PN Pharmacology for Nursing 7.0

What are the types of local anesthetics?

--Central/Spinal--intrathecal and epidural --Peripheral--infiltration (deaden an area of skin with stitches), nerve block (where the nerve enters), and topical (EMLA)

What should nurses consider when administering acetaminophen/APAP?

--Dose ceiling is 3 g per day --Drug has minimal anti-inflammatory action --Liver damage can occur--no alcohol with APAP --It is not an antithrombotic

What are some drug-drug interactions with NMBDs?

--Elderly are at risk because of polypharmacy --Pts taking benzos and opioids --Antihypertensives and beta-blockers have additive effects with general anesthetics

What are some potential adverse effects of general anesthesia?

--Hepatotoxicity (dose dependent) --Respiratory depression (dose dependent) --Malignant hyperthermia

Who is the highest risk for malignant hyperthermia?

--Pediatric pts --Pts with preexisting musculoskeletal abnormalities --Pt with a genetic predisposition

What are some adverse effects of local anesthetics?

--Spinal headache --If IV, moderate or conscious sedation

What are the criteria for an opioid tolerant pt?

--Taking the med for a week or longer --at least 60 mg or morphine a day --or at least 30 mg or oral oxycodone daily --or at least 8 mg of oral hydromorphone daily --or an equianalgesic dose of another opioid

Safety measures when administering a fentanyl patch:

--Use only on intact skin (no rashes or scratches) --Clip, do not shave, excess hair @ site --avoid direct external heat sources (heating pad, heating blanket) --Carefully monitor pts who develop a fever or who increase body temp due to exertion (absorption could increase by 1/3) --Don't prep area with alcohol--it increases absorption --If nurse accidentally contact the gel, don't wash hands with anything but clear water --Don't use patch if it is cut, damaged, or changed in any way

When is a general anesthetic considered effective, a.k.a. successful?

--When the pt has loss of consciousness, loss of body reflexes, elimination of pain throughout the entire body, and smooth muscle paralysis

What are some contraindications in certain anesthesia drugs?

--pregnancy --narrow-angle glaucoma --known susceptibility to malignant hyperthermia --A known drug allergy to propofol

An order for a child reads "give ibuprofen suspension 30 mg/kg/day, divided into 4 doses, for pain." The child weighs 33 lbs. How many mg will this child receive for this dose?

112.5 mg per dose

When is a fentanyl patch at it's peak level? When, after removal, is the medicine out of a pt's system?

24-72 hrs; after removal, 50% is out of the pt's system after 72 hrs

What is the duration of action for meperidine?

3-9 hrs

What is naloxone's half-life?

30-81 min

What is the duration of action of succinylcholine?

4-6 min

What is substance P

A neurotransmitter released by injured cells; it causes vasodilation and the release of histamine from mast cells

A nurse is admitting a toddler to the hospital after an acetaminophen overdose. Which of the following meds should the nurse anticipate administering to this client?

Acetylcysteine

What was the first NSAID?

Acetylsalicylic acid (aspirin)--first marketed in 1899

A nurse is completing a nursing history for a client who takes simvastatin. The nurse should identify which of the following disorders as a contraindication to adding ezetimibe to the client's meds?

Active hepatitis C

A pt is recovering from general anesthesia. What is the nurses main concern during the immediate post-op period?

Airway

A pt with a history of renal problems is asking for advice about which antacid he should use. The nurse will make which recommendation?

Aluminum-based antacids are the best choice for you

What is feverfew?

An antiinflammatory used for migraine headaches, menstrual cramps, inflammation, and fever. There is possible risk for an increase in bleeding

What is the most widely used drug in the world?

Aspirin, a salicylate

What drug is a precursor to modern NMBDs?

Curare

The pt is taking diphenoxylate with atropine. What does the nurse assess when monitoring for therapeutic effects?

Decrease in loose, watery stools

What is the last sense to go when a person is put under general anesthetic?

Hearing

A nurse is planning to admin IV alteplase to a client who is demonstrating manifestations of a massive pulmonary embolism. Which of the following interventions should the nurse plan to take?

Hold direct pressure on puncture sites for up to 30 min

In what route is succinylcholine delivered?

IV

Which nursing diagnosis is possible for a pt who is now recovering after having been under general anesthesia for 3-4 hrs during surgery?

Impaired gas exchange due to CNS depressant effect of general anesthesia

What are the most commonly used acetic acid derivative NSAIDs?

Indomethacin and keterolac

What is an opioid antagonist?

It blocks an opioid response--they are often given to pts in labor or during a dental procedure

A nurse is teaching the parents of a school-age child about transdermal methylphenidate. Which of the following instructions should the nurse include?

