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104 Cards in this Set

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Endogenous analgesia system -
Pain suppression system of the CNS involving opiate receptors, ascending and descending pain pathways, enkephalins, dynorphins, and beta-endorphins
The GOLGI COMPLEX
stores hormones and other substances produced by the endoplasmic reticulum
The limbic system borders and interconnects with the thalamus, hypothalamus, basal ganglia, hippocampus, amygdala, and septum
Define Teaching
an interactive process that promotes learning. It consists of conscious and deliberate set of actions that helps individuals gain new knowledge or perform new skills
Symptoms of Withdrawal
* Anxiety * Aggressiveness
* Restlessness * Generalized body aches
* Insomnia * Lacrimation
* Rhinorrhea * Perspiration
* Pupil dilation
* Piloerection (goose flesh)
* Anorexia * Nausea
* Vomiting * Diarrhea
* Elevation of body temperature
* Elevation of respiratory rate
* Elevation of systolic blood pressure
* Abdominal and other muscle cramps
* Dehydration * Weight loss
Chronic inflammation may result from recurrent or progressive episodes of acute inflammation or from a low grade, smoldering type of tissue response to persistent irritants
Metabolism
after meds reach the site of action it is metabolized (i.e. broken down) - if not being metabolized correctly a build up of meds may cause toxicity
Role of the nurse in teaching and learning
* Answering questions
* Providing information based on your patient's health needs and treatment plans
* Clarifying information
The chief clinical use of opioid antagonists is
to relieve CNS and respiratory depression induced by therapeutic doses or overdoses of opioids
Schedule IV
drugs with some potential for abuse
The cerebellum, which is connected with motor centers in the cerebral cortex and basal ganglia, coordinates muscular activity
Define Learning
the acquisition of new knowledge or skills through reinforced practice and experience
Opioid analgesics are drugs that relieve moderate to severe pain by
* reducing the perception of pain sensation
* producing sedation
* decreasing the emotional upsets often associated with pain
Systemic effects
are those resulting from absorption into the blood stream and circulated through the body
Membrane Permeability
medications must pass through biological membranes of the organ
- Fat soluble meds pass through the blood brain barrier
Specific neuroendocrine functions include -
* producing oxytocin and ADH
* regulating body temperature
* assisting in regulation of arterial blood pressure by its effects on the vasomotor center
* regulating anterior pituitary hormones
* regulating food and water intake by the hypothalamic thirst, appetite, hunger, and satiety centers
* regulating the physical changes associated with emotions
Psychomotor Learning
Demonstration
Provides presentation of procedure or skills by nurse
Permits client to incorporate modeling of nurse's behavior
Allows nurse to control questioning during demonstration
Practice
Gives patient opportunity to perform skills using equipment
Provides repetition
Return Demonstration
Permits patient to perform skills while the nurse observes
Excellent source of feedback and reinforcement
Independent Project, Game
Requires teaching method that encourages adaptation and origination of psychomotor learning
Permits learner to use new skills
* learns with motor skills
* integration of mental and motor activity
* attempt to increase confidence
Opioid antagonists reverse or block analgesia, CNS and respiratory depression, and other physiologic effects of opioid agonists
Prostaglandins =
found in virtually all body tissues and act in the area where they are produced to regulate many cellular functions before being rapidly inactivated
In general, the pathogenesis of excessive CNS stimulation may involve one or more of the following mechanisms -
1 - Excessive amounts of excitatory neurotransmitters (eg nor epinephrine)
2 - Increased numbers or sensitivity of excitatory receptors.
