question

What are the 5 functions of the skin?

answer

**Think PTSSD** 1. Protection (1st line of defense) 2. Thermoregulation 3. Sensation (heat, cold, pressure, pain, contact) 4. Secretion/Excretion 5. Vitamin D formation

question

What are 9 factors that affect skin integrity?

answer

1. Age 2. Mobility 3. Moisture of the skin 4. Nutrition and Hydration 5. Diminished Sensation or Cognition (ex, a diabetic patient who doesn't understand the disease process) 6. Impaired Circulation 7. Fever 8. Lifestyle 9. Medications

question

When it comes to skin integrity, any break in the skin can lead to infection. What are the 2 focuses of the nurse regarding the skin?

answer

1. Protecting the skin. 2. Maintaining skin integrity.

question

What are the 3 factors that can cause a break in skin integrity?

answer

1. Traumatic injuries. 2. Surgery. 3. Pressure.

question

What are the 3 layers that make up normal skin?

answer

1. Epidermis: top layer, avascular, receives nutrition from the dermis, epithelial cells on this layer are constantly being replaced to protect against pathogens. 2. Dermis: 2nd layer, provides strength and mechanical support. 3. Subcutaneous Fat Layer: fatty tissue that provides cushioning.

question

When performing a skin assessment, what are the 9 factors that should be evaluated?

answer

1. Color: pallor, erythema (redness), jaundice, cyanosis. 2. Temperature: Warm or Cold. 3. Moisture 4. Odor 5. Turgor 6. Vascularity 7. Edema 8. Lesions 9. Texture/thickness

question

There are two types of wounds in regards to skin INTEGRITY, what are they?

answer

1. Closed wound: when the epidermis and dermis remain intact. Ex, a bruise or contusion. 2. Open wound: when there is a break in the skin or mucous membrane.

question

What are 3 types of open wounds? Give examples of each.

answer

1. Laceration: a tearing injury, usually with irregular wound edges. These wounds are usually contaminated with debris, dirt, or bacteria. Ex, a scratch. 2. Abrasion: SUPERFICIAL, involves the scraping or rubbing of superficial layers of the skin. Ex, a skinned knee. 3. Puncture: a PENETRATING injury due to a pointed object without a blade; depth is greater than length. Ex, an ice pick puncture wound.

question

In regards to skin integrity, what is the term used to describe a closed, intentional surgical incision?

answer

An APPROXIMATED incision

question

In regards to the HEALING TIME of a wound, what are the two types of wounds?

answer

1. Acute Wound: this wound heals on its own over a short duration, proceeds through an orderly and timely reparative process, and in a healthy person it usually heals w/o complications. This wound can be a result of trauma or a surgical incision. 2. Chronic Wound: this wound takes a lonngggg time to heal and usually exceeds the expected length of recovery. It fails to proceed through an orderly and timely reparative process, and healing is usually interrupted due to infection, continued trauma, ischemia, or edema. Ex, pressure, arterial, venous, and diabetic ulcers.

question

In regards to WOUND CONTAMINATION, what are the 3 types of wounds?

answer

1. Clean: UNCONTAMINATED. This wound contains no pathogenic organisms and does not include areas going into the GI, GU, respiratory, or oral-pharyngeal cavities. 2. Clean Contaminated: a wound made under ASEPTIC CONDITIONS, but involving a body cavity that normally harbors microorganisms so it DOES include the GI, GU, respiratory, and oral-pharyngeal cavities. 3. Contaminated: involves a MAJOR BREAK in aseptic technique; open traumatic wounds not under controlled conditions. Ex, spillage from GI tract or a ruptured appendix.

question

In regards to the DEPTH of wounds, what are the two types?

answer

1. Partial-thickness: wounds that are SHALLOW, involving loss of the epidermis and possibly partial loss of the dermis. This wound type heals be REGENERATION. Ex, Stage II wounds. 2. Full-thickness: wounds that extend into the DERMIS and into deeper tissues (subcutaneous fat and muscle). This wound type heals by SCAR FORMATION because deep skin structures do not regenerate.

question

What are the 3 different PROCESSES of wound healing?

answer

1. Primary Intention: skin edges are approximated or CLOSED. This is usually when a patient had surgery and the wounds were intentionally created in an operating room. 2. Secondary Intention: skin layer are NOT close or approximated. This wound is left open until SCAR TISSUE or granulated tissue forms. If there is a large gaping wound that is being PACKED, the wound is healing by secondary intention. 3. Tertiary Intention: healing occurs when a wound is closed at a later time after the wound surfaces have already started to granulate. This is used when wounds are deep or until there are no more signs of infection. Whenever a wound is left open for a long period of time TO DRAIN, the wound is healing by tertiary intention.

question

The wound repair process is different for partial-thickness and full-thickness wounds. What are the 2 stages of the wound repair process for partial-thickness wounds, such as a Stage II pressure ulcer?

answer

1. Inflammatory Response: this is generally limited to the first 24 hours and involves redness, swelling, and a moderate amount of serous exudate. 2. Proliferation (reproduction) and Migration: epithelial cells begin to reproduce and migrate across the wound bed soon after the wound occurs. Wounds left open to the air resurface in 6-7 days. **Wounds kept moist resurface in only 4 days because epithelial cells migrate better across a moist surface**

question

The wound repair process is different for partial-thickness and full-thickness wounds. What are the 4 stages of the wound repair process for full-thickness wounds, such as Stage III and Stage IV pressure ulcers?

answer

1. Homeostasis: the body's natural response to trauma. Injured blood vessels constrict, platelets stop the bleeding, and clots form a fibrin matrix. 2. Inflammatory Phase: begins 3 minutes after injury and last up to 3 DAYS. Damaged tissue and mast cells secrete histamine, resulting in the vasodilation of capillaries and WBC's go to the damaged tissue. 3. Proliferation (Reproductive) Phase: begins and lasts 3-24 DAYS. Granulation tissue is produced to fill and resurface the wound with new skin. 4. Remodeling (Maturation) Phase: final stage of the healing process and can take UP TO A YEAR. The collagen scar continues to gain strength, but the healed wound does not have the strength of the original tissue.

question

The Inflammatory Phase of the wound healing process results in exudate or wound drainage. Exudate is made up of fluid and cells that escape from the blood vessels and are deposited in wound drainage. When assessing drainage it's important to note the amount, color, consistency, and odor. What would excessive exudate be an indication of?

answer

The presence of an infection.

question

What are the 3 functions of wound drainage?

answer

1. Dilution of Toxins: produced by bacteria and dying cells. 2. Transportation: this includes leukocytes, plasma proteins, and antibodies to the site. 3. Removal away from the site: this includes bacterial toxins, dead cells, and debris.

question

What are the 4 different type of wound drainage?

answer

1. Serous: clear, watery plasma. 2. Serosanguineous: drainage is a mixture of serous and some blood tinged, seen with surgical incisions. Pale, pink, watery mixture of clear and red fluid. 3. Sanguineous: indication of capillary damage; large number of RBC's, severe inflammation. This drainage is bright red and indicates active bleeding. Will also see clotting. 4. Purulent (Pus): indication of severe inflammation WITH INFECTION. Contains leukocytes, liquified dead cells, dead and living bacteria. This drainage is thick, yellow, green, tan or brown.

question

Drains are special equipment that pull drainage away from a surgical area when a wound has been closed. What are the 3 types of drains?

answer

1. Jackson-Pratt or J.P. Drain: closed suction drainage system that should be emptied when half full. 2. Hemovac: closed suction drainage system. 3. Penrose: drains by GRAVITY. It's a rubber type tube with openings on both ends, allowing the drainage to accumulate on gauze placed underneath.

question

What are 5 complications of wound healing?

