Exam #3 Flashcards
What 5 things cause diarrhea?
Drugs, bacteria, viruses, dietary intolerances, and chronic conditions
Increase in frequency and fluidity of BMs is known as?
Diarrhea
About how long does acute diarrhea last?
3 days to 2 weeks
About how long does chronic diarrhea last?
3-4 weeks
What 3 things are we trying to prevent when we treat the cause of diarrhea
Weight-loss, nutrió al deficits, and F&E imbalances
When should anti-diarrheals not be administered (2 contraindications)
If the patient has a suspected C.diff or E. Coli infection
This anti diarrheal is an adsorbent
Bismuth subsalicylate (pepto)
This antidiarrheal treats mild to moderate diarrhea and acts by binding to bacteria and toxins to get rid of the bacteria in the stomach
Bismuth subsalicylate (Pepto)
Nursing implications:
This medication may cause tongue and stools to darken
Bismuth subsalicylate (Pepto)
Nursing implications:
This medication should has potential drug drug interactions with aspirin, warfarin, or NSAIDS
Bismuth Subsalicylate (Pepto) Adsorbent
What Anti diarrheal reduced bowel motility and transit time
Diaphenoxylate/ atropine (an opiate)
How does diaphenoxylate/ atropine work as an anti-diarrheal
Reduces bowel motility and transit time
Also reduces rectal spams pain and decreases stool frequency and volume
(It is an opioid)
Diaphenoxylate/ atropine is a combo med, what are the classifications for each med?
How does diaphenoxylate affects the body vs atropine
Antidiarrheal/ anticholinergic
Diaphenoxylate acts as a synthetic opiate agonist by slowing operative bowel
(It is a weak opioid)
Atropine is an anti-cholinergic that discourages recreational use of the combo med
It causes dry mouth and decreases peristalsis and increases hr
What kind of medication is loperamide?
What does it do?
How is it available?
Loperamide is an anti-diarrheal (opiate)
It acts similar to diaphhenoxylate
It inhibits peristalsis and prolongs transit time
It directly effects the nerves in the intestinal muscle wall
Decreases fecal volume and frequency
Available OTC
What kind of medication is lactobacillus acidophilus
What does it do
How does it affect diarrhea and when
Where is it found
It is a probiotic
It restores the normal intestinal flora
It may be helpful for diarrhea d/t antibiotics
Promotes good bacteria and suppresses bad bacteria
Found in fermented foods and fiber
Infrequent passage of abnormally hard and dry stools
How many stools per week
Constipation
2 or less per week
Feeling of incomplete evacuation
Constipation
What are the adverse effects of diaphenoxylate
Drowsiness and dizziness
What treats constipation and how
Laxatives, increase fecal movement and facilitate defecation
How long should you wait to take a laxative after any other meds
2 hours
Common adverse effects for laxatives include (4)
Bloating, gas, abdominal discomfort, cramping
In which 2 cases should you not use laxatives
Contraindicated with Gi obstruction and bowel perforation
What kind of medication is psyllium
How does it work
When and why is it advised to use and where is it available?
