NUR 155 Exam 4
A client has a prescription to receive purified protein derivative, 0.1 mL, intradermally. The nurse should administer the medication by using a tuberculin syringe according to which guidelines?
26-gauge, 5/8 inch needle inserted almost parallel to the skin, with the bevel side up
How can med errors be prevented and why do they occur?
3 checks Drugs look/sound alike
Maximum fluid amount of IM injection in ventrogluteal
3 mL
IM injection ventrogluteal syringe size?
3 to 5 mL
When is a patient's pain usually the worst post-op?
3-4 days
Needle size of SubQ injection for an obese adult?
3/8 inch @ 90 degrees
Peak Plasma Level PO
30-60
What angle do you give a sub Q injection?
45-90
How to give a sub Q injection
45-90 degrees, 20-30 gauge (5/8ths- 3/8ths needle, no more than 1 mL
WHat angle do you give an inradermal injection?
5-15
Angle for intradermal injection?
5-15 degrees
Needle size of SubQ injection for an adult of normal weight?
5/8 inch @ 45 degrees
What degree do you give an IM injection?
90 degrees
irritating
A Z-track technique is encouraged when using medication that is ____ to decrease pain and bruising by sealing the drug into the muscle
filter needle
A ________ is used to draw up medication from an ampule; the needle is changed before administering the injection
In preparation for cataract surgery, the nurse is to administer prescribed eye drops. The nurse reviews the primary health care provider's prescriptions, expecting which type of eye drops to be prescribed?
A mydriatic medication
Mexican Americans view pain as
A part of life and a sign of strength
African Americans believe that pain is
A part of life and is to be endured
Ampule
A small sealed glass container that holds a single dose of medication; may have glass in them from the breaking of the container
Filter needle
A special type of needle required when drawing up certain types of medications to keep small particles of glass (from a vial or ampule) from entering the syringe and being injected along with the intended solution
3mL
A volume of up to _____ can be administered with IM injections in an adult
What should you do before giving a BP medication?
ALWAYS check BP
S/S of acute pain
Abnormal vitals, patient complains of pain
How far do you insert a vaginal suppository?
About 8-10 centimeters along posterior wall
How does diet affection drug action
Absorption
Coming to term with the loss
Acceptance
Implementing: Strategies for Pain Management
Acknowledge and accept pain. Listen attentively to client's description § Convey that you believe client and are asking questions because everyone's pain is unique § Attend to needs promptly § Cautious with the words complaints of. Instead ask do you have any discomfort? o Assist support persons § Hard to see loved one in pain § Usually want to help § Teach how to be supportive (wash cloths, massage, distraction etc...) o Reduce misconceptions about pain § Education § Less than 5% of clients become addicted to pain meds § Explain what to expect regarding pain and pain management o Reduce fear and anxiety § Strong emotions can amplify pain § Provide accurate information § Encourage client to express emotions/concerns
Which most essential element should the nurse consider to promote client adherence to care recommendations?
Adhering to the client's cultural preferences
1mL 25,27,29 gauge needle 5/8 inch 5-15 degree
An ID injection should be done using a ___ syringe with a ______ gauge needle that is ______ inch long. The needle is inserted at a ____ degree angle and the medication is injected slowly to form a bleb underneath the skin
Intramuscular injection
An injection into deep muscle tissue, usually of the buttock, thigh, or upper arm
Drug Allergy Effects
Anaphylactic reaction, happens immediately after the drug is administered, does not mean you have a side effect of the drug
Stage of belief where the client or family may direct anger towards nurse or staff
Anger
45-90 degrees
Angle of insertion of a subcutaneous injection; depends on patients size and length of needle used
Drug Adverse Reactions (adverse effects)
Are not expected; deadly; may justify the discontinuation of the drug
When communicating with a client who speaks a different language, which best practice should the nurse implement?
Arrange for an interpreter to translate
How do you check the placement of an NG tube?
Aspirate all stomach contents then measure residual volume OR auscultate
Examples of NSAIDS
Aspirin, acetaminophen
If a patient is administered a medication and has an adverse reaction, what do you do?
Assess vitals, stop medication, contact PCP
What elements are essential for the nurse to address to be able to deliver culturally competent care? Select all that apply.
Assessing the client's health preferences, Having knowledge of various racial and ethnic groups, Acknowledging personal misconceptions of various ethnic groups, Recognizing that subcultures exist and not every characteristic of the cultural group is present
A new graduate nurse is moving from a small rural college town to a metropolitan area to begin work in a county hospital. The nurse has had limited prior experience with the various cultural groups that are served by the hospital. What might be this nurses greatest challenge?
Assimilation
A nurse is working with a home health client whose spouse was not born in the United States. During the home visit, the nurse realizes that the client has acquired the identity of her spouses culture and has adopted some of the health practices of that culture. Which process should the nurse identify as occurring with the spouse?
Assimilation
Racism
Assumptions about racial groups
When do you perform the third check of med administration?
At bedside
How many pt identifiers?
At least 2.
Holistic health belief
Balance/harmony must be maintained; Illness results from an imbalance or disharmony
When a patient seeks to bargain to avoid loss they are experiencing
Bargaining
Compatibility
Before mixing two medications in a syringe, check for ________
Diversity
Being different or unique
Puerto Ricans react to pain by
Being loud and outspoken
When pulling medications from a vial, the needle tip should be where?
Below the fluid level
Subjective response experienced by surviving loved ones
Bereavement
A client has been prescribed betaxolol eye drops for the treatment of glaucoma. The ambulatory care nurse determines that the client understands proper medication use if the client states the need to return to the office for monitoring of what item(s)?
Blood pressure
The nurse manager is concerned that a staff nurse provides client care with a cultural prejudice. Which situation did the manager observe to come to this conclusion?
Bringing previous negative information and experiences into this situation
The nurse is performing an admission assessment on a client who has a history of glaucoma and uses latanoprost eye drops. Which assessment finding would indicate a side/adverse effect of these eye drops?
Brown pigmentation of the iris
When pouring liquid or dissolved medication into the syringe barrel, how do you allow the med to flow?
By gravity
What system is used in KY for tracking controlled substances
CASPER
If you think a doctor wrote a wrong order, what do you do?
Call PCP and verify
Pt has a fever on tylenol and now has a headache. What should the nurse do?
Call the doctor to obtain an order for a stronger dose
what disease effect drug action?
Cancer, circulatory issues, gut, renal, liver
31...63...43
Census Bureau predictions for 2060: Hispanic/Latins will represent -% of the total population; white non-Hispanics will decrease from -% to -%
Allergies
Check for drug _______ before administration of injection
Pain that is prolonged and interferes with function
Chronic
Anaphyactic shock
Circulatory failure from an allergic reaction; symptoms urticaria, bronchiolar constriction, edema, or circulatory collapse
The nurse is preparing to administer medication through a nasogastric tube that is connected to suction. To administer the medication, the nurse should take which action?
Clamp the nasogastric tube for 30 to 60 minutes following administration of the medication
The home care nurse is reviewing the record of a client newly diagnosed with glaucoma who is scheduled for a home visit. The nurse notes that the primary health care provider (PHCP) has prescribed atropine sulfate and pilocarpine hydrochloride eye drops. The nurse should contact the PHCP before the home visit for which reason?
Clarify the prescription for the atropine sulfate
Post mortem care?
Clean and get them ready for family to view, You may leave in a central line, all equipment and soiled linens removed, place in supine, family may wash body, bathing may be done by CNA
The nurse is preparing to administer an intradermal medication. Which action should the nurse take before administering the medication?
Cleanse the site of injection with an alcohol swab and wait for the alcohol to dry
Anger
Client or family may direct anger at nurse or staff about matters that normally would not bother them
Kublers stages- anger
Client/family may direct anger towards nurse about matter than doesn't bother them. Help pt understand anger is a normal response
A Chinese client is hospitalized with a fever of unknown origin and follows a very traditional, cultural view of illness. Which food should the nurse offer the client?
Cold liquids
Kubler stages- acceptance
Comes to terms with loss, may have decreased interest in surroundings and support people. May wish to begin to make plans
Priority for a dying pt?
Comfort and promotion of dignity
In preparation for cataract surgery, the nurse is to administer cyclopentolate eye drops at 9:00 a.m. for surgery that is scheduled for 9:15 a.m. What initial action should the nurse take in relation to the characteristics of the medication action?
Consult the surgeon, as there is not sufficient time for the dilative effects to occur.
If a client is experiencing depression, the nurse should
Convey caring by touch, communicate nonverbally
Why do we keep medical recs?
Creates the most accurate list of all medications. Follows them through admission, transfer and discharge
The nurse is annoyed by a healthy Hispanic American client who had minor abdominal surgery 2 days ago. The client claims he cannot get out of bed by himself, and the nurse lectures the client and tells him to try to be tough. What type of cultural behavior is this called?
Cultural imposition
prejudice
Culturally ignorant; preconceived notion or judgement not based on sufficient knowledge; may be favorable or unfavorable
What is the max amount to give in the deltoid/Gluteal
Deltoid-1mL Gluteal-3-mL
Grieving over what has happened and what cannot be; Client may withdraw or talk freely
Depression
If you have to crush a tablet to administer via NG tube, you must...
