- Information
- AI Chat
Exam III Blueprint
Pharmacology (NSG 124)
Herzing University
Recommended for you
Preview text
NSG Fundamentals EXAM III Blueprint
Unit 6 and 7 Medication Administration and Complementary Therapies Complementary health approaches: refers to interventions that can be used with conventional medical interventions and thus complement them Integrative health: refers to the combination of complementary health and conventional health approaches in a coordinated way
Complementary and alternative medicine (CAM) is also still widely used; however, the terms have recently changed to reflect the fact that CHAs and IH care are not “medicines” and people without medical degrees practice CHA/IH.
Allopathic medical care has not been totally effective in dealing with persistent symptoms related to chronic illness and patient quality of life. Increasingly, CHAs are being used as an “answer” to the problem of chronic illness. The CHA and allopathic systems differ fundamentally in several ways. Until recently, the majority of decision-making in CHA has been based on observation, experience, and traditional healing manuscripts, in contrast to allopathic medicine, which has moved away from these methodologies to evidence-based practice. Many CHAs are based on a theory and philosophy of holism upon which holistic nursing also is based. Complementary health approaches that involve mind-body practices
Mind–body practices use a variety of techniques designed to enhance the mind's ability to affect bodily function and symptoms.
Examples include yoga, meditation, acupuncture, energy medicine, manipulative and body-based practices (e., chiropractic), and others.
The scientific field of psychoneuroimmunology (PNI) studies neurochemicals such as neuropeptides that are now believed to be the messenger molecules that connect the body and mind. Neuropeptides have properties that allow them to affect neurologic and physiologic tissue receptors. Many neuropeptide receptor sites lie along the gastrointestinal tract; this explains why people can experience a large variety of gastrointestinal symptoms in response to emotional situations. Meditation
Patients seeking inpatient care might have a meditation practice they want to continue. Nurses should provide the time necessary for this to occur.
A quiet location: Meditation is usually practiced in a quiet place with as few distractions as possible. This can be particularly helpful for beginners.
A specific, comfortable posture: Depending on the type being practiced, meditation can be done while sitting, lying down, standing, walking, or in other positions.
A focus of attention: Focusing one's attention is usually a part of meditation. For example, the meditator may focus on a mantra (a specially chosen word or set of words), an object, or the sensations of the breath. Some forms of meditation involve paying attention to whatever is the dominant content of consciousness.
An open attitude: Having an open attitude during meditation means letting distractions come and go naturally without judging them. When the attention goes to distracting or wandering thoughts, they are not suppressed; instead, the meditator gently brings attention back to the focus. In some types of meditation, the meditator learns to “observe” thoughts and emotions while meditating. Definitions
Pharmacokinetics is the effect the body has on a drug. It is the study of the movement of drug molecules as they enter the body, reach their site of action, metabolize, and exit the body.
Pharmacotherapeutics addresses why we administer a specific drug, which is more commonly known as the clinical indication(s)
Pharmacodynamics is the effect of the drug on the body. It is the process by which drugs act on target cells resulting in alterations in cellular reactions and function.
Pharmacogenetics where differences in the responses of patients receiving the same medication may result from genetic differences, such as genetic variations in certain enzymes, that may cause differing drug responses Types of medication a. Extended release/sustained release: preparation of a medication that allows for slow or continuous release over a predetermined period, aka Controlled Release, sustained release/action, long acting, or timed release b. Enteric coating: tablet or pill coated to prevent stomach irritation c. Capsule: powder of gel form of an active drug enclosed in a gelatinous container; liquigel Pharmacokinetics
Absorption: transferred to bloodstream (Route/lipid solubility/pH/blood flow/site)
Distribution: the drug molecules are transported throughout the body to where they take action; depends on (1) the adequacy of blood circulation; (2) protein binding, which affects the drug's ability to leave the bloodstream or storage areas (such as muscle, fat, or other tissues) and enter the cells; and (3) the selectively permeable blood– brain barrier that protects the central nervous system (CNS) with its capillary wall, but can also limit the passage of drugs intended to act on the CNS
Metabolism: changes from active form to inactive form; liver is the primary site for drug metabolism; some drugs are extensively metabolized in the liver and do not make it to the systemic circulation. a. Reduction in bioavailability is referred to as the first-pass effect or presystemic metabolism. b. Drugs with extensive or variable first-pass effects, like nitroglycerin, are not given orally because most of the drug would be destroyed by the liver, with little or no drug left to work in the body- only given via sublingual, transdermal, or intravenous routes. c. Some drugs are metabolized by the liver to an inactive form, reducing the amount of active drug left in the body. Other drugs do not undergo metabolism at all in the liver, and others may be metabolized to an active drug metabolite (another form), and may be more active than the original drug.
