Pharmacology And Parenteral Therapy Flashcards
0
Q
What are the components of blood transfusions?
A
Whole blood, PRBCs, Plts, Plasma, Albumin, Prothrombin, Factor VIII
1
Q
What are the two types of transfusion?
A
Allogenic (from another) Autologous (self)
2
Q
What is done with whole blood once donated from an individual?
A
It is broken down into components
3
Q
How long can PRBCs be refrigerated?
A
42 days
4
Q
Who typically receives PRBCs?
A
Surgical pts and anemia
5
Q
Over what period of time is PRBCs infused?
A
Over 2-4 hrs
6
Q
Which is the most delicate of the whole blood components?
A
Platelets
7
Q
How long can platelets be stored?
A
5 days
8
Q
Who typically receives platelets?
A
Patients with leukemia
9
Q
How quickly are platelets infused?
A
Within an hour for 4 units
10
Q
What is fresh frozen plasma (FFP) typically used for?
A
Coagulopathy and burns
11
Q
What is albumin used for?
A
Volume expansion
12
Q
What is prothrombin used for?
A
To increase clotting time for pt experiencing decreased clotting time
13
Q
What is factor VIII used for?
A
Hemophilia
14
Q
Which blood type is the universal donor?
A
O
15
Q
Which blood group is the universal recipient?
A
AB
16
Q
What are things to remember about administering blood and blood products?
A
Obtain baseline VS, 18-gauge, start 0.9% NS, run slow first (5 mL/min for 15 min), stay with pt for 15-30 min, infuse in 4 h or less
17
Q
Why should you use a large bore (18-gauge) when administering blood?
A
To avoid lysing of RBCs
18
Q
What is the minimum gauge that can be used to administer blood?
A
20 gauge, in pediatric pt can be smaller if ran slowly
19
Q
What do you do if an adverse event occurs when transfusing blood, regardless of type of adverse event?
A
Stop the transfusion!
20
Q
What are common pharmacological interventions for transfusion reactions?
A
Antihistamine (Benadryl), steroids, ASA, hang NS
21
Q
What blood transfusion reaction is a hypersensitivity reaction demonstrating AgA deficiency that mainly occurs with RBCs?
A
Allergic Reaction
22
Q
An allergic reaction occurs most frequently when administering what blood component?
A
Whole blood
23
Q
What are the clinical manifestations of an allergic reaction to a blood transfusion?
A
Hives, itching, or flushing
24
What should be done if an anaphylactic reaction occurs when administering blood?
Stop transfusion, maintain airway, Benadryl, steroids, epinephrine
25
Which blood transfusion reaction describes incompatibility? Commonly occurring with mismatch or presence of rare component.
Hemolytic reaction
26
When may a hemolytic reaction occur?
Immediately to 24 hrs later
27
What are the manifestations of a hemolytic reaction?
Systemic reactions - low back pain, hypotension, hematuria
28
What should be done for a hemolytic reaction?
Stop transfusion, maintain airway, antihistamine
29
What type of transfusion reaction is an antibody reaction?
Febrile reaction
30
With what blood component(s) does a febrile reaction most commonly occur?
With platelets, factor VIII, even PRBCs and whole blood
31
When may a febrile reaction to a blood transfusion occur?
Within minutes to hours
32
What interventions are necessary when a febrile reaction occurs?
Stop the transfusion and give ASA
33
What reaction occurs when contaminated blood is administered?
A bacterial reaction
34
What are the manifestations of a bacterial reaction to a transfusion?
Fever, chills, hypotension
35
With what type of transfusion is a bacterial reaction common?
With autologous administration
36
What manifestations are noted with fluid volume overload when administering blood?
SOB, rales, crackles
37
What interventions are necessary for fluid volume overload when administering a transfusion?
Slow the administration rate, maintain a patent airway, call practitioner
38
What are considerations for autologous transfusion?
Collected 4-6 wks prior to surgery, safest form, prevent viral infection before donation, used for pts with h/o transfusion reactions or rare blood types
39
What are the contraindications to autologous blood transfusion?
Infection, chronic disease, cerebrovascular or cardiovascular disease
40
What are the steps taken when a transfusion reaction occurs?
Stop blood, restart NS, airway management, Benadryl, ASA, return blood container to blood bank, collect blood and urine sample, monitor voiding
41
What is tonicity?
The concentration of the fluid you are dealing with
42
What are isotonic fluids?
Fluids that have the same tonicity as the body fluids you are putting it in. This is the same tonicity as a STABLE patient.
