Pharm Unit Exam 1

Safety

Minimize risk of harm to patients and providers through both system effectiveness and individual performance

System effectiveness safety

How a hospital help us not mess up

-Tech

-Policies

-Tall-man lettering

-No-blame environment

Third leading cause of death in the US

Medical errors

-Med admin errors is a major one

Therapeutic effect

Indication

-Why is the patient getting this? Is it appropriate?

Adverse effects

Undesired and unexpected

Severe!

Toxic effects

Misuse of medication

Inappropriate absorption

Long-term buildup

Interactions

With other drugs, supplements, herbals, specific foods

Precautions

Requires close monitoring

Contraindications

Who should NOT have it?

What goes into sharps containers?

Ampules, needles, glass

What is the correct process for disposing a liquid/pill?

Ensure it is okay to dispose and dispose in appropriate container

High risk drugs require:

Always double checking with another nurse

After a medication administration error, what is the priority for the nurse?

Assess the client for adverse effects

Important consideration of drug admin

All drugs have the potential to cause harm

Side effects

Can be beneficial or harmful

Usually predictable

Primary actions

Extension of the primary action

Ex. Warfarin causing excessive bleeding

Secondary actions

Effects other than the desired effects

Ex. Diphenhydramine causes drowsiness

Hypersensitivity

Drug allergies

-Antibodies against a certain medication

What should the nurse consider when the patient reports a drug allergy?

Clarify if it is a true allergy

Angioedema

Lip/tongue swelling

Nurse’s priority during anaphylaxis

Stop the allergen

Epinephrine

Maintain airway open

Treatment of less severe anaphylaxis

Withdrawal of the allergen

Antihistamines (diphenhydramine)

Nursing management of type II hypersensitivity

Discontinue drug/blood

Notify provider

Monitor VS

Nursing management of type III hypersensitivity

Withdraw allergen

Notify provider

Ice for joints

Administer medication for fever/pain

Nursing management of type IV hypersensitivity

Withdraw allergen

Notify provider

May require topical corticosteroids

Blood dyscrasia

Any disease affecting the blood, bone marrow, or lymphatic tissues

Lymphoadenopathy

Enlarged or swollen lymph nodes

Leukopenia

Low WBC count

Thrombocytopenia

Low platelet count

Stomatitis

Inflammation of the mucous membranes

Hepatotoxicity

Damage to the liver due to drug metabolism

Malaise

General feeling of discomfort

Why is the liver more likely to drug-induced damage than the rest of the body?

The tissue is exposed to the drug before metabolism

Golden rule of safe medication administration

Always check liver and kidney function before giving medications!

Polydipsia

Increased thirst

Polyphagia

Increased hunger

Micronutrients

Vitamins, minerals, and electrolytes

Fiber

Type of carbohydrate that is indigestible

Why is fiber important in the diet?

Adds bulk and makes it easy to void

Reduces risk for colon cancer

Helps decrease cholesterol levels

Complete proteins

Contain all 9 essential amino acids

Are sterols needed from dietary sources?

No, liver produces enough on its own

Wet Beriberi

High output heart failure

Heart hypertrophy

Edema

Lactic acidosis

Dry Beriberi

Peripheral neuropathy

Gait ataxia

Wernicke’s encephalopathy

Gait ataxia

Neurological wide-based, irregular walking

Symptom of dry Beriberi

Wernicke’s Encephalopathy

Altered mental status caused by severe B1 deficiency

Symptom of dry Beriberi

Landmark symptoms of B9 deficiency

Megaloblastic anemia

Neural tube defects

What vitamins work together to avoid neural tube defects?

B9 (folate) and B12 (folate activation)

Pernicious anemia

Autoimmune destruction of the GI parietal cells/intrinsic factor

Inability to absorb B12

Insufficient creation of healthy RBC

Xerophthalmia

Hardening/clouding of the cornea

Lifestyle changes to increase bone health

Daily sunshine

No smoking/responsible drinking

Weight-bearing exercise

Proper calcium intake

Iron supplementation

May cause GI symptoms

Toxicity can happen

Nursing action with religious considerations

Assess, don’t assume

What type of nutrition is the best if possible?

Oral/enteral

Keeps the GI muscles active

Types of enteral feedings

Total and supplemental

Cyclical enteral feeding

Administered during a continuous period of time

Usually at night

Bolus enteral feeding

Determined dose every certain time

Mimics normal feeding

TPN

Central lines

More concentrated

PPN

Peripheral IV access

Less concentrated

B1

Thiamine

B2

Riboflavin

B3

Niacin

B5

Pantothenic acid

B6

Pyroxidine

B7

Biotin

B9

Foliate

B12

Cobalamin

Vitamin C deficiency

Scurvy (think PIRATE)

Vitamin C function

Immune functions/tissue rebuilding

Iron absorption

B1 function

ATP production

Nervous/cardiac system

B1 deficiency

Rare!

Beriberi

Wernicke-Korsakoff syndrome

B2 function

Metabolism/energy

B2 deficiency

Dry cracked corners of lips

Risk factors for B2 deficiency

Vegan diet without supplementation

Birth control

B3 function

Fat, glucose, alc metabolism

Can decrease cholesterol!

B3 deficiency

Pellagra (Dermatitis, diarrhea, dementia)

B3 risk factors

Drug and alc use

Chronic GI issues

B5 function

Fatty acid synthesis

B5 deficiency

Very rare!

Fatigue

Numbness

Headaches

Irritabilities

B6 function

Cognitive development

Hgb formation

B6 deficiency

Rare!

Anemia

Dermatitis

Glossitis

CNS effects

B6 risk factors

Kidney disease

B7 function

AA metabolism

Glucose/fat formation

B7 deficiency

Hair loss, brittle nails

B9 function

Hgb/AA synthesis

Prevention of neural tube defects

B9 deficiency

Megaloblastic anemia

Neural tube defects

CNS disturbances

B12 function

Folate activation

DNA formation

B12 deficiency

Pallor

Fatigue

Glossitis

B12 deficiency causes

Pernicious anemia

Vitamin A function

Vision

Immune support

A deficiency

Hyperkeratosis

Xerophthalmia

Vitamin C function

Calcium/phosphorous absorption

Bone mineralization

C deficiency

Osteoporosis

Rickets

Vitamin E function

Antioxidant

Skin health

E deficiency

Anemia

Skin changes

Vitamin K function

Clotting

Bone formation

K deficiency

Increased bleeding

Delayed wound healing

Iron deficiency Sx

Fatigue

Palpitations

Poor focus

Headaches

Inflammatory mediators

Histamines and prostaglandins