Pharm Exam 3

Anticids Drug name

CALCIUM CARBONATE, ALUMINUM HYDROXIDE, MAGNEISUM HYDROXIDE

antacids action

neutralize acid

histamine - 2 receptor antagonists drug name

famotidine, cimetidine

histamine - 2 receptor antagonist action

inhibits action of histamine at the H2 receptors, DECREASE AMOUNT and ACIDITY

proton pump inhibitors drug name

pantoprazole, omeprazole

proton pump inhibitors action

BIND TO H+K+ATPase to prevent the release of gastric acid from parietal cells

5-aminosalicylates drug name

sulfaSALAZINE

5-aminosalicylate action

reduces inflammation and inhibits prostaglandin

corticosteroids drug name

prednisone, prednisolone, hydrocortisone, betamethasone

corticosteroids action

reduces inflammation (suppress prostaglandin, histamine, leukotrienes)

immunosuppressants drug name

azathioprine, mercaptopurine, cyclosporine, methotrexate

immunosuppressants action

inhibits proliferation of B and T lymphocytes

immunomodulators drug name

infliximab, natalizumab, ustekinumab, adalimumab

immunomodulators action

suppress the immune response by neutralizing tumor necrosis factor alpha

Antidiarrheal drug names

diphenoxylate, loperamide

Antidiarrheal action

activate opioid receptors in GI tract to decrease intestinal motility and to increase absorption of fluid

bulk - forming drug name

psyllium, methylcellulose, polycarbophil

bulk forming action

diarrhea: absorbs water in the digestive tract and forms a gel

constipation: after digestion, swells in water to form a gel (softens fecal mass and increases bulk)

surfactant drug name

docusate sodium

surfactant action

lowers surface tension to allow water to penetrate the stool and inhibits fluid absorption from the intestinal wall

stimulant drug name

bisacodyl, SENNA, CASTOR OIL

stimulant action

stimulants intestinal motility and increase the amount of water and electrolytes with the intestinal

Osmotic drug name

magnesium hydroxide, magnesium citrate, sodium phosphate

osmotic action

LAXATIVE SALTS ARE POORLY ABSORBED WHICH DRAWS WATER INTO THE INTESTINE AND CAUSES FECAL MATTER TO SWELL

constipation

IBS-C

diarrhea

IBS-D, GI infection, Crohn’s, UC, Celiac

colonoscopy prep

4 LITERS, need to ingest 250-300 mL every 10 min, need to see clear, let provider know if not

constipation diagnoses and plan

constipation, pain

constipation implementation

increase fiber and hydration, activity, regular schedule, positioning - squatty potty, positions for bowel movement

diarrhea diagnoses and risks

skin integrity, impaired nutrition, diarrhea, HYPOVOLEMIA

nonpharmacological implementation for celiac disease

refrain from gluten and read labels

pharmacological implementation for celiac disease

INCREASE IRON AND FOLATE TO PREVENT ANEMIA

nonpharmacological implementation for GI infection

obtain sample to confirm, contact isolation (gown, gloves, mask for c.diff), wash hands with soap and water not just hand sanitizer, wound nurse if needed, PPE, hydration PO, fecal management system

pharmacological implementation for GI infection

antibiotics, hydration IV if unable to take PO

non-pharmacological implementation for crohns and UC

diet: high protein/low residue, avoid cold foods, FODMAP diet, hydration PO, smoking cessation, surgical management (colostomy)

ostomy care

ENCOURAGE EARLY AMBULATION - to prevent DVT and atelectasis, pain medication PRN: surgical CO2 gas, referred pain in right shoulder from gas, stoma and skin assessment: color and position: pink/beefy red, wound-ostomy nurse, output: ileostomy 24-48hrs liquid continuous 600-1200ml/day, colostomy 3-6 days soft to formed 200-600 ml/day, emotional support, dietary - low residue (avoid foods that cause gas/odor)

dysphagia diet

solid textures, PUREED FOOD, thickened liquids

regular diet

no restrictions

clear liquid diet

liquid at room temp, nutritional inadequate

pureed diet

food pureed to liquid form

soft diet

require minimal chewing

carbohydrate diet

consumption of so many carbs/day

types of enteral feeding tubes

nasoenteric tubes: GASTRIC, DUODENAL, JUJENAL

ostomies: PEG, JEJUNOSTOMY

administration via enteric tubes

large bore catheters vs small bore catheters, can administer PO medications via catheters, check expiration date, DO NOT ALTER FEEDINGS, ROOM TEMP, check tube placement, check orders: type of formula, rate, WHEN INTIATING FEEDINGS, START SLOW AND TITRATE

continuous feedings

infusion pump, flush every 4 hours, need to check residual

cyclic feedings

continuous rate for set amount of hours, infusion pump

bolus feedings

administered in equal portions every 4-6 hours, pump or gravity, flush peg tube after every bolus feeding

