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227 Cards in this Set
- Front
- Back
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what happens first when a vessel is injured?
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the vessel spasms and constricts
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Normal blood clotting occurs how fast?
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6 min
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What is required for the liver to make clotting factors
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Vitamin K
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INR range to prevent DVT?
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2-3
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what effect does garlic have on coagulation?
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Decreases the aggregation of platelets (anticoagulation effect)
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Anticoagulants' mech of action?
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either:
1. Inhibit specific clotting factors 2. diminish the action of platelets. |
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Advantage of Low molecular weight heperains (LMWH) over heparin?
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1. Duration is 2-4 times longer
2. produce more stable response a. fewer lab follow-ups b. family can learn to administer 3. less likely to cause HTP |
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Heparin - Drug class?
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Therapeutic - anticoagulant
Pharma - indirect thrombin inhibitor |
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Heparin - what to monitor?
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S&S of bleeding
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Heparin - what not to do when injecting
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aspirate or massage the site
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Heparin - dose
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5,000-10,000 units BID
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Heparin - drug-drug interactions?
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Drugs that inhibit platelet aggregation:
1. Aspirin & Ibuprofen 2. Nicotine, Digoxin, antihistamines |
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Heparin - Herbal interaction?
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Ginger, garlic- increase risk for bleeding
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Heparin - treatment of overdose?
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Protamine sulfate- 1mg for every 100 units of heparin
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Warfarin (coumadin) - Drug Class?
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Therapeutic - Anticoagulant
Pharm - Vitamin K antagonist |
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Warfarin (coumadin) - time of onset?
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2-7 days
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Warfarin (coumadin) - treatment of overdose?
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give Vitamin K
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Warfarin (coumadin) - drug-drug interactions?
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numerous - alcohol, NSAIDS, diuretics, antibiotics, (no OTC meds without approval by PCP)
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Patients receiving anticoagulant therapy - Potential Nursing Dx
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Pain R/T thrombosis & lessened perfusion
ineffective tissue perfusion R/T decresed circulation in affected area Impaired skin integrity in lower extremities R/T perfusion Risk for injury(bleeding) |
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Patients receiving anticoagulant therapy - adverse effects
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Bleeding at IV site, petechiae, hemoptysis, pallor dizziness, hypotension, tachycardia
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Patients receiving anticoagulant therapy - therapeutic ranges of
1. aPTT and aPT 2. INR |
1. aPTT and aPT = 1.5-2.5 times norm
2. INR = 2-3.5 or 4 times norm |
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Patients receiving anticoagulant therapy - how many alcoholic drinks per day?
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men=2
women=1 |
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Patients receiving anticoagulant therapy - teaching
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maintain norm diet, avoid increasing or decreasing vit-K
avoid garlic Wear ID bracelet at all times |
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Patients receiving anticoagulant therapy - what to tell nursing women?
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Nipple bleeding may occur
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Patients receiving anticoagulant therapy - If INR is high?
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give vit K
give aqua-mephyton |
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Clopidogrel (Plavix) - adverse effects
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Flulike syndrome, bleeding
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Clopidogrel (Plavix) - What class?
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Therapeutic - antiplatelet
Pharma - ADP receptor blocker |
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Alteplase (activase) - What class?
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Therapeutic - drug for dissolving clots
Pharma - thrombolytic |
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Alteplase (activase) - Goal of therapy?
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quickly restore blood flow to tissue served by the blocked vessel
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Alteplase (activase) - admin: Timeframe for effective treatment of:
1. MI 2. CVA |
1. MI = 12 hrs
2. CVA = 3 hrs |
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Patients receiving thrombolytic therapy - Assessments throughout administration: how often to check vitals and ECG?
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q15 min for 1st hour
q30 min for rest of infusion q30 min 1st 8 hrs after infusion |
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Patients receiving thrombolytic therapy - if dysrhythmias occur?
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report immediately
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Aminocaproic Acid (Amicar) - What class?
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Thera- clot stabilizer
Pharma - Hemostatic/antifibrinolytic |
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Which of the following clotting factors are formed after injury?
a. fibrin, vit-K b. thromboplastin, fibrinogen c. prothrombin, thrombin d. thrombin, fibrin |
b.
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How does heparin work?
a. Makes blood less thick b. doesn't thin blood but prevents clots from forming as easily c. decreases the number of platelets d. dissolves the clot |
b.
anticoagulants affect platelets so that clumping is inhibited |
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if a patient is receiving alteplase (activase) which condition is most likely attributed to this agent?
a. skin rash w/ urticaria b. wheezing w/ labored respirations c. bruising & epistaxis d. Temp elevation of 100.8 F |
c.
