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305 Exam 2 Flashcards

1
Q

ADPIE Parts

A

-Assessment
-Diagnosis
-Planning
-Implementation
-Evaluation

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2
Q

Assessment

A

-Collection of health history data and physical assessment
-Med use, otc drugs, illicit drug use, lifestyle habits
-Most important step - reference for everything in the future

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3
Q

Reassessment

A

-After pharmacotherapy assess for response
-Desired response
-Adverse effects
-Patient capability of assuming responsibility
for self admin

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4
Q

Diagnoses (Nursing)

A

-Focus on patient needs
-3 main parts
1. Promote therapeutic drug effect
2. Minimize adverse effects and toxicity
3. Maximize patient ability for self care

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5
Q

Risk Diagnoses

A
  1. Diagnostic statement
  2. Related factor or inferred cause
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6
Q

Actual Diagnoses

A
  1. Diagnostic statement
  2. Related factor or inferred cause
  3. Evidence to support statement
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7
Q

Planning

A

Goals for Patient Receiving Meds
-Bases on nursing diagnoses
-Focused on what pt will do/achieve
-Discussed with pt or caregiver
-Can be short or long term

Outcomes for Patient
-Provide specific and measurable criteria
-Evaluate level of completion of goal
-Focus on what patient will do

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8
Q

Implementation

A
  1. Administer
  2. Continue
  3. Monitor
  4. Carry out
  5. Provide (education)

Monitoring Drug Effects
-Monitor for therapeutic effect
-Reassess patient (condition, vs, weight, labs)
-Monitor side/adverse effects

Document
-Admin of med
-Therapeutic/adverse effects
-Pt statements
-Objective assessment data

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9
Q

Evaluation

A

-Compares current status with goals

Evaluation Begins New Cycle When
-New assessment data gathered and analyzed
-Nursing diagnoses reviewed/rewritten
-Goals or outcomes are refined
-New interventions are carried out

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10
Q

Factors that Contribute to Med Errors

A
  1. Omitting (one of the rights)
  2. Failing (to perform safety check)
  3. Failing (to identify patient variables age, weight, liver function)
  4. Giving (meds on verbal orders)
  5. Giving meds (on incomplete/illegible orders)
  6. Practicing (under stressful conditions)
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11
Q

Methods For Reporting Med Errors

A

-RN’s legal and ethical responsibility to report all errors (near misses and errors, near miss and errors the RN observes)

FDA coordinates the reporting of med errors
-MedWatch
-NCC MERP
-DMEPA

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12
Q

Documenting Med Errors

A

-Med given
-Monitor VS
-Asses for Adverse Effects
-Notify Provider
-Admin antidote
-Document everyone notified
-Inform patient

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13
Q

Med Reconciliation

A

-Can reduce med errors
-Accurate collection of all meds and substances the client has taken within the past month

Done when:
-Proceeds form one provider to another
-On admission to a facility
-When transferring facilities or units
-When discharged

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14
Q

Electronic Health Records (EHR)

A

-Used to reduce med errors

e-prescribing
-Increase accuracy of orders
-Allows for accurate records keeping
-Increase efficiency in checking contraindications and drug-drug interactions
-Allows for electronic transmission of orders to pharmacy

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15
Q

Patient Teaching Reduces Med Errors

A

Every patient, every dose
-Patient must receive info/education prior to receiving first dose of a med
-Allows patient to decide if they want to take it

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16
Q

Reinforce Patient Education with Each Dose

A

Client should be able to state
-Name of med, why taking, dose, time route
-Adverse reactions and what to do
-Teach back
-Have patient demonstrate specific skill related to administering med

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17
Q

Erikson’s Developmental Stages

A
  1. Trust vs Mistrust ( birth-18mo)
  2. Autonomy vs Shame and doubt (18mo-3yr)
  3. Initiative vs Guilt (3-5yr)
  4. Industry vs Inferiority (5-12yr)
  5. Identity vs Confusion (12-18yr)
  6. Intimacy vs Isolation (18-40yr)
  7. Generativity vs Stagnation (40-65yr)
  8. Integrity vs Despair (65-death)
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18
Q

Pregnancy Pharmacotherapy Considerations

A

-Drug therapy postponed until after pregnancy and lactation
-Non pharmacological alternatives used
-Only use pharmacotherapy in pregnant pt if preexisting condition exists (epilepsy, hypertension, psychiatric disorder)

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19
Q

Conditions That May Arise During Pregnancy That Need Treatment

A

-Gestational diabetes
-Gestational hypertension
-Acute UTI (use antibiotics)
-STI
-Estimated 90% of preg women take med and 70% take at least one prescription med

