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144 Cards in this Set
- Front
- Back
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A very common reason for low levels of potassium might be?
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diuretic administration
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A normal potassium level is?
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3.5-5.5 mEq/L
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A common reason for elevated levels of serum potassium might be?
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renal failure
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An important electrolyte to monitor bc it affects the rate & force of cardiac contraction & therefore, cardiac output is?
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Potassium
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IV potassium can be given?
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as an IV infusion at no greater than 10 mEq/L an hour.
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Changes in levels of this electrolyte either high or low, may result in EKG changes?
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Potassium
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Patients who have imbalances r/t sodium should be monitored for?
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CNS changes
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Which of the following electrolytes is more likely to reflect an incr. or decr in water?
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Sodium
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Patients who retain large amounts of fluid are likely to have?
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Hyponatremia
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Immobility which causes demineralization of bones may result in which electrolyte imbalance?
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Hypercalcemia
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Which of the following elctrolytes is regulated by the parathyroid gland?
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Calcium
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A normal blood sugar is?
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80-120 mg/dL
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Which group of meds may cz hyperglycemia?
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steroids
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About ammonia?
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Ammonia is the end product of protein metabolism. The liver normally removes ammonia & changes it to urea. With liver damage, the ammonia level increases. The level can be lowered by decreasing protein intake & using antibiotics to decrease intestinal bacteria.
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When should you evaluate ammonia level?
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when you have liver probs
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What is often given to pts w/ high ammonia levels?
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Lactulose. A laxative which czs ammonia levels to be eliminated from the body.
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What med would be administered to a pt w/ liver disease and elevated levels of ammonia?
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Lactulose(Cephulac)
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About BUN (blood urea nitrogen)
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used as a gross indicator of kidney function.
-incr BUN is usually due to inadequate excretion due to kidney dz or urinary obstruction/renal failure |
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About creatinine?
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elevated creatinine is often seen w/ elevated BUN (or poor kidney function)
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An elevated level of what 2 lab values would make the nurse suspect that the pt has impaired kidney function?
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BUN/Creatinine
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Normal WBC levels?
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4,100-10,900 cells/uL
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WBC count used for?
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-to determine inf/infl
-to determine is differential or bone marrow biopsy needed -used to monitor chemotherapy or radiation therapy |
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Leukocytosis?
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-is an elevated WBC count
-indicates infection |
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Leukopenia?
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a low WBC count indicates bone marrow depression.
-would usually be in reverse isolation |
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WBC differential?
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provides more specific information about the pts immune system.
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What is often given to pts w/ high ammonia levels?
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Lactulose. A laxative which czs ammonia levels to be eliminated from the body.
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What med would be administered to a pt w/ liver disease and elevated levels of ammonia?
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Lactulose(Cephulac)
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About BUN (blood urea nitrogen)
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used as a gross indicator of kidney function.
-incr BUN is usually due to inadequate excretion due to kidney dz or urinary obstruction/renal failure |
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About creatinine?
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elevated creatinine is often seen w/ elevated BUN (or poor kidney function)
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An elevated level of what 2 lab values would make the nurse suspect that the pt has impaired kidney function?
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BUN/Creatinine
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A shift to the left means?
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-sign of an acute infection
-more bands(immature neutrophils) are seen than segs(mature neutrophils) |
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If a pt had an inf which of the following lab values would you expect to see?
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-an elevated WBC(leukocytosis)
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If a pt is receiving Heparin which of the following labs would be monitored?
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PTT
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An average hemoglobin value for either males or females would be?
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40-50%
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A pt who has a low hemogloin might have trouble with what since hemoglobin is the oxygen carrying component of the RBC's?
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breathing
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Which lab result would you expect to be elevated in a pt that has pancreatitis?
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amylase
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Which 2 labs would a doc most likely order if he wants to rule out a MI?
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troponin/CK-MB
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A pt that has an elevated BNP would most likely be suffering from which of the following probs?
