Obj from SQ2 Damelio
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| Name 5 places where drug excretion occurs. | 1.Kidneys 2. GI/Biliary 3. Liver 4.Lungs 5. Exocrine
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| Describe excretion in the kidneys | Primary area, small unbound molecules, Renal extraction depends on the ph of the urine (which can be manipulated)
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| Describe excretion in the liver | First Pass effect. Metabolized by liver for easier filtration & excretion in kidneys.
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| Describe excretion in the GI/Bile | Some is unabsorbed and passed as feces. Some is delivered through bile to duodenum & passed.
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| Describe excretion in the Lungs | Largely unmetabolized. Rate depends on blood flow to the lungs, rate of breathing, gas solubility and diffusion.
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| Describe excretion in the exocrine | Water soluble drugs can be excreted in sweat, saliva, breast milk. Ewwwwww.....
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| Define onset | • Onset-the time required for the drug to elicit a therapeutic response
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| Peak time | • Peak-the time required for a drug to reach its maximum therapeutic response
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| Duration of drug action | • Duration of drug action- the length of time that the drug concentration is sufficient
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| Therapeutic lvel | range in which the drug is expected to be effective
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| Peak Level | max. concentration of a drug in the circulation
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| Trough level | lowest therapeutic concentration
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| Biological half-life | Time it takes to reduce plasma levels by 50%. Usually there are 4 half lives.
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| Primary effects | Intended effects of the drug
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| Secondary effects | All other effects besides primary. Can be beneficial or dangerous.
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| Side- effects | Those which are predictable from studies.
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| Adverse reactions | Unexpected, unintentional, undesired, or excessive.
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| Toxic reactions | AKA dose-related reactions. Excessive amount prescribed.
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| Allergic reactions | immunologic bypersensitivity reaction.
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| Anaphylactic reaction | Severe, life threatening. Extreme drops in temp, circulation, respiration, etc.
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| Idiosyncratic | Specific to the person, unusual reaction
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| drug-drug interaction | pharmacological activity of a drug caused by the presence of another drug.
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| Antagonistic relationship | adding a second drug diminishes the effect of the first drug
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| Synergistic relationship | adding a second drug enhances the effect of both. Gestaltian.
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| Medication contraindication | inadvisable to prescribe 2 drugs together.
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| Nursing Assessment before, during, after drug administration | Know medicine/take vitals/assess swallowing/allergies/evaluate for effectiveness and side effects
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| Know 3 checks of Meds and 6 Rights of administering the meds | Really? You thought I was going to type all of that out??
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| Differentiate among the various sources of nutritional information (e.g., USDA dietary guidelines, food guide pyramids). | Dietary Guidelines are evidence-based nutrition information and advice for people age 2 and older. They serve as the basis for Federal food and nutrition education programs/The food guide pyramid (2005) was crafted by the USDA/food plate MO
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| NSA Diet | No Salt Added. I think I would die.
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| NCS | No Concentrated sweets to reduce sugar intake
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| Healthy Heart- 8 suggestions per Mayo | Reduce fats,low fat protein choices,more fruit/veggies, whole grains, less salt, smaller portions, daily menus, occasional treat. Now doesn't that sound special....
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| Diabetic | control sweets and carbs. Monitor glucose.
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| Tools for gathering subjective nutritional data/status | Food Record/ 24 Hour Recall/ Dietary Interview /
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| Discuss BMI amongst yourselves | BMI is a ratio based on height and weight. BMI<24? is malnourished, >25 is overweight, >30 is obese, >40 is extremely obese
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| Note general physical appearance to gauge a general state of health | Common sense answers here. Flaky skin, hollow face, dry membranes, beefy tongue.
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| Biochemical assessments to determine status | serum or urine
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| Example of serum assessment | Example 1: You know that albumin synthesis depends on normal liver function & supply of amino acids→ Serum sample reveals low albumin → conclude there is protein depletion → Patient RF malnutrition.
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| Example of urine assessment | Example 2: You want to know if patient’s creatinine levels are w/in normal ranges. → obtain 24 hr urine sample → find values lower than normal → loss of lean body mass and protein malnutrition.
