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Pre-operative
EXAM 3 M6
| Question | Answer |
|---|---|
| Define Anesthesia? | means the absence of feelings (pain), (an, meaning "without," and esthesia, meaning "awareness of feeling"). May be divided into three categories: general, regional, and local |
| Define Embolus? | a thrombus that becomes dislodged and travels through the blood stream. |
| Define Infarct? | localized area of necrosis caused by inadequate blood supply |
| Define Informed Consent? | permission obtained from the patient to perform a specific test or procedure. |
| Define Intraoperative? | during surgery |
| Define Perioperative? | a term used to describe the entire term of the surgery, including what occurs before, during and after the operation. |
| Define preoperative? | begins with the decision to perform surgery and continues until the client has reached the operating area |
| Define Thrombus? | an accumulation of platelets, fibrin, clotting factors, and cellular elements of the blood attached to the anterior wall of the vessel |
| What pre-operative patient teaching is taught? | Turning, coughing, deep breathing, incentive spirometry, leg exercises, early ambulation, and pain management. |
| Why is turing important for a surgical patient? | Improves, venous return, respiratory function, and gastrointestinal peristalsis. |
| How many times an hour post-op should a patient perform deep breathing exercises? | 5-10 times an hour for the first 5 days after surgery during waking hours. |
| Define Homan's sign? | Pain in the calf with dorsiflexion of the foot, indicating thrombophlebitis or thrombosis. |
| Define SCD? | Sequential Compression Devices (SCD) |
| List the points that should be included in incentive spirometer patient teaching? | Have patient sit upright with head of bed elevated 45 degrees, Instruct the patient to take 2-3 normal breaths and then insert the spirometer's mouthpiece, Inhale through the mouth and hold their breath for 3-5 seconds, exhale slowly and fully. |
| What form should be completed for the Administration of Anesthesia and for performance of operations and other procedures? | SF 522 |
| What gastrointestinal preparation should be done before surgery? | At midnight before surgery, the client is placed on NPO status, NPO sign placed over the client's bed, all fluids removed from the room, and a bowel cleanser may be ordered. |
| what are the 3 types of anesthesia that may be used during a surgical procedure? | General, Regional, and Local. |
| Define Elimination? | The process that removes drugs from the body. |
| Define Half Life? | The time required to reduce the concentration of a drug in the body by half. |
| Define Analgesia? | The inability to feel pain though conscious. |
| Define Autonomic Stability? | Relative sympathetic and parasympathetic nervous system homeostasis. |
| Define muscle relaxation? | The inability of the muscles to contract or remain resting tone. |
| What situation is general anasthesia used? | Used for major procedures requiring extensive tissue manipulation. |
| What are the 3 stages of Anasthesia? | Induction phase, maintenance phase, emergence phase. |
| What is Malignant hyperthermia? | Uncommon but potentially fatal rapid rise in bocy temperature, tachycardia, tachypnea and muscle rigidity. Children, adolescents and those with skeletal or muscular abnormalities are at increased risk. |
| What are the benefits of moderate sedation? | Does not cause complete loss of consciousness, does not normally cause respiratory arrest, and allows for relaxation, reduction of anxiety and allows the patient to respond verbally and maintain own airway. |
| Define Spinal Anesthesia? | Intrathecal/Subarachnoid block where an anesthetic agent is delivered to the subarachnoid space. |
| Define Epidural? | Local anesthetic is delivered to the epidural space located between the Dura and overlying connective tissue, commonly used during labor and delivery. |
| Define Nerve Block? | Anesthetic solution is injected at the site where a nerve innervates a specific area. |
| Define Infiltration? | Anesthesia injected into the tissue that surrounds the operative area, used for procedures-wound suturing or dental surgery and is often used with agents that cause constriction of local blood vessels. |
| What are some common agents used in moderate/conscious sedation? | Opioids, sedatives/Benzodiazepines and combinations of medications. |
| Who must monitor a the consciously sedated patient? | An RN. |
| What role does the Surgeon play in a surgical team? | Responsible for performing the surgery in a safe and effective manner, and leader of the surgical team. |
| Who counts the sponges, needles, and instruments? | Both the scrub nurse and the circulating nurse. |
| What are the risk factors and potential complications of surgery? | Infection- Catheters, drains, surgical wound, burns, hypothermia, hyperthermaia, bleeding/hemorrhage, pressure sores and trauma injuries. |
