MARK KLIMEK Flashcards
(161 cards)
1
Q
First generation antipsychotics: Common ending and three examples
A
Phenothaizines (-zine’s); chlorpromazine, promethazine, hydroxyzine
Small doses are antiemetics, high doses they are the MAJOR TRANQUILIZER
2
Q
Side effects of phenothaizines
A
ABCDEFG
Anticholinergic (dry mouth), blurred vision, constipation, drowsiness, extrapyramidal symptoms, “f”otosensitivity, aGranulocytosis
3
Q
Teaching points with Phenothaizines
A
Report sore throat and s/s of infection to doctor, never stop the -zine
4
Q
1 nursing diagnosis for Phenothaizines
A
Safety; Risk for injury
5
Q
What are the two classes of psych drugs that have a deaconate form? (two classes, one specific drug)
A
Phenothaizines, Haloperidol, ziprasidone (GeoDon)
6
Q
Three examples of tricyclic antidepressants
A
amitriptyline, imipramine, trazodone
7
Q
Side effects of tricyclic antidepressants
A
ABCDE
Anticholinergic (dry mouth), blurred vision, constipation, drowsiness, euphoria
8
Q
How long do you have to take tricyclic antidepressants for there to be an effect?
A
2-4 weeks
9
Q
What are benzodiazepines used to treat? Two examples
A
Antianxiety meds, MINOR TRANQUILIZER (-ZEP’s); also used for induction of anesthetic, muscle relaxant, alcohol withdraw, seizures, facilitates mechanical ventilation
lorazepam, diazepam
10
Q
How long can you take benzodiazepines?
A
Tranquilizers work quickly, must not take for more than 2-4 weeks
11
Q
1 nursing diagnosis for benzodiazepines
A
SAFETY; risk for injury
12
Q
Side effects of benzodiazepines
A
ABCD
Anticholinergic (dry mouth), blurred vision, constipation, drowsiness
13
Q
Three examples of monoamine oxidase inhibitors
A
isocarboxazid, phenelzine, tranylcypromine
14
Q
Side effects of MAOI’s
A
ABCD
Anticholinergic (dry mouth), blurred vision, constipation, drowsiness
15
Q
Teaching points for MAOI’s
A
To prevent severe, acute and sometimes fatal hypertensive crisis; the patient must avoid all foods containing tyramine:
BAR (bananas, avocados, raisins and all other dried fruits), no organ or preserved meats, no cheese except mozzarella and cottage, no alcohol, yogurt, elixirs, tinctures, caffeine, chocolate, licorice, soy sauce, and no OTC drugs
16
Q
What are the three side effects of Lithium?
A
3 P’s: Polyuria, pooping (diarrhea), paresthesia (tingling/numbness)
17
Q
What is the normal range for Lithium? What is the toxic level and toxic effects?
A
Normal is 0.6- 1.2; toxic is above 2 in which patient would experience severe diarrhea, tremors, and metallic taste
18
Q
What other electrolyte does Lithium effect and how so?
A
1 nursing intervention is to increase fluids; watch for dehydration and sodium levels. Low sodium makes lithium more toxic; if someone is on Lithium and becomes dehydrated, give sodium as well as fluids (don’t give water!!)
19
Q
What are the side effects of fluoxetine?
A
ABCDE
Anticholinergic (dry mouth), blurred vision, constipation, drowsiness, euphoria
20
Q
What are some teaching points for fluoxetine?
A
Causes insomnia, must give before noon- if BID give at 6a and noon,
When changing the dose for an adolescent or young adult, there is an increased risk for suicide.
21
Q
What is haloperidol used to treat?
A
Tranquilizer
22
Q
Side effects for haloperidol
A
ABCDEFG
Anticholinergic (dry mouth), blurred vision, constipation, drowsiness, EPS, “f”otosensitivity, aGranulocytosis
23
Q
What is Neuroleptic Malignant Syndrome?
A
Elderly patients may develop NMS from overdosage of haloperidol. NMS is potentially fatal hyperpyrexia, anxiety and, tremors with temperatures up to 104. Dosage for elderly patient should be half of usual adult dose.
