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Nurs 232 > Nurs 232-Midterm > Flashcards

Nurs 232-Midterm Flashcards

1
Q

Normal lab values RBC

A

4.5-9.5

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2
Q

Normal lab values WBC

A

4-10.5

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3
Q

Normal lab values Hgb

A

136-170

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4
Q

Normal lab values Hct

A

0.40-0.52

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5
Q

Normal lab values platelet

A

100-400

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6
Q

Normal lab values Neutrophils

A

2-6

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7
Q

Normal lab values PTT

A

23-32

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8
Q

Normal lab values INR

A

0.9-1.1

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9
Q

Normal lab values Na

A

135-145

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10
Q

Normal lab values K

A

3.5-5.0

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11
Q

Cefazolin

A

Antibiotic, Classification (antibacterial- cephalosporin first generation)
MOA: semisynthetic, preferentially binds to one or more of the penicillin binding proteins and inhibits the final stage of bacterial cell wall synthesis thus killing the bacterium
Adverse effects: anaphylaxis, fever, seizure, diarrhea, anorexia, abdominal cramps
A: determine history or hypersensitivity to cephalosporins, penicillins & other durgs, before therapy is initiated

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12
Q

Ceftriaxone

A

Antibiotic, Classification (antibacterial- cephalosporins)
MOA: inhibits cell wall synthesis by binding 1 or more penicillin-binding proteins, exerts antimicrobial effect by interfering with synthesis of Peptidoglycan(major structural component of bacteria cell wall)
side effects: diarrhea, anaphylaxis, rash, pain, thrombocytosis, nausea
-instruct pt to take medication as directed around the clock & finish medication completely (even if feeling better), to prevent antibiotic resistant, notify health care professionals about any side effects

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13
Q

Metronidiazole

A

Anti-infective, anti-protozoals, anti-ulcer agent
MOA: disrupt DNA & protein synthesis in susceptible organisms
side effects: seizures, dizziness, headache, aseptic meningitis(IV), encephalopathy, abdominal pain, anorexia,NVD, furry tounge
Asses:
Pt ta

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14
Q

Normal value of CRP

A

0.0-2.0

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15
Q

Imipenem cilastatin

A

Anti-bacterial, Antibiotic classification: carbapenems
MOA: binds to cell wall which causes cell death
cilastin prevents renal inactivation of imipenem
Common side effects: NVD, rash

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16
Q

Pipercillin tazobactam

A

Anti-bacterail, antibiotics Classification: extended spectrum penecillins
MOA: Pipercillin -binds to bacterial cell wall causing cell death
tazobactum- inhibits beta-lactamase, an enzyme that can destroy penicillins
Common side effects: diarreah, allergy to drug most usual contradiction
Asses: assess for infet, obtain history of penicillin, specimen for C&S

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17
Q

Blood lab tests:

A
  • Complete blood count (CBC)
  • white blood cell (differential)
  • RBC (hemoglobin) (hematocrit)
  • platelets
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18
Q

WBCS

A
  • bodys primary defense system
  • signifies activation of inflammatory response
  • lifespan of WBCS is 13-20 days
  • destroyed by lymphatic system, excreted in feces
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19
Q

hemoglobin

A

carries oxygen throughout body

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20
Q

hematocrit

A

is the ratio of RBC volume to total volume of blood

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21
Q

Polycythemia

A

increase in rbcs

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22
Q

platelets

A

essential for clot formation & hemostasis

  • lifespan 5-9 days
  • source of growth factor for tissue repair
  • destroyed by spleen & liver
  • production regulated by erythropoietin
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23
Q

PTT

A

partial thromboplastin time 23-32 seconds

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24
Q

PT-INR

A

prothrombin time, international normalized ration 0.9-1.1 seconds

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25
Q

Normal lab values of GFR

A

greater than 60

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26
Q

Normal lab values of Creatinine

A

60-100

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27
Q

Anit-hypertensive Drugs

A
  • Furosemide
  • HCTZ
  • Metoprolol
  • Diltiazem
  • Rampipril
  • Candesartan
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28
Q

