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Exam 3
SCCC
103
Nursing
Undergraduate 2
10/18/2013

Additional Nursing Flashcards

 


 

Cards

Term
Names for medications
Definition
Chemical, Generic and Trade® or Brand Name
Term
Classifications for medications
Definition
-Therapeutic Class
-Pharmacologic Class
-Other
*Pregnancy Category
*Controlled Substance Schedule
Term
Preparations for medications
Definition
Oral
Topical
Term
Routes of Administration
Definition
Oral (PO)
Sublingual (SL)
Buccal
Topical
Enteral
Parenteral (IM, IV)
Term
Systems of Medication Distribution
Definition
Unit-dose system
Automated medication-dispensing system
Bar code medication administration
Self-administered medication system
Term
Medication/Physician Orders: Types of Orders
Definition
Routine or Standing Orders
PRN Orders
Standing Protocols
One-Time Orders
STAT Orders
Telephone and FAX Orders
Verbal Orders
Electronic Orders
Term
Medication Order: Components
Definition
Patient, Date, Time
Medication Name
Medication Dosage
Route of Administration
Frequency
Time
Purpose or
Special Considerations
Signature
Term
Pharmacology
Definition
What the body does to the medication
What medication does to the body
Different forms of medications.
Different routes for administering medication.
Term
Principles of Drug Action
Definition
Pharmacokinetics
Pharmacodynamics
Term
Pharmacokinetics
Definition
Absorption
Distribution
Metabolism
Excretion
Term
Absorption
Definition
Movement of drug into the bloodstream
Affected by
Route of Administration
Form
Drug Solubility
Body Surface (Local vs. Systemic)
Food
Term
Distribution
Definition
Drug transport to sites of action
Factors affecting distribution:
Circulatory System
Amount bound to protein
Tissue specificity
Term
Metabolism
Definition
Biotransformation: chemical conversion of drug into metabolites that can be excreted
The slower the metabolism, the greater the risk of toxicity
Factors affecting metabolism
Liver Function
Term
Excretion
Definition
Elimination of the drug
Primarily through the kidneys
Also through lungs, bowel, sweat, mammary glands
Term
Factors affecting Pharacokenetics
Definition
Age
Weight
Environment
Pathological States
Genetic Factors
Psychological Factors
Term
Pharmacodynamics
Definition
-Therapeutic Effects
*Indication
*Action
-Adverse Effects (Adverse Drug Event)
*Side Effects
*Tolerance
*Allergic Reactions
Anaphylactic
*Toxicity
Term
Food/Drug Interactions
Definition
MAO Inhibitors and Tyramine
Coumadin and Green Leafy Vegetables
Milk
Grapefruit
Potassium
Full or Empty Stomach
Term
Medication Assessment
Definition
Information Collected During Initial Assessment
Medication History
Medication Reconciliation
Allergies and Intolerances
Medical History
Pregnancy and Lactation
Teratogens
Term
Medication Assessment
Definition
Assessment before Medication Administration
Physician’s Orders
Medication Record
Diet and Fluid Orders
Laboratory Values
Physical Assessment
Ability to Swallow
Gastrointestinal Motility
Body System Assessment
Term
Rights?
Definition
TRAMP
Time
Route
Amount
Medication
Person
Evaluation
Documentation
Term
Medication Administration Safety
Definition
Medication Reconciliation
Culture of Safety/Standardized Communication
Ask another nurse to check the order
Take vitals, check labs (don’t delegate)
Know and use your resources
Contact the physician for clarification, concerns, questions
Consult the pharmacist
Know what can be crushed, opened
Watch for drugs with similar names
Evaluate Response to Medication
Term
Preventing Errors
Definition
Watch for HIGH ALERT medications
Watch for patients with similar names
Seven Rights
Three Checks
Identify patient using two Identifiers
Check for allergies
Honor patient’s concerns
Document
Term
What to do if you commit a Medication Error
Definition
Check the patient
Consult a drug reference source for side effects to the medication
Identify type of error
Notify nurse manager or supervisor
Notify physician and obtain orders
Document
Incident Report
Full disclosure to patient
Term
The Elderly and Medications
Definition
Physiologic Changes
Mechanical/Cognitive
Polypharmacy
Term
Cultural Considerations
Definition
Risk for injury related to reactions to drug therapy and impact of cultural, racial, and/or ethnic factors on pharmacokinetics
Assess for
Leaders in the family or community
Health beliefs and practices
Past use of medicine
Use of herbal treatments, folk remedies, or supplements
Dietary habits
Term
Topical
Definition
Applied directly to body surface/body cavities
Skin, Instillation, Inhalation
Local Effects
Lotions, Creams, Ointments
Eye, Ear
Local and Systemic Effects
Inhalations, Vaginal, Rectal , Nasal
Systemic Effects
Transdermal Patches
Term
Over the Counter/Herbal Medications/ Dietary Supplements
Definition
Over the Counter
Herbal Medications
Dietary Supplements
Alternative
Complementary/Integrative
Term
Nursing Diagnosis
Definition
Knowledge Deficit
Noncompliance
Ineffective Health Maintenance
Readiness for Enhanced Knowledge
Risk for Injury
Risk for Aspiration
Term
Cognitive-Perceptual Pattern
Definition
“The cognitive-perceptual pattern deals with thought, thought processes, and knowledge as well as the way the patient acquires and applies knowledge.”
