Exam #2 Flashcards
What are some of the reasons someone may be prescribed Hydrocodone?
They need a decrease in the severity of their pain or suppression of the cough reflex.
What is the trade name of Hydrocodone?
Norco/Vicodin
What classification is Hydrocodone associated with?
Opioid Analgesics
What are the usual routes of Hydrocodone?
By mouth (PO) or By mouth ER (Extended Release)
What is some of the patient teaching for Hydrocodone?
Take this medicine as directed. Potential abuse to this medication. Teach how to recognize respiratory depression. May cause drowsiness or dizziness. Change positions slowly. Notify of current medications. Advise important oral hygiene. Notify if pregnant.
Why would you not allow someone to take Hydrocodone?
If the client is susceptible to drug abuse or vitals are abnormal.
What are some potential side effects of Hydrocodone?
Respiratory Depression
Blurred Vision, Diplopia, Miosis
Urinary Retention
Confusion, dizziness, sedation, nausea, constipation, dyspepsia.
What is the antidote for Hydrocodone?
Naloxone
What drugs does Hydrocodone have interactions with?
Trazodone, alcohol, tramadol, nalbuphine, antipsychotics, mirtazapine, etc.
What do you evaluate or look for after someone has taken Hydrocodone?
Look for suppression of nonproductive cough, and also see if this medication has decreased their severity in pain.
What do you assess before administering Hydrocodone?
Assess vitals, bowel function. Assess the type, location, and severity of pain. Assess for opioid addiction or abuse in the past.
What are some lab value alterations that may be caused by Hydrocodone?
A rise in plasma amylase and limase concentrations may occur.
What is the trade name for Hydrochlorothiazide?
HCTZ/Microzide
What classification is Hydrochlorothiazide associated with?
Antihypertensives/Diuretic
What are the usual routes Hydrochlorothiazide is given?
By mouth (PO)
What are some of the reasons someone may be given Hydrochlorothiazide?
May help with lowering BP in hypertensive patients and diuresis with mobilization of edema.
Promotes excretion of chloride, potassium, hydrogen, magnesium, phosphate, calcium, and bicarbonate.
Increase excretion of sodium and water by inhibiting sodium reabsorption in the distal tube.
What are some potential side effects of Hydrochlorothiazide?
Skin Cancer, Steven Johnson Syndrome
Pancreatitis
Dehydration, anorexia, cramping, hepatitis.
Dizziness, drowsiness, lethargy, weakness, nausea, vomiting.
What is some of the patient teaching for Hydrochlorothiazide?
Take medicine same time everyday. Monitor weight biweekly. Change positions slowly. Use sunscreen. Undergo skin cancer screenings. Need Follow-up exams. Discuss dietary potassium requirements. Notify of current medications.
What are some of the lab value alterations that may be caused by Hydrochlorothiazide?
Monitor electrolytes, potassium, blood glucose, BUN, serum creatinine, and uric acid.
What are the drugs Hydrochlorothiazide has interactions with?
Antihypertensives, alcohol, digoxin, cholestyramine, colestipol, piperacillin, tazobactam.
What do you assess before administering Hydrochlorothiazide?
Monitor vitals and weight. Assess for skin rash and for allergies.
Why would you not give someone Hydrochlorothiazide?
If rash occurs!
What do you evaluate or look for after administering Hydrochlorothiazide?
Look for a decrease in BP and decrease in edema.
What is the trade name for Heparin?
Hepalean
What classification is Heparin associated with?
Anticoagulants
What are the usual routes Heparin is given?
Sub Q, IV
What are the reasons you would prescribe Heparin?
To prevent thrombus formation (clots), extension of existing thrombi.
What is the antidote for Heparin?
Protamine sulfate
What are the potential side effects of Heparin?
Alopecia, rash, urticaria.
Osteoporosis
Fever, hypersensitivity reactions
Bleeding, Heparin-Induced Thrombocytopenia (HIT)
What is some of the patient teaching for Heparin?
Report any symptoms of unusual bleeding or bruising. No meds with aspirin. Stay away from things that cause bleeding such as razors, knifes, etc. Report pregnancy and current medications.
What are some of the lab value alterations that may be caused by Heparin?
Monitor activated partial thromboplastin time. Monitor platelet count.
What drugs may have interactions with Heparin?
Streptokinase, digoxin, nicotine, warfarin, antihistamines, aspirin, dextran, cefotetan, thrombolytics, clopidogrel, tirofiban.
What do you assess before administering Heparin?
Asses for signs of bleeding and hemorrhage. Monitor for hypersensitivity reactions.
Why would you not allow someone to take Heparin?
If signs of bleeding, bruising, or hemorrhage occur.
What do you evaluate or look for after administering Heparin?
Patency of IV catheters.
Prevention of deep vein thrombosis and pulmonary emboli.
Prolonged partial thromboplastin time.
What is the trade name for Haloperidol?
Haldol
What classification is Haloperidol associated with?
Antipsychotics
What are the usual routes Haloperidol are given?
By mouth (PO), IM, IM decanoate
What are the reasons someone may be given Haloperidol?
Diminished signs and symptoms of psychoses.
Improved behavior in children with Tourettes syndrome or other behavioral problems.
What are some potential side effects of Haloperidol?
Seizures, confusion, drowsiness, restlessness, tardive dyskinea.
Neuroleptic Malignant Syndrome.
Agranulocytosis
Torsades de Pointes, hypotension, tachycardia.
What is some of the patient teaching for Haloperidol?
Take medicine as directed. Inform possibility of extrapyramidal symptoms. Change positions slowly. May cause drowsiness. Notify of current medications. No alcohol. Use sunscreen. Use frequent mouth rinses. Notify if pregnant. Need follow-up exams.
What drugs can Haloperidol possible have interactions with?
Antihypertensives, alcohol, antihistamines, antidepressants, atropine, opioid analgesics, sedatives/hypnotics, etc.
What needs to be assessed before administration of Haloperidol?
