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course work Flashcards

1
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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2
Q

How much fluid may be injected into the deltoid?

A

1 ml or less of clear, non-irritating solutions

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3
Q

Whaat does ISBAR stand for?

A

Identify, Situation, Background, Assessment, Recommendation

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4
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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5
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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6
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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7
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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8
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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9
Q

what are the two different classifications of WBCs?

A

granulocytes - neutrophils, basophils and eosinophils

non-granulocytes

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10
Q

resp rate: normal range

A

12 - 20

(adult)

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11
Q

pulse rate: normal range

A

60 - 100 (adult)

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12
Q

body temp (tympanic): normal range

A

35.5 - 37.5 (adult)

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13
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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14
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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15
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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16
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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17
Q

what are the four aspects of pharmacokinetics?

A

absorption, distribution, metabolism, excretion

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18
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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19
Q

how are most drugs absorbed in the body?

A

simple diffusion

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20
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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21
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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22
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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23
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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24
Q

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

A

inhibition (the drugs are ‘enzyme inhibitors’)

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25
Q

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

A

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

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26
Q

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

A

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

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27
Q

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

A

either agonism or antagonism

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28
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.

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29
Q

define partial agonist

A

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

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30
Q

define antagonist

A

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

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31
Q

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

A

metformin

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32
Q

which neurotransmitters are implicated in the development of mental illness?

A 
acetylcholine
noradrenaline
dopamine
seratonin
GABA
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33
Q

define akathisia

A

restlessness where the person cannot stay still

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34
Q

anosognosia

A

lack of insight

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35
Q

antipsychotic medication

A

medication prescribed to reduce psychotic symptoms

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36
Q

ataxia

A

lack of voluntary muscle movement

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37
Q

atypical antipsychotic medication

A

the newer, second generation of antipsychotic medication

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38
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

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39
Q

dystonia

A

state of abnormal muscle tone

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40
Q

extrapyramidal side effects

A

drug-induced movement disorders

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41
Q

half-life

A

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

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42
Q

iatrogenic

A

an effect caused by medication or by health personnel

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43
Q

Parkinson’s syndrome

A

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

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44
Q

polypharmacy

A

use of multiple medications simultaneously

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45
Q

serotonin syndrome

A

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

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46
Q

tardive dyskinesia

A

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

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47
Q

typical antipsychotic medication

A

traditional type of antipsychotic medication

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48
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
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49
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

50
Q

benzodiazepines - mechanism of action

A

thought to potentiate the inhibitory effect of GABA in the CNS

51
Q

what are the two groups of anti-anxiety meds?

A

benzodiazepines

non-benzodiazepines

  • azapirones
  • beta-adrenergic blockers
52
Q

what are antidepressant meds used to treat besides depression?

A

anxiety disorders such as panic disorder and OCD

53
Q

types of antidepressants

A

SSRIs
SNRIs
tricyclics
MAOIs (monoamine oxidase inhibitors)

54
Q

what is the primary survey approach?

A 
Airways
Breathing
Circulation
Disability
Exposure
55
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

56
Q

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

A

Disability:

level of consciousness
speech
pain

57
Q

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

A

Circulation:

pulse rate and rhythm

blood pressure

urine output

58
Q

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

A

Breathing:

respiratory rate

work of breathing

oxygen saturation

59
Q

what is another name for chronic pain?

A

persistent pain

60
Q

what are nerve receptors of pain called?

A

nociceptors

61
Q

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

A

in the thalamus and cerebral cortex

62
Q

where are emotional and cognitive responses to pain integrated?

A

in the reticular formation and limbic systems

63
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

64
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

65
Q

define acute pain

A

less than three months

has identified cause

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

66
Q

what are the three major types of acute pain?

A

somatic pain

visceral pain

referred pain

67
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

68
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

69
Q

what is a dermatome?

A

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

70
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)

71
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
72
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)
73
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

74
Q

approx. what percentage of australians suffer from persistent pain?

A

17 - 20%

75
Q

what is breakthrough pain?

A

pain occurring between doses of analgesia

76
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

77
Q

what is incident pain?

A

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

78
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

79
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

80
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
81
Q

what are simple analgesics?

A

such as paracetamol (analgesic and antipyretic)

82
Q

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

A

60% male

55% female

83
Q

what are the fluid compartments in the body?

A 
intracellular fluid (2/3 of total)
extracellular fluid (1/3 of total)
84
Q

what’s the difference between bactericidal and bacteriostatic?

A

one actually kills bacteria, the other slows there growth enough to render them harmless

85
Q

which antibiotics will need drug plasma concentrations monitored?

A

gentamicin, tobramycin, vancomycin

86
Q

what were the first broad spectrum antibiotics developed?

