Lecture 3 Nursing 100

Question 1

Steps of Therapy (6)

Answer 1

1. Assess the problems
2. Assess the options
3. Selecting the therapy
4. Implementing the therapy
5. Monitoring therapy
6. Reassessing the problem

Question 2

Therapeutic use of Drugs (3)

Answer 2

Prevention,
Diagnosis,
Treatment

Question 3

Prevention (3)

Answer 3

vaccines- help build antibodies
antibiotics- don’t get infected
estrogen

Question 4

Diagnosis (2 examples)

Answer 4

Iodine dye- tracking through body

PPD- skin test for TB

Question 5

Treatment (2 examples)

Answer 5

Digoxin- slows <3

thiamine- supplement for liver problems

Question 6

Factors for choice of therapy (4)

Answer 6

Drug’s risk
Drug’s benefits
Pt compliance (will they take this?)
Cost

Question 7

Factors influencing pt’s response (6)

Answer 7

Therapeutic index
Disease (organ function)
Age
Genetics: certain enzymes in liver
gender: male less adipose tissue
circadian rhythm: night shift worker

Question 8

Clinical response affected by: (5)

Answer 8

Drug potency- check exp date
Psychological and emotional factors
pt compliance
Health beliefs- less med is better for some
Drug interactions (& food)

Question 9

Drug abuse

Answer 9

non medical use of substance

detrimental to user, family, society

Question 10

Drug dependence

Answer 10

physical withdrawal symptoms
psychological- desire but not physical signs
ex: chocolate!

Question 11

Addiction

Answer 11

Drug seeking behavior

may have dependence (phys or psych)

Question 12

Drug tolerance

Answer 12

happens in the tissues

body requires increased amts to produce same effect

Question 13

Impaired nurse

Answer 13

high risk of substance abuse
stressful work
access to drugs
believe invulnerable due to knowledge

Question 14

Nursing Process (5)

Answer 14

Assessment
Nursing diagnosis
Planning
Intervention
Evaluation

Question 15

Assessment

Answer 15

Subjective- pt history, drug history (Rx & OTC), allergies: what are they? What happened?
Objective: physical exam, lab tests, look/listen/feel

Question 16

Elements of pt history

Answer 16

allergies, medical history, socioeconomic lvl, lifestyl and beliefs, OTC drugs, Prescription drugs
Drugs: reason, knowledge, frequency, effectiveness, pattern, and route of admin

Question 17

Planning (goals and expected outcomes)

Answer 17

measureable and objective
one behavior per goal
time frame
state in term of “pt will…”

Question 18

Implementations (interventions) [3]

Answer 18

Nursing actions:
Independent- cool washcloth, lay on side
interdependent- prn» need physician but use judgment
Dependent- q day until pt shows side affects; but! call dr and inform

Question 19

Medication order

Answer 19

name, date, time, medication, dose, route, frequency, signature

Question 20

“5” rights to get meds

Answer 20

1. pt
2. drug
3. dose- calculation
4. time- look at which time to give!
5. route

check 3 times each! also! check your documentation!

Question 21

Drug delivery systems (3)

Answer 21

floor stock
individual drug
unit dose 24 hr period

Question 22

Ethical/legal responsibility of nurse

Answer 22

administer with knowledge- edu fam of symptoms
clarify if unclear or unusual- like you’re tell your BFF
do not ignore an order
can refuse if unsatisfied with clarification- even dr. says it’s ok

Question 23

Malpractice Issues (2)

Answer 23

Error of Omission- fail to give necessary care
ex: failing to count resp
Error of Commission- necessary care given improperly
ex: 100 mg of morphine

Question 24

Evaluation

Answer 24

Expected outcomes: meet your goal?
Rx effectiveness
Pt compliance
Adverse reactions
Document in pt record

Question 25

Basic human needs- safety

Answer 25

Goal- pt will be free of sx [signs] of infection | intervene to prevent or treat

Question 26

Signs of infection

Answer 26

redness, swelling, pain, heat

Question 27

Pharmocologic Aminoglycosides

Answer 27

1st- Streptomycin- but became resistant Next Neomyci- some mutants resisting Now Gentamicin and Tobramycin- kills off worse bact

Question 28

Pharmacokinetics of Aminoglycosides

Answer 28

absorbed poor po, well IM or IV distributed widely not metabolized excreted by kidneys

Question 29

Aminoglycosides action

Answer 29

``` Rx transported across bact cell mem inhibits protein synthesis bacterialistic- limits # inhibits multiplication inhibits growth ```

Question 30

Why use aminoglycosides?

Answer 30

used for major infections nonsocomical infections (infections you get in hospital) Critically Ill- Bacteremia: peritonitis, pneumonia, gm+ and gm- bact

Question 31

Aminoglycosides drug interactions

Answer 31

don't give with penicillins | give at least 1 hr apart

Question 32

Aminoglycosides adverse reactions

Answer 32

``` limited use due to serious toxicity predictable- ototoxicity (hearing), nephrotoxicity (kidneys) superimposed infection nausea/vomitting/diarrhea (NVD) neuromuscular blockage Unpredictable- allergic reactions ```

Question 33

Aminoglycosides nursing implications

Answer 33

assess renal function; assess hearing; C (culture) and S before starting; hydrate pt; monitor resp rate, HR, for neuromuscular blockage; obtain & monitor peak and trough lvls