NURS 331 1st test Flashcards
The nursing process
ADPIE - assessment, nursing diagnosis, planning, implementation evaluation
nursing diagnosis
choose diagnosis, related to, as evidence by
nine rights
right drug, right dose, right time, right route, right patient, right documentation, right reason, right response, right refusal
pharmacodynamics
what the drug does to the body
mechanism of actions
receptors, enzyme, nonselective, unknown
receptor mechanism of action
agonist - mimicking or antagonist - blocking. binding is receptor, is selective, is on a grade
enzyme mechanism action
catalyst, can inhibit or enhance
nonselective mechanism of action
non selective will work with many receptors, selective will work with only one
pharmacokinetics
what our body does to the drug - absorption, distribution, metabolism, excretion
IV
rapid onset, allows direct control
IV disadvantage
risk for infection, risk for fluid overload
IV considerations
rapid onset, risk for infection, continuous monitoring, compatibility
IM
good for poorly soluble drugs
IM disadvantages
discomfort of injection, slower onset
IM considerations
longer duration, risk for infection, delayed onset, nursing onset, nursing technique, SUBQ
Oral
easier, reversible, safer injection
oral disadvantage
variable absorption, inactivation of some drugs by stomach acid
oral drug considerations
food, water, antacids
sublingual
rapid absorption, rapid onset, avoids first pass metabolism
sublingual disadvantage
patient may swallow pill instead of keeping under tongue
rectal
good alternative when oral not available
rectal disadvantages
discomfort, embarrassment
rectal considerations
absorption is unpredictable, patient must be on left side
topical
delivers directly to affected area
topical considerations
skin should be clean
transdermal
provides relatively constant rate of absorption, patch
transdermal disadvantage
absorption can be affected by sweat
transdermal considerations
placed o alternating sites, clean, non hairy skin
inhalation
rapid absorption, directly into lung
inhalation disadvantage
absorption can be too rapid, need to be exactly as prescribed
bioavailability
amount of drug available for absorption - IV - 100%, sublingual - 100%
enteral
through intestine
enteral considerations
gastric dumping, sepsis from decreased blood flow, food.water, ability to take
parenteral
injectables
topical
creams, transdermal, patches
transdermal
systemically
inactive prodrugs
inactive until in your body
pharmacogenomics
same drug but different response in different bodies
excretion
mostly from kidneys but we also eliminate from lungs, liver, bowel, sweat, mammary glands
GFR
gives us an idea of how fast a drug can be metabolized - BUN test
acute therapy
(short term) intensive drug treatment, acutely ill or critically ill, needed to sustain life or disease
maintenance therapy
ongoing, prevent progression or disease or condition, treatment of chronic illness
supplemental therapy
replacement - supplies the body with substance needed to maintain normal function
palliative therapy
comfort, end of life, make patient as comfortable as possible, relief from symptoms, pain, and stress
supportive therapy
recovery - maintains the integrity of body functions while the patient recovers from illness or trauma
prophylactic therapy
prevent illness (antibiotics)
polypharmacy
more than one drug
comorbidities
more than one disease
physiologic changes in older adults
cardiac output, perfusion, hepatic and renal function all decrease
black box warning
strictest warning put in labeling of prescription drugs, highlights serious sometimes life threatening adverse reactions
innate immunity
immune responses you are born with. closed system. epithelial, normal microbiome, PPRs
epithelial
skin, GI, respiratory. secrete substances that protect against infection - mucus, sweat, saliva, tears
epithelial type of mechanisms
physical, mechanical, biochemical
what do tears and saliva contain
lysozyme which is an enzyme that attacks cell walls of gram positive bacteria
antimicrobial peptides
kill or inhibit the growth of disease causing bacteria, fungi, and viruses
how do sebaceous glands protect you?
they secrete fatty acids that have an acidic ph which creates inhospitable environment for bacteria
how does your skin protect you
low temp, low ph, sloughing, and sweating
how does GI protect you
stomach has low ph and can also make you vomit. also by secreting through urine
how does respiratory protect you
mucus, cilla, coughing, and sneezing
normal microbiome
part of innate, benefits GI, prevents colonization of pathogens
how does normal microbiome protect you
synthesizes metabolites such as vitamins K and Bs and synthesizes serotonin
broad spectrum ABX
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
gut brain axis
gut health can affect our brain. Stress, but epithelial breakdown= “leaky gut”
inflammation
programmed response that limits tissue damage.