Mental status, assess positive symptoms of schizophrenia. Assess weight and vital signs. Monitor intake and output. Assess for fall risks.
Why would you not administer Haloperidol to someone?
If mental health is not improving.
What do you evaluate or look for after administering Haloperidol?
Decrease in hallucinations, insomnia, agitation, hostility, and delusions.
Decreased Tics.
Improved behavior in children with severe behavior problems.
What is the trade name for Gabapentin?
Neurotin
What classification is Gabapentin associated with?
Anticonvulsant
What are the usual routes Gabapentin is given?
PO-IR (Immediate Release), PO-SR (Sustained Release)
What are the reasons someone would be given Gabapentin?
To decrease incidence of seizures.
Decrease postherpeutic pain.
Decrease leg restlessness.
What are some of the potential side effects of Gabapentin?
Steven-Johnson Syndrome
Rhabdomyolysis
Hypersensitivity Reactions
Suicidal Thoughts
What is some of the patient teaching for Gabapentin?
Take medicine as directed. Do not take this med within 2 hrs of antacid. May cause dizziness or drowsiness. Notify if pregnant and any current medications. Notify risk of respiratory depression. Notify risk of suicidal thoughts.
What drugs may have interactions with Gabapentin?
Antacids, antihistamines, alcohol, sedative/hypnotics, hydrocodone.
What needs to be assessed before administering Gabapentin?
Monitor behavior changes. Seizures, pain, migraines. Look for a good change.
Why would you not administer Gabapentin?
If having suicidal thoughts!
What needs to be evaluated or looked at after administering Gabapentin?
Desired frequency or cessation of seizures. Decreased pain. Increased mood stability. Decreased frequency of headaches. Decreased effects of restless leg syndrome.
What is the trade name for Fentanyl?
Duragesic
What classification is Fentanyl associated with?
Opioid Analgesics
What are the usual routes Fentanyl is given?
Transdermal
What are the reasons you would administer Fentanyl?
To decrease the severity of chronic pain.
What is the antidote for Fentanyl?
Naloxone
What food interacts with Fentanyl?
Grapefruit Juice
What are some of the potential side effects of Fentanyl?
Bradycardia, hypotension.
Anorexia, constipation, dry mouth, vomiting, nausea.
Apnea, Respiratory Depression.
Confusion, sedation, weakness, sweating.
What is some of the patient teaching for Fentanyl?
Instruct how often to take med. Instruct correct application and disposal of patch. Advise about addiction.
What lab value alterations can be caused by Fentanyl?
May increase plasma amylase and lipase levels.
What drugs may interact with Fentanyl?
Antidepressants, other analgesics.
What needs to be assessed before administration of Fentanyl?
Find out about pain, vital signs, bowel function, risk of addictions or abuse. Notify if pregnant or breastfeeding. Watch for symptoms of respiratory depression.
Why would you not administer Fentanyl?
Breathing problems, drug abuse past, constipation.
What needs to be evaluated or looked at after the administration of Fentanyl?
Decreased in severity of pain.
What is the trade name for Enoxaparin?
Lovenox
What classification is Enoxaparin associated with?
Anticoagulant
What are the usual routes Enoxaparin is given?
Subcutaneous
What are the reasons someone would be prescribed Enoxaparin?
Prevention of blood clots.
What are the reasons someone would be prescribed Enoxaparin?
Prevention of Blood clots.
What is the antidote for Enoxaparin?
Protamine Sulfate 1mg for each mg of enoxaparin should be administered by slow IV injection.
What are some of the potential side effects of Enoxaparin?
Bleeding, anemia.
Dizziness, headache, insomnia.
Nausea, vomiting, fever.
Edema, rash
What is some of the patient teaching for Enoxaparin?
Teach proper injection care, and disposal of equipment. Report unusual bleeding, bruising, dizziness, itching, rash, fever, swelling, or difficulty breathing. Do not take aspirin, naproxen, ibuprofen. Notify before dental or medical treatment or surgery. Notify if pregnant or breastfeeding.
What drugs may have interactions with Enoxaparin?
Warfarin, aspirin, dipyridamole, some penicillins, clopidogrel, dextran, tirofiban, abciximab, eptifibatide, other anticoagulants.
What needs to be assessed before administration of Enoxaparin?
Watch for increased clots, and inflammation of injection site.
Why would someone not be administered Enoxaparin?
Unusual bleeding or bruising occurs.
What needs to be evaluated or looked at after administering Enoxaparin?
Prevention of blood clots and resolution of acute deep vein thrombosis.
What is the trade name for Docusate Sodium?
Colace
What classification is Docusate Sodium associated with?
Laxative
What are the usual routes Docusate Sodium is given?
By mouth (PO) and Rectal
What are some of the reasons someone may be prescribed Docusate Sodium?
Needs stool softened to allow regular bowel movements.
What are some potential side effects of Docusate Sodium?
Throat Irritation
Mild cramps, diarrhea
Rashes
What is some of the patient teaching for Docusate Sodium?
Only use short-term! Encourage bulk diet, fluid intake increase, increase in mobility. Do not use when having abdominal pain, nausea, vomiting, or fever. Advise to not take other laxatives 2 hr within Docusate Sodium.
What drugs may interact with Docusate Sodium?
None!
What needs to be assessed before administering Docusate Sodium?
Assess for abdominal distention, presence of bowel sounds, and usual pattern of bowel function. Assess color, consistency, and amount of stool produced.
Why would someone not be administered Docusate Sodium?
If the client is having abdominal pain, nausea, vomiting, fever.
What needs to be evaluated or looked at after administration of Docusate Sodium?
Hopefully will see relief and client will have a soft, formed bowel movement usually within 24-48 hours.
What is the trade name for Hydromorphone?
Dilaudid
What classification is Hydromorphone associated with?
Opioid Analgesics
What are the usual routes that Hydromorphone are given?
PO-IR (Immediate Release), PO-ER (Extended Release), Subcut, IM, IV, Rectal
What is the antidote for Hydromorphone?