answer

1. Dehiscence: total or partial disruption of the wound edges. The wound edges have OPENED UP. 2. Evisceration: the protrusion of viscera through a wound opening. 3. Infection: temp >100.4, swelling, redness, pain, tachy, increased WBC count. 4. Hemorrhage: hypotension, HR tries to increase but pulse is weak and thready, can occur post-op; hematoma. 5. Fistula: abnormal tube-like passage that forms between 2 organs, or between 1 organ and the outside of the body.

question

What is the FIRST intervention the nurse should make when a dehiscence of the wound occurs? What is the second?

answer

First: Cover with a STERILE DRESSING. Second: Notify the physician.

question

What is the FIRST intervention the nurse should make when an evisceration of the wound occurs? What is the second?

answer

First: Cover with a STERILE SALINE-SOAKED GAUZE. Second: Notify the physician.

question

What is the tern used to describe the sliding movement of skin and subcutaneous tissue while the underlying muscle and bone are stationary?

answer

Shearing Force

question

What is the term used to describe a localized injury to the skin and other underlying tissue, usually over a bony prominence, as a result of PRESSURE or in combination with shear and/or friction?

answer

Pressure Ulcer.

question

What are the 3 pressure related factors that increase the risk for a pressure ulcer?

answer

1. Pressure INTENSITY: blanching versus tissue ischemia. 2. Pressure DURATION: low pressure over a long period of time and high pressure over a short period pose the same increased risk. 3. Tissue tolerance: how healthy is the skin and tissue?

question

What are 15 risk factors for pressure ulcers?

answer

1. Immobility 2. Friction 3. Shearing Force 4. Moisture 5. Incontinence 6. Infection 7. Altered Mental Status 8. Poor Nutrition 9. Obesity 10. Impaired Peripheral Circulation 11. Decreased Sensory Perception 12. Decreased Physical Activity 13. Medications 14. Devices 15. Diseases (diabetes, anemia)

question

What type of pressure ulcer is described as a non-blanchable erythema of intact skin (hyperemia or redness), or mottling (hypoxia to the tissue) where only the epidermis is affected?

answer

Stage One

question

What type of pressure ulcer is described as a partial-thickness skin loss involving the epidermis and dermis and is without sloughing, such as a blister?

answer

Stage Two

question

What type of pressure ulcer is described as a full-thickness skin loss that involves damage to the subcutaneous tissue and may extend to the fascia, but bone, muscle tissue, and tendon are not present? Some slough may be present.

answer

Stage Three.

question

What type of pressure ulcer is described as a full-thickness skin loss that occurs with extensive destruction or necrosis or damage to the muscle, and may extend to the bone or tendon? Slough or eschar may be present. Includes undermining and tunneling.

answer

Stage Four.

question

What type of tissue injury is described as a full-thickness skin or tissue loss where the depth of the injury is unknown because the base of the wound is obscured?

answer

Unstageable.

question

What type of tissue injury is described as a purple or maroon localized area of discolored intact skin or a blood filled blister caused by damage to soft tissue? *It looks like a bruise but it's open and the bruising goes deep.*

answer

Deep Tissue Injury.

question

When using the Braden Scale to predict pressure sore risk, is a higher number or a lower number more at risk?

answer

Lower. The lower the number, the more at risk.

question

When using the Braden Scale, what are the 5 categories being assessed that put the patient at risk for skin breakdown?

answer

1. Sensory Perception 2. Moisture 3. Activity 4. Nutrition 5. Friction and Shear

question

How do we document a wound?

answer

Use LOAD CEEM: LOCATION, ODOR, APPROXIMATED OR NO, DRAINAGE, COLOR, ERYTHEMA, EDEMA, AND MEASUREMENTS. Also include any note of tunneling or undermining, the patient's pain level, and their nutritional status.

question

When taking a culture of a wound, what should the nurse do FIRST?

answer

CLEAN THE WOUND FIRST and then take the culture. The nurse would then collect the culture using a zig-zag pattern over the middle of the wound.

question

What are 9 factors that impair wound healing?

answer

1. Age 2. Malnutrition 3. Obesity 4. Impaired Oxygenation 5. Impaired Circulation 6. Smoking 7. Drugs 8. Radiation 9. Wound Stress

question

What are 11 possible nursing interventions for wound healing?

answer

1. Apply standard precautions. 2. Provide nutrition and fluids: diet high in protein, vitamins A and C. **Think of PAC man** 3. Use evidence-based practice in proving care. 4. Support and position the affected body part. 5. Apply heat or cold as needed. 6. Change positions q 2 hours. 7. Frequently reassess the wound for healing and other areas of breakdown. 8. Clean and irrigate as ordered. 9. Utilize specialty beds. 10. Dressings as ordered. 11. Manage moisture (provide hygiene needs).

question

What is the primary reason for irrigating a wound?

answer

To remove debris from the wound.

question

There are different dressings used for different stages of pressure ulcers. What type of dressings would be used for a: 1. Stage I? 2. Stage II? 3. Stage III? 4. Stage IV?

answer

1. Transparent film or Hydrocolloid. 2. Hydrocolloid or Hydrogel. 3. Hydrocolloid, Hydrogel covered with foam dressing, Calcium Alginate, and Gauze. 4. Hydrogel covered with foam dressing, Calcium Alginate, and Gauze.

question

If a wound is shallow with either partial-thickness or eschar, what type of dressing would be used?

answer

HYDROGEL.

question

What is the appropriate technique for cleaning a surgical wound?

answer

Clean the wound from the least contaminated area to the dirtiest, using one swab per stroke.

question

What are the 5 purposes of dressings?

answer

1. Protects the wound from contamination. 2. Promotes healing. 3. Supports or splints the wound. 4. Promotes thermal regulation. 5. Promotes a moist environment **remember wounds heal faster when epithelial cells can migrate across a MOIST wound surface**

question

What kind of strap is used over a dressing to hold it in place when they are changed frequently?

answer

Montgomery straps.

question

When is VAC Therapy used in wound healing?

answer

Used for a pressure ulcer or large chronic wound that isn't healing. Assists in wound closure by applying localized negative pressure to draw the edges of the wound closer together. It suctions continuously to pull moisture and drainage away from the wound bed so it can heal and granulate faster.

question

Overall, what is the MAIN purpose of a wound VAC or any negative pressure wound therapy?

answer

To increase vascularity.

question

What is the effect of heat application on a wound site?

answer

Vasodilation and tissue metabolism, pain relief.

question

When are aquathermia or K pads used?

answer

Used on patient who have an infiltration.

question

What is the effect of a cold application on a wound site?

answer

Vasoconstriction and decreases tissue metabolism, pain and swelling.

question

What is the protocol for heat and cold application for traumatic injuries?

answer

Apply ice the first 24 hours and THEN heat.

question

How often should the skin be assessed when using heat/cold applications?

answer

Every 5-10 minutes.

question

On what 3 types of patient's should heat/cold applications be used very cautiously?

answer

The debilitated, unconscious, and children.

question

What is the main purpose of an abdominal binder?

answer

Used for SUPPORT following surgery/incision.

question

If a patient complains of numbness or tingling 5 minutes after the application of a bandage, what would be the best nursing intervention?

answer

To take off the bandage and re-wrap it.

question

Antibiotics are produced by fungi/bacteria and they destroy the GROWTH of microorganisms. Antimicrobials, Antibacterials, and Bacteriostatic drugs also destroy the GROWTH. What is the mechanism of action against microorganisms for BacteriCIDAL drugs?

answer

They kill bacteria by causing cell death.

question

What is the tern used to describe antibiotics that are active against a SMALL selection of bacteria?

answer

Narrow-spectrum antibiotics.

question

What is the term used to describe antibiotics that are active against MANY types of bacteria?

