118 Unit 1 Exam

THE BIBLE

Name 8 Sources of drug information

Name 8 Sources of drug information

a. US Pharmacopeia (USP) National Formulary (NF)

b. Physician’s Desk Reference (PDR)

c. Package inserts

d. Nursing Journals/articles

e. Electronic Databases

f. Medline (US National Library of Medicine)

g. DailyMed - high quality information about marketed drugs

h. In collaboration with FDA, NLM, AHRQ, NCI, Department of Veteran’s Affairs

i. Clinical Pharmacist

Name 3 ways drugs are named

• Chemical

• Generic

• Trade/household

Name 4 ways drugs are classified

• Body systems, where the drug works

  • ex - cardiovascular, gastrointestinal

• Clinical indication/therapeutic use - Why the drug is used

  • Antihypertensive, laxative

• Physiologic or Chemical action - What the drug is made to do

  • Beta blocker, stool softener

• Prescription vs non-prescription vs illegal

Name 5 route of administration

• Transmucosal

• Oral

• Topical

• Enteral

• Parenteral

What is parenteral administration?

• medical administration into body w/o entering the digestive system

  • Intravenous (IV)

  • Intramuscular (IM)
    Subcutaneous (SubQ)

  • Intradermal

  • Epidural

  • Intraspinal

  • Intrathecal

What is Enteral administration?

• directly into intensities (feeding tube)

What is topical administration?

• localized drug, they are applied directly at the site of action

  • Transdermal (patches)

  • Instillation (putting med in body cavity)

  • Inhalation (drug broken into fine particles to breathe)

What is oral administration?

systemic drug, transported to site of action, taken through mouth (syrups, pills)

What is Transmucosal administration?

• held against the mucous membrane in the cheek

  • Sublingual (under tongue)

  • Buccal (cheek)

What are the 4 concepts of pharmacokinetics

• Absorption

• Distribution

• Metabolism

• Excretion

What is absorption?

Movement from place of administration until enters bloodstream

What is distribution?

How drugs are transported throughout the body. Begin when the drug enters the circulatory system until it hits its desired location (usually organs)

What is metabolism?

Begins when the drug reaches the site of action, and chemically breaks down & inactivates the drug (in kidney)

What is excretion and name three examples.

The removal of drugs from the body. drug molecules are removed from site of action and eliminated from body

ex:

• kidney - urine

• GI/liver - feces

• Lung - exhalation

Name 7 general drug terms & definitions

• Onset of action: The time required for the drug to reach effectiveness

• Duration of action: how long the drug is effective

• Therapeutic level: the drug causes the desired effect WITHOUT TOXICITY

• Half-life: Time until half of drug is eliminated

• Peak: The drug is at its highest concentration level

• Trough: The drug is at its lowest concentration level

Name 5 primary effects of Pharmacodynamics

• Palliative

• Supportive

• Substitutive

• Chemotherapeutic

• Restorative

What is Pharmacodynamics?

What drugs do to the body

Name 6 secondary effects of Pharmacodynamics

• Side effects

• Adverse reactions

• Toxic reactions

• Allergic reactions

• Idiosyncratic reaction

• Cumulative effect

What are “side effects” in Pharmacodynamics?

Secondary effect

• Side effects: Unintended but predictable, can continue drug

What are “adverse reactions” in Pharmacodynamics?

Secondary effect

• : Unintended and HARMFUL must stop drug

  • can be life threatening

  • can require intervention to prevent permanent impairment or death

What are “toxic reactions” in Pharmacodynamics?

Secondary effect

• Dangerous & damaging

  • can occur by overdosing or abnormal sensitivity

What are “Allergic reactions” in Pharmacodynamics

Secondary effect

• immune system reaction

What are “Idiosyncratic reactions” in Pharmacodynamics?

• Secondary Effect:

  • Unexpected, Abnormal, Peculiar response

What are “cumulative effect” in Pharmacodynamics?

