Exam 1 Flashcards
What is the nursing role?
Assessment
Planning appropriate pharmacotherapy
Intervention
Evaluation
(Reassess and revise the plan if needed)
What are the 5 schedules of drugs based on?
Abuse potential
Which drug schedule has the highest/lowest abuse potential?
I - Highest
II - High
III - Moderate
IV - Low
V - Lowest
Give examples of drugs in each schedule.
I - Heroin, LSD, marijuana
II - Potent opioids (high does of codeine, fentanyl, methadone, morphine, oxycodone, hydrocodone, meperidine)
III - Codeine (lower doses compounded with ASA or acetaminophen)
IV - Benzodiazepines (alprazolam, diazepam, midazolam, temazepam), tramadol, zolpidem
V - Cough medicine with codeine, anti-diarrheals w/small amounts of opioids
How are medications stored? And what is their storage based on? What does this system prevent?
In an automated computerized system called Omnicell, where all medications are stored based on pharmaceutical recommendations. Prevents accidentally removing the wrong med and diversion.
What is to be disposed of in Black 2 Gallon Sharps Containers?
Hazardous medications left in a syringe or ampoule
Coumadin (warfarin)/Nicotine packaging
Tablets - whole, broken or partial
Labeled as a hazardous medication for “black bucket waste”
What is to be disposed of in Black 8 Gallon Containers?
Coumadin (warfarin)/ Nicotine packaging
Full or partial IV bags, bottles or vials
Labeled as Hazardous Medications or “black bucket waste”
NO SYRINGES
Place items that may leak in a clear ziplock bag prior to disposal
What is to be placed in Red Sharps Containers?
Sharps that DO NOT contain any medication
Empty syringes and ampoules
Broken glass
Staples
What is to be placed in blue Rx waste containers? Are syringes allowed?
Full or partial IV bags, bottles or vials
Tablets - whole, broken or partial
Syringes w/ medication allowed
But they must NOT have a Black Bucket Waste code on any of these items
What do you do with anything labeled SP/SPO/SPC?
Send back to the pharmacy. Anything labeled as SP needs to be returned to the pharmacy for proper disposal. Ex: aerosols and inhalers
What is the purpose of having high alert medication labels?
To identify medications with increased risk of significant harm and to increase vigilance in the preparation and administration of the ordered dose and monitoring of the patient
What does the abbreviation PRN mean?
As needed
What is the abbreviation q8H stand for?
Every eight hours
What is the abbreviation RUE stand for?
Right upper extremity
What does the abbreviation PO stand for?
By mouth (per os)
What is the abbreviation NKA mean?
No known allergies
What does the abbreviation IM mean?
Intramuscular
What does the abbreviation SOB mean?
Shortness of breath
What does the abbreviation BRP mean?
Bathroom privileges
What does the abbreviation FWW mean?
Front wheel walker
What does the abbreviation HOB mean?
Head of bed
What is the abbreviation IV mean?
Intravenous
What is the abbreviation BID mean?
Twice daily (bi-daily)
What does the abbreviation QID mean?
Four times a day
What does the abbreviation LLQ mean?
Left lower quadrant
What does the abbreviation ADLs mean?
Activities of daily living
What does the abbreviation NPO mean?
Nothing by mouth (nil per os)
What is the abbreviation mL mean?
Milliliter
What does the abbreviation q4h mean?
Every four hours
What does the abbreviation NKDA mean?
No known drug allergies
What does the abbreviation TID mean?
Three times a day
What is the Calcium regulation cycle if calcium levels are too high?
Thyroid releases CALCITONIN which increases calcium deposition in bones, decreases calcium uptake in intestines, and decreases calcium reabsorption in kidneys. Calcium levels fall and return to normal levels in the blood.
What is the calcium regulation cycle if calcium levels are too low (hypocalcemia)?
The parathyroid releases parathyroid hormone (PTH), which increases calcium release from bones, increases calcium uptake in intestines, and increases calcium reabsorption in the kidneys. Calcium levels rise to normal levels in blood, returning to homeostasis.
Which vitamins are fat-soluble? Where are they stored in the body?
A,D,E, & K. Stored in the liver and adipose tissue
What are the functions of Vitamin A? And what are the primary dietary sources of it?
Formation of visual purple (rhodopsin) in the retina, which allows vision in dim light.
Formation and maintenance of mucosa (nose, mouth, GI tract, respiratory tract, etc.)
Preformed vitamin A (retinol) is found in animal sources
Provitamin A (beta-carotene) - found as carotenoids in the plant foods carrots, cantaloupe, apricots, tomato juice, and spinach
What are the symptoms of Vitamin A deficiency?
Night blindness
Conjunctival & corneal changes (xerophthalmia - dry eye condition)
Dry/scaly skin (keratinization)
Decreased saliva secretions
What are the functions of Vitamin D? And what are the primary dietary sources?
Calcium and phosphorus absorption
Muscle contraction
Develop/ maintain strong bones
Natural sources include fish and egg yolks
Fortified foods (like milk, cereals, cheese, juice, etc.)
