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NURSING School > NURS 331 1st test > Flashcards

NURS 331 1st test Flashcards

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1
Q

The nursing process

A

ADPIE - assessment, nursing diagnosis, planning, implementation evaluation

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2
Q

nursing diagnosis

A

choose diagnosis, related to, as evidence by

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3
Q

nine rights

A

right drug, right dose, right time, right route, right patient, right documentation, right reason, right response, right refusal

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4
Q

pharmacodynamics

A

what the drug does to the body

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5
Q

mechanism of actions

A

receptors, enzyme, nonselective, unknown

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6
Q

receptor mechanism of action

A

agonist - mimicking or antagonist - blocking. binding is receptor, is selective, is on a grade

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7
Q

enzyme mechanism action

A

catalyst, can inhibit or enhance

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8
Q

nonselective mechanism of action

A

non selective will work with many receptors, selective will work with only one

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9
Q

pharmacokinetics

A

what our body does to the drug - absorption, distribution, metabolism, excretion

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10
Q

IV

A

rapid onset, allows direct control

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11
Q

IV disadvantage

A

risk for infection, risk for fluid overload

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12
Q

IV considerations

A

rapid onset, risk for infection, continuous monitoring, compatibility

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13
Q

IM

A

good for poorly soluble drugs

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14
Q

IM disadvantages

A

discomfort of injection, slower onset

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15
Q

IM considerations

A

longer duration, risk for infection, delayed onset, nursing onset, nursing technique, SUBQ

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16
Q

Oral

A

easier, reversible, safer injection

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17
Q

oral disadvantage

A

variable absorption, inactivation of some drugs by stomach acid

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18
Q

oral drug considerations

A

food, water, antacids

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19
Q

sublingual

A

rapid absorption, rapid onset, avoids first pass metabolism

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20
Q

sublingual disadvantage

A

patient may swallow pill instead of keeping under tongue

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21
Q

rectal

A

good alternative when oral not available

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22
Q

rectal disadvantages

A

discomfort, embarrassment

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23
Q

rectal considerations

A

absorption is unpredictable, patient must be on left side

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24
Q

topical

A

delivers directly to affected area

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25
Q

topical considerations

A

skin should be clean

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26
Q

transdermal

A

provides relatively constant rate of absorption, patch

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27
Q

transdermal disadvantage

A

absorption can be affected by sweat

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28
Q

transdermal considerations

A

placed o alternating sites, clean, non hairy skin

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29
Q

inhalation

A

rapid absorption, directly into lung

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30
Q

inhalation disadvantage

A

absorption can be too rapid, need to be exactly as prescribed

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31
Q

bioavailability

A

amount of drug available for absorption - IV - 100%, sublingual - 100%

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32
Q

enteral

A

through intestine

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33
Q

enteral considerations

A

gastric dumping, sepsis from decreased blood flow, food.water, ability to take

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34
Q

parenteral

A

injectables

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35
Q

topical

A

creams, transdermal, patches

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36
Q

transdermal

A

systemically

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37
Q

inactive prodrugs

A

inactive until in your body

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38
Q

pharmacogenomics

A

same drug but different response in different bodies

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39
Q

excretion

A

mostly from kidneys but we also eliminate from lungs, liver, bowel, sweat, mammary glands

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40
Q

GFR

A

gives us an idea of how fast a drug can be metabolized - BUN test

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41
Q

acute therapy

A

(short term) intensive drug treatment, acutely ill or critically ill, needed to sustain life or disease

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42
Q

maintenance therapy

A

ongoing, prevent progression or disease or condition, treatment of chronic illness

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43
Q

supplemental therapy

A

replacement - supplies the body with substance needed to maintain normal function

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44
Q

palliative therapy

A

comfort, end of life, make patient as comfortable as possible, relief from symptoms, pain, and stress

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45
Q

supportive therapy

A

recovery - maintains the integrity of body functions while the patient recovers from illness or trauma

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46
Q

prophylactic therapy

A

prevent illness (antibiotics)

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47
Q

polypharmacy

A

more than one drug

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48
Q

comorbidities

A

more than one disease

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49
Q

physiologic changes in older adults

A

cardiac output, perfusion, hepatic and renal function all decrease

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50
Q

black box warning

A

strictest warning put in labeling of prescription drugs, highlights serious sometimes life threatening adverse reactions

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51
Q

innate immunity

A

immune responses you are born with. closed system. epithelial, normal microbiome, PPRs

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52
Q

epithelial

A

skin, GI, respiratory. secrete substances that protect against infection - mucus, sweat, saliva, tears

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53
Q

epithelial type of mechanisms

A

physical, mechanical, biochemical

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54
Q

what do tears and saliva contain

A

lysozyme which is an enzyme that attacks cell walls of gram positive bacteria

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55
Q

antimicrobial peptides

A

kill or inhibit the growth of disease causing bacteria, fungi, and viruses

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56
Q

how do sebaceous glands protect you?

