Exam 4 material Bl 1 Word Scramble
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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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