procedure
    • Put pt in semi to high fowlers
    • assess abdomen before and after procedure and watch for hemorrhage
  92. Thoracentesis does what?
    Special considerations?
    Common Assessments
    • removal of fluid from pleural space (around lung)
    • watch for dyspnea, HOB 30 degrees
    • Monitor respiratory status before, during and afer procedure
  93. Liver biopsy Special considerations
    • Must be able to hold breath for 10 seconds
    • remain still
    • stay in supin or left later position with knees flexed.
    • AFTER procedure pt will be on right side for 1-2 hours (compresses liver)
  94. Most common complication from liver biopsy? What do you monitor?
    • bleeding
    • clotting studies
    • abdominal assessment
    • frequent VS
  95. CBC measures
    • WBC
    • RBC
    • Hct
    • Hgb
  96. Hematocrit normal range is what?
    • 40-54% for men
    • 36-46% for women

    It is a measure of % of RBCs and is 3x's Hgb
  97. Hgb normal values
    • Measures 02 carrying capacity
    • Males 13.5-18 g/dL
    • Females 12-16
    •  
    • Is 1/3 of HCT
  98. Why would you see increased Hgb levels?
    • COPD
    • CHF
    • High Altitude
  99. RBC Normal levels
    • 4.6-6 in males
    • 4.0-5 in females

    • Decrease can be from over hydration (IV fluids)
    • Increase can be from Dehydration, COPD and High Altitude
  100. WBC Normal and panic level
    • Normal is 4,500-10,000
    • Panic if less than 500
  101. Platelets Normal
    Panic Level
    • 150,000-400,000 is normal
    • Panic is less than 20,000
  102. Normal range for Potassium
    3.5-5.5
  103. Whats the most important part of perioperative nursing?
    Pt education....decreases returns to hospital!!
  104. #1 Nanda for Peri-Operative care is....
    KNOWLEDGE DEFICIT
  105. What's immediate post op
    Time from PACU until return to regular or outpatient unit
  106. What's Post Operative Convalescent?
    • Time from discharge from recovery until till full recovery.  Includes:
    • Post Op afternoon, evening or night.

    It is Post Op Day 1!!!
  107. Post Operative assessment Priority
    • Airway
    • Breathing
    • Circulation
  108. Post Op how often do you monitor VS?
    • q 15min x 4
    • q 30 min x 2
    • q 1 hour x 4
    • Monitoring VS 10 x's total but for 6 hours all together
  109. What does shock look like?
    • Nauseated
    • Low BP
    • Weak and rapid pulse
    • Cold and clammy
  110. How many rails up after surgery?
    3
  111. Pre Op labs
    • Urinalysis
    • CBC
    • Bun
    • Creatnine
    • Serum Electrolytes
    • PT/INR
    • Blood type
    • Chest X Ray
    • EKG
  112. Nursing assessments and interventions for the inflammatory response
    • Pain
    • Erythema (redness)
    • Edema
    • warmth
    • reduced function
    • fever
    • exudate
  113. When is a fever normal and abnormal after surgery?
    First 24-48 hours it's an adaptive response to illness and is NORMAL

    After 48 hours it could indicate infection so need to monitor temp q 2-4 hr
  114. What can result from a fever?
    Dehydration....push fluids!
  115. Left Shift
    A condition when immature neutrophils (bands) are released from the bone marrow in response to low neutrophil count.  Means bacterial infection is taking over and possible sepsis
  116. Increased Leukocyte count means
    Leukemia
  117. Pancytopenia
    Low RBC, WBC and Platelet count
  118. Who gets Degenerative Joint Disease?
    How old and why?
    • Women
    • 55+
    • decreased estrogen and calcium
  119. Herberdens and Bouchards Nodes
    Herberdens are found in the Distal part of fingers

    Bouchards are found in the proximal part of fingers/hands
  120. Crepitis
    crackling sound produced by joint bones rubbing together
  121. Aectaminophen
    Does what?
    Side effect
    • Tylenol
    • Blocks pain
    • Liver Failure
  122. NSAIDS Does what
    Side Effect
    • Advil/Motrin/Aleve
    • anti inflammatory
    • gastric upset, HTN
  123. Cox 2 Inhibitor drug is called?
    what does it do? 
    Side effect?
    • Celebrex
    • Anti Inflammatory
    • Renal Failure
  124. Opiods do what?
    Side Effect?
    • Vicodin, Norco
    • Block pain
    • Addictive
    • *Dont put a heating pad on site....wont feel skin burning
  125. What diagnoses joint problems?
    Arthroscopy
  126. What scrapes and removes degenerated bone by arthroscopy?
    Debridement
  127. Removal of a damaged synovial membrane
    Synovectomy
  128. Whats it called when a bone is cut and a wedge is removed so a joint can be realigned?
    Osteotomy
  129. Joint fusion or putting a rod in the joint
    Arthrodesis
  130. Total joint replacement:
    knee, hip, shoulder, finger, wrist, ankle
    Arthroplasty
  131. How do you decrease risk for infection pre op?
    Prophylactic IV treatment
  132. What are people at risk for when have joint surgery?
    PE or Fat embolus
  133. Abductor pillow does what?
    Prevents the leg from ADDUCTING!
  134. How do you properly use a walker?
    Walker forward...affected foot to walker, good foot to walker
  135. CPM Machine
    used for knee replacement...it prevents scar tissue and reduces stiffness.