Naloxone
What are some of the potential side effects of Hydromorphone?
Respiratory Depression
Adrenal Insufficiency
Hypotension, Bradycardia
Confusion, sedation, dizziness, dry mouth, nausea, vomiting
What is some of the patient teaching for Hydromorphone?
Advise about potential abuse. Learn to recognize respiratory depression. May cause drowsiness, dizziness. Change positions slowly. Avoid alcohol. Notify about current medications.
What are the lab value alterations that may be caused by Hydromorphone?
May rise plasma amylase and lipase concentrations.
What drugs may interact with Hydromorphone?
MAO, antipsychotics, alcohol, tramadol, trazodone, linezolid, mirtazapine, etc.
What needs to be assessed before the administration of Hydromorphone?
Assess vitals, bowel function. Assess the type, location and intensity of pain. Assess for abuse or addiction signs and symptoms.
Why would someone not be able to take Hydromorphone?
If abuse or addiction occurs or vitals are abnormal.
What needs to be evaluated or looked at after the administration of Hydromorphone?
Decrease in severity of pain and suppression of cough.
What is the trade name for Furosemide?
Lasix
What classification is Furosemide associated with?
Diuretic/Water Pill
What are the usual routes that Furosemide is given?
PO, IM, IV
What are some of the potential side effects of Furosemide?
Steven-Johnson Syndrome, Toxic Epidermal Necrolysis, Erythema Multiforme
Aplastic Anemia, Agranulocytosis
Dehydration, hypocalcemia, hypochloremia, hypokalemia, hypomagnesemia
Hyponatremia, hypovolemia, metabolic alkalosis.
What are some of the reasons someone would be administered Furosemide?
Hypertension
Edema due to heart failure, hepatic impairment, or renal disease
What needs to be evaluated or looked at after the administration of Furosemide?
Decrease in Edema.
Decrease in BP.
Increase in urinary output.
What needs to be assessed before administration of Furosemide?
Assess fluid status and monitor weight daily. Monitor BP. Assess fall risks. Assess for allergy to sulfonamides. Assess for tinnitus and hearing loss. Assess for skin rash.
Why would someone not be administered Furosemide?
If skin rash occurs, or if allergy appears.
What is some of the patient teaching for Furosemide?
Advise to take medicine as directed. Change positions slowly. Advise to ask about potassium since it could possibly drop potassium levels. If gained more than 3 lbs in 1 day inform health care professional. Notify of current medications. Use sunscreen. Notify health care professionals immediately if rash or any other symptoms occur. Advise diabetic patients to monitor glucose levels as levels may rise. Notify is pregnant. Needs follow-up appointments.
What drugs may have interactions with Furosemide?
Antihypertensives, alcohol, diuretics, corticosteroids, digoxin, lithium, cisplatin, etc.
A nurse receives a prescription for phenobarbital for a client who has a seizure disorder. The medication has a long half-life of 4 days. How many times per day should the nurse expect to administer the medication?
A. One
B. Two
C. Three
D. Four
A. One
Medications with long half-lives remain at their therapeutic levels between doses for long periods of time. Expect to administer this medication once a day.
A nurse is reviewing medication metabolism. Which of the following factors should the nurse determine as a reason to administer lower medication dosages? (Select all that Apply)
A. Increased renal excretion
B. Increased medication-metabolizing enzymes
C. Liver failure
D. Peripheral vascular disease
E. Concurrent use of medication the same pathway metabolizes
C. Liver failure
Liver failure decreases metabolism and thus increases the concentration of a medication. This requires decreasing the dosage.
E. Concurrent use of medication the same pathway metabolizes
When the same pathway metabolizes two medications, they compete for metabolism, thereby increasing the concentration of one or both medications. This requires decreasing the dosage of one or both medications.
A nurse is preparing to administer eye drops to a client. Which of the following actions should the nurse take? (Select all that apply)
A. Have the client lie on one side
B. Ask the client to look up at the ceiling
C. Tell the client to blink when the drops enter the eye
D. Drop the medication into the client’s conjunctival sac
E. Instruct the client to close the eye gently after instillation
B. Ask the client to look up at the ceiling
The client should look upward to keep the drops from falling onto the cornea.
D. Drop the medication into the client’s conjunctival sac
Drop the medication into the conjunctival sac to promote distribution.
E. Instruct the client to close the eye gently after instillation
The client should close the eye gently to promote distribution of the medication.
A nurse is reinforcing teaching to a client about transdermal patches. Which of the following statements should the nurse identify as an indication that the client understands?
A. “I will clean the site with an alcohol swab before I apply the patch.”
B. “I will rotate the application sites weekly.”
C. “I will apply the patch to an area of skin with no hair.”
D. “I will place the new patch on the site of the old patch.”
C. “I will apply the patch to an area of skin with no hair.”
The client should apply the patch to a hairless area of skin to promote absorption of the medication.
A nurse reviewing a client’s medical record notes a new prescription for verifying the trough level of the client’s medication. Which of the following actions should the nurse take?
A. Obtain a blood specimen immediately prior to administering the next dose of medication.
B. Verify that the client has been taking the medication for 24hr before obtaining a blood specimen.
C. Ask the client to provide a urine specimen after the next dose of medication.
D. Administer the medication, and obtain a blood specimen 30 min later.
A. Obtain a blood specimen immediately prior to administering the next dose of medication.
To verify trough levels of a medication, obtain a blood specimen immediately before administering the next dose of medication.
A nurse is preparing a client’s medications. Which of the following actions should the nurse take in following legal practice guidelines? (Select all that apply)
A. Reinforce teaching with the client about the medication.
B. Determine the dosage.
C. Monitor for adverse effects.
D. Lock compartments for controlled substances.
E. Determine the client’s insurance status.
A. Reinforce teaching with the client about the medication.
Reinforcing teaching with the client about the medication is part of the rights of medication administration.
