Exam 2

Generic name

morphine, insulin, furosemide

Brand name

duramorph, novolin, lasix

Analgesic

pain reliever

Antibiotic

fight bacterial infections in the body and animals

Antidepressant

types of medications used to treat depression

Mechanism of drug action

Absorption:

Distribution: the disbursement of un-metabolized drugs

Factors affecting drug action

age , well

Medication Reconciliation

process of comparing a pt’s medication orders to all the medications that the patient has been taking

5 process of medication reconciliation

1. develop list of current medications

2. develop list of medications to be prescribed

3. compare the med on the 2 lists

4. make clinical decisions based on the comparison

5. communicate the new list to the appropriate caregivers and to the pt

Complete medication orders contain:

• Pts name and DOB/MRN

• Date and time that the order was written/entered

• Name of medication

• Dose of medication

• Route of administration

• Frequency of administration

• Indication

• Name and Signature of provider

What is wrong with this order?

Metoprolol 50mg PO QD

Should say daily and not QD

What is wrong with this order?

Dilaudid 1mg IV push Q4H PRN pain

Does not say pain scale 1-10 like mild, moderate, severe

What is wrong with this order?

Morphine 2-4mg IV push Q 4-6H PRN severe pain

Can’t have 2 ranges in a order must say

2mg every 4-6 hrs

2-4mg ever 4-6hrs

What is wrong with this order?

Ondansetron 4mg IV PRN

What? does not say nausea, insomnia or how frequent like every 4-6 hours etc

purpose of MAR

• Lists all current medication

• Indicates when scheduled doses are due, previous doses administered, held doses, prn doses given

Routine order

administered until the health care provider discontinues the order or until a prescribed number of doses or days have occurred

PRN order

Given only when the client requires it. Use is determined by objective and subjective assessment and clinical judgment of the nurse

• can give for side effects like itching, nausea etc

One time or on call order

Given only once at a specified time often before a diagnostic or surgical procedure

STAT order

Given immediately and only once in a single dose; frequently given in emergency situations

Now order

Used when a medication is needed quickly but not as immediate as a stat medication; given one time

What must a nurse know for every medication administered ?

• its purpose

• how it works (mechanism of action)

• typical dosage range

• route(s)

• what must be monitored before and after assessments

• common Side effects and black box warning

commonly ordered medications include

• Analgesics

• Anticoagulants

• Antihypertensives

• Anti-infectives

• Diabetic meds

• Diuretics

• Mental health meds

Laboratory values to review

Electrolytes, Glucose, CBC, Coagulation tests, Renal function tests, Liver function tests, Serum lvls of specific meds

Before administering a medication the nurse should asses the pt’s ????

• Orientation and LOC

• GI function and motility

• Ability to swallow

• Venous access for IV piggyback/IV medication (not leaking)

• Review client’s vital signs and pertinent labs

What are the 11 rights of safe medication administration

• right client

• right medication

• right dose

• right route

• right time

• right reason

• Right response

• Right documentation

• Right education

• Right to refuse

• Right Assessment data

What is the first check of medication administration

1. When the nurse finds/picks up the medication in the cassette drawer and compares to the eMAR/MAR

What is the second check of medication administration

2. After retrieval from the drawer and compared with the eMAR/MAR

What is the 3rd check of medication administration

at the pt’s bedside and immediately before administering the medication

what are the risk factors for medication errors?

• lack of pharmacological knowledge

• number of pts assigned

• fatigue

• distractions while preparing and administering a medication

what are preventions for medication errors?

• self study/ continuing education

• advocate for safe staffing ratios

• self care practices

• form and consistently follow safe habits and routines

What are the actions to promote pt safety

• Review client chart/ history

• check for allergies

• follow 11 rights of med admin

• Verify MAR against physician orders

• Perform 3 checks

• 2 client I.D

• ensure client can swallow etc

• Educate pt

• Document

• Report errors or near misses

• question unusual orders

IF a MED error occurs what should you do?

