Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
92 Cards in this Set
- Front
- Back
|
What is the difference between subjective data and objective data?
|
Subjective--includes what the patient says or perceives
Objective--gathered through physical assessment, laboratory tests, other diagnostics |
|
|
What are the five overlapping phases of the nursing process?
|
1. Assessing
2. Diagnosis 3. Planning 4. Implementing 5. Evaluating |
|
|
What does assessment include?
|
1. determining whether the patient is experiencing the expected therapeutic benefits of meds
2. patient's perceptions of adverse effects 3. follow-up vital signs & lab reports 4. ability of the patient to assume responsibility for self-admin of meds |
|
|
What do nursing diagnoses provide?
|
The basis for establishing goald and outcomes, planning interventions, and evaluating the effectiveness of the care given
|
|
|
How does nursing diagnosis differ from medical diagnosis?
|
Nursing diagnosis focuses on a patient's response to actual or potential health and life processes. Medical diagnosis focuses on a disease or condition.
|
|
|
The diagnosis phase of the nursing process address what three main areas of concern?
|
1. Promoting therapeutic drug effects
2. Minimizing adverse drug effects and toxicity 3. Maximizing the ability of the patient for self-care, including the knowledge, skills, and resources necessary for safe and effective drug administration |
|
|
What are the two most common nursing diagnoses for medication administration?
|
1. deficient knowledge
2. non-compliance |
|
|
What is involved in the planning phase of the nursing process?
|
1. prioritizing diagnoses
2. formulating desired outcomes 3. selecting nursing interventions that can assist the patient to return to establish an optimum level of wellness. |
|
|
What should be done before administration of medications?
|
Nurses should establish clear, realistic goals and outcomes so that planned interventions ensure safe and effective use of these agents.
|
|
|
With respect to pharmacotherapy, what two main components does the planning phase involve?
|
1. drug administration
2. patient teaching |
|
|
What occurs after the goals and outcomes are identified based on the nursing diagnoses?
|
A patient-focused care plan is written
|
|
|
What is the implementation phase of the nursing process?
|
When the nurse applies the knowledge, skills, and principles of nursing care to help move the patient toward the desired goal and optimal wellness.
|
|
|
What does implementation involve?
|
Action on the part of the nurse or patient administering a drug, providing patient teaching, and initiating otehr specific actions identified by the plan of care.
|
|
|
Why do children cause concern in drug administration?
|
Pediatric dosages are often unclear becuase medication research often does not include children, so there is a potential for adverse drug reactions and a greater risk for serious medication errors.
|
|
|
Why does the elderly population present the nurse with additional nursing considerations?
|
Eldersly patients often have chronic iillnesses and age-related changes that may cause medication effects to be unpredictable. Also drug-drug interactions are a concern because these patients often take multiple drugs. It is also important to co-teach the patient's caregiver, if there is one.
|
|
|
What does the evaluation phase do for the nursing process?
|
Compares the patient's current health status with the desired outcome. This step determines if the plan of care is appropriate, if it was met, or if it needs revision.
|
|
|
Why is drug therapy often postponed until after pregnancy and lactation?
|
Because of the fetal/placental barrier. Many drugs can be considered teratogens that cross this barrier and cause adverse side effects to the fetus.
|
|
|
What are some serious conditions the patient exhibited prior to pregancy that may require pharmacotherapy in pregnant patients?
|
-epilepsy
-hypertneison -psychiatric disorder |
|
|
What is the responsibility of the practitioner when administering drugs during preganancy?
|
Weighing the therapeutic benefits of a medication against its potential adverse effects.
|
|
|
The placenta is what type of membrane?
|
Semipermeable (some substances readily pass from mother to fetus, while others are blocked)
|
|
|
Which drugs are less likely to cross the plancenta to the fetus?
|
Drugs that are water soluble, ionized, or bound to plasma proteins
|
|
|
What can affect pharmacotherapy during pregnancy?
