For those of you who don't routinely check your student emails, here's the latest from Mr. Scott....
Dear HS 3, N 3 Students:Beginning now, I will posting grades in the turnitin.com website rather than DocuShare. Each student’s grade will be anonymous and the gradebook will retain all of your scores. It is an improved way of record keeping for me as well as a better way of you tracking your performance in the class.In order for you to get your grades in this course, you will need to go to the turnitin.com website and open an account. Below are the instructions to do this.Go to the turnitin.com home page.In the upper right corner, you will see, “New Users.” Click on that.On the page that appears, click on “Student.”Under class ID, enter 2441659Under class enrollment password, enter pharmacologyComplete the remaining portion of the form and click on I agree—create profileOnce you are enrolled, you will be able to access the course, HS 3, N 3 Administration of Medication.I will not be developing the gradebook until students have enrolled. Please be patient, this may take some time. I hope to place your Exam II scores in the turnitin gradebook.Thanks for participating.Bruce Scott
Tuesday, September 30, 2008
N001...the final
The final is scheduled for october 16 at EMSTI from 0800-1200. It is comprehensive and worth 100 pts of the grade.
*50 pts-multiple choice (like what we usually have)
*25 pts-dosage calculations (application type calculations, not like pharm)
*25 pts-short answer response to case scenario
There will be a study guide available on Mrs. Semillo's DocuShare when it is ready.
*50 pts-multiple choice (like what we usually have)
*25 pts-dosage calculations (application type calculations, not like pharm)
*25 pts-short answer response to case scenario
There will be a study guide available on Mrs. Semillo's DocuShare when it is ready.
Monday, September 29, 2008
pharmacology GRM week #7 (brief)
Week 7-Chapter 51
1. What are the functions of HCl, bicarbonate, pepsinogen, intrinsic factor, mucus and prostaglandins in the stomach?
a. HCl: aids in digestion and barrier to infection,
b. bicarbonate: natural mechanism to prevent hyperactivity
c. pepsinogen: precursor to pepsin which digests protein
d. intrinsic factor: facilitates absorption of B12,
e. mucus: protection from HCl and digestive enzymes
f. prostaglandins: antiinflammatory and protective functions
2. Which cells produce HCl?
a. parietal cells
3. What usually causes hyperacidity in the stomach?
a. food, caffeine, chocolate, alcohol or emotional stress
4. What is the typical pH of the stomach?
a. 1-4
5. What is the primary target of the drugs that treat acid-related disorders?
a. parietal cells
6. What are the three types of receptors on the parietal cells?
a. acetylcholine (Ach), histamine, and gastrin
7. What is the name of the mechanism which transports HCl from the parietal cells to the stomach?
a. proton pump
8. How do anticholinergics reduce HCl production?
a. block Ach receptors which also decrease hydrogen ion secretion from parietal cells
9. Why do aluminum and calcium based antacids also contain magnesium?
a. contributes to acid-neutralizing capacity and conteracts constipating effects of calcium and aluminum
10. To what degree do antacid dosages raise the gastric pH?
a. 0.3 points, reducing it by 50%
b. 1 point, reducing it by 90%
11. How do H2 receptor blockers raise the gastric pH?
a. competitively block H2 receptor of acid-producing parietal cells and reduces responsiveness to histamin and stimulation of Ach and gastrin
12. How do PPI’s raise the gastric pH?
a. bind to proton pump preventing movement of hydrogen ions and blocks gastric acid secretion
13. When both antacids and H2 blockers are given, what is the proper practice?
a. Do not administer simultaneously.
14. Why are antacids to be given with water?
a. enhance absorption in stomach
15. In relation to other medications, how should antacids be given?
a. 1-2 hours before other medications are taken
16. What may happen if ranitidine is given rapidly IV?
a. hypotension
Week 7-Chapter 52
17. What is the definition of diarrhea?
a. abnormal passage of stools with increased frequency, fluidity, weight, or with increased stool water excretion
18. How do adsorbents work in treating diarrhea?
a. coat the wall of the GI tract, binding to causative bacteria or toxin to their surface to be eliminated from the body through stool
19. How do anticholinergic drugs reduce diarrhea?
a. slow peristalsis by reducing the rhythmic contractions and smooth muscle tone of the GI tract
20. How do opioids treat diarrhea?
a. reduce bowel motility
21. How do opiods affect absorption?
a. increases the absorption of water, electrolytes, and nutrients
22. Why might someone who takes oral anticoagulants with absorbants be at higher risk for bleeding?
a. may bind to vitamin K which is needed for clotting
23. Why does Lomotil contain atropine?
a. discourages recreational opiate use
24. What is the definition of constipation?
a. abnormally infrequent and difficult passage of feces through the lower GI tract
25. What problems can chronic laxative use cause?
a. laxative dependence, damage to bowel or intestinal problems
26. What are the three ways in which laxatives work?
a. affecting fecal consistency, increasing fecal movement through colon and facilitate defecation through the rectum
27. Describe the way in which the 5 categories of laxatives work. Know drug examples from each laxative category. Table 52-4
Laxatives: Drug Effects
*Bulk: Psyllium
Increase peristalsis, causes increased secretion of water and electrolytes in small bowel, inhibits absorption of water in small bowel, increases water in fecal mass, softens fecal mass
*Emollient: Mineral oil
Increase peristalsis, causes increased secretion of water and electrolytes in small bowel, inhibits absorption of water in small bowel, increases wall permeability in small bowel, increases water in fecal mass, softens fecal mass
*Hyperosmatic: Glycerin
Increase peristalsis, acts only in large bowel, increases water in fecal mass, softens fecal mass
*Saline: Magnesium hydroxide
Increase peristalsis, causes increased secretion of water and electrolytes in small bowel, inhibits absorption of water in small bowel, increases water in fecal mass, softens fecal mass
*Stimulant: Senna
Increase peristalsis, causes increased secretion of water and electrolytes in small bowel, inhibits absorption of water in small bowel, increases wall permeability in small bowel, increases water in fecal mass, softens fecal mass
28. How does lactulose reduce serum ammonia levels in patients with hepatic encephalopathy?
a. converts ammonia to ammonium which cannot be reabsorbed in the small intestine
29. How long does it take polyethylene glycol 3350 to cleanse the bowel if it is taken properly?
a. 4 hours
30. What color does bismuth subsalicylate turn the stool?
a. black or grey
1. What are the functions of HCl, bicarbonate, pepsinogen, intrinsic factor, mucus and prostaglandins in the stomach?
a. HCl: aids in digestion and barrier to infection,
b. bicarbonate: natural mechanism to prevent hyperactivity
c. pepsinogen: precursor to pepsin which digests protein
d. intrinsic factor: facilitates absorption of B12,
e. mucus: protection from HCl and digestive enzymes
f. prostaglandins: antiinflammatory and protective functions
2. Which cells produce HCl?
a. parietal cells
3. What usually causes hyperacidity in the stomach?
a. food, caffeine, chocolate, alcohol or emotional stress
4. What is the typical pH of the stomach?
a. 1-4
5. What is the primary target of the drugs that treat acid-related disorders?
a. parietal cells
6. What are the three types of receptors on the parietal cells?
a. acetylcholine (Ach), histamine, and gastrin
7. What is the name of the mechanism which transports HCl from the parietal cells to the stomach?
a. proton pump
8. How do anticholinergics reduce HCl production?
a. block Ach receptors which also decrease hydrogen ion secretion from parietal cells
9. Why do aluminum and calcium based antacids also contain magnesium?
a. contributes to acid-neutralizing capacity and conteracts constipating effects of calcium and aluminum
10. To what degree do antacid dosages raise the gastric pH?
a. 0.3 points, reducing it by 50%
b. 1 point, reducing it by 90%
11. How do H2 receptor blockers raise the gastric pH?
a. competitively block H2 receptor of acid-producing parietal cells and reduces responsiveness to histamin and stimulation of Ach and gastrin
12. How do PPI’s raise the gastric pH?
a. bind to proton pump preventing movement of hydrogen ions and blocks gastric acid secretion
13. When both antacids and H2 blockers are given, what is the proper practice?
a. Do not administer simultaneously.