Furosemide

A

-Anti-hypertensive, Loop Diuretic
-blocks re-absorption of sodium & water in the loop of henele
-side effects: dry mouth, thirst, Muscle cramping (d/t electrolyte imbalance), postural hypo-tension
Asses: CHECK POTASSIUM BEFORE ADMIN

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29
Q

HCTZ

A

-Anti-hypertensive, Thiazide diuretic
-reduces plasma volume & cardiac output by interfering w sodium re-absorption across distal tubule
Side effects: dry mouth, thirst, Muscle cramping (d/t electrolyte imbalance), postural hypo-tension
Asses: CHECK POTASSIUM BEFORE ADMIN

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30
Q

Metoprolol

A

Anti-hypertensive, Beta blocker
-blocks the sympathetic nervous system(beta adrenergic receptors) especially sympathetics to the heart
Side effects: light headedness
Asses: CHECK HR (will decrease HR)

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31
Q

Diltiazem

A

-Anti-hypertensive, Calcium channel blocker
-inhibits calcium ion influx through slow channels into cell of myocardial smooth muscle
Asses: CHECK HR (will decrease HR)

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32
Q

Ramipril

A

-Anti-hypertensive, ACEI
-inhibits conversion of angiotensin 1 to angiotensin 2 & inhibits aldosterone release
Side effects: dry cough

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33
Q

Candesartan

A

-Anti-hypertensive, ARB
-blocks the effect of angiotensin 2 at receptor sites
Side effects: potassium loss

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34
Q

all antihypertensive listed drugs can have side effect of

A

postural hypotension

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35
Q

abnormal values of creatinine & GFR are indicators of

A

renal dysfunction

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36
Q

Electrolyte: SODIUM

A

role: -EC osmolarity
- trans-membrane potential
- acid-base balance
- numerous chemical rx

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37
Q

Hypernatremia

A

increase in sodium in the blood

main causes: to much salt intake, to much na+ IV, loss of fluids, getting fed through GI, not enough water

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38
Q

Hyponatremia

A

decrease sodium in the blood

signs & symptoms: siezures, stupor, lethargy, abdominal cramping

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39
Q

Electrolyte: POTASSIUM

A

Role: -trans-membrane potential

  • intracellular osmolarity
  • acid-base balance
  • intracellular enzyme reactions
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40
Q

Hyperkalemia

A

Increase in potassium
Main causes: renal failure
S&S: muscle weakness, decrease in urine

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41
Q

Hypokalemia

A

decrease in potassium
Main causes: drug, laxitives, too much water intake, fluid loss
S&S: weak thready pulse

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42
Q

Ultrasound

A

imaging technique that uses high frequency sound waves to acquire real time images
-useful for viewing abdominal contents, pelvis, muscles, pregnancies, vessels, the heart & other soft tissue structures

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43
Q

CT scan

A
  • computerized Xray machine
  • two dimensional image
  • uses ionizing x rays
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44
Q

Informed consent

A

Focused communication process which professional nurse or PHYSICIAN discloses all relevant information related to procedure/treatment with full opportunity for dialogue, questions & expressions of concern, before asking client/health care agent to sign a legal consent form

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45
Q

For all legal consent to be valid it must contain three elements:

A
  • must be voluntary
  • client has full disclosure of risks, benefits, cost, potential side effects of proposed tx/procedure, information about alternative should be provided if available
  • client must have capacity & competnecy to understand the information to make an informed choice
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46
Q

Consent has 3 components

A

-Disclosure
-capacity
-voluntary
WHEN THESE 3 ARE MET=INFORMED CONSENT

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47
Q

how to express consent

A
  • clear statement by patient oral or written
  • pt has right to withdraw consent or revoke a previously given consent at anytime even orally, providing mentally competent to do so
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48
Q

Implied consent

A

When individuals nonverbal behaviour indicates willingness
ex. in emerg sit when cannot provide/express consent
during surgery when additional procedures needed that are consistent w procedure already consented to

