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nrsg 213 > Lecture 1 > Flashcards

Lecture 1 Flashcards

1
Q

objective data

A

what you can see or measure

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2
Q

subjective data

A

what patient/family has to tell you

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3
Q

what is included in medication history

A
  1. prescription meds
  2. otc meds
  3. herbal preparations
  4. vitamins
  5. home remedies
  6. alcohol/tobacco
  7. caffeine
  8. street drugs
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4
Q

nursing diagnosis

A

analyze data gathered –> make conclusion (special wording)

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5
Q

planning

A

identiication of a goal to be met

planning what interventions will be done

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6
Q

planning wording and requirement

A

“the patient will” not “the nurse will”

must be objective, measurable, and realistic

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7
Q

three types of implementation

A

1) teaching/education
2) action
3) further assessment

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8
Q

evaluation

A

how did it work out?

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9
Q

eight rights of med admin

A
  1. right drug
  2. right time
  3. right dose
  4. right route and form
  5. right patient
  6. right documentation
  7. right reason
  8. right response
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10
Q

one more right of med admin

A

right to refuse (and presented in the right manner)

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11
Q

do’s and don’ts of charting med errors

A
  • chart facts
  • don’t chart about staffing problems or conflicts
  • don’t mention incident report
  • don’t use “accident”, “mistake”, or “miscalculation”
  • document pt response, maybe a set of vitals
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12
Q

generic name

A

long chemical name (one for each med)

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13
Q

trade name

A

catchy drug company name (each med may have several)

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14
Q

medication classifications

A

groupings of medications with similar uses or actions

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15
Q

pharmacoeconomics

A

study of the economic factors influencing the cost of medication therapy

e.g. cost-benefit analysis

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16
Q

pharmacodynamics

A

how the medication works and affects the body on the chemical level

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17
Q

pharmacotherapeutics

A

understanding of medication actions for treatment and prevention of disease

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18
Q

pharmacokinetics actions

A

1) absorption
2) distribution
3) metabolism
4) excretion

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19
Q

absorption

A

getting the medication inside the body into the blood

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20
Q

absorption routes

A

enteral (PO)
parenteral injections (SQ/SC and IM)
intravenous (IV)
topical

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21
Q

enteral (PO) route bioavailability…

A

subjected to the “first-pass effect” of passing through the liver before getting through the blood, thus it starts to break down medications, limiting bioavailability

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22
Q

PO pros

A
  • easy and cheap
  • takes 30 min to work
  • pills, tablets, capsules, liquids
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23
Q

PO cons

A
  • not all meds can be given this way

- interference: acid/food in stomach, small intestine disease, poor bloodflow to stomach/intestine

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24
Q

PO variations

A
  • enteric coated
  • sublingual
  • rectal suppositories
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25
Q

enteric coated

A

coat meds that are destroyed by acid so they do not dissolve until they reach the alkaline pH of intestine.

DO NOT CRUSH

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26
Q

sublingual

A

placed under tongue
absorbed into venous system to bypass liver
e.g. nitroglycerin

DO NOT CHEW OR SWALLOW

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27
Q

rectal suppositories

A
  • some used for local effect e.g. constipation
  • often used when oral meds cannot be given
  • absorbed uncertainly as stool interferes
  • bypasses liver
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28
Q

SQ/SC and IM are absorbed by…

A

absorbed by diffusion into capillaries; bloodflow is important.

avoid the first-pass effect

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29
Q

SQ/SC goes into the… (& time to absorb)

A

goes into the fat (20-30 min to begin)

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30
Q

IM

A

goes into the muscle (10-15 min to begin)

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31
Q

pros of SQ/SC/IM

A
  • quick

- easy to learn

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32
Q

cons of SQ/SC/IM

A
  • can damage tissue
  • cannot control precisely
  • can be affected by body temp
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33
Q

IV pros

A
  • fastest method (immediate)
  • complete absorption
  • no barriers
  • can be used for very irritating meds
  • 100% bioavailable
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34
Q

IV cons

A
  • very expensive (equipment and skills)

- can’t “take it back” if mistakes are made

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35
Q

topical methods

A

skin: creams/lotions, transdermal patches
eyes: drops and ointments
ears: drops
nose: drops/sprays
lungs: inhalers (very quick; mostly for direct action on lungs)

36
Q

topical pros

A
  • can have excellent local effects

- bypasses liver

37
Q

topical cons

A
  • doesn’t work quickly or predictably for systemic effects
38
Q

pediatric absorption variations (PO, topical, IM)

A
  • stomach has less acid until 3 yo
  • peristalsis is irregular and slow
  • topical absorption is faster due to thick skin
  • IM absorption is faster and irregular
39
Q

geriatric absorption variations

A
  • less HCl acid in stomach
  • slowed GI emptying
  • less blood flow to GI tract due to decreased cardiac output
  • villi flattening = less absorptive area
40
Q

distribution

A

getting the medication from blood to the cells, where it can be used. begins to be eliminated by liver or kidney

41
Q

what is key in distribution

A

blood flow!

