Exam 2 study guide set Flashcards
Calcium uses
blood clotting enzyme activation acid-base balance firmness and rigidity to bones and teeth lactation function of nerves and muscles (including heart muscle) maintenance of membrane permeability
Vitamin D uses
used to treat and prevent infantile rickets, spasmophilia (infantile tetany), and softening of bone.
also important in normal growth and mineralization of skeleton and teeth.
Why do we take calcium with vitamin D?
Vitamin D increases calcium absorption
Too much Vit D?
hypercalcemia anorexia nausea vomiting polyuria(excessive urination) polydipsia(excessive thirst) weakness anxiety pruritus(tingling/burning skin sensation) altered renal function
Iron uses
The body uses iron to make hemoglobin as well as some enzymes
(acidic environment increases iron absorption TAKE W/ ORANGE JUICE)
Too much Iron?
overdose is especially dangerous for children - can cause GI upset and bleeding, nausea, vomiting
Too much Calcium?
Hypercalcemia - fatigue depression confusion nausea vomiting constipation renal stones increased urination occasional cardiac arrhythmias
Iron deficiency?
anemia, lowered vitality, exertional breathlessness, pale complexion, conjunctival pallor, retarded development, and a decreased amount of hemoglobin in each red cell.
Folic acid
Vitamin B9
needed for amino acid metabolism and DNA synthesis
Deficiency in pregnant women can result in neural tube defects of baby (spina bifida)
Vitamin C
wound healing
collagen and tissue production in general
too much can cause GI upset and reduced B12 absorption
Vitamin A
wound healing
Necessary for growth, bone development, vision, reproduction, integrity of mucosal and epithelial surfaces, and formation of visual pigment.
too much can cause hair loss and peeling skin - can be stored in the liver for 2 years can cause toxicity
Vitamin E
acts as an antioxidant and protects red blood cell membranes
stop before surgery - increases clotting time
too much causes Fatigue, weakness, GI upset, Headaches, breast tenderness
Vitamin K
Vitamin K is necessary for synthesis of clotting factors VII, IX, X, and prothrombin by the liver
deficiency can prolong clotting time
Vitamin K1 phytonadione can be used to treat blood thinner overdoses (Coumadin(warfarin) and aspirin)
Selenium
Necessary trace element in diet
Too much may cause : weakness Hair loss dermatitis Nausea diarrhea abdominal pain Garlic-like odor from skin and breath
Zinc
Wait at least TWO HOURS after ANTIBIOTIC admin. to take zinc
Important for wound healing
too much May cause copper deficiency, decrease in HDL cholesterol, weakened immune system
What vitamin is contraindicated in surgery?
Vitamin E - prolongs clotting time
What vitamin/mineral can interfere with antibiotics?
zinc
What patient education is relevant to someone taking a Vitamin A supplement?
Toxicity signs -
Review symptoms of hypervitaminosis A syndrome (headaches, bulging fontanelles in infants, irritability, yellow-orange discoloration of skin, drying and desquamation(peeling) of skin and lips, hair loss, anorexia, vomiting, joint and bone pain).
What are signs of Vitamin D toxicity?
hypercalcemia anorexia nausea vomiting polyuria(excessive urination) polydipsia(excessive thirst) weakness anxiety pruritus(tingling/burning skin sensation) altered renal function
What should you closely monitor in a patient on TPN(total parenteral nutrition)?
Coughing or SOB (TPN can cause air embolism)
Blood glucose - Hypo/hyper glycemia
Infection- elevated temperature, elevated heart rate, chills, sweating, redness, swelling at the insertion site, and lethargy
Fluid overload - cough, dyspnea, neck vein engorgement, chest rales, and weight gain
True or False? All enteral nutrition equipment and tubing is changed and labelled every 24 hrs.
True!
What are the methods of enteral delivery?
Bolus-250 to 400 mL of solution is rapidly administered into the tube 4 to 6 times a day
- Intermittent drip-administered every 3 to 6 hours over 30 to 60 minutes by gravity drip or infusion pump.
- Continuous drip-administered at a slow rate over a 24-hour period.
- Cyclic infusion -infusion pump delivers the nutrient solution for specified hours of the day and is turned off during other hours
Nocturnal feedings are administered only at night
What are main complications of enteral feeding?