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49
Q

obtaining informed consent for specific medical & surgical treatments is responsibility of ____
nurses responsibility is often to _____

A
  • Physician
  • witness giving of informed consent for medical procedures which involves: witnessing exchange between client & physician
  • establishing that client really did understand that it was truly informed
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50
Q

Canadian common law doesn’t specify age below which a person is presumed

A

capable
-some provinces have legislation that lowers age of consent below 18 –minor can give consent if determined has adequate knowledge & judgement

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51
Q

Individuals unconscious/injured in a way unable to give consent required substitute consent from ____

A

another individual

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52
Q

Drugs have 3 different names

A
  • generic name: used in most official drug compendiums to list drugs
  • chemical name:
  • trade name: generally created by manufacturer, propriety name
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53
Q

Drugs are grouped together based on similar properties known as

A

drug classification

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54
Q

Pharmacuetics

A

study of how various dosage forms influence way in which drug effects the body

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55
Q

pharmacodynamics

A

study of what drug does to body

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56
Q

pharmacokinetics

A

study of what body does to drug involving process of absorption, distribution, metabolism & excretion of drugs

57
Q

Drug absorption of various oral preparations

A 
fastest --- slowest 
liquids (ex. elixirs, syrups) 
suspension solutions 
powders 
capsules
tablets 
coated tablets 
enteric coated tablets
58
Q

Mechanism of action definition

A

way in which a drug exerts its therapeutic effect

59
Q

Time release technology

A

used in tablets & capsules, drug molecules are released in pts gastrointestinal tract over an extended period of time
easily identified by various capital letters abbreviations attached to their names such as:
SR (slow release or sustained release)
SA (sustained action)
CR (controlled release)
XL (extended length)
XT (extended time)
Must not be crushed, could cause accelerated release of drug & possible toxicity

60
Q

medication routes

A

Enteral
Parenteral
Topical

61
Q

Absorption

A

movement of drug from site of administration into bloodstream for distribution to tissues

62
Q

Bioavailability

A

extent of drug absoprtion
ex. IV drug has 100% bioavailability
drug absorbed form intestine must first pass through liver before reaches systemic circulation, if large proportion of drug chemically changed into inactive metabolites in liver, much smaller amount of drug will pass into circulation (amount that goes into circulation is amount bioavalible)

63
Q

Anti-inflammatory

A

Acetysalicylic Acid

64
Q

Anti-pyretics (reduces fever)

A

acetaminophen

65
Q

Anti-bacterial

A 
Cefazloin 
Ceftriaxone 
Imipenem-Cilastatin 
-Metronidazole 
-Piperacillin-Tazobactam 
-Vancomycin
66
Q

Opiods

A
  • Codeine, Fentanyl

- Hydromorphone, Morphine

67
Q

Opiod antagonist - antidote

A

Naloxone

68
Q

Acetaminophen

A

-antipyretic, non-opiod analgesic
MOA: inhibits the synthesis of prostaglandins that may serve as mediators of pain
-few side effects
Assess: may check liver enzymes, do not take with alcohol

69
Q

Morphine

A

-Opiod analgesics, Opiod agonists
MOA: binds to opiod receptors in CNS. Alters the perception of and response to painful stimuli while producing generalized CNS depression
Side effects: confusion, sedation, hypotension, constipation serious:respiratory depression
Asses: assess level of consciousness, bp, pules & respiration’s If resp rate less than 10/min, assess level of sedation

70
Q

Codiene

A

-Opiod analgesics, opiod agonist
MOA: binds to opiate receptors in CNS, alters perception & response to painful stimuli, while producing generalized CNS depression
side effects: confusion, hypotension, constipation, NV
Assess: assess cough & lung sounds, cough & breathe deeply every 2 hours

71
Q

Hydromorphone

A

Opiod agonist
MOA: binds to opiate receptors in the CNS, alters the perception of & response to painful stimuli while producing generalized CNS depression
side effects: confusion, sedation, hypotension, constipation
Asses: Bp, pulse and reparations, if rr lower than 10 assess level of sedation, assess bowel function routinely prevention of constipation w fluids, bulk, laxatives, assess cough & lung sounds

