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Considerations when setting up sterile field

Grasp along 1 in border before putting on sterile gloves and place where needed first. Add items 6in above. Contamination can occur with coughing, sneezing, or talking directly over it. Should not reach over it, turn back to field or allow contact with moisture. Anything that touches the 1in border is contaminated!!


NG-tube medication administration

Always verify placement first, aspirate contents. If there is 100ml or less, return to pt. Flush with 15-30 ml of water before and after each med. Dissolve crushed meds in 15-30mL. Tap water ok unless immunocompromised, then use distilled/sterile water.


What medications cannot be given by tube?

Extended-release, time-released, fluid-filled, have enteric coating, or to be administered sublingual.


Mechanical soft diet

regular diet, just has soft texture. Foods can be cooked, mashed, diced and ground. Veg, fruit, ground meats, juice, dairy liquids, gelatin. NO SEEDY FOODS.


Risk factors for Hyperkalemia

--If pt is using salt substitutes, like CHF pt who need to reduce Na intake. These substitutes are high in K+.
--Potassium-sparing diuretics
--Decline in kidney fxn w/ older adults so excreting less
--Shift in ECF can occur when insulin is low (insulin drives glucose and K+ into the cell), there is a state of acidosis, or tissue breakdown that may occur with sepsis, trauma, surgery, or MI


Clinical manifestations of hyperkalemia

EKG: V-fib, peaked T waves, wide QRS
VS: pulse is low, irregular, low BP
LOC: irritable, confused
Muscles: weak, lack reflexes
Neuro: tingling, prickling, burning feeling, paralysis from top to bottom
GI: high K+ increases mvmt resulting in abdominal cramping and diarrhea, hyperactive sounds
GU: minimal UO


How should vancomycin be administered? What allergy is contraindicated?

Over 60 minutes!! Any faster and red man syndrome may occur. Shows as rash, flushing, tachycardia and hypotension. Before giving a second dose, check Vano levels b/c renal toxicity is a adv s/e. DO NOT GIVE TO PT WITH ALLERGY TO CORN.


What drugs can cause ototoxicity?

hearing loss can occur w/ vancomycin, loop diuretics, and aminoglycoside antibiotics.


Indications for use of benzodiazepines

rapid tx for generalized anxiety d/o, panic d/o
Other uses: seizure d/o, insomnia, muscle spasm, ETOH w/d, induces anesthesia, given before surgery for amnesic effect


What is ibandronate (Boniva) given for? And what should pt be educated about it?

Boniva is for postmenopausal osteoporosis. It can cause esophagitis.

Should take with minimum 8oz of water while in upright position, walking for 30 min is good. Wait to eat or take other meds for 1 hr afterwards.

All bisphosphates cause GI issues: pain, N, diarrhea, constipation


What does the drug class antimetabolites treat and how?

Interfere with one or more enzymes or their reactions that are necessary for DNA synthesis. They affect DNA synthesis by acting as a substitute to the actual metabolites that would be used in the normal metabolism (for example antifolates interfere with the use of folic acid).

Antimetabolites are drugs used in cancer chemotherapy. Cancer cells divide more rapidly compared to normal cells so antimetabolites affect cancer cell replication more than they affect normal cell replication.


Which cells in the body proliferate rapidly normally?

GI tract, hair follicles, and bone marrow. That's why they are affected by chemo drugs. Cancer cells are fast growing and the drugs act on the fast cells, so some normal cells are affected as well.


What does Fluorouracil (Adrucil) treat? Adv s/e?

Given for AML, breast or colon cancer, and superficial skin cancers.

Adv s/e: bone marrow suppression which results in low WBC, RBC, and platelets (neutropenia, anemia, thrombocytopenia) CHECK LABS! (WBC, Plt, Hgb, Hct)


What is leuprolide and it's adv s/e?

Noncytotoxic chemo agent that inhibits production of testosterone by the testes.

Can cause hot flashes, decreased libido, gynecomastia, decreased bone density, arrhythmias, and pulmonary edema.

Pt should increase Ca/VitD and perform wt-bearing exercises. RN needs to monitor heart rhythm and breath sounds (for possible fluid build-up in lungs)


When might a type2 DM pt need to start using insulin?

When diet, exercise and oral meds do not manage it. Diabetic neuropathy occurs from high blood sugar which can cause nerve dmg so insulin would be necessary.

Or if liver and kidney fxn can not metabolize or excrete oral medications.


Why does DKA and HHNS occur?

with DKA the body id unable to use the glucose b/ insulin is not available to drive it into the cells.

HHNS occurs when blood glucose is extremely high and insulin is needed to lower the amt in the blood and promote uptake in the cells.


Which drugs mask signs of hypoglycemia?

Beta blockers.

When given with insulin, will make pt more hypoglycemic.


Which drugs cancel out action of insulin?

thiazide diuretics and glucocorticoids b/c they raise blood glucose.


What is timolol (Timoptic) prescribed for? What should RN tell pt about drug?

reduce Intraocular pressure by decreasing aqueous humor. This fluid is draining slower than normal so pressure builds up, and prod needs to slow down.

Stinging sensation with eye drops is normal.
But report blurred vision, sensitivity to light, dry eyes or conjunctivitis.

If DM pt, it can mask signs of hypoglycemia, monitor BS! B/c beta 1 & 2 blocker, heart and lungs can be affected.


