1
Q
What are 5 causes of diarrhea?
A
drugs
bacteria
viruses
dietary intolerances
chronic conditions
2
Q
definition of diarrhea
A
increase in frequency and fluidity of BMs
3
Q
what is the range of time for diarrhea to be considered acute?
A
3 days - 2 weeks
4
Q
chronic diarrhea may last how long?
A
3-4 weeks
5
Q
Three possible effects of diarrhea on the body
A
weight loss
nutritional deficits
F&E imbalances
6
Q
Antidiarrheals are contraindicated if what two causes are expected?
A
C. difficile or E. coli
7
Q
a substance that attracts and holds substances on its surface
A
adsorbent
8
Q
medical name for Pepto Bismol
A
bismuth salicylate
9
Q
True or False: bismuth salicylate is an adsorbent antidiarrheal
A
True
10
Q
What does bismuth subsalicylate treat? (pepto bismol)
A
mild to moderate diarrhea
11
Q
What are the nursing implications for giving Pepto Bismol?
A
Interacts with aspirin, warfari and NSAIDs
May cause tongue and stools to darken
12
Q
Lomotil is an antidiarrheal made up of what two drugs?
A
diphenoxylate and atropine
13
Q
How does diphenoxylate/atropine (Lomotil) affect diarrhea?
A
Reduces bowel motility and transit time
Reduces rectal spasm pain
Decreases stool frequency and volume
14
Q
What type of drug is diphenoxylate and what are its Adverse Effects?
A
A Schedule V (weak) opioid.
It is a synthetic opiate agonist that slows overactive bowel.
AE: drowsiness, dizziness
15
Q
What type of drug is atropine and why is it given with diphenoxylate?
A
An anticholinergic that discourages recreational use of the opiate.
16
Q
What are the opiate antidarrheals?
A
diphenoxylate/atropine (Lomotil)
loperamide (Imodium)
17
Q
Which synthetic opioid medication is available OTC as an antidiarrheal?
A
loperamide (Imodium)
18
Q
What affects does loperamide (Imodium) have on the intestines?
A
inhibits peristalsis and prolongs transit time
direct effect on the nerves in the intestinal muscle wall
decreased fecal volume and frequency
available OTC
19
Q
What antidiarrheal is a probiotic that restores normal intestinal flora, especially after a course of antibiotics?
A
Lactobacillus acidophilus
20
Q
What foods naturally have probiotics like Lactobacillus acidophilus?
A
whole grains, beans - fiber and fermented foods like yogurt and kimchi
21
Q
What is constipation?
A
Infrequent passage of abnormally hard/dry stools - two or less per week
22
Q
The feeling of incomplete evacuation is associated with what?
A
Constipation
23
Q
What should we remember about administering PO laxatives within 2 hours of other meds?
A
Could decrease absorption of med
24
Q
What are common AEs for laxatives?
A
bloating, gas, abdominal discomfort, cramping
25
True or False: Laxatives are for short term use only
True
26
What 2 conditions are laxatives contraindicated with?
GI obstruction and bowel perforation
27
Which laxative is bulk forming - increases fecal mass?
psyllium
28
Which laxative is the safest for prevention and long-term management of constipation?
psyllium (Metamucil)
29
What is the Nursing Implication for administering psyllium?
the mixture congeals so ensure patient drinks it immediately to prevent obstruction
30
What are two emollient laxatives?
docusate sodium (Colace) and mineral oil
31
Which laxative promotes water and fat absorption to ease the passage of stool?
docusate sodium
32
Which laxative is an osmotic agent used as a bowel cleanser to prep for colon procedures?
polyethylene glycol 3350 (Golytely, MiraLax)
33
What are the nursing implications for polyethylene glycol 3350 used for bowel prep?
Drink 8oz every 10-15 mins the day before a procedure
34
True or False: Miralax (polyethylene glycol 3350) can be used for treating constipation for up to 14 days in addition to using for bowel prep.
False - up to 7 days
35
How does saline affect constipation?
Increases osmotic pressure and draws water into the colon
36
Which laxatives use saline to draw water into the colon?
Fleet enema (saline enema), magnesium hydroxide (Milk of Magnesia), magnesium citrate (Citroma)
37
Which laxative is contraindicated in renal disease?
magnesium hydroxide (Milk of Magnesia)
38
Which laxative is also an antacid?
magnesium hydroxide
39
What are the NI for magnesium hydroxide?
Shake the solution; watch for signs of F&E imbalance
40
What two types of laxatives are used for bowel prep?
magnesium citrate (Citroma) and polyethylene glycol (MiraLax and Golytely)
41
What are the nursing implications for magnesium citrate?
refrigerate; monitor for fluid and electrolyte imbalance
42
What are two stimulant laxatives?
bisacodyl (Dulcolax)
Senna (Senokot)
43
How do stimulant laxatives work?