Excretion is the process of removing a drug, or its metabolites (products of metabolism), from the body. The kidneys excrete most drugs through urine. The lungs are the primary route for the excretion of gaseous substances, such as inhalation anesthetics. Some drugs or their metabolites are excreted through bile—either directly through feces or returned to the liver and then eventually excreted by the kidney. The skin has minimal excretory function. Some medications may be contraindicated, or dosages may need to be adjusted, if renal excretion is impaired.
Peak level: highest plasma concentration, of the drug should be measured when absorption is complete. The peak level may be affected by factors that affect drug absorption as well as the route of administration. The peak level is typically drawn 1 hour after a drug has been administered (depending on the route)
Half-life: point when the drug is at its lowest concentration, indicating the rate of elimination. The trough level is typically drawn 30 minutes before the next dose is scheduled to be administered. The dosage schedule, as well as the half-life of the drug, can affect the trough level.
Trough level: the amount of time it takes for 50% of the serum concentration of a drug to be eliminated from the body. When a drug is given at a consistent dose, it takes four or five half-lives to achieve a steady concentration and develop balance between tissue and serum concentrations. Incomplete Prescriptions
Clarify with provider: When preparing to administer a medication, ask yourself why the patient is receiving the medication—is there a rationale you can provide as to why this medication has been prescribed? Do the therapeutic and pharmacologic classes link with your patient's condition(s)? If not, then ask the provider or pharmacist, and/or use an appropriate resource to further investigate. Perhaps the provider inadvertently ordered the wrong medication—the only way to be sure is to ask.
5 rights of medication need to be on prescription: a. Medication b. Dose
Medication Administration Teaching (Child-parent) Techniques a. If coating or is extended release, can request the medication in liquid form b. Be honest about taste c. Mix in pudding, ice cream, food to mask flavor d. Suck on ice cube or popsicle to numb taste buds e. Syringe b/w gum and cheek, few taste buds Refusing medication or treatment a. Explain patient rights, explain benefits b. Document med, dose, route and reason in chart c. Document information given to patient d. Notify provider e. Verifies the reason medication was omitted and ensures that health care personnel providing care for the patient are aware of the occurrence. Unit 8 Nursing Support of Nutrition and Dietary Requirements Vitamins: Vitamins are organic compounds needed by the body in small amounts. Most vitamins are active in the form of coenzymes, which, together with enzymes, facilitate thousands of chemical reactions in the body. Although vitamins do not provide energy (calories), they are needed for the metabolism of carbohydrates, protein, and fat. a. Water soluble: Water-soluble vitamins include vitamin C and the B-complex vitamins (ascorbic acid, thiamin, riboflavin, niacin, pyridoxine, biotin pantothenic acid, folate, and cobalamin). They are absorbed through the intestinal wall directly into the bloodstream. Although some tissues can hold limited amounts of water- soluble vitamins, they usually are not stored in the body. Toxicities are not likely. b. Fat-soluble: Vitamins A, D, E, and K, the fat-soluble vitamins, are absorbed with fat into the lymphatic circulation. Like fat, they must be attached to a protein to be transported through the blood. Secondary deficiencies of the fat-soluble vitamins can occur anytime fat digestion or absorption is altered, such as during malabsorption syndromes and pancreatic and biliary diseases. The body stores excesses of the fat-soluble vitamins mostly in the liver and adipose tissue. Because they are stored, a daily intake is not imperative and deficiency symptoms may take weeks, months, or years to develop. Excessive intake, particularly of vitamins A and D, is toxic. Dietary History Adolescent: Nutrient needs
- Nutrient needs: a. Infant: birth to one year of age is the most rapid period of growth. Birth weight doubles in 4 to 6 months and triples by one year of age. Length increases 50% in the first year. Nutritional needs per unit of body weight are greater than at any other time in the life cycle. Breastfeeding is recommended as the major source of nutrition for the first 6 to 12 months of life. b. Toddler/PreK: Mobility, autonomy, and coordination increase, as do muscle mass and bone density. Language skills improve, and the 3- to 5-year-old child also develops attitudes toward food; often experience an inadequate intake of fruits and vegetables and/or excessive intake of sweetened fruit drinks. c. School age: uneven, individualized, sometimes erratic growth pattern. Permanent teeth erupt as the digestive system matures. Socialization and independence increase. At this stage, the body accumulates reserves in preparation for the upcoming adolescent growth spurt. Focus on health promotion. Increasing energy requirements need to be balanced with foods of high nutritional value. The appetite improves but still may be irregular. d. Adolescents: period of rapid physical, emotional, social, and sexual maturation. The growth spurt begins at different ages among individuals. Girls begin menstruation and experience fat deposition, whereas males experience an increase in muscle mass, lean body tissue, and bone; Childhood nutrition problems
