Fundamentals of Nursing: Pharmacology, Airway, Nutrition, and Wound Management

Comprehensive review flashcards covering Chapter 50 (Medication Adverse Effects & Interactions), Chapter 51 (Individual Pharmacological Considerations), Chapter 52 (Glucose Specimen Collection), Chapter 53 (Airway Management & Oxygenation), Chapter 54 (Enteral Nutrition & NG Intubation), and Chapter 55 (Pressure Injuries & Wound Management).

Why is albuterol administered prior to fluticasone in a client with asthma, and what is the recommended time interval between inhalations?

Albuterol is inhaled $5\,\text{min}$ prior to fluticasone to increase the absorption of fluticasone through bronchodilation, demonstrating an increased therapeutic effect.

What are the most common medications that cause angioedema, and what is its typical onset?

Nonsteroidal anti-inflammatory drugs (NSAIDs) and angiotensin-converting enzyme (ACE) inhibitors are the most common medications that cause angioedema. Its onset can occur within the first $24\,\text{hr}$ following dosing or develop after long-term exposure.

What are the initial, respiratory, and cardiovascular manifestations of anaphylaxis?

Initial manifestations include GI cramping, apprehension, generalized itching, hives, progressing to angioedema and intensely large hives. Respiratory manifestations include crackles, wheezing, decreased breath sounds, feeling of a lump in the throat, hoarseness, and stridor. Cardiovascular manifestations include a weak, thready pulse, tachycardia, and hypotension.

What clinical risk occurs when a client taking monoamine oxidase inhibitors (MAOIs) consumes foods high in tyramine?

Consuming tyramine-rich foods (such as avocados, figs, aged cheese, yeast extracts, beer, and smoked meats) while taking MAOIs can lead to a hypertensive crisis.

What is the mechanism by which grapefruit juice interacts with oral medications such as nifedipine?

Grapefruit juice inhibits presystemic medication metabolism in the small bowel, which increases the absorption and blood levels of oral medications, potentially resulting in intensified adverse reactions.

How do FDA Pregnancy Risk Categories A, B, C, D, and X differ?

Category A shows no fetal risk in controlled human studies. Category B shows no risk in animal studies with no human studies, or animal risk refuted by human studies. Category C shows adverse effects in animals with no controlled human studies. Category D demonstrates human fetal risk, but potential benefits may warrant use. Category X demonstrates fetal abnormalities in animal or human studies; the risks outweigh any benefits and use is strictly contraindicated.

Why is body surface area (BSA) considered a more precise method for calculating medication dosages than body weight alone?

Because an individual's percentage of body fat can alter medication distribution, BSA provides a more precise method of regulating an individual's response to a medication.

What physiological factors in infants ($2\,\text{days}$ to $1\,\text{year}$ old) increase sensitivity to medications affecting the central nervous system?

Infants have immature liver and kidney function, alkaline gastric juices, and an immature blood-brain barrier.

What pharmacokinetic changes occur in older adults ($65+\text{ years}$) regarding gastric absorption, body composition, and protein binding?

Older adults experience increased gastric pH (alkaline), decreased GI motility and gastric emptying time (slowing absorption), decreased total body water, increased body fat, decreased lean body mass, and decreased protein-binding sites leading to lower serum albumin levels.

What instruction should a nurse provide to a lactating client regarding the timing of safe medication administration?

Administer safe medications immediately after breastfeeding to minimize the medication's concentration in the infant's next feeding, using the lowest effective dosage for the shortest possible duration.

Why is urine glucose testing not an effective measure for monitoring blood glucose levels?

Urine testing is ineffective because blood glucose levels must exceed $220\,\text{mg/dL}$ before glucose spills over and appears in the urine.

What are the correct nursing actions for site preparation and capillary blood sampling during blood glucose testing?

Select the outer edge of the fingertip, cleanse with warm water and soap or an antiseptic swab (do not use alcohol because it interferes with results), hold the finger dependent, pierce perpendicular to the skin with a sterile lancet, and wipe away the first drop of blood before applying blood to the strip without smearing.

What casual blood glucose values define hyperglycemia and hypoglycemia?

A casual (random) blood glucose level greater than $200\,\text{mg/dL}$ indicates hyperglycemia, whereas a blood glucose level less than $70\,\text{mg/dL}$ indicates hypoglycemia.

What preprocedure voiding instruction must be given to a client before collecting a urine specimen for glucose testing?

