NURS 331 1st test Flashcards
(217 cards)
1
Q
The nursing process
A
ADPIE - assessment, nursing diagnosis, planning, implementation evaluation
2
Q
nursing diagnosis
A
choose diagnosis, related to, as evidence by
3
Q
nine rights
A
right drug, right dose, right time, right route, right patient, right documentation, right reason, right response, right refusal
4
Q
pharmacodynamics
A
what the drug does to the body
5
Q
mechanism of actions
A
receptors, enzyme, nonselective, unknown
6
Q
receptor mechanism of action
A
agonist - mimicking or antagonist - blocking. binding is receptor, is selective, is on a grade
7
Q
enzyme mechanism action
A
catalyst, can inhibit or enhance
8
Q
nonselective mechanism of action
A
non selective will work with many receptors, selective will work with only one
9
Q
pharmacokinetics
A
what our body does to the drug - absorption, distribution, metabolism, excretion
10
Q
IV
A
rapid onset, allows direct control
11
Q
IV disadvantage
A
risk for infection, risk for fluid overload
12
Q
IV considerations
A
rapid onset, risk for infection, continuous monitoring, compatibility
13
Q
IM
A
good for poorly soluble drugs
14
Q
IM disadvantages
A
discomfort of injection, slower onset
15
Q
IM considerations
A
longer duration, risk for infection, delayed onset, nursing onset, nursing technique, SUBQ
16
Q
Oral
A
easier, reversible, safer injection
17
Q
oral disadvantage
A
variable absorption, inactivation of some drugs by stomach acid
18
Q
oral drug considerations
A
food, water, antacids
19
Q
sublingual
A
rapid absorption, rapid onset, avoids first pass metabolism
20
Q
sublingual disadvantage
A
patient may swallow pill instead of keeping under tongue
21
Q
rectal
A
good alternative when oral not available
22
Q
rectal disadvantages
A
discomfort, embarrassment
23
Q
rectal considerations
A
absorption is unpredictable, patient must be on left side
24
Q
topical
A
delivers directly to affected area
25
topical considerations
skin should be clean
26
transdermal
provides relatively constant rate of absorption, patch
27
transdermal disadvantage
absorption can be affected by sweat
28
transdermal considerations
placed o alternating sites, clean, non hairy skin
29
inhalation
rapid absorption, directly into lung
30
inhalation disadvantage
absorption can be too rapid, need to be exactly as prescribed
31
bioavailability
amount of drug available for absorption - IV - 100%, sublingual - 100%
32
enteral
through intestine
33
enteral considerations
gastric dumping, sepsis from decreased blood flow, food.water, ability to take
34
parenteral
injectables
35
topical
creams, transdermal, patches
36
transdermal
systemically
37
inactive prodrugs
inactive until in your body
38
pharmacogenomics
same drug but different response in different bodies
39
excretion
mostly from kidneys but we also eliminate from lungs, liver, bowel, sweat, mammary glands
40
GFR
gives us an idea of how fast a drug can be metabolized - BUN test
41
acute therapy
(short term) intensive drug treatment, acutely ill or critically ill, needed to sustain life or disease
42
maintenance therapy
ongoing, prevent progression or disease or condition, treatment of chronic illness
43
supplemental therapy
replacement - supplies the body with substance needed to maintain normal function
44
palliative therapy
comfort, end of life, make patient as comfortable as possible, relief from symptoms, pain, and stress
45
supportive therapy
recovery - maintains the integrity of body functions while the patient recovers from illness or trauma
46
prophylactic therapy
prevent illness (antibiotics)
47
polypharmacy
more than one drug
48
comorbidities
more than one disease
49
physiologic changes in older adults
cardiac output, perfusion, hepatic and renal function all decrease
50
black box warning
strictest warning put in labeling of prescription drugs, highlights serious sometimes life threatening adverse reactions
51
innate immunity
immune responses you are born with. closed system. epithelial, normal microbiome, PPRs
52
epithelial
skin, GI, respiratory. secrete substances that protect against infection - mucus, sweat, saliva, tears
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epithelial type of mechanisms
physical, mechanical, biochemical
54
what do tears and saliva contain
lysozyme which is an enzyme that attacks cell walls of gram positive bacteria
55
antimicrobial peptides
kill or inhibit the growth of disease causing bacteria, fungi, and viruses
56
how do sebaceous glands protect you?
they secrete fatty acids that have an acidic ph which creates inhospitable environment for bacteria
57
how does your skin protect you
low temp, low ph, sloughing, and sweating
58
how does GI protect you
stomach has low ph and can also make you vomit. also by secreting through urine
59
how does respiratory protect you
mucus, cilla, coughing, and sneezing
60
normal microbiome
part of innate, benefits GI, prevents colonization of pathogens
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how does normal microbiome protect you
synthesizes metabolites such as vitamins K and Bs and synthesizes serotonin
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broad spectrum ABX
antibiotics, act against many bacteria, but kill both good and bad. can lead to yeast or opportunistic microorganism build up such as C. diff and pseudomonas aeruginosa
63
gut brain axis
gut health can affect our brain. Stress, but epithelial breakdown= "leaky gut"
64
inflammation
programmed response that limits tissue damage.
