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Exam 4 material Bl 1
Exam 4
| Question | Answer |
|---|---|
| Example of an opioid | Morphine, Demerol, Percocet |
| what is the antidote for opioids | Narcan |
| opioids are contraindicated in what conditions | Respiratory disease, and allergy |
| dangerous interactions with opioids | other CNS depressants, alcohol |
| adverse effects of opioids | respiratory depression, constipation, ALOC, itchy, |
| Signs of opioid withdraw | irritability, diaphoresis |
| potent opioid that is toxic, and can be used for 3-4 days only | meperidine |
| example of a non opioid | acetaminophen |
| actidote for non opioid | acetyleystene |
| Max daily dosage of acetaminophen | 4000mg daily |
| Acetaminophen is contraindicated in what condition | liver disease, and during alcohol use |
| acetaminophen is indicated for what | mild to moderate pain or fever |
| Examples of NSAID's | ibuprofen, aleve,aspirin |
| NSAID's are indicated for what | pain, bone pain |
| NSAID's are contraindicated in what | Kidney disease, gi issues |
| Action of NSAID's | they decrease prostaglandin production |
| adverse effects of NSAID's | GI upset, Renal failure, Bleeding |
| Signs of toxicity of NSAID's | tinnitus, hypo-ventilating |
| administration of NSAID's | always take with food |
| metformin precautions | hold drug 48 hrs before and after any procedure with contrast. |
| mixing unsulin, which one first | clear before cloudy |
| rapid acting insulin parameters | onset: 5-15 min, peak: 1-2 hours, duration: 3-5 hours |
| short acting insulin parameters | onset: up to 30 min, peak: 2-3 hours, duration: 3-6 hours |
| intermediate acting insulin parameters | onset: 2-4 hours, peak: 4-12 hours, duration: 12-18 hours |
| long acting insulin parameters | onset: 6-10 hours, peak: 10-30 hours, duration: 30-36 hours |
| Thyroid replacement hormone prototype | synthroid |
| Biguanides | (Metformin) acts on liver, decreasing the production of glucose from glucogen. |
| Thiazolidizones | (Rezulin) Acts in the muscles making the muscles more sensitive to insulin. |
| Solfonylureas | (Glipizide) Stimulate the beta cells in the pancreas to increase production of insulin. These were the fiirst insulins from the 1950's |
| Meglitinides | Starlix) Stimulates the beta cells to increase production of insulin, need to be taken with each of 3 meals |
| Alpha Glucosidase | (Precose) Blocks the breakdown of starches and slows the breakdown of some sugars like table sugar, slowing the rise in bloodsugar after meals. may be combined with sulfonylureas. |
| Avandia | is a thiazolidinedione. can be used with insulin or metformin |
| where do Biguanides act | in the liver. keeps liver from releasing too much glucose |
| where do Thiazolidinediones act | In the muscle cells. it makes muscle cells more sensitive to insulin. |
| where do Sulfonulureas act | in the pancreas. stimulates pancreas to release more insulin |
| where do meglitinides act | in the pancreas. stimulate release of insulin |
| Where do alpha glucosidase inhibitors act | in the intestine. it slows the digestion of some carbs. after meal blood glucose spikes are not as high. |
| Opioids Indications | Moderate to severe pain |
| Agonists (opioid) | bind to opioid receptor in brain causing analgesic response or decrease in pain. |
| Mild Opioids | Codeine, Vicodin, Darvon |
| Strong Opioids | Morphine, Dilaudid, Levodromoran, Oxycontin, Opana, Demerol, Methadone. |
| Partial agonists (opioid) | Talwin, Nubain |
| Antagonist (opioid) | Narcan |
| Hemostasis | Takes place in the blood: Process to stop the bleeding |
| Embolus | Clot that is moving through blood vessel |
| Thrombus | Clot that is stuck to cell wall |
| Tissue plasminogen activator (TPA) | A substance that dissolves formed clots |
| Fibrin | clot forming substance in large concentrations; |
| Fibrinolytic system | initiates breakdown of clots, balancing clotting process. |
| Hemophilia | Bleeding disorder where blood does not clot |
| anticoagulants | inhibits the action or formation of clots forming. |
