Unit 3 Flashcards
Fat-soluble vitamins
ADEK
Vitamin A
Immune and blood cell development
Found in liver, carrots, pumpkin, sweet potatoes
Vitamin D
Promotes calcium, phosphorus, magnesium absorption
Found in sunlight, mushrooms, yeast, egg yolks
Vitamin E
antioxidant
Found in wheat germ, sunflower seeds, almonds
Vitamin K
Clotting.
Found in green leafy veggies.
Infants need vitamin K injection due to lack of vitamin K at birth
Water Soluble Vitamins
C,B1-3,5-7,9,12
Vitamin C
Process proteins, antioxidants-given for wound healing.
Found in citrus fruits, OJ, peppers, strawberries
Vitamin B1
Thiamine
Deficiency-Beriberi: body needs thiamin to break down and digest the foods you eat, to keep your metabolism going, and help your muscles and nervous system do their jobs effectively
Found in soybeans, whole grains, milk, lentils
Vitamin B2
Riboflavin
Skin and hair, transports RBCs.
Found in cow milk, asparagus, almonds, broccoli
Vitamin B3
Niacin
DNA repair and cancer prevention
Found in mushrooms, sunflower seeds, peanuts
Vitamin B5
Pathothenic Acid
Helps produce coenzymes
Found in egg yolks, pork, shellfish, legumes
Vitamin B6
Pyridoxine
Helps produce serotonin
Found in turkey, salmon, cereals, nuts, spinach
Vitamin B7
Biotin
Produce fatty acids to promote cell growth.
Found in egg yolks, salmon, liver, pecans, soybeans
Vitamin B9
Folic Acid
Helps create new DNA (fetal development)
Found in legumes, nuts, green leady veggies, avocado
Vitamin B12
Cyanocobalamin
Cognition and neurological function and RBC development
Found in sardines, beef, milk
National Patient Safety Goals
Proper Patient Identification
Improve Staff communication
Use medication safely
Use alarms safely
Prevent Hospital Acquired Infections
Identify client safety risks and reduce risk of suicide
Prevent adverse events in surgery
Culture of Safety
Goal of decreasing errors that can lead to illness, injury or death
Confidential reporting of safety issues, incidents, near misses
Mentorship and leadership for employees
Rapid Response Team
Standardized Communication Tools (ISBARR)
Near Misses
potential error that could’ve caused harm
Safety Event
Unexpected event that caused or could have caused harm
Adverse Events
Situation that caused unexpected harm
Sentinel Event
“Never” Events
Hospital Acquired Injuries (HAI)
Focus as nurse to prevent these
Infections, burns, blood transfusion incompatibility, falls, ineffective insulin usage, DVT, pressure injury, surgical site infection (SSI), ect
Who’s most at risk for HAIs?
Patients with disabling medical conditions such as stroke, neurodegenerative disorders (MS or Parkinson’s)
Behavioral disorders such as schizophrenia, personality disorders, and substance abuse disorder
Vision Disabilities, vision impairment/blindness; including eye conditions such as cataracts
Communication disabilities such as autism, hearing impairment, neuro-conditions
Braden Assessment
Risk for skin breakdowns assessment
Morse Assessment
Risk for falls assessment
RACE
Rescue
Alarm
Contain
Extinguish
PASS
Pull
Aim
Squeeze
Sweep
Common factors associated with workplace violence?
Violence that is unreported, Providing care for clients with a history of violence, Providing care alone in client’s home, Space that prevents escape from violence, Inability to call for help, Staff shortages
What are the signs of staff perpetuated violence?
Worsening quality of care, Persistent complaining about circumstances, Abuse of facility policies, Mood swings, Drug alcohol abuse, emotional outburst upon receiving criticism, Paranoia
Active Shooter
Run
Hide
Fight
Factors that contribute to patient falls
Disease processes: strokes, recent surgery
Mobility: amputation, chronic pain, history of falling
Perceptual Impairment: Visual impairment
Environmental: Room clutter, poor lighting, slippery floors
Cognitive Impairment: dementia, depression,sleep disorders
Medication: antidepressants, antihypertensives, anticonvulsant
Staffing: short-staffed units
Toileting: frequency, with or without incontinece
Age: older age
Universal Fall Precautions
non-skid footwear, bed in low position, locked bed, call light in reach
Types of restraints
Physical
Mechanical
Chemical
Barrier
Seclusion
What must be assessed and tended to for restrained patients?
Personal hygiene, Vitals, Device checks, Fluids and food, Circulatory, Respiratory, Skin checks, Client must be monitored frequently (every 2 hours at least)
Preseizure Interventions
Suction equipment at bedside, Oxygen at the bedside, Establish 2 IVs, Padded side rails, Inspect environment and remove items that could be dangerous, educate family to not put anything in the patient’s mouth during a seizure
Seizure Interventions
Call for immediate assistance, Put the patient in side-lying position, Protect the head, Maintain airway and provide suction PRN, Note duration of seizure and typeof movements
Postseizure Intervention
Determine mental status, Measure vital signs and O2 levels, Assess gag reflex, Provide comfort and explain what happened to family and patient, and Provide a quiet environment for recovery, Document
Pharmacokinetics
What the body does to the drug
Absorption
Distribution
Metabolism
Elimination
Pharmacodynamics
What the drug does to the body
Drug Effects
Drug Concentration
Drug Effects
Onset
Peak
Duration
Onset
The time it takes for a drug to produce a therapeutic effect
Peak
When the drug is fully absorbed and the med is distributed throughout the body and the drug is at its highest level of concentration
Duration
Total amount of time drug is producing theraputic effect
Half-Life
the time it takes for meds to fall to half its strength through excretion
Trough
Lowest level of concentration of a med that correlated to the level of elimination
Drug Concentration
Peak
Trough
Pregnancy Categories
Categories for the assessment of medications for the risk of fetal injury due to the medication (if taken as directed).