Secondary effect

• Increased response from repeated doses

  • occurs when rate of administration is greater than rate of metabolism

What are “Restorative effects” in Pharmacodynamics?

Primary effect

• Return the body or to maintain the body at optimal levels of health

  • ex: vitamin supplements

What are “chemotherapeutic effects” in Pharmacodynamics?

Primary effect

• Destroy disease-producing microorganisms or body cells

  • ex - Antibiotic for infection

What are “substitutive effects” in Pharmacodynamics?

Primary effect

• Replace either body fluids or chemical required for body to improve functioning

  • ex - insulin to a diabetic

What are “supportive effects” in Pharmacodynamics?

Primary effect

• Support the integrity of body functions

  • ex - acetaminophen for patient with infection/fever

What are “palliative effects” in Pharmacodynamics

Primary effect

• Relieves the S&S, no effect on the disease itself

  • ex - morphine for d/t cancer

Name 5 Drug Interactions

• Agonist (1+1=2 ): desired combination effects

• Antagonistic (1+1=1): One drug blocks another

• Synergistic (1+1=3): Additional effects when working together

• Potentiating (A+B=AAAAAAA): One drug enhances other to toxic levels

• Incompatibilities (1+1=0): Mixed drugs cause chemical deteriating of each other

  • should not be administered, example: clear IV gets cloudy

Differentiate between Healthcare Acquired Infections (HAI) & Nosocomial

• one of them is any healthcare setting

• the other is hospital acquired infection

How many links are in the spread of infection and what are the names?

Spread of infections has 6 links and the names are:

• Infectious agent

• Reservoir

• Portal of exit

• Mode of Transmission

• Portal of entry

• Susceptible host

What is “infectious agent” in chain of infection?

Pathogens, normal flora that turn bad

What is “reservoir” in chain of infection?

• Where pathogens live & multiply

  • Could be in humans, animals, insects

What is “portal of exit” in chain of infections?

• How the infection leaves / exits

  • body fluids

  • coughing, sneezing, saliva

  • wound drainage

  • IV lines

What is “mode of transmission” in chain of infections?

Some modes of transmission are:

• Contact

  • direct: kissing, touching

  • indirect: contact with fomite (contaminated objects that transfer pathogens)

    • stethoscope, keyboard, pen

• Droplet

• Airborne

• Vector: bug bites

What is “portal of entry” in chain of infections

• normal body opening

  • ex - eyes, mouth, anus, vagina

• Abnormal body opening

  • ex - wounds, cuts, scrapes

• Bites from a vector

  • mosquito bite, flea bite

What is “susceptible host” in chain of infections

A person who is at risk of infection because of inadequate defenses

• person without good defense

  • ex - very young (limited composures) very old (decreased immune function)

What are the 5 stages of a typical infectious process?

• Incubation: time of entry, possible s&s can appear

• prodromal: vague s&s can appear (not all diseases have this stage)

• illness: obvious s&s present

• decline: number of pathogens decline

• convalescence: tissue repair, return to normal health state

Discuss 4 ways to classify infections

• Local vs Systemic (1 body system vs 2+ body systems compromised)

• Primary vs secondary: primary is the root cause of problem, secondary is a complication of the root cause)

  • ex: common cold:

    • primary: runny nose, sneezing, congestion

    • secondary: sore throat and sinus pressure from the

    • complications above

• Endogenous vs Exogenous

  • exogenous: acquired from a healthcare environment

  • endogenous: infection acquired from patients normal flora

• Acute vs Chronic

  • Acute > 6 mnths

  • Chronic < 6 mnths

latent - not shown (hidden symptoms)

What is “primary body defenses”?

prevent organisms from entering the body

ex:

• Normal flora

• Skin (intact & healthy)

• Respiratory “tree”

• Eyes (lysosomes in tears)

• Mouth (lysosomes in saliva)

What is “secondary body defenses”?

