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Any disease triggered by external factors and not directly caused by a person's genes (e.g., an infectious disease, noncongenital cardiovascular diseases)
The two or more alternative forms of a gene that can occupy a specific locus (location) on a chromosome (see chromosomes).
A collective term for all of the chromosomal material within a given cell.
Structures in the nuclei of cells that contain threads of deoxyribonucleic acid (DNA), which transmit genetic information, and are associated with ribonucleic acid (RNA) molecules and synthesis of protein molecules.
The biologic unit of heredity; a segment of a DNA molecule that contains all of the molecular information required for the synthesis of a biologic product such as an RNA molecule or an amino acid chain (protein molecule).
New therapeutic technologies that directly target human genes in the treatment or prevention of illness
Any disorder caused directly by a genetic mechanism.
DNA or RNA molecules or portions thereof.
genetic polymorphism (PMs)
Variants that occur in the chromosomes of 1% or more of the general population (i.e., they occur too frequently to be caused by a random recurrent mutation)
The presence of certain factors in a person's genetic makeup, or genome (see next page), that increase the individual's likelihood of eventually developing one or more diseases.
The study of the structure, function, and inheritance of genes.
The complete set of genetic material of any organism. It may be contained in multiple chromosomes (groups of DNA or RNA molecules) in higher organisms; in a single chromosome, as in bacteria; or in a single DNA or RNA molecule, as in viruses
The study of the structure and function of the genome, including DNA sequencing, mapping, and expression, and the way genes and their products work in both health and disease.
The particular alleles present at a given site (locus) on the chromosomes of an organism that determine a specific genetic trait for that organism (compare phenotype).
The characteristics and qualities that are genetically passed from one generation to the next through reproduction.
human genome project
A scientific project of the U.S. Department of Energy and National Institutes of Health to describe in detail the entire genome of a human being.
Genetic disease that results from defective alleles passed from parents to offspring.
Molecules of DNA and RNA in the nucleus of every cell. DNA makes up the chromosomes and encodes the genes.
The use of molecular and genetic characterizations of both the disease process and the patient for the customization of drug therapy.
A general term for the study of the genetic basis for variations in the body's response to drugs, with a focus on variations related to a single gene
A branch of pharmacogenetics (see earlier) that involves the survey of the entire genome to detect multigenic (multiple-gene) determinants of drug response.
The expression in the body of a genetic trait that results from a person's particular genotype (see earlier) for that trait.
The entire set of proteins produced from the information encoded in an organism's genome.
The detailed study of the proteome, including all biologic actions of proteins.
recombinant DNA (rDNA)
DNA molecules that have been artificially synthesized or modified in a laboratory setting
Drugs used in combination with anesthetic drugs to control the adverse effects of anesthetics or to help maintain the anesthetic state in the patient. (See balanced anesthesia.)
The loss of the ability to feel pain resulting from the administration of an anesthetic drug.
Drugs that depress the central nervous system (CNS) or peripheral nerves to produce decreased or loss of consciousness, or muscle relaxation.
The practice of using combinations of different drug classes rather than a single drug to produce anesthesia.
A drug-induced state in which the CNS nerve impulses are altered to reduce pain and other sensations throughout the entire body. It normally involves complete loss of consciousness and depression of normal respiratory drive.
A drug-induced state in which peripheral or spinal nerve impulses are altered to reduce or eliminate pain and other sensations in tissues innervated by these nerves
A genetically linked major adverse reaction to general anesthesia characterized by a rapid rise in body temperature, as well as tachycardia, tachypnea, and sweating.
A milder form of general anesthesia that causes partial or complete loss of consciousness but does not generally reduce normal respiratory drive (also referred to as conscious sedation)
A theory that describes the relationship between the lipid solubility of anesthetic drugs and their potency
Local anesthesia induced by injection of an anesthetic drug near the spinal cord to anesthetize nerves that are distal to the site of injection (also called intraspinal anesthesia).
A class of stimulant drugs that includes amphetamine sulfate and all of its drug derivatives
Central nervous system (CNS) stimulants that have generalized effects on the brainstem and spinal cord, which produce an increase in responsiveness to external stimuli and stimulate respiration.
Drugs used to control or suppress appetite.
attention deficit hyperactivity disorder
A syndrome characterized by difficulty in maintaining concentration on a given task and/or hyperactive behavior; may affect children, adolescents, and adults. The term attention deficit disorder (ADD) has been absorbed under this broader term.
