Exam Two Flashcards
Define off-label.
Use of drug for some purpose for which it has not been approved
What is family-centered care?
Essential in ensuring safety during, and after, health care interventions, especially during drug administration
What is the Principle of Atraumatic Care?
Provision of therapy using interventions that minimize or eliminate psychological and physical distress experienced by patients, particularly children with their families
Reasons for limited pediatric research include?
- Difficulty in obtaining informed consent
- Parents are reluctant to put children at risk
- Pediatric drug market is small, equaling less profits
What factors influence drug absorption in children?
- Child’s age
- Health status
- Weight
- Route of administration
- Nutritional habits
- Physical maturity
- Hormonal difference
- Hydration
- Underlying disease
- GI disorders
- Thin skin
Changes in the GI system in children include what?
- Alkaline gastric pH at birth
- Decreased intestinal surface area
- Decreased microbe colonization
What factors influence drug distribution in children?
- Body fluid composition
- Body tissue composition
- Protein-binding capability
- Changes in the blood-brain barrier
Do children have a higher or lower fluid volume?
Higher
Is body fat percentage increased or decreased in children?
Decreased
Do children have increased or decreased plasma proteins and receptor sites?
Decreased
Does the reduction in plasma proteins and receptor sites result in more or less free drug in the blood?
More
How does an increased bilirubin affect free drug levels in the blood?
Bilirubin binds to plasma proteins, leading to increased free drug in the blood
Do neonates have a more permeable or less permeable blood-brain barrier?
More permeable
What factors affect drug metabolism in children?
- Maturation level
- Liver metabolism
- Overall metabolic rate
Do infants have increased or reduced blood flow to the liver?
Reduced
Do infants have more or less drug-metabolizing enzymes?
Less
What factors affect excretion of drugs through the kidneys in children?
- Renal blood flow
- GFR
- Renal tubular function
What measures how much blood passes through the glomeruli?
Glomerular Filtration Rate (GFR)
Do infants have decreased or increased renal blood flow?
Decreased
True or False: Toxicity effects can occur in children even when serum drug levels are within the recommended range.
True
True or False: Giving children choices can increase their cooperation with drug administration.
True
True or False: Honey can be used when giving medication to a 9 month old.
False
Infants have _____ protein sites than adults, resulting in _____ risk of toxicity.
- Less
- Increased
Gastric pH does not reach adult acidity until around _____ to _____ years of age?
2 to 3
Until about the age of _____, the pediatric patient requires a _____ dose of water soluble drugs to achieve therapeutic levels.
- 2
- Higher
The 18-month-old child has been prescribed an oral drug that is water-soluble. Based on the nurses knowledge of drug distribution, what modification needs to be made to the dosage in order to reach therapeutic level?
Increase dosage
Since the blood-brain barrier in infants is immature, what might this due to the drug outcome?
Increase risk for toxicity
What drug action does the nurse know about the rate of absorption for topical drugs to a 3-year-old child?
The drug will absorb faster due to thin skin
A child has been admitted for nausea, vomiting, and diarrhea, and the HCP has prescribed several drugs. Which concerns are appropriate for the nurse to have regarding drug administration?
A) Renal tubular function is decreased
B) Dehydration may lead to toxicity
C) The drugs should not be administered by the oral route
D) Rectal administration will promote quick absorption
E) Developmental levels must be considered
A, B, C, E
The nurse is teaching a group of parents how to administer drugs to their children. Which elements of drug administration will be included in the teaching?
A) Allow the children to determine the time of drug administration
B) Lightly restrain the child as needed
C) Praise the child after successful administration
D) Never threaten the child into taking the drug
E) Never tell the child what to expect; just give the drug
F) Herbal preparations should not be given to children
B, C, D, F
The nurse is teaching a group of parents how to administer drugs to their children. Which elements of drug administration will be included in the teaching?
A) Allow the children to determine the time of drug administration
B) Lightly restrain the child as needed
C) Praise the child after successful administration
D) Never threaten the child into taking the drug
E) Never tell the child what to expect; just give the drug
F) Herbal preparations should not be given to children
B, C, D, F
Any person over the age of 65 is considered an?