types of inflammation
sterile - no pathogen, septic - pathogen present
cardinal signs of inflammation
(HEELP) heat (fever), erythema (redness), edema (swelling), loss of function, pain
what leads to a loss of function
swelling and pain
is inflammation specific or nonspecific
nonspecific - will do same thing every time
what happens when inflammation is present
vasodilation, increased vascular permeability, and white blood cell infiltration
plasma protein systems
compliment system, clotting system, and kinin system
compliment system
destroys pathogens directly. activation C3b, C5a, and C3a
C3b
opsonins - coat the surface of bacteria and increase their chances of being phagocytized and killed
C5a
chemotactic factors - diffuse from site of inflammation and attract phagocytic cells to that site
C3a
anaphylatoxins- degranulate mast cells which release histamine which causes vasodilation and vascular permeability
clotting system
forms blood clot, plug damaged vessels and stops bleeding
clotting system cascade
factor X, thrombin, fibrinogen, fibrin, clot
fibrin
protein that leads to clot
Kinin system
bradykinin which causes vasodilation and works with prostaglandins to induce pain ,smooth muscle contraction, and vascular permeability
PPRs
“hall monitors” recognize infectious agents (septic) and cellular damage (sterile)
erythrocytes
RBCs. carry O2 to tissue
platelets
activate when they find abnormalities and synthesize thromboxane A2 (TXA2)
thromboxane A2 (TXA2)
potent vasoconstrictor
leukocytes
WBCs - neutrophils, basophils, eosinophils, macrophages, lymphocytes
neutrophils
first responders
basophils
allergic reactions
eosinophils
parasitic infection
cytokines
signalling molecule. can be pro or anti inflammatory
interleukins
produced in response to PPRs. enhance or suppress inflammation
interferon
kind of cytokine, work against viruses, control inflammatory response
Mast cells
release granules that have histamine, cytokines, and chemotactic
leukotriene
cause smooth muscle to contract which leads to bronchial constriction. increase vascular permeability
prostaglandins
increase vascular permeability, cause pain, neutrophil movement toward inflammation
adaptive immunity
acquired - remembers pathogens, systemic, uses antibodies, immunoglobulins, and humoral immunity
antibodies
protect against infection either directly by neutralization or indirectly by phagocytosis
immunoglobulins
IgG - show past infection and IgM - show present infection
humoral immunity
respond to antigen. include b-cells which create antibodies (20% of lymphocytes), and T-cells (70% of lymphocytes)????
cytotoxic
a type of T cell that kills cells that have gone bad
acute inflammation
less than 2 weeks, exudate. signs include - serous, fibrinous, and purulent
exudate
mass of cells and fluid that has seeped out of the blood vessels
serous
blister (early)
fibrinous
phlegm (advanced)
purulent
pus (bacteria)
how do you get a fever
cytokines stimulate the hypothalamus and cause fever
endothelial cells do what to blood flow and clotting
maintain blood flow and regulate blood clotting
what does nitric oxide do
relaxes smooth muscle, increases blood flow, inhibits platelet activation
leukocytosis
hight amount of WBC
SED rate
test for inflammatory response
chronic inflammation
more than 2 weeks, dense infiltration of macrophages and lymphocytes, granuloma, caseous, tissue damage, and reduced function
caseous
liquéfaction necrosis
capillary hydrostatic pressure
pushing pressure inside the arterial part of the vessel where filtration is favored
interstitial oncotic pressure
pulling pressure outside the vessel on the arterial side
interstitial hydrostatic pressure
pushing pressure on venous side of vessel where reabsorption is favored
plasma oncotic oressure
pulling pressure inside the vessel on the venous side
edema
increased capillary pressure, decreased plasma oncotic pressure, decrease capillary permeability, increase tissue oncotic pressure
why would your capillary hydrostatic pressure increase
venous obstruction or water/salt retention
why would your plasma oncotic pressure decrease
loss or decrease in plasma protein
what does increased capillary permeability lead to
loss in plasma protein
nursing diagnosis or edema
fluid volume excess, activity intolerance, risk for injury and infection, impaired skin integrity
fluid osmolity
concentration
renin angiotensin aldosterone system
angiotensinogen- angiotensin 1 - angiotensin 2 from the liver - aldosterone goes to the kidneys - increased sodium/water retention, increased extracellular fluid, and increased blood pressure
fluid excess leads to what
edema
fluid can accumulate in
pericardial sac, interpleural space, peritoneal space, and joint spaces
hypervolemia
high volume (excess sodium)
what mechanisms are compromised with hypervolemia?
