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Questions and Answers
What are the side effects of Zofran?
What is the normal range for platelets?
150,000-450,000/uL
Which of the following are complications associated with Lisinopril?
What is the antidote for Warfarin/Coumadin?
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Heparin is safe to use during pregnancy.
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What is a common use for Diphenhydramine/Benadryl?
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Sodium levels are measured in __________.
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What does CPAP stand for?
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Which of these is a sign of hypokalemia?
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What is a nursing consideration for patients taking Statins?
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What should patients not do during anticoagulant therapy?
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Foot drop is a condition affecting the ability to plant flex the foot.
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Signs of a transfusion reaction include:
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Match the following medications with their purpose:
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The range for sodium is __________ mEq/L.
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What medication is used to treat nausea and vomiting?
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What is Lisinopril used to treat?
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What are potential complications of Lisinopril?
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Blood transfusion reactions may include dark urine.
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What is the normal platelet count range?
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What condition is characterized by a sodium level below 135 mEq/L?
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What is a vital role of potassium in the body?
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Which of the following is a symptom of hyperkalemia?
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What is Warfarin used for?
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What is the antidote for Warfarin?
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Heparin can be used safely during pregnancy.
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The condition where the foot is permanently fixed in plantar flexion is called ______.
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What device is used to treat obstructive sleep apnea?
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What are the common treatments for obstructive sleep apnea?
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The acronym 'OLD CARTS' helps assess pain by considering ______, ______, and ______.
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What should be avoided when the patient is on anticoagulants?
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Study Notes
Zofran
- Treats nausea and vomiting.
- May cause headaches.
- Can be administered sublingually.
Lisinopril
- Treats hypertension.
- Potential complications include hyperkalemia (elevated potassium levels) and angioedema (swelling).
Blood Transfusions
- Requires two registered nurses to verify.
- Hemolytic reaction symptoms include headache, low back pain, decreased blood pressure, increased heart rate, and dark urine.
- Tylenol or Benadryl may be administered for symptoms.
- Maximum infusion time is 4 hours due to risk of bacterial growth.
- Consent form is required.
- Normal hemoglobin (Hgb) levels:
- Male: 14-18 g/dL
- Female: 12-16 g/dL
- Normal hematocrit (Hct) levels:
- Male: 39%-54%
- Female: 36%-48%
- Signs of transfusion reaction: tachycardia, itching/skin rash/urticaria, wheezing/dyspnea/tachypnea, anxiety, flushing/fever, back pain.
Platelets
- Normal range: 150,000-450,000/uL.
- Help clot blood.
- Platelet aggregation forms a plug at injury sites.
- Thrombocytopenia (low platelet count) can occur due to certain cancers and infections.
Sodium (Na+)
- Normal range: 135-145 mEq/L.
- Major electrolyte.
- Essential for acid-base and fluid balance, active and passive transport mechanisms, nerve and muscle tissue irritability and conduction.
-
Hyponatremia (low sodium):
- Symptoms: stupor/coma, anorexia, lethargy, tachycardia, limp muscles, orthostatic hypotension, seizures/headache, stomach cramping.
- Think "salt loss."
- Increased sodium excretion may be due to diaphoresis (sweating), diarrhea, drains, or diuretics.
-
Hypernatremia (high sodium):
- Symptoms: flushed skin, restlessness, increased blood pressure and fluid retention, edema, decreased urine output, dry and flushed skin, agitation, low-grade fever, thirst.
- Think "fried salt."
Potassium (K+)
- Normal range: 3.5-5 mEq/L.
- Vital role in metabolism and nerve impulse transmission.
- Affects the function of cardiac, lung, and muscle tissues, and acid-base balance.
-
Hypokalemia (low potassium):
- Symptoms: lethargy, low and shallow respirations, cardiac dysrhythmias, frequent and large volume urine, leg cramps, limp muscles, low blood pressure, ECG changes (ST depression, shallow or inverted T wave, prominent U wave).
- Think "7 Ls" (low).
