Pathopharm - Final Exam

osteoarthritis - risk factors

Increased age Joint trauma, long-term mechanical stress Obesity

conditions affecting the urinary tract and bladder

Urinary tract infections (UTIs) Nephrolithiasis (kidney stones) BPH (prostate enlargement)

warfarin - adverse effects

cramps, nausea, dermal necrosis, bleeding, fever

black box warning

created by fda in 1997 to regulate drugs w potential for serious injury or death black box around safety info on drug package insert OTC have them too

trade(brand) drug name

created by pharmaceutical company requesting approval for the drug and identifies it as the exclusive property of that company

type II hypersensitivity

cytotoxic - killing cells, antibody attacks cell and antigen, destroying cells causing the destruction of the cell, Destroy RBC, cells lining an organ ex. transfusion reaction (destroy RBC) antigen-cell destruction

hypertension (joint national committee)

normal - Systolic pressure of less than 120 mmHg and a diastolic pressure of less than 80 mmHg prehypertensive - Systolic pressures between 120-139 mmHg and diastolic pressures between 80-89 mmHg hypertension - systolic blood pressure is 140 mmHg or higher and the diastolic blood pressure is 90mmHg or higher adults with DM - less than 130/80 mmHg preferred Underlying kidney disease may be more likely to be treated for blood pressure control

electrical system of heart

normal conduction of atria down to ventricles

disorders of platelets

normal range : 150,000-350,000 cells/mL Thrombocytosis refers to increased platelet levels, increases risk of thrombus formation (clots) -Sometimes when body wants to increase RBC it will increase platelet levels as well Thrombocytopenia describes the condition of decreased platelet levels, increases risk of bleeding, can be congenital (inherent) or acquired (from a treatment) -Bone marrow is not making platelets.. chemo/radiation -Can be exposed to chemicals in a work place that can cause this due to it damaging the bone marrow Diseases of platelets include issues with quantity and quality

disorders of the white blood cells

normal range : 5,000 to 10,000 cells/mL Leukocytosis: a state of increased WBC, usually indicated infectious process Leukocytopenia: a state of decreased WBC, indicate immune deficiency, bone marrow suppression Neutropenia: decreased neutrophil count, makes body poorly equipped to fight infection - Neutrophils are first responders

crohns complications

small intestine obstruction, fistulas, abscesses

beta 2 agonists - adrenergics

*epinephrine (Adrenalin, Bronkaid) **albuterol (Proventil, Ventolin) most common SABA salmeterol (Serevent) - LABA formoterol (Foradil) - LABA

expectorants

Increase productive cough, decrease viscosity, reduces adhesiveness of secretions **guaifenesin (Mucinex) Cautions: Monitor for GI effects - most common

nursing considerations for thrombolytic agents

Assess history of bleeding risks Monitor for bleeding Baseline and interval VS, mental status Follow labs such as CBC

heart failure (right) clinical manifestations

JVD(jugular vein gets distended with fluid), hepatomegaly , dependent edema, ascites, abdominal fullness

fractures - healing indirect

Most often observed when a fracture is treated with a cast or other nonsurgical method Callus formation Remodeling of solid bone

B (PC)

animal studies show no risk to fetus no adequate studies in pregnant woman

cyancobalamin

b12

neoplasia

cancerous

Kayexalate: pharmacologic class

cation-exchange resins

anemia classification

classified by cause or by cell shape cytic - refers to cell size chromic - refers to cell Hgb content

Assessment (nursing process)

data gathering: history, physical assessment, holistic

meperidine - demerol

for moderate to severe pain short acting caution in renal failure - toxic seizures

heparin - generic

heparin

AE: hormonal changes

infertility

tromponin

indicates some sort of death (MI) biomarker/cardiac marker to indicate muscle breakdown blood sample look at it along EKG and symptoms/risk factors

Lasix: brand name

lasix

duration of action

length of time that drug is exerting therapeutic effect

define physiology

mechanisms of body functions

anterior pituitary hormones - FSH and LH

stimulate gonads → sex hormones

Kayexalate: teaching points

take other drugs at least 3 hrs before or after, low potassium

peak effect

time required for drug to reach maximum therapeutic effect

ulcerative colitis diagnostic tests

**Sigmoidoscopy - friable, edematous mucosa, eroisons Colonoscopy - inflammation is circumferential - Continuous, (no skipped lesions)

warfarin - generic

warfarin, warfarin sodium

hypo vs hyper glycemia

"Cold and clammy need some candy" Sweating Nervousness Hunger Headache Mental confusion Argumentative Tremors Diaphoresis Loss of consciousness leading to seizures, coma, and death "Hot and dry sugar high" Unusual thirst Frequent urination Fatigue and weakness Blurred vision Abdominal pains Nausea and vomiting Rapid weight loss Skin infection Changed mental status Warm, dry, flushed skin

hypothalamus gland

"Master gland" of the neuroendocrine system Action - Constantly monitors the body's homeostasis by: - Analyzing input from the periphery and the CNS - Coordinating responses through the autonomic, endocrine, and nervous system - Produces releasing hormones to stimulate the pituitary to produce its hormones

bone cells - osteoclasts

"bone-chewing" cells → bone resorption "bone-breaking" cells

DM - type 1

(Insulin - Dependent Diabetes Mellitus) (IDDM) Usually a rapid onset; seen in younger people Connected in many cases to viral destruction of the beta cells of the pancreas

DM - type 2

(T2DM, NIDDM) Usually occurs in mature adults Has a slow and progressive onset

Secondary HTN

(a specific pathophysiology behind their high blood pressure... more likely to be identified) Renal hypertension, adrenocortical hormones, pheochromocytoma, aortic coarctation, oral contraceptives

nitrofurantoin

(macrodantin) Short half-life so given qid Many times 5-7 day regimen S/E - mainly GI, can affect liver Causes urine to be brown → will go away

antacids - magnesium salts

** milk of magnesia (MOM) Commonly causes diarrhea Usually used with other drugs to counteract this effect Dangerous when used with renal failure due to accumulation of magnesium

antacids - aluminum salts

**AlternalGel Have constipating effects Often used with magnesium to counteract constipation Often recommended for patients with renal disease Binds to phosphate, eliminates in feces

Cephalosporins - side effects

**GI-N/V/D -- C.DIFF potential ETOH interaction > disulfiram reactions CNS symptoms - dizziness, HA Nephrotoxicity Monitor electrolytes esp. BUN/creatinine Monitor for N/V/D Small frequent meals helpful, increase fluids to promote excretion Do not drink alcohol while on antibiotics

antidiarrheals - combination products

**Lomotil → diphenoxylate with atropine diphenoxylate - chemically related to meperidine diphenoxylate is combined with sub-therapeutic amounts of atropine Can cause respiratory depression, dependence → due to their being a narcotic Large dosages will result in extreme anticholinergic effects (dry mouth, abdominal pain, tachycardia, blurred vision), urinary retention

Angiotensin-converting enzyme (ACE) inhibitors (DRUG EXAMPLES AND MONITORING)

**captopril (Capoten) - short half life, bid and tid dosing → original → given 2-3/day **enalapril (Vasotec) - short half life, given IV and PO lisinopril (Prinivil and Zestril) → given once a day quinapril (Accupril) ramipril (altace) benazepril (Lotensin) fosinopril (Monopril) trandolapril (Mavik) Need to have calcium levels monitored, kidney function monitored, check potassium (patients might have to come off due to potassium becoming too high), sodium levels, make sure they are not orthostatic, AE: dry irritated cough → week or two after start of medication... reason why they get off of ace inhibitor because they can't get rid of cough, teratogenic

antitussives

**dextromethorphan (Robitussin) anti cough suppress cough reflex by direct action on medullary cough center of brain contraindications: - head injury (due to cns effect) - cough needed to ensure airway (cough is a protective mechanism)

stool softeners

**docusate (Colace) Promote more water and fat in the stools Lubricate the fecal material and intestinal walls Usually act within 1-3 days Cautions : Can decrease absorption of fat soluble vitamins A, D, E, K

low molecular weight heparins (LMWH)

**enoxaparin (Lovenox) - Synthetic - inhibits thrombus/clots by binding to factors Xa and IIa - Prevention or management of thromboembolic disorder - No monitoring of blood required - Less thrombocytopenia than unfractionated heparin - Dosage based on weight... same dose every time based on weight of patient Often used for bridge therapy with warfarin Patient teaching of administration technique

nasal steroid decongestants

**fluticasone (Flonase) Anti-inflammatory effect Takes time (weeks) to see full effect Use more for seasonal allergies (start before expect of symptoms) Not typically used for acute sinusitis Cautions: - Monitor for candida infection (fungal infections → more when used in mouth... can happen in nose as well) - Avoid exposure to airborne illnesses Can be taken longer term

Angiotensin ii recetor blockers (ARBs)

**losartan (Cozaar) Allows Angiotensin II to be made but prevents body from responding to Angiotensin II - Prevents vasoconstriction - Prevents aldosterone secretion Much less likely to cause hyperkalemia or persistant cough than ACE-I Monitor BP, renal function Do not take with an ACE inhibitor

sublingual nitroglycerin

**nitroglycerin (Sublingual) Potency deteriorates when bottle opened (tablets lose shape and crumble) Change every 6 months unopened; every 3 months if opened Light sensitive → dark bottle Adverse effects related to vasodilation - Dizziness - Headache - Lowers BP - fall potential - Flushing, sweating

oral decongestants

**pseudoephedrine (Sudafed) Decrease nasal congestion, earache pain Cautions: - Combined use with other adrenergic drugs - Cautions with cardiac patients, HTN, hyperthyroid - Assess for adrenergic effects - HR, BP - Monitor for rebound, limit use 3-5 days -- Taking it longer can result in a rebound of being more decongested (counterproductive → causes more symptoms)

antacids - calcium salts

**tums (calcium carbonate) May cause constipation, kidney stones Also not recommended for patients with renal disease - may accumulate to toxic levels Long duration of acid action may cause increased gastric acid secretion (hyperacidity rebound) Often advertised as an extra source of dietary calcium If you take too much calcium it can cause kidney stones

metformin (Glucophage)

*initial drug for Type II DM Usually needs to be dosed twice daily, available in sustained release Give with meals GI complications - usually early on Iodine containing dyes - stop metformin day of exam and 48 hours after - Assess for lactic acidosis Dose adjustment with renal disease

ACE inhibitors (SIDE EFFECTS)

*irritating cough dizziness

diverticular disease labs and imaging

+ stool occult blood, mild to moderate leukocytosis ** CT scan of abdomen; colonic wall thicken and pericolic fat stranding

intracerebral hematoma

- results from bleeding in the brain tissue itself - caused by contusion or shearing injuries but can also result from hypertension, cerebral vascualar accidents (strokes), aneurysm, or vascular abnormalities -- cat scan or MRI

subarachnoid hematoma

- results from bleeding in the space between the arachnoid and pia - the primary clinical presentation is severe headache with sudden onset and that it is worse near the back of the head

steps of inflammatory response

1. Chemical signals released by activated macrophages and mast cells at the injury site cause nearby capillaries to widen and become more permeable 2. Fluid, antimicrobial proteins, and clotting elements move from the blood to the site. Clotting begins. 3. Chemokines released by various kinds of cells attract more phagocytic cells from the blood to the injury site

Sodium (Na+) serum values

135-145 mEq/L

SECOND LINE OF DEFENSE = ADAPTIVE IMMUNE RESPONSE TO THE 2ND LINE OF DEFENSE

2 components of the adaptive response Humoral immunity - B lymphocytes - B cells become plasma cells which make antibodies - The principal defense against extracellular microbes and toxins Cell-mediated immunity or cellular immunity - Mediated by specific T lymphocytes - Defends against intracellular microbes such as viruses

stroke

2 types: ischemic and hemorrhagic ischemic - obstructed cerebral blood flow due to clot hemorrhagic - bleed into cerebral tissue due to high BP, ruptured cerebral artery treatment depends on the type - ischemic (most common) - thrombolytics to dissolve the clot - hemorrhagic - control BP, reverse anticoagulation diagnosis with head CT

myocardial infarction

2 types; NSTEMI and STEMI based on changes in EKG (shows what kind of heart attack patient is having → determines treatment) Symptoms are same: CP, SOB, jaw or neck pain, left arm pain, nausea (upset stomach), some have no symptoms (patients with diabetes) Women have less effects than men (SOB or fatigue) NSTEMI - ekg does not show changes STEMI - changes in ekg (more serious and many times they will go right into invasive surgery, a total blockage)

Potassium (K+) serum levels

3.5-5 mEq/L

5 alpha reductase inhibitors

5 alpha reductase inhibitor → blocks testosterone production *finasteride(Proscar)* Reduces size of prostate gland Permits flow, emptying of bladder, increases force of stream Women - glove when handling due to risk when handling (Pregnancy category x) Takes awhile to work

proper drug administration

5 rights of medication admin... nurse required to know right drug right patient right route right dose right time *document

chronic kidney disease

5 stages identified by Glomerular filtration rate (GFR) - Stage 1 is mild → stage 5 is worst Multiple concerns for patient: Hyperkalemia Acidosis Anemia Hypocalcemia/hyperphosphatemia Oliguria and edema Anorexia Uremic frost Dialysis is worsening stages → may be on it waiting for a transplant

pharmacologic treatment therapies for IBD

5-Aminosalicylic acid agents = 5 ASAs; Mesalamine (Asacol, Pentasa) - po and pr - Sulfasalazine (azulfidine) Different preparations used depending on site of bowel you want them to work in Few S/E except sulfasalazine Immunomodulators - - Thiopurines; Azathioprine (imuran) and mercaptopurine (6 MP) - Methotrexate (po or sq) S/E: BM suppression, lymphoma, liver toxicities, nonmelanoma skin cancer Biologics - monoclonal antibodies (proteins) that target immune system - anti-TNF (ex Infliximab, adalimumab, certolizumab, golimumab) - S/E immune suppression, opportunistic infections (TB) reactivation of Hep B, lymphoma, liver toxicity

Type 1 DM

90-95% have type 1A immune-mediated Combination of genetic predisposition (diabetogenic genes), an environmental trigger (often infection) and T lymphocyte mediated hypersensitivity reaction against some pancreatic beta cell antigens Autoantibodies against glutamic acid decarboxylase (GAD) and against tyrosine phosphatase IA-2 Outcome is destruction of beta cells and lack of insulin Requires lifelong insulin replacement (irreversible problem where you need to supply insulin)

acute coronary syndrome (ACS)

A continuum of myocardial ischemia that includes: Stable angina → stable with some chest pain but it is predictable Unstable angina → not as predictable MI → have tissue death Typically coming to emergency when they have unstable angina or an MI

hypoxemia

A reduction of PO2 of the arterial blood (typically less than 60 mmHg) - Cyanosis Impaired function of vital centers - Agitated or combative behavior, euphoria, impaired judgement, convulsions, delirium, stupor, coma - Hypotension and bradycardia Activation of compensatory mechanisms - Sympathetic system activation

transient ischemic attack (TIA)

A temporary episode of cerebral ischemia that results in symptoms of neurologic deficits Also called ministrokes because these neurologic deficits mimic a cerebral vascular accident (CVA) or stroke except that these deficits typically resolve within 24 hours (1-2 hours in most cases) May occur singly or in a series Symptoms begin quickly and last a short time Important to tell pcp - May be a warning about a stroke or may still need some treatment 1 in 3 people will have a stroke at some point - usually within a short period of time (1 year) Ischemia can occur because of cerebral artery occlusion (thrombus, emolus (blood clot that traveled from somewhere else and got stuck in artery), or plaque), or cerebral artery narrowing (atherosclerosis or spasms) Additional risk factors - migraines, smoking, diabetes mellitus, advancing age, hypercholesterolemia, oral contraceptive usage, illicit drug use - Can be warning for future stroke

adaptive response

ADAPTIVE RESPONSE T cells and b cells mingle with antigens as they circulate throughout the body's fluids and peripheral lymphoid tissue (ex. Tonsils, lymph nodes, spleen). The two main reasons they mingle is to destroy the antigen and produce antibodies against the antigen T cells get their name from where they mature, the thymus. T cells are produced in the bone marrow, after which they enter the bloodstream and travel to the thymus for maturation Two major types of T cells: 1. Regulator cells : helper T cells (activate B cell to produce antibodies) and suppressor T cells (turn antibody production off) 2. Cytotoxic T cells : respond to virus infection, cancer cells are transplanted tissue cells

outline the 4 phases of pharmacokinetics and describe the effects on individual's response to medication

ADME absorption distribution metabolism/biotransformation excretion

generalized seizures

Abnormal neuronal activity on both sides of the brain May cause loss of consciousness, falls, or massive muscle spasms Absence seizures (previously called petit mal seizure): individual may appear to be staring into space and/or have jerking or twitching muscles Tonic- clonic seizures (previously called grand mal seizure) : causes stiffening of the body and repeated jerks of the arms and/or legs as well as loss of consciousness Postictal period: just after the seizure, the individual may be confused, fatigued, and fall into a deep sleep

Salicylates

Acetylsalicylic acid (ASA)- inhibits thromboxane A2 and the synthesis of prostaglandins. ASA prevents platelet aggregation and clotting Benefits; antipyretic, analgesic, platelet inhibitor, anti-inflammatory Patient considerations: - Allergy - Bleeding hx, recent surgery, use of other anticoagulants ** viral influenza/chickenpox in children/adolescents (reyes syndrome) Pregnancy/lactation Eighth cranial nerve damage, monitor for otoxicity/tinnitus Take with meals or coated form

vitamin d

Absorbed from dietary sources or also produced endogenously when ultraviolet rays from sunlight strike the skin and trigger vitamin D synthesis Conversion of food, supplement or sun to active form is required - 1st in the liver and then the kidneys Vitamin D increases the intestinal calcium absorption

antacids - drug interactions

Absorption of other drugs with antacids Most drugs formulated for acid environment Alkaline environment interferes with drug breakdown Reduces the ability of the drug to be absorbed into the body Result - reduced drug absorption Separate antacids from any other meds by 1-2 hours → very important

bronchodilators -anticholinergics

Acetylcholine (ACh) causes bronchoconstriction and narrowing of the airways Anticholinergics block action of ACh Result → bronchoconstriction is prevented, airways dilate Useful for patients unable to tolerate B2 agonists - not as effective **ipratropium (Atrovent) - short acting - In inhaler, nebulizer tiotropium (Spiriva) - long acting - Not used for acute asthma exacerbations - Maintenance, used every day Cautions: Increase in anticholinergic effects when combined with other anticholinergics

GERD

Acid is able to get back up the esophagus, tissue lining of esophagus is not the right tissue to tolerate the acidic environment and it is irritated by acid and over time the tissue is change Some medications/foods are linked to the relaxation of the sphincter Aka : heart burn, acid reflux

urinary tract infections

Acute cystitis - infection of bladder. Bacteria adhere to wall of bladder and the bacteria cover themselves with a "biofilm" making it hard for immune system to access bacteria **Most common organism is e coli → gram negative bacteria that most often comes from stool Host of others; klebsiella, proteus, pseudomonas Treatment: antibiotics

factors essential to producing healthy RBCs

Adequate amounts of iron - To form hemoglobin rings to carry the oxygen Minute amounts of Vitamin B12 and Folic acid (helps form structure and DNA material) - To form a supporting structure that can survive being battered through blood vessels for 120 days Essential amino acids and carbohydrates - To complete the hemoglobin rings, cell membrane, and basic structure

adrenal cortex

Adrenal cortex Produces corticosteroids Androgens : male and female sex hormones Glucocorticoids: - Increase blood glucose levels, fat deposits, and protein breakdown for energy Mineralocorticoids: - Cause Na and water retention (think aldosterone)

diverticular disease

Affects 2.5 millions people in US, increased incidence with ae Diverticula: saclike protrusions of the mucosa into the muscular wall of colon. Most common sigmoid Diverticulosis: presence of diverticula in the colon; rarely symptomatic Diverticulitis: inflammation in or around a diverticulum that results in retention of undigested food and bacteria Inflammation or localized perforation of diverticulum with potential abscess or fistula formation

serology

After exposure to an infectious agent, the body produces antibodies Antibody titer rise IgM: rises and fall during the acute phase IgG: remains elevated after the acute phase

anticoagulants

All coagulants work in clotting cascade but do so at different points Prevent formation of new clots and extension of clots already present Do not dissolve clots Heparin and warfarin are commonly used Used to prevent or manage thrombophlebitis, deep vein thrombosis (DVT), and pulmonary emboli (PE) Main adverse effect is bleeding

gout - manifestations

An increase in serum uric acid concentration (hyperuricemia) Recurrent attacks of monoarticular arthritis (inflammation of a single joint) - hot, red, tender joint Approximately 50% of initial attacks occur in the metatarsophalangeal joint of the great toe - Other areas include the heel, instep of foot, knee, wrist, or elbow Deposits of monosodium urate monohydrate (tophi) in and around the joints Renal disease involving glomerular, tubular, and interstitial tissues Formation of renal stones

hypercapnia

An increase in the CO2 content of the arterial blood (PCO2 greater than 50 mm Hg) Respiratory acidosis leads to: - Increased respiration - Decreased nerve activity -- Carbon dioxide narcosis -- Disorientation, somnolence, coma - Decreased muscle contraction -- Vasodilation --- Headache; warm flushed skin

tamsulosin (flomax)