14. Why are antacids to be given with water?
a. enhance absorption in stomach
15. In relation to other medications, how should antacids be given?
a. 1-2 hours before other medications are taken
16. What may happen if ranitidine is given rapidly IV?
a. hypotension
Week 7-Chapter 52
17. What is the definition of diarrhea?
a. abnormal passage of stools with increased frequency, fluidity, weight, or with increased stool water excretion
18. How do adsorbents work in treating diarrhea?
a. coat the wall of the GI tract, binding to causative bacteria or toxin to their surface to be eliminated from the body through stool
19. How do anticholinergic drugs reduce diarrhea?
a. slow peristalsis by reducing the rhythmic contractions and smooth muscle tone of the GI tract
20. How do opioids treat diarrhea?
a. reduce bowel motility
21. How do opiods affect absorption?
a. increases the absorption of water, electrolytes, and nutrients
22. Why might someone who takes oral anticoagulants with absorbants be at higher risk for bleeding?
a. may bind to vitamin K which is needed for clotting
23. Why does Lomotil contain atropine?
a. discourages recreational opiate use
24. What is the definition of constipation?
a. abnormally infrequent and difficult passage of feces through the lower GI tract
25. What problems can chronic laxative use cause?
a. laxative dependence, damage to bowel or intestinal problems
26. What are the three ways in which laxatives work?
a. affecting fecal consistency, increasing fecal movement through colon and facilitate defecation through the rectum
27. Describe the way in which the 5 categories of laxatives work. Know drug examples from each laxative category. Table 52-4
Laxatives: Drug Effects
*Bulk: Psyllium
Increase peristalsis, causes increased secretion of water and electrolytes in small bowel, inhibits absorption of water in small bowel, increases water in fecal mass, softens fecal mass
*Emollient: Mineral oil
Increase peristalsis, causes increased secretion of water and electrolytes in small bowel, inhibits absorption of water in small bowel, increases wall permeability in small bowel, increases water in fecal mass, softens fecal mass
*Hyperosmatic: Glycerin
Increase peristalsis, acts only in large bowel, increases water in fecal mass, softens fecal mass
*Saline: Magnesium hydroxide
Increase peristalsis, causes increased secretion of water and electrolytes in small bowel, inhibits absorption of water in small bowel, increases water in fecal mass, softens fecal mass
*Stimulant: Senna
Increase peristalsis, causes increased secretion of water and electrolytes in small bowel, inhibits absorption of water in small bowel, increases wall permeability in small bowel, increases water in fecal mass, softens fecal mass
28. How does lactulose reduce serum ammonia levels in patients with hepatic encephalopathy?
a. converts ammonia to ammonium which cannot be reabsorbed in the small intestine
29. How long does it take polyethylene glycol 3350 to cleanse the bowel if it is taken properly?
a. 4 hours
30. What color does bismuth subsalicylate turn the stool?
a. black or grey
pharmacology GRM week #6 (brief)
Week 6-Chapter 26
1. What are the three main body fluid compartments?
a. intracellular fluid, interstitial fluid, and plasma volume
1. What are the three main body fluid compartments?
a. intracellular fluid, interstitial fluid, and plasma volume
2. Know the terms extracellular fluid, extravascular fluid, interstitial fluid, intracellular fluid and intravascular fluid.
a. extracellular fluid: fluid outside the cells
b. extravascular fluid: fluid outside blood vessels
c. interstitial fluid: fluid between cells
d. intracellular fluid: fluid within a cell
e. intravascular fluid: fluid within blood vessels
a. extracellular fluid: fluid outside the cells
b. extravascular fluid: fluid outside blood vessels
c. interstitial fluid: fluid between cells
d. intracellular fluid: fluid within a cell
e. intravascular fluid: fluid within blood vessels
3. What does isotonic mean?
a. equal concentration of solutes across a membrane
a. equal concentration of solutes across a membrane
4. There are two forces within the capillaries that bring about the movement of water. Hydrostatic pressure pushes water out of the capillaries and oncotic or colloidal oncotic pressure pulls or retains water within the vessels. The arterial blood pressure is what provides for the hydrostatic pressure. It is a person’s arterial blood pressure that promotes the movement of fluid from within the capillaries to outside the capillaries (tissues and cells). Serum protein (albumin) is what causes a person to have oncotic pressure so it is actually the albumin that pulls water into the capillaries. So, hydrostatic pushes and oncotic pulls.
5. What is the principle extracellular electrolyte?
a. albumin
a. albumin
6. What are the three categories of agents used to replace lost fluids?
a. crystalloids, colloids, and blood products
a. crystalloids, colloids, and blood products
7. What are the constituents of crystalloids?
a. fluids and electrolytes normally found in the body
a. fluids and electrolytes normally found in the body
8. How do colloids move fluid from the interstitial compartment to the plasma compartment? a. pull fluid from blood vessels
9. What are the indications for the following blood products?
a. Cryoprecipitate: 1, FFP: 1.7x, PRBCs: 2.2x, whole blood: 3.33
Week 6-Chapter 53
1. What are the two areas of the brain responsible for vomiting?
a. vomiting center and chemoreceptor trigger zone
a. Cryoprecipitate: 1, FFP: 1.7x, PRBCs: 2.2x, whole blood: 3.33
Week 6-Chapter 53
1. What are the two areas of the brain responsible for vomiting?
a. vomiting center and chemoreceptor trigger zone
2. What are parents advised to do when a child ingests a toxin?
>?
>?
3. How do most antiemetics work?
a. block one of 6 vomit pathways and in doing so block the neurologic stimulus that induces vomiting
a. block one of 6 vomit pathways and in doing so block the neurologic stimulus that induces vomiting
4. Know the ways in which categories of antiemetics work by studying
Antiemetic Drugs: Mechanisms of Action
*Anticholinergics: scopolamine
Block Ach receptors in the vestibular nuclei and reticular formation
Antiemetic Drugs: Mechanisms of Action
*Anticholinergics: scopolamine
Block Ach receptors in the vestibular nuclei and reticular formation
*Antihistamines: diphenhydramine
Block H1 receptors, thereby preventing Ach from binding to receptors in the vestibular nuclei
Block H1 receptors, thereby preventing Ach from binding to receptors in the vestibular nuclei
*Neuroleptics: prochlorperazine
Block dopamine in the CTZ and may also block Ach
Block dopamine in the CTZ and may also block Ach
*Prokinetics: metoclopramide
Block dopamine in the CTZ or stimulate Ach receptors in the GI tract
Block dopamine in the CTZ or stimulate Ach receptors in the GI tract
*Serotonin blockers: ondansetron
Block serotonin receptors in the GI tract, CTZ, and VC
Block serotonin receptors in the GI tract, CTZ, and VC
*Tetrahydrocannabinoids
Have inhibitory effects on the reticular formation, thalamus, and cerebral cortexcerebral cortex
Have inhibitory effects on the reticular formation, thalamus, and cerebral cortexcerebral cortex
pharmacology GRM week #5 (brief)
Week 5-Chapter 12
1. Compare sedatives and hypnotics.
a. sedatives reduce nervousness, excitability, and irritability without causing sleep in small amounts. Hypnotics have a more potent effect on the CNS and cause sleep.
2. In terms for barbiturates, what is meant by a “low therapeutic index?”
a. there is only a narrow margin where the drug is effective and beyond that margin the drug is rapidly toxic
3. Since GABA is an inhibitory amino acid, what happens to the CNS when it is potentiated?
a. inhibit nerve impulse transmission
4. What does it mean to raise the convulsive or seizure threshold?
a. decreases the threshold a patient has to convulse or have a seizure
5. What do barbiturates do to the respiratory rate?
a. decrease repiratory rate
6. By stimulating the action of enzymes that are responsible for the metabolism of many drugs, how do barbiturates affect the duration of action of these other drugs?
a. shortens their duration time
7. What are the 4 indications of barbiturates?
a. ultra-short acting, short acting, intermediate acting, and long acting
8. Which bodily system is most affected by barbiturates?
a. the CNS
9. What is the most frequent response to barbiturate overdose?
a. respiratory depression leading to respiratory arrest
10. What are the mainstays of treatment of barbiturate overdose?
a. maintenance of adequate airway, assisted respiration, and oxygen administration if needed
11. What is meant by “pressor support?”
a. drugs that cause vasoconstriction and therefore, raise the blood pressure.
