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85 Cards in this Set

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Define medication error
"Any preventable event that may cause or lead to inappropriate medication use or patient harm while the med in in control of the health care professional, patient, or consumer" (NCC MERP)
According to NCC MERP, what is the medication error index?
This index categorizes medication errors by evaluating the extent of the harm an error can cause
How can patients or their home care givers contribute to med errors?
~Taking drugs prescribed by several practitioners without informing each of their health care providers about all prescribed meds
~Getting prescriptions filled at more than one pharmacy
~Not filling/refilling Rx
~Taking meds incorrectly
~Taking meds that may been left over from a previous ilness or Rx for something else
How can health care providers contribute to medication errors?
~Omitting one of the 5 rights of drug admin
~Failing to perform an agency system check (pharmacists and nurses collaborating on checking accuracy and appropriateness of drug orders)
~Failing to account for patient variables (age, body size, impairment in renal/hepatic function)
~Giving meds based on verbal/phone orders (misinterpretation, lack of docmunentation)
~Giving meds based on incomplete orders, or illegible orders
~Practicing under stressful work conditions
TRUE or FALSE
The most common cause of morbidity and preventable death within a hospital is surgical mishaps.
FALSE.
It is medication errors
What is the drug most frequently associated with medication errors at home? Second most frequent? Third? and fourth?
Warfarin
Insulin
Morphine
Vancomycin
The FDA is one organization involved in the report of medication errors, what is the second organization?
The National Coordinating Councel for Medication Error Reporting and Prevention
(NCC MERP)
What does the NCC MERP do?
Coordinates information on medication errors and provices medication error prevention education
What are sentinel events?
Unexpected occurrences involving death or serious physical or psychological injury, or risk thereof. They are always investigated and interventions are put in place.
There are 4 strategies for reducing medication errors, what are they?
1. Assessment
2. Planning
3. Implementation
4. Evaluation
List, in order of percentage occurrence, the most common types of errors reported.
41% Administering an improper dose
16% Giving wrong drug
16% using wrong route of administration
Why are children vulnerable in medication administration?
Because they receive doses according to weight, which can lead to error and dosage miscalculations
Why are elderly patients considered a risk for medication error?
Because they often take numerous medications, have multiple health care providers, and are experiencing normal, age-related changes in physiology
Explain medication reconciliation
The process of "keeping track" of a patient's medications as they proceed from one care provider to another.
Why is the frequency of adverse effects of meds increased in elderly patients?
Because of their decreased ability to absorb and metabolize medications
How can nurses educate patients and caregivers to minimize the potential for medication errors?
Teach them to:
~Know the names of all meds, uses, doses, and when/how they should be taken
~Know side effects and report if necessary
~Read label prior to each administration and use the med device that comes with liquid meds
~Carry a list of all meds (including OTC), herbal and dietary supplements
~Ask questions.
How do health care facilities reduce medication errors?
~Correct storage (light/temp control)
~Read the drug label to avoid expired meds
~Avoid transfer of doses between containers
~Avoid overstocking of meds to prevent expiration
~Monitoring compliance with prohibited Rx abbreviations
~Removing outdated reference books
What 3 agencies track medication errors?
1. FDA (MedWatch)
2. ISMP (Institute for Safe Medication Practices)
3. MEDMARX (anonymous, through US Pharmacopeia)
Each nurse is responsible for becoming familiar with the nurse practice acts of the state becuase these acts:
a) protect the nurse from malpractice suits
b) contain national standards or responsibilities
c) contain job descriptions for all nurses
d) define nursing practice standars of care for the nurse practicing in a specific state
The nurse administers a medication to the wrong patient. The appropriate nursing action is to:
a) monitor the patient for adverse reaction before reporting the incident
b) document the error if the patient has an adverse reaction
c) report the error to the physician, document the medication in the patient record, and complete a report of the error for further follow-up and analysis
d) notify the physician and document the error in a report only
The patient with liver dysfunction experiences toxicity to a drug following administration of several doses. This adverse reaction may have been prevented if the nurse followed which phase of the nursing process?
a) assessment
b) planning
c) implementation
d) evaluation
Nurses have a legal and moral responsibility to report medication errors. The steps of reporting these errors include
a) punishing the nurse who committed the error
b) monitoring unsafe medication facilities
c) identifying potential unsafe medication facilities
d) examining interdisciplinary causes of errors and assisting professionals in ways to avoid mistakes
The nurse has administered a medication to the wrong patient. Which of the following is a correct action the nurse must take (select all that apply)
a) notify the physician
b) document that a medication error occured int he nurse's notes
c) assess vital signs
d) document medication on the MAR
e) complete a facility report of the error
When the nurse enters the patient's room with a medication, the patient states "I'm on the phone, just leave my pill on the table." What would be the best response by the nurse?
a) leave the pill at the bedside as requested
b) ask the patient to let the nurse know when the phone call is completed so the nurse can return with the meds
c) instruct the patient to either take the medication or refuse it
d) chart the medication as "unable to give" and skip the dose
What is CAM?
