1
Q
What does ADPIE stand for?
A
Assessment
Diagnosis
Planning
Intervention
Evaluation
2
Q
Reviewing the EMAR is part of which stage of the nursing process?
A
Assess
3
Q
Providing care and treatment is what stage of the nursing process?
A
Implement
4
Q
Assessing compliance is what stage of the nursing process?
A
Evaluate
5
Q
Diagnostic tests are what part of the nursing process?
A
Implement
6
Q
Reviewing orders is what part of the nursing process?
A
Planning
7
Q
Looking at outcomes and interpreting results is what part of the nursing process?
A
Evaluate
8
Q
What is the study of drugs, their administration and how they affect a patient?
A
pharmacology
9
Q
administering a drug-based intervention for a health condition
A
pharmacotherapy
10
Q
What are three factors that can influence how well a med works in a patient?
A
- pain tolerance
- med tolerance
- genetics
11
Q
what legislation established 5 schedules of drugs based on abuse potential?
A
The Controlled Substance Act of 1970
12
Q
What schedule of controlled substances have the highest abuse potential?
A
Schedule 1
(Schedule 4 is high, 3 is moderate, 2 is low and 1 is lowest)
13
Q
Which three drugs are schedule 1 controlled substances and have no current therapeutic dose?
A
marijuana, LSD and heroin
14
Q
Which drugs are schedule 2 controlled substances? (high abuse potential)
A
Potent opioids: hydrocodone, fentanyl, oxycodone, methodone, morphine, meperidine, high doses of codeine
15
Q
Which controlled subtance has moderate abuse potential? Drug Schedule III.
A
Codeine - lower doses with aspirin or acetaminophen
16
Q
What drugs are considered schedule IV? Low abuse potential.
A
tramadol, zolpidem and benzos: alprazolam, diazepam, midazolam, tempazepam
17
Q
What drugs are considered schedule V controlled substances? Lowest abuse potential?
A
Cough meds with codeine and anti-diarrheals with small amounts of opioids
18
Q
Which drug schedule has accepted medical use but is severely limited?
A
Schedule II
19
Q
What are the 5 drug types that are considered controlled substances?
A
opioids
stimulants
depressants
hallucinogens
anabolic steroids
20
Q
What goes in the CSRx container?
A
CS medication in the following forms:
1. drained IV liquids (not bag)
2. contents of syringes, not syringe itself
3. vials and ampoule contents (not containers)
4. pills, tablets, patches and capsules
21
Q
What waste goes in the red sharps container?
A
empty syringes and ampoules
22
Q
What waste goes in the blue Rx container?
A
- Full or partial IV bags, bottles or vials
- Tablets
- non-sharps syringes with medication
23
Q
Where are hazardous medications disposed of?
A
In the black waste container
24
Q
What medication waste goes in the black 2 gallon container?
A
- hazardous sharp meds in syringe or ampoule
- Coumadin and nicotine packaging
- hazardous tablets
25
What medication waste goes in the black 8 gallon container?
1. no syringes
2. hazardous liquids that may leak in Ziploc
3. full or partial IV bags, bottles or vials
4. coumadin, nicotine packaging
26
Where do you dispose of medications labeled SP, SPO, SPC? What are two examples?
Pharmacy; aerosols and inhalers
27
What 6 IV solutions can be disposed of down the drain?
1. dextrose
2. lactated ringer
3. electrolytes
4. K+
5. glucose
6. saline
28
the strongest type of warning the FDA can require for a prescription drug, indicating an increased risk of serious adverse reactions like death or injury
Black box warning
29
two examples of drugs with black box warnings
1. avendia
2. zoloft
30
Drugs that bear a heightened risk of causing significant patient harm when they are used in error. Deemed by the Institute for Safe Medicine Practices.
High Alert medications
31
What is 1 example of a high alert med?
fentanyl
32
True or False: the FDA to approves dietary supplements for safety and efficacy
False
33
True or False: Supplements, vitamins and minerals are considered drugs and should be considered for drug-drug interactions
True
34
BRP meaning
bathroom privileges
35
fww medical abbreviation
front wheeled walker
36
What are the 4 fat soluble vitamins?
DEKA
37
Where are fat soluble vitamins stored?
In the liver and fatty tissue
38
What are the water soluble vitamins and minerals?