| Complications of an embolus | MI, Strokes, PE, DVT |
| Heparin | Anticoagulant, Large molecule drug, SQ/IV only, must monitor PTT levels, 2 RN's to verify dose, |
| Low molecular weight Heparin's (LMWHs) | Do not need PTT monitoring, usually a prophylactic with surgeries. monitor INRs |
| Warfarin (Coumadin) | Narrow therapeutic window can lead to toxicity,Requires monitoring of PTT and INR, advise to limit intake of green leafy substances high in Vitamin K, has a lot of drug interactions |
| INR | International normalized ratio. Measures how long it takes to clot. normal time is 1 second, with warfarin is 2-3.5 sec. |
| Anti platelets | Aspirin, not used in children, interacts with heparin, |
| Indications for anticoagulants | MI, unstable angina, atrial fibrillation, pooling or slowed blood flow. Long airplane trips. |
| Contraindications of anticoagulants | Known drug allergy, high risk for acute bleeding, Pregnant |
| counteract anticoagulants with | protamine sulfate. it takes 1mg per 100 units of heparin, and 1mg per ml dose of others. |
| signs of toxicity of anticoagulants | hematuria, melena, petechiae, ecchymoses(bruising), gum and mucous membrane bleeding. |
| Gram positive bacteria stain? | purple |
| Gram negative bacteria stain? | red |
| Empiric antibiotic therapy | is therapy recieved based on the signs and symptoms and best idea of infecting organism |
| definitive antibiotic therapy | treatment recieved based on lab results (definitive) |
| Prophylactic antibiotic therapy | used for compromised autoimmune or prior to surgery. |
| Antibiotics can do harm by causing what? | Superinfections (C-Dif) by killing off the nomal flora. |
| Antibiotic resistance | caused from overprescribing, or incorrect prescribing of antibiotics, or patients not completing the required therapy time. |
| What antibiotic causes teeth discoloration | tetracyclene |
| Two actions of antibiotics | bactericidal (kills bacteria), and bacteriostatic(inhibit growth) |
| antibiotics that inhibit cell wall synthesis | bacatracin, vancomycin, isoniazid |
| antibiotics that interfere with dna synthesis | quinolones, metronidazole |
| antibiotics that interfere with mRNA synthesis | rifampin, rifabutin. used for meningitis |
| antibiotics that interfere with protein synthesis | Tetracyclines, aminoglycosides |
| Sulfonamide antibiotics are? | bacteriostatic, inhibit the folic acid required for bacteria growth, do not harm human cells |
| most common sulfonamide antibiotic | sulfamethoxazole(Bactrim) |
| Sulfmoamides are used for? | UTIs, PJP found in patients with HIV |
| Interactions of sulfonamide antibiotics | coumadin, and certain diabetic drugs. it decreases the effectiveness of the diabetic medication |
| with sulfonamides what do you not want to do? | spend too much time in the sun |
| With all antibiotics what nursing implications should you consider? | take with at least 2000ml water per day, oral forms should be taken with food or milk to reduce GI upset. |
| Side effects of all antibiotics | rash, photosensitivity, anemia, nausea and vomiting, headaches |
| lactam is what? | a substance that was added to penicillins so it can penetrate cell walls so it can eat the bacteria. |
| Penicillin works on what kind of bacteria? | Gram + bacteria: strep, Staph, and syphilis. |
| penicillins interact with what | NSAIDs, oral contraceptives, warfarin and many others |
| ddo not take penicillins with what foods/drinks? | caffeine, citrus fruit, colas, fruit juices, tomato juice |
| Cephalosporins are? | bactericidal- broad spectrum |
| 1st generation Cephalosporins | Ansef, Keflex. works against gram - bacteria |
| 2nd generation cephalosporins | cefotan, ceftin, ceclor. gram + and - bacteria. |
| 3rd generation cephalosporins | more effective against gram - strains, penetrates blood brain barrier(meningitis), prototype rocephin(can mix with lidocane) |
| 4th genersation cephalosporins | most broad spectrum, parenteral route only, gram + and - bacteria, prototype maxipime |
