exam 2-first 4 ppts

Sylfamethoxazole/Trimethoprim 800mg/160mg (double strength) PO

Trade name: Bactrim

• Bactericidal against susceptible bacteria; UTIs and pneumocystis jiroveci pneumonia

Enoxaparin 20 mg (pre-filled syringe) subq

Trade name: Lovenox

• Anticoagulant; prevention of thrombus (clot) formation *Do not expel air bubbles

Humalog 8 Units subq ac

Generic name: Insulin lispro

• Rapid-acting insulin used for glycemic control for diabetes mellitus *Monitor glucose (for hypoglycemia) and rotate sites to prevent lipodysterophia

5 medication rights

1. Right patient
2. Right medication
3. Right dosage
4. Right route
5. Right time

Medication labels

-Generic name -trade name (manufacturer) -strength (concentration) -amount -expiration date -route of administration -lot number -handling storage -controlled substance status

Enteric-coated tablets

Can't be crushed or diluted because they can irritate stomach lining or be destroyed by acid

Before administration of gastric tube meds

• Elevate HOB to min of 30
• Flush before and after (30 ml and 5-15mL between)
• Dilute med (15-30 mL)
• Do not mix with feeding
• Verify tube placement - X-ray

Sublingual and buccal meds

Enter blood stream directly; bypass liver *Dissolve completely before any PO intake

oral disintegrating tablets

on top of tongue *Dissolve completely before any PO intake

MDI

metered-dose inhaler - used to deliver aerosolized medications to patients

• direct med

DPI

dry powder inhaler

Nebulizer

device that creates a mist used to deliver medication for giving respiratory treatment -fine mist of med and saline over a period of time

Barriers of respiratory meds

• inspiratory effect
• proper technique

MDI technique

1. shake for 3-5 secs
2. Breathe out
3. place inhaler in spacer
4. Actuate med
5. Breathe in deep
6. hold breath for 5-10 secs
7. pause 1-5 mins between puffs

Why do I need to rinse mouth after respiratory meds?

To prevent oral thrush

ophthalmic meds

• Drops: into lower conjunctival sac
• Ointment: thin ribbon from INNER canthus outward

otic meds

• warm to room temp to prevent pain, vertigo, or nausea
• apply drops to side of canal

intranasal meds

• apply to side of nasal passage while holding opposite nare
• position client's head back not down or forward
• avoid blowing nose 5-10 mins after instilation

vaginal meds

• have client void
• apply to posterior wall
• remain supine for 5-10 mins after instilation

rectal meds

• always use lubricating jelly
• insert 3-4 in
• remain in left lateral position after administered

topical meds

local effect; creams, lotions, ointments, sprays

Transdermal meds

systemic effect; consistent absorption over time

Transdermal patch safety

• Remove old patch
• clean/dry skin
• rotate sites
• avoid irritated or broken skin
• wear gloves
• document site

parenteral meds

look up meds to confirm;

• Indications
• safe dosage
• dilution if powder
• compatibility with dilutent
• rate (slow push)
• functions, adverse reactions, labs, vitals

What type of syringe is used for intradermal injections?

1-mL tuberculin

What gauge and length of needle is used for intradermal injections?

25-27 gauge, 1/4 - 5/8 in

At what angle should intradermal injections be administered?

15 degrees

What are the common sites for intradermal injections?

Inner forearm, upper arm, across scapula

What should you not do after administering an intradermal injection?

Do not massage or apply pressure after injection

What is the typical syringe size for an intramuscular injection?

1-5 mL

What is the gauge range for needles used in intramuscular injections?

19-25 gauge

What is the length range for needles used in intramuscular injections?

5/8 - 3 inches

What angle should an intramuscular injection be administered at?

90 degrees

What are the three common sites for intramuscular injections?

Ventrogluteal, vastus lateralis, and deltoid

What method is used for irritating or vesicant drugs in intramuscular injections?

Z-track method

If med requires dilution, what do you draw up first?

Dilutent

What is the syringe size range for sublingual injections?

1/2 - 3mL or insulin syringe (u-100, u-50, u-30)

What is the needle gauge range for sublingual injections?

25-31 gauge, 3/8 - 5/8 in (Insulin: 29-33 gauge, 1/8 in - 5/16 in)

What angle should sublingual injections be administered at?

45-90 degrees

What are the common sites for sublingual injections?

Abdomen, lateral upper arm and thigh, scapula, upper ventrodorsal gluteal region

How should insulin be measured for injections?

Insulin is always measured in units.

What is the order for drawing insulin from vials?

Always draw CLEAR before CLOUDY.

What should be done with bubbles in prefilled syringes?

Leave bubbles in prefilled syringes.

