nur 304 study guide for unit 1 test
TRANSCRIPT
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NUR 304: Study Guide for Unit 1 Test
Chapter 1:
Understand the following processes/terms:
F irst-pass effect
Process in which the drug passes to the liver FI RST(hepatic 1 st pass)
Protein-binding Effect (distribution) primarily albumin
D rug dose is prescribed according to the percentage in which the drug binds to protein
H ighly protein bound drugs (89% +)
Moderately protein bound drugs (61-89 %)Low protein bound drugs (30 60 %)
Peak/trough; therapeutic range of drugs
Peak drug Level
H ighest plasma concentration of drug at a specific timeIndicates the rate of absorption
Trough D rug Level
Lowest plasma concentration of a drugMeasures the rate at which a drug is eliminated
Therapeutic Range of D rugs (therapeutic window) ED 50 & LD50 close to ratio 1 toxic
Concentration range in plasma should be between M INIMUM effectiveconcentration in plasma for obtaining desired drug action and the M INIMUMTOXIC concentration ( protein bound & free)
Narrow range-monitor to avoid drug toxicityWide range- not considered highly toxic
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Pharmacokinetics
Process of drug movement to achieve drug action.Ab sorption
P assive Ab sorption (Lipid solu b le) D iffusion
o Lipid &nonionized faster than water a b sorption
Active Ab sorption (water solu b le)o N eed carrier
D istri b ution (protein b inding effect) V olume of drug distri b ution is dependent on drug dose & its concentration
in b ody
Meta b olism ( b iotransformation) Liver (primary site and GI tract)
Excretion Main route Kidney b ut also b ile, feces, lungs, saliva, sweat, b reast milk
Pharmacodynamics
The study of drug concentrations and its effects on the body
Primary effect response is desirableSecondary effect response may be desirable or undesirable
Ex. Benadryl: prim (symp of allergies)/Sec (drowsiness; bad id driving auto)
Onset of action- time to meet min. effective concentrationPeak Action- H ighest plasma concentrationD uration of Action- length of pharmacological effect
Loading doseWhen immediate drug response is desired, a large initial dose is given to achieve arapid minimum effective concentration in the plasma.
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Absorption of different drug preparations
Blood flow, pain, stress, hunger, fasting, food, & p H affect drug absorption
Pain, stress, & solid, hot, fatty, foodsslow gastric emptying timeExercise: decr bl flow to G I tract (more bl to peripheral muscle)D rugs that lipid soluble and non-ionized are absorbed faster than water soluble &ionized drugs
Onset, peak, duration of action
Onset of action- time to meet min. effective concentrationPeak Action- H ighest plasma concentrationD uration of Action- length of pharmacological effect
Chapter 2:
H ow to develop educational goals; what constitutes a good goal
RUMBA stands for Relevance ,Understandable, Measurable,Behavioral and AttainableEffective Goal setting Qualities
Client centered; Clearly states expected changeAcceptable to both Client & NurseRealistic & MeasurableShared with other H ealth Care ProvidersRealistic D eadlinesIdentifies Components for Evaluation
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Steps of the nursing process and how they relate to teaching about drug therapy
Assessment (incl Nursing Diagnosis)
Subjective D ata Prescription, OTC, herbs, Vitamins
Objective data ROM, F ine Mtr Control, Visual impairment affect taking meds Identify H igh risk clients for Adverse Reactions Probs w/ compliance; cost, forgetfulness, trust, value systems
Includes Nursing D iagnosis Cultural/lamguage barriers Pain/fear of addiction Ineffective H ealth maintenance (not having preventive care) Ineffective regimen management Noncompliance related to forgetfulness/costs Risk for Injury/side effects
Planning/goalsClient centered; Clearly states expected changeAcceptable to both Client & NurseRealistic & MeasurableShared with other H ealth Care ProvidersRealistic D eadlinesIdentifies Components for EvaluationExamples
Client will independently adm prescribed dose of Insulin by end of 4 th session of instructions
Client will prepare a medication recording sheet that correctly reflectsprescribed meds schedule within 3 days
Implementation
Client Ed & teaching very important in this stage.In practice settings, adm of drugs assessment of drug effectiveness areimportant nursing responsibilities.