Alpha1 - adrenergic blocker Once a day medicine Selective a1 receptor antagonist that has preferential selectivity for the a1a receptor in the prostate When alpha 1 receptors in the bladder neck, the prostate, the ureter, and the urethra are blocked, a relaxation in smooth muscle tissue results. This mechanism decreases resistance to urinary flow, reduces discomfort associated with BPH Results in relaxation of SNS effects on bladder and urinary tract Side effects include: - Postural hypotension → get up slowly from a chair, etc. (first dose syncope) - Dizziness Monitor vs *

focal seizure

Also called partial seizure Occurs in just one part of the brain Simple focal seizure: individual remains conscious but experiences unusual feelings or sensations that can take many forms (sudden and unexplainable feelings of joy, anger, sadness, or nausea; hear, smell, taste, see, or feel things that are not real) Complex focal seizure: individual has changes in or loss of consciousness, producing a dreamlike experience; may display strange, repetitious behaviors (blinking, twitching, moving their mouth, walking in a circle) called automatisms

cerebral vascular accident

Also known as stroke or brain attack An interruption of cerebral blood supply Ischemic damage is permanent Causes: total vessel occlusion (thrombus, embolus, plaque) or cerebral vessel rupture (cerebral aneurysm, arteriovenous malformation, or hypertension) Major types of CVA - Ischemic strokes are the most common Hemorrhagic strokes are the most fatal

antiarrhythmic drugs

Alter heart's electrical conduction system Mechanism of action is to reduce automaticity, slow conduction and prolong refractory period Goal is to prevent arrhythmias, relieve symptoms, and prolong life Indication: Atrial fibrillation and atrial flutter Decrease ventricular rate and irregularity

treatment of kidney stones

Analgesics IVF Filter urine Lithotripsy Nephrolithotomy

angina

Angina pectoris - chest pain ** O2 supply does not equal demand** Continuum of CAD moves from angina to MI

drugs used to treat HTN

Angiotensin-converting enzyme (ACE) inhibitors Angiotensin II receptor blockers (ARBs) Calcium channel blocking drugs Vasodilators Thiazide diuretics What's there mechanism, how do they work, type of medication, teaching points

lobes of pituitary gland

Anterior lobe - Produces six major anterior pituitary hormones Posterior lobe - Stores two hormones

hormones produced by the hypothalamus

Antidiuretic hormone (ADH) Oxytocin - Stored in the posterior pituitary to be released when stimulated by the hypothalamus A neurological network delivers ADH and oxytocin to the posterior pituitary to be stored

two hormones produced by hypothalamus

Antidiuretic hormone (ADH) Oxytocin - Stored in the posterior pituitary to be released when stimulated by the hypothalamus A neurological network delivers ADH and oxytocin to the posterior pituitary to be stored

rheumatoid arthritis

Antigen-antibody complex deposits in tissues and elicits inflammatory response WBcs attracted to area destroy normal cells, the dying cells release enzymes to cause persistent cell death Inflammation, scarring, and fibrosis of synovial membrane>>> bone erosion and joint deformity Smaller joints affected. Especially morning stiffness Rheumatoid factor = antibodies made by immune system that attack healthy tissue Treatment: gold (injection or oral form), anti-inflammatories including prednisone, methotrexate, gold

antileukotrienes (leuikotriene receptor antagonist)

Antileukotriene drugs prevent leukotrienes from attaching to receptors on cells in the lungs and in circulation Prophylaxis And chronic treatment of asthma in adults and children NOT meant for management of acute ashmatic attacks **montelukast (Singulair) - monitor/assess: -- HA, n/v/d, elevated LFTs, myalgia

drugs affecting clot formation

Antiplatelet drugs -Alter the formation of the platelet plug -Conditions needing this: stroke, heart attack Anticoagulation drugs aka anticoagulants -Interfere with the clotting cascade and thrombin formation Many patients on both categories of drugs

pharmacologic treatment of urge incontinence

Antispasmodics : relieve spasms by suppressing overactivity by parasympathetic stimulation, block acetylcholine, and results in relaxation of smooth muscle (detrusor) in bladder Examples of antispasmodics: Anticholinergics : oxybutynin (Ditropan XL) Also tolterodine (Detrol), darifenacin (Enablex), fesoterodine (Toviaz) Darifenacin (Enablex), Solifenacin (VESIcare)

diverticular disease - treatment

Antispasmodics for colon Antibiotics Diet modifications - initially bowel rest (NPO or clear liquids) then advance

cutaneous administration of nitrates (Prophylaxis) - nitro patch

Apply to clean area (not to breasts) Do not shave hair (OK to clip) Rotate sites Leave off at bedtime (to reduce tolerance) → keep on 12 take off 12 More angina during the day so nothing needed at night... if it does happen at night take a sublingual May need to go up in dose if a tolerance is built up In hospital-date, record placement in MAR Monitor for skin reactions

Antiplatelet drugs

Aspirin (ASA): Inhibits the platelet synthesis of Thromboxane A2 Clopidogrel (plavix): Interferes with platelet aggregation Antiplatelet meds are used with MI, stroke, after cardiac stent procedures

nursing implications - lower respiratory tract agents

Assess baseline for comorbidities, especially CV disease with beta agonists If inhalants used for exercise induced asthma use 30 to 60 minutes prior to exercise Monitor for anticholinergic effects Steroid inhaler - not in acute infection, may take a few weeks to reach max effectiveness

nursing concerns with insulin

Assess baseline status; VS, labs, self care ability, schedule of meds taken at home Monitor for acute events that would change med requirements Appropriate site, syringe, needle Date vials Pre-drawn syringes good for 1 week Give mixed insulin within 15 minutes Glargine (Lantus) can NOT be mixed → long acting Teach, teach, teach Nutritional consult VNA referral Follow-up, when to call PCP/NP

thyroid replacement medications - nursing concerns

Assess cardiovascular status, may need med adjustment *Assessment for excess dose (hyperthyroidism) *Take regularly in AM, empty stomach → with water May need diabetic med adjustments *Periodic blood tests for thyroid function

antacids - nursing concerns

Assess for allergies and pre-existing conditions: Heart failure - sodium content Renal disease GI obstruction Fluid/electrolytes concerns Be sure that chewable tablets are chewed thoroughly, and liquid forms are shaken well before giving Administer with at least 8 ounces of water to enhance absorption Monitor for adverse effects - Nausea, vomiting, abdominal pain, diarrhea - With calcium-containing products: constipation, acid rebound

antiemetics - nursing concerns

Assess for comorbidities, renal, hepatic disease, CNS depression, etc Assess for any drug-drug interactions Nutritional assessment Appropriate route of administration PO 30 minutes before food/activity/drugs IV slow and per protocol PR; be sure free from stool

beta 2 agonists - nursing consdierations

Assess lung sounds pre/post VS pre/post Teach use of inhalers

nursing interventions for UTI

Assess pt status and comorbidities Monitor foley catheter use, remove ASAP Avoid foods that will alkalinize urine such as antacids, citrus, sodium bicarbonate Education to: report painful urination to PCP/NP Toileting hygiene Increase fluids/cranberry juice

nursing concerns

Assessment - Allergies, baseline status of seizure activity, mental status - Triggers for seizure Interventions - Stop drug for toxic effects - Administer with food to reduce GI upset - Monitor labs - CBC, LFTs (liver function tests), renal, Drug levels - Wean off to prevent seizure events - Consel re: expected effects to promote compliance - Pregnancy counseling - Medic-alert bracelet

general nursing concerns with antihypertensive meds

Assessment of comorbidities, allergies Assess lifestyle influences Monitor/teach safety re: postural hypotension

respiratory tract diseases

Asthma - reversible airway obstruction COPD - chronic obstruction of airways - Emphysema - damage to alveoli - Chronic bronchitis - inflammation/mucus airway Characteristics - Bronchoconstriction - Inflammation, mucosal edema - Excessive mucus production

acute cystitis

Asymptomatic Frequency Urgency Dysuria Suprapubic pain Hematuria

ulcerative colitis

Autoimmune Inflammation of colon only. Often begins in rectum and moves up Left lower quadrant discomfort

Chron's disease

Autoimmune in origin Transmural inflammation of entire GI tract (inside mucosa to outer mucosa) → can be sm or lg intestine, illium of sm intestine is most affected

cyancobalamin - brand

B-12, Vitamin B12, Nascobal, Athlete, Calomist, Cobalamin, Cobex, Crystamine, Prime, Rubramine PC, Vibisone, Eligen B12

Antihistamines

Benadryl Reduces inflammation but dries you up (feel dehydrated) Good for a little while Drugs that directly compete with histamine for specific receptor sites Management of: Seasonal allergic rhinitis (hay fever) Allergic reactions → you have hives, trying to reduce inflammatory reaction in allergen Motion sickness Sleep disorders → a side effect of an antihistamine is sedation so may take it so they can go to bed Have several properties - Antihistaminic - Anticholinergic → block effect of acetylcholine (slow things down and be a problem with urinary retention and bowel issues such as constipation) - Sedative - Antipruritic (anti-itch) **diphenhydramine (Benadryl) Comes in PO, IV (before a procedure to make sure there's no reaction), liquid Cautions: Respiratory disease due to thickening of bronchial secretions (causes more thickening → creates an obstruction) Monitor for anticholinergic effects (constipation and urinary retention)

bronchodilators

Beta 2 agonists Quickly dilates bronchi and increases rate and depth of respirations Long term control (prophylactic) = LABA - Achieve and maintain control of persistent construction - Taken everyday, prophylactic, maintenance Quick relief (rescue) = SABA - Used during periods of acute symptoms - Quick, used on the spot, works right away

metabolic functions of the liver - bilirubin excretion and drug and hormone metabolism

Bilirubin excretion Drug and hormone metabolism Biotransformation into water-soluble forms Detoxification or inactivation of meds

antithryoid drugs

Block formation of thyroid hormones in thyroid gland, treat hyperthyroidism Several treatments to reduce overproduction of thyroid hormones: - Thioamide medications - prevent the formation of thyroid hormone within the thyroid cells, lowering the serum level of thyroid hormone' -- Partially inhibit the conversion of T4 to T3 --Iodine products - iodine needed to produce thyroid hormone, large doses block this function. Cause the thyroid cells to become oversaturated with iodine and stop producing thyroid hormone - --Potassium iodide - --Sodium Iodide I131 - thyroid cells destroyed by radioactivity

histamine 2 antagonists

Blocks H2 receptor sites on the parietal cells The H2 sites are stimulated to cause the release of HCI in response to gastrin or PSNS stimulation Most popular drugs for treatment of acid-related disorders **famotidine (Pepcid) Cautions - decrease acidity may decrease B12 absorption - CNS effects - H/A, drowsiness, confusion - Urinary retention, cardiac arrhythmias, hypotension Administer with or before meals and HS

pulmonary embolism

Blood clot in pulmonary artery obstructing blood flow and resulting in infarcted lung tissue Typically starts as a thrombus → came from somewhere and traveled to the lung DVT is a significant risk factor for PE → typically starts in leg Immobility and malignancy are also risks - DVT - Hypercoagulated blood (patients treated with cancer more at risk)

hypoglycemia

Blood sugar concentration lower than 40 mg/dL occurence - Starvation Lowering the blood sugar too far with treatment of hyperglycemia

osteomyelitis

Bone infection often caused by bacteria, usually Staphylococcus aureus Hematogenous - Pathogens carried through the bloodstream -- Cutaneous, sinus, ear, and dental infections Insidious onset Vague symptoms - Fever, malaise, anorexia, weight loss, and pain Contiguous - Infection spreads to an adjacent bone - - Open fractures, penetrating wounds, surgical procedures - Manifested by signs and symptoms of soft tissue infection -- Low-grade fever, lymphadenopathy, local pain, and swelling Treatment for osteomyelitis: potent antibiotics and surgical debridement

Folate and B12 deficiencies

Both are macrocytic anemias Folate and B12 - essential for growth of the RBC Folate (leafy greens) Deficiencies: Secondary to increased demand - developing fetus Absorption problems in small intestine (celiac, crohn's) Secondary to the malnutrition of alcoholism Vitamin B12 Deficiencies: Poor diet or increased demand Lack of intrinsic factor made by the stomach (Pernicious anemia) - a subset of B12, type of B12 deficiency Has to do with the substance needed to absorb B12 Intrinsic factor - made by cells in the stomach If stomach does not make you can not absorb B12

thrombolytic agents

Break down the thrombus that has been formed by stimulating the plasmin system: - Alteplase (Activase) - Reteplase (Retavase) - Tenecteplase (TNKase) - Urokinase (Abbokinase) Actions - Activating plasminogen to plasmin, which in turn breaks down fibrin threads in a clot to dissolve a formed clot Pharmacokinetics - Drugs must be injected and are cleared from the body after liver metabolism Adverse effects - Bleeding - Hypersensitivity - rash, flushing, bronchospasm, and anaphylactic reaction

fluoroquinolone - ciprofloxacin "cipro"

Broad spectrum of activity Common quinolones - - Ciprofloxacin (Cipro), which is most widely used - fluoroquinolone, gemifloxacin (Factive), levofloxacin (Levaquin), moxifloxacin (Avelox), norfloxacin (Noroxin), ofloxacin (Floxin, Ocuflox), and finafloxacin (Xtoro)

asthma - treatment

Bronchodilators; B2 agonists, xanthines, anticholinergics → dilate and open up airways (quicker) Inhaled corticosteroids → may take awhile to kick in... on for maintenance Mast cell inhibitors → preventing mast cells from releasing histamine Reduce exposure to triggers Oxygen → for severe

calcium formulations

Calcium carbonate (40 percent elemental calcium) Calcium citrate (21 percent elemental calcium) Calcium gluconate (9 percent elemental calcium) Calcium lactate (13 percent elemental calcium) Elemental calcium is the active form The two main forms of calcium supplements are carbonate and citrate. Calcium carbonate is cheapest and therefore often a good first choice **no need to memorize

non-hodgkin lymphoma

Can be divided in to aggressive (fast growing), indolent (slow growing) Can arise from B cells in 0% of cases or T cells in 20% Clinical manifestations: swollen, painless lymph nodes, weight loss, persistent fever, night sweats, coughing, malaise, recurrent infections, pruritus Diagnosis: biopsy of lymph node Treatment: chemotherapy, radiation, bone marrow transplant Main different with non HL: involves multiple nodes scattered throughout the body and metastasizes in an unorganized manner All ages... most common 40+ Metastasis is often present at diagnosis Non-HL more difficult to treat Prognosis is not as good

furosemide (Lasix)

Can be given IV (slow push) or PO - Watch for dehydration, potassium levels, sodium levels, electrolytes, CO2, kidney function (BUN and creatinine) Side effects - hypokalemia, hypocalcemia, hyponatremia, hypotension/dizziness, monitor for ototoxicity (from iv), worsening renal function Nursing concerns - overall assessment of labs, I&Os, weights - Check KCL prior to dosing - watch for hypokalemia - Alkalosis due to loss of bicarb - Assess for s/s of hypokalemia - IVP slow usually over 1-2 minutes - Tinnitus - ototoxicity - may be reversed if drug is stopped early, compounded with aminoglycosides - Nutrition consult - dietary potassium needs

xanthines

Can be given to a patient in the hospital IV or in oral form Original respiratory med for bronchodilation Cause smooth muscle relaxation in respiratory tract Inhibit release of slow-reacting substance of anaphylaxis and histamine → reduced bronchial edema Narrow margin of safety and many drug interactions Avoid caffeine → makes it more likely to become toxic Check blood levels (theophylline normal level - 10-20 mcg/mL With elevated levels see pcp - Tachycardia, nausea, irritability, seizures (if blood levels become too high) Examples: aminophylline, theophylline Aminophylline - IV (severe asthma attack) Theophylline - PO

Hodgkin's Lymphoma

Can start in any lymph node Can be a b or t cell (mostly b) Most often occur in the neck, chest, upper arms The cancer cells are called Reed-Sternberg cells Clinical manifestations: swollen, painless lymph nodes, weight loss, persistent fever, night sweats, coughing, mailasise, recurrent infections, pruritus Diagnosis: biopsy of lymph node, CBC (complete blood count), chest x-ray __________________________ Tends to be in younger population (late teens 20s/30s) - can be an older spike in patient population Spread to other spots through lymph system Common sites for lymph node enlargements

functions of thyroid gland

Carbohydrate and lipid metabolism Growth and development Heat regulation Cardiac function Neuromuscular function Calcium balance

Cardiotonics (inotropic)

Cardiac glycoside (Foxglove) digoxin (Lanoxin) - Improves cardiac contraction and pumping ability - Increases force of contraction (positive inotropic effect) - Increases cardiac output and renal perfusion - Decreases electrical impulses allowed to reach ventricles - Slows heart rate by slowing repolarization (negative chronotropic effect) → given for someone with a fast heart rate digoxin administration - - Oral (contraction) or IV (need to slow someones hr in hospital quickly) - AP for one full minute 0 hold for < 60 bpm (adult) - Digitalization if rapid effect required → IV doses to get it started quickly and then switch to oral dose - Narrow therapeutic index -- 0.5 - 2.0 ng/mL - serum digoxin level - Antidote: digoxin immune Fab (Digibind/Digifab) digoxin cautions: - If they get a toxicity to it... very slow heart rate - Watch for renal failure → drug excreted unchanged in kidney, dose reduce - Check HR as can cause Bradycardia, heart block - Hold for pulse < 60 bpm - Monitor electrolytes - especially K - hypokalemia may cause digoxin toxicity digoxin nursing concerns - - s/s of digoxin toxicity -- N/V, visual changes (yellow/green halos), rhythm disturbances - fast or slow - Teach patient to notify PCP if unable to take med

determinants of blood pressure

Cardiac output = HR x SV Arterial resistance: Influenced by increased blood viscosity and decreased artery diameter

life span consideration upper respiratory agents

Care used in children due to sedation Careful with combination of OTC drugs Caution with older adults - consider renal/hepatic function, use of other drugs, monitor for safety concerns with CNS effects Use topical nasal decongestants to avoid systemic effects when possible Teach when to seek further medical assessment of symptoms Teach use and expected side effects - rebound, GI effect, CNS effects, anticholinergic side effects Encourage fluids

potassium sparing diuretics

Cause loss of sodium but retention of potassium *spironolactone (Aldactone) * - Only PO - Aldosterone antagonist - blocks action of aldosterone - Often used along with other diuretics > assess for dehydration Nursing concerns - - Overall assessment of status, co morbidities, drug used, labs, I&Os - Teach self care- weights, s/s of dehydration, when to call PCP/NP - Monitor for effects of hyperkalemia - Nutrition consult -- Avoid salt substitutes -- Avoid foods high in potassium

inflammatory response

Caused by damage or injury to body tissue - triggered with a cut - Cancers, diabetes, cardiovascular 2 stages of acute inflammation: vascular and cellular The arterioles in the area briefly go into spasm and constrict to limit the bleeding and the extent of injury. Momentary vasoconstriction is immediately followed by vasodilation, which increases blood flow to injured area in an attempt to dilute toxins and provide essential immune cells like (neutrophils, monocytes), nutrients and oxygen Leukocytes clean up or phagocytose (engulf foreign agents) and debris. Fibrinogen transforms to fibrin to help wall of the injured area so the bad guys are contained (think about the scab that forms with a cut finger... good thing) The inflammatory response is triggered by a set of mediators

cushing's syndrome

Caused by too much ACTH from pituitary, (cushing's disease), adrenal tumor producing excess hormones, or long term exogenous supply of glucocorticoids (iatrogenic cushing syndrome) - moon face/buffalo hump - thin extremities (protein wasting) - skin changes - purple striae, thin skin - water retention - edema, hypertension - K+ loss (due to holding on to sodium) - osteoporosis - delayed wound healing - bruising - weight gain - diabetes mellitus (from increase blood sugars)

