fundamentals exam 2 Flashcards
What is pharmacokinetics & why is it important for nurses?
study of what the BODY DOES TO THE DRUG
It is important for nurses to understand:
- Timing of medication administration
- Selecting the route of administration
- Evaluating a patient’s response
- How body reacts to a drug
- Helps assess the patient to suggest one medication over another
Principles of ADME
Absorption
Distribution
Metabolism
Excretion
What would you do if a client has a known drug allergy and the provider prescribes a medication that they are allergic to?
Hold the medication & talk to the provider
What would you do if a client asked for a medication and it is not in the MAR?
Do not adminster the medication
Speak to the provider
What are common medication administration parameters and what would you do if you are giving medications at 0800, the MAR says “hold if pulse is less than 60 bpm” for this drug and your assessment reveals that the client pulse is 48?
The common medication administration parameters are usually certain vital signs
If patient does not meet those parameters, the drug will be held
I will hold the drug because their pulse is lower than 60
What is STAT order & when is it given?
STAT order is immediately
It is given within 30 minutes of the time it is ordered
7 Rights of medication adminstration
Right Drug
Right Dose
Right Documentation
Right Route
Right Reason
Right Time
Right Patient
Do we all experience & express pain in the same way?
We do not
What is tolerance?
body gets used to the drug so that either more drug is needed or a different is needed
What is dependence?
Use of drug continues even when significant problems have occured
What is withdraw?
physical and mental symptoms that a person has when they suddenly stop the use of drug
What is addiction?
a chronic, relasping disorder characterized by compulsive drug seeking and use
What are general types of medication for pain management & what is the nurses’ role with giving pain medication?
pain relievers, NSAIDS, nonopioids, opioids, Acetaminophen
Nurses manage the patients pain through assessment, intervention
Monitor side effects, determine patients ability to self adminster
How would you know if a pain medication is effective?
Symptoms become less severe
Patient stating pain level is decreased
When would you reassess pain after giving oral medication
After 30 minutes to an hour
What things do nurses teach patients about use of medications for pain control?
Take meds at prescribed time and w/ food
Can cause constipation (increase fluid and fiber intake)
Maintaining wellness habits
Nonpharmacological pain-relief interventions
Side effects
Right dose for your pain
How do we assess pain?
Use the pain scale
Use OLDCART
What are some interventions for managing pain?
Medication
Ice
Physical therapy
Relaxing
What are some complications of oral pain medications?
Respiratory depression
Constipation
Patient vital signs with pain:
Vital signs will be increased
PCA pump:(patient-controlled analgesia)
Family cannot use the pump
Patient must understand how to use it
Risk for fall:
Mobility issues
Incontinence
Old / weak
Bad balance
Hazards
Medications - any medication that makes you drowsy, muscle relaxants, Antipsychotic
Risk factor for skin breakdown:
Immobility
Poor nutrition / fluid intake
Incontinence
Bedrest all the time
Unconscious
Pressure injury
Unintended
Immobility causes them
Surgical wound
Intended
Stages of pressure wounds
Stage 1
Red doesn’t go away
Skin intact
Move them to get it off the pressure
Stage 2
Loose the top of skin loss
Kinda looks like a blister
Stage 3:
More deeper skin loss
Stage 4:
Down to muscle and bones
Full thickness of skin loss
Interventions for pressure wounds:
Repositioning the patients
Good hygiene
Good fluid / nutritional intake
Outcome for pressure wound:
Healing
Improvement
Signs wound is healing:
Smaller
Granulation tissue - pink tissue
The skin comes together
If there is necrotic tissue in the wound bed how could it be treated?
Debridement (removing the necrotic tissue)
Antibiotics are part of the treatment
Wound care is needed
Surgically removed, prevents wound from healing
Know the phases of wound healing what you would see on assessment in each phase. What things would you see to indicate the wound is healing?
Hemostasis- stage that controls blood loss, bacterial control
Injured blood vessels constrict & platelets gather
Clot formation occurs
Inflammatory phase:
Inflammation or redness at the wound site, edema, heat, and pain.
