N15 Exam 1

Front 1

The most commonly reported medication side effects are:

Back 1

•Anorexia
•Nausea
•Vomiting
•Dizziness
•Drowsiness
•Dry mouth
•Abdominal gas
•Constipation
•Diarrhea

Front 2

Patients at Increased Risk for Adverse Medication Reactions

Back 2

•Patients taking a medication for the first time
•Very young and/or older adult patients
•Women
•Patients taking more than four to five medications (polypharmacy)
•Patients who are extremely underweight or overweight
•Patients with renal and/or hepatic disease
•Patients with altered blood flow conditions
•Patients with a past history of an adverse medication reaction
•Patients with depression and/or anxiety
•Patients with sensory deprivation and/or overload
•Patients who abuse alcohol, nicotine, or street medications
•Patients who self-medicate with over-the-counter medications

Front 3

idiosyncratic reaction
re: medication

Back 3

in which a patient overreacts or underreacts to a medication or has a reaction different from normal. Predicting which patients will have an idiosyncratic response is impossible.

Front 4

allergic reaction

Back 4

another unpredictable response to a medication. Exposure to an initial dose of a medication may cause an immunologic response. The medication acts as an antigen, which causes antibodies to be produced. With repeated administration, the patient develops an allergic response to the medication, its chemical preservatives, or a metabolite.
antibiotics cause a high incidence of allergic reactions

Front 5

Medication tolerance

Back 5

occurs when patients receive the same medication for long periods of time and require higher doses to produce the same desired effect. Patients who are taking pain medications may develop tolerance over time.

Front 6

Cross-tolerance

Back 6

may occur after tolerance to a medication. In cross-tolerance, a patient develops tolerance to pharmacologically similar medications and medications that act at the same receptor sites.

For example, a patient who takes Darvocet (propoxyphene hydrochloride), an opioid analgesic for chronic back pain, may have cross-tolerance to Valium (diazepam) when it is administered for anxiety and as a result may require a larger dose of the Valium to obtain the desired effect. Or if a patient is dependent or tolerant to alcohol, a higher-than-usual pain medication dose may be required for the desired effect of the medication.

Front 7

medication dependence

Back 7

Two types of medication dependence exist:
•Psychological (or addiction): The patient desires the medication for some benefit other than the intended effect.
•Physical: This involves a physiologic adaptation to a medication that manifests itself by intense physical disturbance when the medication is withdrawn.

Front 8

Medication Interactions

Back 8

When two medications are given simultaneously, they can have a synergistic (or additive) effect. With a synergistic reaction, the physiologic action of the two medications in combination is greater than the effect of the medications when given separately.

For example, alcohol is a central nervous system depressant that has a synergistic effect with antihistamines, antidepressants, or opioid analgesics.

A medication interaction may be desirable. Often a physician orders combination medication therapy to create a medication interaction for a therapeutic benefit.

Front 9

After you administer a medication, it undergoes:

Back 9

•Absorption
•Distribution
•Metabolism
•Excretion

Front 10

These processes are influenced by factors such as:

Back 10

•Body surface area
•Body water content
•Body fat content
•Body protein stores

Front 11

Onset of medication action

Back 11

This is the time it takes after a medication is administered for it to produce a response.

Front 12

Peak action

Back 12

This is the time it takes for a medication to reach its highest effective concentration.

Front 13

Duration of action:

Back 13

This is the length of time during which the medication is present in a concentration great enough to produce a response.

Front 14

•Plateau:

Back 14

This is the blood serum concentration reached and maintained after repeated, fixed doses.

Front 15

steady state levels of drug in the body.

Back 15

it takes 5 half lives for a drug to reach steady state levels in the body.

Front 16

trough level

Back 16

•The lowest serum level is the trough level. Blood samples for trough levels are usually drawn 30 minutes before the medication is administered.

Front 17

peak levels

Back 17

•The highest serum concentration or peak concentration of medication usually occurs just before the last of the medication is absorbed.
•Blood samples for peak levels are drawn to coincide with the time that the medication is expected to reach its peak concentration. This varies with medication pharmacokinetics.

Front 18

Six Rights for Administration of Medication

Back 18

Right Patient
Right Drug
Right Dose
Right Time
Right Route
Right Documentation

Front 19

A physician's order includes

Back 19

•The name of the medication, which may be either the trade name (e.g., Percocet) or the generic name (e.g., oxycodone)
•The dose (e.g., 5 mg)
•The form (e.g., tabs)
•The route (e.g., PO)
•The frequency (e.g., q4h)
•Orders for drugs to be given prn also include the reason they are to be given (e.g., for pain)
•The signature of the prescriber

Front 20

Dosage Preparation

Back 20

Agency policies differ, but most require another nurse to verify prepared doses of:
•Anticoagulant
•Insulin
•IV push medications

Front 21

Crushed medications

Back 21

Crushed medications should be mixed with very small amounts of food and/or liquid. Avoid using the patient's favorite food and liquids because the medication may alter the taste and decrease the patient's desire for them. Never crush medications that are to be given sublingually (under the tongue) or that are enteric coated and/or time released. Time release medications may have one of the following designations:
•XR = extended release
•CR = controlled release
•LA = long acting
•SR = slow release

Front 22

Scheduled Medications

Back 22

All routinely ordered medications should be given within 30 minutes before or after the scheduled time, or according to agency policy.
A medication may also be ordered for special circumstances.

