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227 Cards in this Set
- Front
- Back
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Agonist drugs do what to receptors?
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stimulate them
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Antagonist drugs do what to receptors?
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inhibit them
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What is the mechanism by which drugs produce chemical and physiological changes in the body?
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pharmacodynamics
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What is the movement of drugs into the systemic circulation?
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pharmacokinetics
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What are 4 ways drugs move through the body?
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absorption, distribution, metabolism, excretion
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What is adsorption?
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movement of a drug from the site of administration into the systemic circulation
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What is distribution?
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the movement of the drug from the systemic circulation into the tissues
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What is metabolism?
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alteration of drug to more or less active form, usually in the liver
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What is excretion?
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the elimination of the drug from circulation
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The rate and degree of absorption depends on:
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a. administration route
b. patients age c. physical condition d. lipid or water solubility of the drug e. any potential drug interaction with other drugs or foods |
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Distribution of a drug from the systemic circulation may be affected by:
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a. blood brain barrier
b. cardiac output c. body composition d. blood supply to tissue e. degree of vessel constriction or dilation f. degree to which the drug binds to plasma proteins |
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What determines a drugs dosing schedule?
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the drugs pharmacokinetic properties
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What is considered when establishing dosing schedules?
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a. route of administration
b. onset of action c. peak concentration level d. duration of action e. half life |
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What is the area of the body where the drugs absorption will take place?
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route of administration
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What is the time when a drug effects first become noticeable?
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onset of action
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What is the maximum blood concentration level achieved through absorption at this level most of the drug reaches the site of action and provides the therapeutic response?
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peak concentration level
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What is the lenght of time a drug acts on the body?
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duration of action
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What is the time required for a drugs plasma concentration to decrease by 50%?
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half life
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What are 5 ways that excretion of a drug can occur?
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a. by the kidneys via urine
b. by the liver via bile and into feces c. by the lungs via exhaled air d. into breastmilk e. through saliva, tears, sweat |
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What is pharmacotherapeutics?
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the use of drugs to treat a specific disease or produce a desired effect
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In pharmacotherapeutics what are the therapeutic steps ? (6)
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a. assessing the nature and extent of the problem
b. assessing the options c. selecting the type of therapy d. implementing the therapy e. monitoring effectiveness of the therapy f. reassessing the problem |
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What are 8 factors that affect the response to a drug?
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1. disease or disorder
2. route of administration 3. patients body size 4. patients weight 5. patients gender 6. past medical history 7. tolerance or dependence 8. psychological and emotional factors |
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What are the measures of drug efficacy?
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vital signs, body weight, easing of symptoms
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What is a loading dose?
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this refers to administration of one or more doses at the onset of therapy to quickly reach the therapeutic blood level and thereby hasten a therapeutic effect
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What is adverse reaction?
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refers to the unwanted or potentially harmful effects of a drug
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What is dose related reaction?
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may be reactions to the drugs primary effect or a secondary effect
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What is sensitivity reaction?
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occurs when a patient is hypersensitive or allergic to a drug or one of its components
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What is toxicity?
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reaction when drug levels exceed therapeutic range
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What is idiosyncrasy?
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reaction that is unexpected or peculiar
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What are three types of interactions?
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1. incompatibilities
2. pharmacokinetic interactions 3. pharmacodynamic reactions |
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What is imcompatibilities?
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chemical or physical reaction between two or more drugs
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When might incompatibilities occur?
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1. when preparing an IV admixture
2. administering medications in IV bolus or piggyback 3. mixing medications in a syringe |
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What are sontrolled substances?
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drugs that have potential for abuse or physical and psycholoical dependence
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What is additive effect?
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combining 2 or more drugs to cause an effect equal to the sum of their separate effects
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What is synergism effect?
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combining 2 or more drugs to cause an effect greater than the sum of their separate effects
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What is potentiation effect?
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occurs when 1 of 2 or more drugs are combined and one of the drugs exerts an action greater than if it was given alone
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What is antagonistic effect?
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conbining 2 ot more drugs to produce an effect less than the sum of their separate effects
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What does a medication order have to have?
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patients full name, date, time, drug name, dosage form, dose amount, route, schedule, prescribers signature
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How many times should you check a drug against the drug label?
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3 times
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Why are most medications administered via oral route?
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safe, convenient, least expensive
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What is buccally administered medications?
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medications that are placed between the cheek and the teeth
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What is sublingually administered medications?
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medications that are placed under the tongue
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Buccally and sublingually administered drugs bypass the ___________ and are immediatily absorded into the _________________.
