course work Flashcards
What is phlebitis and what are the three types of phlebitis?
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
How much fluid may be injected into the deltoid?
1 ml or less of clear, non-irritating solutions
Whaat does ISBAR stand for?
Identify, Situation, Background, Assessment, Recommendation
When do you assess the patency of an IV cannula?
each time it is accessed for use
at least once every shift
any time a patient is transferred between wards or departments
Aside from patency, what other assessments are involved when caring for a patient with an IV
cannula? (6)
erythema tenderness pain swelling dressing integrity PIVC position
How long does an IV cannula remain insitu?
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
what are the four essential elements of valid consent?
it must be voluntary, specific, informed, and the person must have legal capacity
what is measured in a FBC or CBC and diff?
RBC count haemoglobin haematocrit (PCV) blood smear platelet count mean platelet volume red blood cell indices WBC count
what are the two different classifications of WBCs?
granulocytes - neutrophils, basophils and eosinophils
non-granulocytes
resp rate: normal range
12 - 20
(adult)
pulse rate: normal range
60 - 100 (adult)
body temp (tympanic): normal range
35.5 - 37.5 (adult)
define affinity
the extent of binding of a drug to a receptor
how well the drug fits into the receptor
define specificity and selectivity
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.
define efficacy
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
define potency
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
what are the four aspects of pharmacokinetics?
absorption, distribution, metabolism, excretion
what factors influence the absorption of drugs?
- surface area of absorbing site
- blood circulation to site of administration
- drug solubility - (lipids and lipid soluble absorbs faster)
- ionisation, which is determined by pH of the environment (acid drugs absorb well in acid environment; basic drugs in basic)
- size of the molecule of the drug (smaller is faster)
- formulation eg, SR, enteric coating
how are most drugs absorbed in the body?
simple diffusion
how do almost all drugs work, with the exception of many chemotherapy drugs?
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
what are the four main types of molecular drug targets?
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
what factors influence the magnitude of a pharmacological effect of a drug?
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
what factors influence the concentration of a drug at the site of action?
the absorption, distribution, metabolism and excretion of the drug (ie pharmacokinetics)
what is the interaction of a drug with a enzyme called?
inhibition (the drugs are ‘enzyme inhibitors’)
what is the interaction of a drug with a transporter called?
inhibition (e.g. citalopram is a serotonin reuptake transporter inhibitor)
what is the interaction of a drug with a ion channel called?
blocking (e.g. verapamil is a calcium channel blocker)
what is the interaction of a drug with a receptor called?
either agonism or antagonism
define agonist
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.
define partial agonist
Partial agonists produce less than the maximal effect caused by the endogenous ligand even when all receptors are occupied.
define antagonist
An antagonist binds to a receptor and blocks access of the endogenous ligand, thus diminishing the normal response.
what is one of the few examples of an drug that acts on an enzyme and doesn’t inhibit it?
metformin
which neurotransmitters are implicated in the development of mental illness?
acetylcholine noradrenaline dopamine seratonin GABA
define akathisia
restlessness where the person cannot stay still
anosognosia
lack of insight
antipsychotic medication
medication prescribed to reduce psychotic symptoms
ataxia
lack of voluntary muscle movement
atypical antipsychotic medication
the newer, second generation of antipsychotic medication
cogwheeling rigidity
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
dystonia
state of abnormal muscle tone
extrapyramidal side effects
drug-induced movement disorders
half-life
the time until the serum level of a drug is reduced by half
iatrogenic
an effect caused by medication or by health personnel
Parkinson’s syndrome
imbalance between dopamine and acetylcholine, resulting in involuntary movements, reduced movements, rigidity and abnormal walking and posture
polypharmacy
use of multiple medications simultaneously
serotonin syndrome
a potentially life-threatening syndrome caused by excessive brain cell activity as a result of high levels of serotonin
tardive dyskinesia
involuntary movements of the tongue, lips, face, trunk and extremities caused by a dopamine receptor blocking agent
typical antipsychotic medication
traditional type of antipsychotic medication
how do psychotropic medications produce their therapeutic action?
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
what are the five types of psychotropic medications?
anti-anxiety (anxiolytic) medications
antidepressant medications
mood-stabilising (antimania) medications
antipsychotic medications
sedative-hypnotic medications
benzodiazepines - mechanism of action
thought to potentiate the inhibitory effect of GABA in the CNS
what are the two groups of anti-anxiety meds?
benzodiazepines
non-benzodiazepines
- azapirones
- beta-adrenergic blockers
what are antidepressant meds used to treat besides depression?
anxiety disorders such as panic disorder and OCD
types of antidepressants
SSRIs
SNRIs
tricyclics
MAOIs (monoamine oxidase inhibitors)
what is the primary survey approach?
Airways Breathing Circulation Disability Exposure
what is assessed under E in an A-E assessment?
Exposure:
body temperature
skin integrity
signs of pressure injury
wounds, dressings or drains, invasive lines
ability to transfer and mobilise
bowel movements
what is assessed under D in an A-E assessment?
Disability:
level of consciousness
speech
pain
what is assessed under C in an A-E assessment?
Circulation:
pulse rate and rhythm
blood pressure
urine output
what is assessed under B in an A-E assessment?
Breathing:
respiratory rate
work of breathing
oxygen saturation
what is another name for chronic pain?
persistent pain
what are nerve receptors of pain called?
nociceptors
where are pain impulses perceived, described, localised and interpreted?
in the thalamus and cerebral cortex
where are emotional and cognitive responses to pain integrated?
in the reticular formation and limbic systems
what is the ‘analgesia system’?
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
what are endorphins?
what triggers their release?