Complementary and alternative medicine
What are the common characteristics of CAM systems?
1. focus on treating the person as an individual
2. considers the health of the whole person
3. emphasizes the integration of mind and body
4. promotes disease prevention, self-care, and self-healing
5. recognizes the role of spirituality in health and healing
Give examples of CAM therapy
~Alternative health care systems
~Biologic-based therapies
~Manual healing
~Mind-body intervention
~Spiritual
~Other
Give some examples of Mind-body interventions
Yoga
Meditation
Hynotherapy
Guided imagery
Biofeedback
Movement-oriented therapies (music, dance)
Give some examples of Spiritual therapies
Shamans
Faith and prayer
Give some examples of Alternative health care systems
Naturopathy
Homeopathy
Chiropractic
Native American medicine (sweat lodges, medicine wheel)
What are biologic-based therapies?
These include herbal therapies, nutritional supplements and special diets to alter the human body in natural ways
What is meant by "manual healing"?
This refers to massage, pressure-point therapies, and hand-mediated biofield therapies.
Are detox therapies and animal-assisted therapy considered to be part of the CAM systems?
Yes
What is the primary use of echinacea?
To enhance the immune system
Anti-inflammatory
What is milk thistle most commonly used for?
Antitoxin
Protection against liver disease
Garlic bulbs are used for
Reduction of blood cholesterol
Reduction of BP
Anticoagulation
What is the primary use of cranberry?
To prevent UTI's
What herb is used in the Tx of benign prostatic hypertrophy?
Saw palmetto
What herb is associated with improvement of memory and reduction of dizziness?
Ginkgo
Describe some uses for St. John's wort
Reduction of depression
Reduction of anxiety
Anti-inflammatory
What herbs are most commonly used to treat menopause symptoms?
Soy
Black cohosh
Evening primrose
Name an herb used to promote sleep and one used to decrease fatigue
Valerian
Ginseng
What functions does soy serve?
~Source of protein, vitamins, minerals
~Relief of menopausal symptoms
~Prevention of cardiovascular disease
~Anticancer properties
Which herb provides a method to lower LDL cholesterol?
Green tea leaves
What are the two basic formulations for herbal products?
Solid (pills, tablets, capsules, salves/ointments)
Liquids (extractions, decoction, infusion, tea, tincture)
How is a tincture made?
Active ingredients are extracted using alcohol by soaking the herb, alcohol remains as part of the liquid.
Describe an infusion
Fresh or dried herbs are soaked in hot water for long periods, at least 15 minutes.
Which is stronger? Tea or infusion?
Infusion
How is tea made?
Fresh or dried herbs are soaked in hot water for 5-10 minutes before ingestion (convenient)
What is an extract?
Active ingredients are extracted using organic solvents to form a highly concentrated liquid or solid form; solvent may be removed or be part of final product
Describe the process to make a decoction.
Fresh or dried herbs are boiled in water for 30-60 minutes until much of the liquid has boiled off--very concentrated
How are herbal products and dietary supplements regulated on the market?
They are regulated by the Dietary Supplement Health and Education Act (DSHEA) of 1994
TRUE or FALSE
Dietary supplements are included in the Food, Drug, and Cosmetic Act.
FALSE.
They are specifically exempted.
