Skills final - meds Flashcards
metapropolol
beta blocker
metoprolol MOA
blocks stimulation of beta 1 (increases heart rate) and adrenergenic (proteins) receptors. Adrene binds to epinephrine and releases it from sympathetic nerve endings. does not usually affect beta 2. causes the heart to beat more slowly and with less force, which lowers blood pressure
metoprolol succinate: dose (100 at the meta)
Initially 100 mg, Effects of daily dose beyond 400 mg aren’t known.
Metoprolol succinate - adverse effects (withdrawals, fat, and depressed at the met)
bradycardia, pulmonary edema. CNS:fatigue,dizziness,depression,headache
CV:hypotension
Metoprolol succinate generic and trade name (the met is low depressor)
Metoprolol succinate - generic
Lopressor - Toprol XL - trade
Metoprolol - high alert or not?
high alert. if giving IV, have 2nd nurse check. Abrupt withdrawal may cause heart attack.
Metoprolol onset peak duration (no peak at the met)
15 min, peak unknown, 6-12 hours
Metoprolol teaching (met withdrawals and what do you do before you adminster it???)
same time every day, check pulse, may cause drowsiness, notify provider if taking any meds, or pregnant, and take with food. don’t stop abruptly. edema
Furosimide - action (furious about my sodium and choloride and my swelling)
slows sodium and chloride reabsorption in the loop of henley. Increases excretion of water and sodium, mag, potassium, ca, cl. for pulmonary edema. helps treat edema and swelling.
Furosimide - dose (furious at 20)
20 to 80 mg PO daily in the morning. up to 600 mg daily
Furosimide - adverse effects: (Furious about stevens johnson and anemia)
headache,dizziness, hypotension, Stevens-Johnson syndrome, anemia.
metroprolol hold
if systolic BP is less than 110 or apical is less than 60 bmp
furosemide generic and trade
furosemide generic
lasix trade
furosemide - use caution with what patients?
renal impairment, diabetes, hypotension, hearing loss, dehydration, hyponatremia, hypokalemia, aplastic anemia
furosemide O/P/D (my 30s were a furious 1, then I turned 68)
30 - 60 min, peak 1-2 hours, duration, 6-8 hrs.
furosemide teaching (furious about my weight gain and alcohol)
may cause ortho hypo, do not use alcohol, don’t exercise in hot weather, advise if weight gain more than 3 lbs in 1 day, OTC meds, pregnancy, muscle cramps
lisinopril trade name (Lisin, zesty princess)
Prinivil and Zestril
lisinopril MOA
treats high BP. ACE inhibitor. stops the conversion of angiotensin I to the vasoconstrictor substance, angiotensin II. Angiotensin II also stimulates aldosterone secretion by the adrenal cortex. Lowers BP.
lisinopril adverse affects (kalema loves to lisin to angie)
hypotension, rash, hyperkalemia, angioendema
lisinopril dose (listen I’ll be there at 10:40)
10 mg a day, up to 20 - 40 mg
lisinopril O/P/D (listen to KROQ from 16 - 24)
1 hr, 6 hr, 24 hrs.
lisinopril patient teaching (lisin I’ll teach you about no salt)
take at same time every day, do not disconitue, avoid salt subistiues containing potassium or sodicum. chang poisition slowly to avoid hypotension. advise dr. of any OTC. notify dr of rash, sore throat, chest pain. quit smoking.
lispro (a rapid lisp is l for log, but you must eat afterwards) and food when?
humalog - rapid. must eat meal afterwards
aspart (a spartan is rapid novel log)
novolog (brand name) - rapid.
glulisine (glide into rapid apid)
apidra - rapid
rapid acting - how adminstered?
SC or continous SC pump - NOT IV
regular insulin (to be short and regular is humalin) And how administered? (check the human part)
humalin - short-acting. ONLY ONE that can be given IV bolus, IV infusion, or IM.
short-acting - how fast?
onset 30 to 60 min
rapid-acting - how fast?
5 -15 min
isophane (NPH) and clear or cloudy? (NPR is boring and intermediate)
neutral protamine hagedorn - intermediate acting. CLOUDY.
glargine (gargle clear lantus for a long time) and clear or cloudy?
lantus - long-acting. clear. referred to as basal insulin. 2 hrs/24
determir (mir and levimir are long and clear)
levemir - long-acting. clear. referred to basal insulin. 2/24
insulin pt teaching
have meals ready, Avoid spots w/scar tissue, moles, swelling, divide into 4 quadrants, can turn into fat deposits, be aware of signs and symptoms of hypoglycemia and hyperglycemia, proper storage - refrigerate, needle disposal, roll intermediate insulin between hands, no cure for diabetes,
NPH clear or cloudy?
cloudy
insulin high alert
need 2nd nurse
insulin MOA
stimuates glucose uptake in skeletal muscle and fat. inhibits glucose production in liver. enhances protein synthesis.
aspart dose
.5 - 1 units/kg/day
reasons for a foley
surgery involving abdomen, pelvis, bladder after child birth
enlarged prostate in men
neurogenic bladder
critically ill pts
Assist in healing open sacral/ perineal wound in incontinent pts
Provide improved comfort for end-of-life care
Prolonged patient immobilization
cancer
braden scale (SNMAMF)
sensory perception
nutrition
mobility
activity
moisture
friction and shear
teaching for diabetes
signs of hypo and hyper.
carry glucose with you.
medical alert bracelet.
lifestyle - exercise and diet.
foot care.
use of glucose monitor.
techniques for injection and rotation of sites.