often worsen during adolescence. Adolescents tend to skip breakfast, contributing to a lower-quality diet and decreased performance in school. Children in this age group tend to consume inadequate amounts of fruits, vegetables, whole grains, and dairy products. 2. Evaluate nutritional requirements: a. nutrient needs, especially for calories, protein, calcium, and iron, increase to support growth. 3. Ask what kind of food they eat a. Food is often eaten away from home, consisting of products from fast-food restaurants, convenience stores, and vending machines—foods high in fat, sugar, and salt. 4. Weight is an issue at this age a. Weight consciousness may become compulsive in teenaged girls, resulting in anorexia nervosa, an eating disorder characterized by extreme weight loss, muscle wasting, arrested sexual development, refusal to eat, and bizarre eating habits. BMI
- Obesity definition: Obesity is defined as body weight 20% or more above ideal weight or having a BMI of 30 or more.
- First step: Focus on factors that could cause weight gain, changes, stress a. a low resting metabolic rate or an inherited family tendency contribute to obesity b. increased number of fat cells, a lowered basal metabolic rate setpoint, a decreased amount of brown fat that burns kilocalories, insulin resistance, and hormone imbalance
- Second step: Non-therapeutic- types of food and reasons, and personal impression a. food and family environment that encourages overeating, a lifestyle in which exercise is minimal, and the availability of foods in a multitude of settings at all times are environmental factors that contribute to obesity b. psychological reasons for obesity, including compulsiveness, using food to satisfy emotional needs, relying on food for compensation for lack of affection and companionship, and overeating as a release mechanism for boredom, anxiety, and feelings of inadequacy Basal Metabolic Rate a. Factors that increase BMR: include growth, infections, fever, emotional tension, extreme environmental temperatures, and elevated levels of certain hormones, especially epinephrine and thyroid hormones b. Factors that decrease BMR: aging, prolonged fasting, and sleep, fasting or following a very–low-calorie diet Therapeutic Diet: Renal Diet a. reduce kidney workload, cuts down on waste in blood, control accumulation of uremic toxins a. Decrease fluid: amount dependent on pt situation b. Decrease potassium: amount dependent on pt situation c. Limit sodium: limit to 1000 to 3000mg/day d. Limit protein, only high quality: restrict to 0-1g/kg/day Clear liquid diet a. Clear fluids that become fluid at room temp b. Requires minimal digestion and leaves minimal residue c. Clear broth, coffee, tea, clear fruit juices, gelatin, popsicles, commercially prepped d. Gelatin and popsicles Full liquid diet (High-calorie, high-protein supplements recommended if full liquid diet is used for <three days) a. Everything on clear liquid list plus: b. Vegetable juices c. Milk/milk drinks d. Puddings/ custards e. Pasteurized eggs
Urinary system: Child
- Bladder usually not palpable when empty
- Palpated above symphysis pubis to umbilicus
- Normal urine pH 5-
- Color Normal: pale yellow to amber
- Urethral orifice: no presence of inflammation
- Odor Normal: NONE Urinary System: Health History
- Voiding habits: usual patterns, recent changes, aids to elimination
- Current or past difficulties: nature, onset, frequency, causes, severity, symptoms, interventions
- Presence of artificial orifices
- Medications
- Water intake
- Pain
- Incontinence a. Stress: involuntary loss of urine related to increase in intrabdominal pressure b. Urge: urine loss as soon as urge hits c. Mixed: urine loss with features of two or more types of incontinence d. Functional: caused by factors outside the urinary tract e. Transient: appears suddenly and lasts 6 months of less f. Overflow: overdistention and overflow of the bladder g. Reflex: emptying of the bladder without sensation of need to void h. Total: continuous, unpredictable loss of urine i. Nocturia: awakening at night to urinate j. Dysuria: pain or difficult urination Sterile specimen from Foley
- A urine culture requires about 3 mL, whereas routine urinalysis requires at least 10 mL of urine.