can be caused by renal failure, heart failure, or RAAS
RAAS
renin angiotensin aldosterone system
what can hypervolemia cause
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
hypovolemia
deficient fluid volume
urine output less than
30 ml/hr is really bad
hypovolemia can be caused by
age and weight, hyper metabolic rate, diuretics, fluid loss, immobility, lack of plasma proteins from malnutrition, burns, or liver failure, pain, paralysis, IBS
hypovolemia can cause
poor skin turgor, weak thready pulse because of less perfusion, hypotension
colloids
large proteins. increase oncotic pressure by pulling fluids into the vascular space. example is albumin
albumin
plasma volume expander, blood derivative, watch for vascular overload
crystalloids
decrease oncotic pressure and increase volume in intravascular space and interstitial space. watch for fluid overload
tonicity
concentration of solutes dissolved in a solution which determines diffusion
isotonic
250-375 mOsm/L equal osmotic pressure. no shifting of fluid
normal blood osmolity
290-310 mOsm/L
nursing considerations when using isotonic solution
use caution when using in renal, cardiac, or geriatric patients. fluid overload. elevate HOB (head of bed)
hypotonic
less than 250 mOsm/L. causes fluid to shift from intravascular space to intracellular space (hydrates cell)
hypotonic solutions
0.45% NaCl, 0.25 % NaCl, and D5W
hypotonic solution nursing considerations
fluid volume deficit, cerebral edema, do not use with patients with liver disease, trauma, ICP or burns, can deplete intravascular volume
ICP
increased cranial pressure
hypertonic
greater than 375 mOsm/L. fluid shift out of cell into vascular space. used for severe hyponatremia
hypertonic solutions
3% NaCl, 5% NaCl, and D10W
hypertonic solution nursing considerations
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
extracellular electrolytes
sodium, chloride, bicarb
intracellular electrolytes
potassium, magnesium, phosphate
Normal sodium levels
135-145 mEq/L
sodium function
transmits nerve impulses, maintains osmolality through thirst, renal, and ADH, assists regulation of acid/base balance, and promotes muscle contractibility
hyponatremia
low sodium, water follows sodium inside the cell and expands the cell (brain cells sensitive)
signs and symptoms of hyponatremia
ALOC, seizures, ICP, coma, cerebral adema, muscle weakness, twitching, or tremors
Signs of hypernatremia
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
function of potassium
acid/base balance, cardiac rhythm, skeletal and smooth muscle contraction
normal levels of potassium
3.5 -5
insulin IV is good at what?