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digestive tract
systemic circulation |
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What are 4 methods of parenteral administration?
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intravenous, intramuscular, subcutaneous, intradermal
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What type of administeration gives immediate action?
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IV
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What type of administration is given in a muscle?
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IM
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What type of administration is given in the fatty tissue?
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SC
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What type of administration is given in dense vascular tissue?
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ID
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What type of drug is applied directly to the skin and includes lotions, creams, ointments and transdermal patches?
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topical
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What are ophthalmic drugs used for?
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their local effects within the eye
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Why would you use an otic drug?
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treat local infection or inflammation, soften cerumen, provide local anesthesia
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When appling ear drops to an adult you pull?
to a child you pull? |
ADULT CHILD
P O W N |
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How is a topical medication delivered into the respiratory tract for local and systemic effects?
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inhaled medications
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What absords the inhaled medications?
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muscosal lining of the lungs
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What two ways can drugs be administered into the respiratory tract?
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inhaler, nebulizer
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What route of administration would you use if other routes were not available?
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rectal
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Drugs that are given rectally are absorded where?
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large intestine
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What can cause an increased absorption of topical drugs in children?
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thin epidermis
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What may delay metabolism in infants?
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immaturity of the liver
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What may delay excretion in infants?
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immaturity of the kidneys
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Cholinergic agonists directly stimulate what?
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cholinergic receptors
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Cholinergic agonists mimis what action?
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the action of acetylcholine
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Where is cholinergic agonists metabolized?
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in the plasma and the liver
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What metabolizes cholinergi agonists?
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cholinesterases at teh muscarinic and nicotinic receptor sites
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How is cholinergic agonists excreted?
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urine
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What is the pharmacokinetics of cholinergic agonists?
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ABSORPTION: varies widely
DISTRIBUTION: widely distributed, binding primarily to muscarinic receptors METABOLISM: by cholinesterases at the muscarinic and nicotinic receptor sites, in the plasma and the liver EXCRETION: urine |
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Why is cholinergic agonists rarely given IM or IV?
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because they are subject to immediate breakdown by cholinesterases
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How is cholinergic agonists usually given?
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orally or SUB-Q
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What are 4 reasons you would give a cholinergic agonists?
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*glaucoma
*bladder/intestinal function stimulation *nonobstruction urine retention *neurogenic bladder |
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When would you not use a cholinergic agonists?
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*prostate enlargement
*possible urine/GI obstruction *hypertension *bradycardia/atrioventricular conduction defect *asthma *pregnancy |
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What are some side effects of cholinergic agonists?
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*hypotension
*headache *flushing *sweating *increased salvia *abdominal cramps *nausea/vomiting *diarrhea *blurred vision *bronchial constriction |
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When administering bethanechol chloride which is a cholinergic agonist drug you would base your evaluation on what?
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increased bladder tone and function
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When given bethanechol chloride which is a cholinergic agonist drug you would assess the patients what?
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urinart status
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Cholingeric agonist drug:
If toxicity occurs while giving bethanechol chloride what is the antidote? |
atropine
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What are the key nursing responibilites when giving bethanechol chloride which is a cholinergic agonist drug?
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*evaluate
*assess *observe patient for 20-60 minutes after given SUB Q *monitor for s/s of toxicity |
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CHOLINERGIC
What 2 drugs are used to diagnosis myasthenia gravis? |
edrophonium and neostigmine
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CHOLINERGIC
What drug is used to promote muscle contractions and are used to treat myasthenia gravis? |
neostigmine
ambenonium/pyridostigmine |
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CHOLINERGIC
What drug is used to prevent or treat postoperative ileus/distention and treat nonobstructive urine retention? |
neostigmine
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CHOLINERGIC
What drugs are used to reverse the effects of nondepolarizing neuromuscular blockers? |
edrophonium and neostigmine
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CHOLINERGIC
How would the drugs edrophonium and neostigmine be excreted? |
excreted in urine
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CHOLINERGIC
What are edrophonium and neostigmine metabolized by? |
plasma esterases
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CHOLINERGIC
When would you not use neostigmine and edrophonium? |
possible urinary or GI odstruction
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CHOLINERGIC
What are the nursing actions when giving neostigmine and edrophonium? |
*assess neuromuscular status before and after therapy
*monitor for drug toxitiy *monitor vital signs *monitor breath sounds every 4 hours *take seizure precautions |
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Anticholinergics block the action of what?
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acetylcholine at muscarinic receptors in the parasympathetic nervous system
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What are some cholinergic drugs?
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*neostigmine (prostigim)
*edrophonium (tensilon) *urecholine (bethanechol) |
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What are some anticholinergic drugs?
