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| you will pass this first exam! keep on studying hard to become an RN. |
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moving an extremity away from the body.
e.g. arms moving away from the body. |
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moving an extremity towards the body from the lateral position.
e.g. bring the arms to the side |
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| slow breath rate <10 RRPM |
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a temperature scale where
freezing point of water as 0°
boiling point as 100° |
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| a breathing patter when a PT. will breath with an occasional apnea. |
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| moving of an appendage in a circle, any ball and socket joint can preform this action. |
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the transfer of heat into a physical object.
e.g. sitting on a cold chair, eventually it becomes warm. |
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the shortening of the muscle, either voluntary or involuntary.
e.g. flexing your bicep, it contracts or extension of your arm. triceps contracts. |
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| A factor that renders the administration of a drug or the carrying out of a medical procedure inadvisable |
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the transfer of heat by means of air.
e.g. cold air hitting your body. |
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| bluish coloration of the skin, due to lack of perfusion/oxygenation. |
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| the number that come after the systolic pressure. the amount of force of blood returning to the heart. |
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when heat is in the form of liquid is evaporated (steam) due to heat.
e.g. sweating. |
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| turn sole of the foot laterally |
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| rotation of an appendage outward |
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| a temperature scale that registers the freezing point of water as 32° and the boiling point as 212° |
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| describing a pt. with fever |
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the primary muscle contracts.
flexing your arms (bicep) |
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| inability or difficulty to dorsiflex the ankle & toes. |
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| a manner or style of walking |
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| a sheet that has a collection of vital signs (T. P., BP, RR) |
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extension of an joint beyond its normal anatomical limitations.
e.g. pulling of the wrist/ hand towards the forearm. |
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| blood pressure that exceeds 120> sys / >80 dys three types levels. |
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| Abnormally fast or deep RR, which results in the loss of CO2 from the blood, causing |
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| rotating an appendage inward. |
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| turn sole of foot medially |
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| the force of a human muscle that is applied during constant velocity of motion |
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| an increase in muscle tension or muscle work but no shortening or active movement of the muscle. |
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| the sounds of the systolic and diastolic BP,when taking a BP. |
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| occupational therapy (OT) |
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Definition
| The use of productive or creative activity in the treatment or rehabilitation of physically or emotionally disabled people. |
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Definition
| when a patient can only breathe when standing upright, and has SOB while laying down. |
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| treatment of physical dysfunction or injury by the use of therapeutic exercise |
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| rotating the hand facing downward, palm side down. |
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| the difference between sys and dia BP. |
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usage of the pivotal joint
(turning your head left and right) |
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| PT. HOB at 45-60 degrees. |
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| an audio took that helps acusticate lung and heart sounds. |
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| the body is laying facing upward, back against the floor |
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| the pressure that is required to contract the heart. |
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| rotation of the palm of the hand facing upward |
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Definition
| Temperature, pulse, Respiration. |
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Definition
| hearing of sounds via stethoscope. |
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Definition
| Rescue, Alarm, Contain, Extinguish. |
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Term
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Definition
Principles and procedures to prevent and control infections and its spread.
assume that all blood, bodily fluids, non-intact skin and mucous membranes are infectious. |
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Definition
Protect clients rights to confidentiality
Avoid discussing clients in public hallways and provide reasonable levels of privacy in communicating with and about clients in any matter. |
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Term
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Definition
AKA: sterile technique
prevents contamination of an open wound. Isolates the operative area from the unsterile environment and maintains a sterile field for surgery.
Used during:
1. procedure that require intentional perforation of clients skin (i.e. IV catheters)
2. skin integrity broken (i.e. burns, incision, trauma)
3. procedures that involve insertion of catheters or surgical instruments into sterile body cavities (i.e. urinary catheter) |
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Definition
Health Insurance Portability and Accountability Act
-Provides rights to clients and protects employees
-Limits who is able to access clients' record (consent)
-Establishes the basis for privacy and confidentiality concerns |
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Term
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Definition
Health Care Associated Infections
aka: nosocomial or healthcare acquired infections
- HAI's can occur as a result of invasive procedure, antibiotic administration, the presence of multidrug-resistant organisms, and breaks in infection prevention and control services
Can be:
1.) exogenous- organism that is present outside the client. I.e: post-operative infection
2.) endogenous- organism is part of normal flora.
Major sites of HAI's:
-urinary tract
-surgical or traumatic wounds
- respiratory tract
- bloodstream |
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Definition
aka: clean technique
procedures used to reduce the number or organisms present and prevent the transfer of organisms (i.e. hand hygiene, gloves, and cleaning the environment) |
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Personal Protective Equipment
gowns, masks/respirators, protective eyewear and gloves |
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Definition
human, mechanical and or physical device that is used with or without the clients permission to restrict his/her freedom to move (i.e. Ativan, safety vests, etc)
Only used after all other possible alternatives have been attempted (need to document alternatives)
Effect on Restraints:
-Sensory Deprivation
-Emotional Distress
Restraints usually need MD's order. -Type of restraint to be used
-Reason for restraint placement
-Time limit of restraint
-Criteria for removal
Patient must be visually checked for comfort and safety every 15 minutes and document every 2 hours. Removed every 2 hours to perform ROM, assess skin and circulation
Restraints:
- reduce the risk of client injury from falls
- prevent interruption of therapy (IV)
-reduce the risk of injury to others
-prevent confused/combative patients from removing life support equipment |
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| Discuss the spread and control of infectious agents |
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Definition
Major Mode of Transmission is Hands! Can also be spread through:
-Contact
_direct: person to person
_indirect: contaminated object
_droplet: contaminated secretions
-Air
_Droplet: carried on dust particle
_Vehicles: contaminated items
_Vectors: mosquito, fleas, ticks, flies, lice
Most effective way to prevent spread of infection: HAND HYGIENE! |
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Term
| Factors that increase the risk of infection for health care personnel |
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Definition
1. Age
2. Lifestyle
3. Occupation
4. Diagnostic procedures
5. Heredity
6. Travel history
7. Trauma
8. Nutrition |
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Term
| Compare and contrast standard precautions with transmission based precautions |
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Definition
Standard Precautions:
Transmission-Based Precautions: |
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Term
| Describe assessment data needed to determine an adult client's safety status |
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Definition
• Developmental Risk Factors
-Toddler – poisoning
-Teens – Motor vehicle crashes, accidents, suicide, risk behaviors e.g. drugs and ETOH, unsafe sex
-Adults – stress, lifestyle habits e.g. smoking
-Older Adults – falls, polypharmacy
(Note – abuse is a risk for all stages of development e.g. child abuse, elder abuse, spousal abuse)
• Individual’s Risk Factors
-Musculoskeletal Impairment – Mobility – gait and balance problems
-Sensory Impairment
-Communication Impairment
-Lifestyle – drugs, ETOH, stress
-Lack of Safety Awareness – keeping meds away from children
• Environmental Risk Factors
-Improper Heating Systems – carbon monoxide poisoning
-Food – e-coli
-Physical – stairs
-Thermal – hot coffee
-Chemical – drugs, cleaning agents
-Radiation – sun
