Nursing Process Overview Quiz

Nursing Process: ADPIE

• Assessment, Diagnosis, Planning, Implementation, Evaluation are the steps in the nursing process.
• Unclear Orders: Verify with provider, don't assume.
• Patient education: Adverse effects of medication (BP meds, diabetic meds). Monitor BP and blood sugar.

Vaccines

• Purpose of titers: Shows the amount of antibodies in the blood to prove immunity to disease.
• Vaccine Contraindications: Allergies, immunodeficiency, recent immune globulin administration (past 3 months), and acute infections.

Serum Sickness

• Symptoms: Fever, arthritis, flank pain, muscle pain, joint pain.
• Immune reaction to injected antibodies.

Pain Assessment

• Pain Score: 0-5 mild, 6-8 moderate, 9-10 severe.
• Use pictures or facial expressions/hemodynamics if numeric score isn't possible.

Aspirin

• Purpose: Antipyretic, analgesic, anti-inflammatory. Reduces risk of blood clots.
• Adverse Effects: GI upset (nausea, epigastric pain, heartburn), bleeding, nephrotoxicity.
• Patient teaching: Do not give to children, stop 5-7 days before surgery, do not crush/chew enteric-coated tablets and check blood pressure.

pH teaching

• Don't give to children.
• Stop 5-7 days before surgery.
• Check blood pressure.
• Enteric coated cannot be crushed/chewed.
• Risk of bleeding with warfarin.

Toxicity

• Symptoms include tinnitus, confusion, nausea/vomiting/diarrhea, high blood pressure/heart rate, seizures.

NSAIDs (Motrin):

• Monitor renal function (BUN/Creatinine).
• Do not give to patients with renal injury.
• Ketorolac (Toradol) is a non-narcotic option.
• No possibility of addiction with non-narcotic options.

Opiates

• Morphine, Codeine, Fentanyl, Hydrocodone, Oxycodone.
• Worry about respiratory depression, especially in hospice patients and older adults.
• Take vitals before giving, and monitor hemodynamics.
• Not a first-line treatment.

Acetaminophen (Tylenol)

• Purpose: Non-narcotic analgesic (pain reliever), non-anti-platelet.
• No anti-inflammatory qualities.
• Maximum daily dose: 4000mg.
• Enteric coated, do not crush/chew.
• Do not exceed maximum dose.
• Adverse Effects: Hepatotoxicity (jaundice), Nephrotoxicity (BUN/creatinine), Integumentary issues.
• Take every 3-4 hours.

Anti-tussives

• Dextromethorphan, Benzonatate.
• Purpose: Suppress cough.
• Excessive suppression can cause inability to cough, hallucinations, risk of falls.

Tamsulosin (Flomax)

• Purpose: For benign prostatic hyperplasia (BPH).
• Teaching/Precautions: Worry about postural hypotension.
• Medication affects blood pressure, do not give to hypotensive patients.

Glaucoma

• Prostaglandin analogs, beta-adrenergic blockers, alpha2-adrenergic agonists.
• Special Concerns: Affects blood pressure.

Acid Controlling Drugs (PPIs)

• Purpose: Suppress acid secretions.
• Drug interactions: Increases levels of diazepam and phenytoin.

Antiemetics

• Purpose: Relieve nausea and vomiting.
• Used prophylactically, for example, before chemotherapy.

IV Fluids

• Therapeutic effects: Increased urine output & vital signs.
• Adverse effects: Edema, fluid in the lungs (listen for crackles).

Corticosteroids

• Therapeutic effects: Reduce inflammation, helps with pain.
• Adverse effects: Hyperglycemia, immunosuppression, decrease in immunity.
• Patient teaching: Taper off, avoid large crowds, and check blood sugars.

Constipation/Diarrhea relief

• Prevention includes increasing fiber intake, fluid intake, exercise.
• Consider suppositories or enemas for fecal impaction.
• Avoid giving magnesium to renal patients.
• Bismuth salicylate (Pepto Bismol) for diarrhea.
• Allergies to aspirin could be a concern for various treatment approaches.

Levothyroxine (Synthroid)

• Therapeutic effects: Increase weight, increase respiration rate, weight loss, increase energy levels.
• Take in the morning on an empty stomach, do not take with iron or antacids.