For example, a preoperative medication may be ordered:
•"stat": to be given immediately
•"now": as soon as available, usually within an hour
•"on call": the operating room will notify the nurse when it is the appropriate time

A medication may be ordered "AC" (before meals) or "PC" (after meals).

Front 23

tid

Back 23

Medications to be given tid (3 times a day) may be routinely scheduled for 0800, 1400, and 2000 or for 0900, 1300, and 1900, depending on the agency policy.
A medication may also be ordered q8h (every 8 hours), which is also 3 times a day. However, the medication ordered q8h needs to be given around the clock to maintain adequate therapeutic levels and would, for example, be given at 0800, 1600, and 2400. Antibiotics are one example of a medication which may be ordered around the clock.

Front 24

Right Documentation

Back 24

• a. name of the medication you gave,
• b. dose,
• c. time and route of administration,
• d. injection site (if the medication was injected),
• e. and date and time of your entry.
• 2. Also provide your initials or signature, where required.
• 3. Make sure your notations reflect only medications you administered or witnessed the patient selfadminister.

Front 25

Common routes of medication absorption are:
•Oral (by mouth, PO):

◦Tablet
◦Capsule
◦Pill
◦Liquid
◦Suspension

•Sublingual (under the tongue for venous absorption; NOT to be swallowed or chewed)
•Buccal (between gum and cheek)

Back 25

•Oral (by mouth, PO):

◦Tablet
◦Capsule
◦Pill
◦Liquid
◦Suspension

•Sublingual (under the tongue for venous absorption; NOT to be swallowed or chewed)
•Buccal (between gum and cheek)

Front 26

Common routes of medication absorption are:

Back 26

•Three topical routes:

◦Skin applications (lotions, pastes, ointments, or patches)
◦Inhalation (aerosol sprays)
◦Instillation (in nose, eye, ear, rectum, or vagina)

Front 27

Common routes of medication absorption are:

Back 27

•Four parenteral routes:

◦Intradermal
◦Subcutaneous
◦Intramuscular
◦Intravenous

Front 28

Medication Conversions

Back 28

Medications ordered in units and milliequivalents cannot be converted to metric or household measurements.

Front 29

When administering medications, three basic outcomes should be met:

Back 29

1.The patient achieves the medication's therapeutic effect.
2.The patient does not experience complications related to the method of administration.
3.The patient and family will understand how to self-administer the medications safely.

Front 30

To determine a medication's effectiveness and the absence of adverse effects, you should evaluate the following

Back 30

•Monitor the patient's physical response to the medication (e.g., vital signs, urine output, relief of pain, or other symptoms).
•Monitor the patient's behavioral responses to the medication (e.g., level of anxiety, agitation, consciousness).
•Observe any injection sites for bruises, inflammation, localized pain, numbness, or bleeding.
•Determine the patient's understanding of the medication therapy and the ability to self-administer the medication.

Front 31

Sublingual/buccal medicines take effect in how many minutes?

Back 31

15 minutes or less.

Front 32

Cascade Cough

Back 32

The client inhales and holds the breath for 2 seconds then coughs during the expiration.
This technique promotes airway clearance in pts w/large volumes of sputum.

Front 33

Quad cough

Back 33

The pt exhales forcefully and you push against the abdomen. For pts who lack control of their abdomen muscles.

Front 34

Huff Cough

Back 34

This stimulates a natural cough reflex and is generally effective only for clearing large central airways.

Front 35

Nasal Cannula

Back 35

< or equal to 6L, usually not higher than 4L because high flow rates have a drying effect on mucosa.

Front 36

O2 masks
Simple Face mask

Back 36

low O2 concentration and are not appropriate for CO2 retainers.
O2 mixes w/room air via side holes in mask.

Front 37

Medication Dose Response

Back 37

ADME
Absorption - Distribution - Metabolism - Excretion

These processes are influenced by factors such as:
•Body surface area
•Body water content
-Body fat content
•Body protein stores

Front 38

Complications of Wound Healing—Dehiscence

Back 38

This most commonly occurs before collagen formation (3 to 11 days after injury).
Dehiscence is the partial or total separation of wound layers. A patient who is at risk for poor wound healing (e.g., poor nutritional status, infection, obesity) is at risk for dehiscence. However, obese patients have a higher risk because of the constant strain placed on their wounds and the poor healing qualities of fat tissue.

Front 39

Complications of Wound Healing—Evisceration

Back 39

With total separation of wound layers, evisceration (protrusion of visceral organs through a wound opening) may occur. The condition is an emergency that requires surgical repair. When evisceration occurs, the nurse places sterile towels soaked in sterile saline over the extruding tissues. The patient should be allowed nothing by mouth (NPO), observed for signs and symptoms of shock, and prepared for emergency surgery.