318 exam 1 Flashcards
(147 cards)
1
Q
what is QSEN?
A
Quality and Safety Education for Nurses
2
Q
what is the Joint Commission?
A
- National Patient Safety Goals is to improve client safety
- Accrediting body for healthcare organizations & programs
3
Q
what is the trade name of a drug?
A
the proprietary brand name ex: tylenol
4
Q
what is the generic name of a drug?
A
official name, nonproprietary ex: acetaminophen
5
Q
can you crush extended release tablets?
A
extended release tablets should never be crushed or cut in half
6
Q
what are elixers?
A
sweetened, hydroalcoholic liquids used in the preparation of oral liquid medications.
7
Q
what is an emulsion?
A
a mixture of two liquids that are not mutually soluble
8
Q
what is a suspension?
A
liquids in which particles are mixed but not dissolved
9
Q
how are drugs absorbed with transdermal patches?
A
drug is absorbed through the skin producing a systemic effect
10
Q
what is a nebulizer?
A
device that changes a liquid medication into a fine mist or aerosol that can reach the lower, smaller airways
11
Q
what is an MDI?
A
meter-dosed inhaler
handheld device used to deliver asthma and bronchitis drugs to the lower respiratory tract
12
Q
what is a nasogastric (NG) tube?
A
soft, flexible tube inserted via the nasopharynx, with the lip lying in the stomach
13
Q
what is a gastrostomy (G) tube?
A
tube surgically placed directly into the client’s stomach
14
Q
what is a jejunostomy (J) tube?
A
tube surgically placed directly into the jejunum region of the small intestine
15
Q
what is a cone or spindle-shaped suppository best for?
A
the rectum
16
Q
what is a globular or egg shaped suppository best for?
A
the vagina
17
Q
what is a pencil shaped suppository best for?
A
urethra
18
Q
what groups are suppositories best for?
A
babies, uncooperative clients, cases of vomiting or digestive disorders
19
Q
AC, ac meaning
A
before meals
20
Q
HS, hs meaning
A
at bedtime
21
Q
ad lib meaning
A
as desired
22
Q
prn meaning
A
as needed
23
Q
BID, bid meaning
A
twice a day
24
Q
TID, tid meaning
A
three times a day
25
QID, qid meaning
four times a day
26
qam meaning
every morning
27
qh meaning
every hour
28
q4h meaning
every 4 hours
29
qd meaning
every day
30
PO meaning
per mouth (oral)
31
PR meaning
per rectal
32
ID meaning
intradermal (skin)
33
subQ meaning
subcutaneous (into fatty layer btwn skin and muscle)
34
IM meaning
intramuscular (into muscle)
35
IV meaning
intravenous (into vein)
36
IVPB meaning
intravenous piggyback
37
gtt/gtts meaning
drop/drops
38
1 cup to ounces
8 ounces
39
1 glass to ounces
8 ounces
40
1 oz to Tbsp
2 Tbsp
41
1 fl oz to mL
30 mL
42
1 Tbsp to tsp
3 tsp
43
1 tsp to mL
5 mL
44
1 g to mg
1000 mg
45
1 kg to g
1000 g
46
1 kg to lb
2.2 lb
47
1 L to mL
1000 mL
48
1 mg to mcg
1000 mcg
49
1 mL to cubic centimeter
1 cc
50
what happens during the pharmacokinetic phase?
Absorption
Distribution
Metabolism
Excretion
51
what happens during the pharmacodynamic phase?
Receptor binding
Post-receptor effects
Chemical reaction
52
what happens during drug absorption in pharmacokinetics?
Drug movement from GI tract into bloodstream
53
what happens during disintegration in pharmacokinetics?
Breakdown of oral drug form into small particles
54
what happens during dissolution in pharmacokinetics?
Process of combining small drug particles with liquid to form a solution
55
what happens in passive transport? (pharmacokinetics) (absorption method)
diffusion and facilitated diffusion
56
what happens in active transport? (pharmacokinetics) (absorption method)
Requires energy and carrier substance (enzyme)
57
what happens in pinocytosis? (pharmacokinetics) (absorption method)
Cell carries drug across membrane by engulfing drug particles.