    On for 8-12 hrs a day.

    20-30 degree angle flexion and 0 extension, two cycles per minute
  136. Before a knee replacement pt can leave what must the new knee be able to do?
    Extend the knee fully and flex the knee 90degrees
  137. How long is a knee replacement pt in the hospital?
    3-7 days
  138. Bulk forming 
    • Metamucil/Citrucel
    • Absorbs water in to stool
    • Give one full glas of water with each dose
  139. Emollient/Fecal softener
    • Docusate Sodium/Surfak/Colace
    • Lowers surface tension of feces....makes soft
    • PROPHYLAXIS=Prevention
  140. When do you use Surfak?
    Pt with cardiac failure, htn, edema or kidney problems
  141. When should you use Colace cautiously?
    When a persons on anticoagulants....cuz it blocks vitamin K and other fat soluble vitamins and makes them more susceptible to bleeding
  142. Lubricants
    • Mineral Oil
    • Makes stool slippery

    Administer on an empty stomacy, only to pt who dont have a swallowing problems and same anticoagulant problem
  143. Osmotic Cathartics
    • MOM and Go Lytely
    • Increase fluid bulk in feces by pulling H20 thru intestinal walls by osmosis

    Can cause gas and cramping
  144. Stimulant (chemical irritants)
    • Dulcolax and Ex Lax
    • Increases peristalsis by chemical irritation to bowl nerve endings
  145. Problems with Dulcolax and stimulants
    Abused the most

    dont crush or chew them....and dont give within 1 hour of milk or antacids

    Dont use if person has obstipation or fecal impaction
  146. Peritinitis
    • Bowel obstruction with no known cause
    • Rigid Stomach
  147. Labs to be done with a pt who has diarrhea
    • Stool for occult blood, ova and parasites
    • CBC
    • HCT
    • WBC
    • Fecal Fat
  148. Upper GI Diagnostics:
    • Pt. will do a barium swallow
    • NPO 8-12 hours prior (midnight)

    Drink lots of water after....or get constipated
  149. Lower GI Diagnostics
    Enemas or Laxatives usually ordered pre care

    Post care may have need more laxatives (contrast medium causes impaction)

    may be tired and need a ride home
  150. CT Scan WITH CONTRAST ONLY.....pt will
    drink 1 litre of water prior to procedure

    Must check Bun and Creatinine
  151. Endoscopy
    Prep?
    Looks at?
    NPO 8 hours prior to exam and after NPO till gag reflex returns

    Looks at bleeding inflammation, masses, tumors and polyps
  152. EGD
    Looks at?
    Pre and Post Care
    Looks at Stomach and Duodenum

    NPO 8 hours before exam and NPO after till gag reflex returns
  153. ERCP
    Looks at?
    Pre and Post care
    Views GB, liver, pancrease using DYE to see organs

    NPO 8 hours before exam and post until gag reflex returns
  154. Sigmoidoscopy, Colonoscopy and Proctoscopy

    Pre care
    Watch for
    Which procedure has conscious sedation only?
    Enemas and laxatives

    Watch for fluid and electrolyte abnormalities

    Colonoscopy is the only one with conscious sedation
  155. Auscultating the abdomen and bowel sounds

    Normal
    Hyper
    Hypo

    When can I say NO BS?
    Normal 5-35 per min

    Hyper is more than 35

    Hypo is less than 5

    Listen in each quadrant for 2 min...then nothing say NO BS
  156. Where are bowel sounds loudest?

