Kaplan Content Review - Chapter 1 Flashcards
Blood should be infused within ____ hrs for each unit. How frequently during this time should vital signs be obtained?
What should you change for each unit of blood?
2hrs
Every our until complete and then hourly for 3 hrs
Entire IV line
What should you do if a blood transfusion reaction is suspected? (6)
Stop blood
Restart NS
Save blood container and tubing and return to blood bank
Draw blood sample for plasma, hgb, culture, retyping
Collect urine sample + send to lab for hgb determination
Monitor urine symptoms for hematuria
What is an allergic reaction/hypersensitivity to blood transfusion?
When does it occur?
Hypersensitivity to antibodies in donor’s blood
Immediate or w/n 24hrs
What is an acute intravascular hemolytic blood transfusion reaction?
When does it occur?
What are the s/s?
Incompatability with donated blood
Within mins to 24 hrs
N/V
Fever
Low back pain
Tachy
Decreased UOP
Hematuria
What would a blood transfusion circulatory overload look like?
Dyspnea
Crackles
Tachypnea
Tachy
Isotonic fluids have the same concentration as _____
Hypertonic solution have a concentration greater than the _____
ECF
ECF
Isotonic fluids: 3 types
Main function:
NS
LR
D5W
Maintain / restore F + E balance
Hypotonic solution
Hypertonic solution
0.45% NS
3% NS
Sodium Bicarb 5%
10-15% dextrose in water
You are giving IV fluids to a pt and they have suspected circulatory overload. What would you observe? What are the 4 nursing care steps to address this?
Crackles
Dyspnea
Confusion
Seizures
- Reduce IV rate
- Asses VS
- Asses lab values
- Notify HCP
You suspect infiltration / extravasation. What s/s would you see? Nursing care steps? (4)
Edema
Pain
Coolness in area
Decrease in flow rate
- D/c IV
- Apply warm compress to site
- Sterile dressing
- Elevate arm
What are s/s of phlebitis? What should you do? (3)
Redded, warm area at IV site
Tenderness
Swelling
- D/c IV
- Apply warm, moist compress
- Restart IV at new site
What would you see with an IV line hematoma? What would you do as the nurse? (3)
Eccymosis
Immediate swelling
leaking of blood at site
- D/c
- Apply pressure with sterile dressing
- Apply cool compress/ice intermittently for 24 hrs, followed by warm compresses
What should you do if a clot forms in your IV line?
d/c it! DON’T milk, irregate, aspirate or up the flow rate
What should you do for a hemolytic blood transfusion reaction?
- Stop transfusion
- Maintain IV access by restarting NS
- Notify HCP
- Supportive care (oxygen, diphenhydramine, airway management)
Where is the tip of the catheter for a PICC?
What should you NOT do if your pt has a PICC line?
SVC or Brachiocephalic vein
No BP or blood draws from that extremity
Difference between a tunneled central catheter and a non-tunnled percutaneous central cath? How frequently do you change dressings?
Tunnled = long term use (yrs)
Non-tunnled: short term IV therapy
2-3 x /week
Norephinephrine ADRs
HA
Palpittaions
Angina
HTN
TISSUE NECROSIS with extravasation
What is norephinephrine used for?
What should you monitor for?
What should it be infused with (and what should it NOT be)?
Vasoconstriction to increase BP and CO
UOP + BP
Dextrose yes, NS no
Dopamine, at a high dose, can be used for what?
What is an early sign of drug excess?
What should always be used with it?
Vasoconstriction, increased nyocardial oxygen consumption
HA
Infusion pump
Isoproterenol is used for…(4)
Isoproterenol should not be given when?
Heart block
Ventricular arrythmyia
Bradycardia
Bronchodilation for asthma and brochospasms
Do not give at bedtime, it interrupts sleep patterns
Phenylephrine is used to treat
Hypotension (alpha 1 agonist)
Dobutamine Hydrochlorie is a _____ stimulator
How is it administered?
What should be monitored when giving this med?
Beta 1
Through central venous cath or large peripheral vein with infusion pump
Monitor EKG
I/O
Serum K+
Dobutamine Hydrochlorie is a _____ stimulator
How is it administered?
What should be monitored when giving this med?
Beta 1
Through central venous cath or large peripheral vein with infusion pump
Monitor EKG
I/O
Serum K+
What is milrinone used to treat?
Smooth muscle relaxant for severe HF
It’s a positive inotrope
Nitroprusside is used for (3)
ADR
Dilation of cardiac veins and arteries
Decreases pre-load and afterload
Increases myocardial perfusion
HYPOTENSION + IICP
What does diphenhydramine do?
Blocks effects of histamine on bronchioles, GI tract, blood vessels
-sone drugs (ex: Cortisone, Dexamethasone, Prednisone) are generally, what class of medications? What are they treating?
Adrenalcorticoid: Glucocorticoid meds
Use:
- prevention / supression of cell-mediated immune reactors
- addrenal insufficiency
Glucocorticoid drugs (-sone):
- Overdosing these meds could lead to _____
- Abrupt withdrawal could lead to _____
- When should these meds be given? + administered with what?
- Stress/surgery means what for these meds?
- What should be consistently checked in adults and then especially in kids?
Cushings sundrome
Addisonian crisis (HA, N/V, papilledema)
Morning, before 9am + antacid
Increase need for steroid doses in times of stress
BP, I/O, weight
Growth in kids
Glucocorticoid drugs increases a pt susceptibility to ______.
