PATHO AND PHARM (EXAM 1) Flashcards
What’s the main important thing to do when administering transdermal medication
Wear gloves!!
The steps to administering a transdermal medication
- Perform hand hygiene and wear gloves
- Remove the old patch
- Clean and prepare the skin
- Open the patch
- Remove the liner
- Place the patch on the area
When administering transdermal medication do you put it on the same spot
Nooo
Why do we wear gloves when administering transdermal medication
Because it can be absorbed thriugh the skin into your skin
How do you administer eye drops
- Hand hygiene wear gloves
- Ask patient to lay back in chair. Look at the ceiling
- Remove any discharge with a clean cloth.
- Draw the skin down until you can see the conjunctival sac
- Notify the patient so they won’t blink
- Administer drops
Should the top of the drop touch they eye
No
What will happen if the eye drop is placed directly where the cornea is
It may cause discomfort or damage
What do you do after the steps are completed
Gently pres the lacrimal duct with a cotton ball for 1-2 minutes to prevent systemic absorption through the lacrimal canal
What should the patient do to promote absorption after eye drops is administered
close eyes for 1-2 minutes
How do you administer eye ointment
You squeeze the ointment onto the conjuctival sac
Instruct the patient to close their eyes for 2-3 minutes
How long should the patient close their eyes for after administering eye ointment
2-3 minutes
What should the patient expect after administering eye ointment
Blurry vision. Do not drive!
When administering ear drops what temperature should it be
Room temperature
What position should the patient be in when administering ear drops
They should lay on their unaffected side
How long after the ear drops have been administered should the patient lay in this position
Why?
2-3 minutes
To make sure the drop reaches the unaffected area
Which way do you pull,the ear for children younger than 3
Pull down and back
Children older than 3 ear drop administered
And adults
Pull up and outwards
Where should you avoid allowing g the ear drops to fall
On the tympanic membrane
Where should the ear drops be aimed
At the side of the ear canal so it can run down
How do you prevent contamination of the ear drop
Keeping the tip of it clean. So do not let it touch the ear
What should you do before administering nasal medication and why
Blow your nose
Mucous can inhibit the medication
Steps on how to administer Nasal drops and spray
- Hand hygiene and gloves
- Ask patient to blow nose
- Tilt head back and toward affected side
- Administer
How do you administer with one nostril closed
Tilt the head to the closed side and hold breath
If the patient is using nasal spray how do you position
The patient looking down at their feet with the stay tip aimed towards the eye
How li g should the patient keep their head tilted back after installation drops
For 5 minutes
What kind of lubricant do you use when administering rectal suppositories
Water soluble
Why should you not use petroleum jelly when administering rectal medication
Because it may inhibit the absorption of the medication
What position should the patient lie in when administering suppositories
Left lateral recumbent position
Basically lying on the left side
What should the pt do when laying in this position
Breathe slowly through the mouth and relax anal sphincter
How do you administer the rectal suppository
Apply water soluble lubricant to the tip of the unwrapped suppository
Gently insert into the anus and beyond the internal sphincter
Where should the suppository go beyond
Why
The internal sphincter
Because it will not stick
In what position and how long should the patient stay in
Flat or on 1 side
30 minutes
Fluid volume deficit is?
Dehydration
Hypovolemia
What causes hypovolemia
Anything that makes you lose water
Contributing factors of hypovolemia
Vomiting
Diarrhea
Not drinking enough water
Fever
Blood loss
GI suctioning
Hypernatremia and hypovolemia
This is when there is too high of salt concentration in the body
This cause the cells to be dehydrated and shrink
Lose watet
What is usually the first sign of hypovolemia
Why?
