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1
Q

metoclopramide: indications

A

control of nausea and vomiting (secondary to chemo, radiation, opioids, labour, infectious diseases and other known causes)

diabetic gastroparesis,

GORD

adjunct for gastrointestinal radiological examinations

parenteral metoclopramide may be used to facilitate small-intestinal intubation

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2
Q

metoclopramide: adverse reactions

A

restlessness, anxiety, drowsiness, fatigue

diarrhoea, nausea,

extrapyramidal (parkinsonism) effects, tardive dyskinesia

rare but life threatening: agranulocytosis, neutropenia, seizures, suicidal ideation

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3
Q

metoclopramide: routes of administration

A

PO, IM, IV

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4
Q

metoclopramide: nursing care considerations

A

use cautiously in patients with history of depression, Parkinson’s, hypertension

patient should avoid activities which require alertness for 2hrs

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5
Q

diazepam: indications for use

A

ANXIOLYTIC/SEDATIVE

anxiety (short term use only)

insomnia

preoperative sedation

acute alcohol withdrawal/ withdrawal from benzodiazepines

before endoscopic procedures

muscle spasms/spasticity

febrile seizures and epilepsy
and several more

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6
Q

diazepam: adverse reactions

A

CNS depression, dependence, neuro dysfunction

drowsiness, fatigue, dizziness, muscle weakness

less common: disturbances of memory, gastrointestinal tract (GIT) function, genitourinary functions, and vision and skin reactions.

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7
Q

diazepam: routes of administration

A

oral - tablets or elixir, IM, IV, rectal tubes (for seizures)

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8
Q

diazepam: nursing care considerations

A

possibility of addiction and abuse/prescribe for short periods only

contras: COAD, severe respiratory or liver disease, sleep apnoea, substance dependence, hypersensitivity to benzodiazepines

use with caution: glaucoma, impaired liver/renal function, depression or psychosis, elderly or very young, pregnancy and lactating

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9
Q

What is phlebitis and what are the three types of phlebitis?

A

inflammation of a vein

mechanical - movement of cannula within vein causes friction

chemical - caused by the drug or fluid being infused (for example, antibiotics are reported to increase the
incidence of chemical phlebitis due to
their low pH)

infective - caused by the introduction of bacteria into the vein

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10
Q

What are the key considerations when choosing a site for an intra-muscular injection?

A

determine that the site is free of pain, infection, necrosis, bruising, and abrasions. Also consider the location of underlying bones, nerves, and blood vessels and the volume of medication you will administer

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11
Q

What are the anatomical landmarks for IM injection into the deltoid?

A

Feel for the bone (acromion process) that’s located at the top of the upper arm. The correct area to give the injection is two finger widths below the acromion process. At the bottom of the two fingers, will be an upside-down triangle. Give the injection in the center of the triangle.

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12
Q

What are the advantages and disadvantages of each of subcutaneous drug administration?

A

blood supply to SC tissue is poor, so absorption is relatively slow (SR of drug, for example insulin) client may experience some pain as subcutaneous tissue contains nerve endings

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13
Q

What are the nursing responsibilities associated with a patient’s cannula?

A 
recording notes on IV intervention
maintaining fluid balance chart
changing dressing as necessary
assisting patient to ambulate if needed, assisting patient to change clothes when needed
assess for patency etc
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14
Q

What are the advantages and disadvantages of intravenous drug administration?

A

avoids process of absorption, which results in fast action
good when medication is irritating to tissue
rapid dilution of extremely irritant medicines in bloodstream
because of rapidity of effect, potential adverse effects pose a higher risk

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15
Q

What are the advantages and disadvantages of intramuscular drug administration?

A

muscles highly vascular so quite rapid absorption
large site so large volumes can be injected (deltoid not so much)
good for medications that are irritating/painful
risk of damage to nerve (especially dorsogluteal site)

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16
Q

How much fluid may be injected into the deltoid?

A

1 ml or less of clear, non-irritating solutions

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17
Q

Whaat does ISBAR stand for?

A

Identify, Situation, Background, Assessment, Recommendation

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18
Q

What is a Peripheral Intravenous Cannula?

A

a device that is designed to be
inserted into and remain within a peripheral vein (excludes peripherally
inserted central line catheters)

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19
Q

When do you assess the patency of an IV cannula?