-Microbial – immunosuppressed patient exposed to polio
-Lead Paint
-Temperature Extremes – heat exhaustion, hypothermia
• Health Care Agency Risks
∗ Falls account for up to 90% of all reported incidences in hospitals
∗ Patient Inherent Accidents – seizures
∗ Procedure Related Accidents – Medication Errors, breaking sterile technique
∗ Equipment Related Accidents – misuse of equipment |
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Term
| Identify factors that may be safety hazards in the adult clients environment |
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Definition
-Adequate lighting
-Clutter
-Bathroom Hazards
-Electrical and Fire Hazards |
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Term
| Discuss factors that put an adult client at risk for injury |
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Definition
∗Age
∗Level of Awareness (Normal is Alert & oriented to person, place, and time (x 3))
∗Sensory Perception
∗Psychological factors – stress
∗Physical condition e.g. mobility status
∗Medications – tricyclic antidepressants, loop diuretics, alpha agonists, alpha blockers, dopamine agonists, benzodiazepines
∗Assessment Tools
-Morse Fall Scale |
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| Describe health promotion activities and interventions appropriate for clients to prevent injury |
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Definition
1. Patient Education
2. Safe Environment
-Bed in low position
-Call bell within reach
-Provide assistance when getting OOB if patient is unstable
-Slippers when ambulating
-Reduce clutter in room
-Decrease verbal stimuli/noise
-Confused patient’s
• Move closer to Nurse’s station
• Bed Alarm device – will signal if patient gets OOB
• Family participation
• Cover IV sites/Tubing
• Restraints as a last measure |
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Term
| Discuss alternatives to restraints |
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Definition
1.) orient/reorient to surroundings
2.) modify environment (pt. closer to nurses station)
3.) sitter
4.) visual and auditory stimulation
5.) changing or eliminating bothersome treatment
6.) tolieting routines
7.) psychosocial interventions (relaxation techniques) |
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Term
| Discuss hazards associated with the use of restraints |
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Definition
-Fear
-Anger
-Choking
-Pneumonia
-Constipation
-Skin Breakdown |
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Definition
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Term
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Definition
| a large vesicle or blister greater than 1cm in diameter |
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Definition
| a covering formed from serum drying on the skin |
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Term
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Definition
| non-elevated discoloration of the skin |
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Term
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Definition
| a raised solid lesion that is deeper and larger than a papule |
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Definition
| a transient elevation of the skin caused by edema of the dermis and capillary dilatation |
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Definition
| a solid elevated palpable lesion less than 1cm in diameter |
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Definition
| a solid elevated lesion on the skin or mucous membrane that is greater than 1cm in diameter |
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Definition
| a lesion that contains pus |
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Definition
| heaped up horny layers of dead epidermis |
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Definition
| a small elevation of the skin that is filled with clear fluid |
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Term
| Compare and contrast common skin problems and related interventions |
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Definition
1. Dry Skin- flaky, rough texture
Intervention: bathe less frequently, increase fluid intake, use moisturizing cream to aid healing, add moisture to air (humidifier)
2. Acne- inflammatory, papulopustular skin eruption
Interventions: wash hair and skin with warm soap and water to remove oil; use cosmetics sparingly (oily cosmetics can accumulate in pores and make condition worse); implement dietary restrictions
3. Skin Rashes: skin eruptions that result from overexposure to sun or moisture or allergic reactions
Interventions: wash area thoroughly and apply antiseptic spray or lotion (prevent itching and aid in healing process)
4. Contact Dermatitis- inflammation of skin characterized by abrupt onset with erythema, pain and scaly oozing lesions
Interventions: avoid cauative agents (cleansers and soaps)
5. Abrasion- scraping or rubbing away from epidermis that will result in localized bleeding
Intervention: wash with mild soap and water; avoid scratching patient with jewelry or fingernails; observe dressing or bandage |
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Term
| 2. Describe health promotion activities appropriate for clients to prevent the development of impaired skin-integrity |
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Definition
a. Skin care
- Hygiene and skin care
b. Mechanical loading and support devices
- Proper positioning and use of therapeutic surfaces
c. Education |
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Term
| Describe factors that may put a client at risk for development of impaired skin integrity |
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Definition
-Immobilization
-Reduced Sensation
-Nutrition and Hydration Alterations
-Secretions and Excretions on the Skin
-Vascular Insufficiency
-External Devices |
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Term
| Describe pathogenesis of pressure ulcers |
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Definition
Pressure Intensity
-If the pressure applied over a capillary exceeds the normal capillary pressure (15-32 mm Hg). Results in tissue ischemia or tissue death.
Pressure Duration
-Low pressures over a prolonged time & high-intensity pressure over a short period time= tissue damage
Tissue Intolerance
-Extrinsic factors (shearing, friction, & moisture) affect skins ability to tolerate pressure
-Systemic factors (poor nutrition, increased aging, and low BP) affect the tissue tolerance |
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Term
| Compare and contrast the four stages for classification of pressure ulcers |
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Definition
Stage 1
-Intact skin with nonblanchable redness of localized area
Stage 2
-Partial thickness skin loss involving epidermis and/or dermis
-Ulcer superficial and presents clinically as an abrasion, blister or shallow crater
Stage 3
-Full thickness skin loss involving damage or necrosis of subcutaneous tissue
-Bone, tendon, or muscle are not exposed
-Appears as a deep crater with or without undermining of adjacent tissue
Stage 4
-Full-thickness tissue loss with exposed bone, tendon, or muscle
-Undermining and tunneling |
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Term
| Discuss the rationale for early, aggressive intervention to prevent pressure ulcers |
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Definition
| Minimizes the impact that risk factors or contributing factors have on pressure ulcer development |
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Term
| Describe health-promotion activities appropriate for clients to prevent development of impaired oral mucous membranes |
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Definition
-Oral hygiene: brushing, flossing
-Keep mucosa well hydrated, minimize foods irritating to tissues, and provide cleansing that soothes and reduces tissue inflammation |
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Term
| Discuss conditions that may put a client at risk for impaired oral mucous membranes |
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Definition
Malnutrition
Chemical trauma |
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Term
| List common hair and scalp problems and their related interventions |
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Definition
1. Dandruff
-Intervention(s): shampoo regularly with medicated shampoo
2. Ticks
-Intervention(s): oil or petrolatum
3. Pediculosis
_Head Lice
-Intervention(s): medicated shampoo, manual removal, vacuum infested areas of home
_Body Lice
-Intervention(s): bathe or shower thoroughly, pediculicide lotion, another bath or shower after 12-24 hours, bag infested clothing, vacuum rooms
_Crab Lice
-Shave hair off affected area, cleanse as for body lice
4. Hair Loss
-Interventions: Stop hair care practices that damage hair (i.e., curlers, tight braiding, and use of hot comb) |
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Term
| Describe factors that influence personal hygiene practices |
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Definition
1. Social Practices
-Family customs
2. Personal Preferences
3. Body Image
4.Socioeconomic Status
-Cost of hygiene supplies
5. Health Beliefs and Motivation
-Knowledge of importance of hygiene; motivation to maintain self care
6. Cultural Variables
-Some cultures only shower 1x week; nurse needs to be non-judgemental
7. Physical Condition
-May lack energy to perform hygienic care |
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Term
| Discuss normal physical findings of the skin, hair and nails in middle-ages adults as compared to an older adult. |
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Definition
Skin
-Middle aged: elastic, well hydrated, firm & smooth
-Older adult: dry (sebaceous glands less active), wrinkled (due to epithelium thinning and shrinking of elastic collagen),
Hair
-Scalp hair becomes thinner and drier with aging
Nails
-more brittles, dull, and opaque and yellow in older adults --cause: insufficient calcium; cuticle also becomes less thick and wide |
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Term
| Nutrients that aid in wound healing |
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Definition
1. Calories
2. Protein
3. Vitamin C
4. Vitamin A
5. Vitamin E
6. Zinc
7. Fluid |
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Term
| Variations in skin color (bluish, red, yellow) |
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Definition
Bluish
-Increased concentration of deoxygenated hemoglobin in blood
Peripheral – cool skin
Central - heart or lung disease - lips, mouth, nails
Assessment of cyanosis in dark-skinned client more difficult