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A patient has started Plavix after a TIA. the desired therapeutic effects will be:
a. anti-inflammatory and antipyretic b. reduce risk of stroke from clots c. analgesic as well as clot-dissolve d. stop clots from becoming emboli |
b.
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The nurse is working on a medical unit in which a patient suddenly develops left-sided weakness & garbled speech. The PCP Dx is a CVA & orders heparin 5,000 units IV & a drip to run at 1,000 units/hour. What should the nurse do?
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Question the order. No patient who appears to be having a CVA should have heparin until a CT scan has been done. Approximately 20% of CVA's are hemorrhagic; these must be ruled out before administration
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A patient has had an acute MI and has received alteplase (activase) to lyse the clot. what nursing actions should have been taken prior to admin?
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all tubes (naso, foley, endotrach) must be inserted, blood drawn, & IV's inserted before administration
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What role does the kidneys have in erythropoiesis (RBC production)
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Releases Erythropoietin
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What is the primary signal for the increase of erythropoietin secretion?
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reduction in oxygen reaching the kidneys.
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Epoetin Alfa (epogen, Procrit) - What Class?
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thera - drug for anemia
Pharma - Hematopoietic growth factor, erythropoietin |
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Epoetin Alfa (epogen, Procrit) - onset?
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7-14 days
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Epoetin Alfa (epogen, Procrit) - adverse effects?
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HTN
increase risk of - cardiovascular events, thromboembolic events, DVT |
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Epoetin Alfa (epogen, Procrit) &
Filgrastim (neupogen) - teaching about administration? |
Never shake vial
vials are single use (discard remainder) kept refrigerated; warm in hand |
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Colony stimulant factors - Use?
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Stimulate the growth and differentiation of leukocytes (WBC's)
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Filgrastim (Neupogen) - drug class?
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thera - increasing neutrophil production
pharma - colony stimulating factor |
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Filgrastim (Neupogen) - Monitor?
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ECG ST segment depression (potential for serious dysrthymias)
Bone Pain (33% of patients) |
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Filgrastim (Neupogen) - teaching regarding cancer therapy?
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Filgrastim (Neupogen) doesn't treat cancer it is an adjunct therapy
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oprelvekin (Neumega) - Drug class?
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Platelet production enhancer
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name 3 antianemic agents?
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1. Cyanocobalamin (B12)
2. Folic Acid 3. Ferrous Sulfate (Iron) |
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Foods high in Folic acid?
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Leafy green veggies, citrus, dried beans and peas
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Foods high in Cobalamin (vit-B12)
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all meats, eggs, milk, and fortified breakfast cereals
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Foods high in Iron?
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Meats, lentils, beans
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Ferrous Sulfate administration regarding meals?
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taken on empty stomach
sipped through straw to avoid teeth Vit-C enhances iron absorbtion |
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Folic acid - commonly prescribed for what modifiable risk factor?
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Alcoholism
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Cyanocobalimin - uses?
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Treat pernicious anemia
Pregnancy |
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Ferrous Sulfate - teaching of common adverse effects.
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Darken stools (harmless)
Constipation (increase fiber intake) |
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The nursing plan of care for a patient receiving epoetin alfa (Procrit) should include careful monitoring for symptoms of?
a. angina, or a change in LOC b. severe hypotension c. impaired liver function d. Severe diarrhea |
a.
ration - This drug increases the risk for thromboembolic disease. the patient should be monitored for early signs of CVA or MI |
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to best monitor the therapeutic effects of filgrastim (neupogen) the nurse will monitor?
a. Hgb and Hct b. WBC and ANC counts c. electrolytes d. RBC count |
b.
Filgrastim stimulates WBC's. |
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The nursing plan of care for a patient receiving filgrastim (Neupogen) should include?
a. frequent observations for infection b. frequent monitoring of vitals, especially BP c. periodic ECG monitoring d. I & O measurements |
a.
Filgrastim stimulates WBC's and is used in cancer/HIV treatment. Risk of infection is high until WBC counts increase. all other answers may be monitored based on patient condition but are not required specific to filgrastim. |
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A patient newly diagnosed with renal failure asks the nurse why he must receive injections of epoetin alfa (procrit). Develop teaching points for a patient starting this med.
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Renal failure decreases erythropoietin secretion
Teaching Points: 1. Importance of monitoring BP (HTN) 2. Side effects: NV, constipation, confusion, numbness, chest pain, trouble breathing should be reported 3. maintain a healthy diet and follow dietary restriction of renal failure |
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A patient is receiving filgrastim (Neupogen). What nursing interventions are appropriate to safely administer this drug & provide patient safety throughout therapy?
