Skills final - meds Flashcards by Amanda S.

metapropolol

beta blocker

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metoprolol MOA

blocks stimulation of beta 1 (increases heart rate) and adrenergenic (proteins) receptors. Adrene binds to epinephrine and releases it from sympathetic nerve endings. does not usually affect beta 2. causes the heart to beat more slowly and with less force, which lowers blood pressure

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metoprolol succinate: dose (100 at the meta)

Initially 100 mg, Effects of daily dose beyond 400 mg aren’t known.

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Metoprolol succinate - adverse effects (withdrawals, fat, and depressed at the met)

bradycardia, pulmonary edema. CNS:fatigue,dizziness,depression,headache
CV:hypotension

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Metoprolol succinate generic and trade name (the met is low depressor)

Metoprolol succinate - generic
Lopressor - Toprol XL - trade

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Metoprolol - high alert or not?

high alert. if giving IV, have 2nd nurse check. Abrupt withdrawal may cause heart attack.

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Metoprolol onset peak duration (no peak at the met)

15 min, peak unknown, 6-12 hours

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Metoprolol teaching (met withdrawals and what do you do before you adminster it???)

same time every day, check pulse, may cause drowsiness, notify provider if taking any meds, or pregnant, and take with food. don’t stop abruptly. edema

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Furosimide - action (furious about my sodium and choloride and my swelling)

slows sodium and chloride reabsorption in the loop of henley. Increases excretion of water and sodium, mag, potassium, ca, cl. for pulmonary edema. helps treat edema and swelling.

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Furosimide - dose (furious at 20)

20 to 80 mg PO daily in the morning. up to 600 mg daily

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Furosimide - adverse effects: (Furious about stevens johnson and anemia)

headache,dizziness, hypotension, Stevens-Johnson syndrome, anemia.

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metroprolol hold

if systolic BP is less than 110 or apical is less than 60 bmp

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furosemide generic and trade

furosemide generic
lasix trade

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furosemide - use caution with what patients?

renal impairment, diabetes, hypotension, hearing loss, dehydration, hyponatremia, hypokalemia, aplastic anemia

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furosemide O/P/D (my 30s were a furious 1, then I turned 68)

30 - 60 min, peak 1-2 hours, duration, 6-8 hrs.

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furosemide teaching (furious about my weight gain and alcohol)

may cause ortho hypo, do not use alcohol, don’t exercise in hot weather, advise if weight gain more than 3 lbs in 1 day, OTC meds, pregnancy, muscle cramps

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lisinopril trade name (Lisin, zesty princess)

Prinivil and Zestril

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lisinopril MOA

treats high BP. ACE inhibitor. stops the conversion of angiotensin I to the vasoconstrictor substance, angiotensin II. Angiotensin II also stimulates aldosterone secretion by the adrenal cortex. Lowers BP.

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lisinopril adverse affects (kalema loves to lisin to angie)

hypotension, rash, hyperkalemia, angioendema

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lisinopril dose (listen I’ll be there at 10:40)

10 mg a day, up to 20 - 40 mg

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lisinopril O/P/D (listen to KROQ from 16 - 24)

1 hr, 6 hr, 24 hrs.

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lisinopril patient teaching (lisin I’ll teach you about no salt)

take at same time every day, do not disconitue, avoid salt subistiues containing potassium or sodicum. chang poisition slowly to avoid hypotension. advise dr. of any OTC. notify dr of rash, sore throat, chest pain. quit smoking.

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lispro (a rapid lisp is l for log, but you must eat afterwards) and food when?

humalog - rapid. must eat meal afterwards

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aspart (a spartan is rapid novel log)

novolog (brand name) - rapid.

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glulisine (glide into rapid apid)

apidra - rapid

rapid acting - how adminstered?

SC or continous SC pump - NOT IV

regular insulin (to be short and regular is humalin) And how administered? (check the human part)

humalin - short-acting. ONLY ONE that can be given IV bolus, IV infusion, or IM.

short-acting - how fast?

onset 30 to 60 min

rapid-acting - how fast?

5 -15 min

isophane (NPH) and clear or cloudy? (NPR is boring and intermediate)

neutral protamine hagedorn - intermediate acting. CLOUDY.

glargine (gargle clear lantus for a long time) and clear or cloudy?

lantus - long-acting. clear. referred to as basal insulin. 2 hrs/24

determir (mir and levimir are long and clear)

levemir - long-acting. clear. referred to basal insulin. 2/24

insulin pt teaching

have meals ready, Avoid spots w/scar tissue, moles, swelling, divide into 4 quadrants, can turn into fat deposits, be aware of signs and symptoms of hypoglycemia and hyperglycemia, proper storage - refrigerate, needle disposal, roll intermediate insulin between hands, no cure for diabetes,

NPH clear or cloudy?

cloudy

insulin high alert

need 2nd nurse

insulin MOA

stimuates glucose uptake in skeletal muscle and fat. inhibits glucose production in liver. enhances protein synthesis.

aspart dose

.5 - 1 units/kg/day

reasons for a foley

surgery involving abdomen, pelvis, bladder after child birth enlarged prostate in men neurogenic bladder critically ill pts Assist in healing open sacral/ perineal wound in incontinent pts Provide improved comfort for end-of-life care Prolonged patient immobilization cancer

braden scale (SNMAMF)

sensory perception nutrition mobility activity moisture friction and shear

teaching for diabetes

signs of hypo and hyper. carry glucose with you. medical alert bracelet. lifestyle - exercise and diet. foot care. use of glucose monitor. techniques for injection and rotation of sites.