| What are are the primary nursing interventions in the immediate postoperative phase? | A-Airway, B-Breathing, C-Circulation, C-Consciousness, S-System review. |
| What post anesthesia patient care would you apply to the patients Airway? | Head position, Gag/swallow reflex, Suction, Oxygen. |
| What post anesthesia patient care would you apply to the patients Breathing? | Evaluate depth, rate, rhythm, and chest movement, mucous membranes, coughing and deep breathing exercises, chart time oxygen is discontinued and O2 saturation. |
| What post anesthesia patient care would you apply to the patients Circulation? | Monitor T, P, R, and B/P every 10 to 15 min, assess pulse, evaluate skin and nail beds, peripheral pulses as indicated, incision/dressing, monitor wound drainage output, IV's solution (rate and site), and cardiac monitors. |
| What post anesthesia patient care would you apply to the patients consciousness? | Able to extubate, patient responds to commands, verbalizes responses, and reacts to stimuli. |
| What post anesthesia patient care would you apply to the patients System? | System Review: Neurological functions, drains and tubes, dressings, pain, allergic reactions, urinary output. |
| How often are vital signs checked in the post-anesthesia care unit (PACU)? | Minimum every 15 minutes. |
| What are are the primary nursing interventions in the immediate postoperative phase? | A-Airway, B-Breathing, C-Circulation, C-Consciousness, S-System review. |
| What post anesthesia patient care would you apply to the patients Airway? | Head position, Gag/swallow reflex, Suction, Oxygen. |
| What post anesthesia patient care would you apply to the patients Breathing? | Evaluate depth, rate, rhythm, and chest movement, mucous membranes, coughing and deep breathing exercises, chart time oxygen is discontinued and O2 saturation. |
| What post anesthesia patient care would you apply to the patients Circulation? | Monitor T, P, R, and B/P every 10 to 15 min, assess pulse, evaluate skin and nail beds, peripheral pulses as indicated, incision/dressing, monitor wound drainage output, IV's solution (rate and site), and cardiac monitors. |
| What post anesthesia patient care would you apply to the patients consciousness? | Able to extubate, patient responds to commands, verbalizes responses, and reacts to stimuli. |
| What post anesthesia patient care would you apply to the patients System? | System Review: Neurological functions, drains and tubes, dressings, pain, allergic reactions, urinary output. |
| How often are vital signs checked in the post-anesthesia care unit (PACU)? | Minimum every 15 minutes. |
| What is spinal anesthesia used for? | Lower abdominal, pelvic procedures, lower extremity procedures, urology procedures, and surgical obstetrics. |
| What are some risks during spinal anesthesia? | Migration of drug, amount, and patient position. Vasodilation/decrease in BP, and respiratory paralysis. |
| What should you monitor during spinal anesthesia? | Monitor the vital signs q 3 to 5 minutes until patient is stable, LOC, level of anesthesia, physical assessment, and proper position. |
| What vital signs are most important to monitor in the recovery of a patient with spinal anesthesia? | Respiratory rate and blood pressure. |
| What are the potential postoperative complications? | Nausea and vomiting, aspiration, hypothermia/hyperthermia, larynospasm, hypoxia, hemorrhage, pain, hypovolemic shock, decreased absent urine output, and increase/decrease IV input. |
| List the things you need to document during your postoperative assessment? | Identify patient, time patient arrived, LOC, safety measures, vital signs, type of anesthesia given, type of procedure, medications pre/post-op, surgeon, output, IV's, drains, dressing, discharge/exudate, wound packs, estimated blood loss(EBL),and pain. |
| How do you prevent venous stasis in a post-op patient? | Have the patient move legs frequently and do leg exercises, don nout use pillows under knees or calves, avoid pressure to lower extremities, use antiembolism stockings, ambulate as ordered, heparin, and sequential compression device. |
| When are dressings changed post-op? | Dressings are not usually changed for 24 hours post op. |
| What are some nursing interventions for a post-op patient in pain? | Decrease external stimuli, reduce interruptions, deep breathing and relaxation techniques, back run, ventilation of feeling/concerns, diversional activities, reposition, tube placement, neat/restful environment, asses pain q 3-4 hours. |
| What does PCA stand for? | Patient controlled analgesia. |
| What is a PCA and what does it do? | A pump that has a predetermined amount of analgesic,Programmed to allow only a specified amount of analgesic to be dispensed, Self-administered by pressing a control button, The PCA unit should be monitored closely every 3 to 4 hours. |
| What does TENS stand for? | Transcutaneous electric nerve stimulation. |