12. How does activated charcoal cause the elimination of a drug from the body?
a. assists in pulling the drug from circulation then eliminating it through the GI tract
13. Know that Phenobarbital (Luminal) is the prototype barbiturate.
a. Luminal is the prototype barbiturate
14. What is the most commonly prescribed class of sedative-hypnotics?
a. benzodiazepines because they have favorable adverse effect profiles, efficacy and safety
15. What are the two classifications of benzodiazepines?
a. anxiolytics and sedative-hypnotics
16. How do benzodiazepines depress the CNS?
a. inhibit stimulation of the brain
17. Why are benzodiazepines used to prevent the symptoms of alcohol withdrawal?
a. their receptors in the CNS is the same area or alchohol addiction
18. What are the 4 most common uses of benzodiazepines
a. sedation, sleep induction, anxiety relief, and musculo-skeletal relaxation
19. What are the most commonly reported undesirable effects of benzodiazepines?
a. headaches, dizziness, paradoxical excitement or nervousness, drowsiness, vertigo, lethargy, and cognitive impairment
20. Why should benzodiazepines be avoided in the elderly?
a. create a significant fall hazard
21. What are the manifestations of a benzodiazepine overdose?
a. somnelence, confusion, coma, and diminished reflexes
22. What two substances should benzodiazepines not be combined with?
a. alcohol and analgesics
23. What is the reason for not inducing vomiting in an unconscious patient?
>?
24. How does flumazenil work as a benzodiazepine reversal agent?
>?
25. What are the pharmacologic properties of the nonbenzodiazepine hypnotics such as zolpidem (Ambien) and eszoplicone (Lunesta)?
a. anxiolytic, sedative, muscle relaxant, and anticonvulsive effects
26. How long should the nonbenzodiazepine drugs be used to treat insomnia?
a. 7-10 days
27. Which class of hypnotics has the shortest half-life, benzodiazepines or nonbenzodiazepines?
a. benzodiazepines
28. Which would you guess would have the greater “hangover” effect?
a. nonbenzodiazepines
29. How does the group of muscle relaxants act?
a. act within the CNS to relieve pain associated with skeletal muscle spasms
30. What are the two classes of muscle relaxants
a. central acting skeletal muscle relaxants and direct acting skeletal muscle relaxants
31. What is the antidote or reversal drug for muscle relaxant overdose?
a. no specific antidote
32. What may barbiturates undesirably cause in children and the elderly?
>?
33. What happens if a barbiturate is given too rapidly IV?
a. profound hypotension and marked respiratory depression
34. What is the normal blood level for phenobarbital?
>?
35. What standard safety precautions should be used on someone taking hypnotics?
>?
36. Should zolpiedem (Ambien) be taken with a mealtime snack or on an empty stomach?
a. empty stomach
Week 5-Chapter 16
37. How do most CNS stimulant drugs act?
a. stimulate the excitatory neurons in the brain
38. What are the 3 excitatory neurotransmitters?
a. dopamine, norepinepherine, and epinepherine
39. What do amphetamines stimulate?
a. areas of the brain associated with mental alertness like the cerebral cortex and thalamus
40. What is the pharmacologic action of amphetamines?
a. mood elevation or eupohoria, increased mental alertness and capacity for work, decreased fatigue and drowsiness, prolonged wakefulness, relaxation of bronchial smooth muscle, increased respiration, and dilation of pulmonary arteries
41. How do serotonin receptor agonists reduce migrane headache pain?
a. stimulate serotonin receptors in cerebral arteries and cause vasoconstriction
42. What is the original prototype SSRA?
a. sumatriptan (Imitirex)
Week 5-Chapter 17
43. What are adrenergics?
a. synthetic and naturally occurring substances
44. Why are adrenergics also called sympathomimetics?
a. mimic the effects of the SNS neurotransmitters of norepinepherine, epinepherine, and dopamine
45. You must know Table 17-1 on page 270 and what happens when alpha 1, beta 1 and beta 2 receptors are stimulated.
Adrenergic Receptor Responses to Stimulation
Body System --> Location --> Receptor --> Response
Cardiovascular:
*Blood Vessels
Alpha 1: Constriction
Beta 2: Dilation
*Cardiac Muscle
Beta 1: Increased Contractility
*Atrioventricular Node
Beta 1: Increased Heart Rate
*Sinoatrial Node
Beta 1: Increased Heart Rate
Endocrine
*Pancreas
Beta 1: Decreased Insulin Release
*Liver
Beta 2: Glycogenolysis
*Kidney
Beta 2: Increased Renin Secretion
Gastrointestinal
*Muscle
Beta 2: Decreased Motility
*Spinchters
Alpha 1: Constriction
Genitourital
*Bladder Spinchter
Alpha 1: Constriction
*Penis
Alpha 1: Ejaculation
*Uterus
Alpha 1: Contraction
Beta 2: Relaxation
Respiratory
*Bronchial Muscles
Beta 2: Dilation
Ocular
*Puppilary Muscles of Iris
Alpha 1: Mydriasis
46. What happens when a dopaminergic receptor is stimulated by dopamine?
a. cause vessels of renal, mesenteric, coronary, and cerebral arteries to dilate, increasing blood flow to these tissues
47. What happens when adrenergic drugs stimulate alpha 1 receptors?
a. vasoconstriction occurs on sites located on smooth muscle
48. What happens when adrenergic drugs stimulate beta 1 receptors?
a. increase force of contraction, increase in heart rate, and increase in the conduction of cardiac electrical nerve impulses through atrioventricular node
49. What happens when adrenergic drugs stimulate beta 2 receptors?
a. relaxation of bronchii, increased glycogenolysis, and increased renin secretion
Week 5-Chapter18
50. What is another name for an adrenergic blocker?
a. sympatholytic or adrenergic antagonist
51. What does alpha 1 adrenergic blockade lead to?
a. vasoconstiction of arterioles
52. What do ergot alkaloids cause?
a. peripheral and cerebral vasoconstriction as well as constriction of dilated arteries
53. What is an ergot alkaloid such as ergotamine (Ergostat) used for?
a. migraines and cluster headaches
54. What are the alpha blockers doxazosin, prazosin, terazosin, and tamsulosin used for?
a. venous and arterial vasodilation which lowers blood pressure
55. What are the two reasons prazosin is used?
a. treat hypertension and reduce urinary obstruction in men
56. What do beta adrenergic blocking drugs do?
a. lower HR, lower heart contractility, vasocontriction in the heart, and bronchoconstriction
57. Where are beta 1 receptors primarily located?
a. heart
58. Where are beta 2 receptors primarily located?
a. bronchioles
59. Distinguish cardioselective from nonselective beta blockers.
a. cardioselective beta blockers only block the beta receptors on the heart and nonselective beta blockers block receptors on the heart, bronchioles, and blood vessels
60. What is the effect of cardioselective beta blockade?
a. lowers HR, vasoconstriction, and lowers heart contractility
61. What happens to the bronchioles when beta 2 receptors are blocked?
a. bronchoconstriction
62. What happens to blood vessels when beta 2 receptors are blocked?
a. vasoconstriction
63. How might beta 2 blockade cause elevation of blood glucose?
a. impairs glycogenolysis
64. How does beta blockade raise blood triglyceride levels?
a. release free fatty acids from adipose tissue
65. How are some beta blockers useful in the treatment of angina?
a. lowers HR and contractility which leads to less oxygen consumption and relieves angina pain related to lack of oxygen
66. What is the mechanism for some beta blockers being cardioprotective?
a. inhibit stimulation of the heart muscles by circulating catecholamines
67. How might a beta blocker reduce the blood pressure?
a. lowers heart rate, contractility, and vasoconstriction
68. Page 291, right column under Assessment, the dotted bullets are very important information.
a. alpha blocking: cause block of the sympathetic stimulation of blood vessels which results in vasodilation and decrease in blood pressure
b. beta 1 blocking: cause block in sympathetic effects leading to lower HR, contractility and conduction which helpts treat dysfunctional irregularities in heart rate
c. beta 2 blocking: cause block in sympathetic effects on bronchial smooth muscle resulting in bronchoconstriction
69. When giving beta blockers, what SBP and HR measurements should the nurse use in determining when to notify the provider?
