Exam II Flashcards
The higher the guage the _______ the needle
smaller
Regular syringe
Used for IM or subQ injections
Calibrated in milliliters
1- ,3- , 5-mL syringes for most injections
Tuberculin syringe
Holds 1 mL
Good choice for small precise volumes of meds such as those for newborns and infants
Good for TB skin test
Insulin syringe
Similar to TB syringe
Can hold 0.3, 0.5, and 1 mL
Tiny gauge, short, permanantly attatched needle
Prefilled syringes
Single does ready to use, disposable syringe cartridges.
can have needle attatched or not
Contains specific dosages
ID injections
Used mostly for diagnostic tests (TB test)
should be 1/4-5/8 in
25-30 g
Bevel up at 15 degree angle
Between layers of dermis
Do not apply pressure or massage injection site
SubQ injections
For medications that need to be absorbed slowly
3/8-7/8 in
24-29g
administer at 45 degree angle, can differ depending on amount of fat
1-2 mL syringe
when giving a SubQ med in the abdomen know that…
it absorbs faster here than other subq sites
Sub Q injection sites
back of upper arms, abdomen, anterior thighs, area of back just below scapulae, upper buttocks
Trough level
Lowest concentration of medication in blood.
Take before next dose regarless of route
Peak level
Highest concentration of medication in blood
Peak level depends on drug
Theraputic index for PO meds
between 1-3 hrs after administration
Theraputic index for IV meds
10 mins after administration
Do not give diabetic medications _____ hours prior to contrast testing because ________
48
It can cause lactic acidosis
Potassium rich foods
Artichoke Avacados bananas Cantaloupe cassava dried fruits grape fruits honey dew jack fruit kiwi kohlrabi lima beans mango meats milk dried peas and beans nuts oranges/orange juice papaya peaches pears plaintains pomegranate Potatoes punes/prune juice Pumpkin rhunarn salt substitute spinach sunflower seeds'swiss chard tomatoes vegetable juice winder squash
tyramine foods
Aged cheese american processed cheese avacados bananas bean curd beer and ale caffine containing beverages caviar chocolate distilled spirits fermented sausage liver meats tenderized miso soup over ripe fruit peanuts rasins raspberries red wine sauerkraut sherry shrimp paste smoked or pickled fish soy sauce vermouth yeasts yogurt
Neuropletic malignant syndrome
A rare but life-threatening reaction to any and/or all antipsychotics drugs or tranquilizers
Extrapyrimidial reactions
Involuntary movements
Steven johnson syndrome
a rare but serious disorder of the skin and mucous membranes. Its usually a reaction to medication that starts as flu like symptoms, followed by a painful rash that spreads and blisters. Ibuprofen can cause this in children
Half life
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 steady blood concentration.
Serotonin syndrome
too much serotonin, can because by antidepressants or pain medications.
Anticholinergic syndrome
delirium following tx with anticholinergics
Chvostek’s sign
tap the face in front of the ear and below the zygomatic bone. Facial twitching constitutes a positive sign and hypocalemia
troussue’s sign
Inflate blood pressure cuff and if flexion of wrist occurs then pt trousseau’s sign is positive and indicates hypocalemia
Milk alkali syndrome
characterized by high blood calcium and metabolic alkalosis caused by taking in too much calcium and absorbable alkali
Sodium Docusate
Colace
o Laxative- makes stool softer
o Can be give PO
o For clients who should not strain: pt’s who have had an MI, rectal surgery, or cardiac surgery.
o Can cause vagal response, which could cause the client to have hypotension and or bradycardia, which could cause the patient to fall and/or pass out.
o Can be taken with fluids or on an empty stomach…empty stomach inhibits fast results.
o Teach pt to be cautions when taking another laxative.
o Should be used short term only.
o Pt should be taught to have a high fiber diet and drink plenty of fluids if the provider permits.
o Pt’s who have had nausea, vomiting, abdominal pain, and fever should contact their physician. Should not be given for following symptoms.
o May take 3-5 days to work PO. Rectal within 2-15 mins
Enoxaparin
Lovenox
o High alert med (there have been serious complications with this medication)
o Given biased by weight in kg
o Anti coagulant
o Does not break up blood clots; keeps clots from forming.
o Given subq in fatty tissue; needs to be given in the abdomen or love handles to be absorbed slow. DOES NOT GO IN THE ARMS.
o Do not rub it in.
o Sometimes started before Warfarin (Coumadin) because warfarin can take several days to be effective in preventing clots.
o Clotting times (PTT &PTNINR) should be checked before administration (refer to appendix B) If labs are high pt may need an antidote. If labs are too low, pt may require more lovenox.
o Antidote is protamine sulfate
o Pt should be monitored for and taught to monitor for any unusual bleeding and to avoid contact sports.
o Nurses should ask if clients have reactions to pork products.
o Clients may go home on this medication
o Nurses need how to clean and rotate the injection sites and need to be taught why.