“The..pattern becomes the essential premise for all other patterns used in the practice of nursing.”
“…any failure in recognizing alterations in this pattern will hamper assessment and intervention in all the other patterns.”
Term
Sensory/Perception
Definition
“Sensations are the first stages in the functioning of senses to represent stimuli from the environment, and perception is a higher brain function about interpreting events and objects in the world.”
Term
Normal Sensory Perception
Definition
Special Senses
-Sight (Visual)
-Hearing (Auditory)
-Smell (Olfactory)
-Taste (Gustatory)
Somatic Senses
-Touch (Tactile)
-Kinesthetic (proprioception) [placement of action of our body parts]
-Visceral Senses [period cramps, stomach gases, etc.]
Term
Normal Sensory Perception
Definition
~Sensory Receptors
-Stimuli is received by the senses and transmitted to the RAS
~Reticular Activating System (RAS)[arousal mech. makes you aware of world. overwhelmed or understimulated =problems]
-Multiple stimuli are converted by the RAS into an impulse and conducted to the cerebral cortex
~Functioning Nerve Pathways
~The cerebral cortex perceives the impulse
Term
Terms associated Normal S/P Function
Definition
Sensoristasis
-State of optimum arousal (personal)
Adaptation
-Sensory receptors adapt to repeated stimulation by responding less and less
(live next to highway)(driiling becomes background) (don't smell after awhile)
Term
Factors Affecting Sensory Perception
Definition
Environment
Previous Experience
Lifestyle
Culture
Illness
Medications
Age
Variations in Stimulation
Term
Sensory Function Changes with Aging
Definition
Hearing Loss
Nerve degeneration
Low vision or Blindness
Diminished Proprioception (body awareness)
Physical and Psychological Factors
Polypharmacy
Nutritional Deficits
Term
Variations in Stimulation
Definition
Sensory Overload (Hyperactive Delerium)
Sensory Deprivation (Hypoactive Delerium)
Sensory Deficits (vision, hearing, taste, smell, tactile, kinesthetic sense)
Term
Sensory Overload
Definition
Environmental or Internal Stimuli is more than sensory system can process.
Internal Factors [anxious about procedure, meds, not feeling well, lack of sleep]
Information[too much info, giving diagnosis]
Environment[noise, nurses are loud, lights, invasive devices
Term
Sensory Deprivation
Definition
A state of RAS depression caused by lack of meaningful stimuli. Causes include:
~Altered Sensory Reception [sensory deficit]
-dementia, depression, neurological injury, sensory losses or deficits, CNS depressants
~Environmental Conditions
-Non-stimulating
-Monotonous
-Isolation
-Restricted Mobility
[brain starts to stimulate itself=hallucination] [brain makes other senses more acute blind=hear better]
Term
Altered Sensory Perception Function
Definition
Anxiety
Cognitive Dysfunction [disturbances in momory, reasoning, problem solving]
Hallucinations [har things see things]and Delusions [thoughts "poisoning me"]
Depression and Withdrawal
Restlessness, Sleeplessness
Decreased Appetite
Term
Assessment of Sensory/Perceptual Function
Definition
-Normal pattern identification
-Risk identification
(Age
Culture and Language
Activity/Stimulation Level
Medical History
Medications
Experience with healthcare settings)
-Dysfunction identification (can't see)
Term
Assessment
Definition
Medical and Psychological History
Medications/Substance Use
Recent changes in sensory perception/stimulation
Use of sensory devices
Ability to perform ADL’s
Stress and Pain
Numbness, tingling, balance
Daily Activities and Socialization
Focused examination of vision, hearing, taste, smell, touch, and balance. (Subjective and Objective Data)
Diagnostic Tests and Procedures
Term
Nursing Diagnosis
Definition
~Disturbed Sensory Perception
-Sensory Deficit (specify)
-Sensory Overload
-Sensory Deprivation
~Unilateral Neglect
Term
Implementation
Definition
Health Promotion
-Patient teaching
-Procedure Preparation
-Nurse-Patient Interaction
Term
Terms Associated with Cognition
Definition
Cognition
Consciousness
Attention
Memory
Learning
Communication
Term