Leave the patch on for 9 hrs

What are the different types of anesthesia?

Local and general (parenteral and inhalation)

Name an opioid antagonist

Naloxone, naltrexone

Sx and Sx of withdrawal include

Nausea, vomiting, anorexia, diarrhea/abdominal cramps, anxiety/irritability, shivering/chills, piloerection (goose bumps), restlessness, insomnia, lacrimation (tears), rhinorrhea (runny nose), yawning, perspiration, backache, joint pain, increased BP, RR and HR

A nurse is providing a client who has peptic ulcer disease with instructions about managing his condition. Which of the following instructions should the nurse include? (Select all that apply)

Seek measures to reduce stress and avoid smoking

What is the initial dose of naloxone given to adults?

Small increments of 0.1-0.2 mg IV

A pt is receiving an IV infusion of heparin and has started on warfarin therapy the night before. Why is this done?

The heparin provides anticoagulation until therapeutic levels of warfarin are reached

What is malignant hyperthermia treated with?

The medication Dantrolene and cardiorespiratory support

What are agonist opioids?

They cause an opioid response; may be strong or weak

What is polypharmacy?

When a person takes several meds at a time, which can result in increased drug interactions

NSAIDs have less adverse effects than which type of med?

corticosteroids

What are some potential effects of Reyes-Syndrome?

encephalopathy, liver damage, coma, and death

What are some moderate examples of opioid agonists?

hydrocodone, oxycodone, codeine

The physician has requested lidocaine with epinephrine. The nurse recognizes that the most important reason for adding epinephrine is:

it reduces bleeding in the surgical area

What are the names of the adjuvant drugs used to prevent aspiration and pneumonia?

ranitidine and famotidine

A nurse is preparing to administer an opioid agonist to a client who has acute pain. Which of the following complications should the nurse monitor?

urinary retention

What is paracetamol/acetaminophen

(N-acetyl-p-aminophenol)--a non-opioid that is sometimes mixed with opioids for synergistic effects. Also called APAP. There is also no risk of bleeding with this med so most pts with bleeding are recommended this med or tylenol

What assessments do we need to consider when a pt is going to take anesthesia?

--ABCs --Hx of alcohol use and smoking --Weight and height --Neuro baseline --Swallowing and gag reflexes --Watch for slight changes in VS and labs

What are some common drug interactions with NSAIDs?

--Alcohol --Anticoagulants --Aspirin and other salicylates w/ other NSAIDs --Corticosteroids --Cyclosporine --Diuretics and ACE inhibitors --Feverfew, garlic, ginger, and gingko

What are adjunctive drugs used for?

--Anesthesia induction --Anxiety reduction --Drying up of excessive secretions --Pain prevention and relief --Amnesia and sedation --Prevent aspiration/pneumonia

For what purposes are neuromuscular blocking drugs (NMBDs) used?

--As adjuncts with general anesthetics for surgical procedures (facilitates controlled ventilation) --Used prior to intubation, laryngoscopy, bronchoscopy, and esophagoscopy --To reduce spasms from tetanus --To prevent bone fractures during electroconvulsive therapy

What are some potential adverse reactions of naloxone?

--Excitement --Hypotension --Hypertension --Ventricular tachycardia --Fibrillation --Pulmonary edema --Weakness

What herbs might effect anesthetics?

--Feverfew --Garlic --Ginger --Kava --Ginseng --St. John's Wort

Implementation of pain relief with pain meds for nurses

--Give meds before pain is at peak --Give meds with food or antinausea agent if upset stomach --Give antiemetics PRN --Take safety measures like bed alarms, call bell and phone within reach --consider which route to use

Adverse effects of NSAIDs are:

--Heartburn to GI bleed --Acute renal failure--worse w/ dehydration, heart failure, liver dysfunction, diuretics or ACE inhibitors --Pulmonary edema --Hepatotoxicity --Tinnitis, hearing loss --CV risk of MI, stroke, or GI risks (black box warning)

What are some associated side effects of succinylcholine?

--Hyperkalemia --Dysrhythmias --Muscle fasciculations (hands, feet, face) --Muscle pain --Myoglobinuria --Increased intraocular, intragastric, and intracranial pressure --Malignant hyperthermia

What pt/family teaching needs to be done for pts receiving anesthesia?

--Importance of NPO --Report that pts receiving NMBD can still hear --Arise slowly and dangle legs before ambulation; call for help --Warn about PCA by proxy (family should not push button)

What are the Sx and Sx of acute or chronic salicylate intoxication?