B-vitamins and Vitamin C
Iron and calcium
39
Which type of vitamins require an acidic environment for absorption?
water soluble
40
Most water soluble vitamins and minerals need daily replenishment, except?
B-12; stored in liver for 3-5 years
41
Which type of vitamins have a higher risk of toxicity? Why?
Fat soluble; are stored in the body longer so can build up over time
42
Vitamin A is primarily stored where?
Liver (90%)
43
What are two functions of Vitamin A?
1. formation of rhodopsin (visual purple - rod responsible for low light vision)
2. formation and maintenance of mucosa and healthy skin
44
4 results of vitamin A deficiency
1. night blindness
2. conjunctival and corneal changes (can lead to xerophthalmia - dry eyes)
3. dry/scaly skin
4. decreased saliva secretions
45
What are dietary sources of vitamin A?
1. animal sources - preformed vitamin A (retinol)
2. carotenoids in plant sources such as canteloupe, carrots, apricots, tomato juice, spinach) - provitamin A (beta-carotene)
46
What are the three types of vitamin D and where do they come from?
1. cholecalciferol (D3) - animal sources and skin synthesis
2. ergocalciferol (D2) - plant sources
3. calcitriol - active form; produced in kidneys and controls body's level of calcium and phosphorous
47
What are three functions of vitamin D?
1. Develop and maintain strong bones
2. Calcium and phosphorous absorption
3. Muscle contraction
48
a childhood bone disease characterized by soft, weak, and deformed bones, most often caused by a vitamin D or calcium deficiency. Symptoms include bone and muscle pain, delayed growth, and skeletal deformities like bowed legs.
Ricket's disease
49
What is a complication of low vitamin D?
Osteoclast activity due to low Ca2+ which can lead to osteoporosis
50
What are dietary sources of vitamin D?
1. fish and eggs - cholecalciferol (D3)
2. fortified foods
51
What are the steps of the vitamin D cycle?
1. vitamin D is absorbed into the bloodstream in the form of cholecalciferol (D3) and ergocalciferol (D2) from skin synthesis and the small intestine (dietary intake)
2. An enzyme in the liver converts vitamin D to calcidiol
3. In the kidneys, calcidiol is converted to calcitriol (active vitamin D) via the enzyme alpha-1-hydroxylase
4. Ca and P absorption into the blood stream increases
5. Increased bone mineralization with Ca and P due to normocalcemia
52
What is the function of vitamin E?
to neutralize free radicals by donating an electron (antioxidant)
53
What are two results of vitamin E deficiency?
1. hemolytic anemia (RBCs are exposed to oxidation)
2. disrupts myelin sheath formation which can affect nerve impulses leading to things like trouble walking or neuropathy
54
What are dietary sources of vitamin E?
vegetable oils, nuts and fortified cereals
55
What are three types of vitamin K and where do they come from?
1. phylloquinone - plant and animal foods
2. phytonadione (synthetic form of phylloquinone)
3. menaquinone - synthesized by gut bacteria
56
What is the primary function of vitamin K?
to initiate blood clotting through activation of four liver proteins
57
Vitamin K is the antidote for overdose of which drug?
warfarin (Coumadin)
58
Why is vitamin K given to newborns?
Their intestinal tract is sterile at birth so they are at higher risk of hemorrhage
59
What is the main concern in someone wiith a vitamin D deficiency?
Increased risk of bleeding
60
What dietary sources are a good source of vitamin K?
dark, leafy green veggies, asparagus, brussels, broccoli
61
What is another name for vitamin B1?
thiamine
62
What is the main function of thiamine?
Supports cell energy metabolism by combining with phosphate to form thiamine pyrophosphate (glucose metabolism)
63
B1 deficiency affects many body systems - what are 4 examples?
1. GI: constipation
2. CNS: fatigue and loss of alertness
3. CV: cardiac failure
4. Musculoskeletal: loss of energy/weakness
64
True or Fale: chronic alcohol abuse affects thiamine absorption
True
65
Dietary sources of B1
whole/enriched grains and legumes
66
Vitamin B9 is also known as?
folic acid
67
What is the primary function of B9?
coenzyme in DNA synthesis and cell division
68
What are two concerns with folic acid deficiency?
1. neural tube defects such as spina bifida (in pregnancy)
2. megaloblastic anemia
69
What is one cause of B9 deficiency?