A condition characterized by abrupt attacks of muscular weakness and hypotonia triggered by an emotional stimulus such as joy, laughter, anger, fear, or surprise. It is often associated with narcolepsy
central nervous system (CNS) stimulants
Drugs that stimulate specific areas of the brain or spinal cord.
Drugs that narrow or constrict blood vessels in the brain and provide relief of pain for certain migraine headaches
A common type of recurring painful headache characterized by a pulsatile or throbbing quality, incapacitating pain, and photophobia.
A syndrome characterized by sudden sleep attacks, cataplexy, sleep paralysis, and visual or auditory hallucinations at the onset of sleep.
serotonin receptor agonists
A class of CNS stimulants used to treat migraine headaches; they work by stimulating 5-hydroxytryptamine 1 receptors in the brain and are sometimes referred to as selective serotonin receptor agonists or triptans.
CNS stimulants such as noradrenergic drugs (and, to a lesser degree, dopaminergic drugs) whose actions resemble or mimic those of the sympathetic nervous system.
Drugs that are added as a second drug for combined therapy with a primary drug and may have additive or independent properties.
Classically defined as “without movement.” Absence or poverty of movement that results in a masklike facial expression and impaired postural reflexes.
Slowness of movement; a classic symptom of Parkinson's disease.
A condition characterized by involuntary, purposeless, rapid motions such as flexing and extending the fingers, raising and lowering the shoulders, or grimacing.
Term for abnormal and distressing involuntary movements; inability to control movements, which often occurs as a side effect of levodopa therapy
Impaired or distorted voluntary movement, often involving the head, neck, or feet
A term describing any substance produced outside of the body that may be taken into the body (e.g., a medication, food, or environmental toxin)
A common experience of patients taking medication for Parkinson's disease in which they experience periods of greater symptomatic control (“on” time) alternating with periods of lesser symptomatic control (“off” time).
A slowly progressive, degenerative neurologic disorder characterized by resting tremor, pill-rolling of the fingers, masklike facies, shuffling gait, forward flexion of the trunk, loss of postural reflexes, and muscle rigidity and weakness.
A decrease or change in motor and muscle movements that leads to unsteadiness and hesitation in movement and gait when the individual starts or stops walking, or causes leaning to the left or right when sitting; occurs in Parkinson's disease.
Drugs that exert their antiparkinson effects before the nerve synapse.
Resistance of the muscles to passive movement; leads to the “cogwheel” rigidity seen in Parkinson's disease
(Tremor, rigidity, akinesia, postural instability); an acronym for symptoms of Parkinson's disease.
In Parkinson's disease, shakiness of the extremities seen mostly at rest.
A gradual worsening of parkinsonian symptoms as a patient's medications begin to lose their effectiveness, despite maximal dosing with a variety of medications.
domains of learning
- affective domain
- psychomotor domain
- cognitive domain
patient education assessment
- •Adaptation to any illness
- •Cognitive abilities
- •Coping mechanisms
- •Cultural background
- •Developmental status (cognitive and
- mental processing abilities)
- •Emotional status
- •Environment: home and work
- •Family relationships
- •Financial status
- •Psychosocial growth and development
- •Health beliefs
- •Cultural impact
- •Information patient understands about
- past and present medical conditions, medical therapy, medications
- •Level of education/literacy level
- •Level of knowledge about current medications
- •Misinformation about drug therapy
- •Limitations (physical, psychologic,
- cognitive, motor)
- •Current medications, including over-the-counter and herbal medications
- •Nutritional status
- •Past and present health behaviors
- •Past and present experience with drug regimens and other therapies
- •Race and/or ethnicity
- •Readiness to learn
- •Religious beliefs
- •Self-care ability
- •Sensory status
- •Social support
patient education: nursing diagnoses
- •Deficient knowledge
- •Ineffective health maintenance
- •Ineffective therapeutic regimen management
- •Risk for injury (self)
- •Impaired memory
patient education: planning
- and Outcome Criteria
- –Based on patient needs
- –Stated in patient terms
- –Time frame
patient education: implementation
- •Teaching-learning sessions
- •Consideration of age-related
- •Consideration of language barriers
- •Safe administration of medications
- at home
- –Return demonstration with equipment
- •For adults, it is recommended that
- materials be written at an 8th grade level
patient education: teaching-learning sessions
- •Individualize the teaching session
- •Use positive rewards or reinforcement for accurate return demonstration of
- procedures or technique
- •Use audiovisual aids
- •Involve family members or significant others