--Increased HR, tinnitus, hearing loss, dimness of vision, headache, dizziness, mental confusion, drowsiness, N/V/D, sweating, thirst, hyperventilation, hypo or hyperglycemia

Information about lidocaine transdermal

--It is used in patches --Can use up to 3 patches if the area is large --patches are worn for no longer than 12 hrs/day to avoid systemic toxicity --Watch for skin eruptions

What labs do we need to check before a pt takes anesthesia?

--Kidney and liver function --Serum K (NMBDs) --Hgb, Hct, WBC with diff --PT, aPTT, INR, and platelet count --Serum electrolytes: potassium, sodium, chloride, phosphorus, magnesium, and calcium --Pregnancy test

What are some contraindications to opioid use?

--Known allergy --Severe asthma --Extreme caution with increased intracranial pressure, morbid obesity/sleep apnea (respiratory), myasthenia gravia (respiratory), paralytic ileus (constipation), and pregnancy --Itching and nausea are side effects, not allergies (however, a bad side effect can be classified as an allergy) --Use caution when giving any other substance that can cause sedation and/or respiratory depression

What are some contraindications for NSAIDs?

--Risk for bleeding --Vitamin K deficiency --Peptic ulcer disease --Allergy to aspirin --Severe renal or hepatic disease --Pregnancy--category C for 1st and 2nd trimesters; category D for 3rd trimester --Nursing moms --Week prior to elective surgery

What are some things nurses should consider with opioid use in the elderly?

--Their health status and physiological function may impair drug absorption, distribution, metabolism, and elimination. --Opioids can be safely used in the elderly if their response to medication is slowly titrated and closely monitored --Increased risk of falls --We cannot justify the holdings of opioids in elderly even though they may be more sensitive --Polypharmacy

What happens when a pt is in moderate or conscious sedation?

--There is no complete loss of consciousness --Pt maintains their own airway --One or more benzos and/or opioids are necessary --Pt experiences reduced anxiety, pain, and mild amnesia

What are some associated side effects of NMBDs?

--They can cause a release of histamine resulting in bronchospasm, hypotension, and/or excessive bronchial and salivary secretion. They seldom affect the GI tract but constipation or ileus is possible

What are the typical uses of NSAIDs?

-Mild to moderate myalgia, neuralgia, and arthralgia -postop pain -arthritis, gout, bone pain -inhibit platelet aggregation -bone cancer pain -chronic back pain

A pt will be receiving diazepam, 2 mg, IV push as part of preprocedural sedation. The med is available in an injectable solution of 5 mg/ml. How many ml will the nurse give for this dose?

0.4 ml

The nurse is administering an IV dose of morphine sulfate to a 48 year old postop pt. The dose ordered is 3 mg every hr PRN for pain. The med is supplied in 4 mg/ml. How much will be drawn into the syringe for this dose?

0.75 ml

How do we treat a severe salicylate toxicity?

1) DC salicylate 2) Supportive therapy (including lavage and activated charcoal) 3) dialysis

What are the parameters for the sedation scale?

1--alert; easy to arouse 2--occasionally drowsy; easy to arouse 3--Frequently drowsy 4--Somnolent; difficult to arouse 5--Sleep; easy to arouse

What is the duration of action for morphine?

12-24 hrs

What is naloxone's onset time?

2 min

What is the duration of action for fentanyl?

2-3 hrs

What is naloxone's duration of action?

45 min

What is naloxone's peak?

5-15 min

What is the limit dose to meperidine?

600 mg in 48 hrs

The surgical nurse is reviewing operative cases scheduled for the day. Which of these pts is more prone to complications from general anesthesia?

A 79 year old woman who is about to have hip replacement surgery

A nurse is reviewing the health history of a client who has migraine headaches and is to begin prophylaxis therapy with propranolol. Which of the following findings in the client history should the nurse report to the provider?

A ECG indicates a first-degree heart block

A nurse is caring for 4 clients who have peptic ulcer disease. The nurse should recognize misoprostol is contraindicated for which of the following clients?

A client who is pregnant

What is ketamine?

A disassociative peripheral general anesthetic often used in veterinary medicine. It is a common drug of abuse, often referred to as a date rape drug. Adverse effects of this include hypertension and tachycardia

A pt is currently taking a statin. The nurse considers that the pt may have a higher risk for developing rhabdomyolysis when also taking which product?

A fibric acid derivative

What kind of drug is a NMBD considered to be?

A high alert drug

Addiction to a med is defined as:

A primary, chronic, neurobiological disease, with genetic, psychosocial, and environmental factors, resulting in (the 3 C's): 1)craving or complusive use, 2) loss of control, and 3) use despite adverse consequences

What is physical dependence

A property that can arise from constant opioid use--a state of adaptation manifested by a drug-class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug and/or administration of an antagonist.