Examine lips, tongue, nail beds, conjunctivae, palms & soles at regular intervals for subtle color changes
Red - erythema
Increased visibility of oxyhemoglobin caused by dilation or increased blood flow
Yellow-orange - jaundice
Increased deposit of bilirubin
R/t liver disease, red blood cell hemolysis
Seen first in sclera, then mucous membranes and generalized |
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Term
| Variations in Skin Temperature (hot, cold) |
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Definition
Cool, cold: Decrease circulation
Hot, warm: Increased circulation
R/T hot shower or hot compresses |
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Term
| Variations in Skin Moisture |
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Definition
Very dry: Characterized by scaling of the stratum corneum. More pronounced over the distal lower extremities
Wet
Perspiration expected with activity |
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Term
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Definition
•Amount of skin elasticity
•Indication of hydration status
•Pinch gently between thumb and forefinger
•Normal - pinched skin returns to place immediately upon release
•Poor - takes 3 seconds or longer for skin to return to its original position
•Normal loss of elasticity with aging makes assessment of skin turgor difficult in elderly clients - with the patient in the supine position the forehead or chest tissue gives the best indication of skin hydration
•Document mobility & turgor
•Pinched skin moves easily and returns to place immediately upon release
can be diminished by edema or dehydration |
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Term
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Definition
swollen from buildup of fluid in tissues;
Skin appears shiny, taut & pale in color
R/t congestive heart failure
Rate the degree of edema – pitting edema is rated on a 4-point scale
• 0 no pitting
• 1+ barely detectable 2mm
• 2+ indentations of 4 mm
• 3+ indentations of 6 mm
• 4+ indentations of more than 8 mm |
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Term
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Definition
Skin tends to stay pinched or tented with dehydration – turgor poor
Document poor - pinched skin tents greater than 2-3 sec. upon release |
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Term
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Definition
characteristics associated with skin cancer
• A - asymmetry of shape
• B - border irregularity
• C - color variation within one lesion
• D - diameter greater than 6 mm
• E - elevation |
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Term
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Definition
small, non-blanchable vascular lesions < 0.5mm diameter
r/t increased capillary fragility |
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Term
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Definition
| bruise, larger areas of hemorrhage which range in size from several mm to many cm |
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Term
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Definition
•Inflammation of subcutaneous tissues
•Common bacterial infection
R/t - infection with streptococci, staphylococci
S&S
•Local - pain, redness, swelling, hot
•Systemic
• Red streaks extending from the patch indicate that the lymph vessels have been infected
• Fever & malaise
• Systemic potentially dangerous but usually can be treated successfully with antimicrobials
Cellulitis on the face must be given special attention because the infection may extend directly to the cavernous sinuses of brain |
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Term
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Definition
Inflammation of the skin.
R/t - various animal, vegetable and chemical substances, from heat or cold, from mechanical irritation, from certain forms of malnutrition, or from infectious disease
-S&S – itching, redness, crustiness, blisters, watery discharges, fissures, or other changes in the normal condition of the skin
-TX – varies r/t cause
•Topical corticosteroids
•Severe systemic steroids
•Avoid irritant
•Antihistamine |
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Term
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Definition
Shingles
-Acute viral disease which is communicable
-Incidence increases with age and degree of host immunosuppression
-Cutaneous eruption estimated to affect 300,000 persons a year in the US
• r/t - reactivation of the varicella-zoster virus (chickenpox)
-S&S
Linear patches along dermatome of grouped vesicles on erythematous base
Usually unilateral and on trunk
Neuralgia preceding outbreak
Mild to severe pain during outbreak
TX
-Symptomatic aimed at relieving the pain and itching
-Local application lotions to dry blisters may help
-Use of the antiviral agent acyclovir can shorten the course of infection and reduce the incidence of post-herpetic neuralgia |
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Term
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Definition
Name applied to many different kinds of fungal infection of the skin
• Tinea pedis – chronic superficial fungal infection of the skin of the foot, especially between toes, on soles
• Tinea capitis – fungal infection of the scalp
• Tinea corporis – fungal infection of the glabrous (smooth & bare) skin |
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Term
| Risk factors for development of pressure ulcers |
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Definition
•Impaired sensory input
•Impaired physical mobility
•Alterations in LOC
•Casts
•Traction
•Various equipment – O2 cannula
Also:
-shearing forces
-moisture
-poor nutrition
-edema |
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Term
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Definition
Is composed of six subscales:
1. Sensory Perception
2. Moisture
3. Activity
4. Mobility
5. Nutrition
6. Friction & Shearing
Total score ranges from 6 to 23. A lower score indicates a higher risk for skin breakdown. |
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Term
| Health promotion for skin |
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Definition
•Limit sun exposure - chronic sun exposure is the single most important factor leading to degeneration of skin components
• Educate anyone with moles or birthmarks to perform periodic skin self-examination and assess for ABCDE's
•Skin survey at 3 year intervals for patients 20 to 40 years of age & annually for patients older than 40 years. |
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Term
| Wound classification is by the color (black, yellow, red) |
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Definition
•Black = necrotic
•Yellow = exudate and yellow fibrous debris
•Red = active healing phase, clean with pink to red granulation & epithelial tissue |
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Term
| Pressure ulcers in dark skin clients |
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Definition
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Term
| Primary Functions of the Skin |
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Definition
Protective function/barrier against:
• Microorganisms
• Ultraviolet radiation
• Loss of body fluids
• Stress of mechanical forces
• Temperature regulation
• Involved in production of vitamin D
• Sensory function
• Touch & pressure receptors provide protective function & pleasurable sensations |
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Term
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Definition
•Symmetrical smile
•Color, moisture, swelling, lesions, signs inflammation
•Pink, moist, symmetrical & smooth, with no evidence of lesions or inflammation
•Pallor
•Cyanosis
Palpation:
Lips should not be flaccid & lesions should not be present |
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Term
| Assessment of Buccal Mucosa |
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Definition
•Color on the inside of the cheek may vary according to race
•African Americans - bluish hue
•Caucasians - pink mucosa
•Glistening, moist, smooth, free of lesions |
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Term
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Definition
•Normally adult has 32 teeth, should be white with smooth edges, in proper alignment & without caries
•Older adults common to see yellow or darkened teeth r/t wear & tear that exposes the darker underlying dentin |
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Term
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Definition
| Pink, smooth, moist with tight margin at each tooth |
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Term
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Definition
•Midline in the mouth
•Dorsum/top medium or dull red, moist, slightly rough on top (due to taste buds)
•Smooth along lateral margins
•Ventral surface pink, smooth with large veins between the frenulum folds |
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Term
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Definition
is a protein that is formed within the liver, it makes about 60% of
total protein, maintains osmotic pressure, transport blood constituents like drugs, hormones, enzymes.
-Indicator of Hepatic function, liver function and health. Used to study nutritional status.
Half life is 21 days - slow in
reflecting status. Indicator of malnutrition in chronic illness.
Normal: 3.5-5.0 g/dl
Mild depletion = 3.0-3.4 g/dl
Moderate depletion = 2.5 -2.9 g/dl
Severe depletion= <2.5 g/dl |
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Term
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Definition
Basal Energy Expenditure- is used to determine the caloric need in a
24 hour period depending on the level of activity. |
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Term
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Definition
Basal Metabolic Rate- is the energy needed to maintain life-sustaining
activities like breathing, circulation, HR, Temp @ rest. Factors like age,
body mass, gender, fever, starvation, etc. can affect energy requirements. |
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Term
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Definition
Body Mass Index- measures weight corrected for height and serves as an
alternative to trasitional height-weight relationships. Assessment of fat.
Formula is Weight (kg)/height (m)^2= BMI
BMI< 18.5 is underweight
BMI>18.5 and <24.9 is healthy weight
BMI 25 to 29.9 is overweight
BMI 30 to 39.9 is obese
BMI> 40 or greater is extreme obesity |
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Term
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Definition
AKA: kcal
-use to measure a unit of food energy.
