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CSN Nurs 125 Exam I
CSN Nurs 125 exam 1 - Bk notes & Lecture Notes
| Question | Answer |
|---|---|
| fat solubles are | adek they metabolized slowly and can be stored in fatty tissue |
| vitamin a can be stored in the liver for how many years | 2 years |
| vitamin A is essential for what? | bone growth, maintenance of epithelial tissues, skin, eyes and hair |
| How much Vitamin A is toxic for a pregnant woman? | >6000 international units = teratogenic effect (birth defect) |
| Massive doses of vitamin A may cause what? what is its symptoms | hypervitaminosis A = hair loss and peeling skin |
| Vitamin D has a major role in regulating what? | calcium and phosphorus metabolism and is needed for calcium absorption |
| Where is vitamin D absorbed at? | It is absorbed in the small intestine and requires bile salts for absorption |
| What are the two types of Vitamin D | Vitamin D2 = Ergocalciferol, and Vitamin D3 Cholecalciferol (a natural form of vitamin D influenced by UV sunlight through the skin) |
| What regulated Vitamin D | Parathyroid hormone PTH and calcitonin regulates calcium and phosphorus. |
| Excretion of vitamin D is primarily in what? | BILE |
| Vitamin E | has antioxidant properties that protect cellular components from being oxidized and red blood cells from hemolysis. |
| Vitamin E depends on what? | bile salts, pancreatic secretion and fat for its absorption |
| Vitamin E may prolong what? | Prothrombin Time, persons taking warfarin should have their PT monitored closely. |
| Vitamin E should not be taken with what? | Iron and Vitamin E = NO Because Iron can interfere with the bodys absorption and use of vitamin E |
| how many forms does vitamin K have? | four forms - K1-phytonadione, K2 menaquinone (synthesized by intestinal flora), K3 menadione and vitamin K4 Menadiol |
| What is vitamin K needed for | the synthesis of prothrombin and clotting factos |
| What clotting factors is Vitamin K needed for | Clotting factors 7, 9, and 10 |
| What are the water soluble vitamins | BC |
| what are the four vitamin B complex members? | Vitamin B1 (thaimine), Vitamin B2 (riboflavin) Vitamin B3 (Nictorinic Acid or niacin) and Vitamin B6 pyridoxine |
| for Vitamin B1 (thiamine) what can it lead to if there is a deficiency | polyneuritis and cardiac pathology seen in beriberi or to wenickes encephalopathy that progresses to korsakoff syndrome (conditions most commonly associated with alcohol abuse). |
| What is Korsakoff syndrome seen in vitamin B1 deficiency? | a significant central nervous system disorder characterized by confusion, nystagmus, diplopia, ataxia and loss of recent memory->Unless treated it may cause irreversible brain damage. |
| What is Riboflavin or Vitamin B2 used for | to manage dermatologic problems such as scaly dermatitis, cracked corners of the mouth and inflammation of the skin and tongue. To treat migraine headache riboflavin is given in larger doses than for dermatologic concerns |
| Niacin or vitamin B3 is given to alleviate what? | pellagra and hyperlipidemia |
| Pyridoxine or Vitamin B6 can be given for what? | to correct vitamin b6 deficiency ( by lack of adequate diet, inborn error of metabolism or drug inducded deficiencies seondary to inh, penicillamine or cyclosporin, it may also help alleviate the symptoms of neuritis caused by isoniazid INH therapy for TB |
| Vitamin B6 is an essential for what? | nucleic acids, red blood cell formation and synthesis of hemoglobin |
| where is vitamin B6 or Pyridoxine - absorbed and where is it stored? | it is absorbed in the jejunum an stored in the liver, muscle, and brain It is metabolized int he liver and excreted in the urine. |
| where is Vitamin C or Ascorbic Acid absorbed in | Small intestine |
| Vitamin C aids in the absorption of what? | iron |
| the recommended daily dose of vit c is? and how much vit c can a person take per day? | the recommended daily dose is 50-100 mg per day. A person can take 500 to 6000 mg to treat upper respiratory infection, cancer or hypercholesterolemia. |
| vitamin C is needed for what to metabolize? and what to synthesis | carbohydrate metabolism, and protein and lipid synthesis |
| Folic acid ( BABIES ) =) What is it essential for? | is essential for body growth, it is needed for DNA synthesis and without folic acid there is a disruption in cell division |