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types of inflammation
sterile - no pathogen, septic - pathogen present
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cardinal signs of inflammation
(HEELP) heat (fever), erythema (redness), edema (swelling), loss of function, pain
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what leads to a loss of function
swelling and pain
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is inflammation specific or nonspecific
nonspecific - will do same thing every time
69
what happens when inflammation is present
vasodilation, increased vascular permeability, and white blood cell infiltration
70
plasma protein systems
compliment system, clotting system, and kinin system
71
compliment system
destroys pathogens directly. activation C3b, C5a, and C3a
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C3b
opsonins - coat the surface of bacteria and increase their chances of being phagocytized and killed
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C5a
chemotactic factors - diffuse from site of inflammation and attract phagocytic cells to that site
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C3a
anaphylatoxins- degranulate mast cells which release histamine which causes vasodilation and vascular permeability
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clotting system
forms blood clot, plug damaged vessels and stops bleeding
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clotting system cascade
factor X, thrombin, fibrinogen, fibrin, clot
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fibrin
protein that leads to clot
78
Kinin system
bradykinin which causes vasodilation and works with prostaglandins to induce pain ,smooth muscle contraction, and vascular permeability
79
PPRs
"hall monitors" recognize infectious agents (septic) and cellular damage (sterile)
80
erythrocytes
RBCs. carry O2 to tissue
81
platelets
activate when they find abnormalities and synthesize thromboxane A2 (TXA2)
82
thromboxane A2 (TXA2)
potent vasoconstrictor
83
leukocytes
WBCs - neutrophils, basophils, eosinophils, macrophages, lymphocytes
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neutrophils
first responders
85
basophils
allergic reactions
86
eosinophils
parasitic infection
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cytokines
signalling molecule. can be pro or anti inflammatory
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interleukins
produced in response to PPRs. enhance or suppress inflammation
89
interferon
kind of cytokine, work against viruses, control inflammatory response
90
Mast cells
release granules that have histamine, cytokines, and chemotactic
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leukotriene
cause smooth muscle to contract which leads to bronchial constriction. increase vascular permeability
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prostaglandins
increase vascular permeability, cause pain, neutrophil movement toward inflammation
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adaptive immunity
acquired - remembers pathogens, systemic, uses antibodies, immunoglobulins, and humoral immunity
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antibodies
protect against infection either directly by neutralization or indirectly by phagocytosis
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immunoglobulins
IgG - show past infection and IgM - show present infection
96
humoral immunity
respond to antigen. include b-cells which create antibodies (20% of lymphocytes), and T-cells (70% of lymphocytes)????
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cytotoxic
a type of T cell that kills cells that have gone bad
98
acute inflammation
less than 2 weeks, exudate. signs include - serous, fibrinous, and purulent
99
exudate
mass of cells and fluid that has seeped out of the blood vessels
100
serous
blister (early)
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fibrinous
phlegm (advanced)
102
purulent
pus (bacteria)
103
how do you get a fever
cytokines stimulate the hypothalamus and cause fever
104
endothelial cells do what to blood flow and clotting
maintain blood flow and regulate blood clotting
105
what does nitric oxide do
relaxes smooth muscle, increases blood flow, inhibits platelet activation
106
leukocytosis
hight amount of WBC
107
SED rate
test for inflammatory response
108
chronic inflammation
more than 2 weeks, dense infiltration of macrophages and lymphocytes, granuloma, caseous, tissue damage, and reduced function
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caseous
liquéfaction necrosis
110
capillary hydrostatic pressure
pushing pressure inside the arterial part of the vessel where filtration is favored
111
interstitial oncotic pressure
pulling pressure outside the vessel on the arterial side
112
interstitial hydrostatic pressure
pushing pressure on venous side of vessel where reabsorption is favored
113
plasma oncotic oressure
pulling pressure inside the vessel on the venous side
114
edema
increased capillary pressure, decreased plasma oncotic pressure, decrease capillary permeability, increase tissue oncotic pressure
115
why would your capillary hydrostatic pressure increase
venous obstruction or water/salt retention
116
why would your plasma oncotic pressure decrease
loss or decrease in plasma protein
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what does increased capillary permeability lead to
loss in plasma protein
118
nursing diagnosis or edema
fluid volume excess, activity intolerance, risk for injury and infection, impaired skin integrity
119
fluid osmolity
concentration
120
renin angiotensin aldosterone system
angiotensinogen- angiotensin 1 - angiotensin 2 from the liver - aldosterone goes to the kidneys - increased sodium/water retention, increased extracellular fluid, and increased blood pressure
121
fluid excess leads to what
edema
122
fluid can accumulate in
pericardial sac, interpleural space, peritoneal space, and joint spaces
123
hypervolemia
high volume (excess sodium)
124
what mechanisms are compromised with hypervolemia?