-
Hyperkalemia (high potassium):
- Symptoms: muscle weakness, little or no urine output (renal failure), respiratory failure, decreased cardiac contractility (weak pulse/low HR).
- Initial symptoms: muscle twitches/cramps, ECG changes (tall peaked T waves, flat P waves, widened QRS complexes, prolonged PR intervals).
- Think "Murder."
- Potassium and sodium have an inverse relationship (increased sodium = decreased potassium).
- Potassium imbalance can cause life-threatening cardiac dysrhythmias.
Anticoagulants
Warfarin/Coumadin
- Interferes with vitamin K.
- Long-term therapy given orally (PO).
- Contraindicated during pregnancy.
- Antidote: Vitamin K (found in leafy green vegetables, kale, spinach, etc.).
- Labs: prothrombin time (PT).
- Normal PT: 10- 20 seconds.
- Therapeutic range: 20-34 seconds (based on patient condition).
- Avoid NSAIDs.
Heparin
- Inhibits fibrin clot formation.
- Short-term therapy given intravenously (IV) or subcutaneously (SC).
- Safe during pregnancy.
- Antidote: protamine sulfate.
- Labs: partial thromboplastin time (PTT).
- Normal PTT: 30-40 seconds.
- Avoid NSAIDs.
Other Medications
- Pyridium/Phenazopyridine: Relieves urinary urgency, pain, and discomfort after urinary catheterization. Causes bright-orange urine.
- Diphenhydramine/Benadryl: Relieves allergic symptoms. Side effects include drowsiness and dry mouth.
- Acetaminophen/Tylenol: Antipyretic (fever reducer) and non-opioid analgesic (pain reliever). Complications include nausea and vomiting. Do not exceed 3g/day.
- Meloxicam/Mobic: NSAID used for arthritis pain relief. Complications can include gastrointestinal bleeding.
- Statins: Antihyperlipidemic drugs used to lower cholesterol. Monitor for rhabdomyolysis (rare muscle breakdown condition). Avoid grapefruit juice.
- Nitroglycerin: Antianginal used to treat angina (chest pain). Side effect of headache. Administer every 5 minutes up to 3 doses. Can be taken sublingually or buccally. Monitor blood pressure (decreases BP and dilates vessels).
4 Gs
- Foods to be mindful of when patients are on anticoagulants:
- Green leafy vegetables
- Garlic
- Ginger
- Ginseng
- Ginkgo biloba
Blood Pressure
- Wide cuff = low reading.
- Small cuff = high reading.
Neurovascular Assessment Sites
- Dorsalis pedis pulse
- Radial pulse
- Apical pulse (5th intercostal space, midclavicular line, left side)
- Popliteal pulse (behind knee)
Medication Administration
- Drug administration process: absorption, distribution, metabolism, excretion.
Routes of Medication Administration
- Oral (PO)
- Transdermal
- Sublingual (SL)
- Rectal
- Intravenous (IV)
- Buccal
- Inhalation
- Intramuscular (IM)
- Subcutaneous (SC)
DNR (Do Not Resuscitate)
- Doctors cannot override a valid DNR order made by a mentally competent patient.
- Exceptions:
- Emergency situations where the DNR status is unknown and immediate life-saving resuscitation is needed.
- Pregnant patients, as some states require resuscitation to potentially save the fetus.
- When the DNR order does not comply with facility policies or its validity is questionable.
Foot Drop
- Occurs when the foot is fixed in plantar flexion, making it difficult to dorsiflex and lift toes.
- Increases stumbling risk.
- Related to nerve injuries, paralysis, or disorders affecting muscles, nerves, brain, or spinal cord.
Continuous Positive Airway Pressure (CPAP)
- Used to treat obstructive sleep apnea (OSA).
- Delivers constant airflow to keep airways open during sleep.
- Improves sleep quality, reduces daytime sleepiness, and lowers risks associated with OSA.
Sequential Compression Device (SCD)
- Used to promote leg blood flow and prevent venous stasis and blood clots in immobile patients.
- Newer devices allow ambulation while wearing them.
