N305 exam 2 Flashcards
Do some herbal products contain active substances as powerful (or even more effective) than currently approved medications?
Yes
Do herbal product formulations need proven safety of efficacy?
No
What is St. John’s wort used for primarily
Depression
What is ginkgo biloba used for primarily
Claudication
What is Hawthorn used for primarily
HTN
What are effects of St. John’s wort?
Increased sedation
Decreased anticoagulant effects
Interacts with - CNS depressants
- SSRIs
-warfarin
What regulatory act is there for herbal formulas
DSHEA
Dietary supplement health and education act.
-Exempts dietary supplements from regulation
-act allows FDA to remove any harmful herbal products
What is included in CAM
(Complementary and alternative medicine)
-herbal therapy
-nutritional supplements
-probiotics
-special diets
-massage
-meditation
Are all CAM therapies subjected to clinical and scientific study?
No
What is the nursing process
ADPIE
Assess, diagnose, plan, implement, evaluate
What is included in assessing
Collect, organize, validate, and document data
What is included in diagnosing (nursing process)
Analyzing data and identifying health problems/risks
What is included in the planning stage of nursing process?
Prioritizing problems
Formulating goals
Selecting and writing nursing interventions.
What is involved in the implementation stage of nursing process?
Reassess, implement nursing interventions, document
What is involved in the evaluating stage of nursing process?
Relate actions to goals/outcomes;
Determine if interventions worked.
What are things that would be assessed during medication administration
Allergies
Prescription meds/otc
Dietary supplements/diet
Social and medical history
Subject
(What the patient says or perceives)
and objective data
( lab test, diagnostics, physical assessment data)
-renal and liver function tests most important
What does the joint commission consider a primary role for nurses?
Teaching. (Patient education)
After providing patient education you should do what?
Ask patient to summarize key points
Patient teaching is a vital component of what stage in the nursing process
Implementation.
(Interventions)
Should you discuss medication with a client every time it is given?
Yes
What are the rights of drug administration?
Right …
Patient
Medication
Dose
Route
Time
Refusal
Can you give medications based on a verbal or phone order?
No. It can cause a medication error
What is the FDA safety and adverse event reporting program called
Med watch
Who are medication errors typically reported to?
Risk management team
Pharmacy
Provider
If a medication error occurs what do you put in the patients chart
You document what happened in the chart and what interventions you did after wards.
What are the most common medication errors
Improper dose
Wrong drug
Wrong route of administration
What is medication reconciliation?
Tracking meds as pt moves from one healthcare provider to another.
When does medication reconciliation occur?
-Initial admission
-Transferred to another setting/level of care (unit)
- at discharge
What are some risk reduction methods for medication errors?
-E-prescribing
-barcode assisted medication administered (BCMA)
- risk management departments
When educating a patient, what should be included to reduce risk of medication errors?
-know names of meds they are taking
- know side effects
- read the label
- carry a list of all meds (including otc and herbals)
- ask questions
In general, drugs that are water soluble, ionized, or bound to plasma proteins are less likely to cross the placenta.
T/f
True.
During pregnancy what changes happen that affects absorption
-Hormonal changes and pressure on expanding uterus on the blood supply to organs can affect absorption
- increase levels of progesterone delays gastric emptying = longer absorption time for oral drugs
- gastric acidity is also decreased; can affect some drugs
- progesterone affects respiratory system which can cause inhaled drugs to be absorbed to a greater extent.
What happens in pregnancy that affects excretion.
Blood flow in kidney increases by over 50% = increased excretion rate.
What happens during pregnancy that affects distribution and metabolism?
Increases cardiac output, increased plasma volume = dilution of drugs and decreased plasma protein levels affecting distribution; altered regional blood flow- uterus, kidneys, and skin is increased where skeletal muscles in decreased.
Altered lipid levels may alter drug transport and distribution.
What is a teratogen
A drug that can cause significant adverse effects to a growing fetus.
Bad for baby.
Teratogen Drug exposure during the preimplantation phase can cause what?
Death of the embryo or no affect at all
Which period of pregnancy would the fetus be most likely to develop structural malformation and spontaneous abortion if exposed to a teratogenic drug?
The embryonic period (3-8 weeks)
Exposure to teratogens during the fetal period ( 9-40 weeks) is more likely to produce what?
Slowed growth or impaired organ function
What teratogenic category would warfarin and isoretinoin be in?
X
What teratogenic category would you find lithium, ace inhibitors and nsaids in?
D
Most prescription medicines are in what teratogenic category?
C
Penicillins, azithromycin, an acetaminophen would be in what teratogenic category?
B
Teratogenic Category A has what drugs in it?
Insulin
Prenatal vitamins
Folic acid
Levothyroxine (thyroid hormone replacement)
Damages to liver and kidney in adulthood could influence what pharmacokinetic process?
Metabolism and excretion
Can drugs be secreted into breast milk?