C. Monitor for adverse effects.
Monitor for adverse effects as part of the rights of medication administration.
D. Lock compartments for controlled substances.
Lock controlled substance in a drawer, cart, or other compartment to prevent misuse.
A nurse is preparing to administer digoxin to a client who states, “ I don’t want to take that medication. I do not want one more pill.” Which of the following responses should the nurse make?
A. “Your physician prescribed it for you, so you really should take it.”
B. Well, let’s just get it over quickly then.”
C. “Okay, I’ll just give you your other medications.”
D. “Tell me your concerns about taking this medication.”
D. “Tell me your concerns about taking this medication.”
Although clients have the right to refuse a medication, this response is correct in determining the reason for refusal by asking about the client’s concerns. Then information can be provided about the risk of refusal and facilitate and informed decision. At that point, if the client still exercises their right to refuse a medication, notify the provider and document the refusal and the actions taken.
A nurse is reviewing a client’s prescribed medications. Which of the following situations represents a contraindication to medication administration?
A. The client drank grapefruit juice, which could reduce a medication’s effectiveness.
B. The medication has orthostatic hypotension as an adverse effect.
C. A medication is approved for ages 12 and older, and the client is 8 years old.
D. An anti anxiety medication that has an adverse effect of drowsiness is prescribed as a preoperative sedative.
C. A medication is approved for ages 12 and older, and the client is 8 years old.
Age is one factor that can be a contraindication to medication administration. Contraindications are findings that indicate the client should not receive a medication and are different from instances where an undesirable effect or more monitoring are needed.
A nurse is collecting data from a client before administering medications. Which of the following data should the nurse obtain? (Select all that apply)
A. Use of herbal products
B. Daily fluid intake
C. Ability to swallow
D. Previous surgical history
E. Allergies
A. Use of herbal products
Inquire about the client’s use of herbal products, which often contain caffeine, prior to medication administration because caffeine can affect medication biotransformation.
C. Ability to swallow
Determine the client’s ability to swallow to see what route or formulation of the medication the client requires.
E. Alleriges
Inquire about food allergies during the pre-assessment to identify any potential reactions or interactions.
A nurse is working with a newly licensed nurse who is administering medications to clients. Which of the following actions should the nurse identify as in indication that the newly hired nurse understands medication error prevention?
A. Taking all medications out of the unit-does wrappers before entering the client’s room.
B. Checking the prescription when a single dose requires administration of multiple tablets.
C. Administering a medication, then looking up the usual dosage range.
D. Relying on another nurse to clarify a medication prescription.
B. Checking the prescription when a single dose requires administration of multiple tablets.
If a single dose requires multiple tablets, it is possible that an error has occurred in the prescription or transcription of the medication. This action could prevent a medication error.
A nurse is observing a client’s IV infusion site. Which of the following findings should the nurse identify as indications of phlebitis? (Select all that apply)
A. Pallor
B. Dampness
C. Erythema
D. Coolness
E. Pain
C. Erythema
Erythema and warmth at the insertion site are manifestations of phlebitis.
E. Pain
Pain and burning at the insertion site are manifestations of phlebitis.
A nurse is assisting with the initiation of IV therapy for an older adult client. Which of the following actions should the nurse plan to take?
A. Use a disposable razor to remove excess hair on the extremity.
B. Select the back of the client’s hand to insert the IV catheter.
C. Distend the veins by using a blood pressure cuff.
D. Direct the client to raise their arm above the heart.
C. Distend the veins by using a blood pressure cuff.
Distend the veins using a blood pressure cuff to reduce overfilling of the vein, which can result in a hematoma.
A nurse monitoring the IV catheter insertion site for a client receiving a nonvesicant solution and notes swelling at the site with decrease skin temperature. Which of the following actions should the nurse take? (Select all that apply)
A. Stop the infusion
B. Start a new IV access distal to this site.
C. Apply warm compresses to the insertion site.
D. Elevate the client’s arm.
E. Obtain a specimen for culture at the insertion site.
A. Stop the infusion
Decreases temperature and swelling at the insertion site are manifestations of IV infiltration. Stop the infusion and start a new line in the other extremity.
C. Apply warm compresses to the insertion site.
Apply a warm or cold compress for a client who is experiencing manifestations of an IV infiltration, depending on the solution.
D. Elevate the client’s arm
Elevate the arm of a client who is experiencing edema with an infiltration.
A nurse is preparing to administer a medication the nurse has never administered previously. Which of the following information should the nurse identify as a contraindication to administering the medication? (Select all that apply)
A. Decrease heart rate is an adverse effect of the medication.
B. The client is allergic to a component of the medication.
C. The client is five years younger than the age requirement for the medication.
D. The client’s kidney function tests indicate a need for a dosage reduction.
E. The client will need additional monitoring of liver function if the medication is administered long-term.
B. The client is allergic to a component of the medication.
An allergy to a component of the medication is a contraindication because taking the medication will cause client harm.
C. The client is five years younger than the age requirement for the medication.
Not meeting age or weight requirements for a medication is a contraindication to medication administration.
A nurse is preparing to administer an IM dose of penicillin to a client who has a new prescription. The client states when they took penicillin 3 years ago, they developed a rash. Which of the following actions should the nurse take?
A. Administer the prescribed dose.
B. Withhold the medication.
C. Ask the provider to change the prescription to an oral form.
D. Administer an oral antihistamine at the same time.
B. Withhold the medication.
Withhold the medication and notify the provider of the client’s previous reaction to penicillin so that an alternative antibiotic can be prescribed. Allergic reactions to penicillin can range from mild to severe anaphylaxis, and prior sensitization should be reported to the provider.
A nurse is comparing a newly prescribed medication to a client’s current medications. Which of the following interactions should the nurse identify as increasing the risk of medication toxicity?