Stimulate the intestinal nerves to induce peristalsis and increase H2O in colon
44
What type of laxatives are most prone to dependency/habit forming?
stimulants - bisacodyl (Dulcolax) and Senna (Senokot)
45
NI for stimulant laxatives
electrolyte imbalances; do not take bisacodyl within 1 hour of milk or antacids; taking a stimulant laxative decreases transit time for drugs and increases motility
46
What are some of the effects of laxative use and abuse?
loss of muscle and nerve response
Increased risk of dehydration in older individuals
Increased risk of fluid and electrolyte imbalances
47
What aging changes affect BMs?
decreased water and fiber intake
decreased activity
chronic illness may delay evacuation
increased usage of laxatives
48
What percentage of patients experience a medication error?
3-6.9%
49
What are near misses?
A pt. is exposed to a med error but is not harmed due to detection or luck
50
When can med errors occur?
At any time from prescribing to filling to administering
51
What are the 5 stages of the medication process?
Prescribing
Transcribing
Dispensing
Administering
Monitoring
52
What is involved in the Prescribing stage of the medication process
Clinical decision making by HCP/pharmacist regarding:
-Drug choice
-Drug regimen
Medical record documentation
Order (verbal, written, electronic)
53
What is involved in the Transcribing stage of the medication process?
The nurse receives an order from the eMAR and checks it to make sure its correct
54
What is involved in the Dispensing stage of the medication process?
The pharmacist:
-Enters the order data and screens the med
-Prepares, mixes and/or compounds the medication
-Double checks the order and medication
-Dispenses the medication to the unit
55
What is involved in the Administration stage of the medication process?
The nurse:
-prepares the drug for administering
-verifies the order
-administers the drug
-Documents in eMAR
56
What is involved in the Monitoring stage of the medication process?
The nurse, physician or pharmacist:
-Assess the pt. for therapeutic and adverse effects
-Review the lab results if necessary
-Treat AE if occurring
-Document in medical record
57
What types of formal reports/measurements are created in the Monitoring stage?
Mandatory safety reporting for serious events internally in the health care org, to the FDA and the state
Voluntary safety reporting for learning
Outcomes measurement for certain pops
58
The stages of the medication process lead to what?
Quality Improvement Activities
59
What are examples of failure to assess/evaluate on the part of the nurse?
-Not seeing significant changes in pt. condition after med administered
-Not reporting the changes in condition after medication
-Not taking a complete medication history and nursing assessment/history
60
What are examples of failure to ensure safety (during drug therapy) on the part of the nurse?
-Not monitoring pt. after med admin
-Lack of adequate monitoring
-Failure to identify pt. allergies and other risk factors related to medication therapy
-Inappropriate drug admin. technique
-Failure to implement appropriate nursing actions based on a lack of proper assessment of patient's condition
61
What are examples of med errors on the part of the nurse?
-Not clarifying unclear med order
-Failure to identify and react to adverse drug reactions
-Being unfamiliar with a medication prior to its administration
-Not maintaining your level of professional nursing skills for current practice
-Not identifying the patient's identity prior to drug admin
-Not documenting drug admin in eMAR
-Failure to provide the nursing care that was documented
62
What are the 5 to 9 rights of medication administration
1. Right drug
2. Right dose
3. Right time
4. Right route (and form)
5. Right patient
6. Right documentation
7. Right reason
8. Right response
9. Right to refuse
63
How do you ensure you are giving a medication to the right patient?
Ask pt. name and date of birth
Verify with ID band
Verify with eMAR
64
What are the components of a medication order?
Patient's Name
Medication Name
Dose with unit measurement
Frequency
Route
Prescriber's signature with date and time
Indication (sometimes - on PRN, not always on all meds)
65
What system is used to distinguish between sound-alike, look alike (SALAD) drugs?
TALLman lettering
66
What are the two types of adverse drug events?
Medication Errors
Adverse Drug Reactions
67
What are some of the negative effects of Adverse Drug Events (ADEs)?
Prolonged hospitalization
Disability
Life-threatening
Death
68
What are the 4 types of Adverse Drug Reactions?
Drug-Drug Interactions
Known Adverse Effects
Allergic Reaction
Idiosyncratic
69
What are the major differences in Adverse Drug Reactions and Medication Errors?
ADRs may or may not be preventable.
They are unexpected and unintended.
And they occur at therapeutic dosages.
Medication errors are preventable.
There is an error in the med process that may or may not cause harm.
The patient rights are compromsised.
70
How do known adverse effects resolve?
Discontinuation of the med
71
What are idiosyncratic Adverse Drug Reactions?
Unpredictable, unexpected outcomes that are rare and peculiar
72
What are 8 common causes of med errors?
Not doing "three checks"
Giving meds to the wrong patient
Confusing sound-alike and look-alike drugs
Not obtaining a thorough medical history
Lack of knowledge (of drug and its affects or how to administer)
Dosing miscalculations
Work-arounds
Environmental factors
73
What are 11 ways to prevent med errors?
