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semester 1 2019 > 258 revision > Flashcards

258 revision Flashcards

1
Q

what’s the difference between bactericidal and bacteriostatic?

A

one actually kills bacteria, the other slows there growth enough to render them harmless

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2
Q

what is therapeutic range?

A

the concentration at which drugs have their desired therapeutic effect

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3
Q

what are the three common gram positive microorganisms

A

staphylococcus, streptococcus and clostridium

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4
Q

what are the mechanisms of action of antibiotics?

A
  1. disruption of cell membrane function
  2. inhibition of cell wall synthesis
  3. inhibit dna and rna synthesis
  4. impact protein synthesis by ribosomes
  5. inhibit folic acid metabolism
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5
Q

what’s the mechanism of action of penicillin and cephalosporins?

A

cell wall destruction

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6
Q

how is antibiotic dosage calculated in paeds?

A

based on weight

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7
Q

which antibiotics will need drug plasma concentrations monitored?

A

gentamicin, tobramycin, vancomycin

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8
Q

what is important to note about antibiotic therapy in paeds?

A

cultures should be taken before initiating therapy and continued until infection is no longer present

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9
Q

what are macrolides?

A

class of antibiotics that inhibit rna synthesis

used to treat respiratory/ENT infections

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10
Q

give two examples of macrolides

A

erythromycin and roxithromycin

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11
Q

adverse reactions of macrolides

A

nausea and vomiting
abdo pain
rash
anaphylaxis

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12
Q

what are cephalosporins?

A

class of antibiotics that inhibit cell wall synthesis

used for gram positive and some gram negative bacteria

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13
Q

how many generations of cephalosporins are there?

A

four

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14
Q

adverse reactions to cephalosporins?

A

impaired vitamin K

high sodium

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15
Q

two examples of cephalosporins?

A

cephazolin

cephalexin

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16
Q

what were the first broad spectrum antibiotics developed?

A

tetracyclines

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17
Q

give an example of a bacteriostatic antibiotic

A

tetracyclines

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18
Q

what are tetracyclines?

A

antibiotics that inhibit protein synthesis

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19
Q

what are three examples of tetracyclines?

A

tetracycline
doxycycline
tigercycline

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20
Q

what are aminoglycasides?

A

antibiotics that bind to ribosomes and inhibit protein synthesis

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21
Q

three examples of aminoglycasides?

A

gentamycin, neomycin, tobramycin

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22
Q

adverse effects of aminoglycasides?

A

ototoxicity

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23
Q

what is gentamycin used to treat?

A
  1. Serious or life threatening conditions
  2. When other agents are not appropriate
  3. Gram neg. infections
  4. Surgical prophylaxis
  5. Eye infections
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24
Q

what are the adverse effects of gentamycin?

A

Nephrotoxicity
Vestibular ototoxicity
Use with caution with the elderly

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25
Q

how is gentamycin adminstered?

A

parenterally

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26
Q

what are penicillins and what do they treat?

A

antibiotics that inhibit cell wall synthesis

used to treat respiratory infections, UTIs and systemic infections

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27
Q

adverse reactions to penicillins

A

GI upset, nausea and vomiting

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28
Q

examples of penicillins

A
  • amoxycillin
  • ampicillin
  • benzylpenicillin
  • flucloxacillin
  • procaine penicillin
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29
Q

which types of surgery are associated with prophylactic use of antibiotics?

A
  • Joint replacement
  • Bowel
  • Head and neck
  • Dental or oral
  • Emergency
  • Trauma
  • Cardiac

also in people with compromised immune systems

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30
Q

how can nurses help to prevent antibiotic resistance?

A 
Educate our patients to 
• Take as prescribed
• Complete the prescribed doses
• Throw away unused antibiotics
• Do not share antibiotics
• Antiseptic use
• Correct medication preparation
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31
Q

what is ototoxicity?

A

toxicity to the ear - the cochlea, the auditory nerve and sometimes the vestibular system

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32
Q

what are the clinical manifestations of T2DM?

A 
polyuria (excessive urination)
glycosuria (glucose in urine)
blurred vision
polydipsia (excessive thirst)
polyphagia (excessive appetite)
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33
Q

what are the advantages of PCA pumps for analgesua?

A

patients usually require less medication but have better pain relief

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34
Q

how is risk of overdose managed with a PCA?

A

lockout period

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35
Q

is PCA medication continuous or bolus?

A

can have a continuous infusion/background rate and still allow additional bolus doses

36
Q

how is PCA medication delivered?

A

usually IV but can also be SC or epidural

37
Q

what is a PCA used for?

A

to manage post-op and chronic pain

38
Q

what are the core concepts of family centred care?

A

dignity and respect
information sharing
participation
collaboration

39
Q

what does PEWS stand for?

A

Paediatric Early Warning System or Score

40
Q

what is an IDEAL discharge?

A 
specific to patient and their needs -
Include
Discuss
Educate
Assess
Listen
41
Q

What types of anaesthetics are there?

A 
General
Nerve block - spinal or epidural
Regional
Local infiltration
Sedation/analgesia
42
Q

how do diuretics work?

A

modify kidney function to cause increased diuresis and increased natriuresis

43
Q

what are the main classes of diuretics?

A 
osmotic diuretics
loop diuretics
thiazide diuretics
potassium sparing diuretics
(carbonic anhydrase inhibitors)
44
Q

describe the effects of loop diuretics?

A

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

45
Q

what are loop diuretics commonly indicated for?