24
Q
What are some teaching points with haloperidol?
A
SAFETY; risk for injury
Only antipsychotic med you can use with pregnant women!
25
What is clozapine used to treat?
Second generation antipsychotic used to treat severe schizophrenia; NEW MAJOR TRANQUILIZER, -ZAPINE's
26
Side effects of clozapine
SEVERE agranulocytosis
27
What is the generic name for GeoDon?
ziprasidone (prolongs QT interval)
28
What does sertraline treat?
antidepressant; SSRI
29
Teaching points with sertraline
Also causes insomnia but you can give it in the evening
Watch for interactions with St Johns Wort (serotonin syndrome) and warfarin (bleeding); sertraline increases chance of toxicity of other drugs
30
Side effects of sertraline
SAD Head
Sweating Apprehensive (impending sense of doom) Dizzy Headache
31
Creatinine
0.6-1.2
32
INR
Warfarin therapy: 2-3; above 4 is bad
33
Hemoglobin
12-18
34
Hematocrit
36-54
35
PO2
78-100
36
BNP
<100 (best indicator of CHF)
37
WBC
Total (5,000-11,000)
ANC (>500)
CD4 (>200)
38
Albumin
3.4-5.4
39
Calcium
9-11
40
Magnesium
1.3-2.1
41
Phosphate
3.0-4.5
42
Chloride
98-106
43
What is the earliest sign of any electrolyte disorder?
Numbness and tingling (paresthesia)
44
What is the universal sign of electrolyte imbalance?
Muscle weakness (paresis)
45
What do -kalemia's do?
The same as the prefix except for urine output and heart rate.
46
Key teaching with potassium IV
NEVER PUSH IV K AND NEVER >40/L
47
What is the treatment for hyperkalemia?
D5W with regular insulin (temporary fix)
Polystyrene sulfonate (PO/Rectal) and then treat hypernatremia with IV fluids
48
What do the -calcemia's do?
The opposite of the prefix; no exceptions
49
What are the two signs that indicate hypocalcemia?
Chvostek's: cheek tap
Trousseau's: hand spasm with BP cuff
50
What do the -magnesmia's do?
The opposite of the prefix; no exceptions
51
What should you think of with hypErnatremia? S/s?
dEhydration; hot, flushed, dry, thready pulse, rapid HR
52
What should you think of with hypOnatremia? S/s?
Overload; crackles, distended neck
53
When would you first auscultate a fetal heart?
8 weeks
54
When would you most likely auscultate a fetal heart?
10 weeks
55
When should you auscultate a fetal heart by?
12 weeks
56
Nagele's rule
First day of LMP, add 7 days, subtract three months
57
Weight gain in pregnancy (total and by trimester)
Total: 28 (+/- 3)
1st trimester: 1lb/month (3lbs)
2nd/3rd trimester: 1lb/week
**after 12 weeks, take the week and subtract 9
58
Fundal heights
Not palpable until week 12, will reach umbilicus by weeks 20-22
59
Time period for beginning of quickening
16-20 weeks
60
4 positive signs of pregnancy
1. Fetal skeleton on x-ray
2. Fetal presence on ultrasound
3. Auscultation of FHR by doppler (8-12 weeks)
4. Examiner palpates fetal movement/outline
61
4 probable/presumptive signs of pregnancy
1. All blood and urine pregnancy tests
2. Chadwick's sign (blue cervix)
3. Goodell's sign (cervical softening)
4. Haegar's sign (uterine softening)
62
Office visits for pregnancy timing
Once a month until week 28
Every 2 weeks until week 36
Every week until delivery or week 42
63
What are five examples of aminoglycosides?
Streptomycin
Vancomycin
Clindamycin
Gentamycin
Tobramycin
64
What routes can aminoglycosides be given?
65
What routes can aminoglycosides be given?
IM/IV/PO*
66
Under what circumstances can aminoglycosides be given PO?