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1. Check vitals q4 hrs (pulse & Temp) to monitor for infection.
2. S&S of: MI, Dysrhythmias, hepatic dysfunction |
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A patient is receiving Ferrous Sulfate. What teaching should the nurse provide to this patient?
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1. GI distress that may occur
2. may be taken with food to reduce potential GI upset. 3. constipation is common, increase fiber 4. warnings about children getting into med, Iron supplement toxicology is a common emergency for children |
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HIV - Prevention of perinatal transmission?
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Mother takes Retrovir
C-section is performed |
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Patients receiving pharmacotherapy for HIV-AIDS - common cause of noncompliance?
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Having to take multiple expensive drugs with serious adverse effects
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HIV - rational for "highly active antiretroviral therapy (HAART)
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Reduces the probability that HIV will become resistant to treatment.
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What is HAART?
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Highly active antiretroviral therapy
aggressive treatment with multiple drugs concurrently for treatment of HIV/AIDS |
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Patients receiving pharmacotherapy for HIV-AIDS - how is therapeutic effects monitored?
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1. CD4 counts
2. viral load 3. ability to perform ADLs 4. absence of S&S of concurrent infections |
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Zidovudine (Retrovir) - Drug Class?
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Thera - antiretroviral
pharma - Nucleoside reverse transcriptase inhibitor (NRTI) |
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Zidovudine (Retrovir) - common side effects
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N.V. diarrhea, headache, fatigue during 1st few weeks of therapy
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Efavirenz (sustiva) and delavirdine (rescriptor) - Drug Class?
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Thera - antiretroviral
pharma - Nonnucleoside reverse transcriptase inhibitor (NNRTI) |
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Efavirenz (sustiva) and delavirdine (rescriptor) - life-threatening adverse effect?
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Stevens-Johnson syndrome
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Zidovudine (Retrovir) - Serious Adverse effect
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Bone marrow suppression
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lopinavir/ritonavir (Kaletra) - Drug Class?
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thera - antiretroviral
Pharma - Protease inhibitor |
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Patients receiving pharmacotherapy for HIV-AIDS - what is the rational for encouraging fluid intake of 2-3 L/day
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HIV meds may be renal and hepatic toxic & increasing fluids will prevent drug accumulation in kidneys
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Patients receiving pharmacotherapy for HIV-AIDS - Stevens-Johnson syndrome is a potentially fatal adverse effect. What should you assess for?
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monitor for red/purplish skin rash, blisters, or peeling skin
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Acyclovir (zovirax) - Drug Class?
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Thera - antiviral for herpes viruses
Pharma - Nucleoside analog |
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Acyclovir (zovirax) - Serious Adverse effect when given IV
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Nephrotoxicity
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Acyclovir (zovirax) - Labs?
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Serum Creatinine and BUN
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amantadine (Symmetrel) - Drug Class?
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Thera - antiretroviral for influenza
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amantadine (Symmetrel) - Adverse effect
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Seizures
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amantadine (Symmetrel) - contraindicated for?
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Patients with history of seizures, epileptics
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When the patient is started on HAART, nursing education should include?
a. This drug will cure the disease over time b. this drug will not cure the disease, but may extend the life expectancy. c. this type of drug will be used prior to vaccines d. the drug is readily available all over the world for treatment |
b.
rational: There is no cure or vaccine for HIV |
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what labs must be assessed while a patient is on HIV drugs? (select all that apply)
a. CBC b. clotting factors c. HIV RNA d. CD4 lymphocyte count e. BUN |
c & d
Rational: 2 lab test used to guide therapy are CD4 count and HIV RNA (viral load) |
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When educating regarding NRTI drugs, the nurse should say, "take...
a. on an empty stomach b. on a full stomach c. with apple juice to decrease taste d. with orange juice to increase absorption |
a.
This should be taken on an empty stomach for max absorption |
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A patient is concerned about contracting influenza. The best response is?
a. after vaccination you'll be protected in about 2 months b. if you're exposed, 2 drugs, Tamiflu or Relenza are available to help prevent or shorten the duration c. you only need vaccination if older than 50 d. the infectious particles aren't easily spread, & you can wait. |
b.
may prevent flu if taken within 48 hrs of exposure |
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A patient started on a NNRTI should be taught?
a. this will cure the disease b. there are few notable adverse effects of this drug c. nervous system effects such as dizziness, difficulty thinking, nightmares may occur but improve after 3-4 wks d. the drug should be taken with a high-fat meal to delay absorption and prolong effect. |
c.
