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180 Cards in this Set

  • Front
  • Back
What must you do before you give Digoxin?
Take apical pulse because it will lower pulse.
Can you “hold” a medicine? When?
If you decide that it’s clinically unsafe - but you must document the fact and why.
What must you do to with controlled substances?
Have a witness for wasting.
Legally, you must prepare your drugs __________.
yourself
Discuss legal responsibility for nursing.
Patient consent, knowledge of medications, safe & timely delivery, controlled substances, hold drugs for patient safety, prepare drugs yourself, responsible for your own actions, agency restrictions, follow policy.
What are the major ways to prevent errors?
Patient identification, CEUs every 2 years
What is a one-time order?
Maybe pre-op or any time, but just once. Have to tell doctor you did it.
What is stat order?
Give them one now. Not common in real life.
How do you know that you’ve taken phone/verbal orders correctly?
READ BACK. Sign VORB (verbal order read back) M Troxell, Dr. Payne
What do you need to know about a patient before administering meds?
Medication & Medical history, allergies & intolerances, Pregnancy and lactation status
Allergy is:
Hives, swelling (edema), respiratory distress.
Intolerance is:
a side-effect that the patient doesn’t particularly like.
What orders should you consider before administering meds?
Check MAR, verify physician orders, diet & fluid orders, laboratory values, physicals
What are AST & ALT?
Liver enzyme test
What are SGOT & SPGT?
Liver enzyme tests
What are BUN and Creatinine and EGFR?
kidney function tests.
Nurse’s rights of medication administration.
1. right to clear orders 2. R..... (in powerpoints)
Define Lymphodystrophy.
Define ecchymosis.
the medical term for a subcutaneous purpura larger than 1 centimeter or a hematoma, commonly called a bruise. It can be located in the skin or in a mucous membrane.
What are major purposes of the physical examination?
Gather baseline data about the client's health status; Supplement, confirm, or refute data obtained in the history; Confirm and identify nursing diagnoses; Make clinical judgments about a client's changing health status and management; Evaluate the outcomes of care
Define Thoracic Excursion.
thoracic (chest) movement, indicating respiratory effort.
Define Crepitus.
Crepitus is a medical term to describe the grating, crackling or popping sounds and sensations experienced under the skin and joints.
Define hyperhidrosis.
Excess perspiration.
Define bromhidrosis.
Foul-smelling perspiration.
What can sweet, fruity breath indicate?
Diabetes.
List a logical order for physical examination.
SITTING - Head and neck, back, posterior thorax and lungs, anterior thorax and lungs, breasts, axillae, heart, vital signs, and upper extremities; SUPINE - Head and neck, anterior thorax and lungs, breasts, axillae, heart, abdomen, extremities, pulses; KNEES RAISED - Head and neck, anterior thorax and lungs, breasts, axillae, heart, abdomen; STIRRUPS - vagina; SIMS - buttocks, rectum, vagina?
What is CAGE?
A method of questioning in suspected substance abuse. Have you ever felt the need to Cut down on your drinking or drug use? Have people Annoyed you by criticizing your drinking or drug use? Have you ever felt bad or Guilty about your drinking or drug use? Have you ever used or had a drink first thing in the morning as an Eye-opener to steady your nerves or feel normal?
What is considered significant weight loss?
If the client has lost more than 5% of body weight in a month or 10% in 6 months, the loss is significant.
What are some drugs that might influence weight gain?
steroids, oral contraceptives, antidepressants, insulin
What are some drugs that might influence weight loss?
diuretics, insulin, fluoxetine, prescription and nonprescription appetite suppressants, laxatives, oral hypoglycemics, and herbal supplements
What things might integument assessment reveal?
changes in oxygenation, circulation, nutrition, local tissue damage, and hydration.
Define palpebral conjunctivae.
Define Vitiligo.
Congenital or autoimmune condition causing lack of pigment
List some skin indications of possible substance abuse.
Diaphoresis; Spider angiomas; Burns (especially fingers); Needle marks; Contusion, abrasions, cuts, scars; “Homemade” tattoos; Increased vascularity of face; Red, dry skin
What might you find on the arms and legs of recent IV drug abusers?