Overconsumption of alcohol - affects absorption
70
What is megaloblastic anemia?
anemia caused by deficiency of vitamins B9 and B12 that lead to bone marrow producing large, immature red blood cells
71
What are dietary sources of vitamin B9?
dark leafy greens, orange juice, chicken liver, legumes, fortified cereals and grains
72
How does B9 mask B12 deficiency symptoms?
B9 can correct anemia, which may present before neurological symptoms. Cannot correct neurological symptoms resulting from B12 deficiency.
73
Cobalamin is also known as what?
vitamin B12
74
What are three functions of VItamin B12?
1. amino acid metabolism
2. myelin sheath formation
3. heme formation
75
What two compounds does B12 need for absorption?
1. HCl (except supplemental B12)
2. Intrinsic Factor
76
What condition is caused by the body's inability to absorb vitamin B12 (usually due to low/no IF or HCl)?
pernicious anemia (a form of macrocytic)
77
What are two signs/symptoms of pernicious anemia?
1. tingling in hands/feet
2. decline in thought process
78
What are three causes of low IF and HCl?
gastrectomy, low gastric acid, IBD
79
What are 4 functions of vitamin C?
1. antioxidant
2. maintains bone matrix
2. maintains cartilage and collagen integrity
3. facilitates iron absorption
80
What are 3 results of low vitamin C?
1. poor wound healing
2. petchiae/easy bruising
3. weak bones
81
dietary sources of vitamin c
citrus fruits and juices, tomatoes, bell peppers,
strawberries
82
What is the main function of iron?
functional part of Hgb - heme- that binds O2 and delivers it to cells
83
What protein stores iron in our tissues?
ferritin
84
What causes iron deficiency?
1. low gastric acid (cannot release it from food)
2. poor absorption
85
What are 3 s/sx of iron deficiency?
1. pallor
2. muscle weakness
3. fatigue
86
What are dietary sources of iron?
liver, meat, chicken, fish, whole grains, fortified foods,
87
What are 4 functions of Calcium?
1. with phosphorous, provide strength and rigidity to skeleton
2. supports fibrin threads during clot formation
3. assists with nerve transmission
4. helps with muscle contraction and relaxation
88
What vitamin is needed for absorption of Ca?
Vitamin D
89
A positive Chvostek's or Trousseau's sign indicates what electrolyte imbalance?
hypocalcemia
90
What are dietary sources of calcium?
dairy products, dark green veggies, fortified foods
91
How is calcium regulated when blood levels are too high?
The thyroid releases calcitonin which increases calcium deposition in the bones, decreases uptake in the intestines and decreases reabsorption in the urine
92
How is calcium regulated when blood levels are too low?
The parathyroid released parathyroid hormone which increases bone resorption, increases calcium uptake in intestines and increases reabsorption from kidneys.
93
What breaks down carbs to glucose during chemical digestion and where is it present in the body?
salivary amylase - mouth, pancreas, SI
94
1. What body compound activates a digestive enzyme that breaks down proteins into amino acids?
2. What is that digestive enzyme?
1. HCl
2. Pepsin
95
What enzyme breaks down fats during digestion and where is it found in the body?
Lipase - mouth, stomach and pancreas
96
lymphatic capillary that absorbs dietary fats in the villi of the small intestine
lacteal
97
visible finger-like projections on the intestinal mucosa that line then entire SI wall. Contain blood capillaries and lacteal to carry absorbed nutrients.
villi
98
primary role of the SI villi
increase SA and move nutrients into blood
99
microscoping hair-like extensions of the cell membrane on the surgace of epithelial cells that cover the villi
microvilli
100
Role of microvilli in SI
further expand surface area for max absorption and contain digestive enzymes that aid in final nutrient breakdown
101
What are 8 digestive changes that occur with aging?
1. decreased taste and smell
2. dry mouth (xerostomia)
3. chewing and swallowing issues (dysphagia)
4. decreased thirst
4. early satiety
5. decreased HCl acid secretion
6. decreased peristalsis
6. decreased absorption of nutrients
102
True or False: CHO and fat intake recommendations remain the same for adults over 70, but protein and caloric needs increase.
False: CHO and fat remain the same, protein needs increase and caloric needs decrease
103
Which vitamins/minerals do we need to increase after 70?
Vitamin D and calcium
104
True or False: iron needs decrease as we age.
True
105
True or False: vitamin B12 needs remain the same as we age
True
106
What is the role of vitamin A in wound healing and illness?
maintains skin and mucous membranes; promotes immunity through migration of macrophages
107
What is the role of B12 in wound healing and illness?