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20
Q

What Can Affect Absorption During Pregnancy

A

-Hormones
-Pressure of expanding uterus on blood supply to abdominal organs
-Gastric Acidity decreased
-Increase progesterone can delay gastric emptying (more absorption time)
-Progesterone causes greater tidal volume (inhaled drugs absorbed more)

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21
Q

What Can Affect Distribution and Metabolism During Pregnancy

A

Increased cardiac output, plasma volume, altered blood flow
-Dilution of drugs
-Decreased plasma protein concentration

Altered lipid levels
-Affect drug transport and distribution
-Fat soluble drugs ma be passed to infant via breast milk

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22
Q

What Can Affect Excretion During Pregnancy

A

Increased blood flow through kidneys by over 50%
-Drug excretion may increased
-Doses and med may need to be adjusted

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23
Q

Teratogen Definition

A

Substance, organism, or physical agent that can cause permanent abnormality in structure or function, causes growth retardation, or results in death

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24
Q

Thalidomide

A

Causes birth defects between days 35-48
35-37 days: No ears
39-41 days: No arms
41-43 days: no uterus
45-47 days: No tibia
47-49 days: Triphalangeal thumbs

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25
Preimplantation Period
-Weeks 1-2 -"All or none" period -Exposure to teratogen either causes death or has no effect -Nicotine can cause intrauterine growth retardation
26
Embryonic Period
-Weeks 3-8 -Rapid internal development -Maximum sensitivity to teratogens -Teratogen exposure can lead to structural malformation or spontaneous abortion
27
Fetal Period
-Weeks 9-40 Blood flow to placenta increases and placental vascular membranes thin -Max the transfer of substances to fetus -Fetus can receive larger dose of med and substances -Meds will have prolonged duration within fetus (lack metabolic enzymes and efficient excretion) Teratogen exposure will cause slowed growth or impaired organ function rather than malformation
28
FDA Pregnancy Category Ratings
-A: No increased risk of fetal abnormalities -B: No evidence of harm to fetus in animal studies -C: Animal studies show no adverse effect. No well controlled studies in pregnant women -D: Demonstrated risk to fetus in pregnant women. Benefits may outweigh risks -X: No indication for use in pregnancy. Abnormalities and risks to fetus
29
Effective Pharmacotherapy Includes
-Culture -Environment -Genetics -Gender -Psychosocial Nurse must take all of these into consideration
30
Psychosocial Influences on Pharmacotherapy
-Concerns when illness threatens health -Ill health -Suffering -Loneliness -Despair -Death
31
Spiritual or Religious Beliefs Affecting Pharmacological Outcomes
-Meaning -Hope -Value -Capacity to love, give, forgive -Compassion and empathy -Enjoyment of life -Ability to find peace of mind -Fulfillment of living
32
Ethnic Influences on Pharmacotherapy
-Biologic and genetic similarities
33
Cultural Influences on Pharmacotherapy
-Beliefs, values, and norms that provide meaning
34
Ethnic and Cultural Influences on Pharmacotherapy
-Influence on med outcomes -Dietary considerations -Alternative Therapies -Beliefs about health and illness -Genetic differences
35
Cultural Awareness
Aware of different cultures and beliefs
36
Cultural Sensitivity
Knowledgeable about relevant cultures
37
Cultural Appropriateness
Apply cultural knowledge to deliver care
38
Cultural Competence
Understand and address entire cultural context
39
Cultural Imposition
Impose rules of your culture onto another
40
Genetic Polymorphism
-2 or more versions of the same enzyme -Caused by single base mutation in DNA -Amino acid change in enzyme -Enzyme functions change Pharmacogenetics -Study of genetic variations that cause differences in the way patients handle meds -99.8% of DNA is that same
41
CAM
Complementary and Alternative Medicine
42
Complementary Medicine
Nonmainstream practice is used together with conventional medicine
43
Alternative Medicine
Nonmainstream practice is sued in place of conventional med
44
Integrative Medicine
Traditional and complementary approaches are used together
45
Alternative Healthcare Systems
-Naturotherapy, homeotherapy, chiropractic -Native American Med (sweat lodge, med wheels) -Chinese Traditional Medicine (acupuncture, Chinese herbs) -Aurvita (ancient Indian therapy to balance mind, body, and spirit)
46
Biologic Based Therapies
-Herbal therapies -Nutritional supplements -Special Diets
47
Manual Healing
-Massage -Physical therapy -Pressure-point therapy -Hand-mediated biofield therapies
48
Mind-Body Interventions
