1
Q
Normal lab values RBC
A
4.5-9.5
2
Q
Normal lab values WBC
A
4-10.5
3
Q
Normal lab values Hgb
A
136-170
4
Q
Normal lab values Hct
A
0.40-0.52
5
Q
Normal lab values platelet
A
100-400
6
Q
Normal lab values Neutrophils
A
2-6
7
Q
Normal lab values PTT
A
23-32
8
Q
Normal lab values INR
A
0.9-1.1
9
Q
Normal lab values Na
A
135-145
10
Q
Normal lab values K
A
3.5-5.0
11
Q
Cefazolin
A
Antibiotic, Classification (antibacterial- cephalosporin first generation)
MOA: semisynthetic, preferentially binds to one or more of the penicillin binding proteins and inhibits the final stage of bacterial cell wall synthesis thus killing the bacterium
Adverse effects: anaphylaxis, fever, seizure, diarrhea, anorexia, abdominal cramps
A: determine history or hypersensitivity to cephalosporins, penicillins & other durgs, before therapy is initiated
12
Q
Ceftriaxone
A
Antibiotic, Classification (antibacterial- cephalosporins)
MOA: inhibits cell wall synthesis by binding 1 or more penicillin-binding proteins, exerts antimicrobial effect by interfering with synthesis of Peptidoglycan(major structural component of bacteria cell wall)
side effects: diarrhea, anaphylaxis, rash, pain, thrombocytosis, nausea
-instruct pt to take medication as directed around the clock & finish medication completely (even if feeling better), to prevent antibiotic resistant, notify health care professionals about any side effects
13
Q
Metronidiazole
A
Anti-infective, anti-protozoals, anti-ulcer agent
MOA: disrupt DNA & protein synthesis in susceptible organisms
side effects: seizures, dizziness, headache, aseptic meningitis(IV), encephalopathy, abdominal pain, anorexia,NVD, furry tounge
Asses:
Pt ta
14
Q
Normal value of CRP
A
0.0-2.0
15
Q
Imipenem cilastatin
A
Anti-bacterial, Antibiotic classification: carbapenems
MOA: binds to cell wall which causes cell death
cilastin prevents renal inactivation of imipenem
Common side effects: NVD, rash
16
Q
Pipercillin tazobactam
A
Anti-bacterail, antibiotics Classification: extended spectrum penecillins
MOA: Pipercillin -binds to bacterial cell wall causing cell death
tazobactum- inhibits beta-lactamase, an enzyme that can destroy penicillins
Common side effects: diarreah, allergy to drug most usual contradiction
Asses: assess for infet, obtain history of penicillin, specimen for C&S
17
Q
Blood lab tests:
A
- Complete blood count (CBC)
- white blood cell (differential)
- RBC (hemoglobin) (hematocrit)
- platelets
18
Q
WBCS
A
- bodys primary defense system
- signifies activation of inflammatory response
- lifespan of WBCS is 13-20 days
- destroyed by lymphatic system, excreted in feces
19
Q
hemoglobin
A
carries oxygen throughout body
20
Q
hematocrit
A
is the ratio of RBC volume to total volume of blood
21
Q
Polycythemia
A
increase in rbcs
22
Q
platelets
A
essential for clot formation & hemostasis
- lifespan 5-9 days
- source of growth factor for tissue repair
- destroyed by spleen & liver
- production regulated by erythropoietin
23
Q
PTT
A
partial thromboplastin time 23-32 seconds
24
Q
PT-INR
A
prothrombin time, international normalized ration 0.9-1.1 seconds
25
Normal lab values of GFR
greater than 60
26
Normal lab values of Creatinine
60-100
27
Anit-hypertensive Drugs
- Furosemide
- HCTZ
- Metoprolol
- Diltiazem
- Rampipril
- Candesartan
28
Furosemide
-Anti-hypertensive, Loop Diuretic
-blocks re-absorption of sodium & water in the loop of henele
-side effects: dry mouth, thirst, Muscle cramping (d/t electrolyte imbalance), postural hypo-tension
Asses: CHECK POTASSIUM BEFORE ADMIN
29
HCTZ
-Anti-hypertensive, Thiazide diuretic
-reduces plasma volume & cardiac output by interfering w sodium re-absorption across distal tubule
Side effects: dry mouth, thirst, Muscle cramping (d/t electrolyte imbalance), postural hypo-tension
Asses: CHECK POTASSIUM BEFORE ADMIN
30
Metoprolol
Anti-hypertensive, Beta blocker
-blocks the sympathetic nervous system(beta adrenergic receptors) especially sympathetics to the heart