answer

Broad-spectrum antibiotics.

question

What is the term used to describe a reaction to a drug that was natural and ANTICIPATED? What is the term used to describe a reaction to a drug that is rare and UNEXPECTED?

answer

Anticipated rxn: Side Effect Unexpected rxn: Adverse Reaction

question

What is the term used when the body becomes resistant to an antibiotic?

answer

Superinfection.

question

In regards to mechanisms of antibacterial action, bacteriostatic drugs and bactericidal drugs both alter the membrane permeability and inhibit protein synthesis. 1. Which drug type is ONLY responsible for the inhibition of cell wall synthesis and the inhibition of synthesis of bacteria RNA/DNA? 2. Which drug type is ONLY responsible for interfering with cellular metabolism?

answer

1. BacteriCIDAL drugs. 2. BacterioSTATIC drugs.

question

What is the biggest problem in regards to antibiotic use today?

answer

Antibiotic resistance.

question

What is the mechanism of action for Penicillins?

answer

They are BOTH bacteriostatic and bactericidal. **Penicillans have a Beta-lactam structure that they use to try and penetrate the cell walls of bacteria, but the bacteria become resistant by producing beta-lactamases that attack the nucleus of the beta-lactam structure(the penicillin). Sooooo, penicillin is then supplemented with a beta-lactamase inhibitor: a 2nd med that blocks the release of the beta-lactamase from the bacteria.**

question

What are some examples of penicillin antibiotics?

answer

Broad-spectrum Penicillins: Amoxicillin, Ampicillin Penicillinase-resistant Penicillins: Methicillin, Nafcillin Beta-lactamase inhibitors: Augmentin, Unasyn, Zosyn

question

What is the most common side effect of Penicillin use?

answer

Diarrhea. Very common with the use of Amoxicillin (broad-spectrum), but it does go away.

question

What are the two common adverse reactions of Penicillin use?

answer

1. Superinfection (body become resistant to the abx) 2. Hypersensitivity (refers to undesirable reactions produced by the normal immune system, including allergies and autoimmunity. These reactions may be damaging, uncomfortable, or occasionally fatal: ANAPHYLAXIS)

question

What are 3 nursing interventions/teachings usually necessary with the use of Penicillins?

answer

1. Notify should be taken with food. 2. Monitor the patient's lab work. 3. Broad-spectrum Penicillins: With Amoxicillin: diarrhea common so would notify patient and tell them to still finish out the entire abx. With Ampicillin: any signs or symptoms of a superinfection should be reported, such as chills, wheezing, fever, and coughing.

question

What is the mechanism of action for Cephalosporins?

answer

They are Bactericidal! They inhibit the synthesis of the bacteria cell wall.

question

Cephalosporins have a similar molecular structure to Penicillins (therefore they produce similar side effects and drug allergies that Penicillins would) and are the largest class of antibiotics, what are some examples of Cephalosporin antibiotics?

answer

Ancef, Cefotan, Keflex, Duricef, and Ceclor.

question

Cephalosporins are divided into 4 generations that get stronger as you increase in generation. What type of bacteria does each generation work against?

answer

1st Generation: against Gram + bacteria, staph 2nd Generation: against Gram + bacteria also, but has a broader antimicrobial activity range than the 1st generation. 3rd Generation: against Gram - bacteria. 4th Generation: has a wide range against BOTH Gram + and Gram - bacteria.

question

Cephalosporins are most commonly used to treat which type of skin/wound infection?

answer

Cellulitis.

question

If a patient is allergic to Penicillins, what is the contraindication of using a Cephalosporin antibiotic?

answer

Since they have similar molecular structure, if pt allergic to penicillin then the patient will also be allergic to cephalosporin so it's use is contraindicated.

question

What is the most common side efffect of Cephalosporins?

answer

Slows the time it takes for blood to clot.

question

What are 2 common adverse reactions to Cephalosporins?

answer

Anaphylaxis and Nephrotoxicity (poisonous effect on the kidneys)

question

What is the most important nursing intervention for a patient using a Cephalosporin?

answer

Monitor lab work! If cephalosporins prolong the time it takes for blood to clot, it's important for a nurse to monitor PT/PTT/INR levels depending on whether this is a problem for that patient. Since they also can be poisonous to the kidneys, BUN and Creatinine levels would need to be monitored.

question

What is the mechanism of action for Macrolides?

answer

They inhibit bacterial protein synthesis so BOTH. But it's usually bacteriostatic in LOW DOSES and bactericidal in HIGH DOSES.

question

Macrolides are broad-spectrum antibiotics that are usually used to treat mild-moderate infections and are most effective against what type of bacteria?

answer

Against Gram + bacteria.

question

In addition to Cephalosporins, Macrolides are ALSO most commonly used to treat what type of skin/wound infection?

answer

Cellulitis.

question

What are some examples of Macrolides?

answer

Erythromycin, Zithromax, and Biaxin.

question

What is the most common side effect of Macrolide use?

answer

Nausea.

question

What are the 3 adverse reactions from Macrolide use?

answer

Hepatotoxicity (poisonous to the liver), superinfections, anaphylaxis.

question

What are 2 important nursing interventions for Macrolide use?

answer

1. Notify the patient to take Erythromycin 1 hour before meals or 2 hours after unless GI upset then take with food. Macrolides need to be absorbed WITHOUT food to be effective though. 2. Monitor labs: since Macrolides can cause liver damage.

question

What is the mechanism of action for Glycopeptides?

answer

They are bactericidal because they inhibit cell wall synthesis for Gram + microorganisms.

question

What types of infections are Glycopeptides most often used to treat?

answer

Severe infections! C Diff, Staph Aureus, and MRSA (*more specifically Vancomycin is the glycopeptide drug of choice for treatment of MRSA*)

question

What are 3 adverse reactions to Glycopeptide use?

answer

1. Ototoxicity (in the ear) 2. Nephrotoxicity (poisonous to the kidneys in high doses) 3. Red-man syndrome: characterized by diffuse burning, itching, chills, fever usually 4-10 minutes after the infusion has started.

question

What important nursing interventions should be used in regards to Glycopeptides?

answer

Monitor levels of Vancomycin! Peak action is 30 minutes after the end of the IV infusion. *If the patient gets flushed right after receiving Vancomycin, stop the infusion, give the patient Benadryl, and restart the infusion at a lower dose.*

question

What is the mechanism of action for Tetracyclines?

answer

They are bacteriostatic: inhibit bacterial protein synthesis.

question

Tetracyclines were the 1st broad spectrum antibiotic ever discovered, what are some examples of this type of antibiotic?

answer

Vibramycin and Teracycline.

question

Tetracycline is also a very strong medicine, what are two common side effects of using it?

answer

GI disturbances and Photosensitivity (the skin is more sensitive to UV ray and will burn easier)

question

What are 3 adverse reactions from Tetracycline use?

answer

Superinfections, Hepatotoxicity, and Nephrotoxicity.

question

What are 2 nursing interventions that could be used during tetracycline use?

answer

1. Give tetracycline 1 hour before meals or 2 hours after with a full glass of water. 2. Tell patient to use sunblock, wear protective clothing and sun glasses during use.

question

What is the mechanism of action for Aminoglycosides?

answer

They are bactericidal: inhibit bacterial protein synthesis.

question

When are aminoglycosides most often used?

answer

1. Against Gram - Bacteria: e coli, pseudomonas, proteus, klebsiella. 2. Normally reserved for serious systemic infections.

question

What are some examples of aminoglycosides?

answer

Gentamycin, Amikacin, Streptomycin, Tobramycin, Neomycin.

question

What are 3 adverse reactions of aminoglycoside use?