Proliferative phase
Reconstruction progress, takes 3-24 days
Filling granulation tissue in wound, fibroblast and collagen are present
Vascular bed reestablishes, contraction, surface repaired
Maturation- collagen scars regain strength- in serious cases can take up year
Remodeling stage
Fewer pigmented cells (melanocytes)
Lighter skin area than the rest
Unless on a darker pigmented skin, then that area will be highly pigmented than surrounding tissue
Healthy granulation tissue is pink in color would indicate the wound is healing
3 common urinary problems
urinary retention: unable to empty bladder fully / difficulty urinating
urinary tract infection - infection in any part of the urinary system
- Results from catheterization or procedure
urinary incontinence - leaks urine by accident/ loss of bladder control
Types on incontinence
Stress incontinence: Urine leaks when you exert pressure on your bladder
- laughing, sneezing, coughing can cause a little pee to be released
Urge incontinence: sudden, intense urge to urinate
Overflow incontinence: frequent or constant dribbling of urine due to bladder doesn’t empty fully
When a client tells you they cannot urinate, what should you do first?
Palpate the bladder, feel for distension
What is a common diagnostic test to determine if a client has a urinary tract infection (UTI)?
Urinalysis - urine culture test with antimicrobial susceptibility testing
What factors put clients at risk for UTIs?
Not urinating
Not wiping front to back
Patients on a catheter
What are common signs of a UTI?
Burning when peeing
Itching around vaginal area
Cloudy
Strong smelling urine
Urge to pee
Flank pain
Frequent urination
What are some concerns with urinary health and medication use in older adults? What assessment data would you collect to understand this?
Renal function - the medication stays longer in pt’s body causing side effects to last longer
Everything works slower in older adults
Check blood- to check renal function and urinalysis test
What are some considerations for clients who must void in bed or at the bedside (bedpan, urinal or commode)?
Make accommodations for the client to be comfortable and able to use the bedpan, urinal, and commode
Hygiene care is integral to keep skin around that area healthy
Moisture problems could cause skin breakdown
Risk of infection is also key
What is peristalsis and what can decreased peristalsis contribute to?
Peristalsis series of wave-like muscle contractions that move food through the digestive tract (GI tract)
Decreased peristalsis can contribute to constipation forming hard stool and water continues to be reabsorbed
Bacterial overgrowth
Electrolyte and nutritional deficiencies
What is a common diagnostic test to determine if a client has an infection in the lower gastrointestinal (GI) tract? Aside from diagnostic testing, what other signs indicate GI infection?
A stool culture can determine if a client has an infection in the lower gastrointestinal tract
Colonoscopy, endoscopy
Other signs indicating GI infection are nausea, vomiting, stomach cramps, watery stool
If a client has ongoing vomiting & diarrhea, what is our concern?
Dehydration
What actions help prevent constipation? If a client routinely uses laxatives, what unintended outcome can occur?
Drinking a lot of fluids
Diet high in Fiber- Whole wheat, beans, broccoli, avocado, apples
Moving around can prevent constipation, physical activity
unintended outcome - constipation
Treatment for constipation
Laxatives
Doculate pills
Suppository
How to assess someone’s bowel movement:
When was their bowel movement
How many times
Find their pattern
Listen to their bowel sounds
What foods in the diet can cause gas?
Cauliflower & Broccoli
What physical assessment findings would lead you to a nursing diagnosis of constipation?
Stool samples - having the stool to be large and dry
Abdominal Assessment ( palapte, auscultate, & possibly percuss)
Abdominal distention or pain
Infrequent passing of stool
Pain upon defecation
Classic signs of dehydration
Skin tenting
Pale
Dry
Cracked lips
What nutritional factors relate to skin integrity (why do we give supplements?)
Pt are given supplements bc they are not receiving the standard nutrients they need in their regular diet or the body is not able to produce a sufficient amount of vitamins
Giving supplements will enhance wound healing, give pt adequate nutrition, support immune system, and help with skin repair and tissue, skin integrity
Why is sterile technique used? If anything in the field touches something that is not sterile, what would you do?
If anything in the field touches something that is not sterile, you have to start over again
Sterile technique is used because it reduces the risk of transmission of microorganisms
Also used when integrity of skin is assessed, impaired, or broken