Dissolve crushed powder in at least 30 mL of warm water
Which is the best nursing interventions regarding complementary and alternative medicine?
Educating the client about therapies that he or she is using or is interested in using
An antihypertensive medication has been prescribed for a client with hypertension. The client tells the clinic nurse that he would like to take an herbal substance to help lower his blood pressure. The nurse should take which action?
Encourage the client to discuss the use of an herbal substance with the PCP.
A newly immigrated client is constantly attended to by family members. This has presented a problem to the nursing staff and the delivery of nursing care. In order to address this issue in a culturally sensitive manner, the nurse should take which action?
Evaluate the benefits of family participation in the clients care
What should you do before administering meds?
Explain each med and procedure
Pt admitted and house burns while in the hospital
Get them access to community services to get them back on their feet
What do you do when an allergic reaction occurs?
Give Benadryl permission is not required
PRN
Given when the patient requires it
Ampules
Glass containers with narrow neck, body and stem that are opened by breaking the glass; Usually contain a single dose medication; Tap or flick the stem several times with a finger to free the trapped solution
Vastus lateralis injection sight
Greater trochanter & Patella, hands facing away from you, where they come together is vastus lateralis
Rectus femoris injection sight
Greater trochanter & Patella, hands facing away from you, where they come together move to top of thigh
Total response to the emotional experience related to loss
Grief
Kubler stages- Depression
Grieves over what happened and what cannot be
When administering a pain patch, you must...
Have a nurse witness administration; Sign/date the patch; Put patch in new spot each change
Before applying a topical medication, you must...
Have an order from PCP
Magico-religious health belief
Health and illness are controlled by supernatural forces; Evil spirit, magic, or spell can cause illness; Illness resulted from "being bad" or opposing God's will; Getting well is also dependent on God's will
Urticaria
Hives; an eruption of wheals on the skin accompanied by itching
What do you ask if doctor tells you to give ibuprofen?
How much to administer
Newly diagnosed patient, what should you figure out?
How they learn the best
The nurse is preparing a plan of care for a client and is asking the client about religious preferences. The nurse considers the client's religious preference as being characteristic of a Jehovah's Witness if which client statement is made?
I cannot have any food containing or prepared with blood
The nurse is providing medication instructions to a parent. Which statement by the parent indicates a need for further instruction?
I should mix the medication in the baby food and give it when I feed my child
The nurse is providing medication instructions to a parent. Which statement by the parent indicates a need for further instruction? *I should cuddle my child after giving the medication *I can give my child a frozen juice bar after he swallows the medication *I should mix the medication in the baby food and give it when I feed my child *If my child does not like the taste of the medicine, I should encourage him to pinch his nose and drink the medication through a straw
I should mix the medication in the baby food and give it when I feed my child
The charge nurse is educating a new nurse on culturally competent communication techniques. Which response(s) made by the new nurse indicates a need for follow-up? Select all that apply
I should use a language interpreter for all culturally diverse groups, I should recognize my own biases and address known stereotypes with the client
The nurse is reviewing the instillation technique for both eye ointment and eye drops with the parent of a pediatric client diagnosed with bacterial conjunctivitis. Which statement made by the parents would indicate that learning has taken place?
I will be careful not to touch the eye or eyelid during administration
The nurse has completed client teaching regarding medication administration. Which client statement best illustrates compliance?
I'm glad to know about my medications, it makes taking them a lot easier
Painful and traumatic
IM injections in children are ____ and ____. It is preferable to find another way to give medication if possible
Nerve, blood vessel, or tissue damage
Improper selection of injection site may cause _____
Sympathetic nervous system responses to acute pain
Increased vitals, diaphoresis, dilated pupils
Parenteral
Injected VIA - § Intradermal - under the epidermis (into the dermis) § Subcutaneous - into the subcutaneous tissue, just below the skin § Intramuscular - into a muscle § Intravenous - into a vein
Subcutaneous route
Injection of a small amount of medication into the tissue below the dermal layer into subcutaneous fat
Intradermal route
Injection of drugs within or between the layers of the skin; usually used for skin (TB) or allergy testing; forms a skin bleb or small bump
Nature of Pain
Involves physical, emotional, and cognitive components Results from physical and/or mental stimulus Reduces quality of life Not measurable objectively Subjective and highly individualized component
The nurse is preparing to administer medications to a client via a percutaneous endoscopic gastrostomy tube. Which medication prescription should the nurse question? *Furosemide 20 mg via PEG tube daily *Digoxin 0.25 mg via PEG tube daily *Isosorbide mononitrate 30 mg via PEG tube daily *Acetaminophen elixir 650 mg via PEG every 4 hours as needed for temperature >101 F
Isosorbide mononitrate 30 mg via PEG tube daily
The nurse educator is orienting a new nurse to the pediatric unit and is including tips for medication administration. Which statement by the new nurse indicates that the teaching has been effective? *It helps to use magical thinking with the infant-age group *It helps to use magical thinking with the school-age group *It helps to use magical thinking with the toddler-age group *It helps to use magical thinking with the preschool-age group
It helps to use magical thinking with the preschool-age group
When taking med cart room to room what should you always make sure of?
It is always locked
Nasal Meds
It is suggested clients blow their nose prior to administration of nasal sprays unless contraindicated.
The preoperative medication sheet identifies that cyclopentolate is prescribed for a client before cataract surgery. The client asks the nurse what the medication is for, and the nurse provides education. Which statement by the client indicates that teaching has been effective?
It paralyzes the muscles in my eye
When a client is dying and experiences loss of muscle tone, what happens?
Jaw may sag, difficulty speaking, dysphagia, diminished body movement
Controlled Substance system tracking in KY?
KASPER
What is the US legislation for med admin?
Keep drugs on or off the market
Side effects and therapeutic action
Know the medication you will administer and observe for ______________
Patients name The name of the drug The dose
Label the syringe with __________
What is the #1 barrier in communication?
Language
African Americans believe that doing what will free a person from pain?
Laying of hands
Per agency policy, tubes must be ...
Left in place
Position for rectal suppository?
Left lateral or left Sims'
Where are topical medications applied?
Locally to skin in hairless areas; Side, back, butt
Sources of loss
Loss of oneself, object external to oneself, environment, loss of a loved one
How to administer eye drops?
Lower conjunctive, never touch tip to eye, do not allow pt to rub eyes
When teaching a client with glaucoma about the effects of a miotic medication, the nurse should tell the client that the medication will produce which effect?
Lower intraoccular pressure and improve blood flow to the retina
What end goes first when inserting a vaginal suppository?
Lubricated rounded end
When inserting a rectal suppository, what end goes first?
Lubricated rounded end
A client makes the following statement: I must be paying for all the wrongs I did in my life, to have such a diagnosis as this. The nurse suspects that this client views health from which type of belief?
Magico-religious belief
The nurse educator asks a student to list the 5 main categories of complementary and alternative medicine, developed by the National Center for Complementary and Alternative Medicine. Which statement, if made by the nursing student, indicates a need for further teaching regarding CAM categories?
Magnetic therapy and massage therapy are a focus of CAM
The nurse is reinforcing instructions to a client about the use of an incentive spirometer. The nurse tells the client to sustain the inhaled breath for 3 seconds. When the client asks the nurse about the rationale for this action, the nurse explains that which is the primary benefit?
Maintain inflation of the alveoli
The nurse is preparing to administer a tuberculin skin test to a client via the intradermal route. Which action should the nurse perform when administering this test to the client? *Inject the medication and place a pressure dressing over the medication site *Make a circular mark around the injection site after administration of the tubreculin test *Administer the injection with the needle bevel facing downward at a 10 to 15 degree angle *Massage the area with an alcohol swab after injection to ensure that the medication is absorbed
Make a circular mark around the injection site after administration of the tuberculin test
Stereotyping
Make assumptions that an individual reflects all characteristics associated with being a member of a group.
Pt receiving meds through NG tube
Make sure they're going by gravity, NEVER PUSH/FORCE
Why do you aspirate before giving an injection?
Make sure you're not in a vessel
How does sex effect drug action
Males = more protein & metabolize faster; females = more adipose tissue
Nonpharmacologic interventions to control body pain
Massage, heat/ice, positioning, acupressure, diet/nutrition, exercise
Analgesic
Medication that reduces or eliminates pain
The nurse is preparing to administer an intramuscular injection of pain medication to a new postoperative client. When the nurse walks into the client's room, the client asks why he is receiving an intramuscular form of the medication instead of the oral form. What is the nurse's best response with regard to the absorption of the medication?
Medications given this way are absorbed more quickly than by other routes
What are you checking for when assesing cognitive skills?
Mental status
The nurse plans care for an older client admitted with a fractured hip. Which analgesic prescribed by the primary health care provider at standard doses and frequencies would the nurse question?
Meperidine hydrochloride by IM route
Deltoid, dorsogluteal, ventrogluteal, vastus lateralis, and rectus femoris
Most common sites for a intramuscular injection
3mL syringe
Most frequently used syringe Chosen for giving volumes of medication of 1 to 3mL Measures tenths of a milliliter (0.1 mL) Used for most IM injections
Behavioral process through which grief is usually resolved
Mourning
A client is the child of an African American father and Asian American mother. The client has been exposed to cultural foods, traditions, and customs from both parents throughout life. What term should the nurse use to describe this client's cultural development?
