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52 Cards in this Set
- Front
- Back
subjective...
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obtained through an interview or pt rep
always ID the info giver must support the assessment and plan |
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objective...
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info obtained by verifiable means
numbers, lab data physical exam, rx records all info must support the A&P |
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S vs O
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who reported it?
who measured it? keep it brief and focused |
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Assessment
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assessment of medical / DRUG Therapy related problems
list numerically-prioritize problems MUST include explanation of why problem exists MUST contain therapeutic goals |
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Plan
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numbered the same way as assessment
INDIVIDUALIZED instructions for drug therapy ALWAYS include endpoints and followup Use generic names - Sign your name |
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format of a problem in assessment
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justify existence
describe therapeutic goals outline reasonable therapeutic alternatives DO NOT use "I recommend" use bullet points within each number |
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abbreviations in the note?
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avoid as much as possible
when in doubt, spell it out NEVER abbreviate drug names |
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5 most common mistakes of soap notes
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inclusion of extraneous info
exclusion of important info info in the wrong place vague or unclear reasoning vague or unclear info give EXACT numbers |
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Resume tips
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keep it brief, good ones get read
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CV tips
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CV is always more detailed than Resume
Preferred by employers exceeds 1-2 pages can even be 30-40 goes through every rotation DOES not contain objective grad prog, leadership, awards |
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Resume organization
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chronological
functional chronofunctional |
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resume content
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list 2 addresses if possible
Objective! your #1 task area of interest within the profession REVERSE chronological order of education - No high school REVCHRON of work too |
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Achievements not related to pharmacy?
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nope!
Should include pharmacy and community service References - available upon request |
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Resume formatting
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white or off white bond paper
10-14 pt font, no more than 3 sizes 1 inch margins preferably just one page, NMT 2 |
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3 components of interview
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opening formalities
information exchange the close - say you look forward to hearing from them, WRITE a thank you |
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should you bring up the salary?
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no, let the interviewer do it.
be prepared to discuss if they bring it up |
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medication errors definition
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any preventable event that may cause or lead to inappropriate medication use or patient harm
May occur while the medication is in the control of Professional, Patient, or Consumer |
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How many errors occur out of every 250 RXs? cost $ or lives?
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4 - 98.5% accuracy
$77 million in error money 7,000 people in the US die |
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5 rights of every RX
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patient
strength drug ROA time |
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Lack of patient info
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demographic info
labs and vital signs Safety strategies: document allergies, confirm pt ID, inquire about diagnosis, get lab values |
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lack of drug info
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ex. incomplete med history *OTCs
knowledge deficit: refers to health pro safe ideas: reconciliation processes, up to date info on drugs, pharmacist review |
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communication/teamwork failures
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handwritten/spoken orders
intimidation: be confident safe ideas: e-rx, fax, read back verbal orders, spell drugs! |
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drug names, labels, packaging
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look alike/ sound alike, unlabeled meds
safe ideas: education, separate storage, indications! |
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drug concentrations, storage, distribution
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multiple concentrations of drugs stocked, unsafe storage, untimely distribution resulting in missed/late doses
safe ideas: choose specific strengths, remove chem from drug areas, establish realistic delivery procedures |
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medication delivery devices
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pump programming errors, orla meds given orally via leur devices
safe strategies: limit varieties, provide training, independent double checks, use specially designed oral syringes |
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environmental factors and staffing issues
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clutter, noise distractions lights, inadequate staffing
Safe strategies: provide adequate/organized space and lighting, decrease distractions, schedule breaks and limit shifts |
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staff competency and education
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interns increase risk of med errors, poor orientation, education and staff, new meds, poor error reporting
safe strategies: avoid overloading trainers, new med notices, encourage medication error reporting |
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patient medication education
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pharmacists seen as too smart
literacy and language, unaware of causes and prevention available safe strategies: encourage questions, 8th grade level instructions, pt's keep up to date drug list |
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Quality assurance and risk management
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fear of disciplinary action, lack of double checks
safe strategies: promote reporting, use technology, independent double checks |
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Decimals and zeros
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never follow a whole number with a decimal and a zero
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naked decimal point?
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NO! always place a zero before the decimal if the dose is smaller than 1
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Abbreviations to avoid
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use daily instead of QD
use unit instead of U every other day not QOD morphine sulfate and magnesium sulfate should be written out |
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symbols to avoid
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><, write them out!
write drugs in full do not use apothecary units do not use CC, write mL use mcg not ug don't use @, write at |
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other ways to avoid errors
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give adequate space b/w drug dose unit
repeat verbal orders watch units counsel counsel counsel! |
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In those older than 50, which is a more important indication of cardiovascular disease? sys or dia?
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systolic BP greater than 140mmHg is more important as a risk factor
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at what measure does CVD begin to double for each increment of 20/10?
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beginning at 115/75 mmHg, CVD risk doubles for each increment of 20/10mmHg
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What's the deal with being normotensive at 55 years old?
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Those who are normotensive at 55 years of age will have a 90 percent lifetime risk of developing hypertension
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Prehypertensive individuals (SBP 120—139 mmHg or DBP 80—89 mmHg)
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require health- promoting lifestyle modifications to prevent the progressive rise in blood pressure and CVD;
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How many meds required for BP target goal of 130/80 in diabetics and those with chronic kidney disease?
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2 meds; thiazide diuretic + ACE, ARB, or Ca channel blocker
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how is orthostatic hypertension defined?
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supine to standing decrease greater than 20mmHg or greater than 10mmHg diastolic; more OH in diabetics
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causes of resistent hypertension
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improper measurement
volume overload: too much salt, volume retention, inad. diuretic therapy drug induced: nonadherence, NSAIDS, illicit drugs, OTCs other conditions: alcohol and obesity |
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blood pressure readings for normal, prehyper, stage 1 and 2
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Normal-less than 120/80 mm HG
Pre-HTN-120-139/80-89 mm Hg Stage I-140-159/90-99 mm HG Stage II-Greater than or equal to 160/100 mm HG |
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reading if cuff is too large or too small?
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too large? falsely low reading
too small? falsely high reading |
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normal heart rate and respiration rate for adults
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heart 60-100
RR 12-20 |
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how should the earlobe be moved for proper admin of otic drops?
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Adults- hold the earlobe up and back
Children-hold the earlobe down and back Keep head tilted for 2-5min |
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how to instill an eye drop?
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pull back lower eyelid and look up
instill drop, close eye and look down place pressure near nose to slow drainage WAIT at least 5 min between drops |
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how to instill an eye ointment?
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look up and make a pouch from eyelid
instill .25 to .5 inches of ointment close eye and look in all directions for even distribution 1-2 minutes may blur vision - wait 10 minutes before applying another drug |
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Metabolic syndrome (X) is characterized by 3 of the following signs
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insulin resistance
abdominal fat high blood sugar high triglycerides low HDL Pro-thrombotic state elevated BP |
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Indications of diabetes
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FPG of greater than or equal to 126
casual blood glucose of greater than or equal to 200 2 hour plasma glucose greater than or equal to 200 during an oral glucose tolerance test |
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can a meter diagnose diabetes?
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no
2 tests on 2 different days need to see a doctor |
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normal FSBS measurements
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fasting 70-100
preprandial <110 postprandial <140 A1C 4-6% |
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Diabetic FSBS measurements
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fasting 80-130
preprandial <140 postprandial <180 A1C <7% now <6.5% |