Have the client void and discard the urine $30\text{ to }40\,\text{min}$ prior to testing to ensure that fresh urine is tested, rather than urine that has remained in the bladder for several hours.

What is the expected reference range for blood oxygen saturation via pulse oximetry ($\text{SpO}_2$), and what threshold defines hypoxemia?

The expected reference range is $95\%$ to $100\%$ (though certain chronic illnesses allow for $88\%$ to $92\%$); readings less than $90\%$ reflect hypoxemia.

What are the early manifestations of hypoxia compared to late manifestations?

Early manifestations include tachypnea, tachycardia, restlessness, anxiety, confusion, pale skin and mucous membranes, elevated blood pressure, and accessory muscle use. Late manifestations include stupor, cyanosis, bradypnea, bradycardia, hypotension, and cardiac dysrhythmias.

What is the delivered $\text{FiO}_2$ and flow rate for a nasal cannula, and at what flow rate is humidification required?

A nasal cannula delivers an $\text{FiO}_2$ of $24\%$ to $44\%$ at flow rates of $1\text{ to }6\,\text{L/min}$. Humidification is required for flow rates of $4\,\text{L/min}$ and greater.

Why must a simple face mask be set to a minimum oxygen flow rate of $6\,\text{L/min}$?

A minimum flow rate of $6\,\text{L/min}$ is required to flush carbon dioxide ($\text{CO}_2$) out of the mask and prevent rebreathing of $\text{CO}_2$.

How must the reservoir bag of a non-rebreather mask be maintained, and what $\text{FiO}_2$ does it deliver?

The flow rate must be set at $10\text{ to }15\,\text{L/min}$ to keep the reservoir bag $\frac{2}{3}$ full during inspiration and expiration. It delivers an $\text{FiO}_2$ of $80\%$ to $95\%$.

Which oxygen delivery device provides the most precise oxygen concentration, and for which client population is it best suited?

The Venturi mask delivers the most precise oxygen concentration ($\text{FiO}_2$ of $24\%$ to $50\%$ at $4\text{ to }12\,\text{L/min}$) and is best suited for clients who have chronic lung disease.

What factors cause oxygen toxicity, and what are its clinical manifestations?

Oxygen toxicity results from high concentrations of oxygen (typically $> 50\%$), long durations of therapy (typically $> 24\text{ to }48\,\text{hr}$), and underlying lung disease severity. Manifestations include a nonproductive cough, substernal pain, nausea, vomiting, fatigue, dyspnea, restlessness, and paresthesias.

What are the requirements for collecting a sputum specimen to test for acid-fast bacilli (AFB)?

Diagnosing tuberculosis via AFB testing requires collecting three consecutive morning sputum samples.

How should chest physiotherapy (CPT) be scheduled in relation to meals and bronchodilator therapy?

CPT should be scheduled $1\,\text{hr}$ before or $2\,\text{hr}$ after meals, and at bedtime. Bronchodilators or nebulizer treatments should be administered $30\,\text{min}\text{ to }1\,\text{hr}$ prior to postural drainage.

What are the suction catheter size, suction pressure, and pass duration limits for endotracheal suctioning?

The catheter diameter should not exceed one-half the internal diameter of the endotracheal tube (no larger than a $16\,\text{French}$ catheter for an $8\,\text{mm}$ tube). Suction pressure must be no higher than $120\text{ to }150\,\text{mm Hg}$. Each suction attempt must be limited to $10\text{ to }15\,\text{seconds}$, with total suctioning time capped at $5\,\text{min}$.

How far should an endotracheal suction catheter be inserted before applying suction?

Advance the catheter into the lumen until resistance is met at the carina (level of bifurcation into the mainstem bronchi), then pull it back $1\,\text{cm}\,(0.4\,\text{in})$ prior to applying suction.

What safety equipment must always be maintained at the bedside of a client with a tracheostomy?

Two extra tracheostomy tubes (one the client's size and one a size smaller), the obturator for the existing tube, an oxygen source, suction catheters, a suction source, and a bag-valve-mask (BVM).

What is the recommended cuff pressure for a cuffed tracheostomy tube, and why is this maintained?

Keep cuff pressure between $14\text{ to }20\,\text{mm Hg}$ (checked at least once every $8\,\text{hr}$) to prevent tracheal tissue necrosis and tracheal stenosis.

What is the emergency response if accidental decannulation occurs within the first $72\,\text{hr}$ after tracheostomy placement?

Because the tract has not matured, this is an emergency: ventilate the client with a bag-valve-mask (BVM), call for assistance immediately, and do not attempt forced reinsertion.