| Folic acid should be cautious with which antiseizure drug? | Dilantin - folic acid can lower the serum level of dilantin which could increase the risk of seizures. |
| vitamin B12 is essential for what? | dna synthesis, also for normal hematopeoiesis (development of red blood cels in the bone marrow) and maintaining nervous system integrity especially the myelin. |
| What do you need for b12 to be absorbed? | The gastric parietal cells produce an intrinsic factor that is necessary for the absorption of vit b12. no intrinsic factor = no b12. |
| where is vitamin B 12 stored? and how long does it to be excreted from our system? | B12 is stored i the liver and it can take 2 to 3 years for stored b12 to be depleted and a deficit noticed. |
| Iron a mineral is vital for what? | hemogloblin regeneation. 60% of iron in the body is found in hemoglobin. one of the causes of anemia. |
| What vitamin increases Iron | Vitamin C |
| What can decrease Iron | tetracycline and antacids, chamomile, feverfew and peppermint & st. johns wort. |
| copper is needed for what? | RBC formation and connective tissues. |
| Copper is a what to enzymes? | Cofactor to many enzymes and its function is in the production of neurotransmittters norepinephrine and dopamine. |
| Excess serum copper levels may be associated with what? | Wilson Disease - Which is an inborn error of metabolism that allows for large amounts of copper to accumulate in the liver, brain and cornea or kidneys |
| What is zinc important for? | Zinc is important for enzymatic reactions and is essential for normal growth and tissue repair, wound healing and taste and smell |
| If a person take large doses of zinc, more then 150 mg it can cause what defiency | copper defiency and HDL-good cholesterol, and weakened the immune response |
| Zinc can inhibit what drug? | Tetracycline aborption - the antibiotic |
| Chromium is said to be helpful in the control of what? | type 2 diabetes it is thought that this mineral helps to normalize blood gluose by increasing the effects of insulin on cells |
| selenium acts as a cofactor for an antioxidant enzyme that what? | protects proteins and nuleic acids from oxidative damage |
| Selenium acts with what? | Vitamin E |
| enteral feeding vs Parenteral nutrition | parenteral feeding has a higher chance of infection but when a patient is critiially ill, there is a decrease or absence in gastric emptying time |
| what can be a complication of feedings? | dehydration, if an insufficient amount of water is given with or bewteen feedings. also a nurse should check for gastric residual |
| the head of the bed should be at what degree? and why? | at least 30 degrees, bc you do not want the patient to aspirate |
| one major problem of enteral feeding is what? | Diarrhea - this can by rapid administration of feeding, high caloric solutions, malnutrion, GI Bacteria ( c. diff ) and drugs. |
| what are two pancreatic enzyme medication used by individuals with panreatic enzyme deficiency resulting from pancreatectomy, pancreatic obstruction, and cystic fibrosis. | Precreatin and pancrelipase - they promote digestion and absorption of foods |
| Dilantin is significantly reduced in the presence of what? | protein, so it is important to stop the feeding for 30 minutes |
| how much do u flush the enteral tubing? | 30 ml before and after. If tube obsructed, then use warm wateror cola. MX for Diarrhea. If there is Diarrhea then decrease anteral feeding flow rate |
| TPN or total paraenteral nutrition is the primary method for providing complete nutrients by the parenteral or IV route. TPN is an infusion of what? | hyperosmolar glucose, amino acids, vitamins, electrolytes, minerals and trace elements. |
| TPN is indicated for what individuals? | clients with severe burns who are in negative nitrogen balance, clients with GI disorders, when the GI tract needs a complete rest and clients with debilitating diseases such as metastic cancer or aquired immunodeficiency syndrome |
| What is inflammation? | Is a response to tissue injury and infction. When inflammatory process occurs, a vascular reation takes place in which fluid, elements of blood, leukocytes and chemical mediators accumulate at the injured tissue or infection site |
| Infection is caused by | microorganisms and results in flammation but not all inflammatin are caused by infection |