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congestive heart failure
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Bactericidal?
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kills the bacteria directly
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Bacteriostatic?
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-stops the reproduction of the bacteria but doesn't kill it
-the pt's own immune system must also help to stop the continued growth of the bacteria |
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Inherent resistance to an antibiotic?
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org. will always be resistant to that antibiotic
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Acquired resistance to an antibiotic?
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-org. changes so that is is now resistant to the antibiotic when it may not have been in the past
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What should be the first step in deciding which antibiotic to use?
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IDing bacteria czing infection
-may be done thru a physical exam or with a culture |
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2nd step in IDing bacteria czing infection?
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2nd step should be to select proper antibiotic
-may be done thru experience or w/ the help of antibiotic susceptibility testing |
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How can the site of inf affect antibiotic therapy?
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-depending on where inf is, it will also influence antibiotic used
-some meds don't cross the blood/brain barrier -some areas of the body are poorly perfused |
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How can other drugs affect antibiotic therapy?
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-pts receiving other drugs may find the antibiotics less effective
-steroids may cz immunosuppression & decrease the effectiveness of the antibiotics |
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How can a pts clinical status affect antibiotic therapy?
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-assess h/o antibiotic hypersensitivity
-renal function is important -many antibiotics are excreted by the kidneys -hepatic function is also important -pts w/ chronic dz may be more resistant |
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Direct toxicity(side effects of antibiotics)
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each class has its own signs of toxicity
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Allergic rxns(side effects of antibiotic therapy)
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-may range from simple to severe
-usually requires direct exposure to the antibiotic but not always |
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Superinfections (side effects of antibiotic therapy)
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Inf that arise during the antibiotic therapy bc the normal flora is destroyed
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Viral Inf(misuse of antibiotics)
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we over request antibiotics for things that are viral in nature
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Early Discontinuation of Antibiotics
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-pts tend to d/c antibiotics for things that are viral in nature
-the bacteria may still be alive -org becomes drug resistant |
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Instability of Stored Antibiotics
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-pts want to keep meds on hand in case they get sick again
-should not self-treat w/ old meds -may not be using the correct med -if cultures are needed, antibiotic has already been started |
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Penicillins/Cephalosporins
(Mechanism of Action) |
individuals can develop resistance to penicillins and cephalosporins ex:MRSA
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Penicillins/Cephalosporins
(Allergic Rxns) |
-common
-skin rash,uticaria,anaphylaxis(first 10 mins) -rxns may occur any time during therapy -pts should be observed for at least 30 min at the beginning of new therapy -should always ask about allergies -pts who are allergic to PNC are usually also allergic to Cephalosporin |
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Penicillin/Cephalosporin
(interactions) |
Check compatibility w/ other drugs
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Nursing Implications for Penicillin G
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-obtain culture before starting therapy
-determine sensitivity history b4 starting -monitor pt if receiving med for 1st time |
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What is the leading cz of colitis w/ antibiotic use?
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Ampicillin
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What antibiotic may cz oral contraceptives to be less effective?
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Ampicillin
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Adverse Rxns and Contraindications of Cephalosporins?
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-may cause GI upset
-superinfections may arise -may cz platelet dysfunctions -DO NOT give w/ aspirin -cannot take if allergic to PCN |
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Adverse Rxns & Contraindications of Quinolones?
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damage to developing cartilage(not given to kids under age of 8)
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Uses of Macrolides?
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-Erythromycin is used for many of the same bacteria that PCN is used for
-may be used in pts that are allergic to PCN |
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Adverse Rxns and Contraindications of Clindamycin?
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-colitis(biggest prob)
-pt should be instructed to d/c drug & immediately notify MD for incr in frequency of BM or softness of stool -d/c promptly if significant diarrhea |
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Use of vancomycin?
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used with bacteria that are resistant to PNC ex:MRSA
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Adverse Rxns of Vancomycin?