Short-acting insulin

• Purpose: Taken during meals to reduce blood glucose levels.

Long-acting insulin

• Taken at the same time every day.
• Side effects include shakiness, sweating, increased heart rate, hunger, blurred vision.
• Check blood sugar when showing signs.

A1C Check

• Check A1C with oral meds.
• Metformin should be stopped 24-48 hours before diagnostic testing.

Antidepressants

• Stabilize mood, takes 3-4 weeks to see improvement.
• Do not stop taking medication abruptly.

Anxiolytics

• Examples: Diazepam, Lorazepam, Alprazolam.
• Promote relaxation/calming.
• Avoid combining with opioids; do not abruptly stop.
• Fall risk.

Immunosuppressants (Methotrexate)

• Use for conditions like rheumatoid arthritis, psoriasis, and cancer.
• Can accumulate to toxic levels, causing kidney or liver damage.
• Should be taken with food and not with citrus juices.

Statins

• Decreases low-density lipoprotein (LDL), increases high-density lipoprotein (HDL), and decreases triglycerides.
• Monitor liver function tests (ALT, AST).

Potassium Channel Blockers (Amiodarone)

• Risks: dysrhythmias, hypotension, bradycardia, hepatotoxicity and pulmonary toxicity.
• Monitor lung sounds (resp rate).

Digoxin

• Adverse effects: hypotension, bradycardia, PVCs, digoxin toxicity.
• If toxicity occurs, discontinue the medication. Digibind is the antidote.

Hypertension Meds (ARBs) -Sartan

• Losartan is an example
• Teaching: Check blood pressure at home before taking drug.
• Log blood pressure in journal.

Losartan Teaching

• Rebound hypertension.
• ARBs MOA: decreases vasoconstriction, lowers blood pressure, increases renal flow.

Nitrates

• Nitroglycerin, isosorbide mononitrate, isosorbide dinitrate.
• Purpose: Treats angina.
• Contraindications: Erectile dysfunction medications (cause hypotension)

Diuretics

• Loop diuretics (furosemide), potassium-sparing diuretics (spironolactone).
• Loop Diuretics (furosemide): Risk for hypokalemia (monitor potassium levels).
• Potassium sparing diuretics (spironolactone): Risk for hyperkalemia (monitor potassium levels).

Heparin

• Routes: Subcutaneous (SQ) or intravenous (IV).
• Monitoring: Hemoglobin levels (Hgb), activated partial thromboplastin time (aPTT), platelets.
• Antidote: Protamine sulfate
• Heparin-induced thrombocytopenia (HIT): Stop heparin, assess, and notify the provider.

Warfarin (Coumadin)

• Dietary concern: Vitamin K (salads).
• Monitor for bleeding.
• General anticoagulant concerns: Don't destroy clots, just prevent formation.

Phenytoin (Dilantin)

• Teaching: Do not switch between generic and brand versions.
• Adverse effects: Gingival hyperplasia, osteoporosis, liver toxicity, Steven Johnson Syndrome.

Bone marrow suppression

• Oldest drug class: Phenobarbital.
• Adverse effects: Central nervous system depression (fatigue, drowsiness, sedation), risk of status epilepticus, and risk of suicidal ideation.

Benzos (Diazepam, Lorazepam)

• Used during tonic-clonic seizures.

Carbamazepine (Tegretol)

• Adverse effects: Heart block, respiratory depression, hepatitis, and risk of suicidal ideation
• Avoid driving for several months if using this medication.

Alzheimer's drugs (Aricept)

• Slows the progression of Alzheimer's, enhances memory and learning.

Parkinson's drugs (Sinemet, Amantadine)

• Treats symptoms of Parkinson's, improves mobility, posture, speech and mood.
• Levodopa effects can decrease; need to adjust doses accordingly.

Antibiotics (e.g, Tetracycline, Vancomycin)

• Considerations: Do not take with dairy products, antacids, or iron; 6-8 oz of water with tetracycline and other antibiotics to flush out kidneys.

Antiviral (e.g, Oseltamivir (Tamiflu))

• Should be taken within 2 days of symptom.

Test your knowledge on the nursing process with a focus on the steps involved in ADPIE. This quiz covers the essential phases including Assessment, Diagnosis, Planning, Implementation, and Evaluation. Assess your understanding of objectives, interventions, and the ultimate goals in patient care.