Anatomic Structures involved in Cognition
Definition
Sensory Organs
Nervous Pathways
Reticular activating system (RAS)
Cerebral Cortex
Motor Reflexes
Term
Normal Cognitive Function
Definition
~Perception of Information
-Exteroceptors[hearing, vision, taste, smell, pain, touch]
-Proprioceptors[somatic sensors=body awareness inner ear, muscles, joints, tendons]
-Interoceptors[visera + organs]
~Consciousness[awareness]
~Thoughts
~Memory
~Speech
Term
Normal consciousness
Definition
Awareness -> RAS (if stimulated) + Cerebral Cortex (how we interpret what we do about it)
Term
Characteristics of Normal Cognition
Definition
Intelligence [ability to concentrate, comprehend, meaning of stimuli]
Reality perception[aware interpretation of place, situation, and self]
Orientation[knowing who you are, where you are, what time it is]
Judgment[insight=process lots of infor and make a judgement]
Recall and Recognition [moemory,retrieving it, and relate to current situation]
Language[relationships w/ other people, say their thoughts]
Term
Normal Cognitive Patterns
Definition
Attending[focus on a specific stimulit w/ out distraction]
Perceiving[receiving and interpreting sensory stimuli for understanding]
Thinking[sorting, organizing, and catogorizing info to form mental conecpts and perceptions]
Learning[aquiring knowledge that depends on abstract functions such as symbols, language, classifications, and concepts as well as concrete operations]
Remembering
Communicating
Term
Cognition and the older adult
Definition
-Structural changes affect sensory organs
-Slower Processing and Reaction Time
-Decreased ability for rapid problem solving
-Slower voluntary movements
-Pathological Processes
-Polypharmacy
-Normal aging does not affect intelligence
Term
Physiologic Factors affecting…
Definition
~Blood Flow[oxygen to work]
~Nutrition, Fluid and Electrolytes, Metabolism[iron, dehydration]
~Infections
~Degenerative Processes
-Dementia[chronic confussion=gradually gets worse]
=Alzheimers[form of dementia= dee on an MRI large area not functioning, degeneration of neurons]
~Head Trauma
Term
More Factors
Definition
Sleep and Rest[REM sleep]
Pharmacologic[medications that alter consciousness]
Environmental[new enviornment, etc]
Culture[meanings of words]
Psychological[self concept if poor =depressed can effect cognition]
Term
Altered Cognitive Function
Definition
~Disorganized Thinking [disturbed thought processes=schizophrenia, bipolar, can't reason w/ them b/c thought process not logical]
~Impaired Though Processes
-Altered Level of Arousal[reactivity to incoming stimuli]
-Altered Attention[inability to focus easily distracted]
-Memory Impairment
~Impaired Communication[Function of altered cognitive function]
Term
Dememtia
Definition
-Gradually gets worse
-older person no chenge in level of consciousness, disturbed memory, lost, lack of orientation.
Term
Delirium
Definition
-Acute confusion
-increased or decreased psychomotor activity.
-Altered sleep, see/hear things not there
Term
Sundown Syndrome
Definition
-Nocturnal delirium
-@ Night time becomes more agitated/confused.
Term
Schizophrenia
Definition
-Thought disorder
-Disturbance in reality perception
Term
Affect disorder
Definition
-Bipolar, happy then sad
Term
Confusion
Definition
-Nursing notes don't just say confused, must say what's occuring, impaired judgement, inappropriate behavior/speach, etc.
Term
Impaired Communication
Definition
~Expressive Aphasia
~Receptive Aphasia
~Anomic Aphasia
~Global Aphasia
~Dysarthria
Term
Expressive Aphasia
Definition
brain problem, limited speach that is slow and halteding with great effort, reduced grammar, and poor articulation
Term
Receptive Aphasia
Definition
-speech that is well articulated and has good melody and normal or slightly faster rate
-inparied auditory comprehension and feedback
-difficulty understanding spoken and writen word.
Term
Anomic Aphasia
Definition
-word finding problems=milder than expressive aphasia
Term
Global Aphasia
Definition
-severe and extensive damage to all language barriers
-can't speak or understand speach, can't read or write.