A

each time it is accessed for use
at least once every shift
any time a patient is transferred between wards or departments

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20
Q

Aside from patency, what other assessments are involved when caring for a patient with an IV
cannula? (6)

A 
erythema
tenderness
pain
swelling
dressing integrity
PIVC position
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21
Q

How long does an IV cannula remain insitu?

A

no more than 72 hours, unless there is no sign of infection and either replacement is likely to be difficult or it’s likely to be needed for no more than 24 hours more

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22
Q

what are the four essential elements of valid consent?

A

it must be voluntary, specific, informed, and the person must have legal capacity

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23
Q

what is measured in a FBC or CBC and diff?

A 
RBC count 
haemoglobin
haematocrit (PCV)
blood smear
platelet count
mean platelet volume
red blood cell indices
WBC count
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24
Q

what are the two different classifications of WBCs?

A

granulocytes - neutrophils, basophils and eosinophils

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25
Q

resp rate: normal range

A

12 - 20

(adult)

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26
Q

pulse rate: normal range

A

60 - 100 (adult)

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27
Q

body temp (tympanic): normal range

A

35.5 - 37.5 (adult)

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28
Q

define risk? (MH)

A

risk is the likelihood of an adverse event or outcome

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29
Q

define risk factors

A

the particular features of illness, behaviour or circumstances that alone or in combination lead to an increased risk

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30
Q

define risk assessment

A

an estimation of the likelihood of particular adverse events occurring under particular circumstances within a specified period of time

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31
Q

define affinity

A

the extent of binding of a drug to a receptor

how well the drug fits into the receptor

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32
Q

define specificity and selectivity

A

The specificity of a drug describes the number of effects the drug produces, while selectivity describes the number of molecular targets the drug interacts with.

An ideal drug would interact with a single molecular target, at a single site, and cause only one effect. Such a drug would be described as having complete specificity; unfortunately, no drugs can lay claim to that title. Most drugs show some degree of selectivity – that is, a preference for a molecular target – but may lack specificity either because they act on more than one molecular target or because they act on a molecular target that is located in multiple organs or tissues throughout the body.

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33
Q

define efficacy

A

the ability of a drug to produce an effect once it is bound to the molecular target.

The maximal efficacy of a drug is the maximum response a drug can produce.

The clinical effectiveness of a drug depends on its efficacy, not on its potency.

important: only an agonist has efficacy - an antagonist has affinity but not efficacy

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34
Q

define potency

A

the relative amount of a drug that has to be present to produce a desired effect

the more potent the drug, the lower the dose required to acheive effect (ie fentanyl is much more potent than oxycodone)

important - efficacy and potency are not the same thing

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35
Q

what are the four aspects of pharmacokinetics?

A

absorption, distribution, metabolism, excretion

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36
Q

what factors influence the absorption of drugs?

A
  1. surface area of absorbing site
  2. blood circulation to site of administration
  3. drug solubility - (lipids and lipid soluble absorbs faster)
  4. ionisation, which is determined by pH of the environment (acid drugs absorb well in acid environment; basic drugs in basic)
  5. size of the molecule of the drug (smaller is faster)
  6. formulation eg, SR, enteric coating
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37
Q

how are most drugs absorbed in the body?

A

simple diffusion

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38
Q

how do almost all drugs work, with the exception of many chemotherapy drugs?

A

by binding to proteins, which are known as molecular targets or sites of action

many chemo drugs are the exception because the bind to DNA, which is not a protein

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39
Q

what are the four main types of molecular drug targets?

A

transporters eg SSRIs

ion channels eg calcium channel blockers

enzymes eg ACE inhibitors

receptors - largest and most diverse type of molecular drug target eg morphine and other opiates work on opioid receptors

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40
Q

what factors influence the magnitude of a pharmacological effect of a drug?

A

the nature of the interaction with the target

the affinity of the drug for the target

the concentration of a drug at the site of action

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41
Q

what factors influence the concentration of a drug at the site of action?

A

the absorption, distribution, metabolism and excretion of the drug (ie pharmacokinetics)

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42
Q

what is the interaction of a drug with a enzyme called?

A

inhibition (the drugs are ‘enzyme inhibitors’)

43
Q

what is the interaction of a drug with a transporter called?

A

inhibition (e.g. citalopram is a serotonin reuptake transporter inhibitor)

44
Q

what is the interaction of a drug with a ion channel called?