Neurologic adverse effects may occur but improve after 3-4 wks. |
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A patient has started Acyclovir. The nurse will teach...(select all that apply)
a. increase fluid up to 2L / Day b. report any dizziness, tremors, confusion c. decrease the amount of fluids taken so that the drug can be more concentrated d. only take when having the most itching or pain |
a & b
can be renal toxic and fluids should be incresed Neurotoxicity may occur, S&S should be reported immediately |
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A patient is 72 and lives in assisted living. the nurse advises receiving symmetrel. What is the rationale?
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Prevention through vaccination is the best approach to dealing with influenza.
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A newly diagnosed HIV patient has been put on Retrovir. Identify priorities of nursing care for this patient.
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1. This may cause bone marrow suppression.
2. Potential for leukopenia is high 3. watch for S&S of infection |
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A PCP has ordered acyclovir as an IV bolus to be infuse over 15 min. The patient is seriously ill with systemic herpesvirus infection., and the PCP wants the patient to have immediate access to medication. What is the nurse's best response?
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Inform the PCP that the med needs to be administered over a minimum of 1 hour, and that the nurse is unable to give the med as a bolus or IV piggyback for less than 1 hour. The IV site must be monitored closely for potential infiltration while the medication is infused. If this occurs, the IV must be stopped immediately.
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lindane (Kwell) - Drug Class?
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thera - Antiparasitic
Phrama - Scabicide, pediculidide |
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lindane (Kwell) - Contraindication
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People with seizure disorders
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lindane (Kwell) - serious adverse effect
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Nervous system toxicity
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Permthrin (Acticin, Elimite, Nix) - Drug Class?
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thera - antiparasitic
Pharma - Scabicide; pediculicide |
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Permthrin (Acticin, Elimite, Nix) - Contraindicated for?
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Those with asthma, lactating women
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Patients receiving therapy with scabicides - Teaching regarding administration
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1. wear gloves
2. apply only over affected area 3. Irritating to eyes and face 4. call PCP if ineffective 5. Comb hair with small-toothed comb to remove remaining dead lice |
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Patients receiving therapy with scabicides - teaching regarding housing infestation
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1. Wash bedding and clothes
2. vacuum furniture and carpet 3. seal toys in plastic bags for 2 wks if they cannot be washed |
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Accutane - Drug Class?
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Thera - Antiacne agent
Pharma - Retinoid |
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isotretinoin (Accutane) - Adverse Effects
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Suicidal Ideation
Birth defects |
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Tretinoin (Retin-A) - Drug Class
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Thera - antiacne agent
Pharma - Retinoid |
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Tretinoin (Retin-A) - Common adverse effects
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Redness, scaling, peeling of skin
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Following treatment with permethrin (Elimite, Nix) the nurse reinforces instructions to:
a. Remain isolate for 48 hrs b. inspect hair shaft, checking for nits daily for 1 wk after treatment. c. shampoo with med 3x daily d. wash linens with cold water & bleach |
b.
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signs of over-application of permethrine (Elimite) include: (multi)
a. N & V b. Headache c. eye irritation d. diaphoresis e. restlessness |
a, b, e
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the teaching plan for tretinoin (Retina-A) therapy should include: (Multiple answers)
a. 20-30 min of sun will help dry the skin and prevent breakouts b. Wash face with a mild soap, avoiding scrubbing, twice a day. c. use oil-free sunscreens, sun hats, and protective clothing d. expect some dryness, redness, and peeling, but report severe skin irritation |
b, c, d
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After many other treatments, a 28-year-old female is started on Accutane. While on this med she must: (multi)
a. use two forms of birth control and have pregnancy tests before beginning, during, and after she is on the therapy. b. have vision checks q6 months c. increase intake of vit-A foods d. return q2-3 months for lab test |
a, b, d
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Vaccines - common side effect
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Fever
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Vaccines - True or False: Ibuprofin can be given for vaccine related fever
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True
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Vaccines - teaching
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The importance of vaccinations
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Vaccines - assessment before administration
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Previous history of reaction to vaccinations
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Vaccines - Influenza: groups at risk?
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1. elderly
2. children |
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Vaccines - what is the Hep B series schedule for adults?
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3 doses total
1. 1st dose 2. 30 days later 3. 6 months after 1st dose |
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Hepatitis B vaccine - related to pregnacy?
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Pregnancy category C
Causes birth defects Teach importance of birth control while receiving vaccine |
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Interferon alfa-2b (intron-A) - Drug Class?
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Thera - immunostimulant
Pharma - Interferon |
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Interferon alfa-2b (intron-A) - side effects?
