By X. Rendell. Smith College. 2018.

Sustained platelet count >600 × 109/L Hematology/Apply knowledge of special procedures/ Myeloproliferative diseases/Classifications/3 1 12.5 mg hyzaar with mastercard blood pressure chart new zealand. A 19-year-old man came to the emergency Answers to Questions 1–3 department with severe joint pain order 50 mg hyzaar otc blood pressure diary, fatigue, cough, and fever. Answers to Questions 4–5 Which section of the scatterplot denotes the number of monocytes? The scatterplot represents B A the relationship between volume (x axis) and light scatter (y axis). Monocytes account for the dots in V section A, neutrophils are represented in section B, eosinophils in section C, and lymphocytes are O denoted in section D. D Hematology/Apply basic principles to interpret results/ Automated cell counting/2 5. Based on this finding and the results provided, what automated parameter of this patient is most likely inaccurate and what follow-up test should be done to accurately assess this parameter? Hgb/perform serum:saline replacement Hematology/Apply knowledge to identify sources of error/Instrumentation/3 1. A Lymphocytosis with numerous atypical lymphocytes Hematology/Apply knowledge of fundamental is a hallmark finding consistent with the diagnosis biological characteristics/Normal values/2 of infectious mononucleosis. However, on peripheral smear examination, 60 atypical lymphocytes and only 6 monocytes were noted. Atypical lymphocytes are often misclassified by automated cell counters as monocytes. Therefore, the automated analyzer differential must not be released and the manual differential count must be relied upon for diagnostic interpretation. Review the following scatterplot, histograms, and Answers to Questions 8–9 automated values on a 61-year-old woman. D All of the automated results have R or review flags indicated; none can be released without verification procedures. Review the automated results from the previous Additionally, the platelet count must be verified by question. None of the automated counts can be released without follow-up verification Hematology/Apply knowledge to identify sources of error/Instrumentation/3 1. Refer to the following scatterplot, histograms, and Answer to Question 10 automated values on a 45-year-old man. A The platelet clumping phenomenon is often induced before releasing these results? Redrawing a sample from the patient using a sodium citrate tube usually corrects this phenomenon and allows accurate platelet enumeration. Platelet clumps cause a spurious decrease in the platelet count by automated methods. Warm specimen at 37°C for 15 minutes; rerun specimen Hematology/Apply knowledge to identify sources of error/Instrumentation/3 36 Chapter 1 | Hematology 11. Refer to the following scatterplot, histograms, and Answer to Question 11 automated values on a 52-year-old woman. D The presence of a high titer cold agglutinin in a before releasing these results? The patient’s red blood cells will quickly agglutinate in vitro when exposed to ambient temperatures below body temperature. Warm the specimen at 37°C for 15 minutes; rerun the specimen Hematology/Apply knowledge to identify sources of error/Instrumentation/3 1. Refer to the following scatterplot, histograms, and Answer to Question 12 automated values on a 33-year-old woman. C The rule of thumb regarding the Hgb/Hct correlation before releasing these results? This rule is violated in this patient; therefore, a follow-up verification procedure is indicated. To correct for the presence of lipemia, a plasma Hgb value (baseline Hgb) should be ascertained using the patient’s plasma and subsequently subtracted from the original falsely elevated Hgb value. Warm the specimen at 37°C for 15 minutes; rerun the specimen Hematology/Apply knowledge to identify sources of error/Instrumentation/3 38 Chapter 1 | Hematology 13. Refer to the following scatterplot, histograms, and Answers to Questions 13–14 automated values on a 48-year-old man. To increase the yield and thereby facilitate counting, differential smears should be prepared using the buffy coat technique. Similarly, the patient’s age and the lack of atypical lymphocytes make infectious mononucleosis unlikely.