Tachycardia
This is because there isn’t a lot of fluid in the body so the heart is pumping faster to circulate and get more blood
The body tries to compensate for the low blood bolume
Other signs and symptoms of hypovolemia
Hypotension Orthostatic
Weight loss
Decreased skin turgor= takes longer
Dizziness
Weakness
Increased HR
Hypotension
What are some interventions for HYPOVOLEMIA
Administer fluids
Monitor lab values
Encourage the patient to drink water
Safety precautions
Monitor I&O
Why would you have a safety precaution for a patient who has HYPOVOLEMIA
Since they are weak and even confused they are more prone to falls
What is the normal capillary refill
Less than 2 sec
Another name for fluid volume excess
Hypervolemia
Another name for fluid volume excess
Hypervolemia
Contributing factors to Hypervolemia
Heart failure
Kidney injury
Cirrhosis of the liver
Intravenous fluids bolus
Prolonged corticosteroids therapy
Relationship between corticosteroids and Hypervolemia
They cause retain of water
Signs and symptoms of Hypervolemia
Edema
Weight gain
Crackles
Shortness of breath
Hypertension
Tachycardia
Bounding peripheral pulse
Orthopena
What is orthopena
Difficulty breathing when laying flat
Why do we have bounding pulses with Hypervolemia
Because of the excess fluid
Tachycardia and Hypervolemia
The heart is going to work hard because you are going to be having difficulty breathing.
Heart works harder to get oxygen
Orthopena and Hypervolemia
The fluid goes upward when lay on back
Intervention for Hypervolemia
Diuretic
Restrict fluid
Monitor I&O
Monitor weight
Monitor respiratory
Place patient in semi Fowler position
What should you always do first when administering fluids
Listen to lung sounds
What charge are cations
Positive
What charge are anions
Negative
What is potassium deficient
What is the value for it
Hypokalemia
Low potassium
Less than 3.5
Contributing factors to Hypokalemia
Vomiting
Diarrhea
Corticosteroids
Gastric suction
Signs and symptoms of Hypokalemia
HINT: EVERYTHING IS SLOW AND LOW
Polyuria
Fatigue
Anorexia
Nausea
Vomiting
Muscle weakness
Decreased bowel motility
Muscle cramps
Parenthesia
What is another name for potassium excess
Hyperkalemia
What is the range for hyperkalemia
Higher than 5.0
What is the main contributing factor to hyperkalemia
Potassium conserving diuretics
What are other hypokalemia contributing factors
Addison disease
Crush injury
Burns
Stored bank blood transfusions
Rapid IV administration of potassium
NSAIDs
Ace inhibitors
Signs and symptoms of hyperkalemia
Muscle weakness
Cardiac changes
Cramps
Abdominal distention
What is the top nursing interventions with potassium disturbances
Always monitor your patient cardiac
12 Lead EKG
What is the main reason potassium chloride is given
For Hypokalemia
What route should you never give potassium chloride
Intramuscular
What route should you give potassium chloride
Oral
IV
If your patient is on potassium supplement what should they not be on?
Why?
No salt substances because they are high in potassium
What potassium level should you give potassium chloride
Less than 3.5
Hypokalemia
What should you make note of when administering potassium chloride PO
The patient should sit up for 30 min after administration
When you administer potassium chloride IV
When the patient is having difficulties swallowing
What are some side effects of potassium chloride
Nausea
Vomiting
Diarrhea
Abdominal cramps
Phlebitis with IV
Contraindications of potassium chloride
Addison disease
Renal insufficiency
Hyperkalemia
Severe dehydration
Acidosis
Potassium soaring diuretic
Drug and potassium chloride
With any disease that causes high potassium levels or potassium retention
Food and potassium chloride
Licorice excessive intake causes hypokalemia and sodium retention
Salt substitute
What is the main adverse reactions with potassium chloride
Hyperkalemia
Oliguria
GI ulceration
Life threatening effect of potassium chloride
Cardiac dysthymia
Respiratory distress
Ventricular fibrillation
Cardiac arrest
If you have a patient who is on potassium supplements and i given oral potassium chloride what should you do?
Monitor with an EKG
When should oral potassium be administered
With after meals
With a large glass of water
What position should the patient sit in when given oral potassium?
For how long?
Upright
30 minutes
What should you do with power, liquid solution of potassium supplements
Dilute!!