A. One of the client’s current medications minimizes the adverse effects the new medication.
B. The new medication increases the effectiveness of one of the clients current medications.
C. One of the client’s current medications has a similar adverse effect as the new medication.
D. The new medication decreases the rate of metabolism of another medication.
D. The new medication decreases the rate of metabolism of another medication.
When metabolism of a medication is reduced, it remains active in the body for longer time periods or at higher levels.
A nurse is reviewing a client’s health record and notes that the client experienced permanent extrapyramidal symptoms (EPS) caused by a previous medication. The nurse should recognize that the medication affected which of the following systems in the client?
A. Cardiovascular
B. Immune
C. Central Nervous
D. Gastrointestinal
C. Central Nervous
EPS are movement disorders that can be caused by a number of central nervous system medications (typical antipsychotic medications).
A nurse is caring for a client who is experiencing anaphylaxis. Which of the following medications should the nurse expect to administer?
A. Angiotensin-converting enzyme (ACE) inhibitors
B. Naloxone
C. Antihistamines
D. Anticholingerics
C. Antihistamines
Antihistamines medications (diphenhydramine) reduce angioedema and urticaria associated with anaphylaxis.
Pharmacokinetics
Refers to how medications travel through the body. They undergo variety of biochemical processes that result in absorption, distribution, metabolism, and excretion.
Absorption
The transmission of medications from the location of administration (gastrointestinal [GI] tract, muscle, skin, mucous membranes, or subcutaneous tissue) to the bloodstream.
Distribution
The transportation of medications to sites of action by bodily fluids.
Metabolism
(Biotransformation) changes medications into less active or inactive forms by the action of enzymes. This occurs primarily in the liver, but it also takes place in the kidneys, lungs, intestines, and blood.
What are the factors influencing the rate of medication metabolism?
Age
Increase in some medication-metabolizing enzymes
First-pass effect
Similar metabolic pathways
Nutritional status
Metabolism Factor: Age
Infants have a limited medication-metabolizing capacity. The aging process also can influence medication metabolism, but varies with the individual. In general, hepatic medication metabolism tends to decline with age. Older adults require smaller doses of medications due to the possibility of accumulation in the body.
Metabolism Factor: Increase in some medication-metabolizing enzymes
This can metabolize a particular medication sooner, requiring an increase in dosage of that medication to maintain a therapeutic level. It can also cause an increase in the metabolism of other concurrent-use medications.
Metabolism Factor: First-pass effect
The liver inactivates some medications on their first pass through the liver, and thus they require a nonenteral route (sublingual, IV) because of their high first-pass effect.
Metabolism Factor: Similar metabolic pathways
When the same pathway metabolizes two medications, it can alter the metabolism of one or both of them. In this way, the rate of metabolism can decrease for one or both of the medications, leading to medication accumulation.
Metabolism Factor: Nutritional status
Clients who are malnourished can be deficient in the factors that are necessary to produce specific medication-metabolizing enzymes, thus impairing medication metabolism.
Outcomes of Metabolism
Increased renal excretion of medication
Inactivation of medications
Increased therapeutic effect
Activation of pro-medications (also called pro-drugs) into active forms
Decreased toxicity when active forms of medications become inactive forms
Increased toxicity when inactive forms of medications become active forms
Excretion
The elimination of medications from the body, primarily through the kidneys. Elimination also takes place through the liver, lungs, intestines and exocrine glands (such as in breast milk). Kidney dysfunction can lead to an increase in the duration and intensity of a medication’s response, so it is important to monitor BUN and creatinine levels.
Therapeutic Index
Medications with a high (TI) have a wide safety margin. Therefore, there is no need for routine blood medication-level monitoring. Medications with a low TI require close monitoring of medication levels.
Half-Life
Refers to the time for the medication in the body to drop by 50%. Liver and kidney function affect half-life. It usually takes four half-lives to achieve a steady blood concentration (medication intake = medication metabolism and excretion).
Short Half-Life
-Medications leave the body quickly(4 to 8 hrs)
-Short-dosing interval or MEC drops between doses
Long Half-Life
-Medication leave the body more slowly: over more than 24 hr, with a greater risk for medication accumulation and toxicity.
-Medications can be given at longer intervals without loss of therapeutic effects.
-Medications take a longer time to reach a steady state.
Pharmacodynamics
Describes the interactions between medications and target cells, body systems, and organs to produce effects. These interactions result in functional change that are the mechanism of action of the medication. Medications interact with cells on one of two ways or in both ways.
Agonists
Medications that bind to or mimic the receptor activity that endogenous compounds regulate. For example, morphine is an agonist because it activates the receptors that produce analgesia, sedation, constipation, and other effects. (Receptors are the medication’s target sites on or within the cells.)
Antagonists
Medications that can block the usual receptor activity that endogenous compounds regulate or the receptor activity of other medications. For example, losartan, an angiotensin II receptor blocker, is an antagonist. It works by blocking angiotensin II receptors on blood vessels, which prevents vasoconstriction.
Partial Agonists
Act as agonists and antagonists, with limited affinity to receptor sites. For example, nalbuphine acts as an antagonists at mu receptors and an agonist at kappa receptors, causing analgesia with minimal respiratory depression at low doses.
Oral or Enteral Medications
The most common route that comes in tablets, capsules, liquids, suspensions, elixirs, lozenges.
Sublingual
Medication given under the tongue.
Buccal
Medication given between the cheek and the gum. Directly enters the bloodstream and bypasses the liver.
Topical Medications
Medications directly applied to the mucous membranes or skin. Includes powders, sprays, creams, ointments, pastes, oil-and suspension-based lotions.
Transdermal Medications
Medication in a skin patch for absorption through the skin, producing systemic effects.
Inhalation Medications
Administered through metered-dose inhalers (MDI) or dry-powder inhalers (DPI).
Chemical Name
The name of the medication that reflects its chemical composition and molecular structure (isobutylphenylpropanoic acid).
Generic Name
The official or nonproprietary name the United States Adopted Names Council gives a medication. Each medication has only one generic name (Ibuprofen).
