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