GI complications

constipation, overfeeding, diarrhea, cramping/bloating/paing, N/V, DUMPING SYNDROME

mechanical complications

tube misplacement, aspiration pneumonia, irritation of the skin, clogging of the tube

metabolic complications

dehydration, hyperglycemia, electrolyte imbalances, fluid overload, refeeding syndrome

preventing complications

always check tube placement before during and after administration, confirm tube placement with x-ray and confirmed by radiology, HOB>30 degrees, check residual volumes if ordered: if greater than 250 mL hold infusion and contact provider, reposition tape and assess skin around catheter site, think about rights of medication administration, when providing medications by tube: pause feedings before administering medications flush administer flush, prokinetic agent for delayed gastric emptying METACLOPRAMIDE - blocks dopamine and serotonin receptors in CTZ increases upper GI motility increases peristalsis high dose therapy can result in diarrhea and tardive dyskinesia

PPN

dextrose 2.5-10%

TPN

dextrose >10%

TPN administration

double check orders with infusion bag, 1.2 micron filter NEEDS TO BE CHANGED EVERY 24 HRS with new bag, strict aseptic technique, pharmacists, provider, and nutritionist work together to create formula, initiate slow rate, then titrate up, NEVER ADMINISTER WITH IV MEDS

complications

pneumothorax, air embolism, clotted catheter line, catheter displacement, and infection/sepsis, hyperglycemia: check blood glucose and notify the provider, fluid volume overload, rebound hypoglycemia, refeeding

what to do to help reduce complications with parenteral nutrition

lab (electrolytes, glucose, albumin), slide insulin scale PRN, infusion bag, lipid infusions, IV pump, microfilters, S/S infection

achalasia:

reduce aspiration risk: tuck chin when swallowing, NPO if apsiration

achalasia diagnoses

pain, aspiration, imbalanced nutrition less than body requirements

Hiatal Hernia/GERD/ Barrett Esophagus diagnoses

nausea, pain, knowledge deficit

Esophageal Cancer diagnoses

imbalanced nutrition less than body requirements, fluid volume deficit, aspiration, knowledge deficit

achalasia implementation

eat slow and with water, botox, calcium channel blockers, endoscopic pneumatic dilation

Hiatal Hernia/GERD implementation

nausea and pain: small frequent meals, low fat diet, sit upright after eating (for at least an hour) to reduce pressure and digest, antiemetics, avoid eating/drinking 2 hours before bed

deficient knowledge: weight reduction, eliminate tobacco/alcohol/coffee, avoid tight fitting clothes (inc. pressure), take medications as prescribed, surgical management

Barrett esophagus implementation

nausea and pain: small frequent meals, low fat diet, sit upright after eating (for at least an hour) to reduce pressure and digest, antiemetics, avoid eating/drinking 2 hours before bed

deficient knowledge: weight reduction, eliminate tobacco/alcohol/coffee, avoid tight fitting clothes (inc. pressure), take medications as prescribed, surgical management

abblation, regular EDG every 3-5 years

esophageal cancer implementation

imbalanced nutrition: less than body requirements: strict NPO after surgery, enteral tube feedings or total parenteral nutrition after surgery, daily weights

fluid volume deficit: IV fluids via IV

aspiration: suction at bedside, nasogastric tube to suction, fowler’s position, IS/ C&DB

deficient knowledge: chemo/radiaton, surgery, consent

EDG before

physical exam, blood tests, NPO at least 8hrs before, assess for allergies, pregnancy, patient education risks and complications, consent forms

EDG during

IV sedation, local anesthetic gargle/ Spray, guard to protect teeth, left lateral side lying, air used to expand the GI tract, esophagus, stomach, duodenum evaluation r/o bleeding, inflammation, growths, can take biopsies and remove small growths, endoscope is removed

EDG after

rest for about an hour until sedation wears off, have family drive home d/t sedation, biopsy will be ready in a week, s/s of perforation: call if N/V, hematemesis stomach pain black tarry stools trouble swallowing fever, mild throat discomfort, d/c instructions: verbal and written

Gastritis diagnoses

pain, imbalanced nutrition: less than body requirement, potential complications (hemorrhage, perforation, obstruction), deficient knowledge

gastritis implementation

Pain: avoid NSAIDS, avoid alcohol, treat H. pylori: proton pump inhibitor (prazole), 2 antibiotics, bismuth subsalicylate, treat NSAIDS/corticosteroid ulcers: Misoprostol: increases mucus production and reduces acid secretion, antacids, PPI, H2 receptor antagonists; sucralfate: administer one hour before medications or food

Imbalanced nutrition: less than body requirements: NPO during flare-ups - gastritis, advance diet as tolerated, IV fluids if unable to eat, avoid caffeinated beverages, alcohol, smoking

Potential complications (hemorrhage, perforation, obstruction): presence of bleeding (occult blood in stool), NG tube to LIS, ABCs, EGD w/w/o intervention, surgery: Vagotomy w/wo pyloroplasty, gastroduodenostomy/gastrojejunostomy