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occurs mostly if vanco is given IV undiluted.
-must be diluted in large vol. of fluid |
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Toxicity of Vanco?
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Ototoxic
-assess for tinnitus or hearing loss -assess renal function |
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Interactions of Vancomycin?
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administer w/ caution in pts receiving other ototoxic or nephrotoxic drugs.
-Get baseline BUN or creatinine. |
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Adverse Rxns of Tetracycline?
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-stained teeth
-sensitive to sunlight exposure |
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Adverse Rxns of Aminoglycosides?
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-nephrotoxic
-may be ototoxic |
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Toxicity of aminoglycosides?
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-have toxic effects w/ hearing,kidney function,& neuromuscular activity
-Ototoxicity *czs hearing loss, loss of equilibrium or both *may continue after med is d/c *N/V may be a sign of equilibrium balance -Nephrotoxicity *czs damage to the renal tubules and glomeruli of kidneys |
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Interactions of Aminoglycosides?
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-give cautiously in pts who are receiving other meds that have same toxic effect
-doses for other toxic meds must be at separate times. |
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(NSAIDS) Cyclooxygenase(COX) inhibitors?
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-suppress infl.
-relieve pain -reduce fever -protect against MI's(aspirin only) |
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Adverse effects of COX inhibitors?
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*GI effects:
-gastric irritation -nausea -heartburn -bleeding -ulcerations in the GI tract *Bleeding:ASA inhibits platelet aggregation *Renal impairment w/ resulting edema & fluid retention. Is usually reversible. |
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Adverse Rxns of Aminoglycosides?
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-nephrotoxic
-may be ototoxic |
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Toxicity of aminoglycosides?
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-have toxic effects w/ hearing,kidney function,& neuromuscular activity
-Ototoxicity *czs hearing loss, loss of equilibrium or both *may continue after med is d/c *N/V may be a sign of equilibrium balance -Nephrotoxicity *czs damage to the renal tubules and glomeruli of kidneys |
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Interactions of Aminoglycosides?
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-give cautiously in pts who are receiving other meds that have same toxic effect
-doses for other toxic meds must be at separate times. |
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(NSAIDS) Cyclooxygenase(COX) inhibitors?
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-suppress infl.
-relieve pain -reduce fever -protect against MI's(aspirin only) |
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Adverse effects of aspirin?
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*GI effects:
-gastric irritation -nausea -heartburn -bleeding -ulcerations in the GI tract *Bleeding:ASA inhibits platelet aggregation *Renal impairment w/ resulting edema & fluid retention. Is usually reversible. |
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Salicylism of Aspirin?
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-seen w/ aspirin levels just above therapeutic
-clinical manifestations:tinnitus,sweating,H/A,dizziness,acid base disturbances -stop the aspirin until symptoms go away |
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Aspirin poisoning?
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-aspirin overdose:fairly common
-more often fatal in kids -czs acid base disturbances which result in respiratory depression,coma & death. |
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Drug Interactions w/ Aspirin?
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take w/ care when taking w/ other meds that interfere w/ clotting
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Adverse effects of corticoteroids(AKA glucocorticoids)?
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-osteoporosis:on for long period of time,then at risk for falls
-Inf:on for long time,have decr. immune system -glucose problems:glucose elevated,usually have hyperglycemia -myopathy -fluid and electrolyte imbalances:retain Na+ so then retain H2O -growth retardation -peptic ulcer dz:irritating to GI tract -Iatrogenic Cushing's syndrome |
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Drug Interactions of Glucocorticoids?
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-may cz hypokalemia so take w/ caution w/ any meds that cz a loss of potassium or cardiac meds(bc of arrythmias)
-take w/ caution w/ meds that cz GI disturbances or that incr. bld sugar |
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Why must glucocorticoids be decr slowly?
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so as not to cz withdrawal syndrome w/ symptoms of hypotension,hypoglycemia,myalgia,arthralgia,fatigue
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Examples of corticosteroids(glucocorticoids)?