| What are the five characteristics of inflammation or cardinal sins of inflammation? | Redness, edema (swelling), heat, pain, and loss of function |
| what are the two phases of inflammation? | vascular phase which occurs 10 to 15 minutes after an injury ( is associated with casoilation and increased capillary and permeability) and the delayed phased |
| aspirin is the oldest anti-inflammatory drug | relieve pain (analgesic), antipyretic (reduce body temperature), anticoagulant (inhibit platelet aggreation) |
| NSAIDS | Nonsteroidal anti-inflammatory drugs - drugs that are prostaglandin inhibitors |
| There are 7 groups of NSAIDS | Salicylates, parachlorobenzoic acid derivatives, phenylacetic acids, propionic acid, fenamates, oxicams, selective cox-2 |
| Aspirin and other NSAIDS relieve pain by inhibiting the enzyme? | COX- which is needed for the biosynthesis of prostaglandin. (Cox 2--> triggers pain and inflammation at the injured site) |
| patients can have a sensitivity to aspirin such as..? | tinnitus (ringing in he ears), vertigo (dizziness), bronchospasm ( asthmatic clients) |
| Patients should not take what if he or she is sensitive to aspirin? | Diflunisal, prunes, raisins, licorice, curry powder and paprika. |
| one of the first NSAIDS introduced was called? | Indocin |
| Indocin was used for? | RA, gouty arthritis , osteoarthritis. ALSO indocin can be very irritating to the stomach and should be taken with food. It is a highly protein bound and displaces other protien bound drugs, resulting in potential toxicity |
| what drug is classified as a cox 2 inhibitor? | Celebrex |
| CORTICOSTEROIDS - such as prenisone, prenisolone and dexamethasone are used for what? | anti-inflammatory agents |
| What therapies an help with DMARDS (diseae-modifying antirheumatic drugs) | Gold therapy, immunosuppressive agents, immunodulator and antimalarials |
| what drugs are used to suppress cancer growth and proliferation, and might be used to suppress the inflammatory process of rheumatoid arthritis when other treatments fail | azathioprine (imuran), cyclophosphamide (cytoxan) and methotrexate (mexate) |
| Gout the disease of kings, because in the past royalty ate rich foods, drink wine and alcohol and suffered from gout. GOUT is... | infammatory condition that attacks joints, tendons and others tissues, it may be called gouty arthritis . |
| Gout is characterized by .. | uric acid metabolism disorder and defect in purine metabolism, resulting in an incresae in urates ( uric acid salts) and an accumulatin of uric acid (hyperuricemia) |
| What drug is used for gout? | Allopurinol & colchicine |
| pain is defined by the international association for study of pain as | an unpleasant sensory and emotinal experience related to tissue injury |
| What is the fifth vital sign? | Pain |
| Pain tolerance | the amount of pain a peson can endure without having it interfere with normal functioning |
| Pain tolerance can be influenced by what? | age, gender,culture, ethnicity, previous experience, anxiety level, specific circumstances |
| Mild to moderate pain is frequently relieved by? | nonopiod analgesic |
| moderate to severe treated by | narcotic or opioid |
| Children younger then 12 cannot TAKE what? | Aspirin, it is contraindicated for any elevated temperature, regardless of cause because of the danger or REYE syndome ( neuorlogical problems associated with viral infection treated with salicylates) |
| aspirin and other NSAIDS relieve pain by inhibiting biosynthesis of what? | prostaglandin by different forms of the enzyme cyclooxygenase |
| a person can take how much tylenol per day? But if that person takes it on a regular basis, how much per day? | 4 gram / day, but 2 gram/day to avoid the possibility of hepatic or renal dysfunction. Anything more can be toxic to hepatic cells |
| Define Addiction | Is defined as a psychologic and physical dependence upon a substance beyond normal voluntary control, usually after prolonged use of a substance |
| Morphine a prototype opioid is obtain from.. | the seeds pods of opium poppy. Codeine is another drug obtained from opium |
| How do opioids act primarily? | they at mostly on the mu? receptors while also exerting a weak activation of kappa (k) receptors. |
| What are the effects of of the Mu activation? | analgesia, respiratory depression, euphoria, sedation |