Multicultural
What culture may want to give a ritual bath and prepare body for burial?
Muslim, hindu and jewish
Side effects of Opioids
N/V, constipation, sleepiness
1 to 1 1/2 inch needle that is 23-20 gauge
Needle size and gauge for IM injection
19-23 gauge, 1-3 inches long
Needle size used for intramuscular injections
13 to 30
Needles available in standard sizes from ___ to ___
Discrimination
Negative treatment based on race, ethnicity, gender, culture, sexual orientation
When caring for someone from a different culture
Never assume, don't act different, know what is acceptable in their culture
S/S of chronic pain
Normal VS, dry/warm skin, normal pupils, continue beyond healing, client doesn't complain of pain, lasting 3-6 months
Parasympathetic nervous system responses to chronic pain
Normal vitals, dry/warm skin, pupils normal or dilated
Is it okay to use humor?
Not all culture think humor is okay, know patient background
The nurse is providing instructions to a client who will be self-administering eye drops. To minimize systemic absorption of the eye drops, the nurse should instruct the client to take which action?
Occlude the nasolacrimal duct with a finger after instilling the drops
Where do you place drops in eye?
Onto outer third of lower conjunctival sac
Patients name Generic/trade name Dosage Route Time
Order for medication must always have these five things
Sites for SubQ injection?
Outer upper arm, thigh, abdomen
A Spanish-speaking client arrives at the triage desk in the emergency department and states to the nurse that an interpreter is needed. Which is the best action for the nurse to take?
Page an interpreter from the hospital's interpreter services
What type of care do you provide to the dying patient?
Palliative
Quick drug action
Parenteral routes are used when medications cannot be taken by mouth or __________ is desired
Ampules Vials Mix-O-Vials Unit dose cartridges
Parenteral solutions may be available in ________
This loss can be experienced by one person but cannot be verified by others
Perceived
The nurse is discussing the techniques of chest physiotherapy and postural drainage (respiratory treatments) to a client having expectoration problems because of chronic thick, tenacious mucus production in the lower airway. The nurse explains that after the client is positioned for postural drainage the nurse will perform which action to help loosen secretions?
Percussion and vibration
What do Roman Catholics do when someone is sick?
Perform sacrament of the sick
Nonpharmacological interventions to relieve social pain
Pet/family therapy, volunteering, support groups
Nurse must have what to administer meds?
Physician's orders
Who writes medication orders?
Physicians
The nurse is implementing the complementary therapy of therapeutic touch when caring for clients. The nurse should implement which action when performing therapeutic touch?
Position hands 2-4 in from the body
Nonpharmacologic interventions to control spirit pain
Prayer, meditation, meaningful rituals, spiritual healing
Vastus lateralis
Preferred IM injection site for 1 year old?
What are the drug classifications?
Prescription and OTC Generic name or Trade/Brand Name
Drug classification
Prescription and OTC Generic name or Trade/Brand name
When finished inserting a rectal suppository...
Press buttocks together for a few minutes, ask client to remain in position for 5 minutes
Once the ear drops have been administered you must
Press firmly on tragus
Acute/transient pain
Protective, identifiable, short duration; limited emotional response
The nurse is teaching a mother to instill drops in her infant's ear. The nurse explains that to give the ear drops correctly, the mother needs to take which action?
Pull down and back on the earlobe and direct the solution toward the wall of the canal
Ear drops are prescribed for an infant with otitis media. Which is the most appropriate method to administer ear drops to an infant?
Pull down and back on the pinna, and direct the solution toward the wall of the canal
Betaxolol eye drops have been prescribed for a client with glaucoma. The nurse monitoring this client for side/adverse effects of the medication would place highest priority on which assessment?
Pulse rate
Z-track method
Push and retract skin; insert at 90 degree angle; wait 10 seconds before withdrawing needle slowly; used for medications highly irritating to the tissue
When administering a nicotine patch, you must...
Put in new spot each change
Place cap on hard flat surface Scoop cap Press cap and needle on hard surface until cap snaps into place
Recapping a clean needle
What should you do if a powder medication needs to be mixed?
Reconstitute with whatever it calls for. Usually water/saline
Adding a diluent to a powdered drug is known as
Reconstitution
Type of pain that arises in other parts of the body
Referred
What are the 2 types of pain
Referred and visceral
When in pain, Japanese may
Refuse pain medication
Kubler stages- denial
Refusing to believe loss is happening. Verbally support pt, do not reinforce denial
Nonpharmacologic interventions to control mind pain
Relaxation, imagery, pain diary, reducing fear, music
A client has requested that she have a special item present in her room and explains that it gives her a feeling of comfort and a sense of organization. On which psychosocial component is this client focusing?
Religion
How do Native Americans respond to pain?
Remain quiet, tolerating a high level of pain
How do Buddhist clients respond to pain
Remaining calm
What should you do when giving a trasdermal patch?
Remove old patch, clean area, Give in different spot each time
If you aspirate and get blood...
Remove the needle and restart with new needle
All
Report ____ needle sticks
Non pharmacological ways to relieve pain?
Repositioning, masage, hot/cold apps
The nurse is providing care to a Hispanic client who is terminally ill. Numerous family members are present most of the time, and many of the family members are very emotional. What is the appropriate action?
Request permission to move the client to a private room and allow the family members to visit
When a client is dying and experiences changes in respiration, what happens
Respirations become rapid, shallow, or abnormal, death rattle occurs, mouth breathing
Before a client goes to surgery, he requests to have his spiritual leader present and pray over him. According to the HEALTH traditions model, which traditional method is the client invoking?
Restoring HEALTH
When administering a non-liquid medication via NG tube, you should...
See if the tablet can be crushed--Enteric coated CANNOT be crushed
Kubler stages- bargaining
Seeks to bargain to avoid loss
Bargaining
Seeks to bargain to avoid loss (ex: let me live until... and then I will be ready to die)
Tissue layer
Select the appropriate length of needle to deposit the medication in the proper ___________
Tissue
Select the correct site to prevent damage to the ______
The nurse is preparing to administer an oral medication to an infant. In which position should the nurse place the infant? *Prone *Semi-Fowlers *Trendelenburg's *Dorsal recumbent
Semi-Fowler's
Position for ear medications?
Side lying
When in pain, Chinese value
Silence
This loss occurs when losing a job, death of a child, etc. happens
Situational
27 gauge, 3/8 to 1/2 inch or 25 gauge, 5/8 inch
Size of needle needed for subcutaneous injections
24, 25, or 27 gauge needle
Size of needle used for Intradermal injections
Bloom's Psychomotor domain deals with
Skills, fine/gross motor
Patient receiving antibiotics and rash forms?
Stop, give benadryl and call the doctor
Pharmacokinetics
Study of how drugs enter the body, reach their site of action, are metabolized, and exit from the body.
What is bereavement?
Subjective response experienced by the surviving loved ones (mourning)
Position for eye medications?
Supine
Position for vaginal suppository?
Supine
What position do you place a postmortem patient in?
Supine
An older client is seen in the clinic for a physical examination. Laboratory studies reveal that the hemoglobin and hematocrit levels are low, indicating the need for further diagnostic studies and a blood transfusion. The client is a Jehovah's Witness and refuses to have a blood transfusion. The nurse should take which most appropriate action?
Support the client's decision not to receive a blood transfusion
The needle Tip Inner barrel Plunger
Syringe surfaces that must remain sterile
Religion
System of beliefs, values, practices & ethical values about superhuman power worshiped as creator or ruler of the universe
What needle size/angle for Intradermal injections?
TB Given in the dermis, 25-27 gauge. 1/4-5/8ths. 5-15 degrees. 1mL syringe
How do you dislodge any bubbles in the syringe?
Tap the syringe barrel
A client is in the bathroom when the nurse arrives at his room with his scheduled medications. The client calls to the nurse, "Just leave my medication on the bedside table like the rest of the nurses, and I will take it when I get finished." What is the nurse's best action? *Tell the client that he or she will be back when he is finished *Leave the medication at the bedside as the client requested *Let another nurse who is not busy give the client his medication when he is finished *Tell the assistive personnel to give it to the client when he is finished
Tell the client that he or she will be back when he is finished
Where is a buccal med given?
The cheek
A community health nurse works with a variety of cultures providing health care services that include preventive care, acute treatment, and education. Of the following clients, which is the most likely to use folk medicine?
The client who speaks little English and does not have a job
Trochanter Ventrogluteal
The head of the ____ and the anterior illiac spine are the landmarks used for this IM injection site?
Needle
The larger the number the smaller the ______
Before administering an eye drop you must expose
The lower conjunctival sac by pulling down on cheekbone
A miotic medication has been prescribed for the client with glaucoma, and the client asks the nurse about the purpose of the medication. Which response should the nurse provide to the client?
The medication causes the pupil to constrict and will lower the pressure in the eye
A client who is scheduled for cataract surgery requires preoperative instillation of cyclopentolate eye drops as prescribed. The client asks the nurse why this medication is needed, and the nurse provides education. Which statement by the client indicates that teaching has been effective?
The medication dilates the pupil of the operative eye
The nursing student is assigned to care for a client with glaucoma for whom pilocarpine hydrochloride eye drops have been prescribed. The nursing instructor asks the student to describe the action of the eye medication. Which statement by the student indicates an understanding of the purpose of this medication?
