Test 4 fundies

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Test 4 fundies
2010-09-30 15:57:11
test fundies

test 4 fundies
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  1. What is impaired skin integrity?
    Intactness of the skin is interrupted by any type of wound.
  2. What are the components of a drug order?
    • full name
    • date written
    • drug name
    • dosage
    • route of administration
    • time and frequency of administration
    • signature of physician.
  3. Types of Mediation orders?
    • standing
    • prn
    • one time
    • stat
    • prescription
    • verbal
    • telephone
  4. What are routes of administration?
    • oral-buccal SL
    • parenteral-subq, iv, im,id
    • topical-transdermal patch
    • suppository
    • irrigation
    • sprays
    • inhalation
    • intraocular
  5. What are the 5 rights of med admin?
    • right medication
    • right dose
    • right client
    • right route
    • right time
  6. What are nursing responsibilities for medication administration?
    • knowledge
    • experience
    • accountability
    • report and document effects good and bad
    • report and document errors
  7. What are some more indepth nursing responsibilities?
    • client and family teaching
    • receiving medication orders
    • correct transcription of orders
    • accurate dosage calculation and measur.
    • documentation
  8. Every client has a right to?
    • information related to med.
    • refuse
    • advised of experimental drugs
    • receive labeled meds
    • receive appropritate supp. therapy
    • not receive unnecessary med.
  9. What is the first check procedure?
    • check med order
    • wash hands
    • prepare one drug at a time
    • select correct drug and compare name and dose with MAR
  10. What is the second check procedure?
    • calculate drug dose
    • break scored tabs(pill cutter)
    • place drug in cup
    • continue selecting other drugs
    • after all drugs are in cup, check against MAR again- name, dose ,expiration, date,time route
  11. What are the third check procedures?
    • take med to client
    • check armband against MAR
    • be prepared to explain drugs
    • check drugs against MAR and open
    • assist client to proper positioning
    • ask if client wants pills one at a time or all at once.
  12. How do you properly administer a medication?
    • offer water or juice
    • place pill in clients hand
    • do not touch med
    • confirm all medication is taken
    • document administration
    • evaluate effect of med
  13. Where do you place eye medication?
    in the conjuctival sac 1/2 inch above side of eye.
  14. How do you give ear medication?
    • adult: pulled up and back
    • child: pulled down and back.
  15. How far in should a suppository be inserted?
    1 inch pas the internal anal sphincter. patient is on left side.
  16. List some types of syringes.
    • hypodermic
    • insulin
    • tuberculin
    • tubex
    • carpojet
  17. What are factors that determine needle size.
    • size of pt
    • viscoscity of med
    • type of injection
  18. How much liquid is used for an intradermal injection
    0.1 ml
  19. How do you perform a Sub-Q injection?
    • 45-90 degree angle
    • .5-1. cc
    • pinch the skin.
  20. How do you perform an IM injection?
    90 degrees , spread the skin, it by passes the GI tract and its faster then the SQ route. Avoid BV bones and nerves.
  21. Wheres the ventrogluteal site
    form a "V" with fingers inject in the middle on the greater trochanter. its a safe site because of no large nerves.
  22. Wheres the dorsogluteal site?
    divide buttocks into 4 quads, upper upper right.
  23. Where is the vastus lateralis.
    in between the knee and hip, on the lateral side.
  24. Where is the rectus femoris site
    middle thigh, front
  25. Deltoid injection?
    shoulder/arm area
  26. How do you perform a Z track method injection?
    • pull tissue laterally to side
    • inject into muscle
    • aspirate
    • injects medication
    • count 10 second then withdraw needle
    • release skin, do NOT massage area
  27. Why are IVs used?
    • supply fluid if not able to take po
    • hydration
    • facilitate blood and blood products
    • adminster meds
    • life line
    • first choice for emergency/ pain relief
  28. What is diffusion?
    solid matter moves from higher concentration to lower concentration distributing particles.
  29. What is osmosis?
    movement of fluid(solvent) via semi-perieable membrane from lower concentration to higher concentration.
  30. What is active transport?
    ions move lesser to higher against concentration gradient-need ATP
  31. What is filtration?
    water and substances move together in response to fluid pressure high hydrostatic pressure(arterial) to low hydrostatic pressure(venous)
  32. What is osmolality?
    what is osmolarity?
    • 1. concentration of particles in plasma
    • 2. number of molecules in a liter of solution.
    • *measure in miliosmoles per liter
    • normal serum osmolality=280-295
    • over = dehydration under=overhydration
  33. When an IV bad has the osmolarity level what does that determine?
    tonicity of the solution and how it affects fluid movement.