72
Q

Vancomyocin

A

Antibiotic, Glycopeptide antinfective
MOA: inhibits cell wall biosynthesis, blocks glycopeptides polymerization by binding tightly to cell wall precursor
Side effects: nephrotoxicity leading to uremia, hypersensitivity rx (shock-like state)
Monitor: monitor BP & HR, Asses hearing, blood serum levels

73
Q

Fentanyl

A

Opiod analgesic, Opiod agonist
MOA: binds to opiate receptors in the CNS, altering the response to & perception of pain
Side effects: dizziness, drowsiness, headache, constipation, nausea, vomiting, respiratory depression
Asses: if an opiod antagonist is required to reverse respiratory depression or coma, naloxone (narcan) is anitdote, HIGH ALERT

74
Q

Naloxone (narcan)

A

opiod antagonist, Antidote (for opiods)
MOA: competitively blocks effects of opiods, including CNS & respiratory depression, without producing any agonist (opiod-like) effects.
side effects: ventricular arrhythmias
Asses: naxolone is a pure antagonist with no agonist properties and minimal toxicity

75
Q

First pass effect

A

reduces bioavalibilty of drugs to less than 100%

passes through other before reaching systemic circulation, IV drugs don’t have first pass effect

76
Q

enteral route

A

drgu absorped into systemic circulation through mucosa of stomach/small intestine

77
Q

buccal/sublingual routes

A

drug absorbed rapidly into highly vascularlized tissue under tounge

78
Q

parenteral route

A

fastest route drugs can be absorbed

79
Q

absorption

A

process of movement of a substance from it site of administration, across body membranes to circulating fluids
-primary factor that determines the length of time for the drugs effect to occur

80
Q

distribution

A

how pharmacological agents are transported throughout body

81
Q

protein binding (of drug)

A

a percentage of a drug given is bound to proteins (most commonly albumin) this is portion of drug is pharmacologically inactive
-other portion of drug is “unbound” and is responsible for therapeutic effects. It may be termed a “free” drug

82
Q

Metabolism

A

(also called biotransformation)
process of chemically converting a drug to a from that is usually more easily removed from the body
mostly occurs in the liver
first-pass over effect renders some oral drugs inactive due to hepatic metabolism

83
Q

Excretion

A

how drugs are removed from the body

84
Q

onset

A

time it takes for a drug to create a response

85
Q

loading dose

A

a higher amount of drug given normally once or twice to prime the blood stream with a level of sufficient to induce a therapeutic response

86
Q

peak

A

time it takes for drug to reach maximum response

87
Q

maintenance dose

A

before plasma levels can drop back towards zero intermittent maintenance doses are given to keep the plasma drugs levels in therapeutic range

88
Q

duration

A

length of time that drug concentration is sufficient to create a response

89
Q

half-life

A

length of time required for a medication to decrease concentration in the plasma by one-half after administration

90
Q

mechanism of action

A

term refers to the specific biochemical interaction through which a drug substance produces its pharmacological effect

91
Q

potency

A

amount of drug required to produce an effect

92
Q

agonist

A
  • molecule that activate receptors(neurotransmitters, hormones)
  • when drugs act as agonists they bind to the receptor & mimic the action of body’s own regulatory molecules
93
Q

antagonist

A

-produce their effects by preventing activation of receptors by agonists
-can produce benefical pharmacological effects by BLOCKING -actions of endogenous (produced in the body) molecules
or BLOCKING actions of drugs @ receptor sites

94
Q

Resistance (relating drugs)

A

reduction in effectiveness of a drug
-antimicrobial resistance
narcotic resistance

95
Q

Efficacy (relating to drugs)

A

-producing a desired effect

-

96
Q

therapeutic drug monitoring

A

process of measuring peak & trough levels of a drug in a persons blood w goal of adjusting the dosage to maximize the therapeutic effect (and minimize toxicity)