The medication increases the blood flow to the retina and also will lower the pressure in the eye
Gauze
The neck of the ampule is wrapped with ____ and snapped open away from the nurse
The nurse is preparing to provide preoperative teaching to a Spanish-speaking client and the client's family. Which nursing action would be most effective for teaching the client?
The nurse secures the assistance of a professional interpreter to communicate with the client
Aspirate
The nurse should not _____ before the insertion of medication because evidence does not support this practice
Cognitive teaching
Thinking part of it, knowing, comprehending
Bloom's Cognitive domain deals with
Thinking, knowing, comprehending
A client with glaucoma is receiving acetazolamide. The nurse educator provides education to a group of nurses about the indications for and effect of this medication. Which statement by one of the nurses indicates that the teaching has been effective?
This works to decrease introccular pressure
How should you encourage the client to breathe for a rectal suppository?
Through the mouth
Examples of Nonverbal communication
Touching, facial expression, eye movement, body posture
Verbal barriers absolutely require
Translators not family
Sepsis
Use sterile equipment and aseptic technique to prevent infection and _____
Z-track method
Used for deep IM injections of drugs such as iron dextran or Vistaril; Reduces pain caused by irritating drugs leaking into sub-q tissue; seals the medication in the muscular layer
Tuberculin syringe
Used to administer an intradermal injection; graduated measurements to 1mL
U-100 syringe/U-50 syringe
Used with U-100 strength /U-50 strength insulin Calibrated in units Needle is part of the syringe and is not removable
Upper outer portion of the arm Anterior surface of the thigh Abdomen
Usual sites for subcutaneous injections
Type of pain arising from organs
Viscera
30 minutes
Wait ______ after an injection to monitor the patient
What do muslimms want when they're dying?
Want their body to be turned towards Mecca. Hindus face south
The nurse is caring for a client who takes ibuprofen for pain. The nurse is gathering information on the client's medication history and determines it is necesssary to contact the PCP if the client is also taking which medications? Select all that apply
Warfarin, Glimepiride, Amlodipine
The nurse preparing a client for ear irrigation as prescribed by the pcp. Which action should the nurse take when performing the procedure?
Warm the irrigating solution to 98.6
The nurse is preparing to administer eye drops. Which interventions should the nurse take to administer the drops? Select all that apply. *Wash hands *Put gloves on *Place the drop in the conjunctival sac *Pull the lower lid down against the cheekbone *Instruct the client to squeeze the eyes shut after instilling the eye drop *Instruct the client to tilt the head forward, open the eyes, and look down
Wash hands, put gloves on, place the drop in the conjunctival sac, pull the lower lid down against the cheekbone
90 degree
What is the angle for IM injection?
5-15 degree angle
What is the angle of insertion used when administering an ID injection?
2-3 mL
What is the size of the syringe for an IM injection?
Pt states "I am dying" what should we ask?
What makes you think that?
21-23 gauge
What size needle is most appropriate for an IM injection?
Now
When a medication is needed right away, but not STAT
Side effects of the drug Previous site condition Evidence of therapeutic effect
When a repeat injection is given, assess for ________ before administration of the next dose
Long acting first then Short
When mixing long and short acting insulin, inject air into the ______ first and then the _____ acting
Shake
When reconstituting a medication from a powder, always rub between your hands, never ______
25, 27, or 29 gauge
Which needle gauges are typically used for ID injections?
When do you perform the second check of med administration?
While preparing
Date
____ all multidose vials when you open them
Charts
____ are often available to outline which drugs are compatible
Rotation
____ of sites for medication prevents fibrosis of the tissue
0.05 to 1 mL
______ of solution may be injected subcutaneously
SubQ injections
_______ Injections are placed beneath the dermis and above the muscle
The community health nurse is using the Heritage Assessment Interview tool with a group of community members. Which data indicate heritage consistent? Select all that apply *a client frequently visits the old country neighborhood he grew up in *a client is raised by a single parent *the clients education occurred at a religious school *the client participates in religious festivals and cultural events *the client has been the first of his family to earn a college degree
a client frequently visits the old country neighborhood he grew up in, the clients education occurred at a religious school, the client participates in religious festivals and cultural events
heritage inconsistent
acculturation into dominant culture
What are the two durations of pain?
acute and chronic
Types of pain
acute, chronic, cancer, inferred pathology, idiopathic
Cultural assessment
address by last name or what they prefer; ask about culture/religion upon admit
factors influencing pain
age, fatigue, genes, neurological functions, social factors, spiritual factors, psychological factors, cultural factors
drug half life
amount of time for half the med to get out of the body
half-life
amount of time for half the med to get out of the body
Allergy (Drug)
anaphylactic reaction (occurs immediately after the drug is administered), doesn't mean you had side effects of a drug
PRN means?
as needed
culture assessment
ask about faith and belief systems to understand culture and spirituality relationships
racism
assumptions held about racial groups which include the belief that races are biologically discrete and exclusive groups that are inherently unequal and ranked hierarchically
folk medicine
beliefs and practices relating to illness prevention and healing that derive from cultural traditions rather than modern medicine; thought to be more humanistic than biomedical health care; consultation and treatment take place in the community; may be less expensive than scientific or biomedical care; frequently includes ritual practice by healer or client; more comfortable, less frightening to client
Folk medicine
beliefs/practice from cultural traditions
Pilocarpine hydrochloride is prescribed for a client with glaucoma. The nurse checks the medication supply room to ensure that atropine sulfate is available for administration in the event that systemic toxicity occurs from the use of pilocarpine hydrochloride. The nurse also monitors for which sign of systemic toxicity?
bradycardia
culturally responsive nursing care
centered on client's cultural perspectives; integrates client's values and beliefs into plan of care; develops self-awareness of nurse's own culture, attitudes, and beliefs; examines nurse's biases and assumptions about different cultures; nurse gains knowledge and skills to create environment where trust can develop
The nurse is preparing to administer medication using a client's nasogastric tube. Which actions should the nurse take before administering the medication? Select all that apply.
check the residual volume, aspirate the stomach contents, turn off the suction to the nasogastric tube, test the stomach contents for a pH indicating acidity
excretions
chemical makeup of the body determines the organ excretion -liver -kidneys -bowel -lungs -exocrine glands
A community health nurse is learning about the REACH initiative and has decided to implement community education on this approach. What topics should the nurse include in this education? Select all that apply *child and adult immunizations *cardiovascular disease *chronic lower respiratory disease *stroke *infant mortality
child and adult immunizations, cardiovascular disease, infant mortality
race
classification of people according to shared biologic characteristics and physical features
Visceral pain is
comes from an organ, pain felt in the region of the organ stimulation of deep internal pain receptors Ex. GI infections, menstrual cramps, thorax, Cramping, throbbing, pressing, aching
Acute pain
comes on quickly, can be severe and lasts only a relatively short time
Generalizations
common cultural patters; assuming everyone from the same culture is the same
lives; health problems arise
culturally responsive care looks at the context in which the client - and the situations in which ---
nutritional patterns
different cultures have different -- meaning that some cultures have strict dietary restrictions
time orientation
different cultures have different -- meaning they have different focuses on past, present, and future
space orientation
different cultures have different -- meaning they have different intimate zones, personal zones, and public zones
discrimination
differential and negative treatment of individuals on the basis of race, ethnicity, gender, or group membership
The nurse teaching a mother how to administer ear drops to an infant tells the mother to pull the child's ear in which direction?
down and back and direct the solution toward the wall of the canal
Oral med admin
easiest, most durable food may decrease therapeutic effect aspiration precautions enteral/small-bore feedings (verify tube location compatible w/med absorption, follow ASPEN guidelines, use liquids when possible, if to admin med on empty stomach allow at least 30 min. before/after feeding)
cultural encounters
engaging in face-to-face cultural interactions with persons from diverse backgrounds, and learning to modify one's existing beliefs and prevent possible stereotyping
Space orientation due to culture
everyone has own definition of personal space; Italians - close, Indians - far
Thermal pain
exposure to extreme temperatures (hot or cold)
diversity
fact/state of being different--> sex, age, culture, ethnicity, socioeconomic status, education level, religion; exists between cultural groups AND WITHIN cultural groups
authority figure in family; value placed on children, other adults; gender-role behavior; extent of family's involvement in hospitalized client's care; needs of extended family; naming systems (family and given name)
family pattern variables that are shaped by culture
Affective teaching
feelings, how you connect with pts, acknowledge state that they are in
pain is the ______ vital sign ?
fifth
How do you find deltoid sight for IM Injections?
find the acromion process, 4 fingers, 3 fingers down make a V, in between V is Deltoid injection
social, behavioral, environmental, biologic/genetic
four determinants of health
How do genes effect drug action?
genetic testing
STAT
given immediately in an emergency
single dose med
given only once for a specific reason
Race
groupings of people with common origin or background, associated with perceived biological factors; Only one human race
Ventrogluteal injection sight
hand facing away from you, Palm on greater trochanter, finger on iliac crest, another finger on anterior superior iliac spine.
