Unit V Flashcards
When administering morphine for pain you should always assess what
pain level and LOC
What vitals need to be monitored when a pt is taking morphine?
Respirations, pulse. bloodpressure
This drug is given to sickle cell patients who are in sickle cell crisis or patients who have just had an MI
Morphine
MAO inhibitors cannot be given with morphine because they cause what?
Serotonin syndrome
What does a patient need to do to prevent lung infections when taking opioids?
Turn Cough Deep breath every two hours
Beta blocker, used for hypertension, angina, MI or heart attack, migranes and irregular heartbeats
Metoprolol (lopressor)
When taking metoprolol _____ should be assessed to ensure ________
Lung sounds
fluid is not building up
Caffine should be limited when taking ________
metoprolol
Metformin is a _______ which can only be taken by ________
oral antidiabetic
type 2 diabetics
Metformin can case what kind of GI problem
Diahrrhea
Discontinue Metformin ___ hours before contrast imaging
48
Use Metformin cautiously in
Severe renal impaired pt’s and chronic alcohol abusers
When taking metoprelol and you miss a dose always remember
To take it at the same time everyday, do not skip or double dose. Do not let more than 8 hrs go by between doses
Abrupt withdrawal of Metoprolol can cause
life threatening arrhythmias, hypotension, or myocardial ischemia
Metoprolol can increase sensitivity to what?
Cold
What should diabetics know about taking metoprolol?
It can raise blood sugar so they should monitor blood glucose closley`
Why does a patient need routine follow ups with metformin?
regular blood sugar checks, renal function,
CHills, diahrrhea, dizziness, low BP, muscle pain, abdominal pain, sleepiness, and slow heart beat or pulse, dyspnea, or weakness are all symptoms of…
Lactic acidosis
Blood sugar checks and urine ketones should be monotored closely during _______
times of stress or illness
Discontinue metformin if:
severe infection, dehydration, and severe or continuing diarrhea occurs or if a medical test or surgery is required
Patients taking metformin should be advised to alwasy carry what?
An ID card detailing therapy
A form of sugar
If hypoglycemia occurs advise pt to take:
a glass of orange juice
2-3 tsp of sugar, honey, or corn syrup dissolved in water
and to notify PCP`
Memantine
(Namenda)
Used to improve the symptoms of alzhimer’s disease, but is NOT a cure. Does NOT stop the progression of the disease.
A patient who is taking Memantine should have their cognitive funtion assessed when?
Before they start this medication and periodically throughout tx to see if symptoms are improving or worsening
If a severely renal impaired pt is prescribed memantine the nurse should expect:
to administer a lower dose
When a pt is prescribed memantine the pt and the caregiver should be taught how to _____ the dose.
titrate
When missing a dose of memantine:
take missed dose as soon as remebered but do not double dose.
If several days are missed pt may need to start on a lower dose.
Meclizine
Antivert
antihistamine
motion sickness
can cross milk barrier
A patient should take meclizine a ______ before motion sickness is expected
1 hr
Magnesium Oxide
MAg Ox
Elecrolyte replacement for Mag
Can be used as a laxative or antacid
If using Mag Ox as a laxative:
the abdomen ahould be assessed and withheld if there is any sign of a fever
When taking mag ox with other meds remeber…
DO NOT take withing 2 hr of other meds. esp fluoroquinolones
How long does it take mag ox to work?
3-6 hours
Symptoms of electrolye imbalance
muscle pain, dizziness, weakness, muscule cramps
Meclizine
antivert
Antihistamine
treats Motion sickness
treats Vertigo
When taking meclizine prophylactically…
take an hour before anticipated motion sickness
Metmantine
Namenda
used to manage sypmtoms of alzheimers
Lorazepam
Ativan antianxiety Benzodiazapine sedative hypnotic anticonvulsive Can be used as anesthetic
What vitals should be monitored when taking ativan or lorazepam
Heart rate and respiratory rate (esp if IV)
What to do if pt is having a seizure`
DO NOT hold them
Items that are close should be moved away if possible.
Time seizure to see if pt’s brain has been deprived on oxygen.
DO NOT put anything in pt’s mouth
If ativan is less effective after a week…
call PCP
Methods of manageing anxiety
increase exersize, support groups, reaxation techniques, adressing the source of anxiety, and improving coping skills
Ativan decreases the effects of…
Birth control
Levothyroxine
Used to tx hypothyroidism
What to do if lorazepam is less effective after a week…
notify PCP; do not increase dose
Use Ativan cautiously in
hepatic/renal/pulmonary impaired patients Depression Psychosis hx of suicide hx of drug abuse COPD Sleep apnea
Levothyroxine
Synthroid
For hypothyroidism
increases metabolism of the body
If a pt is taking Levothyroxine what vitals should be monitored?
BP and pulse
If you miss 2-3 doses of synthroid
notify PCP
Take 4 hours apart from Synthroid
antacids, iron, and calcium suppluments
Signs and symptoms of hyperthyroidism
headache, nervousness, diarrhea, excessive sweating, heat intolerance, chest pain, increased pulse, palpations, weight loss greater than two pounds in a week
Do you take levothyroxine with food?