Trade Name
The brand or proprietary name the company that manufactures the medication gives it. One medication can have multiple trade names (Advil, Motrin).
Uncontrolled Substances
Require monitoring by a provider, but do not generally pose risks of misuse and addiction. Antibiotics are an example of uncontrolled prescription medications.
Controlled Substances
Have a potential for misuse and dependence an have a “Schedule” classification. Heroin is in Schedule 1 and has no medical use in the United States. Medications in Schedules II through V have legitimate applications. Each subsequent level has a decreasing risk of misuse and dependence. For example, morphine is a Schedule II medication that has a greater risk for misuse and dependence than phenobarbital, which is a Schedule IV medication.
Intravenous Therapy (IV)
Involves administering fluids via an IV catheter to administer medications, supplement fluid intake, or give fluid replacement, electrolytes, or nutrients.
What is the antidote for Acetaminophen?
Acetylcysteine (Mucomust)
What is the antidote for Anticholingerics?
Physostigmine
What is the antidote for Benzodiazepines?
Flumazenil (Romazicon)
What is the antidote for Calcium Channel Blockers?
Calcium Gluconate
What is the antidote for Cyanide or Nitrate?
Methylene Blue
What is the antidote for Digoxin (Lanoxin)?
Digibind
What is the antidote for Iron?
Deferoxamine (Desfersal)
What is the antidote for Insulin?
Glucagon
What is the antidote for Lead?
Succimer (Chemet)
What is the antidote for Magnesium Sulfate?
Calcium Gluconate
What is the antidote for Opioid?
Naloxone (Narcan)
What is the antidote for Warfarin?
Vitamin K
What is the antidote for Streptokinase?
Amicar
What is the antidote for Beta Blockers?
Glucagon
What is the antidote for Aprepitant?
Neuokinin
What is the antidote for Aspirin?
Active Charcoal
What is the antidote for Lovenox
Flumazenl
What is the antidote for Lorazepam?
Romazicon
Drug Interactions
One drug modifies the action of another.
Polypharmacy
Many medications for one client are prescribed.
Side Effects
Unintended actions, expected for the medication.
Adverse Effects
Unexpected, undesirable effects with more serious consequences.
Peak
Highest concentration of drug in blood.
Trough
Lowest concentration of drug in blood.
Anaphylaxis
Severe allergic reaction.
Therapeutic Range
Levels of the drug in the blood that will produce the desired effect of the drug.
Black Box Warning
Strongest warning from FDA, serious side effects or life-threatening risks.
Toxic Effects
Harmful levels of the drug in the blood that rise above therapeutic ranges and cause unintended damage.
7 Right of Medication Administration
Right Patient
Right Drug
Right Dose
Right Time
Right Route
Right Reason
Right Documentation
Schedule 1
Drugs not currently accepted for medical use in US (some opioids, LSD, heroin, etc.)
Schedule II
Accepted in US, high potential for abuse (Dilaudid, Methadone, Oxycodone, Oxycontin/Percocet)
Schedule III
Accepted, less of a change of abuse.
Schedule IIII
Same
Schedule V
Same as IIII
Medication Reconciliation
Reviewing a clients complete medication regimen at admission, transfer, and discharge.
MAR
Medication Administration Record
eMAR
Electronic Medication Administration Record
Medications can be affected by:
Genetics
Age
Sex
Race
Renal Function
Hepatic Function
Other Diagnosis
Other Variations (Brand versus Generic)
Causes of Medication Errors
Communication
High Alert Medications
How the medication is written or typed
What medication is stored where and how it is packaged
Miscalculation
Incorrect Administration
Lack of Client Education
CAM
Complimentary and Alternative Medicine
Kilo
1,000
Milli
0.001
5mL
1 tsp
15mL
1 tbsp
30mL
1 oz
240mL
1 cup
1kg
2.2lbs
2.5 cm
1 in
1ft
12in
1cm
10mm
m
meter
cm
centimeter
mm
millimeter
g
gram
kg
kilogram
mg
milligram
mcg
microgram
lb
pound
L
liter
mL
milliliter
tsp
teaspoon
Tbsp
tablespoon
oz
ounce
gtt
drop
PO
By mouth
SL
Sublingual
OD
Right eye
OS
Left eye
OU
Both eyes
AD
Right ear
AS
Left ear
AU
Both ears
ID
Intradermal
IM
Intramuscular
IV
Intravenous
PT
Per tube
INH
Inhalation
NEB
Nebulizer
PR
Rectally
Sub Q, Subcue, Subcut
Subcutaneous
QD
Once daily
BID
Twice daily
TID
Three times daily
QID
Four times daily
QOD
Every other day
PRN
As needed with reason
Q2H
Every two hours
Q2HP
Every 2 hrs PRN
XI
Once
STAT
Now
AM
Morning
HS
Bedtime
AC
Before meals
ACB
Before breakfast
ACL
Before lunch
ACS
Before supper
PC
After meals
CC
With meals
RX
Prescription or prescribe
Recon
Reconstitute (Mix for Solution)
mg/mL
Milligrams per Milliliter
NS
Normal Saline
Phlebitis
Inflammation of the inner layer, or intimate, of a vein.
Extravasation
Leakage of vesicant IV fluid or medication into the tissue surrounding the IV insertion site; vesicant means that is causes blistering, necrosis, and sloughing of tissue.
Thrombophlebitis
Inflammation of a vein in conjunction with the formation of a thrombus.
Localized Infection
Infection at the IV cannula insertion site.
Septicemia
Life-threatening infection of the bloodstream.
Severed Cannula
A piece of the IV cannula breaks off inside the vein.
Air Embolism
Obstruction of a blood vessel by an air bubble traveling through the circulatory system.
Speed Shock
Shock caused by rapid IV infusion of medication/solution.
Circulatory Fluid Overload
Excessive fluid volume within the cardiovascular system.
Higher the Number of the Needle
The smaller the needle is.