answer

1. Ototoxicity 2. Nephrotoxicity 3. Superinfections **Aminoglycosides can get built up in the blood so if not monitored, can effect the kidneys and become toxic. Important to draw a peak level 30 minutes to an hour after infusion.**

question

What are important nursing interventions for aminoglycoside use?

answer

1. Increase patient's fluid intake. 2. Monitor labs. 3. Tell patient to use sunblock. 4. Daily assessments. 5. Monitor for signs and symptoms of a superinfection.

question

What is the mechanism of action for Fluroquinolones (Quinolones)?

answer

Bactericidal: they inhibit the synthesis of bacterial DNA.

question

When are Fluroquinolones most often used?

answer

1. To treat UTI's and respiratory infections. 2. Effective against Gram + AND Gram - microorganisms.

question

What are some examples of Fluroquinolones?

answer

Cipro, Levaquin, Avelox. Most are well absorbed orally and may be taken with food. But cannot be taken with antacids because they coat the stomach lining and prevent the absorption of the Fluroquinolone.

question

What are 3 adverse reactions from Fluroquinolone use?

answer

1. Seizures 2. Hematuria 3. Oral Candidiasis (thrush: seen as fuzzy white film on the tongue)

question

What are important nursing interventions for Fluroquinolone use?

answer

1. Notify patient not to take antacids during use so as not to inhibit absorption. 2. Give with a full glass of water. 3. No driving or operating machinery during use.

question

What is the mechanism of action for Sulfonamides?

answer

Bacteriostatic: they inhibit bacterial synthesis of folic acid.

question

When are Sulfonamides most often used?

answer

1. Used when patient's are allergic to Penicillins and Cephalosporins. 2. Used for Gram + AND Gram - microorganisms. 3. Used for UTI's cause by E. coli.

question

What are some examples of Sulfonamides?

answer

Bactrim and Gantrisin.

question

What are 3 adverse reactions from Sulfonamide use?

answer

1. Superinfection (however anaphylaxis not common) 2. Renal Failure 3. Thrombocytopenia (low platelet count)

question

What are important nursing interventions for Sulfonamide use?

answer

1. Take with a full glass of water. 2. Use sun block. 3. Instruct patient to report bruising or bleeding and check labs.

question

What are 8 factors to remember about antibiotic use?

answer

1. Asses the patient. 2. Assist in identifying the organism. 3. Monitor the patient's response to the abx. 4. Prevent and treat side effects and adverse reactions. 5. Be aware of patient allergies to medications. 6. Be aware of absorption problems related to food/antacids. 7. Educate patient about the antibiotic. 8. Instruct patient to take alllll of the antibiotic.

question

What is the most common infectious cause of limb swelling?

answer

Cellulitis: an infection of the dermis and subcutaneous tissue, is NOT contagious because it's present in the lower layers of the skin. *Can be a single isolated event or a series of recurrent events.* Sometimes misdiagnosed as recurrent thrombophlebitis or chronic venous insufficiency.

question

What is the cause of cellulitis?

answer

It's caused by Staph and Strep bacteria, and from a break in the skin such as a cut, a small puncture wound, or even an insect bite and can be found everywhere in the body. Sometimes it may be due to microscopic cracks in the skin that are inflamed or irritated or even appear in the skin near surgical wounds or ulcers where there's been a break in skin integrity.

question

What are some signs and symptoms of cellulitis?

answer

1. Acute onset of swelling, begins as an area of tenderness. 2. Localized redness. 3. Pain: often associated with systemic signs of fever, chills and sweating. 4. Redness may not be uniform, often skips areas. 5. Regional lymph nodes may also be large and tender.

question

Again, what are the two most common antibiotics used to treat Cellulitis?

answer

Cephalosporins and Macrolides. Sometimes Penicillins and Fluroquinolones are also used.

question

What are some other risk factors for cellulitis?

answer

1. Chronic leg swelling (edema) 2. Pre-existing skin infection, ex: athlete's foot 3. Impetigo (chicken pox/shingles) 4. Inflammatory conditions of the skin, ex: eczema, psoriasis 5. Skin damage caused by radiation/chemotherapy 6. Immunocompromised patient's with dry skin, ex: diabetic patients, HIV/AIDS patients 7. Venous insufficiency, obesity, pregnancy, or surgeries

question

When assessing a client with Cellulitis on the right leg, which finding should the nurse expect to observe? a. Painful skin that is swollen and pale in color. b. Cold, red skin. c. Small, localized blackened area of the skin. d. Red, swollen skin with inflammation spreading to surrounding tissues.

answer

d. Red, swollen skin with inflammation spreading to surrounding tissues.

question

What are some components of the nurse's role during antibiotic use by the patient?

answer

1. Assess the patient. 2. Admin the drug on time and at proper intervals. 3. Monitor patient's response. 4. EDUCATE the patient! 5. Prevent and treat adverse reactions. 6. Evaluate how the patient has achieved their outcome. 7. Evaluate how interventions have worked to achieve the outcome. 8. Make adjustments in the plan if patient has not achieved the outcome desired or if interventions are ineffective.

question

What is the term used to describe the ability to move physically?

answer

Mobility

question

Our ability to move is dependent on what 3 body systems?

answer

1. Skeletal System 2. Muscular System 3. Nervous System

question

What are 7 factors that can affect mobility?

answer

1. Developmental Stage 2. Nutrition 3. Lifestyle 4. Environmental Factors 5. Socioeconomic Factors 6. Diseases and Abnormalities 7. Body Mechanics

question

What are 4 nursing responsibilities in regards to mobility?

answer

1. Assess patient's mobility status and needs 2. Utilize good body mechanics 3. Work with other disciplines 4. Interventions

question

What part of the body acts as the center of gravity for proper body alignment?

answer

The hips.

question

What is the term used to describe an increased lumbar curvature? What population is this most commonly found in?

answer

Lordosis, most commonly found with pregnant women.

question

What is the term used to describe an exaggeration of posterior curvature of thoracic spine? What population is this most commonly found in?

answer

Kyphosis (hunchback), most commonly found with older adults.

question

What is the term used to describe a lateral spinal curvature? What population is this most commonly found in?

answer

Scoliosis, most commonly found with teenage girls.

question

What are 4 common effects of immobility?

answer

1. Atony: loss of muscle tone 2. Loss of muscle strength (weakness) 3. Contractures: permanent shortening of the muscles because of the flexor muscles overpowering the weaker extendor muscles 4. Osteoporosis: decalcification of the bone

question

What are 5 nursing interventions important to use in regards to mobility?

answer

1. ROM exercises 2. Encourage active exercises 3. Proper body alignment 4. Use assistive devices 5. Montior blood calcium levels (bones become brittle with low levels)

question

What are the 4 common effects that immobility has on elimination?

answer

1. Urinary Stasis: can lead to UTI 2. Renal Calculi: due to urinary stasis AND bone demineralization 3. Decreased Bladder Tone: inability to fully empty the bladder 4. Constipation or Fecal Impaction: from decreased peristalsis

question

What are 7 nursing interventions the nurse can provide in regards to elimination problems as a result of immobility?

answer

1. Increase activity 2. Maintain adequate fluid intake 3. Change positions frequently 4. Assess labwork (urinalysis) 5. Observe urine clarity, color, odor 6. Monitor bowel sounds 7. Document bowel movements

question

What are 4 effects that immobility has on Oxygenation?

answer

1. Decreased metabolic needs so oxygen needs are less. 2. Respirations are slower and more shallow. 3. Atelectasis: collapse of the alveoli. *This leads to impaired gas exchange and can lead to hypostatic pneumonia: pooling of respiratory secretions, warm, moist, dark environment.* 4. Decreased muscle strength.

question

What are 5 nursing interventions that can be used in regards to oxygenation problems as a result of immobility?