|
1. absorption (hormones and blood supply changes may affect absorption of drugs)
2. Distribution and metabolism (hemodynamic changes in the prenant patient increase cardiac output, plasma volume, and change regional blood flow) 3. excretion (blood flow through mom's kidneys increase 40-50%, affecting excretion rates, and affecting onset of action) |
|
|
TRUE or FALSE:
There are "absolute teratogens" |
FALSE
Whether or not a drug produces a teratogenic effect depends upon multiple, complex factors. |
|
|
What is the "all-or-none" period? Why is it called this?
|
The preimplantation period (weeks 1-2 of the first trimester) because exposure to a teratogen either causes death of the enbryo or has no effect at all.
|
|
|
When is the embryonic period?
|
Weeks 3-8 postconception, during which there is rapid development of internal structures and maximum sensitivity to teratogens
|
|
|
What is the fetal period?
|
9-40 seeks postconception or until birth.
|
|
|
There are 5 pregnancy categories that guide the health care team and patient inselecting drugs that are least hazardous for the fetus. How are they categorized?
|
A, B, C, D, and X
|
|
|
Give an example of a drug in risk category X
|
Accutane
misoprostol thalidomide |
|
|
Give an example of a drug in risk category B
|
Penicillins
cephalosporins azithromycin acetaminophen ibuprofen *first and second trimesters* |
|
|
Give an example of a drug in risk category A
|
Prenatal multivitamins
insulin thyroxine folic acid |
|
|
Give an example of a drug in risk category D
|
ACE inhibitors
angiotensin receptor blockers (ARBs)--2nd/3rd trimesters gentamicin ibuprofen (3rd trimester) tetracyclines Premarin alcohol nicotine |
|
|
Give an example of a drug in risk category C
|
Most Rx meds
antimicrobials (clarithromycin, fluoroquinolones, bactrim) SSRIs corticosteroids most antihypertensives |
|
|
In regard to meds given during lactation, list some recommendations.
|
1. Drugs with a shorter half-life are preferable (drug quickly cleared from maternal plasma, reduces amount of drug exposure to infant)
2. Drugs that have long half-lives (or active metabolites) should be avoided because they can accumlate in the infant's plasma (barbituarates, benzos, meperidine, and fluoxetine) 3. Drugs with high protein-binding ability should be selected when possibel (not secreted as readily to the milk) 4. OTC herbal and dietary supplements should be avoided because the safety of most to the infant has not been determined. |
|
|
In teaching patients about drug therapy during pregnancy, what points should a nurse include?
|
1. Keep all scheduled physician appointments and lab visits for testing
2. Do not take other Rx drugs, OTC meds, herbals, or dietary supps without notifying your provider. 3. Take iron, folic acid, and multivitamin supps as perscribed ruring pregnancy 4. Eliminate alcohol and tobacco use 5. Join a pregnancy registry if taking Rx drugs 6. Understand that adverse effects of drug treatment may be confused with common discomforts of preganancy (nausea, vomiting, heartburn, constipation, hyptension, heart palpitations, fatigue) 7. Use nonpharmacologic alternatives (ie: massage for pain or calming music for anxiety) whenever possible. |
|
|
What fetal effects are known to be caused by marijuana?
|
low-birth-weith babies
risk or premature delivery withdrawal symptoms (crying, trembling) |
|
|
What fetal effects are known to be caused by cocaine?
|
increased risk of miscarriage
premature delivery malformations of fetal limbs and kidneys behavioral disturbances (jittery, irritable, crying) |
|
|
List some effects known to cause harm to the fetus with use of heroin.
|
increased risk of miscarriage
low-birth-weight withdrawal symptoms diarrhea fever sneezing yawning tremors seizures irregular breathing irritability increased risk of SIDS |
|
|
List some risks of tobacco use during preganancy
|
increased risk of stillbirth
premature delivery low-birth-weight increased risk of SIDS |
|
|
List some alcohol-related effects on the fetus.
|
miscarriage/stillbirth
fetal alcohol syndrome (small stature, joint problems, problems with attention/memory/intelligence/coordination and problem solving) |
|
|
What substance(s) is/are known to cause low-birth-weight?