Psyllium/ metamusal is a bulk forming laxative (Fiber)
Increases fecal mass and prevents/ long term management of constipation
Safest laxative and OTC: prevents constipation without water and electrolyte loss
What is the nursing implication for psyllium (metamusal)
Mixture congeals, drink immediately to prevent obstruction
Must drink all 6-8 oz to work
What kind of medication is docusate sodium (Colase)
How does it work
How should you administer it
It is a stool softener (emollient)
Promotes H20 ad fat absorption into the stool to ease passage of stool
Must administer with a full glass of water
What kind of medication is mineral oil and how does it work
Laxative
Lubricates fecal material and eases passage of the stool
What kind of medication is Polyethylene glycol 3350 (miralax and golytley)
How does it work
When is it used (before what)
What is the nursing implications
How long should someone use miralax for
Hyperosmotic laxative (golytley and miralax)- has electrolytes in it to prevent dehydration
Induces bowel cleansing by pulling water (osmotic agent) into the colon
To prep for colon procedures
Given the day before a procedure
Daily use for treating constipation for up to 7 days
What kind of medication is a fleet enema and how does it work
Saline, increases osmotic pressure and draws water into the colon
What kind of medication is milk of magnesia (magnesium hydroxide)
When is it contraindicated
What is its secondary function
Nursing implications (2)
Saline laxative
Contraindicated in renal disease
Acts as a laxative and an antacid
Shake solution and F&E imbalances
What kind of medication is magnesium citrate
What is it used for
How does it work
Nursing implications (2)
Saline laxative
Bowel prep
Pulls water into the colon
Refrigerate and F&E imbalances
What kind if medication is bisacodyl and senna
How does it work
What are the risks
nursing implications (2)
Stimulant laxative
Treats constipation
Stimulates intestinal nerves to increase peristalsis and H20 in the colon
Can lead to a laxative dependence and F&E deletion (habit forming
Electrolyte imbalnces and increased peristalsis
What are 4 risks of laxative use and abuse
Loss of muscle and nerves response
Risk of dependence
Increase risk fo dehydration especially in older individuals
Increased risk of fluid and electrolyte imbalances
5 aging changes and that influence the bowels
Decreased water intake
Decreased fiber intake
Decreased activity
Chronic illness may delay evacuation
Increased use of laxatives/ dependence
An estimated ________ of patients experience a medication error
3-6.9%
9 rights of medication administration
Right…
Drug
Dose
Time
Route and form
Patient
Documentation
Reason
Response
Right to refuse
What are the 7 components of a medication order
Patients name
Medication name
Dose with unit measurement
Frequency
Route
Prescribers signature with date and name
Indication, may not be indicated with PRN
When is tall man lettering used
To draw attention to sound a-like, look a-like drugs
Should you ever administer a medication you did not prepare yourself
NO
8 causes of medication errors
Not doing 3 checks
Giving medications to the wrong patient
Confusing sound alike and look alike drugs
Not obtaining a througout medical history
Lack of knowledge
Dosing miscalculations work around
Environmental factors
Error in med process
Preventable
May/ may not cause harm
“Rights compromised”
Medication errors
Unpredictable and unexpected reaction, rare and peculiar
(Not even noted in Davis drug guide
May or may not be preventable
Occurs at therapeutic dose
Unexpected/ unintended
Idiosyncratic reaction
Hypersensitivity
Immune response
May or may not be preventable
(unexpected, unintended)
Occurs at a therapeutic dosage
Allergic
May or may not be preventable
Occurs at therapeutic dosage
Unexpected, unintended
Predictable
May need symptom management
Resolves with discontinuation
Adverse reaction
2 or more drugs
Enhance or diminish effects of another drug
Drug- drug interaction
What contributes to medication errors (5)
System processes
Workload
Lack of communication and collaboration
Inadequate education
Work arounds
What is a near miss and why is it important to report them?
A near miss is when a patient is exposed to a med error but is not harmed d/t detection or luck. It is important to report becase it could be d/t a system error that needs change
What are the nursing roles in stages of medication processes
(3)
Transcribing, administering, monitoring
What is the first thing you should do if you make a drug error
Assess your patient first
When documenting do not say “ i made an error, state exactly what happened and which medication you gave
What is the function of electrolytes in the body (4)
Nurse impulses
Muscle contractions
Acid base balance
Fluid balance
What is the function of electrolytes in the body (4)
Nurse impulses
Muscle contractions
Acid base balance
Fluid balance
Sodium
ECF concentration?
Regulated by?
Controls?
Most abundant in ECF
Regulated by kidneys
Controls water distribution and fluid balance (water follows Na+)
Sodium function
Influences (2)
Role in (4)
ECF osmolality
- Influences water distribution between ECF and ICF and ratio of Na to water
Role in:
Maintaining BP
Transmission of nerve impulses
Muscle contractility
Acid base balance
Hypovolemic hyponatremia
What is it, why does it happen
(who is it common in (4))
Both sodium and water are lost but, Sodium loss is greater than total water lost
Common in adults with comorbidities, multiple RX, lack of access to food and water, lack or thirst
4 causes of hypovolemic hyponatremia
Excessive sweating
Vomiting
Diarrhea
Diuretics
Hypervolemic Hyponatremia
What is it?
Who is it common in?