Obstructive Sleep Apnea (OSA)
- Chronic sleep disorder where the upper airway repeatedly becomes blocked during sleep.
- Muscles in the throat relax, causing soft tissues to collapse and obstruct the airway.
- Leads to pauses in breathing (apneas) lasting at least 10 seconds.
- Causes oxygen desaturation and sleep arousals.
- Associated with loud snoring, daytime sleepiness, morning headaches, and increased risk of hypertension, heart disease, and stroke.
- Treatment options include:
- CPAP
- Oral appliances
- Weight loss
- Surgery
OLD CARTS
- Mnemonic for pain assessment:
- Onset: When and how the complaint began.
- Location: Where the pain is, including which body part(s) are affected.
- Duration: How long or how often the complaint occurs.
- Characteristic: What type of pain the patient is experiencing.
- Aggravating factors: What makes the pain worse.
- Relieving factors: What makes the pain better.
- Treatment: What treatment the patient has tried.
- Significance: The importance of the complaint.
Oxygen Delivery Devices
- Nasal cannula: 1-6 L O2.
- Simple face mask: 5-10 L O2.
- Non-rebreather mask: 10-15 L O2.
Incentive Spirometry
- Reduces risk of atelectasis (collapsed lung).
- Patient inhales deeply using the device as if through a straw.
- Hold breath for at least 5 seconds.
Pressure Injuries (AVOIDS PRESS)
- Risk factors:
- Aging skin
- Vascular disorders
- Obesity
- Immobility and incontinence
- Diabetes
- Skin friction
- Poor nutrition
- Reduced RBCs (anemia)
- Edema
- Sensory deficits
- Sedation
- Prevention includes:
- Skin hygiene
- Repositioning every 2 hours
Antihyperlipidemic Drugs (Statins)
- Nursing considerations:
- Monitor for rhabdomyolysis (muscle breakdown):
- Elevated creatine kinase levels.
- Dark urine, tea-colored or cocoa-like.
- Monitor for rhabdomyolysis (muscle breakdown):
- Avoid grapefruit juice.
Anticoagulant Diet Restrictions
- When patients are on anticoagulants, they should avoid:
- Leafy green vegetables (spinach, kale, broccoli, Brussels sprouts)
- Chickpeas
- Liver
- Egg yolks
- Avocado
- These foods can reduce the effectiveness of anticoagulants.
Zofran
- Treats nausea and vomiting (N/V)
- May cause headaches
- Can be administered sublingually
Lisinopril
- Used to treat hypertension
- Potential complications include hyperkalemia (elevated potassium levels) and angioedema (swelling)
Blood Transfusions
- High alert medication requiring two registered nurses to verify
- Hemolytic reactions can cause headache, low back pain, decreased blood pressure, increased heart rate, and dark urine.
- Tylenol or Benadryl can be administered to treat transfusion reactions
- Maximum transfusion time is 4 hours to prevent bacteria growth
- Consent form is required
- Normal Hemoglobin (Hgb) levels:
- Male: 14-18 g/dL
- Female: 12-16 g/dL
- Normal Hematocrit (Hct) levels:
- Male: 39%-54%
- Female: 36%-48%
- Signs of transfusion reaction: tachycardia, itching, skin rash, urticaria, wheezing, dyspnea, tachypnea, anxiety, flushing, fever, and back pain.
Platelets
- Normal platelet range is 150,000-450,000/uL
- Platelets help clot blood
- Platelet aggregation is when platelets clump together to form a plug at an injury site
- Thrombocytopenia is a platelet count less than 450,000/uL and can be caused by certain cancers and infections
Sodium (Na+)
- Normal range: 135-145 mEq/L
- Major electrolyte that is essential for acid-base balance, fluid balance, active and passive transport, and the irritability and conduction of nerve and muscle tissue
- Hyponatremia (low sodium) is less than 135 mEq/L
- Possible causes: "salt loss" (diaphoresis, diarrhea, drains, diuretics)
- Symptoms: Stupor/coma, anorexia, lethargy, tachycardia, limp muscles, orthostatic hypotension, seizures/headache, and stomach cramping
- Hypernatremia (high sodium) is more than 145 mEq/L
- Possible causes: "fried salt" (dehydration)
- Symptoms: Flushed skin, restlessness, increased blood pressure and fluid retention, edema, decreased urine output, skin flushed and dry, agitation, low-grade fever, and thirst
Potassium (K+)
- Normal range: 3.5-5 mEq/L
- Plays a vital role in metabolism and the transmission of nerve impulses, the functioning of cardiac, lung, and muscle tissues, and acid-base balance.