| What does Transcutaneous electric nerver stimulation do? | Attached to the skin and applies electric impulses to block pain signals to the brain. |
| Explain the postoperative patient recovery period? | Begins when the patient arrives in the hospital room or a post-surgical unit, extends until after disharge from the hospital and ends when full activity is resumed. |
| What are the major goals of nursing management are prevention and detection of complications? | Prevent injury, regain independence, and patient education. |
| Pain medication should be timed in relation to? | Activities, such as dressing changes or ambulation. |
| Because a surgical patient's condition may change rapidly during the immediate postoperative recovery, the nurse should monitor the patient's status at least every______ minutes. | 15 minutes. |
| Define Pulmonary embolism? | Obstruction of one or more arterioles originating in the venous system. |
| What are the signs and symptons of a Pulmonary embolism(PE)? | Sharp, stabbing chest pain, cyanosis, anxiety, profuse diaphoresis, rapid, irregular pulse, dyspnea, tachypnea. |
| What are some nursing interventions for a Pulmonary Embolism (PE)? | Administer oxygen, have patient sit in an upright position, reassure and comfort patient, monitor vital signs, EKG, and ABG's, Administer analgesics as ordered, initiation of thrombolytic therapy, and notify charge nurse STAT. |
| Define Pneumonia? | Inflammation of the alveoli as a result of an infectious process or foreign material. |
| What causes Pneumonia? | Aspiriation, infection, depressed cough reflex, dehydration, immobilization, and increased secretions from anesthesia. |
| What are the signs and symptoms of pneumonia? | Elevated temperature, chills, crackles or wheezes on auscultation, dyspnea, chest pain, and reproductive cough. |
| What are some nursing interventions for pneumonia? | Semi-Fowlers to facilitate lung expansion, administer 02 as ordered, maintain nutritional/fluid status, encourage turning, coughing, and deep breathing, frequent oral hygiene, proper disposal of tissue and sputum, rest and comfort, and emotional support. |
| What is singultus? | Hiccups |
| what are some nursing interventions for hyperthermia? | Administer antipyretics as ordered, and apply hypothermia blanket as ordered. |
| What should you monitor a post-op patients I&O's for? | Assess for bladder for distention within 8 hours after surgery, or when the patient voids, maintain IV fluids as ordered, encourage PO fluids as ordered and tolerated, provide privacy and chatherize as ordered. |
| Why would a patiet contact their physician after discharge? | Fever/chills, drainage from incision, foul odor or pus from an incision, redness, streaking pain or tenderness. |
| List 4 possible comfort measures for the patient with nausea and vomiting. | Maintain clean environment, provide frequent oral hygiene, encourage sips of liquids at frequent intervals, and administer medications as ordered. |
| Define Infection? | The invasion and multiplication of infective agents in the body. |
| What are the phases of wound healing? | Hemostasis, Inflammatory Phase, Reconstruction Phase, and Maturation Phase. |
| Define Hemostasis? | Termination of bleeding. |
| Define the Inflammatory Phase? | Initial increase in blood elements and water flow from the vessels to the vascular space. |
| Define the Reconstruction Phase? | Collagen formation from fibroblasts at wound site. Begins 3rd or 4th day after injury. |
| Define the Maturation Phase? | Roughly 3 weeks after surgery fibroblasts begin to exit the wound. Scar Developes. |
| In reguards to wound healing what is Primary Intention? | When wound edges are directly next to one another, little tissue loss, minimal scarring occurs, most surgical wounds heal be first intention healing, wound closurei sperformed with sutures, staples, or adhesive at the time of initial evaluation. |
| In reguards to wound healing what is Secondary Intention? | The wound is allowed to granulate, May be packed a wound with gauze or use a drainage system, results in a broader scar, healing process is slow, and wound care must be performed daily. |
| In reguards to wound healing what is Delayed Primary Closure? (Tertiary Intention) | The wound is initially cleaned, debrided and observed, typically 4 or 5 days) before closure, the wound is purposely left open. |
| What are some factors that complicate the wound healing process? | Extent of the injury, type of injury, patient nutritional status, age of patient, obesity, infection, drugs, diabetes mellitus, and smoking. |
| What are some wound complications? | Abscess, adhesion, cellulitis, dehiscence, evisceration, extravasations, hematoma, and compartment syndrome. |
| Define compartment syndrome? | A progressive degeneration of tissue and muscle caused by a severe interruption of blood flow. |