Side effects: light headedness
Asses: CHECK HR (will decrease HR)
31
Diltiazem
-Anti-hypertensive, Calcium channel blocker
-inhibits calcium ion influx through slow channels into cell of myocardial smooth muscle
Asses: CHECK HR (will decrease HR)
32
Ramipril
-Anti-hypertensive, ACEI
-inhibits conversion of angiotensin 1 to angiotensin 2 & inhibits aldosterone release
Side effects: dry cough
33
Candesartan
-Anti-hypertensive, ARB
-blocks the effect of angiotensin 2 at receptor sites
Side effects: potassium loss
34
all antihypertensive listed drugs can have side effect of
postural hypotension
35
abnormal values of creatinine & GFR are indicators of
renal dysfunction
36
Electrolyte: SODIUM
role: -EC osmolarity
- trans-membrane potential
- acid-base balance
- numerous chemical rx
37
Hypernatremia
increase in sodium in the blood
| main causes: to much salt intake, to much na+ IV, loss of fluids, getting fed through GI, not enough water
38
Hyponatremia
decrease sodium in the blood
| signs & symptoms: siezures, stupor, lethargy, abdominal cramping
39
Electrolyte: POTASSIUM
Role: -trans-membrane potential
- intracellular osmolarity
- acid-base balance
- intracellular enzyme reactions
40
Hyperkalemia
Increase in potassium
Main causes: renal failure
S&S: muscle weakness, decrease in urine
41
Hypokalemia
decrease in potassium
Main causes: drug, laxitives, too much water intake, fluid loss
S&S: weak thready pulse
42
Ultrasound
imaging technique that uses high frequency sound waves to acquire real time images
-useful for viewing abdominal contents, pelvis, muscles, pregnancies, vessels, the heart & other soft tissue structures
43
CT scan
- computerized Xray machine
- two dimensional image
- uses ionizing x rays
44
Informed consent
Focused communication process which professional nurse or PHYSICIAN discloses all relevant information related to procedure/treatment with full opportunity for dialogue, questions & expressions of concern, before asking client/health care agent to sign a legal consent form
45
For all legal consent to be valid it must contain three elements:
- must be voluntary
- client has full disclosure of risks, benefits, cost, potential side effects of proposed tx/procedure, information about alternative should be provided if available
- client must have capacity & competnecy to understand the information to make an informed choice
46
Consent has 3 components
-Disclosure
-capacity
-voluntary
WHEN THESE 3 ARE MET=INFORMED CONSENT
47
how to express consent
- clear statement by patient oral or written
- pt has right to withdraw consent or revoke a previously given consent at anytime even orally, providing mentally competent to do so
48
Implied consent
When individuals nonverbal behaviour indicates willingness
ex. in emerg sit when cannot provide/express consent
during surgery when additional procedures needed that are consistent w procedure already consented to
49
obtaining informed consent for specific medical & surgical treatments is responsibility of ____
nurses responsibility is often to _____
- Physician
- witness giving of informed consent for medical procedures which involves: witnessing exchange between client & physician
- establishing that client really did understand that it was truly informed
50
Canadian common law doesn't specify age below which a person is presumed
capable
-some provinces have legislation that lowers age of consent below 18 --minor can give consent if determined has adequate knowledge & judgement
51
Individuals unconscious/injured in a way unable to give consent required substitute consent from ____
another individual
52
Drugs have 3 different names
- generic name: used in most official drug compendiums to list drugs
- chemical name:
- trade name: generally created by manufacturer, propriety name
53
Drugs are grouped together based on similar properties known as
drug classification
54
Pharmacuetics
study of how various dosage forms influence way in which drug effects the body
