Search for Hyperthermia

Know the relationship between molecular weight and rate of diffusion The rate of diffusion is inversely proportional to the molecular weight Small weight-fast diffusion; heavy weight-slow diffusion Identify RBC’s in various solution and determine tonicity Tonicity - the ability of an extracellular solution to make water move into or out of a cell by osmosis If a cell is placed in a hypertonic solution, there will be a net flow of water out of the cell, and the cell will lose volume (shrink). A solution will be hypertonic to a cell if its solute concentration is higher than that inside the cell, and the solutes cannot cross the membrane. If a cell is placed in a hypotonic solution, there will be a net flow of water into the cell, the cell will gain volume (bigger). If the solute concentration outside the cell is lower than inside the cell, then solutes cannot cross the membrane, then the solution is hypotonic to the cell. If a cell is placed in an isotonic solution, there will be no set flow of water into or out of the cell, and the cell’s volume will remain stable. If the solute concentration outside the cell is the same as inside the cell, and the solutes cannot cross the membrane, the solution is isotonic to the cell. Homeostatic feedback loop for respiratory rate, heart rate and temperature Respiratory Rate: Stimulus : The level of carbon dioxide (CO2) in the blood increases (often due to exercise or hypoventilation) . Receptors: Chemoreceptors in the medulla oblongata, carotid arteries, and aortic arch detect changes in blood pH and CO2 levels Control Center: The medulla oblongata processes this information Effectors: Respiratory muscles (diaphragm and intercostal) adjust breathing rate and depth Response: Increased respiratory rate removes CO2 and increases O2 intake, restoring normal pH and gas levels. Heart Rate: Stimulus : Changes in blood pressure, O2, CO2, or pH levels Receptors: Baroreceptors (detect blood pressure changes) in the carotid sinus and aortic arch; chemoreceptors monitor blood chemistry Control Center: The medulla oblongata (cardiac center) processes signals Effectors : The autonomic nervous system (ANS) adjusts heart rate through the sympathetic nervous system (increases heart rate) or parasympathetic nervous system (decreases heart rate) Response : Heart rate increases during low O2 or low blood pressure (to circulate oxygen) and decreases when homeostasis is restored. Temperature Regulation Stimulus: Changes in body temperature (hyperthermia or hypothermia) Receptors: Thermoreceptors in the skin and hypothalamus detect temperature fluctuations. Control Center: The hypothalamus processes this information and signals effectors Effectors and Responses: If too hot: Blood vessels dilate (vasodilation) to release heat, and sweat glands produce sweat for cooling If too cold: Blood vessels constrict (vasoconstriction) to retain heat, and shivering generates warmth. Steps of a generic homeostatic feedback loop Stimulus : A change in the internal or external environment that disrupts homeostasis (eg. temperature change, pH levels, blood sugar levels) Sensor (Receptor) : Specialized cells or receptors detect the change and send information to the control center. Control Center (Integrator): Often the brain or endocrine glands, this component processes the information from the sensors and determines the appropriate response to restore balance. Effector: This component carries out the response to the stimulus as dictated by the control center. Effectors can be muscles or glands that help to counteract the change. Response: The action taken by the effectors to restore homeostasis. This could involve increasing or decreasing a physiological process (e.g. sweating to cool down or shivering to warm up) Feedback: The results of the response are monitored. If homeostasis is restored, the system maintains its state; if not, the loop may repeat, continuing to adjust until balance is achieved. How to evaluate data to determine the set point, error, and disturbance Identify the set point The set point is the optimal level or range that the system aims to maintain. To determine the set point: Gather baseline data: Collect data over a period to understand the normal range for the variable in question (e.g. body temp., BP, blood glucose levels) Analyze Trends: Look for patterns in the data to identify the average or median value that represents the stable condition of the system. Consult