answer

1. Increase activity 2. Incentive spriometer EVERY HOUR 3. Coughing and deep breathing exercises 4. Elevate HOB 5. Keep well hydrated

question

What are 4 effects that immobility has on Perfusion?

answer

1. Increased cardiac workload 2. Edema and pressure ulcers 3. Venous stasis and thrombus formation (DVT) 4. Orthostatic hypotension

question

What are 7 nursing interventions that can be used in regards to perfusion problems as a result of immobility?

answer

1. Increase activity!! 2. Check vitals: HR 3. Assess peripheral circulation: pulses, edema 4. Monitor for signs of DVT 5. Turn every 2 hours, ROM 6. TEDs and SCDs 7. Dangle, move gradually when getting patient OOB

question

What are 4 effects of immobility on Nutrition and Metabolism?

answer

1. Loss of appetite 2. Increased risk of dehydration 3. Increased risk of electrolyte imbalance 4. Altered carb, fat, and protein metabolism

question

What are 5 nursing interventions that can be used in regards to nutrition and metabolism problems as a result of immobility?

answer

1. Work with dietary: provide patient with adequate needs for total protein, calories, fiber, fluids and other nutrients 2. Provide smaller meals or supplements 3. Ask family to bring food from home 4. Assess patient's likes and dislikes 5. Appropriate environment to eat

question

What are the 2 most common effects of immobility on Skin Integrity?

answer

1. PRESSURE ULCERS! 2. Prolonged tissue ischemia can lead to necrosis.

question

What are 5 nursing interventions that can be used in regards to skin integrity problems as a result of immobility?

answer

1. Assess skin every shift 2. Turn every 2 hours, pad bony prominences 3. Hand Hygiene! 4. Maintain clean dry skin and a wrinkle free bed 5. Nutritional status

question

What are 3 commons effects of immobility on Psychosocial Integrity?

answer

1. Feelings of depression, anxiety, hostility, loss of control, fear, isolation. 2. Inappropriate behaviors and mood changes 3. Sensory alterations

question

What are 6 nursing interventions that can be used in regards to psychosocial problems as a result of immobility?

answer

1. Orient patient to person, place and time 2. Provide stimulation and diversions 3. Increase daytime activity 4. Encourage family and friends to visit 5. Get patient out of room if possible 6. Allow patient to make decisions

question

What are 8 common nursing diagnoses related to immobility?

answer

1. Risk for falls 2. Activity Intolerance 3. Risk for injury 4. Risk for loneliness 5. Impaired physical mobility 6. Risk for impaired skin integrity 7. Impaired transfer ability 8. Impaired walking

question

What are the 4 components that make up a great nursing outcome?

answer

Outcomes are: 1. Patient-Centered 2. Measurable 3. Realistic 4. Have a target date

question

What are the 2 purposes of therapeutic positioning?

answer

1. Prevents complications of immobility 2. Facilitates diagnostic testing/surgery

question

When a patient is experiencing orthopnea, what would be the best position to place them in?

answer

Fowler's Position: it promotes respiratory function, however heels and sacrum area are a concern here.

question

What position in bed is a big concern for "foot drop" occurring?

answer

Supine: heels, elbows, occiptal (back of the head) also a concern in this position.

question

What is the term used to describe the position where a patient is laying supine: 1. With their feet up? 2. With their feet down?

answer

1. Feet up: Lithotomy. 2. Feet down: Dorsal recumbent. Used most often when inserting a urinary catheter.

question

On which side is a patient ALWAYS placed when in the Sims Position (on side with legs bent)? When is this position most often used?

answer

ALWAYS ON LEFT SIDE IN SIMS. Used for enema or rectal meds.

question

When is a patient placed in a prone position?

answer

To take the stress off of the buttocks and heels. The mattress is also pushed up to prevent foot drop.

question

What are some examples of positioning support devices?

answer

1. Trochanter Roll: prevents the hips from going outwards, maintains alignment. 2. Wedge: used during q 2 hour turns. 3. Foot board: used to prevent "foot drop." 4. Wrist splint: used for patients with contractures. Prevents them from squeezing their hand shut. 5. Round pillow with the hole in the middle: used to relieve stress on occipital area.

question

What is the Golden Rule for moving a patient?

answer

If they can...have the patient transfer themselves!

question

What are the 4 purposes of ROM exercises as an INTERVENTION?

answer

1. Improves and maintains joint function 2. Prevents contractures 3. Improves muscle strength and tone 4. Increases circulation

question

How often should ROM exercises be done on a bedridden patient?

answer

2-3 times A DAY! 5 times for each activity motion to be effective.

question

What are the differences between: 1. Active ROM? 2. Active-Assist ROM? 3. Passive ROM?

answer

1. Active: patient does everything for self. 2. Active-Assist: pt slightly assisted with some movements 3. Passive: for patient who cannot do anything for self.

question

What are 4 indications that a patient would require ROM?

answer

1. Any patient with restricted mobility: paralyzed, elderly, trauma or disease. 2. Restrained patient. 3. Patient in pain: may be hesitant to move. 4. Post-procedure.

question

What are the two theories for why we age?

answer

1. Stochastic theories: aging is a result of cell damage that happens over time. 2. Non-stochastic theories: there is already a genetically programmed age when we are born.

question

What are the three psychosocial theories of Aging?

answer

1. Disengagement: a result of not being as active in productive areas of life. 2. Activity Theory: as people age they should try to stay as active as possible. 3. Continuity Theory: Your personality stays stable throughout age; the older we get our behavior gets more predictable.

question

What are the biggest developmental tasks of aging?

answer

Adjustment to losses and changes, including: 1. Physical abilities 2. Physical appearance 3. Retirement 4. Need for assistance (ADLs) 5. Loss of a spouse/partner/friends 6. New relationships with adult children **elderly people are fairly resistant to depression. They are no more depressed than younger individuals**

question

What factors effect individual aging?

answer

1. Genetics 2. Gender: women tend to live longer but this trend may change with women now prevalent in work place. 3. Occupation: nurses, police officers, night shift 4. Lifestyle/socioeconomic 5. Exercise/activity 6. Nutrition: high fiber, low Na, good fat vs bad fat 7. Obesity 8. Mental Health

question

At what age do most normal aging changes take place?

answer

30's to 40's

question

What are normal aging changes related to Perfusion?

answer

Decreased: 1. Cardiac Output 2. Vessel Elasticity 3. Lumen of vessels: the opening gets smaller from cholesterol and plaque build up 4. Cardiac stroke volume (amt of blood ejected from the heart with each pump decreases with certain diseases) 5. Peripheral Circulation (puts them @ risk for clots) Increased systolic BP Changes in heart valves (leads to heart murmurs)

question

What are normal aging changes related to Oxygenation?

answer

Decreased: 1. Cough reflex (puts them at greater risk for pneumonia related to aspiration) 2. Cilia (moisture being moved around the lungs is decreased) 3. Flexibility of lungs and chest (harder to take a deep breath) 4. # of alveoli (oxygen exchange decreases) 5. PO2 decreases (by up to 15%) 6. Lung capacity (can't take a deep breath) 7. Flexibility of the diaphragm 8. Gas exchange rate Increased: 1. Risk of infections (URI's, LRI's, pneumonia which can cause confusion in older patients)

question

What are normal aging changes related to the Immune System?

answer

Decreased: 1. T cell function 2. Thymus size 3. Thyroid hormone secretions (a lot of older patients are on a supplemental thyroid replacement) 4. Immune response What would this mean? An increased susceptibility to infections

question

What are normal aging changes related to Nutrition?