55
pharmacodynamics
study of what drug does to body
56
pharmacokinetics
study of what body does to drug involving process of absorption, distribution, metabolism & excretion of drugs
57
Drug absorption of various oral preparations
```
fastest --- slowest
liquids (ex. elixirs, syrups)
suspension solutions
powders
capsules
tablets
coated tablets
enteric coated tablets
```
58
Mechanism of action definition
way in which a drug exerts its therapeutic effect
59
Time release technology
used in tablets & capsules, drug molecules are released in pts gastrointestinal tract over an extended period of time
easily identified by various capital letters abbreviations attached to their names such as:
SR (slow release or sustained release)
SA (sustained action)
CR (controlled release)
XL (extended length)
XT (extended time)
Must not be crushed, could cause accelerated release of drug & possible toxicity
60
medication routes
Enteral
Parenteral
Topical
61
Absorption
movement of drug from site of administration into bloodstream for distribution to tissues
62
Bioavailability
extent of drug absoprtion
ex. IV drug has 100% bioavailability
drug absorbed form intestine must first pass through liver before reaches systemic circulation, if large proportion of drug chemically changed into inactive metabolites in liver, much smaller amount of drug will pass into circulation (amount that goes into circulation is amount bioavalible)
63
Anti-inflammatory
Acetysalicylic Acid
64
Anti-pyretics (reduces fever)
acetaminophen
65
Anti-bacterial
```
Cefazloin
Ceftriaxone
Imipenem-Cilastatin
-Metronidazole
-Piperacillin-Tazobactam
-Vancomycin
```
66
Opiods
- Codeine, Fentanyl
| - Hydromorphone, Morphine
67
Opiod antagonist - antidote
Naloxone
68
Acetaminophen
-antipyretic, non-opiod analgesic
MOA: inhibits the synthesis of prostaglandins that may serve as mediators of pain
-few side effects
Assess: may check liver enzymes, do not take with alcohol
69
Morphine
-Opiod analgesics, Opiod agonists
MOA: binds to opiod receptors in CNS. Alters the perception of and response to painful stimuli while producing generalized CNS depression
Side effects: confusion, sedation, hypotension, constipation serious:respiratory depression
Asses: assess level of consciousness, bp, pules & respiration's If resp rate less than 10/min, assess level of sedation
70
Codiene
-Opiod analgesics, opiod agonist
MOA: binds to opiate receptors in CNS, alters perception & response to painful stimuli, while producing generalized CNS depression
side effects: confusion, hypotension, constipation, NV
Assess: assess cough & lung sounds, cough & breathe deeply every 2 hours
71
Hydromorphone
Opiod agonist
MOA: binds to opiate receptors in the CNS, alters the perception of & response to painful stimuli while producing generalized CNS depression
side effects: confusion, sedation, hypotension, constipation
Asses: Bp, pulse and reparations, if rr lower than 10 assess level of sedation, assess bowel function routinely prevention of constipation w fluids, bulk, laxatives, assess cough & lung sounds
72
Vancomyocin
Antibiotic, Glycopeptide antinfective
MOA: inhibits cell wall biosynthesis, blocks glycopeptides polymerization by binding tightly to cell wall precursor
Side effects: nephrotoxicity leading to uremia, hypersensitivity rx (shock-like state)
Monitor: monitor BP & HR, Asses hearing, blood serum levels
73
Fentanyl
Opiod analgesic, Opiod agonist
MOA: binds to opiate receptors in the CNS, altering the response to & perception of pain
Side effects: dizziness, drowsiness, headache, constipation, nausea, vomiting, respiratory depression
Asses: if an opiod antagonist is required to reverse respiratory depression or coma, naloxone (narcan) is anitdote, HIGH ALERT
74
Naloxone (narcan)
opiod antagonist, Antidote (for opiods)
MOA: competitively blocks effects of opiods, including CNS & respiratory depression, without producing any agonist (opiod-like) effects.
