Title: ECRN Packet: Culturally Diverse Patients Geriatric Population Medications for Home Use
1ECRN PacketCulturally Diverse
PatientsGeriatric PopulationMedications for
Home Use
- Condell Medical Center EMS System
- 2006
- Site Code 10-7214-E-1206
- Revised by Sharon Hopkins, RN, BSN
- EMS Educator
2Objectives
- Upon successful completion of this module, the
ECRN should be able to - understand the sensitivity required when caring
for a culturally diverse patient population. - describe the unique assessment and care necessary
for the geriatric population - describe common medications taken by the
population and potential impacts with clinical
presentations
3Culturally Diverse Patients
- Differences of any kind race, class, religion,
gender, sexual preference, personal habitat,
physical ability - Good healthcare depends on sensitivity toward
these differences - Every patient is unique
- Westernized medicine is not
accepted by all
4Culturally Diverse Patients
- Key points
- Individual is the foreground, culture is the
background - Not all people identify with their ethnic
cultural background - Respect the patients beliefs
- Every patient needs to be treated equally
- Do not force someone
to have an intervention
that is against their
personal beliefs
5Culturally Diverse Patients
- Respect the integrity of cultural beliefs
- Patients may not share your explanation of causes
of ill health and not accept conventional
treatments - Recognize your personal cultural assumptions,
prejudices and belief systems.
- Avoid letting your prejudices
interfere with patient
care
6 Patient Rights
- Patients have the right to self-determination
- If the patient is of legal age (18 or older, not
emancipated), the patient has the right to refuse
any care or treatment offered - Document what has been refused and why
- The patient, or person authorized to consent,
must sign for themselves - spouses, grandparents, older siblings, police
officers cannot sign a refusal - if telephone permission is taken, witness by 2
persons, and add the name of the person
supplying permission
7Groups By Region
- Many groups overlap regions
- Older population usually refer to themselves by
their ethnic region (ie Chinese, Mexican) - Younger population usually refer to themselves by
racial terms (ie Asian, Latino) - Cannot always judge the ethnicity based on
appearances - ask the patient if you need
clarification
8Culturally Diverse Patients
- Locale of practice
- get to know the predominate cultures of your area
- the more you understand the culture, the more
effective a practitioner you can be - know resources available in your
hospital/community
9Culturally Diverse Patients
- Language barriers
- your assessment and accuracy of interpretation
will be hindered when a language barrier is
present - if an interpreter is used, document their name
and relationship - in some cultures, use of children is insulting to
adults and seen as too much responsibility placed
on the child - language lines are available - use them when
gathering/sharing medically pertinent information
10Culturally Diverse Patients And Body Language
- Very important especially when a language barrier
exists - Usually at a subconscious level
- Components of body language
- eye contact
- facial expressions
- proximity
- posture
- gestures
11Body Language - Eye Contact
- Can play a key role in establishing rapport
- Failure to make eye contact can be a sign of
dishonesty - Making eye contact can be a sign of disrespect in
some cultures (Chinese)
12Body Language - Facial Expressions
- One of the most obvious forms of body language
- Can convey mood, attitude, understanding,
confusion, other emotions - Smiles are usually universally understood
- Smiling and winking can have different
connotations from a friendly gesture to flirting
to disrespect (culture dependent)
13Body Language - Proximity
- Acceptability varies widely culture to culture
- In the United States, twice the arm length is a
comfortable social distance - 4-12 feet - Personal space is 1.5 - 4 feet