-When energy is met = weight stays the same
-When kcal exceed energy demands = gain weight
-When kcal fail to meet demand = weight loss |
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Term
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Definition
are the main source of energy, each gram produces 4 kcal and
serves as main source of fuel (glucose) for the brain, skeleton muscle,
during exercise and other activities.
-Obtained from plants foods, except for
lactose.
-Storage: small amounts are stored in the liver and muscle as glycogen.
Excess are stored as fat
Recommended: 40-60% of total calories in complex carbs.
Fiber is a carb. |
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Term
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Definition
is the breakdown of biochemical substances into simpler
substances and occurs during physiological state of negative nitrogen
balance. ie. starvation, when wasting of body tissue occurs |
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Term
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Definition
Fats that are compose of chains of carbon and hydrogen atoms
with an acid group at the end and methyl group at the other. Ex. saturated,
unsaturated, monounsaturated, polyunsaturated. Provide 9 kcal/g of energy |
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Term
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Definition
a basic guide for buying food and meal preparations, provides for diet ranging from 1600-2800 kcal/day. Foods are selected from enriched cereals, complex carbs and grains to round out meals and meet energy requirements.
1-2 servings: eggs, fish, poultry
2-4 servings: plant oils
4-8 servings: whole grains
5-13 servings: fruits and vegetables
5-8 (8oz) glasses of water daily |
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Term
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Definition
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Term
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Definition
Ideal Body Weight.
-provides an estimate of what a person should weigh
% of IBW= Current Weight/Ideal Weight x 100 |
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Term
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Definition
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Term
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Definition
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Term
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Definition
(Fat) the most calorie dense nutrient, providing 9kcal/g, composed
of triglycerides and fatty acids.
-Triglycerides circulate in the blood and are made up of 3 fatty acids and glycerol.
-The synthesis of fatty acids is called lipogenesis.
Saturated – higher in animal fats
Unsaturated – mono- and poly- are higher in vegetable fats
Trans - formed when vegetable oils are hardened into solids (hydrogenated oil); may be identified as a portion of the saturated fat on food labels
Linoleic acid, an unsaturated fatty acid, is the only essential fatty acid in humans.
Fat is the body’s major form of stored energy. The metabolism of 1 gm of lipid yields more than twice the energy as CHO or PRO.
Recommended that only 30% of kcal are from fat (typically 35-45% of American diet), & that intake of saturated fat and cholesterol is low.
New technology:
Benecol has cholesterol lowering properties; 3 servings/day for 1 year |
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Term
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Definition
Clear Liquid: broth, coffee, tea, carbonated beverages, clear fruit juices, gelatin (jello) & popsicles
Full Liquid: ice cream, custards, cooked cereals, all fruits and vegetable juices |
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Term
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Definition
inorganic elements also essential in the body as catalysts in biochemical reactions
Classification:
-macro minerals: daily requirement 100mg or more
-trace elements: daily requirement less than 100mg |
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Term
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Definition
| 1 mililiter is the SI unit of measurment and is referred to as mL for measurment tools. cc is the same as cubic centimeter which refers to the volume of the substance occupying the space in the measurement tool. 1 cc is the same as mL. |
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Term
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Definition
Source for energy; 1 gm PRO = 4 kcal.
Essential for building, repair, & replacement of body tissue; nitrogen balance.
PRO is 16% nitrogen & the body’s only source of nitrogen (essential for growth, maintenance of muscle fiber & vital organs, & in wound healing).
Amino acid (AA) is the simplest form of PRO. Essential AA – body cannot synthesize, must come from diet.
Nonessential AA – body can synthesize.
Complete PRO (AKA high-biological value PRO) – contains the entire essential AA in sufficient quantity to support growth & maintain nitrogen balance.
Meat, fish, poultry, milk, & eggs
Incomplete PRO + Incomplete PRO (contains missing AA or increases the amount of AA) = supplies essential AA to support growth and nitrogen balance.
Cereals, legumes (beans, peas), and vegetables
Incomplete PRO can also be made complete with supplement of synthetic amino acids |
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Term
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Definition
Recommended Dietary Allowance
- average indicator, the amount necessary for all healthy people |
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Term
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Definition
Clear Liquid: broth, coffee, tea, carbonated beverages, clear fruit juices, gelatin (jello), & popsicles
Full Liquid: ice cream, custards, cooked cereals, all fruit & vegetable juices
Puree: scrambled eggs, pureed meats fruit & vegetables, mashed potatoes & gravy
Mechanical Soft: diced meats, cottage cheese, cheese, rice, soups, & peanut butter
Soft or Low Residue: pastas, cooked fruits & vegetables, cakes & cookies
High Fiber: fresh fruits & vegetables, oatmeal, bran, dried fruits
Low Sodium: no added salt to severe sodium restriction (500mg Na diet) that requires selective food purchases.
Low Cholesterol: 300 mg/day
Diabetic: recommended 1800 calories. Balanced intake of carbohydrates, fats, and proteins.
Regular: no restrictions, unless specified |
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Term
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Definition
| No restrictions, unless specified |
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Term
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Definition
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Term
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Definition
Diet consists predominantly of plant foods; can be nutritionally adequate if planned carefully.
-Lactoovovegetarian – eats eggs and milk
-Lactovegetarians – drinks milk, avoids eggs
-Vegans – only plant foods
-Vegan, Zen macrobiotic (only brown rice & herb tea) and fruitarian (only fruits, nuts, honey, and olive oil) are nutrient poor and may result in malnutrition. |
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Term
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Definition
Organic substances, essential for normal metabolism; act as catalysts in biochemical reactions. Body can not synthesize required amounts, must be supplemented.
Vitamin content highest in fresh foods, used quickly with minimal exposure to heat, air, water.
Water-soluble vitamins – vitamin C and B-complex. Cannot be stored in the body, must be provided each day through diet.
Fat-soluble vitamins – A, D, E, & K; can be stored in the body. Toxicity may result from mega doses of synthetic vitamins. |
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Term
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Definition
Water is 60-70% of total body weight. Muscle contains more water than any tissue except blood (so, lean people have higher % than the obese).
Cell function depends on a fluid environment; acts as a solvent for nutrients.
Fluid needs met through intake of fluids, foods high in water content, & by water produced through the oxidation of food.
Normally I = O. Average 2200-2700;
Oral Intake 1100-1400,
Solids 800-1000 |
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Term
| Describe key components of basic nutrition |
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Definition
carbohydrates
proteins
fats
water
vitamins
minerals. |
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Term
| Identify individual factors that commonly influence basic nutrition |
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Definition
a. Age
b. Diet life style
c. Financial status
d. Influences |
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Term
| List essential nutrients and food sources required for adult nutritional balance. |
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Definition
-Grains
.Whole grain cereals, rice, pasta
-Vegetables
.Broccoli, spinach, dark leafy greens
-Fruits
.Fresh, frozen, canned, or dried fruit.
-Milk
.Milk, yogurt, milk products
-Meat & beans
.Lean meats and poultry |
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Term
Describe the food guide pyramid and discuss its value in planning
meals for adult clients. |
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Definition
1-2 servings: eggs, fish, poultry
2-4 servings: plant oils
4-8 servings: whole grains
5-13 servings: fruits and vegetables
5-8 (8oz) glasses of water daily
-Adults exercise 30min 5x week to maintain weight
-60-90 minutes to prevent weight gain
-most should take a multi-vitamin
In planning diets for adults, depending on their
condition(s), a balance diet will be needed to tend to their disease
processes or nutrient needs. Based off the 2000k/cal a day,
certain food may need to be replaced with other groups due to,
personal preference or allergies. E.g protein from meats can also be
found in certain vegetables. (self-written based of RDA allowances
and food guidelines) |
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Term
| Describe the major methods of nutritional assessment |
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Definition
1. Screening: part of the initial assessment in identifying malnutrition or risk of malnutrition.
2. Anthropometry: is the measurement system of the size and makeup of the
body.