58
what are factors that affect absorption? (pharmacokinetics)
Blood circulation
Pain, stress
Food texture, fat content, temperature
pH
Route of administration
59
how do drugs move from GI tract to liver? (pharmacokinetics)
Via portal vein
First pass effect
60
what factors impact bioavailability? (pharmacokinetics)
Drug form
Route of administration
Gastric mucosa and motility
Administration with food and other drugs
Changes in liver metabolism
61
what is distribution moving across? (pharmacokinetics)
movement across the blood brain barrier
62
what are enzymes of the liver? (part of drug metabolism)
Aspartate transaminase (AST)
Alanine aminotransferase (ALT)
Alkaline phosphatase (ALP)
63
what are components we assess when looking at drug excretion in the kidneys?
Creatinine clearance
BUN
Glomerular filtration rate
64
what are factors that affect drug excretion?
Drugs that affect renal excretion
Drugs that decrease cardiac output
Use of diuretics
Competition of drugs that undergo the same route of excretion
Change of urine pH
clients with decreased renal or hepatic function
65
what are labs we look at for drug excretion?
Kidney- Creatinine (CR) and blood urea nitrogen (BUN)
66
what is the primary effect? (pharmacodynamics)
desirable response
67
what is the secondary effect? (pharmacodynamics)
desirable or undesirable
68
what is the onset of a drug? (pharmacodynamics)
Time it takes for drug to reach minimum effective concentration
69
what is the peak of a drug? (pharmacodynamics)
when its the highest concentration in the blood
(Drawn at a specific time AFTER the dose is given)
70
what is the duration of a drug? (pharmacodynamics)
Length of time taken for a drug to exert a therapeutic effect
71
what is the trough drug level? (pharmacodynamics)
Drawn just before the next dose
Point of lowest concentration of the drug
72
what is the receptor theory? (pharmacodynamics)
Drugs bind to receptors
To activate receptor
To produce a response
To inactivate a receptor
73
what do agonists do? (pharmacodynamics)
Activate receptors
Produce desired response
74
what is pharmacodynamics?
study the way drugs affect the body
75
what do antagonists do? (pharmacodynamics)
prevent receptor activation
block response
76
where are cholinergic receptors located? (pharmacodynamics)
in the bladder, heart, blood vessels,
stomach, bronchi, and eyes.
77
what receptors does epinephrine affect? (pharmacodynamics)
alpha1: blood vessels (inc. BP)
beta1: heart (inc. HR)
beta2: bronchus (relax bronchioles)
78
what are mechanisms of drug action? (pharmacodynamics)
Stimulation
Depression
Irritation
Replacement
Cytotoxic action
Antimicrobial action
Modification of immune status
79
what are side effects? (pharmacodynamics)
secondary drug effects
80
what are adverse reactions? (pharmacodynamics)
more severe than side effects
undesirable
81
what is drug toxicity? (pharmacodynamics)
drug level exceeds therapeutic range
82
what are biologic variations looking at? (pharmacogenetics)
Study of genetic factors influencing individual response
83
what is tachyphylaxis? (pharmacogenetics)
Acute, rapid decrease in drug responsiveness regardless of time
84
what is tolerance? (pharmacogenetics)
decreased drug responsiveness over time
85
what is the placebo effect? (pharmacogenetics)
drug response not attributed to chemical drug properties
86
what are drug interactions? (pharmacodynamics)
Altered drug effect due to interaction with another drug
87
what are Pharmacokinetic interactions?
Changes occurring in absorption, distribution, metabolism, and excretion
88
Pharmacodynamic Interactions:
what is an additive?
Sum of effects of two drugs (1 + 1 = 2)
89
Pharmacodynamic Interactions:
what is syngenetic effect?
Effect is much greater than effects of either drug alone (1 + 1 > 2)
90
Pharmacodynamic Interactions:
what is antagonistic effect?