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Flu-like symptoms (50% of patients)
Nausea, vomiting |
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Interferon alfa-2b (intron-A) - drug-drug interaction?
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alcohol (drowsiness and dehydration)
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Patients receiving immunostimulant therapy - Reasons for use?
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1. patients with infections
2. patients with cancer |
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Patients receiving immunostimulant therapy - contraindicated for?
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Patients with renal/liver disease
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Patients receiving immunostimulant therapy - Adverse effect
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encephalopathy
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Patients receiving immunostimulant therapy - what to monitor for signs of encephalopathy?
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1. Depression
2. Suicidal ideation |
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Immunosupressants - Use?
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1. transplant patients (to prevent rejection)
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inflixamab (Remicade) - Drug Class?
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Thera - Immunosuppresant
Pharma - Antibodies |
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inflixamab (Remicade) - What disorder does it treat?
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Arthritis
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cyclosporin (Neoral, Sandimmune) - Drug Class?
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thera - immunosuppressant
Pharma - Calcineurin inhibitor |
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cyclosporin (Neoral, Sandimmune) - What skin disorder does this treat?
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Psoriasis
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cyclosporin (Neoral, Sandimmune) - Serious adverse effect?
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Nephro/neuro toxic
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Methotrexate (Rheumatrex) - Drug Class?
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Thera- immunosuppressant
Pharma - antimetabolites and cytotoxic agents |
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Methotrexate (Rheumatrex) - Adverse effect?
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Leukopenia
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cyclophosphamide (Cytoxan) - Drug Class?
|
thera - immunosuppressant
Pharma - antimetabolites and cytotoxic agents |
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cyclophosphamide (Cytoxan) - Adverse effect?
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Nausea/vomiting,
1. alopecia (hair loss) |
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Immunosuppresants - Corticosteroids - what to monitor?
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Signs of infection
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Patients receiving immunosuppressant therapy - interventions to minimize adverse effects?
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1. monitor BP/TEMP, S&S of infection
2. assess for alopecia 3. pregnancy should be avoided 4 months following therapy |
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Patients receiving immunosuppressant therapy - teaching regarding how to prevent infection?
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1. Avoid large crowds (especially indoors)
2. avoid sick people & children 3. hygiene |
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Patients receiving immunosuppressant therapy - teaching regarding what to report?
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1. Joint Pain
2. hair loss 3. fever 4. neurologic changes |
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A female (55) is on cyclosporine after a heart transplant. she has; WBC= 12,000, a sore throat, fatigue, and a low-grade fever. you suspect?
a. transplant rejection b. heart failure c. dehydration d. infection |
d
ration: Due to immunosuppression infections are common |
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a client is on cyclosporine. Which statements shows a need for more teaching?
a. I will report any reduction in urine output to my doc b. I will wash my hands frequently c. I will take my BP at home daily d. I will take med at breakfast with a glass of grapefruit juice |
d
Grapefruit drink increases cyclo levels 50-200% resulting in toxicity |
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the nurse should monitor a transplant patient for the major adverse effect of cyclosporine therapy by assessing which lab test?
a. CBC b. Serum creatinine c. Liver enzymes d. Electrolytes |
b
ration: 75% of patinets on cyclosporine experience decreased renal output |
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The nurse would question an order for immunostimulant therapy if the patient had which of the following conditions? (multiple answers)
a. Pregnancy b. Renal disease c. Infection d. Liver disease e. Metastatic cancer |
a, b, d, e,
these are contraindications (infection and cancer are indications for the use of the drug) |
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A child (5) is due to school immunizations. Which of the statements by the mom may indicate a possible contraindication and would require further exploration?
a. her cousin has the flu b. The mother just finished her hep B series c. Her arm got really sore after her last tetanus shot. d. they're caring for the granny who just finished her 2nd chemo treatment for breast cancer. |
d
live vaccines may be contraindicated when there's an exposure risk to people with compromised immune sys |
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A patient had a renal transplant 6 months ago and is taking cyclosporine daily. Identify three precautions that the nurse should be aware of when caring for him/her.
|
Cyclosporine is a toxic med with many serious adverse effects;
1. Cannot be given with grapefruit 2. need regular kidney function tests 3. if taking steroids concurrently, than glucose need to be monitored |
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What are the 5 basic steps in inflammation?
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1. Vasodilation (redness, heat)
2. Vascular permeability (edema) 3. Cellular infiltration (pus) 4. Thrombosis (clots) 5. stim of nerve endings (pain) |
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What affect does histamine have on blood vessels?
|
1. Dilates nearby blood vessels
2. causing capillaries to be more permiable |
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aspirin - Drug class?
