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NCLEX Review Week
| Rights of delegation: | Task, person, communication, feedback/supervision, circumstances |
| LPN's cannot do: | Admissions assessments, IV meds, nursing dx, teaching (can reinforce), complex skills, acute conditions, unstable clients |
| LPN's can do: | Vitals, stable clients, chronic diseases, oral and IM meds |
| UAP's can do: | Feeding, basic hygiene, basic skills, stable clients, chronic diseases, ambulation |
| Steps in processing ethical dilemma | Gather info, examine/determine own vales, verbalize the problem, consider possible courses of action, negotiate the outcome, evaluate the the action |
| Rights of Medication Administration | Patient, route, dose, time, med, right to refuse |
| Antidote for insulin | Glucagon |
| Antidote for magnesium sulfate | Calcium gluconate |
| Antidote for heparin | Protamine sulfate |
| Antidote for digoxin | Digibind |
| Antidote for narcotics | Narcan |
| Antidote for benzodiazapines | Romazicon |
| Antidote for coumadin | Vitamin K |
| Antidote for tylenol | Mucamyst |
| Which do you administer first? Bronchodilators or steroids? | Bronchodilators are administered before steroids |
| Infiltration s/s and interventions | S/S: edema, pain, coolness. Interventions: elevate, compress, apply warm or cold. (This is not an infection, but it does cut off perfusion to tissues) |
| Phlebitis s/s and interventions | S/S: heat, redness, tenderness, not swollen. Interventions: warm, moist compress |
| Hold antineoplastics for platelets <? and neutrophils <? | Platelets: <75,000 Neutrophils: <2,000 |
| Side effects of antineoplastics | Alopecia, stomatitis, anorexia, N/V/D, anemia (give epogen), neutropenia (give neupogen), thrombocytopenia (give interluken-11), elevated uric acid levels (give allopurinol), and tissue irritation at site |
| Antithyroid medications | Tapazole, PTU, iodine |
| Thyroid hormones | Synthroid- needs to be taken on empty stomach, once daily, before breakfast, no multivitamin, antacids, or iron 4 hrs before or after administration |
| Glucocorticoids | Must be tapered; take in AM with food; all end in "-one" or "-sone". Side effects: decreased immune response, decreased inflammation, hyperglycemia, hypokalemia, Na/H2O retention, GI irritation, mood swings. |
| Uses of glucocorticoids | Adrenal insufficiency, arthritis, allergic reactions, cerebral or spinal cord edema, asthmatic attacks, shock, ARDS. Decreases effects of insulin/oral hypoglycemics, diuretics, and K supp. Mask signs of infection |
| Side effects of estrogens | HTN, storke, MI, blood clots, HA, vomiting; exacerbated by smoking |
| Sulfonylureas | Stimulate beta cells to produce more insulin; can cause hypoglycemia; glipizide, glyburide, glimepiride; don't take with ETOH |
| Biguanide | Decrease sugar production in liver and increase insulin sensitivity; metformin (Glucophage); doesn't cause hypoglycemia; give with meals; SE: diarrhea, lactic acidosis |
| Thiazolidinediones | Decrease liver glucose production and enhance insulin utilization; Actos and Avandia |
| Meglitinides | Stimulate release of insulin from beta cells; fast acting/short duration; Starlix, Prandin; Take with meals, don't take if meal is skipped |
| Rapid acting insulin | Must eat immediately, end in "-log" |
| Regular insulin | Short acting, take 20-30 min before meals, used for SS coverage, ONLY insulin that can be given IV |
| Which is mixed first? Regular or NPH | Regular is drawn up before NPH |
| Lantus | Continuous, no peak, usually once a day at bedtime. Can't be mixed with other insulin |
| Sick days (Insulin) | Increased metabolic rate increases need for insulin; check q4-6h; increase intake of high carb fluids |
| Exercise (Insulin) | Body uses more carbs for energy so there is decreased need for insulin; eat a high carb snack before exercise |
| PPI's | Only PO, give before meals, end in "-zole" |
| Antacids | Allow 1 hr between AA and other meds. Aluminum containing=constipation, contain Na; magnesium containing=diarrhea, do not give with renal failure |
| H2 Receptor Antagonists | Block action of histamine which triggers gastric acid secretions; cause diarrhea; end in "-dine" |
| Anticonvulsants | Dilantin, phenobarbital, benzodiazapines (end in "-pam") |
| Dilantin | Used for tonic-clonic seizures; therapeutic blood level: 10-20; SE: drowsiness, gingival hyperplasia, aplastic anemia; give with meals; toxicity: nystagmus, confussion, nausea |
| Valium (Benzodiazapine) | For status epilepticus; CNS depressant, don't take with ETOH; SE: drowsiness, hypotension, tachycardia, resp depression, hepatotoxicity; antidote: romazicon |
| Phenobarbital (Barbiturate) | Longer acting; causes respiratory depression; don't take with ETOH; SE: angioedema and laryngospasm |
| Sulfonamides | Maintain alkaline urine; force fluids. Good for UTI's |
| Tetracycline | Photosensitivity; no milk products 1 hr before and after; drink through straw |
| Aminoglycocides | Oto- and nephrotoxicity (check BUN and Cr); get peak and trough levels |
| Cipro | Force fluids |
| SSRI | Many drug interactions, avoid ETOH; serotonin syndrome if given with MAOI or cold medicine (tachypnea, high temp- CV response); end in "-pram" or "-ine" (citalopram, sertraline) |