a. lower than 100 mm Hg or 60 bpm
Week 5-Chapter 19
70. What are the other terms for cholinergics?
a. cholinergic agonists and parasympathomimetics
71. What is the neurotransmitter responsible for transmission of effector cells in the PSNS?
a. acetycholine (Ach)
72. What are the two types of cholinergic receptors and what is it that stimulates them?
a. nicotinic receptors are stimulated by alkaloid nicatine and muscarinic receptors are stimulated by alkaloid muscarine
73. What does cholinesterase do?
a. enzyme responsible for breaking down acetylcholinesterase (AchE)
74. When cholinergic receptors are stimulated, what happens in the body?
a. permeability of cells changes and calcium and sodium are permitted to flow into the cell depolarizing the cell membrane to stimulate the effector organ
75. What are the indications or uses of cholinergic drugs?
a. reduce intraocular pressure for glaucoma patients or ocular surgery, treat various GI and bladder disorders, diagnose and treat myasthenia gravis, treat Alzheimer’s disease, and treat excessively dry mouth from Sjogren’s syndrome
76. How might cholinergics improve patient performance in Alzheimer’s?
a. replenish the brain of Ach for normal brain function
77. Page 302, right column under Assessment, the dotted bullets are very important information.
a. effects of cholinergic drugs:
-decrease in heart rate
-increase in GI and GU tone through increased contractility of the smooth muscle
-increase in the contractility and tone of bronchial smooth muscle
-increased respiratory secretions
-miosis (pupillary constriction)
Week 5-Chapter 20
78. What are the other terms for cholinergic blockers?
a. anticholinergics, parasympatholytics, and antimuscarine drugs
79. What do cholinergic blockers do?
a. block or inhibit actions of acetylcholine in the PSNS
80. What other class of ANS drugs do cholinergic drugs share the same effects with?
a. adrenergics
81. What are the major sites of action for anticholinergics?
a. heart, respiratory tract, GI tract, urinary bladder, eye, and exocrine glands
82. What do cholinergic blockers do to the eye?
a. causes pupil dilation and increased intraocular pressure
-Remember, cholinergic blockers might be detrimental to persons with glaucoma (abnormally high IOP) because they increase the IOP.
83. What is the effect of cholinergic blockers on the GI tract?
a. decreased GI motility, secretions, and salivation
84. What do cholinergic blockers do to the HR?
a. increase heart rate
85. What do they do to the bladder?
a. decrease bladder contraction leading to urine retention
86. What do they do to the skin?
a. reduce sweating
87. What do they do to the respiratory system?
a. dry mucous membranes and cause bronchial dilation
88. How do low doses of cholinergic blockers slow the HR?
a. effects cardiac center in the medulla
89. Table 20-1 on page 307 is important.
Cholinergic Blockers: Drug Effects
*Cardiovascular
Small Dose: decrease HR
Large Dose: increase HR
*Central Nervous
Small Dose: decrease muscle rigidity and tremors
Large Dose: cause drowsiness, disorientation, and hallucinations
*Eye
Dilate pupils, decrease accomodation by paralyzing ciliary muscles
*Gastrointestinal
Relax muscle tone, decrease intestinal and gastric secretions, decrease motility and peristalsis
*Genitourinary
Relax detrusor muscle of bladder, increase constriction of internal spinchter; may result in urine retention
*Glandular
Decrease broncial secretions, salivation, sweating
*Respiratory
Decrease bronchial secretions, dilate bronchial airways
1. Compare sedatives and hypnotics.
a. sedatives reduce nervousness, excitability, and irritability without causing sleep in small amounts. Hypnotics have a more potent effect on the CNS and cause sleep.
2. In terms for barbiturates, what is meant by a “low therapeutic index?”
a. there is only a narrow margin where the drug is effective and beyond that margin the drug is rapidly toxic
3. Since GABA is an inhibitory amino acid, what happens to the CNS when it is potentiated?
a. inhibit nerve impulse transmission
4. What does it mean to raise the convulsive or seizure threshold?
a. decreases the threshold a patient has to convulse or have a seizure
5. What do barbiturates do to the respiratory rate?
a. decrease repiratory rate
6. By stimulating the action of enzymes that are responsible for the metabolism of many drugs, how do barbiturates affect the duration of action of these other drugs?
a. shortens their duration time
7. What are the 4 indications of barbiturates?
a. ultra-short acting, short acting, intermediate acting, and long acting
8. Which bodily system is most affected by barbiturates?
a. the CNS
9. What is the most frequent response to barbiturate overdose?
a. respiratory depression leading to respiratory arrest
10. What are the mainstays of treatment of barbiturate overdose?
a. maintenance of adequate airway, assisted respiration, and oxygen administration if needed
11. What is meant by “pressor support?”
a. drugs that cause vasoconstriction and therefore, raise the blood pressure.
12. How does activated charcoal cause the elimination of a drug from the body?
a. assists in pulling the drug from circulation then eliminating it through the GI tract
13. Know that Phenobarbital (Luminal) is the prototype barbiturate.
a. Luminal is the prototype barbiturate
14. What is the most commonly prescribed class of sedative-hypnotics?
a. benzodiazepines because they have favorable adverse effect profiles, efficacy and safety
15. What are the two classifications of benzodiazepines?
a. anxiolytics and sedative-hypnotics
16. How do benzodiazepines depress the CNS?
a. inhibit stimulation of the brain
17. Why are benzodiazepines used to prevent the symptoms of alcohol withdrawal?
a. their receptors in the CNS is the same area or alchohol addiction
18. What are the 4 most common uses of benzodiazepines
a. sedation, sleep induction, anxiety relief, and musculo-skeletal relaxation
19. What are the most commonly reported undesirable effects of benzodiazepines?
a. headaches, dizziness, paradoxical excitement or nervousness, drowsiness, vertigo, lethargy, and cognitive impairment
20. Why should benzodiazepines be avoided in the elderly?
a. create a significant fall hazard
21. What are the manifestations of a benzodiazepine overdose?
a. somnelence, confusion, coma, and diminished reflexes
22. What two substances should benzodiazepines not be combined with?
a. alcohol and analgesics
23. What is the reason for not inducing vomiting in an unconscious patient?
>?
24. How does flumazenil work as a benzodiazepine reversal agent?
>?
25. What are the pharmacologic properties of the nonbenzodiazepine hypnotics such as zolpidem (Ambien) and eszoplicone (Lunesta)?
a. anxiolytic, sedative, muscle relaxant, and anticonvulsive effects
26. How long should the nonbenzodiazepine drugs be used to treat insomnia?
a. 7-10 days
27. Which class of hypnotics has the shortest half-life, benzodiazepines or nonbenzodiazepines?
a. benzodiazepines
28. Which would you guess would have the greater “hangover” effect?
a. nonbenzodiazepines
29. How does the group of muscle relaxants act?
a. act within the CNS to relieve pain associated with skeletal muscle spasms
30. What are the two classes of muscle relaxants
a. central acting skeletal muscle relaxants and direct acting skeletal muscle relaxants
31. What is the antidote or reversal drug for muscle relaxant overdose?
a. no specific antidote
32. What may barbiturates undesirably cause in children and the elderly?
>?
33. What happens if a barbiturate is given too rapidly IV?
a. profound hypotension and marked respiratory depression
34. What is the normal blood level for phenobarbital?
>?
35. What standard safety precautions should be used on someone taking hypnotics?
>?