Holistic Approach to Nursing Care
Involves healing the mind, body, soul of our clients. It involves thinking about and assisting clients with the effects of illness on the body, mind, emotions, spirituality, religion, and personal relationships.
Assessment and Data Collection: Signs
-Abnormalities that can be verified by repeat examination.
-Objective Data
-What can be observed
-Ex. Fever, heart murmur, wound, etc.
Assessment and Data Collection: Symptoms
-What the client states is occurring.
-Cannot be verified by examination.
-Subjective Data
-What the subject states.
-Ex. Nausea, pain level, dizziness, etc.
ABC’s
Airway, Breathing, Circulation
General Adaption Syndrome (Stress Syndrome)
3 Stages
-Alarm
-Resistance
-Exhaustion
Stress Signs
-Rapid, shallow breathing
-Dry Mouth
-Diaphoresis
-Shakiness, tremors
-Restlessness
-Increased Pulse
-Muscle tension
-Rapid Speech
-Frequent Urination
Stress Symptoms
-Dizziness
-Anxiety
-Irritability
-Nausea
-Changes in appetite
-Feeling of shortness of breath
-Chest pain or pain in other parts of the body
Sources of Stress
-Chronic illness or injury
-Acute illness or injury
-Work
-School
-Family or Friends
-Mental, behavioral, emotional or spiritual health issues
-Finances
-Time
-Role Changes
-Environmental Factors
Regular Temperature Averages
96.8-100.4 F
Regular Pulse Averages
60-100 beats per minutes (bpm)
Regular Respiratory Rate Averages
12-20 beats per minute (bpm)
Regular Oxygen Saturation Averages
91-100%
Regular Blood Pressure Averages
Less than 120/80
Can be too low which is 90/40
Afebrile
No Fever
Febrile/Pyrexia
Fever
Hyperpyrexia
High Fever
Diaphoresis
Excessive sweat production
Hypothermia
Cold, below 95 degrees F
Hyperthermia
Hot, above 102.2 degrees F
Radial Pulse
Felt in the wrist.
Carotid Pulse
Felt on the side of your neck to the side of the windpipe.
Apical Pulse
Felt on your chest under your left nipple.
Pedal Pulse
Felt on the dorsal aspect of the foot.
Tachycardia
Rapid pulse rate (greater than 100 bpm).
Bradycardia
Slow pulse rate (lower than 60 bpm).
Arrhythmia
Irregular pulse rate due to an abnormal heartbeat.
Pulse Rate can be affected by…
Age, physical activity, blood pressure, drugs, emotions, blood loss, changes in body temperature, pain, and other factors.
Pulse Strength
-0: Absent
-1+: Diminished
-2+: Normal, Brisk
-3+: Increased
-4+: Bounding
S1, S2 Heart Sounds
Normal heart sounds
S3, S4 Gallop
Extra heart sounds
Murmurs
Blowing or swishing sound heard over the heart, best heard with the bell of the stethoscope.
Thrills
Vibration you can feel, rare, accompany murmurs or other abnormalities.
Bruits
Blowing or swishing sounds heard over blood vessels, listen with the bell.
Tachypnea
Rapid respirations
Bradypnea
Slow respirations
Dyspnea
Difficulty breathing
Apnea
No respirations
Inspiration
Breathe in, inhalation
Expiration
Breathe out, exhalation
Factors that affect respiratory rate include…
Age, emotions, pain, physical activity, fever, drugs, illness, and others.
Hyperventilation
Pattern that is too rapid and or deep.
Hypoventilation
Pattern that is too slow and/or shallow.
Cheyne-Stokes
Respirations that become faster and deeper, then slower, alternates with periods of apnea.
Kussmaul’s
Faster and deeper respirations without pauses.
Retractions
Muscles of the chest wall and/or abdomen moving inward with inhalation, cue to work of breathing.
Nail Flaring
Widening of the nostrils during inhalation, cue to hypoxia.
Cyanosis
Blue discoloration of the skin or mucous membranes, cue to hypoxia.
Crepitus
Crackly feeling of the skin, like rice krispies, cue to pneumothorax or punctured lung.
Bronchial
Loud, high pitched, heard over trachea, expiration longer then inspiration.
Bronchovesicular
Medium pitched, blowing sounds, heard over bronchial tubes and bronchioles, expiration equal to inspiration.
Vesicular
Soft, low pitched, heard over peripheral areas of the lungs, inspirations longer than expiration.
Crackled or Rales
Fine to coarse bubbly sounds, rice krispies sound, indicates fluid.
Wheezes
High pitched musical sounds, indicates airway constriction or obstruction.
Stridor
High pitched barking sounds, indicates more emergent airway constriction or obstruction.
Rhonchi
Coarse, low pitched rumbling sounds, indicates fluid or mucous.
Pleural Friction Rub
Dry, grating, or rubbing sounds, indicates inflammation of the lung lining, can be painful.
Absence of Breath Sounds in the Presence of Respirations Indicate…
Collapsed or punctured lung, absence of lung lobe due to surgical removal.
You can apply oximeter to what places?
Finger, toe, and ear.
Hypoxia
Decrease oxygen in the tissues.
Hypoxemia
Decreased oxygen in the blood (when you see -emia think blood.)
Anoxia
No oxygen
Hypercapnia
Increased carbon dioxide.
Hypotension
Low blood pressure
Hypertension
High Blood Pressure
Orthostatic Hypotension
Blood pressure falls with position changes from lying, to sitting, to standing.
White Coat Syndrome
Blood pressure is higher in office or hospital settings due to anxiety.
Acute Pain
Short duration, hours to days.
Chronic Pain
Long duration, months to years.
Neuropathic
Related to dysfunction of the nervous system, can often be burning, numbness, tingling, dull, heavy pressure.
Phantom Pain
Pain after the loss of a body part where the body part would be.
Pain Threshold
Point at which a person feels pain.
Pain Tolerance
Level of pain a person can tolerate.
Pain Intensity
Pain scale, appropriate scale for client.
Pain Location
Where is the pain located?