-some have meaningless recurent sounds as speach.
Term
Dysarthria
Definition
-motor problem, being able to make the sounds.
-physically unable
Term
Aphasia
Definition
Language disability caused by brain injury (stroke)
Term
Assessment of Mental Status
Definition
~Level of Consciousness
-Hypervigilant, Alert, Lethargic, Obtunded, Comatose
~Orientation
-person, Place, Time
~Ability to pay attention
Term
Assessment continued…
Definition
~Behavior and Appearance [appropriate, bizare]
-Affect[flat affect=doesn't smile, cry, emotionless]
~Language, Memory, Reasoning, Problem Solving
-Verbal, Written and Nonverbal Expression
-Comprehension
~Functional Status[sleep+rest, problem solving, safety awareness]
Term
More assessment…
Definition
Physical Assessment
Diagnostic Tests and Procedures
Tests of Cognitive Function
Behavioral Observation Scales
Term
Outcome Identification and Planning
Definition
Identify patients at risk for acute confusion
Reverse contributing factors
Provide an environment with appropriate stimulation
Facilitate Communication
Assist with ADL’s
Protect from physical injury
Term
Implementation
Definition
~Health Promotion
-Encouraging healthy lifestyles
-Improving Memory
-Identifying patients at risk for acute confusion
Term
Intervention for Impaired Cognitive Function
Definition
Orientation to surroundings
Alternative communication methods
Environmental restrictions
Fluid Intake and Nutrition
Mobility
Safety
Therapeutic communication
Reality orientation
Socialization therapies
Family support
Term
T/F? The cerebral cortex coordinates consciousness, thought, memory, learning, and communication.
Definition
T
Term
T/F? Interoceptors are located in the inner ear, muscles, tendons, and joints.
Definition
F
Term
Which of the following is an example of perceiving?
a. The idea of beauty
b. Organizing information in memory
c. Hearing a phone ring
d. Facial expressions
Definition
c. Hearing a phone ring
Rationale: Hearing a phone ring is an example of perceiving, which includes receiving and interpreting sensory stimuli that function as a basis for understanding, knowing, or learning. The idea of beauty is an example of thinking. Organizing information in memory is a process of learning. Facial expressions are a form of communicating.
Term
Nociception
Definition
The physiologic process by which information about tissue damage is communicated to the Central Nervous System.
Involves four processes:
-Transduction
-Transmission
-Perception
-Modulation
Term
Transduction
Definition
(reception of pain)
~Nociceptors
-Mechanical, Chemical, Thermal
~Neurochemicals/Neurotransmitters
-Bradykinin, Histamine, Prostaglandins
~Two types of peripheral nerve cells:
-A-delta fibers – fast and large (sharp, localized pain/pleasurable skin receptors).
-C fibers – smaller, slow (dull, diffuse, achy, persistent)
Term
Transmission
Definition
From site of transduction to the spinal cord and on to the brain.
Term
Perception
Definition
-The pain is recognized, defined and responded to by the individual experiencing the pain.[social factors, individual=effect perception of pain]
Term
Modulation
Definition
~Changes the perception of pain by inhibiting the pain signal [brain send down signals to inhibit pain from getting to brain] (opiod receptors)
=Endogenous opioids[produced by body]
=Exogenous opioids[administered to person]
Term
Types of pain?
Definition
Acute Pain [signal=potential/actual tissue injury. Diminishes over time. treat underlying cause, give pain medication]
Persistent (chronic) pain [longer than 3-6 months, percists even after healing]
Intractable Pain[nothing is working]
Nociceptive pain[damage of tissue outside CNS, skin, bones, visceral receptors. Aching, deep, throbbing, cramping]
Neuropathic pain [Damage to peripheral of CNS nerves. Phantom pain, tumors on nerves. Tingling, burning, itching]
Term
Factors Affecting Pain Perception and Pain Response
Definition
~Enviornment=light/dark
~Behavioral
~Emotional
~Congnitive
~Physical
Term
Pain and the Elderly
Definition
~Prevalence of chronic pain in elderly ranges from 45% to 80%.
~May falsely believe that pain and suffering come with age.
~May have multiple conditions presenting with vague symptoms.
~May withhold complaints because of fear of the treatment, of a lifestyle change, or of becoming dependent.
~Fear being a burden or “bad patient” if they express pain or that nothing can be done about pain.
~High prevalence of cognitive, sensory-perceptual, and motor problems that infere with a person’s ability to process info and communicate.
~More likely to use words “aching,” “soreness,” or “discomfort.”