hypothyroidism

Causes insufficient thyroid hormone - Absence of thyroid gland-cretinism - Lack of necessary iodine - Tumor or auto-immune disease (Hashimoto disease) - Pituitary or hypothalamus disease - Radiation to thyroid - Surgical resection

laxatives - magnesium citrate

Cautions: - Cardiac disease due to F/E imbalance Monitor: - Diarrhea, cramps, F/E imbalances, dehydration - Take 30 mins before/after other meds - Take with generous amounts of water

warfarin nursing concerns

Cautions: - Monitor for bleeding, frequent labs to assess therapeutic range - Many, many drug and food interactions Monitoring (PT, INR) - INR (nl <1.1) goal determined by dx (2-3 most common range) --Gives an idea of how thin your blood is -- The higher the INR the thinner the blood is Antidote - phytomenadione (vitamin K) - PO, SQ - Different color tablets based off of strength

atrial fibrillation

Chaotic, irregular fibrillating of the atria. The sinus node is no longer in charge of rate and rhythm Often faster rate than patient's normal sinus rhythm rate Due to lack of coordinated contraction of atria blood pools in atria, thrombus can develop and embolize from heart to brain causing embolic stroke Anticoagulation needed to prevent stroke - warfarin, heparin Antiarrhythmic meds - many used **amiodarone (Cordarone) Diltiazem EKG - no p waves founds and more rapid and irregular rhythm

diabetes medications - special populations

Children Insulin-minute doses in infants Adolescents-constant changing insulin needs Pregnancy Gestational diabetes; diet or med controlled Insulin drug of choice when pregnant Elders Comorbidities, meds, physical limitations

chronic bronchitis

Chronic irritation of major and small airways Increased number of mucous cells >> mucus hypersecretion Airway obstruction Fibrosis of bronchiolar wall Primary manifestation is productive cough Pulmonary function test → mild, moderate, etc COPD

lipids

Consists of Triglycerides and cholesterol Lipids are attached to lipoproteins for transport in blood Low-density lipoprotein (LDL) - Lower density: less protein, more cholesterol (brings more fat) - Transports cholesterol from the liver to cells - Main carrier of cholesterol High-density lipoprotein (HDL) - Higher density: more protein, less cholesterol - Transports cholesterol from cells to the liver

urinary tract anti-inefectives

Common antibiotics Bactrim Nitrofurantoin Ciprofloxacin

Oral iron preparation

Common oral ones; Ferrous Gluconate (Fergon) and Ferrous Sulfate (Feosol) Pharmacokinetics Absorbed in small intestines Transported in the blood bound to transferrin Adverse effects GI irritation (nausea and bloating) and constipations and CNS toxicity Patient teaching : Stool is black Stool softener helper Vitamin C supplement or drinking orange juice will enhance absorption Can take 2-3 weeks to see improvement Increase intake of iron rich food like liver, red meat, fish, beans, raisins, and green leafy vegetables Separate calcium intake by a couple of hours

gi disorders

Constipation Diarrhea GERD PUD Inflammatory bowel disease Diverticulitis Cholecystitis

warfarin - brand

Coumadin, Jantoven

cyancobalamin - generic

Cyanocobalamin

PE diagnosis

D dimer (blood test → measurement of breakdown materials from a clot) , lower extremity ultrasound, VQ scan (ventilation perfusion scan.. compare oxygenation in the lungs to perfusion in the arteries) , CT angiogram (of chest)

cardiomyopathy

Dilated - stretched LV leading to poor cardiac output and HF Hypertrophic - increased size of myocardial cells in response to prolonged stress from HTN, aortic valve narrowing. Eventually LV dilates. The hypertrophy increases O2 requirements of heart Restricted - stiff LV that can't relax and fill (can be born with)

acid controlling meds

Decrease secretion activity, block action of secretions, or form protective coating. Used for GERD and ulcer Examples are: H2 antagonists Proton pump inhibitors (PPIs) Antacids

glucagon

Decreased blood glucose → glucagon secretion - High blood amino acids also stimulate secretion Glucagon stimulates release of glucose into blood by promoting - Glycogen → glucose (glycogenolysis) - Fat → fatty acids for energy (lipolysis) - Amino acids → glucose (gluconeogenesis)

laxatives - chemical stimulants

Directly stimulate the nerve plexus in intestinal wall **bisacodyl (Ducolax) senna (Sennakot, Ex-Lax) Cautions: cardiac disease - stimulation of vagus nerve with PR administration

orthostatic hypotension

Definition - an abnormal decrease in blood pressure on assumption of the upright position Causes - decrease in venous return to the heart due to pooling of blood in lower part of the body, inadequate circulatory response to decreased cardiac output and a decrease in blood pressure Condition that decreases vascular volume → dehydration Conditions that impair muscle pump function → bed rest, spinal cord injury Conditions that interfere with cardiovascular reflexes → medications, disorders of autonomic nervous system, effects of aging on baroreflex function

osteoarthritis

Degenerative joint disease - degenerative changes in articular cartilage Idiopathic or primary OA due to aging changes secondary osteoarthritis - congenital or acquired Damaged joint cartilage tries to heal itself - Creating osteophytes or spurs Cartilage contains more water, less collagen - Cartilage becomes weak, rough, eroded - No longer protects the surface of the bone

hypothyroidism - s/s

Depressed metabolic rate Depressed cardiac function Bradycardia CNS depression Need more sleep Skin, hair, and nail changes Hair gets brittle, skin itchiness Goliter Bulging of the neck where thyroid is

treatment for DI

Desmopressin (DDAVP) - Treatment of DI - Nasal spray - Desmopressin is also indicated for the treatment of hemophilia A and von Willebrand's disease. Increases levels of clotting factor VIII Has pressor and antidiuretic effects Side effects: - Water intoxication - Related to the shift in water retention - Local nasal irritation - Hypersensitivity

metoprolol (Lopressor) beta blocker - cautions

Diabetes can mask signs of hypoglycemia (may not get signs that their BS is low) Hypothyroidism Caution with use of additional cardiac meds

rhabdomyolysis - diagnosis

Diagnosed with creatinine kinase (CPK) level five to ten times upper limit of normal (about 1000 units/L) Myoglobin found in urine and blood Hyperkalemia Renal failure likely when CK reaches 15,000 units/L

cholesterol regulation

Dietary lipids absorbed as chylomicrons Adipose, muscle cells take up lipids from chylomicrons - remnants are IDLs IDLs become LDLs (bad cholesterol) Some LDLs taken up by scavenger cells (macrophages) HDL aids in enhanced excretions of cholesterol by the liver

anemia

Disorders with too few or ineffective RBCs Results from alteration in erythropoiesis or hemolysis of cells Classified based on size of RBCs or underlying etiology of the anemia

peptic ulcer disease

Disruption of the mucosal integrity of the stomach or duodenum → local excavation due to inflammation Etiology - Helicobacter pylori (H. pylori) present in up to 90% of duodenal ulcers - NSAIDs or corticosteroids associated with 15% of gastric and 5% of duodenal ulcers Different ulcers may have different symptoms Stomach ulcers have been linked to stomach cancer Anti - ulcer meds for trauma patients Dx. - Can have an edoscopy to find where the ulcer is, if theres any bleeding Duodenal - 40-50 age group Gastric - 55+ age group

blood gasses - carbon dioxide

Dissolved carbon dioxide = PaCO2 or PCO2 - Normal value 35 to 45 mmHg Carbon dioxide bound to hemoglobin - carbaminohemoglobin Carbonic acid → bicarbonate ion and H+ When you exhale, you remove CO2 from your blood and also decrease the amount of carbonic acid, raising your blood pH

blood gasses - oxygen

Dissolved oxygen = PaO2 or PO2 Normal value greater than 80 mmHg Oxygen bound to hemoglobin = oxyhemoglobin Normal value 95% to 97% saturation

heart failure - drug treatment overview

Diuretics Cardiotonic (Inotropic) drugs ACE inhibitors and Angiotensin Receptor blockers Vasodilators Beta adrenergic antagonists (B blockers)

hemolytic anemia

Due to excessive destruction or hemolysis of erythrocytes Causes of hemolytic anemia include: idiopathic causes, autoimmune causes, genetics, infections (malaria), blood transfusion reaction, and blood incompatibility in the neonate We will explore on type: sickle cell anemia

osteoporosis potential causes

Endocrine dysfunction - Parathyroid hormone, cortisol, thyroid hormone, estrogen Medications - steroids, chemotherapies Vitamin D and calcium deficiency Low physical activity Low BMI Excessive caffeine → leaches calcium out of bone? not definite Smoking

action of skeletal muscle relaxants - direct acting

Enter muscle fibers directly Examples are: Botulinum Toxins (Botox)

self-admin of epinephrine

Epinephrine stimulates Alpha I receptors in the blood vessels to vasoconstrict (elevate BP) and B2 receptors in bronchi to cause bronchodilation REmove EpiPen from carrying case Hold in a fist with the black tip (injecting end) down and remove the gray safety release cap Hold black tip near the outer thigh. Swing arm and jab firmly into outer thigh until a click is heard with the devid perpendicular to thigh Hold firmly for 10 seconds, then remove unit and massage area Activate emergency medical system (911) - can have secondary emergency response

ischemic stroke

Etiology - obstructed cerebral blood flow due to clot (thrombus or embolus) Diagnosis with head CT and MRI Carotid ultrasound - assess patency of artery Treatment - Thrombolytics to dissolve clot - treatment should be delivered within 3 hours of symptom onset Can't give medicine if you can't remember when the onset started (if they were asleep) - it can cause more harm Anticoagulants to prevent further clots Antiplatelet agents (ASA or Plavix)

vasodilators

Example - Hydralazine, PO or IV, tid or qid Mechanisms of action - Acts directly on smooth muscle in blood vessels - Resulting in dilation, relaxation, and decreased PVR (Peripheral Vascular Resistance) - Reduces afterload Short acting and can have rebound effect May get reflex tachycardia if patient's BP drops Often used in severe HTN crisis/ emergencies Closely monitor VS, fall risk

urinary tract analgesics

Example is *Phenazopyridine (Pyridium)* Direct topical analgesic effect on urinary tract mucosa Used with UTIs Orange-red urine with use Increase liver toxic effects if used > 2 days and in combination with antibiotics

centrally acting skeletal muscle relaxants

Example: Baclofen, Flereril Indications - Alleviation of spasticity; use in spinal cord injuries, MS Adverse reactions: Drowsiness Fatigue Weakness Confusion Headache Nausea Dry mouth Hypotension Urinary frequency

hyperthyroidism

Excessive amounts of thyroid hormone produced Signs and symptoms: Enhanced metabolism → weight loss Tachycardia Flushed, sensitive to heat Goiter Exophthalmos → eyes are bulging out of head... no protective socket... can get better when pt is treated or times where it won't get better with medication Graves disease-autoimmune disease - most common cause of hyperthyroidism Diagnostic test - Low TSH, high T3 & T4

osteoarthritis - conservative treatment

Exercise and weight loss Pharmacologic therapies Analgesics and anti-inflammatories Nutritional supplements - Glucosamine - Chondroitin

CAD - diagnosis

Exercise tolerance test (stress test) Myocardial scans → nuclear scanning that can take pictures of heart muscles and identify an area of the heart that has already had a heart attack Coronary angiogram (cardiac catheterization) → invasive using dye to take pictures of the coronary arteries itself

signs of stroke and tia

FAST F (face) one side of face is dropping A arm weakess S speech difficulty T time to call the ambulance

describe the effects of stress on the body

Factors that can affect the body's ability to adapt include: genetics, age, gender, health status, nutrition, sleep-wake cycle, hardiness, psychosocial factors Diseases and ailments that have been attributed to stress include anxiety, depression, headache, insomnia, infections, and cardiovascular disease Some examples of effects of stress on body systems include: Nervous system: anxiety, fatigue, autoimmune disease Cardiovascular: CAD, HTN GI: diarrhea, gastritis GU: impotence, menstrual irregularity Integumentary: acne, hair loss Resp: asthma, hay fever Immune system: immunodeficiency Endocrine: diabetes mellitus, hyperglycemia Musculoskeletal: rheumatoid arthritis individual factors: factors - genetics, age, life, experiences, gender, dietary status, social support maladaptive coping strategies (cause more harm than benefits) such as smoking, ETOH, drug, overeating adaptive coping strategies - relaxation, lifestyle modifications, physical activity, optimal dietary, adequate sleep, distraction, biofeedback

labs to diagnose DM

Fasting blood sugar (FBS); >/= 126 is diagnostic for DM Postprandial BS; OGTT; >/= 200 is diagnostic for DM (after eating) HbA1C; >/= 6.5 is diagnostic for DM (reflects bs level over last several months → takes an average of what it runs on a day to day basis)

clinical s/s of hyperglycemia

Fatigue Lethargy Irritation Glycosuria and Polyuria Polyphagia Polydipsia Itchy skin

ferrous sulfate - brand

Feosol, Fer Iron, Fer-Gen-Sol, Fer-in-Sol, Fer-Iron, Feratab, Ferosul, Ferra-TD, Ferro-Bob, Lydia E. Pinkham, MyKidz Iron 10, Slow Fe

renal colic

Flank pain Groin pain Waxing/waning pain Urgency, frequency, dysuria - Pain comes on and off (colic) Hematuria (blood in urine) Nausea/ vomiting Genetic component, dehydration can lead to development, high protein diet can result in high uric acid stones

H pylori

For detection of H. Pylori - Endoscopic Bx - gold standard - Serum H. pylori antibody - Urea breath test → urease breaks down urea into carbon dioxide and ammonia and the ammonia makes the stomach more alkolitic → swallow radioactive capsule with urea in it, the enzyme breaks it down and the enzyme breaks it down and you blow out CO2 (positive) - Stool H. pylori antigen Treatment is Quadruple therapy → takes 4 different things at the same time - B/M/T + PPI x 10-14 days Bismuth subsalicylate 2 tabs 4 x day (peptil bismul) Metronidazole 250 mg 4 x day or 500 mg tid Tetracycline 500 mg 4 x day PPI of choice twice daily Linked to duodenal ulcers and some gastric

nitroglycerin (Nitro-bid)

For immediate relief of angina Administration of NTG tab SL Should "burn" under tongue (show that medication is in effect) Rushing of blood to the head/headache Stop all activity Sit quietly ** administer every 5 min x 3 doses (SL Q5 mins x 3) → if no relief with the first If no relief after 3 ... call 911... need more treatment

musculoskeletal injuries

Fractures A fracture is a break in the continuity of a bone Classifications *complete or incomplete *closed or open (does it cause an opening in the skin?) *by cause - Sudden injury (a fall, some type of penetrating event) - Stress fractures (cumulative stress on a particular bone, over use) - Pathologic fractures (osteoporosis, a cancer that has spread to their bone)

kidneys

Functional unit of kidneys is the nephron Blood supply provided by the renal artery Kidneys play a key role in: Regulating fluid volume Electrolyte control Blood pressure Red blood cells production Acid-base balance Excretion of medication

acid related diseases

GERD - gastroesophageal reflux disease PUD - peptic ulcer disease - Patients can have both GERD and PUD - Three different types of ulcers - gastric, duodenal, stress Helicobacter pylori (H. pylori) - Bacterium found in GI tract of 90% of patients with duodenal ulcers, and 70% of those with gastric ulcers Complication of ulcer can be GI bleeding (blood in stool)

major adverse effects of penicillins

GI-N/V/D, stomatitis, furry tongue Rash, urticaria, superinections - especially yeast Hypersensitivity - allergy to other PCNs or cephalosporins Give most PCN on empty stomach and 8 oz water - amoxicillin and augmentin with food if needed Monitor for N/V/D PCN dosed more frequently as it is cleared quickly (3 or 4 times a day)

tetracyclines - side effects

GI; N/V/D, glossitis Rash/ photosensitivity Damage to teeth & bones; *do not use in children <8 years due to teeth discoloration, delayed bone grown Superinfections

Respiration

Gas exchange of O2 and CO2 - Oxygen moves from alveolar air into blood - Carbon dioxide moves from blood into alveolar air What affects gas exchange? - Ventilation - Diffusion across alveolar-capillary membrane What are disorders of respiration? - Inflammation, fluid, mucus in alveolar Side effects of some medications

types of seizures

Generalized - 40% - Begin in one area, spreads, most often involves LOC (loss of consciousness) - Multiple classifications Partial (Focal) - 60% - Usually focal origin, does not spread - Presentations depend on area of the foci - Epilepsy - recurrent seizures

sickle cell anemia

Genetic type of hemolytic anemia in which the erythrocytes have an abnormal crescent of sickle shape Caused by: an abnormal type of hemoglobin called hemoglobin S, Hemoglobin S distorts the shape of the erythrocytes, especially when the supply of oxygen is low. These fragile, sickle-shaped cells deliver less oxygen to the body's tissues. These cells can clog blood vessels and occlude blood flow People of Africican, Mediterranean, SOuth central america, caribbean, and middle east have higher incidence

Primary or Essential HTN

Genetics, race, age, insulin resistance, diet (some people are more salt sensitive), obesity, alcohol

meds to treat hypoglycemia

Glucose elevating medications - Assess blood sugar before acting/medicating - For conscious patient --- Glucose tablet or gel-absorbed rapidly Unconscious patient - D50% given IVP - Glucagon SQ, may induce vomiting, turn patient on side

metabolic functions of the liver - carbohydrate, protein, and lipid metabolism

Glucose → stored as glycogen, converted to glucose, used to make fats, formed from amino acids and other substrates Lipids → oxidized for energy, synthesized, packaged into lipoproteins Proteins → synthesized from amino acids, transamination, and deamination (ammonia made into urea)

clostridium difficile colitis

Gram + anaerobic spore forming bacillus One of the most common HCA infections 20 - 50% of hospitalized inpatients are carriers Commonly occurs as result of abx Culprits: can be any abx but mostly clindamycin, cephalosporins, and fluoroquinolones Due to change in gut flora Treat with oral vancomycin, flagyl, or Fidaxomicin (dificid) Patients with c.diff need to be oral for Vancomycin

clostridium difficile colitis

Gram + anaerobic spore forming bacillus One of the most common HCA infections 20-50% of hospitalized inpatients are carriers Commonly occurs as the result of Antibiotics Culprits: can be and ABX but most commonly; clindamycin, cephalosporins, and fluoroquinolones Due to change in gut flora Treat with oral vancomycin, metronidazole (flagyl), or Fidaxomicin (dificid) PPE : Need to wear gown and gloves, on contact precautions, clean surfaces with certain type of disinfectant, wash hands with soap and water

lipid profile

HDL - desirable 60 mg/dl - borderline 35-45 mg/dl - high risk <35 mg/dl LDL - desirable 60 - 130 mg/dl - borderline 130- 159 mg/dl - high risk 160 - 189 mg/dl Triglycerides - desirable <150 mg/dl - borderline 150-199 mg/dl - high risk 200-499 mg/dl Total Cholesterol - desirable <200 mg/dl - borderline 200-239 mg/dl - high risk 240 mg/dl

Lipid Lowering drugs

HMG-CoA Reductase Inhibitors - the "statins". Inhibit the enzyme that aids in synthesizing cholesterol. Results in decreased LDL Significant first pass effect so can increase LFTs → need to have their liver function tests monitored, use AST and LST enzymes Can cause myalgia, myopathy → muscle soreness and muscle break down, doesn't get better GI effects coommon Examples of statins: - lovastatin (Mevacor) → first one, not used as much anymore - pravastatin (Pravachol) - *simvastatin (Zocor) - ** atorvastatin (Lipitor) - rosuvastatin (Crestor)

Type 2 DM hallmarks

Hallmarks: Relative insulin deficiency → generally a lower amount of insulin being made Insulin resistance Increased glucose produced by liver

unstable plaques

Have thin fibrous caps Plaque can rupture → clot forms (thrombus) - May completely block the artery - May break free and become an embolus (travel from one place to another)

bone healing

Hematoma formation Cellular proliferation >> collagen fibrin network fills in Formation of soft tissue callus Calcium salts deposited in new tissue New tissue remodeled into normal shape Hematoma → cartilage → bone

fate of bilirubin

Hemoglobin from old red blood cells becomes unconjugated bilirubin The liver links unconjugated bilirubin in blood to glucuronide → conjugated bilirubin → bile Excess unconjugated bilirubin in blood → bilirubinemia → jaundice

heparin - brand

Hep-Pak, Heparin Lock Flush, Hep-Pak CVC, Hep-Lock, Heparin Sodium ADD-Vantage

at risk for hypoglycemia

Hepatic disease Renal failure Beta cell tumors (insulinoma) Gastric disorders which interfere with absorption Critically ill with : cardiac, sepsis, or severe trauma History of severe hypoglycemia Type 1 Diabetes Severe malnutrition