Pain Quality
How does it feel? Sharp, dull, burning, achy, cramping, stabbing, tearing, etc.
Pain Timing
When did the pain begin? Does it come and go or is it constant? Have you felt this pain before?
Aggravating Factors
What makes the pain worse? Eating, walking, sitting, standing, etc.
Relieving Factors
What makes the pain better? Medications, changing positions, rest, eating, bowel movements, etc.
Accompanying Symptoms
Are you having any other symptoms? Nausea, vomiting, dizziness, sweating, etc.
Acceptable Level of Pain
What level of pain is acceptable?
Opioid
Addictive medications such as Morphine, Vicodin, etc.
Non-opioid
Non addictive medications such as Ibuprofen, Tylenol, Aspirin, etc.
Adjuvent
Anticonvulsants, anti anxiety agents, antihistamines, steroids, etc.
Patient-Controlled Analgesic (PCA)
A pump that the patient controls with provider-ordered settings.
Pain Patch
Patch applied to skin, releases pain medication continuously.
Non-Pharmacological Treatments (Non Medications)
-Relaxation Technique
-Electrical Nerve Stimulation
-Distraction
-Imagery
-Massage
-Acupuncture/Acupressure
-Binders/Braces
-Hydrotherapy
-Hypnosis
-Physical Therapy
-Heat/Cold
Active Range of Motion (AROM)
Individual can actively move limbs.
Passive Range of Motion (PROM)
Individual cannot actively more, limbs must be moved by another person.
Contractures
Inability to straighten an appendage actively or passively.
Perfusion
Circulation of blood to extremities.
4 Bowel Quadrants
RLQ, RUQ, LUQ, LLQ
Normoactive
5-30 clicks/gurgles in 2 mins
Hypoactive
Less than 5 clicks/gurgles in 2 mins
Hyperactive
Greater than 30 clicks/gurgle in 2 mins or rumbling.
Absent
No clicks/gurgles for at least 5 mins.
ADLs
Activities of daily living (toileting, showering, dressing, etc.)
Guaiac
A test for blood in the stool, also called hem occult test.
Petechiae
Pinpoint, round, red, and purple spots on the skin, like small blood vessels have popped.
Sputum
Lung secretions ejected from the mouth.
Tinnitus
Ringing in the ears.
Vertigo
Dizzy whirling sensation
Syncope
Fainting
Flatus
Gas passed through the rectum
Peristalis
Movement of intestines.
Peristalsis
Movement of Intestines
Concave
Curving inward, sunken.
Convex
Curving outward, bulging.
Distended Abdomen
Protruding, taut abdomen.
Rigid Abdomen
Firm, board-like on palpation.
Striae
Stretch marks
Hypertrophy
Overdevelopment
Atrophy
Underdevelopment or wasting of muscle tissue.
Regression
Reverting back to behaviors once outgrown, like bedwetting.
Early Signs and Symptoms of Hypoxia
-Agitation
-Anxiety
-Changes in level of consciousness.
-Headache
-Disorientation
-Irritability
-Restlessness
-Tachypnea
Late Signs and Symptoms of Hypoxia
-Bradycardia
-Cardiac Dyshythmias
-Cyanosis
-Decreased Respiratory Rate (Bradypnea)
-Retractions
What way of taking temperature is the most accurate?
Rectal
Newborn Heart Rate Average
120-160 bpm
1-2 Years Old Heart Rate Average
90-120 bpm
3-18 Years Old Heart Rate Average
80-100 bpm
Adults Heart Rate Average
60-100 bpm
Newborns Respirations Average
30-60 Breaths per minute
Infants Respirations Average
20-40 Breaths per minute
Children Respirations Average
20-30 Breaths per minute
Adolescents Respirations Average
14-25 Breaths per minute
Adults Respirations Average
12-10 Breaths per minute
Normal Blood Pressure Averages
Systolic: Less than 120
Diastolic: Less than 80
Elevated Blood Pressure Averages
Systolic: 120-129
Diastolic: Less than 80
High BP Stage 1 Averages
Systolic: 130-139
Diastolic: 80-89
High Blood Pressure Stage 2 Averages
Systolic: 140 or Higher
Diastolic: 90 or Higher
Pale
A lighter color, more white than usual; if not the patients normal “fair coloring”, indicates poor circulation.
Erythematous
Redness of a designated site, usually a sign of inflammation due to increased circulation to the inflamed site.
Flushed
Widespread, diffuse red color of face; possible includes the body; usually cause by fever, embarrassment, exertion or sunburn.
Jaundiced
Yellow or orange coloring of the skin and mucous membranes, easily detected in the sclera and palm of the hands; cause by liver impairment.
Cyanotic
Bluish-gray color of the skin and mucous membranes due to hypoxia and extreme vasoconstriction.
Ecchymotic
Caused by bruising of the skin (ecchymosis); fresh bruises are bluish-purple, and older bruises turn greenish-yellow as they begin to resolve.
Bronzing
Bronze pigmentation of the skin due to disorders of iron metabolism; iron pigments are deposited in the body tissues.
APETM
Aortic, Pulmonary, Erb’s Point, Tricuspid, Mitral
PERRLA
Pupil Equal Round and Reactive to Light and Accomodation
Neuroleptic Malignant Syndrome
A rare, but life-threatening, idiosyncratic reaction to neuroleptic medications that is characterized by fever, muscular rigidity, altered mental status, and autonomic dysfunction.
Extrapyramidal Symptoms
An inability to sit still, involuntary muscle contraction, tremors, stiff muscles, and involuntary facial movements.
Anticholinergic Syndrome
Drugs that block and inhibit the activity of the neurotransmitter acetylcholine (ACh) at both central and peripheral nervous system synapses.
Some medications should be held 48 hours prior to or after a client has IV contrast for testing these are?
Glucophage, Fortament, Riomet, Glumetza, Metformin, Avandament, Glucovance, Metaglip, Actoplus Met, Janumet, Kombiglyze.