~Treatment complicated by increased sensitivity and polypharmacy
Term
Culture Examples?
Definition
~Asian and Pacific Islander patients are often reluctant to express their pain because they believe that the pain is God’s will or punishment for past sins.
~Native Americans use massage, heat/cold and herbal remedies for pain relief.
~In Arab cultures, patients are expected to openly express their pain and anticipate immediate relief, preferably through injections or IV.
~Non-Hispanic white adults reported pain more often than adults of other races.
Term
Number one Rule on Pain?
Definition
"Pain is whatever the experiencing person says it is, existing whenever and wherever the person says it does………”
Term
When to Assess Pain
Definition
-On admission
-At rest and during activity
-When patient complains of pain
-Before implementing pain management and 30 to 45 (P.O.) minutes later
-Before and after each potentially painful treatment or procedure
-As the 5th Vital Sign
Term
What to Assess
Definition
Location
Quality
Intensity, Strength and Severity
Timing: Onset, Duration, Frequency
Aggravating/Relieving Factors
Associated Symptoms[anxiety, fatigue, depression.
Term
Assess for
Definition
-Effect on ADL’s
-Meaning of Pain
-Past pain experiences
-Pain relief goals
-Coping resources
-Assess for knowledge deficits, fear of addiction
-Non-verbal signs!
Term
Objective Assessment
Definition
Observation
Behavioral Responses
Verbal
Non-verbal
Inspection
Palpation
Term
Tolerance
Definition
Increased amount for same effect
Term
Physical Dependence
Definition
Physiologically dependent=>Will withdraw (taper them off)
Term
Addiction
Definition
Psycologically=>Euphoric effect, crave it, despite harm causing them.
Term
Misuse
Definition
Used inappropriately
=take too much laxatives, too much tylenol
Term
Drug Abuse
Definition
Used inappropriately
=drive after taking sedative
Term
Illicit drugs
Definition
street drugs
Term
Multimodal Pain Management
Definition
~Nonopioid analgesics
-Mild to Moderate Nociceptive Pain
~Opioid Analgesics
-Moderate to Severe Pain
~Adjuvant Analgesics
-Enhance the effects of opiates and alleviate symptoms that aggravate pain; also alleviates neuropathic pain
~Adjuvants
-Drugs without analgesic properties
~Non-pharmacological Methods
Term
Nonopioid Analgesics
Definition
~Tylenol (Acetaminophen): analgesia and antipyretic effects. Toxic to liver in large doses.
~NSAID’s (Non-Steroidal Anti-Inflammatories): broad class of drugs with varying efficacy: interfere with the production of prostaglandin
-aspirin (acetylsalicylic acid or ASA): effective for mild pain, but limited use due to side effects, including gastric upset, platelet dysfunction, bleeding, tinnitis, decreased hearing acuity.
-ibuprofen (Motrin, Advil):. Side effects can be serious and include renal failure, cardiovascular thrombotic events and GI bleed.
Term
Opioid Analgesics
Definition
-Bind with opiates receptor sites to block the pain response.
-Most opioids are Mu Agonists: Morphine, oxycodone,codeine, methadone, Dilaudid (hydromorphone), fentanyl, Demerol (meperidine), methadone
-Oral Opioids are commonly prescribed with a non-opioid analgesic: Tylenol # 3, Vicodin, Percocet or Percodan.
-Antagonist – naloxone (Narcan)
Term
Side Effects of Opioid Analgesics
Definition
-Most common include: constipation, pruritus, orthostatic hypotension, urinary retention, nausea/vomiting, sedation, and respiratory depression.
-Diminishes with continued use except constipation.
-Many side effects are treated with other medications.
Term
Sedation/Respiratory Depression
Definition
-Excessive sedation will precede respiratory depression.
-Patients at risk for respiratory depression include those who are opioid naïve, elderly, have underlying lung disease or are receiving other CNS depressants.
-Always assess the patient for level of alertness and respiratory status before and after administering opioid.
-Reduce dose or administer an opioid agonist such as Naloxone (Narcan)
Term
Principles of Nonpharmacologic Pain Medication
Definition
~Basic Comfort Measures
~Cutaneous Stimulation
-Heat
-Cold
-Massage
-Trancutaneous Electrical Nerve Stimulation (TENS)
Term
RICE
Definition
rest,ice, compression, elevation
Term
Non-pharmacologic continued
Definition
~Cognitive and Behavioral Strategies
-Distraction
-Breathing and Relaxation
-Imagery
-Biofeedback
~Complementary and Alternative Medicine
-Prayer
-Acupuncture
-Meditation
-Chiropractry
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