What are the symptoms of vitamin D deficiency?
Low calcium levels, which can cause osteoclastic activity, and eventually osteoporosis (increasing risk of fractures)
Bone growth retardation (Rickett’s)
What is the function of vitamin E? What are the primary sources of it?
It’s an antioxidant (prevents free radical damage)
Dietary sources include vegetable oils, such as canola and safflower
Nuts and fortified cereals
What are the symptoms of vitamin E deficiency?
Hemolytic anemia (RBC membranes exposed to oxidation)
Neuropathy - numbness/tingling (Disrupts myelin sheath formation)
What are the functions of vitamin K? And what are some dietary sources of it?
Initiates liver synthesis of four proteins for clotting - it is the “koagulation vitamin”
It is used as an antidote for an over-dosage of warfarin (an anticoagulant)
Green veggies - in the form of phylloquinone
Dark green leafy vegetables, Brussels sprouts, broccoli, asparagus
What are the symptoms of vitamin K deficiency? And who is always deficient and needs vitamin K IM injections?
Increase risk of bleeding/hemorrhage
Newborns. Because of their sterile, intestinal tract newborns don’t have bacteria in their guts to form vitamin K and clot if necessary.
What is the function of Vitamin B1 (thiamine) and what are the dietary sources of it?
Supports cellular energy metabolism (combines with phosphorus into thiamin pyrophosphate (TPP), which is involved with glucose metabolism)
Found in whole or enriched grains and legumes
What are the symptoms of vitamin B1 (thiamine) deficiency?
Weakness
Affects multiple systems, such as G.I., CNS, CV, MS
Constipation, cognitive decline, heart failure, fatigue
What are the functions of vitamin B9 (folate/folic acid)? And what are the dietary sources of it?
It is a coenzyme in DNA synthesis and cell division (making it very important during pregnancy)
Produces heme for hemoglobin
Dark green leafy vegetables, OJ
Legumes, chicken liver
fortified cereals, and grains
What are the symptoms of vitamin B9 (folate) deficiency?
Megaloblastic anemia
Neural tube defects, such as spina bifida
What are the functions of vitamin B12 (cobalamin)? What are the dietary sources of it? And what else is needed for its absorption?
Amino acid metabolism
Heme formation
Roll in the synthesis of the myelin sheath
Animal products and fortified foods (cereals)
HCl (except with B12 supplement) and intrinsic factor (IF) for absorption
What are the symptoms of vitamin B12 (cobalamin) deficiency? What are possible causes? Who are the at risk populations?
Macrocytic anemia/pernicious anemia
Neuropathy (Tingling in hands or feet)
Decline in cognition
HCl & IF deficiency caused by Gastrectomy, IBS, low gastric acid
Vegans (aren’t intaking it unless they’re taking a supplement) and elderly people (often don’t have enough HCl or IF to absorb it, often on antacids which can cause low HCl levels)
What is the B12 absorption process?
Vitamin B12 is ingested from dietary sources, HCl releases it from protein, then it combines with IF (from parietal cells) in the stomach, gets absorbed in the last 60 cm of the small intestine (ileum), travels in the blood to growing cells to be used, or to the liver to be stored for 3-5 years, excess gets excreted into bile to be recycled.
What are the functions of vitamin C (ascorbic acid)? What are the dietary sources of it?
Essential in formation of collagen for capillary walls
Maintains bone matrix, cartilage, and collagen
Facilitates iron absorption
Antioxidant
Citrus fruits and juices, tomatoes, bell peppers, strawberries
What are the symptoms of vitamin C (ascorbic acid) deficiency?
Poor wound healing (traumatic injury/surgery), easy bruising, petechiae
Weak bones
What are the functions of iron? What are the dietary sources of it?
Forms part of the functional unit of hemoglobin (Hgb), heme, which binds oxygen to be delivered to cells
Liver, meat, chicken, fish, whole grains, fortified foods
What are the symptoms of iron deficiency? And what are two causes?
Fatigue, muscle weakness, pallor (skin looks pale)
Low gastric acid (Hcl needed to liberate iron)
Malabsorption issues (from celiac disease or Crohn’s disease for example)
What are the functions of calcium? And what are the dietary sources of it?
Combines with phosphorus to provide strength and rigidity to skeleton
Plays an important role in clot formation (helps cross-linking fibrin threads)
Nerve transmission
Muscle contraction and relaxation
Dairy products, dark-green vegetables
Fortified foods
What are the symptoms of calcium deficiency? What are two possible causes? And what are two quick tests you can do to check for it?
Osteoporosis
Tenany (painful muscle spasms)
Immobilization can lead to resorption (osteoclastic activity - withdrawing Calcium from bones)
Hypothyroidism - low parathyroid hormone (PTH) to regulate calcium levels
Chvostek’s sign - tapping the facial nerve near the ear/cheekbone causes a twitch of the facial muscles on that side
Trousseau’s sign - Involves inflating a blood pressure cuff on the upper arm above systolic pressure for a minute, which can trigger a spasm in the hand and forearm, causing the fingers to flex into a “claw hand”