A

they secrete fatty acids that have an acidic ph which creates inhospitable environment for bacteria

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57
Q

how does your skin protect you

A

low temp, low ph, sloughing, and sweating

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58
Q

how does GI protect you

A

stomach has low ph and can also make you vomit. also by secreting through urine

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59
Q

how does respiratory protect you

A

mucus, cilla, coughing, and sneezing

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60
Q

normal microbiome

A

part of innate, benefits GI, prevents colonization of pathogens

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61
Q

how does normal microbiome protect you

A

synthesizes metabolites such as vitamins K and Bs and synthesizes serotonin

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62
Q

broad spectrum ABX

A

antibiotics, act against many bacteria, but kill both good and bad. can lead to yeast or opportunistic microorganism build up such as C. diff and pseudomonas aeruginosa

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63
Q

gut brain axis

A

gut health can affect our brain. Stress, but epithelial breakdown= “leaky gut”

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64
Q

inflammation

A

programmed response that limits tissue damage.

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65
Q

types of inflammation

A

sterile - no pathogen, septic - pathogen present

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66
Q

cardinal signs of inflammation

A

(HEELP) heat (fever), erythema (redness), edema (swelling), loss of function, pain

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67
Q

what leads to a loss of function

A

swelling and pain

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68
Q

is inflammation specific or nonspecific

A

nonspecific - will do same thing every time

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69
Q

what happens when inflammation is present

A

vasodilation, increased vascular permeability, and white blood cell infiltration

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70
Q

plasma protein systems

A

compliment system, clotting system, and kinin system

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71
Q

compliment system

A

destroys pathogens directly. activation C3b, C5a, and C3a

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72
Q

C3b

A

opsonins - coat the surface of bacteria and increase their chances of being phagocytized and killed

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73
Q

C5a

A

chemotactic factors - diffuse from site of inflammation and attract phagocytic cells to that site

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74
Q

C3a

A

anaphylatoxins- degranulate mast cells which release histamine which causes vasodilation and vascular permeability

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75
Q

clotting system

A

forms blood clot, plug damaged vessels and stops bleeding

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76
Q

clotting system cascade

A

factor X, thrombin, fibrinogen, fibrin, clot

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77
Q

fibrin

A

protein that leads to clot

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78
Q

Kinin system

A

bradykinin which causes vasodilation and works with prostaglandins to induce pain ,smooth muscle contraction, and vascular permeability

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79
Q

PPRs

A

“hall monitors” recognize infectious agents (septic) and cellular damage (sterile)

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80
Q

erythrocytes

A

RBCs. carry O2 to tissue

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81
Q

platelets

A

activate when they find abnormalities and synthesize thromboxane A2 (TXA2)

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82
Q

thromboxane A2 (TXA2)

A

potent vasoconstrictor

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83
Q

leukocytes

A

WBCs - neutrophils, basophils, eosinophils, macrophages, lymphocytes

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84
Q

neutrophils

A

first responders

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85
Q

basophils

A

allergic reactions

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86
Q

eosinophils

A

parasitic infection

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87
Q

cytokines

A

signalling molecule. can be pro or anti inflammatory

88
Q

interleukins

A

produced in response to PPRs. enhance or suppress inflammation

89
Q

interferon

A

kind of cytokine, work against viruses, control inflammatory response

90
Q

Mast cells

A

release granules that have histamine, cytokines, and chemotactic

91
Q

leukotriene

A

cause smooth muscle to contract which leads to bronchial constriction. increase vascular permeability

92
Q

prostaglandins

A

increase vascular permeability, cause pain, neutrophil movement toward inflammation

93
Q

adaptive immunity

A

acquired - remembers pathogens, systemic, uses antibodies, immunoglobulins, and humoral immunity

94
Q

antibodies

A

protect against infection either directly by neutralization or indirectly by phagocytosis

95
Q

immunoglobulins

A

IgG - show past infection and IgM - show present infection

96
Q

humoral immunity

A

respond to antigen. include b-cells which create antibodies (20% of lymphocytes), and T-cells (70% of lymphocytes)????