36. Should zolpiedem (Ambien) be taken with a mealtime snack or on an empty stomach?
a. empty stomach
Week 5-Chapter 16
37. How do most CNS stimulant drugs act?
a. stimulate the excitatory neurons in the brain
38. What are the 3 excitatory neurotransmitters?
a. dopamine, norepinepherine, and epinepherine
39. What do amphetamines stimulate?
a. areas of the brain associated with mental alertness like the cerebral cortex and thalamus
40. What is the pharmacologic action of amphetamines?
a. mood elevation or eupohoria, increased mental alertness and capacity for work, decreased fatigue and drowsiness, prolonged wakefulness, relaxation of bronchial smooth muscle, increased respiration, and dilation of pulmonary arteries
41. How do serotonin receptor agonists reduce migrane headache pain?
a. stimulate serotonin receptors in cerebral arteries and cause vasoconstriction
42. What is the original prototype SSRA?
a. sumatriptan (Imitirex)
Week 5-Chapter 17
43. What are adrenergics?
a. synthetic and naturally occurring substances
44. Why are adrenergics also called sympathomimetics?
a. mimic the effects of the SNS neurotransmitters of norepinepherine, epinepherine, and dopamine
45. You must know Table 17-1 on page 270 and what happens when alpha 1, beta 1 and beta 2 receptors are stimulated.
Adrenergic Receptor Responses to Stimulation
Body System --> Location --> Receptor --> Response
Cardiovascular:
*Blood Vessels
Alpha 1: Constriction
Beta 2: Dilation
*Cardiac Muscle
Beta 1: Increased Contractility
*Atrioventricular Node
Beta 1: Increased Heart Rate
*Sinoatrial Node
Beta 1: Increased Heart Rate
Endocrine
*Pancreas
Beta 1: Decreased Insulin Release
*Liver
Beta 2: Glycogenolysis
*Kidney
Beta 2: Increased Renin Secretion
Gastrointestinal
*Muscle
Beta 2: Decreased Motility
*Spinchters
Alpha 1: Constriction
Genitourital
*Bladder Spinchter
Alpha 1: Constriction
*Penis
Alpha 1: Ejaculation
*Uterus
Alpha 1: Contraction
Beta 2: Relaxation
Respiratory
*Bronchial Muscles
Beta 2: Dilation
Ocular
*Puppilary Muscles of Iris
Alpha 1: Mydriasis
46. What happens when a dopaminergic receptor is stimulated by dopamine?
a. cause vessels of renal, mesenteric, coronary, and cerebral arteries to dilate, increasing blood flow to these tissues
47. What happens when adrenergic drugs stimulate alpha 1 receptors?
a. vasoconstriction occurs on sites located on smooth muscle
48. What happens when adrenergic drugs stimulate beta 1 receptors?
a. increase force of contraction, increase in heart rate, and increase in the conduction of cardiac electrical nerve impulses through atrioventricular node
49. What happens when adrenergic drugs stimulate beta 2 receptors?
a. relaxation of bronchii, increased glycogenolysis, and increased renin secretion
Week 5-Chapter18
50. What is another name for an adrenergic blocker?
a. sympatholytic or adrenergic antagonist
51. What does alpha 1 adrenergic blockade lead to?
a. vasoconstiction of arterioles
52. What do ergot alkaloids cause?
a. peripheral and cerebral vasoconstriction as well as constriction of dilated arteries
53. What is an ergot alkaloid such as ergotamine (Ergostat) used for?
a. migraines and cluster headaches
54. What are the alpha blockers doxazosin, prazosin, terazosin, and tamsulosin used for?
a. venous and arterial vasodilation which lowers blood pressure
55. What are the two reasons prazosin is used?
a. treat hypertension and reduce urinary obstruction in men
56. What do beta adrenergic blocking drugs do?
a. lower HR, lower heart contractility, vasocontriction in the heart, and bronchoconstriction
57. Where are beta 1 receptors primarily located?
a. heart
58. Where are beta 2 receptors primarily located?
a. bronchioles
59. Distinguish cardioselective from nonselective beta blockers.
a. cardioselective beta blockers only block the beta receptors on the heart and nonselective beta blockers block receptors on the heart, bronchioles, and blood vessels
60. What is the effect of cardioselective beta blockade?
a. lowers HR, vasoconstriction, and lowers heart contractility
61. What happens to the bronchioles when beta 2 receptors are blocked?
a. bronchoconstriction
62. What happens to blood vessels when beta 2 receptors are blocked?
a. vasoconstriction
63. How might beta 2 blockade cause elevation of blood glucose?
a. impairs glycogenolysis
64. How does beta blockade raise blood triglyceride levels?
a. release free fatty acids from adipose tissue
65. How are some beta blockers useful in the treatment of angina?
a. lowers HR and contractility which leads to less oxygen consumption and relieves angina pain related to lack of oxygen
66. What is the mechanism for some beta blockers being cardioprotective?
a. inhibit stimulation of the heart muscles by circulating catecholamines
67. How might a beta blocker reduce the blood pressure?
a. lowers heart rate, contractility, and vasoconstriction
68. Page 291, right column under Assessment, the dotted bullets are very important information.
a. alpha blocking: cause block of the sympathetic stimulation of blood vessels which results in vasodilation and decrease in blood pressure
b. beta 1 blocking: cause block in sympathetic effects leading to lower HR, contractility and conduction which helpts treat dysfunctional irregularities in heart rate
c. beta 2 blocking: cause block in sympathetic effects on bronchial smooth muscle resulting in bronchoconstriction
69. When giving beta blockers, what SBP and HR measurements should the nurse use in determining when to notify the provider?
a. lower than 100 mm Hg or 60 bpm
Week 5-Chapter 19
70. What are the other terms for cholinergics?
a. cholinergic agonists and parasympathomimetics
71. What is the neurotransmitter responsible for transmission of effector cells in the PSNS?
a. acetycholine (Ach)
72. What are the two types of cholinergic receptors and what is it that stimulates them?
a. nicotinic receptors are stimulated by alkaloid nicatine and muscarinic receptors are stimulated by alkaloid muscarine
73. What does cholinesterase do?
a. enzyme responsible for breaking down acetylcholinesterase (AchE)
74. When cholinergic receptors are stimulated, what happens in the body?
a. permeability of cells changes and calcium and sodium are permitted to flow into the cell depolarizing the cell membrane to stimulate the effector organ
75. What are the indications or uses of cholinergic drugs?
a. reduce intraocular pressure for glaucoma patients or ocular surgery, treat various GI and bladder disorders, diagnose and treat myasthenia gravis, treat Alzheimer’s disease, and treat excessively dry mouth from Sjogren’s syndrome
76. How might cholinergics improve patient performance in Alzheimer’s?
a. replenish the brain of Ach for normal brain function
77. Page 302, right column under Assessment, the dotted bullets are very important information.
a. effects of cholinergic drugs:
-decrease in heart rate
-increase in GI and GU tone through increased contractility of the smooth muscle
-increase in the contractility and tone of bronchial smooth muscle
-increased respiratory secretions
-miosis (pupillary constriction)
Week 5-Chapter 20
78. What are the other terms for cholinergic blockers?
a. anticholinergics, parasympatholytics, and antimuscarine drugs
79. What do cholinergic blockers do?
a. block or inhibit actions of acetylcholine in the PSNS
80. What other class of ANS drugs do cholinergic drugs share the same effects with?
a. adrenergics
81. What are the major sites of action for anticholinergics?
a. heart, respiratory tract, GI tract, urinary bladder, eye, and exocrine glands
82. What do cholinergic blockers do to the eye?
a. causes pupil dilation and increased intraocular pressure
-Remember, cholinergic blockers might be detrimental to persons with glaucoma (abnormally high IOP) because they increase the IOP.
83. What is the effect of cholinergic blockers on the GI tract?
a. decreased GI motility, secretions, and salivation
84. What do cholinergic blockers do to the HR?
a. increase heart rate
85. What do they do to the bladder?
a. decrease bladder contraction leading to urine retention
86. What do they do to the skin?
a. reduce sweating
87. What do they do to the respiratory system?
a. dry mucous membranes and cause bronchial dilation
88. How do low doses of cholinergic blockers slow the HR?
a. effects cardiac center in the medulla
89. Table 20-1 on page 307 is important.
Cholinergic Blockers: Drug Effects
*Cardiovascular
Small Dose: decrease HR
Large Dose: increase HR
*Central Nervous
Small Dose: decrease muscle rigidity and tremors
Large Dose: cause drowsiness, disorientation, and hallucinations
*Eye
Dilate pupils, decrease accomodation by paralyzing ciliary muscles
*Gastrointestinal
Relax muscle tone, decrease intestinal and gastric secretions, decrease motility and peristalsis
*Genitourinary
Relax detrusor muscle of bladder, increase constriction of internal spinchter; may result in urine retention
*Glandular
Decrease broncial secretions, salivation, sweating
*Respiratory
Decrease bronchial secretions, dilate bronchial airways
pharmacology GRM week #4 (brief)
Week 4-Chapter 29
1. Which part of the CNS controls the pituitary?
a. hypothalamus
2. Know the functions of the hormones of the pituitary glands.
Anterior Pituitary:
Adrenocorticotropic Hormone (ACTH)
-Supports physical and emotional stress and starvation, redistributes body nutrients
Follicle-Stimulating Hormone (FSH)
-Stimulates egg and sperm growth/ production
Growth Hormone (GH)
-Promotes skeletal and muscular growth
Luteinizing Hormone (LH)
-Promotes secretions of sex specific hormones
Prolactin (PH)
-Stimulates mammary glands for lactation
Thyroid-Stimulating Hormone (TSH)
-Increases production and secretion of thyroid hormones
Posterior Pituitary:
Antidiuretic Hormone (ADH)
-Increases water retention and concentration of urine
Oxytocin
-Stimulates ejection of milk and contraction of uterine smooth muscle
Week4-Chapter 30
3. What is required in the diet in order to produce thyroid hormones?
a. iodide
4. What triggers the release of thyroid hormones?
a. thyroid stimulating hormone or thyrotropin
5. What is the most significant adverse effect of thyroid medications?
a. cardiac dysrhythmia with the risk for life-threatening or fatal irregularities caused by overdose
6. What might the effect of thyroid medications be on anticoagulants?
a. it may increase the activity of oral anticoagulants
7. What effect do thyroid medications have on digitalis levels?
a. increases potassium levels
8. When a patient is on thyroid medications and antidiabetic agents, how might this affect their antidiabetic medication dosing?