-Ht/wt and IBW% on admission
-Assessment of body weight: (current wt/usual wt) x 100
-Compare to reference data or previous usual body weight
-Try to weigh at same time/on same scale/in same clothes
-Body Mass Index (BMI)
-Assessment of body fat
-Weight (lbs) times 705/Height (inches)/Height (inches)
BMI < 18.5 is underweight
BMI >18.5 and < 24.9 is healthy weight
BMI 25 to 29.9 is overweight
BMI 30 to 39.9 is obese
BMI 40 or greater is extreme obesity
-Ratio of Ht: Wrist Circumference
-Estimate of body frame: Ht (cm)/ Wrist (cm); >10.1 - small, 10.1-11 - medium, < 11 - large
-Mid-upper arm circumference (MAC) estimates skeletal muscle mass
-Triceps skin fold (TSF) is used to est. fat content of SQ tissue
-Mid-upper arm muscle circumference (MAMC) measure skeletal muscle mass
-Compare findings to standard
-Changes over time are more significant than isolated measurements.
3. Lab & Biochemical tests
-No single lab test is diagnostic for
malnutrition. Factors that influence test results are fluid balance, liver functions, kidney function, and presence of disease. Ex of test to study malnutrition are plasma proteins
like albumin, transfferin, prealbumin, retinol binding proteins, Total iron-binding and hemoglibin.
*Albumin is a better indicator for chronic illnesses
4. Diet History/Health History
• Focuses on the patient’s habitual intake of food and fluids
• Also looks at preferences, allergies, problems, ability to obtain food
• Activity level to determine energy needs
5. History/Physical exam: most important. observe for malnutrition
6. Dysphagia: refers to the difficulty of swallowing, indicators of neurogenic,
myogenic and obstructive problems. Can cause aspiration pneumonia,dehydration, decrease nutritonal state and weight loss. Leads to disability or decrease functional status, increase length stay and cost of care
-Signs are: cough during eating, change in voice tone, or quality after swallowing,
*Abnormal signs of the mouth, tongue, or lips. Delay swallowing, “silent
aspiration”.
* Often leads to inadequate food intake which can lead to malnutrition. |
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Term
Identify nursing diagnoses for clients with actual or risk for
nutritional problems. |
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Definition
• Risk for aspiration
• Constipation
• Diarrhea
• Health-seeking behaviors (nutrition)
• Deficient knowledge (nutrition)
• Imbalanced nutrition: less than body requirements
• Imbalanced nutrition: more than body requirements
• Readiness for enhanced nutrition
• Feeding self-care deficit |
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Term
| Describe dietary modifications for older adults |
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Definition
Dietary modifications:
1. Diets typically low in PRO foods and high in breads, cakes, cereals
2. Provide PRO with cheese (calcium), eggs, & peanut butter, beans, peas
3. Encourage whole grain cereals & breads
4. Encourage cream soups & meat-based vegetable soups
-Decreased need for calories: decreased metabolic rate.
-Factors influencing nutritional status:
.Income – fixed income, spend less on food.
.Health – therapeutic diets; difficulty eating due to lack of teeth or dentures, or ill-fitting dentures; at risk for food-drug interactions.
.Physical disability – makes preparation difficult.
.Lack of transportation – males shopping difficult.
.Living alone – decreases interest and pleasure of meals.
Physiological changes:
1. Decreased taste acuity
2. Decreased gastric secretions (less efficient digestion)
3. Decreased thirst sensation (inadequate fluid intake)
4. Decreased GI motility |
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Term
| Discuss dietary guidelines for promotion of nutritional health in adult clients |
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Definition
1. Dietary Reference Intakes - DRIs (1997)-- Presents a range for acceptable intake of protein, vitamins & minerals in place of absolute values.
Generic term encompassing 4 values:
A.) Estimated Average Requirement (EAR)
-minimum indicator
-risk of ingesting too few nutrients is 50%
B.) Recommended Dietary Allowance (RDA)
-average indicator, the amount necessary for all healthy people
C.) Adequate Intake (AI)
-followed when RDA is not known
-derived from expert judgment, not scientifically proven
D.) Tolerable Upper Intake Level (UL)
-the maximum level of daily nutrient intake the is evidenced as unlikely to cause toxicity
2. Food Guide Pyramid (USDA, 2003)--Models a daily diet for between 1600-1800 kcal/day. Specifies food choices for the total diet by recommending a diet adequate in protein, vitamins, minerals, & fiber, without excessive amounts of calories, fat, saturated fat, cholesterol, sodium, added sugars, & alcohol.
3. Daily Reference Values (DRVs)--
Developed by the Nutritional Labeling and Education Act (NLEA) in 1990 to provide a more understandable format for the general public. DRVs are listed for CHO, PRO, FAT (total and saturated), fiber, cholesterol, sodium, and potassium. NLEA also set standards for terms like lite, diet, and low calorie. |
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Term
| Describe the role of the Rn in relationship to other members of the health care team when caring for clients with nutritional problems |
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Definition
| multidisciplinary approach-- coordinating plan of care with healthcare provider, dietitian, etc. |
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Term
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Definition
| a drug or dietary fiber-forming agent that relieves the symptoms of diarrhea |
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Term
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Definition
| the removal of a small piece of living tissue from an organ or other part of the body for microscopic examination to confirm or establish a diagnosis |
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Term
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Definition
a large vesicle or blister greater than 1cm in diameter
the compression of food that is created by mastication and moved by peristalsis into the stomach |
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Term
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Definition
| is a process in which a patient develops a routine to defecate every day at the same time. E.g. by waking up every morning, attempting to defecate at the same time every day until he or she regains control of bowel reflexes. This requires time, patience and consistency on the patient half |
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Term
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Definition
| the portion of the large intestine extending from the cecum to the rectum |
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Term
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Definition
| inflammatory condition of the large intestine |
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Term
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Definition
depending on the location of the site, it is a surgical opening created with the ends of the intestines to the
abdominal wall (stoma).
- ostomy means a surgical procedure that
creates an artificial opening for the elimination of bodily wastes.
If the site at the colon it is called a colostomy and if it’s in the ileum it’s called an ileostomy |
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Term
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Definition
| is a symptom and not a disease of improper diet; reduce fluid intake, lack of exercise and certain medications which cause constipation. Sign and symptoms follow; infrequent bowel movement difficulty passing stools, excessive straining, inability to defecate at will, and hard feces |
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Term
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Definition
| the eliminating of feces from the digestive tract through the rectum |
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Term
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Definition
| an increase in the number of stools and the passage of liquid with unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract |
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Term
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Definition
Endoscopy- visualization of the interior of the organs and cavities
with an endoscope
Fiberoptics - technical process by which an internal organ or cavity
can be viewed using glass or plastic fibers to transmit light through
a specially designed tube and reflect a magnified image. |
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Term
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Definition
a procedure where a water base solution is introduced the rectum and sigmoid colon via anus, to promote defecation by stimulating peristalsis. The volume of the fluid instilled breaks up the fecal mass, stretches the rectal wall and initiates the defecation
reflex |
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Term
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Definition
RN who is qualified to provide care for
persons with stomas, draining wounds, fistulae, incontinence, and actual or potential alterations in tissue integrity. |
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Term
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Definition
| presence of an excessive amount of air or gas in the stomach and intestinal tract. |
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Term
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Definition
| a mass peristaltic movement of the colon that often occurs 15-20 minutes after food enters the stomach. |
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Term
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Definition
a test which can determine if there is blood presented
in the stool, also known as a hemoccult test. Stool is applied onto two guaiac papers. Then a developing solution is applied on the back of the guaiac paper; IFF there is blood present in the stool the paper will turn blue, if not it will remain white |
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Term
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Definition
is the dilation of engorged veins in the lining of the
rectum, which can cause either external or internal hemorrhoids. If the vein is hardened, there is usually a purplish discoloration.