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| Vitamin and mineral supplement | Not needed if you have a balanced diet. Can easily overdose on nutrients.
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| Describe nursing interventions for Impaired swallowing. | Impaired Swallowing: “Never feed someone who appears to be having difficulty swallowing” - powerpoint, slide 36
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| Describe nursing interventions for NPO | Nothing by mouth.
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| Describe nursing interventions for Older adults | Provide least assistance needed. Make sure glasses, hearing aids and dentures are provided if needed.
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| Safely provide enteral nutrition for patients. (As performed in lab) | Check for residual, rinse tube with 30 ml. Rinse after to make sure all has gone in.
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| Discuss the role of teaching in professional nursing | Teaching, as a specific function of nursing, is included in all state nurse practice acts and in the Standards of Clinical Nursing Practice of the ANA. It is an independent function of nursing and is a primary nursing responsibility.
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| Describe the processes of teaching and learning.: | • Learning: defined as acquiring knowledge, attitudes, or skills
• Teaching: helping another person to learn.
• Ways to teach: Demonstration, literature, hands on, video, role model, simulation, group settings, distance learning, assigned helper.
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| After teaching you always.... | assess learning!! Frequently
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| Name, define, and give one example of each of Bloom’s three domains of learning. | • Cognitive: mental skills (Knowledge – Insulin level)
• Affective: growth in feelings or emotional areas (Attitude- Rage control)
• Psychomotor: manual or physical skills (Skills-self inject)
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| Factors that can affect learning in either a positive or negative manner: | motivation, physical condition, emotions, timing, active involvement, feedback, repetition, environment, , amount and complexity of the content, communication, special needs (e.g., learning disability), developmental stage, culture, and literacy.
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| List at least six barriers to teaching and learning | a. Deafness, blindness, speech impediment
b. Illiteracy, denial of illness, prejudice vs. teacher or student
c. Inability to get to the resources
d. Lack of motivation, depression
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| Describe some strategies for motivating learners | a. Present in a different manner
b. Make benefits relevant and clear
c. Teach in smaller units and assess regularly
d. Allow them to mentor a similar patient after learning info
e. Reward system
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| Develop strategies for working with clients with cultural or learning differences | a. Learn about the culture, show intentional respect
b. Learn and practice different teaching styles
c. Have appropriate resources to meet learning challenge
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| Discuss correct and incorrect uses of the nursing diagnosis Deficient Knowledge | Try to avoid “Deficient knowledge”;not a human factor relating to or causing the diagnosis.
Ex: “ ineffective therapeutic regimen related to lack of information about ___. This relates to the specific deficit provides guidance for the teaching plan.
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| List four methods for evaluating the outcomes of teaching and learning: | a. Direct observation
b. Rating scales, checklists
c. Anecdotal notes
d. Oral questioning or written tests
e. Measure the actual behavior or test result.
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| Document teaching content, methods, and patient responses (learning). | Clearly document all stages: diagnosis,priorities,goals,strategies used, expected/obtained outcomes, documentation.
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| Identify concepts pertaining to cultural diversity in nursing: | Nutrition and dietary,
Beliefs about illness, causes/cures.
Disorders specific to a particular group/ sickle cell anemia among the Blacks.
Specific anatomical characteristics/ stature, skin,hair texture).
e. Religious beliefs about illness and death.
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| Discuss patterns of behavior that can reflect cultural and ethnic influences. | Bathing, elimination practices, gender roles, eye contact, personal space.
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| Practices believe the forces of nature must be kept in balance or harmony. It is Believed if the balance is disturbed illness or disease will result. Ex: Yin and Yang | Naturalistic or Holistic
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| Practice is based on the view that the world is an arena in which supernatural forces dominate, and that the fate of the world and those who are in it depends on the supernatural forces for good and evil. EX: Faith healing in Christianity | Magico-Religious
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| Vary among the different cultures and might include a person, a certain artifact, or particular “superstition” to aid in healing. EX: Medicine Man | Folk healers and/or beliefs
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| Assessing that your patient is Islamic and therefore will not eat pork is an example of... | Culturally Competent Care
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| facilitates the return of deoxygenated blood to the right side of the heart by massaging the venous vasculature | THE PHYSIOLOGY OF MOVEMENT
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| 5 Legal Issues in Nursing: | 1)always get a signature on an order 2)Document everything 3)Report or tort it.4)HIPPA Baby 5)6 Rights to avoid med errors.