a. may need to increase dosing
Week 4-Chapter 32
9. What two hormones does the adrenal medulla secrete?
a. norepinepherine and epinepherine
10. What are the other names for epinephrine and norepinephrine?
a. adrenaline and noreadrenaline
11. What are the two types of hormones secreted from the adrenal cortex (corticosteroids)?
a. glucocorticoids and mineralocorticoids
12. What affect does aldosterone have on serum sodium?
a. it maintains sodium homeostasis by reabsorbing it
13. What affect does aldosterone have on serum potassium?
a. in affect, serum potassium is decreased
14. How does ACTH affect the adrenal cortex?
a. stimulates the production of corticosteroids
15. What is the disorder in which there is an oversecretion of adrenocortical hormones?
a. Cushing’s syndrome: redistribution of fat from the arms and legs to face, shoulders, trunk; retention of water and loss of potassium
16. What is the disorder in which there is an undersecretion of adrenocortical hormones?
a. Addison’s disease: low blood sodium and glucose levels, high potassium levels, dehydration and weight loss
17. Which is the only corticosteroid drug with exclusive mineralocorticoid activity?
a. fludrocortisone
18. What is the main effect of cortisol?
a. inhibition of inflammatory and immune responses
19. In what specific ways do glucocorticoid inhibit or help control the inflammatory response?
a. stabilize cell membranes of inflammatory cells called lysosomes, decreasing capillary permeability to inflammatory cells, and decrease the migration of white blood cells into already inflamed areas
20. What is the effect of glucocorticoids on protein metabolism?
a. loss of muscle mass and muscle weakness
21. What is the effect of glucocorticoids on glucose?
a. weight gain
22. What is the effect of glucocorticoids on fat distribution?
a. redistributes fat to face, shoulders, and trunk
23. Why is it best to give exogenous glucocorticoids early in the morning?
a. leads to the least amount of adrenal suppression; from 0600-0900
24. How does the nurse minimize the patient’s gastric upset when giving oral glucocorticoids?
a. administer with milk, food, or non-systemic antacids
25. What should the patient be advised to avoid when taking corticosteroids?
a. avoid alcohol, NSAIDS, and aspirin
26. Why should abrupt withdrawal of glucocorticoid hormones be avoided?
a. could lead to life threatening Addisonian crisis marked by fatigue, nausea, vomiting, and hypotension
27. What are the instructions that should be given to a patient using nasally instilled glucocoricosteroids?
a. rinse mouth with luke warm water
28. Why should the patient rinse his mouth after using an orally inhaled glucocorticoid?
a. prevent fungal overgrowth
29. What effect does long-term glucocorticoid therapy have on post-surgical healing?
a. increased healing time
1. Which part of the CNS controls the pituitary?
a. hypothalamus
2. Know the functions of the hormones of the pituitary glands.
Anterior Pituitary:
Adrenocorticotropic Hormone (ACTH)
-Supports physical and emotional stress and starvation, redistributes body nutrients
Follicle-Stimulating Hormone (FSH)
-Stimulates egg and sperm growth/ production
Growth Hormone (GH)
-Promotes skeletal and muscular growth
Luteinizing Hormone (LH)
-Promotes secretions of sex specific hormones
Prolactin (PH)
-Stimulates mammary glands for lactation
Thyroid-Stimulating Hormone (TSH)
-Increases production and secretion of thyroid hormones
Posterior Pituitary:
Antidiuretic Hormone (ADH)
-Increases water retention and concentration of urine
Oxytocin
-Stimulates ejection of milk and contraction of uterine smooth muscle
Week4-Chapter 30
3. What is required in the diet in order to produce thyroid hormones?
a. iodide
4. What triggers the release of thyroid hormones?
a. thyroid stimulating hormone or thyrotropin
5. What is the most significant adverse effect of thyroid medications?
a. cardiac dysrhythmia with the risk for life-threatening or fatal irregularities caused by overdose
6. What might the effect of thyroid medications be on anticoagulants?
a. it may increase the activity of oral anticoagulants
7. What effect do thyroid medications have on digitalis levels?
a. increases potassium levels
8. When a patient is on thyroid medications and antidiabetic agents, how might this affect their antidiabetic medication dosing?
a. may need to increase dosing
Week 4-Chapter 32
9. What two hormones does the adrenal medulla secrete?
a. norepinepherine and epinepherine
10. What are the other names for epinephrine and norepinephrine?
a. adrenaline and noreadrenaline
11. What are the two types of hormones secreted from the adrenal cortex (corticosteroids)?
a. glucocorticoids and mineralocorticoids
12. What affect does aldosterone have on serum sodium?
a. it maintains sodium homeostasis by reabsorbing it
13. What affect does aldosterone have on serum potassium?
a. in affect, serum potassium is decreased
14. How does ACTH affect the adrenal cortex?
a. stimulates the production of corticosteroids
15. What is the disorder in which there is an oversecretion of adrenocortical hormones?
a. Cushing’s syndrome: redistribution of fat from the arms and legs to face, shoulders, trunk; retention of water and loss of potassium
16. What is the disorder in which there is an undersecretion of adrenocortical hormones?
a. Addison’s disease: low blood sodium and glucose levels, high potassium levels, dehydration and weight loss
17. Which is the only corticosteroid drug with exclusive mineralocorticoid activity?
a. fludrocortisone
18. What is the main effect of cortisol?
a. inhibition of inflammatory and immune responses
19. In what specific ways do glucocorticoid inhibit or help control the inflammatory response?
a. stabilize cell membranes of inflammatory cells called lysosomes, decreasing capillary permeability to inflammatory cells, and decrease the migration of white blood cells into already inflamed areas
20. What is the effect of glucocorticoids on protein metabolism?
a. loss of muscle mass and muscle weakness
21. What is the effect of glucocorticoids on glucose?
a. weight gain
22. What is the effect of glucocorticoids on fat distribution?
a. redistributes fat to face, shoulders, and trunk
23. Why is it best to give exogenous glucocorticoids early in the morning?
a. leads to the least amount of adrenal suppression; from 0600-0900
24. How does the nurse minimize the patient’s gastric upset when giving oral glucocorticoids?
a. administer with milk, food, or non-systemic antacids
25. What should the patient be advised to avoid when taking corticosteroids?
a. avoid alcohol, NSAIDS, and aspirin
26. Why should abrupt withdrawal of glucocorticoid hormones be avoided?
a. could lead to life threatening Addisonian crisis marked by fatigue, nausea, vomiting, and hypotension
27. What are the instructions that should be given to a patient using nasally instilled glucocoricosteroids?
a. rinse mouth with luke warm water
28. Why should the patient rinse his mouth after using an orally inhaled glucocorticoid?
a. prevent fungal overgrowth
29. What effect does long-term glucocorticoid therapy have on post-surgical healing?
a. increased healing time
Sunday, September 28, 2008
Study Guide #3 (brief)
1. Discuss the education needed to prevent urinary infections.
-focus on client’s specific elimination problem
-learn significance of symptoms for prevention control
2. Discuss the goals/outcomes that will improve mobility.
-obtain appropriate assistive devices, reposition patient throughout the day, physical therapy, teach relaxation breathing, develop therapeutic relationship, and provide a positive, safe environment