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*atropine
*cogentin (benztropine) *pro-banthine (propantheline) |
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What is the pharmacokinetics for anticholinergic drugs?
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ABSORPTION: in GI tract, mucous membranes, skin, and eyes
DISTRIBUTION: does not cross blood brain barrier METABOLISM: hydrolyzed in the GI tract and liver EXCRETED: in the feces and urine |
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why are anticholinergics used?
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*to reduce saliva
*to reduce gastric secretions *to reverse a heart block *to induce mydriasis *to treat parkinsons disease *to treat GI spasms *to treat motion sickness *to treat enuresis |
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What are anticholinergics?
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parasympatholytics: cholinergic blocker
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What drugs are used to treat bradyarrhythmias, arrhythmias, and sinus arrest?
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atropine which is a anticholinergic drug
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What drug is used to treat dyskinesia, extrapyramidal reactions, and parkinsonism?
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benztropine which is an anticholinergic drug
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What drug is used to treat peptic ulcer and bowel spasms?
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propantheline which is an anticholinergic drug
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What drug is used to induce mydriasis?
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atropine which is an anticholinergic drug
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What drug is used to decrease saliva and bronchial secretions before surgery?
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atropine which is an anticholinergic drug
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What are the ophthalmic side effects when using topical application of atropine which is an anticholinergic drug?
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blurred vision, conjunctivitis, and photophobia
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What are the the systemic adverse effects of atropine which is an anticholinergic drug?
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tachcardia, constipation, dry mouth, urinary hesitancy or urine retention
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What decreases absorption of parasympatholytic drugs?
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antacids
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What are the nursing responsibilities when giving anticholinergic drugs?
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*assess relief of symptoms
*monitor for side effects *educate patient *monitor patients intake and output *watch for s/s of urine retention |
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When should you give an anticholinergic drug when giving to reduce GI motility?
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30 minutes before meals and at bedtime
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When giving anticholinergic drugs educate the patient to reduce dry mouth by?
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using ice chips, hard candy, or gum
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When giving anticholinergic drugs educate the patient to reduce constipation by?
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exercising and increasing fiber/fluid intake
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What is classification?
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a family or group of drugs that are used to treat a clinical condition or a group of drugs that affect a body system
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Classification of drugs are often sub classed based on what?
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the site of action
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What is phototype?
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a drug in each classification that is typical of how the class of drugs work. this is usually the most commonly used drug or drug that fits the class action/use.
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What is primary use?
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the clinical indication of the drug. some drugs will have more than one use
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Perioperative includes 3 phases:
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1. preoperative
2. intraoperative 3. postoperative |
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five purposes of surgery
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1.diagnostic
2.curative 3.restorative 4.palliative 5.cosmetic |
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If a patient is having diagnostic surgery what is this
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to determine origin and cause of disorder or cancer
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if a patient is having curative surgery what is this
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to resolve a problem
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if a patient is having restorative surgery what is this
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to improve clients sunctional ability
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if a patient is having palliative surgery what is this
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to releive symptoms
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if a patient is having cosmetic surgery what is this
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to alter or enhance personal appearance
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five surgical categories
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1. elective
2. urgent 3. emergent 4. required 5. optional |
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what is elective surgery
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failure to have surgery not catastrophic planned for correction of a non acute problem
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what is urgent surgery
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requires prompt intervention can be life threatening is no interventions in 24-48 hours
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what is emergent surgery
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requires immediate intervention because of life threatening consequences
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what is required surgery
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requires surgery within few weeks or months
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what is optional surgery
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personal perference
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what is an example of an elective surgery
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repair of a scar
simple hernia |
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what is an example of aurgent surgery
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acute cholecystits
kidney stones |
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what is an example of emergent surgery
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severe bleeding
bladder or intestinal obstruction fractured skull gunshot or stab wound extensive burns |
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what is an example of a required surgery
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cataracts
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what is an example of optional surgery
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cosmetic surgery
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what is the degree of risk with minor surgery
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without significant risk
local anesthetic |
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what is the degree of risk with major surgery
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greater risk
long and intense |
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when does preoperative phase begin
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with the decision for surgical intervention
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when does preoperative phase end
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wtih the transfer to operating room
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what are some responsiblities of the nurse in preoperative phase
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preadmission testing
admission to unit holding area preop assessment surgical history informed consent |
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the responsibility to provide appropriate information for consent belongs to who
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physician
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type and cross match is good for how long
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72 hours
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where is the signed consent form placed
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on the patients chart and accompanies the patient to the operating room
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what is appropirate covering for an elderly patient who is being transfered to and from the operating room