  34. What are isotonic solution?
    • resemble same osmolality of the blood. (250-350)
    • no fluid movement in the compartment
  35. What is a hypotonic solution?
    • has less concentration that our plasma solutes (<250)
    • fluid will shift from the vascular compartment to the cell, thus causing the cell to swell.
  36. What is a hypertonic solution?
    • has greater solute concentration that plasma (>350)
    • fluid moves from the cell into the vascular compartment, thus shrinking the cell, and expanding the vascular compartment.
  37. What are the different types of IV meds?
    • iv drip infusion
    • ivpb
    • ivp or iv bolus
  38. what are the nurses responsibilities for monitoring IV therapy?
    • change and labe solution Q 24 hours
    • change and label tubing Q 72 hours
    • patient teaching
    • discontinue IV
    • *observe site and document, clean , dry ,intact, no redness, leaking, swelling,
  39. What are complications at the IV site?
    • hematoma
    • phlebitis
    • inflitration/extravasion
    • venous spasm
  40. Describe a hematoma?
    • mass of blood in tissue space
    • hard and tender at site
    • iv rate decreased
    • nurse should remove IV and restart
    • observe for bleeding
    • apply warm soaks
  41. Describe phlebitis
    • inflammations of vein
    • irritated, reddened, hard to palpate
    • red line may be present
    • nurse removes IV and restart
    • apply warm soaks
    • notify MD if increased temp.
  42. Describe infiltration
    • seepage of fluid into surrounding tissue
    • swelling
    • discomfort, burning, pain
    • tight feeling/edema
    • nurse remove and restart
    • apply warm soaks, elevate limb, check pulse and CRT
  43. Describe a venous spasm
    • sudden onset of pain along vein
    • cause= irritating drug of cold solution
    • nurse decrease flow rate, remove if needed and restart
    • apply warm soaks
    • infuse solutions at room temp
  44. What are some systemic complications?
    • septicemia
    • air embolism
    • speed shock
    • circulatory overload
    • pulmonary edema
    • catheter embolism
  45. What is septicemia?
    • systemic infection, patient is extremely sick. fever chills N/v hypotension, tachycardia, pain, altered mental status
    • start new site
    • obtain blood cultures
    • administer meds as ordered
    • monitor patient
  46. What is an air embolism?
    • large amount of air entered the IV
    • emergency situation- air occludes circul.
    • light headedness, dyspnea, tachypnea, wheezes, cp, hypotension, seizures
    • get help call phys.
    • place in trendelenberg rigth side, monitor VS give 02 and meds as ordered
  47. What is speed shock?
    • patient is in shock position
    • medical emergency as shock progresses
    • irregular pulse, hypotension, chest pain, dizziness
    • resuscitation may be necessary anticipate code procedures
  48. 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
  49. What is pulmonary edema?
    • worst case of circulatory overload
    • lungs are filled with fluid
    • emergency situation
    • SOB , labored breathing, apprehensie, frothy pink sputum
    • 02 therapy, meds given as ordered, anticipate code
  50. 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
  51. Describe heparin?
    • anticoagulant
    • does not dissolve clots, prevent them from forming or increasing
    • maybe give subQ or IV
    • do not rub site afte subq
    • do not aspirate
    • monitor PTT
    • antagonist-protamine sulfate
  52. Describe coumadin?
    • prevents clots from forming
    • given PO
    • monitor PT
    • monitor INR
    • monitor for bleeding tendencies
    • antagonist= vit K
  53. What is LMWH?
    • lovenox
    • 1/2 of heparin
    • longer half life then heparin -administer less frequently
    • low incident of antiplatelet formation
    • greater bioavaliablity
    • give sub Q rather than IV
  54. 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
    • soft toothbrush
    • watch diet leafy greens no good
  55. 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
  56. 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
  57. 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
  58. over the counter drugs could be sold without a prescription
    differentiated to those requiring prescriptions
    Durham Humphrey Amendment of 1952
  59. provided that drugs must be effective prior to marketing
    Kefauver Harris- Drug Amendment of 1962
  60. 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
  61. 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.
  62. 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
  63. name given by drug company before it becomes official
    generic name
  64. name list in USp
    official name
  65. name that describes it chemically
    chemical name
  66. given by company, protected by patent
    ex) tylenol
    brand name - trade name
  67. action only where applied
  68. absorbed into systemic circulation
  69. when 2 or more drugs are given
    may have a different effect than expected
    drug interaction
  70. 2 drugs with similar actions are given together for a greater effect. can use smaller doses ex - tylenol #3
    additive effect
  71. when one drug increases the effect of the other greater than one drug given alone ex) demerol and phenergan
    potentiation/synergistic effect
  72. a drug that produces the desired or predicted effect at the site. the therapeutic effect
  73. a drug that blocks or counteracts the effect of another drug- may bind to receptor site
    narcan,. vitk/ coumadin
  74. harmful or unintended reaction to a drug at a normal dose.
    side effects
    ex) cancer chemo: n/v hair loss
    ADR- adverse drug reactions.