3 - Insufficient amounts of inhibitory neurotransmitters (eg GABA)
4 - Decreased numbers or sensitivity of inhibitory receptors
Social Services =
help with depression, getting back into community, etc
Opioid agonists
morphine and morphine-like drugs
Schedule V
products containing moderate amounts of controlled substances. May be dispensed by a pharmacist without a physician's prescription
Circulation
enters bloodstream and carried through tissues and organs
ST (speech therapy) =
working on swallowing, cognitive things
Pain occurs when tissue damage activates the free nerve endings (pain receptors or Nociceptors) or peripheral nerves
Leukotrienes =
help regulate cellular responses to injury, including inflammation
The Thalamus receives impulses carrying sensations such as
heat, cold, pain, and muscle position sense
Basic Learning Principles
* motivation to learn
- internal impulses
- mental state
- allows learner to focus
* health beliefs
- pt. must be actively involved
* readiness to learn
- accept reality of disease process
- once a pt. has accepted that's the best time to teach
* ability to learn
- teaching must be done at the level of the patient's understanding
- pain levels must be conducive to learning
- body needs must be met in order for pt. to focus on learning
* developmental and physical capability
- does the patient have adequate psychomotor skills?
Factors that influence absorption
Route of administration -
- Oral Route (po)
- Sublingual Route (under tongue) (sl or subl)
- Buccal - in mouth (between cheek and gums)
- Parenteral Route - intramuscular (IM), intravenous (IV), subcutaneous (subq)
- Inhalation - breathing in; respiratory therapy
- Intraocular - eyedrops
* Ability of the mediation to dissolve - depends on form of preparation
* Blood flow in and to site of administration
* Body surface area - absorption in small intestine (large surface area)
* Lipid solubility - increased lipids cross cell membrane; absorbed more quickly on empty stomach
Schedule III
drugs with less potential for abuse than those in Schedules I and II, however abuse may lead to psychological or physical dependence
The reticular activating system is a network of neurons that extends from the spinal cord through the medulla and pons to the thalamus and hypothalamus
Disability =
usually the consequence of an impairment. Described in terms of altered functional ability
Serum Half Life
time it takes for excretion to lower the serum med. Concentration by half; this is when half of the med is out of your body. You want to know this in order to give regular fixed doses. You are supposed to give the next dos when the first dose reaches its half life
WBC (granulocytes)
* neutrophils
* eosinophils
* Basophils
- Stimulants
Mild stimulation is characterized by wakefulness, mental alertness, and decreased fatigue.
Increasing stimulation produced produces hyperactivity, excessive talking, nervousness, and insomnia.
Excessive stimulation can cause convulsive seizures, cardiac arrhythmias
PT (physical therapy) =
motor skills
Sources of Drug Information
* Pharmacology text books
* Drug reference books
* PDR (Physician's Desk Reference)
* Drug Handbooks
basophils =
release histamine, major chemical mediator in inflammatory and immediate hypersensitivity reactions
The hypothalamus has extensive neurological and endocrine functions
The hypothalamus is stimulated or inhibited by nerve impulses from different portions of the nervous system and by concentrations of nutrients, electrolytes, water, and hormones in the blood
Rehab services include
PT
OT
ST
nursing
and social services
For a medication to be therapeutically useful, it must
- be taken into a patient's body
- absorbed and distributed to cells, tissues, or a specific organ
- and alter a physiological function
neutrophils =
body's main defense against pathogenic bacteria; major leukocytes in the bloodstream
Standards (the five rights)
Right Medication
Right Dose
Right Patient
Right Route
Right Time
The cerebral cortex is involved in all conscious processes, such as
learning, memory, reasoning, verbalization, and voluntary body movements
Generally, teaching and learning begin when
a person identifies a need for knowing or acquiring an ability to do something
Distribution
every medication has a specific site of action. After absorption it is distributed to tissues and organs and ultimately to its site of action
Schedule II
drugs that are medically used and have high abuse potentials
The medulla oblongata contains groups of neurons that form the vital cardiac, respiratory, and vasomotor center
OT (occupational therapy) =
psychomotor skills (cleaning, cooking, etc.)