Chemical activation triggered when pathogens get past primary defenses

ex:

• Phagocytosis - elevated WBC

• Fever - rise in core + body temp, increased metabolism

What is “teritary line of defense”?

body’s superhero squad once the two initial defenses fall through (think AoT military police)

• Natural Active: get sick normally, you make antibody

• Artificial Active: get sick on purpose to make antibody (vaccine)

• Natural Passive: get sick normally, get antibody from someone else

• Artificial passive: you temporarily get antibodies to help fight the virus/enzymes

Discuss 12 factors that place an individual at risk for infection:

• Age

• Immunosuppressant

• Immune deficiency disease

• Substance abuse

• Lifestyle

• Stress

• Invasive surgical procesudres

• Improper use of antibiotics—taking too many

• Living or work environment

• Skin breakdown

• Inadequate nutrition

• Travel

Identify 5 activities that promote immune function

• Adequate nutrition

• Balanced hygiene

• Rest/exercise

• Reducing stress

• Immunization

What is Protective Environment Precautions?

protective precaution is most strict

• reverse isolate, neutropenic precautions

• no fresh fruits, salads, v vegetables

• no live plants, fresh flower

• no standing water

List 3 nursing actions/interventions that contribute to medical & surgical asepsis

• Hand hygiene

• Use medical & surgical asepsis

• Appropriate precautions & PPE

List 7 nursing interventions that promote wellness & support host defenses

• Administer ordered treatment medications

• Monitor vital signs

• Monitor lab values

• Maintain skin integrity (T&P q 2h)

• Reduce stress/anxiety

• Promote immune function: diet, activity, sleep, lifestyle

• Encourage immunizations

List 4 signs & symptoms of infections

Temperature > 100.4

Tachycardia > 100

WBC > 10,000

Fatigue

Name & differentiate the three phases of the perioperative period

• Preoperative

  • begins with client decision to have surgery

  • ends when enters operative room

• Intraoperative

  • Begins patient entering operating suite

  • Ends when patient admitted to PACU

• Post-operative stage

  • patient enters PACU

  • healed from surgical procedures

    • recovery from anesthesia (PACU)

    • recover from surgery (surgical unit)

Describe the 4 ways in which surgeries can be classified

• Body system: helps determine the risk

• Purpose: why surgery was performed

• Degree of urgency: how critical it is to have surgery performed

• Degree of Risk: Is the degree of seriousness

What are the 6 types of surgery purposes?

• Ablative surgery: involves removal of a diseased body part

• Diagnostic (exploratory) surgery: is done to confirm or rule out a diagnosis

• Palliative surgery: is performed to relieve discomfort or other disease symptoms without producing a cure

• Reconstructive surgery: Is performed to restore function (ex: rotator cuff repair)

• Cosmetic surgery: is done to improve appearance

• Transplant surgery: Replacing a malfunctioning body part, tissue, or organ

What are 8 pre-existing conditions that put older adults at risk in surgery?

• Delirium: sudden & serious change in how your brain works, makes you confused

• Respiratory changes

• Age related skin changes

• Decreased gastrointestinal motility

• Decreased genitourinary function

• Kidney function

• Decreased cardiac output

• Increased peripheral vascular resistance (harder for blood to get thru)

What are 5 medications that put older adults at risk in surgery?

• Anticoagulants: increase risk of bleeding

• Anti-hypertensives: Increase the risk of hypotension during surgery

• Aspirin: increase risk for bleeding

• Corticosteroids: delay wound healing & increase risk for infection

• Opioids: increase the risk of respiratory depression

What are some nursing interventions & responsibilities in the preoperative period?

• Health & physical

  • history

    • health history

    • physical status

    • allergies

    • medication

    • mental status

    • understanding of the surgery

  • physical

    • respiratory system

    • vital signs

    • risk for thrombophlebitis (clot)

• pre-op teaching

  • pain management

  • coughing & deep breathing

  • incentive spirometer

  • splinting

  • leg exercising

  • anti-embolism stocking

  • sequential compression devices

  • post-op dressing, equipment

What are some lab & diagnostic test you take in the preoperative period?