What is the primary function of the blue pigtail port on a Salem sump nasogastric (NG) tube?

It provides negative air release, which prevents vacuum suction pressure from adhering the tube to the gastric mucosal lining and enables continuous secretion drainage; it must never be clamped when connected to suction.

What anatomical landmarks are used to measure the insertion length of an NG tube?

Measure from the tip of the client's nose to the earlobe, and then down to the xiphoid process.

What is the gold standard method to confirm NG tube placement, and what gastric aspirate pH is expected?

Placement is definitively confirmed with an abdominal X-ray. Gastric contents typically have a pH of $4$ or less ($0\text{ to }4$). Note that auscultating injected air over the abdomen is not an acceptable practice.

What is the caloric density of standard polymeric enteral formula compared to modular formula?

Standard (polymeric) formulas deliver $1\text{ to }2\,\text{kcal/mL}$, whereas modular formulas deliver $3.8\text{ to }4\,\text{kcal/mL}$.

What is the highest priority nursing intervention when formula aspiration is suspected during enteral feeding?

Immediately withhold/stop the feeding to prevent further entry of formula into the lungs, turn the client to the side, suction the airway, provide oxygen as needed, and notify the provider.

What are the three stages of wound healing and their respective durations?

1. Inflammatory stage: begins with injury and lasts $3\text{ to }6\,\text{days}$. 2. Proliferative stage: lasts the next $3\text{ to }24\,\text{days}$. 3. Maturation (remodeling) stage: begins on or about day $21$ and can take more than $1\,\text{year}$ to complete.

How do primary, secondary, and tertiary intention wound healing differ?

Primary intention involves little/no tissue loss with well-approximated edges (e.g., surgical incision with sutures), rapid healing, and minimal scarring. Secondary intention involves tissue loss with widely separated edges healing by granulation (e.g., pressure injury). Tertiary intention involves widely separated, deep wounds left open until free of infection and edema before being closed later.

How are serous, sanguineous, serosanguineous, and purulent wound exudates characterized?

Serous is watery, clear or slightly yellow (like blister fluid). Sanguineous is thick and reddish containing serum and RBCs (bright red indicates active bleeding). Serosanguineous is watery and pink (mixture of serum and red blood cells). Purulent is thick, containing WBCs, tissue debris, and bacteria, often with a foul odor and variable color (yellow, tan, green, brown).

What syringe, needle gauge, and pressure should be used to irrigate a deep wound?

Use a $30\text{ to }60\,\text{mL}$ syringe fitted with a $19\text{-gauge}$ needle (or catheter) to deliver approximately $8\,\text{psi}$ (within the recommended range of $5\text{ to }8\,\text{psi}$), holding the tip $2.5\,\text{cm}\,(1\,\text{in})$ above the wound.

What immediate nursing actions are required upon identifying wound evisceration?

Call for help and notify the provider immediately; stay with the client; cover protruding organs with sterile towels or dressings soaked with sterile normal saline solution (do not attempt to reinsert organs); position the client supine with hips and knees bent; observe for shock; and maintain NPO status for emergency surgery.

What is the defining clinical characteristic of a Stage 2 pressure injury?

Partial-thickness skin loss with exposed dermis presenting as a viable, reddish-pink wound bed without slough, eschar, granulation tissue, or adipose tissue; it can also present as an intact or ruptured serum-filled blister.

What is the difference between a Stage 3 and a Stage 4 pressure injury?

Stage 3 involves full-thickness skin loss with visible adipose tissue, epibole, and potential undermining/tunneling, but without exposed bone, tendon, or muscle. Stage 4 involves full-thickness skin and tissue loss with directly visible or palpable cartilage, bone, fascia, muscle, ligaments, or tendon.

What defines an unstageable pressure injury, and what is the exception regarding eschar removal?

An unstageable pressure injury is full-thickness skin and tissue loss in which the actual depth cannot be determined because it is obscured by slough or eschar. Stable, secure eschar on the heel or ischemic limbs should not be softened or removed.

What repositioning schedule, bed elevation angle, and hydration level are recommended to prevent pressure injuries?

Reposition clients in bed at least every $2\,\text{hr}$ and every $1\,\text{hr}$ in a chair (instruct mobile sitting clients to shift weight every $15\,\text{min}$). Keep the head of the bed at or below a $30^\circ$ angle (or flat) to reduce shear. Encourage a fluid intake of at least $2,500\,\text{mL/day}$ unless contraindicated.