Literature: Reference established physiological norms or previous studies to confirm the typical set point for the variable. Assess Disturbance A disturbance is any factor or event that causes a deviation from the set point. To evaluate disturbances: Identify External and Internal Factors: Analyze the data for any external influences (e.g. environmental changes, dietary habits) or internal changes (e.g. illness, stress) that might have impacted the variable. Quantity Disturbance: Measure the magnitude and duration of the disturbance. This can be done by comparing the data points during the disturbance against the established set point. Monitor Changes: Track how the system responds to disturbances over time to assess their impact on maintaining homeostasis. WBC types and normal distribution values/ abnormal values and what those values indicate (infections/diseases) (Never Let Monkeys Eat Bananas) Neutrophils (50-70%) - First responders to infections, especially bacterial. High levels indicate bacterial infections, inflammation, or stress. Low levels can indicate bone marrow disorders or severe infections. Lymphocytes (20-40%) - Include B cells and T cells, important for immunity. High levels can suggest viral infections or leukemia, while low levels might indicate immune deficiency. Monocytes (2-8%) - Help with cleaning up dead cells and fighting infections. High levels can be linked to chronic infections or autoimmune diseases. Eosinophils (1-4%) - Involved in allergic reactions and fighting parasites. Elevated levels may indicate allergies or parasitic infections. Basophils (0.5-1%) - Release histamine during allergic reactions. High levels might be see in allergic conditions or blood disorders. Normal WBC Count Total WBC Count: 4000-11000 cells per microliter of blood (varies slightly by lab) Leukocytosis (High WBC): Can indicate infection, inflammation, stress, or leukemia Leukopenia (Low WBC): Can result from bone marrow disorders, viral infections, or autoimmune diseases Neutrophils: Banded vs Segmented Neutrophils are the most abundant type of white blood cells and play a crucial role in fighting infections. They exist in different stages of maturation: Banded Neutrophils (“Bands”) - Immature Neutrophils Appearance: Have a curved, unsegmented nucleus (band-shaped) Normal Range: 0-6% of total WBC count (~0-700/uL) Clinical Significance: Increased Bands (Bandemia) -> Indicates an acute bacterial infection or severe stress (e.g. sepsis). The bone marrow releases immature neutrophils in response to infection. Low Bands -> Not clinically significant unless the total WBC count is low, which could suggest bone marrow suppression. Segmented Neutrophils (“Segs”) - Mature Neutrophils Appearance: Have a segmented nucleus with 2-5 lobes Normal Range: 50-70% of total WBC count (~2500-7000/uL) Clinical Significance: High Segs (Neutrophilia) -> Suggests bacterial infections, stress, chronic inflammation, or leukemia Low Segs (Neutropenia) ->Can be caused by viral infections, bone marrow disorders, chemotherapy, or autoimmune diseases. Discuss the stages of cell cycle/mitosis-which stages are longest/shortest The cell cycle is a series of events that cells go through to grow and divide. It consists of two main phases: Interphase (Longest Phase) – Preparation for division Mitosis (Shortest Phase) – Actual cell division Stages of the Cell Cycle Interphase (90% of the Cell Cycle – Longest Phase) Interphase is the period of cell growth and DNA replication. It has three subphases: G1 Phase (Gap 1) The cell grows, produces proteins, and prepares for DNA replication. Longest variable phase; some cells may stay here indefinitely (e.g., neurons in G0 phase). S Phase (Synthesis) DNA replication occurs, ensuring each daughter cell gets a complete genome. Takes about 6-8 hours in human cells. G2 Phase (Gap 2) The cell prepares for mitosis by producing proteins and organelles. Shorter than G1 but still significant in length. Mitosis: Prophase, Metaphase, Anaphase, Telophase Know proportional and inversely proportional relationships Direct (Proportional) Relationship When two quantities increase or decrease together at a constant rate, they are directly proportional. Inversely Proportional When one variable increases, the other decreases proportionally. Know relationship between molecular weight and rate of diffusion The rate of diffusion of a substance is inversely proportional to the square root of its molecular weight. Lighter molecules diffuse faster Heavier molecules diffuse slower due to greater mass. Know relationship between filtration rate and pressure of fluid or weight of fluid Filtration rate is directly proportional to the pressure or weight of the fluid driving the filtration process. Higher pressure → Higher filtration rate Lower pressure → Lower filtration rate Know why men and women blood values are different The differences in blood values between men and women are due to biological, hormonal, and physiological factors