- •Keep teaching on a level that is meaningful to the patient
- •Consider resources when the patient does not speak English
- –If possible, communicate with the patient in the patient’s native language
- –Use a translator if necessary
- –Provide publications in the patient’s
- native language
patient education: evaluation
- •Validate whether learning has occurred
- –Ask questions
- –Have the patient provide a return
- –Behavior, such as compliance and
- adherence to a schedule
- –Occurrence of few or no complications
- •Develop and implement new plan of teaching as needed for:
- –Inadequate levels of learning
Parenteral Antidiabetic Agents: Insulin Products
- Insulin is supplied in:
- -Rapid onset forms
- -Intermediate-acting forms
- -long-acting forms
- It is most often prescribed and administered subcutaneously
- IV route is reserved for specific acute care situations
- •Insulin is supplied in two concentrations:
- U 100 (100 units/mL) and U 500 (500
short rapid acting insulins
- •Short rapid-acting insulins are
- administered to treat a current blood glucose elevation or an anticipated
- elevation (i.e., after the next meal)
- •Humalog and Novolog insulin are given 10-15 minutes before a meal or with a meal
- •Humalog R and Novolog R must be given 30 minutes before a meal
intermediate acting insulins
•Patients receiving intermediate-acting insulin products usually receive an AM and PM injection
- •Long-acting insulin is released more slowly than the fast- and intermediate-acting insulins
- •Long-acting insulins cannot be given IV because they contain additives to extend the action
- •Assume that insulin products cannot be mixed until you read the drug literature for each order
- •Always check compatibilities with current drug literature and/or the pharmacy
steps to prepare doses for insulin syringe
- •Obtain current blood glucose value (hold insulin if BG is low according to prescriber’s directions)
- •Check the order for:
- –Name, type, dose, time, and route
- •Select appropriate insulin/insulin syringe
- –Insulin syringe matches the number of units/mL on label of insulin bottle
- •Examine medication vials for clump and precipitation
- –Check expiration date
- •Gently roll if suspension insulin to disperse the content
- •Draw the appropriate amount of units in the insulin syringe
- •Sliding-scale, short-acting insulins are
- titrated to patient’s current blood glucose levels
mixing insulins: short fast-acting and slower-acting intermediate mixes
- •Mixed insulins provide:
- –Blood glucose coverage for meals with a small amount of short-acting insulin and between meal coverage
- –Plus an added amount of slower-release, intermediate-acting insulin
first premixed intermediate-and short-acting combination insulins
- •The first number indicates the percentage of
- slower, intermediate-acting insulin
- •The second number indicates the percentage of short- or rapid-acting insulin
- •Order: Novolin Mix 70/30, 18 units subcut 30
- minutes ac breakfast and dinner
technique for prepping insulin mixes
- •Occasionally, the nurse must prepare an insulin mix, drawing up two different insulins in one syringe
- •Common combination:
- –Regular and intermediate-acting insulins
- –Always check the order and compatibility of the two types of insulin
- •Identify the vials, verify the order, shake intermediate suspension gently, and clean tops of vials with alcohol swabs
- •Insert air equal to the amount of insulin ordered into each vial
- –Start with the intermediate-acting insulin
- –Followed by the short-acting insulin
- •Withdraw the clear, short-acting insulin first and verify the correct amount
- •After gently mixing suspension from the intermediate-acting insulin, withdraw the
- exact amount of insulin
- •Gently tap out any air bubbles and verify the precise combined amount.
- –Discard and start over if the total amount is incorrect
sequence for preparing insulin mixes
- •Cloudy refers to intermediate suspension
- •Clear refers to short-acting preparation
intravenous insulin infusions
- •Insulin infusions are administered in the hospital for acute hyperglycemia
- •Regular or Humalog insulin (fresh/unopened bottle) is used when preparing an insulin
- infusion according to the prescribed order
- •Insulin should be administered on its own separate line
- •The IV solution should be labeled with the number of units and concentration
- •Ordered: Humulin R insulin IV at 3 units/hr
- •Available: Humulin R insulin 100 units in 100 mL 0.9% NaCl solution
- –Estimated flow rate in mL/hr?
- –Ordered flow rate in mL/hr?
- •DA equation:
- mL/hr = (100 mL/100 units) x (3 units/1 hr) = 3 mL/hr
insulin administration devices
- •Prefilled pens
- –Contain regular insulin, intermediate-acting insulin, and mixtures of the two
- •Devices worn by patients who are unresponsive to intermittent subcutaneous injection
- •The insulin pump allows a programmed, continuous, subcutaneously injected basal dose of fast-acting insulin to be delivered throughout the day and night
- •Added boluses are administered on the pump to cover meals and glucose elevations