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Chapter 5:
Schedules of drugs
Schedule I (labeled C-I) D rugs with high Abuse potential. NO ACCEPTE D MED ICAL USE
H eroin, H allucinogenics (Lsd, Marijuana(except presc), mescaline,peyote, psilocybin)
Sch II thru Sch V have accepted med use (dep decr as you move down)
Schedule II (labeled C- II )H igh potential for abuse. ACCEPTE D MED ICAL USE. Can lead to strong physical
dependence& Psychological dependence D emerol, Morphine, H ydrocodone, H ydromorphine, Methadone,
Oxycodone, Codeine, Amphetamines, Secobarbital, Pentobarbital
Schedule III (labeled C- III )Medically accepted D rugs. Potential for abuse is less than I or II . May causedependence
Codeine preparations, Paregoric, nonnarcotic drugs-Pentazocine,Propoxyphene
Schedule IV (Labeled C- IV)Medically Accepted D rugs. May cause dependence
Phenobarbital, Benzodiazepines (diazepam, oxazepam, lorazepam,chlordiazepoxide), Chloral H ydrate, Meprobamate
Schedule V (labeled C-V)Opioid-controlled substances for diarrhea & cough (eg codeine in coughpreparations)
Example: Codeine is a sch II drug but when added to acetaminophen, it becomes a sch III drug and
when in combination with cough preparations, it becomes a sch V drug
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Pregnancy categories
F D A developed a classification system related to the effects of drugs on the unbornchild (fetus). A preg category is indicated on most drugs
Pregnancy Categories:
CATEGORIES A& B are considered to be within SA F E LIM ITS, esp. during 1 st Tri-semester A- No risk to F etus (studies have shown no evidence) B- No risk in Animal Studies and well controlled studies in pregnant
women are not available. It is ASSUMED there is little or no risk C- Animal Studies indicate a risk to the F etus. Control studies on
pregnant women are not available. Risk VS Benefit of the drug must
be determined. D -A Risk to the H uman F etus has been Proved. Risk VS Benefit of the
drug must be determined. It could be used in L IF E TH REATENINGCOND ITIONS
X- A Risk to the H uman F etus has been Proved. Risk outweighs theBenefit and drug should be avoided during pregnancy
Chapter 7:
General guidelines as to the use of OTC drug preparations
Category I D rugs judged to be both safe & effective
Category II D rugs judged to be either unsafe or ineffective; these drugs should not beincluded in nonprescription products
F D A recommends drugs in CAT II be reformulated to be incl. in CAT I orremoved from the market
Category III D rugs for which there insufficient data to judge safety or efficacy
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Chapter 9:
General guidelines as to the use of herbal medications/preparationsD o not take if pregnant or attemptingD o not take if nursingD o not take a lge quantity of any one herbal preparationBuy only preparations that have the plant & their quantities listed; noguarantee of safetyContact H CP before stopping use of prescription medStore in a cool dry dark place; dark glass containers preferredUse only herbs that are bought currently and are freshD o not delay seeking care for severe or persisting symptomsAdvise against belief in unsubstantiated claims of miracle cures
Consumers need to think of herbs as medicine MORE IS NOT BETTERH erbs are not placebosMost less potent than conventional medsConventional meds fasterLabeling of herbal products important
Scientific name & parts of plantMfg name & addressBatch & Lot #D ates ogmfg&exp; many have short shelf life
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Chapter 11: p 199
General nursing implications for medication use in the elderly client
The # of drugs taken , drug interactions&physical health are factors assoc with drug
effectsy H ypnotics- Benzodiazepines ( low doses w/short term therapy suggested) y Anthypertensives- Start low/grad incr as per needs y Anticoagulents- ck PT , INR y Antibacterial- reduced doses/reduced clearance/prolonged t y Antidepressants- reduce 30-50 % & incr as per need
AbsorptionD ecr gastric acidity alters absorp of weak acids such as aspirinD ecr Bl flow in G I tract (40-50%less) is caused by decr cardiac output andabsorp is slowedReduction in G I motility rate (peristalsis) may delay onset of actionReduction in Gastric emptying time occursAmt of oral dose that is absorp is not affected by age (just longer)
D istributionBecause of decr body H 2O, water soluble drugs are concentratedBecause if incr F at to water ratio, fat- soluble drugs are stored &accumulateD ecr in circ serum protein (fewer protein binding sites) there is morefree drug available to body tissue at receptor sites
MetabolismD ecr in H epatic Enzyme production, hepatic Bl flow, Total LiverF unctioncause a reduction in drug metabolism
