305 Exam Final Flashcards
Key roles of nurse in preparing for and responding to bioterrorist attack?
Education
Resources
Diagnosis and treatment
Planning
What category of infectious agents would anthrax, botulism, smallpox, tularemia, viral hemorrhagic fevers, and plague and Ebola be in?
Category A.
(Agents easily transmitted individual to individual; cause high mortality, with potential for major public health impact. Public panic.
What category of infectious agents would salmonella, ecoli, viral encephalitis, and water safety threats be in?
Category B
(Moderate morbidity and low mortality. )
A patient is overdosing on benzodiazepines, what would the nurse expect to use?
Activated charcoal.
What individual would smallpox vaccine be contraindicated for
Pregnant patient
Early symptoms of radiation poisoning
Nausea, vomiting, diarrhea
A patient experiences a phenobarbital overdose. What would be used to induce alkaline diuresis?
Sodium bicarbonate
Atropine can treat what kind of terrorist attack threat
Nerve agent exposure
A patient seeks medical attention after a nerve agent is sprayed on the skin. What treatment can the nurse anticipate
5% liquid bleach tooically
What is the purpose of the strategic national stockpile ?
Provide a repository of medications and medical supplies for emergency use
Lead poisoning can be treated with what
Calcium disodium versenate (calcium EDTA)
What derivative of anthrax is responsible for producing inhalation anthrax ?
Anthrax spores
What is given to treat gaseous cyanogen chloride?
Milk
What is the most common cause of household poisoning
Medications
What is done with unused anthrax antitoxin doses?
Return them to the cdc
What is the antidote for acetaminophen poisoning
Acetylcysteine
After exposure to phosgene gas, the patient should be provided with what?
Fresh air.
After skin exposure to mustard-Lewis mixture, how do you treat the patient
Flush the area with copious amounts of water
Recommended dietary allowance for vitamin D per age groups
Under 1 year- 400IU
1-70 years- 600IU
Over 70 years - 800IU
Recommended dietary allowance of calcium per day for adults
800-1200 mg
PTH and Calcitonin influence what 3 targets
Bones, kidneys, gastrointestinal
Serum calcium levels exceeding 5.5mEq/L result in what
Hypercalcemia.
What is the hypocalcemia serum calcium level ? In mEq/L
Below 4.5 mEq/L
High calcium levels lead to what in the cells
Decreased sodium permeability across cell membrane. Dangerous state
Hypocalcium levels result in what in the cell
Cell membranes can become hyperexcitable and convulsions or muscle spasms occur
Calcium salts are used for what
To return serum calcium to normal levels with mild hypocalcemia.
Ex:
Osteoporosis, Paget’s disease, chronic hypothyroidism , rickets, pregnancy, lactation, rapid childhood growth
What are adverse effects of calcium salts
Hypercalcemia.
Hypotension, Bradycardia, dysrhythmias, cardiac arrest.
What is the most common metabolic bone disease
Osteoporosis
Pharmacotherapy of osteoporosis
Calcium and vitamin D therapy
Bisphosphonates
Selective estrogen receptor modulators (Serm)
Calcitonin
Miscellaneous
Osteomalacia in children is
Rickets
How to treat osteomalacia
Calcium and vitamin D supplements
Alendronate (fosamax) is used for what
It is a bisphosphonate. Used for
The prevention and treatment of osteoporosis and Paget’s disease
Raloxifene (evista) is what and used for what
Is a SERM and is used to prevent osteoporosis is post menopause women.
Calcijex, and Rocaltrol (calcitriol) is what and used for what
An active form of vitamin D
Used for impaired kidney function or hyperparathyroidism— also rickets
What are signs of Hypercalcemia
Drowsiness, lethargy, weakness, headache, anorexia, nausea, vomiting, thirst, increased urinating
What are physical assessment signs for hypocalcemia
Facial twitching, muscle spasms, parasthesias, seizures
What lab studies should the nurse monitor in regards to gout treatment
CBC, platelets
Liver and renal function studies
Uric acid levels, urinalysis
Calcium and cut D are critical for the proper functioning of which systems
Nervous
Muscular
Cardiovascular
What is the role of the nurse when treating a patient with gout
Obtain thorough health history, including current medications and vitals
Complete a physical examination
Monitor lab studies
What are Lopurin and Zyloprim (allopurinols) used for?
Uris acid inhibitors. For gout
Calcium salts are contraindicated for what patients?
Patients with ventricular fibrillation,
Metastatic bone cancer, renal calculi, or Hypercalcemia
What is is a general term referring to a cluster of disorders that have in common defects in structure of bone.