Promotes tissue repair, granulation tissue and energy boost
108
What is the role of Vitamin C in wound healing and illness?
enhances tensile wound strength and blood vessel formation
109
What is the role of vitamin E in wound healing and illness?
helps decrease inflammation
110
What two vitamins/minerals are important for blood clotting?
vitamin K and calcium
111
What is the role of protein in nutrition and wound healing?
1. build and repair skin/tissues
2. fight infection
3. balance fluids
4. formation of hemoglobin
112
What is the RDV of fruit, veggies, grains, protein and dairy?
fruits - 2 C
veg - 2 C
grains - 6oz
protein - 5.5 oz
dairy - 3 C
113
Which vitamins and minerals are listed on a nutrition label?
vitamin D
calcium
iron
potassium
114
What is the BMI that correlates with being underweight?
18.5 or less
115
What is a normal BMI?
18.6-24.9
116
What BMI correlates to being overweight?
25- <30
117
What BMI correlates to being obese?
30-39.9
118
What BMI correlates to extreme obesity?
40 and above
119
Pallor and spoon shaped nails correlates with what nutritional deficiency?
iron
120
What are two major risk factors for the development of pneumonia?
1. dysphasia
2. aspiration
121
True or False: you do not need an MD order to complete a swallow protocol.
True
122
What are 6 criteria that if met would make a patient too high risk to complete a swallow screening?
1. unable to remain alert
2. baseline modified diet/thickened liquid
3. tube feeding in place
4. head of bed must be <30 deg.
5. has a tracheostomy tube
6. NPO by physician order
123
What are the three steps of the Yale Swallow Protocol?
1. Brief cognitive screen
2. Oral mechanical exam
3. 3 oz water swallow challenge
124
What are the three questions you ask for brief cognitive screening during swallow protocols?
1. What is your name?
2. Where are you?
3. What year is it?
125
What is involved in the oral mechanical exam of the Yale Swallow protocol?
Tongue Range of Motion: stick out your tongue and move it side to side
Facial symmetry: smile/pucker
Lip closure: puff up your cheeks and hold
126
What are the steps of the 3oz water swallow challenge?
1. Sit the patient up as high as tolerated
2. Ask patient to drink 3oz of water from cup or straw with sequential swallows-slow and steady but without stopping
127
What is the most common food intolerance?
Intolerance to lactose (milk sugar)
128
What can patients have on a clear liquid diet?
minimum residue fluids that can be seen through
juices without pulp, broth and jello
also lists water, black coffee, tea, popsicles, carbonated bevs
129
What can patients have on a full liquid diet?
fluids that are creamy - ice cream, pudding, thinned hot cereal, custard, strained cream soups and juices with pulp
130
When are patients prescribed a mechanically altered aka soft diet?
when there are problems with chewing and swallowing - dental conditions, missing/no teeth, dysphagia
131
What is allowed on a mechanically altered/soft diet?
chopped or ground meats, raw fruits and veggies
132
Which diet is indicated for those with wired jaws and extremely poor dentition in which chewing is inadequate?
puree
133
What are three common types of therapeutic diets?
1. nutrient modifications
2. texture modification
3. food allergy or food intolerance modification
134
True or False: you must have an MD order to advance a diet
True
135
True or False: if a patients diet order says NPO, they can't have anything by mouth except ice chips.
False! Nothing by mouth at all
136
the study or science of drugs
pharmacology
137
preparing and dispensing drugs, including dosage form design, which determines rate of dissolution and absorption
Rate these oral drug preparations in order from fastest absorption to slowest
138
1. buccal, SL
2. capsules
3. enteric coated tablets
4. tablets
5. liquids, syrups
1. buccal, SL
2. liquids, syrups
3. capsules
4. tablets
5. enteric coated tablets
139
study of how the drug moves throughout the body - absorption, distribution, metabolism, excretion
pharmacokinetics
140
What types of drugs undergo first pastt effect?
oral
141
What type of drugs are enteral?
oral, subq, sublingual, rectal
142
What types of drugs are parenteral?
injections (IMs and subq) and IVs
143
What types of drugs undergo first-pass effect?
oral and rectal (partial)
144
What types of drugs are considered topical?
ointments, gels, patches, drops, inhalers
145
What is bioavailability?
how much of the drug is absorbed into the bloodstream
146
What is the first pass effect?
oral drug is absorbed into the blood in the small intestine and then travels to liver where it is broken down into less active form before being absorbed back into the blood for distribution.