| Activating the K receptors leads | analgesia and sedation |
| Opioids not only suppress pain impulses but also respiration/coughing by acting on what centers of the brain? | medulla of the brainstem |
| What are the side effects of opioids? | N/V (nausea/vomitting), constipation, decrease blood pressure and orthostati hypotension |
| High doses of opioids may also cause what? | respiratory depression, urinary retention ( usually in older adults) and antitussive effects |
| What is an overdose of opioid antagonist? | Narcan (naloxone), Naltrexone Hydrochloride (ReVia) Nalmefene (Revex) |
| Mepridine is preferred to morphine because why for pregnancy? | it does not diminish uterine contractions and causes less neonatal respiratory depression. |
| Meperidine should not be prescribed for long term use | the dose is frequently limited to 600 mg in a 24 hr period, no longer than 48 to 72 hrs. |
| Hydromorphone is also called what? | Dilaudid |
| Dilauded or hyromorphone is how many times more potent then morphine? | 6x with fewer hypnotic effects and less GI distress - is a faster onset and shorter duration |
| When giving Dilauded IV how much should you dilute the medication? | 5ml of sterile water or normal saline is preferred |
| How much dilauded and over what time? should Dilauded be given | Dilauded should be given over 2-5 minutes with 2mg or less! |
| You should never give opioids for clients with what? (Contraindicated) | Head injuries - opioids decrease respiratio, thus causing an accumulation of carbon dioxide. with an increase in CO2 retention blood vessels dilate (vasodilation), especially cerebral vessels which causes increased intracranial pressure |
| Hyrocodoe and ibuprofen | Vicoprofin (nsaid and opioid) |
| Generally drugs are both disintergrated and absorbed faster in acidic fluids with a pH of? | ph of 1 or 2 rather than in alkaline fluids. NOTE that both the very young and very old have less gastri acidity |
| pharmacokinetics is . . .? | the process of drug movement to achieve drug action |
| the four processes are what? | absorption, distribution, metabolism ( or biotransformation) and excretion (elimination) |
| Drugs that are lipid soluble and nonionized are absorbed faster than water soluble and ionized drugs | drugs given IM are absorbed faster in muscles that have more blood vessels than in those that have fewwer blood vessels. |
| When 2 highly protein bound drugs are given concurrently they compete for protein binding sites, thus causing more free durg to be released into the circulation in this situation, drug accumulation and possible drug toxicity canresult | |
| pharmacokinetics is . . .? | the process of drug movement to achieve drug action |
| the four processes are what? | absorption, distribution, metabolism ( or biotransformation) and excretion (elimination) |
| Drugs that are lipid soluble and nonionized are absorbed faster than water soluble and ionized drugs | drugs given IM are absorbed faster in muscles that have more blood vessels than in those that have fewwer blood vessels. |
| When 2 highly protein bound drugs are given concurrently they compete for protein binding sites, thus causing more free durg to be released into the circulation in this situation, drug accumulation and possible drug toxicity canresult | of weak base drugs and alkaline urine promotes elimination of weak acids drugs. Aspirin a weak acid is excreted rapidly in alkaline urine |
| What can cause low protien levels? | Malnutrition and advanced aging!!! |
| to avoid possible drug toxicity what should the NURSE check? | protein binding percentage - plasma protein, albumin levels |
| Urine PH varies from what? | 4.5-8 |
| Acid urine promotes the elimination of what? | of weak base drugs and alkaline urine promotes elimination of weak acids drugs. Aspirin a weak acid is excreted rapidly in alkaline urine |
| If a person overdose on aspirin what can be given as a anti-dote? | sodium bicarbonate to change the urine pH |
| Large Quantities of Cranberry juice can decrease urine pH (= making more acidic)= | inhibiting the elimination of aspirin |
| What is the more accurate test to determine renal funciton? | creatinine clearane (Clcr). Creatinine is a metabolic byproduct of muscle that is excreted by the kidneys |
| What is the normal creatine clearance range? | 85 to 135 ml/min |
