Indications for adults to receive pneumococcal vaccine include a variety of chronic health problems such as chronic lung disease (including asthma), chronic cardiovascular dis- eases, diabetes mellitus, chronic liver disease including cirrhosis, chronic alcohol abuse, cigarette smokers age 19 years or older, malignancy, chronic renal failure or nephrotic syndrome, functional or anatomic asplenia (e.g., sickle cell disease or splenectomy [if elective splenectomy is planned, vaccinate at least 2 weeks before surgery]), immunocompromising conditions or recipient of immunosuppressing medications, select organ transplant, cochlear implants, and cerebrospinal fluid leak. Other individuals for whom vaccination is indicated include residents of nursing homes or other long-term care facilities, and all adults 65 years or older regardless of health status. Consideration should also be given to recommending PPSV23 for Alaska Natives and American Indians ages 50 through 64 years who are living in areas in which the risk of invasive pneumococcal disease is increased.
• CN I—Olfactory: You have one nose, where CN I resides. Its function contributes to the sense of smell.
• CN II—Optic: You have two eyes, where you will find CN II. Function of this CN is vital to vision and visual fields and, in conjunction with CN III, pupillary reaction.
• CN III—Oculomotor: CN III, the eye (oculo-) movement (motor) nerve, works with CNs III, IV, and VI (abducens, which helps the eyeball abduct or move). The actions of these CNs are largely responsible for the movement of the eyeball and eyelid.
• CN IV—Trochlear: This nerve innervates the superior oblique muscle of the eye.
• CN V—Trigeminal: Three (tri) types of sensation (temperature, pain, and tactile) come from this three- branched nerve that covers three territories of the face. For normal corneal reflexes to be present, the afferent limb of the first division of CN V and the effect limb of CN VII need to be intact.
• CN VI—Abducens
• CN VII—Facial: Dysfunction of this nerve gives the characteristic findings of Bell's palsy (facial asymmetry, droop of mouth, absent nasolabial fold, impaired eyelid movement).
• CN VIII—Auditory or vestibulocochlear: When this nerve does not function properly, hearing (auditory) or balance is impaired (vestibulocochlear). Rinne's test is part of the evaluation of this CN.
• CN IX—Glossopharyngeal: The name of this CN pro- vides a clue that its function affects the tongue (glosso) and throat (pharynx). Along with CN X, the function of this nerve is critical to swallowing, palate elevation, and gustation.
• CN X—Vagus: This CN is involved in parasympathetic regulation of multiple organs, including sensing aortic pressure and regulating blood pressure, slowing heart rate, and regulating taste and digestive rate.
• CN XI—Accessory or spinal root of the accessory: Function of this CN can be tested by evaluating shoulder shrug and lateral neck rotation.
• CN XII—Hypoglossal: Function of this CN is tested by noting movement and protrusion of the tongue.
Ripened cheeses (cheddar, Stilton, Brie, Camembert) Sausage, bologna, salami, pepperoni, summer sausage,
Chicken liver, pâté
Herring (pickled or dried)
Any pickled, fermented, or marinated food Monosodium glutamate (MSG) (soy sauce, meat
tenderizers, seasoned salt)
Freshly baked yeast products, sourdough bread Chocolate
Nuts or nut butters
Broad beans, lima beans, fava beans, snow peas Onions
Figs, raisins, papayas, avocados, red plums Citrus fruits
Caffeinated beverages (tea, coffee, cola) Alcoholic beverages (wine, beer, whiskey) Aspartame/phenylalanine-containing foods or
infection of meninges, CSF, and ventricles
can be bacterial, viral, fungal etc
most common cause is encephalitis, which can cause flu like sx, fever, HA, confusion, sz, sensory or motor impairment
Classic Triad: fever, HA, nuchal ridgidity
CSF findings: ■ Low glucose, PMN predominance
Kernig and Brudzinski signs indicate
A 25-year-old female presents to her primary care provider reporting fever, headache, nuchal rigidity, and decreased consciousness. She was previously treated for sinusitis. Which of the following is the most likely diagnosis?
An acute inflammation of the meningeal tissues surrounding the brain and the spinal cord; specifically, the arachnoid mater and the CSF; diagnosed by increased CSF presssure, increased WBCs, increased proteins, and decreased glucose
A chronic disease of the central nervous system marked by damage to the myelin sheath. Plaques occur in the brain and spinal cord causing tremor, weakness, incoordination, paresthesia, and disturbances in vision and speech
Sx occur acutely, worsen over a few days, can last weeks, followed by period of partial to full resolution
Descending weakness, Charcot's sign (intention tremor, nystagmus, scanning speech)
phenytoin, carbamazepine, clonazepam, ethosuximide, and valproic acid, and more recently developed antiepileptic drugs (AEDs), such as gabapentin, lamotrigine, and topiramate
need expert knowledge for AEDs
certain AED, phenytoin, carbamazepine have narrow therapeutic index
ANCC-FNP-BC. more on professional issues. 37% on foundations of Advanced practice. 17% on professional practice. 46% on independent practice- health promo and ebp and illeness and disease mgmt. 145 q on clinical content, 30 to professional issues
AANP-FNP-C, 35% assessment, 24% dx, 22% plan, 17% eval. When people do poorly, assessment is lowest score. 2.9% prenatal, 14.1% peds, 17.8% adolescent, 38.5% adult, 20.7% gero, 5.9% frail elderly
85% pass the test.
AANP- 15 hrs CE prior to retest
need recert 5yrs. need practice hrs +CE
olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, accessory, hypoglossal Lives in dark, undisturbed areas, violin mark on back, Mild stinging, fatty areas become necrotic in hours, "blue-gray" bullae, can cause hemolytic anemia, DIC, death. Tx: Ice, elevation, abx, ASA S=sensory M=motor B=bot
oh oh oh to touch and feel a girls very soft hands
Oculomotor- Eyelid and eyeball movement
Trochlear- Innervates superior, oblique, turns eye down and lateral
Trigeminal- chewing, face, and mouth touch and pain
Abducens- turns eye lateral
Facial- most facial expressions and secretion of tears, saliva, taste
Acoustic- hearing, equilibrium, sensation
Glossopharyngeal- taste, senses carotid, BP
Vagus- Senses aortic BP, slows HR, stim digestion, taste
Spinal Accessory- Control traps and sternoclei, swallow
Hypoglossal- control tongue move
moans, groans, stones, and bones with psychic overtones
low E, poor concentration, memory, depression, osteoporosis, insomnia, GERD, dec libido, hair loss, bone and joint aches.
Kidney stones, HTN, arrythmia, AFIB, liver, ABN protein