43
What are hypertonic solutions?
Solutions that has a tonicity greater than body fluids. Pull fluids into the vessels.
44
What are hypotonic solutions?
Solutions that have a lesser tonicity than that of the body fluid it is being put into. Pull fluid into the tissues.
45
What is the primary purpose of IV therapy?
To maintain or restore fluid and electrolyte balance
46
What is the secondary purpose of IV therapy?
To give medications, nutrition, and blood components
47
What are the isotonic fluids?
0.9% NaCl and D5W (becomes hypotonic when dextrose absorbed)
48
What is an example of a hypotonic fluid?
0.45% NaCl
49
What is an example of a hypertonic fluid?
D10W
50
What are important considerations when determining the location to place an IV catheter?
Vascular condition, type of fluid or medication (caustic requires larger vein), duration (longer duration - larger vein), clients age, size, status, skill of nurse
51
When do you change the tubing for an IV?
Every 72 hours
52
When do you change a fluid bag in IV therapy?
Every 24 hrs
53
What are the manifestations of infiltration?
Cool skin, swelling, pain, decrease in flow rate
54
What do you do if an IV infiltrates?
Discontinue IV, warm compresses, elevate arm, start at new site proximal to infiltrated site
55
What is infiltration?
When the IV fluid is leaking out of the vein
56
What is a method to assess infiltration?
Place a tourniquet proximal to the IV site and look at drip chamber. No drip indicates no infiltration.
57
What is extravasation?
Occurs with infiltration. Inadvertent administration of a vesicant. A vesicant is a medication or IV solution that causes blisters and tissue sloughing.
58
What are common medications that may result in extravasation?
Gentamicin, penicillin, vancomycin, Dilantin, antineoplastics, calcium, potassium, epinephrine, nitroprusside
59
What are manifestations of an extravasation?
Pain, burning, edema, blanching at the site
60
How do you intervene when extravasation occurs?
Prevent! Know which meds cause this, place IV in larger veins, assess patency of site before med admin, stop IV, aspirate
61
What are considerations for heat/cold therapy when extravasation occurs?
Use heat for Vinca Alkaloids, use cold for all others!
62
What is phlebitis and thrombophlebitis?
Inflammation of the blood vessels. The vessels are irritated by whatever you are doing to them.
63
What are assessment findings for phlebitis and thrombophlebitis?
Redness, warmth, tenderness, swelling, leukocytosis
64
What manifestations may occur with a hematoma?
Ecchymosis, swelling, leakage of blood
65
What interventions should be taken when a hematoma occurs during IV therapy?
DC IV, apply pressure, ice bag 24 h, restart IV in opposite ext
66
What assessment findings are noted with clotting of the IV site?
Decreased flow rate, back flow of blood into tubing
67
What interventions should be performed if clotting occurs with an IV?
DC, do not irrigate, do not milk, do not increase rate or hang solution higher, do not aspirate cannula, inject Urokinase
68
What are the complications of a PICC line?
Pneumothorax, dysrhythmias, thrombophlebitis, nerve or tendon damage, respiratory distress, embolism
69
Why is the dominant arm used for a PICC?
To ensure good circulation and decrease dependent edema
70
How long can a PICC remain in place?
Up to 6 mo
71
What assessment findings are noted in a PICC complication?
Respiratory distress, altered neurovascular status of PICC arm
72
What interventions are necessary to maintain a PICC?
Change dressing 2-3 times a week, when wet of nonocclusive; flush 2 mL NS followed by 5 mL heparin (500 u/mL) into each lumen; no BP on PICC side
73
What is a midline catheter (MLC)?
A small, relatively firm catheter. It will enlarge by about 2 gauges and will elongate by 2.5 cm.
74
How long can a MLC be left in place?
1.8 wks
75
What are the complications of a MLC?
Thrombosis, phlebitis, air embolism, infection, vascular perforation
76
What are interventions for maintaining an MLC?
Change dressing 2-3/wk, when wet or nonocclusive; flush 5-10 cc NS followed by 5 mL heparin (100 u/mL) to each lumen q 12 h or after each infusion; anchor securely
77
What is a percutaneous central catheter?
Tripple lumen placed into subclavian vein. One for meds, one for blood draws, one for TPN.
78
Discuss the insertion of a percutaneous central cath.
Place supine in low-head position, turn head away from proc, perform Valsalva, Abx ointment and transparent sterile dressing, verify position c XR, secure each lumen with luer lock
79
What are interventions for the maintenance of a percutaneous central catheter?