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-dexamethasone(Decadron)
-hydrocortisone(Solu-Cortef) -methylprednisolone(Solu-Medrol) -prednisone(Deltasone) |
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What is Airborne Isolation used for?
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highly transmissible dz spread by airborne droplet nuclei.
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4 dz's airborne isolation used for?
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-tuberculosis
-measles -small pox -chicken pox(varicella) |
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What is Droplet Isolation used for?
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when inf is spread for short distances(about 3 ft) thru the air.
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5 inf Droplet Isolation used for?
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-haemophilus influenza
-meningococcal pneumonia -streptococcus pneumoniae -mycoplasma pneummoniiae -neisseria meningitis |
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Contact Isolation used for?
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to prevent transmission of infs by close or direct contact or when in contact w/ environmental surfaces or pt care ites in pt environment
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Infections that Contact Isolation may be used for?
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-C.Diff
-MRSA -VRE -herpes simplex -scabies -skin wounds and drainage |
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About MRSA?
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location:skin,nasal secretions
mode of transmission:contact,person to person,contact w/contaminated surfaces tx:vancomycin |
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Where is VRE located?
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GI tract and female genital tract
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What type of precautions for VRE?
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contact
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TX of VRE?
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combined B-lactam and aminoglycoside therapy
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What is PRSP and where is it located?
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penicillin resistant strep pneumoniae.
located in respiratory tract |
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Mode of Transmission for PRSP?
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droplets from respiratory tract
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TX for PRSP?
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ceftriaxone(Rocephin),cefotaxime(Claforan),cefapime(Maxipime) or vanco
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What is C.Diff?
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a spore forming,gram pos. anaerobic bacillus that prods 2 endotoxins:toxin A & toxin B
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What is a common cz of antibiotic-assoc. diarrhea(AAD)?
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C.Diff bc antibiotics kill normal flora in GI & get C.Diff
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What % of AAD episodes is C.Dff accountable for?
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15-25%
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What dz's result 4m C.Diff?
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-pseudomembranous colitis
-toxic megacolon -perforations of the colon -sepsis -death(rarely) |
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Main clinical S/S of C.Diff
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-watery diarrhea
-fever -loss of appetite -nausea -ab pain/tenderness |
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Pts at risk for C.Diff?
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-antibiotic exposure
-GI surgery/manipulation -length of stay in HC settings -a serious underlying illness -immunocompromised conds -advanced age |
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How to determine if pt has C.Diff?
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-lab tests
-stool culture |
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About stool cultures r/t C.Diff?
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-c.diff toxin unstable
-degrades at room temp & may be undetectable w/in 2 hrs after collection of a stool specimen -false neg occur when specimens not promptly tested or kept refrigerated until testing can be done |
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Transmission of C.Diff?
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-shed in feces:any surface,device,material that becomes contaminated w/ feces may serve as a reservoir for the C.Diff spores
-C.Diff spores are transferred to pts mainly via the hands of hc personnel who have touched a cont. surface or item. |
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TX of C.Diff?
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-oral metronidazole(Flagyl)
-oral vancomycin |
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What is herpes zoster?
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-shingles
-czed by the same virus that czs chickenpox -nurses who have not had chickenpox shouldn't care for pts w/shingles |
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herpes zoster commonly seen in?
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-elderly
-AIDS -Hodgkins dz -bone cancers |
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Manifestations of herpes zoster?
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-clusters of small vesicles which form a line
-follow course of peripheral sensory nerves -usually unilateral; do not cross midline although nerves on both sides may be involved -lesions seen on chest,face,eye,scalp |
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Initial & Ongoing S/S of herpes zoster?
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Initially:
-malaise -fever -itching -pain Ongoing: -discomfort & pain -itching |
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Tx of herpes zoster?
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*acyclovir:speeds up healing.decreases pain
-analgesics:for pain -calamine lotion:for itching -looose clothing |
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Complications of herpes zoster?
