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What are the legal and ethical considerations of pharmacology in nursing?
Professional standards of practice, Protect public, Provide consistency of care, Vary from state to state, Common areas of negligence
- Ethical Autonomy means
- Right to make decision without coercion
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Ethical Nonmaleficence means
Right to be free from harm
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Ethical Beneficence means
Right to receive help
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What happens to the drug in the body (called pharmacokinetics)?
Absorption, Distribution, Metabolism, Excretion
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What is Pharmacodynamics?
How the drug affects the body
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What are the types of medication orders?
written, pre-printed, verbal, telephone, one-time(stat or single), standing, PRN(as needed), and/or automatic (stop) date
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What information should be included in the medication orders?
client's full name, date and time order was written, name of medication, dosage size, frequency, and number of doses, route of administration, and signature of the prescriber
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What are the steps to medication accuracy?
know your medications, verify the order with the physician or nurse, make sure the patient is not allergic to the medication ordered, and when in doubt ask never assume
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What are the six rights?
Right drug, dose, time, route, patient, and documentation
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What are the three additional rights?
Right reason, right to know or be educated, and right to refuse
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What are the three checks for medication administration?
check the drug against medication administration record (MAR) when removing the drug from the storage facility, label against MAR when preparing dose, and patient's armband against MAR prior to adminstration of medication
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To ensure safety of medication administration you should always do what?
check the medication three times by checking before you mix, pour, or draw up the medication; after you prepare the medication; and at the bedside
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To ensure you are administering the correct dose you should consider what?
weight, sex, pregnancy, age, and that it is within the recommended dose range
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To ensure that the timing of medication is correct you should?
check when meals are/where given, check for scheduled procedures, know the window of one half hour to one hour before and after scheduled dose (depending on facility) except for psychotropic and narcotic medication
- What are the types of routes for medication administration?
- Oral, Intramuscular, Intradermal, Subcutaneous, Intravenous, Topical, Suppository, Enteral, Sublingual, Inhalants
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What are the steps taken to ensure the right patient receives the right medication?
have the patient verify name and birthday, check the armband, and know your patient (to notice behavioral changes and/or physical changes)
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What is the right Documentation on chart/Medex/Pyxis?
Time and date given; Evaluation of response to medication; and Name, dose, route, date/time of medication and your initials
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Primary effects (want to happen)
Predicted, intended, and desired action/Teach client actions of medication
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Side effects (predictable)
Unintended, often predictable/Teach client about common side effects and when to notify the physician or health care provider
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What are the reactions to medication?
Allergic (Immune system identifies as foreign, Range from minor to serious responses; Urticaria, pruritus, and rhinitis); Anaphylactic (Life-threatening; Occurs immediately; and Shortness of breath, hypotension, death); Adverse reactions (Dose related (i.e.. Too much insulin results in too low blood sugar); and Patient sensitivity to drug; Toxic reactions (Damaging effects to organs or tissue; and Overdosing, drug accumulation)
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What are the special considerations for giving children medications?
Don�t lie or be deceitful about medication, Offer favorite juice or popsicle after medication received, Preventative measures for choking/aspiration
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What are the special considerations for giving elderly people medications?
Difficulty swallowing, impaired vision, forgetfulness, difficulty opening containers and lack of understanding; Polypharmacy (more than one medication); Altered pharmacokinetics; Metabolism and excretion; and Immune system
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What is the Nursing Process for Medication Administration?
Assessment (Before, during and following administration), Planning goals/outcomes (Be able to self-administer or take medication without difficulty, Understanding about medication, and Report problems or symptoms), Interventions and Implementations (Teach name, actions and side effects of medications and Demonstration of how to take medication and when to report problems), Evaluation (Response to medication and Reports understanding about medication usage and side effects)
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What are the procedures for infusion therapy?