Updated 43d ago

Pharmacology Basics a. What types of assessments and evaluations are important to do before and after giving a medication? -Vital signs -Modified head to toe exam -Pt allergies -Labs - Med history -Speci drug data -Pt understand of drugs - Age related concerns -Liver failure? Malabsorption syndrome? Renal disease? -Pt home drugs? - When intended effect will happen - Urine outpit - Lung sounds - Monitoring (desired outcome obtained? What was drug response? Any adverse effects? Any toxic effects?) b. What are the 9 rights you must consider before giving a medication? - Right pt - Right drug - Right dose - Right route - Right time - Right indication - Right documentation - Right response - Right to refuse c. What drugs are considered to be controlled substances and why? - Schedule 1-5 drugs due to the high abuse potential d. What are black box warnings? - Highest safety-related warning for meds that are assigned by FDA. This warning is intended to bring the consumer and the nurses attention to the major risk of the drug. e. Why do you have to know the generic name of a drug? - This is the name used on the NCLEX and the DR can call/prescribe it by either name. f. What is Pharmaceutics? - Developing a chemical to be used as a drug. g. What are enteral drugs? - PO drugs, it has to pass through intestines/ be absorbed in GI tract h. What are parenteral drugs? -Drug given by injection (passing outside the intestines) i. What is Pharmacokinetics? - Study of what happens to the drug while it is in the body j. Why do we consider the absorption of the drug? - Absorption affects the speed and concentration at which a drug may arrive at its desired location of effectg - k. What factors affect the absorption of a drug? - CYP450= enzyme in liver responsible for breaking down drugs and making them bioavailable l. What is the First Pass phenomenon? m. Which route of administration will be absorbed fastest and slowest? - IV/ parentral drugs are absorbed faster. - n. Why do we consider the distribution of the drug? • -Distribution describes how a substance is spread throughout the body. To be effective, a medication must reach its designated compartmental destination, described by the volume of distribution, and not be protein-bound in order to be active. o. What factors affect the distribution of a drug? - biochemical properties of the drug as well as the physiology of the individual taking that medication, ; protein bound drugs, if it has protein bound to it, it makes it harder to reach the site. p. What is a drug to drug interaction and why does this occur? - Drug- drug interaction occurs when taking more than one medication together. q. What is the importance of drug metabolism? - Metabolism changed drug to inactive metabolite to more soluble form, to a more potent active metabolite. Affecting the liver. r. What are the cytochrome P-450 enzymes and why are they so important to medication administration? - This is an active enzyme used to break down the drug; there are multiple enzymes used to break down drugs by PY450 is common; if that enzyme is already in use for a drug the enzyme may not be effective for another drug taken at the same time requiring the action of that enzyme. s. What organ is responsible for most drug metabolism? - Liver t. What labs do we monitor to make sure that organ is not damaged from metabolizing the drugs? - Liver labs u. What factors affect the metabolism of drugs? - The enzymes. Certain enzymes might make a drug more effective potentially causing toxicity and some enzymes can impede a drugs effectiveness. v. What organ is most frequently responsible for excretion of drugs? - Kidneys w. What labs do we monitor to make sure that organ is not damaged excreting the drugs? -Kidney function x. What is the onset of action of a drug? - Time required for drug to take effect y. What is the peak level of a drug? - Time required for drug to reach its maximum therapeutic response. z. What is the