Several pts have standard orders for acetaminophen as needed for pain. When the nurse reviews their history and assessments, the nurse discovers that one of the pts has a contraindication to APAP therapy. Which pt is the one who should receive an alternate med?

A pt admitted with severe hepatitis

What is opioid tolerance?

A state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug's effects over time. In this case, higher doses are needed to achieve the desired effect. This condition develops less often that physical dependence and can occur in as little as 1 week.

What is fentanyl?

A synthetic opioid dosed in mcg. It is short-acting, and 0.1 mcg of fentnayl=10 mg IV morphine sulfate

What is tramodol hydrochloride?

A weaker, centrally acting, oral opioid that is most often used for dental pain. It is not for use in pts older than 75 YOA. There is a risk of seizures for a pt at any dose.

A nurse administering niacin would implement which action to help to reduce adverse effects?

Admin a small dose of aspirin or an NSAID 30 min prior to the niacin dose

A pt is receiving an opioid via a PCA pump as part of his postop pain management program. During rounds, the nurse finds him unresponsive, with respirations of 8 breaths per min and BP of 102/58 mm Hg. After stopping the opioid infusion, what should the nurse do next?

Admin an opioid antagonist per standing orders

A pt is starting warfarin therapy as part of treatment for afib. The nurse will follow which principles of warfarin therapy?

Admin the oral dose at the same time every day, assess carefully for excessive bruising or unusual bleeding, and monitor lab results for a target INR of 2-3

The nurse is administering cholestyramine, a bile acid sequestrant. Which nursing interventions are appropriate? (Select all that apply)

Administering the drug with meals, instructing the pt to take a fiber supplement while taking this drug, increasing fluid intake, and not administering this med at the same time as other drugs

A nurse is teaching a client who is taking sucralfate PO for peptic ulcer disease and has a new prescription for phenytoin to control seizures. Which of the following instructions should the nurse include?

Allow a 2-hr interval between these meds

A nurse is teaching a school-age child and his parents about a new prescription for lisdexamfetamine. Which of the following info should the nurse include in the teaching? (Select all that apply)

An adverse effect of this med is CNS stimulation, monitor blood pressure while taking this med, and this med raises the levels of dopamine in the brain

A pt is receiving an IV solution of a thrombolytic drug during treatment for an acute MI. The nurse notices that there is a slight amount of bleeding from the antecubital area where venous lab work is drawn. What should the nurse do first?

Apply pressure to the site with a gauze pad

For best results when treating severe pain associated with pathologic spinal fractures related to metastatic bone cancer, the nurse should remember that the best type of dosage schedule is to admin the pain med:

Around the clock, with additional doses as needed for breakthrough pain

A nurse is preparing to admin pamidronate to a client who has bone pain related to cancer. Which of the following precautions should the nurse take when administering this med?

Assess the IV site for thrombophlebitis frequently during admin

A nurse is preparing to administer butorphanol to a client who has a history of substance abuse disorder. The nurse should identify which of the following info as true regarding this med>

Butorphanol can cause abstinence syndrome in opioid-dependent clients. Manifestations include abdominal pain, fever, and anxiety

Name a mixed agonist-antagonist opioid.

Butorphanol, pentazocine, nalbuphine, buprenorphine

What are some weak examples of opioid agonists?

Codeine when mixed in cough syrup

IV morphine is prescribed for a pt who has had surgery. The nurse informs the pt that which common adverse side effects can occur with this med? (Select all that apply)

Constipation, pruritis (itching), and nausea

When administering niacin, the nurse needs to monitor for which adverse effect?

Cutaneous flushing

During a teaching session about antigout drugs, the nurse would tell the pt that antigout drugs work by which mechanism?

Decreasing serum uric acid levels

A nurse is planning care for a client who has brain cancer and is experiencing headaches. Which of the following adjuvant meds are indicated for this client?

Dexamethasone

A nurse is reviewing the med admin record for a client who is receiving transdermal fentanyl for severe pain. Which od the following meds should the nurse expect to cause an adverse effect when administered concurrently with fentanyl?

Diazepam

What are the names of the adjuvant drugs used for anxiety reduction?

Diazepam and midazolam (Benzos)

A nurse is caring for a client who received prochlorperazine 4 hrs ago. The pt reports spasms of his face. The nurse should anticipate a prescription for which of the following meds?

Diphenhydramine

A nurse is assessing a client who has salicylism. Which of the following findings should the nurse expect? (Select all that apply)

Dizziness, tinnitus, and headache

Why might lidocaine be mixed with epinephrine?

