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NCLEX-RN > Pharmacology And Parenteral Therapy > Flashcards

Pharmacology And Parenteral Therapy Flashcards

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0
Q

What are the components of blood transfusions?

A

Whole blood, PRBCs, Plts, Plasma, Albumin, Prothrombin, Factor VIII

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1
Q

What are the two types of transfusion?

A

Allogenic (from another) Autologous (self)

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2
Q

What is done with whole blood once donated from an individual?

A

It is broken down into components

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3
Q

How long can PRBCs be refrigerated?

A

42 days

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4
Q

Who typically receives PRBCs?

A

Surgical pts and anemia

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5
Q

Over what period of time is PRBCs infused?

A

Over 2-4 hrs

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6
Q

Which is the most delicate of the whole blood components?

A

Platelets

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7
Q

How long can platelets be stored?

A

5 days

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8
Q

Who typically receives platelets?

A

Patients with leukemia

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9
Q

How quickly are platelets infused?

A

Within an hour for 4 units

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10
Q

What is fresh frozen plasma (FFP) typically used for?

A

Coagulopathy and burns

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11
Q

What is albumin used for?

A

Volume expansion

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12
Q

What is prothrombin used for?

A

To increase clotting time for pt experiencing decreased clotting time

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13
Q

What is factor VIII used for?

A

Hemophilia

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14
Q

Which blood type is the universal donor?

A

O

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15
Q

Which blood group is the universal recipient?

A

AB

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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

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17
Q

Why should you use a large bore (18-gauge) when administering blood?

A

To avoid lysing of RBCs

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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

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19
Q

What do you do if an adverse event occurs when transfusing blood, regardless of type of adverse event?

A

Stop the transfusion!

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20
Q

What are common pharmacological interventions for transfusion reactions?

A

Antihistamine (Benadryl), steroids, ASA, hang NS

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21
Q

What blood transfusion reaction is a hypersensitivity reaction demonstrating AgA deficiency that mainly occurs with RBCs?

A

Allergic Reaction

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22
Q

An allergic reaction occurs most frequently when administering what blood component?

A

Whole blood

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23
Q

What are the clinical manifestations of an allergic reaction to a blood transfusion?

A

Hives, itching, or flushing

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24
Q

What should be done if an anaphylactic reaction occurs when administering blood?

A

Stop transfusion, maintain airway, Benadryl, steroids, epinephrine

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25
Q

Which blood transfusion reaction describes incompatibility? Commonly occurring with mismatch or presence of rare component.

A

Hemolytic reaction

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26
Q

When may a hemolytic reaction occur?

A

Immediately to 24 hrs later

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27
Q

What are the manifestations of a hemolytic reaction?

A

Systemic reactions - low back pain, hypotension, hematuria

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28
Q

What should be done for a hemolytic reaction?

A

Stop transfusion, maintain airway, antihistamine

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29
Q

What type of transfusion reaction is an antibody reaction?

A

Febrile reaction

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30
Q

With what blood component(s) does a febrile reaction most commonly occur?

A

With platelets, factor VIII, even PRBCs and whole blood

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31
Q

When may a febrile reaction to a blood transfusion occur?

A

Within minutes to hours

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32
Q

What interventions are necessary when a febrile reaction occurs?

A

Stop the transfusion and give ASA

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33
Q

What reaction occurs when contaminated blood is administered?

A

A bacterial reaction

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34
Q

What are the manifestations of a bacterial reaction to a transfusion?

A

Fever, chills, hypotension

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35
Q

With what type of transfusion is a bacterial reaction common?

A

With autologous administration

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36
Q

What manifestations are noted with fluid volume overload when administering blood?

A

SOB, rales, crackles

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37
Q

What interventions are necessary for fluid volume overload when administering a transfusion?

A

Slow the administration rate, maintain a patent airway, call practitioner

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38
Q

What are considerations for autologous transfusion?

A

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

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39
Q

What are the contraindications to autologous blood transfusion?

A

Infection, chronic disease, cerebrovascular or cardiovascular disease

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40
Q

What are the steps taken when a transfusion reaction occurs?

A

Stop blood, restart NS, airway management, Benadryl, ASA, return blood container to blood bank, collect blood and urine sample, monitor voiding

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41
Q

What is tonicity?