|
Marijuana
Heroin Tobacco |
|
|
What substance(s) is/are known to cause withdrawal symptoms?
|
Marijuana
Heroin |
|
|
What substance(s) is/are known to cause problems with attention, memory, intelligence, coordination, and problem solving?
|
Alcohol
|
|
|
What substance(s) is/are known to cause behavioral disturbances (jittery/irritable/crying)?
|
Cocaine
|
|
|
What substance(s) is/are known to cause an increased risk of sudden infant death syndrome (SIDS)?
|
Heroin
Tobacco |
|
|
What substance(s) is/are known to cause irregular breathing?
|
Heroin
|
|
|
What substance(s) is/are known to cause malformations of fetal limbs and kidneys?
|
Cocaine
|
|
|
What substance(s) is/are known to lead to an increased risk of miscarriage and/or stillbirth?
|
Cocaine
Heroin Tobacco Alcohol |
|
|
What substance(s) is/are known to lead to risk of premature delivery?
|
Marijuana
Cocaine Tobacco |
|
|
In regard to pharmacotherapy of infants, where should oral meds by directed?
|
To the inner cheek. The child should be given time to swallow the drug to avoid aspiration.
|
|
|
When administering rectal suppositories, how long should the buttocks be held together to prevent expulsion?
|
5-10 minutes
|
|
|
Why is it controversial to administer meds to very young infants via a nipple?
|
Because the infant may associate the nipple with medication and refuse feedings
|
|
|
There are special considerations that must be observed when administering IM or IV injections to infants. List some.
|
--the smallest needle appropriate for the drug should be used
--for volumes less than 1mL, a tuberculin syringe is appropriate --The vastus lateralis is a preferred IM site --the gluteal site is usially contraindicated |
|
|
Why is the vastus lateralis preferred for IM injections in infants?
|
Because it has few nerves and is relatively well developed in infants.
|
|
|
Why is the gluteal site contraindicated for IM injections in infants?
|
Because of potential nerve damage to the sciatic nerve, injury to which may result in permanent disability.
|
|
|
For IV sites, what are the preffered venous access sites in infants?
|
The feet
and Scalp veins |
|
|
What age period is toddlerhood?
|
1 to 3 years
|
|
|
What is considered the neonatal period?
|
The first 28 days of life
|
|
|
How should nurses educate parents of toddlers in regard to protecting their children from poisoning?
|
1. Read and follow directions on label before using drugs and OTC products
2. Store all drugs and harmful agents out of reach and in locked cabinets 3. Keep all household products and drugs in original containers 4. Always ask pharmacist to place meds in child-resistant containers 5. NEVER tell a child that meds are candy 6. Keep the Poison Control Center number near phones--call immediately if poisoning is suspected 7. Never leave meds unattended in a child's room or where child plays |
|
|
What is the correct way to explain med admin to a toddler? Why?
1. Long, detailed explanation 2. Short, concrete explanation |
Short, concrete explanations followed immediately by drug admin are best for this age group, so as not to prolong admin and cause additional anxiety.
|
|
|
TRUE or FALSE
Oral meds (even those that taste bad) should NEVER be mixed with a vehicle (jam, syrup, fuit puree) |
FALSE
Oral meds that taste bad SHOULD be mixed with a very small amount of some kind of vehicle if possible |
|
|
Why should nurses teach parents to avoid placing meds in milk, orange juice, or cereals?
|
Because the child may associate these healthful foods with bad-tasting meds.
|
|
|
What is the preferred site for IM injections in a toddler?
|
The vastus lateralis
|
|
|
What is preferred for IV injections in toddlers?
|
Scalp
Feet Additional peripheral site options become available late in toddlerhood |
|
|
What precaution is taken in adminstering IV meds to a toddler due to their movement and resistance?
|
IVs must be firmly secured. Longer tubing may be used to give the toddler more play room. The nurse should take at least one helper into the room for assitance in restraining the toddler if necessary.
|
|
|
What age range is considered to be a preschool child?
|
3 to 5 years
|
|
|
Why is iron poisoning a concern in children under age 6?