- Different messages are interpreted when standing
above, at, or below eye level - above eye level shows authority, can be
intimidating - at eye level indicates equality
- below eye level shows willingness to let patient
have some control over the situation
14Body Language - Posture
- Range of attitudes conveyed from interest,
respect, subordination, disrespect - Can replace or accompany verbal communication
- Some cultures it is impolite to show the bottom
of the shoe because it is dirty they will not
sit with a foot crossed resting on opposite knee
15Culturally Diverse Patients - Financially
Challenged
- May refuse health care due to its costs
- We need to be an advocate for these people and
make sure they are offered initial medical
screening - Know your community and county resources to offer
to this group of people - As a reminder, use your own resources wisely
16Culturally Diverse Patients - Financially
Challenged
- Signs of impairment
- homelessness
- chronic illness with frequent hospitalizations
- poor personal hygiene
- self-employment
17Resources for Referral
- PADS - public access to provide shelter
- provide meals and shelter October 1 - April 30
- open 7 pm - 7 am
- goals -
- connect person with resources to be able to leave
the street - commit to own effort for health and recovery
- to gain personal and economic self-sufficiency
with safe, affordable permanent housing - HealthReach Clinic - medical screening
- 847-360-8800 (Waukegan)
18Resources for Referral
- Catholic Charities
- to help families individuals overcome tragedy,
poverty, other life challenges - Lake County
- adult agency 847-377-4504
- juvenile agency 847-377-7800
- Salvation Army 847-336-1800
- Connection Crisis Referral Hotline 847-689-1080
- Department Chaplain
- Hospital Social Worker
-
19Geriatrics
20Challenges in the Geriatric Population
- Fear of losing autonomy/independence
- mobility - walking and by car
- want to continue to live on own
- Patient fears financial burden of hospitalization
- Patient is embarrassed by burden they become to
family and friends - Multiple disease processes affecting health
- Difficulty in communicating pain and fears
21Challenges in Dealing With the Geriatric
Population
- Patient fatigues easily
- Many layers of clothing hamper detailed
examination - Need for modesty and privacy
- May minimize their symptoms
- fear that they may be hospitalized, illness will
cost money they dont have, illness may cause
nursing home or alternate living arrangements
with loss of independence
22Challenges in the Geriatric Population
- Often suffer from concurrent illnesses
- Chronic problems make assessment of acute
problems difficult - Aging affects response to illness/injury
- Social/emotional factors have great impact on
health - Depression isolation - highest suicide rates in
people over 65
23Sensory Related Changes
- Vision
- cataracts cause blurring of vision unable to
distinguish between blue purple - if cataracts opaque (cloudy), may not see
pupillary response with a penlight - be in front of person make touch contact with
the patient before beginning to speak - Hearing
- decreased hearing
- diminished sense of balance
- speak slowly and distinctly check for hearing
aids write notes if necessary
24- Taste smell
- altered (decreased sensitivity)
- creates decreased appetite which causes poor
nutritional condition - Touch
- neuropathies cause decreased sensitivity to
tactile senses - increased risk of injury without patients
awareness (ieburns from heating pads sores on
feet becoming infected) - Pain
- lowered sensitivity - smaller amounts of
pain medication are necessary
25Communicating with the Geriatric Population
- Make eye contact before speaking
- Always identify yourself
- Position yourself at the patients eye level
- Locate hearing aid, eyeglasses, dentures
- Turn on lights, turn off TV to minimize
distractions - Use surname (Mr., Mrs., Ms.) until permission
given to address patient otherwise - Be patient and gentle - give time for the patient
