Fundamentals of Nursing 7th Unit 7-9 test 3

Take apical pulse because it will lower pulse.

If you decide that it’s clinically unsafe - but you must document the fact and why.

Have a witness for wasting.

yourself

Patient consent, knowledge of medications, safe & timely delivery, controlled substances, hold drugs for patient safety, prepare drugs yourself, responsible for your own actions, agency restrictions, follow policy.

Patient identification, CEUs every 2 years

Maybe pre-op or any time, but just once. Have to tell doctor you did it.

Give them one now. Not common in real life.

READ BACK. Sign VORB (verbal order read back) M Troxell, Dr. Payne

Medication & Medical history, allergies & intolerances, Pregnancy and lactation status

Hives, swelling (edema), respiratory distress.

a side-effect that the patient doesn’t particularly like.

Check MAR, verify physician orders, diet & fluid orders, laboratory values, physicals

Liver enzyme test

Liver enzyme tests

kidney function tests.

1. right to clear orders 2. R..... (in powerpoints)

the medical term for a subcutaneous purpura larger than 1 centimeter or a hematoma, commonly called a bruise. It can be located in the skin or in a mucous membrane.

Gather baseline data about the client's health status; Supplement, confirm, or refute data obtained in the history; Confirm and identify nursing diagnoses; Make clinical judgments about a client's changing health status and management; Evaluate the outcomes of care

thoracic (chest) movement, indicating respiratory effort.

Crepitus is a medical term to describe the grating, crackling or popping sounds and sensations experienced under the skin and joints.

Excess perspiration.

Foul-smelling perspiration.

Diabetes.

SITTING - Head and neck, back, posterior thorax and lungs, anterior thorax and lungs, breasts, axillae, heart, vital signs, and upper extremities; SUPINE - Head and neck, anterior thorax and lungs, breasts, axillae, heart, abdomen, extremities, pulses; KNEES RAISED - Head and neck, anterior thorax and lungs, breasts, axillae, heart, abdomen; STIRRUPS - vagina; SIMS - buttocks, rectum, vagina?

A method of questioning in suspected substance abuse. Have you ever felt the need to Cut down on your drinking or drug use? Have people Annoyed you by criticizing your drinking or drug use? Have you ever felt bad or Guilty about your drinking or drug use? Have you ever used or had a drink first thing in the morning as an Eye-opener to steady your nerves or feel normal?

If the client has lost more than 5% of body weight in a month or 10% in 6 months, the loss is significant.

steroids, oral contraceptives, antidepressants, insulin

diuretics, insulin, fluoxetine, prescription and nonprescription appetite suppressants, laxatives, oral hypoglycemics, and herbal supplements

changes in oxygenation, circulation, nutrition, local tissue damage, and hydration.

Congenital or autoimmune condition causing lack of pigment

Diaphoresis; Spider angiomas; Burns (especially fingers); Needle marks; Contusion, abrasions, cuts, scars; “Homemade” tattoos; Increased vascularity of face; Red, dry skin

A client who takes repeated IV injections has edematous, reddened, and warm areas along the arms and legs.

hyperpigmented and shiny or scarred areas.

Hardened skin.

Turgor is the skin's elasticity.

Petechiae are pinpoint-sized, red or purple spots on the skin caused by small hemorrhages in the skin layers.

1+ edema equals a 2-mm depth, 2+ edema equals a 4-mm depth, 3+ equals 6-mm, and 4+ equals 8-mm

thickening of skin.

ruby red papules

When you detect a lesion, inspect it for color, location, texture, size, shape, type, grouping (clustered or linear), and distribution (localized or generalized). Observe any exudate for color, odor, amount, and consistency. Measure the size of the lesion by using a small, clear, flexible ruler divided in centimeters. Comparing a lesion with a household measure, such as a coin or eraser, is not reliable (Seidel and others, 2006). Measure lesions in height, width, and depth.

Not as dangerous, most common in sun-exposed areas and frequently occurs in a background of sun-damaged skin; it almost never spreads to other parts of the body.

more serious than basal cell and develops on the outer layers of sun-exposed skin; these cells may travel to lymph nodes and throughout the body.

Flat, nonpalpable change in skin color, smaller than 1 cm (e.g., freckle, petechia)

Palpable, circumscribed, solid el evation in skin, smaller than 1 cm (e.g., elevated nevus)

Elevated solid mass, deeper and firmer than papule, 1-2 cm (e.g., wart)

Solid mass that extends deep through subcutaneous tissue, larger than 1-2 cm (e.g., epithelioma)

Irregularly shaped, elevate or superficial localized edema; varies in size (e.g., hive, mosquito bite)

Circumscribed elevation of skin filled with serous fluid, smaller than 1 cm (e. g., herpes simplex, chickenpox)

Thinning of skin with loss of normal skin furrow, with skin appearing shiny and translucent; varies in size (e.g., arterial insufficiency)

hair growth on the upper lip, chin, and cheeks, with vellus hair becoming coarser over the body.

Hair loss

ABCD: A- Asymmetry; B- Border irregularity; C– Color, uniformity (blue, black, brown variegated and areas of pink, white, gray, blue, or red are abnormal; D- Diameter than pencil eraser.

the buildup of cerebrospinal fluid in the ventricles

a disorder caused by excessive secretion of growth hormone.

Visual acuity for central, reading for near, Snellen for distance.

(D / H) x V = amount to give (Dose ordered over what you have times vehicle or volume)

60 mg

30 mL

2 T

5 mL

Before meals and at bedtime.

How medications move throughout the body.

Absorption

Route of administration, ability to dissolve, Blood flow to site of administration, Body surface area, lipid solubility of medication.

IV & skin

Passive (get in alone), Active (need help), Pinocytosis (someone “carries” them across ie. enzyme).