Hyperkalemia

High K+ k+ concentration greater than 5 mEq/L doesn't occur in healthy people caused by conditions that impair excretion (renal failure), increase intake (oral K+ supplements) low, slow heart rate increased k+ affects many body systems: nervous, cardiac, respiratory, GI S/S: muscle weakness, paresthesia (numbness tingling), flaccid paralysis, bradycardia, dysrhythmia (can be fatal), cardiac arrest, respiratory depression, abnormal cramping, nausea, vomiting prevent muscles, nerves, gi system, heart from working correctly reduce supplements/change diet to restrict k+ kayexalate (sodium polystyrene)

Hypernatremia

High Na+ serum sodium levels exceeds 145 mEq/L loss of water with a near normal body sodium - not enough water to balance out salt intake causes: inadequate water intake, excessive sweating, fever, vomiting, diarrhea clinical manifestations - thirst, bounding pulse, increase blood pressure s/s of dehydration - restrict sodium in their diet give them fluids to dilute sodium (lower salt ratio to balance)

signs of impending dangerous complications of hyperglycemia

High amount of sugar (miss insulin/ not enough insulin, stressed, eat too much) Fruity breath as the ketones build up in the system and are excreted through the lungs Dehydration as fluid and important electrolytes are lost through the kidneys Slow, deep respirations (Kussmaul's respirations) as the body tried to rid itself of high acid levels → lungs are trying to compensate Loss of orientation and coma (type 1 DM situation → make sure they are getting insulin even if they are not eating or if they are going into surgery) - Type 2 don't get to this step because they have some insulin that protects them

risk factors for htn

High cholesterol High sodium diet → take away canned and prepackaged food, shaking salt, fast food Obesity → in conjunction with other risk factors Stress Caffeine Alcohol consumption → Encourage patient to decrease alcohol intake Genetics → if it runs in family get bp checked at a younger age Oral contraceptive use Smoking (bad combo with oral contraceptives)

lifestyle factors contributing to htn

High salt intake Obesity Excess alcohol consumption Dietary intake of potassium, calcium, and magnesium Oral contraceptive drugs Stress

gout - dietary management

High-purine foods: the 4 foods to avoid eating with gout Alcohol, soft drinks, sea food, liver

drugs for generalized seizures

Hydantoins - ***phenytoin (Dilantin)*** - Stabilize nerve membranes, reduce conduction, reduce movement of Na - Generally less sedating than other anti-seizure meds - Therapeutic serum level - 10-20 mcg/mL - IV - slow Adverse effects - CNS depression - Beware ETOH and other sedating meds - Do not stop abruptly - Liver toxicity */ renal toxicity (liver function blood tests more common) - *Gingival hyperplasia (gums get thicker and start to cover over teeth) - *Bone marrow suppression - *Skin reactions - can be severe - Arrhythmias; bradycardia, VF (ventricular fibrillation) Barbiturates - ***Phenobarbital (Luminal)** -- Inhibits impulse conduction in brain -- Decreases CNS excitation, motor response - Cautions: -- CNS depression -- Addiction/withdrawal - **Carbamazepine (Tegretol)** - Stabilizes nerve endings by altering sodium and calcium channels or increasing activity of GABA - Very long half life - long time to wean off - Nursing considerations -- *CNS effect -- Bone marrow suppression can occur so follow CBC, rash, renal or hepatic dysfunction, many drug interactions -- Hyponatremia Benzodiazepines (Benzos) - Diazepam (Valium) and Lorazepam (Ativan) -- Potentiate the effects of GABA decreasing nerve excitability -- Watch for paradoxical effects - should be suppressing seizure... in some patients it causes agitation -- Watch for CNS effect when taken with ETOH and other CNS depressants

metabolic syndrome

Hyperglycemia Intra-abdominal obesity Increased blood triglyceride levels Decreased HDL levels Increased blood pressure Systemic inflammation

negative feedback system

Hypothalamus senses a need for a particular hormone It secretes the releasing factor directly into the anterior pituitary In response, the anterior pituitary secretes the hormone In turn, it stimulates the gland The hypothalamus will sense increased levels of a particular hormone and send messages to the anterior pituitary to stop producing the hormone

mucolytics

Increase or liquefy respiratory secretions in high risk respiratory patients **acetylcysteine (Mucomyst) Can be used with a nebulizer Mist to help mucus Cautions: - Monitor for GI upset - Separate nebulizer - precipitates if mixed

rhabdomyolysis - treatment

IV fluid are used to prevent kidney failure and maintain adequate urinary output Dialysis

identification of the pathogen

Identification of the infecting pathogen is done by culture A culture of a tissue sample from the infected area is done A swab of infected tissue is allowed to grown on agar plate Staining techniques and microscopic examination identify the bacterium Classified according to: Aerobic or anaerobic - use of oxygen Gram stain - +/- by stain color

Type I hypersensitivity

IgE mediated, immediate (antigen will bind to IgE and IgE will release histamine) B cell and antibodies ex. asthma, allergic rhinitis, anaphylaxis after taking something before your body creates an antibody against it so when taken again allergic reaction occurs allergic response

osteopenia

Imbalance between bone formation and breakdown Decreased mineralization Bone mass is less than expected for person's age, ethnicity, or gender S/S; bone pain, fractures without trauma, kyphosis (thoracic curvature), height reduction

topical nasal decongestant sprays

Immediate onset of action Local effect, not generally systemic → just works in nasal mucosa (safer with people with high BP) **phenylephrine (Coricidin) Caution with cardiac patients, HTN, hyperthyroid Assess for adrenergic effects - HR, BP (safer than oral) Monitor for rebound, limit use 3-5 days If there is already a problem in your nose (ulcer) may not want to use

Methotrexate (trexall)

Immunosuppressant Given po, 3 times per week or weekly, or sq weekly Side effects: increased risk of infection, neutropenia, liver dysfunction, fatigue, nausea Pregnancy category X

compare and contrast common cellular structural adaptation

In cell biology and pathophysiology, cellular adaptation refers to changes made by a cell in response to adverse environmental changes. The adaptation may be physiologic(al) (normal) or pathologic(al) (abnormal)

heart failure

Inability of heart to function efficiently → low cardiac output LV remodeling with hypertrophy then ventricular dilation Variety of causes: HTN, valve disease, MI, cardiomyopathy

CBC = Complete Blood Count

Includes RBC, Hgb & Hct, WBC, platelet count HGB - measure of the amount of circulating hemoglobin (12-16 F, 13.5 - 17.5 M) Hct: the percent of RBCs in the blood (36-46 F 41-53 M) WBC - White blood cells (5,000-10,000 cells/mL) Platelet count - 150,000-350,000 cells/mL

HTN - causes

Increased SNS stimulation Increased activity of renin-angiotensin-aldosterone system Genetic variances Age related changes - Decreased vasodilation - Plaque formation White coat hypertension → monitor bp throughout day to determine whether or not they need medication

pyelonephritis

Infection of kidney due to ascending organism from lower urinary tract or from blood stream Manifestations: flank pain, fever, UTI sx Diagnostic tests: CT, renal u/s, cystourethrogram, urine and blood cultures Treatment: IVF, antipyretics, antibiotics

rhinosinusitis (sinusitis)

Infection or allergy obstructs sinus drainage Acute: facial pain, headache, purulent nasal discharge, decreased sense of smell, fever Chronic: nasal obstruction, fullness in the ears, post nasal drip, hoarseness, chronic cough, loss of taste and smell, unpleasant breath, headache

copd - mechanisms

Inflammation and fibrosis of the bronchial wall Hypertrophied mucous glands → excess mucus - Obstructed airflow Loss of alveolar tissue - Decreased surface area for gas exchange Loss of elastic lung fibers - Airway collapse, obstructed exhalation, air trapping

airway obstruction in asthma

Inflammatory mediators Airway inflammation - Increased mucociliary function - Edema - Epithelial injury Increased airway responsiveness - Bronchospasm - Airflow limitation

Kayexalate: brand name

Kayexalate

management of seizures

Keep patient safe - protect head, position on side to prevent aspiration Airway management and oxygen - if it goes on for too long... ischemic brain tissue or infarx Give meds to halt seizure; IV Benzodiazepine, usually Ativan (or Valium or Midazolam) If need another drug - IV Phenytoin or fosphenytoin (Cerebyx)

calcium channel blockers

Inhibit movement of calcium ions across myocardial/arterial muscle cells which: - Slows cardiac impulse - Causes vasodilation → reduction of blood pressure - Decrease of venous return - Also used as antiarrhythmic - Helpful with angina (relax blood vessels in coronary circulation and help return blood flow to the coronary arteries) **diltiazem (Cardizem) - Often used in extended release - Others: Amlodipine (Norvasc), Nifedipine (Procardia XL) Nursing considerations: - Contraindicated with Heart block, bradycardia, and hypotension - GI effects - nausea/constipation - Grapefruit juice can potentiate

Heparin

Inhibits the conversion of prothrombin to thrombin Indications - DVT prevention - Prevention of clottin gin blood samples/dialysis tubing - Drug choice in pregnancy - if necessary - MI and peri-procedure SC or IV IV continuous infusion - Weight based ordering - Monitor aPTT/PTT. Goal is 1.5 to 2.5 x normal value Watch for bleeding - Thrombocytopenia Heparin antidote - protamine sulfate

Inflammatory Pathways

Injured cells release arachidonic acid Arachidonic acid works via 2 pathways to produce inflammatory mediators - Lipoxygenase pathway to produce leukotriene - Cyclo-ogenase pathway (Cox 1 and Cox 2) to produce Prostaglandins and Thromboxane - Different anti-inflammatory drugs work to block these different pathways

addison's disease

Insufficient production of adrenal hormones Causes of Adrenal insufficiency - A patient does not produce enough ACTC - Adrenal glands are not able to respond to ACTH - Adrenal gland is damaged - Secondary to surgical removal of the gland - Prolonged use of corticosteroid hormones Treatment - corticosteroid replacement (small or large amount depending on where the problem lies)

arrhythmias

Involve changes of rate and rhythm due to automaticity or conduction abnormalities Causes - Electrolyte imbalance - Ca, K, Na, Mg - Hypoxia - Structural damage that alters conduction pathway - Acidosis/waste accumulation - renal failure - Other cardiac drugs - proarrhythmic

antithyroid treatment

Iodine solutions Cautions: - Monitor for hypothyroidism, begin replacement therapy - GI distress n/v/d - Teeth staining with liquids → use a straw - Monitor serum levels of some drugs

ferrous sulfate - category

Iron products / supplements

Macrocytic anemia (aka megaloblastic)

Large RBCs Normal amount of Hgb Examples are folate and B12 deficiency

leukotriene receptor antagonists

Leukotrienes - substances released when a trigger starts a series of chemical reactions in the body Leukotrienes cause inflammation, bronchoconstriction, and mucus production Result: coughing, wheezing, shortness of breath

treatment of hypothyroidism

Levothyroxine (Synthroid) - It's Synthetic T4 **Dose in micrograms Cautions: - Monitor for hyperthyroidism - Cardiac patients increased risk tremors, headache, nervousness

diuretics

Loop diuretics - act at loop of Henle to reduce absorption of chloride and sodium as well as water - Also may have some vasodilating effect, reducing preload and afterload - Relaxes arteries and veins - Primarily given to get rid of fluid

stress incontinence

Loss of urine from pressure (stress) exerted on bladder by : coughing, laughing, straining, sneezing, lifting heavy objects Cause : weakened pelvic floor muscles leading to weakened/incompetent sphincter muscle Treatment : kegels, bladder training Medications : alpha 1 agonists to increase internal sphincter tone

enoxaparin - brand

Lovenox, Lovenox HP, Clexane, Clexane Forte

diseases of the WBC

Lymphomas (B and T cell specific) - Hodgkin's lymphoma - Non-Hodgkin's lymphoma (NHL), ~40 types Leukemias - 4 types; Acute Lymphocytic Leukemia, Chronic Lymphocytic Leukemia, Acute Myeloid Leukemia, Chronic Myeloid Leukemia Multiple Myeloma (plasma cells that make antibodies)

types of bulk stimulants

Magnesium Citrate (Citrate of Magnesia) Magnesium Hydroxide (Milk of Magnesia) Lactulose (Chronulac) Psyllium (Metamucil) Polyethylene glycol (Miralax) Bulk forming fiber/ increases water Cause fecal matter to increase in bulk → turn gel like distend bowel to initate reflex bowel activity Often preferred for long term use Examples Psyllium (Metamucil) Methylcellulose (Citrucel) Polyethylene glycol (Miralax) electrolyte solutio

endocrine system

Main function is to maintain homeostasis Too much or too little glandular activity Disrupts homeostasis Leads to various disorders Interferes with the normal functioning of other endocrine glands

gout - risk factors

Male sex Overweight Increasing age High intake of alcohol, red meat, and fructose Drugs - thiazide diuretics

asthma - manifestations

Manifestations - wheeze, SOB, chest tightness Symptoms are more common at night

metronidazole (flagyl)

May be given po or IV, topical Side effects: Discoloration of urine (dark reddish brown) CNS - headache, dizziness, ataxia Metallic taste GI: N/V/D ETOH (alcohol) reaction

cardiac meds (general patient education)

Medication use/dosing/rationale - esp. missed dosage teaching Expected side effects Safety concerns When to call the PCP Need for daily weights at home Lifestyle changes - diet, exercise, eight loss, control of diabetes, smoking cessation Follow up appointment Social service referrals, VNA referral, nutrition consult

persons at risk for for iron deficiency anemia

Menstruating women who lose RBCs monthly Pregnant and nursing women who have increased demands for iron Rapidly growing adolescents, especially those who do not have a nutritious diet Persons with GI bleeding

acetaminophen

Mild to moderate pain relief and reduction of fever ** lacks anti-inflammatory effect **does not cause bleeding or GI problems ** can cause hepatotoxicity Frequently used in children **Antidote-acetylcysteine (Acetadote) PO or IV

antibiotics

Mode of effect - bactericidal or bacteriostatic Spectrum of effect - - Broad spectrum (a range of microorganisms) - Narrow spectrum (only a few microorganisms) Selectivity of antibiotic - toxicity - drug is selective in affecting those proteins utilized by pathogens but does not affect human host cells Antibiotics inhibit bacteria by inhibiting: - Cell wall synthesis - Protein synthesis - Nucleic acid synthesis - Metabolism Bacteria fight back by: - Inactivating antibiotics - Altering antibiotic binding sites - Using different metabolic pathways - Changing cell walls to keep antibiotics out

pyrogens

Molecules released by macrophages (WBC) that have been exposed to bacteria Travel to hypothalamus (part of the brain primarily responsible for body temperature). They pyrogens turn up the heat on the bacteria, producing fever and certain unpleasant environment Fever also increases metabolism, which facilitates healing and accelerates phagocytosis. Temp of 105 or more can be life threatening bc the heat affects proteins and enzymes needed by the body Antipyretic medication - tylenol, aspirin, and ibuprofen (reduces fever)

metoprolol (Lopressor)

Monitor VS (don't take HR less than 60 BP less than 100) Assess lung sounds (especially if new to medication... always a tiny effect on lungs (very minimally) → beta 1 effect just make sure there is no wheezing with bronchi constricting)

diarrhea

More than 3 bowel movements/day or liquid stool Causes: Osmotic Motility disorders Infectious Dx with stool samples for O&P, c diff, WBC Treatment : fluids, lytes, antidiarrheals

iron deficiency anemia

Most common type of anemia worldwide (RBCs) Cells are pale and small Clinical manifestations: cyanosis (blue coloration) to sclera of eyes, brittle nails that can be spoon shaped or concave, headache, lightheadedness, fatigue, sob (shortness of breath), unusual food cravings (pica) Diagnosis: H&H (Hgb and Hct), serum ferritin (stored iron), serum iron (circulating iron), might guilaic stool to look for blood loss in GI tract

warfarin (coumadin)

Most commonly used as oral anticoagulant Prevents synthesis of vitamin K by bacteria in the GI tract - This inhibits production of clotting factors II, VII, IX, and X -- known as the Vit K dependent factors Anticoagulant effects occur 2-5 days after oral use Indications: prevention or management of DVT, PE, and embolization associated with atrial fibrillation and prosthetic heart valves

fractures - healing direct

Most often occurs when surgical fixation is used to repair a broken bone Intramembranous bone formation No callus formation

Type 2 DM - pathogenesis

Multifactorial ; genetic, behavioral, environmental Familial predisposition Obesity - adipose tissue linked to excess free fatty acids which get deposited as fat into pancreas and are toxic to beta cells. FFAs (free fatty acids) inhibit glucose uptake by cells and glycogen storage FFAs interfere with liver insulin sensitivity so liver makes more glucose Also adipocytes make less adiponectin. Adiponectin typically increases tissue sensitivity to insulin. With less adiponectin made you have reduced insulin sensitivity Decreased incretin hormones leading to less insulin secretion from pancreas

cardiomyopathy heart failure

Muscle issue with the heart (cardiomyopathy) If heart muscle is not contracting as strongly as it should the heart can not work as ultimately and lead to heart failure (weaker and not working as it should) Three types of cardiomyopathy - dilated (ventricles enlarge) - hypertrophic (walls of the ventricles thicken and become stiff) - restrictive (walls of ventricles become stiff, but not necessarily thickened) - Cardiomyopathy... = Can be congenital → may not be evident until they are older = Develop heart weakness due to heart attacks = Chemotherapy can weaken heart muscle = Alcohol and other toxins can weaken heart muscle = Weakness due to heart valve = High BP

TIA manifestations

Muscle weakness or paralysis of the face, arm, or leg (usually unilateral) Unilateral paresthesia Aphasia or receptive aphasia Dysphagia Change in levels of consciousness Confusion Vision issues (e.g. diplopia, nystagmus, and partial or complete loss of vision) Ataxia Vertigo or dizziness - Different part of the brain can correlate with different symptoms

vancomycin

Must be given orally to treat c diff Usually given qid for 10-14 days If recurrent c diff: dose may be high with a tapered dosing schedule S/E: N/V, ringing in ears or hearing loss, kidney dysfunction Given for other things: mrsa, serious staph infection

gout treatment

NSAIDS or steroids (prednisone) Colchicine - Begin with symptom onset Rapid symptom relief, within 12 hours Side effects - diarrhea Allopurinol (zyloprim) - blocks uric acid production (working at the xanthine step) Taken daily Maintenance treatment Side effect - rask or steven-johnson syndrome Bone marrow suppression

effect of glucocorticoids on body

Named for stimulation of glucose for energy Effect on body processes - Increase protein breakdown, decrease protein formation (more protein breakdown) - Inhibit action of lymphocytes/antibodies - Increase lipogenesis: formation and storage of fat - Growth retardation due to suppression of hypothalamic-pituitary function Inflammation/healing - Decreases action of neutrophils and macrophages - Decreases capillary permeability → reducing inflammation but protein/nutrients as well Nervous system - Decrease nerve excitability, slow activity in cerebral cortex GI System - Decrease viscosity of mucus Musculoskeletal system - Cause muscle breakdown r/t lack of protein synthesis - Decrease bone formation, increase breakdown - Decrease calcium absorption in intestines, increases renal excretion (osteoporosis) Respiratory - helps to maintain open airway, responsiveness to endogenous epinephrine, inhibit release of histamines Mental status - Short or long term use can lead to steroid psychosis, anxiety, insomnia Adrenal suppression → causing body's own production to stop - Caused impaired stress response; patient unable to respond to stressors such as surgery, trauma - Use short courses, taper and off whenever possible

atherosclerosis - clinical manifestations

Narrowing of the vessel and production of ischemia Sudden vessel obstruction due to plaque hemorrhage or rupture Thrombosis and formation of emboli resulting from damage to the vessel endothelium aneurysm formation due to weakening of the vessel wall

inhaled corticosteroids

Need to take every day or it wont work Take bronchodilator first and then steroid if using both *budesonide (Pulmicort Turbuhaler) fluticasone (Flovent) beclomethasone (Beclovent, Vanceril) ** inhalation advantage - does not produce systemic effects ** Go right to the airway and directly reduce inflammation Nursing considerations: - Pharyngeal irritation, coughing, dry mouth - Oral fungal infections - rinse mouth after use of inhaled steroids - Bronchodilator first... then steroid

prerenal, intrarenal, post renal

Nephrotoxic antibodies - intrarenal Renal ischemia during surgery - prerenal or intrarenal Bilateral renal calculi - intrarenal or post renal Massive hemorrhage - prerenal Untreated enlarged prostate - post renal

antacids

Neutralize stomach acid once it is in the stomach → does not change the amount of acid produced Promote gastric mucosal defense mechanisms Antacids DO NOT prevent over production of acid Used alone or in combination: Aluminum salts Magnesium salts Calcium salts Sodium bicarbonate

emphysema

Neutrophils in the alveoli secrete trypsin - Increased neutrophil numbers due to inhaled irritants can damage alveoli - Neutrophils release protease enzymes such as trypsin which break down elastin and other alveolar wall components α1 -antitrypsin (antiprotease enzyme) inactivates the trypsin before it can damage the alveoli - A genetic defect in α1 -antitrypsin synthesis to alveolar damage End result is loss of lung elasticity and abnormal enlargement of the distal air spaces, destruction of alveolar walls and capillary beds reduces the sites for gas exchange. There is increased lung compliance and loss of elastic recoil With reduced elasticity there is air trapping > hyperinflation of lungs Primary manifestation is SOB Barrel chest, finger clubbing, hyperinflated lungs

pharmacologic treatment for CAD/MI

Nitrates - coronary vasodilation to improve blood flow, relieve CP Beta blockers - Block SNS (catecholamine) stimulation of beta -1 receptors in heart... cardio-protective. See HR and contractility reduced. BP also lowered (lower hr, bp, and relax heart muscle → take demand off of heart) - Pill form (pt may go home with) and IV(ED) Antiplatelet agents - thin blood, prevent thrombus

intrinsic (nonatopic) asthma

No allergic component Triggers include: exercise, cold air, drugs, air-borne pollutants, upper respiratory infections, emotional stress