more meds go to areas where there is more blood: heart, liver, brain, kidney
less medication goes to areas such as fat or bone

42
Q

blood brain barrier

A

system of special capillaries w limited entry to the brain.

pro: keeps harmful substances out
con: keeps helpful substances out

43
Q

medications must be ____ to get past the BBB

A

fat soluble or have their own transport system

44
Q

fat soluble medications are better distributed because …

A

they don’t bind to proteins

45
Q

water soluble medications are less well distributed because …

A

proteins take them out of the body

46
Q

pediatric variations in distribution

A
  1. greater total body water
  2. less fat content
  3. decreased protein binding due to immature liver to make proteins
  4. immature BBB
47
Q

geriatric variations in distribution

A
  1. more fat and less water

2. less proteins produced by the liver

48
Q

metabolism AKA biotransformation

A

transformation of medications into something that can be excreted/inactive

49
Q

main organ of metabolism

A

liver

50
Q

metabolism is affected by (3 things)

A
  • age (young immature liver or old worn out liver)
  • malnutrition (liver doesn’t have enzymes needed
  • route (contact with liver)
51
Q

pediatric variations in metabolism

A
  1. immature liver does not make many of the enzymes needed to detoxify meds (slower metabolism)
  2. older children may need higher dose bc liver is working so well
52
Q

geriatric variations in metabolism

A
  1. decreased enzyme production by liver

2. decreased liver blood flow

53
Q

excretion

A

removal of the medication from the body

54
Q

main organ of excretion

A

kidney

55
Q

most medications are excreted in the

A

urine

56
Q

other routes of excretion

A
  • bowel
  • sweat
  • saliva
  • breast milk
  • expired air
57
Q

pediatric variations in excretion

A
  • kidneys are immature, so filtration is slower

- less blood flow to kidneys

58
Q

geriatric variations in elimination

A
  • decreased number of functioning nephrons

- less blood flow to kidneys

59
Q

medicating pregnant women 1st trimester

A
  • most harmful to fetus
  • limited blood flow to fetus
  • relatively safe
60
Q

medicating pregnant women: 3rd trimester

A
  • medication transfer to fetus is most likely due to excellent blood flow
  • fetus is more resilient now
61
Q

pregnancy safety categories

A

pregnancy
lactation
females and males of reproductive potential

62
Q

breastfeeding women

A

low dosage crosses into breast milk; must eval risks and benefits

63
Q

pediatric categories

A

neonate/newborn: <1 mo

infant: 1 mo - 1 yr
child: 1 - 12 yrs
adult: > 12 yrs (depending on weight)

64
Q

body surface area formula for children

A

body surface area/1.73 * adult dose = child dose

65
Q

why is body surface area calculation better than weight alone

A

1) better estimate of maturity and metabolic rate

2) dosage based on weight alone assumes child is just a “little adult” physiologically

66
Q

physiologic changes with advanced age affecting geriatric medication (cardiac, GI, hepatic, renal)

A

cardiac: decreased cardiac output, decreased bloodflow

GI: decreased acid, decreased peristalsis

Hepatic: decreased enzyme production

Renal: decreased blood flow

67
Q

polypharmacy

A

multiple medications taken at once for a variety of problems

(prescription and OTC); more meds = more interaction

68
Q

goal in polypharmacy

A

eliminate unneeded drugs, decreasing interaction

69
Q

onset

A

time to start working

70
Q

peak

A

time when working best

71
Q

duration

A

length of time drug has high enough concentration to be therapeutic

72
Q

half life

A

time for half of the med to be eliminated

73
Q

goals of medication therapy

A
  1. maintain therapeutic index/level of med in blood
  2. avoid too little or too much med for pt
  3. do what it is supposed to do
74
Q

interactions/mechanisms of action

A
  • receptor interaction
  • enzyme interaction
  • nonspecific interaction
75
Q

receptor interaction

A

binds to a receptor site, which causes or blocks an action

76
Q

enzyme interaction

A

binds with an enzyme, which may act with or block that enzyme

77
Q

nonspecific interaction

A

alters a cell wall or disrupts a normal process

78
Q

reasons for treatment with meds

A
  • acute needs
  • maintenance needs
  • supplemental needs
  • palliative needs
  • prophylactic needs
79
Q

monitoring needs

A

important because the more meds a pt has in his/her system the higher chance of interactions

80
Q

adverse medication effect/side effect

A

unwanted effects produced by therapeutic levels of a drug

usually predictable

81
Q

toxic effects/poisoning

AKA overdose

A

avoidable sfx because dose was too high

fx are usually exaggerated effect of desired action

82
Q

additive effects

A

2 meds with similar actions given together; often can get by with smaller dose of each

83
Q

synergistic effects

A

two meds given together makes the effect greater than if alone

84
Q

antagonistic effects

A

two meds given together work against each other so effect is less than expected

85
Q

incompatibility

A

two meds given react chemically to deteriorate the medications (may cause cloudiness, precipitate, or change in colour

86
Q

allergic reaction

A

a reaction that triggers a person’s immune system; triggers histamine and inflammation.

nrsg 213 (9 decks)

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