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-posttherpetic neuralgia(PHN)
*occurs in 10% of ppl w/ herpes zoster -pain may present for yrs -pain becomes chronic -may be placed on an antidepressant |
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About scabies?
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-inf czed by the scabies mite
-lesions form as the impregnated female scabies mite burrows into the epidermis where she deposits her eggs & fecal material. This forms grayish,thin lines. Dx:made 4m scrapings of burrow |
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Clinical Manifestations of Scabies?
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-pruritis(itching) w/ impaired skin integrity r/t itching
-lesions usually seen on interdigital surfaces,axillary-cubital area,popliteal folds & inguinal regions |
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TX of scabies?
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-application of scabicide(Kwell)
-tx all persons who had direct contact w/ inf. person |
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What is thrush?
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-fungal inf.
-oral candidiasis |
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Clinical Manifestations of thrush
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white adherent patches on the tongue,palate,or inner aspects of the cheek
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TX of thrush?
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Nystatin(swish & swallow)
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What is ringworm?
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-fungal inf.(tinea corporis)
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How is is transmitted?
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occurs quickly in poor,crowded conds.
-poor hygiene increases likelihood |
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Clinical Manifestations of ringworm?
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-round lesion w/erythema
-slight scaling & pustules at edge of lesions |
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Transmission of Rocky Mountain Spotted Fever?
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-from a tick 4m wild rodents or dogs
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Clinical Manifestations of Rocky Mountain Spotted Fever?
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-fever
-malaise -anorexia -myalgia -severe H/A -vomiting -rash mostly on palms and soles |
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Tx for Rocky Mountain Spotted Fever?
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-tetracycline
-be supportive |
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Prevention for Rocky Mountain Spotted Fever?
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-protect 4m bite w/repellent & clothing
-inspect kids regularly |
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About Lyme DZ?
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-most common tick-borne dz in the US
-czed by spirochete(Borrelia burgdorferi)which enters the skin & bldstream thru saliva and/or feces of ticks |
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Symptoms of Lyme Dz?
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-flu-like
-can lead to neurological probs,arthritis,cardiac |
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Dx of Lyme Dz?
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-history
-observation of lesion -development of symptoms -lab tests not yet standardized |
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Common vector of Lyme dz?
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-deer tick
-ticks are clear to light brown & very small |
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Tx of Lyme Dz?
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-kids over 9(amoxicillin/PCN)
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Prevention of Lyme Dz?
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DEET protection
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About the tetanus vaccine?
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-given to prevent tetanus(lock jaw)
-IM |
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How often should receive tetanus vaccine?
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-every 10 yrs unless working in high risk area(farm workers,working w/fertilizer)then should get every yr.
-or if h/o vaccination is unclear |
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About the flu vaccine?
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-given IM or as intranasal spray
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Who should the flu vaccine be given to?
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-anyone over 50,ppl w/ chronic illnesses,ppl w/ compromised immunity,ppl in institutions,hc providers
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About the pneumococcal vaccine?
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-given to prevent pneumonia czed by pnumococcus bacterium(not other microes that cz pneumonia)
-at risk ppl:those over 65 yrs old,ppl w/ chronic conds,ppl w/ compromised immune systems -given IM |
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Extracellular?
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combo of intravascular & interstitial fluid
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Transcellular?
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fluid that is separated y thin layer of epithelial cells from ECF. includes digestive juices,intraocular fluid,CSF. only accts for about 1-3% of all body fluid
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Factors that affect osmosis?
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-concentration
-temperature -electrical charge -diffs bw osmotic pressure |
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active transport?
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the mvmt of material across the cell memrane by means of chemical activity. allows the cell to admit larger molecules than otherwise would be allowed.
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osmotic pressure?
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the amt of pressure necessary to stop the flow of water across the membrane
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hydrostatic pressure?
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exerts pressure in favor of the flow of water across the membrane
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