| 5th generation cephalosporins | not avail yet, broader spectrum of all, covers MRSA, parenteral route only. |
| cephalosporin cross sensitivity with what whatother antibiotic? | Penicillin. if someone is allergic to penicillin, they may have reaction to cephalosporins |
| why would you have an "antabuse" like reaction when taking antibiotics. | if you are taking a cephalosporin and drink alcohol, an antabuse reaction can occur. |
| 1st generation Cephalosporins | Ansef, Keflex. works against gram - bacteria |
| 2nd generation cephalosporins | cefotan, ceftin, ceclor. gram + and - bacteria. |
| 3rd generation cephalosporins | more effective against gram - strains, penetrates blood brain barrier(meningitis), prototype rocephin(can mix with lidocane) |
| 4th genersation cephalosporins | most broad spectrum, parenteral route only, gram + and - bacteria, prototype maxipime |
| 5th generation cephalosporins | not avail yet, broader spectrum of all, covers MRSA, parenteral route only. |
| cephalosporin cross sensitivity with what whatother antibiotic? | Penicillin. if someone is allergic to penicillin, they may have reaction to cephalosporins |
| why would you have an "antabuse" like reaction when taking antibiotics. | if you are taking a cephalosporin and drink alcohol, an antabuse reaction can occur. |
| Macrolides | Prototype azithromycin (Zithromax, Z-Pac) bacterialstatic, may be bacterialcidal in larger concentrations. take with food, has significant gi irritating properties. |
| uses for Macrolides | Strep infections,resp infections, STD's |
| drug interactions for macrolides | has severe interactions with other protien bound drugs, macrolides are highly protien bound. |
| Tetraclyclines | bacteriostatic, binds to Ca, Mg to form insoluble complexes. |
| nursing implications for tetracyclines | check bmp, and cmp to monitor lytes since it binds to Ca, and Mg. Avoid sunlight and tanning beds. avoid dairy, and iron, and antacids. take with 6-8oz of water. |
| reasons to take tetracyclines | wide spectrum, gram- and + effective, used for STD's and acne. |
| adverse effects of tetracyclines | discoloration of teeth, gastric upset, enterocolitis |
| nursing implications for all antibiotics. | assess drug allergies, renal liver and cardiac function. Obtain health history, take with food |
| pt education of taking abx | take as rx'd, do not stop early, assess for superinfections(perineal itching, cough, lethargy, discharge)All oral abx should be taken with at least 6-8oz of water. |
| Antibiotic therapy toxicities | Ototoxicity, and Nephrotoxicity |
| ototoxicity | temp of perm hearing loss, balance problems |
| nephrotoxicity | varying degrees of renal impairment, rising serum creatinine may indicate reduced CCR. monitor creatinine levels q3 days |
| Steven- Johnson's syndrome | blistering from the inside out, skin just sloughs off. |
| Aminoglycosides | bacteriocidal, heavy duty abx,end in mycin, |
| nursing implications of Aminoglycosides | monitor kidney function(BUN/Creatinine) i&o, daily weights, monitor for toxicity, p&t, watch for signs of superinfection |
| types of aminoglycosides | amikacin, gentamycin, tobramycin |
| Fluoroquinolones | broad spectrum abx, end in floxacin, bacteriocidal, |
| Fluoroquinolones indications | anthrax, STD's UTI's, lower respiratory infections |
| Fluoroquinolones adverse effects | superinfections, headaches, dizzieness, diarrhea |
| Fluoroquinolones interactions | antacids, theophylline(theodur, oral anticoagulants warfarin, iron, |
| clindamycin | used for cellulitis, bugbites, not for babies <1 month, |
| metronidazole | antifungal, c-dif |
| vancomycin | "big gun" antibiotic,used for mrsa, needs to be given slowly 1.5-2 hours or can cause redman syndrome. no IM injection, give iv benadryl 30 min before |
| Nitrofurantoin | used for UTI's, |
| Zyvox | used for VRE, MRSA. adverse reactions with tyramine, no fancy cheese, wine, processed meats. can be used with intubated patients. |
| Flagyl | used for prophylactic of c-dif, #1 use is for an antiulcer (h-pylori)adverse reactions with alcohol (antabuse reaction) |
