Asess 3 Flashcards
How should the nurse respond to an injection to relieve pain?
Anesthetic creams, sprays, suppositories can be rubbed on the skin before an injection
How should the nurse best respond to apply a local anesthetic?
rubbed on the skin before an injection
What type of local anesthetic are anesthetic creams?
locals and lidocaine
What is a prototype drug for topical anesthesia?
lidocaine aka Xylocaine
What essential information should the nurse include in the medication instruction to apply topical lidocaine? (4)
- Apply a thin layer on small areas of skin
- I must wear gloves when I apply the lotion
- Do not allow it to come into contact with the eyes.
- Wash hands after use/before touching eyes
Why should topical lidocaine not be applied to large areas?
there can be significant absoption
Which priority lab result should the nurse assess for Direct-acting antispasmodics?
Assess aspartate aminotransferase (AST) and alanine aminotransferase (ALT)
What are some adverse affects of Direct-acting antispasmodics?
Hepatitis
hepatitic toxicity/necrosis
What is the MOA of Direct-acting antispasmodics?
interferes with release of calcium ions in skeletal muscle to relieve dystonias and leg cramps
What information should the nurse include in the teaching plan for the pharmacokinetics of Dantrolene Sodium?
Onset is 1-2h , Peak is 5 hours, and duration is variable
What priority assessment question should the nurse ask the client prior to administration of an Dantrolene Sodium (Dantrium)?
Assess for pregnancy/lactation prior to administration
What information should the nurse include in the teaching plan for Cyclobenzaprine taking?
Increase the intake of fiber while taking this medication because it causes constipation
What priority assessment should the nurse complete prior to administering cyclobenzaprine? Why?
How old are you, because those older than 65 can experience confusion, hallucinations, and adverse cardiac events from the drug
and younger patients
Which assessment finding should the nurse instruct the client to report immediately when taking Cyclobenzaprine?
Experience confusion, hallucinations, and adverse cardiac events from the drug
What information should the nurse include in the teaching plan for Osteoporosis nonpharmacologic interventions?
avoid drinking alcohol
exercise 3-5 times/wk
Walk every day for 30 minutes
drink milk regularly
What types of exercise are effective for osteoporosis?
weight-bearing
walking for 30 minutes/day
What information should the nurse include in the teaching plan for calcium supplement therapy?
Take calcium supplement and vitamin D
Avoid alcohol
Take with meals
What priority physical assessment should the nurse complete prior to administering this calcium supplement therapy? (3)
Assess IV site for extravasation
Look for necrosis of the tissue
What teaching should the nurse include in the plan of care for Vitamin D therapy?(2)
Spending 20 mins/day in the sunlight on most days provides all the Vitamin D required
What physical priority assessment question should the nurse ask the client prior to administration of Bisphosphonates for Osteoporosis?
Muscle spasms and facial twitching
What does Muscle spasms and facial twitching when taking bisphosphonates mean in terms of electrolytes?
low calcium levels
What essential information should the nurse include in how to take Alendronate (Fosamax) instruction?
Remain in an upright position for at least 30 minutes after a dose and until after the first food of the day to reduce esophageal irritation.
What information should the nurse include in the teaching plan for Alendronate swallowing? (3)
All doses must be taken on an empty stomach, preferably in a fasting state 2 hours before breakfast
With a full glass of water to ensure absorption
Do not lie down for at least 30 minutes after taking the medication.”
Which priority lab result should the nurse assess for Alendronate administration?
Perform a bone density scan (test)
During and after treatment – to determine effectiveness of the medication
What teaching should the nurse include in the plan of care for Alendronate in regards to Vitamin D?
Spend 15-20 minutes in the sun on most days
Vitamin D is supported by sun exposure
Provides all the Vitamin D required
- What priority outcome should the nurse expect the client to report about Alendronate (Fosamax)?
report heartburn and esophagitis to provider
What priority assessment should the nurse complete prior to and after administering Alendronate?
Assess for new onset thigh or groin pain
atypical fracture
Which finding should the nurse instruct the client to report immediately for Alendronate ADR’s?
thigh or groin pain
What teaching should the nurse include in the plan of care for Acetaminophen and other OTCs?
Teach parents to read medication labels including OTC medications
Why is it important to teach parents to read medication labels including OTC medications?
avoid toxicity
What information should the nurse include in the teaching plan of contraindications for NSAIDs?
thrombotic events, MI, and stroke, which can be fatal.
Which finding should the nurse instruct the client to report immediately for NSAIDs?