• Urinalysis

• Complete blood count (CBC)

• ECG

• Chest x ray

• Blood type and crossmatch

• Serum electrolytes

• Fasting blood sugar

• Comprehensive metabolic panel

Discuss informed consent & roles of surgeon & nurse

• Includes:

• Type of surgery

• Risks & benefits

• Statement that patient has right to refuse

• Helps protects patient from having a surgery they don’t want or

understand

• Protects healthcare agency and workers from later claims that the patient

did not consent to having the procedure

• Surgeon

• Give the patient the necessary information, ie explain procedure

• Obtains signature of patient

• Determine the patient’s competence to to make an informed decision about

the surgery

• Nurse

• Nurse’s job is to Prepare the client physically & mentally

• Verify that consent has been signed & witnessed

• Nurse can witness the signing of consent

• That it is included in medical record

What are the 3 parts of Universal Protocol

• 1. Pre-verification process

  • verify correct patient, correct procedure, correct site

  • have pt verify with you

• Marking site

  • have practitioner mark the site, nurse verifies. involve pt have them verify with you

• Time Out

  • 3 parts: ID patient, ID site, verbalize procedure being performed

What are the role of the nurse before surgery?

• Maintain Normo-themia (normal body temp)

• Ensuring NPO status

• Skin prep

• Bowel prep

• Checking to make sure that bladder emptied before surgery

• Status of routine medications

• Removal of dentures, artificial limbs, contact lenses

• Anti-embolism stockings or sequential compression devices

What are some pre-op meds used?

• Opioid

  • morphine

• Anti-infective

  • ampicillin

  • azithromycin

• Anesthetic sedation

  • midazolam

  • Propofol (used in moderate sedation)

• Anticholinergic

  • atropine (reduces secretions to prevent aspiration pneumonia)

• Antiemetic

  • ondansetron

What are the two nurse teams during surgery?

• Circulating Nurse “clean team”

  • Client advocate

    • Coordinator of activities

    • Maintains safe environment

    • Continually monitors client & sterile field

    • Attends to patient during induction of anesthesia

    • Documents

    • Handles specimens

• Scrub nurse

  • part of “sterile team”

  • sets up sterile field

  • prepares instruments

  • responds to surgeon needs (passing instruments)

  • maintain integrity of sterile field

  • boss of sterile field

Name 4 different classifications of anesthesia?

• Local

• Moderate sedation

• Regional

• General

What are the roles of a PACU nurse?

• Assess their patient q5-15 minutes

• If unconscious, position on side

• pt will remain in PACU until RN determines recovery from effects of anesthesia

What is ABCN?

• Airway

  • If unconscious, turn pt to side

• Breathing

  • Respiratory rate, lung sounds, skin color

• Circulation

  • Blood pressure, pulse rate

  • drainage on dressing

• Nausea, Pain

Where does a patient go after PACU?

• Post surgical floor

  • patient has recovered from anesthesia, so now is transferred to post surgical floor

Discuss responsibilities of the nurse on the post surgical floor. What 2 things does the nurse assess?

• Recovery from surgery

  • patient assessment

    • IMMEDIATELY perform

      • vital signs

      • head to toe assessment

What is the typical assessment protocol on arrival to post surgical nursing unit?

• Every 15 minutes for the first hour

• Every 30 minutes for the next 2 hours

• Every hour for the next 4 hours

• Then every four hours

IN THE PACU IT WILL BE

• assessment q5-15 minutes

What are 5 interventions that nurse performs for post-surgical

• Pain Control

• Cough, deep breath, incentive spirometer, splinting

• Leg exercises, anti-embolism stockings, sequential compression devices

• Control of N&V

• Activities

  • ex: progressive ambulation, physicals therapy

What are the 5 things to assess before starting a patient’s diet post surgical?