3. Discuss factors that affect the nutritional status of the elderly patient.
-income, therapeutic diet, loss of teeth, dentures, risk for drug-nutrient interaction
4. Discuss the nursing care of the patient with enteral feedings.
-assess
-check for placement: aspirate or pump air, check for residual, elevate head to at least 30 degrees
-monitor weight, I&Os, lung sounds, O2, BS and BM
-maintain good oral hygiene
5. Discuss the nursing diagnoses appropriate for patients with oxygenation dysfunction.
-activity intolerance, anxiety, decreased cardiac output, fatigue, impaired gas exchange, impaired spontaneous ventilation, impaired verbal communication, ineffective airway clearance, ineffective breathing pattern, ineffective health maintenance, risk for imbalanced fluid volume, and risk for infections
-related to…patient etiology and as evidenced by…patient’s signs and symptoms
6. Discuss the nutritional education needed for patients who have fluid and electrolyte dysfunction.
-make a patient focused meal plan that includes patient’s preferences, income,
7. Discuss the education needed to prevent dehydration.
-avoid certain types of food, knowing medications which cause increased thirst, knowing daily values of water needed everyday, be aware of early signs and symptoms
8. Discuss the complications of diarrhea.
-serious fluid and electrolyte or acid-base imbalances
9. Discuss the interventions needed for the patient with a fecal impaction.
-laxatives, enemas, and digital removal of stool
-increased fiber diet, increased fluid intake, and bowel training
10. Discuss the assessment needed for the patient with hypoxia.
-defined as inadequate tissue oxygenation at the cellular level
-cyanosis, increased HR, increased RR and depth, increased BP
-apprehension, restlessness, inability to concentrate, declining level of consciousness, dizziness, behavioral changes, unable to lie down, appears fatigued and agitated
11. Discuss the signs and symptoms of urinary retention.
-bladder distention causing pressure, discomfort, tenderness, restlessness, and sweating
-absence of urine output or only small amounts (dribbling) over several hours
12. Discuss the assessment needed for patients with allergies.
-ask about allergen exposures, the type and degree of allergic response, and what improves or worsens the condition
13. Discuss the assessment needed for patients with sodium imbalance.
-weight change, dry and sticky mucosa, personality change, increased RR, decreased BP with postural change, changes in HR, and dry and flushed skin
14. Discuss the assessment needed for patients with altered perfusion.
-SpO2, RR, HR, BP, lung sounds, heart sounds, changes in activity tolerance, shortness of breath, difficulty breathing
15. Discuss the physiological factors that affect oxygenation.
-decreased oxygen-carrying capacity
-decreased inspired oxygen concentration
-hypovolumia: shock or severe dehydration resulting in extracellular fluid loss and reduced circulating blood
-increased metabolic rate and increased oxygen demand
16. Discuss factors that affect immobility.
-loss of muscle, negative nitrogen balance, increased weakness, decreased nutritional intake
17. Discuss the assessment needed for the patient at risk for aspiration.
-coughing during eating, change of voice after swallowing, abnormal mouth, tongue, and lip movements, unusual speech, regurgitation, abnormal gag, pooling of food, and delayed swallowing
18. Describe the nursing interventions for the patient experiencing respiratory distress.
-breathing/coughing techniques: promotes relaxation and effective breathing and more productive coughs
-positioning: positions patient in more comfortably to breath and drain secretions effectively
-suctioning: dislodge and loosen secretions to clear airway
19. Describe the assessment needed for patient in respiratory distress.
-increased RR, difficulty breathing, irregular lung sounds, increased HR, pain, fatigue, lifestyle, health risks, medications and allergies
20. Discuss the education needed for a healthy diet.
-meal plan patient focused with preferences and income integrated with daily values and food guidelines (MyPyramid)
-high fiber, low fat
21. Discuss the nursing interventions needed for the patient with urinary incontinence.
-schedule toileting, bladder training exercises, use absorbent product, limit fluids 2 hours before bedtime
22. Discuss the nursing interventions for the patient in acute respiratory distress.
-breathing/coughing techniques, airway maintenance, suctioning, humidification, nebulization, postural drainage and chest percussion
23. Discuss the signs and symptoms of patients with excess fluid volume.
-decreased LOC, convulsions, and coma
24. Discuss the nursing interventions for the patient receiving oxygen therapy.
-keep patient hydrated, teach coughing techniques, teach breathing exercises, improve muscle strength and endurance for increased activity tolerance with respiratory muscle training
25. Discuss the assessment needed for the patient with a productive cough.
-inspect sputum speciman of color, changes in color, odor, quantity, consistency, and presence of blood
26. Discuss the education needed for the patient with a urinary diversion.
-manage diversion
-enhance coping and adaptation to lifestyle and body-image changes
-ability to maintain normal ADLs
27. Discuss the assessment needed for the patient who just had a central venous catheter placed for TPN.
-check infusion rate of pump (not gravity driven), monitor complications like perforation through vessel and hyperglycemic reactions, monitor daily weights and I&Os, BS, and BM
28. Discuss the assessment needed for patients with fluid and electrolyte dysfunction.
-age, prior medical history, environmental factors, diet, lifestyle, medication, I&Os, laboratory studies
29. Discuss the assessment needed for the patient with GI dysfunction.
-urination pattern, symptoms of urinary alterations, factors affecting urination, skin and mucosal membranes inspection, kidney palpation, bladder palpation, urethral meatus inspection, and assessment of urine (subjective and objective)
30. Discuss the purpose of the various suctioning techniques.
-oropharyngeal and nasopharyngeal: patient effectively coughs, but is unable to clear secretions
-orotracheal and nasotracheal: patients with pulmonary secretions, no artificial airway, and no effective cough
-tracheal: dislodge and loosen secretions in artifical airway
-focus on client’s specific elimination problem
-learn significance of symptoms for prevention control
2. Discuss the goals/outcomes that will improve mobility.
-obtain appropriate assistive devices, reposition patient throughout the day, physical therapy, teach relaxation breathing, develop therapeutic relationship, and provide a positive, safe environment
3. Discuss factors that affect the nutritional status of the elderly patient.
-income, therapeutic diet, loss of teeth, dentures, risk for drug-nutrient interaction
4. Discuss the nursing care of the patient with enteral feedings.
-assess
-check for placement: aspirate or pump air, check for residual, elevate head to at least 30 degrees
-monitor weight, I&Os, lung sounds, O2, BS and BM
-maintain good oral hygiene
5. Discuss the nursing diagnoses appropriate for patients with oxygenation dysfunction.
-activity intolerance, anxiety, decreased cardiac output, fatigue, impaired gas exchange, impaired spontaneous ventilation, impaired verbal communication, ineffective airway clearance, ineffective breathing pattern, ineffective health maintenance, risk for imbalanced fluid volume, and risk for infections
-related to…patient etiology and as evidenced by…patient’s signs and symptoms
6. Discuss the nutritional education needed for patients who have fluid and electrolyte dysfunction.
-make a patient focused meal plan that includes patient’s preferences, income,
7. Discuss the education needed to prevent dehydration.
-avoid certain types of food, knowing medications which cause increased thirst, knowing daily values of water needed everyday, be aware of early signs and symptoms
8. Discuss the complications of diarrhea.
-serious fluid and electrolyte or acid-base imbalances
9. Discuss the interventions needed for the patient with a fecal impaction.
-laxatives, enemas, and digital removal of stool
-increased fiber diet, increased fluid intake, and bowel training
10. Discuss the assessment needed for the patient with hypoxia.
-defined as inadequate tissue oxygenation at the cellular level
-cyanosis, increased HR, increased RR and depth, increased BP
-apprehension, restlessness, inability to concentrate, declining level of consciousness, dizziness, behavioral changes, unable to lie down, appears fatigued and agitated
11. Discuss the signs and symptoms of urinary retention.
-bladder distention causing pressure, discomfort, tenderness, restlessness, and sweating
-absence of urine output or only small amounts (dribbling) over several hours
12. Discuss the assessment needed for patients with allergies.
-ask about allergen exposures, the type and degree of allergic response, and what improves or worsens the condition
13. Discuss the assessment needed for patients with sodium imbalance.
-weight change, dry and sticky mucosa, personality change, increased RR, decreased BP with postural change, changes in HR, and dry and flushed skin
14. Discuss the assessment needed for patients with altered perfusion.
-SpO2, RR, HR, BP, lung sounds, heart sounds, changes in activity tolerance, shortness of breath, difficulty breathing