A

blocking (e.g. verapamil is a calcium channel blocker)

45
Q

what is the interaction of a drug with a receptor called?

A

either agonism or antagonism

46
Q

define agonist

A

An agonist binds to the receptor (governed by affinity), and activates the receptor (governed by efficacy) to produce the same response as the endogenous ligand.

47
Q

define partial agonist

A

Partial agonists produce less than the maximal effect caused by the endogenous ligand even when all receptors are occupied.

48
Q

define antagonist

A

An antagonist binds to a receptor and blocks access of the endogenous ligand, thus diminishing the normal response.

49
Q

what is one of the few examples of an drug that acts on an enzyme and doesn’t inhibit it?

A

metformin

50
Q

which neurotransmitters are implicated in the development of mental illness?

A 
acetylcholine
noradrenaline
dopamine
seratonin
GABA
51
Q

define akathisia

A

restlessness where the person cannot stay still

52
Q

anosognosia

A

lack of insight

53
Q

antipsychotic medication

A

medication prescribed to reduce psychotic symptoms

54
Q

ataxia

A

lack of voluntary muscle movement

55
Q

atypical antipsychotic medication

A

the newer, second generation of antipsychotic medication

56
Q

cogwheeling rigidity

A

type of rigidity seen in parkinsonism whereby the muscles respond with cogwheel-like jerks to the application of constant force in attempting to bend the limb

57
Q

dystonia

A

state of abnormal muscle tone

58
Q

extrapyramidal side effects

A

drug-induced movement disorders

59
Q

half-life

A

the time until the serum level of a drug is reduced by half

60
Q

iatrogenic

A

an effect caused by medication or by health personnel

61
Q

Parkinson’s syndrome

A

imbalance between dopamine and acetylcholine, resulting in involuntary movements, reduced movements, rigidity and abnormal walking and posture

62
Q

polypharmacy

A

use of multiple medications simultaneously

63
Q

serotonin syndrome

A

a potentially life-threatening syndrome caused by excessive brain cell activity as a result of high levels of serotonin

64
Q

tardive dyskinesia

A

involuntary movements of the tongue, lips, face, trunk and extremities caused by a dopamine receptor blocking agent

65
Q

typical antipsychotic medication

A

traditional type of antipsychotic medication

66
Q

how do psychotropic medications produce their therapeutic action?

A

by altering communication among the neurons in the CNS

in particular by altering the way NTs work at the synapse:
- modifying the reuptake of NTs into presynaptic neuron

  • activating or inhibiting postsynaptic receptors
  • inhibiting enzyme activity
67
Q

what are the five types of psychotropic medications?

A

anti-anxiety (anxiolytic) medications

antidepressant medications

mood-stabilising (antimania) medications

antipsychotic medications

sedative-hypnotic medications

68
Q

what are the domains of risk?

A 
risk of harm to others 
risk to self
risk from others (ie exploitation)
risk of treatment not-compliance or absconding
risk of substance abuse
69
Q

describe some times when a risk assessment should be conducted

A

at first contact with a service

a change in or transfer of care

a change in legal status (MHA or criminal charges)

expressions of concern from family/caregivers/community

discharge

occurrence of a significant life event

significant change in mental state

70
Q

benzodiazepines - mechanism of action

A

thought to potentiate the inhibitory effect of GABA in the CNS

71
Q

what are the two groups of anti-anxiety meds?

A

benzodiazepines

non-benzodiazepines

  • azapirones
  • beta-adrenergic blockers
72
Q

what are antidepressant meds used to treat besides depression?

A

anxiety disorders such as panic disorder and OCD

73
Q

types of antidepressants

A

SSRIs
SNRIs
tricyclics
MAOIs (monoamine oxidase inhibitors)

74
Q

what is the primary survey approach?

A 
Airways
Breathing
Circulation
Disability
Exposure
75
Q

what is assessed under E in an A-E assessment?

A

Exposure:

body temperature

skin integrity

signs of pressure injury

wounds, dressings or drains, invasive lines

ability to transfer and mobilise

bowel movements

76
Q

what is assessed under D in an A-E assessment?

A

Disability:

level of consciousness
speech
pain

77
Q

what is assessed under C in an A-E assessment?

A

Circulation:

pulse rate and rhythm

blood pressure

urine output

78
Q

what is assessed under B in an A-E assessment?

