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225 test 2
Terms in this set (218)
bontanicals and herbals med types? Y/N
Distribution systems for medications:
unit dose, automated dispensing system, self-administered system, bar code system
medication orders need to include the following specifications:
Name, dose, route, purpose, provider
what do you document about meds?
patient, dose, route, time, response
For a scheduled drug, the first one is always:
TORB stands for?
telephone order read back
when listening to a phone order, what must you do?
pt with renal failure will excrete med faster or slower?
slower- may need to lower dose.
do you use a drug that had an adverse effect again/
vitals effected in this adverse reaction
when drugs work together when interacting, its called?
drug that is placed between gums and inner cheek
6 rights of med administration:
can you put transdermal patches over hair?
no- shave them
if pt starts to cough when meds are given in gastric tube, what does that mean?
tubes possibly in lungs/
transdermal patches, you need to do what safety precautions?
document when it comes off, when it goes on, wear gloves, date/time patch, document PLACEMENT
when are intradermal meds used/
allergy and TB testing. tuberculin/insulin
If we want a drug to stay in body for a long time, how do we give it? (also if it is really thick)
What does IV infiltration mean?
needle no longer in vein, but in SubQ
if this med gets infiltrated from IV, it makes everything necrotic
systemic- red lines- when vein gets inflamed
clots that travel and can cause an embolism
what is extravasation?
when meds get into the subq
lbs to kg divide by
How to find BSA or m2
weight in kg x height in cm, divide that number by 3600, then take sq. root of that number
what do you do when you have a med error?
report it, just stating facts, assess pt. frequently.
US adopted names council gives drugs what name
brand name aka
circled letter R in trade names
fundamental rule of safe med administration:
never administer an unfamiliar med
liquid preparation of med with alcohol base
suspension within an oil base
tablet held in mouth to be dissolved
finely ground drug mixed with liquid before administration
time release capsule, dissolves more slowly
med in liquid which needs to be shaken before admin
medicine dissolved in sugar and water
potent solution with alocohol base made from plants,
pharmacy prepackage and prelabel an individual patient ose
gold standard system of med distribution in hospitals
machine with meds that scans nurse finger and select function from choices. med is delivered in unit dose package
automated med dispensing system
pt scans pt ID bracelet and selects meds from a drawer on med cart
bar code medication administration
each patient supplied with his or her prescribed dose and quantities for a given period. meds at pt. bedside and he or she can administer her own
self administered medication system
meds obtained without a written order
danger of OTC drugs
lie in misuse, mistreatment, and serious drug interactions
legal order for preparation and administration of a med
when would a med require medical supervision?
if therapeutic and toxic dose range is small
hypericum perforatum (st johns wort) used for
coneflower is used as
ginkgo biloba used for
increases blood circulation and improve cognitive function
ginkgo can cause _______ when mixed with _____
bleeding with warfarin/coumadin
ALWAYS THINK OF ANY CHEMICAL PUT INTO BODY AS A DRUG THAT CAN HAVE A SERIOUS EFFECT
FYI: provider of a med should specify pt, name, med name, amt and frequency of dose, route. Also purpose. Date and time prescription was written. Signature of healthcare provider. First and last name. Or ID number or MRN with written order.
whats a common thing to do in a med order that can cause high risk as a potential source of error
R/PR both mean
3 times a day
tall man lettering
distinguish look alike medication names on screens to minimize risk of selecting the wrong medication name
what is appropriate: 5.0 mg or 5 mg?
whats the purpose of including the purpose in a med order
can help evaluate drug effectiveness
an unsigned med order is ____
med order written for meds to be administered in a specific situation with criteria for administration outlined for pts on a specific unit.
single order for a med that must be given immediately
does dr ever have to sign telephone med order?
yes, usually within 24 hours
verbal orders usually given in times of _____
emergency. nurse still must read back order in entirety.
can we decline administering med?
can you give a med prepared by another nurse?
not unless unit dose label identifies drug and seals intact
drugs considered to have limited medical use or high potential for abuse or addiction
what type of drugs need to be counted at end of shift or when taken out of drawer?
controlled substance- high abuse potential
process by which medication is delivered to target cells and tissues
chemically changing drugs in the body
metabolism- mostly in liver
any effect other than the therapeutic effect
minor adverse effects called
decreased response to drug requiring increased dosage to achieve therapeutic effects
drugs can precipitate from solutions or become inactive. called
during an initial assessment, what do you need to know about drugs?
med history. allergies, and medical history. especially about renal hepatic cardiacc respiratory endocrine or neurologic dysfunction.
drugs that can cause birth defects called
how many identifiers do you use to administer med?