One drug reduces or blocks effect of the other drug
91
what are Drug-nutrient interactions?
Food may increase, decrease, or delay drug response.
92
what are Drug-laboratory interactions?
Drugs may cause misinterpretation of test results.
93
what is Drug-induced photosensitivity?
Skin reaction caused by sunlight exposure.
94
what is genetic testing used for?
- to identify a trait
- Diagnose a genetic disorder
- Identify individuals who have a genetic predisposition to diseases
95
what is genomics?
The study of all the genes in the human genome together, including their interaction with one another, their interactions with the environment, and the influence of other cultural and psychosocial factors
96
what do healthcare providers used genomic info for?
Tailor treatments to the individual client
Personalize the care for the client
97
what is carrier testing?
Testing to determine if a person “carries” the genetic variation that causes a disease
98
what is diagnostic testing?
Identifies a genetic variation that is either causing a person to have a genetic condition or disease or may cause a condition in the future
99
what is pharmacogenetics?
The field of research that looks at the difference in each individual’s response to medications based on genetic variations
100
what is the goal of pharmacogenetics?
To create an individualized drug treatment program that involves the best choice and dose of drugs for a particular client
101
is there is a direct correlation between genetic makeup to drug response, drug-drug interactions, and adverse drug events?
yes
102
can an individual’s genetic markers pave the way for pharmacotherapy with a more therapeutic benefit and decreased amount of adverse reactions?
yes
103
who are opioids less effective for?
Caucasians, Asians, and those from Middle East
104
what is Pharmacogenomics?
The field of research that looks for genetic variations associated with drug discovery and development
105
what did Pharmacogenomics lead to?
to the creation of new drugs that can be tailor-made for each specific client and adapted to that person’s particular genetic makeup
106
how do you complete the 'right client' part of med admin?
Two forms of identification required
107
how do you complete the 'right drug' part of med admin?
- Prescription must be prescribed by licensed health care provider
- Drug label must be read three times
- Nurse should be familiar with client’s health record, allergies, lab results, and vital signs
- Nurse should know why the client is receiving medication
108
how do you complete the 'right dose' part of med admin?
Nurse should check dosage calculation
109
how do you complete the 'right time' part of med admin?
- Use health care agency policy
- Use of military time reduces errors
110
how do you complete the 'right route' part of med admin?
- Necessary for adequate absorption
- Assess ability to swallow
- Do not crush, cut or mix medications without instruction
- Check if client is scheduled for diagnostic procedures or dialysis
- Offer water (Place nearby within easy reach)
111
what ethical rights are a RN's reponsibility?
- Right assessment
- Client’s right to education
- Right evaluation
- Client’s right to refuse
112
how do you complete the right assessment?
Collect appropriate baseline data before drug administration
(Health history, allergies, vital signs, lab results)
113
what is the nurses responsibility with eduation when administrating meds?
Teach client accurate and complete drug information
114
what is the nurses responsibility with evaluation of medication admin?
- Determine drug effectiveness
- Determine side effects and adverse drug reactions
115
what is the nurses responsibility when the patient has the right to refuse?
- Nurse should explain risks involved
- Nurse should reinforce reasons and benefits of the drug
- Nurse should document refusal immediately
- Follow-up is required
116
what are nurses rights when administering meds?
- Right to a complete and clear prescription
- Right to have the correct drug, route (form), and dose dispensed
- Right to have access to information
- Right to have policies to guide safe medication administration
- Right to administer medications safely and to identify system problems
- Right to stop, think, and be vigilant when administering medications
117
what is the culture of safety?
ANA encourages organizations to avoid punitive approaches in drug error reporting
118
what is Just Culture?
Fair and not punitive
Encourages reporting of errors
Goal is to repair system
119
what is The Joint Commission (TJC)?
- has taken steps to support safety and quality care in the workplace
- developed National Patient Safety Goals
- focuses on health care safety problems and resolution
120
what are steps to drug reconcilliation?
- Develop an accurate list of current medications
- Advise client to always carry a list of personal drug information in the case of emergency
- Advise client to update drug list whenever a change occurs
- Advise client to bring a list of medications to each doctor appointment
121
what is the correct disposal of medications?