- Hypokalemia (low potassium) is lower than 3.5 mEq/L:
- Symptoms: "7 L's (low)" - Lethargic, Low and shallow respirations (failure), Lethal cardiac dysrhythmias with ECG changes (ST depression, shallow or inverted T wave, prominent U wave), Lots of urine (frequent and large volume), Leg cramps, Limp muscles, Low blood pressure
- Hyperkalemia (high potassium) is greater than 5 mEq/L.
- Symptoms: "Murder" - Muscle weakness, Urine output little or none (renal failure), Respiratory failure (due to muscle weakness), Decreased cardiac contractility (weak pulse, low heart rate), Early symptoms: muscle twitches/cramps/ECG changes (tall peaked T waves, flat P waves, widened QRS complexes, prolonged PR intervals)
- Potassium and Sodium have an inverse relationship meaning increased sodium levels correlate with decreased potassium levels
Anticoagulants
- Warfarin/Coumadin:
- Interferes with Vitamin K absorption
- Long-term oral therapy
- NOT safe during pregnancy
- Antidote: Vitamin K (found in kale, spinach, and green vegetables)
- Labs: PT (prothrombin time)
- Normal range: 10-20 seconds
- Therapeutic range: 20-34 seconds (based on patient's condition)
- Avoid taking NSAIDs
- Heparin:
- Inhibits the formation of fibrin clots
- Short-term therapy (IV or subq)
- Safe during pregnancy
- Antidote: Protamine sulfate
- Labs: PTT (partial thromboplastin time)
- Normal range: 30-40 seconds
- Avoid taking NSAIDs
Pyridium/Phenazopyridine
- Relieves urinary urgency, pain, and discomfort after urinary catheterization
- Causes bright-orange urine
Diphenhydramine/Benadryl
- Relieves allergic symptoms
- Think "Martha" - drowsiness/dry mouth
Acetaminophen/Tylenol
- Antipyretic (fever reducer) and non-opioid analgesic (pain reliever)
- Complications: Nausea and vomiting
- Do not exceed 3g daily
Meloxicam/Mobic
- NSAID (non-steroidal anti-inflammatory drug)
- Provides pain relief from arthritis
- Complications: Gastrointestinal bleeding
- Take with food to help decrease stomach upset
Antihyperlipidemic Drugs (Statins)
- Monitor for signs of rhabdomyolysis (rare condition where muscle breaks down and is released into the bloodstream)
- Elevated creatine kinase levels are a sign of rhabdomyolysis.
- Dark, tea-colored urine is another sign of rhabdomyolysis.
- Avoid grapefruit juice
Nitroglycerin
- Antianginal to treat angina (chest pain)
- Causes headaches
- Administered sublingually or buccally
- Give every 5 minutes up to 3 doses
- Monitor blood pressure, as it decreases blood pressure and dilates blood vessels.
Blood Pressure
- Too wide blood pressure cuff = low reading
- Too small blood pressure cuff = high reading
Neurovascular Assessment
- Includes checking:
- Dorsalis pedis pulse
- Radial pulse
- Apical pulse (5th intercostal space, midclavicular line, left side)
- Popliteal pulse (behind the knee)
Medication Administration
- The process of medication administration involves:
- Absorption
- Distribution
- Metabolism
- Excretion
Routes of Medication Administration
- Oral (PO)
- Transdermal
- Sublingual (SL)- 25 gauge needle
- Rectal suppository
- Intravenous (IV)
- Buccal
- Inhalation
- Intramuscular (IM)
- Subcutaneous
DNR (Do Not Resuscitate)
- Doctors cannot override a valid Advance Directive (like a DNR) made by a mentally competent patient.