|
Because of its presence in vitamins. Pediatric vitamins may be tempting and may have the taste and appearance of candy.
|
|
|
What are the symptoms of iron poisoning?
|
nausea
vomiting diarrhea GI bleeding Can progress to coma/death |
|
|
What site can be used for IM injections in a preschool age child?
|
Ventrogluteal, after the child has walked for about a year (less pain than vastus lateralis site)
|
|
|
What site can no longer be used for IV access in preschool age children?
|
Scalp veins
|
|
|
What is often used in conjunction with explaining medication admin to preschool children?
|
Role playing with a "sick" doll
|
|
|
At what stge do early ethical-moral developments begin to take shape?
|
School-age children (between 6 and 12 years)
|
|
|
What is the preferred site of injections for IM in school-age children?
|
Ventrogluteal site, although the muscles of older children are developed enough for other site use.
|
|
|
What is the age of adolescence?
|
13 to 16
|
|
|
What are the most common needs for pharmacotherapy in adolescents?
|
Skin problems
Headaches Menstrual symptoms Eating disorders Contraception Alcohol Tobacco use Sports-related injuries |
|
|
What is the primary concern in regard to adolescent behavior?
|
The initiation of sexual intercourse and avoidance of pregnancy and STDs
|
|
|
Why should adolescents by carefully questioned about their eating habits and use of OTC appetite suppressants or laxatives?
|
Because eating disorders are common in this population
|
|
|
TRUE or FALSE
All state laws regarding teens privacy and confidentiality are the same. |
FALSE.
The njurse needs to be familiar with their state laws affecting confidentiality and informed consent |
|
|
What ages are considered for young adulthood? Middle adulthood? Older adulthood?
|
18-40
40-65 65+ |
|
|
What is the main concern during ages 18-24?
|
Substance abuse and sexually transmitted diseases
|
|
|
What is a cause of concern for the middle-aged adult?
|
Stress-related causes for illness and health impairments and alterations.
|
|
|
List some health impairments related to the middle-aged adult.
|
Cardiovascular disease
Hypertension Obesity Arthritis Cancer Anxiety |
|
|
What is prominent in the population older than 50 in regard to pharmacotherapy?
|
Antidepressants and antianxiety agents
|
|
|
What is polypharmacy?
|
Taking of multiple drugs concurrently (common among older adults)
|
|
|
Why is polypharmacy a concern?
|
It dramatically increases risk for drug interactions and side effects.
|
|
|
What can the nurse do to help the patient avoid these issues in polypharmacy?
|
Urge the patient to report all Rx and OTC products on each office visit and teach the patient to use one pharmacy for their Rx needs.
|
|
|
What accomodations may be needed fro older adults with certain impairments?
|
The nurse needs to provide drug instructions in large type and obtain patient feedback to be certain that med instructions are understood.
|
|
|
In geriatric patients, the functioning ability of major organ systems progressively declines. What does this affect in regard to pharmacotherapy?
|
Absorption
Distribution Metabolism Excretion |
|
|
How is absorption affected in geriatric patients?
|
Absorption of drugs is slower due to diminished gastric motility and decreased blood flow to digestive organs.
|
|
|
How is distribution affected in geriatric patients?
|
Increased body fat provides a larger storage compartment for lipd-soluble drugs and vitamins. Plasma levels are reduced and the therapeutic response is diminished. The liver produces less albumin (less plasma protein-binding ability)
|
|
|
How is half-life affected in regard to geriatric patients?
|
Hepatic drug metabolism is reduced because the enzyme production int he liver decreases and visceral blood flow is diminished. This leads to an increase in the half-life of many drugs (prolongs and intensifies drug response)
|
|
|
Is excretion increased or decreased in older adults? Why?
|
Decreased for drugs that are eliminated by the kidneys due to reduced renal blood flow, glomerular filtration rate, active tubular secretion, and nephron function.
|
|
|
What is the cause of the most common etiology of adverse drug reactions in older adults?
|
The accumlation of toxic amounts of drugs secondary to impaired renal excretion
|