peak plasma level
highest level of med. PO (30-60) IV (med is done)
spend time with client and convey genuine desire to learn their values and beliefs; address client by last name (Mr. Jones, Mrs. Jones, until given permission to use another name); introduce self by full name; be authentic and honest about the culture; use language that is culturally sensitive; consider what client thinks about his/her health problem, illness, and treatment; ask about anything you don't understand; show respect for client's values, beliefs, and practices; show respect for client's support people; obtain client's trust
how to convey cultural sensitivity
heritage consistent
identification with traditional cultural heritage
The clinic nurse is caring for a client who has been prescribed fentanyl, a potent opioid, for chronic pain. In what forms is it available for chronic pain administration in the at-home setting. Select all that apply
intranasal spray, oral transmucosal lozenge, 72-hour transdermal patch, effervescet buccal oralets
Somatic pain
joint, muscle, bone (Throb, ache, stabbing pain) Ex: sprains/ paper cuts
If a patient is experiencing bargaining the nurse should
listen attentively
Signs of impending death
loss of muscle tone slowing of the circulation changes in respiration sensory impairment
Syringes
made of plastic or glass; used to irrigate wounds, aspirate fluids, or inject medications
Cultural Sensitivity
making sure you do what you can to accommodate their culture
Decision maker in a lot of cultures
males
prescription
medication to be taken outside of the hospital
metabolism
metabolized into a less potent or an inactive form
trough
minimum blood serum concentration before next scheduled dose
Betaxolol hydrochloride eye drops have been prescribed for a client with glaucoma. Which nursing action is most appropriate related to monitoring for side and adverse effects of this medication?
monitoring blood pressure
Betaxolol eye drops have been prescribed for a client with glaucoma. The home health nurse preparing to visit the client develops a plan of care that includes monitoring for the side/adverse effects of this medication by taking which assessment action?
monitoring body weight
silence, touch, eye movement, facial expressions, body posture
nonverbal communication involves the use of?
white
nurses are predominantly - and workforce demographics do not reflect national demographics
What are the 3 checks?
o 1stcheck - Upon removal § Read the MAR and remove the medications from the clients drawer. Verify that the clients name and room number match the MAR. § Compare the label of the medication against the MAR § If the dosage does not match the MAR, determine if you need to do a math calculation § Check the expiration date of the medication o 2ndcheck - When preparing § While preparing the medication (pouring, drawing up or placing unopened package in a medicine cup), look at the medication label and check against the MAR o 3rdcheck - At bedside § Recheck the label on the container (vial, bottle or unused unit-dose medication) against the MR before returning to its storage OR before giving the medication to the client
IM injections
o 23-25 gauge for deltoid o 21-22 gauge for larger muscles o 1-1/2 length o 1ML max for deltoid o 1-4ML for larger muscles o 90 degrees o Aspirate!!!! o Ventrogluteal, Vastus lateralis, Rectus femoris, Deltoid
Pain assessing
o 5thvital sign is pain o Major barriers to pain control o Inadequate assessment o Believing the client's report of pain o Concerns about addiction (less than 5% clients without hx of drug abuse becomes addicted from use of prescribed pain medications) o Unwanted side effects o Reporting pain will lead to tests o "complainer" - pain and complaints have emotional/sociocultural meaning. Do you have any discomfort right now? Instead of do you have any complaints of pain? o Self-report is the "gold" standard for pain assessment. Nonverbal clients may be challenging- use behavioral responses to pain. o Pain history - Old injuries, chronic pain (meds/coping), allergies, location (use one finger to show pain location, what nonpharmacological thing helps o Why wouldn't pain be reported? - Afraid of pain meds (addiction) Looks weak o Observing - Nonverbal - rubbing, groaning - Physiological - HR & RR up, sweat, pupils dilated Pain Diary - what triggers pain & when it happens
Types of loss
o Actual - external object, something is missing o Perceived - cannot be verified, battles internally o Anticipatory - before the loss every occurs o Developmental - retiring, kids moving out, leaving job
opiods for pain
o Addiction- Compulsive craving & compulsive behavior to get ahold of it. Lie, steal & buy. o Physical Dependence - Chronic Pain. Used to taking meds and use them to get through everyday. Taper off o Tolerance - Genetics & how much you take them = tolerance
What factors may affect learning in patients?
o Age/developmental o Motivation o Readiness o Active Involvement o Relevance o Feedback o Nonjudgmental support o Simple to complex o Repetition o Timing o Environment o Emotions o Physiological Events o Culture aspects **LANGUAGE IS #1 BARRIER** o Psychomotor ability
Transdermal meds
o Applied to skin, local and maybe systemic effects o Lotion, creams, ointments, patches o Soap/water, gloves, pat dry and apply o Wrap in glove and put in sharps container o Rotate sites
Source of lost
o Aspect of self - vasectomy, wound, scar, loss of self-image o External objects - pet, object, o person o Familiar environment - forced into new home o Loved ones
What do you do if a med error is made?
o Asses VS & pt physical status o Notify PCP/Charge nurse o Incident report - NEVER put in pt chart o Most errors can be reversed, allergic/too much is where it gets bad
What steps should be taken to administer drugs safely?
o Assessment - based on drug type and drug action - BP, HR, AAO o Suitable route - right size syringe/needle o Med History - taken it before, allergies, any illegal drugs, herbal drugs o Allergies o Drug specifics - time of day? w/ or w/o meals? o Self-administration issues - Vision, dexterity
Stages of grief
o Denial, Anger, Bargaining, Depression, Acceptance
Neuropathic pain
o Diabetic patients o Described as "burning, numbness, itching, pins and needles" o Pain meds don't touch o Complex and often chronic o Damaged or malfunctioning nerves o Arises from injury to a nerve and the injury causes the transmission of repeated pain signals even when there is no painful stimuli. o Poorly controlled diabetes, stroke, tumor, alcoholism, viral infection o Use Gabapentin, Lyrica
What is required for a drug order to be valid?
o Full name of pt. o Date/time written o Name of drug o Dosage o Frequency o Route o Signature
intradermal injection
o Given in dermis ONLY o Use 1ML syringe (TB syringe) o 25-27-gauge needle, ¼ - 5/8 in o Max dose = 0.1 ML o Bevel up, wheal needed to be successful o Chest, scapula, forearms
Med administration process
o Identify client o Inform client o Administer drug (after completion of 3 checks) o Interventions as needed o Document drug administered o Evaluate drug response o PRN - if PRN need to document why given and make sure it worked
Opthalmic meds
o Instilled in the form of liquid or ointments o Instruct client to look up at the ceiling. Give client dry sterile absorbent sponge o Expose the lower conjunctival sac after placing the thumb of fingers on your nondominant hand on client's cheekbone drawing skin down
SubQ injection
o Max 25-gauge needle, 3/8-5/8 length o 1ML MAX dose o 45 degrees = average or thin o 90 degrees = obese o Pinch or spread skin o Arm, abdomen, thigh, scapula, back adipose tissue
Assessment of learning needs includes?
o Nursing history - age, problems, cultural belief practice o Physical Exam - energy level, nutrition, ROM, vision/hearing o Readiness to learn - ask questions, seek information o Motivation - do they want to learn, get better? o Health literacy - can they read? o Overall health
What are the 5 rights
o Patient, Drug, Route, Time, Dose o Documentation, education, refuse, asses, evaluate
Responses to pain
o Psychological/Psychosocial effects § Fight or flight, BP up, makes pt. not nice § may increase heart and respiratory rate, trigger reflexes, stop movement, lead to muscle atrophy and dermal ulcers o Unrelieved pain =negative effects on overall health
Grief
o Responses to loss § Physical - weight loss, crying, no appetite § Psychological - depression, turning to alcohol/drugs § Spiritual - questioning spirituality o Bereavement § the mourning and adjustment time after a loss § Timeframe o Mourning § Behaviors associated with grief § How you act about the loss § Culturally different
Oral medication route
o SAFEST ROUTE/MOST CONVIENENT - does not break skin barrier o Tablets - can be scored/crushed as long as not enteric coated o Capsules, liquid o Sublingual(under tongue - NITROGLYCERIN) o Buccal(Cheek) o Enteral - tube feed, crushed or liquid
What considerations must be taken before and during an injection?
o Safe distance from nerves, large blood vessels & bones o Free from injury, abscesses, tenderness or necrosis o Right site/route to accommodate amount of med given
IM Z-Track Technique
o Seals needle track o Displace or Pull skin to side o Insert, aspirate, inject (wait 5-10 seconds), withdraw, release skin
Topical meds
o Skin/body cavity o Eye - Lower and outer. Ointment is applied in to out o Ear - 3+ up & back, -3 down & back o Vagina - Need to go up by cervix o Rectum - lube always, make sure not melted or too cold o Nose - blow before, slow inhale
Methods of pain med administration
o Transdermal-non invasive; delivers continuous amount of drug for 24 hrs - 3 days/ Fentanyl patch. Systemic effect (opposed to topical). DISCARD PAIN PATCH IN SHARPS CONTAINER o Transmucosal- oral mucosa is well vascularized. Treat break through cancer pain. o Rectal - Dysphasic clients or N/V o Topical- localize effect to the body area where applied. Used for painful procedures. o Subcutaneous- Continuous subcutaneous infusion. Prolonged opioid use. Unable to take PO o Intramuscular- avoided due to variable absorption rate and potential for nerve damage o Intravenous- most rapid onset o Intraspinal- into epidural or intrathecal space o PCA- Interactive method of pain management that permits client to treat their pain by self administering doses of analgesics. Used for postoperative pain. Allows client to maintain a more constant level of medication in blood. 2 RN check. Document assessment on flowsheet. Has protective mechanisms o Choose dependent upon: GI status, goal of pain relief (immediate relief, long lasting pain relief), severity of pain, available form, IV access
Mechanical pain
o external forces that result in pressure or friction against the body. § Ex. surgical incisions, edema, cast
Pain receptors (nociceptors)
o respond to stimuli that are potentially damaging. Can result from mechanical, thermal, chemical (external and internal). Nociceptors- are receptors that are sensitive to pain. They are located in the skin (a lot) and organs. These receptors are attached to a nerve fiber that transmits a message of pain to the spinal cord.
