Patient Care 2: Midterm Flashcards
As a radiographer, basic knowledge of the following is important (referring to pharmaceuticals)
- safe dosage and routes of administration
- limitations of the medications
- side effects
- potential adverse reactions and toxic reactions
- indications and contraindications for their use
What is the generic name of a drug?
The name given to a drug when it becomes commercially available (derived from more complex chemical name)
-starts with small letter
What is the trade/brand name of a drug?
- the name given to a drug manufactured by a specific company
- starts with a CAPITAL
What information do drug information sheets include?
- trade name
- generic name
- chemical composition
- chemical strength
- usual dosage
- indications and contraindications
- reported side effects
The regulation of medications is governed in Canada under the ____?
Food and drug act
What governs the utilization and control of all narcotic drugs?
The Canadian Narcotic Control Act
What symbol represents narcotics? Controlled drugs?
- N
- C with a circle around it
What is the difference between a narcotic and a controlled drug?
Narcotic: a drug with addictive qualities
Controlled drug: a drug that is potentially addictive and has the potential for abuse
Where is the usage of narcotics documented and what information must be included when giving a narcotic to a patient?
- the “Narcotic Control” book
- full name of patient
- name of ordering physician
- date
- time
- exact dosage administered
- wastage dosage
How do the 5 different controlled substance schedules work?
The lower the number, the higher addiction potential
People process drugs based on what?
- age, sex, and nutritional status
- physical condition and body weight
- immune status, existing pathological conditions
- ethnicity
- time of day, state of mind
- environmental conditions
Describe the 4 main aspects of pharmacokinetics
- Absorption: process by which a drug enters systemic circulation in order to provide and desired effect
- Distribution: how the drug travels through the bloodstream outwards to the target tissue and site of action
- Metabolism: chemically changes the drug into a metabolite that can be excreted
- Excretion: leaves body
To be absorbed, a drug must be _________?
Made up of the same components as those at its intended absorption site
Absorption can depend on?
- Surface area
- Blood flow
- Concentration (high to low)
- Compatibility: some drugs react with others to form un-absorbable precipitates
What is the first pass effect?
The partial metabolism of a drug before it reaches systemic circulation.
Describe the 3 factors that affect distribution
- Regional blood flow: amount of blood supplied to the organ/area
- Cardiac Output: amount of blood pumped by the heart per minute
- Drug Reservoirs: drug accumulations that are bound to specific sites, drugs must cross barriers to be effective
What is another word for metabolism?
Biotransformation
What organ is primarily responsible for metabolism?
The liver
2 types of chemical reactions of drugs
- Oxidation, hydrolysis, or reduction: gain an electron
2. Conjugation: transforms a drug into a lipid
6 factors affecting metabolism
- Age
- Overall health/nutrition
- Time of day
- Emotional status and mental health
- Presence of other drugs in the body
- Genetic variations and disease processes/states
Where does excretion mainly take place? What does the excretion route depend on?
The kidneys which can only excrete water-soluble substances. The excretion route depends on the chemical makeup of the drug
What is the blood brain barrier and what does it have to do with pharmaceuticals?
It is a selective mechanism opposing the passage of certain things into the brain. Some medications won’t be able to pass and therefore will not be effective on the brain.
10 effects of medications
- Therapeutic effect: prescription/OVC meds used to treat injury or illness
- Side effects: unwanted, but expected effects
- Idiosyncratic effect: abnormal reaction
- Adverse effect: unwanted, but unexpected effects
- Toxic reaction: dangerous reaction caused by allergy
- Nephrotoxic reaction: damage to kidney tissues due to drug toxicity
- Dependency reaction: OVC meds, psychic craving
- Withdrawal reaction: symptoms involved with an addict who is deprived of addicting agent
- Teratogenic effect: causing congenital anomalies, birth defects
- Carcinogenic effect: causing cancer (potentially)
Intents of drug therapy
- Control pain
- Cure disease
- Alleviate symptoms of a disease
- Diagnose a disease
What is a drug receptor?
The target area for which a drug is intended
Charting medications: what must be charted?
