Exam 3 Flashcards
Bismuth Subsalicylate
Adsorbant Anti-Diarrheal
Drug interactions: warfarin, ASA, and NSAIDS
MA: works by binding to bacteria and toxins; it coats the GI tract to capture the toxins
NI: may turn stool dark and tongue dark
diphenoxylate/atropine (Schedule 5)
Brand: Lomotil
Antidiarrheal/ Anticholinergic
-Slows bowel motility and transit time of food which allows more time for mass to form and water to be reabsorbed
-reduces pain from rectal spasms
-reduces stool frequency and volume
Diphenoxelate (Schedule 5)
Opiate Antidiarrheal/Synthetic Opiate Agonist
-slows over active bowel
Atropine
Opiate Anti-Diarrheal
-has an Anticholinergic effect in larger doses
-discourages recreational use (there are side effects with this one that make it less addictive-why its merged diphenoxylate)
-NI: drowsiness, dizziness
Loperamide (Immodium)
Opiate Anti-Diarrheal
-inhibits peristalsis and slows transit time
-ut has a direct effect on the nerves in intestinal muscle wall
-reduces fecal volume and frequency
-available OTC
Lactobacillus Acidophilus
Probiotic
- restores intestinal flora
-maybe helpful for diarrhea associated with antibiotics
-suppresses bacterial invasion and growth
-found in foods like kefir and yogurt
- ongoing research about its benefits
Psyllium (Metamucil)
Bulk Forming Laxative
-the safest laxative and is available otc
-prevents constipation, and can be used for long term management
NI: the mixture congeals
Docusate Sodium (Colace)
Emollient stool softener
-promotes water and fat absorption.
-eases the passage of stool
NI: take with a full glass of water
Mineral Oil
-lubricates fecal material
-prevents escape of water
Polyethylene Glycol 3350 (Golytely, Miralax)
Hyperosmotic Laxative
-osmotic agent that induces bowel cleaning
-reconstituted with water and administered the day before a procedure
NI: drink 8 oz every 10-15 minutes
Hypovolemic Hyponatremia
Low sodium and Low water in the blood
Causes of Hypovolemic Hyponatremia
Excessive Sweating
Vomiting
Diarrhea
Prolonged GI suctioning (not usually in hospital bc of IV fluids)
- diuretics
-significant blood loss
Functions of Na +
-Primary determinant of ECF Osmolality (influences the water distribution b/t ECF and ICF)
-Aids in transmission of Nerve Impulses, muscle contraction and acid base balance
Symptoms of Hypovolemic Hyponatremia
-Headache
-Lethargy
-Confusion
-Seizures
-Coma
-Muscle Cramps
-Dry mucus membranes (less Na/H20)
-Postural Hypotension (reduced BV and BP)
-Tachycardia (heart has to work harder to compensate for the lack of volume)
Hypervolemic Hyponatremia
This is when there is fluid overload d/t an organ failure. You have normal or high levels of sodium but it’s diluted by so much water
Describe what happens to water and cells in Hypovolemic Hyponatremia
Sodium is low in the intravascular space and water moves by osmosis into the cells, causing them to swell
Hypovolemic Hyponatremia Tx
Water and Na need to be replaced
Stop diuretics
Use of isotonic IV therapy (prevents fluid shifting in blood) this only replaces the volume lost
Restriction of free water 24 hours to allow Na to catch up
Nursing Implications for Hypovolemic Hyponatremia
-Correct the issue slowly to avoid swelling/creating of cells
-if severe they are sent to icu (seizure watch) and labs are done q4h
-Neuro Assessment
-Implement fall precautions (muscle cramps)
-Assess BP and HR: IV therapy can elevate BP if given too long
-monitor intake, output, and weight: to make sure that what’s going in comes out (vomitting/diarrhea may not have much output)
Hypernatremia
> 145 mEq/L
“High Sodium in blood”
Causes of Hypernatremia
-Not drinking enough water, or having excess water loss (heat stroke, fever, diuretics, hyperventilation)
-impaired thirst mechanism (geri)
-high consumption of sodium
Hypernatremia Sx
-Headache, confusion, lethargy, seizures, coma
