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.
Why does DKA and HHNS occur?
with DKA the body id unable to use the glucose b/ insulin is not available to drive it into the cells.
HHNS occurs when blood glucose is extremely high and insulin is needed to lower the amt in the blood and promote uptake in the cells.
Which drugs mask signs of hypoglycemia?
Beta blockers.
When given with insulin, will make pt more hypoglycemic.
Which drugs cancel out action of insulin?
thiazide diuretics and glucocorticoids b/c they raise blood glucose.
What is timolol (Timoptic) prescribed for? What should RN tell pt about drug?
reduce Intraocular pressure by decreasing aqueous humor. This fluid is draining slower than normal so pressure builds up, and prod needs to slow down.
Stinging sensation with eye drops is normal.
But report blurred vision, sensitivity to light, dry eyes or conjunctivitis.
If DM pt, it can mask signs of hypoglycemia, monitor BS! B/c beta 1 & 2 blocker, heart and lungs can be affected.
What is hydrochlorothiazide (methyldopa) given for? What are the s/e?
Tx primary HTN.
Decreases HR, CO and BP.
Drowsiness, sedation, dry mouth temporarily, with continued use sedation will subside but activities require alertness should no be performed until then
MUST GRADUALLY D/C B/C REBOUND HTN CAN OCCUR.
What does verapamil (Calan) treat? How does it work?
Tx HTN and It is an antidysrhythmic, calcium-channel blocker. Causes vasodilation in periphery arterioles and heart arteries/arterioles. Decreases force of contraction due to blockge of Ca channels in SA node, AV node and heart; hR decreases and slows conduction thru the AV node. Depresses depolarization and decrease O2 demand of the heart.
Adv s/e: orthstatic hypotension and constipation
What is alteplase (tPA) for? Major adv effect?
thrombolytic, breaks up clots already present in the body. DOES NOT PREVENT CLOTS.
Given only IV w/in 3h of onset of symptoms.
Tx acute MI, massive pulmonary emboli and acute ischemic stroke.
What is sumatriptan (imitrex) used for? What are the contraindications for use?
Migraines, given AFTER PRODROMAL SYMPTOMS, not prophylaxis, It is a serotonin receptor agonist that prevents inflammation and vasodilation in the intracranial vessels.
liver failure, ischemic heart dz, hx of MI, uncontrolled HTN, and other heart dz.
What is adenosine given for? How is it adminstered?
SVT. Given IV bolus, and flushed with saline.
Short half life so s/e last less than 1 min.
- -Bradycardia: decreased conduction thru AV node
- -SOB: bronchoconstriction
- -Flushing: vasodilation
- -low BP
