combinate

This practice question appears on several web pages: A patient has taken an overdose of aspirin. Which of the following should a nurse most closely monitor for during acute management of this patient? Onset of pulmonary edema Metabolic alkalosis Respiratory alkalosis Parkinson's disease type symptoms D. Parkinson's disease type symptoms. Aspirin overdose can lead to metabolic acidosis and cause pulmonary edema development. Notice the rational is conflated with the wrong answer, but I can't find clear explanation of any of these effects. Does anyone know a rationale for one of these?

It's much more general than "blaming mommy". Dr. Mate has talked about his own struggle with ADD, compulsive working, and compulsive shopping, and how ADD/OCD may have come about: He posits that the huge stresses on his mother in Hungary, during constant bombing of WWII, while he was in the womb (He's in his 70s) played a significant role in his premature birth and various heath struggles (again including some ADD and OCD). His "theory" (not sure if he is funded as a research investigator) is not really about his own case, as he has studied and practiced successfully for many decades. The bombs/warfare were coming from elsewhere (across the world even). Some mothers don't behave and nurture their children well, but there are any number of contributing factors (abuse, addiction, poverty, disease ... warfare{I heard there is some of that in the world}). Mothers need nurturing to then nurture the child. Mate discusses addiction mechanisms from the womb, throughout life, in the individual, and across society. It's about understanding, not blaming or punishing.

Discussion about the degree to which the Nurse Jackie characters reflect real medical personnel got me searching for a quote. I did not find it, but it goes something like this: "People write fiction to get at the truth, and some write non-fiction to hide the truth" Here are some wonderful related quotes that did shake out: https://www.brainpickings.org/2012/01/27/famous-authors-on-truth-vs-fiction/ The addiction tragedies discussed here are heart wrenching. May we find some cures, and may we find better ways to deal with the social problems in the meantime (maybe like in Portugal, for example). Author and doctor Gabor Mate believes that addiction is linked to deficient nurturing in early childhood development. He apparently has some success to treat the deficit in adults. I haven't read his books yet; maybe someone else here has better information; but you can easily find info about his work (including interviews) on the internet.

Thank you both! "Frequent follow up"

There is an AN post from a few years back, where the test taker was told they were using too many "boards" (during their test!) and the administrator was going to have to report an irregularity and hold their results. The results were held longer than usual (8 days, I think), and that person was failed. It's not appropriate to accuse a test taker of using too many boards during a test like that, especially when there is no rule for allotment. Maybe I should have explained the scenario in more detail, but from memory others have described similar treatment "irregularities" (thought the issue might be recognizable). I'm not against rules, but they should not be arbitrary, and they should not be made up during the process.

They call the "marker" a pen; I hope it is not a fat-tipped marker, as I need a fine point if I get a long math problem (and preferred in general). A "Sharpie" is fat. Anyway, what is it at the NCLEX? I don't think I will try to "brain-dump" on the whiteboard, but I read here many times that it is fine to do as long as you wait till after the instruction video (and maybe a question or two into the test). If I write some stem elements and A B C D to cross out wrong answers, I might go through a few boards. Is there any way to ask the TA ahead not to distract, harass, or accuse me of cheating because of some arbitrary count of the boards? It's a worry that test takers are being subjected to that. It sounded like some here might have been failed based on those criteria, and they seem arbitrary (no obvious mechanism to cheat). And, one more related ***** point: Why the clunky boards and markers and not just 5 sheets of paper and a pencil? They could count to ensure that the same five sheets are left at the station or turned in at the end. If any NCLEX/Pearson Test Nazis are reading, I have a suggestion(s): Print and explain ALL the rules in detail, especially those that seem petty or arbitrary. Example: Explaining how using more whiteboards than "others" could be used to cheat could help deter the cheaters. It could also help most test takers to not trigger scrutiny that seems petty, arbitrary, and makes no sense.

"abbreviation" Sorry; no edit function

I found this phrase in some online notes about care for patients with Addison's disease, and repeated for patients with Cushing's disease: "Importance of ffup care" It is probably so obvious, simple, and trivial; and maybe that is why I can't find any definition/description of ffup. Does anyone here recognize it?

I can accept that ICP increases in upright posture compared with lying down. Now, can someone in the forum please explain the mechanism(s) causing this increase. I tried to explain a couple potential mechanisms, but they don't support the common clinical finding. What does explain the phenomenon?

Ok, the increase in ICP is not due to movement dynamics; even without movement, a strict position is prescribed. The four ventricles are connected to one another and to the space around the brain, and around the spinal cord (one interconnected compartment system). The fluid "circulates", but even if that is very slow (essentially static, as you suggest), the hydrostatic effect of raising the head would increase the pressure going down along the spine and decrease pressure in the head. This is intuitive because we feel the hydrostatic pressure changes on blood and other fluids when we change positions (lying, sitting up, dangling limbs, Trendelenburg ...). There must be an additional mechanism that causes increased ICP in a raised-head posture compared with lying supine or at 30 degrees.

It seems the "fluid shift" upon sitting upright might cause a pulse (slosh) or two (transient effect), but then, wouldn't gravity have the same old orthostatic effect to pull the fluid down along the spine, causing a decrease in ICP? Another question rationale says "Elevating or lowering the head after lumbar puncture can increase ICP". How come "NCLEX gravity" works different than "Earth gravity"? Can I take a magic pony to the NCLEX for good luck?

A study question rationale I am looking at says that brain tumor symptoms in a child are headache and morning vomiting related to getting out of bed. A sudden increase in ICP occurs with the change of position, causing the vomiting.” Would it not be a sudden decrease in ICP due to the orthostatic change? I think the answer is correct but the rationale is wrong. ??

Thank you Lev, I'll list the continuum of sepsis: SIRS So, if a patient is septic, do we start the 30 ml/kg fluid resuscitation (and, blood culture and lactate, Abx, 3-hr bundle)? The 6-hour bundle states to apply vasopressors for hypotension that does not respond to initial fluid resuscitation. That is the first mention of blood pressure, but it must be implicitly required as we measure HR and RR for the SIRS determination, right? Or, is it required to measure BP when we ID or rule-out infection (the very next step anyway)? It is very strange that it is not listed explicitly because I think a patient can have an infection with normal, high, or low blood pressure. Therefore, a patient can have sepsis with normal or high blood pressure. And in that situation, do we still start the same fluid resuscitation? Still further, a CHF or renal patient may already have fluid overload; resuscitate with fluid in that case?

I'm studying some sepsis control plans and related literature for a school project and have some questions about a potential subset of patients. Do patients in med-surge (or other) units develop nosocomial sepsis, or are the vast majority of cases detected on presentation for admission (ED or otherwise)? The three- and six-hour treatment bundles are usually discussed in the literature with regard to severe sepsis and septic shock. Are they applied the same way to sepsis” (just 2 SIRS criteria + new infection) and, how effective are they to stop progression to severe sepsis? If sepsis is found when a patient presents for admission for some other problem, is it more likely to be severe sepsis, or is there even distribution of severity? Thank you

Hospital or unit performance: % Pts w trigger criteria that receive the complete sepsis treatment/care "bundles" in the respective time periods (3 and 6 hours). Would this make sense? Then; # hospital days of those Pts. triggering the sepsis bundles; % of readmits within 30 days of discharge, and probably % of deaths in these patients triggering sepsis treatment. I made these up. Does anyone have a couple good references that define how the leading institutions measure hospital performance?