A client who takes repeated IV injections has edematous, reddened, and warm areas along the arms and legs.
What might be evidence of old injection sites in IV drug abusers?
hyperpigmented and shiny or scarred areas.
Define indurated.
Hardened skin.
Define turgor.
Turgor is the skin's elasticity.
Define Petechiae.
Petechiae are pinpoint-sized, red or purple spots on the skin caused by small hemorrhages in the skin layers.
What are the measurements of pitting edema?
1+ edema equals a 2-mm depth, 2+ edema equals a 4-mm depth, 3+ equals 6-mm, and 4+ equals 8-mm
Define senile keratosis.
thickening of skin.
Define cherry angiomas.
ruby red papules
List the ways to evaluate/document lesions.
When you detect a lesion, inspect it for color, location, texture, size, shape, type, grouping (clustered or linear), and distribution (localized or generalized). Observe any exudate for color, odor, amount, and consistency. Measure the size of the lesion by using a small, clear, flexible ruler divided in centimeters. Comparing a lesion with a household measure, such as a coin or eraser, is not reliable (Seidel and others, 2006). Measure lesions in height, width, and depth.
Discuss Basal cell carcinoma.
Not as dangerous, most common in sun-exposed areas and frequently occurs in a background of sun-damaged skin; it almost never spreads to other parts of the body.
Discus Squamous cell carcinoma.
more serious than basal cell and develops on the outer layers of sun-exposed skin; these cells may travel to lymph nodes and throughout the body.
Define Macule.
Flat, nonpalpable change in skin color, smaller than 1 cm (e.g., freckle, petechia)
Define Papule.
Palpable, circumscribed, solid el evation in skin, smaller than 1 cm (e.g., elevated nevus)
Define Nodule
Elevated solid mass, deeper and firmer than papule, 1-2 cm (e.g., wart)
Define Tumor.
Solid mass that extends deep through subcutaneous tissue, larger than 1-2 cm (e.g., epithelioma)
Define Wheal.
Irregularly shaped, elevate or superficial localized edema; varies in size (e.g., hive, mosquito bite)
Define sicle.
Circumscribed elevation of skin filled with serous fluid, smaller than 1 cm (e. g., herpes simplex, chickenpox)
Define Atrophy.
Thinning of skin with loss of normal skin furrow, with skin appearing shiny and translucent; varies in size (e.g., arterial insufficiency)
Define hirsutism.
hair growth on the upper lip, chin, and cheeks, with vellus hair becoming coarser over the body.
Define alopecia.
Hair loss
How do you evaluate the cancer warning signs?
ABCD: A- Asymmetry; B- Border irregularity; C– Color, uniformity (blue, black, brown variegated and areas of pink, white, gray, blue, or red are abnormal; D- Diameter than pencil eraser.
Deinfe hydrocephalus.
the buildup of cerebrospinal fluid in the ventricles
Define acromegaly.
a disorder caused by excessive secretion of growth hormone.
What are the tests for 3 types of vision?
Visual acuity for central, reading for near, Snellen for distance.
What is the basic medication administration formula?
(D / H) x V = amount to give (Dose ordered over what you have times vehicle or volume)
1 gr (grain) = _____ mg
60 mg
1 oz. = _____ mL
30 mL
1 oz. = _____ T
2 T
1 t = ___ mL
5 mL
When do you do blood glucose testing?
Before meals and at bedtime.
Know drug “schedules” Kee table 5-1
Define pharmacokinetics.
How medications move throughout the body.
What are four types of pharmacokinetics?
Absorption
List factors that influence medication absorption.
Route of administration, ability to dissolve, Blood flow to site of administration, Body surface area, lipid solubility of medication.
What are the fastest and slowest areas for absorption?
IV & skin
Three types of absorption.
Passive (get in alone), Active (need help), Pinocytosis (someone “carries” them across ie. enzyme).
What are factors that affect absorption?
Dose, composition, GI mucosa & motility, GI tract pH, Enzymatic action, Drug-drug or food-drug interaction, blood flow to site of drug administration, hepatic first-pass effect.