97
Q

Pregnancy considerations w drugs

A

medications may pass through placental barrier

98
Q

lactating women considerations w drugs

A

some medications are passed through breast milk to infant

99
Q

infants (one month to year) considerations with drugs

A

prescribed in mg/kg or body surface, liver 7 kidney function immature, metabolism & excretion are decreased

100
Q

toddlers (1-3 years)

preschoolers & school age drug considerations

A

child resitant containers keep meds out of reach

syrup of epicac

101
Q

older adult drug considerations

A

-experience more adverse effects than other age ranges
-gastric ph, motility & gastric emptying are decreased
-decreased production of liver enzymes, liver produces less albumin less proteins for drugs to bind to
-decreased cardiac output
-percentage of body water decreases
POLYPHARAMCY

102
Q

rights of drug administration

A 
right client 
right medication 
right dose 
right route of administration 
right time of delivery 
right documentation 
right reason 
right to refuse medication
103
Q

acute illness

A
  • curable

- relatively short

104
Q

chronic illness

A
  • long term, generally non-curable
  • often associated with disablility but not always
    ex. diabetes, cardiovascular, COPD, cancer
105
Q

top 3 leading causes of canadians death

A
  • heart disease
  • cancer
  • chronic lower respiratory disease
106
Q

risk factors for chronic disease

A
  • smoking
  • unhealthy diet
  • physical incativity
  • overweight & obestiy
107
Q

phases of chronic illness

A
  • pretrajectory:
  • trajectory
  • stable
  • unstable
  • acute
  • crisis
  • comeback
  • downward
  • dying
108
Q

Characteristic pattern of chronic conditions

A

-more than medical problems, emotional, psychological, and social distress, threats to identity & role changes– means continuous adaption & accommodation
-acute periods, stable & unstable periods, flare ups & remissions
-important component for management is adherence & therapeutic regimens (non adherence increases risk developing complications or accelerating disease process.complexities, demands & priorities of life can create challenges to adherence)
-one chronic disease can lead to development of other chronic conditions
-Chronic illness affects whole family. stress & care taker fatigue common w severe chronic conditions
-with today’s health care system, self-care is major
-developmental process of trial & error. each person must discover how body acts, fine tuning
-collaborative process of managing chronic illness
-medical management is expensive
-raise difficult ethical issues for pt, health care prof
& society
- living with chronic illness means living w uncertainty

109
Q

Pretrajectory phase of chronic illness

A

genetic factors or lifestyle behaviors that place an individual or community at risk for the development of chronic disease

110
Q

trajectory phase of chronic illness

A

appearance of noticeable symptoms; includes period of diagnostic workup & announcement of diagnosis; may be accompanied by biographic limbo as person begins to discover and cope with implications of diagnosis

111
Q

stable phase of chronic illness

A

illness course & symptoms are under control; biography and everyday life activities are being managed within limitations of illness; illness management centered in the home

112
Q

unstable phase of chronic illness

A

period of inablilty to keep symptoms under control or reactivation of illness; biographic distribution and difficulty in carrying out everyday life activities; adjustments being made in regimen with care usually taking place @ home

113
Q

acute phase of chronic illness

A

severe and unrelieved symptoms or the development of illness complications necessitating hospitalization or bed rest to bring illness course under control: biography and everyday life activated temporarily placed on hold or drastically cut back

114
Q

crisis phase of chronic illness

A

critical or life threatening situation requiring emergency treatment or care; biography and everyday life activities suspended until the crisis passes

115
Q

comeback phase of chronic illness

A

gradual return to an acceptable way of life within limits imposed by disabilty or illness, involves physical healing, stretching limitations through rehabilitative procedures, psychosocial coming to terms and biographic reangagment with adjustment in everyday life activities

116
Q

downward phase of chronic illness

A

illness course characterized by rapid or gradual physical decline accompanied by increasing disability or difficulty in controlling symptoms; requires biographic adjustment and alterations in everyday life activities with each major downward step