to respond to your questions
26Physiological Changes Affecting Mobility
- Diminished vision
- Loss of exercise tolerance
- Diminished breathing capacity - become short of
breath quicker and lose energy to complete tasks - Slowed psychomotor skills - losing independence
- Decreased reflex time to prevent falls - more
prone to injury
27Mobility in Geriatrics
- Bone loss affects mobility
- Osteopenia - less than the normal amount of bone
- Osteoporosis - bone mass so reduced that the
skeleton loses its integrity and becomes unable
to perform its supportive function - Loss of bone strength and size
- Loss of flexibility
- Vulnerable areas in women
- spine, wrist, hip, collarbone, upper arm, leg,
pelvis - Treatment - meds, weight bearing exercises like
walking and lifting weights
28 Cardiovascular Changes in Geriatrics
- Left ventricle thickens and enlarges
(hypertrophy) decreasing compliance - Decreased responsiveness to catecholamine
stimulation - Diminished ability to raise the heart rate in
response to stress - Decreased function of SA AV
nodal cells increasing risk of
dysrhythmias - Cardiac output decreased by 30
29- Arteries become increasingly rigid
- Increased blood pressure to pump through rigid
blood vessels - Reduced blood flow to all organs
- Decreased peripheral resistance
- Widened pulse pressure - increasing systolic
blood pressure - Heart muscle stiffens
- Postural hypotension - vessels less reflexive and
blood pressure drops when patient stands up too
fast - Atherosclerosis - progressive, degenerative
disease of medium and large sized arteries
30Cardiovascular Disease
- Risk factors for developing cardiovascular
disease - Previous MI
- Angina
- Diabetes
- Hypertension
- High cholesterol level
- Smoking
- Sedentary lifestyle
31Geriatrics and Acute Myocardial Infarctions
- Elderly do not present with typical signs or
symptoms of acute myocardial infarctions - Silent MIs are marked by atypical complaints
such as fatigue, nausea, abdominal pain and
breathlessness - High index of suspicion for MI with unusual or
absent warning signs/symptoms - Mortality doubles after age 70
32Heart Failure
- A clinical syndrome where the hearts mechanical
performance (pumping) is compromised and cardiac
output cannot meet the bodys needs - Caused by ischemia, valvular disease,
dysrhythmias, hyperthryoidism, anemia,
cardiomyopathy - In elderly, large incidence of non-cardiac causes
- Generally divided into right and left heart
failure - Ventricular output insufficient to meet the
metabolic demands of the body
33Heart Failure
- Left ventricular failure
- left ventricle fails as a forward pump
- back pressure of blood in the pulmonary system
leads to pulmonary edema - Right ventricular failure
- right ventricle fails as a forward pump
- back pressure of blood into the systemic venous
circulation leads to venous congestion - Congestive heart failure
- reduced stroke volume causes an overload of fluid
in body tissues
34Signs and Symptoms of Heart Failure
- Dyspnea
- Fatigue
- Orthopnea - often sleeping on extra pillows to be
more upright - Dry, hacking cough progressing to frothy sputum
- Dependent edema due to right heart failure (check
most dependent part of body depending on mobility
- feet or sacral area) - Nocturia - urinating at nighttime
- Anorexia, ascites (fluid in abdomen)
35EMS Protocol Treatment Pulmonary Edema
- Routine medical care
- Oxygen via nonrebreather initially
- BVM and intubation if needed
- Stable patient with B/P 100 systolic
- Nitroglycerin 0.4 mg sl (can repeat every 5
minutes to a maximum of 3 doses) - venodilator - reduces return of blood to heart to
reduce workload of heart - Lasix 40 mg IVP (80 mg if on lasix)
- diuretic and venodilator - reduces fluid return
workload on the heart
36Pulmonary Edema contd
- Stable patient contd
- If B/P 100 systolic, morphine 2 mg slow IVP
- repeat 2mg every 3 mins as needed max 10 mg
- reduce anxiety venodilator
- Consider CPAP if B/P 90
- Unstable patient B/P
- contact medical control
- consider cardiogenic shock protocol