o With reduction in metabolic rate, t life INCREASES and drugaccumulation can result
ExcretionD ecr in RENAL BLFLOW/GLOM FI LTR at 40 t0 50 %D ecr renal function causes decr drug excretions and accumulation canresult. Poss. drug toxicity
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Chapter 14:
Nursing implications of your prototypes
Vitamins
Assessmento Ck client for Vit deficiencies before start & regularly thereaftero Obtain 24 & 48 hr diet history analysis
Nursing interventionso Adm vitamins w/ food to promote absorptiono If drop form, use the calibrated dropper for accurate dosingo Adm IM to clients unable to take PO(GLmalabsorptionsyndrome)
o Vit A-To avoid risk for hemolytic anemia recognize need for Vit Esupplements for infants receiving Vit A
o Vit A-Monitor Vit A serum levels (80-300 int l units/ml)
o Vit C Abrupt withdrawal can result in rebound deficiencyo Vit C decr effects of oral anticoagulantso Vit C-smoking & Oral contraceptives decr levelso Vit C- megadoses taken w/aspirin or sulfamides may cause
crystal formation in urine (crystalluria)
o Iron-incr amt needed during 1 st trimestero Iron-Megadoses cause teratogenic effect on fetuso Iron-iron Toxicity serious cause of poisoning in childreno Iron-hemorrhage due to ulcerogenic effects of unbound iron
leads to shock
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B12 D eficiency uncommon unless there is a disturbance in the intrinsicfactor & intestinal absorptionPernicious Anemia (lack of intrinsic factor) major cause of deficiency
Vitamin CScurvy
Know the purpose of all vitamins/minerals that have a significant impact onillness/disease processes
Vitamin A
Purposeo Essential for bone growth & the maintenance of epithelial
tissues, skin, eyes & hairUsed F or:
o Treats Vitamin D eficiencies Biliary tract or pancreatic disease, colitis, cirrhosis, celiac
dis., sprue
Skin disorders (acne) Night Blindness
Vitamin D
Purposeo Major role (calcitriol) in regulating calcium & phosphorus
metabolism and needed for calcium absorption from smallintestines (if Ca levels low, more Vit D activated, when Canormal, Vit D is decr)
Used F or:
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Vitamin E
Purposeo
Antioxidant properties that protect cellular components (fattyacids, RBCs from hemolysis). Promotes functioning of RBCs,muscles & tissues
Used F or:o 400-800 Int l units per day reduces # of Myocardial Infarctions
(M I)o 200 Int l units a day reduce CA D o Prolongs PT; monitor
Vitamin K
Purposeo Needed for synthesis of Prothrombin and clotting factors V II , IX,
XUsed F or:
o Antidote for oral anticoagulant overdoseo To prevent & treat hypoprothombinemia of Vit K deficiencyo Newborns Vit K deficiency
Vitamin B 1 Thiamine
Purposeo It functions as a coenzyme during carbohydrate metabolism. It is
essential for the functioning of heart, muscles and nerves Used F or:
o Treatment of Wernicke-Korsakoff Syndrome
Vitamin B 2 Riboflavin
Purposeo It promotes carbohydrate and protein metabolism. Riboflavin is
necessary for healthy skin, nerves and oral mucosaUsed F or:
o Treat Migraine headaches/dermatological concerns
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Vitamin B 3 Niacin
Purposeo maintains good mental health, digestive tract and healthy skin.
Used F or:o Reduce Cholesterol levelso Alleviates Pellagra & hyperlipidemia
Vitamin B 6 Pyridoxine
Purposeo Essential building block of nucleic acids, RBC formation &
synthesis of hemoglobin; maintains NS integrity (myelin)Used F or:
o Treat Vit B 6D ef o Neonates w/seizures refractive to traditional therapy
Vitamin C
Purposeo Aids in absorption of IRON and conversion of F OLIC ACID ; plays a
role in the metabolism of connective tissue, collagen fibersynthesis and production of strong skin. It increases theresistance of the body to fight infections and also keeps theteeth, gums and joints healthy
Used F or:o Treat D eficiency of vitamin C that results in scurvy
Folic Acid (folate)
Purposeo Essential for body growth; D NA synthesis; w/out there is a
disruption in cellular division
Used F or:o F olic acid def in 1 st trimester
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Iron
Purposeo Vital for hemoglobin regeneration (RBC development)o
O2 transport via hemoglobin
Used F or:o Prevent & treat Iron deficiency
Copper
Purpose
o F ormation of RBCs and Connective tissues & production of neurotransmitters Norepinephrine & epinephrine
ZincPurpose
o Important to enzymatic reactions; essential for normal growthand tissue repair; wound healing and taste & smell
Used for:o Poss. alleviate common cold
Chromium
Purposeo Control of type II diabetes by helping to normalize Bl glucose bt
incr the effects of insulin on the cells
Selenium
Purposeo Cofactor for an antioxidant enzyme that protect protein and
nucleic acids from oxidative damageUsed F or:
