258 revision Flashcards
what’s the difference between bactericidal and bacteriostatic?
one actually kills bacteria, the other slows there growth enough to render them harmless
what is therapeutic range?
the concentration at which drugs have their desired therapeutic effect
what are the three common gram positive microorganisms
staphylococcus, streptococcus and clostridium
what are the mechanisms of action of antibiotics?
- disruption of cell membrane function
- inhibition of cell wall synthesis
- inhibit dna and rna synthesis
- impact protein synthesis by ribosomes
- inhibit folic acid metabolism
what’s the mechanism of action of penicillin and cephalosporins?
cell wall destruction
how is antibiotic dosage calculated in paeds?
based on weight
which antibiotics will need drug plasma concentrations monitored?
gentamicin, tobramycin, vancomycin
what is important to note about antibiotic therapy in paeds?
cultures should be taken before initiating therapy and continued until infection is no longer present
what are macrolides?
class of antibiotics that inhibit rna synthesis
used to treat respiratory/ENT infections
give two examples of macrolides
erythromycin and roxithromycin
adverse reactions of macrolides
nausea and vomiting
abdo pain
rash
anaphylaxis
what are cephalosporins?
class of antibiotics that inhibit cell wall synthesis
used for gram positive and some gram negative bacteria
how many generations of cephalosporins are there?
four
adverse reactions to cephalosporins?
impaired vitamin K
high sodium
two examples of cephalosporins?
cephazolin
cephalexin
what were the first broad spectrum antibiotics developed?
tetracyclines
give an example of a bacteriostatic antibiotic
tetracyclines
what are tetracyclines?
antibiotics that inhibit protein synthesis
what are three examples of tetracyclines?
tetracycline
doxycycline
tigercycline
what are aminoglycasides?
antibiotics that bind to ribosomes and inhibit protein synthesis
three examples of aminoglycasides?
gentamycin, neomycin, tobramycin
adverse effects of aminoglycasides?
ototoxicity
what is gentamycin used to treat?
- Serious or life threatening conditions
- When other agents are not appropriate
- Gram neg. infections
- Surgical prophylaxis
- Eye infections
what are the adverse effects of gentamycin?
Nephrotoxicity
Vestibular ototoxicity
Use with caution with the elderly
how is gentamycin adminstered?
parenterally
what are penicillins and what do they treat?
antibiotics that inhibit cell wall synthesis
used to treat respiratory infections, UTIs and systemic infections
adverse reactions to penicillins
GI upset, nausea and vomiting
examples of penicillins
- amoxycillin
- ampicillin
- benzylpenicillin
- flucloxacillin
- procaine penicillin
which types of surgery are associated with prophylactic use of antibiotics?
- Joint replacement
- Bowel
- Head and neck
- Dental or oral
- Emergency
- Trauma
- Cardiac
also in people with compromised immune systems
how can nurses help to prevent antibiotic resistance?
Educate our patients to • Take as prescribed • Complete the prescribed doses • Throw away unused antibiotics • Do not share antibiotics • Antiseptic use • Correct medication preparation
what is ototoxicity?
toxicity to the ear - the cochlea, the auditory nerve and sometimes the vestibular system
what are the clinical manifestations of T2DM?
polyuria (excessive urination) glycosuria (glucose in urine) blurred vision polydipsia (excessive thirst) polyphagia (excessive appetite)
what are the advantages of PCA pumps for analgesua?
patients usually require less medication but have better pain relief
how is risk of overdose managed with a PCA?
lockout period
is PCA medication continuous or bolus?
can have a continuous infusion/background rate and still allow additional bolus doses
how is PCA medication delivered?
usually IV but can also be SC or epidural
what is a PCA used for?
to manage post-op and chronic pain
what are the core concepts of family centred care?
dignity and respect
information sharing
participation
collaboration
what does PEWS stand for?
Paediatric Early Warning System or Score
what is an IDEAL discharge?
specific to patient and their needs - Include Discuss Educate Assess Listen
What types of anaesthetics are there?
General Nerve block - spinal or epidural Regional Local infiltration Sedation/analgesia
how do diuretics work?
modify kidney function to cause increased diuresis and increased natriuresis
what are the main classes of diuretics?
osmotic diuretics loop diuretics thiazide diuretics potassium sparing diuretics (carbonic anhydrase inhibitors)
describe the effects of loop diuretics?
they produce rapid and intense diuresis over a fairly short period (4-6 hrs)
they have a number of direct vascular effects: venodilation, reduced responsiveness to angiotensin II and noradrenalin
what are loop diuretics commonly indicated for?
oedema cirrhosis renal impairment nephrotic syndrome adjunct therapy for APO
when should loop diuretics be used with caution?
- Diabetes mellitus
- Gout
- Hearing impairment
- Hepatic and renal impairment
- Hypokalaemia
adverse reactions to frusemide?