- follow specific information on drug label or insert
- Transfer drug from original container to undesirable substance (i.e., kitty litter)
- Place mixture in container (i.e., sealed plastic bag)
- Remove all identifying information on label before disposing of empty container
- Do not flush drugs down toilet unless specifically instructed
- Return drugs to community “drug take-back” program
- Consult pharmacist if any disposal questions
122
who contributed to Sharps safety?
The Occupational Safety and Health Administration (OSHA) Needlestick Safety and Prevention Act of 2000
The Consensus Statement and Call to Action (2012)
123
what kind of tablets can be split?
scored tablets
124
what should you do before crushing a drug?
Always consult pharmacist, health care provider, or reliable drug source
125
what are high alert medications?
Can cause significant harm if given in error
ex: Epinephrine, insulin, opium tincture, nitroprusside, potassium chloride injection concentrate, heparin, warfarin
126
what should you do for error reporting?
- ask Is the client safe?
- Notify immediate supervisor
- Check for adverse drug reporting
- Identify your responsibility for external reporting
U.S. Pharmacopeia Medication Errors Reporting Program
1-800-233-7767
127
what is autonomy?
right to self determination
128
what is beneficence?
obligation of the RN to protect the client from harm
129
what is a nurses role in clinical safety?
Responsible for client safety and integrity of research protocol
130
how does total body water and lean body mass change in geriatric patients?
it decreases
131
how does kidney mass and function change in geriatric patients?
it reduces
132
how does liver mass and function change in geriatric patients?
it reduces
133
how does physiologic processes that maintain equilibrium change in geriatric patients?
it reduces over time
134
what are 4 parts of pharmacokinetics?
Absorption
Distribution
Metabolism
Excretion
135
what is Beers criteria for potential inappropriate drug use?
1. Medications to avoid if you’re over 65 years old and not in a hospice or a palliative care setting.
2. Medications to avoid among people with certain health conditions.
3. Medications to avoid that cause drug interactions when combined with other medications.
4. Medications to avoid due to harmful side effects that outweigh the benefits.
5. Medications to use at limited doses or avoided due to their effects on kidney function (renal impairment).
136
what does Beers criteria address?
The American Geriatrics Society uses specific criteria to list potentially inappropriate medications for adults over age 65
137
what are ways to teach older adults?
- make sure their senses are as sharp as possible (clean eyewear, functional hearing aids)
- speak in clear tones
- face client when speaking
- limit distractions
- treat client w respect
- use large print and bright colors
138
what are influencing factors of absorption of drugs with pediatric patients? (pharmacokinetics)
- Child’s age, health status, weight, route of administration
- Nutritional habits, physical maturity, hormonal differences
- Hydration, underlying disease, GI disorders
139
why is topical creams different with pediatric patients?
the skin is more thin and porous
140
what decreases the absorption of enteric coated tablets?
high fat foods
141
what changes in absorption occur in older patients? (pharmacokinetics)
GI changes: decrease in sm. bowel surface area, slowed gastric emptying, red. gastric blood flow, 5-10% decrease in gastric acid production
142
what does reduction in albumin impact with older patients? (pharmacokinetics)
10% reduction in albumin which results in
decreased protein binding of drugs and
increased free drug availability
(leads to increased therapeutic effect) (increase risk for toxicity)
143
what does increased body fat in older patients impact?
lipid soluble drugs have a greater volume of distribution
increased drug storage reduced
elimination and prolonged period of
actions
144
what happens to the hepatic blood flow of older patients?
may be decreased by as much as 40 percent
145
what does the reduction of hepatic metabolism impact?
can decrease the first pass metabolism and can prolong the half-life of a drug
liver enzymes should be
checked periodically if an older person
is on medication for a long period of
time
146
what happens as renal excretion and kidneys decrease with age?
leads to a prolonged half life and elevated drug levels dosage adjustments may be required
drug stays in body longer, might lead to drug toxicity
147