A

The concentration of the fluid you are dealing with

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42
Q

What are isotonic fluids?

A

Fluids that have the same tonicity as the body fluids you are putting it in. This is the same tonicity as a STABLE patient.

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43
Q

What are hypertonic solutions?

A

Solutions that has a tonicity greater than body fluids. Pull fluids into the vessels.

44
Q

What are hypotonic solutions?

A

Solutions that have a lesser tonicity than that of the body fluid it is being put into. Pull fluid into the tissues.

45
Q

What is the primary purpose of IV therapy?

A

To maintain or restore fluid and electrolyte balance

46
Q

What is the secondary purpose of IV therapy?

A

To give medications, nutrition, and blood components

47
Q

What are the isotonic fluids?

A

0.9% NaCl and D5W (becomes hypotonic when dextrose absorbed)

48
Q

What is an example of a hypotonic fluid?

A

0.45% NaCl

49
Q

What is an example of a hypertonic fluid?

A

D10W

50
Q

What are important considerations when determining the location to place an IV catheter?

A

Vascular condition, type of fluid or medication (caustic requires larger vein), duration (longer duration - larger vein), clients age, size, status, skill of nurse

51
Q

When do you change the tubing for an IV?

A

Every 72 hours

52
Q

When do you change a fluid bag in IV therapy?

A

Every 24 hrs

53
Q

What are the manifestations of infiltration?

A

Cool skin, swelling, pain, decrease in flow rate

54
Q

What do you do if an IV infiltrates?

A

Discontinue IV, warm compresses, elevate arm, start at new site proximal to infiltrated site

55
Q

What is infiltration?

A

When the IV fluid is leaking out of the vein

56
Q

What is a method to assess infiltration?

A

Place a tourniquet proximal to the IV site and look at drip chamber. No drip indicates no infiltration.

57
Q

What is extravasation?

A

Occurs with infiltration. Inadvertent administration of a vesicant. A vesicant is a medication or IV solution that causes blisters and tissue sloughing.

58
Q

What are common medications that may result in extravasation?

A

Gentamicin, penicillin, vancomycin, Dilantin, antineoplastics, calcium, potassium, epinephrine, nitroprusside

59
Q

What are manifestations of an extravasation?

A

Pain, burning, edema, blanching at the site

60
Q

How do you intervene when extravasation occurs?

A

Prevent! Know which meds cause this, place IV in larger veins, assess patency of site before med admin, stop IV, aspirate

61
Q

What are considerations for heat/cold therapy when extravasation occurs?

A

Use heat for Vinca Alkaloids, use cold for all others!

62
Q

What is phlebitis and thrombophlebitis?

A

Inflammation of the blood vessels. The vessels are irritated by whatever you are doing to them.

63
Q

What are assessment findings for phlebitis and thrombophlebitis?

A

Redness, warmth, tenderness, swelling, leukocytosis

64
Q

What manifestations may occur with a hematoma?

A

Ecchymosis, swelling, leakage of blood

65
Q

What interventions should be taken when a hematoma occurs during IV therapy?

A

DC IV, apply pressure, ice bag 24 h, restart IV in opposite ext

66
Q

What assessment findings are noted with clotting of the IV site?

A

Decreased flow rate, back flow of blood into tubing

67
Q

What interventions should be performed if clotting occurs with an IV?

A

DC, do not irrigate, do not milk, do not increase rate or hang solution higher, do not aspirate cannula, inject Urokinase

68
Q

What are the complications of a PICC line?

A

Pneumothorax, dysrhythmias, thrombophlebitis, nerve or tendon damage, respiratory distress, embolism

69
Q

Why is the dominant arm used for a PICC?

A

To ensure good circulation and decrease dependent edema

70
Q

How long can a PICC remain in place?

A

Up to 6 mo

71
Q

What assessment findings are noted in a PICC complication?

A

Respiratory distress, altered neurovascular status of PICC arm

72
Q

What interventions are necessary to maintain a PICC?

A

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
Q

What is a midline catheter (MLC)?

A

A small, relatively firm catheter. It will enlarge by about 2 gauges and will elongate by 2.5 cm.

74
Q

How long can a MLC be left in place?

A

1.8 wks

75
Q

What are the complications of a MLC?