Hepatic encephalopathy
Pre-op bowel surgery to sterilize bowel
67
What are some key teaching points with PO aminoglycosides and what two drugs are used to sterilize the bowel?
NO toxic affects
NEO-KAN
Neomycin and Kanamycin
68
What are the toxic effects of amniglycosides?
Ototoxicity: monitor hearing, ringing in ears (tinnitus), and balance/dizziness
Nephrotoxicity: monitor creatinine (24 hour creatinine clearance)
"8": toxic to cranial nerve VIII and administer Q8h
69
What are four examples of calcium channel blockers?
-dipines
amlodipine
nifedipine
PLUS verapamil and diltiazem (continuous IV drip)
70
CCB's are...
Negative ionotrophic (strength)
Negative chronotrophic (rate
Negative dromotrophic (conductivity)
71
CCB's are...
Negative ionotrophic (strength)
Negative chronotrophic (rate
Negative dromotrophic (conductivity)
72
What do you have to check prior to CCB administration?
Always check BP first, hold if SBP <100
73
What do CCB's treat?
AAA
Antihypertensives
Anti-angina
Anti-atrial arrhythmic
PLUS treatment of SVT's
74
Two side effects of CCB's
Headache and hypotension
75
What is the only aspect that matters in trough and peak questions?
ROUTE
76
Sublingual trough/peak
Trough: 30 minutes before to next dose
Peak: 5-10 minutes after drug dissolves
77
IV trough/peak
Trough: 30 minutes before to next dose
Peak: 15-30 minutes after drug FINISHES
78
IM trough/peak
Trough: 30 minutes before to next dose
Peak: 30-60 minutes after injecting
79
PO trough/peak
Trough: 30 minutes before to next dose
Peak: too variable to test
80
What are the five uppers?
Cocaine, caffeine, PCP/LSD (psychedelic hallucinogens), methamphetamines, adderall
81
pH goes _____, patient goes _____. Except for _________.
up/up
down/down
potassium
82
What sequence of questions do you ask in ABG questions?
1. Is it LUNG? If so, it is respiratory.
2. Not LUNG? Metabolic
Respiratory:
Overventing? Alkalosis
Underventing? Acidosis
Metabolic:
Vomiting/suctioning? Alkalosis
Anything else? Acidosis
83
If the pH and the Bicarb are both in the same direction, then it is ___________.
Metabolic
84
Respiratory alkalosis in a MV patient means:
Alkalosis = overventing; vent settings are too hgih
85
Respiratory acidosis in a MV patient means:
Acidosis = underventing; vent setting too low
86
What would cause a high pressure alarm?
Obstructions:
1. Kinks in tubing
2. Water in tubing
3. Mucous buildup: turn, cough/deep breathe, suction
87
What would cause a low pressure alarm?
Disconnection:
1. Disconnection of main tubing
2. Oxygen sensing tubing
88
What three medications should you give both AWS and DT patients?
Anti-HTN
Tranquilizer
Multivitamin (to prevent Wernickes)
89
What is the onset and duration of antabuse?
Onset: 2 weeks
Duration: 2 weeks
90
What is the normal level for Lithium? Toxic level
0.6-1.2, greater than 2 is toxic
91
S/s of Lithium toxicity
N/V, tremors, polyuria, muscle weakness, ataxia, EKG changes, convulsions, coma, death
92
What are the adverse effects of Lithium?
GI (take with food), hypothyroidism, tremors, renal damage, polyuria, birth defects (avoid in first trimester)
93
What drug-drug interactions for Lithium?
NSAIDS, diuretics
94
Normal/toxic ranges for Digoxin
Normal: 1-2
Toxic: greater than or equal to 2
95
What must you check before adminstering digoxin?
Apical pulse
96
What puts a patient at risk for toxicity while on digoxin?
Hypokalemia
97
Normal/toxic ranges for Phenytoin
Normal: 10-20
Toxic: greater than or equal to 20
98
What are some s/s of digoxin toxicity?
N/V, anorexia, fatigue, visual distrubances
99
What are some s/s of phenytoin toxicity?
