Midterm Flashcards
In which step of the nursing process determines the direction of care?
Patient problems
In which step of the nursing process would you determine whether the goals and objectives set earlier were met?
Evaluation
Which step of the nursing process would be where a nurse shows a patient how to administer insulin?
Nursing interventions
What type of drug name is the one assigned to or approved by the FDA?
Generic name
What are two characteristics of Generic name drugs?
The official, nonproprietary name for the drug
Every drug had one generic name that defines the active ingredient
What would you tell a patient who has concern about a C category FDA drug risk classification?
No controlled studies have been conducted in animals or humans
Which FDA drug risk category has evidence of human risk to the fetus, but benefits may outweigh risks in certain situation?
Category D
B category stands for
bouncy bunnies- animal studies only show no risk to the fetus
Which FDA drug risk category has evidence of fetal abnormalities in both animals and humans, but the risk in pregnant women outweighs any possible benefit?
x
What are some teaching responsibilities of the nurses on OTC medications? (4)
Start medication reconciliation upon admission
Be aware of OTC products and implication on patient’s drug therapy
Emphasize that OTC can react with other meds anc be potent
Caution patients against self-diagnosis and self- prescribing
With what schedule drug would you ask another nurse to observe and cosign wasting the remaining drug from the vial?
Schedule II and III
What are some factors influencing absorption?
(8)
Dose
Drug formulation
Dietary/herbal products
Molecule size
Surface area
Route of admin
Interactions
pH
What is the dose that keeps plasma-drug concentration in therapeutic range?
Maintenance dose
Why would a patient be given a higher dose of a medication?
Aka loading dose, a plateau is reached faster and quickly produces therapeutic response
What are some drug history assessments necessary for a patient’s medical history profile?
(6)
Comorbidities
Allergies
vitamins, herbs, recreational drugs
alcohol, caffeine, nicotine, illegal drugs
Life-style issues such as diet
Life stage issues – infancy, pregnancy, aging
If a medication is given “stat”, how long does a nurse have?
5 minutes
If a medication is given “now”, how long does a nurse have?
30 minutes
If a medication is given “ASAP”, how long does a nurse have?
60 minutes
What are common medication admin considerations?
(4)
Med-food interactions
Circadian rhythms meds
Patient’s habits and sleep patterns
Discuss with prescriber if patient is going to OR for test/procedure
What are nursing actions regarding medications that may cause your patient’s demise?
(4)
Miscalculation of dosage
Not checking the patient’s identity
Misinterpretation of order
Administration of the wrong drug
How should a patient be positioned for an enteral drug?
Sitting up, alert, and able to swallow
Why should an enteric-coated drug not be crushed?
It destroy the enteric coating and give you upset stomach and clog the tube
What are five types of isotonic solutions?
normal saline
lactated ringer’s
Plasma-Lyte 148
5% dextros in water
5% dextrose in 0.2% normal saline
What are four types of hypertonic solutions?
hypertonic saline (3% NaCl)
5% dextrose in normal saline
5% dextrose in lactate Ringer’s
5% dextrose in Plasma-Lyte 56
What are two types of hypotonic solutions?
hypotonic saline (0.45% NaCl)
Plasma-Lyte 56
What are some reasons involving the GI that cause water and electrolyte loss?
vomiting, diarrhea, laxatives, suctioning
What are some reasons not involving the GI that cause water and electrolyte loss? (5)
Perspiration, burns, hemorrhage, excessive diuresis, ketoacidosis
With hypertonic IV therapy, where does the water move from?
From the interstitial spaces to the ECF
What is hypertonic IV solution used for?
(3)
TBI and trauma with hemorrhagic shock.
What are three effects of hypertonic solutions?
RBCs shrink
Decrease intracranial pressure
Improve hemodynamics
What should you monitor for when giving a hypertonic solution?
Monitor for circulatory overload
With hypotonic intravenous IV therapy, where does the water move from?
move INTO the interstitial and intravascular spaces from the ECF
What are three effects of hypotonic solutions?
RBCs swell
Increase cerebral edema
Headache, irritability, and decreasing level of consciousness
What should you monitor for when giving a hypotonic solution? (4)
Monitor for hemolysis,
Headache, irritability, and
decreasing level of consciousness
decrease in blood pressure
What are some signs of hyponatremia-? (7)
lethargy, confusion, apprehension, muscle twitching, abdominal cramps, N/V, seizures
What would IV would you give for low sodium?
Give a 0.9% NS fluid
What are some signs of hypernatremia? (4)
DIARRHEA, thirst, dry mucous membranes, weak
What are some signs of severe hypernatremia? (2)
decreased LOC and convulsions
What fluid would you give for high Na+ level
Give a hypotonic fluid like 0.45% NS for high Na+ level
What type of solution would you give for fluid loss caused by a surgical procedure?
5% dextrose in 0.2% water - Isotonic solution
What are some considerations when administering volume and electrolyte replacement?
(7)
All routes of fluid intake and loss
Daily water requirements
Water, electrolyte, and protein requirements
Patient’s weight, caloric needs
Body surface area
Illness
N/v after a surgical procedure
What should the patient be taught about sodium balance?