15. Discuss the physiological factors that affect oxygenation.
-decreased oxygen-carrying capacity
-decreased inspired oxygen concentration
-hypovolumia: shock or severe dehydration resulting in extracellular fluid loss and reduced circulating blood
-increased metabolic rate and increased oxygen demand
16. Discuss factors that affect immobility.
-loss of muscle, negative nitrogen balance, increased weakness, decreased nutritional intake
17. Discuss the assessment needed for the patient at risk for aspiration.
-coughing during eating, change of voice after swallowing, abnormal mouth, tongue, and lip movements, unusual speech, regurgitation, abnormal gag, pooling of food, and delayed swallowing
18. Describe the nursing interventions for the patient experiencing respiratory distress.
-breathing/coughing techniques: promotes relaxation and effective breathing and more productive coughs
-positioning: positions patient in more comfortably to breath and drain secretions effectively
-suctioning: dislodge and loosen secretions to clear airway
19. Describe the assessment needed for patient in respiratory distress.
-increased RR, difficulty breathing, irregular lung sounds, increased HR, pain, fatigue, lifestyle, health risks, medications and allergies
20. Discuss the education needed for a healthy diet.
-meal plan patient focused with preferences and income integrated with daily values and food guidelines (MyPyramid)
-high fiber, low fat
21. Discuss the nursing interventions needed for the patient with urinary incontinence.
-schedule toileting, bladder training exercises, use absorbent product, limit fluids 2 hours before bedtime
22. Discuss the nursing interventions for the patient in acute respiratory distress.
-breathing/coughing techniques, airway maintenance, suctioning, humidification, nebulization, postural drainage and chest percussion
23. Discuss the signs and symptoms of patients with excess fluid volume.
-decreased LOC, convulsions, and coma
24. Discuss the nursing interventions for the patient receiving oxygen therapy.
-keep patient hydrated, teach coughing techniques, teach breathing exercises, improve muscle strength and endurance for increased activity tolerance with respiratory muscle training
25. Discuss the assessment needed for the patient with a productive cough.
-inspect sputum speciman of color, changes in color, odor, quantity, consistency, and presence of blood
26. Discuss the education needed for the patient with a urinary diversion.
-manage diversion
-enhance coping and adaptation to lifestyle and body-image changes
-ability to maintain normal ADLs
27. Discuss the assessment needed for the patient who just had a central venous catheter placed for TPN.
-check infusion rate of pump (not gravity driven), monitor complications like perforation through vessel and hyperglycemic reactions, monitor daily weights and I&Os, BS, and BM
28. Discuss the assessment needed for patients with fluid and electrolyte dysfunction.
-age, prior medical history, environmental factors, diet, lifestyle, medication, I&Os, laboratory studies
29. Discuss the assessment needed for the patient with GI dysfunction.
-urination pattern, symptoms of urinary alterations, factors affecting urination, skin and mucosal membranes inspection, kidney palpation, bladder palpation, urethral meatus inspection, and assessment of urine (subjective and objective)
30. Discuss the purpose of the various suctioning techniques.
-oropharyngeal and nasopharyngeal: patient effectively coughs, but is unable to clear secretions
-orotracheal and nasotracheal: patients with pulmonary secretions, no artificial airway, and no effective cough
-tracheal: dislodge and loosen secretions in artifical airway
test-taking tutorial
the test-taking tutorial is available in the nursing computer lab and is very helpful, this is an outline of the main points and makes more sense if you already looked at the tutorial.
*Parts of a Question
-case scenario: describes nursing problem
-stem: points forward to the answer
*Critical Elements
-issue: primary problem
-->answer must relate to the issue
-client: person of focus in stem
-->answer must relate to the client
-key words: important words in the question
-->points forward to the best option
-stem: asks to solve the problem in scenario presented
-->true response: answer will be a true statement
-->false response: answer will be a false statement
-distractors: distracts from answering the question correctly
-->label your options as true statements (+), false statements (-), and statements you are unsure of (?)
*Points to Remember
1) Identify the critical elements (issue, client, key words, and stem)
2) Restate the question to identify the issue
3) Rule out options containing new information
-remember...what is the best for the client?
-and...time is never a factor
*Test-Taking Strategies
Strategy 1: Global Response Options
-the general, comprehensive option is usually correct
-includes ideas from other "correct" options
Strategy 2: Eliminate Similar Distractors
-eliminate options saying nearly the same thing
Strategy 3: Similar Word Options
-options using similar words as the question are usually correct, but not always!
*Communication Questions: Always Identify the Client First
-communication tool: promotes therapeutic communication
-->includes being silent, offering self, showing empathy, focusing, restatement, validation/clarification, giving information, dealing with here and now
-communication blocks: do not promote therapeutic communication and can be eliminated
-->includes giving advice, showing approval/disapproval, cliches and false reassurance, requesting explanation, devalue feelings, being defensive, focus on inappropriate issues, putting concerns "on hold"
*Maslow's Hierarchy
-physiological needs first (airway, breathing, circulation), then safety
**What is the safest, most ideal, and within a nurse's scope of practice?
*Parts of a Question
-case scenario: describes nursing problem
-stem: points forward to the answer
*Critical Elements
-issue: primary problem
-->answer must relate to the issue
-client: person of focus in stem
-->answer must relate to the client
-key words: important words in the question
-->points forward to the best option
-stem: asks to solve the problem in scenario presented
-->true response: answer will be a true statement
-->false response: answer will be a false statement
-distractors: distracts from answering the question correctly
-->label your options as true statements (+), false statements (-), and statements you are unsure of (?)
*Points to Remember
1) Identify the critical elements (issue, client, key words, and stem)
2) Restate the question to identify the issue
3) Rule out options containing new information
-remember...what is the best for the client?
-and...time is never a factor
*Test-Taking Strategies
Strategy 1: Global Response Options
-the general, comprehensive option is usually correct
-includes ideas from other "correct" options
Strategy 2: Eliminate Similar Distractors
-eliminate options saying nearly the same thing
Strategy 3: Similar Word Options
-options using similar words as the question are usually correct, but not always!
*Communication Questions: Always Identify the Client First
-communication tool: promotes therapeutic communication
-->includes being silent, offering self, showing empathy, focusing, restatement, validation/clarification, giving information, dealing with here and now
-communication blocks: do not promote therapeutic communication and can be eliminated
-->includes giving advice, showing approval/disapproval, cliches and false reassurance, requesting explanation, devalue feelings, being defensive, focus on inappropriate issues, putting concerns "on hold"
*Maslow's Hierarchy
-physiological needs first (airway, breathing, circulation), then safety
**What is the safest, most ideal, and within a nurse's scope of practice?
Saturday, September 27, 2008
lecture recordings
do you have the capability to upload classroom recordings onto your computer?
if so, those recordings can be added to this page...please share!
if so, those recordings can be added to this page...please share!
Student Directory
*e-mail your e-mail address to be added to the directory, but only if you're comfortable with other students knowing your email!
anh: aha48@ymail.com
anh: aha48@ymail.com
Thursday, September 25, 2008
to add a new post...
you first:
-need to be invited to the blog, so email me at aha48@ymail.com
-there will be an email sent to you inviting you to join the blog
-click on the link and it will take you to where you need to be
then you:
-will need to follow the steps given to create a google id (openID)
once that's done...
-you will be taken to your own profile
-click on the link that says new post
-from there add a post!
keep in mind:
-if you post a comment on a previous post, it requires a little more "digging" for other authors to see it, so POST rather than COMMENT.
-positive and constructive comments please, inappropriate comments will be deleted
-inform an author of errors/concerns regarding their posts
AND...
-i know these steps aren't the best, please ask someone if you're stuck!
-need to be invited to the blog, so email me at aha48@ymail.com
-there will be an email sent to you inviting you to join the blog
-click on the link and it will take you to where you need to be
then you:
-will need to follow the steps given to create a google id (openID)
once that's done...
-you will be taken to your own profile
-click on the link that says new post
-from there add a post!
keep in mind:
-if you post a comment on a previous post, it requires a little more "digging" for other authors to see it, so POST rather than COMMENT.
-positive and constructive comments please, inappropriate comments will be deleted
-inform an author of errors/concerns regarding their posts
AND...
-i know these steps aren't the best, please ask someone if you're stuck!
Subscribe to:
Posts (Atom)