answer

Decreased: 1. Saliva (hinders the breakdown of food) 2. Gastric secretions 3. Pancreatic enzymes 4. Peristalsis and motility (leads to constipation) 5. Stomach size (atrophy: it shrinks) 6. Sense of taste 7. Gag reflex 8. Liver size and function (it filters things you don't need and breaks down things you do and that is decreased) 9. Gums (atrophy)

question

What are normal aging changes related to Elimination?

answer

Men: prostate enlarges! Results in a difficulty to begin urinating Decreased: 1. Nephrons 2. Renal blood flow 3. Filtration rate 4. Bladder tone and capacity 5. Sphincter control 6. Rectal sensation 7. Motility (risk for constipation)

question

What are normal aging changes related to Reproduction?

answer

Males have decreased: 1. Pubic hair 2. Size of testicles 3. Testosterone 4. Sperm production (but the supply doesn't completely cut off) 5. Ability to initiate and maintain erection 6. Ejaculation Females have decreased: 1. Pubic hair 2. Estrogen (but it never completely goes away) 3. Size of ovaries, fallopian 4. Vaginal moisture and flexibility 5. Vaginal atrophy: "wastes away" or weakens and decreases in size. *Menopause starts in late 40's-50's*

question

What are normal aging changes related to the Endocrine System (Regulation)?

answer

Increased: 1. Anti-inflammatory hormone: cortisol which is what is dumped out during the fight or flight response or during periods of stress, therefore the immune reaction is not as good but still have inflammatory response. 2. PTH: related to osteoporosis and bone growth Decreased: 1. In most hormone production overall 2. Ability to respond to stress

question

What are normal aging changes related to Vision?

answer

Decreased: 1. Pupil Size (night driving is harder with age, pupil dilation is effected) 2. Tear production (nurses can give artificial tears NOT visine to compnesate) 3. Lens clarity, yellowing (cataracts) 4. Ability to discriminate colors (nursing homes more prone to use colors to discriminate differences in rooms and carpet to cut down on glare) 5. Ability to accommodate near and far 6. Adjustment to light/dark 7. Peripheral vision 8. Ability to focus on NEAR objects: *Presbyopia- farsighted*

question

What are normal aging changes related to Hearing?

answer

Decreased: 1. Ability to hear 2. Ability to hear HIGH FREQUENCY: *Presbycusis* The first thing they lose are high sounds. 3. Discrimination: may have to repeat the same words but different ways and at different volumes Increased: 1. Eardrum thickness 2. Excessive cerumen 3. Sclerosis of the inner ear (the bones in the ear develop arthritis and don't vibrate as easily to pass along sound)

question

What are normal aging changes related to Touch?

answer

Decreased: 1. Sensation 2. Ability to feel temperature (hot and cold) Puts them at risk for dehydration and overheating 3. Ability to feel pain 4. # of touch receptors (Peripheral neuropathy or numbness) 5. Ability to determine body position in space *known as Proprioception* Basically they are at an increased risk of being unable to recognize when they've injured themselves.

question

What are normal aging changes related to Skin?

answer

Decreased: 1. Moisture: decreased more due to dehydration and the inability to tell when they are thirsty 2. Elasticity (dry, wrinkles) sun exposure also damages the skin and causes shearing 3. Subcutaneous fat: loss of heat and padding for insulation, have difficulty regulating their body temp 4. Epithelial layer 5. Efficiency of sweat glands 6. Peripheral circulation: healing takes longer and skin bruises easier 7. Hair: decreased protection and hair used to conserve body heat Pigmentation changes (age spots)

question

What are normal aging changes related to Taste?

answer

Decreased: 1. # of taste buds 2. Ability to identify specific tastes: ESPECIALLY BITTER, SOUR, SALTY. 3. Sensation declines: especially SWEET: older patient's usually add sugar and salt to compensate

question

What are normal aging changes related to Smell?

answer

Decreased: 1. Olfactory nerve fibers 2. Ability to identify specific odors 3. AFFECTS TASTE: whether we enjoy food or not is linked to taste, which leads to a decreased appetite which leads to weight loss.

question

What are normal aging changes related to Cognitive Aging?

answer

Decreased: 1. Neurons 2. Neuron impulse conduction rate 3. Cerebral blood flow 4. SHORT TERM MEMORY 5. Attention span and concentration 6. Ability to sleep: try to keep patients more active to decrease nap times. When they have less dream sleep, they are less refreshed after sleeping. Slowed: 1. Thinking 2. Reaction Time 3. Reflexes **Older patients can still learn new info, you just have to break learning sessions into smaller chunks and it takes more repetition**

question

What factor makes all the difference in terms of aging well?

answer

STAYING ACTIVE! Function makes all the difference! Increases the ability to: 1. Stay independent 2. Take part in activities 3. Care for self at home **Many injuries happen when an older pt doesn't want to ask for help and tries to do things w/o it**

question

In terms of functional assessment, what should be evaluated before seeing if an older person should be in a nursing home?

answer

ADLs: dressing, bathing, eating, toileting, maintaining continence, ability to transfer. If can do independently, they can live alone.

question

What are normal aging changes related to Mobility?

answer

Decreased: 1. Height (average 2 inches) 2. Strength of bones: get porous and brittle and look like a honeycomb. Need to take CALCIUM WITH VITAMIN D to compensate. 3. Joint flexibility 4. Cartilage (not as much padding between the bones) 5. Muscle mass (can be maintained through weight-bearing exercises because they rebuild calcium back into the bones) 6. Dehydration in discs in spine (shock absorbers have less room in between spinal column which can result in a pinched nerve) 7. Kyphosis: hunchback, which effects visibility and center of gravity

question

Is Osteoporosis a normal part of the aging process?

answer

NOOOOO

question

Who experiences more changes in mobility, men or women?

answer

Women, especially those past menopause because they start to lose calcium from the bone.

question

Osteoporosis is checked for with a bone density test. What types of foods should older patients eat to supplement calcium back into their diet?

answer

Milk, Oj, canned salmon, leafy green veggies.

question

What kind of medications are patients who have osteoporosis given?

answer

Bisphosphonates such as Fosamax, Boniva, and Actonel. Usually taken once a week or once a month.

question

What are normal aging changes related to Mental Health?

answer

Personality remains the same. Basic intelligence is maintained. Learning IS NOT DECREASED, it just takes more repetition. Coping with many losses and changes.

question

Is it normal for an older patient to be depressed?

answer

NOOOOOO

question

What are the 6 categories of geriatric syndromes that nurses assess for using the Fulmer SPICES Assessment Tool?

answer

S: Sleep disturbances P: Problems with eating or feeding I: Incontinence C: Confusion E: Evidence of falls S: Skin breakdown It helps pick up on problems that need to be further addressed and identify interventions.

question

What are the top 10 Geriatric Syndromes? *Think of FALL SPECIALE*

answer

FALL, SPECIALE: None of these are part of the normal aging procress! Falls Sleep Pain Eating Disorders Confusion Incontinence Anxiety Living Abilities Skin Integrity Issues Elimination Issues

question

What are abnormal factors related to Falls?

answer

1. Osteoporosis: cause or the result? 2. Medications 3. Postural Hypotension 4. Hypertension (CVA, TIA where the blood camps down in the brain temporarily) 5. Cardiac Arrythmias (PVCs) these are best heard at the apical pulse 6. CHF: the heart muscle gradually gets weaker and compensates by getting bigger resulting in a fluid buildup in peripherals, lung congestion, and fatigue which makes it harder to get up and thus they get weaker with a lack of activity.

question

What are abnormal factors related to Sleep?

answer

1. Difficulty initially falling asleep from a change of sleeping time, discomfort, mobility, and anxiety. 2. Getting up frequently because of increased voiding. 3. Trouble returning to sleep as a result of anxiety, rumination, discomfort.

question

What are 3 possible nursing interventions for problems related to sleep?