Dose, composition, GI mucosa & motility, GI tract pH, Enzymatic action, Drug-drug or food-drug interaction, blood flow to site of drug administration, hepatic first-pass effect.

grapefruit juice, grapefruit

Once drug is absorbed by bowel, goes into mesentery empties into portal vein, then to liver - who decides how much of the drug gets through. (Oral only)

Distribution to body tissues, organs and specific sites of action.

Circulation, membrane permeability, protein binding.

Protein-binding competition, low plasma protein/albumin levels, blood flow, blood-brain barrier, drug affinity (attraction).

Body disfunction here: Liver, lungs, kidneys, blood, intestines.

kidneys.

Kidney, lungs, bowel, skin via perspiration, tears, saliva, breast milk, liver.

lowering body mass & total body water = lowering volume for distribution of drug. Lowering flow to kidneys & lowering of renal mass = lowering of drug excretion.

None

Expected or predicted effect.

unintended, secondary (nontherapeutic effects).

Also unintended and secondary, but severe, concerning - Reasons to take them off.

Medication has accumulated in the blood stream to now have a poisonous effect.

Over- or under-reaction to a medication.

Initiates drug action; produces response.

Prevents blocks drug reaction.

Narcan

Mazicon

The time it takes the body to metabolize down the drug to 1/2.

Time it takes for a medication to produce a response.

Time at which a med reaches it highest effective concentration.

Minimum blood serum concentration before next scheduled dose.

Time medication takes to produce greatest result.

Blood serum concentration is reached and maintained.

Age & gender, body weight, pharmacogenetics, ethnic characteristics, pathological effects, psychological effects.

Labeled “natural” doesn’t mean safe. Can act in same way as drugs. Don’t use for preg/lact/children. May interact with other medicines. Seek guidance from medical professional. Regulated by FDA as food not drugs.

Lab test to assess serum drug levels in the prevention of drug toxicity.

The most accurate test to determine renal function is creatinine clearance (CLcr)

85 to 135 ml/min.

Onset of action is the time it takes to reach the minimum effective concentration (MEC) after a drug is administered.

(1) kinase-linked receptor, (2) ligand-gated ion channels, (3) G protein-coupled receptor systems, and (4) nuclear receptors.

The ligand-binding domain for drug binding is on the cell surface. The drug activates the enzyme (inside the cell), and a response is initiated.

The drug spans the cell membrane and, with this type of receptor, the channel opens, allowing for the flow of ions into and out of the cells. The ions are primarily sodium and calcium.

There are three components to this receptor response: (1) the receptor, (2) G protein that binds with guanosine triphosphate (GTP), and (3) the effector that is either an enzyme or an ion channel.

Cell nucleus and not on the surface of the cell membrane. Activation of receptors through the transcription factors is prolonged. With the first three receptor groups, activation of the receptors is rapid.

Any drug that functions to enhance the effects mediated by acetylcholine in the central nervous system, the peripheral nervous system, or both.

The chemical compound acetylcholine (often abbreviated ACh) is a neurotransmitter in both the peripheral nervous system (PNS) and central nervous system

The four categories of drug action include (1) stimulation or depression, (2) replacement, (3) inhibition or killing of organisms, and (4) irritation.

The therapeutic index (TI) estimates the margin of safety of a drug through the use of a ratio that measures the effective (therapeutic or concentration) dose (ED) in 50% of persons or animals (ED50) and the lethal dose (LD) in 50% of animals (LD50) (Figure 1-8).

Drugs with a low therapeutic index have a narrow margin of safety. Drugs with a high therapeutic index have a wide margin of safety and less danger of producing toxic effects.

When immediate drug response is desired, a large initial dose, known as the loading dose, of drug is given to achieve a rapid minimum effective concentration in the plasma.

Pharmacogenetics is the effect of a drug action that varies from a predicted drug response because of genetic factors or hereditary influence.

A decreased responsiveness over the course of therapy.

A rapid decrease in response to the drug.

In the traditional stock drug method, the drugs are dispensed to all clients from the same containers. In the unit dose method, drugs are individually wrapped and labeled for single doses.

sublingual (under tongue for venous absorption); buccal (between gum and cheek); via feeding tube; topical (applied to the skin); inhalation (aerosol sprays); instillation (in nose, eye, ear); suppository (rectal, vaginal); and four parenteral routes: intradermal, subcutaneous (subQ), intramuscular (IM), and intravenous (IV).

capsule

dram

elixir

gram

grain

drops

kilogram

liter

square meter

microgram

milliequivalent

milligram

milliliter

minim

right ear

left ear

both ears

intradermal

intramuscular

intravenous

intravenous piggyback

keep vein open

left

nasogastric tube

right eye

left eye

both eyes

by mouth

right

subcutaneous

sublingual

to keep open

vaginal

before meals

as desired

twice a day

with

hour of sleep

nothing by mouth

after meals

whenever necessary, as needed

every

every morning

every hour

every 2 hours

every 4 hours

every 6 hours

every 8 hours

without

once if necessary: if there is a need

immediately

three times a day

This term refers to the first adverse symptoms that occur at a particular dose. Toxicity is more prevalent in persons with liver or renal impairment and in the very young and old.

This occurs when the drug is metabolized or excreted more slowly than the rate at which it is being administered.

the abdomen, upper hips, upper back, lateral upper arms, and lateral thighs (

ventrogluteal, deltoid, and vastus lateralis (pediatrics)

Needle: 25 to 27 gauge, ½ to ⅝ inches in length, Syringe: 1 to 3 ml (usually 0.5 to 1.5 ml injected)

Needle: 20 to 23 gauge; 18 gauge for blood products; 1 to 1.5 inches in length, Syringe: 1 to 3 ml (usually 0.5 to 1.5 ml injected)