A

tetracyclines

87
Q

what is ototoxicity?

A

toxicity to the ear - the cochlea, the auditory nerve and sometimes the vestibular system

88
Q

What types of anaesthetics are there?

A 
general
nerve block - spinal or epidural
regional
local infiltration
sedation/analgesia
89
Q

how do diuretics work?

A

modify kidney function to cause increased diuresis and increased natriuresis

90
Q

onset of action for thiazide diuretics?

A

about 12 hours

91
Q

how do thiazide diuretics work?

A

inhibit reabsorption of sodium and water, and promote the excretion of electrolytes

92
Q

how potent are thiazide diuretics?

A

how potent are thiazide diuretics?

93
Q

what do thiazide diuretics promote the reabsorption of?

A

urea, leading to increased uric acid. can lead to gout.

94
Q

what are thiazide diuretics indicated for?

A

oedema, HTN

95
Q

which diuretics are commonly used in conjunction?

A

thiazides and potassium-sparing diuretics

96
Q

what are potassium-sparing diuretics commonly indicated for?

A
  • Diuretic induced hypokalaemia
  • Treatment of oedema related to heart failure
  • Hepatic cirrhosis
97
Q

example of a potassium-sparing diuretic?

A

spironolactone (Aldactone)

98
Q

which diuretic doesn’t interfere with sodium and cholride transport?

A

spironolactone

99
Q

how do osmotic diuretics work?

A

they add to solutes already present, increasing the osmolality of the filtrate in the nephrons

100
Q

indications for osmotic diuretics?

A

cerebral oedema
to educe intraocular pressure
acute closed angle glaucoma

101
Q

examples of osmotic diuretics?

A

mannitol

acetazolamide

102
Q

nursing care considerations for diuretics - what should be monitored?

A

fluid input and output
blood pressure
blood serum levels
BGLs

103
Q

nursing care considerations for diuretics - patient education points

A

education: avoid sudden posture changes
take in the morning
use sunscreen

104
Q

other nursing care considerations for diuretics

A

ensure patients have access to toileting
if IDC is present, ensure it’s patent etc
monitor for dehydration

105
Q

electrolytes: role of sodium?

A

nerve transmission, muscle contraction, maintains normal

concentration of ECF

106
Q

electrolytes: role of chloride?

A

acid/base balance, nerve transmission

107
Q

electrolytes: role of potassium?

A

nerve transmission, muscle contraction, normal heart rhythms, concentration of ICF

108
Q

electrolytes: role of calcium?

A

nerve transmission, muscle contraction, strong bones and teeth, blood clotting, enzyme reactions

109
Q

electrolytes: role of magnesium?

A

enzyme reactions; cardiac and respiratory function

110
Q

how is excess glucose stored?

A

converted to glycogen and stored in the liver and muscles or converted into fat and stored in adipose tissue

111
Q

what is cholesterol used for in the body?

A

cell membranes, steroid hormones, bile

112
Q

what is nitrogen balance?

A 
when nitrogen (protein) intake is equal to nitrogen (protein) output. no nitrogen, no amino acids.
it's widely considered to be the primary goal of nutritional support, and is closely associated with improved patient outcomes.
113
Q

what is nitrogen essential for?

A

wound healing; growth, repair and maintenance of tissues

114
Q

what BMIs mean:

A

BMI < 18.5 - underweight
BMI > 25 overweight
BMI > 30 obese
BMI > 40 morbidly obese

115
Q

what are the two types of nutritional support (feeding) if you can’t eat?

A

enteral - NG tube, gastrostomy (PEG), jejunostomy tube

parental - via veins

116
Q

signs and symptoms of fluid overload?

A 
full, bounding pulse
distended jugular veins
high BP
oedema
pulmonary oedema
117
Q

another name for Hartmann’s?

A

CSL (compound sodium lactate)

118
Q

IDEAL discharge

A

Include – patient and family (with consent)
Discuss–home, medications, problems, warning signs, follow-up appointments
Educate – patient’s condition in plain language
Assess – how well education from doctors and nurses has been received
Listen – and respect patient’s goals, preferences, concerns

119
Q

about how long till wound has healed enough to remove staples?

A

1 week

120
Q

how long til primary intention wound achieves 90% strength?

A

about 3 weeks

121
Q

what assessments should a nurse be performing post-op?

A 
ABCDE (primary assessment) 
FGH (secondary assessment) 
F is for fluids/full set of vital signs
G is for glucose/give comfort
H is for head to toe assessment
122
Q

what is shock?

A

a condition of circulatory impairment leading to inadequate vital organ perfusion and oxygen delivery relative to the individual’s metabolic needs

general studies (6 decks)

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