getting potassium back into the cell
hypokalemia and what are signs and symptoms
low potassium can cause irregular pulse, dysrhythmias, or arrest. everything is slow, can flatten T and U waves, muscle aches, paralysis, V/D
hyperkalemia and what are the signs and symptoms
high levels or potassium. decreased cardiac contractibility, cramps, cause peaked Ts and widened QRS, Brady dysrhythmias or arrest, hyperactive smooth and skeletal muscle
treatment for hyperkalemia
kayexalate, calcium gluconate, IV insulin, hemodialysis
acid base balance
maintains homeostasis, keeps ph within 7.35-7.45
ph of less than 7.4
acidosis
ph greater than 7.4
alkalosis
regulations of ph
chemical buffers, intracellular phosphate and protein, lungs, kidneys
chemical buffers
CO2, HCO3, and hemoglobin
uncompensated
CO2 or HCO3 normal
fully compensated
ph is normal
partially compensated
nothing is normal
respiratory acidosis vs metabolic acidosis
respiratory acidosis has a co2>44, metabolic acidosis has a HCO3<22
respiratory alkalosis vs metabolic alkalosis
respiratory alkalosis has a CO2< 38, metabolic alkalosis has a HCO3 > 26
acidosis symptoms
headache, SOB, coughing, arrhythmia, increased HR, seizures, weakness N/V/D
alkalosis symptoms
light headedness, hand tremor, numbness or tingling, spasms N/V/D
respiratory compensation response
increase or decrease ventilation
metabolic buffer system
secrete or retain H+ or HCO3
respiratory acidosis
build up of CO2 due to alveolar hypoventilation. exchange of gases not happening, slow respirations, can become disoriented or go into coma
respiratory acidosis causes
drugs, collapsed alveoli, or head injury, pulmonary edema
respiratory acidosis compensations
kidney retains HCO3, tachypnea (rapid breathing)
respiratory alkalosis and what causes it
low CO2 caused by hyperventilation, anxiety, pain, fear, asthma
respiratory alkalosis compensations
kidney retains H+ and excretes HCO3
metabolic acidosis
increased acids, low HCO3 caused by high acid production, low acid excretion, or low bicarb levels. diarrhea, vomiting, fistula, renal failure
DKA
diabetic keto acidosis
metabolic acidosis compensations
deep rapid breathing (Kussmaul’s), kidneys will start producing more HCO3
metabolic alkalosis
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
how do you treat metabolic alkalosis and what are compensations
with isotonic fluids. body tries to compensate by hyperventilating to increase CO2
iatrogenic
caused by medical treatment
PaO2
O2 dissolved in blood 80-100 mmHg
SaO2
O2 saturation 95%-100%
PaCO2
35-45 mmHg
HCO3 levels
33-36 mEq/L
bass excess
indicates amount of excess or insufficient bicarbonate in system - negative indicates base deficit
ROME
respiratory opposite, metabolic same
hyperaldosteronism
causes increased Na+ which leads to decreased H+ and K+ which increases HCO3
nursing interventions for hypernatremia
restrict NA+ intake, isotonic solution, educate about diet
sodium chloride NS 0.9%
isotonic crystalloid solution
sodium chloride NS 0.9% contraindications
hypernatremia and hyperchloremia
what does sodium chloride NS 0.9% do? what do you need to watch out for?
replaces water and sodium, watch for fluid overload
sodium chloride NS 0.9% indications
hemorrhage, GI loss, metabolic acidosis, hyponatremia
sodium chloride 0.45% 0.25%
hypotonic solution, moving fluid out of vein and into the cell
sodium chloride 0.45% 0.25% adverse effects
hemolysis of red blood cells
sodium chloride 3% 5%
hypertonic solution, high risk solution, moving fluid out of cell into the vein. sometimes used for severe hyponatremia but must be given slowly
sodium chloride 3% 5% adverse effects
osmotic demyelination syndrome which is potentially fatal. if given to quick can lead to irreversible brainstem damage
Albumin
colloid. increases oncotic pressure which expands volume of circulating blood. restores plasma volume.
albumin contraindications
hypersensitivity, severe anemia, pulmonary edema, renal insufficiency, CHF (congestive heart failure)
albumin nursing considerations
pulmonary edema, fluid, overload, hypotension
sodium polystyrene sulfonate
also known as kayexalate. potassium removing resin. removes potassium by exchanging sodium for potassium in body primarily in large intestine
sodium polystyrene sulfonate uses
hyperkalemia
sodium polystyrene sulfonate contraindications
hypersensitivity, GI obstruction, reduced gut mobility
sodium polystyrene sulfonate adverse effects
intestinal necrosis, hypernatremia, hypokalemia, hypocalcemia
potassium chloride
replaces potassium levels
potassium chloride indications
hypokalemia
potassium chloride adverse effects
N/V/D, GI bleeding, cardiac arrest, phlebitis
do you do an iv push with potassium chloride
NO also it must be diluted.
decreased perfusion to gut causes what with medications in elderly
low absorption
decreased liver function causes what with medications in elderly
decreased metabolism
decreased kidney function in elderly cause what with medications?
decreased kidney function
drug interactions
drugs that bind to the same type of receptor will have drug interactions
example of sublingual drug
nitroglycerin which is a medication to treat chest pain
K+ level inside cell
95% k+ is in side cell
if in a car accident what happens to K+ level
they increase because your dead cells release K+
what would you give a patient if they have cerebral edema
hypertonic solution to take the fluid out of the cells