| pharmaceutics | the study of how various drugs forms influence he way in which the drug affects the body |
| pharmacokinetics | the study of what the body does to the drug |
| what are the four steps of pharmacokinetics? | absorptions, distrbution, metabolism, and excretion |
| what is pharmacognosy | the study of natural (versus synthetic) versus drug sources (plants, animals, and minerals) |
| intrathecal | in the joint (steroid shots) |
| factors that increase metabolism | fast acetylator, barbituate therapy, rifampin therapy, phenytoin therapy |
| what are the four main sources of drugs | plants, animals, minerals, laboratory synthesis |
| younger then 38 weeks is | premature |
| younger than one month | neonate/newborn |
| one month to one year | newborn |
| one year to 12 years | child |
| when considering neonates for medication | gastric pH less acidic, gastric emptying slowed, intramuscular absorption faster and irregular |
| neonatal pediatric considerations for distribution | greater total body water means lower fat content, decreased level of protein binding, immature blood brain barrier |
| neonatal and pediatric considerations for metabolism | the liver immature, older children may have increased metabolism. Kidney immaturity (decreased perfusion rate of the kidneys may reduce excretion of drugs) |
| Pediatric considerations when giving drugs | stomach lacks acid to kill bacteria, lungs have weaker mucus barriers, body temperatures less regulated. |
| elderly is considered older then what? | 65 |
| considerations for elderly is what? | high use of medications, polypharmacy, noncompliance, increased incidence of chronic illnesses |
| allergic reaction | hives, fever, swelling |
| procuring | pharmacy |
| you should never use what with a zero | never use a trailing zero |
| what should you always do with a zero | use a leading zero |
| where is ADEK stored | in the liver and fatty cells |
| vitamin A comes from what? | carotenes which are found in green and yellow vegetables and yellow fruits |
| vitamin A is required for what? | growth and development of bones and teeth, essential for night and normal vision |
| deficiency in vitamin A shows in what? | hyperkeratosis of the skin, night blindness, acne, psoriasis, keratosis, isotretinoin |
| Too much Vitamin A in infants in what? | too much ICP |
| Vitamin D | sunshine vitamin |
| Vitamin D2 - is called what? | Ergocalciferol - plant vitamin D and obtained through dietary sources |
| What is Vitamin D3 | Cholecalciferol, produced in the skin by the ultraviolet irradiation |
| What is the function of Vitamin D | Works with parathyroid hormone to regulate absorption of and use of calcium and phosphorus |
| Indications of Vitamin D deficiency | Rickets, Tetany and osteomalacia |
| Vitamin D toxicity | Hypertension, weakness, fatigue, headache, anorexia, dry mouth, metallic taste, nausea, vomiting, abdominal cramps, ataxia and bone pain |
| How many forms of vitamin E are there | there are 4 forms of vitamin E - alpha, beta, gamma and deltatocopherol |
| vitamin K functions? | Essential for synthesis of blood coagulation factors in the liver, 2,7,9,10 |
| Thiamine | Vitamin B - BeriBeri, Wernickes Encephalopathy |
| BeriBeri | Brain Lesions, Polyneuropathy of peripheral nevers and serous effusions cardiac anatomic changes |
| Wernickes Encephalopathy VB1 deficiencies | Cerebral Beriberi |
| what is the function of vitamin B1 | carbohydrate metabolism, metabolic pathways including Kreb Cycle, Peripheral nervous system, cardiovascular system and GI tract |
| What is the major cause of vitamin B2 - Riboflavin? | Alcoholism is a major cause and intestinal malabsorption |
| What is the function for vitamin B2 | converted to enzymes for tissue respiration, needed for vitamin B6, converts trptophan into niacin |
| Vitamin B2 deficiency is seen by | Cheilosis (chapped or fissured lips), seborrheic dermatitis and keratitis |
| what is an adverse reaction of Vitamin B2 | colors urine to a yellow orange |
| vitamin B3 synthesized from what? | tryptophan (an essential amino acid obtained from protein digestion) |
| Vitamin B3 (niacin) is treatment for what? | cholesterol |
| Vitamin B3 (niacin) what is a deficiency | Pellegra |
| Vitamin B6 (pyridoxine) | Necessary for integrity of peripheral nerves, skin, mucous membranes, hematopoietic system |