Epinephrine prolongs the duration of lidocaine through vasoconstriction

True or false: drug therapy with enoxaparin must be closely monitored with activated partial thromboplastin times (aPTTs) lab tests

False

What are the adverse effects of aspirin?

GI intolerance, bleeding, and renal impairment. It is also an irreversible inhibitor of antiplatelet activity

A pt has received a double dose of heparin during surgery and is bleeding through the incision site. While the surgeons are working to stop the bleeding at the site, the nurse will prepare to take what action at this time?

Give IV protamine sulfate as an antidote

A pt who is taking oral tetracycline complains of heartburn and requests an antacid. Which action by the nurse is correct?

Give the tetracycline, but delay the antacid for 1-2 hrs

When the nurse is administering a PPI, which actions by the nurse are correct? (Select all that apply)

Giving the PPI on an empty stomach and making sure the pt does not crush or chew the capsules,

Which is the correct action when the nurse is administering sulcralfate?

Giving the drug on an empty stomach

What are the different types of neuro inhibitors?

Glycine, GABA, and enkaphalins (AKA endorphins--endogenous morphine)

A 75 year old man fell at home and hit his head against a table. His wife calls her daughter to find out what to do. She reports to her daughter that he does not have cuts or scratches, but there is a small lump on his upper scalp. She does not see any blood. He is taking warfarin and an antidysrhythmic as his treatment for chronic afib. What is the main concern at this time?

He needs to be examined for possible internal bleeding from the fall

A nurse is planning to admin ondansetron IV for an older adult client who has a history of diabetes mellitus and cardiac myopathy and is receiving chemotherapy for cancer. For which of the following adverse effects of ondansetron should the nurse monitor? (Select all that apply)

Headache, diarrhea, and prolonged QT interval

A nurse is caring for a client who has a new prescription for niacin to reduce cholesterol. The nurse should monitor for which of the following findings as an adverse effect of niacin? (select all that apply)

Hyperglycemia, flushing of the skin, and jaundice

The nurse is reviewing a pt's med list during a preop visit. The pt is scheduled for diagnostic laproscopy in 2 weeks. He asks the nurse "I hope I can continue the Motrin, because I really ache if I don't take it. It's just minor surgery, right?" What is the nurse's best response?

I'll check with your prescriber, but this drug is usually stopped a week before surgery because it can cause increased bleeding tendencies

A nurse is providing teaching to a client who is experiencing migraine headaches. Which of the following instructions should the nurse provide? (select all that apply)

Identify and avoid trigger factors, lie down in a dark quiet room at the onset of a migraine, and avoid foods that contain tyramine

What are the general considerations for all populations with opioids?

Impaired renal function, impaired hepatic function, respiratory impairment, and neurological deficits

The nurse is assessing a pt who has a new prescription for vorapaxar. Which of these conditions are considered contraindications of the use of this med? (Select all that apply)

Impaired renal function, impaired liver function, and history of stroke

A nurse is planning to admin subcut enoxaparin 40 mg using a prefilled syringe og enoxaparin 40 mg/0.4 ml to an adult client following hip arthroplasty. Which of the following actions should the nurse plan to take?

Insert the needle completely into the client's tissue

What is succinylcholine used for?

Intubation

The nurse is monitoring a pt who is receiving antithrombolytic therapy in the ED because of a possible MI. Which adverse effect would be of the greatest concern at this time?

Irregular heart rhythm

What is one unlisted use for morphine?

It can be given for shortness of breath--it opens the airways

What is a consequence some pts face with chronic salicylate ingestion?

It can cause a toxicity at lower blood levels that are required to cause acute damage

A 30-year-old pt is taking simethicone for excessive flatus associated with diverticulitis. During a pt teaching session, the nurse explains the mechanism of action of simethicone by saying:

It causes mucus-coated gas bubbles to break into smaller ones

A nurse is teaching a client about the new prescription for celecoxib. Which of the following info should the nurse include in the teaching?

It increases the risk for MIs

When teaching about antigout drugs, which comment about colchicine is accurate?

It is best taken on an empty stomach

Which point will the nurse emphasize to a pt who is taking a antilipemic med in the "statin" class?

It is important to report muscle pain immediately

What is a unlisted use of aspirin?

It is used to treat thrombotic events

Why is meperidine in disfavor?

It metabolizes to nonmeperidine, which is neurotoxic and can increase a pt's risk for seizures

What are some contraindications for aspirin?

It should not be given to teenagers or children for viral illnesses or fever--there is a risk of Reyes-syndrome

What are some safety measures to consider when administering methadone?