| What are the signs and symptoms of Compartment Syndrome? | Pain with pressure, diminished sensation distal to the compartment area, and diminished to absent extremeity pulses distal to the injury. |
| What are the signs and symptoms of internal bleeding? | Dressing may remain dry, increased thirst, restlessness, rapid/thready pulse, decreased blood pressure, decreased urinary output, cool clammy skin, abdomen rigid and distended, and hypovolemic shock. |
| What signs and symptoms might tell you that a wound has become infected? | Purulent (pus) drainage, foul odor, brown/yellow/green, fever, tenderness, pain, edema and elevated WBC. |
| Which wound complication is a surgical emergency? | Evisceration |
| What supplies do you need to do a dry sterile dressing change? | Gloves, gauze, tape, basin, NSS, 30-60 ml syringe, and pad. |
| When do you change out wet to dry dressings? | Dressings are changed per doctor's orders, or when the wound requires an assessment, care,the drssing has becom loose or saturated. |
| What are the steps to applying a wet to dry dressings? | Assemble required equipment, use sterile technique, remove the dressing, do not tear the wound or dislodge drains, sterile saline to moisten dressing sticking, assess old dressing, assess the wound bed tissue, irrigating and clean as prescribed. |
| What are the steps to applying a wet to dry dressing? (part II) | The drssings that touch the wound directly will be dampened, never allow to dry out, the outer dressings are applied dry and never form a constricting band with tape. |
| What types of wounds would require a wet to dry dressing? | Abdominal evisceration, dehiscence, infected open wounds, pressure ulcers and diabetic foot ulcers. |
| What are the possible types of drainage you might find coming from a wound? | Serous, Sanguineous, Serosanguineous, and purulence. |
| How much exudate/drainage from a wound is considered abnormal? | 300ml in the first 24 hours. |
| What are some wound drainage systems? | Penrose drain, Jackson-Pratt, hemovac drainage systems. Penrose drains are open drainage systems, while Jackson-Pratt and Hemovac are closed systems. |
| What are some things you need to document when it comes to wound care? | Location, size (length x width x depth), drainage type and amount, odor, neurovascular status and peripheral vascular status-depending on site of injury. |
| What are some potential nursing diagnosis for a patient requiring wound care? | Potential for infection related to alteration in skin integrity, alteration in comfort related to injury, and knowledge deficit related to wound care. |
| How do you evaluate wound healing? | Reduced size, depth, increase in granulation tissue, free of signs and symptoms and relief of pain. |
| Describe Serous drainage? | Clear to straw colored fluid. |
| Describe Sanginous? | Red/bloody fluid. |
| How much fluid is anticipated when using a Jackson-Pratt drainage system? | 100-200ml |
| How much fluid is anticipated when using a Hemovac drainage system? | 500ml |
| Define Acute pain? | pain-sudden in onset, usually subsides when treated & typically occurs over less than a 6 week period. |
| Define Addiction? | primary, chronic, neurobiologic disease whose development is influenced by genetic, psychosocial and environmental factors. Also referred to as Psychologic Dependence. |
| Adjuvant analgesic drugs? | drugs that are added as a second drug for combined therapy and may have additive or independent analgesic properties or both. |
| Define Agonist? | Substance that binds to a receptor and causes a response. |
| Define Analgesics? | Medications that relieve pain without causing a loss of consciousness. |
| Define Antagonist? | A drug that binds to a receptor and prevents (blocks) a response. |
| Define Chronic pain? | Pain that lasts longer than 6 months. |
| Define Narcotics? | Originally applied to drugs that produce insensibility or stupor. Currently used in clinical setting to refer to any medically used controlled substance. Falling out of favor-substituting the term Opioid. |
| Define NSAID's? | A large chemically diverse group of drugs that are analgesics and also possess anti-inflammatory and antipyretic activity but are NOT steroids. |
| Define Opioid analgesics? | Synthetic drugs that bind to opiate receptors to relieve pain but are not derived from the opium plant |
| What are Synergistic effects? | Drug interactions in which the effect of a combination of two or more drugs with similar actions is greater that the sum of the individual effects of the same drugs given alone. |
| Define antibiotic? | Having or pertaining to the ability to destroy or interfere with the development of a living organism. |
| Define Antiseptic? | A chemical that inhibits the growth and reproduction of microorgansims without necessarily killing them. |
| Define Bactericidal antibiotic? | Antibiotics that kill bacteria. |
| Define Bacteriostatic antibiotics? | Antibiotics that do not actually kill bacteria but inhibit their growth. |