Review physician�s orders, Assess patient, Gather proper equipment, Prepare for venipuncture, Perform venipuncture, and Safety measures and tips
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What are the four primary modes of administration for therapy infusion?
continuous infusion, intermittent infusion, direct injection, and PCA
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What are the complimentary and alternative therapies?
not considered part of conventional medicine, common therapies (non-vitamin and non-mineral products), used by 38 percent of adults and 12 percent of children, mind-body therapies (biofeedback, guided imagery, intercessory prayer, meditation, and relaxation exercises), biologically based therapies (herbal therapies and vitamins and dietary supplements), manipulative and body-based therapies (acupuncture and acupressure, chiropractic, message, Tai Chi, Yoga), energy therapies (Reiki and therapeutic touch), alternative medical systems (Homeopathy, Naturopathy, and Osteopathy), Other types (Humor, music therapy, and Spiritual therapies)
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What is pain?
an unpleasant feeling conveyed to brain by sensory neurons, Subjective, Sensitivity and response to pain varies, and Nurse has unique role in managing pain
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What are the pain management pathways and mechanisms?
Transduction, transmission, and modulation
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What are some of the responses to pain?
sociocultural influences (stoicism is valued by many cultures), age (many elderly feel chronic pain and it is incorrect that children fell less pain), and gender differences
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What are the types of pain?
nociceptive, chronic, malignant, neuropathic, and acute
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What is nociceptive pain?
somatic (rheumatoid arthritis), visceral (appendicitis), referred (myocardial infarction)
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What is chronic pain?
usually longer than six months, psychological implications, and difficult to treat
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What is malignant pain?
caused by cancer/side effects of cancer treatment, persistent pain, and breakthrough pain (BTP breaks through medication treatment and is episodic), intractable pain (resistant to treatment)
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What is neuropathic pain?
paroxysmal and persists beyond normal healing
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What is acute pain?
common experience and usually responds to treatment
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What assessment tools do you use to assess pain?
systematic assessment with standard tools, numeric scale, Wong-Baker faces scale, verbal graphic rating, PAINAD scale (rates breathing, negative vocalizations, facial expressions, body language, and comfort and is especially useful in assessing the pain of patients with dementia)
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What are some barriers to pain assessment and management?
outdated norms, inadepuate knowledge by healthcare providers, patients beliefs and values, communication barriers, and ethical considerations
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Some planning and interventions for pain management are
contemporary pain management measures, interventions for management of acute pain, interventions for management of chronic pain, physical care of patients with pain, pharmacology, drug forms and routes of administration of analgesics, side effects of opiods, geriatric considerations affecting administration of analgesics, contraindications for opioid analgesics, alternative therapy for pain relief, and psychological counseling, support groups, therapeutic touch, exercise, and physical therapy
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What are the procedures for infusion therapy?
Review physician�s orders, Assess patient, Gather proper equipment, Prepare for venipuncture,Perform venipuncture, and Safety measures and tips
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What are the four primary modes of administration of infusion therapy?
Continuous infusion, Intermittent infusion, Direct injection, and PCA
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If your client has hypovolemia or hyperglycemia, which type of infusion therapy would you use?
Isotonic (risk for fluid overload) - pertaining to a solution with the same osmotic pressure as a reference solution
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If you client has electrolyte imbalances or parenteral nutrition, which type of infusion therapy would you use?
Hypertonic - pertaining to a solution of higher osmotic pressure than another
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If your client is dehydrated, which type of infusion therapy would you use?
hypotonic - pertaining to a solution of lower osmotic pressure than another
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What are the four classifications of central catheters?
Tunneled, Percutaneous, Implanted ports, and Closed-ended catheters
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What are the types of infusion therapies?
TPN - total parental nutrition, blood components, oncology therapy, and pain management
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What is a colloid?
a substance used as a plasma expander in place of blood
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What are crystalloids?
the opposite of a colloid
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What is erythropoietin?
a cytokine made by the kidneys that stimulates the proliferation of red blood cells
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What is phlebitis?
inflammation of a vein
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What is extravasation?
the escape of fluid from its physiologic contained space, e.g. bile, blood, CSF, into the surrounding tissue
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What is infiltration?
the deposition and accumulation of an external substance within the cell, tissue, or organ, such as fat deposition within a damaged liver
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What is a vesicant?
an agent used to produce blisters - it is much less severe in its effects than escharotics
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What is sepsis?
a systemic inflammatory response to infection, in which there is fever or hypothermia, tachycardia, tachypnea, and evidence of inadequate blood flow to internal organs
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What is biofeedback?
a training program designed to develop one's ability to control the autonomic (involuntary) nervous system (client may be able to control skin temp, heart rate, and blood pressure)
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What is meditation?