- Electrolyte imbalances
- Dizziness
- Postural hypotension
- Ototoxicity
onset of action for thiazide diuretics?
about 12 hours
how do thiazide diuretics work?
inhibit reabsorption of sodium and water, and promote the excretion of electrolytes
how potent are thiazide diuretics?
moderately potent
what do thiazide diuretics promote the reabsorption of?
urea, leading to increased uric acid. can lead to gout.
what are thiazide diuretics indicated for?
oedema, HTN
adverse reactions to thiazide diuretics?
- Dizziness
- Vertigo
- Orthostatic hypotension
- Hypokalaemia
- Hyperglycaemia
- Photosensitivity - use sunscreen!
examples of thiazide diuretics?
hydrochlorothiazide, chlorothiazide
what diuretics are commonly used in conjunction?
thiazides and potassium-sparing diuretics
what are potassium-sparing diuretics commonly indicated for?
- Diuretic induced hypokalaemia
- Treatment of oedema related to heart failure
- Hepatic cirrhosis
example of a potassium-sparing diuretic?
spironolactone (Aldactone)
what’s the action of spironolactone?
aldosterone receptor blocker
indications for spironolactone?
- Oedema
- Heart failure
- Hyperaldosteronism
- Hirsutism
which diuretic doesn’t interfere with sodium and cholride transport?
spironolactone
how do osmotic diuretics work?
they add to solutes already present, increasing the osmolality of the filtrate in the nephrons
indications for osmotic diuretics?
- Cerebral oedema
- Reduce intraocular pressure
- Acute closed angle glaucoma
examples of osmotic diuretics?
mannitol
acetazolamide
nursing care considerations for diuretics - what should be monitored?
fluid input and output
blood pressure
blood serum levels
BGLs
nursing care considerations for diuretics - patient education points
education: avoid sudden posture changes
take in the morning
use sunscreen
other nursing care considerations for diuretics
ensure patients have access to toileting
if IDC is present, ensure it’s patent etc
monitor for dehydration
potential post-op complications of the cardiovascular system?
haemorrhage hypovolemic shock hypo/hypertension deep vein thrombosis Anticoagulants, antiplatelets, NSAIDs increase bleeding
potential post-op complications of the respiratory system?
hypoxia because of increased secretions and bronchoconstriction
atelectasis (collapsed lung) after artificial airway
laryngospasm - uncontrolled spasm or constriction due to anaesthetic gas or airway intubation
infection
pulmonary embolus
potential post-op complications of the renal system?
urine retention
fluid and electrolyte imbalance
renal failure esp due to dehydration
potential post-op complications of the GIT system?
constipation, diarrhoea, nausea, vomiting, paralytic ileus
potential post-op complications of the integumentary system?
infection,
dehiscence,
scarring,
pressure injuries,
nerve injuries due to innappropriate positioning
hypothermia (can lead to cardiac arrhythmias)
potential post-op complications of the nervous system?
confusion (post-operative emergence deirium)
chronic pain
potential post-op complications of the endocrine system?
hormone imbalance e.g. loss of control of diabetes
potential post-op complications of the musculoskeletal system?
loss of mobility and strength
potential psychosocial post-op complications?
anxiety, depression, altered body image, anger
important pre-op diagnostics
- Urinalysis
- Renal function – urea, electrolytes, creatinine (UEC)
- Full blood count/examination (FBC or FBE)
- Coagulation studies
- Cross match, group and hold
what are the different types of nurses involved at the intra-op stage?
anaethetic nurse
instrument/scrub nurse
circulation/scout nurse
electrolytes: role of sodium?
nerve transmission, muscle contraction, maintains normal
concentration of ECF
electrolytes: role of chloride?
acid/base balance, nerve transmission
electrolytes: role of potassium?
nerve transmission, muscle contraction, normal heart rhythms, concentration of ICF
electrolytes: role of calcium?
nerve transmission, muscle contraction, strong bones and teeth, blood clotting, enzyme reactions
electrolytes: role of magnesium?
enzyme reactions; cardiac and respiratory function
why are patients at risk of developing fluid or electrolyte imbalances in the perioperative period?
release of hormones due to stress of surgery - ADH, aldosterone IV fluid administration fluid shifts transfusion parenteral nutrition
what should we assess for around fluid/electrolyte imbalance?
nausea and vomiting diarrhoea renal function intake and output serum electrolytes medications (e.g. diuretics, opioid analgesia)
potential complications around fluid and electrolyte imbalances?
- Hyponatraemia Na+ <135mmol/L due to release of antidiuretic hormone which retains H2O in the circulation and dilutes Na+
- Hypokalaemia K+ <3.5mmol/L due to release of aldosterone which retains Na+ and excretes K+
- other electrolyte imbalances - calsium, magnesium
- Hypovolaemia/hypervolaemia