SBAR

Background: Vital signs, mental and code status, list of medications, and lab results I - intro - Amanda, nursing student S - calling about ellen scheduled for surgery. She's having doubts. B - admitted yesterday, positive for cancer. history. A - more than just gitters R - should I hold the pre-op? R - I understand you want me to hold the pre-op meds.

what is furosemide for?

diruetic. used to treat high BP and edema.

what is metroprolol used for?

beta blocker - high PB.

what is lisinipril used for?

ace inhibitor. high PB.

sterile dressing change - important to check (think big wound)

need pain meds before you do dressing change. ambulate, position, check if patient has been to bathroom at least every hour. if it’s not w ritten as sterile change, no need for sterile gloves. Braden if they are a pressure risk

equipment for NG tube

tube, connector - clear, pen light, tongue depressor, tape, water, basin, pad, tissues, lubricant, measure suction thing, ph test kit.

with NG tube, don't forget to

check gag reflex and measure tube!!!

steps to set up pump (prime, feed, flush)

1. prime pump (top button) - goes to next screen and choose "hold to prime flush" also press "hold to prime feed" (button below that one. Hold tube over basin here, it's when water will come out. Press done. 2. adjust feed - 2nd button on homepage 3. feed rate (top button) - enter feed rate "200" then enter (top button) 3. feed VTBD (volume in bag) (2nd button on home page) - enter "1000" enter. done. 4. adjust flush (3rd button down on home page) 5. flush volume - "100" enter 6. flush interval "every 2 hours" enter 7. then run, and you're done

set up for foley

2 kits, trash by bedside

ALWays do what with dressing change?

intitals on dressing after change

heparin MOA

binds to antithrombin and makes it active. AT then binds to factor 10 (X), which stops thrombin from converting to prothrombin. Prothrombin creates blot clots.

insulin check what before you administer?

check blood sugar

furosimide is

potassium wasting

COPD sounds

crackles

heparin SQ O/P/D (hep was best between 20 and 28)

20 - 60 min, 2 hr, 8 - 12 hrs.

what to do before heparin? and how soon? (heman on heparin)

monitor hematocrit also! draw PTT 30 min before each dose and then periodically during treatment, every 2 - 3 days. may cause hyperkalemia

heparin teaching (and what else - think meds)

report unusual bleeding, use electric razor, soft toothbrush, do not take NSAIDS. notify if pregnant.

heparin high alert - need another nurse to check

before adminstering

heparin used to treat

pulmonary emboli and venous thromboembolism. use caution with liver or kidney impairment.

heparin dose

5000 units/kg

heparin generic and trade (heparin moon)

heparine (porcine) = generic trade = Monoject Flush Syr/Hep Lock

Bronchial or Tubular sounds (blowing then whisper)

Blowing, hollow sounds. Sound on expiration is longer and lower on expiration

Bronchovesicular (combo is medium)

Medium-pitched. Inspiration and expiration sounds have similar pitch

Vesicular (a blowing whisper)

soft, whispering sound. Sound on inspiration is longer

diabetes numbers

over 126 or 6.5

metoprolol antidote

glucagon or charcol

reasons to take furosemide (keep it simple)

heart failure, hypertension, and renal disease

heparin adverse effect

thromocytopenia (low plaletes), bleeding gums, nose, tarry stools, anemia

furosimide treats what?

pulmonary edema

what treats hypertension?

lisinipril and metoprolol

lisinipril treats what? So monitor for what? what is the main thing you keep forgetting? Then monitor for what?

heart failure - monitor weight for fluid overload, crackles, dyspnea.

when to eat after insulin?

rapid - within 15 min short - within 30 min intermediate - with 30 - 60 min

rapid acting insulin o/p/d

5 - 15, 1-2, 4-6

short acting insulin o/p/d (short at 24 and 68)

30 - 60, 2-4, 6-8

intermediate acting insulin o/p/d (the middle child is 12, adult is 46, and then 12 again)

1-2, 4-6, more than 12 hr.

long acting insulin o/d

2 hours, 24 hrs.

S3 and S4 (my heart fails at 3, and it's stiff at 4)

s3 heart failure s4 - stenosis

abnormal cardiac assessment (the rush is abnormal)

abnormal - thrills - rushing vibrations

crackles

popping - pneumonia

course

bubbles - HF

rhonchi

snoring, copd

stridor

high - obstruction

furosmide monitor

HR and BP before adminstering