Take every med pass seriously
Assess drug allergies, vital signs and lab data
Never administer drugs you did not prepare yourself
Recalculate doses for high alert meds, pediatric patients and second RN
Avoid verbal orders if possible
Use authoritative sources
Question the need for overriding systems
Investigate patient concerns
Seek translators when needed
Ask questions!
Report errors and near misses
74
How to report and document a med error
1. assess the pt. first
2. report to the instructor and nurse
3. monitor changes in condition
4. document follow-up assessments using factual info
5. Notify physician and follow-up orders
6. Provide full disclosure to the pt.
7. File incident report; report is not documented in the chart
75
K+ is the most abundant cation in the ICF or ECF?
ICF
76
Na+ is the most abundant cation in the ICF or ECF?
ECF
77
What type of electrolyte is Chloride and where is it more concentrated?
anion; ECF
78
What is the function of the sodium potassium pump?
Powered by the hydrolysis of ATP, it pumps 2 K+ ions into the cell and 3 Na+ ions out of the cell against their concentration gradient.
79
Which organ regulates Na+ and what is the result?
Kidneys - appropriate levels of sodium controls water distribution throughout the body (because water follows sodium), helping maintain fluid balance
80
What are the functions of Na+?
-primary determinant of osmolality (solute concentration) in the ECF
-influences water distribution between the ECF and ICF
-helps maintain blood pressure
-affects transmission of nerve impulses, muscle contractility and body's acid-base balance
81
What does the concentration of Na+ in blood serum reflect?
The ratio of Na+ to water in the blood
82
What is the normal lab range for sodium?
135-145 mEq/L
83
passive movement of a solvent (water) from area of low solute concentration to high solute concentration
osmosis
84
the amount of water and sodium in your body both decrease, but the amount of sodium decreases more.
hypovolemic hyponatremia
85
Causes of hypovolemic hyponatremia
excessive sweating
vomiting
diarrhea
diuretics
86
the amount of water and sodium in your body both increase, but the amount of water increases more.
hypervolemic hyponatremia
87
Causes of hypervolemic hyponatremia
Fluid volume overload d/t:
kidney failure
liver failure
heart failure
88
Edema is common with ...?
Chronic conditions w/ hypervolemic hyponatremia
89
S/Sx of hyponatremia
Stupor/coma
Anorexia
Lethargy
Tendon reflexes decrease
Limp muscles/cramps
Orthostatic hypotension
Seizures
Stomach cramps
Headache
Altered mental status
90
Interventions for hypovolemic hyponatremia
withhold diuretics
replace sodium and water
isotonic IV therapy
91
What is isotonic IV therapy and what are some examples?
solution that has same/similar concentration as blood plasma so water does not move in/out of cells
Examples are: 0.9% NaCl (normal saline), lactated ringer and dextrose in water (D5W)
92
Nursing Implications (involvement in care) for both types of hyponatremia
1. Conduct a neurological assessment
2. Implement seizure precautions if severe
3. Implement fall precautions
4. Monitor I/Os
5. Take daily weights if edema is present (hypervolemic)
93
high serum sodium concentration due to more water being lost OR more Na+ being gained
hypernatremia
94
95
Causes of hypernatremia
Greater water loss than Na+:
dehydration (loss of water)
inadequate water intake
high fever
diarrhea
Excess Na+ gain
excess IV fluids containing
Na+
excess oral intake of Na+
(sea water/diet)
96
True or False: diarrhea can cause hypovolemic hyponatremia and hypernatremia
True
97
S/sx of hypernatremia
Flushed skin
Restless
Intense thirst
lEthargy
Decreased urine output
Skin is dry
Agitation
Low grade fever
Thirst, sticky mucous membranes
Seizures or coma if severe
98
Interventions for Hypernatremia
Restrict sodium intake
Replace fluids via PO or IV
99
Implications of hypernatremia for Nurses
neurological assessment
seizure precautions
fall precautions
100
What are areas of potential liability for nurses related to medications?
1. Failure to assess/evaluate
2. Failure to ensure safety
3. Medication errors
4. Fraud
101
102
What is the relationship between K+ and aldosterone?
High aldosterone levels can lead to low potassium levels aka hypokalemia.
103
Do K+ and Na+ have an inverse relationship?
Yes
104
How do low potassium levels (hypokalemia) affect insulin and ultimately blood sugar?
Low K+ = low insulin production = high glucose levels = high blood sugar.
105
What is the affect of insulin on the Na/K pumps?
When glucose enters bloodstream, K+ moves out of cell with glucose. Insulin release increases the number of pumps so K+ and glucose return to the cell and Na+ goes to ECF.
106
What is the main source of potassium and where is the majority found in the body?
Source - diet
Found mainly in muscles
107
True or False: the kidneys eliminate approx. 80% of K+ from our body.
False - 90%
108
Normal range for K+
3.5-5 mEq/L
NRAD 201D
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