Do not take ______ with medications.
grapefruit juice, grapefruit
What is hepatic first-pass effect?
Once drug is absorbed by bowel, goes into mesentery empties into portal vein, then to liver - who decides how much of the drug gets through. (Oral only)
What happens with drug after absorption?
Distribution to body tissues, organs and specific sites of action.
What things does distribution depend on?
Circulation, membrane permeability, protein binding.
What factors affect distribution?
Protein-binding competition, low plasma protein/albumin levels, blood flow, blood-brain barrier, drug affinity (attraction).
What are factors that affect metabolism?
Body disfunction here: Liver, lungs, kidneys, blood, intestines.
What is the main organ of excretion?
kidneys.
What organs participate in excretion?
Kidney, lungs, bowel, skin via perspiration, tears, saliva, breast milk, liver.
How does aging effect drug distribution/excretion?
lowering body mass & total body water = lowering volume for distribution of drug. Lowering flow to kidneys & lowering of renal mass = lowering of drug excretion.
How does aging effect drug absorption?
None
Define Pharmacodynamics.
Define THerapeutic effect.
Expected or predicted effect.
Define side effects.
unintended, secondary (nontherapeutic effects).
Define Adverse effects.
Also unintended and secondary, but severe, concerning - Reasons to take them off.
Define toxic effect.
Medication has accumulated in the blood stream to now have a poisonous effect.
Define idiosyncratic reaction:
Over- or under-reaction to a medication.
Define drug agonist.
Initiates drug action; produces response.
Define antagonist.
Prevents blocks drug reaction.
What is the antagonist for narcotics?
Narcan
What is the antagonist for benzodyazopine?
Mazicon
Define serum half-life.
The time it takes the body to metabolize down the drug to 1/2.
Define drug onset.
Time it takes for a medication to produce a response.
Define medication “peak.”
Time at which a med reaches it highest effective concentration.
Define medication “trough.”
Minimum blood serum concentration before next scheduled dose.
Define medication “duration.”
Time medication takes to produce greatest result.
Define medication “plateau.”
Blood serum concentration is reached and maintained.
What are client related variables in drug metabolism?
Age & gender, body weight, pharmacogenetics, ethnic characteristics, pathological effects, psychological effects.
Look at Kee pg #120-121 for transcultural drug consideration
List considerations of “herbal medicines.”
Labeled “natural” doesn’t mean safe. Can act in same way as drugs. Don’t use for preg/lact/children. May interact with other medicines. Seek guidance from medical professional. Regulated by FDA as food not drugs.
Define Peak & Trough test.
Lab test to assess serum drug levels in the prevention of drug toxicity.
What is the most important accurate test for kidney function?
The most accurate test to determine renal function is creatinine clearance (CLcr)
What is the normal range for creatinine?
85 to 135 ml/min.
Define drug onset of action.
Onset of action is the time it takes to reach the minimum effective concentration (MEC) after a drug is administered.
What are the four (drug) receptor families?
(1) kinase-linked receptor, (2) ligand-gated ion channels, (3) G protein-coupled receptor systems, and (4) nuclear receptors.
Discuss Kinase-linked receptors.
The ligand-binding domain for drug binding is on the cell surface. The drug activates the enzyme (inside the cell), and a response is initiated.
Discuss Ligand-gated ion channels.
The drug spans the cell membrane and, with this type of receptor, the channel opens, allowing for the flow of ions into and out of the cells. The ions are primarily sodium and calcium.
Discuss G protein-coupled receptor systems.
There are three components to this receptor response: (1) the receptor, (2) G protein that binds with guanosine triphosphate (GTP), and (3) the effector that is either an enzyme or an ion channel.
Discuss Nuclear receptors.
Cell nucleus and not on the surface of the cell membrane. Activation of receptors through the transcription factors is prolonged. With the first three receptor groups, activation of the receptors is rapid.
Define Cholinergic.
Any drug that functions to enhance the effects mediated by acetylcholine in the central nervous system, the peripheral nervous system, or both.