| Tricyclic antidepressants | Block reuptake of norepinephrine; use with MAOI's can cause HTN crisis; risk for cardiac toxicity and hypotension; give at bedtime; Tofranil, sinequan, elavil; also used for OCD, panic disorder, insomnia, neuropathic pain, and ADHD |
| MAOI's | Inhibit enzyme monoamine oxidase which results in increased levels of norepinephrine and serotonin; 3rd line drug; tyramine, decongestants, analgesics, and other antidepressant use can cause a HTN crisis. Marplan, Nardil, Parnate |
| Mood stabilizers | Tx bipolar; lithium (narrow therapeutic window 0.6-1.5) check levels q2months, increased level with dehydration, hypernatremia; toxicity leads to renal failure, coma, death |
| Abilify | Atypical antipsychotic |
| Tegretol | Seizure med. Monitor CBC (causes decreased WBC & RBC) |
| Gabapentic (Neurontin) | Diabetic neuropathy pain |
| Seroquel | Atypical antipsychotic |
| Typical antipsychotic meds | Thorazine, Haldol; extrapyramidal side effects |
| Atypical antipsychotic meds | More commonly used because of decreased incidence of extrapyramidal side effects; Abilify, Clozapine, Seroquel, Risperidone |
| Extrapyramidal side effects | Dystonias, Parkinsonism, Akathisia (restlessness, agitation), tardive dyskinesia (repetitive involuntary movements- often irreversible) |
| Neuroleptic malignant syndrome | Life threateningl muscle rigidity, increased temperature, decreased level of consciousness |
| Anticholinergic response | Dry mouth, increased pulse, urinary retention, constipation, hypotension |
| Antianxiety medications | Benzodiazepines and barbiturates; no ETOH; cause CNS depression; need to be tapered; physical dependency |
| Benzodiazepines | End in "-pam" or "-lam"; Alprazolam, Diazepam, Lorazepam |
| Barbiturates | End in "-bital"; phenobarbital, pentobarbital |
| Adrenergic medications | Stimulate the sympathetic nervous system; Epinephrine: non-selective, used as potent vaso-constrictor (shock, cardiac arrest) and as brochodilator (astham, allergic reaction) |
| Beta agonists | Stimulate beta 1&2 receptors; end in "-erol"; used as bronchodilator. Use with caution in HTN, DM, narrow angle glaucoma; Albuterol, Salmetrol |
| Anticholinergics | End in "-pium"; used as brochodilator; block muscarinic receptors in parasympathetic nervous system; SE: dry mouth, constipation; Ipratropium, Theophylline |
| Major side effects of TB meds | Liver toxicity, increased uric acid, peripheral neuritis (give vitamin B); Can't drink ETOH |
| Alpha receptor blockers | Decrease blood pressure by blocking vasoconstriction effect of norepinephrine; end in "-zosin"; Doxazosin (Minipress), Prazosin; Terazosin; can cause orthostatic hypotension; also used to tx enlarged prostate and sexual dysfunction |
| ACE Inhibitors | End in "-pril"; prevent vasoconstriction; SE: cough, increased potassium, orthostatic hypotension |
| Angiotensin receptor blockers | End in "-sartan"; prevent vasoconstriction and decrease aldosterone; SE: Increased potassium, orthostatic hypotension, angioedema |
| Beta blockers | Inhibit beta adrenergic stimulation; end in "-lol"; decrease HR and BP (decrease O2 consumption of heart); used for HTN, glaucoma, prevent MI, and migraines; contraindicated in asthma and bradycardia, mask s/s of hypoglycemia; SE: depression, hypotension |
| Calcium Channel Blockers | Decrease cardiac contractility and conductivity; promote vasodilation; check liver enzymes; "A Very Nice Drug": Amlodipine, Verapamil, Nifedipine, Diltiazem |
| Loop diuretics | Lasix; fast acting; oto- and nephrotoxic |
| Osmotic diuretics | Mannitol; used to prevent renal failure, decrease intraocular and intracranial pressure, and diuresis with chemo; given IV with inline filter; SE: pulmonary edema |
| Thiazide diuretics | HCTZ; not fast acting; causes hyperglycemia |
| Potassium sparing diuretics | Aldactone; Give with food; SE: hyperkalemia (don't give with ACE or ARB) |
| Digoxin | Adult dose: 0.125-0.25 mg; therapeutic level: 0.5-2.0; check K; hold for pulse <60 in adult, <90 in child, apical for full minute |
| Dig toxicity | More common in elderly; abdominal pain, anorexia, N/V (GI often 1st symptom), visual disturbances (yellow halo), bradycardia. Antidote: Digibind |
| Thrombolytics | Break down existing clots, end in "-ase" (streptokinase, alteplase); SE: allergic reaction, dysrhythmias; contraindicated with any kind of bleeding |
| Anticoagulants | Prevent clot formation; Coumadin: PT and INR, antidote is vitamin K |
| Heparin | APTT, antidote: protamine sulfate |
| Antiplatelet | Aspirin; prophylaxis of long term complications |
| Niacin | Decreases cholesterol and triglycerides; SE: flushing |
| Fibric acid derivatives | Tricor, Lopid; decrease triglycerides |
| HMG-CoA reductase inhibitors | Inhibit the enzyme that initiates cholesterol synthesis; Statins; SE: GI, liver toxicity, muscle cramps, fatigue- can be life threatening |
| Contact Precautions | MRSA, VRE, ESBL, CDiff; gloves and gown |
| Strict Precautions | Chicken pox, shingles; gloves, gown, N95 respirator (non-immune staff), and negative pressure room |
| Airborne precautions | TB; Mask, N95 respirator, negative pressure room |
| Droplet precautions | Meningococcal, influenza; mask, eye protection, N95 repirator, negative pressure room |
| Environmental precautions | WBC<1000 or ANC<500; Mask |
Created by:
kahadzima1
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