It does not include any risks conferred by medication in breast milk.
Pregnancy Category A
No risk in Human studies
Example: Thiamine, Pyridoxine, Folic acid, Docusate, Senna, Bisacodyl, Dextromethorphan, Doxylamine, Levothyroxine, Isoniazid
Pregnancy Category B
No risk in studies
Examples: Acetaminophen, Ketamine, Penicillin, Amoxicillin, Glucagon, Metformin
Pregnancy Category C
Risk cannot be ruled out
Examples: Ibphrofen
Pregnancy Category D
Positive evidence of risk
Examples: Aspirin, Warfarin, Lithium
Pregnancy Category X
Contradictory in pregnancies
Example: Valproate, Methotrexate, Ribavirin, Triazolam, Bosentan, Aliskiren, Emergency contraception: Levonorgestrel, Ulipristal, Griseofulvin, Methylene blue, Oxytocin, Riociguat, Isotretinoin
10 Rights of Med Administration
Right Client
Right Medication
Right Route
Right Dose
Right Time
Right Assessment
Right to Refuse
Right Evaluation
Right Documentation
Right Education
Oral (PO)
Tablets, capsules, liquids, enteric-coated tablets, suspensions, elixirs, lozenges
Contraindications for oral meds are vomiting, decreased GI mobility, absence of gag reflex, aspiration risk, difficulty swallowing, decreased level of consciousness
Enteral Feeding Tube (EFT)
Nasogastric tube (NG), Gastrostomy tube (GT), Jejunostomy tube (JT), Nasoduodenal tube (ND)
Use liquid forms of meds for tube, do not crush sublingual, extended/time-release, fluid-filled, enteric-coated medications
Flush tubing before and after each medication with 15mL-30mL water
Flush with another 30mL-60mL after instilling all medications
Sublingual (SL)
under the tongue
bypasses the liver and directly enters the bloodstream
do not eat or drink until medication fully dissolves
Buccal
between cheek and the gum
bypasses the liver and directly enters the bloodstream
do not eat or drink until medication fully dissolves
Rectal (PR)
For clients who are having trouble swallowing, an obstructed bowel, decreased movement in intestinal tract, or patients that are unconscious
Medication (suppository) is absorbed through linning of the rectal vault
The patient is positioned in the left lateral or Sims’ positions
Vaginal (PV)
Patient is positioned in dorsal recumbent position or modified lithotomy
Insert suppository or creams, jellies, or foams along the posterior wall of the vagina
Instruct patient to remain supine for at least 5 mins after the insertion
Inhalation
Administer through meter dose inhalers (MDI) or dry powder inhalers (DPI)
Typically for respiratory conditions such as asthma, chronic obstructive pulmonary disease (COPD), cystic fibrosis, and infectious pulmonary disease
Nasal (NAS)
Drops or sprays instilled within the nostrils
Absorbed through the mucous membranes into the bloodstream
Otic
Instilled into the outer ear pull up and out for adults and down and back for children, massage tragus if not painful
Have patient remain in a side-lying position for 2-3 mins after administration
Ophthalmic
Meds are applied to the mucous membranes of the eyes or conjunctiva
Resthandon forehead, drop the medication into the conjunctival sac, and have them close their eyes gently
For ointment apply a thin ribbon to the edge of the lower eyelid
Transdermal
Patches are applied to the upper torso, chest, upper arms, back, or behind the ear
Allows for the meds to be absorbed slowly, providing prolonged med release
Subcutaneous (subcut)
Can be self-administered
Max delivery is 1mL-2mL
Slow absorption
Into the subcutaneous tissue
Rotate sites
Pinch skin and insert at 45° to 90° angle
Use 90° for obese clients
25G-27G
Insulin use 28G-31G insulin syringe
3/8-5/8 inch length
Intramuscular (IM)
Delivered into larger skeletal muscles
Faster absorption compared to PO
Painful
Deltoidsite used frequently for immunization in adults
Injections should be given at 90°
Length may need adjusting depending on the patient’s weight and size
18G-25G (depends on amount and viscosity of medication)
Intradermal
Injected into Dermis
Usually for Allergies or Tuberculosis
Don’t rub spot after
Max amount: 0.1mL
5°-15° angle in dermis
25G-27G
1/4-5/8 inch length
IM Ventrogluteal max fluid
3mL
IM Deltoid max fluid
2mL
IM Vastus Lateralis max fluid
1mL to 3mL
(can be self administered)
Biological Therapies
Substances found in nature. Supplements, vitamins, herbs/botanic medications, nutritional supplements, vitamins and minerals, and probiotics
Mind Body Therapies
Focus on interactions of mind, the body and the brain, to positively affect physical functions and health promotion
Relaxation, meditation, biofeedback, hypnosis, yoga
Manual Therapies
Hands on Focus on the structures and systems of the body
Massage, chiropractor, reflexology
Bioenergetic
Therapies
Manipulation of energy fields.
Veritable (measurable) relies on electromagnetic fields; Magnet therapy or Light therapy
Putative (assumed) is based on the concept that humans possess energy; Healing touch, Theraputic touch, Reiki
Movement therapies
Use of exercise or activity to promote physical and emotional wellbeing
Pilates and Dance Therapy
Alternative Systems
Whole medical systems that develop over time and in different cultures separate from western medication practice
Ayurverda, traditional Chinese medicine, Homeopathy, Naturopathy