Total body water gain> Na+
More water gained than Na+
Common in older adults d/t:
- comorbidities
-multiple Rx
-lack of access to food/ water
-lack of thirst
Causes of Hypervolemic hyponatremia
Why and what (3)
Fluid volume overload d/t (organs can’t pump extra fluid):
- Kidney failure
- Liver failure
-Heart failure
(edema is common with these chronic conditions)
Symptoms of Hyponatremia
Headache, altered mental status, muscle weakness and cramps (everything slows down)
(S)tupor/ coma
(A)norexia
(L)ethargy
(T)endon reflexes decrease
(L)imp muscles
(O)rthostatic hypotension
(S)eizures
(S)tomach cramping
How do hyponatremia symptoms present depending on the severity of the deficiency?
Mild= asymptomatic
As Na+ decreases symptoms get more severe
Nerve impulses and signals slow down with low Na+
Nursing interventions and implications (3) Hypovolemic hyponatremia (5)?
Interventions:
- withhold diuretics
-replace sodium and water
-isotonic IV therapy (iso= same concentration as blood)
NI:
- neurological assessment
-implement seizure precautions (if severe)
-implement fall precautions
-monitor intake and output
-daily weights if edema present
(Same for Hypervolemic)
Hypervolemic hyponatremia interventions (2) and nursing implications (5)?
Interventions:
- fluid restriction (may have edema) (more water = more weight)
-Main: treatment of underlying condition (ex. HF)
NI:
- neurological assessment
-implement seizure precautions (if severe)
-implement fall precautions
-monitor intake and output
-daily weights if edema present
Hypernatremia (Na+) >145mEq/L
Definition?
Why does it happen? (2)
Examples (4 and 2)
Serum sodium is high (high Na+ osmolality- hyperosmolality)
Happens due to greater water loss than Na+
Ex.
- dehydration
- inadequate water intake
- high fever (sweating)
- diarrhea (can cause sodium and water loss so it depends on if the diarrhea is watery)
Excess Na+ gain
- Excess IV fluids containing Na+
- excess oral intake of Na+ (ex. Seawater and diet)
Hypernatremia symptoms
(F)lushed skin
(R)estless
(I)ntense thirst
L(E)thargy
(D)ecreased urine output
(S)kin is dry
(A)gitation
(L)ow grade fever
(T)hirst, sticky mucous membranes (oral cavity)
(S)eizures possible coma if severe
*symptoms are most evident in skin (dehydration symptoms)
Hypernatremia Interventions (2) and Nursing implications (3)
Interventions:
- Restrict Na+ intake
-Replace fluids PO or IV
NI:
- neurological assessment
-implement seizure precautions (if severe)
-implement fall precautions
Potassium (K+) 3.5-5mEq/L
Concentration?
Source?
Where is it found in the body?
What regulates it?
Inverse relationship with?
Other relationships? (2)
- most abundant intracellular cation
-diet is the main source
-majority is found in the muscles (nerve and muscle contractions)
-Kidneys responsible for balance (Eliminate 90%) - may have inverse relationship with Na+ (ex. Aldosterone increases Na+/ water reabsorption and excretes K+)
- Insulin relationship: insulin moves K+ and glucose into the cell
(more insulin= more K+ in cell)
-Relationship with Mg: need Mg to replenish/ replace/ absorb K+)
(If Mg is low= K+ is low)
Hypokalemia Causes
(4)
Causes:
- drugs (laxatives and diuretics)
(*If Mg+ is low, K+ is low)
-inadequate intake
- too much insulin (moves K+ into the cells)
- Heavy fluid loss (vomiting)
(Vomiting causes loss of H+/ stomach acid which increases bicarbonate, making it alkalosis)
(Alkalosis shifts K+ into cells and moves H+ out of the cells)
Symptoms of Hypokalemia
(6)
6 L’s “Slowing down”
Neurons less excitable and action potential inhibited
- Leg cramps
-Limp muscles, Decreases reflexes, paresthesias (tingling and numbness)