• Consciousness

• Swallow

• Gag reflex

• GI tract

• Vomiting, nausea

Discuss the 3 types of progress diet and examples of each?

• Clear liquids

  • COFFEE - BLACK

  • TEA - PLAIN

  • carbonated drink

  • BROTH/BOUILLON

  • clear fruit juice

  • popsicle

  • gelatin

  • hard candy

• Full Liquids

  • Milk/dairy products

  • Vegetable juices

  • Cream, butter

  • Yogurt

  • Pudding

  • Custard

  • Cream of wheat

  • Ice cream and sherbet

• Soft diet

  • Soft meats

  • Vegetables

  • Fruits

  • Bread & cereals

  • Pureed foods

What are the 3 parts of ongoing assessments for drains post-surgical?

• Is it draining? (COCAF)

• What does site around drain look like? (REEDA)

• Measure drainage at intervals

Name the 3 drains and nurse’s responsibility in care

• Penrose: most basic without suction

• Jackson Pratt: Removes fluid WITH suction, have suction you must compress the device

• Hemovac: removes fluid WITH suction, used more with orthopedic. carries more liquid

what is “REEDA”?

R = redness

E= edema

E= ecchymosis

D= drainage

A= approximation

How do you handle Dehiscence & Evisceration?

• • interventions: maintain bedrest with HOB at 20 degrees

  • knees flexed/bent

  • apply binder to prevent evisceration

• • Cover wound with sterile towels soaked with sterile saline

  • Bedrest with knees bent to prevent strain

  • notify surgeon and prep for surgery

Name the 5 post op complications

• Hemorrhage

• Infection

• Thrombi/thrombilitis: blood clot & inflammation of veins in leg

• Nausea & vomiting

• Respiratory problems

Name 3 respiratory problems post op?

• Pulmonary Embolism: The thrombus breaks away, travels in circulation to lungs

• Atelectasis: blockage of the airways

• Aspiration Pneumonia: Airway inflammation cause by inhaling gastric secretions ( because absent gag reflex due to anesthesia)

We do not start diet until we check what post operation?

• ARE THEY CONSCIOUS/AWAKE

• CAN THEY SWALLOW

• DO THEY HAVE GAG REFLEX

• IS THERE N/V (nausea & vomiting)

• ARE THERE BOWEL SOUNDS

List 3 ways pain is classified (OCD)

• Origin

  • Cutaneous/superficial

  • Deep somatic: ligaments, tendons, nerve, bone, blood vessels

  • Visceral: stimulation deep internal pain receptors

  • Radiating/referred: has a start then extends to another area

  • Phantom: pain/burning/itching from missing extremity

  • Psychogenic: mental

• Cause

  • Nociceptive: Injury to body tissue

  • Neuropathic: Nerve injury

• Duration

  • Acute

  • Chronic

  • Intractable

List 4 pain assessment scales and when to use

• Normal adults or older children

  • Numeric scale

  • Visual analog

• Children or special need individuals

  • Wong baker faces

• Non-verbal or pre-verbal patients

  • FLACC

What is each category of the FLACC scale?

• Face

• Legs

• Activity

• Cry

• Consolability

0-3 low risk

4-6 moderate risk

7-10 high risk

List non-pharmacologic interventions for pain

■ Positioning/Posture

■ Education/Anticipatory Guidance

■ Touch- Gentle pressure or massage

■ Relaxation/Distraction/Music/Pet Therapy

■ Meditation/Guided imagery

■ Aromatherapy

■ Acupuncture/Acupressure

■ TENS (nerve stimulator)

■ PENS

■ Heat/cold treatment

■ Contralateral stimulation

■ Progressive muscle relaxation

■ Hypnosis

■ Journaling

■ Humor

■ Oral sucrose

Name non-opioid pain medications

• Ibuprofen

• Acetaminophen

• Acetylsalic Acid (asprin)