97
Q

cytotoxic

A

a type of T cell that kills cells that have gone bad

98
Q

acute inflammation

A

less than 2 weeks, exudate. signs include - serous, fibrinous, and purulent

99
Q

exudate

A

mass of cells and fluid that has seeped out of the blood vessels

100
Q

serous

A

blister (early)

101
Q

fibrinous

A

phlegm (advanced)

102
Q

purulent

A

pus (bacteria)

103
Q

how do you get a fever

A

cytokines stimulate the hypothalamus and cause fever

104
Q

endothelial cells do what to blood flow and clotting

A

maintain blood flow and regulate blood clotting

105
Q

what does nitric oxide do

A

relaxes smooth muscle, increases blood flow, inhibits platelet activation

106
Q

leukocytosis

A

hight amount of WBC

107
Q

SED rate

A

test for inflammatory response

108
Q

chronic inflammation

A

more than 2 weeks, dense infiltration of macrophages and lymphocytes, granuloma, caseous, tissue damage, and reduced function

109
Q

caseous

A

liquéfaction necrosis

110
Q

capillary hydrostatic pressure

A

pushing pressure inside the arterial part of the vessel where filtration is favored

111
Q

interstitial oncotic pressure

A

pulling pressure outside the vessel on the arterial side

112
Q

interstitial hydrostatic pressure

A

pushing pressure on venous side of vessel where reabsorption is favored

113
Q

plasma oncotic oressure

A

pulling pressure inside the vessel on the venous side

114
Q

edema

A

increased capillary pressure, decreased plasma oncotic pressure, decrease capillary permeability, increase tissue oncotic pressure

115
Q

why would your capillary hydrostatic pressure increase

A

venous obstruction or water/salt retention

116
Q

why would your plasma oncotic pressure decrease

A

loss or decrease in plasma protein

117
Q

what does increased capillary permeability lead to

A

loss in plasma protein

118
Q

nursing diagnosis or edema

A

fluid volume excess, activity intolerance, risk for injury and infection, impaired skin integrity

119
Q

fluid osmolity

A

concentration

120
Q

renin angiotensin aldosterone system

A

angiotensinogen- angiotensin 1 - angiotensin 2 from the liver - aldosterone goes to the kidneys - increased sodium/water retention, increased extracellular fluid, and increased blood pressure

121
Q

fluid excess leads to what

A

edema

122
Q

fluid can accumulate in

A

pericardial sac, interpleural space, peritoneal space, and joint spaces

123
Q

hypervolemia

A

high volume (excess sodium)

124
Q

what mechanisms are compromised with hypervolemia?

A

can be caused by renal failure, heart failure, or RAAS

125
Q

RAAS

A

renin angiotensin aldosterone system

126
Q

what can hypervolemia cause

A

JVD (jugular vein distention), ALOC (altered consciousness) due to sodium effects on neurotransmitters, S3 caused by fluid around the heart, lung sounds, decreased hemoglobin and hematocrit, altered electrolytes

127
Q

hypovolemia

A

deficient fluid volume

128
Q

urine output less than

A

30 ml/hr is really bad

129
Q

hypovolemia can be caused by

A

age and weight, hyper metabolic rate, diuretics, fluid loss, immobility, lack of plasma proteins from malnutrition, burns, or liver failure, pain, paralysis, IBS

130
Q

hypovolemia can cause

A

poor skin turgor, weak thready pulse because of less perfusion, hypotension

131
Q

colloids

A

large proteins. increase oncotic pressure by pulling fluids into the vascular space. example is albumin

132
Q

albumin

A

plasma volume expander, blood derivative, watch for vascular overload

133
Q

crystalloids

A

decrease oncotic pressure and increase volume in intravascular space and interstitial space. watch for fluid overload

134
Q

tonicity

A

concentration of solutes dissolved in a solution which determines diffusion

135
Q

isotonic

A

250-375 mOsm/L equal osmotic pressure. no shifting of fluid

136
Q

normal blood osmolity

A

290-310 mOsm/L

137
Q

nursing considerations when using isotonic solution

A

use caution when using in renal, cardiac, or geriatric patients. fluid overload. elevate HOB (head of bed)