can be caused by renal failure, heart failure, or RAAS
125
RAAS
renin angiotensin aldosterone system
126
what can hypervolemia cause
JVD (jugular vein distention), ALOC (altered consciousness) due to sodium effects on neurotransmitters, S3 caused by fluid around the heart, lung sounds, decreased hemoglobin and hematocrit, altered electrolytes
127
hypovolemia
deficient fluid volume
128
urine output less than
30 ml/hr is really bad
129
hypovolemia can be caused by
age and weight, hyper metabolic rate, diuretics, fluid loss, immobility, lack of plasma proteins from malnutrition, burns, or liver failure, pain, paralysis, IBS
130
hypovolemia can cause
poor skin turgor, weak thready pulse because of less perfusion, hypotension
131
colloids
large proteins. increase oncotic pressure by pulling fluids into the vascular space. example is albumin
132
albumin
plasma volume expander, blood derivative, watch for vascular overload
133
crystalloids
decrease oncotic pressure and increase volume in intravascular space and interstitial space. watch for fluid overload
134
tonicity
concentration of solutes dissolved in a solution which determines diffusion
135
isotonic
250-375 mOsm/L equal osmotic pressure. no shifting of fluid
136
normal blood osmolity
290-310 mOsm/L
137
nursing considerations when using isotonic solution
use caution when using in renal, cardiac, or geriatric patients. fluid overload. elevate HOB (head of bed)
138
hypotonic
less than 250 mOsm/L. causes fluid to shift from intravascular space to intracellular space (hydrates cell)
139
hypotonic solutions
0.45% NaCl, 0.25 % NaCl, and D5W
140
hypotonic solution nursing considerations
fluid volume deficit, cerebral edema, do not use with patients with liver disease, trauma, ICP or burns, can deplete intravascular volume
141
ICP
increased cranial pressure
142
hypertonic
greater than 375 mOsm/L. fluid shift out of cell into vascular space. used for severe hyponatremia
143
hypertonic solutions
3% NaCl, 5% NaCl, and D10W
144
hypertonic solution nursing considerations
FVO (fluid volume overload), for temporary use, central line only, and can cause damage to myelin sheath of brain stem which could result in death
145
extracellular electrolytes
sodium, chloride, bicarb
146
intracellular electrolytes
potassium, magnesium, phosphate
147
Normal sodium levels
135-145 mEq/L
148
sodium function
transmits nerve impulses, maintains osmolality through thirst, renal, and ADH, assists regulation of acid/base balance, and promotes muscle contractibility
149
hyponatremia
low sodium, water follows sodium inside the cell and expands the cell (brain cells sensitive)
150
signs and symptoms of hyponatremia
ALOC, seizures, ICP, coma, cerebral adema, muscle weakness, twitching, or tremors
151
Signs of hypernatremia
water rushing outside cell because there is a increased NA+ concentration outside the cell and the cell shrinks, signs are fever, flushed, increased fluid retention, edema, ALOC, coma, muscle twitching, hyperreflexion
152
function of potassium
acid/base balance, cardiac rhythm, skeletal and smooth muscle contraction
153
normal levels of potassium
3.5 -5
154
insulin IV is good at what?