Distribution
o the transportation of a drug from its site of absorption to its site of action
cultural knowledge
obtaining a sound educational foundation concerning the various worldview of different cultures
Acculturation
occurs when people incorporate traits from another culture; adjust to some American cultures but keep their own culture within their homes; Practice their culture as much as they can in the United States; Involuntary process
Drug Interactions
occurs when the administration of one drug before, at the same time as, or after another drug alters the effect of one or both drugs; contraindications, drug compatibility
Drug interactions
occurs when the administration of one drug before, at the same time as, or after another drug alters the effect of one or both drugs; contraindications, drug compatibility
synergistic effect
occurs when the combined effect of two medications is greater than the effect of the medications given separately
distribution
occurs within the bodys tissues
ethnicity
often used interchangeably with race; relationship of individuals who believe they have distinctive characteristics that make them into a group; may shift over time
Single order means?
one time only
Visceral pain
organ pain
What is visceral pain?
organ pain
National Partnership for Action to End Health Disparities; National Stakeholder Strategy for Achieving Health Equity; HHS Action Plan to Reduce Racial and Ethnic Health Disparities; USDHHS Office of Minority Health; CDC Office of Minority Health and Health Equity; National Center on Minority Health and Health Disparities (NCMHD); CDC program REACH U.S.; Healthy People 2020
organizations working to reduce health disparities and emphasize culturally appropriate health care
What is somatic pain?
originating from muscle, bone, joints, tendons, or blood vessels
Phantom pain
pain after loss of limb/amputation
Referred pain is?
pain felt in a different area than the actual source Shoulder pain may be a symptom of cardiac pain.
subculture
people who have distinct identity and are yet related to a larger cultural group; usually shares physical characteristics or ethnic origin with a larger cultural group; examples: occupational (nurses), feminists, etc.
Subculture
people who have distinct identity but are still related to a larger cultural group
multicultural
person who has dual pattern of identification and crosses two cultures' (bicultural) lifestyles and sets of values...may happen with a child with parents from two different countries
plateu
point at which the blood serum concentration is reached and maintained
prejudice
pre-concerned notion or judgment that is not based on sufficient knowledge; may be favorable or unfavorable
nationality
state/country one has citizenship to
nationality
state/country where one has membership
generalizations
statements about common cultural patterns; may not hold true at the individual level and should only serve as openings for individuals to better understand each other
religion
system of beliefs, practices, and ethical values about divine/superhuman power worshipped as creator/ruler of the universe
cultural skills
the ability to collect culturally relevant data regarding the client's health in a culturally sensitive manner
health equity
the highest possible standard of health for all people, especially those at greatest risk for poor health
cultural desire
the motivation to want to engage in process of becoming culturally aware, culturally knowledgeable, culturally skillful, and seeking cultural encounters
absorption
the passage of medication molecules into the blood from the site of administration
What are drug effects?
the physiologic reactions of the body to a drug
Drug Absorption
the process by which a drug is passed into the bloodstream; first step in the movement of the drug through the body
Absorption
the process by which a drug passed into the bloodstream; first step in the movement of the drug through the body
Assimilation
the process by which an individual develops a new cultural identity; becoming like members of the dominant culture, assimilates with American culture
Excretion
the process by which metabolites and drugs are eliminated from the body
onset
the time it takes for the med to start work
Drug Distribution
the transportation of a drug from it's site of absorption to it's site of action
Standing order means?
there if needed in an emergency
Drug Toxicity
too much/ overdose; ingestion of a drug intended for external use or buildup of the drug in the blood because of impaired metabolism or excretion; elderly/kids at risk, kidney/liver
The prenatal clinic nurse is performing an assessment on a culturally diverse client. Besides conversational style, what are some of the most important cultural and communication considerations the nurse must be aware of? Select all that apply.
touch, eye contact, personal space, time orientation
A nurse educator uses Madeleine Leiningers model and describes a formal area of study and practice focused on comparative human-care differences and similarities of the beliefs, values, and patterned lifeways of cultures to provide culturally congruent, meaningful, and beneficial health care to people. What type of nursing is the educator practicing?
transcultural nursing
A new graduate nurse is working in a busy emergency department of a hospital, situated in a culturally diverse area of the city. In striving to be culturally sensitive, what should the nurse do?
try to learn about the attitudes toward health care and traditions of the different cultures in that area
verbal and nonverbal
two different types of communication styles that may vary across cultures
The nurse is admitting a client and knows that clients typically share information about herbal supplements or therapies only if they are specifically asked. What are some additional things the nurse needs to do when dealing with this topic with clients? Select all that apply.
use open-ended questions, respond to clients with comments that invite an open-minded discussion, document the use of any herbal products or dietary supplements in the client record, create an accepting and nonjudgemental attitude when assessing use of or interest in herbal products or dietary supplements
Ethnicity
used interchangeably with race
The nurse is caring for a pediatric client who is going to receive a vaccination. Place the nursing actions for performing this procedure in order of priority
verify prescription, assess for allergies, obtain parental consent, check lot number and expiration, select appropriate site and administer vaccine, provide vaccination record
magics-religious view
view of health beliefs in which health and illness are controlled by supernatural forces; may believe that illness is a result of "being bad" or opposing God's will; getting well is also dependent on God's will; some cultures believe magic can cause illness through spells and may need magical treatment
scientific/biomedical view
view of health beliefs that believes life is controlled by physical and biomechanical processes manipulated by humans; illness caused by germs, bacteria, or breakdown of the body; belief that pills, treatments, or surgery will cure
holistic view
view of health beliefs that believes that forces of nature must be maintained in balance and harmony; human life is one aspect of nature that must be in harmony with rest of nature; when natural balance is disturbed, illness results
awareness, skill, knowledge, encounters, desire
what does the ASKED pneumonic stand for in developing self-awareness in which the nurse identifies own cultural beliefs and assumptions/biases
Peak Plasma Level IV
when med is done
STAT means?
within 15 minutes ASAP
How do you prepare a vial
§ A glass bottle with a sealed rubber cap § scrub the hub for 30 seconds (can use filtered needle as well) § air must be injected into a vial before withdrawing the medication
How do you prepare an ampule?
§ A glass container usually designed to hold a single dose of a drug § Once the ampule is broken, the fluid is aspirated into a syringe using a filtered needle ALWAYS filter needle, has air in them
Acceptance
§ Comes to terms with loss § May have decreased interest in surroundings and support people May wish to begin making plans
Depression
§ Grieves over what has happened and what cannot be. § May talk freely or may withdraw
Reconstituting
§ Technique of adding a diluent to a powdered drug usually have printed instructions § read vial to know what to mix w/ (mostly use sterile water)
pain threshold
§ The least amount of stimuli that is needed for a person to label a sensation as pain § Vary from person to person § Dependent upon numerous factors (age, gender, race) § Knows there's something going on
Pain tolerance
§ The maximum amount of painful stimuli that a person is willing to withstand without seeking avoidance of the pain or relief
o Prevent pain (preemptive analgesia)
§ Treat pain before it occurs or before it becomes severe (stay ahead of pain, easier than chasing it)
Chemical pain
§ external- Ex. lemon juice on a paper cut § internal- chemical changes in the body that result from tissue ischemia
awareness
"A" in the ASKED pneumonic; am I aware of my biases/prejudices as well as racism and other "isms"?
desire
"D" in the ASKED pneumonic; do I really want to become culturally competent?
encounters
"E" in the ASKED pneumonic; do I seek face-to-face and other types of interactions with people who are different from me?
knowledge
"K" in the ASKED pneumonic; am I knowledgeable about the world view of diverse cultural/ethnic groups?
skill
"S" in the ASKED pneumonic; do I have the skill in conducting a cultural assessment in a sensitive manner?
Gauge size for intradermal injection?
#25-27
Insulin gauge size for SubQ injection?