147
True or False: drugs bound to plasma proteins are more likely to be distributed to organs
False - unbound drugs are free to dsitribute; bound drugs are inactive
148
Which receives drugs more rapidly during distribution:
1. heart, liver, kidneys and brain
2. muscle, skin fat
1. heart, liver, kidneys and brain
149
biotransformation refers to which phase of pharmacokinetics?
metabolism - drug breakdown
150
Where does most drug metabolism occur?
the liver
151
The liver converts drugs to one of these four compounds during metabolism
1. water-soluble molecules for excretion
2. inactive metabolite
3. less active metabolite
4. more potent and active metabolite known as a prodrug
152
the study of drug induced physiological changes and mechanism of action is known as
pharmacodynamics
153
the use of drugs to prevent or treat diseases, including therapeutic and pharmacologic classifications
pharmacotherapy
154
Leafy green veggies may decrease the impact of this drug
warfarin
155
Grapefruit juice may cause problems with enzymes and transporters in these four drug classes
1. cardiac meds
2. anti-seizure
3. anti-cholesterol
4. anti-anxiety
156
This food can increase drowsiness and sedation by interacting with CNS depressants
Valerian Root
157
Explain the term "polypharmacy"
refers to taking many drugs at once - people are living longer and baby boomers are reaching geriatric age which increases the need for meds and the possibility of AEs/d-d interactions.
158
True or False: stomach pH decreases as we age
False - it increases (becomes more alkaline) which alters med absorption
159
How does drug dosing for the elderly typically differ from the standard adult dose?
1/2-2/3 of standard adult dose, start low and go slow
160
What are the two kinds of opioid receptors in the CNS?
mu and kappa
161
What are the two major side effects of opioids?
resp depression and constipation
162
What are the two meds that treat opioid induced constipation?
naloxegol (Movantik)
methynatrexone (Relistor)
163
Put these opioids in order from strongest to weakest
1. Fentanyl
2. Hydromorphone (Dilaudid)
3. Morphine
4. Methadone
5. Oxycodone
6. Hydrocodone
7. Codeine
164
What is fentanyl used to treat?
1. perioperative pain
2. long-term **chronic**, persistent severe (or moderate) pain
3. breakthrough cancer pain
165
What form of fentanyl is used for long-term analgesic therapy?
transdermal
166
Fentanyl routes
1. IV (perioperative anesthesia)
2. PO
3. buccal
4. SL
5. transmucosal
6. transdermal
167
What is the duration of action for a fentanyl patch and how long does it take to reach a steady state?
DOA = 72 hours
SS = 6-12 hours
168
What is the indication for hydromorphone?
severe chronic *and* acute pain
169
Dilaudid routes
PO, PO-ER, parenteral, PR (rectal)
170
3 AEs of hydromorphone
1. increased risk of orthostatic hypotension
2. increased risk of urinary retention
3. increased risk for respiratory depression
171
How does dilaudid compare to morphine?
It is 7x stronger, but tends to make patients less nauseous
172
What is the indication for methadone?
moderate to severe pain in opioid tolerant patients. often used for those who need around the clock treatment for those in opioid or heroin withdrawal
173
What is the indication for oxycodone?
moderate to severe pain
174
What is the controlled release form of oxycodone?
oxycontin
175
What is oxycodone + acetaminophen?
Percocet
176
What is oxycodone + aspirin?
Percodan
177
What is the indication for morphine?
chronic pain management and acute pain management
178
What routes can you give morphine?
PO, parenteral and PR
179
What is the brand name for morphine ER and what is the indication?
MS Contin; chronic pain management
180
What semi-synthetic opioid is used for moderate to severe pain?
hydrocodone
181
three names for hydrocodone combined with acetaminophen
Vicodin, Norco, Lortab
182
What opioid is used to treat mild to moderate pain and has an antitussive effect when combined with guaifenesin
codeine
183
True or False: codeien has a ceiling effect - increasing the dose increases the risks of AEs, but not therapeutic effects
true
184
When do you consider holding opiates?
If RR < 12 breaths/min
185
What are two signs of respiratory depression?
RR<10; unresponsive to verbal stimuli, require painful stim
186
Year 1 Fall Semester Finals
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