resuscitation may be necessary anticipate code procedures
What is circulatory overload?
condition of FVE fluid volume excess
weight gain, puffy eyelids, hypertension, SOB, crackles in lungs, moist cough
nurse will decrease IV rate, place in fowlers position, administer o2 and medications as orderd(diuretics) monitor VS
What is pulmonary edema?
worst case of circulatory overload
lungs are filled with fluid
SOB , labored breathing, apprehensie, frothy pink sputum
02 therapy, meds given as ordered, anticipate code
What is a catheter embolism?
catheter breaks off in vein
sharp sudden pain at site, chest pain, tachycardia, sob
apply tourniquet above elbow, contact md immediately, plan for venogram and establish another iv site
always check catheter for intactness
does not dissolve clots, prevent them from forming or increasing
maybe give subQ or IV
do not rub site afte subq
do not aspirate
prevents clots from forming
monitor for bleeding tendencies
antagonist= vit K
What is LMWH?
1/2 of heparin
longer half life then heparin -administer less frequently
low incident of antiplatelet formation
give sub Q rather than IV
What are nursing responsibilities with anticoagulants?
monitor for bleeding tendencies
note any excessive tiredness or weaknes
uncontrolled bleeding from cuts - hold pressure for 5 mins
avoid OTC meds
wear medic alert bracelet
watch diet leafy greens no good
What are the stages of med variance?
level one- meds not charted or transcribed correctly
level two- meds not administered on time, not checking with instructor befor giving, incorrect dose, date or rate, omission of med, incorrect route
level three- incorrect patient, give un ordered med error causes harm, failure to report controlled substance discrepancy
set standards for manufacture and sale of all drugs. all drugs had to meet purity and strength standards. US Pharmcaopeia and National Formulary
Federal Food Drug and Cosmetic Act of 1906
toxicity tests on animals for all drugs before FDA approval. FDA emowered to keep drug from being marketed and can order recalls if a drug is dangerous of if its safety is questioned. Responsible for standardization of pharmacy
Food and Drug Administartion
over the counter drugs could be sold without a prescription
differentiated to those requiring prescriptions
Durham Humphrey Amendment of 1952
provided that drugs must be effective prior to marketing
Kefauver Harris- Drug Amendment of 1962
prevents abuse and misuse of drugs
provides research and funding for abuse and treatment for drug abuse
controlled drug schedule was created based on abuse potential and medical effectiveness
comprehensive drug abuse prevention and controlled substances act of 1970
in 1983 the DEA became the governments sole legal drug enforcement agency. It is under and Justice Department. It is replaced the Bureau of Narcotics and Dangerous Drugs.
grants longer patent protection for new drugs and allows drug companies to maket generic drugs by proving bioequivalence rather than duplicating original company's clinical trials
Drug Price Competition and Patent Term Restoration Act of 1984
name given by drug company before it becomes official
name list in USp
name that describes it chemically
given by company, protected by patent
brand name - trade name
action only where applied
absorbed into systemic circulation
when 2 or more drugs are given
may have a different effect than expected
2 drugs with similar actions are given together for a greater effect. can use smaller doses ex - tylenol #3
when one drug increases the effect of the other greater than one drug given alone ex) demerol and phenergan
a drug that produces the desired or predicted effect at the site. the therapeutic effect
a drug that blocks or counteracts the effect of another drug- may bind to receptor site
narcan,. vitk/ coumadin
harmful or unintended reaction to a drug at a normal dose.
ex) cancer chemo: n/v hair loss
ADR- adverse drug reactions.
unusual or abnormal response to a drug by an individual
may be a genetic reaction.
ex) a tranquilizer that causes agitation
hypersensitivity to a drug
mild to severe
when 2 drugs can be mixed together without an interaction
usually for mixing in a syringe or at an IV site
when 2 drugs are mixed together and there is a chemical reaction
cloudy solution, crystallize, precipitate
could also counteract each other and change desired effects
prolonged use or misuse of a drug may require more medication to achieve the desired effect
needed for alcohol.drug abusers
physical or psychologic need for a drug
psychologic need can exist after physical need or withdrawal has occurred
effect of the drug causes structural defects in an unborn fetus resulting in congenital anomalies
the drug accumulates in the body and the patient can experience toxic effects
frequently seen in renal/liver patients/elderly unable to metabolize and excrete drug
the smallest amount of a drug taht will produre a therapeutic effect
the largest amount of a medication that can be safely given
gives rise to signs and symptoms of overdose or poisoning
1. oj enhances the absorption of ?
2. milk decreases the absorption of :?
prescribing many drugs at one time
excessive use of drugs
common in elderly, chronically ill, AIDS
the stuyd of drugs and their actions on the body
how the body handles a drug from ingestion of the drug until all metabolites of the drug have been cleared by the body
Steps of pharmacokinetics
What are ways of absorption
by mouth, enteric coated,
the transport of the drug by the bloodstream through the body to the desired receptor sites
Where does drug first go to during distribution?
the most vascular organs .
how a drug is broken down into inactive metabolites. liver enzymes most commonly responsible.
metabolism aka biotransformation
how the drug and its metabolites are removed from the body. primarily through the kidneys
the time it take for half of the original dose of the drug to be eliminated
when amount of drug eliminated is equal to the drug absored = plateau
steady state blood levels
the time it takes fro a drug to begin to work = therapeutic effect . will vary on route of administration
onset of action
the time it takes for maximum effect
the time the medication has an effect
duration of action
What are the factors that influence medication dose/response?
age- very young/old -liver/kidney limitations
physical well being
gender-women have more fat and less water.
amount of food in stomach
dosage form/ route of admin
What are some concerns related to older adults?
self prescribing meds
misuse of meds
How are controlled substances classified?
I-street drugs, heroin MJ
II-high abuse potential-
III-moderate to low dependency
V-abuse potential < class IV
How are drugs classified?
indicates effect on body system
drugs can have more than one classification
each class has nursing implication
learn the broad characteristics first
then learn the specific drugs in a classification
a disease resulting from the body's inability to produre or utilize insulin
multi system disease,
insidious, silent killer
major public health problem
inability of the body to produce insulin
originally called juvenile Dm/IDDM
patients require exogenous insuline
type 1 diabetes
body produces less insulin or insuline resistance develops
originally called NIDDM/adult onset
Rx=diet, exercise,oral hypoglycemic agents and possibly insulin
Type 2 Diabetes
glucose levels higher than normal but not diagnostic of diabetes mellitus
(25% will develop DM)
impared glucose tolerance (IGT)
glucose intolerance during pregnancy
gestationa diabetes mellitus (GDM)
other types of diabetes?
symptoms of diabetes
leg ulcer, wounds that wont heal
vaginal, fungal, yeast infections
obesity.inability to lose weight
a result of glycosuria, hypertonic, draws in water to normalize=osmotic diuresis
can lead to dehydration
rental threshold for glucose- 180mg/dl
increased frequency ort volume of urinary ouput
chronic excessive intake of water
a result of polyuria
a result of the bodys inability to use glucose
the cells are starving and will break down fat >ketoacidosis