In the morning 30-60 mins before food to help medication be absorbed
When starting Synthroid know that…
the dose starts low and is gradually increased. Follow up lab work is required to ensure med is theraputic
Ibuprofen
Advil, motrin Antipyretic Antirhumatic NSAID Can be used for menstrul cramps
What is aspirin triad
nasal polyps, asthma, and aspirin allergies. Puts a patient at higher risk to have a reaction to ibuprofen
How is Ibuprofen doesed to children?
by weight in kg
What GI problems can Ibuprofen cause?
GI bleeding
When a patient is about to do ROM exercises, give ibuprofen…
1 half hour before supposed to go
When taking Ibuprofen by mouth, instruct pt to…
Take with full glass of water and remain in an upright 10-15 mins after administration/
Do not administer ibuprofen to dehydrated patients becuase it can cause
vomiting, diarrhea, and increased risk of renal dysfunction
Ibuprofen dereases the effect of:
diuretics, ACE inhibitors, and other hypertensives
Ibuprofen can increase effects of:
insulin and hypoglycemics
Ibuprofen can increase risk of bleeding with
blood thnners, drugs effecting platelet function, and corticosteroids
What is the expected outcome of antipyretics?
Reduction of fever
tx of inflammation and infection
Why are older adults more suseptable to infection?
fragile skin that tears wasily and leaves them at a greater risk for an infection
How do liquids remain sterile? How should liquids be poured?
Hold bottle so that label is against the palm of your hand to keep from messing up label. Pour liquid slowly to avoid splashing. Hold 4-6 inches above the basin. Check expiration date/ open date; liquids are no longer sterile if open too long. Lip the bottle. Inside of the bottle is sterile but the outside is not
proper body mechanics
Plan work carefully
Eleveate your work to a comfortable level. Raise beds so that you do not have to bend over
Keep feet shoulder width apart, one foot slightly ahead of the other when standing for long periods
Avoid twisting, which can cause strain or injury to the lower back. Turn your whole body or pivot on one foot instead of twisting
When lifting heavy objects from another level, such as a low shelf on the floow, bend your knees, not your back. Squat to reach the object and keep your back straight as you flex your hip and thigh muscles of your body to support the load
When carrying an object, hold it close to your body with elbows bent. If the weight is away from your body rather than close the center of gravity shifts and your balance is affected. This increases the strain on your back and increases the chances you will fall
Push pull or slide heavy objects rather than lifting when possible
GET HELP
What is contact dermatitis
Rash from substance or chemical, may not initially occur but can occur within 7-10 days
Treatments for contact dermatitis
Controlling symptoms
Oral or topical antihistamines
Topical drying agents
Topical corticosteroids- apply after bath or shower
If syptoms are severe systemic corticosteroids or topical immunodulators, such as tacrolimus (protopic) and primecrolimus (Elidel), my be prescribed
Signs and symptom of contact dermatitis
Area becomes red and puritic within hours of exposure
What is a major concers with contact dermatitis?`
A secondary infection
What is a CNS?
Culture and sensitivity done to identify microorganisms causing an infection and what kind of antibiotic will successfully treat it.
What is hypersensitivity?
Exaggerated response of the immune system that can cause injury to the body
Signs and symptoms of hypersensitivity
rashes, itching, tearing/burning of the eyes, nose twitching and nasal stuffiness
How fast can hypersensitivity occur?
Usually the second time they are exposed to it and every time after they are exposed it happens quicker
What is MRSA
Methicillin resistant Staphylococcus aureus
Primary treatment of MRSA
IV antibiotics
Monitor pain
Maintain contact precautions
Notify PCP if pain or S/S worsens
Primary infection prevention
Skin, mucous membranes, GI system
Secondary infection prevention
Inflammatory response, elevated temp, complement cascade
Tertiary/collaborative infection prevention
Involved specialized white blood cells called lymphocytes that fight infection either as B cells or T cells
What is range of motion (ROM)
Series of activities designed to move each joint through all of its natural actions
What is ROM do or prevent?
Decreases muscle atrophy, contractures, osteoperosis
How often should ROM be preformed
every 8 hrs
What is celluilitis?
Inflamation of the skin and subcutaneous tissue resulting from infection, usually with staphylococcus or streptococcus bacteria.
Can occur as a result of skin trauma or secondary bacterial infection of an open wound
Does not HAVE to be a result of skin trauma. Often occurs in extremities esp lower legs
What are some of the treatments for cellulitis
Topical antibiotics
Debridment of nonviable tissue
Systematic antibiotics if fever and lymphadenopathy are present
Elevation of the extremity can reduce pain and swelling
Monitor vital signs and report any hypotension and tachycardia Indicative of systematic infection
Measure extremity daily to monitor procress, mark with marker
Signs and symptoms of cellulitis
Localized inflammation; can become generalized if not treated
Warmth, redness, localized edema, pain, tenderness, fever, and lymphphadenopathy