o Works w/ Vit E and thought to have Anticarcinogenic effect
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Chapter 15:
Know the various types of IV solutions and the uses of each
Crystalloid ( crystals mixed in solution)
Replacement and maintenance of fluid therapyEx. D extrose, Saline, Lactated Ringers
Colloids (draw fluids in )
Volume ExpandersEx. D extran solutions; dextran 40-interfere w/platelet functionEx. Amino AcidsEx. H etastarch- isotonic (310 mOsm/l) decr platelet & H ctEx. Plasmanate- Comm l prepared protein product (inst of alb or plasma)
Blood & Blood Products
Whole Bloodo 1 unit -Elevates H gb by 0.5 to 1.0
Packed RBCs-o 1 unit-Elevates H ct by 3o decr chance of Circ overload/less antigen reaction
PlasmaAlbumin
Lipids
A fat emulsion solution which is usually indicated in IV therapy that lastslonger than 5 daysAdds balance to nutritional needs
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Safety issues associated with electrolyte replacement
Monitor vital signsMonitor Urine OutputMeasure wt. dailyCk for signs & symptoms of F luid Vol. deficitCk for signs & symptoms of F luid Vol. OverloadMonitor lab resultsMonitor types fluid client receivingCk IV injection site for infiltration or phlebitisSevere vomitingMeaning of thirst /old /young
Various types of crystalloids and how they work/issues associated with their tonicityWith fluid Volume loss, Isotonic solution Indicated ( similar osmolality to ECF & ICF )
D extroseD 5W-isotonic- 250 mOsmIn water becomes hypotonic ( 3 L +)
Normal Saline0.9 % NaCl- isotonic- 310 mOsm
Lactated RingersIsotonic- 275 mOsm
Ringers Solution
Isotonic- 310 mOsm
H ow do you know if a client is adequately responding to fluid replacement vs havingside effects/adverse effects
Electrolytes would be within their narrow rangesMagnesium 1.5 - 2.5 mg/dLCalcium (total) 8 - 11 mg/dLChloride 96 - 112 mEq/LPhosphorus 2.2 - 4.8 mg/dLPotasssium 3.5 - 5.5 mEq/LSodium 135 - 148 mEq/L
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H ct ( H ct (Male) 39 - 54%) and BUN ( BUN 6 - 23 mg/dL ) are Normal
If both values elevated, indicates F lVol deficit (dehydration)BUN > 60 mg/dl indicates Renal F ailure
Urine Output would be normalNormal output > 35 ml/hr or 1000-1200 ml per dayReport < 25 ml/hr or < 600ml per day
Urine Specific Gravity (SG) would be normal
Normal 1.005 to 1.030> 1.030 indicates H ypovolemia (dehydration)
Ck types of IV fluids
Report Continuous use of D 5W/promotes hypo-osmolality
Signs & symptoms of F luid Over load
Constant irritated cough; Neck Vein Engorgement; hand Vein Engorgement
Moist Rales in Lungs
Sign & Symptoms of F luid D eficit
Excess Thirst (mild Thirst ), Marked Thirst: D ry Mucous membranes, poor skinturgor , decr urine output, tachycardia, Slight decr in Systolic Blood Press
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Chapter 16:
Compare and contrast the uses, complications, side effects, and which clients arecandidates for enteral vs. parenteral nutrition therapy
Enteral Nutrition Therapy (preferred method) 1st Choice-less risk of sepsis/maintains GI integrity/less costly
Route for adm nutritional support orally(can swallow) or by feeding tubes(cannot swallow)
o Nasogatric tube (gastrostomy) S H ORT TERMo Nasoduodenal/nasojejunal/jejunostomy (small Intestinal) LONG TERM
Enteral Solutions- Carbs/protein/fat o Blenderized (liq that pass thru tube)o Polymeric (milk based & lactose free) Supplement/Ensureo Elemental or Monomeric (partial G I tract dysfunction)
Methods for D eliveryo Bolus- 2 50-400ml rapidly o Intermittent- every 3-6 hrs over 30 to 60 minuteso Continuous (critically ill/in intestine) slow rate over 24 hrso Cyclic(continuous) 8-16 hrs
Complications/side effectso D ehydration-if not enough water is given( some hyperosmolar)o D iarrhea: caused by rapid adm/corrected by decr rate of infusiono Ck residual:
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COMPLICATIONS o Result from catheter insertion & TPN infusion o Pneumothorax/hemothorax/hydrothorax/air
embolism/infection/hyperglycemia/fluid overload
ValsalvaManeuver prevents air embolism H yperglycemia when infusion rate too rapido TPN excellent medium for organism growth
Chapter 17-25:
In these chapters guys , you are responsible for primarily the classes and prototypes . For each, you
should b e familiar with mechanism of action , selectivity , safety concerns , client teaching , side effects ,adverse reactions , issues with dosing (times, preparation, anything the book highlights) , antidotes ,and relevant nursing assessments . I assure you that anything you are tested on is important and a b igdeal. This test O V ER ALL is very general.... b ut there are a few specific things pulled out that we definitelywent over in class...and E V ERYT H IN G ON T H E TEST COMES STR AIGH T FR OM YOUR BOOK!!