side effects: ventricular arrhythmias
Asses: naxolone is a pure antagonist with no agonist properties and minimal toxicity
75
First pass effect
reduces bioavalibilty of drugs to less than 100%
| passes through other before reaching systemic circulation, IV drugs don't have first pass effect
76
enteral route
drgu absorped into systemic circulation through mucosa of stomach/small intestine
77
buccal/sublingual routes
drug absorbed rapidly into highly vascularlized tissue under tounge
78
parenteral route
fastest route drugs can be absorbed
79
absorption
process of movement of a substance from it site of administration, across body membranes to circulating fluids
-primary factor that determines the length of time for the drugs effect to occur
80
distribution
how pharmacological agents are transported throughout body
81
protein binding (of drug)
a percentage of a drug given is bound to proteins (most commonly albumin) this is portion of drug is pharmacologically inactive
-other portion of drug is "unbound" and is responsible for therapeutic effects. It may be termed a "free" drug
82
Metabolism
(also called biotransformation)
process of chemically converting a drug to a from that is usually more easily removed from the body
mostly occurs in the liver
first-pass over effect renders some oral drugs inactive due to hepatic metabolism
83
Excretion
how drugs are removed from the body
84
onset
time it takes for a drug to create a response
85
loading dose
a higher amount of drug given normally once or twice to prime the blood stream with a level of sufficient to induce a therapeutic response
86
peak
time it takes for drug to reach maximum response
87
maintenance dose
before plasma levels can drop back towards zero intermittent maintenance doses are given to keep the plasma drugs levels in therapeutic range
88
duration
length of time that drug concentration is sufficient to create a response
89
half-life
length of time required for a medication to decrease concentration in the plasma by one-half after administration
90
mechanism of action
term refers to the specific biochemical interaction through which a drug substance produces its pharmacological effect
91
potency
amount of drug required to produce an effect
92
agonist
- molecule that activate receptors(neurotransmitters, hormones)
- when drugs act as agonists they bind to the receptor & mimic the action of body's own regulatory molecules
93
antagonist
-produce their effects by preventing activation of receptors by agonists
-can produce benefical pharmacological effects by BLOCKING -actions of endogenous (produced in the body) molecules
or BLOCKING actions of drugs @ receptor sites
94
Resistance (relating drugs)
reduction in effectiveness of a drug
-antimicrobial resistance
narcotic resistance
95
Efficacy (relating to drugs)
-producing a desired effect
| -
96
therapeutic drug monitoring
process of measuring peak & trough levels of a drug in a persons blood w goal of adjusting the dosage to maximize the therapeutic effect (and minimize toxicity)
97
Pregnancy considerations w drugs
medications may pass through placental barrier
98
lactating women considerations w drugs
some medications are passed through breast milk to infant
99
infants (one month to year) considerations with drugs
prescribed in mg/kg or body surface, liver 7 kidney function immature, metabolism & excretion are decreased
100
toddlers (1-3 years)
| preschoolers & school age drug considerations
child resitant containers keep meds out of reach
| syrup of epicac
101
older adult drug considerations
-experience more adverse effects than other age ranges
-gastric ph, motility & gastric emptying are decreased
-decreased production of liver enzymes, liver produces less albumin less proteins for drugs to bind to
-decreased cardiac output
-percentage of body water decreases
POLYPHARAMCY
102
rights of drug administration
```
right client
right medication
right dose
right route of administration
right time of delivery
right documentation
right reason
right to refuse medication
```
103
acute illness
- curable
| - relatively short
104
chronic illness
- long term, generally non-curable
- often associated with disablility but not always
ex. diabetes, cardiovascular, COPD, cancer
105
top 3 leading causes of canadians death
- heart disease
- cancer
- chronic lower respiratory disease
106
risk factors for chronic disease
- smoking
- unhealthy diet
- physical incativity
- overweight & obestiy
107
phases of chronic illness
- pretrajectory:
- trajectory
- stable
- unstable
- acute
- crisis
- comeback
- downward
- dying
108
Characteristic pattern of chronic conditions
-more than medical problems, emotional, psychological, and social distress, threats to identity & role changes-- means continuous adaption & accommodation
-acute periods, stable & unstable periods, flare ups & remissions
-important component for management is adherence & therapeutic regimens (non adherence increases risk developing complications or accelerating disease process.complexities, demands & priorities of life can create challenges to adherence)
-one chronic disease can lead to development of other chronic conditions
-Chronic illness affects whole family. stress & care taker fatigue common w severe chronic conditions
-with today's health care system, self-care is major
-developmental process of trial & error. each person must discover how body acts, fine tuning
-collaborative process of managing chronic illness
-medical management is expensive
-raise difficult ethical issues for pt, health care prof
& society
- living with chronic illness means living w uncertainty