half-life of a drug - Time required for 50% of the drug to be eliminated from the body. aa. What is the duration of action of a drug? - Length of time that drug concentration is sufficient enough to elicit a therapeutic response. bb. How do these time factors affect the way we nurses administer and evaluate drug affects? - If a drug has a long half-life then we have to delay or put more time in between giving another dose. cc. What are the common ways that drugs exert their actions? - Through receptors, by effecting enzymes, nonselective interactions (will bind to multiple receptors because we haven’t been able to target just the one area which is why we have side effects) dd. What is acute drug therapy used for? - Antibiotics, given for a short amount of time to get rid of something specific ee. What is maintenance drug therapy used for? - BP meds, taken for a long time to maintain a function ff. What is palliative drug therapy used for? - Given to make someone more comfortable at end of life. gg. What is prophylactic drug therapy used for? - Given to prevent something hh. What are adverse effects or adverse reactions to drugs and why are they important for nurses to recognize? - Adverse effects are basically negative effects or responses to the drug from external sources; ie grapefruit garlic don’t react well with certain meds ii. What is important to consider when giving a drug to a pregnant woman? - What trimester pt is in and category drug jj. What is important to consider when giving a drug to a pediatric patient? - Pt weight kk. What is important to consider when giving a drug to a geriatric patient? - Polypharmy, other drugs taken, physiologic issues, financial issues ll. Why are drugs categorized related to pregnancy? - To determine the potential effects to the fetus mm. What are some cultural or genetic factors you must consider when administering drugs? - Speak different languages, may use herbal remedies that you need to ask about, how thee culture handles illness, be considerate of religious belief because some could affect care , how they feel about the treatment nn. Why is it important to educate patients about their prescribed medications? - So they will know what is happening and how it is happening oo. What are some factors that will improve the patient’s ability to learn about their medications? - Pt age, language barrier, cognitive abilities, literacy level, emotional status, environment at home, barriers of learning, any physical/psych/cognitive limitations pp. What are the different routes of medication administration? - PO, IM, IV, subcutaneous, topical, inhalation, nebulized, rectal, sublingual, intrathecal (epidural/spinal, transdermal qq. Why are drugs ordered to be administered using different routes? - Maybe poor liver, can’t swallow, needs to act quicker rr. What are common causes of drug administration errors? - Abbreviation, misinterpretation, drugs with similar spelling or pronunciation, staff nurse “work around”, high alert medication have more sever consequences w. error, not doing med reconciliation w/ new pt, given to wrong pt, wrong route and time ss. How can we prevent drug administration errors? - 3 checks of the 9 routes, limit telephone orders, multiple systems of checks and balances, be aware of look alike- sound alike drugs, any doubt CALL THE PHARMACIST. tt. What should you do if you make a medication administration error? - Be honest, follow the institutions policies and procedure, complete incident report, stay with pt to monitor for adverse reaction, document accurately thoroughly and objectively include info 2. Pain Medications a. Opioids i. How do you assess pain? - Onset - Location - Duration - Character - Aggravating/ - Relieving Factors - Timing - Severity ii. What are the different types of pain? iii. What are the receptors in the central nervous system that are responsible for pain transmission? -Mu, kappa, and delta -Mu has most side effects/ targeted effects iv. What does an agonist drug do in the body? -Acute, chronic, somatic, vascular, superficial, deep, visceral, neuropathic, referred, phantom, and cancer pain -Binds to receptor, alters function of receptor, and triggers physiologic response for that receptor. (ex: opiates) v. What does an antagonist drug do in the body? - Binds to receptor, but fails to activate physiologic response, vi. What happens when an opioid agonist binds to a Mu receptor? - You get all the effects of the Mu receptor (gi