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a light weight cotton blanket
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a nutritional deficit needs to be corrected before surgery why
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so that enough protein is available to promote healing
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a mild fluid volume deficit can be corrected when
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during surgery
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chronic alcoholics suffer from
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malnourishment
systemic problems increase surgical risk |
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tobacco use increases the risk of surgery how
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increase risk of pulmonary complications
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substance abuse can alter the response to
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anesthia and pain medication
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while taking a medical history the nurse is told the patient has diabetes what might be needed
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more extensive bowel prep
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while taking a medical history the nurse is told that the patient has lupus (SLE) what might be needed
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drugs to off set the stress of surgery
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while taking a medical history the nurse is told that a patient has an infection what might be needed
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the infection might need to be treated before surgery
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in the cardiovascular status the goal is to have a functioning CV system that will meet what needs during the peroperative phase
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oxygen
fliud nutritional |
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a patient with CV diseases may experience what
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1. impaired ability to withstand homodynamic changes
2. alter response to anesthesia 3. increase risk in surgery |
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a patient with CV requires greater than normal nursing attention during which phase
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all phases
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patients who smoke are urged to stop 2 months before surgery but most will not however they must stop how long before
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24 hours
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what are some adverse effects associated with smoking
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1. increased airway reactivity
2. decreases mucociliary 3. physiologic changes inthe cardiovascular and immune systems |
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the goal in respiratory status is
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optimal respiratory function
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why is optimal function of the liver and urinary systems a goal
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so anesthetics, medications, waste, and toxins can be processed and removed from body
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the goal in endocrine function is what
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to maintain blood glucose less than 200mg/dl
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a patient with blood glucose problems is at risk for
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hypo or hyperglycemia
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a patient who is hypoglycemia is at risk postoperative from
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inadequate CHO
excessive insulin |
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if a patient is hyperglycemia they are at risk for
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wound infection that may be from stress of the surgery
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the use of corticosteroid use must be reported to the anesthesiologist and the surgeon why
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increased risk of infection
steroids increase blood sugar |
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if the patient is immunosuppresion then you must look for what postoperative
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any symptoms FEVER 100.5
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what disorders place a patient in the immunosuppresion category
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corticosteriod therapy
renal transplant radiation chemotherapy AIDS |
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if a patient is allergic to shellfish they will also be allergic to
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iodine
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if a patient is allergic to bananas they will also be allergic to
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latex
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if a patient is receiving surgery to the neck, oral, or facial area then the nurse will look for what sings of complications after surgery
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airway complications
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if a patient is receiving surgery to the chest or high abdominal area the nurse will look for what complications after surgery
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pulmonary complications
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if the patient is receiving surgery inthe abdominal area the nurse will look for what complications after surgery
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paralytic ileus
DVT |
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preoperative testing is usually done when
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24 hours to 28 days before surgery
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when is teaching ideal
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during the laboratory assessment
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the preoperative education is taught to whom
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patient
spouse parents guardians |
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what will children fear the most in the operation room
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the mask
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when patient is in the doctors office the teaching needs to be started what might be taught at this time
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date and time of procedure
NPO status medications to take or not to take |
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how does the nurse find out who to teach
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ask the patient
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when does the intraoperative phase begin
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with transfer to the operating room table
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when does the intraoperative phase end
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with transfer to postanesthia care
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what are some responsibilties fo the nurse during intraoperative phase
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safety maintenance
physiologic monitoring psychological support |
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who marks the site where the incision is to be
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patient
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when do you verify the patients name and purpose of surgery
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on floor
during holding in surgery room before doctor starts |
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when would you transfer patient to holding area
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30-60 minutes before surgery
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the surgical team consists of who
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surgeon
anesthia provider nurses and surgical techs patient |
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what is the role of the holding room nurse
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manage care
reviews medical record checklist and consent assess patients physical and emotional condition answer questions document on preioperative record |
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what is the role of the circulating nurse
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manages the OR
monitors traffic in OR ensures sterile asepsis communicates with surgeon communicates with family documents |
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what is the role of the scrub nurse or surgical tech
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set up sterile feild
scrub surgical site prepare equipment counts needles, sponges, instruments labels all specimens and give to circulator to send to lab may not be a nurse just specially trained |
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when is family called while patient is in surgery
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before the surgery starts