- dopamine drip to raise blood pressure
- fluid challenge would not be appropriate in
patient with crackles/rales (wet lungs) - treat dysrhythmias as they present
37Dysrhythmias and Geriatrics
- Common dysrhythmias
- PVCs when over 80 years old
- atrial fibrillation - increased risk for stroke
- Morbidity/mortality
- Serious due to decreased tolerance due to
decreased cardiac output - The cerebral hypoperfusion leads to an increase
in falls - Can lead to TIAs and CHF
(ineffective pumping)
38Aneurysm
- A bulge in a blood vessel if large enough can
put pressure on surrounding structures - May be aortic or cerebral
- Associated risk factors
- Smoking
- Hypertension
- Diabetes
- Atherosclerosis
- Hyperlipidemia
- Polycythemia
- Heart disease
39Hypertension
- Blood pressure ranges
- optimal
- normal range
- hypertensive range 140/90
- Risk factors for developing hypertension
- African Americans
- elderly
- geographics (Southeastern United States)
- males (after menopause, women equally vulnerable)
- socioeconomic status - lower the status the
greater the risk
40Hypertension
- Morbidity/mortality
- B/P greater than 160/95 doubles mortality in men
- If blood pressure remains uncontrolled, damage
seen to circulation (vascular system) and organs - cardiovascular disease (CVD) - stroke, MI, heart
failure - end-stage renal disease
41Hypertension
- Awareness of the disease, its treatment, and
control have improved but are still suboptimal - Prevention and control
- Regular physical check ups
- Follow medication routine if prescribed
- Weight control
- Exercise
- Decreasing salt intake
- Socially/emotionally active
- Smoking cessation
- Decreasing alcohol consumption
42Hypertensive Emergencies
- Definition
- acute elevation of systolic blood pressure
230/120 - Signs symptoms
- epistaxis (nosebleed)
- headache
- visual disturbances
- neurological changes - altered mental status and
seizures - nausea vomiting
43SOP Treatment Hypertensive Emergencies
- Routine medical care IV-O2-monitor
- Blood pressure in both arms and record
- keep arm level with the heart
- Vital signs and neuro status every 5 minutes
- P-R-B/P-mental status-pupillary response-GCS
- Lasix 40 mg IVP (80mg if on Lasix at home) -
diuretic vasodilator - If Medical Control orders, give NTG sl-
vasodilator
44Stroke - Cerebrovascular Accident
- 3rd leading cause of death in the USA
- Occlusive stroke - 80 incidence
- causes brain ischemia
- time to hospital treatment (TPA - fibrinolytic
clot bluster) must be - most important question - what time did the
symptoms start? - Hemorrhagic stroke - 20 incidence
- higher percentage of death
45Risk Factors For Stroke
- Elderly
- Atherosclerosis
- Hypertension
- Immobility
- Limb paralysis
- Congestive heart failure
- Atrial fibrillation
- Diabetes
- Obesity
46Signs and Symptoms of Stroke
- Elevated blood pressure
- Altered mental status or mood
- Coma
- Paralysis or extremity weakness
- Slurred speech
- Seizures
- Note Suspect stroke in any elderly person with a
sudden change in mental status. Always check
blood sugar level in setting of altered mental
status
47Cincinnati Stroke Scale Assessment
- Facial droop - have patient smile big enough to
show their teeth - Arm drift - patient closes their eyes and extends
arms out straight, palms facing up for 10 seconds - Abnormal speech - have the patient repeat back a
response given (speech may have already been
detected during normal conversation)
48Documentation of Cincinnati Stroke Scale Results
- Facial droop
- right, left, or no droop present
- Arm drift
- right, left, or no arm drift
- Abnormal speech
- slurred speech or clear speech
- Even normal responses with no deficits must be
documented to show the assessment was performed
49Endrocrine Emergencies in Geriatrics
- Diabetes and Thyroid Disease
- Due to the aging process and multiple disease
processes the signs and symptoms may not appear
to be classic - Suspect thyroid disease in an elderly patient who
has vague symptoms of illness - 20 of the elderly have diabetes
