Capstone post assessments (ML) Flashcards
Considerations when setting up sterile field
Grasp along 1 in border before putting on sterile gloves and place where needed first. Add items 6in above. Contamination can occur with coughing, sneezing, or talking directly over it. Should not reach over it, turn back to field or allow contact with moisture. Anything that touches the 1in border is contaminated!!
NG-tube medication administration
Always verify placement first, aspirate contents. If there is 100ml or less, return to pt. Flush with 15-30 ml of water before and after each med. Dissolve crushed meds in 15-30mL. Tap water ok unless immunocompromised, then use distilled/sterile water.
What medications cannot be given by tube?
Extended-release, time-released, fluid-filled, have enteric coating, or to be administered sublingual.
Mechanical soft diet
regular diet, just has soft texture. Foods can be cooked, mashed, diced and ground. Veg, fruit, ground meats, juice, dairy liquids, gelatin. NO SEEDY FOODS.
Risk factors for Hyperkalemia
- -If pt is using salt substitutes, like CHF pt who need to reduce Na intake. These substitutes are high in K+.
- -Potassium-sparing diuretics
- -Decline in kidney fxn w/ older adults so excreting less
- -Shift in ECF can occur when insulin is low (insulin drives glucose and K+ into the cell), there is a state of acidosis, or tissue breakdown that may occur with sepsis, trauma, surgery, or MI
Clinical manifestations of hyperkalemia
EKG: V-fib, peaked T waves, wide QRS
VS: pulse is low, irregular, low BP
LOC: irritable, confused
Muscles: weak, lack reflexes
Neuro: tingling, prickling, burning feeling, paralysis from top to bottom
GI: high K+ increases mvmt resulting in abdominal cramping and diarrhea, hyperactive sounds
GU: minimal UO
How should vancomycin be administered? What allergy is contraindicated?
Over 60 minutes!! Any faster and red man syndrome may occur. Shows as rash, flushing, tachycardia and hypotension. Before giving a second dose, check Vano levels b/c renal toxicity is a adv s/e. DO NOT GIVE TO PT WITH ALLERGY TO CORN.
What drugs can cause ototoxicity?
hearing loss can occur w/ vancomycin, loop diuretics, and aminoglycoside antibiotics.
Indications for use of benzodiazepines
rapid tx for generalized anxiety d/o, panic d/o
Other uses: seizure d/o, insomnia, muscle spasm, ETOH w/d, induces anesthesia, given before surgery for amnesic effect
What is ibandronate (Boniva) given for? And what should pt be educated about it?
Boniva is for postmenopausal osteoporosis. It can cause esophagitis.
Should take with minimum 8oz of water while in upright position, walking for 30 min is good. Wait to eat or take other meds for 1 hr afterwards.
All bisphosphates cause GI issues: pain, N, diarrhea, constipation
What does the drug class antimetabolites treat and how?
Interfere with one or more enzymes or their reactions that are necessary for DNA synthesis. They affect DNA synthesis by acting as a substitute to the actual metabolites that would be used in the normal metabolism (for example antifolates interfere with the use of folic acid).
Antimetabolites are drugs used in cancer chemotherapy. Cancer cells divide more rapidly compared to normal cells so antimetabolites affect cancer cell replication more than they affect normal cell replication.
Which cells in the body proliferate rapidly normally?
GI tract, hair follicles, and bone marrow. That’s why they are affected by chemo drugs. Cancer cells are fast growing and the drugs act on the fast cells, so some normal cells are affected as well.
What does Fluorouracil (Adrucil) treat? Adv s/e?
Given for AML, breast or colon cancer, and superficial skin cancers.
Adv s/e: bone marrow suppression which results in low WBC, RBC, and platelets (neutropenia, anemia, thrombocytopenia) CHECK LABS! (WBC, Plt, Hgb, Hct)
What is leuprolide and it’s adv s/e?
Noncytotoxic chemo agent that inhibits production of testosterone by the testes.
Can cause hot flashes, decreased libido, gynecomastia, decreased bone density, arrhythmias, and pulmonary edema.
Pt should increase Ca/VitD and perform wt-bearing exercises. RN needs to monitor heart rhythm and breath sounds (for possible fluid build-up in lungs)
When might a type2 DM pt need to start using insulin?
When diet, exercise and oral meds do not manage it. Diabetic neuropathy occurs from high blood sugar which can cause nerve dmg so insulin would be necessary.
Or if liver and kidney fxn can not metabolize or excrete oral medications.
