Fundamentals Exam 2

Hyper/Hypoglycemia markers

BG 70-120

Hypoglycemia: Hangry and passing-out symptoms

Causes: Too much insulin, not enough carbohydrates, increased exercise

Hyperglycemia: Weakness, headache, urination

Causes: Not enough insulin, too many carbohydrates, stress

Nomenclature

Chemical/Pharmacologic - generic (NCLEX) - Brand Name

Pharmacokinetics

What the body does to the drug ADME

Absorb, Distribute, Metabolize (Liver), Excrete (Kidney)

Half Life

50% of drug decrease, 4-5 until out of system

20 minute half life, after 40 minutes it would be 25%

Idiosyncratic Reaction

Unusual/unintended response

Contraindication vs. Precaution

Contraindication - medication should not be given

Precaution - given with additional assessment or monitoring

Urticaria / Pruritus

Urticaria - Hives: raised, red, itchy wheals

Pruritus - Itching

Anaphylaxis

Emergency 911, airway swelling/difficult breathing, IM epinephrine

Abbreviations

Units > U

International Unit > IU

Daily > QD

Every other day > QOD

No trailing zeros, yes leading zeros

Write Morphine Sulfate or Magnesium Sulfate

Reassure kg or lbs

Glass Ampules (meds that bind to rubber stopper)

Filter needle → administration needle

Schedules I and V

Schedule I: No medical use; high potential for misuse

Schedule V: Lowest misuse

Drug Diversion

Tampering/contaminating medications/equipment → expose patients to infections. Report immediately

Two Tiers of Precautions

Standard precautions: Treat every patient; treat blood, body fluids except sweat, secretions, excretions, non-intact skin, and mucous membranes as potentially infectious.

Transmission-based precautions: Infections or routes

Respiratory Hygiene

Educate signs, cover coughs/sneezes, (HH) after respiratory secretions, offer masks, provide spatial separation (3 feet)

Transmission based precautions

Contact: Gown and gloves, single room (scabies, head lice, MDROs)

Droplet: Spread through respiratory droplets at close range. Medical mask; mask the patient during transport (eye protection is not automatically required)

Airborne: Spread through small particles that remain suspended in the air. Airborne Infection Isolation Room (AIIR) with negative pressure; fit-tested for N95 (once a year); PAPR Powered Air Purifying Respirator

Medication Routes

Enteral - GI, mouth (PO), feeding tube (NG tube), rectally. Oral Liquids shake

Parenteral - Bypasses GI (IV), (IM), (SubQ), and (ID) injections.

Transdermal Patch - Wear gloves, remove the old patch, document the application time and date. Label with date, time, and initials according to facility policy.

Inhalers - MDI: Metered-dose inhaler. pMDI: Pressurized metered-dose inhaler. DPI: Dry-powder inhaler. A spacer can help when coordination is difficult with an MDI. Corticosteroid: rinse the mouth → oral thrush.

DPI Capsules - Load and pierce the capsule; inhale powder; do not swallow/crush

Putting on (Don) and Taking off (Doc)

Don: Gown → Mask → Goggles → Gloves

Doc: Gloves → Goggles → Gown → Mask or Respirator → HH

Standard Precautions: put on before you do the activity

Contact, Droplet, Airborne: put on before the door

Enhanced barrier precautions in LTC

Wounds, indwelling devices, MDRO → gown and gloves for high contact activities

Medical Asepsis vs. Surgical Asepsis

Medical Asepsis: Clean Technique, HH, Clean gloves (colonoscopy)

Surgical Asepsis: Sterile gloves & field; no microorganisms; invasive procedures that break the skin → body cavity (IV, IM). Sterile touches sterile

Pressure Injury Risk Factors & Reactive Hyperemia

Extrinsic factors: Friction, Shear, Moisture

Intrinsic factors: Nutrient, hydration, mobility, sensory

Hyperemia

Tissue compressed; press it, blanching = good; document

Check in an hour; if still there = abnormal reactive hyperemia

Pressure Injuries

Stage 1: intact skin, no blanching; tomato

Stage 2: Partial thickness or serum-filled blister - peeled potato

Stage 3: Full thickness, no muscle, tender, or bone; small bite out of an apple

Stage 4: Muscle, tendon, or bone; peach with bite taken out (eschar on heel is not necessary to remove)

Unstageable: Can’t see the bottom obscured by slough or eschar.