Chapter 17
CLASS:Adrenergics-agonists (Sympatheomimetics/adrenomemetics)
D rugs that stimulate the SYMPAT H TIC NERVOUS SYSTEMMimic SNS
Act on Adrenergic Receptors (cells of muscles: heart,Bronchioles, G I, Urinary bladder,cilary eye muscles
Alpha 1 Receptor: When stimulatedArterioles&venules CONSTR ICT incr peripheral resistance &bl return toheart(BP incr)
Alpha 2 Receptor: When stimulatedInhibits the release of Epinephrine leading to decr invasoconstriction(BP decr)
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Beta 1 Receptor: When stimulatedIncreases MyocardialContractibility and H eart Rate (smooth muscle)
Beta 2 Receptor: When stimulatedCauses relaxation in smooth muscles in lungsIncr Blood flow to skeletal musclesRelaxation of Uterine muscles
D opaminergic Receptor; When stimulatedVessels dilate & blood flow increases
Adrenergic Blockers (antagonist) SYMPAT H OLYTICS
D rugs that block the effects of adrenergic neurotransmitters , alpha/beta, bydirectly occupying the alpha/beta receptors or indirectly inhibiting the releaseof the neurotransmitters Norepinephrine & epinephrineEffects of Adrenergic Blocker at Receptors
Alpha 1 o causes VASO D ILATION; decr BP; reduce smooth muscle
contractionBeta 1
o D ecr H R; reduces force of contractionsBeta 2
o Constricts Bronchioles, Contracts Uterus; inhibit Glycogenolyisis(decr bl sugar)
Alpha-Adrenergic Blockers
PROMOTE VASOD ILATION & D ECR BPBlock or inhibit a response at the alpha adrenergic receptor siteSelective alpha blockers-Alpha1 onlyNonselective- Alpha1 & Alpha2
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Beta-Adrenergic BlockersD ECRH R; D ECR BPF OLLOWS;
Nonselective blocking Beta 1 & 2 o
caution COPD
(bronchiole constriction &H
R)Selective Beta 1 o Good for decr H r& BPo Atenolol
Adrenergic Neuron Blockers (sub of Adrenergic Blockers)Blocks the release of Norepinephrine to D ECR BP
Chapter 18
Cholinergics (parasympathomimetics) AGON IST
Mimic PNS neurotransmitter Acetylcholine (Ach)Cholinergic Receptors
o Muscarinic receptorStimulate smooth muscle & slow heart rate
o Nicotinic receptorsAffect skeletal muscles
D irect Acting Cholinergic D rugso Act on the receptors to activate a tissue responseo Primarily selective to Muscarinic receptors but are nonspecific because
receptors are located on smooth muscle-G I,GU, glands, hearto BethanecholCholride (Urecholine) Increases urination
Indirect Acting Cholinergic D rugs (anticholinesterase/Cholinesteraseinhibitors)
o Inhibit the action of the enzyme Cholinesterase (ChE)(Acetylcholinesterase) by forming a chemical complex, thus permittingacetylcholine to persist and bind to the receptor
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o Primary use to treat Myasthenia Gravis, Glaucomao Reversible Cholinesterase Inhibitors
Pupil constriction (Glaucoma) Incr muscle strength (Myasthenia Gravis)
o Irreversible Cholinesterase
I
nhibitors o Permanent
AntiCholinergics (Parasympatholytics) Antagonisto D rugs that inhibit the actions of acetylcholine by occupying the acetylcholine
receptorso By blocking PNS, the SNS (adrenergic) dominateso Major response is decr G I motility , decr salivation, decr pupils (mydraisis), incr
pulse rateo Can act as an antidote to Cholinesterase inhibitors/organophosphate ingestiono Atropine- Preoperative med to decr salivation, H R, dilate pupils
Anti Parkinson/Anticholinergic D rugso Trihexyphenidyl H CL
D ecr involuntart symptoms of Parkinson or drug induced Parkinson(pseudo)
Blocks cholinergic (muscarinic) receptors