What is hydrochlorothiazide (methyldopa) given for? What are the s/e?

Tx primary HTN.

Decreases HR, CO and BP.
Drowsiness, sedation, dry mouth temporarily, with continued use sedation will subside but activities require alertness should no be performed until then



What does verapamil (Calan) treat? How does it work?

Tx HTN and It is an antidysrhythmic, calcium-channel blocker. Causes vasodilation in periphery arterioles and heart arteries/arterioles. Decreases force of contraction due to blockge of Ca channels in SA node, AV node and heart; hR decreases and slows conduction thru the AV node. Depresses depolarization and decrease O2 demand of the heart.

Adv s/e: orthstatic hypotension and constipation


What is alteplase (tPA) for? Major adv effect?

thrombolytic, breaks up clots already present in the body. DOES NOT PREVENT CLOTS.

Given only IV w/in 3h of onset of symptoms.

Tx acute MI, massive pulmonary emboli and acute ischemic stroke.


What is sumatriptan (imitrex) used for? What are the contraindications for use?

Migraines, given AFTER PRODROMAL SYMPTOMS, not prophylaxis, It is a serotonin receptor agonist that prevents inflammation and vasodilation in the intracranial vessels.

liver failure, ischemic heart dz, hx of MI, uncontrolled HTN, and other heart dz.


What is adenosine given for? How is it adminstered?

SVT. Given IV bolus, and flushed with saline.

Short half life so s/e last less than 1 min.
--Bradycardia: decreased conduction thru AV node
--SOB: bronchoconstriction
--Flushing: vasodilation
--low BP


What is misoprostol (Cytotec) given for?

Peptic ulcer dz. Decreases acid secretion in GI tract, increases secretion of bicarbonate and protective mucus and improves blood flow via vasodilation.

**pt taking NSAIDs long term need this prevention measure.
**Can't take if pregnant


What does cyanocobalamin (Nascobal) treat?

Vit B12 deficiency.
Admin nasally.
Should not be admin w/in 1h of eat hot foods since the foods will increase nasal secretion which decreases chance of absorption.

**note B12 converts folic acid from inactive to active form which is needed for DNA production. The deficiency can be masked by folic acid intake.


Describe the 4 different types of pain: chronic, neuropathic, visceral, somatic

Chronic: >3mo
Neuropathic: numb tingling, shooting, burning, radiating
Visceral: internal deep, sharp
Somatic: bone or connective tissue, throbbing or dull


What should a Pt taking opiates increase in their diet and what s/e s/b advised?

Fiber and use stool softeners to tx constipation.
Nausea is a s/e but will go away in a few days


What is pneumonia? What signs might pt exhibit?

Inflammation in the lungs. Edema and exudate fill the alveoli affecting gas exchg.

HEAR CRACKLES, wheezes, and chest dull with percussion!!

Pt will be SOB or difficulty breathing, tachypnea, coughing, and decrease in O2 saturation.

Since infectious organism can trigger it; fever , chills, flushed face, and diaphoresis may be present.


Clear liquid diet

Broth, water, coffee, gelatin and clear fruit juices.

these foods require little breakdown and create minimal volume in GI tract.


Pre & Post-op care for colectomy?

Removing all or part of colon requires a clear liquid diet before to clear the bowels, and medication to clear will also be prescribed. Antibiotics are given to eliminate any bacteria in GI.

After, limited activity and ostomy care.


A diabetic that undergoes surgery is at risk for what?

decreased intestinal motility, altered blood glucose levels and delayed healing


Neurogenic shock. What is happening and what are manifestations?

type of distributive shock where vasodilation occurs all over and capillaries increase permeability, which affects HR and BP (bradycardia and hypotension).

Loss of sympathetic tone results in body's inability to direct blood flow from periphery back to the core, which can affect the temperature.

Neuro dysfunction, warm dry skin.


Hyperacutre kidney transplant rejection manifestations

Fever, HTN, and pain at site w/in 48h.
Calls for immediate removal of the donor kidney b/c the small blood clots can cause irreversible dmg from occluded vessels.


Acute kidney transplant rejection manifestations

W/in 1wk to 2yrs that is caused by attack on the blood vessels by the immune system.

Oliguria (scant urine), anuria, low-grade fever, HTN, azotemia (elevated BUN/Creat), lethargy, fluid retention and tenderness over transplant site

Immunosuppressive med dose s/b increased.


Chronic kidney transplant rejection manifestations

Gradual, months to years.
D/t overgrowth of the smooth muscles of the blood vessels and the tissue become fibrotic which forms scar tissue and non-fxn organ

Azotemia, fluid retention, electrolyte imbalance and fatigue return

Monitor with con'td immunosuppressive meds until lack of fxn requires dialysis.


Manifestations of intestinal obstruction

colicky, intermittent pain.
small bowel obstruction there will be abdominal pain and profuse sudden projectile vomiting with fecal odor. Pt will be in metabolic alkalois and severe F&E imbalance


Low vs High pressure alarms

High --> obstruction
*increased secretions, kink, pt cough, gags or bites

Low--> disconnection or leak
*occurs in ventilator or pt airway cuff, pt stops spontaneous breathing


What does yellow on peak flow meter indicate?

Asthma pt's airflow is 50-80% of personal best and should take meds and repeat reading in 1-2 min