• Ketorolac

Name some opioid pain medications

• codeine

• Oxycodone acetaminophen (percs)

• Morphine sulfate

• Hydromorphone

Describe the function of PCA

• 2 types

  • mode 1: push button for dose

  • mode 2: patient pushes button plus machine gives continuous dose

YOU CANNOT PRESS BUTTON FOR PATIENT

Discuss 12 factors that affect skin integrity:

• Age

• Impaired mobility

• Nutrition

  • Albumin level is low

    • low albumin level below 3.5 indicates protein intake and a sign of malnutrition

    • normal albumin level is 3.5-5.5

• Hydration

• Diminished sensation

• Diminished cognition

• Impaired circulation

• Medications

• Moisture

• Fever

• Infection

• Lifestyle

What are the 3 types of skin?

• Epidermis

• Dermis

• Subcutaneous tissue

What are the 4 classification of wounds?

• Skin integrity

• Length of time for healing

• Level of contamination

• Depth of wound

List the 5 types of wound drainage

• Serous

• Sanguineous

• Serosanguineous

• Purulent

• Purosanguinous (INFECTION + BLOOD)

List and describe 4 types of wound healing

• Regenerative/Epithelial (growth of new cells)

• Primary Intention

• Secondary intention

• Tertiary Intention

Describe the 3 phases of wound healing

• Inflammatory - Cleansing 1-5 days

• Proliferative - Granulation - Regeneration - Healing: 5-21 days

• Maturation -Epithelialization-Remodeling: 14-21 days & up to 3-6 mnths

What is a pressure injury?

Localized injury to the skin & underlying tissue, usually over a bony prominence

Discuss the 5 types of wound tissue

• Slough

• Eschar

• Granulation tissue

• Clean, non-granulating

• Epithelial

Describe the 5 stages of pressure injuries

Stage 1: Affects 1 layer, epidermis. nonblanchable inflammation
Stage 2: eposes dermis, may resemble blister, partial thickness skin loss. affects 2 layers
Stage 3: Full thickness skin loss, undermining
Stage 4: can extend down to muscle & bone, full thickness skin loss.

Unstagable: covered by eschar so you cannot stage

What are the 6 categories of the braden scale?

• Sensory perception

• Moisture

• Activity

• Mobility

• Nutrition

• Friction & Shear

What is heat therapy used for and when should I not use heat therapy?

• Relieves joint stiffness & soreness

• Contractures

  • benefits:

    • increase blood flow to area

    • promote delivery of nutrients and removal of waste

    • promotes relaxation

when to not :

• First 24 hours after surgery

• Active hemorrhage

• Swelling

• Tumor

• Skin disorder

What is cold therapy used for and when should I not use cold therapy?

Benefits

• Vasoconstriction

• Slows bacterial growth

• Produces local anesthesia

• Decreases capillary permeability

• Reduces cell metabolism

• Treats fevers

• Help control bleeding

• Reduces inflammation and pain

• When to not use cold therapy

  • Open wounds (slows down the healing)

  • Impaired circulation (slows down the circulation of blood)

  • Pressure ulcers (slows down healing again)

Name the 4 components of good body mechanics to avoid injury

• Body alignment

• Balance

• Coordination

• Joint mobility

What is the purpose of ROM?

The goal of ROM is to exercise and keep body in best possible physical condition when bed rest is needed or immobility is present.

Difference between AROM & PROM

• Active Range of motion (AROM)

  • Done by patient without assistance

    • Rehabilitating from illness, injury, surgery

• Passive range of motion (PROM)

  • Done by another person for patient because cannot do themselves

8 Factors affecting mobility

• Developmental stage

• Cognitive status

• Nutrition

• Lifestyle

• Stress

• Environmental Factors

• Diseases & abnormalities

• Respiratory disorders, circulatory disorders, fatigue, bed rest