Internal hemorrhoids have an outer mucous membrane. Excessive or
increased venous pressure from straining at defecation can lead to
hemorrhoids |
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Term
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Definition
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Term
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Definition
|
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Term
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Definition
| an unrelieved constipation of hardened feces, wedged in the rectum that a person cannot expel. With impaction the restricted mass beings to extend into the sigmoid colon. S/S of impaction include; the inability to pass to pass stool for several days, continuous oozing of diarrhea of stool, anorexia, nausea, abdominal distention, cramping, and rectal pain. |
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Term
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Definition
| the physical condition which impairs the anal sphincter from functioning correctly, which leads to the inability to control passage of feces and gas from the anus |
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Term
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Definition
| a person who lacks the ability to produce the enzyme required to digestion of milk sugar |
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Term
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Definition
| are stool softeners, that promote peristalsis. If used correctly it maintains normal elimination patterns, however if used incorrectly it can cause the large intestines to lose muscle tone and become less responsive to stimulation via laxatives. |
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Term
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Definition
| a surgery that involves direct manipulation of the bowel, which temporarily stops peristalsis and usually last for about 24-48 hours |
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Term
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Definition
the type of movement in which the esophagus propels food
to the stomach. |
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Term
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Definition
| a maneuver that assists with stool passage. By applying pressure to the abdominal muscles to contract, while maintaining a forced expiration against a close airway |
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Term
| Discuss the process of defecation and variables that may influence the process |
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Definition
Defecation begins with movement in the left colon, moving towards the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter, and an awareness of the need to defecate.
Variables that may influence the process:
1. GI tract function
2. sensory awareness
3. voluntary sphincter control
4. adequate rectal capacity
5. compliance |
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Term
| Identify individual factors that commonly influence bowel elimination |
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Definition
1. Age
2. Diet
3. Fluid intake
4. Physical activity
5. Psychological factors
6. Personal Habits
7. Position
8. Pain
9. Pregnancy
10. Surgery and Anesthesia
11. Medications |
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Term
| Compare and contrast normal and abnormal characteristics of feces |
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Definition
Normal fecal characteristics:
-Color: yellow (infants), brown (adults)
-Odor: pungent; affected by food type
-Consistency: soft, formed
-Frequency: Varies. For infants breast= fed 4-6x daily, bottle-fed infants= 1-3 daily and for adults= 2-3 times a week
-Amount: 150 g/day
-Shape: resembles diameter of rectum
-Constituents: undigested food, dead bacteria, fat, bile pigment, cells lining intestinal mucosa, water
Abnormal fecal characteristics:
Color: white or clay, black
or tarry, red, pale with fat, translucent mucus, bloody mucus
-Odor: noxious
-Consistency: liquid, hard
-Frequency: infants= more than
6 times a day or less than once every 1-2 days; adults= more than 3x/
day or less than once a week
-Amount: -----
-Shape: narrow, pencil shaped
-Constituents: blood, pus,
foreign bodies, mucus, worms, excess fat |
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Term
| Identify equipment used to facilitate bowel function |
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Definition
-Enemas
-Digital Removal of Stool
-Nasogastric Tube
-Ostomy |
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Term
| Identify nursing diagnosis for clients with actual or risk for bowel function problems |
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Definition
-Bowel incontinence
-Constipation
-Risk for constipation
-Perceived constipation
-Diarrhea
-Toileting self-care deficit |
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Term
| Describe subjective and objective data used used to assess bowl function |
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Definition
Nursing History (subjective)
•History of illness or surgery R/T the GI tract
•Usual pattern & habits – e.g. time of day
•Usual characteristics of stool
•Routines followed to promote elimination e.g. hot fluids
•Use of artificial aids – laxatives, cathartics
•Presence & status of bowel diversions – colostomy, ileostomy
•Patient’s perception of normal or abnormal bowel elimination
•Recent change in elimination pattern
•Diet history – bulk in diet, daily fluid intake
•History of Exercise
•Travel history
•Medication history
•Emotional State
•Social history – where the patient lives may affect toileting habits; do they have to share a toilet?
•Mobility & Dexterity – getting clothes off; ability to get to bathroom
•Post Operative abdominal surgery assess
•Abdominal pain or discomfort
•Flatus within previous 8 hours
•BM within previous 12 – 24 hours
•N & V
•Feeling bloated
•Return of appetite, feeling hungry
•Abdominal cramping
Fecal Characteristics (objective)
•Color – adult brown (black = upper GI bleed, iron)
•Odor – affected by food
•Consistency – soft, formed
•Frequency – adult daily or 2 – 3 times a week
•Amount
•Shape – resembles the diameter of the rectum
•Constituents – undigested food, fat, bile, water, etc.
Pertinent Laboratory and Diagnostic Tests (objective)
• Fecal/Stool Specimens – must accurately obtain & label
• Do not contaminate with urine, or toilet paper
•If test is for fecal fat need 3 – 5 day specimen collection
•Check to see if need warm specimen or can refrigerate stool
•Guaiac Test – hemoccult, fecal occult blood testing
•Diagnostic Examinations
•Direct Visualization – performed under conscious sedation
•Endoscopy – post test – no food or drink (NPO) until gag reflex returns
•Gastroscopy – post test – NPO until gag reflex returns
•Proctoscopy
•Sigmoidoscopy
•Capsule Endoscopy- visualize small intestine
•Indirect Visualization
•UGI Series; Barium Enema |
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Term
| Discuss the mechanism of action, efficacy, and safety of current pharmacological agents used in the prevention and treatment of constipation |
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Definition
1. Laxatives & Cathartics
• Are used to prevent straining during defecation, prevent, & treat constipation
• May be given to prepare patients for diagnostic tests & surgery
• Cathartics have a stronger effect on the intestine
• Use with caution – Stepwise approach is best – first bulk-forming laxatives, followed by stool softeners, osmotics, stimulants, suppositories, & enemas last
Categories:
-Bulk Forming Agents – considered safest of all laxatives. Absorbs H20 to ↑ bulk, which initiates reflex bowel activity e.g. psyllium (Metamucil). Can cause obstruction if not mixed with an adequate amount of H20 (240 mL)
Onset of action 12 hrs to 3 days
- Stool Softener or Emollients – prevents straining during defecation & prevents constipation by ↓ surface tension of feces allowing H20 & fat to enter. Therapeutic effect 1 – 3 days e.g. docusate sodium (Colace), docusate calcium (Surfak)
- Stimulant Laxatives– stimulates motility (peristalsis) by irritating the intestinal mucosa e.g. senna, bisacodyl (Dulcolax)
Oral route = onset of action 6 – 8 hrs; Suppository = onset of action 15 – 30 minutes
-Saline Laxatives – ↑ H20 content of feces = distention which initiate reflex bowel activity e.g. magnesium citrate, lactulose, MOM, fleet enema.
Onset of action 1 – 3 hrs
- Lubricant Laxative– coats the feces with an oily film & prevents the colon from reabsorbing water from the feces e.g. mineral oil. Avoid prolonged use – prevents absorption fat-soluble vitamins. Onset of action 6 – 8 hrs
-Hyperosmotic Agent – ↑ intraluminal osmotic pressure in the bowel. Since they are not absorbed they draw H20 into the intestine, resulting in an ↑ volume which stimulates peristalsis e.g. glycerine suppositories.
Onset of action 15 – 60 minutes after insertion.