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She highlights the practice as involving a power imbalance (“they try one up”) in favour of the prescriber buy cheap hyzaar 50mg on-line blood pressure and alcohol. Amy constructs such an approach as “unhelpful” and causing her to feel “devalued” hyzaar 12.5 mg without a prescription pulse pressure change with exercise. Thus, she states that her response is typically to become non- adherent (“and then you just go totally, totally the opposite way, to the opposite extreme”). Non-adherence is represented as a means of gaining control over the treatment regimen (“their kinds of practice reciprocates”) in a way that makes a statement to the prescriber (“prove a point”) and to 249 “prove my worth”. Amy suggests that a “gentler approach, firm but gentle” would be more effective in encouraging adherence as opposed “threatening” and using scare tactics. It could be assumed that such an approach may not evoke as much resistance, in the form of non-adherence, amongst consumers motivated to prove their worth, like Amy. Peer workers, in particular, were often described as a valuable resource for consumers, particularly because they were presumably stable and adherent, thus representing positive role models for consumers. Additionally, one interviewee who also worked as a peer worker framed this experience positively and could be seen to imply that it enhanced his sense of purpose and life in general. This is consistent with recovery research, which posits that participation in consumer-run programs, including peer worker programs, may engender a feeling of empowerment (Liberman & Kopelopwicz, 2005). Liberman and Kopelowicz (2005) extend this argument further, stating that such feelings of empowerment may be instrumental in motivating a person to sustain treatment. In the following extracts, Travis and Diana highlight the benefits of consumers socializing with each other at community centres and Robyn states that she has benefited from courses run at community centres aimed at assisting consumers to cope with their illnesses: 250 Travis, 19/02/2009 T: Yeah, that’s great and if you’ve got that, the tablet’s working alright, you’ve got the family support, you’ve got a good social friends, that’s the best chance you’ve got, you know. It’s not always that simple though and people are surrounded around different situations, different things and um, and that’s why this place [Club 84 community centre] is a good place because it gives them a chance to get away and be around people that understand. T: Yeah and if they don’t wanna talk, that’s cool, leave them alone, you know you haven’t got all these people saying, snap out of it. Diana, 11/02/2009 D: Going to Club 84’s good because you get to talk to other people with mental illness and you get to do um, classes if you know like. I don’t go quite as much as I used to but I actually think if they had um, you know, more groups, where you sit around in a group and you talk about your mental illness and how it has affected your life. D: Yeah so you could talk about your different experiences and that other person might actually do something that you would like to do, so they can then tell them the steps of how they actually do it. Specifically, Diana and Travis both describe it as “good” and Robyn describes is as a “helpful thing” to her. Travis highlights how community centres, whereby consumers can socialize can be especially beneficial for consumers who lack positive social supports. He suggests that consumers are more likely to “understand” fellow consumers and be patient with one another as opposed to expecting them to “snap out of it”. Diana promotes group-based interventions, involving consumers sharing their illness experiences (“I actually think if they had um, you know, more groups, where you sit around in a group and you talk about your mental illness and how it has affected your life. She elaborates that sharing experiences may enable consumers to problem-solve various issues, as they can adopt strategies that other consumers found helpful (“that other person might actually do something that you would like to do, so they can then tell them the steps of how they actually do it. Robyn suggests that the group-based educational courses run at the centre have been beneficial to her. Thus, in addition to community groups providing a safe environment for consumers and an opportunity for socializing, through sharing experiences, consumers may learn new strategies for managing their illnesses and their medication. In the following extract, in the context of being asked how to assist with medication adherence, Cassie also recommends community centres, 252 specifically the peer worker service they provide, as beneficial particularly to “young” consumers. Both Cassie and Ryan below highlight the benefits of peer workers’ abilities to relate to consumers’ experiences: Cassie, 4/2/09 C: Um, it’s gotta be people that can relate to people, you know what I mean? It can’t be just like some official talking and telling him that, because you just switch off and you don’t wanna know. Like if they had a visit to Club 84 [community centre] and met all the people and then went back and then talked to a peer worker or someone, I reckon that would help. She positions peer workers as more likely to positively influence young consumers than health professionals, as they are easier to “relate to”. Similarly, Ryan highlights the role for peer workers amongst first episode 253 consumers, who can share their “similar” experiences. He suggests that first episode consumers may be “afraid” to talk to other service providers including psychiatrists. Ryan could be seen to imply that by sharing their experiences, peer workers normalize mental illness for first episode consumers, who would likely be feeling overwhelmed upon diagnosis. Cassie additionally contrasts being relatable with “official talking”, which she associates with consumers losing interest and failing to process advice (“you just switch off and you don’t wanna know”). In the following extracts, Amy and Travis highlight how peer workers can provide positive examples to other consumers, which may assist with adherence: Amy, 10/2/09 A: Um, it also helps if somebody’s very respecting and (inaudible) and they’ve got sick and I mean, on the one hand, clients are, if they’re admitted to (inaudible), if they are a peer worker or something, gets sick you know, you sort of lose hope that person’s confidence and professionalism and ability and I think that came up because, that was, “Oh I recognize you from somewhere” and now you hear of someone that’s really fighting, you say, oh well now you’ll see me get better. So um, if they recognize that oh yeah, everyone gets sick, you know, like I’ve found it seems to help people when I say, they felt embarrassed by being sick or they’re a bad person or, you know, I just say to them, a doctor needs a doctor and a priest needs a priest and a psychiatrist needs a psychiatrist.