Should eternic costed or extended release potassium supplements be crushed or chewed
Noooo
What should you tell the patient not to do with enteric coated and extended release potassium
Do not chew or crush
What else can you advise the patient? Hint: suck on tablet
Why?
Do not suck on tablet
It causes stomach ulcerations
What should you do with a patient on patssium therapy
Potassium levels must be drawn to monitor progress
What should you always monitor with a patient on K+ therapy IV
The EKG
Who is IV therapy indicated for with potassium
Those who cannot tolerate oral therapy with patients with severe hypokalemia
How should you never with potassium chloride
Rapid infusion
Bolus
How should you never give potassium chloride
Bolus
Never given fast
How should you give potassium chloride
Slowwww
When administering IV potassium chloride what should you always mix it with
If fluid
Always dilute it
What do we use when administering IV potassium chloride
Use an infusion pump
Give it slow
What is the maximum rate
40 meq
Infuse slowly at what rate
10 meq
Why do we always monitor the IV SITE
What should you look for
Avoid extravasation or infiltration
Redness
Why shouldn’t you give infusion fast with potassium chloride
Cause hyperkalemia and dead😵
What are the symptoms of toxicity with potassium chloride
Slow irregular heartbeat
Fatigue
Muscle weakness
Parenthesia
Confusion
Dyspnea
Peaked t wave
What should you monitor with symptoms of toxicity with potassium chloride
Monitor EKG and heart
Name the 3 types of isotonic crytalloids
Lactated ringers
0.9% sodium chloride
5% dextrose water
What is the main use of a lactated ringer
Corrects dehydration or hypovolemia
What are the contraindications of a lactated ringers?
Which patient should you not use it in?
Patients with liver dysfunction
Patients with kidney disese
What does lactated ringers correct
Dehydration
Why is hyperkalemia a contraindication for lactated ringers
The lactated ringers will increase the potassium even more
What might lactated ringers cause and why?
It may cause fluid volume excess
Because they require large excess of fluid
What is the main use of sodium chloride 0.9%
Corrects dehydration
Corrects sodium depletion
What does sodium chloride and solid
It increases sodium
What is a contraindication with 0.9% of sodium chloride
It requires large infusion
Lead to fluid volume excess
What is sodium chloride 0.9% used for
Sodium depletion
Corrects dehydration
What is 5% dextrose in water used for
Providing calories
When giving fluids what is one of the first things you should do
Why?
Always listen to the lungs first to check if fluid is in the lungs
Name a hypotonic crystalliod
0.45% sodium chloride
When would you administer a hypotonic crystalloid
Volume replacement in hypernatremia.
Remember that hypernatremia causes low fluid volume
What is normal saline
0.9% sodium chloride
What is half normal saline
0.45% sodium chloride
What are the contraindications and precautions of 0.45% sodium chloride
Patients with or suspected increased intracranial pressure, patients with liver disease, shock, or trauma or burns
Hypertonic crystalloids
3% NACL
5% NACL
5% dextrose in 0.9 NACL
5% dextrose in 0.45 NACL
5% dextrose in lactated ringers
What are the purposes of hypertonic crystalloids
Corrects hyponatremia
Decrease ICP
Dextrose provide calories
What are some contraindications and precautions of hypertonic crystalloids
Fluid volume excess
Hypertonic crystalloids are contraindicated in which patients
Cardiac disease
Renal disease
Dehydration
Diabetic ketaacidosis
When would you recommend a hypotonic crystalloid
For volume replace with hypernatremia
When would you recommend hypertonic crystalloids
Hyponatremia
Decreases icp
Dextrose for calories
Name the collioids
Dextran
Albumin
Hetastartch
What is dextran used for?
How did it work?
Restore intravascular volume
Pull the fluids from the cell into the vascular shape
What is hetastarch used for
Restoring intravascular volume
Who should you not give hetastarch
Someone with bleeding disorder
It causes an increase in clotting time
What is albumin used for
Regulate plasma volume and tissue fluid volume balance
Who should you it give albumin with. Contraindications?
Ace inhibitors