Normocytic anemia

Normal size Normal Hgb content Insufficient number of RBCs Many etiologies including Chronic kidney disease, cancers, autoimmune disorders

corticosteroids

Reduces inflammation Take a few days to see effect May be combined in bronchodilator In acute episodes corticosteroids is given IV or/then orally for several days

clinical manifestations of sickle cell anemia

Not usually seen in newborns until 4-5 months because of fetal hemoglobin's unique properties Edema of hands and feet is the first sign/symptom along with fever Vaso-occlusions block blood vessels causing ischemia and necrosis. This results in a painful sickle crisis. Can last hours to days Complications depend on location of obstructed blood flow Episodes can be triggered by dehydration, stress, high altitudes, and extreme temperatures Avoidance of triggers is important With good management most can live into their 50s Clinical manifestations reflect hypoxia and tissue ischemia: fatigue, fever, angina, leg ulcers A simple blood test can detect defective gene Diagnosis: CBC and Bilirubin test (break down of RBC releases bilirubin) Treatment: Stem cell transplant for cure Medication: hydroxyurea

laxatives - nursing concerns

Obtain a thorough history of presenting symptoms, elimination patterns, and allergies Assess fluid and electrolytes Hold for nausea, vomiting, and/or abdominal pain, s/s of obstruction A health, high fiber diet and increased fluid intake should be encouraged as an alternative to laxative use Long-term use of laxatives often results in decreased bowel tone and may lead to dependency All laxative tablets should be swallowed whole, not crushed or chewed, especially if enteric coated Take tablets with 6-8 oz of water

antidiarrheals - nursing concerns

Obtain through history of bowel patterns, general state of health, and recent history of illness or dietary changes, and assess for allergies Rule out acute abdominal condition, infectious process before administering Teach patients to take medications exactly as prescribed and to be aware of their fluid intake, dietary, and medication changes Assess fluid volume status, I&O, and mucous membranes before, during, and after irritation of treatment Monitor for therapeutic effec

folic acid and vitamin B12

Often given together Folic Acid (Leucovorin) and B12 (Hydroxocobalamin) B12 of IM, Folic acid usually PO Assess nutrition; green leafies, meats, fish

neuromuscular abnormalities - muscle spasm

Often results from injury to the musculoskeletal system Caused by the flood of sensory impulses coming to the spinal cord from the injured area Sudden, involuntary tightness or contraction of a muscle

tetracylines - class of antibiotic

Older broad spectrum, not used extensively due to resistance *** tetracycline *** - Doxycycline Useful when PCN allergy present - STDs including Chlamydia - Acne - Lyme disease

prednisone

One of the glucocorticoids. Other names - hydrocortisone, cortisone Cause anti-inflammatory and immuno-suppressive effects Can be po, iv, topical Take an oral dose at the same time each day, usually am. Wean dose down, don't stop abruptly Adverse effects: infection risk, Na and fluid retention/weight gain, elevated BS, muscle weakness, osteoporosis, fragile skin and poor wound healing

decongestants

Open things up and reduce the secretions that make you feel full Usually adrenergics/sympathomimetics (stimulates the sympathetic nervous system) Decrease secretions by vasoconstriction Vasoconstriction shrinks swollen membranes, opens passages → expect to start feeling less congested and blowing your nose Three varieties: Oral Topical nasal sprays Topical nasal steroids

COPD treatment

Overlapping treatment for both types Smoking cessation Oxygen Bronchodilators - Beta agonists, anticholinergics, xanthines Steroids - IV or inhaled Antibiotics → lung infection at risk due to not having lungs that work well

treatment of mi

Oxygen → heart muscle is craving oxygen Aspirin → prevent blood clots (chew so it gets absorbed faster) Nitroglycerine Morphine → helpful for chest pain and relax pt Plavix Heparin Fibrinolytics Percutaneous coronary intervention

Penicillins - class of antibiotic

PCN and related antibiotics First antibiotic introduced for clinical use Resistance = bacteria synthesizes enzyme penicillinase to counter PCN effects Penicillinase - resistant antibiotic - used for bacteria resistant to PCN Beta lactamase inhibitors added to PCN to prevent breakdown of PCN PCN Antibiotics Indicated for strep pharyngitis, endocarditis, meningococcal meningitis, pneumococcal infections, gonococcal infections PCN Broad-spectrum penicillin *** Amoxicillin ***, ampicillin Penicillinase resistant antibiotics Nafcillin, oxacillin Beta Lactamase inhibitors added with PCN Augmentin, timentin, Zosyn

asthma - diagnosis

PFTs (pulmonary function tests → look at lung volumes and how much you can take in/exhale → non invasive but more than peak flow → helps differentiate asthma from COPD) reduced peak expiratory flow

oxybutynin (Ditropan)

PO and by patch and topical gel Contraindicated with urinary obstructive disease and glaucoma Monitor for anticholinergic effects - dry mouth, drowsiness, dizziness, blurred vision, urinary hesitancy, decreased sweating Assess urinary pattern, presence of UTI Encourage fluid intake to prevent urinary stasis and flush the bladder

Lasix: Route

PO, IV

Kayexalate: route

PO, PR

osteoarthritis - manifestations

Pain (worsens with activity) Stiffness (diminishes with activity) Enlargement of the joint Tenderness Limited motion Muscle wasting Partial dislocation Deformity

benign prostatic hyperplasia

Pathogenesis is not totally understood DHT (dihydrotestosterone), an androgen induce its growth Overgrowth of mucosal glands of prostate especially in periurethral area The enlargement of the gland surrounding the urethra leads to discomfort, difficulting in initiating a stream of urine, feelings of bloating, and an increased incidence of cystitis

nursing considerations for anti platelet and anticoagulant drugs

Patient history - prior bleeding, uncontrolled BP, recent or upcoming surgery Monitor for bleeding especially if patient taking several anticoagulant meds, GI distress, monitor for bruising

factors delaying bone healing

Patient's age Current medications (antacids, steroids, ppi's) Debilitating diseases (chronic kidney disease → have problems with calcium, vit D, and have weaker bones to begin with... people with inflammatory bowel diseases (crohns and colitis → don't absorb calcium as well... people with thyroid issues) Circulatory problems Coagulation disorders Poor nutrition (don't have a lot of dairy intake, vitamin D deficient)

inflammatory mediators

Plasma derived - made in the liver and are circulating in plasma - examples are clotting factors and complement proteins. Complement proteins form rings around Antigen-antibody complexes. Attracting phagocytes and release mediators like histamine Histamine - released by certain white cells, causes vasodilation and increases permeability of capillary walls so white cells can get by and get to walls of infection Antihistamine - prevents the swelling and stops the process such as benadryl Cell derived - released from cells such as tissue macrophages, mast cells, endothelial cells, leukocytes and platelets. These mediators include histamine, serotonin (from platelets) , prostaglandin, leukotrienes (part of inflammatory response to bring more white blood cells and help with platelet aggregation so bacteria can get stuck to these cells) Mediators come out of the cells themselves

Potassium in the body

Plays crucial role in electrical conduction (heart), acid base balance, and metabolism Potassium in large quantities in the intracellular space and can be utilized if serum levels drop Serum K+ has very little room for fluctuations up or down without causing serious issues The sodium-potassium pump and the kidneys regulate K+ Diet sources: cantaloupes, raisins, bananas, oranges, green leafy vegetables, and lentils K+ excreted in kidneys (renal failure K+ is elevated) Can also be lost in the GI tract (via vomiting diarrhea)

DM Type 1 s/s

Polyuria Polydipsia Polyphagia Weight loss Fatigue Increase frequency of infections Rapid onset Insulin dependent Familial tendency Peak incidence from 10 to 15 years of age

insulin pens

Pre-filled with insulin; single kind or mixed, deliver insulin SQ, discard after use

corticosteroids

Prednisone is the most common example of glucocorticoids. Other names - hydrocortisone, cortisone, methylprednisolone Acts as anti-inflammatory agents but also have immuno-suppressive effects Can be po, IV, topical Take an oral dose at same time each day, usually am. Wean dose down, don't stop abruptly Adverse effects: increased infection risk, Na and fluid retention/weight gain, elevated BS, muscle weakness, osteoporosis, fragile skin, and poor wound healing

micturition = urination

Pressure of urine in bladder stretches the detrusor muscle and it contracts to expel urine into urethra 2 urethral sphincters; 1 internal in bladder neck is a continuation of detrusor muscle - When detrusor muscle contracts, the internal sphincter is pulled down 1 external comprised of skeletal muscle - " back up" to internal sphincter to maintain continence. It relaxes when the detrusor muscle/internal sphincter contract to let urine flow The inner lining of bladder, the urothelium transmit sensory info to sensory afferent nerves in the detrusor muscle to spinal cord and then cerebral cortex SNS controls bladder relaxation and storage of urine → you aren't going to urinate PSNS controls bladder emptying → encourage voiding Somatic nervous system controls the external sphincter

Glucophage (metformin) - Biguanides

Primarily decreases glucose production in liver Improves insulin sensitivity May also decrease intestinal absorption of glucose Decrease in triglycerides and cholesterol Does not stimulate insulin secretion Does not cause significant weight gain or hypoglycemia

hematopoiesis

Primarily occurs in the bone marrow Pluripotent stem cells differentiate into myeloid and lymphoid stem cells Myeloid stem cells further differentiate into WBC (monocytes and granulocytes) the RBC and platelets Lymphoid stem cells become B and T cells

diverticular disease manifestations

Range from painless rectal bleeding to mild to moderate, aching *LLQ abdominal pain Constipation or diarrhea; n/v Low grade fever, LLQ tenderness, palpable mass; hypoactive bowel sounds

osteoporosis

Progressive loss of bone calcium >> decreased bone mineral density (BMD) Decreased cancellous (spongy) bone strength Decreased bone matrix and mineralization Could be decrease in osteoblast activity or increase in osteoclast activity resulting in Bone resorption > bone formation Can detect on x-ray → shows up more white More common in caucasions and asians Fractures are the major complication, especially hip, spine, and wrist

Nutritional insulin

Rapid acting insulin (Lispro, Aspart) Short acting (Regular) - Given when tray is served or immediately after

rhabdomyolysis

Rapid breakdown of muscle that causes the release of intracellular contents, including the protein pigment myoglobin, into the bloodstream Can result in hyperkalemia, cardiac arrhythmia, or acute renal failure Statins can lead to this in extreme side effect cases Fallen and can't get up for a few days → muscle breakdown Has been found in athletes who exercise at sustained large events Intrarenal disturbance that results in kidneys not working well

ventricular tachycardia

Rapid rhythm from ventricle Resultant reduced cardiac output, low BP, lightheadedness May require cardioversion to terminate rhythm Diagnose with EKG, holder monitor Meds - Amiodarone (IV and po) - Beta blockers Treatment - implantable cardioverter defibrillator (ICD) Meds - amiodarone (IV and po) beta blockers

osteoporosis treatment

Reduce risk factors Calcium / vitamin D Bisphonoates - inhibit bone breakdown and strengthen bone Selective Estrogen receptor modulators (SERMs) - mimics the effects of the hormone estrogen, which increases bone density Bisphoshonates ** alendronate (Fosomax) - can be daily or weekly Must be taken first thing in morning, with full glass of water, 30 minutes before any food or other meals Remain upright for 30 minutes after taking med to aid in digestion and reduce risk of esophageal erosion Side effects - headache, nausea, and diarrhea

neural control of bladder function

Reflex at spinal cord level (thoracic for SNS and sacral for PSNS) Micturition center in pons affects detrusor muscle and internal sphincter. Gets sensory info from bladder and sends motor impulses back Cortical center in brain allow for voluntary control Muscarinic M3 receptors receive PSNS info at detrusor muscle → muscle contracts Alpha 1 in internal sphincter and Beta 3 receptors in detrusor muscle (these are SNS) Stimulate A1 → internal sphincter contracts bladder relaxes and fills Stimulate B 3 receptors → bladder relaxes and fills

thiazide diuretics

Related to sulfonamides* → an allergy to sulfa be cautious of giving thiazide diuretic Inhibit reabsorption of NA, K, and Cl → results in water loss Examples: hydrochlorothiazide (HydroDiuril) = HCTZ (most common) → daily medicine nursing considerations: - Allergy to sulfonamides - Severe renal disease - check renal labs - Monitor BP, follow I/O's at risk for Hypotension - Check BS in diabetics (causes a high blood sugar) - Can precipitate gout → increase in uric acid chlorothiazide (Diuril) → older version of HCTZ metolazone (Zaroxolyn) Work in the distal convoluted tubule In most cases with patients with high BP they will first be administered a diuretic

nitrates

Relax smooth muscle producing vasodilation → increase blood flow to ischemic areas Dilation reduces venous pressure/return → reduce preload Dilation reduces peripheral vascular resistance (afterload) → reduces blood pressure - Check BP before and after administration → often see a drop in bp (if it is already under 100 can't administer nitrates) Multiple routes of administration - Sublingual (in prn situations), buccal, chewable, tablets, capsules, ointments, patches, and IVs -- Depending how fast you want it to work (sublingual is fastest)

calcitonin

Released by the thyroid when blood calcium is high Inhibits the release of calcium from bone - Inhibits osteoclast activity Inhibits calcium and phosphate kidney reabsorption

insulin - action

Released into circulation when the levels of glucose around these cells rise Insulin stimulates uptake, use, and storage of glucose Glucose → glycogen (glycogenesis) Glucose → fat (lipogenesis) → adipose tissue Protein synthesis Insulin inhibits Glycogen breakdown (glycogenolysis) Fat breakdown (lipolysis) Protein breakdown → glucose (gluconeogenesis)

bone remodeling

Resorption: osteoclasts remove areas of bone Formation: osteoblasts replace bone Resorption > formation → loss of bone mass Process influenced by osteoprotegerin (OPG) and RANKL - OPG inhibits osteoclasts and RANKL - Less RANKL >> less osteoclast activity

symptoms of anemia

Respiratory - shortness of breath Digestion - change in stool color Muscle - pain Fainting and fatigue Heart - angina and heart attack Spleen - enlargement Skin - yellowing or paleness Spoon shaping of nails (concave) - not treated quickly enough

neuromuscular abnormalities - muscle spasticity

Result of damage to neurons within the CNS May result from an increase in excitatory influence or a decrease in inhibitory influences within the CNS Sustained activation of muscles that often leads to stiffness, heaviness of limbs

Kayexalate: Rx or OTC

Rx

Lasix: Rx or OTC

Rx

medication use (np and med admin)

Rx, OTC, herbal and dietary supplements, allergic reactions, attitudes about drugs, cultural variations

PE clinical manifestations

SOB (more acute), hypoxia, hemoptysis (coughing up blood → bleeding in lung tissue), pleuritic CP (hurts to take a breath in), elevated RR, elevated HR

COPD - manifestations

SOB, sputum, cough, barrel chest, pursed lip breathing, use of accessory muscles

Memory cue for side effects of steroids

SWISS salt water/weight infection sugar sex - gynecomastia, hirsutism

summary - cardiac meds general nursing considerations

Safe administration - 6 rights - Review labs - renal, liver, electrolytes, drug levels - Pre-med VS - check for parameters as ordered - Do not crush long acting - ECG monitoring for acute episodes - Daily weights - esp with diuretics, HF pts - I and Os - Space out dosing - Document effects - written, VS, ECG strips

hydrochloric acid (HCl)

Secreted by parietal cells when stimulated by food Maintains acidic stomach pH Secretion also stimulated by: - Large fatty meals - Excessive amounts of alcohol - Emotional stress (think SNS stimulation)

parathyroid hormone

Secreted when blood calcium levels decrease Increases blood calcium by increasing: - Bone resorption - Kidney resorption - Intestinal absorption through vitamin D Decreased blood phosphate by decreasing: - Kidney reabsorption

hypercholesterolemia

Serum cholesterol levels 240 mg/dL or greater is elevated Elevated levels could contribute to a heart attack, stroke, or other cardiovascular event associated with atherosclerosis

Myxedematous Coma

Severe end stage hypothyroidism (not detected or not picked up) = myxedematous coma Manifestations - CV collapse, coma, hypothermia, hypoventilation Can lead to death if there is not an immediate intervention

sensitivity of pathogen to drug

Shows which drugs are capable of controlling the particular microorganism Is important with microorganism that have known resistant strains Along with a culture, identifies the pathogen and appropriate drug for treatment

constipation

Slower emptying of large intestine *symptom, not a disease* Fewer than 3 BMs per week, hard stool, strain at stool, or incomplete evacuation Can be caused by a variety of diseases or drugs Treatment determined by patient condition Drugs used to speed up, stimulate, or improve motility or soften stool: - Laxatives - Stool softeners

Sodium in the body

Sodium is ingested in our diet The recommended amount dietary allowance (RDA) of sodium is 2-4 grams. Sodium can be found in many sources such as table sale (1 tsp has more than 2 grams of sodium), processed or packaged foods, (canned food and deli meat), snacks, chips, condiments like ketchup and hot sauce, certain seasoning like garlic sale and seasoning salt Normally sodium losses occur in the kidney. Excessive losses can occur through the GI tract via vomiting diarrhea, and nasogastric suctioning. Extensive burns can also cause sodium losses through the skin. Sodium, losses can occur with excessive sweating (fever, strenuous exercise)

patient teaching all anti-coagulants

Soft toothbrush Electric razor No IM shots Hold venipuncture sites Monitor for bleeding, bruising When/what to report Dietary restrictions (warfarin) Let PCP know of other meds - ASA, Motrin, PCNs, cephalosporins No contact sports Note allergy - consider for ALL heparin products Medical alert bracelet Avoid OTC drugs -- addition of other drugs

diabetic neuropathy

Somatic neuropathy - Diminished perception : vibration, pain, temperature - Hypersensitivity : light touch, occasionally severe "burning" pain Autonomic neuropathy - Defects in vasomotor and cardiac responses - Inability to empty the bladder - Impaired motility of the gi tract - Sexual dysfunction

sliding scale insulin (supplemental insulin)