- Combination of stool softener & stimulant e.g. docusate & senna
2. Enemas
•Types of Enemas – tap water, soap suds, oil retention, fleets, Harris flush
•Side Effect – excess F & E depletion
•Enema Administration – review in book
3. Digital Removal of Stool – review in book
• Can stimulate the Vagal Nerve = reflex slowing of the heart rate
4. Chronic Constipation
• New medication approved for chronic constipation – Amitiza (lubiprostone)
• Acts to increase fluid in small intestines – dose 24 mcg BID
5. Bowel Training
• Daily routine |
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Term
| Discuss the mechanism of action , efficacy , and safety or current pharmacological agents used in the treatment of diarrhea |
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Definition
•Do not use longer than 2 days
•Do not use if fever present
•Non – pharmacological treatment – clear liquids
•Maintenance of Skin Integrity – stool irritates skin and can cause breakdown
•Categories
1. Absorbents – act by absorbing substances such as bacteria that could be the cause of the diarrhea e.g. bismuth subsalicylate (Pepto-Bismol)
2. Synthetic Opiates – are the most effective, they ↓ GI motility & slow peristalsis – e.g. paregoric, tincture of opium. Over-the-counter loperamide (Imodium) is an opiate-related agent
3. Antidiarrheal combinations – most contain a synthetic narcotic ingredient e.g. Lomotil |
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Term
| Describe the role of the RN management of a client experiencing dysfunction in bowel elimination |
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Definition
The role of the RN is to assess the history of the pt and assess a physical examination. You must auscultate to assess bowel in each quadrant and palpate for tenderness or masses.
Then the RN will then identify the correct diagnosis:
-Constipation R/T insufficient physical activity AMB no BM x 5 days
-Risk for Constipation R/T ( dehydration AWBMB no BM x 3 days
-Diarrhea R/T laxative abuse AMB 15 loose stools a day
-Risk for Diarrhea R/T anxiety AWBMB loose watery stools
-Bowel Incontinence r/t immobility AMB fecal staining of bedding and clothing
-Dysfunctional Gastrointestinal Motility r/t pharmaceutical agents AMB abdominal distention and absent bowel sounds
-Risk for Dysfunctional Gastrointestinal Motility r/t sedentary lifestyle AWBMB absent or hypoactive bowel sounds, abdominal distention and cramping, and difficulty passing stool
P: Critically think what the best strategies would be to reach the expected outcome or goals.
NI’s always work to change the etiology of the problem in order to resolve the problem
Want to incorporate the patient’s elimination habits or routines as much as possible
Least invasive nursing interventions (NI’s) and most cost effective should be initiated first – nonpharmacological treatment recommended
I: Implementation
The RN will determine the best ways to treat the problem:
Promotion of Regular Bowel Habits
Take time to defecate
Establish a routine – more likely to occur 1 hour after meals
Promotion of Normal Defecation
Squatting Position
Positioning on Bedpan
Promotion of Adequate Fluid & Food Intake
Grapefruit juice & the caffeine in coffee, tea, colas, & chocolate drinks act as diuretics & take fluids from the bowel so these liquids should not be counted as providing fluid intake for bowel activity.
Studies have shown a mixture of prune juice, applesauce, & bran can provide adequate fiber for effective bowel management. 2 cups Kellogg’s All Bran; 2 cups applesauce; 1 cup 100% prune juice.
Promotion of Regular Exercise
Promotion of Comfort
Promotion of Self-Concept
Avoiding straining and the Valsalva Manuver
Laxatives & Cathartics
E: Evaluate
The RN must determine if the pt was able meet the expected outcome. |
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Term
| Describe health promotion activities and interventions appropriate for clients to prevent development of dysfunction in bowel elimination pattern |
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Definition
∗Promotion of Regular Bowel Habits
• Take time to defecate
• Establish a routine – more likely to occur 1 hour after meals
∗ Promotion of Normal Defecation
• Squatting Position
• Positioning on Bedpan
∗Promotion of Adequate Fluid & Food Intake
• Grapefruit juice & the caffeine in coffee, tea, colas, & chocolate drinks act as diuretics & take fluids from the bowel so these liquids should not be counted as providing fluid intake for bowel activity
• Studies have shown a mixture of prune juice, applesauce, & bran can provide adequate fiber for effective bowel management
• 2 cups Kellogg’s All Bran; 2 cups applesauce; 1 cup 100% prune juice
∗Promotion of Regular Exercise
∗Promotion of Comfort
∗Promotion of Self-Concept
∗Avoiding straining and the Valsalva Manuver |
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Term
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Definition
it’s the passage of medication molecules into the blood
from the site of medication administration. The absorption rate can be influence by route and how fast the absorption occurs.
Passive absorption(transport) = diffusion
Active absorption (transport) = a carrier is needed
Drug absorption is affected by:
∗Blood Flow – sublingual route (SL) has a rich blood flow as compared to subcutaneous (subQ) which has a poor blood flow
∗Solubility of the Drug – the more soluble the drug the more rapidly absorbed – lipid solubility enhances absorption
∗Nature of the Absorbing Surface – transport of drug molecule is faster through a single layer of cells (intestinal epithelium) than several layers (skin). Surface area is also important – small intestine offers a massive absorbing area and a drug is more rapidly absorbed than in the stomach which has a smaller absorbing surface area
•Most oral meds are absorbed into the surface area of the small intestine
∗Dosage Form – the drug can be combined with a resin from which it is slowly released
∗Drug Concentration |
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Term
|
Definition
Adverse drug event
An injury resulting from the use of a drug. Adverse Drug Events may results from medication errors but most do not |
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| are unintended, undesirable, and often unpredictable serves responses for medication. Every medications has an adverse effect, some have a potential harmful effect to the client. |
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•Factors such as age, body mass, gender, environment, time of administration, pathologic state, genetics, and psychological characteristics can alter an individuals response to drug therapy
-Older adults are usually highly responsive to medications
-Drug doses need to be adjusted in proportion to body mass
-Differences in relative proportions of fat and water in men and women may effect drug solubility
-Oxygen deprivation at high altitudes may ↑ sensitivity to some drugs
-Drugs administered on an empty stomach are more readily absorbed
∗ Effect of a drug action may vary from a predicated drug response because of genetic factors or hereditary influence
*Succinylcholine – induced paralysis – usually brief – Usually attributed to genetic characteristics that alter the person’s drug-metabolizing enzymes |
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| In immunology, the strength of binding interaction between antigen and antibody molecules |
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| block response. stops reaction from occuring |
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unpredicted responses to a medication.
-You can develop an allergy to a medication that is administered repeatedly.
*antibiotics cause a high incidence of allergic reactions
* Always check if your patient has any allergies to medications |
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aka: painkiller
Relieves pain. |
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Metabolism.
After a medication reaches its site of action it becomes metabolized into a less active or inactive form that is easier to excrete. Biotransformation occurs under the influence of enzymes that detoxify, break down, and remove biologically active chemicals.
Most biotransformation occurs in the liver (lungs, kidneys, blood and intestines also metabolize medications).