1. IMMEDIATELY assess the client and take necessary action prn to offset adverse effects or med error

2. notify the health care team and the client

3. document

4. incident report

What are adverse drug effects

Vomiting, flushing of skin

What is inflammatory

reaction to cell injury, it. Neutralizes and dilutes the inflammatory agent removes necrotic materials and establishes an environment suitable for healing and repair

What are the 3 lines of defense

• Anatomical/ chemical barriers

• Acute inflammatory response

• Immune system

First line of defense consists of

Skin, mucous membranes, tears, hair, sweat, gastric juices, saliva, urine, vaginal secretions

Second line of defense

Phagocytosis, inflammatory response, fever

3rd line of defense

Specific immune response, natural killer cells, antibodies, memory cells

How does the body protect us from infection via the following routes… skin, lungs, urinary tract

Skin: washing hands, bed bath, CHG bath

Lungs: Cilia cause us to cough and expel the pathogen, drinking water thins mucus so we can cough it up

Urinary tract: flora and urine are acidic

Second line of defense

• Occurs in response to injury-any trauma causes inflammation

• Localized to one area like leg, arm

• Immediate

• Beneficial

• Appropriate lvl of response

• Non specific

Physical causes of inflammation

• Trauma

• Lacerations

• Burns

Chemical causes of inflammation

• Bites

• Allergic response

Micro-organisms cause of inflammation

Bacteria

Purpose of inflammation

• Neutralizes and dilutes toxins

• Removes necrotic material

• Establishes environment suitable for healing and repair

• Not a infection

• Add “itis” to affected body part

4 phases of inflammation

1. Vascular response (think blood vessels)

2. Cellular response (WBC)

3. Formation of exudate ( neutrophils and fluid)

4. Healing (regeneration and repair of tissue)

Steps of the vascular phase/response

• Injury occurs

• Local vasoconstriction

• Release of kinins, histamines, prostaglandins

• Local vasodilation and hypermedia

• Increased cap pressure and permeability

• fluid exudate from capillaries to tissue spaces leading to edema

Steps of cellular phase

• Chemotaxis begins (movement of cells to injury)

• WBC rush to help

• Neutrophils and monocytes migrate through capillary walls to site of injury

• Macrophages signal the immune response

Eosinophils

Allergic response

Lymphocytes

Help Develop immunity

Basophils

Carry histamine and heparin

Summary of inflammatory response

1. Chemical signals released by activated macrophages and mast cells at the injury site cause nearby capillaries to widen and become more permeable

2. Fluid, antimicrobial proteins and clotting elements move from blood to the cite.. clotting begins

3. Chemokines released by various kinds of cells attract more phagocytes cells from the blood to the injury site

4. Neutrophils and macrophages phagocytes pathogens and cell debris at the site and tissue heals

How does exudate form

When fluid from capillaries leaks into tissue spaces

What does exudate consist of

Serous fluid, cells and chemical mediators… can be confused of as infection but if it has no order so infection not present

Healing of minor injury

Return to normal structure and function as cells are replaced and tissues with cells of the same type are regenerated

Healing of extensive damage

• Infection with abscess or granuloma formation

• Repair takes place with replacement of destroyed tissue with scar

• Cover, seal, shrink wound

S/S of inflammation

Redness, swelling, pain, heat, loss of function

Normal WBC count

5,000-10,000

Normal erythrocyte sedimentation rate

<20mm/ hr

What is CRP

C restive protein, non specific test to identify the presence of inflammation normal is <1.0 mg/ dl

What comprises the immune system

Bone marrow, lymph system, thymus gland

Types of immunity

Natural, acquired, active

Natural immunity

Present at birth

Not produced by the immune system

Mothers antibodies cross the placenta to fetus

Acquired immunity

Result of the immune response

Passive after birth, short lived, breast milk

Active immunity

Long term

Exposure to micro-organisms

Immunizations

What are lymphocytes

Type of WBC that remembers and recognizes previous invaders

What are B lymphocytes

They become cells that produce antibodies. The antibodies attach to a specific antigen and make it easier for the immune cells to destroy the antigen

What are T lymphocytes

Attack antigens directly and help control the immune response. They also release chemicals known as cytokines which control the entire immune response

Immune function in geriatric

• Immunologically at risk… decline with age

• Decreased T-cell and specific antibody function

• Increased auto antibodies that attack normal tissue

• Infections, cancers, and auto immunity take place

How do vaccines work?