- 40 have impaired glucose tolerance
- Type II (non-insulin dependent) is the most
common form of diabetes and related to obesity
50Endocrine Disorders
- Hypothyroidism
- Low metabolic state
- ? appetite with weight gain
- Vague musculoskeletal complaints
- Lethargy, fatigue, sluggishness
- Cold intolerance
- Constipation
- Anemia
- Depression, forgetfulness
- Hyponatremia (? Na)
- Moon face
- Hyperthyroidism
- Weight loss
- Mentation changes - nervousness, irritability
- Tachydysrhythmias, palpitations
- Hyperactivity, nervousness, irritability
- Heat intolerance
- Abdominal pain
- Diarrhea
- Weak leg muscles
- ?perspirations
51Endocrine Complications
- Hyperthyroidism
- impaired glucose tolerance - problems with sugar
processing (pre-diabetic condition) - type II diabetes
- tachycardia
- atrial fibrillation
- Hypothyroidism
- bradycardia
52Integumentary (skin) Emergencies
- Risk factors
- Epidermal cellular turnover decreases
- Slower wound healing
- Increased risk for secondary infection
- Increased risk of skin tumors, fungal or viral
infections - Hair becomes finer and thinner
53Pressure Ulcers
- Results from hypoxia to tissue cells
- Usually over bony areas
- Common in immobile patients
- those confined to bed or wheelchairs
- Increased incidence in patients with
- altered sensory perception
- skin exposure to moisture, especially prolonged
- decreased activity inability to shift
positions - poor nutrition
- friction or shear (ie being pulled and dragged
across a surface instead of being lifted)
54Prevention of Pressure Ulcers
- Immobile patients turned every 2 hours
- Adequate hydration and nutrition provided
- Personal hygiene maintained
- Environment kept clean
- Insure immobile patients do not have wrinkled
bedsheets or clothes - Prescribed antibiotics or medications provided as
ordered
55Traumatic Deaths in Geriatrics
- Trauma is the fifth leading cause of death
- Mortality rates markedly increased in the elderly
- One-third of traumatic deaths are in 65 - 74 year
olds secondary to vehicular trauma - 25 result from falls
- 50 of persons 80 years old
die from falls - Post-injury disability more
common in the elderly
56Risk Factors Related to Trauma
- Osteoporosis and muscle weakness increases the
risk of fractures - women more vulnerable after menopause
- men are also at risk for this disease
- Reduced cardiac reserve decreases ability to
compensate for blood loss - Decreased respiratory function increases risk for
adult respiratory distress syndrome (ARDS) - Impaired renal function decreases ability to
adapt to fluid shifts - Unsteady gait increases risks of falls
57Traumatic Emergencies
- Orthopedic Injuries
- Pelvic fractures are highly lethal due to severe
hemorrhage and associated soft tissue injury - Decreased pain perception may mask major fracture
- A large percentage of elderly will die within one
year of a hip fracture
58Orthopedic Injuries
- Hip fractures most common acute injury
- Elderly are susceptible to stress fractures of
femur, pelvis, tibia - Packaging should include adding bulk and padding
between the patient and the back board - Kyphosis (rounding of the back) may require extra
padding under shoulders to maintain alignment - often caused by osteoporosis, arthritis,
vertebral slippage - Try to remove backboards as soon as possible
document removal
59External Rotation
60Fracture site
61Fracture repaired with plate screws
62Orthopedic Injuries From Falls
- Major cause of morbidity/mortality
- 10,000 deaths each year
- One third of elderly fall at home each year
- 1 in 40 are hospitalized
- Cause significant mobility problems
and functional dependence - Evaluate home for safe conditions
- use of non-skid rugs
- adequate lighting - hallways and at night
- sturdy hand rails on stairs and in bathrooms
- items within reach (ie kitchen)
- environment clear of clutter
63Traumatic Head Injuries
- Poorer outcome when injury associated
with loss of consciousness - Brain shrinkage as one ages allows more space and
greater brain movement - Increased incidence of subdural hematoma