Distribution Systems
Unit Dose
Multi Dose
Computer Controlled Dispensing Units
Most drugs are given for their systemic effects
Relatively few drugs act by mechanisms other than combination with receptor sites on cells - these include
* Antacids
* Osmotic diuretics
* Drugs that are structurally similar to nutrients required by body cells
Considerations when doing Group Learning
Make sure the environment is adequate.
Be aware of privacy needs.
Examples of when group learning is a POSITIVE - Lamaze classes
- Outpatient
- Parenting classes
- CPR classes
Example of when group learning might be a NEGATIVE -
Things that are individualized - perineal care
Absorption
message of med molecule into the blood from the site of administration
Schedule I
drugs not approved for medical use and have high abuse potentials
Drugs affecting the CNS
- Depressants
- antipsychotics
- narcotic analgesics
- sedative-hypnotics
Mild CNS depression is characterized by lack of interest in surroundings and inability to focus on a topic.
As depression progresses, there is drowsiness or sleep, decreased muscle tone, decreased ability to move, and decreased perception of sensations such as pain, heat, and cold.
Teaching is most effective when it responds to a learner's needs
Excretion
how the drugs exit the body (kidneys, liver, bowels, lungs, and exocrine (sweat) glands; depends on the chemical makeup
Characteristics of Synthetic drugs
* more standardized in their chemical characteristics
* more consistent in their effects
* less likely to produce allergic reactions
The basal ganglia are concerned with skeletal muscle tone and orderly activity
Affective Learning
Role Play
Allows expression of values, feeling, and attitudes
Discussion (Group)
Allows patient to acquire support from others in group
Permits patient to learn from other's experiences
Promotes responding, valuing, and organization
Discussion (one on one)
Allows discussion of personal, sensitive topics of interest or concern.
* use values
* learner receives and responds
* strong sense of values
* values the teacher and what is being said
Medication measurements
* metric
* household (i.e. drops, tsp, Tbs, cups)
* solutions - injections, irrigations. Given mass of solid substance dissolved in a known volume of fluid
Chemical Mediators of Inflammation
* Prostaglandins
* Leukotrienes
The pyramidal and extrapyramidal systems are pathways out of the cerebral cortex
Impairment =
a loss; abnormality of body structure or structures; alteration in body system or functioning
- temporary or permanent
- interferes with normal activity
Pharmokinetics
The study of how meds enter the body; reach site of action; are materialized; and exit the body
eosinophils =
increase during allergic reactions and parasitic infections
Glutamate is considered the most important excitatory neurotransmitter in the CNS
Handicap =
disadvantage experienced by a person as a result of impairment and/or disability
- loss of ability to be self-sufficient
- limits/prevents fulfillment of a role
Types of Medication Action
* Therapeutic Effects = expected or predictable physiological response to med.
* Side Effects = Predictable unintentional secondary effects. May be harmless; may be severe.
- Side effects are the most common reason people stop taking a drug
* Adverse Effects = Severe response (unpredicted); usually reported to FDA
* Toxic Effects = may develop after prolonged intake of medication because medication has accumulated in the blood
* Idiosyncratic Reactions = Same as adverse effects
* Allergic Reactions = Unpredictable mild or severe (anaphylactic) shock or reaction.
- An anaphylactic shock results in constriction of bronchioles, edema in throat; shortness of breath, wheezing. GIVE IV Benadryl or anti-histamine.
* Medication Interactions = One med may modify or potentiate the action of another med
Guidelines for Effective Study
1 - Try to understand how the drug acts in the body.
2 - Concentrate your study efforts on major characteristics.
3 - Compare the drug with a prototype when possible.
4 - Keep an authoritative, up-to-date drug reference readily available, at work and home.
5 - Use your own words when taking notes or writing drug information cards.