Deep tissue pressure injury (DTI): ohh, that looks bad or blood-filled blister; skin is still intact; eggplant - worse than Stage 2 separate category

“Healing Stage 4”

Prevention: Reposition, support surfaces, manage moisture, protect skin, support nutrition.

Indicates Healthy Wound Healing

Red/pink moist tissue - Granulation Tissue good

Slough (Yellow) - A barrier to wound healing, dead cells/micros

Eschar Black - heal doesn’t need debridement

Wound Excretate / Drainage

Cleared internally: lymphatic system

Removed externally: In dressing material/drains

Serous - clear, watery plasma

Sanguineous: Bright red, containing RBCs

Serosanguineous: pale red, combination of serous plasma and blood.

Purulent: Thick, yellow, green, tan, or brown

Secondary Intention healing

Optimal environment for healing: Warm and moist—not too wet or too dry.

Exposed bone: Use non-wicking material. Fluff, don’t stuff

Hydrogels: Add moisture to the wound for dry or minimally exudative (fluid) wounds.

Moisture Vapor-Permeable Films (Transparent): Protect the wound and maintain moisture. Wounds with light exudate.

Hydrocolloids: Light to moderate exudate. Maintain moisture and support autolytic debridement

Foams: Moderate to heavy exudate. Absorb exudate & maintain a moist environment.

Alginates: Heavily exudative wounds; absorb large amounts of exudate.

Jackson-Pratt (JP) Drains: Remove fluid and reduce tension, anchor the drain

Hemovac Drains: Negative pressure, compressed while active to maintain suction.

Wound dimensions

L (12:00-6:00) x W (3:00-9:00) x D (post-clean, deepest point to wound edges)

Undermining: Hidden tissue destruction under wound edges → Traps bacteria/exudate (effusion caused by inflammation), delaying healing

Tunneling: Deep narrow tracts → difficult to clean/pack, risk of abscess/pus//infection

Types of Wound Healing

Primary Intention – Sutures, staples, adhesive; minimal tissue loss, faster healing

Secondary Intention – Wound heals from the base up (granulation); tissue loss and slower healing

Tertiary Intention – Wound is left open initially and closed later with sutures or other closure methods after swelling or infection is managed.

Insulin

Abdomen, upper buttocks, outer thigh, or upper arm. pinch, rotate sites

Syringes: 0.3 mL (30 units), 0.5 mL (50 units), 1.0 mL (100 units)

U-500 insulin: Highly concentrated (500 units/mL), green cap

Bolus - Extra insulin for meals or high blood sugar.

Rapid - Glulisine, Lispro, Aspart; onset 10-20 minutes, peak 1-2 hours, duration 3-5 hours (Before meal)

Short/Regular - LIN R; onset 30-60 minutes, peak 2-4 hours, duration 4-8 hours

Basal needs - Background insulin throughout the day

Intermediate - NPH, LIN N; onset 1-3 hours, peak 4-10 hours; duration 10-18 hours; AC breakfast/dinner

Long-acting: glargine and detemir; only in syringes; can’t mix; onset 1-5 hours, no peak, duration up to 24 hours (Daily or BID)

Rapid -

Glue a pita close → Glulisine is Apidra

Listen to the human → Lispro is Humalog

If you grow apart you’ll have no vote → Aspart is Novolog

Long -

I’m gonna need a large place to land - Glargine is Lantus

That will determine if I Lev or not - Detemir is Levemir

72 Grams of CHO, BG 240, 1:10, 1:20>120

72 ÷ 10 = 7 units

(240 − 120) ÷ 20 = 6 units

Total insulin: 7 + 6 = 13 units

>5g of fiber, subtract from CHO

Stages of Wound Healing

Hemostasis - Bleeding controlled

Inflammation - Exudate present, wound bed being cleaned

Proliferation - Granulation tissue, collagen, replacement tissue from the bottom up

Maturation - Surface fully closed, collagen strengthens

Collagen production + Scar Appearance

Hypertrophic - within borders (too much collagen)