- Contrast agent’s name and strength
- Volume administered
- Route of administration
- Date and time of administration
- Signature or approved identification
3 types of medication orders
- Stat: immediately
- PRN: as needed, patient controlled
- Standing: specific meds given under certain conditions (ex. After a biopsy)
Standing orders consider?
- Effects of the drug
- Dosage of the drug
- When the drug should be given (post-procedure)
- Condition of the patient
6 Rights of Drug Administration
- Right dose
- Right medication
- Right patient
- Right time
- Right route
- Right documentation
Routes of administration
- Topical: Surface of skin, for local effect or transdermal
- Enteral: directly into GI tract via oral or rectal, rectal dosage in unreliable, oral most common
- Sublingual: variation of topical, not considered oral because not absorbed in stomach, but through oral mucosa
- Parenteral: injected directly to bypass GI tract
Types of parenteral injections
- Intravenous: into vein, most immediate result, invasive procedure, requires consent
- Intradermal: between layers of skin
- Subcutaneous: under skin below epidermis, painful
- Intramuscular: into muscle tissue, larger amounts can be given, pain last for days, slower release
- Intra-arterial: into an artery, achieve high local concentration of a drug for pain relief
- Intrathecal: into spinal canal, past BBB
- Intra-articular: into joint
Difference between medical and surgical asepsis?
Medical asepsis: eliminates/reduces number of microorganisms
Surgical asepsis: completely destroys microorganisms and their spores
Microbes are most commonly spread by ________?
Human hands
When to wash your hands
- before and after handling supplies
- before and after patient contact
- before and after wearing gloves
- before and after completing an invasive procedure
- before and after eating
- after using the restroom
- start and end of shift
Benefits of alcohol-based hand rubs
- more accessible
- quicker
- more effective at reducing nosocomial infections
- less irritating to skin
When to use alcohol-based hand rubs?
- before and after contact with patient
- before donning gloves
- after removing gloves
- after contact with inanimate objects
3 important reasons gloves are worn?
- provide protective barrier from contamination of hands
- reduce risk of transmitting microorganisms from worker to patient
- reduce risk of transmitting microorganisms from patient to patient
What is a nosocomial infection? What is the most common site of a nosocomial infection?
A hospital acquired infection.
Most common site: urinary tract due to catheters
What are standard precautions? What do they apply to?
- designed to reduce the risk of transmission of unrecognized sources of blood-borne and other pathogens in healthcare institutions
- blood, bodily fluids, secretion/excretions (except sweat), non-intact skin, mucous membranes
What are transmission-based precautions? Types?
Used when isolating patients in addition to standard precautions.
- Airborne
- Droplet
- Contact
For infections to be transmitted there must be?
- an infectious agent
- and environment in which pathogenic microbes can live and multiply (reservoir)
- a port of exit from the reservoir
- a means of transmission
- a port of entry into a new host
Standard precaution practices
- hand washing
- gloves
- PPE
- proper handling of soiled patient care equipment
- proper environmental equipment
- minimal handling of soiled linen
- proper disposal of sharps
- used of private rooms/isolation
When is PPE used? What is its purpose
- when there is contact with body fluids, blood, secretions, and excretions
- to provide a barrier between the patient and the healthcare provider to prevent exposure to the skin/mucous membranes
What are airborne precautions? Examples?
- pathogenic organisms that remain suspended in the air for long periods on aerosol droplets or dust (5microns or less)
- TB
- Measles (rubeola)
- Chickenpox (varicella)
- SARS
Actions taken for airborne precautions?
- patient places in a negative pressure isolation room with the door closed
- patient wear mask if leaving room
- healthcare worker wear N95 mask when entering room
What are droplet precautions? Examples?
- droplets contaminated with pathogenic microorganisms are placed in the air (sneezing, coughing, talking etc.) (5microns or greater)
- Influenza
- Rubella (german measles)
- Pneumonia
- Meningococcal meningitis
- Mumps
- Diphtheria
- Mononucleosis
Actions taken for droplet precautions?
- patients placed in private rooms or with others with same condition
- doors can remain open (droplets drop to floor within 3ft)
- healthcare workers wear surgical mask
- special ventilation not needed
- patient wear mask with nose and mouth covered when leaving room
What are contact precautions? Examples?