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| How to decrease the likelihood of committing nursing malpractice | a. Observe standards of care
b. Avoid medication/treatment errors
c. Report/Document
d. Obtain informed consent
e. Attend to safety
f. Maintain Confidentiality
g. Provide education
h. Delegate correctly
i. Observe boundaries
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| Morals | adherence to informal personal beliefs; modes of conduct
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| Ethics: | the formal, systematic study of moral beliefs; a theory or system of moral values; the discipline dealing with what is good and bad and with moral duty and obligation.
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| Bioethics | a discipline dealing with the ethical implications of biological research and applications especially in medicine.
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| Nursing ethics | a branch of applied ethics to activities in the field of nursing;shares many principles with medical ethics,beneficence, non-maleficence, respect for autonomy. distinguished by its emphasis on relationships, human dignity and collaborative care
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| utilitarianism | theory of ethics based on the concept of "the greatest good for the greatest number".
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| Moral dilemmas | a clear conflict exists between 2 or more moral principles or competing moral claims. Must choose the lesser of 2 evils. Story of Solomon.
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| Moral Problem | May be competing moral claims but one is clearly predominant. (I think this could be seeking death w/dignity and laws vs. assisted suicide)
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| Moral distress | You know the right thing to do but have constraints personally vs. doing it (i.e. a full code on a vegetative coma patient)
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| is the utilization of correct muscles to complete a task safely and efficiently, without undue strain to a muscle or joint. | Body Mechanics
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| TRUE/FALSE: According to the Safe Patient Handling Algorithm, it is okay for the nurse to move a patient up in bed by himself as long as he maintains correct body mechanics. | FALSE- moving a patient up in bed is not a 1 person task pg. 447
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| right dose, right drug, right route, right time, and right patient | 5 rights of medication
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| Paternalism | intentional limitation of another persons autonomy justified by the needs of another. Maybe a restraining order?
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| The nurses primary commitment is always to | the patient.
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| Personal values/morals vs. professional values | You may be Catholic and not eat meat on Friday but you have to serve the patient whatever is sent that day.
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| Common moral issues for nurses: | Restraints, confidentiality, trust, end of life.
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| Identify at least eight contemporary ethical issues in health care. | Autonomy, Beneficence (do good), Confidentiality, Double Effect (chemo, Fidelity, Justice, nonmalificence, paternalism,sanctity of life.
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| Nurses obligation in an ethical decision | ADPIE and then to the patient
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| Nurse as a client advocate | Must know ethical issues and help patient to voice their moral concerns.
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| Steps of MORAL model | 1.outline med. facts of the case.2)nonmed issues 3)assess "good" important to case 4) apply principles 5)assess the role of virtues 5)prior cases?? 6)make recommendations
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| EMTALA (Emergency Medical Treatment and Active Labor Act)and National Practitioner Data Bank, ADA (Americans with Disabilities Act)are examples of _______________ laws regulating practice. | Federal
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| Mandatory Reporting, Good Samaritan, and Nurse Practice Acts are examples of ____________ laws regulating practice. | State
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| ___________ law addresses the basic welfare of the public. Classified by either a misdemeanor or a felony. | Criminal
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| ____________ law regulates issues between private parties and business and is processed through the courts as damages or money compensation. | Civil
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| A doctor amputates the wrong leg of a man. The man files for malpractice. This case would be handled in | Civil Court because the amount of compensation demanded by a medical malpractice lawsuit is directly related to the extent of the injury, or damages.
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| A patient dies from excessive doses of morphine. The family takes the doctor to court. | Criminal because the doctor did something in disregard of the life and safety of the patient.
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