A 
oedema
cirrhosis
renal impairment
nephrotic syndrome
adjunct therapy for APO
46
Q

when should loop diuretics be used with caution?

A
  • Diabetes mellitus
  • Gout
  • Hearing impairment
  • Hepatic and renal impairment
  • Hypokalaemia
47
Q

adverse reactions to frusemide?

A
  • Electrolyte imbalances
  • Dizziness
  • Postural hypotension
  • Ototoxicity
48
Q

onset of action for thiazide diuretics?

A

about 12 hours

49
Q

how do thiazide diuretics work?

A

inhibit reabsorption of sodium and water, and promote the excretion of electrolytes

50
Q

how potent are thiazide diuretics?

A

how potent are thiazide diuretics?

51
Q

what do thiazide diuretics promote the reabsorption of?

A

urea, leading to increased uric acid. can lead to gout.

52
Q

what are thiazide diuretics indicated for?

A

oedema, HTN

53
Q

adverse reactions to thiazide diuretics?

A
  • Dizziness
  • Vertigo
  • Orthostatic hypotension
  • Hypokalaemia
  • Hyperglycaemia
  • Photosensitivity - use sunscreen!
54
Q

examples of thiazide diuretics?

A

hydrochlorothiazide, chlorothiazide

55
Q

what diuretics are commonly used in conjunction?

A

thiazides and potassium-sparing diuretics

56
Q

what are potassium-sparing diuretics commonly indicated for?

A
  • Diuretic induced hypokalaemia
  • Treatment of oedema related to heart failure
  • Hepatic cirrhosis
57
Q

example of a potassium-sparing diuretic?

A

spironolactone (Aldactone)

58
Q

what’s the action of spironolactone?

A

aldosterone receptor blocker

59
Q

indications for spironolactone?

A
  • Oedema
  • Heart failure
  • Hyperaldosteronism
  • Hirsutism
60
Q

which diuretic doesn’t interfere with sodium and cholride transport?

A

spironolactone

61
Q

how do osmotic diuretics work?

A

they add to solutes already present, increasing the osmolality of the filtrate in the nephrons

62
Q

indications for osmotic diuretics?

A
  • Cerebral oedema
  • Reduce intraocular pressure
  • Acute closed angle glaucoma
63
Q

examples of osmotic diuretics?

A

mannitol

acetazolamide

64
Q

nursing care considerations for diuretics - what should be monitored?

A

fluid input and output
blood pressure
blood serum levels
BGLs

65
Q

nursing care considerations for diuretics - patient education points

A

education: avoid sudden posture changes
take in the morning
use sunscreen

66
Q

other nursing care considerations for diuretics

A

ensure patients have access to toileting
if IDC is present, ensure it’s patent etc
monitor for dehydration

67
Q

potential post-op complications of the cardiovascular system?

A 
haemorrhage
hypovolemic shock
hypo/hypertension
 deep vein thrombosis
 Anticoagulants, antiplatelets, NSAIDs increase bleeding
68
Q

potential post-op complications of the respiratory system?

A

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

69
Q

potential post-op complications of the renal system?

A

urine retention
fluid and electrolyte imbalance
renal failure esp due to dehydration

70
Q

potential post-op complications of the GIT system?

A

constipation, diarrhoea, nausea, vomiting, paralytic ileus

71
Q

potential post-op complications of the integumentary system?

A

infection,
dehiscence,
scarring,
pressure injuries,
nerve injuries due to innappropriate positioning
hypothermia (can lead to cardiac arrhythmias)

72
Q

potential post-op complications of the nervous system?

A

confusion (post-operative emergence deirium)

chronic pain

73
Q

potential post-op complications of the endocrine system?

A

hormone imbalance e.g. loss of control of diabetes

74
Q

potential post-op complications of the musculoskeletal system?

A

loss of mobility and strength

75
Q

potential psychosocial post-op complications?

A

anxiety, depression, altered body image, anger

76
Q

important pre-op diagnostics

A
  1. Urinalysis
  2. Renal function – urea, electrolytes, creatinine (UEC)
  3. Full blood count/examination (FBC or FBE)
  4. Coagulation studies
  5. Cross match, group and hold
77
Q

what are the different types of nurses involved at the intra-op stage?

A

anaethetic nurse
instrument/scrub nurse
circulation/scout nurse

78
Q

electrolytes: role of sodium?

A

nerve transmission, muscle contraction, maintains normal

concentration of ECF

79
Q

electrolytes: role of chloride?

A

acid/base balance, nerve transmission

80
Q

electrolytes: role of potassium?

A

nerve transmission, muscle contraction, normal heart rhythms, concentration of ICF

81
Q

electrolytes: role of calcium?

A

nerve transmission, muscle contraction, strong bones and teeth, blood clotting, enzyme reactions

82
Q

electrolytes: role of magnesium?

A

enzyme reactions; cardiac and respiratory function

83
Q

why are patients at risk of developing fluid or electrolyte imbalances in the perioperative period?

A 
release of hormones due to stress of surgery - ADH, aldosterone
IV fluid administration
fluid shifts
transfusion
parenteral nutrition
84
Q

what should we assess for around fluid/electrolyte imbalance?

A 
nausea and vomiting
diarrhoea
renal function
intake and output
serum electrolytes
medications (e.g. diuretics, opioid analgesia)
85
Q

potential complications around fluid and electrolyte imbalances?

A
  • 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

semester 1 2019 (5 decks)

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