SBAR
Background: Vital signs, mental and code status, list of medications, and lab results
I - intro - Amanda, nursing student
S - calling about ellen scheduled for surgery. She’s having doubts.
B - admitted yesterday, positive for cancer. history.
A - more than just gitters
R - should I hold the pre-op?
R - I understand you want me to hold the pre-op meds.
what is furosemide for?
diruetic. used to treat high BP and edema.
what is metroprolol used for?
beta blocker - high PB.
what is lisinipril used for?
ace inhibitor. high PB.
sterile dressing change - important to check (think big wound)
need pain meds before you do dressing change. ambulate, position, check if patient has been to bathroom at least every hour. if it’s not w ritten as sterile change, no need for sterile gloves. Braden if they are a pressure risk
equipment for NG tube
tube, connector - clear, pen light, tongue depressor, tape, water, basin, pad, tissues, lubricant, measure suction thing, ph test kit.
with NG tube, don’t forget to
check gag reflex and measure tube!!!
steps to set up pump (prime, feed, flush)
- prime pump (top button) - goes to next screen and choose “hold to prime flush” also press “hold to prime feed” (button below that one. Hold tube over basin here, it’s when water will come out. Press done.
- adjust feed - 2nd button on homepage
- feed rate (top button) - enter feed rate “200” then enter (top button)
- feed VTBD (volume in bag) (2nd button on home page) - enter “1000” enter. done.
- adjust flush (3rd button down on home page)
- flush volume - “100” enter
- flush interval “every 2 hours” enter
- then run, and you’re done
set up for foley
2 kits, trash by bedside
ALWays do what with dressing change?
intitals on dressing after change
heparin MOA
binds to antithrombin and makes it active. AT then binds to factor 10 (X), which stops thrombin from converting to prothrombin. Prothrombin creates blot clots.
insulin check what before you administer?
check blood sugar
furosimide is
potassium wasting
COPD sounds
crackles
heparin SQ O/P/D (hep was best between 20 and 28)
20 - 60 min, 2 hr, 8 - 12 hrs.
what to do before heparin? and how soon? (heman on heparin)
monitor hematocrit also! draw PTT 30 min before each dose and then periodically during treatment, every 2 - 3 days. may cause hyperkalemia
heparin teaching (and what else - think meds)
report unusual bleeding, use electric razor, soft toothbrush, do not take NSAIDS. notify if pregnant.
heparin high alert - need another nurse to check
before adminstering
heparin used to treat
pulmonary emboli and venous thromboembolism. use caution with liver or kidney impairment.
heparin dose
5000 units/kg
heparin generic and trade (heparin moon)
heparine (porcine) = generic
trade = Monoject Flush Syr/Hep Lock
Bronchial or Tubular sounds (blowing then whisper)
Blowing, hollow sounds. Sound on expiration is longer and lower on expiration
Bronchovesicular (combo is medium)
Medium-pitched. Inspiration and expiration sounds have similar pitch
Vesicular (a blowing whisper)
soft, whispering sound. Sound on inspiration is longer
diabetes numbers
over 126 or 6.5
metoprolol antidote
glucagon or charcol
reasons to take furosemide (keep it simple)
heart failure, hypertension, and renal disease
heparin adverse effect
thromocytopenia (low plaletes), bleeding gums, nose, tarry stools, anemia
furosimide treats what?
pulmonary edema
what treats hypertension?
lisinipril and metoprolol
lisinipril treats what? So monitor for what? what is the main thing you keep forgetting? Then monitor for what?
heart failure - monitor weight for fluid overload, crackles, dyspnea.
when to eat after insulin?
rapid - within 15 min
short - within 30 min
intermediate - with 30 - 60 min
rapid acting insulin o/p/d
5 - 15, 1-2, 4-6
short acting insulin o/p/d (short at 24 and 68)
30 - 60, 2-4, 6-8
intermediate acting insulin o/p/d (the middle child is 12, adult is 46, and then 12 again)
1-2, 4-6, more than 12 hr.
long acting insulin o/d
2 hours, 24 hrs.
S3 and S4 (my heart fails at 3, and it’s stiff at 4)
s3 heart failure
s4 - stenosis
abnormal cardiac assessment (the rush is abnormal)
abnormal - thrills - rushing vibrations
crackles
popping - pneumonia
course
bubbles - HF
rhonchi
snoring, copd
stridor
high - obstruction
furosmide monitor
HR and BP before adminstering
