Exam 3 Review: Goldstein Flashcards
What is the difference between a patient who only needs a SABA PRN and someone that will get a daily asthma medication?
(What would make someone get a daily asthma medication instead of a SABA PRN?)
When they use their inhaler too much
o Inhaler is a rescue medication and shouldn’t be used all day/everyday (too much) so they will need to be on daily medication
patient education point - what should someone do after they us their Symbicort inhaler?
rinse out their mouth to prevent thrush
two other combination drugs beside Symbicort that also has an inhaled corticosteroid and a LABA?
o Advair (fluticasone and salmeterol)
o Breo Ellipta (fluticasone and Vilanterol)
what drug has a black box warning that it is not to be used as monotherapy?
Salmeterol
what is monotherapy?
use it by itself
what is the black box warning for montelukast?
neuropsychiatric events such as depression and suicide
three things to monitor to assess for adverse effects of albuterol?
(SE/AE: Tachycardia, Hypokalemia, Hyperglycemia)
o heart rate
o potassium
o glucose
why does albuterol cause tachycardia?
because were activating beta 2 but beta 1 also gets affected
o Beta 1 activates your whole fight or flight response – get high heart rate/BP – when body is super stressed it releases sugar because your body needs energy for the flight or flight
- (reason for AE/SE) Because of the release of sugars it causes hyperglycemia then the body releases insulin to get it under control – and the insulin and glucose into the cell and take potassium with them which causes potassium to go down
two drugs that are used for the treatment of chronic asthma that are not taken by the inhaled route?
o Theophyline (structured similar to caffeine)
o Montelukast
drug for the treatment of asthma that needs to be taken QID?
Cromolyn
long acting anti-cholinergic drug for asthma?
Tiotropium
Two critically important patient education points for anyone diagnosed with asthma?
o recognize and avoid your triggers
o know how to use your inhalers
first line drug for the long-term management of asthma?
inhaled glucocorticoids or corticosteroids (same thing)
two examples of inhaled corticosteroids
o Fluticasone
o Budesonide
in what form is fluticasone available OTC?
intranasal
what is intranasal used for?
allergies
most commonly used add on medication when an ICS is not achieving symptom control
Formoterol (LABA)
IV only drug that is used for acute asthma exacerbation
Magnesium
Most important assessment the nurse must make or monitor for someone who is receiving magnesium
assess for respirations
o magnesium toxicity
two primary pathophysiology issues of asthma
o Bronchoconstriction
o Inflation
what drug class addresses the 3rd and more minor issue of excessive secretions?
o Anticholinergics
four adverse effects of taking systemic corticosteroids
o females post-menopause increases risk of osteoporosis
o raises your blood sugar
o hypertension
o risk of infection
two examples of systemic corticosteroids
o Prednisone
o Methylprednisolone
what is the first line intervention for a patient that comes in with an acute asthma attack?
oxygen
what is room air oxygen
20.9% - 21%
appropriate flow rate for nonrebreather mask
10 - 15
appropriate flow rate for nasal cannula
1 - 6
how much FiO2 is for someone on 2L of oxygen via nasal cannula?
(how much percentage of oxygen a person is breathing if they’re on 2L on nasal cannula?
29%
8+21
a nurse is caring for a patient who is not breathing and requires oxygen, what is the only appropriate method?
bag valve mask (ambu bag)
what is the only device/method a nurse can use to provide both ventilation and oxygenation for our patients?
bag valve mask
what is the highest percentage of oxygen we can deliver to our patients? and how?
o 100%
o nonrebreather mask
normal pulse ox
94 and above
under what guideline can a nurse administer oxygen to a patient without a physicians order
standing order
a patient is receiving albuterol for a severe asthma attack, the patient becomes tachycardic and with a heart rate of 155 and complaining of palpations, what would be an appropriate nursing intervention?
o we just monitor the heart rate as it increases
o notify the doctor
- need to get their breathing under control first before we can address increasing heart rate
- wrong answer would be to “stop medication”
what lung sound would you expect in a patient experiencing an asthma exacerbation
wheezing
what would be the most concerning lung sound in a patient with a severe asthma exacerbation
nothing (diminished/absent)
what lung sound would indicate an issue with the upper airways
stridor
two purposes of ventilation
o breathe in oxygen
o breathe out carbon dioxide
a patient presents to your office and states they need their inhaler twice a day for the last 2 weeks, they are already on fluticasone daily,
what would be your priority question
how are you taking your medication
five drug classes that work to address bronchoconstriction
o LABA
o SABA
o Methylxanthines
o Anticholinergics (short term)
o LAMA (long-term anticholinergic)
four drug classes that work to address inflammation in the airways
o systemic corticosteroids
o ICS
o leukotriene receptor antagonists (LTRA)
o mast cell stabilizer
two most commonly used alternatives to an ICS
o Cromolyn (mast cell stabilizer)
o Theophyline
o Montelukast (LTRA)
(professor wasn’t sure which answer is on the exam so the answer would be cromolyn and one of the other two listed)
what is a patient education point for someone taking a methylxanthines
avoid caffeine while taking this medication
what drug is used for both asthma and allergies
Montelukast
primary indication for sodium bicarbonate via IV route
acidosis
what organ is most responsible for maintaining our pH
Kidneys
the treatment for stable/chronic hyperkalemia
o Polystyrene Sulfonate
o Patiromer
treat immediately
acute/unstable
have time to treat
chronic/stable
if someone has mild hypokalemia, is stable and there is NO symptoms, what would be an appropriate intervention?
recommend foods that have high potassium
(banana, potatoes, gatorade, powerade)
if someone has mild hypokalemia, is stable and have MILD symptoms, what would be an appropriate intervention?