What is acetylcholine?
The chemical compound acetylcholine (often abbreviated ACh) is a neurotransmitter in both the peripheral nervous system (PNS) and central nervous system
What are the four major categories of drug function?
The four categories of drug action include (1) stimulation or depression, (2) replacement, (3) inhibition or killing of organisms, and (4) irritation.
Define therapeutic effect.
The therapeutic index (TI) estimates the margin of safety of a drug through the use of a ratio that measures the effective (therapeutic or concentration) dose (ED) in 50% of persons or animals (ED50) and the lethal dose (LD) in 50% of animals (LD50) (Figure 1-8).
Differentiate between low and high therapeutic index.
Drugs with a low therapeutic index have a narrow margin of safety. Drugs with a high therapeutic index have a wide margin of safety and less danger of producing toxic effects.
Discuss drug “loading dose.”
When immediate drug response is desired, a large initial dose, known as the loading dose, of drug is given to achieve a rapid minimum effective concentration in the plasma.
Discuss pharmacogenetics.
Pharmacogenetics is the effect of a drug action that varies from a predicted drug response because of genetic factors or hereditary influence.
Define drug tolerance.
A decreased responsiveness over the course of therapy.
Define Tachyphylaxis.
A rapid decrease in response to the drug.
Discuss stock drug method versus unit dose method.
In the traditional stock drug method, the drugs are dispensed to all clients from the same containers. In the unit dose method, drugs are individually wrapped and labeled for single doses.
Discuss routes of medication dosing.
sublingual (under tongue for venous absorption); buccal (between gum and cheek); via feeding tube; topical (applied to the skin); inhalation (aerosol sprays); instillation (in nose, eye, ear); suppository (rectal, vaginal); and four parenteral routes: intradermal, subcutaneous (subQ), intramuscular (IM), and intravenous (IV).
cap
capsule
dr
dram
elix
elixir
g, gm, G, GM
gram
gr
grain
gtt
drops
kg
kilogram
l, L
liter
m2
square meter
mcg
microgram
mEq
milliequivalent
mg
milligram
mL, ml
milliliter
m, min
minim
A.D., ad
right ear
A.S., as
left ear
A.U., au
both ears
ID
intradermal
IM
intramuscular
IV
intravenous
IVPB
intravenous piggyback
KVO
keep vein open
L
left
NGT
nasogastric tube
O.D., od
right eye
O.S., os
left eye
O.U., ou
both eyes
PO, po, os
by mouth
®
right
SC, subc, sc, SQ, subQ
subcutaneous
SL, sl, subl
sublingual
TKO
to keep open
Vag
vaginal
AC, ac
before meals
ad lib
as desired
B.i.d., b.i.d.
twice a day
s
with
hs
hour of sleep
NPO
nothing by mouth
PC, pc
after meals
PRN, p.r.n.
whenever necessary, as needed
q
every
qAM
every morning
qh
every hour
q2h
every 2 hours
q4h
every 4 hours
q6h
every 6 hours
q8h
every 8 hours
s
without
SOS
once if necessary: if there is a need
Stat
immediately
T.i.d., t.i.d.
three times a day
Discuss toxicity.
This term refers to the first adverse symptoms that occur at a particular dose. Toxicity is more prevalent in persons with liver or renal impairment and in the very young and old.
Discuss Cumulative effect.
This occurs when the drug is metabolized or excreted more slowly than the rate at which it is being administered.
What are standard locations for subQ injections?
the abdomen, upper hips, upper back, lateral upper arms, and lateral thighs (
What are standard locations for IM injections?
ventrogluteal, deltoid, and vastus lateralis (pediatrics)
What size needle/syringe for SubQ injections?
Needle: 25 to 27 gauge, ½ to ⅝ inches in length, Syringe: 1 to 3 ml (usually 0.5 to 1.5 ml injected)
What size needle/syringe for IM injections?
Needle: 20 to 23 gauge; 18 gauge for blood products; 1 to 1.5 inches in length, Syringe: 1 to 3 ml (usually 0.5 to 1.5 ml injected)