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Exam 4 material Bl 1

Exam 4

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