GCC Block 1 Exam 1

What are the three types of drug classifications? examples?

- pharmacological: grouped by physiological activity and mechanisms of actions ex: beta-blockers, calcium channel blockers, ACE inhibitors, cephalosporins - therapeutic: grouped by therapeutic indications ex: antihistamines, anti-anxiety, anti-depressants, anti-hypertensives -Chemical: by chemical structure regardless of physiological effect

What are the drug absorption factors that affect absorption?

- route -ability to dissolve -blood flow to admission site -body Surface Area (SA) -lipid solubility of drug -presence of food and other drugs

What are types of pharmodynamic responses with mini definitions (4-5 if including allergic effect)?

- therapeutic: expected, desired response - side: predictable, unavoidable secondary effects -Adverse effect: severe, unpredicted, undesireable effect (Stop Meds) - Toxic effect: med accumulation in blood stream and causes symptoms

What is critical thinking in Nursing? what does it in include?

- values all available options - Includes: -looks act situation objectively -determine pertinent info -recognize problem or needs -prioritize needs -consider actions and probable outcomes -make informed decisions -evaluate outcomes

What are some blood-borne pathogens to be aware of?

-HIV, Hep B, Hep C

What are three types of Drug names ?

-chemical: by chemical composition and molecular structure -Generic: (non proprietary) after patent runs out and other manufacturers can make it Trade name: (proprietary) registered trademark (they have a patent)

What are some aspiration (Choking) percautions?

-determine patients' gag reflex first before giving meds or food -easy to swallow meds or crush pills in pudding -patient should administer to self if possible -no straws -give food on strong side of the mouth if stroke patient

How do you tell if a something is sterile? Things to remember with sterile technique (4)?

-dry, intact, (also can be marked, packaged, not expired) - never turn back on the field -sterility for anything entering the body (except GI tract) -not sterile if touches outer 1-inch border -long exposure to air

What forms of drugs can NOT be crushed?

-enteric coating -sublingual -slow extended release (SR,ER,XL, contin)

What are the 4 types of drug administration routes ?

-oral: absorbed into SI -parenteral: IV, IM, ID, Subcutaneous, Intraspinal -topical: eyes, ears, skin -other: inhalants, vaginal, rectal

Who is Florence Nightingale? what are her principles (7)?

-she is the founder of modern nursing -Principles: -1. Care to emphasize health maintenance and restoration? 2. improved sanitization 3. improved nutrition 4. therapeutic environment 5. empathetic care 6. confidential care 7. care through vital assessment

Steps for donning and doffing PPE?

Donning (Put on): -hand hygeine -gown -mask -goggles -gloves Doffing (take off) (most soiled/contaminated first): -gloves -goggles -gown -mask (keep N95 on till you leave the room)

Precaution for MRSA, VRE, C.Diff?

Droplet

What is the goal in the Nursing Process and what is RUMBA?

Goal: opposite of NANDA - RUMBA: Realistic/relevant Understandable Measurable believable achievable

What is Maslows hierarchy of needs and what needs do nurses handle?

- Self actualization -esteem -love/belonging -safety * -physiological *

What are policies OSHA has?

- bloodborne pathogens -sharps, safety, record keeping -expose control plan

where does distribution of medication occur (where does it go)? what does distribution depend on (two things)?

- distributes to tissues, organs, and site of action -Depends on: physical and chemical properties of the drug, and patient physiology (circulation, protein binding (slows distribution), and membrane permeability (blood brain barrier allows fat soluble meds to pass )

Medical vs. Surgical asepsis?

- medical (clean): meds, wound care, - purpose: reduce # of microorganisms present - surgical asepsis (Sterile): ABSENCE of microorganisms

How is Oral medication absorbed?

Through GI mucosa in Small intestine, - they pass through liver through portal circulation before hitting the bloodstream (first pass effect)

What is pharmodynamics?