- Low shallow respirations (K+ is needed to maintain respiratory function)
-Lethal cardiac dysrhythmias
-sLow GI motility (constipation, nausea, paralytic ileus)
Hypokalemia Interventions (3)
- Hold diuretics, laxatives (unless it is K+ sparing)
- infuse K+ if severe
-increase K+ in diet
Bananas
Oranges
Avocados
Tomatoes
Spinach
Hypokalemia Nursing Implications (5)
NI:
ASSESS
- Motor function and strength
-Reflexes
-Respiratory function
-Heart rhythm monitored (regular or irregular)
-Bowel sounds
Hyperkalemia Causes (5)
- renal failure
-excessive K+ intake (ex. Food and supplements)
-Drugs (K+ sparing diuretics- taking too many)
-Muscle breakdown (rhabdomylosis= leaking K+ in the blood)
-Acidosis (K+ ions move out of the cells and H+ moves in)
Hyperkalemia Symptoms
2 Overall
5 points
Increased cell excitability to nerves and skeletal/ smooth muscles
Decreased cardiac depolarization
Decrease HR
Early muscle twitching leading to weakness
Arrhythmias
Tummy troubles (diarrhea- opposite of constipation for Hypokalemia)
Hypotension (can cause death)
Hyperkalemia Interventions (5)
-Restrict K+ food
- Identify K+ sparing meds
- May need diuretics to promote excretion of K+
- PO meds to excrete K+
- IV insulin with dextrose (move K+ into the cell)
Hyperkalemia Nursing Implications
(5)
ASSESS
- Heart rhythm monitored
-muscle function and strength
- Bowel function and character of stool
- Blood pressure
-Glucose level if insulin is being used to treat Hyperkalemia
Chloride (Cl-) 95-105mEq/L
Concentration?
Functions? (2)
Relationships (2)
Regulated by
Excreted in (2)
Most abundant anion outside of the cell
-Maintains acid-base balance w/ HCO3
-A component of HCl- acid
-Na+ and Cl- congregate outside of the cell
(If Na+ if low, Cl- may be low too and vise versa)
-Inverse relationship with HCO3-
(If Cl- goes in. HCO3 goes out)
-Regulated by the kidneys (excrete Cl-)
-Also excreted in sweat and gut juices
Hypochloermia causes
(4)
- GI losses (ex. Vomiting, prolonged NG suction)
- Diuretics (loop diuretics ex. Furosemide)
-Fluid volume overload
-Metabolism alkalosis (ex. Excessive loss of gastric HCl-)
(If less Cl- is available more HCO3- is retained by they kidneys)
Hypochloremia Symptoms
Associated with the cause of hypochloermia (identify the cause)
Headache, altered mental status, muscle weakness and cramps (everything slows down)
(S)tupor/ coma
(A)norexia
(L)ethargy
(T)endon reflexes decrease
(L)imp muscles
(O)rthostatic hypotension
(S)eizures
(S)tomach cramping
Hypochloremia Interventions (4) and Nursing Implications (4)
Interventions:
- Monitor Na+, Cl- and HCO3- levels
- Monitor K+ level
-NaCl- IVs for replacement
-Increase intake of foods rich in Cl- (salty foods)
NI:
-Assess for hypoNa+ symptoms
-monitor K+ level (may decrease in alkalosis)
-Implement safety precautions
-I/O, weight, VS
Hyperchloremia Causes (3)
- Assocaited with excess Na+ intake or IVF high in Na+ (NaCL)
-Not drinking enough water or loss of fluid - Metabolic acidosis (ie. HCO3- loss
d/t diarrhea)
(The more HCO3- is lost, the more Cl- is retained by the kidneys)
Hyperchloremia Symptoms
Associated with the cause for hyperCL- (identify the cause)
(F)lushed skin
(R)estless
(I)ntense thirst
L(E)thargy
(D)ecreased urine output
(S)kin is dry
(A)gitation
(L)ow grade fever
(T)hirst, sticky mucous membranes (oral cavity)
(S)eizures possible coma if severe
*symptoms are most evident in skin (dehydration symptoms)
Hyperchloremia Interventions (3)
-Monitor Na+, Cl- and HCO3- levels
-Hold infusions with NaCl-
-Limit intake of Na+ foods (aso contain Cl-)
Hyperchloremia Implications
(4)
- Assess for hyperNa+ symptoms
-Monitor K+ level (may increase in acidosis)
-implement safety precautions
-I/O weight, VS
