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ATI (chp 1,2,5,6,30) > ATI (chp 30) > Flashcards

ATI (chp 30) Flashcards

(96 cards)

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1
Q

Potassium and magnesium regulate

A

body fluid volume

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2
Q

Iron preparations –> select prototype medications

A

◯ Oral: Ferrous sulfate (Feosol, FeroSul, Slow FE)

◯ Parenteral: Iron dextran (INFeD, DexFerrum)

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3
Q

Iron preparations provide

A

iron needed for RBC development and oxygen transport to cells.

treat iron-deficiency anemia

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4
Q

When is iron in high demand

A

times of increased growth (children and pregnancy) and after blood loss

poorly absorbed by the body

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5
Q

Ferumoxytol is limited to clients

A

with chronic kidney disease

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6
Q

requires only 2 doses every 3 to 8 days

A

■ Ferumoxytol requires only two doses over 3 to 8 days

compared with SFGC and iron sucrose,
which requires 3 to 10 doses over several weeks.

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7
Q

Iron sucrose and SFGC are used solely for clients

A

undergoing long-term hemodialysis (most common way to treat advanced kidney failure)

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8
Q

Adverse effects of Iron

A

-GI distress
-teeth staining (liquid form)
-anaphylaxis risk w/ iron dextran
-Hypotension, which may progress to
circulatory collapse
-fatal iron toxicity in children may offer with overdose (2 - 10 g)

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9
Q

What can be used parenthetically to treat toxicity from iron in children?

A

chelating agent deferoxamine

Desferal

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10
Q

Iron Preparations are contraindications for:

A

Hemolytic anemia
peptic ulcer disease
severe liver disease

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11
Q

Coadministration of ___________ and _____________

reduces absorption of iron.

A

antacids or tetracyclines

separate by atleast 2 hours

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12
Q

Vitamin C increases absorption, but also increases ____________

A

incidence of GI complications

Avoid taking Vitamin C while taking iron

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13
Q

Patient-Centered Care w/ iron

A

-eat on empty stomach to maximize absorption
-Instruct clients to space doses at approximately equal intervals throughout day to most efficiently
increase red blood cell production. Inform clients to anticipate a harmless dark green or black color
of stool.

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14
Q

Foods full of iron

A

(liver, egg yolks, muscle

meats, yeast, grains, green leafy vegetables)

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15
Q

Nursing evaluation on Iron EFFECTIVENESS:

A

Increased reticulocyte count is expected at least 1 week after beginning iron therapy

Increase in hemoglobin of 2 g/dL is expected 1 month after beginning therapy.

Fatigue and pallor (skin, mucous membranes) have subsided, and the client reports increased
energy level.

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16
Q

Vitamin B12

A

intranasal cyanocobalamin (Nascobal)

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17
Q

Vitamin B12 is necessary to convert

A

folic acid from its inactive form to its active form.

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18
Q

Folic Acid

A

All cells rely on folic acid for DNA production.

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19
Q

Vitamin B12 deficiency can result in

A

which results in megaloblastic
anemia (macrocytic) and can cause fatal heart failure if not corrected

-Damage to rapidly multiplying cells can affect the skin and mucous membranes, causing GI disturbances.

Neurologic damage, which includes numbness and tingling of extremities and
CNS damage caused by demyelination of neurons,

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20
Q

Vitamin B12 deficiency affects ALL ________ in ____________

A

blood cells in bone marrow

Loss of erythrocytes leads to heart failure, cerebral vascular insufficiency, and hypoxia.
■ Loss of leukocytes leads to infections.
■ Loss of thrombocytes leads to bleeding and hemorrhage.

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21
Q

Why would a patient need B12 prescribed for the rest of life?

A

Loss of intrinsic factor within the cells of the stomach make in impossible to absorb B12 naturally

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22
Q

Adverse effect of B12

A

Hypokalemia secondary to the increased

RBC production effects of vitamin B12

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23
Q

Nursing Interventions of B12 to prevent hypokalemia

A

Monitor potassium levels during the start of treatment.
› Observe clients for findings of potassium deficiency
(muscle weakness, abnormal cardiac rhythm).
› Clients may require potassium supplements.