- Instances where a DNR can be disregarded:
- Emergency situation where the patient’s DNR status is unknown, and immediate life-saving resuscitation is needed
- For pregnant patients (some states require resuscitation to potentially save the fetus)
- DNR order doesn't comply with facility policies or if the doctor has reason to question its validity
Foot Drop
- Foot drop is a condition where the foot permanently remains in plantar flexion, making it difficult to dorsiflex the foot and lift the toes while walking.
- This increases the risk of stumbling and falls.
- Possible causes of foot drop include nerve injuries, paralysis, disorders impacting the muscles, nerves, brain, or spinal cord.
Continuous Positive Airway Pressure (CPAP)
- Used to treat obstructive sleep apnea (OSA), a condtion where the airways repeatedly become blocked during sleep.
- By delivering constant pressurized air, CPAP keeps the airways open and prevents them from collapsing during sleep.
- Benefits include improvement in sleep quality, reduce daytime sleepiness, and decrease risks associated with untreated sleep apnea, such as hypertension, heart disease, and stroke.
Sequential Compression Device (SCD)
- Intermittent pneumatic compression device used to promote blood flow in the legs and prevent venous stasis and blood clots
- SCDs are especially important for immobile patients but are also becoming increasingly common in ambulatory situations.
- SCDs are used to reduce the risk of venous thromboembolism (blood clots).
Obstructive Sleep Apnea (OSA)
- Chronic sleep disorder where the upper airway repeatedly becomes blocked during sleep, leading to pauses in breathing (apneas).
- Caused by the relaxation of muscles in the throat during sleep, allowing soft tissues to collapse and obstruct the airway.
- OSA can cause snoring, excessive daytime sleepiness, morning headaches, and increased risk of hypertension, heart disease, and stroke.
- Treatment options include CPAP, oral appliances, weight loss, and surgery in some cases.
"OLD CARTS"
- Mnemonic used to remember the important elements of pain assessment:
- Onset
- Location
- Duration
- Characteristic
- Aggravating Factors
- Relieving Factors
- Radiation
- Treatment
- Significance
Oxygen Delivery Devices
- Nasal Cannula: 1-6 L of oxygen per minute
- Simple Face Mask: 5-10 L of oxygen per minute
- Non-Rebreather Mask: 10-15 L of oxygen per minute
Incentive Spirometry (IS)
- Used by patients to help prevent atelectasis (collapsed lung)
- Patients inhale into the IS using a straw-like mouthpiece
- Instruct patients to hold their breath for at least 5 seconds after each inhalation.
Pressure Injuries
- Also known as pressure ulcers or bedsores
- Caused by prolonged pressure on skin
- "AVOID PRESS" mnemonic that helps remember possible risk factors:
- Aging skin
- Vascular disorders
- Obesity
- Immobility and incontinence
- Diabetes
- Skin friction
- Poor nutrition
- Reduced RBC's (anemia)
- Edema
- Sensory deficits
- Sedation
Nursing Considerations
- Skin hygiene is crucial for pressure injury prevention
- Repositioning patients every 2 hours is also crucial.
Antihyperlipidemic Drugs
- Rhabdomyolysis is a rare but serious condition where muscle tissue breaks down and is released into the bloodstream
- Elevated Creatine Kinase levels are a sign of rhabdomyolysis
- Dark, tea-colored urine is another sign of rhabdomyolysis.
Anticoagulants
- Avoid foods high in vitamin K when taking anticoagulants, as these can decrease the effectiveness of the medication.
- Foods to avoid include leafy green vegetables (spinach, kale, broccoli, Brussels sprouts), chickpeas, liver, egg yolks, and avocado.
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Description
This quiz covers essential pharmacology topics including medications such as Zofran and Lisinopril, as well as blood transfusion procedures and protocols. Test your knowledge on drug side effects, administration guidelines, and the requirements for safe blood transfusions. Ideal for nursing students and healthcare professionals.