Its half-life is longer than its duration of action and a prolonged half-life can be the cause of unintentional overdose

A nurse is collecting data from a pt who is taking gemfibrozil. Which of the following assessment findings should the nurse identify as an adverse reaction to the med?

Jaundice

A nurse is planning care for a client who is to receive tetracaine prior to a bronchoscopy. Which of the following actions should the nurse include in the plan of care?

Keep the client NPO until pharyngeal response returns

What is the onset time of succinylcholine?

Less than 1 min

A pt is being assessed before a newly ordered antilipemic med is given. Which conditions would be a potential contraindication?

Liver cirrhosis

A nurse is caring for a school-age child who has a new prescription for atomoxetine. The nurse should monitor the client for which of the following adverse effects of this medication?

Liver damage

What is pancuronium used for?

Long surgical procedures

A nurse is caring for a pt who has diabetes and is experiencing nausea due to gastroparesis. The nurse should anticipate a prescription for which of the following meds?

Metaclopramide

A pt with renal cancer needs an opiate for pain control. Which med would be the safest choice for this pt?

Methadone

When a pt is receiving long-term NSAID therapy, which drug may be given to prevent the serious GI adverse effects of NSAIDs?

Misoprostol

Nurse's role after a pt is coming out of anesthesia?

Monitor the pt for respiratory status, GI status (N/V, ileus, swallowing), mental alertness, circulatory status, VS, pain, and pt safety

A pt with bone pain caused by metastatic cancer will be receiving transdermal fentanyl patches. The pt asks the nurse what benefits these patches have. The nurses best response includes which of these features?

More constant drug levels for analgesia

What are some strong examples of opioid agonists?

Morphine, demerol (meperidine), and fentanyl

What is the potentially toxic metabolite for morphine sulfate and what condition increases the risk of this occurring?

Morphine-6-gluconaride; renal impairment increases risk

What are the 3 main pain receptors and where are they found in the body?

Mu, Kappa, and delta. In the CNS and other body tissues

What are the 3 main pain receptors in the CNS?

Mu, kappa, delta

The nurse recognizes that manifestations of NSAID toxicity include:

N/V

A pt is receiving instructions regarding warfarin therapy and asks the nurse about what meds she can take for headaches. The nurse will tell her to avoid which type of med?

NSAIDs

A nurse is caring for a client who has afib and a new prescription for dabigatran to prevent development of thrombosis. Which of the following meds is prescribed concurrently to treat an adverse effect of dibigatran?

Omeprazole

OLD CART nursing assessment

Onset Location Duration Characteristics Aggravating factors Relieving factors Treatment

What are the classes of analgesic meds?

Opioids, anesthetics, non-opioids (NSAIDs and acetaminophen), and adjuvant meds

A nurse is administering amitriptyline to a client who is experiencing chronic pain. For which of the following adverse effects should the nurse monitor?

Orthostatic hypotension

What do NMBDs do to the pt?

Paralyze the pt by blocking nerves to skeletal and smooth muscles, including the intercostal and diaphragm. The mind is alert, but the med does not relieve pain or anxiety

When evaluating the med list of a pt who will be starting therapy with an H2 receptor antagonist, the nurse is aware that which drug may interact with it?

Phenytoin

A nurse is providing teaching to client who has migraine headaches and a new prescription for ergotamine. For which of the following adverse effects should the nurse instruct the client to stop taking the med and notify the provider (Select all that apply)

Positive home pregnancy test, numbness and tingling in the fingers, and muscle pain

The nurse is prepping to admin the first dose of misoprostol for a pt who has been diagnosed with a gastric ulcer. What condition would be a contraindication for this med?

Pregnancy

What drug, given for gout, is also given to prolong the effect of PCN?

Probenecid

A nurse is providing info about probiotic supplements to a male client. Which of the following info should the nurse include? (Select all that apply)

Probiotics are microorganisms that are normally found in the GI tract. They are used to treat Clostridium Difficile. You can experience bloating while taking these supplements

A nurse is caring for a hospitalized client who is receiving IV heparin for a deep-vein thrombosis. The client begins vomiting blood. After the heparin has been stopped, which of the following meds should the nurse prepare to admin?

Protamine

What are some Sx and Sx of malignant hyperthermia?

Rapid rise in body temp, tachycardia, tachypnea, and muscle rigidity

What are the most commonly used types of NSAIDs?

Salicylates, acetic acid derivatives, propionic acid derivatives, cyclooxygenase-2-inhibitors, and enolic acid derivatives

Name a common side effect of opioids.

Sedation, Respiratory depression, n/v, constipation

What precedes a decrease in respiratory rate for opioid pt's?