Fentanyl
Duragesic
o High alert med (there have been serious complications with this medication)
o Given biased by weight in kg
o Anti coagulant
o Does not break up blood clots; keeps clots from forming.
o Given subq in fatty tissue; needs to be given in the abdomen or love handles to be absorbed slow. DOES NOT GO IN THE ARMS.
o Do not rub it in.
o Sometimes started before Warfarin (Coumadin) because warfarin can take several days to be effective in preventing clots.
o Clotting times (PTT &PTNINR) should be checked before administration (refer to appendix B) If labs are high pt may need an antidote. If labs are too low, pt may require more lovenox.
o Antidote is protamine sulfate
o Pt should be monitored for and taught to monitor for any unusual bleeding and to avoid contact sports.
o Nurses should ask if clients have reactions to pork products.
o Clients may go home on this medication
o Nurses need how to clean and rotate the injection sites and need to be taught why.
Lasix
Furmoside
o Diuretic- reduces fluid in the body
o Should be given in the morning, because clients my need to urinate a lot after taking. The latest it should be given is 5 PM so clients are not up all-night urinating. Know pt schedule…Don’t tell a third shift worker to take it in the AM
o Helps with edema, can be used in clients with heart failure, or hepatic dysfunction.
o The client should be taught to monitor their weight to see of the client is losing fluid or if the fluid if being reduced too much. Notify PCP if they gain too much weight in one day.
o Pt should monitor fluid intake and measure it as ordered
o Pt needs to have their blood pressure and heart rate assessed to ensure they are not dehydrated. A drop in both can lead to falls.
o Check the skin for rashes that may develop
o Lab work should be done prior to starting and during treatment
o Potassium levels can be affected which can affect muscle function, think about the heart
o Glucose levels elevate do diabetics need to be taught that their diabetic medications may need to be adjusted.
o Can increase chance of Dig toxicity
Gabapentin
Neurotin
o Analgesic
o Anticonvulsant
o Mood stabilizer for behavioral health clients
o Safety for behavioral health clients is always a concern; nurses need to assess these clients for suicidal thoughts prior to and during administration.
o Client/care giver should be taught to keep track of the seizures, the duration, and to see if the medication is improving seizure activity
o Clients who take this for pain need to be taught not to increase the dose without a doctor’s order.
o Should not be stopped suddenly, may cause seizures.
Haloperidol
Haldol
o Antipsychotic
o Acute or chronic use
o Can be used for nausea and vomiting after surgery for some clients
o The nurse should verify if the client is having any hallucinations
o The clients BMI should be indicated as this med can cause weight gain
o Can cause constipation teach adequate fluid intake
o Cannot be stopped suddenly as it can cause withdrawal symptoms
o Unusual movements (smacking lips, tremors, etc.)
o Change positions slowly to prevent falls
o PCP should be contacted if there is a change in the urine or bowel movements
o Teach pt ways to prevent dry mouth, dry mouth can cause poor dentition
Heparin
o Anti coagulant
o High alert drug
o Does not break up clots, but prevents them from forming
o Subq- can be given in the fatty tissue of the arm unlike lovenox
o Clients APTT and PTNINR should be checked. If levels are too high client may need antidote. If levels are too low, client may need more heparin.
o Nurses need to teach clients about signs and symptoms of bleeding including bowel changes. Guiac testing
o Can cause HIT- Heparin Induced Thrombocyteopnea, (Low platelet count) weakens ability to clot
o Can be given by client but nurse must educate how to give it and the cleaning of the injection site.
o Teach to monitor for signs and symptoms of bleeding
Hydrochlorothiazide
HCTZ or Microzide
o Diuretic- helps reduce edema or as an anti-hypertensive
o Can be combined with other anti-hypertensive
o Pt still needs to be taught appropriate diet such as salt intake if this is a med for blood pressure
o Pt should be taught to manually take BP; if pt has a machine to measure it at home it must be brought in to ensure it takes the BP accurately.
o Pt should know to weight themselves bi-weekly. If too much is gained or lost in one day it should be reported to PCP
o Pt should be taught to take this first thing in the morning
o Lab work should be done first thing in the morning to measure electrolytes, and to assess body systems such as the kidney which is their renal function. Potassium is a concern esp on this medication this med can lower the potassium which increases the chance of a heart attack.
o Review Appendix K for potassium rich foods
o Teach Pt low fat diet, low cholesterol diet, and still exercise
Hydrocodone
Norco or Vicodin
o Used for a pain but also for a cough
o Addictive physically and psychologically
o The respiratory rate and BP should be monitored when first starting this.