| Define Colonization? | The establishment and growth of microorgansims on the skin, open wounds or mucous membranes or in secretions without causing adverse clinical signs or symptoms. |
| Define Definitive therapy? | The administration of drugs based on known results of culture and sensitivity testing identifying the pathogen causing infection |
| What is a disinfectant? | A chemical applied to nonliving objects to kill microorganisms. |
| What is Empiric therapy? | The administration of drug based on the practitioner’s judgment of the most likely causing pathogen. |
| What is prophylactic antibiotic therapy? | Antibiotics taken before anticipated exposure in an effort to prevent the development of an infection. |
| Define Subtherapeutic? | Referring to antibiotic treatment that is ineffective. |
| What is a Superinfection? | An infection resulting from overgrowth of an organism not susceptible to the antibiotic used. |
| Define synergistic effect? | Drug interaction in which the bacterial killing effect of two antibiotics given together is greater than the sum of the individual effects of the same drugs given alone. |
| How are antibiotics classified? | Antibiotics are divided by categories and mechanisms of action. |
| What are the categories of antibiotics? | Sulfonamides, penicillins, cephalosporins, macrolides, quinolones, aminoglycosides, tetracyclines. |
| How do Sulfonamides work? | Bacteriostatic antibiotic-does not kill the bacteria but does inhibit growth. Inhibiting the growth of bacteria, allows the patients' immune system to fight off the existing bacteria without becoming overwhelmed with the growth of more bacteria. |
| Which types of bacteria do sulfonamides work on? | Have a broad spectrum antibacterial activity cts on both gram positive and gram negative bacteria. |
| What are some of the adverse effects of Sulfonamides. | Rash (extreme is Toxic epidermal necrolysis), Steven-Johnson syndrome, photosensitivity, GI upset, hepatotoxicity,pancreatitis, aplastic anemia, hemolytic anemia, thrombocytopenia |
| How do Penicillins (PCN) work on bacteria? | Bactericidal antibiotic, kills the bacteria by inhibiting cell wall synthesis. 4 subgroups of PCN that can act on either gram positive or gram positive and gram negative bacteria. |
| Where in the body are Penicillins eliminated? | Penicillins are eliminated through the kidneys. |
| What are some adverse effects of Penicillin? | Rash, pruritis, hives, Steven-Johnson syndrome, anaphylactic reaction, GI upset, abdominal pain, taste alterations, oral candidiasis, anemia, granulocytopenia, increased bleeding times, and bone marrow depression. |
| What are some interactions with Penicillin? | Reduce the efficacy of oral contraceptives, Potentiate anticoagulant effects of warfarin (leading to possible hemorrhage), Rifampin inhibits the action of PCN, Probenecid (gout medication) prolongs the effects of PCN. |
| How do Cephalosporins work on bacteria? | Bactericidal antibiotic- kills the bacteria by interfering with cell wall synthesis, Have a broad spectrum antibacterial activity –effects on gram positive , gram negative bacteria and anaerobic bacteria will depend on the generation of Cephalosporins. |
| Where are cephalosporins eliminated in the body? | Cephalosporins are eliminated through the kidneys. |
| What are some contraindications/considerations when using Cephalosporins? | Contraindications the same as for PCN. Because Cephalosporins are chemically related to PCN-if patient is allergic to PCN they may also have an allergic reaction to Cephalosporins. |
| What are some adverse effects of Cephalosporins? | Rash, Pruritis, hives, Steven-Johnson syndrome, Anaphylactic reaction, GI upset, abdominal pain, taste alterations, oral candidiasis, anemia, granulocytopenia, increased bleeding times, and bone marrow depression. |
| What interactions should be considered with Cephalosporins? | ) Reduce the efficacy of oral contraceptives. Potentiate effects of alcohol intake. Antacids and iron decrease effectiveness of cephlosporins, Probenecid (gout medication) prolongs the effects of cephlosporins. |
| How do Macrolides work on bacteria? | Bacteriostatic antibiotic-does not kill the bacteria but does inhibit growth. In high concentrations will have bactericidal properties. |
| Macrolides are considered what kind of antibiotic? | Have a broad spectrum antibacterial activity especially effect bacterial species that reproduce inside host cells instead of in bloodstream or interstitial spaces. |
| Where are Macrolides metabolized in the body? | Macrolides are metabolized in the liver. |
| What antibiotics contraindicated during pregnancy? | MCAT: Metronidazole, Chloramphenicol, Aminoglycoside, Tetracycline |
| What are some adverse effects of Macrolides? | Rash, pruritus, urticaria, thrombophlebitis at IV site, Chest pain, palpitations, prolonged QT interval (rare), GI upset, hepatotoxicity, pancreatitis, headache, vertigo, tinnitus, and hearing loss. |