117
Q

dying phase of chronic illness

A

final days or weeks before death; characterized by gradual or rapid shutting down of body processes, biographic disengagement and closure & relinquishment of everyday life interests and activities

118
Q

Care by phase for chronic illness by applying the nursing process

A

Step 1; identifying the trajectory phase
Step 2: establishing goals
step 3: establishing a plan to achieve desired outcomes
step 4: implementing the plan & interventions
step 5: evaluating the effectiveness of interventions

119
Q

clinical presentation of inflm

A
  • redness
  • swelling
  • pain
  • warmth
120
Q

clinical presentation of infection

A
  • redness
  • swelling
  • pain
  • warmth
  • exudate
121
Q

risk factors for arthritis

A
  • sex(more likely in women)
  • age (40-60)
  • family history
  • smoking
  • environmental exposures
  • obesity
122
Q

signs and symptoms of arthritis

A
  • pain
  • joint swelling
  • limited movement
  • stiffness
  • weakness
  • fatigue
123
Q

medical management & nursing management of arthritis

A
  • ASA
  • NSAIDS
  • cortcosteriods
  • heat, warm moist compress, hot baths
  • exercise to keep joints moving
124
Q

risk factors for a urinary tract infection

A
  • female
  • cathterization or cystoscopy
  • hygiene(incontinence, briefs)
  • diabetic (increase glucose in urine)
  • inability to empty bladder completely
  • obstructed urinary flow
  • decreased natural host defenses
  • inflammation or abrasion of urethral mucosa
125
Q

signs & symptoms of a urinary tract infection

A
  • foul odur -about 50%of pts have no symptoms
  • cognitive changes (older adult)
  • dysuria
  • frequency, urgency
  • nocturia
  • incontinence
  • suprapubic or pelvic pain
  • hematuria or back pain
  • fever
126
Q

Managment of UTIS

A

treat infection (antibiotics )
pain management
increase fluids
avoid irritants

127
Q

Clostridium difficle risk factors

A 
antibiotic therapy 
surgery of GI tract 
disease of colon such as inflammatory bowel disease or colorectal cancer 
weakend immune system 
use of a chemotherapy drug
128
Q

signs and symptoms of clostridum difficle

A
  • watery diarrhea, up to 15X a day
  • severe abdominal pain
  • loss of appetite
  • fever
  • blood or pus in stool
  • weight loss
129
Q

management of c-diff

A
  • antibiotics (vancomyocin)
  • probiotics
  • fluids
  • fecal transplants
130
Q

Pneumonia risk factors

A
  • conditions that produce mucus or obstruct & interfer w normal drainage
  • smoking
  • prolonged immobility w shallow breathing
  • depressed cough reflex
  • advanced age (depressed cough reflex, glottic reflexes & nutrtional depletion)
131
Q

Signs & symptoms of Pneumonia

A

-vary w type of pneumonia
-fever
-chest pain
-tachypenia
tachycardia
-sputum (green or yellow or other)
-orthopenia
MORE
-

132
Q

managment of pneumonia

A
  • admin of antibiotics
  • improving airway patency: remove secretions
  • rest & conserve energy
  • promote fluid intake
  • maintain nutrition
  • promote knowledge
  • monitor & manage potential complications
133
Q

Diagnostic tests for inflm

A
  • wbc
  • differential
  • C- reactive protein
  • rheumatoid factor
  • ESR
134
Q

diagnostic tests for infection

A
  • WBC

- differential

135
Q

rheumatoid factor

A

to diagnose rheumatoid arthritis

-positive results = likely diagnoses of rheumatoid athritis

136
Q

C reactive protein (CRP)

A

non-specific indicator of inflm
monitor for an increase or decrease in CRP to determine response to therapy or progression of inflammatory, infectious proccess

137
Q

Procalcitonin

A

detect or rule out bacterial spesis

138
Q

gate theory of pain

A

The gate control theory of pain asserts that non-painful input closes the “gates” to painful input, which prevents pain sensation from traveling to the central nervous system. Therefore, stimulation by non-noxious input is able to suppress pain.

Nurs 232 (8 decks)

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