  75. unusual or abnormal response to a drug by an individual
    may be a genetic reaction.
    ex) a tranquilizer that causes agitation
    idiosyncratic reactions
  76. hypersensitivity to a drug
    antigen/antibody process
    mild to severe
    allergic reaction
  77. when 2 drugs can be mixed together without an interaction
    usually for mixing in a syringe or at an IV site
  78. 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
  79. prolonged use or misuse of a drug may require more medication to achieve the desired effect
    needed for alcohol.drug abusers
  80. physical or psychologic need for a drug
    psychologic need can exist after physical need or withdrawal has occurred
  81. effect of the drug causes structural defects in an unborn fetus resulting in congenital anomalies
    teratogenic effects
  82. 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
    cumulative effect
  83. the smallest amount of a drug taht will produre a therapeutic effect
    minimum dose
  84. the largest amount of a medication that can be safely given
    maximum dose
  85. gives rise to signs and symptoms of overdose or poisoning
    toxic dose
  86. causes death
    lethal dose
  87. 1. oj enhances the absorption of ?
    2. milk decreases the absorption of :?
    • 1.Fe
    • 2. Tetracycline
  88. prescribing many drugs at one time
    excessive use of drugs
    common in elderly, chronically ill, AIDS
  89. the stuyd of drugs and their actions on the body
  90. how the body handles a drug from ingestion of the drug until all metabolites of the drug have been cleared by the body
  91. Steps of pharmacokinetics
    • absorption
    • distribution
    • metabolism
    • excretion
  92. What are ways of absorption
    • by mouth, enteric coated,
    • IV
    • IM
    • Transdermal
  93. the transport of the drug by the bloodstream through the body to the desired receptor sites
  94. Where does drug first go to during distribution?
    the most vascular organs .
  95. how a drug is broken down into inactive metabolites. liver enzymes most commonly responsible.
    metabolism aka biotransformation
  96. how the drug and its metabolites are removed from the body. primarily through the kidneys
  97. the time it take for half of the original dose of the drug to be eliminated
    half life
  98. when amount of drug eliminated is equal to the drug absored = plateau
    steady state blood levels
  99. the time it takes fro a drug to begin to work = therapeutic effect . will vary on route of administration
    onset of action
  100. the time it takes for maximum effect
    peak actions
  101. the time the medication has an effect
    duration of action
  102. What are the factors that influence medication dose/response?
    • age- very young/old -liver/kidney limitations
    • weight-
    • physical well being
    • psychologic state
    • gender-women have more fat and less water.
    • amount of food in stomach
    • dosage form/ route of admin
  103. What are some concerns related to older adults?
    • polypharmacy
    • self prescribing meds
    • OTC meds
    • misuse of meds
    • noncompliance
  104. How are controlled substances classified?
    • I-street drugs, heroin MJ
    • II-high abuse potential-
    • III-moderate to low dependency
    • IV-Limited dependency
    • V-abuse potential < class IV
  105. 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
  106. a disease resulting from the body's inability to produre or utilize insulin
    DM-diabetes mellitus
  107. multi system disease,
    insidious, silent killer
    major public health problem
    diabetic mellitus
  108. inability of the body to produce insulin
    originally called juvenile Dm/IDDM
    patients require exogenous insuline
    type 1 diabetes
  109. 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
  110. glucose levels higher than normal but not diagnostic of diabetes mellitus
    (25% will develop DM)
    impared glucose tolerance (IGT)
  111. glucose intolerance during pregnancy
    gestationa diabetes mellitus (GDM)
  112. other types of diabetes?
    • drug induced
    • surgically induced
    • disease induced
  113. symptoms of diabetes
    • polyuria
    • polydipsia
    • polyphagia
    • vision changes
    • weakness,fatigue
    • leg ulcer, wounds that wont heal
    • vaginal, fungal, yeast infections
    • impotence
    • obesity.inability to lose weight
  114. 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
  115. chronic excessive intake of water
    a result of polyuria
  116. excessive eating
    a result of the bodys inability to use glucose
    the cells are starving and will break down fat >ketoacidosis
  117. whats a normal blood glucose
    70-110 mg
  118. 1. randoma plasma glucose level?
