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What are anti-ulcer medications? (5)
antacids
H-2 receptor antagonist
Proton Pump Inhibitors (PPI)
Mucosal Protectants
Antiflatulent
What meds should you avoid for ulcers?
aspirin & NSAID’s
How do you do an abdominal assessment for bowel patterns?
Auscultate, palpate, percussion
What do you do if there is blood in vomit or stool?
REPORT IT
How would you identify a proton pump inhibitor?
if it ends in -prazole
Pantoprazole
Esomeprazole
Omeprazole
Lansoprazole
How does PPI work?
to lower stomachs acidity
What would you use PPI for?
PUD
GERD
What is the administration consideration for proton pump inhibitors (PPI)?
long-term therapy can cause hypomagnesemia
use for 3 months or less
What should the patient do if they develop hypomagenesmia?
eat magnesium rich foods
What is the teaching and education you need to give your patient about PPI?
to call provider if symptoms do not improve, especially if bleedings occurs
discourage alcohol use, NSAID’s or food that cause GI irritation
Give an example of a mucosal protectant
sucralfate
What is the mechanism of action for Mucosal Protectants?
covers the ulcer site in the GI tract and protects it against further attack by acid, pepsin, and bile salts
What is the use of a mucosal protectant?
treatment of ulcers
What administration considerations come with mucosal protectants?
take on an empty stomach, 2 hrs after or 1 hour before meals AND at bedtime
constipation may occur
What is an example of an antiflatulent?
simethicone
What do antiflatulents do?
relieve gas discomfort
What are the antidiarrheal medication classes? (#3)
adsorbents
antimotility
probiotics
What do antidiarrheal medications do?
they treat the symptoms of diarrhea but do not eliminate the cause
What is the purpose of adsorbents?
help eliminate the toxin/bacteria from GI tract
What is the purpose of antimotilities?
slow peristalsis (movement of bowel)
What is the purpose of probiotics?
help restore good bacteria
Give an example of an adsorbent.
Bismuth subsalicylate (pepto bismol)
What is an administration consideration of pepto bismol?
can cause black tongue or black stools
Give an example of an antimotility
Hyoscyamine
Is hyoscyamine a anticholinergic?
Yes. (can’t see, pee, spit, shit)
What is docusate?
a stool softener
What is MiraLax?
an osmotic agent
Give an example of a stimulant
bisacodyl (Dulcolax)
What is the mechanism of action for stimulants?
causes intestines to contract, inducing the stool to move through the colon
What are the administration considerations for stimulants?
you can take orally/rectally
hold in suppository for 15-20 minutes
patient must be in Sims position (left side right leg up)
How long does the bowel movement take to produce with a stimulant?
15 minutes
What is the mechanism of action for scopolamine?
anticholinergics prevent nausea-inducing stimuli
What does scopolamine classify as?
anti-ametic
What should the patient know when applying scopolamine?
clean sight
wash hands before and after application
if discarding, fold
What herbal and vitamin supplements can you take as an antiemetic?
Ginger & Vitamin B6 & peppermint tea
What the three hormone producing glands are involved in the endocrine system? (3)
thyroid
adrenal glands
pancreas
What are hormones regulated by?
the negative feedback loop aka the pituitary glands
Which hormones do adrenal glands produce?
aldosterone and cortisol
what hormones does the pancreas produce?
insulin and glucagon
What hormones does the thyroid produce?
Thyroxine (T4) and triiodothyronine (T3) and calcitonin
What affect does aldosterone have on the body?
increases blood sodium levels
What affect does cortisol have on the body?
increases blood sugar levels
What affect does insulin have on the body?
reduces blood sugar
What affect does glucagon have on the body?
increases blood sugar
What affect does T3 and T4 have on the body?
stimulates basal metabolic rate
What does the adrenal cortex produce?
aldosterone and cortisol
What does the pituitary gland regulate?
cortisol
What hormone is a stress hormone?
cortisol
What class is fludrocortisone?
mineralcorticoid
What does fludrocortisone do?
it FLUDS your body with more SALT & WATER
What drug can help treat Addisons disease?
Fludrocortisone
What is Addisons disease?
an adrenal insufficiency (doesn’t produce enough cortisol and aldosterone)
you need to ADD steroid hormone
What are the signs and symptoms of Addison disease? (7)
salt cravings
irritability
N/V (nausea/vomiting)
sexual dysfunction in women (low libido)
low blood pressure
dehydration
weight loss
What are glucocorticoids?
they are used to decrease inflammation and suppress the body’s immune response
-one ending (“own”)
What are the adverse effects of glucocorticoids?
increased blood glucose
weight
new infections
What are some teachings of glucocorticoids?
never stop abruptly
may need to increase the dosage of anti-diabetic medications when started one steroids due to an increase in blood sugar (caused by steroids)
What are the short term complications of diabetes?
hypoglycemia
hyperglycemia
DKA
HHA
What are the treatments for Type 1 diabetes?
requires insulin for life
cannot take oral medications
What are the treatments for Type 2 diabetes?
oral medications and/or insulin
What are the signs and symptoms of hyperglycemia?
