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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