A

Breathing:

respiratory rate

work of breathing

oxygen saturation

79
Q

what is another name for chronic pain?

A

persistent pain

80
Q

what are nerve receptors of pain called?

A

nociceptors

81
Q

where are pain impulses perceived, described, localised and interpreted?

A

in the thalamus and cerebral cortex

82
Q

where are emotional and cognitive responses to pain integrated?

A

in the reticular formation and limbic systems

83
Q

what is the ‘analgesia system’?

A

a group of midbrain neurons that transmits impulses to the pons and medulla, which in turn stimulate a pain inhibitory centre in the dorsal horns of the spinal cord

exact mechanism unknown

84
Q

what are endorphins?

what triggers their release?

A

(ENDogenous mORPHINes)

naturally occurring opioid peptides in brain, spinal cord and GIT

released in response to afferent noxious stimuli (in brain) or in response to efferent impulses (in spinal cord)

bind with opiate receptors on neurons to inhibit pain impulse transmission

85
Q

define acute pain

A

less than three months

has identified cause

usually immediate onset, usually from tissue injury from trauma, injury or inflammation

86
Q

what are the three major types of acute pain?

A

somatic pain

visceral pain

referred pain

87
Q

what is somatic pain?

A

arises from nociceptors in skin/close to body’s surface

can be sharp and localised or dull and diffuse

often accompanied by nausea and vomiting

88
Q

what is referred pain?

A

pain perceived in area distant from site of stimuli

commonly occurs with visceral pain because visceral fibres synapse at the spinal cord, close to fibres innervating other subcutaneous tissue areas

89
Q

what is a dermatome?

A

a body area defined by a spinal nerve route (referred pain)

90
Q

what are some of the characteristic physical responses to acute pain

A
  1. tachycardia,
  2. rapid and shallow breathing,
  3. increased BP,
  4. dilated pupils,
  5. sweating,
  6. pallor

(autonomic stress responses)
(fight or flight)

91
Q

what is persistent (chronic) pain?

A

ongoing and prolonged pain

not always associated with an identifiable cause but often arises from an acute cause including:
post trauma
herpes zoster
acute back pain
post op surgical pain
92
Q

what are the risk factors that can help predict persistent post surgical pain?

A
  1. excruciating pain before and after surgery
  2. repeated surgeries
  3. potential for nerve injury
  4. radiation therapy
  5. neurotoxic chemotherapy
  6. mental illness (eg anxiety, depression)
93
Q

what is ‘persisten (chronic) pain syndrome’?

A

unspecific behaviours/symptoms/feelings that can occur within cycle of persistent pain and disability

may include physical deconditioning, drug tolerance, reduced activity, distorted beliefs, social stresses such as financial hardship, anger, hopelessness and more

94
Q

approx. what percentage of australians suffer from persistent pain?

A

17 - 20%

95
Q

what is breakthrough pain?

A

pain occurring between doses of analgesia

96
Q

how can breakthrough pain be prevented?

A

by giving breakthrough analgesia more frequently

or by increasing the dose of the analgesia

or by increasing the SR/continuous release medication

97
Q

what is incident pain?

A

pain occurring when procedures, dressings or activity increase the pain experience

98
Q

what is cancer pain?

A

a common condition of clients with advanced cancer

often persistent, with acute features also

arising from a number of factors ie. disease process + prescribed treatment + co-morbidities

often a mixture of nociceptive and neuropathic

99
Q

problems with IM pethidine, which used to be one of the most commonly given post-op analgesic

A
  1. late onset respiratory depression
  2. painful to give
  3. can irritate tissues and cause tissue abscess
  4. short acting
  5. can cause seizures

(the first three common to IM morphine also)

pethidine not usually recommended for post-op pain anymore

100
Q

non-pharmacological stategies for managing pain

A
  1. knowledge and information
  2. relaxation (guided imagery, deep breathing,
    progressive muscle
  3. distraction
  4. biofeedback
  5. hypnosis
  6. massage
  7. physio
  8. TENS
  9. heat and cold therapy
  10. acupunture
101
Q

what are simple analgesics?

A

such as paracetamol (analgesic and antipyretic)

102
Q

what percentage of the average healthy adult’s weight is water and electrolytes?

A

60% male

55% female

103
Q

what are the fluid compartments in the body?

A 
intracellular fluid (2/3 of total)
extracellular fluid (1/3 of total)

nursing cards (13 decks)

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