getting potassium back into the cell
155
hypokalemia and what are signs and symptoms
low potassium can cause irregular pulse, dysrhythmias, or arrest. everything is slow, can flatten T and U waves, muscle aches, paralysis, V/D
156
hyperkalemia and what are the signs and symptoms
high levels or potassium. decreased cardiac contractibility, cramps, cause peaked Ts and widened QRS, Brady dysrhythmias or arrest, hyperactive smooth and skeletal muscle
157
treatment for hyperkalemia
kayexalate, calcium gluconate, IV insulin, hemodialysis
158
acid base balance
maintains homeostasis, keeps ph within 7.35-7.45
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ph of less than 7.4
acidosis
160
ph greater than 7.4
alkalosis
161
regulations of ph
chemical buffers, intracellular phosphate and protein, lungs, kidneys
162
chemical buffers
CO2, HCO3, and hemoglobin
163
uncompensated
CO2 or HCO3 normal
164
fully compensated
ph is normal
165
partially compensated
nothing is normal
166
respiratory acidosis vs metabolic acidosis
respiratory acidosis has a co2>44, metabolic acidosis has a HCO3<22
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respiratory alkalosis vs metabolic alkalosis
respiratory alkalosis has a CO2< 38, metabolic alkalosis has a HCO3 > 26
168
acidosis symptoms
headache, SOB, coughing, arrhythmia, increased HR, seizures, weakness N/V/D
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alkalosis symptoms
light headedness, hand tremor, numbness or tingling, spasms N/V/D
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respiratory compensation response
increase or decrease ventilation
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metabolic buffer system
secrete or retain H+ or HCO3
172
respiratory acidosis
build up of CO2 due to alveolar hypoventilation. exchange of gases not happening, slow respirations, can become disoriented or go into coma
173
respiratory acidosis causes
drugs, collapsed alveoli, or head injury, pulmonary edema
174
respiratory acidosis compensations
kidney retains HCO3, tachypnea (rapid breathing)
175
respiratory alkalosis and what causes it
low CO2 caused by hyperventilation, anxiety, pain, fear, asthma
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respiratory alkalosis compensations
kidney retains H+ and excretes HCO3
177
metabolic acidosis
increased acids, low HCO3 caused by high acid production, low acid excretion, or low bicarb levels. diarrhea, vomiting, fistula, renal failure
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DKA
diabetic keto acidosis
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metabolic acidosis compensations
deep rapid breathing (Kussmaul's), kidneys will start producing more HCO3
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metabolic alkalosis
excess loss of acids and high HCO3 caused by ingestions of too many antacids, hyperaldosteronism, low acid due to vomiting or gastrisuction or excesses diuretic use
181
how do you treat metabolic alkalosis and what are compensations
with isotonic fluids. body tries to compensate by hyperventilating to increase CO2
182
iatrogenic
caused by medical treatment
183
PaO2
O2 dissolved in blood 80-100 mmHg
184
SaO2
O2 saturation 95%-100%
185
PaCO2
35-45 mmHg
186
HCO3 levels
33-36 mEq/L
187
bass excess
indicates amount of excess or insufficient bicarbonate in system - negative indicates base deficit
188
ROME
respiratory opposite, metabolic same
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hyperaldosteronism
causes increased Na+ which leads to decreased H+ and K+ which increases HCO3
190
nursing interventions for hypernatremia
restrict NA+ intake, isotonic solution, educate about diet
191
sodium chloride NS 0.9%
isotonic crystalloid solution
192
sodium chloride NS 0.9% contraindications
hypernatremia and hyperchloremia
193
what does sodium chloride NS 0.9% do? what do you need to watch out for?
replaces water and sodium, watch for fluid overload
194
sodium chloride NS 0.9% indications
hemorrhage, GI loss, metabolic acidosis, hyponatremia
195
sodium chloride 0.45% 0.25%
hypotonic solution, moving fluid out of vein and into the cell
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sodium chloride 0.45% 0.25% adverse effects
hemolysis of red blood cells
197
sodium chloride 3% 5%
hypertonic solution, high risk solution, moving fluid out of cell into the vein. sometimes used for severe hyponatremia but must be given slowly
198
sodium chloride 3% 5% adverse effects
osmotic demyelination syndrome which is potentially fatal. if given to quick can lead to irreversible brainstem damage
199
Albumin
colloid. increases oncotic pressure which expands volume of circulating blood. restores plasma volume.
200
albumin contraindications
hypersensitivity, severe anemia, pulmonary edema, renal insufficiency, CHF (congestive heart failure)
201
albumin nursing considerations
pulmonary edema, fluid, overload, hypotension
202
sodium polystyrene sulfonate
also known as kayexalate. potassium removing resin. removes potassium by exchanging sodium for potassium in body primarily in large intestine
203
sodium polystyrene sulfonate uses
hyperkalemia
204
sodium polystyrene sulfonate contraindications
hypersensitivity, GI obstruction, reduced gut mobility
205
sodium polystyrene sulfonate adverse effects
intestinal necrosis, hypernatremia, hypokalemia, hypocalcemia
206
potassium chloride
replaces potassium levels
207
potassium chloride indications
hypokalemia
208
potassium chloride adverse effects
N/V/D, GI bleeding, cardiac arrest, phlebitis
209
do you do an iv push with potassium chloride
NO also it must be diluted.
210
decreased perfusion to gut causes what with medications in elderly
low absorption
211
decreased liver function causes what with medications in elderly
decreased metabolism
212
decreased kidney function in elderly cause what with medications?
decreased kidney function
213
drug interactions
drugs that bind to the same type of receptor will have drug interactions
214
example of sublingual drug
nitroglycerin which is a medication to treat chest pain
215
K+ level inside cell
95% k+ is in side cell
216
if in a car accident what happens to K+ level
they increase because your dead cells release K+
217
what would you give a patient if they have cerebral edema
hypertonic solution to take the fluid out of the cells