| Pain is? | what the patient says it is. Subjective |
| 5 components of pain | Physiologic (transmission, stimulation) Sensory (recognition) Affective(emotions related to pain) Behavioral (the behavioral response) cognitive (attitude toward the pain, and or tx of pain) |
| chemicals that increase pain sensation | substance-p, prostaglandins, bradykinin, k, histamine. |
| Chemical that makes pain sensation go away | endorphins |
| what to document for pain | persons appearance, activity, and all interventions. |
| pain threshold | where the individual person starts to feel the pain. |
| pain tolerance | the highest pain level that the person is willing to tolerate. |
| pain is not: | a normal part of aging |
| pain agony | is a medical emergency |
| acute pain | less than 3 months, has a known cause ie. car accident |
| chronic pain | lasts longer than 3 months, may not have a known cause. |
| idiopathic pain | is chronic, with no known cause |
| psycogenic pain | no explanation, but very real |
| neuropathic pain | results from damaged nerves, usually diabetes. phantom pain from amputation |
| referred pain | felt in another location, but related to the same spinal segment. |
| intractable pain | does not respond to treatment, always in pain |
| lordosis | leaning back(anterior flexion) |
| kyphosis | leaning forward |
| scoliosis | curved sideways spine |
| tendons | connect muscle to bones |
| ligaments | bind joints, connect bones and cartilage |
| cartilage | non vascular connective tissue |
| muscle function | under the control of nervous system, provides for locomotion, support and contraction. |
| osteoporosis | is related to aging, women are at higher risk, calcium is taken from the bones into the bloodstream. |
| medication for osteoporosis | Fosamax, have sit upright for 1 hour after administration. |
| musculoskelatal assessment tenderness grading scale | 0-1-2-3-4 0=no tenderness-4=client will not allow palpation |
| complete fracture | through the bone |
| incomplete fracture | not all the way through the bone |
| simple(closed) fracture | fracture with no skin break |
| open(compound) fracture | fracture causes a break in skin |
| pathological fracture | caused from a physical condition ie osteoporosis, bone cancer etc |
| stress fracture | usuall sports injuries, or abuse from repeated low level stress of a joint or bone |
| fracture healing | takes 4-6 weeks |
| fracture reduction | sometimes done with mild sedation, done to realign bones that have been broken, can be surgical or closed. |
| open reduction internal rixation (ORIF) | pins and screws are placed to maintain allignment |
| fracture interventions | immobilization, splint, cast, traction |
| nursing implications of fractures | assess distal cms. |
| fat embolus | caused from long bone fractures, the marrow enters the bloodstream. s/sx patichei on upper chest usually 72 hours following a fracture |
| post op interventions of fractures | have pt increase protein, dairy, and K foods. patient usually takes lovonox for prevention of DVTs |
| compartmental syndrome | caused from swelling in a confined space, caused from casting too soon. s/sx cold blue, no sensation, pain, pallor |
| Hip fractures | extremely painful, external rotation of extremity, can cause tissue death, 14-36% die within a year of fracture. |
| nursing management of hip fractures. | no elevation, abduction pillow, assess for adema, pain, ROM, constipation |
| osteoarthritis | Not a normal part of aging, bone on bone movement, can hear and feel crepitus,cartilage breaks down. |
| amputations | >90% of all amputations are related to diabetes. most of which are legs. may need home care for wound care, do not elevate |
| wound assessment | appearance, temp, tenderness. note the drainage color, amount, consistance, odor,and edges of wound. measure using a clock directions |
| clean a wound with | normal saline, or approved solution. pour solution directly into the wound lightly |
| stable eschar on the heals. | dry, adherent, intact,without erythema. should not be debrided. |