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24
Q

Hypokalemia

A

Low potassium in your bloodstream. Potassium is a chemical (electrolyte) that is critical to the proper functioning of nerve and muscles cells, particularly heart muscle cells.

Normally, your blood potassium level is 3.6 to 5.2 millimoles per liter (mmol/L). A very low potassium level (less than 2.5 mmol/L) can be life-threatening and requires urgent medical attention.

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25
Contraindication of using folic acid to treat Vitamin B12 deficiency
Vitamin B12 deficiency should never be treated only with folic acid, which can result in neurological damage. If folic acid is used for a client with vitamin B12 deficiency, ensure that dosage is adequate.
26
Oral and intranasal vitamin B12 are what pregnancy category?
Pregnancy Risk Category A
27
Parenteral formulation of Vitamin B12
is Pregnancy Risk Category C
28
signs of vitamin B12 deficiency
such as beefy red tongue, pallor, neuropathy
29
Which patients receive Vitamin B12 injections
loss of intrinsic factor (pernicious anemia), enteritis, and partial removal of the stomach
30
This type of Vitamin B12 medication should be taken atleast 1 hour before or after HOT food
Intranasal cyanocobalamin should be administered 1 hr before or after eating hot foods, which can cause the medication to be removed from nasal passages without being absorbed because of increased nasal secretions.
31
irreversible malabsorption syndrome
(parietal cell atrophy or total gastrectomy)
32
Food group high in Vitamin B12
dairy products
33
Schillings test
to determine vitamin B12 absorption in the gastrointestinal tract. Measurement of plasma B12 levels helps to determine need for therapy.
34
Prescribed Vitamin B12 tests
vitamin B12 levels should be monitored every 3 to 6 months
35
VITAMIN B12 Nursing Evaluation of Medication Effectiveness
◯ Improvement of megaloblastic anemia as evidenced by increased reticulocyte count, absence of megaloblast in bone marrow, macrocytes in blood, and normal or increased Hgb and Hct levels. ◯ Improvement of neurologic symptoms such as absence of tingling sensation of hands and feet and numbness of extremities. Improvement may take months, and some clients will never attain full recovery.
36
Folic Acid is essential for
Folic acid is essential in the production of DNA and erythropoiesis (RBC, WBC, and platelets)
37
Treatment of megaloblastic (macrocytic) anemia ___________ to folic acid deficiency
secondary
38
Why is folic acid needed for all woman of child bearing age?
Prevention of neural tube defects during pregnancy
39
Malabsorption Syndrome
refers to a number of disorders in which the intestine’s ability to absorb certain nutrients, such as vitamin B12 and iron, into the bloodstream is negatively affected.
40
Folic acid can help treat which malabsorption syndrome
sprue
41
Alcohol Use Disorder needs FOLIC ACID supplementation because...
required due to poor dietary intake of folic acid and injury to the liver
42
Folate effect is antagonized by
chloramphenicol | chloromycetin sodium succinate
43
Folate may decrease
phenytoin serum levels because of increased metabolism
44
Assess patient for signs of megaloblastic anemia which may indicate folic acid deficiency
``` megaloblastic anemia (pallor, easy fatigability, palpitations, paresthesias of hands or feet). ```
45
Food sources of folic acid
green leafy vegetables, citrus fruits, and dried peas and beans. Monitor clients for risk factors indicating that folic acid therapy may be needed, such as heavy alcohol use and child-bearing age.
46
Select Prototype Medication: potassium chloride (K-Dur, Klor-Con, Slow-K, KCl 5%)
Other Medications: ◯ Potassium gluconate ◯ Potassium phosphate ◯ Potassium bicarbonate
47
Potassium is essential for....
conducting nerve impulses maintaining electrical excitability of muscle regulation of acid/base balance
48
Potassium supplements are used to treat what???
hypokalemia (potassium less than 3.5 mEq/L
49
When are potassium supplements used?
- For clients receiving diuretics resulting in potassium loss, such as furosemide (Lasix) -For clients with potassium loss due to excessive or prolonged vomiting, diarrhea, abuse of laxatives, intestinal drainage, and GI fistulas