Nystagmus, sedation, ataxia, blurred/double vision
100
Teaching points with phenytoin
IT IS TERATOGENIC!!
Slowly administer IV and only with NS
S/e are drowsiness, gingival hyperplasia, give with food
101
What do you have to watch for with phenytoin?
Stevie J babaaay and toxic epidermal necrolysis
102
What are the s/s of dumping syndrome?
DRUNK + SHOCK + ACUTE ABD DISTRESS
103
What interventions for dumping syndrome?
HOB: LOW
Water content in meal: LOW
Carb content in meal: LOW
Protein: HIGH
104
What interventions with hiatal hernia?
HOB: HIGH
Water content: HIGH
Carb content in meal: HIGH
Protein: LOW
105
In what order do you take OFF PPE?
Alphabetical order :)
Gloves - Goggles - Gown - Mask
106
In what order do you put ON PEE?
Reverse alphabetical order, "M" comes second
Gown - Mask - Goggles - Gloves
107
Regular insulin
Onset: 1 hour
Peak: 2 hours
Duration: 4 hours
Clear solution, can be used IV drip, short acting, rapid.
Regular Rapid Run
108
NPH
Onset: 6 hours
Peak: 8-10 hours
Duration: 12 hours
Cloudy suspension, intermediate acting, cannot use IV drip
Not so fast, Not in the bag, Not clear
109
Insulin lispro
Onset: 15 min
Peak: 30 min
Duration: 3 hours
Must give with meals (not before!), fast acting
110
Insulin glargine
Duration: 12-24 hours
Little to no risk of hypoglycemia, only one you can give at bedtime regardless of sugar; low acting, slow absorption
111
What are the s/s of hypoglycemia?
DRUNK in SHOCK
112
What is the treatment for hypoglycemia? What about if they are unconscious?
Rapidly metabolizing carbohydrates
Unconscious: Glucagon IM, D10/D50
113
What are the s/s of DKA?
(D)ehydration
(K)etones
(K)ussmaul
High (K)
(A)cidosis
(A)cetone breath
(A)norexia related to nausea
114
What is the treatment for DKA?
Fast rate fluids IV (200mg/hr regular insulin)
115
HHS s/s
Severe dehydration; risk for FVD
Dry, flushed, hot, increased HR, decreased skin turgor
116
What are some s/s of hyperthyroidsm?
"Hypermetabolism)
weight loss, tachycardia, hypertension, irritable, hyper, heat intolerance, exophthalmos
117
What are the three treatments for hyperthyroidsm?
1. Radioactive iodine
2. PTU (propylthiouracil); immunosuppresion
3. Thyroidectomy (total/subtotal)
118
What are some risks of a total thyroidectomy?
Need lifelong HRT
Risk for hypocalcemia (everything UP + Chvosteks/Trousseaus)
119
What are some risks of a subtotal thyroidectomy?
Risk for thyroid storm
120
Postop risks with thyroidectomy?
First 12 hours: airway/hemorrhage
Total: between 12-48 hours tetany due to hypocalcemia
Subtotal: 12 hours thyroid storm
121
S/s of hypothyroidsm
"Hypometabolism"
obese, flat, cold intolerance, bradycardic, hypotensive, mentally slow
122
Treatment for hypothyroidsm
Levothyroxine
123
Teaching with Levothyroxine
Must monitor levels, watch for s/s of hyperthyroidism, take in Am before eating, reactions with Ca, Iron, Warfarin, insulin, Dig
124
Addison's Disease s/s
Hyperpigmentation, do not mount stress response (so cannot raise BP or glucose in times of stress and will go into shock)
125
Cushing's Syndrome s/s (also s/e of steroids)
CUSH MAN
Moonface, hirsutism, truncal and central obesity, buffalo hump, gynecomastia, skinny extremities (muscle atrophy), retaining Na/H2O, Losing K, striae, grouchy, immunosuppressed
126
Station
Relationship of fetal presenting part to mom's ischial spine (tightest squeeze)
+ below ischial spine, already passed through
- above ischial spine, "negative news"
127
Engagement
Station "0", at ischial spine
128
Lie
Relationship of spines
Vertical: parallel, uncomplicated, vaginal birth
Transverse: perpendicular; BAD
**Transverse lie that will not go positive, C-section
129
What are the purpose of uterine contractions in the first stage of labor?