every 45 minuted to 1 hour after surgery starts then after surgery starts |
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who monitors vital signs during surgery
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anesthesiologist
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why are surgical nurses hands cultured regularly
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for nosocomial infections
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what is the foundation for preventing surgical site infections
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surgical asepsis
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the surgical scrub is done for how many mintues
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3-5 minutes
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in what direction should the water run in a surgical scrub
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straight off not up or down
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when is the surgical scrub done
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after masking
befoer sterile gown and gloves |
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after the sterile srcub is done what are the steps in entering the OR
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enter with hands higher than elbow
dry from tips to elbow |
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the surgical gown is sterile where
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2 inches down from neck to wasit area
from elbow to wrist area |
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what are the three sedation levels
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minimal
moderate deep sedation |
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what is minimal sedation level
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drug induced state
patient can respond normally ventilation not affected cardiovascular not affected cognitive function impaired coordination impaired |
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what is moderate sedation level
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intravenously
depressed level of consciouness does not impair airway can respond |
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what is the goal for moderate sedation
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calm
tranquil amnesic |
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what is deep sedation
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can not be easily aroused but can respond purposely after repeated stimulation
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what is the difference between sedation and anesthesia
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anesthesized patients can not be aroused
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during anesthesia the patient loses the ability to maintain
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ventilatory function
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general anesthesia is used for what types of surgery
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head, neck, upper torso and abdomen
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analgesia is used for
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pain relief or suppression
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amnesia is used for
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memory loss of surgery
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unconsciousness is used for
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loss of muscle tone and reflexes
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what is the 1 stage of general anesthesia
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analgesia, sedation, relaxation stage
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when does stage 1 of general anesthesia begin
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with introduction of medication
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when does stage 1 of general anesthesia end
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with loss of consciousness
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hearing during stage 1 of general anesthesia is
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exaggerated
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what is the nursing care of a patient in stage 1 of general anesthesia
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close doors
sim lights control traffic secure patient talking to minimum |
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what is stage 2 of general anesthesia
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excitement
delirium |
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when does stage 2 of general anesthesia start
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with loss of conciousness
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when does stage 2 of general anesthesia end
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with relaxation, regular breathing, loss of eyelid reflex
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during stage 2 of general anesthesia a patient may have
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irregular breathing
increased muscle tone involuntary movements |
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during stage 2 of general anesthesia a patient is susceptible to what type of stimuli
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external
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what is the nursing care for stage 2 of general anesthesia
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avoid auditory stimuli
avoid physical stimuli protect extremities assist with suction asist with restraining stay with client |
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what is stage 3 of general anesthesia
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operative or surgical anesthesia
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when does stage 3 of general anesthesia start
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with generalized muscle relaxation
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when does stage 3 of general anesthesia end
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with loss fo reflexes and depression of vital functions
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what type of hearing and sensation is the patient experiencing at stage 3 of general anesthesia
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none
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what are the nursing responisibilities suring stage 3 of general anesthesia
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assist with intubations
place patient in position prep site |
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during anesthesia the most reliable guide of patients condition somes from
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responses of pupils
repiratory status blood pressure cardiac status |
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what are 2 methods of administration of general anesthesia
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inhalation
intravenous |
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what is conscious sedation
|
IV deliveried medication to reduce the level of conciuosness but allow the patient to maintain a patent airway and to respond to verbal commands
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during conscious sedation what areas are monitored
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airway
oxygen saturation V/S q 15 to 30 minutes level of consciuosness ECG status |
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|
what are some common types of skin closures
|
sutures
staples glue |
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when does the postoperative phase begin
|
with admission to PACU recovery
|
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when does the postoperative phase end
|
with follow up evaluation in clinical setting or home
|
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what are some of the nurses responsibilities during the postoperative phase
|
assessment
maintain patent airway monitor hemorrhage monitor hypotension and shock documentation |
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when is patient discharged from PACU
|
fully recovered
stable vital signs oriented to person, place and time uncompromised pulmonary function stable oxygen saturation UOP at least 30ml/hr N/V under control minimal pain |
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|
what nurse gets the supplies needed for patient going to floor
|
floor nurse
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who should be taught how to use and when to use PCA pump
|
patient, family should not push for patient
|
|
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what are some pain releif measures
|
positioning
distractions back rub cool towel for N/V |
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|
what is a general rule for outpatient surgery when can a patient be discharged
|
eat
drink not throw up pee |
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|
what is the typical diet pattern for a patient who has had surgery
|
NPO
clear full soft regular |
|
|
what is the normal range for fliud output
|
30cc an hour if less call doctor
|
|
|
what is a normal pattern of bowel function for a patient that has had surgery
|
bowel sounds
passing flatus bowel movement (patient will not come back from surgery with bowel sounds) |