| Sign and systems of B6 deficiency | Neurologic disturbances,sideroblastic anemia, seborrheic dermatitis, cheilosis, glossitis |
| Vitamin B6 (pyridoxine) causes of deficiency | poor absorption, cirrhosis, hyperthyroidism - DRUG INDUCED - isoniazid, hydralazine |
| b12 - cyanocobalamin | required for metabolic pathways - Fat and carbohydrate metabolism, protein synthesis, growth cell replication, hematopoeisis, nucleoprotein andmyelin synthesis |
| Vitamin B12 (cyanocobalamin ) Deficiency | Pernicious anemia.. Deficiency leads to - neurologic damage, megaloblastic anemia |
| B12 (cyanocobalamin) | oral absorption of b12 (extrinsic factor) requires presence of intrinsic factor |
| What is the intrinsic factor | glycoprotein secreted from gastric parietal cells |
| Vitamin C (ascorbic Acid) | Enhances absorption of Iron, Aids in Cellular Respiration, Aids in resistance to infection |
| Vitamin C | Scurvy - Gingivitis, anemia |
| what is the most abundant mineral element in the body? | DUH calcium!!! |
| Calcium is essential because | Transmission of nerve impulses, contraction of cardiac smooth and skeletal muscles, renal function, respiration and blood coagulation |
| what are some causes of Calcium Deficiency? | Hypo-parathyroidism |
| Severe Hypercalcemia can cause? | Cardiac irregularities, delirium and coma |
| Magnesium | one of the principal cations of intracellular fluid |
| magnesium is required for | nerve physiology and muscle contaction |
| phosphorus is responsible for | cellular energy transfer |
| NSAIDs: Mechanism of Action | Inhibition of the leukotriene pathway, the prostaglandin pathway, or both Blocking the chemical activity of the enzyme called cyclooxygenase (COX) Cyclooxygenase-1 (COX-1) Has a role in maintaining the GI mucosa Cyclooxygenase-2 (COX-2) |
| Aspirin | Irreversible inhibitor of COX-1 receptors within the platelets themselves Reduced formation of thromboxane A2, a substance that normally promotes platelet aggregation Other NSAIDs lack these antiplatelet effects |
| Chemical Categories of NSAIDs | Salicylates Acetic acid derivatives Cyclooxygenase-2 (COX-2) inhibitors Enolic acid derivatives Propionic acid derivatives |
| Acetic Acid Derivatives | Used to treat rheumatoid arthritis, osteoarthritis, acute bursitis or tendonitis, ankylosing spondylitis, and acute gouty arthritis Promote closure of patent ductus arteriosus, a heart defect that sometimes occurs in premature infants Ketorolac (Toradol |
| COX-2 Inhibitor | celecoxib (Celebrex) First and only remaining COX-2 inhibitor Indicated for osteoarthritis, rheumatoid arthritis, acute pain symptoms, ankylosing spondylitis, and primary dysmenorrhea Adverse effects include headache, sinus irritation, diarrhea, fatigu |
| Propionic Acid Derivatives | fenoprofen (Nalfon) flurbiprofen (Ansaid) ibuprofen (Motrin, Advil) ketoprofen (Orudis KT) naproxen (Naprosyn, Aleve) oxaprozin (Daypro) |
| Propionic Acid Derivatives | Used for their analgesic effects in treating rheumatoid arthritis, osteoarthritis, primary dysmenorrhea, gout, dental pain, and musculoskeletal disorders Also used for antipyretic effects Naproxen has fewer drug interactions with angiotensin-converting |
| A patient is admitted with salicylate toxicity. When assessing the patient, the nurse anticipates which manifestation associated with salicylate toxicity? Bradycardia Hypoventilation Constipation Hyperglycemia | Hyperglycemia |
| NSAIDs: Interactions | Serious interactions can occur when given with: Anticoagulants Aspirin Corticosteroids and other ulcerogenic drugs Protein bound drugs Diuretics and ACE inhibitors |
| Antigout Drugs | allopurinol (Zyloprim) febuxostat (Uloric) colchicine (Colcyrs) probenecid (Benemid) sulfinpyrazone (Anturane) |
| Antigout Drugs | allopurinol (Zyloprim) Used to prevent uric acid production. Also used to prevent acute tumor lysis syndrome |
| Antigout Drugs | probenecid (Benemid), sulfinpyrazone (Anturane) Inhibit the reabsorption of uric acid in the kidney and thus increase the excretion of uric acid |
| Antigout Drugs | colchicine Reduces inflammatory response to the deposits of urate crystals in joint tissue Used for short-term management or prevention of gout May cause short-term leukopenia and bleeding into the gastrointestinal or urinary tracts |
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