-Yoga, meditation, hypnotherapy -Guided imagery, biofeedback -Movement-oriented therapies (music, dance)
49
Other Therapies
-Bioelectromagnetics -Detoxifying therapies -Animal assisted therapies
50
Aloe Vera
-Use of leaves -Topical application for minor skin irritation and burns
51
Cranberry
-Use of berries/juice -Prevent UTI
52
Echinacea
-Use entire plant -Increase immune system -Treat common cold
53
Garlic
-Interacts with: Aspirin, NSAIDS, warfrin, insulin, oral antidiabetic drugs -Used for: reduce blood cholesterol, decrease BP, use for anicoagulant -Increase risk of bleeding
54
Ginger
-Interacts with: Aspirin, NSAIDS, heparin, warfin -Used for: antiemetic, antithrombotic, diuretic, stimulate peripheral circulation, anti-inflammatory -Increase risk of bleeding
55
Gingko
-Interacts with: anticonvulsants, aspirin, NSAIDS, heparin, warfarin, tricyclic antidepressants -Used for: improve memory, reduce dizziness -Increase risk of bleeding, increase seizure risk,
56
Ginseng
Used for: reduce stress, enhance immune system, decrease fatigue Interacts with: CNS depressants, Digoxin, diuretics, antidiabetic meds, warfrin Increase risk: Sedation, toxicity, decreased diuretic effects, hypoglycemic risk, bleeding risk
57
Dietary Supplement Health and Education Act of 1994 (DSHEA)
-Regulatory act for dietary supplements -Less rigid than Food, Drug, Cosmetic Act (FD&C) -Dietary supplements are exempted from FD&C -Dietary supplements are exempted from FD&C act standards -Gives FDA power to remove products considered harmful
58
Dietary Supplement and Nonprescription Drug Consumer Act (2007)
Companies Must -Include contact info on product labels for reporting adverse effects -Notify FDA of any serious adverse event reports within 15 days of receiving report -Keep extensive report records
59
Other FDA Rules
Manufacturers of dietary supplements required to evaluate: -Identity -Purity -Potency -Composition Must report on label
60
Coenzyme Q10
-Prevents Heart Disease -Provides antioxidant therapy
61
Fish Oil
-Reduces cholesterol levels -Enhances brain function -Increases visual acuity
62
Role of RN in Preparing and Responding to Bioterrorist Attack
Education -Knowledge/understanding of emergency management Resources -Current list of contacts in health and law enforcement Diagnosis and Treatment -Awareness of signs, symptoms, and treatment of chemical/biologic agents Planning -Involvement in emergency-management plans
63
Disaster Management Cycle
1. Mitigation-Prevention Phase 2. Preparedness Phase 3. Response Phase 4. Recover Stage
64
Triage Categories
-Black: expected to die -Red: Need treatment within 60 min -Yellow: Can wait a few hours -Green: Can wait a while for treatment
65
Category A Biologic Agents
-Highest priority -Poses risk to national security -Highly transmissible Examples: Anthrax, smallpox, botulism, ebola, plague
66
Category B Biologic Agents
-2nd highest priority -High morbidity rate -Low mortality rate Examples: Typhus fever, E-coli, West Nile virus, ricin toxin
67
Category C Biologic Agents
-3rd highest priority -Pathogens that are easy to produce and easily disseminated -High Morbidity -Low mortality rate Examples: Hantavirus, TB, influenza
68
Anthrax
-Carried by hoofed animals and animal products -Inhalation: rare, but near total mortality -Cutaneous: most are cured, "common" -Symptoms start 1-6 days later Treatment: Ciprofloxacin -Use IV cipro -PO cipro prophylaxis for 60 days 2015 FDA approved Anthrasil, an immune globulin from plasm of vaccinated folks (only good for inhalation)
69
Anthrax Vaccine
-5 part series over 18 months -Only for select military and those who work with imported meat -Used for 40 years
70
Cutaneous Anthrax Signs
Skin lesions that turn into black scabs
71
Gastrointestinal Anthrax Symptoms
-Sore throat -Difficulty swallowing -Abdominal cramping -Diarrhea -Abdominal swelling
72
Inhalation Anthrax
-Initially fatigue and fever for several days -Cough and SOB develop
73
Strategic National Stockpile Packages
1. Push Package 2. Vendor-managed inventory
74
Push Package
-Supplies and pharmaceuticals for unknown chemical or biologic threat -Arrives within 12 hours after attack
75
Vendor-managed Inventory
-Supplies and pharmaceuticals for specific chemical or biologic agent -Arrives within 24-36 hours
76
Nerve Agents
-Cause: convulsions, loss of consciousness (within seconds), respiratory failure (within minutes) -Overstimulates acetylcholine at central and peripheral sites in body -Blocks Ach E, increasing action of acetylcholine in synaptic space
77
Nerve Agents and Treatment
GA (Tabun), GB (Sarin), GD (Soman), VX treatment -Give atropine injection -Flush eyes with water -Apply sodium bicarbonate or 5% liquid bleach solution to skin -Do not induce vomiting
78
Ionizing Radiation Causes
-Nuclear Bombs -Nuclear Accidents