MBD
Metabolic bone disease
Major risk factors for osteoporosis
Menopause
Increased age
Fracture history
Excessive alcohol use
Caucasian or Asian race
Smoking
Low physical activity
Gonadal hormone deficiency
Drugs such as corticosteroids, some anticonvulsants, & immunosuppressants
Low calcium or vitamin d
What is osteomalacia
Softening of bones due to demineralization, mostly due to deficient vitamin D and calcium in diet
What are the standards for emergency preparedness for an organizational team
-Organizational needs during crisis
-Actions needed to get back to normal
-Efforts to coordinate resources with the community
-responding to the immediate casualties of the crisis
What are the nurses roles in emergency response
Planning,
Education,
Diagnosis,
Treatment
Category C infectious agents include
Nipah virus,
Signs and symptoms of exposure to nerve agents include
Emesis,
Urination
Salivation
Lacrimation
Defecation
Gastric disturbances
What can potassium iodine be used to prevent
Thyroid cancer
The nurse is administering calcium EDTA to a client. What lab value needs to be monitored to deter the effectiveness?
Lead
Dimercaprol (BAL in oil) is used to treat what poisonings
Heavy metals poisoning of
Gold, arsenic, and mercury
Symptoms of liquid hydrogen cyanide poisoning are
Red eyes
Flushing of skin
Nausea
Headache
Weakness
Activated charcoals benefit is greatest when administered within how long after the medication overdose?
Within 60 minutes. the effectiveness decreases with time
Common symptoms of Ipecac overdose
Diarrhea
Lethargy
Sedation
Bisphosphates and calcium supplements should be taken how close together ?
Bisphosphates are taken 30 min prior to food and 2 hours apart from the calcium supplements
How do you measure the effectiveness of the drug Fosamax ?
Bone density exam
What is the drug of choice for rheumatoid arthritis flare ups
NSAID therapy.
Corticosteroids can also be used short term
Bisphosphates are used to treat what
Paget’s disease and osteoporosis
Disease modifying antirheumatic drugs have what potential adverse effect that needs to be reported to healthcare provider if occurs?
Significant retinal changes with blurred vision, difficulty reading, photophobia, or blacked out areas of the vision field
A patient is prescribed adalimumab (Humira). What finding should case the nurse to withhold the medication?
Low WBC, as this drug has adverse effect of neutropenia and serious infections.
What needs to be assessed prior to administering the drug Denosumab (Prolia)
Serum calcium levels.
This drug can cause severe hypocalcemia
What is an unusual effect from bisphosphonate therapy?
Osteonecrosis of jaw.
-jaw pain and swelling, loose teeth, infection at lesion site.
Should be immediately reported to HCP
Bisphosphates works on Paget’s disease how?
Lowering alkaline phosphate levels. And are administered until the patients ALP levels are within normal limits.
Which condition occurs when bone loss is faster than bone gain?
Osteoporosis
When the thyroid gland release’s calcitonin, what physiological response should the nurse expect?
Decreased serum calcium level
What adverse effects can calcium salts have
Dysrhythmias, constipation, nausea. Vomiting, headaches
Patients with chronic kidney disease has a positive Chvosteks sign and a decreased serum calcium level.
What medication would be prescribed
Vitamin D
What should be monitored on a patient with CKD receiving calcitrol (Rocaltrol)
Calcium and vitamin D levels as there is a risk for Hypercalcemia
Contraindications for calcium salts
V-Fib
Metastatic bone cancer
Renal calculi
Hypercalcemia
Serum calcium of more than 11mg/dL is what
Hypercalcemia
Hypocalcemia level in mg/dL
9mg/dL
Does the amount of calcium consumed control the balance of calcium in the body?
No
Calcium is an electrolyte and excreted through kidneys
T/f
True
The parathyroid glands are regulated by a negative feedback loop that is affected by what?
activated vitamin D and increased serum calcium. They suppress PTH secretion which lowers serum calcium levels.
PTH does what to osteoclast production?
Stimulates it
Paget’s causes what
Bones to enlarge and soften
Headaches,
Facial pain
Hip and femoral pain
A client with osteoarthritis asks about increased pain with movement. What response should the nurse provide ?
Increased Bone spurs and cysts break off in joint spaces and can cause inflammation
Clients with severe malabsorption and decreased serum calcium levels may require how much vitamin D ?
50,000- 100,000 units of Vit D daily
First line treatment for rheumatoid arthritis is…
NSAIDS
Followed by DMARDs to slow damage and modify immune response.
What education would the nurse provide to a client taking bisphosphonates?
Sit upright for 30 minutes after taking medication.
Take drug on empty stomach with plain water no food
Do Weight bearing exercise 3-5 x week
Eliminate caffeinated sodas
Increase calcium rich foods
Corticosteroids can affect blood glucose level how?
They can increase them
Oxalic acid in spinach, beets, Swiss chard, and rhubarb as well as alcohol, caffeine and zinc rich foods should be avoided when taking what?