Keloid - beyond borders (too much collagen)

Atrophic - depressed contour (too little collagen)

Papyraceous - Fragile, wrinkled tissue paper (too little collagen)

Wound infection

All open wounds are contaminated

Colonization: Microbial adherence of organisms to the wound surface

Critical colonization: Bioburden interferes with healing without signs

Infection: Noticeable reaction; wound culture result, Red, Swelling, Pain, Purulent

Regional → Systemic (Swollen lymph nodes, fever, chills, increased WBC, N/V, LOC)

Contained/traumatic wound: signs of infection 2-3 days

Surgical Wound: 4th to 5th day post-op; occurs within 30 days

Wound Vacuum V.A.C

Continuous intermittent suction removes exudate while keeping a moist wound bed, removes infectious materials, reduces edema, promotes perfusion, large, excessive drainage, or when other methods fail

Microstrain - Fiberglass, cellular new tissue growth

Macro strain - Draws wound edges together

Good placement for wound V.A.C. Inflammation Phase, Proliferation phase, and full-thickness wounds heal with granulation tissue, not partial thickness

Documentation: Activity, wound type, location, Removal of Old Dressing and Drainage, Cleaning performed and new dressing, Wound Assessment and Progress, Patient response

What do granulation, slough, and eschar describe?

Granulation is new vascular tissue

Slough is soft yellow/tan devitalized tissue

Eschar is thick, often dark necrotic tissue.

Record what is present and how much.

What are dehiscence, evisceration, fistula, and abscess?

Dehiscence is separation of wound edges

Evisceration is protrusion of organs through a separated incision

Fistula is an abnormal passage

Abscess is a localized collection of pus.

How do cleansing and debridement support healing?

Cleansing removes debris (tissue-compatible solution, saline)

Debride dead tissue using sharp, mechanical, autolytic, enzymatic, or biotherapy. Some stable eschar may be left intact per guidance.

What are the phases and patterns of wound healing?

Phases: hemostasis, inflammation, proliferation, maturation.

Healing by primary intention joins edges; secondary intention fills a defect; tertiary intention delays closure.

How do you choose dressings, pack a wound, and use NPWT (Negative pressure wound therapy) safely?

Moisture and exudate. Pack loosely, leave tail, document material. NPWT removes exudate, supports healing, seals, and restores suction within 2 hours

Core elements of Standard Precautions

1) Hand hygiene

2) Exposure-based PPE

3) Respiratory hygiene

4) Safe injections and sharps handling

5) Equipment disinfection

6) Environmental cleaning

7) Safe linen handling

8) Patient placement

9) Masks for spinal or epidural procedures when indicated.

And these are always

How should PPE be selected?

Task & anticipated exposure, not diagnosis alone. Combine gloves, gown, mask or respirator, and eye protection as needed for contact with droplets, sprays, or aerosols.

When is a respirator or PAPR relevant?

Airborne precautions: fit-tested N95 respirator or PAPR per policy. Know fit-testing and seal-check requirements; a PAPR may be used when a respirator is unsuitable

How do Contact, Droplet, and Airborne precautions differ?

Contact: direct or indirect touch

Droplet: respiratory droplets over short distances

Airborne: smaller particles that remain suspended

What does an AIIR provide?

Airborne infection isolation room, airborne, negative pressure, and air exchanges.

How do you use CDC Appendix A?

Look up the diagnosis or suspected condition, then verify recommended precautions and duration

What is an MDRO, and does colonization equal infection?

MDROs resist multiple antimicrobial drugs; MRSA and VRE

Colonization: organisms are present without disease

Infection includes clinical illness.

Enhanced Barrier Precautions in long-term care?

Gown and gloves for high-contact care activities: wounds, indwelling devices, MDRO.

When might full Contact Precautions be needed in LTC?

Drainage, secretions, outbreak investigation, and public health or facility direction.

What is the difference between medical and surgical asepsis?

Medical asepsis reduces the number and spread of microorganisms.

Surgical asepsis eliminates microorganisms; sterile-to-sterile and no-touch principles

What are the 7 rights of medication administration?

Patient, medication, dose, route, time, documentation, indication & clinical judgement

What medication safety checks belong at preparation and bedside?