79
Ionizing Radiation Symptoms
-Can occur within hours or days -Immediate: Nausea, vomiting, diarrhea -Later: Weight loss, anorexia, fatigue, bone marrow suppression -Treatment: Symptomatic and Potassium Iodide tablets
80
Surface Decontamination of Radiation
-Remove clothes -Flush with water -Soap and water and alcohol washes for undamaged skin
81
Basic Supportive Care for Toxicity
1. ABC 2. Maintain proper blood glucose -Monitor for hypoglycemia -Look for: irritability, confusion, shaking, weakness 3.Provide treatment of developing seizures 4. Antidotes/treatments -If oral route: can lavage and/or charcoal be used
82
Treatments of Poisoning: Gastric Lavage and Aspiration
-If pt ingested life threatening amount of poison -Treatment within 60min
83
Treatments of Poisoning: Single-dose Activated Charcoal
-Used if poison is carbon-based (binds to substance to prevent further absorption) -Greatest benefit within 60min
84
Treatments of Poisoning: Whole-bowel Irrigation
-For potentially toxic ingestions of sustained-release or enteric-coated drugs -For toxic ingestions of iron, lead, zinc, or illicit drugs -Solutions such as: GoLytely administered via NG tube -May also have solutions ordered per rectum
85
Antidote: acetylcysteine
-Trade Name: Acetadote -For Overdose of: Acetaminophen (nonopioid analgesic)
86
Antidote: flumazenil
-Trade Name: Romazicon -For Overdose of: Benzodiazepines (sedative-hypnotic)
87
Antidote: naloxone
-Trade Name: Narcan -For Overdose of: Opioid agents; morphine (opioid analgesic)
88
Antidote: protamine sulfate
-For Overdose of: Heparin (parenteral anticoagulant)
89
Antidote: vitamin K
For Overdose of: Coumadin; warfarin (oral anticoagulant)
90
Factors Influencing Drug Effects on Breastfeeding Infant
-Some drugs destroyed in infant GI tract -Some drugs cannot be absorbed through GI tract -Such small amount in milk causes no harm
91
Breastfeeding and Pharmacotherapy
-Avoid pharmacotherapy if possible -Admin drug immediately after feeding or while the baby is sleeping -Use drugs with shorter half life -Use drugs with high protein binding (will not be as easily secreted in breast milk) -Have OTCs approved by doctor
92
Pharmacotherapy For Infants (birth-12mo)
-Use posterior half of inner cheek for oral drugs -Use vastus lateralis for IM injections (avoid butt bc of sciatic nerve damage risk) -Use feet and scalp veins for IV site
93
Pharmacotherapy for Toddlers (1-3yr)
-Give short explanations and immediate administration of drug -Hug, touch, praise to comfort -Use jam or syrup to mix meds in smallest amount possible -Use vastus lateralis for IM injections -Use scalp and feet veins for IV -Use parents as a tool to help calm child
94
Pharmacotherapy for Preschool (3-5)
-Have them participate if safe -Ventrogluteal site may be used for IM but can still use vastus lateralis -Use peripheral sites for IV -Brief explanation then immediate admin -Child can use doll to act out what will happen or has happened to them to give them more sense of control
95
Pharmacotherapy of School-age (6-12)
-Respiratory and GI upset are most common ailment -Usually quite cooperative -Can let child choose to take one med before the other or choose drink -Make them feel like they have choice
96
Pharmacotherapy Adolescents (13-16yr)
-Primary Concern: Sexual activity, STD/STI, pregnancy -Alcohol and tobacco use -Illicit drug experimentation -Opioid use and overdose -Give teen privacy and time to ask questions -Give independence and education
97
Polypharmacy
-Taking multiple drugs concurrently -Increases risk of drug interactions and side effects -Nurse should encourage pt to report all prescriptions and OTC drugs to provider on each visit -Educate pt on purpose of each drug
98
Absorption in Older Adults
-Slower Due To: decreased gastric motility and decreased blood flow to organs -Increase gastric pH, orals take longer to dissolve
99
Distribution in Older Adults
-Increase fat leads to more storage for lipid soluble drugs and vitamins -Plasma level decreased, lower therapeutic response -Less body water, dehydration effects more severe -Less lean body mass and water, higher concentration of water soluble drugs -Lower plasma protein binding, more free drug in blood, more risk for drug-drug interaction -Less cardiac output, slower drug distribution
100
Metabolism In Older Adults:
-Decreased enzyme production in liver, less hepatic drug metabolism -Lead to increase half life, prolong and intensify drug response -Decline in liver function, decline in first-pass effect -
101
Excretion in Older Adults
-Decreased kidney function -Decreased excretion of drugs by kidneys -Higher potential of toxicity of drug -May need to adjust dosage and timing to reduce risk of toxicity

305 (2 decks)

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