o No alcohol should be used when taking this it can make one sleepy and dizzy…can cause falls
o Ask pt about his/her job; driving may be a concern if on this medication.
o It can slow down the bowel system so pt may have complaints of constipation. Teach the pt ways to prevent this such as fluid intake and diet.
o Do not crush if EC or ER
Hydromorphone
Dilaudid
o Similar to Hydrocodone
o Can be used for allergy relief
o Addictive
o Nurses need to ask if pt has been on any MAO inhibitors before starting this medication.
o No alcohol
o Respirations, heart rate, and blood pressure need to be assessed esp if giving by IV
o Bowels can be slowed like other opioids, know ways to prevent constipation
o PT on any kinds of opioids should not smoke
Coenzyme Q 10
Helps wit heart damage due to cancer treatment. Do not take with anticoags
Cranberry Juice
Helps with UTI’s but do not take with anticoags
Melatonin
help with sleeping; interacts with sleeping pill, analgesics, and opioids. Can interfere with blood sugar.
Soy
can help decrease cholesterol and low density lipo proteins. Helps to improve diarrhea. Helps some women with hot flashes. Interacts with Anticoagulats, antiplatelets, anti-inflammatory meds. Interacts with blood pressure and diabetic meds
alovera
used for skin problems, some people drink for overall health can cause laxative effect when taken orally
Capsaicin
Used in medicated creams and lotions for tenderness and pain of osteoporosis, fibromyalgia, diabetic neuropathy, and shingles. Do not apply to burns if happens seek medical help
Chamomile
helps with sleep, anxiety, and upset stomach. DO not take if allergic to ragweed
Echinace
used as antiviral for flu, colds, and other infections. Slows metabolism of caffeine leads to jittery feelings
Feverfew
anti-inflammatory, migraine headaches, fever suppression, and menstrual cramps. Interacts with anticoags can lead to bleeding and bruising
Garlic
Used to help relieve nausea and vomiting during pregnancy in recommended doses for a short period of time. Interacts with blood thinners
Ginko
used for memory enhancement and dementia. Increases blood flow to the brain. Interacts with meds metabolized in the liver. Should not be used with seizure meds, blood thinners, and diabetic medications
Ginseng
used to help lower bad cholesterol and protect the heart; also help lower blood sugar for type 2 diabetics. May help boost immune system. May interact with blood thinners, blood pressure meds, and diabetic meds.
Peppermint
used with caraway oil to treat heartburn. May improve irritable bowel syndrome and decrease spasms of GI tract. Before and after endoscopic procedures. Avoid taking with antibiotics, antifungals, iron supplements, and medications made to reduce stomach acids
Saw palmetto
used to treat enlarged prostate in men. Helps to improve difficult urination. DOES NOT SHRINK PROSTATE. Do not take med with proscar. Can interact with warfarin, estrogens, and birth control pills.
St. John’s wort
Used for mild to moderate depression: when used for this purpose studies have shown it to be at least as effective as most Rx drugs. Interacts with certain anti-anxiety meds (do not take with xanax). Should not be taken with valerian or muscle relaxers
Valerian
used for tx of insomnia. Helps improve quality of sleep. Interacts with muscle relaxers, sleeping medications, pain medicines, and antidepressants
Schedule I
Highly addictive street drugs
Schecule II
Highly addictive drugs with a medical use
Schecule III
Drugs have a potential for being abused but not as much as Schedule I & II
Schedule IV
Lower risk of being abused than I, II, III.
CNS Depressants
Stop these suppplements before surgery due to bleeding
Cayenne Fevervew Ginkgo biloba Ginseng Omega-3 fatty acids St. John's wort Vitamins A and C Antiplatelets drugs
Z- Track method
method of IM injections prevents iritating and dark colored medications such as iron dextran, from leaking out of the injection site into sensitive tissues or subQ tissues that my stain.
Also helps reduce inflamation
Pull skin taunt then pierce skin skin swiftly
Ventrogluteal Injection site
Safest most comfortble site for pt’s over 7 months
Make a ‘v’ with your hand
Deltoid
Most common site for injection of small volumes.
Only use it in children with adequate muscle mass
Not suitable for newborns and small infants because of lack of muscle development
MDI
Metered dose inhaler
Most efficient way to get medication into the airways
Do not leave in car
Whipe mouth piece after use to remove excess medication
If spacer is being used rinse daily in warm water and let air dry
Hold 1-2 min from face inhale deeply and hold breath for 10 min then breath out through pursed lips
If second puff ordered wait 1 full minute
Rinse and spit if steroid inhaler
Wait 5 min between if more than one inhaler
DPI
Dry powder inhaler
rely on force of pt inhalation rather than cannister
Instruct pt not to exhale into inhaler so not to disperse powder medication
Pt’s with asthma may not have enough air flow to succesfully inhale med