The nurse obtains information during the admission interview that the patient is taking herbal supplements. What implications does this information have for the patient's treatment?
a) This is not important, because herbal products are natural and pose no risk to the patient
b) These products are a welcome adjunct to conventional treatment
c) The nurse must observe the patient for allergic reactions
d) The herbal products may interact with prescribed meds and affect drug action
Appropriate teaching to provide safety for a patient who is planning to use herbal products should include which of the following?
a) Take the smallest amount possible when starting herbal therapy, even less than the recommended dose, to see if allergies or other adverse effects occur.
b) Read the labels to determine composition of the product
c) Research the clinical trials before using the products
d) Read the labels to determine which diseases or disorders the product has been proven to treat or cure
The patient states he has been using the herbal product saw palmetto. The nurse recognizes that this supplement is often used to treat:
a) insomnia
b) urinary problems associated wtih prostate enlargement
c) symptoms of menopause
d) UTI
A patient receiving warfarin (Coumadin) therapy reports use of the herb feverfew. The nurse observes the patient for evidence of
a) liver toxicity
b) increased coagulation
c) renal dysfunction
d) increased bleeding potential
The patient has been taking sertraline (Zoloft), but just added St. John's wort for his depression. He now presents to the ER. The nurse recognizes the signs and symptoms of serotonin syndrome as: (select all that apply)
1. headache
2. dizziness
3. agitation
4. weight loss
5. sweating
What is the difference between an herbal product and a specialty supplement?
a) An herbal product is safer to use than a specialty supplement
b) A specialty supplement tends to be more expensive than an herbal product
c) A specialty supplement is a nonherbal dietary product used to enhance a variety of body functions
d) There are less adverse effects or risk of allergy with specialty supplements than there are with herbal products
What is Ginkgo known to interact with?
Anticonvulsants
Aspirin and NSAIDs
Heparin and warfarin
Tricyclic antidepressants
What is Valerian known to interact with?
Barbiturates
Benzodiazepines
Other CNS depressants
When St. John's wort interacts with SSRIs, what is the result?
Possible serotonin syndrome (sweating, headache, agitation, dizziness)
What is the result of St. John's wort, ginger, garlic, or feverfew reacting with Aspirin, NSAIDs, or warfarin (Coumadin)?
Increased risk of bleeding
What is Coenzyme Q10 used for?
Prevention of heart disease
Provide antioxidant therapy
What are designer drugs?
Synthetic drugs created in illegal labs for the purpose of profiting from illicit drug trafficking.
List some examples of abused CNS-influencing drugs
meperidine (Demerol)
mehylphenidate (Ritalin)
What is an example of a legal anesthetic that is frequently misused?
Ketamine and
gamma hydroxybutyrate (GHB)
Cocaine was once legal; what was it used for?
Anesthetic
LSD was used legally in the 1940's and 50's. What was its use? Why was it withdrawn from the market?
Psychotherapy
People were reporting hallucinations, delustions, and anxiety after recovering from its use
Is it possible to accurately predict if a person will become a substance abuser?
Yes. Psychological profiles and genetic markers allow this prediction.
What are the categories that addiction is dependent on?
~User-related factors (genetics)
~Environmental factors (societal and community norms, role models, etc)
~Factors related to agent/drug (cost, availability, dose, mode of admin, speed of onset, length of use)
What is physical dependence?
An altered physical condition caused by the adaptation of the nervous system to repeated substance use
What is psychologic dependence?
A condition where no obvious physical signs of discomfort are observed after the agent is discontinued
How is alcohol withdrawal treated?
oxazepam (Serax)--a short-acting benzodiazipine
How is opioid withdrawal treated?
Methadone
How are symptoms of nicotine withdrawal relieved?
Replacement therapy (nicotine patches, chewing gum)
List som physiologic and psychologic effects of withdrawal from alcohol.
tremors
fatigue
anxiety
abdominal cramping
hallucinations
confusion
seizures
delirium
What are signs of alcohol toxicity?
extreme somnolence
tremor
diaphoresis
vomiting
cyanosis
tachycardia
Cheyne-Stokes respirations
Withdrawal from what drug presents with excessive sweating, restlessness, dilated pupils, violent yawning, and increased heart rate and BP?
Opioids
Signs of toxic levels of cocaine and amphetamines present with what symptoms?
dysrhythmias
lethargy
skin pallor
psychosis
Which drug presents with euphoria, paranoia, panic reactions, hallucinations, and/or psychotic-like state when reaching toxic levels?
Marijuana
At toxic levels, nicotine causes what symptoms?
heart palpitations
tachyarrythmias
confusion
depression
seizures
Which drug (at a toxic level) causes severe CNS depression?
Barbiturates
Withdrawals of what drug present with sensitivity to light and sound, headache, and muscle twitches?
Benzodiazepines
Which drug causes skin hypersensitivity reactions when going through withdrawals?
Barbiturates