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Thera - NSAID
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aspirin - adverse effects?
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1. tinnitus
2. GI bleeding |
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aspirin - administration guideline to help prevent GI upset?
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administer with food
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ibuprofen (Advil) - Drug class?
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thera - NSAID
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ibuprofen (Advil) - Drug-drug interaction
|
darbaset (Darvan)
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ibuprofen (Advil) - max. dose
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3,200 mg/day
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ibuprofen (Advil) - contraindications
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1. patients with renal/hepatic impairment
2. treatment of perioperative pain for CABG due to MI/Stroke potential |
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acetominophen (tylenol) - drug class?
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Thera- antipyretic & analgesic
Pharma - centrally acting COX inhibitor |
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acetominophen (tylenol) - Drug-drug interaction?
|
warfarin - inhibits warfarin metabolism causing accumulation to toxic lvls
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acetominophen (tylenol) - Teaching regarding administration to infants
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Don't give the adult type
give the baby approved version |
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acetominophen (tylenol) - Ethnic considerations? What is the adverse effect for these groups?
|
1. Asian
2. Africans 3. Saudis hemolysis |
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prednisone - drug class?
|
thera - anti-inflammatory agent
pharma - glucocorticoid |
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prednisone - adverse effects?
|
1. healing impairment
2. immune suppression |
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prednisone - duration of therapy?
|
4-10 days
(short-term therapy) |
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Patients receiving anti-inflammatory and antipyretic therapy - Labs to run before administration
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1. CBC
2. Liver function 3. Cratinine Clearance |
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Patients receiving anti-inflammatory and antipyretic therapy - Intervention to minimize nephrotoxicity?
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1. Stay well hydrated
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on discharge, you discuss types of OTC NSAIDs. which OTC med is often used for pain & fever but is not classified as an NSAID?
a. aspirin b. ibuprofen c. acetaminophen d. motrin |
c
acetaminophen has no anti-inflammatory actions |
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A patient has been taking aspirin for several days for headache. During assessment, you discover the patient has ringing in the ears and dizziness. What is the best choice?
a. Question about history of sinus infection b. determine if patient mixed aspirin with other meds. c. Tell the patient not to take more aspirin d. tell the patient to take aspirin with food or milk |
c
high doses of aspirin can produce these side-effects |
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Glucocorticoids - patient teaching regarding what to report to a PCP
a. a decrese in 2 lb in weight b. an increase in appetite c. any diarrhea d. any difficulty breathing |
d
side effects to report immediately: difficulty breathing heartburn chest, abdom, joint, bone pain nosebleed hemoptysis fruity breath odor GI bleeding mood swings |
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A patient with rheumatoid arthritis has been taking glucocorticoids for a long time. During assessment you observe; a very round moon-shaped face, bruising, abnormal contour of the shoulders.
What do you conclude? a. these are norm reactions to the illness b. these are probable birth defects c. these are symptoms of myasthenia gravis d. these are symptoms of adverse drug effects from the corticosteroids |
d
monitor for dev. of cushing's syndrome |
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a patient (24) takes tylenol fairly regularly for headaches. You know that a patient consuming excess acetaminophen per day or regularly consumes alcohol should be observed for...
a. hepatic toxicity b. renal damage c. thrombotic effects d. pulmonary damage |
a
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you are counseling a mother regarding antipyretic choices for her daughter (8). when asked why aspirin is not a good med to use, you base you answer on the knowledge that aspirin...
a. is not as good a antipyretic as acetaminophen b. may increase fever in children under 10 c. may produce nausea and vomit d. increases the risk of Reye's syndrome in children under 18 with viral infections |
d
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Define pathogenicity
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the ability of an organism to cause infection.
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Define Virulence
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a highly virulent microbe is one that can produce disease when present in minute numbers; just takes a few bacteria to make you sick (describes AIDS also).
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antibiotic therapy; patient teaching - How do antibiotics work?
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antibiotic did not kill all the infection, but only slows the growth, tell the client that our body will kill the rest.
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What role does antibiotic therapy have on normal flora related to superinfections?
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Antibiotics destroy the normal flora which have antimicrobial properties. With these gone pathogenic microbes are able to proliferate without control.
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What are some S&S of a superinfection?
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1. A new infection appearing while on anti-infective therapy
2. diarrhea 3. dysuria 4. vaginal discharge |
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Bacterial infection: if a patient comes in with a fever of 104 F. What is typically performed first to ID the causative agent?
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a blood culture
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Penicillin - Drug Class?
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Thera - antibacterial
Pharma - Cell wall inhibitor |
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Penicillin - Advese effects?