Deficient knowledge: How to take medications properly, avoid triggers, stress reduction, what to report to provider, pernicious anemia - Vitamin B12 injections: how and when to inject

pre-op nursing diagnoses

anxiety, injury, pain, deficient knowledge

preop checklist

detailed history: medical, surgical, family history/genetics, code status/advanced directives, cultural considerations

allergies: medications, latex, banana, kiwi, avocado, eggs, soybean, shellfish

medications: current meds, blood thinners, herbal, opioids, substance use/tobacco

baseline: VS/height/weight, head to toe assessment, dentition/IV placement/prep, nutrition/hydration (NPO status), psychosocial/cultural/religious, support system, translator

preop interventions

anxiety - medications, therapeutic communication, IV access

injury - prevent infection - skin preparation, diagnostic studies, allergy, rights of medication and TIME OUT, preop checklist

pain - pain management, IV access

education - consent, C&DB, acitivity, nutrition/NPO, medication (hold or take before surgery), transportation

informed consent

decision of whether to undergo procedure

must be 18+ (unless emancipated)

need to be informed: procedure, risks, benefits, alternatives, cultural considerations, opportunity for questions

if meds are given that alter orientation: ask next of kin for consent for patient

in emergency situations: implied consent

malignant hyperthermia

autosomal inherited muscle disorder - must ask about personal/family history with anesthesia

induced by anesthetic agents (gas and paralytics) - inhaled (gaseous) anesthetics: DesflurANE, SevoflurANE, IsoflurANE, succinylcholine (muscle relaxer)

alters calcium function in muscle cells → abnormal release of calcium in the muscles = sustained muscle contraction

LEADS TO MUSCLE RIGIDITY, TACHCARDIA, HYPERTHERMIA, HYPOTENSION

treatment: Dantrolene interefers with muscle contraction and decreasing calcium in the muscles, treat symptoms

time out

correct patient/identity, side/site, procedure, allergies, antibiotics, patient position, implants, special equipment/requirements, review of relevant xrays/images, DVT prophylaxis, fire risk assessment, flammable prep dry, no pooling of prep, solution soaked prep pad/towels removed

postop diagnoses

ineffective airway clearance, pain, impaired skin integrity, deficient knowledge, constipation, injury and infection

risk for ineffective airway clearance

C&DB, IS, hydration

risk for ineffective tissue perfusion

Reduced BP/fluid deficit - IV fluids

DVT - compression devices

Hipotermia - bair hugger

Mobility - deambulation/activity

risk for impaired elimination

laxatives - bisacodyl, diet - fiber, hydration, deambulation/activity, check urine output every hours (PACU)

risk for infection and injuries

s/s infection, wound care, drain care, pressure ulcer

aldrete score

>9 can be transferred out

<8 pt still needs to be monitored

phase 1

AIRWAY - supports: ventilator, oxygen mask, oral/pharyngeal airway, have patient sit upright

vitals, LOC, pain, N/V, Neurovascular assessment - pulses cap.refill, surgical site - check for infection, bleeding, pus, are sutures coming apart, bleeding, x-ray, SCDS, warming - bair hugger

phase 2

less frequent monitoring, PO pain control, up and moving ASAP, IS/CDB, PT/OT, education, go home, wound care/drains/tubes, pain/N/V, positioning, immobility - DVT and Resp

phase 3

GU/GI function, home care needs

deficient fluid volume related to prolonged vomiting

IV fluids PRN, strict I’s and O’s, provide oral supplement as tolerated, electrolyte panel (BMP)

nausea r/t etiology

NPO, free of noxious odors, relaxation, antiemetic medications

antiemetics

serotonin antagonists, glucocorticoids, substance P/neurokinin1 antagonists, dopamine antagonists, cannabinoids, anticloinergics, antihistamines

types of laxatives

bulk-forming, surfactant, stimulant, osmotic

implementation crohn’s and UC

5-ASA, corticosteroids, immunosuppressants, immunomodulators, antidiarrheal, antibiotics, pain medications, multivitamin replacement, parenteral nutrition may be needed, IV fluids and electrolyte replacement

pharmacological management for upper GI disorders

antacids, histamine - 2 receptor antagonists, proton pump inhibitors

serotonin receptor antagonists drug name

ondanSetron

serotonin receptor antagonist action

blocks 5-HT3 receptors in the CTZ

glucocorticoids drug name

dexamethasone and methylprednisolone

glucocorticoids action

anti-inflammatory

substance P/neurokinin1 antagonists drug name

aprepitant

substance P/neurokinin1 antagonists action

blocks substance P

dopamine antagonists drug name

prochlorperaZINE, promethaZINE, metoclopramide

dopamine antagonists action

blocks dopamine receptors in the CTZ

cannabinoids drug name

dronabinolc

cannabinoids action

THC (psychoactive agent), helps improve appetite