the art of comtemplative thinking
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What is herbalism?
the use of herbs to promote healing, wellness, and disease prevention
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What is homeopathy?
the proposal that very dilute doses of extracts, medicines, or other substances that produce symptoms of a disease in healthy people will cure that disease in affected patients
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What is a dermatome?
an instrument used for cutting thin slices of skin for transplantation
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What is modulation?
the alteration in function or status of something in response to a stimulus or altered chemical or physical environment
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What is transduction?
a phenomenon causing genetic recombination in bacteria in which DNA is carried from one bacterium to another by a bacteriophage
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What is a nociceptor?
a free nerve ending that is a receptor for painful stimuli
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Whatis hyperalgesia?
an excessive sensitivity to pain
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What is proprioception?
The awareness of posture, movement, and changes in equalibrium and the knowledge of position, weight and resistance of objects in relation to the body
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What is kinesthesia?
The ability to perceive extent, direction, or weight of movement
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What is somesthesia?
the ability to feel sensations and sensory structures of the body
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What is homeostasis?
the state of dynamic equilibrium of the internal environment of the body that is maintained by the ever-changing process of feedback and regulation in response to external or internal changes
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What is fast pain?
rapid pain, originates in the nociceptors of the large myelinated nerve fibers located in the skin, which respond to strong pressure, a cut, or high temperature, eliciting the withdrawl reflex
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What is slow pain?
originates in the nocireceptors of the smaller, unmyelinated nerve fibers and has a longer throbbing or aching quality
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What is pain threshold?
some people may have a higher of lower pain threshold than others, which is the lowest intensity of painful stimulus that the individual perceives as pain
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What is pain tolerance?
the amount of pain a person is willing to endure
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What is somatic pain?
nociceptive pain that originates from the bone, joints, muscles, skin, or connective tissue
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What is visceral pain?
pain arising from the body organs and gastrointestinal tract
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What is refered pain?
the result of the transfer of visceral pain sensations and deep somatic pain via the autonomic nervous system to a body surface at a distance from the actual origin
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What is neuropathic pain (neuralgia, or pathological)?
pain that results from injury to a nerve, malfunction of the neuronal transmission process, or impaired regulation frequently described as paroxysmal (a sudden spasm-like pain) occuring along the branches of a nerve
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What is idiopathic pain?
pain that can be spontaneous and unpredictable or initiated by certain activities such as walking or coughing, and is often reffered to as incidental pain
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What is intractable pain?
pain that is refractory or resistant to some or all forms of treatment
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What is trough drug level?
the minimum blood serum level of a drug
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What is bioavailability?
a subcategory of absorption and can be defined as the percentage of the drug within the systemic circulation that is available to achieve its intended effect in the body
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What is pharmacokinetics?
it describes how the body acts on a drug
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What is biotransformation?
follows absorption and distribution, drugs must be detoxified or broken down to a form that can be eliminated
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What is therapeutic range?
the level between the minimum effective dose and the toxic concentration
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What is half-life?
the time it takes for half of the drug administered to be eliminated or the serum concentration to be decreased by half
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What is peak drug level?
the time it takes for a drug to reach its highest concentration in the blood
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What is total parenteral nutrition?
nutritional support supplying glucose, protein, vitamins, electrolytes, trace elements, and sometimes fats to maintain the body's growth, development, and tissue repair
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What is peripheral parenteral nutrition?
nutrition delivered into a peripheral vein, is designed for mildly stressed patients who are expected to be able to resume enteral feeding within 7 to 10 days
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What is guided imagery?
the use of relaxation and mental visualization to improve mood and/or physical well-being
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Ibuprofen (motrin)
a nonsteroidal anti-inflammatory agent with antipyretic and analgesic properties, which inhibits the synthesis of prostaglandins, that may be responsible for its effects
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Warfarin (coumadin)
an anticoagulant drug
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Potassium chloride (K-Lor)
a mineral/electrolyte administered orally to treat and prevent potassium depletion in patients who are unable to digest adequate dietary potassium
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Fluoxetine (Prozac)
a drug used to treat depression, bulemia, and OCD
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Furosemide (Lasix)
a loop diuretic
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