Decrease in liver function or liver disease= medication eliminated more slowly. |
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•Peak drug level is the highest serum level of drug at a specific time
∗Indicates the rate of absorption
∗PO peak level may be 1 – 3 hours
∗IV peak level may be in 10 minutes
∗Draw blood level to determine peak at proposed peak time |
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the lowest plasma concentration of drug at a specific time
∗Indicates the rate at which the drug is eliminated
∗Drawn immediately before the next dose is administered |
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| The time it takes for the drug to elicit a therapeutic response (minimum effective concentration) after the drug has been administered |
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| Occurs when the drug reaches its highest blood or plasma concentration (maximum therapeutic response) |
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∗Is the length of time the drug has a pharmacologic effect
∗Some drugs produce effects for minutes and others may have an effect for hours or days |
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level of medication is the concentration of a drug needed to elicit a desired clinical response without causing toxic effects
•The safety of a drug is a major concern; the therapeutic index is the ratio between a drug’s therapeutic benefits and its toxic effect
•The therapeutic index estimates the margin of safety of a drug by using a ratio that measures the effective therapeutic dose in 50% of persons or animals and lethal dose in 50% of animals
•Drugs with a low therapeutic index have a narrow margin of safety
*Narrow range between a therapeutically active dose of the drug and a toxic dose
*A drug with a low therapeutic index has a greater likelihood of causing an adverse reaction and therefore requires close monitoring (e.g. assessing plasma levels of the drug)
*Drug dose may need adjustment because of the small safety range between effective dose and lethal dose
•Drugs with a high therapeutic index have a wide margin of safety and there is less danger of producing toxic effects therefore plasma drug levels do not need to be monitored routinely |
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•The main route of drug elimination is the kidneys
-A common change with aging is a ↓ in kidney function = ↑ risk drug toxicity
-Creatinine clearance (CrCl) is a test used to measure the glomerular filtration rate (GFR) of the kidney
•Other routes of excretion are: GI tract, lungs, sweat, breast milk |
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•Physiologic effects not related to a desired drug effect
•Are usually predictable and dose related e.g. drowsiness caused by antihistamines
•May be desirable or undesirable
•Nurses need to be familiar with a drugs potential side effects & monitor for them |
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Definition
1. Absorption
2. Distribution
3. Metabolism/ Biotransformation
4. Excretion/ Elimination |
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The transport of a drug in body fluids from the bloodstream to various tissues of the body and finally to its site of action
Drug distribution is influenced by:
∗Adequacy of Blood Circulation (which is affected by cardiac function)
-Drugs are distributed rapidly to organs with a large blood supply e.g. heart, liver, kidney
∗Plasma Protein-Binding
-As drugs are distributed in the plasma many are bound to varying degrees with protein (primarily albumin) |
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| Describe nursing practices that will prevent medication errors when preparing and administering drugs |
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Definition
•Follow the 6 rights of medication administration (right medication, right dose, right client, right route, right time, right documentation)
•Be sure to read labels at least 3x before administering the medication
•Use at least 2 client identifiers
•Do not allow any other activity to interrupt administration of medication client
•Double- check all calculations, and verify with another nurse
•Do not interpret illegible handwriting; clarify with prescriber
•Question unusually large or small doses
•Document all medications as soon as they are given
•When you have made an error, reflect on what went wrong and ask, how you could have prevented the error
•Evaluate the context or situation in which a medication error occurred. This helps determine if nurses have the necessary resources to safe medication administration
•When repeated medication errors occur within a work area, identify and analyze the factors that may have cause the errors and take corrective actions
•Attend in-service programs that focus on the medications commonly administered |
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| Describe physiologic factors and variables that affect drug actions in the body including absorption, distribution, metabolism, and excretion |
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Definition
Absorption
o Factors that influence medication absorption are:
o Route of Administration
• IV produces most rapid absorption
• Mucous membranes and respiratory airways are quickly absorbed because their tissues contain many blood vessels
o Ability of Medication to dissolve
• Acidic medications pass through the gastric mucosa rapidly
o Blood Flow to the Site of Administration
• Areas that have more blood supply with experience enhanced absorption, facilitating the passage of the medication into blood
o Body Surface Area
• Large surface area= fast rate of absorption
o Lipid Solubility of a Medication
• High lipid solubility= fast rate of absorption
Distribution
o The rate and extent of distribution depend on the physical and chemical properties of medications and the physiology of the person taking the medication
o Rate depends on vascularity of tissues and organs
o Conditions that limit blood flow or blood perfusion inhibit distribution of a medication
o To be distributed to an organ, a medication has to pass through all of organs tissues and biological membranes
o The degree to which medications bind to serum proteins such as albumin affects medication distribution.
Metabolism
o Liver degrades many harmful chemicals before they become distributed to the tissues
Excretion
o Kidneys are the main organs for medication excretion
o GI tract= another route for med excretion |
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| Discuss factors that influence drug pharmacokinetics |
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Definition
•Absorption
•Distribution
•Metabolism
•Excretion |
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| Discuss factors that influence drug action |
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Definition
Varies from drug to drug
Drug – Receptor Interaction
∗Reversible – degree and duration of binding are functions of how well the drug fits the receptor, nature of the bond, and concentration of the drug at the site of the receptor
∗Selective – if the drug fits the receptor tightly or is strongly attracted to the receptor it is considered to have high affinity with the receptor
∗Graded – a threshold number of receptors must be filled with the drug before a pharmacologic response is observed. Once all receptors are occupied a further increase in the drug concentration will not produce an added effect
∗Agonistic, Partial Agonistic, or Antagonistic
• Drugs that bind to a receptor and produce a response are called agonists
• Drugs that bind to a receptor and block a response are called antagonists
Drug – Enzyme Interaction
∗Drugs can inhibit the action of certain enzymes
• Nonspecific Drug Interaction
∗Produce general effects on cell membranes and cellular processes |
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| List essential components of a drug order and describe different types of orders e.g. stat, pm, scheduled |
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Definition
Essential Components of a Drug Order
•Patient’s Name & Identification Number
•Date & Time Order was Written
•Name of the Medication Ordered
•Exact Dosage to be Administered
•Frequency of Administration (e.g. daily, q 6 h, prn)
•Route of Administration (e.g. po, SubQ)
•Physician's Signature
Types of Orders
•Standing / Routine Medication Orders
-Carried out until MD cancels or specified amount of time
(e.g. Amoxicillin 500mg po TID x 10 days)
•STAT / One Time Orders
-Single dose of medication to be given immediately and only once
•PRN Orders
-When the patient requires/requests the medication |
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| Six Rights for Drug Administration |
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Definition
•Right Drug
-Check MD’s order (administering the wrong drug is the most common type of medication error)
-Joint Commission has listed a number of drugs with sound alike names
•Right Dosage
-Need to Look at Drug Reference Guide (e.g. Davis’s Drug Guide, FDA website) & compare dose MD prescribed with usual dose for the route ordered
•Right Time
-Need to know the 24 hour clock e.g. 2000 = 8 pm
-Administering the medication at the correct time is critical to maintaining specific blood-drug level, or avoid interactions with other drugs
•Right Route
-PO, SubQ, IM, IV, ID etc.
•Right Patient
-Check 2 unique patient identifiers – patient must state name and e.g. birth date or address, do not ask are you Mr. Smith? A confused patient may say yes.
•Right Documentation
-Time the drug was administered
-Patient Teaching: name, dose, route, frequency, therapeutic effect, side effects, drugs, foods, herbs, and behaviors to avoid during therapy |
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| Describe health promotion activities appropriate for clients who are taking medications |
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Definition
Client & Family Teaching
-Provide info about the purpose of the medications and their actions and effects in terms that clients can understand
-Teach family or friends how to give injections in case the client becomes ill
-Educate about the benefits of medication and integrate the clients health beliefs and cultural practices
Community Resources
-Make referrals to community resources if the client is unable too afford or cannot arrange transportation to obtain necessary medication |
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| Describe the role of the RN in preparation and administration of medications |
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Definition
6 RIGHTS!
•Asses that the medication ordered is the correct medication
•Assess the clients ability to self-administer medications
•Determine whether a client should receive a medication at a given time
•Administer medications correctly and monitor prescribed medications
•Educate family’s and clients about proper medication administration
•Monitor
•Use the nursing process to integrate medication therapy into care |
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| Describe the role of the RN in relation to other members of the health care team associated with medication administration |
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Definition
| Nurses often collaborate with the prescriber, the pharmacist and case managers to ensure that clients receive medications safely and that clients are able to afford their medications |
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