- STERILE technique
- If urine is not present in the tube, clamp the tube below the access port briefly (not to exceed 30 minutes) to allow urine to accumulate.
- Clean the access port with an antiseptic swab, and carefully attach the syringe to the port.
- Aspirate urine into the syringe, remove the syringe, release the clamp if one was used, and transfer the specimen to the appropriate container.
- Label the specimen with the patient's name, date, and time of collection, then package and transport the specimen according to facility policy. Cystoscopy Procedure Cystoscopy is the direct visual examination of the bladder, ureteral orifices, and urethra with a cystoscope. It is used to view, diagnose, and treat disorders of the lower urinary tract, interior bladder, urethra, male prostatic urethra, and ureteral orifices.
- Preparation a. The patient is allowed liquids on the morning of the examination. b. Sedation and analgesics are usually prescribed before the procedure. c. Verify documentation of informed consent (required for the procedure). d. Explain to the patient that the procedure is ordinarily painless.
- Aftercare a. Know that tissue swelling, dysuria, and hematuria may occur because of trauma from the procedure.
b. Encourage a generous fluid intake and observe and measure urine output for at least 24 hours. c. Observe the patient for urinary retention and for signs of infection; procedure-related infection after a cystoscopy may occur. Teaching Voiding Habits
- Schedule: Some patients report urinating on demand in no apparent pattern. Others have inflexible patterns that have developed over the years and become anxious if these are interrupted. Some patients need assistance to urinate and may experience urgency. Nursing actions should support the patient's usual urinating pattern as much as possible.
- Urge to void: Assist the patient to void when the patient first feels the urge to void. Routinely delaying urination may result in difficulty initiating a stream and/or urinary stasis. Urinary stasis can contribute to the development of UTIs.
- Privacy: Many adults and children cannot urinate in the presence of another person. Unless the patient is extremely weak and requires assistance, provide privacy in the health care facility and in the home.
- Position: Helping patients assume their usual voiding position may be all that is necessary to resolve an inability to urinate. Some male patients cannot use a urinal while lying down or sitting; encourage them to void while standing at the bedside unless this is contraindicated. Similarly, some female patients cannot void easily on a bedpan but respond favorably with a bedside commode.
- Hygiene: Patients who are confined to bed find it difficult to perform their usual genital hygiene. Careful cleansing of the perineal and genital areas is needed for patient comfort and to prevent infection. This is easily accomplished for patients on bedrest by using warmed, moistened disposable washcloths and skin cleanser or by pouring warm, soapy water over the perineal area while the patient is still on the bedpan, followed by clear water. UTI prevention
- Drink 8 to 10 8-oz glasses of water daily.
- Observe the urine for color, amount, odor, and frequency. Report any sign of infection to your health care provider.
- Dry the perineal area after urination or defecation from the front to the back, or from the urethra toward the rectum.
- Drink two glasses of water before and after sexual intercourse and void immediately after intercourse.
- Take showers rather than baths.
- Wear underwear with a cotton crotch and avoid clothing that is tight and restrictive on the lower half of the body. Inter dwelling catheter (Foley) Care
- Drainage bag below level of bladder: Maintain a constant downward flow of urine. Check tubing frequently to ensure kinks and dependent loops (low points) are not present in the tubing. Check to see that the patient is not lying on the drainage tubing and compressing it.
- Always keep the drainage bag off the floor to reduce the risk of infection. The floor is grossly contaminated.
- Push water intake: helps prevent infection and irrigates the catheter naturally by increasing urine output
- Can shower: Help the patient take a shower bath if possible. Remember to keep the collecting bag lower than the bladder to promote drainage.
- Empty when 2/3 full: Empty the leg bag at regular intervals, to allow the bag to become no more than two-thirds full. A full drainage bag may cause reflux of urine into the bladder or may pull away from its attachment on the leg. Use an antiseptic solution to cleanse the bag outlet before and after emptying or changing from the leg bag to a larger overnight collection bag. Inserting an Indwelling catheter
- Surgical asepsis a. The bladder is normally a sterile cavity. b. The external opening to the urethra can never be sterilized.
gastroenteritis, or early/partial bowel obstruction. Decreased or absent bowel sounds, evidenced only after listening for 5 minutes or longer, signify the absence of bowel motility, commonly associated with peritonitis, paralytic ileus, and/or prolonged mobility 2. Absent bowel sounds: Hypoactive bowel sounds indicate diminished bowel motility, commonly caused by abdominal surgery or late bowel obstruction Stool assessment a. GI Bleed (upper) – black stool / (lower) - bright red b. Clay color- absence of bile c. Pencil shape- obstruction d. Fatty- impaired digestion Constipation
Constipation results when stool remains in the large intestine too long (for any number of reasons), which results in the overabsorption of water from the stool, resulting in hard, dry, difficult-to-excrete feces.