Older adult
Define polypharmacy?
- Use of multiple drugs and/or administration of drugs beyond what is clinically warranted
- Use of 5+ drugs
What is the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults document?
A document developed by a consensus panel of 12 experts in geriatric care to aid health care providers in the safe prescription and administration of drugs to older adults
Define adherence.
The extent to which a patient continues to an agreed-on mode of treatment without close supervision
What are the physiological changes in geriatric patients that affect their responses to drugs?
- Reduction in total body water and lean body mass
- Reduction in kidney and liver mass and function
- Reduction in physiological processes that maintain equilibrium
What are the GI changes in older adults that affect drug absorption?
- Decreased surface area of small bowel
- Slowed gastric emptying
- Decreased gastric flow
- Decreased gastric acid production
What changes in older adults affect drug distribution?
Increase in fat
- Decrease in water
- Decrease in plasm protein
What are the factors that affect metabolism of drugs in older adults?
- Decrease in liver blood flow
- Decrease in liver mass
- Decrease in production of drug-metabolizing enzymes
True or False: A decrease in the 1st pass effect leads to an decrease in drug half-life.
False
What factors affect drug excretion in older adults?
Decrease in renal mass and function
True or False: Older adults can have a normal creatinine level, but still have decreased renal function.
True
What factors affect Pharmacodynamics in older adults?
Changes in the number of drug receptors
- Changes in sensitivity of receptors
- Decrease in compensatory response to physiological changes
Risk factors for polypharmacy include:
Female sex
- Multiple health care providers
- Multiple chronic diseases
- Multiple hospitalizations
- Use of herbal therapies and OTC drugs
List adverse drug events (ADEs).
Adverse reactions
- Medication errors
- Therapeutic failures
- Adverse drug withdrawal events
- Overdoses
ADEs occur more frequently in older adults due to what?
- Physical frailty
- Multiple chronic conditions
- Multiple medications
- Cognitive impairment.
Factors that affect an older adult’s adherence to a drug regimen include what?
- Taking several drugs at different times
- Not understanding why a drug is prescribed
- Impairments in memory, dexterity, hearing, and vision
- Cost
- Side effects
When teaching an older adult, make sure to:
- Check if the adult is wearing glasses and hearing aids
- Face the patient
- Be respectful
- Use large print on light background
- Limit distractions
Nursing Interventions related to drug administration in Geriatrics include:
- Monitor lab values
- Observe the patient for adverse reactions
- Recognize a change in behavior or cognition
- Ask patient about all drugs they are taking, including supplements, herbs, and OTCs
- Advise patients to use non-child proof caps when appropriate
What drug would have fewer adverse and toxic effects while maintaining its therapeutic effect?
A drug with a half-life of 4 hours
In older adults, drug dosages are adjusted based on what factors?
- Amount of adipose tissue
- Nutritional status
- Laboratory results
- Response to drug
Before administering drugs to the older adult, which drug information would the nurse know beforehand?
- Whether the drug is highly protein bound
- Half-life of the drug
- Serum levels of drugs with narrow therapeutic range
- Baseline vital signs
What is the Monitoring the Future Project?
A project that tracks drug use in adolescents and young adults
What is polydrug use?
Use of more than one drug
What is substance use disorder?
A disorder evidenced by recurrent use of a substance such that it causes a considerable impairment, including problems with health and an inability to keep up with family and work responsibilities
What is the reward circuit?
A structure that regulates the ability to feel pleasure and other emotions, both positive and negative
Define tolerance.
The need for a larger dose of a drug to obtain the original euphoria
What is epigenetics?
The study of environmental influences on genetics
Define alcohol toxicity?
A life-threatening condition that can occur by drinking large amounts of alcohol over a short period of time
What is vaping?
Inhaling the aerosol produced by an e-cigarette or similar device
What are the short-term effects of alcohol use disorder?
-GI distress
-Headache
Impaired judgement and coordination
-Memory loss
-Dilation of blood vessels in skin
-BP elevation
What are the long-term effects of alcohol use disorder?