A

Thrombosis, phlebitis, air embolism, infection, vascular perforation

76
Q

What are interventions for maintaining an MLC?

A

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
Q

What is a percutaneous central catheter?

A

Tripple lumen placed into subclavian vein. One for meds, one for blood draws, one for TPN.

78
Q

Discuss the insertion of a percutaneous central cath.

A

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
Q

What are interventions for the maintenance of a percutaneous central catheter?

A

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
Q

What should be done if percutaneous central cath will not flush?

A

Call PHCP immediately! Should flush easily!

81
Q

When changing dressing for a percutaneous central cath, what should PPE should be used?

A

Both HCP and pt should wear a mask to prevent contamination of site

82
Q

What are the two main organs associated with almost all medications?

A

Liver (metabolism) and kidney (excretion)

83
Q

What do adrenergics do?

A

Stimulate beta-2 receptors in lungs. Increases peripheral resistance and enhances bronchodilation.

84
Q

What are adrenergics used for?

A

Cardiac arrest, COPD

85
Q

What are examples of adrenergics?

A

Levophed (NE), Intropin (DA), Adrenalin (Epi), Dobutrex (dobutamine)

86
Q

What SE may be noted with adrenergics?

A

Dysrhythmias, tremors, anticholinergic effects (dry mouth, urinary retention)

87
Q

What are nursing considerations for adrengergics?

A

Monitor BP, peripheral pulses, and UO; safety concerns (ambulating, operating machinery)

88
Q

What is the MOA and uses of anti-anxiety agents?

A

Affect Nts and are used for anxiety disorders, manic episodes, panic attacks

89
Q

What are examples of anti-anxiety agents?

A

Librium (chlordiazepoxide), Xanax (alprazolam), Ativan (lorazepam), Vistaril (hydroxyzine), Equanil

90
Q

What are sub-classifications of anti-anxiety agents?

A

Benzos (-pams), Kava, melatonin

91
Q

What are the side effects of anti-anxiety agents?

A

Because they are CNS depressing agents, they cause sedation, confusion, hepatic dysfunction

92
Q

What are nursing considerations for anti-anxiety agents?

A

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
Q

What is the MoA and uses of antacids?

A

Neutralize gastric acids, do not coat stomach they are systemic - PUD, indigestion, reflux esophagitis

94
Q

What are examples of antacids?

A

Amphojel (aluminum hydroxide), Milk of Magnesia (magnesium hydroxide), Maalox (both)

95
Q

What are SE of antacids?

A

Constipation, diarrhea, acid rebound (action extreme)

96
Q

What are nursing considerations for the pt on antacids?

A

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
Q

What is the MOA and uses of antidysrhythmics?

A

Interferes with electrical excitability of the heart - used for Afib and flutter, tachycardia, PVCs

98
Q

What are examples of antidysrhythmics?

A

Atropine sulfate, Lidocaine, Pronestyl (procainamide), Quinidine, Isuprel (isoproterenol)

99
Q

What are SE of antidysrhythmics?

A

Bradycardia, lightheadedness, hypotension, urinary retention

100
Q

What are nursing considerations for the pt on antidysrhythmics?

A

Monitor VS (HR, BP) and cardiac rhythm; Orthostatic hypotension; monitor airway with LOLs!

101
Q

What are general SE for all antibiotics?

A

Allergies (usually not first exposure that causes allergy), superinfection (kills abn as well as normal), organ toxicity (liver and kidney)

102
Q

What should be taught to pts regardless of the Abx they are on?

A

Take until gone, do C&S first, encourage fluids, check expiration date (can become toxic)

103
Q

What is the MoA and uses of aminoglycosides?

A

Inhibits protein synthesis in gram-negative bacteria - Pseudomonas, E. coli

104
Q

What are examples of aminoglycosides?

A

Gentamycin, Neomycin, Streptomycin, Tobramycin

105
Q

What are SE of aminoglycosides?

A

Ontotoxicity, anorexia, N/V, diarrhea

106
Q

What are considerations for the pt on aminoglycosides?

A

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
Q

A pt on lithium carbonate (Lithobid) needs to maintain adequate intake of what ion?

A

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
Q

What should be considered before administering promethazine hydrochloride (Phenergan) IV push?

A

Patency of veins b/c extravasation will cause necrosis

NCLEX-RN (3 decks)

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