(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
define acute pain
less than three months
has identified cause
usually immediate onset, usually from tissue injury from trauma, injury or inflammation
what are the three major types of acute pain?
somatic pain
visceral pain
referred pain
what is somatic pain?
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
what is referred pain?
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
what is a dermatome?
a body area defined by a spinal nerve route (referred pain)
what are some of the characteristic physical responses to acute pain
- tachycardia,
- rapid and shallow breathing,
- increased BP,
- dilated pupils,
- sweating,
- pallor
(autonomic stress responses)
(fight or flight)
what is persistent (chronic) pain?
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
what are the risk factors that can help predict persistent post surgical pain?
- excruciating pain before and after surgery
- repeated surgeries
- potential for nerve injury
- radiation therapy
- neurotoxic chemotherapy
- mental illness (eg anxiety, depression)
what is ‘persisten (chronic) pain syndrome’?
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
approx. what percentage of australians suffer from persistent pain?
17 - 20%
what is breakthrough pain?
pain occurring between doses of analgesia
how can breakthrough pain be prevented?
by giving breakthrough analgesia more frequently
or by increasing the dose of the analgesia
or by increasing the SR/continuous release medication
what is incident pain?
pain occurring when procedures, dressings or activity increase the pain experience
what is cancer pain?
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
problems with IM pethidine, which used to be one of the most commonly given post-op analgesic
- late onset respiratory depression
- painful to give
- can irritate tissues and cause tissue abscess
- short acting
- can cause seizures
(the first three common to IM morphine also)
pethidine not usually recommended for post-op pain anymore
non-pharmacological stategies for managing pain
- knowledge and information
- relaxation (guided imagery, deep breathing,
progressive muscle - distraction
- biofeedback
- hypnosis
- massage
- physio
- TENS
- heat and cold therapy
- acupunture
what are simple analgesics?
such as paracetamol (analgesic and antipyretic)
what percentage of the average healthy adult’s weight is water and electrolytes?
60% male
55% female
what are the fluid compartments in the body?
intracellular fluid (2/3 of total) extracellular fluid (1/3 of total)
what’s the difference between bactericidal and bacteriostatic?
one actually kills bacteria, the other slows there growth enough to render them harmless
which antibiotics will need drug plasma concentrations monitored?
gentamicin, tobramycin, vancomycin
what were the first broad spectrum antibiotics developed?
tetracyclines
what is ototoxicity?
toxicity to the ear - the cochlea, the auditory nerve and sometimes the vestibular system
What types of anaesthetics are there?
general nerve block - spinal or epidural regional local infiltration sedation/analgesia
how do diuretics work?
modify kidney function to cause increased diuresis and increased natriuresis
onset of action for thiazide diuretics?
about 12 hours
how do thiazide diuretics work?
inhibit reabsorption of sodium and water, and promote the excretion of electrolytes
how potent are thiazide diuretics?
how potent are thiazide diuretics?
what do thiazide diuretics promote the reabsorption of?
urea, leading to increased uric acid. can lead to gout.
what are thiazide diuretics indicated for?
oedema, HTN
which diuretics are commonly used in conjunction?
thiazides and potassium-sparing diuretics
what are potassium-sparing diuretics commonly indicated for?
- Diuretic induced hypokalaemia
- Treatment of oedema related to heart failure
- Hepatic cirrhosis
example of a potassium-sparing diuretic?
spironolactone (Aldactone)
which diuretic doesn’t interfere with sodium and cholride transport?
spironolactone
how do osmotic diuretics work?
they add to solutes already present, increasing the osmolality of the filtrate in the nephrons
indications for osmotic diuretics?
cerebral oedema
to educe intraocular pressure
acute closed angle glaucoma
examples of osmotic diuretics?
mannitol
acetazolamide
nursing care considerations for diuretics - what should be monitored?
fluid input and output
blood pressure
blood serum levels
BGLs
nursing care considerations for diuretics - patient education points
education: avoid sudden posture changes
take in the morning
use sunscreen
other nursing care considerations for diuretics
ensure patients have access to toileting
if IDC is present, ensure it’s patent etc
monitor for dehydration
electrolytes: role of sodium?
nerve transmission, muscle contraction, maintains normal
concentration of ECF
electrolytes: role of chloride?
acid/base balance, nerve transmission
electrolytes: role of potassium?
nerve transmission, muscle contraction, normal heart rhythms, concentration of ICF
electrolytes: role of calcium?
nerve transmission, muscle contraction, strong bones and teeth, blood clotting, enzyme reactions
electrolytes: role of magnesium?
enzyme reactions; cardiac and respiratory function
how is excess glucose stored?
converted to glycogen and stored in the liver and muscles or converted into fat and stored in adipose tissue
what is cholesterol used for in the body?
cell membranes, steroid hormones, bile
what is nitrogen balance?
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.
what is nitrogen essential for?
wound healing; growth, repair and maintenance of tissues
what BMIs mean:
BMI < 18.5 - underweight
BMI > 25 overweight
BMI > 30 obese
BMI > 40 morbidly obese
what are the two types of nutritional support (feeding) if you can’t eat?
enteral - NG tube, gastrostomy (PEG), jejunostomy tube
parental - via veins
signs and symptoms of fluid overload?
full, bounding pulse distended jugular veins high BP oedema pulmonary oedema
another name for Hartmann’s?
CSL (compound sodium lactate)
IDEAL discharge
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
about how long till wound has healed enough to remove staples?
1 week
how long til primary intention wound achieves 90% strength?
about 3 weeks
what assessments should a nurse be performing post-op?
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
what is shock?
a condition of circulatory impairment leading to inadequate vital organ perfusion and oxygen delivery relative to the individual’s metabolic needs