2- ID Bracelet and verbal report.
mutiple tablets needed to supply a single med dose can be a sign of
parenteral routes are abosrbed faster and more completely or slower and less completely than oral and topical?
What does reconstituting a med mean?
add amount of diluent to a powedered med
why would you mix two types of insulin?
fewer injections at a lower cost
What happens if you add too much of the second type of med when mixing drugs?
must be discarded
Where in body is insulin administered?
.3 ml of insulin is how many units?
how to rotate insulin injection site?
do it one inch apart in same body part to avoid variations in absorption
opioids usually last how long?
rapid acting insulation lasts how long?
short acting insulin (regular) lasts how long?
intermediate NPH insulin lasts how long
long acting insulin (detemir and glargine) lasts how long
is IM absorbed faster or slower than subQ?
faster, but slower than IV
deltoid site is usually only used for
IV bolus complication that manifests itself in headache, tightness in chest, shock, cardiac arrest
cause of speed shock
administering bolus faster than intended
trauma to vein during catheter insertion or from catheter movement
when preparing insulin in suspension, what do you have to do to mix it?
gently rotate vials between palms of hands to mix
is the shorter or longer acting drawn up first for insulin?
Clear before or after cloudy?
clear before cloudy.
what insulins cant be mixed with other insulins?
Detemir, glargline, and glulisine (lantus, levemir, and apidra)
oxygen is inspired or expired?
inspired- alveoli- pulmonary circulation
CO2 is inspired or exhaled?
what can separate capillaries from alveoli?
fluid, emphysema, etc
what blood gas do you need to know to know ventilation?
diaphragm contract or expand with inhalation?
when does pulmonary pressure increase?
O2 transport is from ___ to ___ while CO2 is opposite
lungs to tissues
what do you do for partial airway obstruction?
nothing, encourage coughing. they can still breathe and talk, its partial
breathing exercise with hand on stomach and chest and only breathe through abdomen, chest hand cant move
people with cystic fibrosis, pulmonary fibrosis, or congestive heart failure likely use what oxygen therapy?
CPAP or BIPAP noninvasive mechanical ventilation?
brown green liquid inbetween lungs
how do O2 and CO2 move between blood and alveoli
whats higher in alveoli? O2 or CO2?
CO2 or O2 plays primary role in determining frequency and depth of ventilation>
greatest ease of lung expansion is in what body position?
standing or sitting erectly.
smoking inhibits mucus removal and can cause airway blockage and what else?
lung tissues swell and stiffen with what factors?
smoking, pulmonary fibrosis, respiratory distress syndrome, and pneumonia
emphysema causes low or high bronchial smooth muscle tone?
low muscle tone. air gets trapped in alveoli
no such thing
coughing up blood
labored breathing or feeling breathlessness
low oxygen levels in blood called
high CO2 lvels in blood is called
breathing too fast can cause what
respiratory alkalosis and dizziness
COPD pts usually sit how
forward leaning position, usues accessory muscle to enlarge chest cavity for more air.
bluish skin discoloration caused by desaturation of oxygen on hemoglobin
arterial blood sampling does what?
precise info about blood gases
SaO2 above what is normal?
95%, lower than 93% is abnormal
arterial blood gas monitoring gives ____ and monitors gas exchange most reliably
O2 CO2 and pH
PaCO2 lower than ____ is hyperventilation
Pa CO2 normal range:
Normal PaO2 range:
normal pH range
normal bicarb HCO3- range
what could cause ineffective breathing pattern
hyper/hypoventilation, obesity, SCI, neuromuscular dysfunction, respiratory muscle fatigue
ineffective airway clearance related to?
cant clear secretions or obstructions from resp. tract. smoke, airway spasm, retained secretions, foreing body, excessive mucus in bronchi
Impaired gas exchanged where theres too much or too little O2 and CO2
imbalance of ventilation and perfusion and alveolar capilary membrane
why would you tell pt with resp. tract issues to drink a lot of water
helps maintain mobility of mucus
should pt be positioned with good lung up or down to promote optimal matching of ventilation
good lung DOWN
Who shouldnt deep breathe?
Nobody, it is good for anyone at any time
incentive spirometry schedule example?