What electrolyte imbalances can occur?
What about glucose levels?
Infection / slow or poor wound healing + osteoporosis (pathologic fractures) + psychosis
Hypokalemia / Hypocalcemia
Hyperglycemia
What is Fludrocortisone given for?
How should it be given?
Class of drug?
What should you watch for as ADRs?
Diet recommendation?
What are nursing considerations?
Adrenal insufficiency
PO with food
Sodium + water retention
Low-sodium, high protein, high-K+ diet
Monitor BP
Monitor serum electrolytes
Daily weight + report of sudden changes to provider
Used with cortisone or hydrocortisone for adrenal insufficiency
Atropine uses
Pt ed
Bradycardia / Mydriasis for ophthalmic exam
Anticholinergic effects
Avoid heat
Scopolamine is used for
How is it given?
ADRs
motion sickness / vertigo
transdermal patch
Anticholinergic effects
Heparin: normal PTT times
How should heparin be administered and how NOT?
Antidote?
20-40 sec (1.5-2.5 x the control without signs of hemorrhage)
IV with pump
SQ
NEVER IM (danger of hematoma)
Protamine sulfate within 30min
Low molecular weight heparin is aka _____
How is it administered?
What is the advantage of this med?
Enoxaparin
SQ - NEVER IV or IM
Does not require lab test monitoring
Warfarin, monitor what? / whats nml?
Antidote?
PT: 9.5-12
INR: 2-3
Vit K
Dabigatran is used to treat
MOA
Stroke
DVT
PE prophylaxis without A Fib
Directly inhibits thrombin
What meds inhibit the synthesis of clotting factors? (4)
Heparin
Enoxaparin
Wafarin
Fondaparinux
Heparin is used to treat….
Warfarin to treat…
Prophylaxis and treatment of thromboemolic disorders
pulmonary emboli
VTE
MI
Atrial dysrrhythmias
Post cardiac valve replacement
A client on anticoag meds should avoid (3)
They should do
IM injections
ASA-containing products
NSAIDs
Soft toothbrush, electric razor, report bleeding gums / petechiae / bruising / epistaxis etc
_______ is the med of choice for seizures in young children
What should it be taken with?
What should be monitored
Valproic acid
Food
Monitor PLTs, bleeding time, liver fx
With gabapentin, what should you monitor for?
Weight + mood changes
Lamotrigine and Topiramate are drugs used for
Anticonvulsants for seizures
Phenelzine sulfate
Isocarboxacid
Tranylcypromine
are what types of drugs?
ADRs?
MAOIs
HTN crisis when taken with tyramine foods: aged cheese, salami, figs, bananas, raisins, beer, red wine)
OR
ephedrine meds (OTCs)
Fluoxetine, Paroxetine, Sertraline, Citalopram are what type of drugs?
SSRIs
Which type of anti-depressants have anticholinergic effects?
Tricyclics (Amitriptyline, Imipramine)
OPD: Lispro
O: 15-30 min
P: 0.5 - 1.5 hrs
D: 3-5 hrs
OPD: Aspart
When is the time of adverse reaction?
O: 15-30 min
P: 1-3 h
D: 3-5 h
mid-morning: trembling / weakness
OPD: Regular Insulin
When is the time of adverse reaction?
O: 30-60 min
P: 1-5 h
D: 6 - 10 h
Mid-morning / mid-afternoon
Isophane NPH OPD
When is the time of adverse reaction?
O: 1-2 h
P: 4-12 h
D: 16 h
Early evening (weakness, fatigue)
For rapid acting insulin (Aspart, Lispro, Gluisine), when should the client eat after injection?
5-15 min after
For regular insulin, when should it be given before meals?
20-30min prior
Which type of insulin can be given after meals?
NPH
Examples of sulfonylurea drugs: (3)
When are they used?
Glimepride
Glipizide
Glyburide
Used if there is some pancreas beta-cell fx, to stimulate release of insulin
Metformin is a ____ type of drug.
How does it work?
When is it NOT given?
What can it lead to adversely?
Biguanide
Decreased glucose production by liver (DOES NOT effect the pacreas)
NOT for renal impairment pts
Avoid alcohol / can lead to lactic acidosis
How to alpha glucosidase inhibitors work?
Names of drugs?
When are these meds taken?
Delay digestion of carbs
Acarbose
Miglitol
Taken immediately before a meal
Within ____ min you can repeat a dose of glucagon for a hypoglycemic pt.
15
Propranolol is a _____ type of drug.
What should you monitor and asses for?
Beta blocker
Apical HR
Cardiac rhythm
BP
Asses: SOB and wheezing
- fatigue / sleep disturbance
- Apical rate for 1 min prior to administration
ADRs of BBs like Propranolol (4)
Bradycardia
Hypotension
Fatigue/sleep distrubances
BRONCHOSPASM
Amiodarone ADR (6)
Hypotension
Bradycardia./ AV block
Msk weakness
tremors
Photosensitivity / photophobia
Liver tox
Verapamil and Diltiazem are _____ types of drugs.
What should you watch for as a nurse?
CCBs
Apical HR + BP
Orthostatic precautions
Instruct clients to report s/s of HF to PCP
Ondansetron is a ______ type of med.
ADRs?
antiemetic
HA
Sedation
Diarrhea / Constipation
Transient elevation in liver enzymes