50
What to do if patient is getting a GI ulcer due to potassium supplement?
› Instruct clients to take the medication with meals or a full glass of water to minimize GI discomfort and prevent ulceration. › Teach clients not to dissolve the tablet in the mouth because oral ulceration will develop.
51
Too much potassium is an adverse effect that can cause _______ when administered with an IV
Hyperkalemia (potassium > 5.0 mEq/L) Monitor clients receiving IV potassium for signs of hyperkalemia, such as bradycardia, hypotension, ECG changes.
52
Potassium contraindications:
severe kidney disease hypoaldosteronism digitalis toxicity with AV block.
53
Concurrent use of potassium-sparing diuretics, such as spironolactone or ACE inhibitors (lisinopril)
INCREASES risk of HYPERkalemia
54
Potassium Oral Administration
◯ Mix powdered formulations in at least 4 oz of liquid. ◯ Advise clients to take potassium chloride with a glass of water or with a meal to reduce the risk of adverse GI effects. ◯ Instruct clients not to crush extended-release tablets. ◯ Instruct clients to notify the provider if they have difficulty swallowing the pills. Medication may be supplied as a powder or a sustained-release tablet that is easier to tolerate.
55
Potassium IV Administration
◯ Never administer IV bolus. Rapid IV infusion can result in fatal hyperkalemia. ◯ Use an IV infusion pump to control the infusion rate. ◯ Dilute potassium and give no more than 40 mEq/L of IV solution to prevent vein irritation. ◯ Give no faster than 10 mEq/hr. ◯ Cardiac monitoring is indicated for serum potassium levels outside of normal parameters. ◯ Assess the IV site for local irritation, phlebitis, and infiltration. Discontinue IV immediately if infiltration occurs. ◯ Monitor the client’s I&O to ensure an adequate urine output of at least 30 mL/hr.
56
Normal Serum Potassium level is _________ and helps a nurse assess the effectiveness of medication
serum potassium level within | expected reference range (3.5 to 5.0 mEq/L).
57
Magnesium Sulfate Oral Name
``` Magnesium hydroxide (Milk of Magnesia [MOM]) and magnesium oxide (Uro-Mag, Maox), magnesium citrate (Citrate of Magnesia, Citroma, Citro-Nesia) ```
58
Magnesium hydroxide and magnesium oxide, when administered at a low does, act as what?
antacid --> act as laxative
59
Function of magnesium in the body:
activates many intracellular enzymes and plays a role in regulating skeletal muscle contractility and blood coagulation.
60
Magnesium supplements are needed in
hypomagnesemia (magnesium level less than | 1.3 mEq/L).
61
What is used to stop preterm labor
IV magnesium sulfate is used to stop preterm labor and as an anticonvulsant during labor and delivery
62
Muscle weakness, flaccid paralysis, painful muscle contractions, cardiac disorders, and respiratory depression
Adverse effect of magnesium
63
neuromuscular blocking agents
should not be used when taking magnesium as it can can potentiate respiratory depression and apnea
64
Magnesium is what pregnancy category?
Category A
65
AV block, rectal bleeding, nausea/vomiting, and abdominal pain, renal and/or cardiac disease
use magnesium cautiously with these patients
66
Magnesium sulfate can decrease the absorption of which antibiotic?
tetracyclines
67
What to give with magnesium sulfate toxicity
Calcium gluconate
68
Foods with magnesium
(whole grain cereals, nuts, legumes, green leafy | vegetables, bananas).
69
Magnesium Patient-Centered Care:
Monitor serum magnesium, calcium, and phosphorus. ● Monitor the client’s blood pressure, heart rate, and respiratory rate when given intravenously. ● Assess for depressed or absent deep tendon reflexes as a sign of toxicity. ● Calcium gluconate is given for magnesium sulfate toxicity. Always have an injectable form of calcium gluconate available when administering magnesium sulfate by IV. ● Teach clients about dietary
70
expected serum magnesium levels
serum magnesium levels within | expected reference range (1.3 to 2.1 mEq/L).
71
Aloe
topical antimicrobial, anti-inflammatory, analgesic, and cathartic › Soothes pain, heals burns (aloe gel) › Softens skin, laxative (aloe latex)
72
Aloe adverse effects