Ask patient to report any bleeding while on this medication
What Black Box warning is on NSAIDs
can increase risk of serious thrombotic events, MI, and stroke and bleeding
What information should the nurse include in the teaching plan for pregnancy and fetuses for NSAIDs?
Cause adverse effects on a pregnant woman’s fetus
Premature closure of the ductus arteriosus in the fetus
Do not give during the third trimester of pregnancy
What priority assessment question should the nurse ask the client prior to administration of an Aspirin?
Are you or could you possibly be pregnant?
Cause adverse effects on a pregnant woman’s fetus
Premature closure of the ductus arteriosus in the fetus
Do not give during the third trimester of pregnancy
What questions/ actions should the nurse plan to include in the nursing management for clients with pain? (4)
- Would you please rate your pain on a scale of 1 to 10?
- Listen carefully to the patient’s comments about pain.
- Show respect for the patient’s preferences about pain.
- Ask questions about the patient’s beliefs and customs regarding pain management.
Which statement by the client should the nurse recognize that the client is experiencing a side effect to the Morphine?
I feel like I am going to throw up- nausea and vomiting
Which client should the nurse recognize as being at highest risk for developing side ADR for morphine?
patients with sickle cell anemia
Which client should the nurse recognize as being at highest risk for developing ADR for Acetaminophen?
African-Americans
because many with higher rates of G6PD enzyme deficiency.
Which priority lab result should the nurse assess for Acetaminophen overdose?
G6PD enzyme deficiency
What is the overdose treatment for Acetaminophen?
N-acetylcysteine (Acetadote), which protects the liver from toxic metabolites
What teaching should the nurse include in the plan of care for NSAIDs and it’s therapeutic class?
anti-inflammatory drug, antipyretic Analgesic and It may take several weeks to achieve therapeutic effect
Which statements by the client should the nurse evaluate as a good understanding of the duration of NSAIDs to be effective?
It may take several weeks to achieve therapeutic effect
What are some types of neuropathic pain?
carpal tunnel
degenerative disk
diabetic retinopathy
intractable cancer
phantom limb
postsurgical
sciatica
What receptors do morphine bind to?
mu and kappa
Why are sickle cell anemia patients at risk for mophine overdose?
because they are always in a lot of pain and they have emergencies with O2
Whay are morphines contraindicated for those with head injuries?
it can increase intercranial pressure and mean arterial pressure
it can mask ALOC
What are four actions of NSAIDS?
Analgesic
Antipyretic
Antiinflammatory
Antiplatelet
what is the difference between COX-1 and COX-2?
COX-1
protects stomach lining
decreases fever
promotes platelet aggregation
Why should patients take aspirin with food or milk?
to decrease GI irritation because COX-1, which protects stomach lining, is inhibited with aspirin
Why should aspirin not be given to people with H. pylori?
it can increase the risk of stomack ulcers
What assessment question should a pregnant person on aspirin be asked?
how far along are you? no third trimester because it can kill the fetus
What does acetaminophen inhibit?
inhibits warfarin metabolism
What are contraindications to Tylenol?
hypersensitivity
phenacetin
chronic alcoholism
what is the difference between spinal and epidural injections?
spinal takes away both spinal and movement and injected into the CSF
epidural- movement is still intact
What does General Anesthetics produce?
unconsciousness
lack of responsiveness to painful stimuli
given as inhalation or IV
What do you monitor after giving general anesthetic before eating?
assess for gag reflex before giving the patient anything to eat or drink to reduce risk for aspiration
Why is exercise important to corticosteroids?
long term use can lead to osteoporosis
What is acute gout triggered by?
alcohol, aspirin, dehydration, injury, other stress
what can organ damage cause?
skin blisters, raw mucus membranes
rashes
organ failure and then death
What are some assessments for the patient for muscle relaxants?
withdrawal syndrome
muscle tone, range of motion, degree of muscle spasm
side effects
c/p dysfunction
alcoholism
Why will calcium supplement therapy cause extravasation?
it is a vescicant and can cause skin irritation
What drug tpes might lower the Ca levels in the blood?
corticosteroids
anticonvulsants
immunosuppressants
What are some S/S of hypercalcemia?
drowsiness, lethargy, weakness
headache
anorexia
n/v
thirst and increased peeing
What is a prototype drug for vitamin D?
calcitrol
What is the prototype drug for Bisphosphonate?
alendronate (Fosamax)
Why should a patient taking alendronate not lay down after taking the medication?
it can cause esophageal irritation