- ? frequency of falls lead to more head injuries
- brain shrinkage allows for more room to bleed
- bleeding is venous - slow development of symptoms
- headache
- mental status changes
64Spinal Column Injuries
- Progressive arthritic and degenerative changes
and osteoporosis associated with the aging
process lead to higher incidence of bony injuries - Injuries have a negative impact on the function
and quality of life - Pain ? ability to perform activities of daily
living - A psychosocial impact and threat to loss of
independence
65Compression Fractures of Spine
- Occurs in 25 of post-menopausal women in the USA
(up to 40 in women over 80) - Applied force may be minimal (lifting an object,
stepping out of tub, sneezing) or more
significant (major fall, MVC) - Acute onset low back pain, tenderness to
palpation usually over T 8-12 and L 1-4 - Rarely neurological symptoms
- Transported in position of most comfort
- Treatment symptomatic conservative -
rest, pain control, physical therapy
66Burns in the Elderly
- 1000 die each year from home fires
- People over 60 have higher mortality rate from
burns - Increased morbidity/mortality due to preexisting
disease, skin changes (thinning slower healing
time), altered nutrition, increased risk to - infection, decreased reaction time to
- move away from source
67Treatment of Burn Injuries
- Fluid important to prevent renal tubular damage
from altered blood flow through the kidneys - Normal aging changes cause a decreased response
in heart rate and stroke volume to hypovolemia - Hydration assessed in initial hours after burn
injury by B/P, pulse, and urine output (1-2
ml/kg/hour minimally) - Rapid IV administration of fluid may cause volume
overload (monitor lung sounds and vital signs
frequently)
68Toxicology Geriatrics
- Alterations in body composition, drug
distribution, metabolism and excretion increases
the risk for toxicity in elderly when exposed to
over-the-counter medications, prescription
medications, and other substances
69Risk Factors Related To Toxicology
- Decreased kidney function alters elimination
- Increased likelihood of CNS side effects
- Altered GI absorption
- Decreased liver blood flow alters metabolism and
excretion - History of alcoholism
- Vision and memory changes
result in noncompliance - Poor dexterity and eyesight decreases
ability to choose correct medication and/or
dosage
70Prevention
- Label medications clearly and in larger print
- Provide assistance with nutrition and medication
administration as needed - Consult with physician frequently
- Make sure all physicians are aware of all
medications taken - over-the-counter prescription
herbal remedies - Limit OTC drug administration
- Segregate storage in medicine
cabinet - ingested medications on one shelf
- topical medications on a different shelf
71Elder Abuse
- May occur in home or institutional setting
- EMS RNs are mandated by State of Illinois to
report suspicions to hot line - Abuse
- any physical injury, sexual abuse or mental
injury inflicted on a person, aged 60 or older,
other than by accidental means - Neglect
- failure to provide adequate medical or personal
care or maintenance in which failure results in
physical or mental injury or deterioration of
condition
72Elder Abuse Reporting
- Document objectively and describe injuries using
measurements and colors and not vague terms - Suspicions reported to ED staff by EMS
- Abuse Hot Line
- M-F 0830 - 1700 1-800-252-8966
- All other times 1-800-279-0400
73Medications for Home Use
- Antidepressants
- depression is a chronic illness of feeling
hopeless and of losing interest - SSRI (selective serotonin reuptake inhibitors)
- improves mood
- lexapro, prozac, paxil, zoloft
- Tricyclic antidepressants
- amitriptyline, nortriptyline
- MAO inhibitors
- could have potentially life-threatening drug
food interactions - nardil, parnate
74Medications for Home Use
- Antianxiety
- to relieve anxiety
- benzodiazepines most common category
- Anticoagulants