| What are some interactions with Macrolides? | Macrolides potentiate the effects of carbamazepine (Tegretol), cyclosporine, digoxin, theophylline and may cause toxicity. Potentiate anticoagulant effects of warfarin (leading to possible hemorrhage). |
| What types of medications can macrolides interact with? | Should not be given with medications that prolong QT interval, and oral contraceptives. |
| How do Quinolones (sometimes referred to as Fluoroquinolones) work on bacteria? | Bactericidal antibiotic-kills bacteria by altering bacteria’s DNA. Have a broad spectrum antibacterial activity –acts on both gram negative and selected gram positive bacteria. |
| Where is Quinolones eliminated in the body? | Quinolones are eliminated through the kidneys. |
| When are Quinolones contraindicated? | Contraindicated in known drug allergy and prepubescent children (affects cartilage development in laboratory animals). |
| What are some adverse effects of Quinolones? | BLACK BOX WARNING-Tendonitis, rash, pruritus, urticaria, photosensitivity reactions, flushing, GI upset, dysphagia, constipation, increase in AST and ALT, aplastic anemia, hemolytic anemia, thrombocytopenia, fever, chills, blurred vision, tinnitus. |
| How might Quinolones affects a patient on antidysrhythmic drugs? | Prolonged QT interval when taken with Class Ia and III antidysrhythmic drugs. |
| What should not be taken with Quinolones? | Do not give with milk, antacids or iron or zinc salts, oral absorption of drug is reduced. |
| What possible interactions can occur with Quinolones? | Potentiate anticoagulant effects of warfarin (leading to possible hemorrhage), Take Ca++ or Mg++ preparations one hour before or one hour after taking Quinolones, Probenecid (Tegretol) reduces renal excretion, and oral birth control. |
| How do Aminoglycosides affect bacteria? | Bactericidal-kills bacteria by interfering with protein synthesis, used for serious gram negative infections and specific gram positive cocci bacteria. |
| How are Aminoglycosides eliminated from the body? | Eliminated through the kidneys-Highly nephrotoxic and ototoxic. Use with extreme caution in patients with pre-existing renal impairment. |
| What contraindications are there with Aminoglycosides? | Contraindicated in known drug allergy, can cross the placental barrier and cause fetal harm. Avoid administration to lactating women. |
| What are some adverse effects of Aminoglycosides? | Highly nephrotoxic-will see urinary casts, proteinuria, increased BUN and serum creatinine, ototoxic –hearing loss is not reversible and is dose dependant, dizziness, tinnitus, rash, fever, headache, and paresthesia (pins and needles). |
| What are some examples of an Aminoglycosides? | Amikacin-Amikin, Gentamicin-Garamycin, Tobramycin--Nebcin. |
| How do Tetracyclines work on bacteria? | Bacteriostatic antibiotic- inhibit growth by interfering with protein synthesis, have a broad spectrum antibacterial activity –acts on many resistant bacteria. |
| Where are Tetracyclines eliminated in the body? | Tetracyclines are eliminated through the kidneys and liver. |
| When are Tetracyclines contraindicated? | Contraindicated in known drug allergy, pregnant and nursing women and pediatric patients under the age of 8 due to tooth discoloration. |
| What are some adverse effects of Tetracycline? | Discoloration/hypoplasia of tooth enamel in children and fetus, retarded fetal skeletal development if taken during pregnancy, rash, photosensitivity reactions (mainly with Demeclocycline),hepatotoxicity, pancreatitis,aplastic anemia, hemolytic anemia. |
| What are some possible interactions of Tetracycline? | Do not give with milk, antacids or iron salts, oral absorption of drug is reduced, Potentiate anticoagulant effects of warfarin (leading to possible hemorrhage), and reduces efficacy of oral contraceptives. |
| What are some examples of Tetracycline? | Demeclocycline-Declomycin, Doxycycline-Doryx. |
| What should the nurse assess the patient for prior to antibacterial therapy? | Hypersensitivity, antibiotics, particularly the penicillins, have been associated with serious hypersensitivity reactions. A complete drug history helps identify possible hypersensitivity or cross-sensitivity. |
| What are Fungi? | Funji are a large and diverse groups of microorganisms. |
| What kinds of Fungi are there? | Yeast—single cell fungi, Molds–multicellular fungi, |
| What are infections caused by a fungus called/labeled? | Infections caused by a fungus is labled a MYCOSIS. |
| What range of severity can fungal infections cause? | Range from mild with irritating symptoms ex: Athlete’s foot to Life Threatening systemic fungal infections. |
| How are fungal infections spread? | Can be acquired by inhaling, ingesting, or cutaneous contact. |
| What are the categories of antifungal medications? | Fungal infections are categorized as: Superficial/Topical or Systemic. |
| How do antifungal medications work? | Interference with cell replication, interference with cell wall structure, can be either fungistatic or fungicidal. |