Sometimes called correctional insulin Given in combination with nutritional insulin Based on the blood sugar reading

cephalosporins - class of antibiotics

Structura;ly and pharmacologically related to penicillin *** potential cross sensitivity with PCN if allergies exist *** Broad spectrum-gram positive/negative but effectiveness varies with each generation Used for skin and respiratory infections, pre-op prophylaxis Over time they make new ones due to bugs (different generations) *assess for allergy to PCN

urge incontinence

Sudden urge to urinate followed by an involuntary loss of urine Have involuntary bladder contractions ex. overactive bladder Causes - UTI, bladder irritants, bowel conditions, nervous system damage

proton pump inhibitors

Suppress secretion of HCL into lumen of the stomach Intended for short term use lansoprazole (Prevacid) omeprazole (Prilosec)** rabeprazole (Aciphex) pantoprazole (Protonix) (IV form available) esomeprazole (Nexium)

gout

Syndrome caused by either overproduction or underexcretion of uric acid. Linked to purine metabolism Manifestations high levels of uric acid in the blood and other body fluids Occurs when the uric acid concentration increases to high enough levels of crystallize Crystals deposit in connective tissues throughout the body When these crystals occur in the synovial fluid, the inflammation is known as gouty arthritis More common in males and African Americans

CAR-T therapy

Taking patient's own T cells, genetically engineering them in lab and then returning them to patient to attack malignant cells Individualized for each patient Used in lymphoma, leukemia (ALL - acute lymphocytic leukemia)

Sodium Movement across cell membrane

The cellular membrane is permeable to sodium, but it is dependent on the sodium-potassium pump As sodium moves into the cell, potassium shifts out, resulting in depolarization (increasing membrane potential and excitability) of the cell membrane When sodium shifts back out of the cell, potassium moves back into the cell, resulting in repolarization (restoring resting potential) of the cell membrane

what is blood pressure

The force of blood against artery walls Recorded as 2 numbers Systolic pressure - heart contracts Diastolic pressure - heart relaxes

HTN target organ damage

The heart - Hypertrophy Brain - Dementia and cognitive impairment Peripheral vascular - Atherosclerosis Kidney - Nephrosclerosis Retinal complications (retinal hemorrhaging) Hemorrhagic stroke

hypothalamus and anterior pituitary

The hypothalamus releases (neuro)hormones Growth hormone - releasing hormone (GHRH) Thyrotropin - releasing hormone (TRH) Gonadotropin - releasing hormone (GnRH) Corticotropin - releasing hormone (CRH) Prolactin - releasing hormone (PRH) These hormones enter portal circulation → anterior pituitary endocrine cells with receptors A vascular network carries the hypothalamic releasing factors directly into the anterior pituitary The anterior pituitary releases its hormones Enter systemic circulation cells → with receptors

Hemoglobin A1C

There is a correlation between A1c levels and average blood sugar levels as follows 4% --> 60 5% --> 90 6% --> 120 7% --> 150 8% --> 180 9% --> 210 10% --> 240 11% --> 270 12% --> 300 13% --> 330

fractures - treatment

Three objectives for treatment of fractures Reduction of the fracture - Closed manipulation or surgical reduction Immobilization - Immobilization through the use of external devices Preservation and restoration of the function

different types of emboli

Thrombus → blood clot that has traveled Fat Amniotic Air Foreign substance

thyroid gland

Thyroid produces the hormones: Thyroxine (T4) Triiodothyronine (T3) Calcitonin Requires iodine to produce its hormones

diabetes insipidus - di

Too little ADH - Reduced synthesis of ADH in hypothalamus - Impaired response of kidneys to ADH - Copious dilute urine - Risk for dehydration and hypernatremia

SIADH - syndrome of inappropriate adh

Too much ADH Impaired negative feedback system Surgery, pain, and stress stimulate excess secretion of ADH in CNS Fluid retention Hyponatremia Treat with fluid restriction

seizure

Transient physical or behavioral alteration that results from abnormal electrical activity in the brain Etiology - altered membrane ion channels, altered extracellular electrolytes and imbalances in excitatory and inhibitory neurotransmitters Manifestations of seizures depends on: - Location of cells initiating electrical impulse - Pathways that are stimulated Diagnosis - EEG, head CT Complications - TBI, aspiration, and status epilepticus

drugs for treating BPH

Two types of drugs used to relieve symptoms of BPH Alpha-1 adrenergic blockers 5-Alpha Reductase inhibitors - drugs that black the effect of androgen and the prostate testosterone effect

extrinsic (atopic) asthma

Type I hypersensitivity: increased IgE synthesis Allergens such as: dust, pet dander - Mast cells release inflammatory mediators - Cause acute response within 10 to 20 minutes -- WBCs enter region and release more inflammatory mediators Airway inflammation causes late-phase response in 4 to 8 hours Want to figure out what the allergen is that is triggering their response

mechanism of development of atherosclerosis

Types of lesions associated with atherosclerosis: Fatty streaks - Thin, flat yellow intimal discolorations that progressively enlarge Fibrous atheromatous plaque - The accumulation of intracellular and extracellular lipids, proliferation of vascular smooth muscle cells, and formation of scar tissue Monocytes attach to the endothelium → macrophages Macrophages release free radicals → oxidized LDL Macrophages ingest oxidized LDL → foam cells WBCs, platelets, and vascular endothelium release chemicals that promote plaque formation Plaques block the arteries

urinary incontinence

Urge incontinence Stress incontinence History - what time of day are they incontinent... Diagnostic tests - UA, bladder diary, cystourethrogram x ray, cystoscopy, PVR, pelvic US Treatment - bladder training, scheduled toileting, fluid and diet changes, Kegels, Meds, surgery

insulin pumps

Typically for Type 1 Deliver rapid or short acting insulin over 24 hours Insulin can be: Basal Bolus Correctional May need to modify for procedures, surgery, diagnostic tests → check hospital policy/hcp order

drugs for seizures

Typically selected based on type of seizure Categories of antiseizure drugs that either - Increase GABA (more inhibition) or decrease Glutamate (reduce stimulation) - Alter influx of NA - Alter influx of Calcium Medications for acute cessation of seizure and preventions of seizure - Meds block Na influx: carbamazepine, Topiramate, Phenytoin, Lamotrigine, Valproic Acid - Meds block Ca Influx: Lamotrigine, ethosuximide, Topiramate, Pregabalin, Gabapentin - Meds that reduce glutamate: Levetiracetam - Meds that increase GABA: Benzodiazepines, Barbiturates Most agents affect entire brain - watch for sedation and dizzinessra

disorders fo the gallbladder - meds

Ursodiol (Actigall) Used to dissolve gallstone and prevent their formation It is a bile acid that decreases the amount of cholesterol produced by the liver and absorbed by the intestines. This medicine helps break down cholesterol that has formed into stones in the gallbladder. This medicine also increases bile flow in patients with primary biliary cirrhosis Actigall is indicated for patients with radiolucent, noncalcified gallbladder stones < 20 mm in greatest diameter Actigall will not dissolve calcified cholesterol stones, radiopaque stones, or radiolucent bile pigment stones S/E - N/D/V, mild abdominal pain, dizziness, H/A

ESAs Considerations

Use with caution with CVD and hx of stroke Contraindicated in: - Uncontrolled hypertension - Monitor for serious allergy/anaphylactic reaction post administration Adverse effects: - CNS - headache, fatigue, arthralgias, dizziness, and seizure - Nausea, vomiting, and diarrhea - CV - hypertension, edema, possible chest pain Follow patient labs - give medication when labs show needed (HGB below 10, do not give if 11 or higher) - Blowed rechecked to make sure HGB and HCT reacted

beta blockers

Used in variety of clinical situations: Heart rate control, HTN, acute MI, angina prevention, irregular heart rhythms Not meant for just high BP due to it affecting other areas as well Get multiple benefits of beta blockers... good for patients that have several things going on Beta blockers inhibit: - SNS stimulation - Decreases rate and force of contraction - Decreases O2 demand by heart - Decreases BP Examples: atenolol (Tenormin) metoprolol (lopressor) (seen most often... comes in short and long acting form → can give it 2+ a day in short acting or 1x a day in long acting) propranolol (Inderal) Monitor for HR and BP when taking bc it effects both Can block beta 1 and beta 1 → can have an effect on the lungs Some are more specific on heart (Beta 1) → preferred for people with heart issues so it has no effect on the lungs **metoprolol (lopressor)

drugs affecting motility

Used to decrease GI tract movement - Has a direct effect on the muscle layers of the GI tract; slows peristalsis and allows increased time for absorption of fluid and electrolytes *loperamide (Imodium) - Can be taken prn Contrast: - Acute abd process, infectious process Monitor: - Constipation, dehydration, CNS effects with opium

osteoarthritis - surgical treatment

Used to improve joint movement, correct deformity, or malalignment, or create a new joint with artificial implants

fixed combination insulin

Usually intermediate acting with rapid or short Numerical designation indicates percentage of each of two component Example: Humulin 70/30 and Novolog 70/30

chronic anti-epiletic drugs

Valproic acid (Depakote) Gabapentin (Neurontin) Lamotrigine (Lamacital) Levetiracetam (Keppra) Topiramate (Topamax) Taper dose up or down while monitoring drug levels and appropriate lab tests - Maintain at lowest, effective dose - Optimal dose guided by seizure frequency and side effects

patient education about antiarrhythmics

Vitals prior to administration always Monitor for med induced arrhythmias teach/monitor for hypotension Teach, teach, teach patients

manifestations of inflammatory response

Warm and redness due to the rush of white blood cells? Swelling bc of fluid released into the tissue Swelling can cause discomfort (pain) Loss of function relates to swelling and pain contributing to not being able to use a particular area to perform functions it normally does Protect the area so it is able to heal Key signs and symptoms for inflammatory response Redness - reuber/arithemer Swelling - edema

insulin signaling

We need to get glucose in our circulation after eating into our cells Insulin will bind to receptors that allows glucose to bind to GLUT4 (glucose transporter) to come into cell If we don't have insulin we can't get glucose into cells and we have a high glucose level in our blood

systematic whole body response

White blood cell response -Inflammatory mediators cause WBC production - WBC count rises (4-10/11 normal range) → leukocytosis - Immature neutrophils released into blood Acute-phase response - Leukocytes release interleukins and tumor necrosis factor --Affect thermoregulatory center → fever --Affect the CNS → lethargy --Skeletal muscle breakdown

maintenance of antianginal drugs

Work by: - Dilating blood vessels - Decreasing work of heart Types of antianginals - aspirin - Nitrates - Nonselective and selective beta-blockers - Calcium channel blockers

oral diabetic medications

Work in a variety of ways - Stimulate pancreas to release insulin - Decrease insulin resistance - Alter glucose absorption in GI - Control release of glucose from liver - Change absorption of glucose in the kidney Adjunct to diet and exercise, can be used with insulin - type II diabetes only

laxatives

Work in three ways Direct chemical stimulation of GI tract Production of bul or increased fluid in the lumen Lubrication of the intestinal bolus to promote passage through the gi tract

nursing implications - respiratory

Yearly flu vaccine If constricted breathing occurs use short acting inhaler (albuterol) for rescule Monitor for appropriate dosing frequency Pneumonia vaccine → five years Refer to VNA to assess home environment for triggers/compliance Review when to call PCP Make sure they use inhaler correctly

idiopathic

a disease or condition that arises spontaneously or where the cause is unknown

genetic disease

a disease that is caused by a change, or mutation, in an individual's DNA sequence... caused by changes in a person's DNA genes or heredity

cancer

a disorder of altered cell differentiation and growth new growth is a neoplasm

insulin - definition

a hormone produced by the beta cells of the islets of Langerhans

remission

a reduction or disappearance of signs and symptoms of disease... no longer evidence of the disease

bronchial asthma

a respiratory disorder characterized by reversible narrowing of the bronchial passages

heparin - monitoring considerations

aPTT (before initiation of heparin, every six hours thereafter until stable, then daily - normal value 1.5-2.5)... considered stable when two aPTT drawn 24 hours apart are within therapeutic range. Platelet count daily. Monitor daily for side effects. Monitor OTC drugs... do not take other medications that thin blood.

crohns common manifestations

abdominal pain, diarrhea with frequent stool, perianal pain, non GI sx- uveitis, joint pain

dysplasia

abnormal changes in size, shape, and organization of mature cell matured cells taking on a weird shape (often precancerous) can be identified as low or high grade (higher grade are more unorganized and more likely to become cancerous can be reversible if you change the underlying issue could be very difficult to go back to normal viral infections (HPV) can lead to dysplasia dysfunctional cell growth

neoplastic disease

abnormal growth of cells... tumor... conditions that cause tumor growth - benign or malignant

microcytic anemia

abnormally small RBCs examples are iron deficiency, thalassemia (mediterranean anemia)

tetracycline - nursing concerns

absorption decreased by food and calcium decreases effectiveness of contraceptives

prevention

action taken to decrease the chance of getting a disease or condition

nursing process - interventions

activies the nurse plans and performs on behalf of the the client teach client: medication use side effect/safety concerns dosing schedule when to call hcp discussion of barriers referral to vna cultural considerations

types of pain

acute - short duration, usually relieved by analgesia chronic - 3/6 months or greater somatic - skin, bone, muscle, and soft tissue superficial - skin, mucous membranes visceral - diffuse not well localized, deep in organs... abdomen, thoracic referred - pain in a different place than injury

Lasix: indications

acute pulmonary edema (excessive fluid in lungs), edema (swelling), hypertension (high bp), heart failure, edema of heart failure, liver failure, renal failure can lower potassium and ?

A (pc)

adequate studies/ no risk to fetus

adrenal disorders

adrenal insufficiency - addison's disease (not enough) glucocorticoid hormone excess (too much) - cushing syndrome

glomerular filtration - review

afferent arterioles Glomerulus Bowman's Capsule (efferent arterioles) Proximal Convoluted Tubule Loop of Henle Distal Convoluted Tubules Collecting Ducts

highest glucagon levels

after fasting or sleeping

prodromal period

after incubation... more signs and symptoms... time during which a disease process has begun is not yet clinically manifested

adaptive immune defense

aka acquired/ specific immunity second line of defense... more effective takes longer... days or weeks dependent on exposure (first, delayed subsequent - immediate due to antibodies) microbe recognition - specific to individual microbes and antigens response to repeated infection - quicker response bc it has been preexposed and has memory of it... plasma cells are able to make that antibody again (immunlogic memory) defense - cell killing - tagging antigen to antibody cellular components - b cells and t cells working together to make antigen and antibody complexes - b and t lymphocytes, macrophages, killer cells molecular components: antibodies, cytokines, complement system

Innate immune defenses

aka: natural/nonspecific immunity the natural resistance with which a person is born... first line of defense barriers, phagocytic cells and NK cells, mediators, inflammatory response fast, takes up to minutes or hours microbe recognition - general pattern, general response... same response response to repeated infection is the same every time defense - epithelium (skin, mucous membranes, phagocytes, inflammation, fever) First line of defense is all about barriers.. Both physical and chemical SKIN AND MUCOUS MEMBRANES Skin made of epidermal cells. Dead skin cells produce a waterproof layer because of keratin contained in dead cells. Skin is first line of defense which is why skin integrity is so important The body is not completely sealed off. Antigens (bad guys) can enter via respiratory, digestive, genitourinary tracts. These tracts are lined with a protective mucous membrane that is not as thick as skin, but still protection First line also includes chemical barriers like the hydrochloric acid in the stomach destroys many ingested bacteria. Tears and saliva contain lysozyme an enzyme that dissolves bacterial cells Phagocytic neutrophils and macrophages engulf and digest pathogens Natural killer (NK) - white blood cell - kill microbes Pyrogens/fever

type 2 DM - ominous octet

all result in hyperglycemia multiple defect in T2DM present multiple targets for intervention - decreased incretin effect - increased lipolysis - increased glucose reabsorption via kidney - decreased glucose uptake - neurotransmitter dysfunction - increased hepatic glucose production - increased glucagon secretion - impaired insulin secretion

ferrous sulfate - adverse effects

allergic reaction, black tarry or bloody stool, fever, upset stomach/throwing up, bad stomach pain, throwing up blood or throw up that looks like coffee grounds

baclofen - indications

alleviation of s/s of spasticity, may be of use in spinal cord injuries or spinal cord diseases

highest insulin levels

an hour after you have eaten

iatrogenic

an illness caused by medical examination or treatment

x (pc)

animal/human studies show fetal abnormalities/risk outweighed by benefit

warfarin - category

anticoagulant

heparin - category

anticoagulant (blood thinner)

enoxaparin - category

anticoagulant, low molecular weight heparin

serotonin type 3 receptor antagonist

antiemetic Block receptors associated with nausea and vomiting in CTZ and locally Particularly effective in decreasing n/v associated with cancer chemotherapy **ondansetron (Zofran) - po, pr, or IV (5-HT3 receptor blockers) Cautions Pregnancy Monitor for HA, pain at injection site, hypotension, constipation, decrease in contraceptive protection

Lasix: therapeutic class

antihypertensives (treat hypertension/high BP)

phenothiazines

antimetics prochlorperazine (Compazine) Promethazine (Phenergan) cautions - hypotension, photosensitivity use with other CNS mediations monitor CNS effects (drowsiness, dizziness)

treatment of tia

antiplants anticoagulants carotid stent or endarterectomy reduce risk for atherosclerosis

describe the adverse drug reactions and the nurse's responsibility in drug administration

any undesired response to an administered drug can occur in anyone at any time most likely to occur in certain drugs with smaller therapeutic window (insulin, coumadin) could be immune (allergy) nurses responsibility to assess and teach the undesired effects that may be unpleasant or even dangerous reasons adverse reactions occur - may have other effects on the body besides the therapeutic effect - patient is sensitive to the drug being given - drug's action on body causes other responses that are undesired or unpleasent - the patient is taking too much or too little of the drug

warfarin - monitoring considerations

assess for bleeding and hemorrhage. Evidence of additional or increased thrombosis. Monitor PT, INR, and other clotting factors. Monitor hepatic function and CBC before and periodically throughout therapy. Monitor stool and urine for occult blood before and periodically

enoxaparin - monitoring considerations

assess for signs of bleeding and hemorrhage, bleeding from surgical sites. Assess for additional or increased thrombosis. Anginal pain. Monitor for hypersensitivity reactions. Monitor epidural catheters for s/s of neurologic impairment. Observe injection sites for hematomas, ecchymosis, or inflammation. Monitor CBC, platelet count, and stools for occult blood periodically during therapy. aPTT monitoring for certain patients. Monitor antifactor Xa levels, hyperkalemia

nursing concerns with mineralocorticoids

assess vital signs, baseline electrolytes, weights increase dose as needed in times of stress monitor for F/E imbalances patient teaching: drug effects, reduced sodium diet, monitoring weights, when to call PCP/NP

steps of nursing process

assessment nursing diagnosis outcomes planning/implementation evaluations

pain management

assessment - nature, severity, location, radiation nonpharmacologic interventions - cognitive - behavioral interventions, physical agents, electroanalgesia, acupuncture pharmacologic treatment - nonnarcotic and narcotic analgesics, depressants, anticonvulsants, muscle relaxants surgical treatment - cure on manage pain

generic drug named

assigned when a drug is being developed. this i the name used by the company that manufactured the drug required to be therapeutically equivalent and less expensive than trade fillers differ but therapeutically equal

coronary artery disesae

atherosclerosis myocardial ischemia (angina) myocardial infarction

neoplasms

benign or malignant benign - well differentiated cells but excess proliferation, no metastasis malignant - less differentiated and excess proliferation - carcinoma metastasize - spread via blood (hematogenous) or via lymphatics

disorders of the gallbladder - cholestasis

bile flow slows down Bile accumulates and forms plugs in the ducts - Ducts rupture and damage liver cells - Alkaline phosphatase released into blood The liver is unable to continue processing bilirubin - Increased bile acids in blood and skin - Pruritus (itching)

congenital disease

birth defect... a condition present at birth regardless of its cause

ulcerative colitis manifestations

bloody diarrhea, rectal urgency, tenesmus, *LLQ discomfort

osteoporosis - diagnosis

bone mineral density (BMD) scan using dual x-ray absorptiometry (DXA) Gold standard for detecting and monitoring osteoporosis

complications of diabetes - macrovascular

brain (cerebrovascular disease) - transient ischemic attack - cerebrovascular accident - cognitive impairment heart (coronary artery disease) - coronary sydrome - myocardial infarction - congestive heart failure extremities (peripheral vascular disease) - ulceration -gangrene - amputation

disorders of the gallbladder - cholelithiasis (gallstones)

cholesterol, calcium salts, or mixed RUQ pain after eating DX by RUQ US Treatment - reduce dietary fat