#30
Adverse reactions
(adverse effects) aren't expected, deadly; may justify the discontinuation of the drug
drug toxicity
(harmful effects of a drug on an organism or tissue) too much/overdose; ingention of a drug intended for external use or buildup of the drug in the blood because of impaired metabolism or excretion; elderly/kids at risk, kidney/liver
nociceptive pain
(nociceptive receptors sensory neurons that detect mechanical, thermal, or chemical conditions associated with potential tissue damage) - Most common type of pain experienced - Pain receptors, called nociceptors, respond to stimuli that are potentially damaging -Result from trauma, surgery, inflammation
Drug side effects
(secondary effect) Expected and treated; may be harmless or potentially harmful
Nursing Knowledge
- attitude of health care providers - assumptions about patients in pain
intradermal
-15 degree - used for TB test/allergies -slow absorption -use tb syringe -insert w/ bevel up -a small bleb will form, if not change injection site
Intramuscular injection
-90 degree -Faster absorption than subq -Needle: 1/2-1 inch -Amount: adults 2-5 ml absorbed children up to 2 ml -ventrogluteal -vasus lateralis -deltoid -z track method
cancer pain
-acute or chronic
eye med admin
-avoid the cornea -avoid the eyelids w/ the dropper or tubes to dec. infection -use only on affected eye
idiopathic pain
-chronic w/o identifiable physical or psychological cause
Intraocular med admin
-disk resembles a contact -teach how to insert and remove disk -teach adverse effects
peripheral iv
-flush w/ 0.9% NS once a shift -should be assessed for any redness, swelling, or drainage -if infiltration is suspected, stop use of site, and remove IV
parenteral med admin
-injection into body tissues -aseptic technique -risk of infection
syringes
-luer lock -non leur lock -0.6-60ml
inferred pathological pain
-musculoskeltal -visceral -neuropathic
chronic/persistant non cancer pain
-not protective -has no purpose -may or may not have an identifiable cause
Assessment
-patients expression of pain - characteristics of pain onset, duration, location, intensity, quality, pattern, relief measures, symptoms
Pain
-reduces quality of life -results from physical or mental stimulus -not measurable objectively -subjective component
10 rights of medication administration
-right medication -right dose -right time -right route -right patient -right education -right documentation -right to refuse right to assessment -right evaluation
topical medications
-use gloves -use sterile technique if open wound -clean skin first -remove old patch
ear med admin
-use sterile solutions -drainage may indicate ruptured eardrum -never occlude the ear canal -do not force meds in occluded ear
Maximum amount of volume in intradermal injection?
0.1 mL
Maximum fluid amount of IM injection in deltoid
0.5 - 1 mL
Maximum fluid amount of SubQ injection?
0.5 - 1 mL
What do the ranges mean on the pain scale? 1-3; 4-6; 7-10
1-3 = mild; 4-6 = moderate; 7-10 = severe
Needle size for intradermal injection?
1/4 - 5/8 inch
pain scales
11 point scale and Wong/Baker scale (kids) (faces)
Difference in pain with pt in post op
1st is not usually as bad as the 3rd. 3rd day is normally the worst
What is the Wong Bakers scale?
"Faces" used to determine how much pain pt is in
Filipino clients believe that pain is
"God's will"
What solution do you flush an IV with?
0.9% NS
IM injection deltoid syringe size?
1 mL
Tuberculin syringe
1 mL in size Calibrated to measure as small as 0.01 mL drug doses
How many people have chronic pain?
1 of 6
A client is prescribed an eye drop and an eye ointment for the right eye. How should the nurse best administer the medications? *Administer the eye drop first, followed by the eye ointment *Administer the eye ointment first, followed by the eye drop *Administer the eye drop, wait 15 minutes, and administer the eye ointment *Administer the eye ointment, wait 15 minutes, and administer the eye drop
Administer the eye drop first, followed by the eye ointment
standing/routine order
Administered until the dosage is changed or another medication is prescribed
When do you do med reconciliation?
Admission, transfer and discharge
Short acting then Long
After injecting air withdraw prescribed amount of ____ acting insulin first and then ____ acting last.
Before touching a pt what should you do?
Always ask permission, some culture don't believe touching is appropriate, some cultures don't believe woman have a voice. You must accept both.
What should you do if you go into patients room and they're asleep?
Always wake them up and give med.
What type of effect do NSAIDS have
Anti-inflammatory
When in pain Arab Americans will
Anticipate immediate relief from pain
Experienced in advance of the event
Anticipatory grief
After family views the postmortem body, what do you do?
Apply ID tags, wrap body in shroud, apply ID to outside of bag
A female client is being discharged after a lengthy hospitalization. The family is from a male-dominated culture. Before discharge instructions are given, which action should the nurse take?
Arrange for teaching when the spouse is available
What do you do before injecting IM?
Aspirate
What are the 3 med checks?
At the med room, when preparing medication (usually at the door), at the bedside before giving
The nurse working in a long-term care facility notes that several clients are taking pilocarpine hydrochloride eye drops. The nurse ensures that which medication is available on the nursing unit for use if a client should develop systemic toxicity from pilocarpine hydrochloride?
Atropine sulfate
The nurse would question the primary health care provider if which medication were prescribed for a client with glaucoma?
Atropine sulfate
Which medication, if prescribed for the client with glaucoma, should the nurse question?
Atropine sulfate
If a client is experiencing anger, how should the nurse react
Avoid withdraw or retaliation
A client with glaucoma is given a prescription for a pilocarpine ocular system. The nurse plans to provide which instruction to the client on how to use the medication?
Check the eye each morning to make sure that they system is in place
Before teaching a patient you must
Determine how they learn best
Stage of grief when a child moves out?
Developmental
Type of loss that deals with expected moments (departure of child, death of aging parents)
Developmental
Sterile water or saline
Dilutents are usually ____ or _______
When a client is dying and experiences slowing of the circulation, what happens
Diminished sensation, mottling, cyanosis, decreased BP, slow pulse
If using an eye ointment you must..
Discard first bead because it is considered contaminated
If the NG tube is connected to a suction, what do you do?
Disconnect the suction and keep the tube clamped for 20-30 minutes to enhance absorption
When a person is unable to acknowledge the loss (abortion, suicide)
Disenfranchised grief
A client who had abdominal surgery is receiving epidural analgesia. The nurse monitors the client closely, knowing that which is a potential complication of this therapy?
Dislodgment of the epidural catheter because the catheter is not sutured in place
Parenteral route
Dispensation of medications via a needle into the skin layers
A client with chronic glaucoma is being started on medication therapy with acetazolamide. The nurse teaches the client that which can occur early with the use of this medication?
Diuresis
A clinic nurse is performing an admission assessment on an African American client scheduled for cataract removal with intraocular lens implantation. Which question should the nurse avoid asking on the initial assessment?
Do you have any family problems?
What do you do if medicine is left lying on table and not given to patient (for 2 hours)?
Document medication hasnt been given. Unknown reason
What to do if pt has a lot of family members in the room?
Don't ask them to leave, include family members if okay with pt
Proper technique when administering ear drops?
Don't touch tip to ear, 3 years and older pull back and up, 3 years and younger pull down and back
Powdered form
Drugs that are unstable in liquid form are prepared in a ________
When providing postmortem care, what must be removed from bed?
Equipment, soiled linens, all supplies
Drug side effects (secondary effect)
Expected and treated; may be harmless or potentially harmful
Bloom's Affective domain deals with
Feelings, attitudes, beliefs, behaviors
Discarded
Filter needles are ______ and new needle is attached to syringe for injecting medication into the patient
What type of needle do you use to withdraw medications?
Filtered
The nurse is preparing a menu for a Jewish client who observes kosher customs. Which food items would be appropriate to serve this client, assuming all have been properly inspected and prepared?
Fish, vegetables, and hot tea
Bleb
Fluid-filled raised area under the skin
How do you approach the eye when administering an eye drop?
From the side
If a medication is in liquid form for NG tube, you must..
Further dilute the liquid with sterile water
If there is a language barrier you must
Get an interpreter
The nurse in a health care clinic is preparing to conduct a nutritional session with a group of culturally diverse pregnant women. At the first session the nurse will be meeting with each client individually. The nurse prepares a list of items to be included in the session and lists which item as the priority?
Identify the food preferences and methods of food preparation for each client
Scientific health belief
Illness is caused by germs, bacteria or a breakdown of the body; Pills, treatment, surgery will cure
What do you need to do if a pt is getting ready to pass away?
Inform family, never give false hope, ask if there is anyone else you need to call and bring in
Before withdrawing a medication from a vial...
Inject air into vial
Medication Dosage Route Site
Injection documentation should include _________
Sterile
Injections must be prepared and given using _____ technique to prevent infection
Sites for intradermal injection?
Inner arm, upper back chest, scapula
A client being discharged to home with a prescription for eye drops to be given in the left eye has received instructions regarding self-administration of the drops. The nurse determines that the client needs further instruction if, on return demonstration, the client takes which action?
Lies supine, pulls up on the upper lid, and puts the drop in the upper lid
Dermal layer
The ID route deposits medication into the _______ of the skin
PRN and stat doses
The _____ and ____ doses may also be recorded in the nurses notes, along with the reason the medication was given and the result and duration of effect of the injection
Larger
The _____ the number of the needle gauge, the smaller the needle and the finer the cannula
Ventrogluteal
The _______ IM injection site is the safest site to use in the adult
45 or 90 degrees (depending on the amount of subcutaneous tissue of the patient)
The angle of insertion for subcutaneous injections
The nurse manager is giving a staff in-service on providing culturally sensitive education to clients. Which statements indicate to the nurse manager that the staff understands providing culturally sensitive education? Select all that apply.
The population served will determine the culturally sensitive resources to use for teaching, assessment of a client's preferred learning approach is essential to facilitate the learning process, it is important to have an accurate translator when the nurse and client do not speak the same language
Otic meds
The position of the external auditory canal varies with age. Children under 3 it is directed upward. Adults the external auditory canal is an S-shaped structure about 2.5cm (1in) long.