Sedation-- at less that 12 breaths per min, the nurse should intercede

A nurse is caring for a client who receives a local anesthetic of lidocaine during the repair of a skin laceration. For which of the following adverse reactions should the nurse monitor the client?

Seizures

An opioid analgesic is prescribed for a pt. The nurse checks the pt's medical history knowing this med is contraindicated in which disorder?

Severe asthma

When is meperidine most often used?

Short term post-op

A nurse is providing instructions about the use of laxatives to a pt who has HF. The nurse should tell the pt he should avoid which of the following laxatives?

Sodium phosphate

What are the criteria for an opioid naive pt?

Someone who wont take opioids for whatever reason--they need less meds and are inclined to have more side effects

What are the different types of neurotransmitters?

Substance P, bradykinins, serontonin, and histamine

What are the most commonly used NMBDs?

Succinylcholine, pancruronium, and vecuronium

A nurse is teaching the parents of a child who has a new prescription for desipramine. The nurse should instruct the parents that which of the following adverse effects is the priority to report to the provider?

Suicidal thoughts

During a pt's recovery from a lengthy surgery, the nurse monitors for signs and symptoms of malignant hyperthermia. In addition to a rapid rise in body temp, which assessment finding would indicate the possible presence of this condition? (Select all that apply)

Tachypnea, tachycardia, and muscle rigidity

A nurse is teaching a pt who is taking digoxin and has a new prescription for colesevelam. Which of the following instructions should the nurse include in the teaching?

Take colesevelam with food and at least one glass of water

A nurse is providing instructions to a client who has a prescription for amoxicillin and clarithromycin to treat a peptic ulcer. Which of the following info should the nurse include in the teaching?

Take these meds with food

A nurse is providing teaching to a client who is starting simvastatin. Which of the following info should the nurse include in the teaching?

Take this med in the evening

What is morphine sulfate?

The benchmark for other opioids; it is an opioid agonist, hydrophilic, with no dose ceiling.

What is methadone?

The drug of choice for detoxing opioid addicts. It is bound to the tissues in the liver, kidneys, and brain. It is eliminated through the liver.

A nurse is caring for a client who has end-stage cancer and is receiving morphine. The client's daughter asks why the provider prescribed methylnaltrexone. Which of the following responses should the nurse make?

The medication will relieve your mother's constipation

A nurse is caring for a client who has cancer and is taking morphine and cabramazepine for pain. Which of the following effects should the nurse monitor for when giving the meds together ?(Select all that apply)

The need fort reduced dosage of the opioid, reduced adverse effects of the opioid, and increased analgesic effects

A pt is about to undergo cardioversion, and the nurse is reviewing the procedure and explaining moderate sedation with propofol. The pt asks, "I am afraid of feeling it when they shock me." What is the nurse's best response?

These meds will help ease any pain during the procedure, and many pts often report having no recollection of the procedure

What are NSAIDs? What is one particularly important thing to consider with NSAIDs?

They are an analgesic, also an antipyretic, and antiinflammitory. There are 23 different NSAIDs in the world and all can cause stomach ulcers--therefore, a pt who has a stomach ulcer should not get these meds. All of these meds also have dose ceilings

What are enkaphalins

They are neuro inhibitors also known as endorphins--they are made in the amygdala, a part of the limbic system that is implicated in emotion

What are mixed agonist-antagonist opioids? What are some examples?

They are partial agonist or mixed agonists. Butophanol, pentazocine, nalbuphine, and buprenorphine

What are the inhalation general anesthetics?

They can be volatile liquids or gases often mixed with oxygen. --Inhaled gas is nitrous oxide --Inhaled volatile liquids: deflurane, enfluane, halothane, isoflurane, methoxyflurane, and sevoflurane

How may elderly react to opioids in comparison to younger adults?

They may react to opioids as if given 3-4x dose given to younger pts, which is why nurses must titrate to the desired effect

What are the usual onsets and duration of action for anesthesia?

They usually have a quick onset and short duration of action

The nurse is teaching a pt about self-administration of enoxaparin. Which statement will be included in this teaching session?

This drug is given in the folds of your abdomen, but at least 2 inches away from your navel

What foods should the pt avoid with NMBDs?

This is not applicable since the pt should be NPO before taking this

A nurse is teaching a pt who has a new prescription for omeprazole for management of heartburn. Which of the following info should the nurse include in the teaching?

This med decreases the production of gastric acid

Name a common side effect of NSAIDS.