What does the drug do to the body

integrity?

act in accordance to code of ethics

Precaution for pulmonary/laryngeal TB, chicken pox, measles?

airborne

Some symptoms of anaphlaxis?

angioedema (face swelling), tight chest, SOB (Shortness of breath), obstructed airway

Transmission for Hep A?

body fluids

altruism?

concern for wellbeing and welfare of others

Malfecience?

do no harm

Beneficience?

doing best for patient

Autonomy?

doing something by yourself without a doctor's order (just not medicine)

What PPE and illness/disease for protective environment?

for immunosuppressed patients, (resp, mask, gown, gloves)

What is Asepsis?

freedom from pathogenic microorganisms (reduce risk)

justice?

give each his or her due (act fairly)

Airborne precautions?

gown, gloves, N95 mask

PPE for contact?

gowns and glove

What is the best way to prevent transmission?

hand hygiene

With medical asepsis, what is most important technique ? What are personal hygiene measures? unit control?

hand hygiene -Personal Hygeine: - hair back, nails shorter than 1/4 inch, minimal jewelry unit control: -PPE, linens away from the body, clean and dirty separate

What is informed consent? what is the purpose of a nurse witness? What about implied consent?

informed consent: written for high risk or invasive procedures, verbal for less invasive Nurse witness: make sure the consent is voluntary, alert and able to make the choice, ethically make sure pt. understands procedure Implied consent: nonverbal behaviors or actions implies consent

fidelity?

keep promises

Libel? Slander?

libel: written defamation (Crazy patient) slander: spoken defamation (idiot doctor)

What are the three major sites for HAIs?

lungs, surgery site, urinary tract

Medical diagnosis vs nursing diagnosis?

medical: identify health problem or process nursing: RESPONSE to health problem

Peak?

medication at the highest effective concentration

Trough?

minimum blood serum concentration before next scheduled dose (you want to administer the new dose before the old dose has been fully gone)

Laissez-faire

no interference

idiosyncratic reaction?

over or under reaction to a medication or peculiar response

negligence:

performing an act a prudent person wouldn't do in the same situation, or not doing something a prudent person would do

Fire safety: what is best fire safety procedure? RACE? PASS?

prevention is best procedure RACE: Rescue and pt. in immediate danger Activate alarm, report per policy Confine (close doors, shut off O2) Extinguish PASS: Pin Aim at base Squeeze Sweep side -to-side

What is the purpose of delegation? What are three things to consider before delegating? What do you NOT delegate?

purpose: to make delivery of care more efficient Things: patient condition, experience of CNA, giving clear directions

human dignity?

respect for inherent worth and uniqueness of person or population

accountability vs responsibility?

responsible for care; and held accountable to care

Veracity?

tell truth

What does a reaction to a intradermal (ID) injection?

that antibodies are present

half-life?

time for serum drug concentration to be halved, time 1/2 of the original amount to be eliminated

duration?

time medication concentration is sufficient to produce a therapeutic response

onset?

time the drug starts producing a response

Social justice?

treat everyone equally no matter what

When to wash with soap and water?

visibly soiled, before eating, after bathroom, body fluids

What is the purpose of accreditation?

voluntary process to see if providing acceptable practice (The Joint Commission)

Synergist ?

when 2 or more meds work together and greater a greater effect

tort?

wrong committed by a person to person or their property

6 rights of the medication?

3 D's and PRT Right dose Right documentation Right drug (medication) Right patient Right route Right time

Malpractice?

Act of negligence as applied to a professional person

Types of Nursing Diagnosis?

Actual: has defining characteristics (s/sx) The risk for diagnosis: risk factors are evident, but s/sx are not present

Assault vs battery?

Assault: threat to make bodily contact without permission Battery: assault carried out

What is bioavailability? bioequivalents?

Bioavailability: amount of drug available for therapeutic effect (oral route will need higher dose due to first pass effect) Bioequivalent: when two drugs have the same bioavailability or the same medication has the same bioavailability in different routes of medications

What are the four steps in pharmokinetics? with mini definition?