PO Potassium
what would I anticipate when infusing potassium into a patient at a rapid rate?
o pain at the injection site
o cardiac abnormal rhythms (abnormal heart rhythms)
what would be the first nursing intervention for a patient that is receiving potassium infusion (IV) and is complaining of pain at the infusion site?
assess the IV site
what would be the most common cause of pain during potassium infusion?
rate is going to fast
o slow it down (do not need a doctor’s order to taper down)
normal serum potassium level
3.5 - 5
what does serum mean
in the blood
what nursing intervention would be used to monitor for the most concerning adverse effect of hyperkalemia?
ECG machine
a patient is receiving an infusion of potassium, what lab can a provider order to monitor their potassium level
o CMP (comprehensive metabolic panel)
o BMP (basic metabolic panel)
what lab can a provider order to monitor magnesium for a patient receiving an infusion?
Magnesium
a patient has hypocalcemia and is stable, what order would the nurse anticipate?
o PO calcium supplements
o increased calcium in your diet
if a patient is hypocalcemic, in addition to calcium supplements, what else MUST the patient take?
Vitamin D
for what reason might a patient who has unstable hyperkalemia (severe electrolyte imbalance) receive calcium?
to protect the heart
what are the two most common causes of hypercalcemia?
o Parathyroid Issues
o Cancer
what two IV drugs are the treatment options for hypocalcemia?
o Calcium Gluconate
o Calcium Chloride (most powerful of the two)
what fluid will pull volume into the cells?
Hypotonic
what fluid will push volume from the bloodstreams?
hypotonic
pull into cell
push from blood
hypotonic
pull into blood
push from cell
hypertonic
another name for hypertonic solution
3% Sodium Chloride
what are 4 names for isotonic fluids?
o Normal Saline
o 0.9
o Sodium Chloride
o NaCl
name 5 different crystalloid fluids
o Normal Saline
o Lactated Ringer (LR)
o 3% Sodium Chloride
o 0.45% Sodium Chloride
o Dextrose 5% in water (D5W)
- - if you just see “Dextrose” then it’s wrong
- - must say “Dextrose 5% in Water”
what fluids utilize oncotic pressure
o 3% Sodium Chloride
o Colloids
- Albumin (most commonly used oncotic pressure)
- Dextran 40% in D5W
- Plasma Protein Fraction
- Hetastarch 6% in NS
what would you monitor for a patient that is receiving sodium bicarbonate?
pH (acid level)
if a patient receives too much sodium bicarbonate, would their pH go up or down?
Up (alkalosis - high pH)
what is a normal pH level
7.35 - 7.45
uses for a magnesium infusion
o Pre-term Labor
o Certain Arrhythmias
o Hypomagnesemia
o Asthma
o Laxative
is magnesium addressing constriction or addressing inflammation?
constriction
what electrolyte imbalance is most dangerous?
hyperkalemia
what is the purpose of using a spacer?
o to increase the amount of medication a patient is receiving
what OTC medication for allergic rhinitis cannot be used for more than a few days?
Oxymetazoline (Afrin)
three medications that are use that block histamine and does NOT cause drowsiness
o Loratadine (Claritin)
o Fexofenadine (Allegra)
o Cetirizine (Zyrtec)
three medications that block histamine and DO cause drowsiness
o Diphenhydramine (Benadryl)
o Hydroxyzine
o Doxylamine
what could happen if you use Oxymetazoline for more than a few days?
can cause rebound nasal congestion
what drug class is intranasal fluticasone in?
Intranasal Glucocorticoids
what drug class is the most used for allergic rhinitis?
Histamine One Receptor Antagonist (H1RA)
the definition of rhinitis
runny nose
a drug that is antitussive
Dextromethorphan (Delsym, Robitussin)
two prescription medications that are also use for patients that have a cough
o Benzonatate (Tessalon Perles) numbing agent
o Codeine
three patient education would you provide for someone prescribed codeine for a cough?
o Don’t take with alcohol (cause CNS depression)
o Intake a lot of fluids (can cause constipation)
o Do not drive
what drug class makes our coughs more effective
Mucolytics
what drug is the most potent drug for the treatment of allergic rhinitis?
Fluticasone
what S/S would you NOT expect in a patient with allergic rhinitis?
Fever
(fever is a sign of infection, not allergy)
MOA of antitussives
Suppresses/decreases sensitivity of cough receptors
Potassium Lab Value
3.5 - 5.0 mg/L
Sodium Lab Value
136 - 145 mEq/L
Calcium Lab Value
9 - 10 mg/dL
Chloride Lab Value
98 - 106 mEq/L
Phosphorus Lab Value
3.0 - 4.5 mg/dL
Magnesium Lab Value
1.3 - 2.1 mEq/L
BUN Lab Value
10 - 20 mg/dL
Creatinine (CR) Lab Value - Males
0.6 - 1.2 mg/dL
Creatinine (CR) Lab Value - Females
0.5 - 1.1 mg/dL