Dehydration – give fluids in between feedings
Aspiration
Diarrhea
What is the safety protocol for enteral nutrition? (ALERT)
Enteral Safety
A- septic technique
L- abel enteral equipment
E- levate head of bed at least 30 degrees
R- ight patient, right formula, right tube
T- race all lines and tubing back to patient.
Why do you dilute an antibiotic when given through an NG tube?
Water added to medication before administration (to prevent diarrhea)
Medications given through NG tube for unclogging? requires HCP prescription
Pancreatin (Creon) and pancrelipase (Viokase)
True or False? The nurse should determine gastric residual before each feeding when patients are receiving intermittent feedings. A residual greater than 50% of a previous feeding indicates delayed gastric emptying and warrants notifying the provider
True
How many days can patients who are well-nourished usually tolerate a lack of nutrients without experiencing major health problems?
14 days
A postoperative patient has been ordered enteral feedings via a nasogastric tube. What best indicates to the nurse that the patient is ready for these feedings?
Bowel Sounds
A patient receiving total parenteral nutrition tells the nurse that she feels shaky and has a headache and that her vision is blurred. The patient’s heart rate is increased, and her skin is cold and clammy. The patient is most likely experiencing which complication of parenteral nutrition?
hypoglycemia
Metoprolol
Selective B1 blocker - usually does not affect B2 (pulmonary etc)
could be indicated for use in Hypertensive pt with a pulmonary disorder where it would be dangerous to be constricting airways.
True or false? beta blockers are adrenergic antagonists
true
atenolol and metoprolol selective or nonselective?
selective
propranolol and nadolol (corgard) selective or nonselective?
nonselective - contraindicated in lung disease
epinephrine
Non-selective adrenergic agonist affects all 4 receptor sites - full sympathetic response watch for URINARY RETENTION tachycardia hypertension
can cause paradoxical bronchospasm
albuterol
Selective B2 adrenergic agonist
bronchodilator
can cause heart palpitations, tremor, chest pain
phenylephrine
alpha adrenergic agonist - constricts blood vessels increase BP
Afrin - nasal - rebound congestion - don’t use for more than 3 days in a row!
What do beta blockers do?
Adrenergic antagonist
They block receptor sites or block release of neurotransmitters
Why shouldn’t you abruptly stop a beta blocker?
Abrupt withdrawal may cause life-threatening arrhythmias, hypertension, or myocardial ischemia
Reserpine
anti-adrenergic
Depletes stores of norepinephrine and inhibits uptake
lowers bp
watch for depression, dry mouth
A patient has two inhalers that are due at the same time. One is a bronchodilator. The other is a corticosteroid. Which one should be taken first? Why?
The bronchodilator - so that the steroid is able to be most effective
What are cholinergic agonists?
Mimic parasympathetic neurotransmitter acetylcholine
What are symptoms of a cholinergic crisis? (SLUD)
S- alivation
L- acrimation (tears)
U- rination
D- efecation
Bethanecol
causes bladder emptying
change positions slowly - causes drop in BP
watch for abdominal discomfort, salivation, sweating, or flushing
Benztropine - cogentin
Antiparkinsonism-Anticholinergic
suppresses tremors and muscle rigidity
similar drugs:
Biperiden (Akineton)
Trihexyphenidyl HCl (Artane)
What are the anticholinergics for treating motion sickness?
Scopolamine (Transderm Scōp)
Dimenhydrinate (Dramamine)
Cyclizine (Marzine)
Meclizine hydrochloride (Antivert)
Parkinsons pt ed?
- goal of treatment is as functional as possible
- is a progressive disease
- may need dose adjustments for medication to remain effective
Dilantin (phenytoin) - anti-epileptic
10-20 mcg/mL(8–15 mcg/mL in neonates) in patients with normal serum albumin and renal function
(neonates, patients with renal failure, hypoalbuminemia, acute trauma), free phenytoin serum concentrations should be monitored. Therapeutic serum free phenytoin levels are 1–2 mcg/mL.
signs and symptoms of phenytoin toxicity include nystagmus (involuntary eye movement) ataxia(loss of coordination) confusion nausea slurred speech dizziness.
dose may need to be increased due to tolerance
DO NOT mix with CNS depressants
What are the 3 main uses of CNS stimulants?