Skin preparations: possible hypersensitivity › Laxative: Possible fluid and electrolyte imbalances › Increases menstrual flow when taken during menses › Avoid taking if the client has kidney disorders
73
Black cohosh
› Acts as an estrogen substitute › Mechanism of action is unknown › Treats symptoms of menopause
74
Black cohosh adverse effects
GI distress, lightheadedness, headache, rash, weight gain › Avoid taking during the first two trimesters of pregnancy. › Limit use to no longer than 6 months due to lack of information regarding long-term effects.
75
Echinacea
› Stimulates the immune system › Decreases inflammation › Topically heals skin disorders, wounds, and burns › Possibly treats viruses (common cold, herpes simplex) › Used to increase T-lymphocyte, tumor necrosis factor, and interferon production
76
With chronic use, this herbal can decrease positive effects ofmedications for tuberculosis, HIV, or cancer.
Echinacea
77
Feverfew
Can block platelet aggregation › May block a factor that causes migraines › May decrease the number and severity of migraine headaches (does not treat an existing migraine)
78
Garlic
When crushed forms the enzyme allicin › Blocks LDL cholesterol and raises HDL cholesterol; lowers triglycerides › Suppresses platelet aggregation and disrupts coagulation › Acts as a vasodilator (may lower BP)
79
› Due to antiplatelet qualities, can increase risk of bleeding in clients taking NSAIDs, warfarin, and heparin › Can increase hypoglycemic effects of diabetes medications › Decreases levels of saquinavir, a medication for HIV treatment
Garlic
80
ginger root
``` › Relieves vertigo and nausea › Increases intestinal motility › Increases gastric mucous production › Decreases GI spasms › Produces an anti-inflammatory effect › Suppresses platelet aggregation › Used to treat morning sickness, motion sickness, nausea from surgery › Can decrease pain and stiffness of rheumatoid arthritis ```
81
Ginger root interacts with what drugs?
interfere with coagulation (NSAIDS, warfarin, | and heparin)
82
Ginkgo Biloba
› Promotes vasodilation – Decreases leg pain caused from occlusive arterial disorders › Decreases platelet aggregation – May decrease risk of thrombosis › Decreases bronchospasm › Increases blood flow to the brain – Improves memory (dementia, Alzheimer’s disease)
83
Seizure patients should take which herb with caution?
Ginkgo Biloba
84
Glucosamine
› Stimulates cells to make cartilage and synovial fluid › Suppresses inflammation of the joints and cartilage degradation » Treats osteoarthritis of the knee, hip, and wrist
85
Which herb should be used with caution if you have a shellfish allergy?
Glucosamine
86
Kava
SHOULD BE AVOIDED - causes liver damage causes liver injury › Possibly acts on GABA receptors in the CNS › Promotes sleep › Decreases anxiety › Promotes muscle relaxation without affecting concentration
87
Ma Huang
› Stimulates the CNS » Suppresses the appetite » Used for weight loss › Constricts arterioles – Increases heart rate and BP › Bronchodilates – Treats colds, influenza, and allergies
88
St. John's Wort
› Affects serotonin, producing antidepressant effects – Used for mild depression › Used orally as an analgesic to relieve pain and inflammation › Applied topically for infection
89
Avoid longterm sun exposure when taking which herb?
St. John's Wort
90
Interactions w/ St. John's Wort
› May cause serotonin syndrome when combined with other antidepressants, amphetamine, and cocaine › Decreases effectiveness of oral contraceptives, cyclosporine, warfarin, digoxin, calcium-channel blockers, steroids, HIV protease inhibitors, and some cancer chemotherapy medications
91
Valerian
› Increases gamma-aminobutyric acid (GABA) to prevent insomnia (similar to benzodiazepines) » Reduces anxiety-related restlessness » Drowsiness effect increases over time
92
Herbal that is FDA Pregnancy Risk Category X
saw palmetto
93
Fiber is recommended when taking _____
iron
94
Potassium should be infused no faster than _____ to prevent vein irritation, phlebitis, and infiltration.
10 mEq/hr
95
Should Cardiac monitoring be implemented to detect cardiac dysrhythmias in a client receiving IV POTASSIUM?
YES
96
With Potassium IV administration, to prevent fatal hyperkalemia due to a rapid infusion rate
infusion pump

ATI (chp 1,2,5,6,30) (5 decks)

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