| red wound | clean, pink, with granulating tissue, drainage free, dry or open air dressing, wound vac works well for clean puffy wounds. |
| yellow wound | may be start of infection, purulant drainage, wet to dry dressing, no wound vac. |
| black wound | has eschar tissue that needs to be removed (except heel) |
| nutrition for wound healing | A&D vitamins |
| partial thickness wound | shallow, ie blisters, road rash, abrasions. |
| full thickness wounds | laceration, trauma, extends deeper into the dermis. heals with a scar formation |
| phagocytosis | eating of the dead cells |
| leukocytosis | fighting infection |
| exudate formation phase | drainage occurs to remove toxins and dead tissue, may last hours or months depending on the nature of the wound |
| primary intention healing | wound is closed with sutures to heal. |
| secondary intention healing | wound is left open to heal. granulation tissue is formed. ie ulcers. complications open to infection |
| fistula | an abnormal passage between 2 organs or organ to outsid of the body. like a tunnel. |
| ulcer staging | 1-4 tissue intact-deep down to the bone. |
| venous stasis ulcers | necrotic crater likeon medial malleoli. more red |
| arterial ulcers | pale well defined edgesfound on toes heals and leteral malleoli. more pale |
| contact dermatitis | caused by contact to allergen, or irritant. ie poison ivy, nickel,etc. |
| atopic dermatitis | eczema, usually genetic |
| Urticaria | Hives, hypersensitive to an enviornmental factor. |
| psoriasis | unknown origin, rapid turnover of epithelial layer. dry flaky skin. |
| cellulitis | infection of the dermis, may be caused by staph, strep or bug bite |
| furuncles | usually caused by staph, begins in a hair follicle, and spresds to surrounding follicles. |
| carbuncle | a group of furuncles that form in a large infected mass. |
| acute necrotizing fascitis | very rapid infection, can cause amputation if not caught early. |
| stress | a state produced by a change in the environment that is perceived as challenging, threatening, or damaging |
| stressors | the cause of the stress |
| stress can lead to | anxiety |
| anxiety | a feeling of apprehension, uneasiness,uncertainty or dread. with an unknown source. |
| fear | a reaction to danger |
| homeostasis | A consistancy in the internal environment of the body. |
| adaptive response | an appropriate response to an environmental demand. |
| fight or flight | increases heart rate, BP, RR and blood sugar levels. |
| stress triggers | a negative feedback response |
| stress response controlled by | medulla oblongada, reticular formation, pituitary gland |
| General adaptation syndrome (GAS) | theory that a stressor can be positive or negative |
| GAS stages | Alarm, Resistance, Exhaustion. |
| Alarm stage | increased vital signs, ready for fight or flight |
| Resistance stage | trying to cope with the stress to the best of their ability |
| Exhaustion stage | when coping mechanisms are gone. The need for others to help or make decisions is present |
| types of stress | distress (acute stress, chronic stress) and Eustress (stress that is good) |
| situational stress | HTN, DM, asthma |
| maturational stress | loss of a parent or child. |
| sociocultural stress | prolonged poverty, imprisonment |
| acute anxiety | something that happens suddenly that threatens ones security, earthquake etc |
| Chronic anxiety | anxiety that a person has lived with for a long time. example: living in a warzone |
| Symptoms of anxiety | fatigue, insomnia, discomfort in daily activities, poor concentration |
| secondary anxiety | due to physiological abnormalities, ie: brain tumors |
| mild anxiety | occurs in everyday life, nailbiting and foot tapping are signs. |
| moderate anxiety | perceptual field narrows, unable to focus on learning, increased HR, BP, RR |
| severe anxiety | cant focus, cant solve problems, needs help! hyperventilation |
| Panic | cannot focus on anything, irrational thoughts. |
Created by:
chadg2013
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