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1. Anaphylaxis
2. Nephrotoxicity 3. rash, diarrhea, nausea fever |
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Penicillin - What to assess before administering?
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1. Previous allergy or reaction to drug
2. if patient has never had PNC before than a scratch test may be performed |
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Penicillin - what to assess after administration?
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have client wait 30 min before discharge to assess for allergic reaction
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Cefotaxime (Claforan) - Drug Class?
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Thera - Antibacterial
Pharma - Cell wall inhibitor; 1st gen cephalosporin |
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Cefotaxime (Claforan) - Contraindications?
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Patients allergic to penicillin
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Tetracycline (sumycin) - Drug class?
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thera - antibacterial
pharma - tetracycline; protein synthesis inhibitor |
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Tetracycline (sumycin) - Contraindications?
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Pregnancy category D
children under 8 |
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Aminoglycosides - Adverse effects?
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Irreversible ototoxicity
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Gentamicin (gramycin) - Drug Class?
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thera - antibacterial
pharma - Aminoglycoside |
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Gentamicin (gramycin) - Adverse effects?
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1. Irreversible ototoxicity
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Vancomycin - Signs of toxicity
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1. Red-man syndrome (areas of reddening)
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Penicillin - Patient teaching to women of child-bearing age?
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Penicillin can lower the effectiveness of oral contraceptives
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What Antibacterial medication is commonly prescribed for strep throat?
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Amoxycillin
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what disease can strep throat lead to?
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Rheumatic fever - heart valve damage
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Amoxycillin - Common Use?
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Strep throat
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Explain how the pharmacotherapy of tuberculosis differs from that of other infections.
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Multiple drug therapies are needed in the treatment of TB, since the complex microbes are slow growing and commonly develop drug resistance
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Who is a greatest risk for developing a fungal infection?
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Immunocompromised
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how is malaria spread?
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mosquitoes
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Amphotericin B (Fungizone) - Drug class?
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Thera - antifungal
Pharma - Polyene |
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Amphotericin B (Fungizone) - Contraindications?
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Caution in patients with renal impairment
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Amphotericin B (Fungizone) - adverse effects
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1. ototoxic
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fluconazole (Diflucan) - Drug Class?
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thera - antifungal
pharma - inhibitor of fungal cell membrane synthesis; azole |
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ketoconazole (Nizoral) - Contraindications?
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chronic alcoholism
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fluconazole (Diflucan) - Adverse effects
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hepatotoxicity- pruritus, jaundice, dark urine, and skin rash
Diabetics - can affect glycemic control |
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Nystatin - Drug class?
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thera - topical antifungal
Pharma - polyene |
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Nystatin - Adverse effect?
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Contact dermatitis (report)
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Nystatin - Patient teaching for oral candidiasis?
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1. "swish and swallow", or "swish and spit"
2. Swished in the mouth for at least 2 min |
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Chloroquine (Aralen) - Drug Class?
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Thera - Antimalarial agent
Pharma - Heme complexing agent |
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Chloroquine (Aralen) - Contraindications?
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1. visual impairment
2. renal impairment |
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metronidazole (Flagyl) - Drug Class?
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thera - anti-infective, antiprotozoan
pharma - disrupts nucleic acid synth |
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metronidazole (Flagyl) - common adverse effects?
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Dry mouth
Metallic taste |
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Mebendazole (Vermox) - Drug Class?
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thera - drug for worm infections
Pharma - Antihelmintic |
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Helminthic infections: patient teaching?
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1. Helminths are worms
2. can sometimes be seen in stool 3. mostly affect children |
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A patient diagnosed with a fungal nail infection. the PCP orders fluconazole (Diflucan). the nurse teaches?