Seven components of medication orders

1. Client name
2. date and time of order
3. name of med
4. dosage
5. route
6. frequency
7. signature of person writing order

sequence of med orders needed on all orders

1. name of med
2. dose
3. route
4. frequency

REM sleep

Deepest sleep; dreaming, feels rested

NREM sleep

Most stages of sleep; don't feel as rested

Lack of sleep can cause

chronic conditions and impair daily mental and physical functions

Sleep is regulated by

CNS (RAS), hormones, and neurotransmitters

physiologic rhythms of sleep

HR, BP, Resp rate, muscle tone, cortisol, and body temp drop

circadian rhythms

The 24-hour biological cycles

• regulated by nerve cells in hypothalamus that secrete melatonin

Sleep cycles

-4 sleep stages

• 3-5 cycles per night, each about 90 minutes

Sleep patterns

Newborns: most sleep (14-17hrs) Elderly: least sleep (6hrs)

polysomnography

sleep study

Dyssomnias

sleep disorders characterized by insomnia or excessive sleepiness

• Circadian rhythm sleep disorders, insomnia, narcolepsy, hypersomnia, sleep apnea, restless leg syndrome

Parasomnias

Abnormal behaviors such as nightmares or sleepwalking that occur during sleep.

• Somnambulism, nocturnal enuresis, sleep terrors and nightmares, bruxism

Somnambulism

sleepwalking

bruxism

grinding teeth

circadian rhythm sleep disorders

sleep disorders that interfere with the typical regulation of the circadian rhythm of sleep, leading to a change in the sleep-wake cycle

hypersomnia

excessive daytime sleepiness

restless leg syndrome

uncomfortable sensations (tingling) in legs causing movement and loss of sleep

• more common in older adults

Secondary sleep disorders

can be disabling symptoms of underlying medical or psychiatric disorders -Heart failure, COPD, pain, gastric reflux, depression, and anxiety

Sleep instruments

epworth sleepiness scale, Pittsburg sleep quality index, sleep hygiene index

Multiple Sleep Latency Test

Sleep study for narcolepsy

sleep deprivation

lack of sleep

insomnia

recurring problems in falling or staying asleep -daytime sleepiness -more common in females -more common in older adults -linked to increased stress

Narcolepsy

uncontrollable sleep attacks during the day -daytime sleepiness

OSA

obstructive sleep apnea -most commonly due to airway collapse -daytime sleepiness

• more common in males
• obesity, hypertension, and smoking are contributing factors

nonpharmacologic interventions for sleep

• Bedtime routines
• bedtime snack
• light exercise
• relaxation

Good sleep hygiene

-Sleep schedule -Light exercise -routine -relaxing room; dark, quiet, and cool

Bad sleep hygiene

-nap too much -don't drink to much alcohol or caffine before bed -no screens -no large meals -no tv or work in bed

sleep meds

Antianxiety Antihistamines Tricyclic antidepressants Sedative-hypnotics; induce unnatural sleep

nocturnal enuresis

bed wetting -more common in children

SIDS

sudden and unexpected death of an apparently healthy infant during sleep

• prone sleeping (on stomach)
• smoking exposure
• age 1-12 months

nature vs nurture

name for a controversy in which it is debated whether genetics or environment is responsible for driving behavior

cephalocaudal pattern

growth that proceeds from the head downward

proximo-distal pattern

growth starts at the center of the body and moves toward extremeties

pregnancy period

conception, zygote, embryo, fetus (40 weeks)

newborn

birth to 28 days

infant

28 days to 1 year

toddler

1-3 years

preschooler

3-6 years

school age5

-12 years

adolescent

12-20 years

young adults

18-34

middle adults

35-65

Older adults5

6+

Freud's Psychosexual Stages

1. Oral Stage (birth-1 year)
2. Anal Stage (1-2 years)
3. Phallic Stage (3-6 years)
4. Latency Stage (6 to puberty)
5. Genital Stage (puberty to adulthood)

freuds personality components

id, ego, superego

Erikson's stages of psychosocial development

1. trust vs. mistrust (birth-18 months)
2. autonomy vs. shame and doubt (early childhood)
3. initiative vs. guilt (preschool)
4. industry vs. inferiority (school age)
5. identity vs. role confusion (adolescence)
6. intimacy vs. isolation (young adults)
7. generativity vs. stagnation (middle adults)
8. integrity vs. despair (older adults)

Piaget's stages of cognitive development

sensorimotor, preoperational, concrete operational, formal operational

Havighurst's Developmental Tasks

tasks that are required to move to next stage

Levinson's Seasons of Life

-transition -life structure -structure reevaluated -culminating life structure

Kohlberg's Theory of Moral Development

Developing children progress through a predictable sequence of stages of moral reasoning (preconventional, conventional, postconventional).

Gilligan Ethics of Care

Critiqued Kohlberg's moral development theory for its male bias.

Fowler Faith Development

faith development phases

wear-and-tear theories of aging

the body wears out from hard use

aging at the level of DNA and cells

-DNA is gradually damaged -free radicals cause cellular abnormalities