Tinnitus, bleeding, stomach upset

A pt has been taking simvastatin for 6 months. Today he received a call that he needs to come to the office for a lab check. The nurse expects which lab studies to be ordered at this time? (Select all that apply)

Total cholesterol, triglyceride, liver function studies, and HDL and LDL levels

A nurse is teaching an adolescent client who has a new prescription for clomipramine for OCD. Which of the following instructions should the nurse include to minimize an adverse effect of this med?

Wear sunglasses when outdoors to decrease incidence of photophobia

When is a local anesthetic considered effective, a.k.a. successful?

When it eliminates pain sensation in tissues innervated by the anesthetized nerves and it does not paralyze the pt's respiratory system

What is pseudo addiction?

When pts are undertreated for pain, they will behave like addicts to get the relief they need

When should a fentanyl patch be used on pts?

When the pt is already opioid tolerant--receiving opioid therapy equivalent to fentanyl 25 mcg/hr. It is for long-term opioid management; make sure the pt know to take the patches off. Do not use in pts under age 2 and monitor the pt carefully if given fentanyl with CYP3A4 inhibitors

A nurse is planning to admin morphine IV to a client who is postop. Which of the following actions should the nurse take?

Withhold this med if the pt has respirations of less that 12 per min

Can people who have been addicted to pain meds ever receive opioid therapy?

Yes--if they need pain meds for severe pain

A mother calls the clinic to ask what med to give her 5-year-old child for a fever during a bout of chicken pox. The nurse's best response would be:

You can use children's doses of acetaminophen or ibuprofen, but aspirin is not recommeneded

What are the names of the adjuvant drugs used for drying up of excessive secretions?

atropine and scopolamine

What are the names of the ester type local anesthetics?

benzocaine (for sunburn), cocaine (throat anesthetics), tetracaine, and dibucaine (rectal)

What are the names of the amide types of local anesthetics?

bupivacaine, lidocaine, prilocaine, and prilocaine/lidocaine (EMLA)

A nurse is monitoring a client who takes 81 mg per day PO aspirin. The nurse should identify which of the following manifestations of daily aspirin therapy (select all that apply)

coffee-ground emesis, tinnitus, and nausea

What are some potential opioid adverse effects?

constipation, N/V, sedation and mental clouding, respiratory depression, overdose, and urinary retention

What are the parenteral general anesthetics?

etomidate, ketamine, propofol, and thiopental

What are the names of adjuvant drugs used for anesthesia induction?

fentanyl, alfentanil, and sufentanil (all have fentanyl in them)

What are some signs and symptoms of Reyes Syndrome?

flaccid paralysis, loss of deep tissue reflexes, seizures, changes in level of consciousness, altered liver function

Which drug is 8x more potent than morphine?

hydromorphone

What are the names of the adjuvant drugs used for amnesia and sedation?

hydroxizine, pentobarbitol, promethazine, secobarbital, and midazolam

A 72 year old woman is taking an over-the-counter vitamin that contains gingko. Her physician has recommendedthat she start taking low-dose aspirin therapy as part of her treatment for TIAs. The concern for taking these 2 drugs together is:

increased risk of bleeding because of the gingko

What is the goal for medications used for breakthrough pain per day

less than 3 doses of med per day for breakthrough pain--use immediate release opioids

What are the names of the adjuvant drugs used for pain prevention and relief?

meperidine and morphine

A nurse is planning care for a client who has cancer and is taking a glucocorticoid as an adjuvant med for pain control. Which of the following interventions should the nurse include in the plan of care? (Select all that apply)

monitor serum glucose, serum potassium level, and monitor for gastric bleeding

Name a symptom of opioid withdrawal:

n/v/d, anxiety/irritability, lacrimation, rhinorrhea, yawning, perspiration, back/joint pain, increased BP/HR and resp rate, restlessness, insomnia

What is the legal term used for opioids?

narcotics

A pt is receiving dabigatran, 150 mg 2x a day as a part of a treatment for afib. Which condition, if present, would be a concern if the pt were to receive this dose?

renal impairment

A nurse in an ED is performing an admission assessment for a client who has severe aspirin toxicity. Which of the following findings should the nurse expect?

respiratory depression

What is the treatment for Reyes Syndrome?

supportive treatment in the ICU, monitor blood glucose level, vitamin K for clotting problems, monitor intracranial pressure, and cautious fluid admin

A 49 year old pt has been admitted with possible chronic salicylate intoxication after self-treatment for arthritis pain. The nurse will assess for which symptoms of salicylate intoxication? (Select all that apply)

tinnitus, headache, and nausea

A nurse is taking a history for a client who reports that he is taking aspirin about 4x a day for sprained wrist. Which of the following prescribed meds taken by the client is contraindicated with aspirin?

warfarin