answer

1. Reducing or stopping caffeine 2. Increase in daytime activity 3. Not eating or drinking right before bed.

question

What are abnormal factors related to Pain?

answer

Arthritis and Gerd: 2 of the main problems for night time pain.

question

What are abnormal factors related to Eating Disorders?

answer

1. Failure to thrive 2. Decreased appetite 3. Weight loss or gain 4. Adverse drug effects

question

What are 6 possible nursing interventions for problems related to eating disorders?

answer

1. Monitor I & O 2. Monitor weight 3. Monitor for anemia and monitor albumin level 4. Monitor drug side effects 5. Dietary consult for supplemental nutrition

question

What are abnormal factors related to Difficulty Swallowing or Dsyphagia?

answer

1. Coughing during meals 2. Hoarse voice after the meal: 1ST S/S USUALLY NOTICED TO INDICATE DIFFICULTY SWALLOWING 3. Gurgling sounds in the throat 4. Drooling 5. URI's 6. Pneumonia

question

Is confusion a normal part of Aging?

answer

NOOOOOO

question

What are abnormal factors related to Confusion?

answer

1. Delirium: sudden confusion over days or weeks that fluctuates throughout the day. *Usually caused by a physical problem: UTI and pneumonia MOST COMMON, also includes dehydration, severe constipation, inadequate O2, fluid and electrolyte disturbances, and glucose, thyroid, or other hormonal abnormalities. 2. Dementia: progressive loss where it's GLOBAL, meaning all cognitive abilities decrease as well as a gradual loss of function and ends with complete dependence. Usually over 5-10 years. **Long term memories and music memories stay the longest**

question

What are abnormal factors related to Urinary Incontinence?

answer

1. Functional: the ability to find and get to a toilet is impaired. 2. Stress: Sphincter muscle is weakened and there is leakage with coughing or sneezing 3. Urge: Bladder is overly irritable. "Got to go RIGHT NOW" 4. Mixed: Stress + Urge together. 5. Reflex: neurological impairment, such as a stroke, paralysis, or tumors therefore they would have an indwelling catheter in place.

question

What are 3 possible nursing interventions for problems related to urinary incontinence?

answer

1. Frequent toileting (bladder training) 2. Skin integrity bypasses such as wearing briefs or kegels 3. Anticholinergic meds (work best for urge incontinence where bladder is overly irritable and spasmodic): Detrol, Ditropan, Vesicare

question

What are abnormal factors related to Fecal Incontinence?

answer

1. Loss of sensation 2. Loss of control 3. Mobility 4. Fecal impaction 5. Infection: C Diff

question

What are 3 possible nursing intervention for problems related to fecal incontinence?

answer

1. Skin breakdown prevention methods 2. Incontinence bed pads are better than briefs because they provide air circulation 3. Frequent toileting esp after meals **Don't use briefs if you don't have to...skin that gets moist MACERATES, meaning it loses fluid and gets mushy on the surface**

question

What 5 factors put a patient at a HIGH risk for skin breakdown?

answer

1. Decreased mobility: bed bound 2. Damp: incontinent 3. Decreased perfusion 4. If they tend to heal slower 5. Impact of nutrition (ALBUMIN LEVELS: A GOOD LEVEL IS NECESSARY FOR WOUND HEALING)

question

Is grieving a normal part of the aging process?

answer

Yes, but it can continue for an indefinite period of time. Depression is NOT normal.

question

What are 4 health promotion activities that can make the aging process easier?

answer

1. Vaccines 2. Screenings: BP, cholesterol, mammo, Pap, colonoscopy, prostate, vision, hearing, dental 3. Decrease or stop smoking 4. Decrease or stop alcohol abuse

question

On average, older individuals are on how many medications at one time?

answer

7!!

question

What is the term used to describe the integration of best current evidence from research literature with clinical experience and patient and family preferences and values for delivery of optimal health care?

answer

Evidence-Based Practice

question

What is the benefit of using EVP in the clinical setting?

answer

You are always up to date on new, better ways of doing things. Not merely reliant on tradition.

question

Why is EVP important?

answer

1. Patients receiving highest quality of care. 2. Decreases length of stays 3. Increases patient satisfaction 4. Better outcomes

question

What are the 5 steps for EVP? **think of the 5 A's**

answer

Ask: formulate your question Acquire: gather evidence Appraise: evaluate the evidence Apply: integrate evidence into practice Assess: evaluate outcome

question

What are the 4 components of the Ask step? **think of PICO**

answer

P: Population of interest I: Intervention of interest C: Comparison of interest O: Outcome

question

What are the 5 levels used to determine to worth of the evidence being used (Appraisal Step) from the least useful to most?

answer

Least: Expert Opinion, then Case Reports (usually only done on one person), then Cohort Studies (data is extrapolated from studies already done), then Randomize Controlled Trials, and the BEST is Systematic Reviews.

question

What is the term used to describe the use of information and technology to communicate, manage knowledge, mitigate error, and support decision making?

answer

Informatics

question

What are the 7 purposes of informatics?

answer

1. Standardized documentation across HC 2. Improved efficiency 3. Repository of data 4. Management of data for practice 5. Analysis of data for research 6. Dissemination of research findings (use electronics to find info) 7. Safety (leads to quality improvement such as what to do with a patient who is a fall risk)

question

What are the 5 nursing roles in using informatics in practice?

answer

1. Documentation 2. Analysis 3. Decision Making 4. Research 5. Education

question

How are nurses knowledge workers?

answer

1. We create data! 2. We use data to support our clinical judgements.

question

What are 2 ethical dilemmas in nursing informatics?

answer

1. Privacy and Confidentiality (HIPAA) 2. Handling and disposing of patient information

question

What are the 3 phases of drug action?

answer

1. Pharmaceutic phase: disintegration (small particles) and dissolution (dissolution to a liquid) 2. Pharmacokinetic phase: the study of what actually happens to a drug from the time it is put into the body until the time it leaves the body. Has 4 phases: Absorption, Distribution, Metabolism, and Elimination. 3. Pharmacodynamic phase: referring to what the drug DOES TO THE BODY!

question

In regards to the pharmaceutic phase, what percentage of drugs are taken orally? What form should oral drugs be in to cross the biologic membrane and be absorbed from the GI tract?

answer

80% and they should be in liquid form (become a solution)

question

Again, what are the four components of pharmacokinetics? Describe each.

answer

1. Absorption: the movement of drug molecules from the site of entry into the body into the circulation. 2. Distribution: the transport of a drug in the body by the bloodstream to the site of action. 3. Metabolism: the drug is broken down and detoxified. 4. Excretion: elimination of a drug from the body.

question

In order for a drug to gain access to the interior of a cell or body compartment it has to penetrate cell membranes. This is accomplished in what 3 ways?

answer

1. Passive transport: movement from higher to lower concentration. 2. Active transport: movement against a concentration gradient from lower to higher concentration. **Active transport requires energy and is more rapid than passive transport** 3. Pinocytosis: cells engulfs the drug particles as a means of getting them across the membrane. **Once the drug molecule pass across a cell membrane they may go directly into the systemic circulation or they may pass from the intestines to the liver via the portal vein before entering the systemic circulation.**

question

What is the term used to describe the process whereby the drug passes to the liver FIRST before getting to the systemic circulation?

answer

The First-Pass Effect or Hepatic First Pass

question

What are some drug examples of First-Pass Effect?

answer

Coumadin and MSO4

question

What is the term used to describe the % of the administered drug dose that actually reaches the systemic circulation?

answer

Bioavailablity. When a drug is metabolized in the liver and some of the active drug becomes inactive or diverted before it can reach the systemic circulation, this makes it's bioavailability less than 100%.

question

Metabolism of a drug in the liver reduces the amount of active drug by how much?