To dilate and efface cervix
130
What are the three phases of stage one?
Latent
Active
Transition
131
Latent phase
Dilation: 0-4cm
Frequency: 5-30 min apart
Length: 15-30 seconds
132
Active phase
Dilation: 5-7 cm
Frequency: 3-5 min apart
Length: 30-60 seconds
133
Transition phase
Dilation: 8-10cm
Frequency: 2-3 min apart
Length: 60-90seconds
134
Contractions should NOT be:
Longer than 90 seconds, closer than 2 minutes apart
Can cause: uterine tetany, hyperstimulation...stop oxytocin
135
Occiput positioning would be indicative of:
Painful back labor (Oh Pain!)
136
Interventions for painful back labor:
Position (knee-chest)
Push (fist into sacrum)
137
Interventions for prolapsed cord:
Push (head back off cord)
Postion (knee-chest)
138
All other complications of labor use...
LION
(Left side, Increase IV, Oxygenate, Notify HCP)
In all crises, stop oxytocin
139
What are the purpose of uterine contractions in the second stage of labor?
To push baby out
140
What is the priority in the second stage of labor?
Clear baby's airway
141
Steps for second stage of labor:
1. Deliver head (stop pushing during this)
2. Suction mouth then nose
3. Check for nuchal cord
4. Deliver shoulders/body
5. Make sure baby has ID band on before leaving delivery area
142
What are the purpose of uterine contractions in the third stage of labor?
Push placenta out
143
Steps for third stage of labor:
1. Make sure it is all there
2. Check for 3-vessel cord (AVA= 2 arteries, 1 vein)
144
What are the purpose of uterine contractions in the fourth stage of labor?
To stop bleeding
145
What four things do you do four times an hour in the fourth stage?
1. VS; assessing for s/s of shock
2. Fundus; boggy = massage, displaced = void/cath
3. Check pads; excessive lochia is 100% of pad saturated in 15 minutes
4. Roll onto side to check for bleeding
146
Low fetal HR
Under 110
BAD
LION, stop oxytocin
147
High fetal HR
Over 160
No biggie, check mom's temperature
148
Low baseline variability
FHR stays the same, does not change
BAD
LION, stop oxytocin
149
High baseline variability
FHR constantly changing
GOOD, document
150
Late decelerations
FHR slows down near the end of a contraction
BAD; placental insufficiency
LION, stop oxytocin
151
Early decelerations
FHR decelerates before or at beginning of contraction
No biggie, document
Head compression
152
Variable decelerations
VERY BAD = prolapsed cord
PUSH then POSITION
153
What are the three bad fetal monitoring patterns?
Low/Low/Late
Low fetal HR
Low baseline variability
Late deceleration
154
What are you assessing every 4-8 hours in postpartum?
BUBBLEHEAD
Breasts, Uterine fundus, Bladder, Bowel, Lochia, Episiotomy, Hemoglobin/Hematocrit, Extremity check, Affect, Discomforts
155
What are the three big things to assess postpartum?
Uterine fundus (firm, midline, and cm as days PP)
Lochia (moderate is okay, 4-6 inches/hr)
Extremity check (for thrombophlebitis; bilateral calf circumference)
156
What are the three tocolytics? What are tocolytics uses for?
1. Terbutaline
2. Mag Sulfate
3. Nifedipine
Used to stop labor, when threatening pre-term labor
157
Teaching with terbutaline
causes maternal tachycardia, do not use with cardiac issues
158
Three oxytocics
1. Oxytocin
2. Methylergometrine
3. Prostanglandin
159
What are the two fetal lung maturing meds?
1. Betamethosone
2. Beractant
160
Betamethasone teaching
Given to mother IM before baby is born
161
Beractant teaching
Surfactant given to the neonate transtracheal after birth