| What are some Superficial/Topical antifungal drugs and how do they work? | Terbinafine/Lamisil, Interferes with cell wall synthesis. |
| What fungal infections does Terbinafine/Lamisil treat? | Used to treat tinea pedia, tinea cruris, tinea corporis and onychomycoses of the fingernails or toenails. |
| When is Terbinafine/Lamisil contraindicated? | Contraindicated in known hypersensitivity to drug or liver disease. Use with caution in patients with a history of Alcoholism. |
| What are some adverse effects of Terbinafine/Lamisil? | Headache, dizziness, GI upset, rash, pruritis, alopecia(hair loss), and fatigue. |
| What are some interactions with Terbinafine/Lamisil? | Interactions are rare but when given with another nephrotoxic drug, increased nephrotoxicity. |
| Name a systemic antifungal drug? | Amphotericin B-drug of choice for many severe systemic fungal infections. Is the oldest of antifungal drugs and has major adverse effects. |
| When is Amphotericin B contraindicated? | Contraindicated in known hypersensitivity to drug, patients with renal impairment or bone marrow suppression. |
| What administration route is Amphotericin B available in? | Amphotericin B iss available in injectable, oral or topical preparations. |
| What are some adverse effects of Amphotericin B? | Fever, chills, malaise, headache, Tachycardia hypotension, GI upset and joint/muscle pain. |
| What drugs might the patient be premedicated with prior to being administered Amphotericin B? | Premedication with antiemetics, antihistamines, antipyretics and corticosteroids may minimize infusion related reactions. Adverse effects may also be reduced by extending infusion times (give slower). |
| What interactions should be considered before administering Amphotericin B? | Give with Digitalis (digoxin), Amphotericin induced hypokalemia may increase the potential for digitalis toxicity, nephrotoxic drug increased nephrotoxicity, thiazide diuretics will increase potential for hypokalemia. |
| What administration routes are avialable for Amphotericin B? | Amphotericin B is available in injectable or oral preperations. |
| What are some adverse effects of Amphotericin B? | GI upset, increased liver enzyme levels, and dizziness. |
| What are some possible interactions with Amphotericin B? | If given with Cyclosporine, Phenytoin (Dilantin), or immunosuppressant there will be an increased plasma concentration of both drugs. Potentiates anticoagulant effects of warfarin (leading to possible hemorrhage). |
| What effects does Amphotericin B have with oral hypoglycemic's? | with a oral hypoglycemic agent there will be a reduced metabolism of hypoglycemic drugs. |
| What should the nurse assess before administering Amphotericin B? | Assess vital signs and lab results before and throughout therapy, CBC, K, Na, Ca, Mg, Liver function test, + BUN (>40mg/dL), creatinine (>3mg/dL) may indicate renal toxicity,+ AST, ALT, alk phos, bilirubin may indicate hepatotoxicity. |
| What should the nurse monitor throughout Amphotericin B therapy? | Monitor weight throughout therapy—indication of renal involvement, +2lbs or more in 24 hours or +5lbs or more in a week. |
| A client with a fungal infection is taking fluconazole (Diflucan). The nurse explains that although this drug is generally well tolerated, possible adverse effects include which of the following? | Gastrointestinal upset. Fluconazole is well tolerated. Adverse effects include headache, gastrointestinal upset, and dizziness. |
| What are viruses? | Viruses are very small microorganisms that can only reproduce or replicate inside a cell of a host. |
| What type of host can a virus attach itself to? | Host can be human, animal or plant. |
| How do viruses enter the body? | Can enter the body by inhalation, ingestion, transplacentally or via inoculation through the skin or mucous membrane. |
| What are the inoculation routes for viruses? | Inoculation route includes sexual contact, blood transfusion, use of shared needles, organ transplantation or bites (animal, insect, spider, human etc). |
| How are viruses replicated? | Viruses are replicated in either host DNA or RNA. |
| How do Antiviral drugs work? | Antiviral drugs are chemicals that kill or suppress viruses by either destroying or inhibiting ability to replicate. |
| What are immunoglobulins? | Immunoglobulins are concentrated antibodies that attach and destroy viruses. |
| What do Interferons do? | Interferons simulate the body’s immune system to kill the virus. |
| What is Acyclovir used to treat and what are it's side effects. | Acyclovir-used to treat Herpes viruses, side effects include GI upset, headache, transient burning when used topically. |
| What is Ribavirin (Virazole) used to treat and what are it's side effects? | Ribavirin (Virazole)-used to treat respiratory syncytial virus. It's side effects include rash, conjuctivitis, anemia, and bronchospasms. |