- muscle cramps
-postural hypotension
-intense thirst, sticky mucous membranes
Water movement in hypernatremia
There seems high Na levels in the blood, water will move from the cells into the intravascular space, causing them to crenate
Nursing implications in Hypernatremia
-Reduce sodium levels slowly
-Conduct neurological Assessments
-implement fall precautions
-implement seizure precautions if severe
-Assess BP and HR
-Restrict Na intake ( main difference between hyper and hypo–> restrict water)
Potassium
3.5-5.0 mEq/L
-very narrow range
-most abundant ion in ICF
-highest concentration of K will be found in muscle cells–> imbalances will impact heart, skeletal, smooth and neuro
Potassium functions
-mainly ingested through dietary sources
- kidneys eliminate 90% of K–> CKD pts often have hyperkalemia
- plays a role in acid base balance
-plays role in neuromuscular function , contraction of cardiac, smooth,&skeletal muscle
Hypokalemia
<3.5 mEq/L
“Low potassium in blood”
Causes of Hypokalemia
“DITCH”
-Drugs: laxatives diuretics (furosemide dumps all electrolytes )
-Inadequate intake: diet
-Too much water: Dilutes it in blood
-Corticosteroids: mineral corticoids cause excretion of K
- Heavy Fluid loss : Prolonged vomiting causes loss of HCL –> PH oh the stomach becomes alkaline which causes the exchange of H+ (move out of cell) with Na and K (move in cell)
Hypokalemia Sx
“6 L’s + H”
Lethargy (fatigue)
Leg Cramps
Limp muscles (slow reflexes and paresthesia –>specific to K)
Low shallow respiration: k is responsible for muscle contractions so GI will also slow
SLow GI motility: nausea, constipation, paralytic ileus
Lethal cardiac arrhythmia: heart is sensitive to K fluctuations
Hyperglycemia: d/t reduced insulin secretion from pancreas
Describe how heavy fluid loss leads to hypokalemia
Prolonged vomiting leads to loss of hydrogen through HCL. The loss of Hydrogen raises the pH in blood (alkalosis) the body will try to correct the blood pH through pulling Hydrogen out of the cells in exchange for moving potassium into the cells. This causes a loss of K in the blood.
Explain why Hyperglycemia is a symptom of hypokalemia
K+ is needed by the pancreas to create insulin. When there is low K in the blood there is a reduction in insulin being produced. This means that body cells are not removing glucose from the blood and it remain floating in the intravascular space. Additionally, the Na/K pump plays a role in moving glucose into the cell, and is also stimulated by insulin. So ultimately because K is not available for the pancreas to make insulin, glucose remains in the blood causing Hyperglycemia.
Hypokalemia Nursing Implementation
- Assessing muscles reflexes, motor function, respiratory function, heart rhythm, bowel sounds, glucose levels with insulin therapy
-for treating the Hyperglycemia, insulin is given but if too much is given, K will be moved into the cell too quickly –>hypokalemia - to avoid this you administer, insulin, dextrose and potassium
-withhold laxatives and diuretics
Dietary sources of Potassium
“Potassium + bananas”
-Potato
-Oranges
-Tomato
-Avocado
-Spinach
-Strawberries
-raisIns
-mUshrooms
-bananas
Hyperkalemia
> 5 mEq/L
Not as common as hypo
Causes of Hyperkalemia
-most common cause is renal failure (90% k eliminated by kidney)
-excessive intake of k
-massive cell destruction (many cells spilling k ions in blood?)
-potassium sparing diuretics (spironolactone)
-metabolic acidosis (k moves out of cell and H moves in) low blood pH
Explain how metabolic acidosis causes hyperkalemia
Acidosis refers to too much H+ in the blood. The body will correct this by moving H+ into the cells. This can only happen if K is pulled out and put into the blood, in exchange. Eventually, excess K will exist in the blood–>hyperkalemia
Hyperkalemia Sx
“LIMP is a FACT”
- Loss of muscle tone
-Irregular pulse/rhythm.