138
Q

hypotonic

A

less than 250 mOsm/L. causes fluid to shift from intravascular space to intracellular space (hydrates cell)

139
Q

hypotonic solutions

A

0.45% NaCl, 0.25 % NaCl, and D5W

140
Q

hypotonic solution nursing considerations

A

fluid volume deficit, cerebral edema, do not use with patients with liver disease, trauma, ICP or burns, can deplete intravascular volume

141
Q

ICP

A

increased cranial pressure

142
Q

hypertonic

A

greater than 375 mOsm/L. fluid shift out of cell into vascular space. used for severe hyponatremia

143
Q

hypertonic solutions

A

3% NaCl, 5% NaCl, and D10W

144
Q

hypertonic solution nursing considerations

A

FVO (fluid volume overload), for temporary use, central line only, and can cause damage to myelin sheath of brain stem which could result in death

145
Q

extracellular electrolytes

A

sodium, chloride, bicarb

146
Q

intracellular electrolytes

A

potassium, magnesium, phosphate

147
Q

Normal sodium levels

A

135-145 mEq/L

148
Q

sodium function

A

transmits nerve impulses, maintains osmolality through thirst, renal, and ADH, assists regulation of acid/base balance, and promotes muscle contractibility

149
Q

hyponatremia

A

low sodium, water follows sodium inside the cell and expands the cell (brain cells sensitive)

150
Q

signs and symptoms of hyponatremia

A

ALOC, seizures, ICP, coma, cerebral adema, muscle weakness, twitching, or tremors

151
Q

Signs of hypernatremia

A

water rushing outside cell because there is a increased NA+ concentration outside the cell and the cell shrinks, signs are fever, flushed, increased fluid retention, edema, ALOC, coma, muscle twitching, hyperreflexion

152
Q

function of potassium

A

acid/base balance, cardiac rhythm, skeletal and smooth muscle contraction

153
Q

normal levels of potassium

A

3.5 -5

154
Q

insulin IV is good at what?

A

getting potassium back into the cell

155
Q

hypokalemia and what are signs and symptoms

A

low potassium can cause irregular pulse, dysrhythmias, or arrest. everything is slow, can flatten T and U waves, muscle aches, paralysis, V/D

156
Q

hyperkalemia and what are the signs and symptoms

A

high levels or potassium. decreased cardiac contractibility, cramps, cause peaked Ts and widened QRS, Brady dysrhythmias or arrest, hyperactive smooth and skeletal muscle

157
Q

treatment for hyperkalemia

A

kayexalate, calcium gluconate, IV insulin, hemodialysis

158
Q

acid base balance

A

maintains homeostasis, keeps ph within 7.35-7.45

159
Q

ph of less than 7.4

A

acidosis

160
Q

ph greater than 7.4

A

alkalosis

161
Q

regulations of ph

A

chemical buffers, intracellular phosphate and protein, lungs, kidneys

162
Q

chemical buffers

A

CO2, HCO3, and hemoglobin

163
Q

uncompensated

A

CO2 or HCO3 normal

164
Q

fully compensated

A

ph is normal

165
Q

partially compensated

A

nothing is normal

166
Q

respiratory acidosis vs metabolic acidosis

A

respiratory acidosis has a co2>44, metabolic acidosis has a HCO3<22

167
Q

respiratory alkalosis vs metabolic alkalosis

A

respiratory alkalosis has a CO2< 38, metabolic alkalosis has a HCO3 > 26

168
Q

acidosis symptoms

A

headache, SOB, coughing, arrhythmia, increased HR, seizures, weakness N/V/D

169
Q

alkalosis symptoms

A

light headedness, hand tremor, numbness or tingling, spasms N/V/D

170
Q

respiratory compensation response

A

increase or decrease ventilation

171
Q

metabolic buffer system

A

secrete or retain H+ or HCO3

172
Q

respiratory acidosis

A

build up of CO2 due to alveolar hypoventilation. exchange of gases not happening, slow respirations, can become disoriented or go into coma

173
Q

respiratory acidosis causes

A

drugs, collapsed alveoli, or head injury, pulmonary edema

174
Q

respiratory acidosis compensations

A

kidney retains HCO3, tachypnea (rapid breathing)