AE: bone marrow suppression

can't fight off infection bc WBC production is stifled, RBC can become anemic

Uses of Glucocorticoids (Steroids)

cancer - lymphomas neurologic conditions, brain edema, autoimmune disease (MS, MG) eye disorders such as optic neuritis organ transplantation asthma, respiratory disorders rheumatic disorders (on and off for flare ups)

etiology

cause/origin of a disease or condition

amiodarone

cautions Oral dose takes awhile to kick in renal/hepatic disease Pro-arrhythmic Pulmonary toxicity - especially if underlying lung disease Liver toxicity Thyroid issues

cell death

cell injuries can be reversible or irreversible pathology of the circumstance can lead to death some cells can adapt and return to normal function all of this depends on underlying etiology vascular changes in the circulation system or reduce oxygen intake - lack of oxygen to ischemia - ischemia can lead to cell injury and death (necrosis)

Type IV hypersensitivity

cell mediated involves t-cells, no antibodies or b cells different t cells that go overboard and start to attack normal tissue or create a response to normal tissue... considered delayed (delayed hypersensitive response) ex. PPD test, contact dermatitis (poison ivy) see response overtime caused by t-cells delayed response

compensatory hyperplasia

cells growing back and physically being replaced ex. liver growing

COPD - risk

chronic obstructive pulmonary disease Cigarette smoking is #1 risk factor Occupational risks - coal, dust Genetic defect - deficiency of alpha 1 antiTrypsin. This enzyme, trypsin, prevents enzymatic destruction of lung disease. With a deficiency, there is more alveolar wall destruction and less elasticity of lung

collection of data (np and med admin)

client interview medical record review laboratory values

acute complications of dm - hyperglycemic hypersomolar state (HHS)

complication of type 2 DM (blood becomes concentration, get dehydrated, bs very high, less alert and more somnolent as bs goes up, don't get ketotic or acidotic → fluid intake to replace blood sugar

hematomas

collection of blood in the tissue that develops from ruptured blood vessels epidural space: between dura and skull - usually due to tear of the meningeal arteries (arterial bleed) - rapid bleeding: unconsciousness may be followed by brief lucid period then unconscious again - -changes in pupil response, weakness in parts of their body - - CAT scan or MRI to visualize where the hematoma is subdural space : between the dura and the arachnoid - tear is in the bridging veins -- venous bleed - slower bleeding : gradual development over days or weeks -- acute - sometimes an acute situation (within 24 hours of bleeding happening) -- subacute - sometime is can be within several days... blood has collected to point of being symptomatic --chronic - slow slow bleeding that takes a long time to cause symptoms (up to weeks) patients on anti platelet/anticoagulant are at risk of bleeding... more inclined to have CAT scan or MRI

classifications of fractures

comminuted greenstick compression oblique spiral transverse

type iii hypersensitivity

complex-mediated antibody-antigen complex big clump of cells travels and gets stuck in blood vessels or something like kidneys, stuck in joints (RA) you do not want them circulating in your body ex. ra, sle (lupus)

acute complications of dm - diabetic ketoacidosis (DKA)

complication of type 1 DM

nursing process and patient med admin

consider: knowledge deficient risk for injury risk for non compliance *knowledge deficient related to cardiac meds as evidenced by patient report

Kayexalate: side effects

constipation, diarrhea, nausea/vomiting, anorexia, hypokalemia

mechanisms of blood pressure (long term regulations)

controls the daily, weekly, and monthly regulation of blood pressure - renal mechanism

mechanisms of blood pressure (short term regulations)

corrects temporary imbalances in blood pressure - neural mechanisms: via baroreceptors and SNS - humoral mechanisms: via RAAS

atrophy

decreased in cellular size smaller muscular dystrophy, any disruption of nerve innervation, malnutrition, low blood supply, long term paralysis, post-cast removal, bed rest brain atrophy with dementia nurses can do range of motion exercises with patient

evaluations (nursing process)

determining if the plan of care was effective at either maintaining or improving the patient's health

virchow's triad

different features that can result in a thrombus Stagnant blood flow Trauma or damage to blood vessel or vein itself Hypercoagulated blood (blood tends to be thicker, severely dehydrated, genetic, patients post op, long flight)

immunodeficiency

diminution a diminished or absent immune response increases susceptibility to infections. mostly caused by viruses. predispose people to opportunistic infection. ex. Kaposi sarcoma (cancer from virus... patients w HIV) immune system can't protect against cancer

excretion

elimination from the body -kidney -skin -liver via bile -feces influences: kidney function protein binding urine pH urine flow

metabolic disease

disrupt normal metabolism, the process of converting food to energy on a cellular level... thousands of enzymes participating in numerous interdependent metabolic pathways carry out this process

enoxaparin - adverse effects

dizziness, headache, insomnia, edema, constipation, rise in liver enzymes, nausea, vomiting, urinary retention, alopecia, ecchymoses, pruritus, rash, urticaria, hyperkalemia, bleeding, anemia, eosinophilia, thrombocytopenia, erythema at injection site, hematoma, irritation, pain, osteoporosis, fever, hemorrhage, hypercopic anemia, dysnipea

nursing diagnosis (nursing process)

drawing a conclusion from the assessment data that was gathered

sources of drug information

drug label package insert reference books journals internet - lexicomp

phase iii

drug tested in large market - when complete, drug evaluated by FDA/committee prescribers informed of all known reactions and precautions prescribers ask patients to keep journals and record symptoms journals evaluated and passed on to drug company that is developing drug fda may request for drug to be removed if unacceptable adverse effects or reactions occur

teratogenicity

drug that can reach the developing fetus and cause harm (birth defects to death) pregnant woman pose an added concern when prescribing medication the benefit to the pregnant woman must outweigh risk to fetus medications should not be handled w bare hand

orphan drug

drug that is not financially viable bc of limited marketability, or narrow safety margin drug companies can adopt these drugs and fund their development

metabolism=biotransformation

drugs are activated or biotransformed by body liver - most important site of drug metabolism cytochrome p450 enzymes (CYP450) - primary enzyme system in liver - some drugs induce or inhibit the CYP450 enzymes - caution: liver disease changes Pathological factors can also influence drug metabolism, including liver, kidney, or heart diseases. Physiological factors that can influence drug metabolism include age, individual variation (e.g., pharmacogenetics), enterohepatic circulation, nutrition, intestinal flora, or sex differences.

layers of the meninges

dura --> arachnoid --> pia mater layers in between is where things can happen and blood can collect

exhaustion (GAS)

during this stage the body becomes depleted and damage may appear as homeostasis can no longer be maintained. Disease or death may result

heparin - adverse effects

easy bleeding and bruising, pain/redness/warmth/irritation/or skin changes where the medicine was injected, itching of feet, bluish-colored skin, hemorrhage, thrombocytopenia, fever, nausea, vomiting, fever

hypothyroidism - diagnostics

elevated TSH, low T3 and T4 For Hashimoto's disease - check thyroid auto-antibodies

Lasix: Teaching points

get up slowly, med causes frequent urination so be near bathroom, take med in morning so not up all night using bathroom, HIGH FALL RISK

crohns diagnosis and treatment/medications

endoscopy and colonoscopy, CT nutrition/hydration/skin integrity, surgery 5 ASAs Steroids Immunomodulators Biologics

GERD - manifestations

epigastric or retrosternal burning/pain, nausea, bloating, belching

nursing assessment

ethno-cultural and racial background health literacy preferred foods and preparation health, illness/disease practices traditional and folk health practices

D (pc)

evidence of human risk but benefit may outweigh risk

hypersensitivity reactions

exaggeration response ... different levels of hypersensitivity, basically there is an excessive response to the antigen abnormal response to antigen, can be harmful can be humoral or cell-mediated can be immediate or delayed

mineralocorticoids

examples: cortisone, fludrocortisone (Florinef), hydrocortisone (Coref) actions - holds sodium, and with it, water in the body - causes excretion of potassium by acting on the renal tubule indications - replacement therapy in primary and secondary adrenal insufficiency contraindications - hypertension - CHF (heart failure)

rhabdomyolysis - pathophysiology

excessive, prolonged or repetitive exercise may overstretch the sacroplasmic reticulum --> skeletal muscles protein fibers sacroplasmic reticulum --> increase in Ca 2+ leaking into muscle cells --> activation of sarcolemma (cell membrane) - degrading enzymes --> increase in sarcolemma permeability --> release of harmful proteins in blood, potentially leading to renal failure, blood clotting and heart arrhythmias

complications of diabetes - microvascular

eye - retinopathy -cataracts -glaucoma kidney (nephropathy) - microalbuminuria - gross albuminuria - kidney failure nerves (neuropathy) - peripheral - autonomic

AE: alopecia

fast dividing cells are targeted lost of hair

lipolysis

fat breakdown

complications of fractures

fat emboli malunion osteomyelitis compartment syndrome

ferrous sulfate - generic

ferrous sulfate

Hypovolemia

fluid volume deficit caused by: reduced fluid or sodium intake/excessive diuresis or sweating/ GI losses, wounds, burns/ hemorrhage clinical manifestations: thirst altered level of consciousness tachycardia weak thready pulse flat jugular veins dry mucous membranes decreased skin turgor oliguira- small amount of urine weight loss dark urine sunken fonatelle's infants deficit - drink more water, maybe have an IV, salt tablets, cut back on diuretic medications

Hypervolemia

fluid volume excess Peripheral edema Swelling around eyes Anasarca ... swelling all over Cerebral edema (including headache, confusion, irritability, anxiety, nausea, vomiting) Dyspnea Bounding pulse Tachycardia Jugular vein distension (swelling of veins) Hypertension Polyuria... pale urine Rapid weight gain 3 lbs a week or 1-2 lbs a day Crackles (adventitious lung sounds) Bulging fontanelles (infants) Low sodium diet Lasix? Congestive heart failure, kidney functions decreases, renal failure, hyperaldosteronism (high adh, too much water held onto), excessive Na/water intake, insufficient losses (high chinese food meal, puffier) High bp, tachycardia then bradycardia

identify two factors that influence how a drug affects the body

food/druig drug/drug age body weight genetics gender (males have more muscle so absorbed fastetr when injected into muscle) disease

planning/implementation (nursing process)

formulation of a plan of care that includes actions to improve or maintain the patient's health

Lasix: general name

furosemide

glucocorticoid induced osteoporosis

induced osteoporosis Type of secondary osteoporosis Glucocorticoids inhibit osteoblasts and promote osteoclasts and reduce absorption of dietary calcium

baclofen - actions

gamma-aminobutyric acid analogue, exact mechanism of action is not understood, inhibits monosynaptic and polysynaptic spinal reflexes, central nervous system depressant

CAD - risk factors

gender age family history cholesterol smoking diabetes

environmental (etiology of cancers)

gene damage due to radiation or chemicals sun damage, radiation, thyroid

outcomes (nursing process)

goals for patient

convalesence

gradual recovery of health and strength after illness or injury... recovering from illness the signs and symptoms are getting better

atherosclerosis

hardening of the arteries won't dissolve on its own... becomes irreversible impair blood flow to heart muscle and slowly to brain

metabolic functions of the liver - bile production

he liver makes bile and secretes it into the small intestine via the common bile duct. Excess bile is stored in the gallbladder, where it also enters the small intestine through the common bile duct when it is needed Bile emulsifies fat molecules so that they are easier to digest

cyancobalamin - adverse effects

headache, infection, astenia, paresthesia, glossitis, nausea, rhinitis, cardiac failure, peripheral cardiac thrombosis, pruritus, transient skin rash, hypokalemia, diarrhea, polycythemia vera, thrombocythemia, anaphylaxis, pulmonary edema, swelling

DISORDERS ASSOCIATED WITH DIABETES - atherosclerosis

heart attacks and strokes related to the development of atherosclerotic plaques in the vessel lining

viruses (etiology of cancers)

hematologic cancers and viral hepatitis (linked to cancer) HPV and cervical cancers

hematoma

hemorrhage - act of bleeding/hematoma - collection of blood Bleeding leads to localized pressure on nearby tissue and increases ICP Blood may coagulate and form a solid mass The hematoma becomes encapsulated by fibroblasts, and blood cells within the capsule lyse Fluid from the hemolysis exerts osmotic pressure, drawing more fluid into the capsule Edema increases the mass size, applying pressure on the nearby tissue and increasing ICP Bleeding can trigger vasospasms, worsening ischemia Can result in herniation Diagnosis: PE (physical exam), head CT, MRI, cerebral angiogram (invasive test with dye and insertion of catheters in procedure area - rarely done due to invasiveness) Treatment: May require no treatment or removal of the blood may not be possible Surgical removal of the blood through burr hole or a craniotomy

schedule ii drug

high potential for abuse and dependence some medicinal qualities ex. Vicodin, cocaine, meth, oxycontin, adderall

GERD atypical s/s

hoareness, chronic cough, sore throat, asthma

explain the concept of homeostasis and 2 feedback systems involved in maintaining homeostasis

homeostasis - pH level, blood glucose level, and internal temp are all equal positive feedback - intensify the variable... ex human being born... pressure --> contractions --> more releases of hormones and on and on negative feedback - when some variable triggers a counter acting response in order to come back to set variable ex. sweating when youre hot, shivering when youre cold (negative feedback loop)

nursing process - evaluation

how does the nurse evaluate the clients status to determine if goals are met? knowledge deficient diagnosis - how will you evaluate if your patient knows about his/her medications as a results of your interventions

phase i

human volunteers, mostly men volunteers are informed of the risk and may be paid some chemicals therapeutic in other animals but no effects in humans studies scrutinize the drugs being tested for human effects look for adverse effects and toxicity dropped bc lack evidence of therapeutic effects in human cause unacceptable adverse effects highly teratogenic too toxic some chemicals move to next stage despite undesirable effects

Kayexalate: indications

hyperkalemia

polydipsia

increased thirst

polyuria

increased urination

brain injury

hypoxia or ischemia - not enough oxygen or lack of blood flow edema due to excess water, blood increased intracranial pressure - due to edema trauma - contusion, concussion, hematoma (collection of blood) - sports related, a fall infectious (meningitis and proseflitis... infections that occur inside the brain)

lowest insulin levels

if you have been fasting, your sugars are low so your pancreas is not stimulated to release insulin

hormones (etiology of cancer)

imbalance female cancers (uteran, ovarian linked to estrogen)

inflammatory disease

immune system attacks the body's own tissues, resulting in inflammation... ex rheumatoid arthritis. disease related to swelling

Resistance (GAS)

in this stage the body chooses the most effective defense. Cortisol levels and the sympathetic nervous system return to normal, causing the flight or fight symptoms to disappear. At this point the body will adapt or alter in an attempt to limit problems or become desensitized to the stressor. If the stressor is prolonged or the body is overwhelmed...

hypertrophy

increase in cell size larger strength training lot of exercise, left ventricular hypertrophy, overworking of heart/high bp, cardiac hypertrophy may occur as result of normal physiologic or abnormal pathologic condition pathological occurs as the result of disease conditions and may be adaptive or compensatory

hyperplasia

increase in the number of cells, increased rate of cellular division callousing, epithelial cells

exacerbation

increase in the severity of a disease or its signs and symptoms... signs and symptoms have come back... periodically symptoms become more pronounced when you have a chronic disease... it never went away you just have more symptoms of it at times

hyperglycemia

increased blood sugar

polyphagia

increased hunger

disorders of the gallbladder - acute and chronic cholecystitis

inflammation caused by irritation due to concentrated bile Infection of gallbladder s/s - fever increased WBC, RUQ pain Dx - US, murphy's sign (pain when pressing on right upper quadrant) Treatment - NP, IVF, Abx, drain, surgical removal

disorders of the gallbladder - cholangitis

inflammation of the common bile duct

acute kidney injury - acute tubular necrosis (intrarenal)

inside the tubules, causes the change in BUN and creatinine Occurs from contrast in a diagnostic test (the dyes given can injury the kidneys if it is not flush out readily), medication related : given pt too many nsaids, certain antibiotics, chronic hypertension, inflammatory process happening

beta 2 agonist - adverse effects

insomnia restlessness tremor cardiac stimulation (palpitations)

ischemia

insufficient blood flow to provide adequate oxygenation leads to hypoxia (reduced oxygen) or anoxia (absence of oxygen) caused by blood clot or spasms of blood vessels tested w physical exam, then x-rays and CT scans treated w medications, clot-busting drugs, angioplasty, surgery localized to one organ or tissue organ failure, gangrene, peritonitis , death

blood coagulation

intrinsic = trauma extrinsic = activation of clotting factors

ferrous sulfate

iron

atherosclerosis - major complications

ischemic heart disease stroke peripheral vascular disease

ketosis

ketones cannot be removed effectively

adverse reactions to anti-ineffective therapy

kidney damage gi tract toxicity - direct effect on cells lining GI - organism death releases toxin>> trigger chemoreceptor trigger zone - liver dysfunction neurotoxicity hypersensitivity reactions superinfections

renal calculi

kidney stones most common calcium also uric acid

codeine

less effect than morphine, for mild-mod pain most effective antitussive (cough) often combined with other drugs (acetaminophen - tylenol #3)

GERD - treatment

lifestyle changes, weight loss, diet, caffeine, alcohol If nocturnal sx - HOB up and no meals 2-3 hours pre bedtime → if this doesn't resolve go to medications H2 antagonists, PPI → two main categories of meds

acidosis

liver cannot remove all of the waste products

Lasix: pharmacologic class

loop diuretics (diuretics (increase urine output) that act on ascending limb of loop of Henle in kidney - rid of fluid which decreases BP)

Hyponatremia

low Na+ develops when serum sodium concentration fall below 135 mEq/L occurs when there is a loss of sodium, inadequate intake of sodium, or dilution of sodium by water excess hyponatremia > ICF osmotic shift, cell swelling manifestations: cerebral swelling, lethargy, confusion, seizure, coma muscle twitching, depressed reflexes, weakness are common under 120 - seizure risk give salt tablets iv with more sodium higher sodium diet restrict fluid intake --> sodium level will rise

ferrous sulfate - indications

low blood levels of iron, treatment and prevention of iron deficiency anemia

Hypokalemia

low k+ severe loss of k+ (below 3.5 mEq/L) results in neuromuscular and cardiac manifestations slows things down muscle weakness atony, cardiac dysrhythmia low K+ decrease heart contractility, less sinus bradycardia, atrial arrhythmias unusual heart rhythms that tend to be faster characteristics ECG changes patient on monitor when K+ is too high or too low lasix (furosemide)

schedule iv drug

low potential for abuse and dependence acceptable medicinal qualities prescription required - fewer refill regulation ex. xanax, darvan, valium, ativan, ambien, tramadol

schedule v drug

lowest potential for abuse and dependence acceptable medicinal qualities prescription required - fewest refill regulations robitussin AC, lomotil, motofen, lyrica

combinations of aluminum and magnesium

maalox mylanta

action of skeletal muscle relaxants - central acting

majority work in the brain and spinal cord interfere with the reflexes causing the muscle spasm disrupt the cycle of muscle spasms and pain often referred to as spasmolytics

bone cells - osteocytes

mature bone cells maintain the bony matrix

chemoreceptors can adjust respiratory rate - central chemoreceptors

measure PCO2 and pH in cerebrospinal fluid increase respiration when PCO2 increases of pH decreases

chemoreceptors can adjust respiratory rate - peripheral chemoreceptors

measure PO2 in arterial blood increase respiration when PO2 less than 60 mmHg

Prostaglandins

mediate pain-sensitizing pain receptors induce inflammation by vasodilation fever- influnces hypothalamic response to pathogens GI - inhibits acid secretion renal protection - perfusion/function involved in regulatory platelet aggregation

treatment

medical care given to a patient for illness or injury/ a session of medical care or the administration of a dose of medicine

microflora

microorganisms normally living in/on your body some are useful all are capapble of causing disease if your health and immunity are weakened opportunistic pathogens - endogenous flora become pathogenic in compromised patient

autoimmune response

misdirection response body's normal defenses become self-destructive... recognizing self as foreign ex. ra, type i dm

schedule iii drug

moderate potential for abuse/dependence acceptable medicinal qualities doctor's prescription required ex. tylenol w codeine, ketamine, steroids, testosterone

ferrous sulfate - monitoring considerations

monitor hemoglobin, hematocrit, and reticulocyte values prior to and every 3 weeks during the first two months of therapy. Serum ferritin and iron levels may also be monitored to assess effectiveness . Monitor stool for occult blood in stool.