- Gastric ulcers
- Gastritis
- Vitamin B deficiency
- Malnutrition
- Cancer
- HTN
- Stroke
- Heart disease
- Sexual problems
- Brain damage
- Liver damage
What does disulfiram do?
- Inhibits aldehyde dehydrogenase
- Ingestion of alcohol at the same time leads to vomiting, headache, palpitations, thirst, chest pain, and blurred vision
What does acamprosate do?
- Balances the effects of GABA and glutamate (impacted by alcohol)
- Decreases unpleasant feeling caused by stopping alcohol use
What does naltrexone do?
- Opioid antagonist
- Decreases the craving for alcohol
- Used in opioid use disorder
What are the short-term effects of Cannabis use?
Impaired memory
- Impaired concentration
- Increased appetite
- Impaired sensory and time perception
- Impaired coordination
What are the long-term effects of Cannabis use?
- Lung irritation
- Increased risk for heart attack and stroke
- Amotivational syndrome
What are the medical uses for Cannabis?
- Chronic pain reduction
- Nausea suppression
- Appetite improvement
- Lower intraocular pressure (glaucoma)
- Decrease in muscle spasticity (MS and spinal cord injury)
The effects of opoids include?
- Sense of euphoria
- Pain reduction
- CNS depression
- Respiratory depression
- Constipation
What is naloxone (narcan)? What is it used for?
- Short-acting opioid agonist
- Can be administered by nasal spray
- Given for opioid overdose
What is methadone? What does it do?
- Opioid agonist-antagonist
- Prevents a sense of euphoria from opioids
- Prevents opioid withdrawal and cravings
What drugs active both mu and kappa receptors?
Pure opioid agonists
What drugs act as antagonists at mu receptors and agonists at kappa receptors?
Opioid agonist-antagonists
A client is seen in the ED for reportedly swallowing a small balloon full of cocaine. What clinical manifestation would the nurse expect to see if the balloon ruptured?
- Dilated pupils
- Restlessness
Which drug can be given to aid a patient with opioid withdrawal?
Methadone
A patient has decided to quit smoking. What key points must the nurse include in the teaching plan?
- Assess that the patient is motivated to quit
- Help the patient identify what increases the desire to smoke
- Provide the client with a list of smoking cessation aids
Which percentage of nurses abuse drugs and demonstrate practice attributable to that abuse?
10-15%
Bath salts are classified as which type of drug?
Synthetic cathinone
Endogenous opioids (opioids made by our own body) active which receptors?
- Mu
- Kappa
- Delta
Requiring confirmation of a patient’s identity with two forms of identification before drug administration is known as what?
Right patient
Requiring confirming that a drug is right for the patient prior to its administration is known as what?
Right drug
Requiring verification by the nurse that the dose administered is the amount ordered and that it is safe for the patient for whom it is prescribed is known as what?
Right dose
What is the unit dose method?
Method of dispensing drugs in which drugs are individually wrapped and labeled for single-dose use for each patient
The time the prescribed dose is ordered to be administered is known as what?
Right time
Ordered by the health care provider, it indicates the mechanism by which medication will enter the body is known as what?
Right route
What is absorption?
Movement of a drug from the GI system into the bloodstream after administration
Requiring the nurse to record immediately the appropriate information about the drug administered is known as what?
Right documentation
What is root cause analysis?
A method of problem solving used to identify potential workplace errors
What is a sentinel event?
An unanticipated event in a health care setting that results in death or serious harm to a patient unrelated to the natural course of the patient’s illness
What is drug reconciliation?
The process of identifying the most accurate list of all medications a patient is taking at transition of care
All drug orders should include what?
- Patient name and DOB
- Date and time of order
- Drug name
- Drug dose
- Route of administration
- Frequency of dosing
- Duration of drug therapy
- PRN indications
Do not use abbreviations include:
- u
- IU
- QD
- QOD
- MS
- MSO4
- MgSO4
Which should be avoided: trailing zeros or leading zeros?
Trailing zeros
True or False: Nurses should encourage patients to split medication tablets when possible to save money.
False
True or False: Enteric coated tablets should never be crushed before administered by a G-tube.
True
What is tall man lettering?
System used to help health care personnel differentiate between medications that have similar spellings