3 P’s:
polydipsia (lots of thirst)
polyphagia (lots of hunger)
polyuria (lots of urine)
Juicy fruit breathe
What is the A1C test?
blood test to diagnose diabetes
over 3 month test
measure sugar when it enters your bloodstream and attaches to hemoglobin
What value is considered diabetic on the A1C test?
greater than 6.5
What value is considered pre-diabetic on the A1C test?
5.7-6.4
What value is considered normal on the A1C test?
less than 5.7
What is considered hypoglycemic?
less than 70 on the diabetic test
causes: excess insulin, skip meals, exercise, excess alcohol
If a patient is conscious what would they give him if he was hypoglycemic?
15g of carbs/8oz of milk
reassess pt in 15 minutes
If a patient is unconscious what do you give the patient?
you would administer glucagon
Hyperglycemia diabetic ketoacidosis (DKA)
life threatening complication of diabetes that causes an increase in blood glucose
ketones in the blood/urine
most common in type 1 diabetes
What is found with DKA?
blood glucose level under 300
ketones will be present in the urine and blood
metabolic acidosis and hyperkalemia
hyperglycemia hyperosmolar state (HHS)
high glucose levels/dehydration
greater than 600
most common in type 2 diabetes
How would you store insulin if not using?
in a refrigerator
if vial is open: store in room @ controlled temp
How would you mix NPH (cloudy) and regular insulin (clear)
You would put clear before cloudy.
Why is it important to know onset, peak, & duration of insulin?
the major side effect/complication of insulin is hypoglycemia which happens @ peak
insulin glargine (Lantus)
insulin detemir (Levemir)
LONG ACTING (NEVER HOLD)
Administer once a day
Onset: 3-4 hours
Peak: none
Duration: 24 hours
insulin lispro (Humalog)
insulin aspart (Novolog)
RAPID-ACTING
Onset: 10-30 min
Peak: 1-3 hours
Duration: 3-5 hours
administer w/meals or immediately after
Humulin R
Novocain R
SHORT-ACTING
Onset: 30 mins - 1 hour
Peak: 2-4 hours
Duration: 4-8 hours
meals 30 mins before
Humulin N (NPH)
Novatin N
INTERMEDIATE
Onset: 1-2 hours
Peak: 6-14 hours
Duration: 16-24 hours
administer 1-2x daily
beta blockers may mask symptoms of hypoglycemia
What is glucagons mechanism of action?
will increase blood sugar
What nurse considerations should u seek for glucagon?
provide patient with food and safely able to swallow
What does metformin (glucophage) do?
decrease glucose production in the liver
increase glucose uptake by the cells
What are administration considerations for metformin?
GI upset
lactic acidosis (overproduction of lactic acid in the body)
What are the mechanisms of action of Glipizide, glyburide and glimepiride?
stimulate the pancreas to release more insulin
What is the peak of glipizide, glyburide and glimepiride?
1-3 hour
What are the administration considerations of glipizide, glyburide and glimepiride?
severe hypoglycemia
must be given 30 mins before meals
What is lipohypertrophy?
build up of scar tissue caused by not rotating injection sites
What insulin should you not mix with any other insulins?
insulin glargine (long)
What are the thyroid hormones?
T3 & T4 (metabolic hormones), TSH (produced by pituitary glands)
What is hyperthyroid?
excessive production of thyroid hormones
What causes hyperthyroidism?
too much iodine
Graves disease
use medication to lower
What is hypothyroidism?
low production of thyroid hormones
What causes hypothyroidism?
not enough iodine
Hashimoto disease
medication to replace the hormone w
What is a hyperthyroid medication?
ptopylthiouracil (PTU)
What is a hypothyroid medication?
levothyroxine (Synthriod)
must be taken 30 mins -1 hour before breakfast
monitor weight and pulse regularly
What is Alendronate (Fosamax) used for?
osteoporosis
What are the administration considerations of Alendronate (Fosamax)?
Give to pt in the morning
wait at least 30 mins before first meal
pt should sit/stand for 30 minutes after administration
What are the three common insulin injection sites?
abdomen
back of upper arm
lateral thigh
A client is prescribed omeprazole. The nurse determines that the client is receiving its therapeutic effect if the client makes which of the following statements?
“I no longer am experiencing constipation.”
“My heartburn and indigestion have improved.”
“I'm having less episodes of diarrhea.”
“I'm having less nausea and vomiting.”
“My heartburn and indigestion have improved”
A client has been prescribed sucralfate for the treatment of gastric ulcer. The nurse should instruct the client to take this medication at what time?
1 hour after meals
At the same time with an antacid
1 hour before meals
Lunch time
1 hour before meals
What is the priority nursing interventions for a client receiving an antiemetic?
Allowing them to eat whatever sounds good
Monitor for dehydration.
Monitor blood pressure
Monitor heart rate
Monitor for dehydration
An osmotic agent use for constipation causes water to be retained with the stool, increasing the number of bowel movements and softening the stool so it is easier to pass. True or false?
TRUE