109
Pretrajectory phase of chronic illness
genetic factors or lifestyle behaviors that place an individual or community at risk for the development of chronic disease
110
trajectory phase of chronic illness
appearance of noticeable symptoms; includes period of diagnostic workup & announcement of diagnosis; may be accompanied by biographic limbo as person begins to discover and cope with implications of diagnosis
111
stable phase of chronic illness
illness course & symptoms are under control; biography and everyday life activities are being managed within limitations of illness; illness management centered in the home
112
unstable phase of chronic illness
period of inablilty to keep symptoms under control or reactivation of illness; biographic distribution and difficulty in carrying out everyday life activities; adjustments being made in regimen with care usually taking place @ home
113
acute phase of chronic illness
severe and unrelieved symptoms or the development of illness complications necessitating hospitalization or bed rest to bring illness course under control: biography and everyday life activated temporarily placed on hold or drastically cut back
114
crisis phase of chronic illness
critical or life threatening situation requiring emergency treatment or care; biography and everyday life activities suspended until the crisis passes
115
comeback phase of chronic illness
gradual return to an acceptable way of life within limits imposed by disabilty or illness, involves physical healing, stretching limitations through rehabilitative procedures, psychosocial coming to terms and biographic reangagment with adjustment in everyday life activities
116
downward phase of chronic illness
illness course characterized by rapid or gradual physical decline accompanied by increasing disability or difficulty in controlling symptoms; requires biographic adjustment and alterations in everyday life activities with each major downward step
117
dying phase of chronic illness
final days or weeks before death; characterized by gradual or rapid shutting down of body processes, biographic disengagement and closure & relinquishment of everyday life interests and activities
118
Care by phase for chronic illness by applying the nursing process
Step 1; identifying the trajectory phase
Step 2: establishing goals
step 3: establishing a plan to achieve desired outcomes
step 4: implementing the plan & interventions
step 5: evaluating the effectiveness of interventions
119
clinical presentation of inflm
- redness
- swelling
- pain
- warmth
120
clinical presentation of infection
- redness
- swelling
- pain
- warmth
- exudate
121
risk factors for arthritis
- sex(more likely in women)
- age (40-60)
- family history
- smoking
- environmental exposures
- obesity
122
signs and symptoms of arthritis
- pain
- joint swelling
- limited movement
- stiffness
- weakness
- fatigue
123
medical management & nursing management of arthritis
- ASA
- NSAIDS
- cortcosteriods
- heat, warm moist compress, hot baths
- exercise to keep joints moving
124
risk factors for a urinary tract infection
- female
- cathterization or cystoscopy
- hygiene(incontinence, briefs)
- diabetic (increase glucose in urine)
- inability to empty bladder completely
- obstructed urinary flow
- decreased natural host defenses
- inflammation or abrasion of urethral mucosa
125
signs & symptoms of a urinary tract infection
- foul odur -about 50%of pts have no symptoms
- cognitive changes (older adult)
- dysuria
- frequency, urgency
- nocturia
- incontinence
- suprapubic or pelvic pain
- hematuria or back pain
- fever
126
Managment of UTIS
treat infection (antibiotics )
pain management
increase fluids
avoid irritants
127
Clostridium difficle risk factors
```
antibiotic therapy
surgery of GI tract
disease of colon such as inflammatory bowel disease or colorectal cancer
weakend immune system
use of a chemotherapy drug
```
128
signs and symptoms of clostridum difficle
- watery diarrhea, up to 15X a day
- severe abdominal pain
- loss of appetite
- fever
- blood or pus in stool
- weight loss
129
management of c-diff
- antibiotics (vancomyocin)
- probiotics
- fluids
- fecal transplants
130
Pneumonia risk factors
- conditions that produce mucus or obstruct & interfer w normal drainage
- smoking
- prolonged immobility w shallow breathing
- depressed cough reflex
- advanced age (depressed cough reflex, glottic reflexes & nutrtional depletion)
131
Signs & symptoms of Pneumonia
-vary w type of pneumonia
-fever
-chest pain
-tachypenia
tachycardia
-sputum (green or yellow or other)
-orthopenia
MORE
-
132
managment of pneumonia
- admin of antibiotics
- improving airway patency: remove secretions
- rest & conserve energy
- promote fluid intake
- maintain nutrition
- promote knowledge
- monitor & manage potential complications
133
Diagnostic tests for inflm
- wbc
- differential
- C- reactive protein
- rheumatoid factor
- ESR
134
diagnostic tests for infection
- WBC
| - differential
135
rheumatoid factor
to diagnose rheumatoid arthritis
| -positive results = likely diagnoses of rheumatoid athritis
136
C reactive protein (CRP)
non-specific indicator of inflm
monitor for an increase or decrease in CRP to determine response to therapy or progression of inflammatory, infectious proccess
137
Procalcitonin
detect or rule out bacterial spesis
138
gate theory of pain
The gate control theory of pain asserts that non-painful input closes the "gates" to painful input, which prevents pain sensation from traveling to the central nervous system. Therefore, stimulation by non-noxious input is able to suppress pain.