- transmission of pathogens by skin-to-skin contact or indirect contact with contaminated objects
- MRSA and VRE
- E. Coli
- Various skin infections
- Hepatitis A
- Varicella
Actions taken for contact precautions?
- patients placed in private room or with another patient with same disease
- when leaving room patient wears appropriate barriers (mask, gloves)
- healthcare staff should be notified or inquire upon rec received
- All equipment should be decontaminated with antiseptic after procedure
- healthcare workers don gloves
- remove gloves and wash hands before exiting room
- gown should be worn if contact is anticipated
What should healthcare workers wear for contact precautions?
- gloves
- gown
Types of isolation
Strict or infectious: used to protect healthcare workers from the patient
Protection or reverse: used to protect the patient from healthcare workers
What is a fomite?
An object that has been in contact with pathogenic organisms
What is strict isolation?
Encompasses airborne, droplet, and contact
- special room
- at entrance there is a sink for hand washing, gowns, mask, caps, and gloves
- also called “expanded” precautions
Strict isolations procedures
- IR covered with protective cover
- patient feel rejected and untouchable
- alleviate patient concerns
- used 2 person team (dirty and clean tech)
What is reverse/protective isolation? Protocols?
Used when a patient’s immunity is compromised
- hand hygiene before touching the patient, bed, or any items that come in contact with the patient
- masks, caps, sterile gowns and gloves may be worn
- clean tech dirty tech roles switch (clean tech touches patient)
Cleaning and proper waste disposal rules
- Wear fresh uniform each day
- Pillow coverings should be changed after each use
- Flush away contents of bedpans and urinals right away
- Rinse bedpans and urinals and sent them for resterilization
- Use equipment/supplies for 1 patient only
- Use paper cups in the DI department and dispose of after 1 use
- If an item touches the floor discard it or get it resterilized
- Avoid raising dust when cleaning, used damp cloth
- Clean imaging equipment with disposable disinfectant wipes
- Start with least soiled area to most soiled area
- Place wet items in waterproof bags and close tightly
- Do not reuse rags or mops before they have been disinfected
- Poor liquids to be discarded into drains or toilets. Don’t splash
- If in doubt of sterility/cleanliness, don’t use item
- Place items contaminated with virulent microorganisms in as biohazard bag
- Treat needles and syringes as if they are contaminated
- Place specimens for the lab in solid containers
- Medical records must be kept away form patient care areas
Diseases that are airborne
- SARS
- Smallpox
- TB
- Varicella (chicken pox)
- Rubeola (red measles or 10-day measles)
Diseases that are droplet
- Influenza
- Rubella (german measles)
- Mumps
- Pertussis (whooping cough)
- Most pneumonias
- Diphtheria
- Pharyngitis
- Scarlet Fever
- Meningococcal meningitis
Diseases that are contact precautions?
- Hepatitis
- Herpes simplex and herpes zoster
- Impetigo
- Scabies
- MRSA
- VRE
- Ebola
- Varicella (chicken pox)
- Norwalk
- Lice
Diseases that are contact-drug resistant wound infections
- C. Difficile
- E. Coli
- Rotavirus
- Shingella
Diseases that are airborne AND contact?
- Varicella (chickenpox)
- SARS
- Herpes zoster
Diseases that are droplet AND contact?
- Diphtheria
Who provides the recommendations to the hospital’s infection control department when new policies are developed? How often are reports published?
The center for disease control and prevention
-weekly
Outline/breakdown what emerging diseases include
- new diseases appearing in the population
- existing ones that are rapidly increasing in incidence and geographic range
- resurgent or recurrent old diseases caused by an old or mutated pathogen
List the 8 factors that precipitate to disease emergence
- Increased human exposure to vectors in nature
- Population growth/migration to crowded cities
- Rapid international travel/transport of goods
- Contact with new strains of dangerous pathogens
- Pathogen mutation due to use of antibiotics
- Breakdown in public health measures
- Climate change
- Bioterrorism
2 causes for the cholera outbreaks in South America and Africa
- poor sanitation
- insufficient chlorine in water
Where did the immigrant that reintroduced diphtheria into the US come from?