Prepare for one patient at a time; give only medications you prepared. Read the label at the required three checks, verify against the source closest to the drug, and confirm the medication with the patient

What should you do if an allergy is suspected or the patient questions a medication?

Pause administration, verify the allergy or order with the appropriate clinician, document and report per policy; never dismiss a refusal.

Which IM injection site is generally preferred, and what is Z-track for?

Ventrogluteal, Z-track, seal medication in the muscle for irritating or staining

What should you know about SQ injections and enoxaparin?

SubQ, do not rub the site, don’t remove airbubble in prefiled syringes

What are onset, peak, duration, and half-life?

Onset: effect begins; Peak: strongest effect; duration: how long the effect lasts

Half-life is the time for the amount or concentration to fall by half. After three half-lives, about one-eighth remains

How can route and patient condition change drug effects?

IV → bypasses GI absorption/first-pass metabolism; PO absorption varies with food, GI function, Liver disease, and kidney impairment. Dose changes require an order

What are priority signs and actions for anaphylaxis?

Airway swelling, breathing difficulty, wheezing, hypotension, or widespread hives. Emergency: stop the medication, call for help

Calculations

1 g = 1,000 mg

1 mg = 1,000 mcg

kg = lb / 2.2

1 cup = 8 oz

30 mLs = 1 oz

1 kg = 2.2 lb

Controlled-substance

Secure, count-control drugs, document waste, witness

Check dose against the order and safe range

Documenting Wound Change

1) Wound Cleaning, Dressing Change, Correct Stage

2) Location

3) Type of dressing removed (outer and packing), #, drainage, exudate type, and amount

4) Cleaning and irrigation performed; cleaning solution NS and method

5) L x W x D

6) Wound base: black eschar, red, yellow, necrotic, granulation tissue, and slough %

7) Edges - color (pale, red, pink, purple, mottled, natural color); thick, thin, swollen, indurated, firm, warm, dry, moist, blanching

8) Surrounding skin - Color, warm, dry, intact, cool, moist, tape abrasions, blanching

9) Odor

10) Tunneling or undermining (clock & measurement)

11) Pain, how patient responded

12) Relevant changes over time

13) Outer dressing type, internal packing dressing type, internal packing dressing amount, # of pieces of gauze, foam, alginate

Example 1:

1000 Dressing change with wound cleaning of a healing Stage 4 pressure injury of the right hip. Removed foam secondary ABD dressing, with 4cm spot thin pink drainage. Removed packing: 3 2x2 gauze pads, all saturated with serosanguineous exudate. Cleaned with NS and a 4x4 gauze pad. Irrigated with NS using a syringe and IV catheter. Slight odor after cleaning. Measurement of opening: L/W/D 2 cm/1 cm/2 cm. Base is 100% red tissue. Wound edges 1 cm from opening, natural color, slightly edematous, tender to touch. Tunnel 3 cm in the base at 6 o’clock. No undermining. Surrounding skin natural color, warm, dry, intact. Packed with one piece of alginate. Covered with Duoderm. Appears worse than last week when tunnel was not present. Pain level 2 during change and cleaning; states, “cannot feel it now; pre-medication helped a lot”

Example 2:

0800: Dressing change with wound cleaning. Stage 3 pressure injury of sacrum. Removed outer abd pad with no drainage. Removed packing: 3 pieces of alginate saturated with serosanguineous exudate. Cleaned with commercial spray wound cleaner and 4x4 gauze pads. No wound odor after cleaning. Measurement of wound opening: L 3.5 cm, W 5 cm, D 2cm. Base is 90% red granulation tissue, 10% yellow slough. Wound edges 0.5 cm from the opening are pink and blanchable, slightly moist and non-edematous. Undermining 1.5 cm deep from 3 o’clock to 6 o’clock. No tunneling. Surrounding skin natural color, warm, dry, intact. Packed with 3 pieces of alginate. Covered with ABD pad. Appears improved from last week. Pain level 3, and throbbing during cleaning but resolved after the procedure was complete. Cleaning: NS, Sterile Gauze Pad. Dressing: Petrolatum Gauze, hydrocolloid gel adhesive pads, Hydrocellular foam dressing, non-adhesive