The nurse is preparing medications for administration. In addition to the right medication, the nurse adheres to which additional rights of medication administration? Select all that apply *The right dose *The right route *The right time *The right client *The right staff member *The right documentation
The right dose, the right route, the right time, the right client, right documentation
Gauge of needle
The selection of a ________ depends on the viscosity of the fluid to be injected and the route of adminstration
Drug Onset
The time it takes for the med to start to work
Polypharmacy
The use of multiple medications on a regular basis.
Who is more likely to report pain?
The younger person
If you administer a whole or undissolved medication via NG tube, what will happen?
Tube will become clogged
What is the point of state laws for med admin?
Restrictions on certain OTC drugs
Trough
Right before dose (lowest amount)
Drug Trough
Right before dose / lowest amount
What are the pts 5 rights?
Right patient, right drug, right dose, right route, right time
What are the 5 rights of med administration?
Right time, patient, medication, dosage, route
What do pt's need to do after a metered dose inhaler?
Rinse mouth to avoid candida, thrush etc.
ID Subcutaneous IM
Routes for parenteral medication
MAR or eMAR
Routine injections are recorded on the _______ only
If a patient is administered a pain medication and gets a headache, what do you do?
See if PRN Tylenol is ordered, contact PCP
Signs of pt about to die?
Slow HR, RR weak pulses
Vials
Small bottle with rubber stopper attached by a metal band; May contain one or more dosages; may be in powder for requiring reconstitution.
Color change Precipitation Clouding
Some signs that occur when a drugs combines with an incompatible drug
3 mL insulin syringe or tuberculin syringe
Type of syringe used for subcutaneous injections
Who can perform postmortem care?
UAP, nurse
When do you perform the first check of med administration?
Upon removal
Aseptic technique
Use ______ in handling the syringe and needle
How long does grief take?
Varies with each person
The nurse prepares to administer an intramuscular injection to a 4-month old infant. The nurse selects which best site to administer the injection? *Ventrogluteal *Lateral deltoid *Rectus femoris *Vastus lateralis
Vastus lateralis
What is the preferred site for IM injections?
Ventrogluteal
If a patient is in denial, the nurse should
Verbally support the client
Before administering a medication you must
Verify ID
stereotyping
assumption that an individual reflects all characteristics associated with being part of a certain group
The nurse is instructing a client on self-administration of a subcutaneous injection. The nurse is using which theoretical construct of learning?
banduras imitation
sibling/family member
be careful using ---- for interpreting for client because they may not translate medical jargon very well
ethnocentrism
belief in superiority of one's own culture/lifestyle
Ethnocentrism
belief that one's culture/lifestyle is superior to another
The nurse is planning to conduct a physical assessment with a client from a different culture. What is the best way for the nurse to show cultural sensitivity when addressing the personal questions required of the nursing history?
break the assessment into shorter intervals and discuss general topics first
health disparities
differences in care experienced by one population compared with another population
The nurse is caring for a non-English-speaking client and is attempting to integrate the client's cultural practices into Western medicine. What are some other aspects of culturally competent care the nurse can employ? Select all that apply.
increasing client safety, using spiritual practices, reducing health disparities, increasing client satisfaction, preventing misunderstandings between the nurse and the client
Most common cause of pain
inflammation
A non-Englishspeaking client needs to have an emergency surgical procedure. The hospital has an interpreter available. When the INT arrives to explain the procedure and help with the consent form, the nurse provides the best support when
requesting that the INT translate, as closely as possible, the same words used by the staff
nonverbal communication
rolling eyes, crossing arms, personal space
cultural awareness
self-exam of one's own prejudices and biases toward the cultures, and an in-depth exploration of one's own cultural/ethnic background
psychmotor teaching
skill, doing/hands on, fine motor/gross motor coordination
how does time of administration effect drug action
some drugs have to be taken with food or without food, or am/pm
use cultural knowledge by acquiring awareness, attitudes, and skills to care for diverse populations; not possible to learn every cultural perspective, but important to become familiar with cultures in communities that nurses serve
things important in providing culturally competent care
heritage
things passed down from previous generations
apply knowledge of social/cultural factors that affect nursing/health care across multiple contexts; use relevant data sources and best evidence in providing culturally competent care; promote achievement of safe and quality outcomes of care for diverse populations; advocate for social justice including commitment to the health of vulnerable populations and the elimination of health disparities; participate in continuous cultural competency development
things the American Association of Colleges of Nursing Competencies says we should know/do when it comes to cultural competency
Psychological factors that effect drug actions
think it won't work, won't take certain meds, generic vs brand names
Culture
thoughts, communications, actions, beliefs, values; institutions of racial, ethnic, religious, or social groups; Learned and shared patters of information that a group uses for meaning among its members.
culture
thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups; learned and shared patterns
magics-religious, scientific/biomedical, holistic
three views of health beliefs
peak
time at which a medication reaches its highest effective concentration
half-life
time for serum medication to be halved
onset
time it takes for a med to produce a response
duration
time medication takes to produce greatest result
The nurse is explaining a preoperative teaching plan to an English-speaking client. What are some other aspects of verbal communication? Select all that apply.
timing, volume, voice tone, ability to share thoughts and feelings
substandard quality of care; inadequate access to care
tow major factors contributing to health disparities
The nurse is preparing to administer eye drops. Which interventions should the nurse take to administer the drops? Select all that apply
wash hands, put gloves on, place the drop in the conjunctival sac, pull the lower lid down against the cheekbone
Ethnic cultural values on pain
§ Pain = weakness, different views on meds and showing pain · Chinese may be quiet in pain; Puerto Ricans may tend to be loud and outspoken about their pain · How is pain viewed? Normal suffering of life; as an indicator of severe disease/illness; private and reserved for immediate family; · Sense of strength (to endure pain), or sign of weakness?
Denial
§ Refusing to believe that loss is happening § Is unready to deal with practical problems (prosthesis) § May assume artificial cheerfulness to prolong denial
windup phenomenon
§ Too much pain, brain tries to protect it & seizure can occur - 24 hours of unrelieved severe pain alters structure and function of nervous system in a way that prolongs and intensifies the pain experience
Stage of believe where the client refuses to believe loss is happening
Denial
This loss can be recognized by others
Actual
Pain that only lasts through the expected recovery period
Acute
A client is prescribed an eye drop and an eye ointment for the right eye. How should the nurse best administer the medications?
Administer the eye drop first, followed by the eye ointment
When a client is dying and experiences sensory impairment, what happens
Blurred vision, impaired taste and smell
What developmental status's effect drug action?
pregnancy, kids (immune body systems), older adults (decreased renal function *start low go slow*- safety tops on pill bottles
Biotransformation (metabolism)
process by which a drug is converted to a less active form, mostly takes place in the liver- products called metabolites
transcultural nursing
providing care within differences and similarities of beliefs, values, and patterns of cultures
When administering an ear med in an adult you must
pull the pinna up and back
Nursing Self-Awareness
put aside own culture, belief & assumptions; avoid bias/prejudice
When to use Z- track method?
IM injections, pull skin over, inject, allow skin to go back in place. This ensures no comes out
Regular gauge size for SubQ injection?
#25
Subcutaneous
45 degree- 90 degree
How do NSAIDS relieve pain?
By inhibiting COX enzyme
Peak Plasma Level
Highest level of med
The nurse is teaching a client from a culture that is present oriented about a dressing change that should be performed twice a day. How should the nurse address the cultural issue?
Instruct the client to change the dressing after breakfast and before going to bed
Parental meds
Intradermal, SubQ, IM, IV
Examples of Opioids
Morphine, Hydromorphone, Oxycodone
chronic episodic pain
Occurs sporadically over an extended duration
What can pain cause?
o sleep loss o irritability o cognitive impairment o functional impairment immobility
Developmental factors effecting pain
· Infants o Use behavioral observations o Glucose pacifier, tactile stimulation, music, tape of heartbeart · Toddler/preschooler o Children as young as 3 can accurately report location and intensity of pain o Often responds with crying or anger · School-aged o Tries to be brave facing pain o Responsive to explanations o May regress in persistent pain · Adolescent o Want to appear brave if in front of peers o Pain or "giving in" may be considered weak · Adult o May ignore pain (may perceive as weakness) o Fear what the pain is from · Older adult o 25-50% have chronic pain o Multiple conditions o Perceive as normal (pain is not normal) o May have decreased sensations or perceptions of pain o Lethargy, anorexia, fatigue, confusion, restlessness, irritability may be pain indicators o "start low and go slow" o Take multiple medications (increases chance of interaction) o Changes in blood flow o Greater risk for under treatment because of reluctance to give pain meds for fear of confusion, excessive sedation, drug interactions, resp. depression. o Pain may be unrecognized due to dementia, coexisting medical conditions, poor communication o Poor pain control can lead to falls, poor sleep, anxiety, reduced activity, delayed healing, poor quality of life o Risk for overtreatment because of changes with aging may cause the drug to last longer and be stronger.
Chronic pain
· Prolonged pain, usually recurring or lasting 3 mos. · Interferes with functioning
25 gauge
Which size needle is the most appropriate for a subcutaneous injection?