Change site q 4 wk; change tubing q 24 h; flush with diluted heparin BID, after infusion, specimen withdrawal, and when DC'd; dressing change 2-3/wk
80
What should be done if percutaneous central cath will not flush?
Call PHCP immediately! Should flush easily!
81
When changing dressing for a percutaneous central cath, what should PPE should be used?
Both HCP and pt should wear a mask to prevent contamination of site
82
What are the two main organs associated with almost all medications?
Liver (metabolism) and kidney (excretion)
83
What do adrenergics do?
Stimulate beta-2 receptors in lungs. Increases peripheral resistance and enhances bronchodilation.
84
What are adrenergics used for?
Cardiac arrest, COPD
85
What are examples of adrenergics?
Levophed (NE), Intropin (DA), Adrenalin (Epi), Dobutrex (dobutamine)
86
What SE may be noted with adrenergics?
Dysrhythmias, tremors, anticholinergic effects (dry mouth, urinary retention)
87
What are nursing considerations for adrengergics?
Monitor BP, peripheral pulses, and UO; safety concerns (ambulating, operating machinery)
88
What is the MOA and uses of anti-anxiety agents?
Affect Nts and are used for anxiety disorders, manic episodes, panic attacks
89
What are examples of anti-anxiety agents?
Librium (chlordiazepoxide), Xanax (alprazolam), Ativan (lorazepam), Vistaril (hydroxyzine), Equanil
90
What are sub-classifications of anti-anxiety agents?
Benzos (-pams), Kava, melatonin
91
What are the side effects of anti-anxiety agents?
Because they are CNS depressing agents, they cause sedation, confusion, hepatic dysfunction
92
What are nursing considerations for anti-anxiety agents?
Potential for addiction/overdose, avoid ETOH (b/c CNS depression), respiratory depression, monitor liver Fx (AST, ALT, LDH), Taper, change in smoking and caffeine habits alters effect of these
93
What is the MoA and uses of antacids?
Neutralize gastric acids, do not coat stomach they are systemic - PUD, indigestion, reflux esophagitis
94
What are examples of antacids?
Amphojel (aluminum hydroxide), Milk of Magnesia (magnesium hydroxide), Maalox (both)
95
What are SE of antacids?
Constipation, diarrhea, acid rebound (action extreme)
96
What are nursing considerations for the pt on antacids?
Interferes with absorption of Abx, iron preps, INH, OCPs; monitor BS; monitor for bowel addiction (bowel becomes addicted to med and dysFx after coming off); take 1-2 h p other meds; FE balance (Mg [CNS depression])
97
What is the MOA and uses of antidysrhythmics?
Interferes with electrical excitability of the heart - used for Afib and flutter, tachycardia, PVCs
98
What are examples of antidysrhythmics?
Atropine sulfate, Lidocaine, Pronestyl (procainamide), Quinidine, Isuprel (isoproterenol)
99
What are SE of antidysrhythmics?
Bradycardia, lightheadedness, hypotension, urinary retention
100
What are nursing considerations for the pt on antidysrhythmics?
Monitor VS (HR, BP) and cardiac rhythm; Orthostatic hypotension; monitor airway with LOLs!
101
What are general SE for all antibiotics?
Allergies (usually not first exposure that causes allergy), superinfection (kills abn as well as normal), organ toxicity (liver and kidney)
102
What should be taught to pts regardless of the Abx they are on?
Take until gone, do C&S first, encourage fluids, check expiration date (can become toxic)
103
What is the MoA and uses of aminoglycosides?
Inhibits protein synthesis in gram-negative bacteria - Pseudomonas, E. coli
104
What are examples of aminoglycosides?
Gentamycin, Neomycin, Streptomycin, Tobramycin
105
What are SE of aminoglycosides?
Ontotoxicity, anorexia, N/V, diarrhea
106
What are considerations for the pt on aminoglycosides?
Check 8th CN (hearing - ringing), check renal Fx (1200 UO/d, Pcr, BUN), take for 7-10 days, encourage fluids (3000 mL/d), peaks (1 h p hanging) and troughs (before hanging) are analyzed to determine therapeutic range (coordinate with lab)
107
A pt on lithium carbonate (Lithobid) needs to maintain adequate intake of what ion?
Sodium - alkali metal salt acts like Na ions in the body; excretion of lithium depends on normal Na+ levels; sodium reduction leads to lithium retention, leading to toxicity
108
What should be considered before administering promethazine hydrochloride (Phenergan) IV push?
Patency of veins b/c extravasation will cause necrosis