| What are some interactions that Acyclovir has? | Acyclovir may have additive CNS and nephrotoxicity with drugs causing similar adverse reactions. |
| What are some interactions that Ribavirin can have? | Ribavirin will have increased risk of hepatotoxicity and lactic acidosis if given with another antiviral drug. |
| When administering Antivirals what should you monitor your patient for in reguards to input/output? | Nephrotoxicity: hematuria, oliguria, fatigue, weakness, and protein in urine. |
| What labs should be done for a patient about to recieve antiviral medication? | Hepatic: AST (Aspartate transaminase), ALT (Alanine transaminase), CBC, PT (prothrombin time), and Renal: UA, protein, BUN, and creatinine. |
| What should implementation measures should be taken while giving antiviral therapy to your patient? | Most systemic antiviral agents should be administered around the clock to maintain therapeutic serum drug levels. Also Increase fluids to 3 liters per day to decrease crystalluria (crystals in the urine) with IV administration. |
| Before administering an antiviral medication the nurse should question the client about their: | Use of OTC or herbal medications. A complete nutritional, medical and pharmaceutical history must be obtained before administering antiviral medications. |
| Define Parasite? | An organism that lives in or on another organism without contributing to the survival or well being of the host. |
| Define Helminthiasis? | Helminthiasis is an invasion of the body by worms (helminthes). |
| Define Amebiasis? | Invasion of the body by an ameba. |
| Define Malaria-protozoal? | Disease with worldwide death rate of 1-2 million per year caused by the organism organism Plasmodium protozoa. There are 4 species of Plasmodium protozoa transmitted by mosquito bite. |
| What is Malaria? | Infectious disease caused by a protozoan and transmitted to humans through the bite of an infected mosquito. |
| What are the two life cycle stages of Plasmodium protozoa? | Sexual inside mosquito, asexual inside host liver and erythrocytes. |
| How do antimalarial drugs work? | Antimalarial drugs only affect the asexual lifecycle, are dependent on the species and its susceptibility, doses depend on whether the drug is being used as prophylaxis or for actual disease. |
| What are Antimalarial drugs mechanism of action? | Interferes with parasite protein synthesis and interferes with the parasites ability to use erythrocyte hemoglobin |
| What are some contraindications of Antimalarial drugs? | Known drug allergies, caution with pregnant women, tinnitus, and reanl, hepatic or hematologic dysfunction. |
| What are the adverse effects of Chloroquine? | GI upset, diarrhea, abdominal distress, dizziness, anxiety headache, reduced seizure threshold, Alopecia (hair loss), rash and pruritus. |
| What are the adverse effects of Mefloquine? | GI upset, abdominal pain, headache, pruritus, dark urine, and hemolytic anemia. |
| What are some interactions with Chloroquine? | If given with anti-seizure medications will result in the loss of seizure control. |
| What are some interactions with Mefloquine? | If given with Beta-blockers, calcium channel blockers or quinidine will increase the risk of dysrhythmias, seizures, and cardiac arrest. |
| What are som interactions with Primaquine? | If given with other hemolytic drugs, will increase risk for myelotoxic effects (muscle weakness). |
| When should treatment start and stop in requards to traveling to a malarious area? | Start treatment two weeks prior to exposure and continue for 4-6 weeks after leaving malarious area. |
| What should malaria drugs be given with and how can it be taken? | Administer with milk or meals to minimize GI distress and tablets may be crushed. |
| What are the causative agents of a helminithic infection? | Platyhelminthes-flatworms, Cestodes-tapewprms and Trematodes-flukes. |
| What must be identified before administering Antihelmintic drugs? | Antihelmintic drugs are specific in their action and require that the causative worm be identified before treatment is begun. |
| What are some contraindications of Antihelmintic drugs? | Known drug allergy to specific agent. Use with caution in patients with liver disease, seizure disorders or pregnant women. |
| Therapy with hydroxychloroquine (Plaquenil) should continue while in a malarious country and for up to how long after leaving the affected area? | 4 weeks. Hydroxychloroquine suppressive therapy should be initiated 2 weeks before exposure to a malarious area and continued throughout the duration of the stay. Therapy should be maintained for 4 weeks after leaving the malarious region |
| Which antibiotics are Cell Wall inhibitors? | Penicillins and Cephalosporins. |
| Which antibiotics inhibit Protein Synthesis? | Macrolides, Aminogylcosides, and Tetracyclines. |
| Which antibiotics are Bactericidal? | Quinolones (Fluoroquinolones) and Sulfonamides. |
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