a. Drug therapy will be short, probable 2 to 4 weeks b. Carefully inspect all intramuscular injection sites for bruising c. Report if you come down with symptoms of a bacterial infection d. Limit fluid intake to 1000 ml/day |
c
ration: Systemic antifungal drugs have little antibacterial activity |
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A patient is prescribed quinine (Quinamm) for treatment of malaria. Prior to beginning therapy the patient will need to:
a. sign a consent form for this med b. have an ECG done c. stop all other meds for 24 hours d. be admitted to an ICU for the 1st 24 hrs of therapy |
b
assessment for pre-existing cardiovascular disease |
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A patient has returned from Cambodia where malaria was contracted. A drug the nurse expects to see used is:
a. proguanil (Paludrine) b. penicillin (Ampicillin) c. rizatriptan (Maxalt) d. chloroquine (Aralen) |
d
Chloroquine (Aralen) is the classic antimalarial |
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The nurse is providing community education about pinworms and roundworms. Which of the following should be included in this teaching? (multiple answers)
a. Hand washing is important to preventing the spread of worms b. Play habits contribute to the transmission of worms c. it is important that children wear shoes when playing outside d. Children should not be allowed to play in open sandboxes e. Once the child has had worms, reinfestation cannot occur |
a, b, c d,
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A patient (32) is on metronidazole (Flagyl) for treatment of trichomonas vaginal infection. she must avoid:
a. caffeine b. acidic juices c. antacids d. alcohol |
d
Alcohol + metronidazole may cause N.V. hypotension |
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Metronidazole (Flagyl) is being used to treat a patient's Giardia lamblia infection. a protozoal infection of the intestines. teach which of the following (multi)
a. Metronidazole may leave a metallic taste b. urine may turn brown c. may be D/C once diarrhea subsides, to minimize side effects d. Take with food to reduce GI upset e. Current sex partners don't need treatment for infection |
a, b, d, e
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A patient is traveling to Africa and is requesting Malarone. What premed assessment must be done?
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Can have profound adverse effects, and patients must be carefully screened and educated.
1. baseline physical assessment 2. Liver and renal function tests 3. hearing and visual assessments Because patient may suffer permanent organ damage while on this med, baseline info is crucial |
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Cyclophosphamide (Cytoxan) - Drug Class?
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thera - antineoplastic
Pharma - Alkylating agent; nitrogen mustard |
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Antineoplastic Drugs - Adverse Effects?
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1. Bone marrow suppression (anemia, leukopenia, thrombocytopenia)
2. GI toxicity (Anorexia, Bleeding, Diarrhea, extreme N.V.) 3. Other (Alopecia, Fatigue, Fetal death, oral ulcerations) |
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Antineoplastic therapy - Patient teaching regarding rational for combination therapy.
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1. Multiple drugs affect different stages in the cell cycle.
2. The different mechanisms of action increase the cell kill. These combinations allow for lower doses, which reduce toxicity and slow the development of resistance. |
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Methotrexate (Rheumatrex, Trexall) - Drug Class?
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Thera - Antineoplastic
Pharm - Antimetabolite, falic acid analog |
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Doxorubicin (Adriamycin) - Drug Class?
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Thera - Antineoplastic
Pharma - Antitumor antibiotic |
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Vincristine (Oncovin) - Drug Class?
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Thera - Antineoplastic
Pharma - Mitotic inhibitor |
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Tamoxifen - Drug Class?
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thera - Antineoplastic
Pharm - Estrogen receptor blocker |
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The effective treatment method for the N & V that accompany chemo is to:
a. give oral antiemetic when patient complains of N & V b. give IM antiemetic when patient complains of N&V c. give an antiemetic prior to antineoplastic medication d. Push fluids prior to giving chemo |
c
for max effect give emetic prior to treatment |
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Which of the following statements by a patient undergoing chemo would be of concern? ( multiple answers)
a. I have attended a meeting of a cancer support group b. my husband and I are planning a short trip next week c. I am eating six small meals plus two protein shakes a day d. I am taking my 15-month-old granddaughter to the pediatrician next week for her shots e. I'm going shopping at the mall next week |
d, e
Patient's family should avoid getting live virus vaccines the patient should avoid crowds |
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To monitor for the presence of bone marrow suppression, the nurse evaluates the results of the:
a. BUN and serum creatinine b. Serum electrolytes c. CBC d. Bone scan |
c
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A 2-year-old is recieving vincristine (Oncovin) for wilm's tumor. Which of the following symptoms should be reported?
a. Diarrhea b. Diminished bowel sounds c. Stomatitis d. Anorexia |
b
the most serious side effect of vincristine is nervous system toxicity. Paralytic ileus is likely in young children |
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Define - Nadir
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The point of greatest bone marrow suppression, as measured by the lowest neutrophil count.
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A patient is newly diagnosed with cancer and is about to start chemo. Identify the teaching priorities for this patient.
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1. Strategies for coping with side effect
2. nutrition is a major focus 3. take anitemetics 1 hour pre-chemo 4. eat small meals, supplements |
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Chemo meds often cause neutropenia. What would be a priority for the nurse to teach a patient receiving chemo at home?
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1. potential for infection
2. hand washing, avoid crowds 3. self-assess temp 4. when to call PCP |
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A nurse is taking chemo IV meds to a patient's room and the IV bag suddenly leaks solution (50 mL) on the floor. What action should the nurse take?
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1. Remain with the solution and call for a chemo spill kit STAT
2. while waiting; cover with paper towel 3. do not touch or leave unattended |