175
Q

respiratory alkalosis and what causes it

A

low CO2 caused by hyperventilation, anxiety, pain, fear, asthma

176
Q

respiratory alkalosis compensations

A

kidney retains H+ and excretes HCO3

177
Q

metabolic acidosis

A

increased acids, low HCO3 caused by high acid production, low acid excretion, or low bicarb levels. diarrhea, vomiting, fistula, renal failure

178
Q

DKA

A

diabetic keto acidosis

179
Q

metabolic acidosis compensations

A

deep rapid breathing (Kussmaul’s), kidneys will start producing more HCO3

180
Q

metabolic alkalosis

A

excess loss of acids and high HCO3 caused by ingestions of too many antacids, hyperaldosteronism, low acid due to vomiting or gastrisuction or excesses diuretic use

181
Q

how do you treat metabolic alkalosis and what are compensations

A

with isotonic fluids. body tries to compensate by hyperventilating to increase CO2

182
Q

iatrogenic

A

caused by medical treatment

183
Q

PaO2

A

O2 dissolved in blood 80-100 mmHg

184
Q

SaO2

A

O2 saturation 95%-100%

185
Q

PaCO2

A

35-45 mmHg

186
Q

HCO3 levels

A

33-36 mEq/L

187
Q

bass excess

A

indicates amount of excess or insufficient bicarbonate in system - negative indicates base deficit

188
Q

ROME

A

respiratory opposite, metabolic same

189
Q

hyperaldosteronism

A

causes increased Na+ which leads to decreased H+ and K+ which increases HCO3

190
Q

nursing interventions for hypernatremia

A

restrict NA+ intake, isotonic solution, educate about diet

191
Q

sodium chloride NS 0.9%

A

isotonic crystalloid solution

192
Q

sodium chloride NS 0.9% contraindications

A

hypernatremia and hyperchloremia

193
Q

what does sodium chloride NS 0.9% do? what do you need to watch out for?

A

replaces water and sodium, watch for fluid overload

194
Q

sodium chloride NS 0.9% indications

A

hemorrhage, GI loss, metabolic acidosis, hyponatremia

195
Q

sodium chloride 0.45% 0.25%

A

hypotonic solution, moving fluid out of vein and into the cell

196
Q

sodium chloride 0.45% 0.25% adverse effects

A

hemolysis of red blood cells

197
Q

sodium chloride 3% 5%

A

hypertonic solution, high risk solution, moving fluid out of cell into the vein. sometimes used for severe hyponatremia but must be given slowly

198
Q

sodium chloride 3% 5% adverse effects

A

osmotic demyelination syndrome which is potentially fatal. if given to quick can lead to irreversible brainstem damage

199
Q

Albumin

A

colloid. increases oncotic pressure which expands volume of circulating blood. restores plasma volume.

200
Q

albumin contraindications

A

hypersensitivity, severe anemia, pulmonary edema, renal insufficiency, CHF (congestive heart failure)

201
Q

albumin nursing considerations

A

pulmonary edema, fluid, overload, hypotension

202
Q

sodium polystyrene sulfonate

A

also known as kayexalate. potassium removing resin. removes potassium by exchanging sodium for potassium in body primarily in large intestine

203
Q

sodium polystyrene sulfonate uses

A

hyperkalemia

204
Q

sodium polystyrene sulfonate contraindications

A

hypersensitivity, GI obstruction, reduced gut mobility

205
Q

sodium polystyrene sulfonate adverse effects

A

intestinal necrosis, hypernatremia, hypokalemia, hypocalcemia

206
Q

potassium chloride

A

replaces potassium levels

207
Q

potassium chloride indications

A

hypokalemia

208
Q

potassium chloride adverse effects

A

N/V/D, GI bleeding, cardiac arrest, phlebitis

209
Q

do you do an iv push with potassium chloride

A

NO also it must be diluted.

210
Q

decreased perfusion to gut causes what with medications in elderly

A

low absorption

211
Q

decreased liver function causes what with medications in elderly

A

decreased metabolism

212
Q

decreased kidney function in elderly cause what with medications?

A

decreased kidney function

213
Q

drug interactions

A

drugs that bind to the same type of receptor will have drug interactions

214
Q

example of sublingual drug

A

nitroglycerin which is a medication to treat chest pain

215
Q

K+ level inside cell

A

95% k+ is in side cell

216
Q

if in a car accident what happens to K+ level

A

they increase because your dead cells release K+

217
Q

what would you give a patient if they have cerebral edema

A

hypertonic solution to take the fluid out of the cells

NURSING School (17 decks)

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