ADHD
Narcolepsy
Reversal of respiratory distress
What is DRESS?
drug rash with eosinophilia and systemic symptoms
Common causes include allopurinol, anticonvulsant drugs (such as carbamazepine and phenytoin) and sulfa drugs.
What drugs are available to treat epilepsy?
Antiepileptic agents include phenytoin or carbamazepine for partial seizures, valproic acid for absence seizures, and any of these agents or phenobarbital, with or without newer drugs, e.g., gabapentin or lamotrigine, for generalized seizures
What causes epilepsy?
Epilepsy may result from congenital or acquired brain disease. marked by recurrent seizures, i.e., by repeated abnormal electrical discharges within the brain. Epilepsy is found in about 2% or 3% of the population
Methylphenidate
CNS stimulant
Increased attention span in ADHD.
Increased motor activity, mental alertness, and diminished fatigue in narcolepsy.
Methylphenidate (Ritalin) is contraindicated in patients who have a history of heart disease, hypertension, hyperthyroidism, parkinsonism, or glaucoma.
No-Doz
caffeine pills
Dalmane (flurazepam)
is a benzodiazepine - used as a sleep aid
Pt ed what foods to avoid when taking ADHD medication
any foods containing caffeine - also alcohol
What would indicate to the nurse that the child taking methylphenidate requires more teaching?
a-The child is seen drinking a cola product
b-The child checks his weight twice a week.
c-The child takes the drug 45 minutes before a meal.
d-The child takes the drug before breakfast and lunch.
a-The nurse should teach the child to avoid caffeine because of its potentiation of methylphenidate
A child has been diagnosed with attention-deficit/hyperactivity disorder. Which drug does the nurse anticipate the health care provider will prescribe?
a-Zolmitriptan
b-Doxapram
c-Benzphetamine
d-Methylphenidate .
d-Methylphenidate is most commonly used to treat ADHD
A patient has been ordered a transdermal patch of methylphenidate. The nurse teaches the family to leave the patch on for how long?
9 hours
Benzodiazepine pt ed/ concerns
- decrease dosage slowly - withdrawal
- do not take with other CNS depressants
- may cause drowsiness or dizziness and can increase risk for falls
What should you monitor with pt on sedative hypnotics?
anticonvulsants (clorazepate, diazepam, phenobarbital)
skeletal muscle relaxants (diazepam)
Monitor BP, pulse, and respiratory status frequently
Ambien (zolpidem)
sedative hypnotic CNS depressant - sleep aid
- drowsiness and dizziness may occur
- do not use with other CNS depressants
- abrupt withdrawal may cause negative effects
True or false? children with ADHD often have learning disabilities
true
What is the goal of treatment with Alzheimers?
- to maintain as much function as possible
- explain to pt disease is progressive
- donepezil (Aricept) - cholinergic
- tacrine(Cognex) - cholinergic
- both drugs inhibit breakdown of acetylcholine
Balanced anesthesia may include:
A hypnotic given the night before
Premedication with an opioid analgesic or benzodiazepine with an anticholinergic
A short-acting barbiturate (propofol)
An inhaled gas (often nitrous oxide and oxygen)
A muscle relaxant given as needed
What is used to maintain anesthesia?
gas ?
What would indicate to the nurse that a patient taking a sedative-hypnotic requires more teaching?
a-The patient wants to listen to music on the radio.
b-The patient has saved her urine to be measured.
c-The patient says she has taken 1800 mL of fluid today.
d-The patient requests a cup of kava kava tea to help her get to sleep faster.
d-Kava kava is an herb that may interact with CNS depressants
A patient is taking a hypnotic nightly to enhance sleep. The patient experiences vivid dreams and nightmares. This may be associated with
a-hangover.
b-tolerance.
c-hypersensitivity.
d-REM rebound.
d-REM rebound, which results in vivid dreams and nightmares, frequently occurs after taking a hypnotic for a prolonged period and then abruptly stopping
What is the most serious adverse effect of spinal anesthesia?
respiratory distress
Which drug is commonly used for conscious sedation?
Midazolam (Versed) is commonly administered for conscious sedation for minor surgery or procedures
How long must an epileptic take seizure medication?
until seizure free
The metabolism of young children is faster than infants and adults. How would a phenytoin dose be adjusted?
the dose will be decreased
A patient has newly diagnosed petit mal seizures. Which drug would you teach the patient about?
diazepam