Soviet union russian immigrants
What disease emergence was responsible for the 1993 Hantavirus pulmonary syndrome?
Climate change
- 6yr drought followed by a mild, wet winter and spring
- rise in population of deer mice, inhaling dust containing particles of droppings
Signs/symptoms of Dengue fever?
- high fever
- rash
- headache
- muscle/joint aches
- malaise
What is the vector for Lyme Disease?
Deer ticks
Which disease emergence is responsible for the spread of “once localized” infection such as HIV?
Human migration from isolated villages to crowded cities
In 2001, terrorists caused an outbreak of which disease in the US?
Anthrax
What was the source of the SARS outbreak in North America in 2203?
Travellers from Asia
List the reason the influenza virus is so successful
- mutates rapidly and readily resulting in new strains
- spreads rapidly
Which flu in 2009 was a vaccine developed for?
Swine flu (H1N1)
Unpasteurized apple juice and contaminated spinach is linked to causing which E.Coli?
E.Coli 0157:H7
In june 2011, a deadly strain of E.Coli caused deaths in Germany. Which countries were linked to this strain as well?
- Egypt
- United Kingdom
The E.Coli 104:H4 has a trait that produces a toxin that causes kidney failure. What is the name of that toxin?
Shiga toxin
Where did the 2014 multi-country outbreak of Ebola occur?
West Africa
List the 3 ways Ebola can spread
- Blood and bodily fluids from an infected person
- Objects contaminated with the virus
- Infected fruit bats and primates
How many days after exposure does the Ebola flu like signs and symptoms appear in an infected person? Is there a vaccine for Ebola?
2-21 days
NO
2 methods that help prevent the Ebola virus?
- Proper use of PPE
2. Disinfection protocols
List the typical HAIs source of infections?
- contaminated hands of healthcare workers
- contaminated instruments
- urinary catheters, ventilators, central lines, surgical sites which allow microbes to gain easy entrance into the body
Which HAI can cause respiratory infections?
MRSA
What is the cause of CA-MRSA?
- recent antibiotic use
- sharing contaminated personal items
- living in crowded settings
- poor hygiene
What are the causes supporting the spread of multi-resistant infections?
- overuse of anti-microbial agents
- poor infection control
Why is C.Difficile so difficult to control?
It is a spore forming bacterium that is not eliminated by routine asepsis methods
What % of patients treated for C.Difficile relapse?
20%
AIDS is what stage of the HIV infection?
3
After how many days can an HIV infected individual transmit the virus to others?
A few days after infection
How is HIV transmitted?
- sexual contact
- contaminated blood or needles
- fluids containing blood
- placental communication from mother to fetus
- mother’s milk
What factors are contributing to a continues decline in AIDS diagnoses and deaths?
- better access to healthcare
- simpler medication regimes
- medication therapy
- early diagnosis
How many types of hepatitis are there? What are they?
5: A, B, C, D, E
How is hep B spread?
- blood or blood products
- bodily fluids
- maternal-fetal contact
What % of healthcare workers are subject to sporadic percutaneous exposure to hepatitis following a needle stick?
1-2%
How can hep B be transmitted?
- needlestick
- nonintact skin contact with infected blood on environmental surfaces
Which types of hepatitis have the potential to develop into chronic infections and cirrhosis?
B and C (mostly C)
Which types of hepatitis have vaccines?
A and B
What is the immediate management of an accidental needle stick by a contaminated object?
Let it bleed under cold water and wash with soap
What allows TB droplet nuclei to live on surface for years?
Waxy coating
What causes the reactivation of TB and what factors contribute to this reactivation?
Weakened immune response
- old age
- illness
- malnutrition
- immunosuppressant therapy
A negative baseline TST test indicates what?
That the person has never been exposed to TB
How should a diagnosed patient with TB be managed?
- patient isolated in negative pressure room
- personnel and visitors wear special masks and follow all precautions/procedures
According to the OHSA, out of 1000 workers, how many could be exposed to TB while on the job?
386/1000
List the diseases that the United States Public Health Service still has the legal authority to detain and quarantine
- cholera
- diphtheria
- viral hemorrhagic fever (Ebola)
- infectious TB
- plague
- smallpox
- yellow fever
- SARS