motility, euphoria, respiratory depression, etc) lots of side effects vii. What are the generic names of the frequently prescribed opioids? - Morphine and Fentanyl viii. What is drug potency? - How much drug is needed to produce the effect you need ix. What are the indications for the use of opioids? - Moderate to severe pain, cough suppression, anti diarrhea, local anesthesia, x. What are the adverse reactions that are frequently seen with the use of opioids? - Respiratory depression, CNS depression (sedation, mental clouding, coma), constipation, n/v, itching, rash, wheal formation, orthostatic hypotension, - Zofran reduces nausea when taking opiates xi. When evaluating the effects of an opioid, what body system must the nurse assess? - Respiratory and cardiac xii. What are the signs and symptoms of opioid overdose or toxicity? - Respiratory depression, CNS depression (sedation, mental clouding, coma), miosis xiii. What should the nurse do if there is a suspected opioid overdose? - Notify provider, use naloxone (antagonist for opiate) xiv. What does it mean to be opioid naïve? - First time user xv. What is drug tolerance and how does it affect a patient? - Larger dose is required to produce the same response, xvi. What is drug dependance and how does it affect a patient? - If you take the drug away they will freak out. xvii. What education should you provide to a patient taking an opioid? - Don’t increase your dose without talking to your doctor - Don’t stop abruptly - Don’t crush or chew ER or controlled release tablets - Can cause drowsiness, don’t partake in hazardous activities while using med - If become light headed or dizzy, sit down; change position slowly - Don’t drink alcohol or other CNS depressants while taking opiods xviii. When is the onset of action of morphine? - 5-10minutes xix. When is the peak action of morphine? Onset : 5-10 Peak: 30 minutes xx. How do we give morphine in the hospital? - IV, PO xxi. How quickly do you push IV drugs? - Slow push xxii. What are appropriate indications (what is it used for) for the use of Fentanyl? - Chronic pain, xxiii. What education should you provide to a patient who has a prescription for a Fentanyl patch? - Shave area and clean, don’t apply heat, flush down toilet, remove old patch first, keep away from children, change patch q72hrs, periodically check that oatch has not fallen off xxiv. What is Naloxone used for? - Opioid antagonist xxv. How should you educate a person or the family of a person that might need to use Naloxone? - After giving it to the step back, call provider/911, be prepared to give second dose if they relapse b. NSAIDS i. What are the main classes of NSAIDS? - Salicylate ( Asprin_ ) ii. What are the three main indications for NSAIDS? - Pain/ fever/ inflammation iii. How do NSAIDs work? - Blocks COX 1&2 enzymes - COX 2 is given for arthritis and causes less GI upset iv. What is the difference between “Protective Prostaglandins” and “Pathologic Prostaglandins”? - Protective goes through GI system (saves liver and kidney) by vaso constricting of dilating, increase clotting factors, v. What are the names of 9 different NSAID drugs? - Aspirin - Diflunisal - Indomethacin - Ketorolac (Toradol) - Diclofenac (Voltaren) - Celecoxib(Celebrex - Ibuprofen (Motrin, Advil) - Naproxen (Aleve) - Oxaprozin (Daypro) - Acetic acid derivatives - Cox 2 - Enclic acid derivatives - Proprionic acid derivatives (Ibuprofen/ Naproxen vi. What are 3 major contraindications for using NSAIDs? - Never in 3rd trimester of pregnancy - Not to be given to pts going to surgery (stop one week prior) - ASA or salicylates not to be given to children with viral illness or fever ages 4-12 vii. What is the major adverse effect that nurses should monitor for in patients taking NSAIDs? - GI Bleed - Reyes Syndrome - Acute renal failure viii. What is Reyes Syndrome and why is understanding this syndrome important? -brain swell and your liver lose function after a viral illness or infection like flu or chickenpox. Common among children who take aspirin to treat symptoms during a viral infection or illness - Don’t give children under 12 asprin ix. What is the Black Box Warning for NSAIDs? - Be aware that patient may be at increased risk for CV events, GI bleed, renal insufficiency; monitor accordingly, don’t give to 3rd trimester x. What are drugs and herbs that will interact with NSAIDs? - Garlic (increases bleeding), fish oil, ginger ginko, feverfew, alcohol, anticoagulants, ulcerogenic