8-10 breaths hourly during waking hours
deep coughing is good for what patients?
how does pursed lip breathing help? and with what patients?
causes a back pressure in airway which eases exhalation and prevents air trapping in COPD and asthma patients.
oxygen therapy is used to reverse
oxygen can actually cause ___ in pts with COPD
BiPAP helps with inspiration or exhalation
assessment to do before teaching incentive spirometer
complete respiratory assessment, history of smokin, breath sounds, resp rate and rhythm, sputum production
pH changes that are result of bicarb changes are termed ______
when Cl levels are high we can also assume what levels are high
anxiety, fear, hyperventilation can lead to
NG tube can cause what acidosis or alkalosis?
most abundant anion in ECF that can substitute for HCO3
respiratory problem will have altered levels of what?
metabolic problem will have altered levels of what?
metabolic acidosis will have a major loss of:
metabolic acidosis will have an increase in
bicarb to acid ratio for stable pH??
hypertonic solutions cause blood cells to shrink or expand?
swollen red blood cell
normal Na values
Na regulates by
thirst, bp changes, and fluid shift from icf to ecf is assoc. with
Normal limits for K+
K usually in ICF or ECF?
Mg usually in ICF or ECF?
Normal limits for MG
renal failure with laxative or antacid use can cause
Total calcium (mostly in bones and teeth, some in ECF)
Normal phsophorus limits (mostly in ICF)
normal limits for chloride in ECF
metabolic alkalosis pH HCO3, and PCO2:
higher than 7.45, higher than 26, normal or high than 45
metabolic acidosis pH, HCO3, and PCO2 levels:
pH lower than 7.35, HCO3 lower than 22, and CO2 lower than 35 or normal
respiratory alkalosis pH, CO2, and HCO3
pH higher than 7.45, CO2 lower than 35, HCO3 normal or lower than 22
respiratory acidosis pH, pCO2, and HCO3 levels:
pH lower than 7.35, CO2 higher than 45, HCO3 normal or higher than 26
open gate pathway
positive charged ions to second order neurons- spark impulse, signals pain to thalamus
inhibit pain transmission by effect of A fibers inhibiting substantia gelatinosa
OPQRST or COLDERR
onset, palliative/precipitating, quality, relief mesaures, severity, timing
key subjective points for pain evaluation:
effect on ADLs, effect on work or studies, coping resources, patient affect
key objective points for pain evaluation:
psyiologic response, facial expression, moaning, immobilization, body movement without purpose, rocking, behavior changes
pain can be an etiology for what other nursing diagnoses?
hopelessness, sleep disturbance, ineffective airway clearance, decreased mobility
pain sequela means:
pain is caused by other things
no cap on dosage in what type opioid?
NSAIDS and nonopioids do or do not have a ceiling effect?
electrical nerve stimulation is a nonpharmacologic pain invention targeting
normal processing of painfuil stimuli occurs when pain becomes a conscious event
4 steps in pain transmission:
complex processing of messages occur
spinal dorsal horn
inhibition of nociceptive impulses in the CNS
result of potential or actual tissue injury- includes activation of nociceptive nerve fibers at site of localized injury
an abnormal pain signaling process with origins that can occur periperally and centrally. cyclical and irreversible and persists longer than 3-6 months
exaggerated response to normal painful stimuli
nociceptive pain in bone skin and soft tissue
pain that originates internally and is result of stretching, distention, inflammation, or damage
pain that arises from damage to peripheral neres or CNS.
Pain causes increased BP (overactivity of sympathetic neverous system), decreased circulation to peripheries.
patients 8 and up can use number scael
ABCDE for pain management
ask, believe, choose treatment, deliver interventions, evaluate treatment effectiveness
drugs that treat pain but it isnt its primary indication
drugs without any analgesic properties that can be critical to pain management in certain poplations and for treatment of related symptoms
TENS- how does it work?
transcutaneous electrical nerve stiumaltion- stimulate nerves near pain site and block pain transmission
now- we want self learners who continue learning after encounters
rational thought, what one generally considers thinking
learning facts, reaching conclusions, solving problems,
learning that changes beliefs, attitudes, or values. refers to emotions or feelings
muscular movements learned to perform new skills and procedures
how to evaluate psychomotor learning
return demonstration by patient
when does effective learning occur?
when patients and healthcare professionals are equal participants and partners in the teaching learning process
what must you do before any teaching with your pt and family?
nursing interventions for health promotion focus on enhancing abilities of pts to engage in safe effective and efficient health behaviors
low level of literacy also affect patients ability to understand ORAL communication.
Even in high level literacy patients, start with easiest material first and add complexity later. because patients can be stressed by illness and teachign
newest vital sign
learning strategy that can enhance cognitive and affective learning. nurse is facilitator
national patient safety foundation recommends and strongly advocates for the use of what evaluation techqniue
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