    Where will I feel fecal mass?
    RLQ is loudest

    Fecal mass is LLQ
  157. Presbyopia and Presbycusis
    Aging of the eyes and ears
  158. Spices assessment in an older adult
    • Sleep disorders
    • Problems with eating or feeding
    • Incontinence
    • Confusion
    • Evidence of falls
    • Skin breakdown
  159. Why are elderly more susceptible to temps?
    Decreased touch receptors....so use heat/cold therapies with caution

    Bath water should be btwn 100-105
  160. Changes in sleep for elderly...what are they and is it normal?
    • It is NORMAL
    • cant fall asleep
    • decreased REM
    • increased awakenings
  161. Why are elderly more at risk for UTI's?
    Decreased renal function: decreased number of nephrons, decreased GFR

    Decreased bladder capacity and muscle tone

    Decreased urinary sphincter control
  162. Is incontinence normal in the elderly?
    YES
  163. Since urination is difficult in older men due to prostate enlargement what do I encourage when peeing?
    Stand and tip forward
  164. 4 common health problems in elderly
    • Impaired Immobility
    • Sensory perceptual deficit
    • impaired thought process
    • Impaired nutrition
  165. What's ageism
    a bised or negative attitude based on age which leads to discimination in the care of the older adult
  166. Eriksons Developmental theor for Elderly
    • 65 to death
    • Integrity vs. Despair

    Feels a sense of fulfillment and contentment and has no desire to make major changes.

    Integrity is achieved with successful completion of previous stages, self acceptance and doesnt fear death

    Despair has regret, bitterness and anger, focused on past failures, fears death and may consider suicide
  167. Cascade disease pattern in older adults?
    • Symptoms will cascade
    • Have incontinence, get a folw, get a UTI
  168. Suggestions to promote health and prevent health problems in elderly
    • Maintain sufficient intake of protein, calcium and vitamins
    • 400 IU of vitamin D daily for calcium
    • Exercise/Wts
    • Be active physically ...but rest too
    • Encourage canes, walker if needed
  169. Advantages of physical activity in elderly
    • Prevents:
    • Muscle atrophy
    • CARTILAGE DEGENERATION
    • Joint Stiffness and decreased flexibility
    • Hunch back
  170. Progressive Kyphosis
    stooped posture
  171. 50% of physcal decline of elderly is caused by...
    disuse...rather than aging process or illness
  172. How can you help an elder learn?
    • Give time to complete tasks and process questions
    • Keep teaching sessions short and allow time to practice
    • Write instructions simply
  173. What can cause short term and reversible acute delirium, and confusion  in the elderly?
    Medication
  174. Elderly are at HIGH risk for injury, especially Falls, how can you prevent in the hospital?
    • orient client to environment
    • adequate lighting
    • consistent caregiver
    • bed in low position
    • clear path to bathroom
    • call light in reach
    • use glasses and walkers
  175. Why are psychoactive meds given in lower than normal doses in elderly?
    brain receptors are more sensitive so they are more potent
  176. What makes elderly at risk for med intoxication due to absorption issues
    Generally not a problem
  177. What makes elderly at risk for med intoxication due to Distribution in the blood issues?
    • Decreased cardiac ouput
    • decreased lean muscle mass and increased adipose tissue
    • Decreased total body water
    • REDUCED concentration of SERUM ALBUMIN
    • Less affective blood brain barrier
  178. What does albumin do with meds?
    It is what the drug binds to...so if less then it just floats around and accumulates
  179. What makes elderly at risk for med intoxication due to metabolism problems
    Drugs half life is increase causing prolonged drug effects

    Deconed ability to transform active drugs to inactive metabolites
  180. What makes elderly at risk for med intoxication due to excretion problems?
    50% decline in kidney and function causing:

    • Longer biological half life
    • Prolonged and elevated plasma level of bdrugs
    • Accumulation of drugs leading to toxicity
  181. Polypharmacy
    the use of multiple meds to one patient who has more than one health problem
  182. What the % of elder hospitalized related to drug reaction?
    12
  183. How can I make sure elderly administer meds safely?
    • Reduce meds that arent essential
    • Assess alcohol use
    • Encourage written reminders
    • Encourage use of one pharmacy
  184. Prevelance of pain is how much HIGER in elderly?
    5 times!!
  185. What makes elderly suicidal?
    • Female
    • divorced
    • Low SES
    • poor social support
    • Recent unexpected event
  186. Normal oral temp in elderly 85 and older is
    96.8
  187. Ideal method for taking a temp in a thing frail old person
    Tympanic
  188. A Temp of 101 in a 97 yr old man whose normal temp is 96 would be equivelant to what temp in a younger adult whose normal temp is 98.6?
    103.6
  189. Respirations in those over 85 are usually:
    Faster and more shallow....watch abdomen rise and fall, not chest
  190. When is it more indicative or possible problems for a fever? 
    Morning or night
    Morning
  191. What affects pulse rate?
    More than just aging
  192. Normal pulse pressure in the old old?
    between 50-100

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