Duh. Yes
What are the most common upsets that school aged children are seen for at clinics?
Respiratory and GI infections
What often occurs in older adults that can lead to a build up of medications and lead to toxicity?
Dehydration.
What are some normal physiological changes with older adults that affect pharmacokinetics?
Decreased absorption
Decreased metabolism (liver)
Reduced excretion. (Renal)
What are the 5 factors of the holistic model of pharmacotherapy?
Psychosocial variables
Environmental factors
Cultural influences
Genetics
Gender
What should the nurse include when completing a psychosocial history for a client in regards to a new medication being prescribed?
Lifestyle preferences
Sexual practices
Religious beliefs
Alcohol intake
A client with depression is being started on a new medication. Which psychosocial interventions should the nurse anticipate being prescribed for this client?
Psychotherapy
Self-help instruction
Physical exercise
Improved sleep hygiene
An adolescent client with type 1 diabetes has several admissions for inadequate blood glucose control. Which psychosocial issue should the nurse consider that may be impacting the clients adherence with prescribed medications?
Viewed as being weak
Embarrassed to have to take medication
Viewed as being unhealthy
Viewed as being dependent
Ethnicity is
Genetics and biological similarities
Culture is
A set of values, beliefs, and traditions that provide meaning for an individual or group.
Which individuals have genetic variances in plasma renin that decreases the effects from Beta Blockers ?
African Americans
People with Asian descent are genetically predisposed to respond differently to what 2 medications?
Warfarin (Coumadin)- enzymes alter the response.
And
Codeine- a gene interferes with the analgesic properties.
What genetic difference exsists in caucasians that should be noted when administering medication.
They have a gene that decreases metabolism of isoniazid (TB drug), can cause toxic build up.
-they are characterized as slow acetylators.
A patient wants to know if a dietary supplement is free of pesticides. What would your response be?
The label must state that the product is free of contaminants such as pesticides.
FDA rule
What herb-drug interaction should be considered for a young female who plans to take St John wort?
It reduces the effectiveness of oral contraceptives.
In herbal medicine, which biologically active substance is measured for its therapeutic effects with standardized labeling?
The entire herb
Salves and ointments are considered an herbal solid formulation. T/f?
True.
How is the liquid extracted from an herb in an herbal tincture?
Active chemicals are extracted from the plant using solvents, then concentrated into varying strengths.
Solvents such as alcohol, water, or glycerol are used.
Who should a patient report severe side effects of an herbal supplement to?
The company directly using contact information on the bottle.
They will have to report it to the fda within 15 days
Ginseng and digoxin interact how?
Ginseng can increase the metabolism of digoxin and cause drug toxicity.
Herbal supplements are allowed to include what information on their label- in regards to health claims?
Claims about a products effect in body structure and function
What are marker substances in herbal products?
They are used to achieve consistency when standardizing the strength or dose of an herbal product.
What is ethnocentrism?
The belief that one’s own culture is superior to somebody else’s.
Cultural competency begins how?
By identifying one’s own beliefs and values to have an idea of where you’re coming from.
What herb has been used for over 5000 years to improve physical endurance and concentration and reduce stress?
Ginseng
What plant has been used topically to aid in wound healing?
Aloe
What herb is used to promote relaxation and sleep; however, prolonged use may cause yellowing of nails and skin and is associated with risk of liver toxicity?
Kava
What herb is used for its immunostimulant effect to reduce cold symptoms and recovery time when taken early in illness
Echinacea
What herb is used to relieve the symptoms of benign prostatic hyperplasia?
Saw Palmetto
Both the seed and oil of this plant are used to reduce high cholesterol levels
Flax
The dried leaf of this plant is used by some to prevent organic brain syndrome
Gingko
A genetic polymorphism does what to drug metabolism
Alters the speed
In a patient with Genetic polymorphism what drug action should be expected ?
Receptors may no longer accept the drug
What is the purpose of identifying a nursing diagnosis for the patient
Evaluate effectiveness
Establish goals
Establish outcomes
Plan interventions
What agencies are involved in reporting medication errors?
FDA
The division of medication error prevention and analysis (dmepa)
National coordinating council for medication error reporting and prevention (ncc merp)
What analytical tool should the nurse expect to be used to determine why a patient received an incorrect med?
RCA. Root cause analysis
An older client reports compliance with treatment and diet for type 2 diabetes mellitus, yet the blood glucose remains high. What factor should the nurse consider that could interfere with the success of this treatment?
Decreased GI motility
Leads to decreased absorption of meds
Older clients should be instructed to increase fluid intake especially with what kind of medication?
Water soluble
What age related factor influence the effectiveness of medications in older adults?
⬇️absorption
Altered distribution and metabolism
⬇️elimination
What clinical manifestation can occur if teratogenic drugs are taken during the embryonic period
Malformation of internal structures
Spontaneous abortion