ppi - omeprazole (Prilosec)

monitor/assess - Decreased absorption of vitamin B12 - Administer before meals - action decreased by food S/E - CNS effects - GI - n/v/d - Stuff nose, cough, hoarseness - Cdiff - Osteoporosis (inhibits calcium absorption) → links to fractures in older people taking PPI

schedule i drug

most potential for abuse and dependence no medicinal qualities will never be prescribed in medical situation ex. heroin, lsd

ventilation

movement of air in and out influenced by: - asthma - older patient - COPD - airway obstruction - pregnancy - ALS - Gillian Barre

identify common adverse effects of cancer pharmacologic treatment

multiple classes of agents including chemotherapies, steroids, immunotherapy, biologic therapies fatigue and weakness

herbal and dietary supplements

multivitamin supplements - may contain vitamin k herbs that may increase warfarin - alfalfa, celery, clove, feverfew, garlic, ginkgo, ginseng, licorice

physiologic hypertrophy example

muscle mass increases with exercise

rhabdomyolysis - triad of manifestations

muscle pain weakness dark urine

genetic (etiology of cancer)

mutation of gene resulting in oncogenes that promote cancer or lack of tumor suppressor genes (promote or not suppress)

narrow vs broad spectrum antibiotics

narrow - effective against only a few microorganisms with a very specific metabolic pathway or enzyme broad - useful in treating a variety of infections

AE: GI

nausea, vomiting, diarrhea common symptoms of cancer treatments fast dividing cells are targeted so this affects inside lining of GI tract

Lasix: side effects

nausea/vomiting, diarrhea, constipation, abdominal pain, dizziness, headache, dehydration

atherosclerosis - risk factors

non modifiable: - increasing age - male gender - genetic disorders of lipid metabolism - family history of premature coronary artery disease potentially modifiable: - cigarette smoking - obesity - hypertension - hyperlipidemia with elevated low-density lipoprotein and low high-density lipoprotein cholesterol - diabetes mellitus additional nontraditional: - inflammation marked by elevated C-reactive protein levels - hyperhomocysteinmia - increased lipoprotein (a) levels

hemorrhagic stroke

often present with headache, high bp 2 types : intracerebral and subarachnoid treatment: managing BP, evacuation of blood, repair of aneurysms and Av malformations

Long Acting - Glargine or Detemir

onset - 1 hour peak - peak less (no peak) duration - 24 hours

intermediate acting - NPH

onset - 2-4 hours peak - 4-12 hours duration - 16-20 hours

short acting - regular

onset - 30-60 min peak - 2-4 hours duration - 4-6 hours pref use - NPO, tube feeding, TPN, IV

Rapid acting - Lispro (Humalog)

onset - 5-15 minutes peak - 60 minutes duration - 2-4 hours pref use - able to eat

first pass effect

oral drugs that may be extensive metabolized in the liver so less of drug has an effect on the target tissue

tramadol (ultram)

oral; for moderate to severe chronic pain less respiratory depression but does cause drowsiness, constipation, hypotension dose reduce with renal/liver dz

routes of administration

orally sublingual - SL parenteral - IV subcutaneous - SubQ intramuscular - IM topical transdermal inhalation PR

bone cells - osteoblasts

ossification and calcification "bone-building" cells

hypoxia

oxygen saturation below 90% caused by: respiratory failure and certain medical conditions - can be environmental (high altitude sickness) oxygen becomes limited tested with pulse oximeter followed by x-rays and ct scans treated w supplemental oxygen by nasal cannula, face mask, mechanical ventilator all organ of body affected could cause cyanosis, brain death

hormonal influences on bone

parathyroid hormone calcitonin

identify pathophysiology importance for clinical practice

pathophysiology focuses on the mechanisms of the underlying disease process and provides the background for preventative as well as therapeutic health care measures and practices

phase ii

patients who have disease drug targets often no charge monitored by pharm reps removed bc less effective than anticipated too toxic with patients unacceptable adverse effects low benefit-to-risk ratio no more effective than other drugs already on market

ACE inhibitors (CAUTIONS)

patients with kidney disease, follow Bun, creatinine (both can increase on medication) Hypotension → teach signs and symptoms Can cause K retention (high potassium) → monitor potassium Rare - Angioedema (hypersensitivity where they get an abrupt onset of swelling in their mouth (lips, tongue, airway (trachea)) Decreases blood pressure

incubation period

period between exposure to infection and the appearance of symptoms

phase iv

post marketing surveillance continual evaluation prescribers required to report to fda any unexpected adverse effects

Kayexalate: Therapeutic class

potassium - removing resins

C (pc)

potential risk in animal studies/ no human data

package insert

prepared by manufacturer contains all the chemical and study information that led to the drug's approval difficult to understand and read

schedule vi

prescription required but not hard to acquire

causes of neuropathic pain

pressure on nerve physical injury to neuron chemical injury to neuron infection of neuron ischemia inflammation

pharmacotherapy (what do drugs do)

prevent disease treat disease improve quality of life

warfarin - indications

prevention/management of DVT, PE and embolization associated with atrial fibrillation and prosthetic heart valves, chronic atrial fibrillation

acute kidney injury - pre renal

problem in something leading up to the kidney, typically when someone does not have good blood flow going into the kidneys so the kidneys start to make renin, starts to put pressure on the kidneys and does not make the urine Occurs in more trauma patients : bleeding internally/low bp/hemorrhaging , people on many medication for bp

thiomides

propylthiouracil (PTU) methimazole (Tapazole) Cautions: - Monitor s/s for over suppression of thyroid function -- lethargy, bradycardia, n/v - Changes serum levels of some drugs as metabolism slows - anticoags, beta blockers

adaptive passive immunity

received antibodies from mother to fetus or through an infusion - immunoglobin G - more immediate but shorter lasting effects (last weeks to 3 or 4 months) host is given antibodies to an antigen to protect against infection rather than host synthesizing them ex injection of gamma globulin transfer from mother to fetus via placenta or breast milk

antimetics

reduce hyperactivity of vomiting reflex by: Local effect - decreased local response to stimuli being sent to medulla to induce vomiting ex, Mild nausea - antacids, Reglan, etc. Central effect - to block chemoreceptor trigger zone (CTZ) ex. Phenothiazines, anticholinergics, antihistamines, Serotonin type 3 receptor antagonist

chemical drug name

relates to chemical structure

metaplasia

replacement of one mature cell by another condition where body exposed to something such as the use of cigarettes changes cells which overtime completely replace normal health cells, constant acid reflux can damage esophageal cells so that they are more like stomach cells more reversible than dysplasia - still normal cells

heparin - teaching points

report any symptoms of unusual bleeding or bruising to health care professional immediately, do not take meds with aspirin or NSAIDs while on heparin, avoid IM injections and activities leading to injury and to use a soft toothbrush and electric razor, inform pcp of medication regimen prior to surgery, carry id card with information at all times

enoxaparin - teaching points

report any symptoms of unusual bleeding or bruising, dizziness, itching, rash, fever, swelling, or difficulty breathing. Do not take aspirin, naproxen, or ibuprofen without consulting hcp while on therapy

mean arterial pressure

represents the average pressure in the arterial system during ventricular contraction and relaxation MAP = 1/3 s = 2/3 d

all narcotic analgesics - side effects

respiratory depression decreased GI motility/constipation urinary retention orthostatic hypotension sedation depressed cough pinpoint pupils tolerance and dependence withdrawal symptoms

antagonists

reverse of block analgesia, CNS and respiratory depression, and other physiological effects of opioid agonists compete with opioid binding to receptors or displace opioid already occupying sites example : naloxone (narcon) - therapeutic effects occur in minutes and last 1-2 hours

ulcerative colitis treatment and meds

same as crohn's May have a surgery where part of the colon is cut out ?? May end up with a colostomy Meds: 5 ASAs Steroids Immunomodulators Biologics

acute

severe and sudden onset of conditions

developmental disease

severe, chronic disability of an individual who has a mental or physical impairment by the age of 22 which is likely to continue indefinitely and results in substantial functional limitations in three or more areas of major life activity

EKG

shows electrical activity in the heart looking for changes in the ST segments - after the heart contracts you can see changes that indicate changes in blood sypply

NSAIDs (non-steroidal anti-inflammatory drugs) - patient concerns

side effects: - gi irritation, bleeding, ulcer - renal - reduced function, fluid retention black box warning for all NSAIDs for GI and CV side effects PPI or H2 blockers for GI protection administer ASA 30 minutes to 2 hours before NSAIDs teach signs of GI bleed-tarry stools, low energy CV Risk - NSAIDs may cause an increased risk for serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. This risk may increase with duration of use. Patients with cardiovascular disease or risk factors for cardiovascular disease may be at greater risk -These drugs are contraindicated for treatment of perioperative pain in the setting of GI risk -NSAIDs cause an increased risk for serious adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients are at greater risk for serious gi events

Kayexalate: Generic name

sodium polystyrene sulfonate

basal insulin

sometimes called background insulin intermediate or long acting NPH, Lantus, Levemir

drug label

specific info that identifies a specific drug understanding how to read is essential

Percutaneous coronary angioplasty

stent procedure pci for patients with risk of heart damage (st change) Procedure to use a catheter with a balloon to press against the plaque and open up the narrowing... may put a stent where blockage was and leave it there to keep that part of the artery open Risk for bleeding Heart attack (more serious) Done in cardiac portion for this (cath lab) If there is a clot in the coronary artery some patients may be given thrombolytic treatment (TPA) to dissolve the clot instead of procedure PCI and TPA are more of a cure

erythropoiesis-stimulating agents (ESAs)

stimulate the bone marrow to make more RBC's - given sq or IV - examples are Epoetin Alfa (Epogen or Procrit) and Darbepoetin (aranesp) - treats: anemia associated with chronic kidney disease, AIDs, cancers

anterior pituitary hormones - ACTH

stimulates the adrenal cortex → cortisol

anterior pituitary hormones - Prolactin

stimulates the breast → milk production

anterior pituitary hormones - GH

stimulates the liver → IGF-I

anterior pituitary hormones - TSH

stimulates the thyroid → thyroid hormones

disorders of the gallbladder - choledocholithiasis

stones in the common bile duct

define pathology

study of functional changes in cells, tissues, and organs of the body that occur as a result of an injury, disorder, or disease

enoxaparin - generic

subq enoxaparin

glycosuria

sugar is spilled into the urine

adrenocortical agents

suppress the immune system... not a cure short term use - relieve inflammation - suppress immune system - replacement therapy when adrenals not working long term use - severe, debilitating conditions

heart failure (left) clinical manifestations

tachypnea (faster resp rate), dyspnea (SOB), orthopnea (need to sleep with head up), PND (paroxysmal nocturnal dyspnea → due to lying flat for a period of time... fluid comes back to heart and heart is weaker and can't process it) , rales (crackles that suggest fluid in smaller airways), pulmonary edema risk (drowning in fluid... lots of fluid in lung tissue)

warfarin - teaching points

take medication as directed and no double doses. Let the doctor know of other medications or supplements being taken. Limited intake of vitamin K foods. No alcohol or aspirins. Avoid cranberry juice. Avoid IM injections and activities that may lead to injury. Use a soft toothbrush, do not floss, shave with an electric razor. Report any symptoms of unusual bleeding or bruising/ pain/color/temperature change to any area of the body. Importance of frequent lab tests to monitor coagulation factors

ferrous sulfate - teaching points

take medication regimen as administered, if missed, take within 12 hours. Do not double doses. Advise patients that stool may become dark green or black. Advise a diet high in iron. Store in a childproof area.

pre clinical

tested on lab animal for two purposes: determine whether they have the presumed effects in living tissues some are discarded bc lack of therapeutic activity w living animals too toxic highly teratogenic safety margins are so small it wouldn't be useful in clinical setting move on if they are found to have therapeutic effects reasonable safety margins

pathogenesis

the development of a disease ... cellular level

pulse pressure

the difference between the systolic and diastolic pressure

manifestation

the display or disclosure of characteristic signs or symptoms of an illness

compensatory hypertrophy example

the enlargement of a tissue or organ as a result of removal or damage when one kidney is removed, the remaining kidney enlarges to compensate for the loss

degenerative disease

the function or structure of the affected tissues or organs changes for the worse over time

prognosis

the likely outcome or course of a disease; the chance of recovery or recurrence

prototype

the original drug in the class or drug that has emerged as the most effective

define pathophysiology

the physiology of altered health pathology + physiology

arterial blood pressure

the pressure of the blood as it moves through the arterial system

recrudescence

the recurrence of symptoms after a period of remission ... a relapse

define pharmacology

the study of drugs

half life

the time it takes for the amount of drug in the body to decrease to half of the peak level it previously achieved affected by drug ADME influences how often drug should be dosed and its duration of effect take more often when short

Alarm stage (GAS)

this stage includes the generalized stimulation of the sympathetic nervous system. The adrenal medulla releases catecholamines (80% epinephrine & 20% norepinephrine) and cortisol, fight or flight response

General Adaptation System (GAS)

three stages - alarm - resistance - exhaustion

Absorption (pharmacokinetics)

time of entry into body to time of entry into circulation/tissue factors that influence: route of administration gi function presence of food or other drugs in gi tract

onset

time required to elicit a therapeutic response

copd - pathophysiology

tissue destruction, chronic release of pro-inflammatory cytokines, thickening and narrowing of bronchi, air flow is diminished, air trapping > lung hyperinflation, hypertrophy of mucus producing goblet cells

baclofen - adverse effects

transient drowsiness, dizziness, weakness, fatigue, constipation, headache, insomnia, hypotension, nausea, urinary frequency

distribution

transport of drug molecules via the blood to the body tissues factors that influence: - circulatory dependent-large vascular organs have faster distribution - protein binding- albumin allows for storage/release - lipid solubility - CNS-blood brain barrier

heparin - indications

treat and prevent blood clots. Before surgery to reduce the risk of blood clots, DVT prevention, thromboprophylaxis, acute thromboembolic problems

enoxaparin - indications

treat or prevent a deep vein thrombosis (DVT), can lead to blood clots in the lung (pulmonary embolism). Prevent blood vessel complications in people with angina or heart attack

BACTRIM: SULFAMETHOXAZOLE/TRIMETHOPRIM

treatment of uti rash and photosensitivity are concerns oral → given twice a day → typically a three day regimen Stevens johnson syndrome - layers of skin come off after getting a rash bone marrow suppression

analgesics

tylenol •Mild to moderate pain relief and reduction of fever• **Lacks anti-inflammatory effect• **Does not cause bleeding or GI problems •**Can cause hepatotoxicity •Frequently used with children• ***Antidote- acetylcysteine (Acetadote) PO or IV

acute complications of dm - hypoglycemia

type 1 and 2 DM, if they have taken too much medication or if they haven't eaten

Prenicious anemia

type of vitamin B12 deficiency Pathophysiology: parietal cells located within the gastric mucosa are destroyed through autoimmune response, immune reaction leads to atrophy of gastric mucosa Intrinsic factor is a protein produced by stomach and is needed to absorb Vitamin B12 B12 can not be absorbed without intrinsic factor Pernicious Anemia lack intrinsic factor Specific manifestations of pernicious anemia; s/s bleeding gums, diarrhea, impaired sense of smell, loss of deep tendon reflexes, anorexia, paresthesias Diagnostic test: serum B12 levels

acute kidney injury - obstructive = post renal

urine coming out of kidneys, urine/bladder/urethra, can't get the urine out and it goes back toward the kidneys Diagnose - elevated BUN and creatinine Reduced urine output and Dilute urine (reduced osmolality) Urine can have protein, blood and myoglobin in it

analgesic use in older adults

use non-opiods when possible use opioids with shorter half life start low and increase doses gradually re-dose less often due to longer action monitor carefully for sedation or confusion assess ability to self-administer consider safety... fall risks

dolophine (methadone)

used in detox of narcotic addicted individuals through methadone addiction programs monitor for long QT

systolic pressure

ventricle contracts influenced by stroke volume being ejected from the heart and the ability of the aorta to stretch and accommodate the stroke volume

diastolic pressure

ventricle relaxes influenced by the energy that is stored in the aorta as its elastic fibers are stretched during systole and the resistance to the runoff of blood from the peripheral blood vessels

cyancobalamin - indications

vitamin B12 deficiency in people with pernicious anemia

cyancobalamin - monitoring considerations

vitamin B12, hematocrit, reticulocyte count, folate and iron levels should be obtained prior to treatment; vitamin B12 and peripheral blood counts should be monitored 1 month after beginning treatment, then every 3-6 months after. Megaloblastic anemia - serum potassium and platelet counts should be monitored during therapy. CaloMist - if B12 levels decline despite max doses then should return to IM dosing

cyancobalamin - category

vitamins

define pharmacokinetics

way the body deals with the drug movement of drug through the body

adaptive active immunity

we are exposed to antigen either through vaccinations or environmental exposure (infection) and we develop an immune response with b and t cells takes longer to develop (days to weeks_ but longer duration of effect long-lasting immunity produced by the immune system in response to antigens ex. Hepatitis A virus infection and subsequent recovery gives rise to an acquired active immune response usually leading to a lifelong protection chickenpox / mmr vaccine vaccination benefit - active immunity without disease or disease complications either get infection or get immunization

cyancobalamin - teaching points

well balanced diet, don't use folic acid instead of B12 to prevent anemia. Instruct patients to report infection or disease in case condition requires increased dosage, tell the patient with pernicious anemia that he must have lifelong treatment with B12 to prevent recurring symptoms and the risk of incapacitating and irreversible spinal cord damage. Instruct patient to store tablets in a tightly closed container at room temperature

define pharmacodynamics

what the drug does to the body body's biological response to the drug

DISORDERS ASSOCIATED WITH DIABETES - nephropathy

when renal dysfunction related to changes in basement membrane of the glomerulus

oxycodone

with aspirin-percodan with acetaminophen-percocet long acting form: oxycontin - should be taken whole, never crushed - high abuse potential - very useful for chronic pain

DISORDERS ASSOCIATED WITH DIABETES - neuropathies

with motor and sensory changes in the feet and legs and progressive changes in other nerves as the oxygen is cut off

DISORDERS ASSOCIATED WITH DIABETES - retinopathy

with resultant loss of vision as tiny vessels in the eye are narrowed and closed

neuropathic pain

•Indicates type of pain that does not adhere to typical phases inherent in nociceptive pain• Neuropathic pain implies an abnormal processing of pain message •This type of pain is most difficult to assess and treat• Often described as burning, shooting, stabbing• Often perceived long after site of injury heals• Sustained on a neurochemical level that cannot be identified by x-ray, computerized axial tomography (CAT) scan, or magnetic resonance imaging (MRI)• Electromyography and nerve-conduction studies are needed

nociception process

•Nociception is the term used to describe how noxious stimuli are perceived as pain• Nociception can be divided into four phases •Transduction- Injured tissues release a variety of chemicals, including substance P, histamine, prostaglandins, serotonin, and bradykinin• -- These are neurotransmitters that propagate pain message, or action potential, along sensory afferent nerve fibers to spinal cord• Transmission- pain impulse moves from level of spinal cord to brain• Perception-conscious awareness of painful sensation• Modulation- pain message is inhibited through phase of modulation

structure and function

•Nociceptors: specialized nerve endings designed to detect painful sensations - Transmit sensations to central nervous system -- Located within skin; connective tissue; muscle; and thoracic, abdominal, and pelvic viscera -- These nociceptors can be stimulated directly by trauma or injury or secondarily by chemical mediators released from site of tissue damage -- Nociceptors carry pain signal to central nervous system by two primary sensory (afferent) fibers: Aδ and C fibers

pain relief - agonists

•Opioid analgesics (agonist) relieve pain by binding to opioid receptors in brain, spinal cord and peripheral tissue:• Inhibiting transmission of pain signals from peripheral tissues to the brain •Reducing the perception of pain sensation in the brain• Producing sedation • Decreasing anxiety associated with pain

morphine: prototype narcotic

•Reduces moderate to severe pain •Schedule II •Produces analgesia, CNS depression, respiratory depression, and acts as GI depressant •Administered; PO (short/long forms), IM, SQ, IV, PCA • Contraindicated—liver disease, respiratory depression and lung disease, ICP, head injury or hypersensitivity

hydromorphone (dilaudid)

•Relief of moderate to severe pain, may be used for cough in some instances •May be given PO, Sub Q, IV(slow), PR, •Often used for those intolerant to morphine •Caution when used with anti-hypertensives as it may cause postural hypotension •Do Not confuse with hydrocodone

fentanyl

•Synthetic opioid narcotic •Moderate to severe pain •IV during and post surgery •Transdermal system: •Changed every 72 hours •Different strengths •Patch CANNOT be cut or altered •Apply to clean dry area •Rotate sites