-Muscle weakness
-Parasthesia ans reduces reflexes
-Fatigue
-Abdominal cramping (diarrhea-diff from hypo which is slow and low)
-Confusion
-Twitching (muscle cramps)
Nursing Implications of Hyperkalemia
-in mild elevations, withhold k from diet
-assess medication use
-assess cardiac and muscle function
-assess bowel sounds /stool appearance
-may need diuretics to promote excretion
-assess glucose and k levels with I sulin therapy
-
Chloride
95-105 mEq/L
Most abundant anion outside the cell, which is why sodium and chloride have a relationship
Chloride function
-Helps maintain acid base balance
-excreted in sweat
-Cl is also regulated by the kidneys
- don’t look at Chloride by itself, look at it in conjunction with Na and K
Hypochloremia
<95 mEq/L
Hypochloremia causes
-GI losses such as vomiting or Prolonged GI suctioning
-Diuretics
-Medications such as antacids
-Fluid volume overload: bc cl resides in ECF fluid overload will water it down but you’ll have to compare it with sodium to see if there is a downward trend
Hyperchloremia
<105 mEq/L
Causes of Hyperchloremia
-associated with excess sodium intake or sodium and Chloride IVF (you don’t usually see this in hospital but it is possible with saline even though it’s isotonic)
-CKD: kidneys arnt excreting Cl
-Fluid volume deficit will increase the concentration
Blood Urea Nitrogen (BUN)
8-12 mg/dL
Causes for elevated BUN
-high protein intake
-excess protein breakdown
-CKD
-fluid volume deficit: reduced BV from dehydration–>kidneys don’t have enough fluid to remove waste products
Urea is a byproduct of protein breakdown by the liver. It is converted to ammonia(contains N) and combines with H, O, C to make uneasy and travels to kidneys to be excreted
Causes of low BUN levels
-Liver failure:impaired ability to convert ammonia into Urea
-low protein diet
-fluid volume excess: BUN gets diluted
BUN Nursing Implications
-assess protein levels and hydration status
-assess other kidney and liver function tests: BUN alone can tell you something about liver and kidney function but to determine which, you’d need to look at liver enzymes and na cl
Creatinine
0.8-1.2 mg/dL
It’s a waste product from protein digestion and normal muscle break down
-Amount of creatinine is proportional to the mass of skeletal muscle
-filtered by glomerulus at constant rate so it is a sensitive indicator of kidney function. If you compare this value to BUN it will tell you if the issue is kidney
Elevated Creatinine causes
-kidneys are damages and not filtering it
-acute MI: breakdown of heart muscle “Rhabdomylosis”
-high protein intake
-fluid volume deficit
Low creatinine levels
Low protein intake
Saline (Fleet Enema)
Enema
-increases osmotic pressure and draws water into the colon
Milk of Magnesia
-Laxative and antacid
-it’s osmotically active in the GI tract but not as much as the hyperosmotics
NI: Shake before administering; doesn’t have fluid/electrolytes so it may cause imbalances
Magnesium Citrate
Bowel preparation
-osmotically active
NI: Has to be refrigerated; may cause Fluid and electrolyte imbalances can occur
Bisacodyl and Senna
Stimulant Laxative
-it stimulates the intestinal nerves to increase peristalsis and water in the colon
Ni: may become habbit forming; -available orally or as a suppository
-may cause imbalances
-reduces peristalsis
What are the 9 rights of drug administration
Right Patient
Right Medication
Right Dosage
Right Time
Right Route
Right Documentation
Right Reason
Right Form
Right Response
What are the components of a medication order
Patient name
Medication name
Dose with unit
Frequency
Route
Proscribers signature
Note that the indication for use may not be there if it’s a PRN med
What are the areas of potential liability for nurses
Failure to Assess & Evaluate
Failure to Ensure Safety
Medication Errors
Fraud
Describe the stages of the medication process
Proscribing: script is written from provider (PCP, NP, DO, pharmacist) its a clinical decision based on drug choice and regimen
Transcribing: the order is received through eMAR. RN responsible for checking the order and if rational os correct
Dispensing: Pharmacist does the data entry and screening and mixes or compounds if necessary, and send to omicel/pixus (rendonda vaught)
Administration: RN prepares the drug for administration, verifies the order, administers the drug and documents in eMAR
Adverse Drug Event
-Refers to injury that can occur from a drug that can prolong hospital stay, cause disability, be life threatening and cause death.
-could be an adverse drug reaction (SE) or from a medication error
Adverse Drug Reaction
-This falls under ADE
-formerly called side effects
-they are unexpected, undesirable, may or may not be preventable, and occur at therapeutic dosages
Ex: constipation from Iron supplement
Drug-Drug Interactions
-Two or more drugs that enhance or diminish the effect of another
-a type of ADR
Ex: being on two antihypertensives
Pharmacologic Reaction
-another ADR
-it’s a reaction that can be predictable, and may need another med to manage the symptoms. The issues go away when the med is stopped
Ex: Someone on an opioid taking a stool softener to manage constipation
Allergic Reaction
-another ADR
- this is a hypersensitivity and immune response that can be preventable or non preventable. The body releases histamine and prostaglandin. Undesirable and unexpected
Idiosyncratic Reaction
-ADR
-It’s unpredictable and unexpected
-not always listed on the drug guide
-it’s not allergy related, but is rare and peculiar
- can be mild or life threatening
You have no idea why it’s happening