- to inhibit the ability to clot does not dissolve
an existing clot - coumadin, lovenox, heparin, plavix, aspirin
75Medications for Home Use
- Lipid management
- to reduce cholesterol and LDL levels which when
elevated increases risks of coronary heart
disease (CHD) - statins lipitor, lescol, zocor, pravachol,
mevacor, baycol, crestor, pitava - non-statin zetia, niacin, velchol, torcetrapib,
panavir
76Medications for Home Use
- ACE inhibitors
- allow blood vessels to enlarge or dilate to
decrease B/P - used to control B/P, treat heart failure, prevent
kidney damage in hypertensive diabetic patients - catopril (capoten), lotensin, vasotec, lisinopril
(prinivil zestril), monopril, ramipril
(altace), aceon, accupril, univasc, mavik
77Medications for Home Use
- Beta blockers
- relieves stress on heart by blocking some
involuntary nervous system control on the heart - slows heart rate, decreases force of
contractions, reduces blood vessels contractions - used to treat cardiac dysrhythmias, atrial
fibrillation, hypertension, angina, post-MI
(reduces morbidity), glaucoma, migraines, anxiety - most generic names end in olol
- atenolol (tenormin), metoprolol (lopressor),
propranolol (inderal), nadolol (corgard),
carvedilol (coreg)
78Medications for Home Use
- Calcium channel blockers
- block entry of calcium into muscle cells of heart
and arteries to decrease the strength and rate of
heart contractions and dilate arteries - used to treat high blood pressure, arrhythmia
(atrial fibrillation), angina, used post-MI - verapamil (calan, isoptin), diltiazem (cardizem),
nifedipine (procardia), bepridil (vascor),
amlodipine (norvasc)
79Medications for Home Use
- Diuretics
- to reduce the vascular fluid volume
- used to treat heart failure, hypertension, fluid
retention - aldactone, aldactazide, bumex, diuril,
hydrochlorothiazide, HCTZ, hydrodiuril, dyazide,
dyrenium, lasix (furosemide) - Diabetes
- inadequate insulin activity for glucose
metabolism - actos, amaryl, avandia, diabeta, glucophage,
glucotrol, prandin, precose, starlix
80Medications for Home Use
- GI system
- to treat acid reflux, excess acid, GERD,
irritable bowel - aciphex, asacol, mylanta, pepcid, prevacid,
prilosec, propulsid, reglan, rolaids, tagamet,
tums, zantac, lomotil, bentyl, imodium
81Medications for Home Use
- Insomnia and sleep disorders
- sleep deprivation affects the bodys metabolism
- insomniacs are at increased risk for host of
diseases decreases motor skill and affects
memory and mental performance - being awake 24 hours is equivalent to a blood
alcohol level of 0.1 - ambien, halcion, restoril, lunesta
benzodiazepines like lorazepam (ativan), diazepam
(valium)
82Medications for Home Use
- Erectile dysfunction
- to improve erectile function (impotence) in men
and sexual arousal in women - increases amount of blood flow, does not
automatically produce an erection but allows one
after physical and psychological stimulation - not to be taken if MI, stroke or life-threatening
dysrhythmia in last 6 months - not to be mixed with nitrate use (NTG) in same 24
hours period -blood vessel dilation could be too
much to reverse could cause death - viagra (sildenafil), cialis, levitra
83Pearls of Medication
- Benzodiazepines
- when mixed with alcohol increases depressant
effects - watch for respiratory depression - Anticoagulants
- increases risk for bleeding complications
- Beta blockers
- patient wont respond with tachycardia even in
shock due to effects of drugs - Hypertensive patient
- a normal reading (ie 100/70) may be shock for
the patient with a chronically elevated blood
pressure
84References
- Bledsoe, B. E., Porter, R. S., Cherry, R. A.
Paramedic Care Principles Practices. Brady
2006. - www.aafp.org
- www.allaboutvision.com
- www.americanheart.org
- www.aoa.org/documents/CPG-8.pdf
- www.clara.abbott.com
- www.dynomed.com/encyclopedia/encyclopedia/spine/
Compression_Fracture.htm - www.glaucoma.org
- www.nihseniorhealth.gov
- www.nlm.nih.gov/medlineplus/cataract.html
- www.pads-crisis-services.net
- www.richmondeyecare.com/vets2html