1. Absorption: rate drug leaves administration site 2. distribution: where the drug goes 3. metabolism: drug break down 4. excretion: leftover drug excreted

What are the 3 medication checks before administering medication?

1. Check MAR with Physician order 2. check medication with MAR while preparing and getting them from drawer 3. Check meds with MAR and patient (in pt. room with patient identification)

What are the four points that have to be present for malpractice?

1. DUTY to the patient 2. BREACH of Duty 3. patient is INJURED 4. Failure to preform duty CAUSED the injury

What are the five rights of delegation?

1. Right task 2. Right circumstance 3. Right person 4. Right direction or communication 5. Right supervision

What are risk factors that increase infection? (7)

1. Skin integrity 2. GI/pH 3. Stress 4. WBC count 5. Age 6. race 7. Sex

What are the four types of interventions?

1. assessment: 2. therapeutic : what will you actually do 3. education: 4. referral

What are the Steps in the nursing process?

1. assessment: gather data 2. Diagnosis: NANDA 3. planning: (goals/ desire outcomes and interventions to achieve these goals) 4. implementation 5. evaluate

What are the 4 modes of transportation for an infectious agent?

1. direct: Person to person 2. indirect: Vector- creature to human; formite: innanimate object to human 3. droplet: greater than 5 mcm 4. airborne: less than 5 mcm

What are the the three categories of Health associated illnesses (HAIs)?

1. endogenous: normal flora altered or enters wrong place (c.diff from GI tract) 2. exogenous: illness comes from outside of patient (salmonella, MRSA) 3. iatrogenic: from procedure

What is the chain of infection?

1. host 2. infectious agent: bacteria, fungi, virus, parasite 3. reservoir: place where organisms grow (warm,moist) 4. Portal of exit 5. mode of transmission: 6. portal of entry

What are the bodys' defenses (7) that the nurses want to do/teach to mantain?

1. normal flora 2. skin/mucous membranes (mouth/eyes) 3. Respiratory tract 4. Urinary tract 5. GI tract 6. Vagina 7. Immune system and inflammatory response

When and how do you use critical thinking in nursing? (3)

1. use knowledge from literature or previous knowledge 2. deal with rapid changes in stressful environment 3. Make possible life saving or altering decisions

Legal term for administering tylenol and you fail to notify MD?

Gross negligence

Hippa?

Health Insurance Portability and Accountability Act that means you can give out PHI (patient health information) -demographic info, -past, present, future health condition) -treatment - financial info

What is the patient determination act?

Health care worker gives patient -advance directives (specify care) -living will -power of attorney -(Right to refuse?) -(DNR?)

What is pharmokinetics?

How the drug moves in the body (drug movement)

What are the types of parenteral routes?

Intravenous (IV) Intramuscular (IM) Subcutaneous (SC) Intradermal (ID) Intraspinal

Who regulates restraints and what are the guidelines required?

Joint commission and medicare require MD order and family consent, and assess frequently

What organ does excretion? what happens if that organ is impaired?

Kidney -risk for toxicity if impaired

What organ is responsible for metabolism? what happens if the organs impaired? what does grapefruit due to metabolism?

Liver -If impaired that could be a risk for toxicity - Grapefruit juice decreases the effectiveness of enzyme to metabolize certain drugs

Droplet precautions?

Mask, gown, gloves

Who does OSHA, CDC, and WHO protect?

OSHA: employees CDC: prevention / protects public WHO: international prevention

What does it mean for the dose when the medication has a first pass effect? what med route has this?

Oral route- when medication goes through portal circulation before hitting bloodstream -will need a higher dose than other routes

What route of medication is the fastest?

Parenteral (due to rich blood supply), (IV is fastest)

What does SBAR stand for?

Situation background Assessment Recommendation