Contain a weakened or inactive part of a particular organism (antigen) that triggers an immune response w/ in the body

This version does not cause the disease in the SuperSonics receiving the vaccine but it prompts immune system to respond

Questions to ask before giving a vaccine?

• Are you currently sick

• Have you had a reaction to the vaccine before

• What is your age

• Any allergies to eggs

What are the 3 types of influenza

Type A, Type, B and C

Influenza type A

• Over 100 kinds mutate and affects other animals

• More deadly mutate often

Influenza type B and C

Only affects humans and is generally mild

Droplet precautions—> inhaling particles

Pathophysiology of influenza

Acute disease that targets the upper respiratory tract and causes inflammation of the upper respiratory tree and trachea

Risk factors for influenza

Age, immunocompromised, hygiene, rest/ sleep dysfunction, stress, environmental

S/S of influenza

Chills, fever, malaise, headache, cough, sore throat, runny nose, watery eyes, congestion, sneezing, body aches, loss of appetite, fatigue

Treatment of influenza

Symptom management, TA I flu, relenza

Chain of infection

Agent, reservoir, portal exit, mode of transportation, portal of entry, susceptible host

where do germs live?

People, animals/ pets, wild animals, food, soil, water

How germs get out?

Mouth, cuts in skin, during diapering and toileting

How germs get around

Contact ( hands, toys), droplet (when you speak, sneeze, or cough)

Next susceptible host

babies, children, elderly, people with weakened immune system, unimmunized people, anyone

Factors that increase our susceptibility to infection

Age, stress, nutritional status, medical therapies, chronic disease, surgical procedures

Risk factors for infection in older adults

Gradual deterioration of immune system with age, weaker, more co-morbidities

What are the 5 movements for hand hygiene

1. Before touching pt

2. Before a clean or aseptic procedure

3. After a body fluid exposure risk

4. After touching pt

5. After touching pt surroundings

What is the sequence for putting on PPE ?

1. Gown

2. Mask

3. Goggles

4. Gloves

Pt that needs to have vitals taken what type of ppe?

Hand hygiene

Pt that is diagnosed with influenza has what type of PPE?

Droplet

Pt with a draining wound infected with MRSA what type of PPE?

Contact

Pt suspected of having TB what type of PPE ?

Airborne

Pt with a broken bone what type of PPE?

Hand hygiene

Pt with C.Diff what type of PPE?

Contact

What is medical asepsis

Practice that inhibits the growth and spread of microorganisms

What are clean techniques of medical asepsis

• Handwashing

• Standard precautions

• Providing personal hygiene

• Cleaning equipment

What is surgical asepsis

Practices that destroy all microorganisms and their spores

When is sterile technique practiced ?

• care of surgical wounds

• Catheter insertion

• Invasive procedures

• Surgery

How to preform sterile technique

• articles must remain away from and in front of body above the waist

• Never reach across a sterile field

• Never turn your back on a sterile field

• One inch around the boarder is considered contaminated

• Flat dry surface to work on

Health care acquired infections (HAIS)

Infections you get while receiving treatment at a health care facility like a hospital or from a healthcare professional like a doctor or nurse

Main sources of infection

• Person to person via hands

• Person clothing or equipment

• Environmental contamination

• Break clean in sterile technique

• Hospital staff who are Carriers

Common health care acquired infections (HAIS)

• Catheter associated UTI (CAUTI)

• Surgical site infections

• Central line associated blood stream infections

• Ventilator assisted pneumonia