Report symptoms of fluid overload
Drink water of balanced sports drinks to replenish
What is the best fluid replacement after exercising?
water
What type of patients should be given Dextran 40?
hypovolemic shock due to hemorrhage, surgery, trauma, or severe burns
How should Dextran 40 be administered?
For acute shock - infused as rapidly as possible until blood volume is restored.
What are some benefits to Dextran 40 in hypovolemic shock patients?
Decreased HR and increased BP
Increased urine output
Reduced platelet adhesiveness
Improved blood flow and reduced blood viscosity and prevention of deep vein thrombosis and postop pulmonary emboli
What are some S/S to report when administering Dextran 40?
dyspnea, urticaria/itching/throat tightness, palpitations, chest pain/tightening, or headache.
What are some ADRs for colloids?
Allergy and anaphylactic reactions
What are some effects of hypokalemia?
Muscle weakness, leg cramps, N/V, decreased bowel sounds, cardiac dysrhythmias, weak and irregular pulses
What are some effects of hyperkalemia?
Oliguria, tachycardia, and abdominal cramping
GI Hyperactivity, irritability, confusion,
bradycardia, cardiac dysrhythmias or even cardiac arrest,
areflexia (absence of reflexes), paresthesias
What are some serious symptoms of hyperkalemia
Dysrhythmias and heart block
How should the nurse respond when a patient can’t swallow and has a nonfunctioning GI tract?
TPN
What should the best plan by the nurse include if a patient is malnourished and have dysphagia and has a functioning GI tract?
NG tube for short term
Peg/G tube for long term
What should the best plan by the nurse include if a patient is malnourished and have dysphagia and has a nonfunctioning GI tract?
Parenteral nutrition (TPN)
What action should the nurse include in the care plan to assess a possible complication from enteral feeding?
(4)
Dehydration
Aspiration pneumonitis
Diarrhea
Refeeding syndrome
Which statement by the client should the nurse evaluate as a good understanding of the teaching provided for continuous pump?
it is the slowest method over 24 hrs
Which statement by the client should the nurse evaluate as a good understanding of the teaching provided for cyclic feeding pump?
It is the fastest over a short period of time
What should the nurse include in the discharge teaching for cyclic feedings?
It should be the same time each day for the same duration
What should the nurse include in the discharge teaching about how g tubes are placed?
G tubes are placed directly into the stomach for direct long term feeding
Which nursing action should nurse take with G tubes?
Don’t crush into G-tubes
Flush routinely to maintain patency
Which assessment finding should be of concern to the nurse to tell the client to not use enteric coated drugs?
G Tube
What assessment finding should the nurse expect with hyperalimentation?
Central or peripheral vein access for infusion pump
What lab assessment should the nurse include in the care plan to assess a possible complication from TPN feedings?
asses blood glucose because TPN can cause hyperglycemia.
How should the nurse respond to the client’s condition of irritation at the TPN central line?
warm the infusion by removing from fridge 30 mintures before hanging
What assessment should the nurse do for enteral feedings?
Skin turgor and mucous membranes
What action should the nurse take next after an enteral feeding?
flush tube
clean the area
clean the equipment between each feeding
refrigerate any feeding not needed for feedingkeep area around insertion site clean
What should the nurse include in the discharge teaching about TPN self-assessment?
assess for dehydration and hydrate if allowed
What is IBS aka?
spastic colon or mucous colitis
Symptoms of IBS?
recurrent abdominal pain for at least 3 months, cramping, bloating, gas and Constipation alternating with diarrhea, mucus in stool
What are PUD’s? 2 types
lesion in stomach- gastric ulcer
s. intestine- duodenal ulcer
What are some risk factors of PUD?
(7)
Family history
Blood group O
Tobacco
Caffeine
Drugs
Lots of stress
h. Pylori infection
What causes primary hypothyroidism?
Decreased T4 and elevated TSH levels from thyroid gland inflammation, radioiodine therapy, excess intake of antithyroid drugs, thyroidectomy
What happens if there is severe hypothyroidism in adults?
Myxedema causing lethargy, apathy, memory impairment, slow speech, edema in eyelids and face
What happens if there is severe hypothyroidism in children?
Congenital Cretinism in children
What causes secondary hypothyroidism?
lack of TSH secretion
What causes tertiary hypothyroidism?
lack of TRH
Which statement by the client should the nurse evaluate as a good understanding of the disease process for DM I?
Absolute lack of insulin secretion for DM I due to autoimmune destruction of pancreatic islet cells and secretes and releases enzymes for chemical digestion of nutrients
What should the nurse include in the discharge teaching for Type one diabetics?
Dietary restrictions exercise inslin therapy via insulin pump
What are some physical conditions associated with causing ED?
(6)
Atherosclerosis, diabetes, KD, stroke, HTN, and tobacco use
What are medications associated with ED?
Thiazide diuretics, beta blockers, selective serotonin reuptake inhibitors (SSRIs), antidepressants
What are some signs of moderate hypoglycemia (BS < 70)?
Nervousness, hunger, headache, shakiness, dizziness, confusion, weakness, diaphoresis
What are some signs of severe hypoglycemia?
Confusion, combativeness, unresponsiveness, coma.
How would you treat moderate hypoglycemia?
Give 4-8 oz. milk and half a cheese sandwich
How would you treat severehypoglycemia?
Treat with glucagon 1M and/or dextrose 5 IV drip or 50 IV push