drugs, diuretics, lithium xi. What are important considerations for enteric coated or sustain released pills? - Don’t crush or chew xii. What are important patient education points the nurse should provide to patients taking NSAIDs? -don’t crush or chew, take with meal xiii. What is the most common reason a patient will take 81 mg of aspirin? - Cardiovascular issues, preventing thrombosis xiv. What are the signs and symptoms of aspirin toxicity in adults? - Tinnitus (ringing in ears), hearing loss xv. What are the signs and symptoms of aspirin toxicity in children? - Dizziness, increased breathing, coma, confusion, tachypnea xvi. What treatment should the nurse expect to be used for patients with aspirin toxicity? - xvii. What is Ketorolac? - xviii. How long should a patient be taking Ketorolac? - Can’t take for more than 5 days xix. What are common indications for Ketorolac? - Post op surgery/ pain control xx. How is Celecoxib different than other NSAIDS? -Blocks COX 2 and has more anti inflammatory properties, used for joint pains xxi. What are the indications for Acetaminophen use? - Preferred antipyretic med for children and adolescents due to Reye’s Syndrome xxii. What patients should be careful when using Acetaminophen? xxiii. What are the potential adverse effects of Acetaminophen? - N/V, liver toxicity xxiv. What is the antidote for Acetaminophen toxicity? - Acetylcysteine (Give within 10 hours of overdose) xxv. What is the recommended daily dose for Acetaminophen? -3,000mg xxvi. What is the recommended daily dose of Acetaminophen for patients with liver disease? - Less than 2,000 xxvii. What is Tramadol? - Used for seizures and constipation, moderatre to severe pain (adverse effects similar to opiods, no more than 400mg per day xxviii. What are the most common indications for the use of Tramadol? - Alleviate pain xxix. What are the names of 3 drugs used to treat Gout? - NSAIDS - Allopurinol - Colchicine xxx. What is Allopurinol and how does it work to treat gout? - Purine inhibitor, maintenance for gout xxxi. What are potential adverse effects of Allopurinol? - Steven Johnson Syndrom, flu like symptom, xxxii. What is Steven Johnson Syndrome? - eruption of mucous membrane leading to bleed out xxxiii. What is Colchicine and how does it work to treat gout? - NSAID xxxiv. What are potential adverse effects of Colchicine? - Don’t give to pregnant in 3rd trimester, GI/GU bleed, Drugs Used for Anesthesia a. What is the goal of Balanced General anesthesia? - b. What are the classes of drugs used in Balanced General anesthesia? - Benzo, analgesics, anasthetics, muscle relaxants c. What are 3 IV general anesthetics? - Dexmedetomidine - Ketamine - IV - Propofol d. What are 3 inhaled general anesthetics? - Sevoflurane - Suprane - Nitrous oxide e. What is malignant hyperthermia? - disease that causes a fast rise in body temperature and severe muscle contractions when someone receives general anesthesia with one or more of the following drugs: halothane, isoflurane, sevoflurane, desflurane or succinylcholine f. What are the signs and symptoms of malignant hyperthermia? - Cramping, seizure, lockjaw, increase temperature, sweating g. What drug should be given if a patient experiences malignant hyperthermia? - Dantrolene (2mg/kg) repeat every 5mins till stable h. What are other nursing interventions that are useful in patients who have malignant hyperthermia? - Chill them, hydrate, critical care meds i. What is Moderate sedation? - Medication that numbs them, but they are awake and alert. j. What are neuromuscular blocking drugs use for? - Muscle relaxant k. What is the name of a neuromuscular blocking drug used in surgery? - succinylcholine l. What is the black box warning for neuromuscular blocking drugs? -cardiac arrest -arrythmia m. What is local anesthesia? - Targeted to numb just that area. n. What is the most commonly used local anesthetic? - Lidocaine - Procaine - Bupivacaine o. What is Local Anesthetic Systemic Toxicity and how does it occur? - Local anestheic doesn’t leave spot, prolonged numbess; too much of the anesthetic. p. What is a spinal headache? - When anesthetic goes into blood stream, cause change in pressure of cebreal spinal fluid, increase ICP, (Pt needs to lay don flat on their back for 5 minutes - q. Why is Epinephrine added to Lidocaine for local anesthesia? - To control bleeding SALYSISM is aspirin poisoning, treat with bicarbonate

Updated 404d ago

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