6 - Mentally practice applying drug acknowledge in nursing care
Glycine is an inhibitory neurotransmitter found in the brain stem and spinal cord
Rehab services are TEAM approach
Nurses role regarding meds
1 - knowledge
2 - patient and family education
3 - administration
4 - assessment of client's ability to use medication on their own after discharge
5 - critical thinking skills
Route of Administration
* For rapid drug action, IV is most effective
* For many drugs, the IM produces drug action within a few minutes because muscles have a large blood supply.
* Oral route is usually slower than parenteral routes
Protein Binding
some meds are designed to bind to proteins and some are designed not to bind to proteins
Definitions/Considerations of Rehabilitation
Restoration of person to fullest physical, mental, social, vocational, and economic usefulness as possible.
Idea of rehab is to restore someone to pre-condition so that they may go back to living as before.
Rehabilitation - gets person to highest functioning level they may achieve
Drugs injected IV do not need to be absorbed because
they are placed directly into the bloodstream
Define Pharmacology
study of drugs that alter functions of living organisms
Using the example of insulin injection with each Domain of Learning
Cognitive -
The pt. must understand why the injection is needed; the proper location; and the importance of using sterile technique.
Affective -
Pt. must be willing to overcome fears and distrusts and accept need for injection.
Psychomotor -
Giving themselves injection.
Bladder Training IG (p 131)
* Facilitating or triggering techniques
* Intermittent catheterization
* Consistent scheduling of toileting routines
Therapeutic effects -
desired responses
IM starts to work in
30 minutes
Nurses =
have the opportunity to do all and reinforce what other therapists are teaching
IV starts to work in
10-20 minutes
Passive diffusion =
most common. Movement of a drug from an area of higher concentration to an area of lower concentration
PO starts to work in
40-50 minutes
Group Learning
"learning occurs when behavior changes as a result of experience or growth"
Epidural starts to work
immediate
SC starts to work in
60-90 minutes
Cognitive Learning
Discussion -
may involve nurse and client or nurse with several clients.
Promotes active participation and focuses on topics of interest to client.
Allows peer support.
Enhances application and analysis of new information
Lecture
Is more formal method of instruction because it is controlled by teacher.
Helps learner acquire new knowledge and gain comprehension.
Question and answer session
Designed specifically to address patient's concerns
Assists client in applying knowledge
Role Play, Discovery
Allows patient to actively apply knowledge in controlled situation
Promotes synthesis of information and problem solving
Independent Project
Allows patient to assume responsibility for completing learning activities at own pace.
Promotes analysis, synthesis, and evaluation of new information and skills.
* understanding learning
* all intellectual
* acquisition of knowledge
* use abstract ideas for concrete concepts
* evaluation
* analysis
* organized
* synthesis
Drugs injected into subcutaneous or intramuscular tissues are usually absorbed more rapidly than oral drugs because they move directly from the injection site to the bloodstream
The main disadvantage of the oral route is
that it is slower and may cause irritation to the GI mucus
Active transport =
Drug molecules are moved from an area of lower concentration to one of higher concentration
Absorption is rapid from IM sites because
muscle tissue has an abundant blood supply
The term parenteral refers to
any route other than GI (enteral), however is commonly used to indicate SC, IM, and IV injections
The mechanisms of drug movement are
* Passive diffusion
* Facilitated diffusion
* Active transport
Facilitated diffusion =
Drug molecules combine with a carrier substance, such as an enzyme or protein
Relatively few drugs act by mechanisms other than combination with receptor sites on cells - these include
* Antacids
* Osmotic diuretics
* Drugs that are structurally similar to nutrients required by body cells
* Metal chelating agents
The _____ synapse is more commonly used to communicate with other neurons or target cells
chemical
Aspartate is an excitatory neurotransmitter found in high concentrations in the brain
Disadvantages of IV
* Time and skill required for venipuncture
* Difficulty of maintaining an IV line
* Greater potential for adverse reactions from rapid drug action
* Possible complications of IV therapy (ie, bleeding, infection, fluid overload)
Adverse effects
- any undesired responses to drug administration