answer

20 - 40 % of the original dose

question

The bioavailability of oral drugs is ALWAYS less than 100% whereas drugs given IV have almost always what percentage of bioavailability?

answer

100%

question

What 6 factors affect the absorption of a drug?

answer

1. The Route: affects both the rate and the speed of which the onset of action occurs AND the magnitude of the therapeutic response. 2. The Drug Form: whether the drug is a pressed tablet or enteric coated, or sustained release, liquid versus solid, etc... 3. GI Mucosal Surface: aka the cell membrane through which the drug must pass. The greater the absorbing surface the greater the absorption and rapidity. ex: Inhaled aesthetics are immediately absorbed b/c of the vast surface area of the lungs. 4. Blood Supply: the richer the blood supply the better the absorption. Ex: Sublingual route (very rich blood supply) has rapid absorption, SQ (very poor blood supply) has slower absorption. 5. Solubility of the Drug: lipid soluble drugs pass more rapidly than GI membranes (b/c membranes contain fatty acid layers). Water soluble drugs require a carrier to pass through. 6. Liver Function: a decrease in liver function can increase bioavailability of a drug but only if it is a first pass drug (like coumadin).

question

Routes of drugs administered can be classified as what two types? What are examples of each?

answer

1. Enteral: oral, sublingual, buccal, gastrointestinal, and rectal. 2. Parenteral (by injection): SQ, IM, IV, ID, Intrathecal (directly into subarachnoid space), and Epidural (epidural space) *Parenteral technically means outside the GI tract so it also includes: topicals, transdermals, eye, ear, nose drops, inhalation drugs, vaginal drugs, and rectal. In general, the parenteral route provides the most rapid form of systemic absorption*

question

What are the 3 factors that influence the distribution of a drug in the body?

answer

1. Blood flow: directly related to cardiac output. This affects the rate and the extent of distribution. Also the blood flow to the target organ/tissue. 2. Affinity to tissue: Most of the drug is distributed to organs that have rich blood supply, ex: heart, liver, kidney, brain. If the drug enters with a poor blood supply, ex: skin, muscles, fat, the distribution will take longer. 3. Plasma protein binding: once in the bloodstream, drugs may become attached to proteins, mainly albumin. Not all of the drug becomes protein-bound, some of it remains free in the plasma. The amounts of protein bound and free drug establish equilibrium. The drug-protein molecule is too large to diffuse through the cell membrane so the drug molecule is trapped in the plasma and does not exert any pharmcologic activity. **It's the FREE DRUG, not the protein bound drug that exerts the drug action. The FREE DRUG is the active form of the drug**

question

If 2 highly protein bound drugs are given together, they will compete for protein binding sites. What are 2 reasons this would be dangerous?

answer

1. It may result in either one or both drugs being less protein bound. 2. If they are less protein bound that means there is more free drug in the blood which could lead to toxicity.

question

What should also be monitored when giving protein bound drugs?

answer

The patient's plasma protein levels because a decrease causes a decreases in protein binding sites and leads to an increase in free plasma drug levels. AGAIN, this could lead to toxicity.

question

What organ is most responsible for metabolism of drugs?

answer

The Liver.

question

If the liver is most responsible for the metabolism of drugs, patient's with what kind of disease or disorders would have problems?

answer

Patient's with liver disease or decreased liver function are at risk for drug accumulation which can lead to toxicity.

question

What is the primary organ responsible for excretion?

answer

The kidneys.

question

By the time most drugs reach the kidneys, they have been extensively metabolized by the liver and only a small fraction of the original drugs is excreted as the original compound. However the function of the kidney is very important to monitor. What is the result of kidney disease?

answer

Kidney disease results in decreased glomerular filtration or decreased renal tubular secretion which can impair or slow down drug excretion.

question

1. The Creatinine Clearance (a 24 hour urine and blood lab test) is the most accurate test to determine what? 2. What is a normal value for the Creatinine Clearance? 3. If the Creatinine Clearance is normal, will the medication be changed or unchanged?

answer

1. Used to determine renal function. 2. 85-135 ml/min is normal. 3. If normal, then the drug is unchanged. **Creatinine is a waste product caused by cellular metabolism. The serum concentration of creatinine is a direct indicator of GFR. BUN is an indirect indicator of GFR. Creatinine Clearance decreases with age so drug does in the elderly may need to be decreased. A decrease in the GFR will increase the serum creatinine and decrease urine creatinine clearance**

question

What does the half-life of a drug mean?

answer

The half-life of a drug is the time it takes for the amount of drug in the body to decrease to ONE-HALF OF THE PEAK LEVEL it previously achieved. **with kidney or liver dysfunction the half-life is prolonged**

question

Which drug action phase refers to the effect the drug has on the body (it's mechanism of action)?

answer

Pharmacodynamic Phase

question

What are the 2 drug effects of the pharmacodynamic phase?

answer

1. Primary effect: is the desired response from the drug 2. Secondary effect: may be desirable or may not be desirable

question

What is the meaning of the therapeutic index?

answer

It's the ratio between a drug's beneficial effects and it's toxic effect. The therapeutic range of a drug should be between the minimum effective concentration (enough to produce the desired drug action) and the minimum toxic concentration (toxic effect).

question

What is the term used to describe the deleterious effect on various body tissues resulting from over dosage or buildup of medications in the blood due to impaired metabolism or excretion?

answer

Toxicity.

question

What is the Onset of Action?

answer

It's the time it takes to reach minimum effective concentration after the drug is given.

question

What is Peak Action?

answer

It's when the drug reaches its highest blood or plasma concentration.

question

What is the Duration of Action?

answer

It's the length of time the drug exerts its pharmacological effect. If a med is order every 6 hours, the duration of action of that med is 6 hours.

question

What are Agonists? What are Antagonists?

answer

Agonists: drugs that produce a response Antagonists: drugs that block a response

question

If a drug has a low therapeutic index it has a narrow margin of safety and must be monitored with serum drug levels. If a patient is on a low therapeutic index drug and after drawing blood the level is within range, what should the nurse do?

answer

The nurse doesn't have to do anything.

question

What is the psychological benefit from a compound that may not have the chemical structure of a drug effect?

answer

Placebo Effect

question

When are trough and peak levels drawn and why? What if the peak is too low? What if the peak or trough is too high?

answer

Trough: drawn immediately before the next dose---it indicates the absorption of the drug. Peak: drawn one hour after the drug is given---measures the rate of elimination. Peak too low= non-therapeutic Peak and trough too high= risk for toxicity

question

When is a loading dose ordered?

answer

When an immediate drug response is desired.

question

What types of foods antagonize the action of coumadin?

answer

Foods high in vitamin k.

question

The chemical name of a drug describes what? Who chooses the brand/trade name? What is the official or non-proprietary name also known as?

answer

Chemical structure Drug company chooses brand name. Generic name.

question

When is the nurse required to count narcotics?

answer

At the beginning and the end of the shift.

question

List the 5 controlled substance levels and give one example for 3 of the 5 levels.

answer

Level I: Heroin, LSD Level II: Demerol, Morphine, Hydrocodone Level III: Codeine Paregoric Level IV: Phenobarbital, Benzodiazepams, Xanax, Valium Level V: Opiod substances for cough and diarrhea *Level one is the highest/most lethal risk of addiction*

question

This route of administration reaches the systemic circulation the fastest.

answer

IV

question

Occurs when one drug increases the effects of another drug.

answer

Synergism or Potentiation.

question

Refers to the % of administered drug dose that reaches the systemic circulation.

answer

Bioavailability.

question

Many oral meds are considered less than 100% bioavailable because of this.

answer

The First-Pass Effect.

question

These proteins in the liver covert drugs to inactive forms.

answer

Enzymes

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