Calcium carbonate (Rolaids, tums, other)
Calcium acetate (PhosLo) needs to be taken with meals. T/f?
True
Evista (raloxifene) is a SERM used to do what
Prevent osteoporosis in post menopausal women and to reduce the risk of breast cancer at high risk
Evista (raloxifene) has what black box warning?
Increases the risk of venous thromboembolism and death from strokes.
The most frequent and serious adverse effects of the drug Zyloprim (allopurinol) used to treat gout would be what?
Micropapular rash and toxic epidermal necrolysis
How fast can you expect a push package from the SNS?
Within 12 hrs
What does vendor managed inventory from the SNS include?
Specifically targeted emergency response supplies for an identified emergency issue
Cutaneous anthrax manifests as what on a person
Skin lesions that develop black scabs
Emerging pathogens that could be engineered for mass dissemination such as Nipah virus, hantavirus, yellow fever and others are in what category of bioterrorism infectious agent
C
What does the cdc stockpile consist of
Antibiotics
Vaccines
Medical, surgical and patient support supplies
How long until a nurse can expect to receive a vender managed inventory package?
Within 24-36 hours
ciproflaxin has been used as a prophylaxis and treatment for what toxin?
Anthrax
Glaucoma that is usually unilateral, caused by stress or impact injury, or medications, and progressively develops is what kind.
Closed angle
What eye disorder is happening When IOP develops over years bilaterally with slow degeneration of optic nerve and gradual vision impairment?
Open angle glaucoma
Drugs for glaucoma
Beta blockers. -decrease aqueous humor with least adverse effects
Prostaglandin analogs (latanoptost- Xaltan). - reduce IOP with side effects of
Eye pain, burning, edema
Brinzolamide (Azopt) - lowers IOP but with systemic adverse effects. Contains sulfur (allergy reaction in some)
What are mydriatic drugs
Used to dilate pupil for assessment.
If a patient is suspected of having glaucoma should a nurse use mydriatics on them?
No. They can worsen glaucoma.
Lifitegrast (Xiidra) is what drug
Enhances Tear production
One drop BID
What medication increases the risk of developing glaucoma?
Long term Corticosteroids
Antihistamines
Antidepressants
Antihypertensives
The median IOP in population is what
15-16 mmHg
Age, daily activities, and time of day all influence IOP
T/F
True
IOP greater than what mmHg requires treatment to prevent permanent vision changes
30
Acute outflow obstruction of aqueous humors produces what symptoms?
Headache
Facial pain
Bulging Iris
Seeing colored halos around lights.
Decrease visual acuity
No reactive pupillary response
Reddened eye
Possible nausea and vomiting.
Pupil constrictions result from stimulation of what nervous system ?
Parasympathetic
The malleus, incus and stapes are responsible for what?
Transmission of sound waves to inner ear.
A client is diagnosed with open angle glaucoma. What treatment would the nurse expect
Prostaglandin analog medication
Surgical Interventions for closed angle glaucoma would be?
Iridectomy, drainage implants, laser trabeculoplasty
Mast cell stabilizers and antihistamines are prescribed to treat what?
Allergic conjunctivitis
Otitis externa is typically treated with what?
Topical analgesics
Antibiotics
And corticosteroids
Mydriatic medications do what to humor outflow
Impair the humor outflow and thereby increase IOP
Alpha2-adrenergic medication is used for what
Open angle glaucoma
Latanoprost (Xalatan) is contraindicated for what?
Pregnancy
Intraocular infection
Closed angle glaucoma
(The drug is used to treat open angle glaucoma and ocular hypertension)
How do cholinergic agonist decrease IOP?
By stretching the trabecular mesh work to allow greater outflow of aqueous humor.
Timolol (timoptic) is contraindicated for what?
Asthma
Heart failure
Sinus Bradycardia
Copd
(This drug treats hypertension and aphasia glaucoma)
A patient taking timolol states they often forget to take their medication. What would you expect the HCP to do
Change their prescription to latanoprost. (Xaltan) as it has a longer duration of action
Timolol. (Beta adrenergic blocker) has what mechanism of action ?
Decreasing the aqueous humor production by the cilary body.
Azopt should not be given to patients with what allergies
Sulfa.
What is the function of vitreous humor in the eye?
Keeps retina in place
Maintains shape of eye
What is the function of the aqueous humor in the eye
Remove wastes, supply eye with nutrients and maintains IOP
What happens if the ears semicircular canals and vestibule are disrupted?
There would be altered balance and equilibrium.
What medication decreases aqueous humor?
Timolol.
Latanoprost interacts with what preservative
Thimerosal
With closed angle glaucoma why does the IOP increase?
The Iris is pushed over the area where aqueous humor normally drains
What is the therapeutic index equation
Ld50/md50.
Higher the number -safer the drug