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Be sure to tell the Pharmacist at each visit if you are having any problems with your medications discount 50mg hyzaar overnight delivery blood pressure yoga exercise. Food and Drug Administration entitled order hyzaar 50mg overnight delivery blood pressure medication used to treat acne, “Safe Medical Treatments: Everyone has a role. Regardless of the medication, you took a risk, because giving a drug safely involves many steps, some beyond your control. In this article, the explanation to what questions to ask to help minimize medication errors will be explained. It will test your critical thinking skills and help you get answers to the Who, What, When, Where, Why, and How of drug therapy. Accept an order only from a health care provider who has appropriate licensure and credentials to practice in your state and who’s authorized to prescribe drugs in your health care agency. Typically, this includes a Physician, Nurse Practitioner, Physician Assistant, and Dentist. Some facilities permit Clinical Pharmacists to order drugs and appropriate lab tests based on established physician approved protocols. Make sure the medication order contains all the necessary components: your child’s name plus the drug name, dose, frequency of administration, and route. If an order is illegible or you have questions, do not administer the drug until you call your Physician for clarification. Some orders are based on established protocols, such as bowel protocols in long term care facilities. If you receive such an order, be sure to specify the drug name, its dosage, frequency, time, and route on the medication administration record. Consult your agency’s policy for appropriate medication administration times; keeping in mind that scheduling should be flexible to meet the child’s needs. Some drugs should be taken with food or after meals to maximize their effectiveness or minimize adverse reactions. For example, if your child needs three cardiovascular drugs once a day, you may need to stagger them to prevent an adverse drug-drug interaction. Some cardiovascular drugs cause bradycardia and hypotension, and receiving three at once could increase the risks. The Pharmacist may recommend dosing times based on the physiologic processes that follow predictable patterns. For example, bronchial patency and airflow are typically decreased in the early morning and at their peak in the afternoon. For this reason, one dose of Theophylline in the evening may be more effective than multiple doses throughout the day. Similarly, some antihypertensive agents must be given at a specific time to reach their peak effect at the correct time. In a hospital, the pharmacy generally delivers needed drugs to each nursing unit at scheduled times. Your facility may use one of the approaches to dispense them: A unit dose system of individually wrapped doses kept in the medication cart. Stock medications commonly used for the patients in the unit; these drugs are kept on hand and replenished by the pharmacy as needed. Storing commonly used drugs or prescribed patient doses, it can automatically charge the patient and record that you gave him a drug and when. You need to know the therapeutic effect of any drug you give your child and whether it is appropriate for his condition. Also review pertinent data that affect whether you can safely administer it, such as blood pressure, lab results, and pain level for your child. If the ordered dosage is not within the recommended range, clarify the order with the Physician. When preparing a unit dose oral medication, do not open the package until you enter your child’s room. Always adhere to the “five rights” of medication administration: These five rights are especially important if more than the parents are giving your child medications. For a unit dose medication, check the label twice against the order on the medication record. Tell your child the name of any drug you are giving him and the reason if appropriate. This gives him a chance to point out anything unusual, such as he has already taken it or the dose is not what other nurses have been giving him. Make sure the ordered dose is within the recommended range and call your Physician for clarification if is not. Give the drug within an hour of its scheduled time or according to your time schedule. If consistent serum levels of a drug are critical, such as for anticonvulsants, antibiotics, anticoagulants, and analgesics, give the dose as close to the scheduled time as possible.

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