    2. Fasting PG?
    3.2 hour OGTT
    • 1. >/= 200mg/dl
    • 2.>126mg/dl two separate times
    • 3. >200 mg/dl at two hours
  119. What are the endocrinologists guidelines?
    2 hours post prandial >140

    Fasting blood glucose >110
  120. Describe hypoglycemia
    • BS<60 -sweating,shaking,palpitations, nervousness, confusion, visual disturbance,unconsciousness
    • Treatment= 15/15 rule : 15 CHO wait 15 mins and if needed another 15 CHO
  121. Sites and speed of insulin
    • abdomen: absorbed quick ,duration is shortest
    • arm, leg, buttock: absorbed slower and has longer duration
  122. Long term complication of insulin
    microvascular: retinopathy, nephropathy,neuropathy

    macrovascular: cardiovascular disease, peripheral vascular disease
  123. What is the key to preventing complications?
    • tight glycemic control
    • patient self management
  124. How do you describe wound depth?
    • deep or superficial
    • partial thickness
    • full thickness
  125. redness of tissues due to ischemia
  126. What are risk factors of wounds?
    • pressuer ulcer, shearing force, ischmia
    • decreased mental status
    • inactivity/ immobility
    • mositure/incontinence
    • malnutrition
    • decreased sensation
    • friction
    • body weight
    • aging
  127. What are the stages of a pressure ulcer?
    • Stage I: involves the epidermis
    • Stage II:a partial thickness skin loss involes the dermis and epidermis
    • Stage III: full thickness skin loss, involving damage or necrosis of subcutaneous tissue and may extend to fascia
    • Stage IV: full thickness skin lose with damage to muscle, bone, and supporting structures.
  128. What do you do during wound assessment?
    • measure the wound in cm
    • note the staging or depth
    • note appearance of surrounding skin
    • note odor
    • note color of wound RYB
  129. What are types of wound treatment?
    • debridement - mechanical, biochemical, sharp, autolytic
    • nutrition- fluids, proteins, calories, vitamins
    • avoidance of pressure
    • maintenance of skin hygiene
  130. How do you describe a wound?
    • intentional/unintentional
    • closed/open
    • external/internal
    • non-infected/infected
  131. What are types of wounds?
    • laceration
    • contusion
    • abrasion
    • puncture
    • incision
  132. What are the phases of wound healing?
    • inflammatory phase- 3-6 days
    • proliferative phase- 4-21 days
    • maturation phase- 21 days to 1-2 years after injury
  133. What are the phases of wound closure?
    • first intention: approximated edges
    • second intetnion: heal from inside out, from edges to center
    • tertiary intention: delay in healing ensues wound closure, closed surgically
  134. What are the types of exudate
    • serous
    • sanguinous
    • serosanguinous
    • purulent
    • pursanguinous
  135. What are some factors that affect wound healing?
    • vasculature/age
    • immune status
    • nutrition
    • obesity
    • smoking
    • stress
    • meds
  136. What are complications of wound healing?
    • infection
    • hematoma
    • foreign objects
    • localized ischemia
    • diabetes
    • hemorrhage
  137. partial or total rupture of a sutured wound
    4-5 days post op
    before collagen is implanted into the wound
  138. protrusion of internal viscera through the incision.
    sudden straing with a cough or sneeze
  139. What are types of drainage devices
    • jackson prat
    • hemovac
    • penrose
  140. What are outcomes of wound care?
    • prevent infection/ promote healing
    • prevent further tissue damage
    • wounds remain free of foreign debris
    • provide means of absorbing exudate and promoting drainage
    • prevention of hemorrhage
    • prevention of skin excoriation
  141. Whate are dressing types?
    • transparent
    • moisture retentive: hyrocolloid, hydrogels, alignates, foam
  142. What are kinds of dressing of wounds?
    • dry
    • wet to dry
    • packing
    • sprays
  143. What do you document on awound?
    • appearance
    • odor
    • exudate- how much
    • wound approximation
    • wound care provided
    • types of dressing applied
    • patient tolerance
  144. What are factors influencing heat and cold effectiveness?
    • duration of application
    • protection of skin
    • body part
    • damage to body surface
    • body surface area
    • age and physical condition
  145. What is mosit heat?
    • decreases drying of skin
    • softens wound exudates
    • penetrates deeply
    • does not promote sweating
    • greater risk for burns
    • prologned exposure causes maceration o skin
  146. What is dry heat?
    • less risk of burns
    • doesent cause skin maceration
    • retains temperature longer
    • increases sweating
    • does not penetrat deeply
    • caused increased drying of skin.
  147. What are the therapeutic effects of heat?
    • vasodilation
    • reduced blood viscosity
    • reduced muscle tension
    • increased tissue metabolism
    • increased capillary permeability
  148. What are the therapeutic effects of cold?
    • vasoconstriction
    • local anesthesia
    • reduced cell meatbolism
    • increased blood viscosity
    • decreased muslce tension
  149. Types of heat and cold applications
    • compresses and soaks
    • sitz bath
    • aqua k pad
    • hot cool packs
    • hot water bottles
    • heating pads
    • and heat lamp