Priority? a. Assess frequency of bowel movements b. Constipating: Processed cheese, lean meat, eggs, and pasta c. Recommendations: i. Regular exercise ii. Adequate fluid intake iii. Decrease/avoid worry iv. Adequate fiber intake Fecal Occult blood test teaching
Fecal occult blood testing (FOBT) is used to detect occult blood in the stool; screening for disorders such as cancer and for gastrointestinal bleeding in conditions such as ulcer disease, inflammatory bowel disorders, and intestinal polyps.
Three consecutive stool samples should be collected over several days to provide the most effective screening for colon cancer
Do not use laxatives, enemas, or suppositories for three days before testing.
Postpone the test if hematuria or bleeding hemorrhoids are present.
Postpone the test if the patient has had a recent nose or throat bleed.
No iron for 3 days prior (may lead to false-positive readings) EGD Care: (esophagogastroduodenoscopy)
Definition of EGD: Allows visual examination of the esophagus, stomach, and upper duodenum by means of a long, flexible, fiberoptic-lighted scope.
Immediate Intervention? for diagnosing inflammatory, ulcerative, and infectious diseases; benign and malignant neoplasms; and other lesions of the esophageal, gastric, and intestinal mucosa.
After: a. Observe for signs of perforation: pain, persistent difficulty swallowing, vomiting blood, or black, tarry stools. b. expect a hoarse voice and sore throat c. Nausea common Food Safety Teaching
Refrigerate perishable foods and leftovers within 2 hours (1 hour in summer). Refrigerator temperatures should be between 40°F and 32°F. Freezer temperatures should be 0°F or below.
Use separate cutting boards and plates for produce and for meat, poultry, seafood, and eggs. Never cut meat on a wooden surface.
Thoroughly wash all vegetables and fruit before preparing or eating.
Do not wash meat, poultry, or eggs to prevent spreading microorganisms to the sink, countertops, and other kitchen surfaces.
Never use raw eggs in any form because of the danger of infection with Salmonella bacillus. When cooking eggs, use only fresh ones that have been purchased within 3 to 5 weeks and kept in the refrigerator.
Do not eat seafood raw. Do not eat seafood if it has a strong, unpleasant odor.
Cook whole meats to 145°F, ground meats to 160°F, and poultry to 165°F. Microwave food thoroughly; cook to the safe temperature of 165°F or above.
Keep food hot after cooking; maintain the safe temperature of 140°F or above.
Give only pasteurized fruit juices to small children. Enema
Ensure client understands procedure: explain the purpose, what they can expect, and how they can participate.
Do not discount fears
Client can refuse
Do not threaten Enema types
Cleansing enemas are given to remove feces from the colon, commonly to: a. Relieve constipation or fecal impaction b. Prevent involuntary escape of fecal material during surgical procedures c. Promote visualization of the intestinal tract by radiographic or instrument examination d. Help establish regular bowel function during a bowel-training program
Carminative a. help to expel flatus from the rectum and provide relief from gaseous distention. Common solutions include the milk and molasses enema (equal parts) and the magnesium sulfate–glycerin–water (MGW) enema (30 mL of magnesium sulfate, 60 mL of glycerin, and 90 mL of warm water).
Medicated a. provide medications that are absorbed through the rectal mucosa.
Oil retention a. lubricate the stool and intestinal mucosa, making defecation easier. About 150 to 200 mL of solution is administered to adults. Large Volume enema
Warm solution: Warming the enema solution amount ordered prevents chilling the patient, which would add to the discomfort of the procedure. Cold solution could also cause cramping; however, a too-warm solution could cause trauma to the intestinal mucosa.
Recommend amount of fluid: 750 to 1,000 mL
Tap water: Tap water is a hypotonic solution that moves fluid from the colon into the interstitial spaces and can cause circulatory overload and electrolyte imbalances.
Where to hang: The height of the fluid container affects the speed of instillation. The maximum recommended height is 18 inches. Hanging the container higher than that can cause rapid instillation and possibly painful distention of the colon.
Exam III Blueprint
Course: Pharmacology (NSG 124)
University: Herzing University
- Discover more from:
