170B Exam 3 Study Guide PDF

170 B Exam 3 Study Guide Exam 3 will cover material from Weeks 5 through 8. Be sure to thoroughly review the Sherpath lessons from Weeks 5 to 8, EAQs, and PowerPoint slides. The exam will consist of 45 questions, totaling 82 points. Please note that some questions will have multiple parts. Below ar...

170 B Exam 3 Study Guide Exam 3 will cover material from Weeks 5 through 8. Be sure to thoroughly review the Sherpath lessons from Weeks 5 to 8, EAQs, and PowerPoint slides. The exam will consist of 45 questions, totaling 82 points. Please note that some questions will have multiple parts. Below are key topics that will be included on the exam. You can find detailed information in the Sherpath lessons, EAQs, and PowerPoint slides. Please review all OSMOSIS videos for medications. *****1.mechanism of action of valacyclovir —Valacyclovir is an antiviral prodrug that is metabolized to acyclovir in the body. — Acyclovir is a synthetic nucleoside analogue that inhibits viral DNA polymerase, preventing replication of herpes simplex virus (HSV) and varicella-zoster virus (VZV). By mimicking a natural building block of viral DNA, acyclovir gets incorporated into the growing viral DNA chain and causes premature termination, halting viral replication. —Valacyclovir provides higher oral bioavailability and allows less frequent dosing compared to acyclovir, but the active metabolite acyclovir is responsible for the antiviral activity against HSV and VZV. **osmosis video: *** These medications include acyclovir, ganciclovir, valacyclovir, valganciclovir, and famciclovir, and they work by inhibiting viral DNA replication. —> Potential side effects include headache and nausea, as well as more serious side effects such as nephrotoxicity, thrombotic thrombocytopenic purpura and hemolytic uremic syndrome. —> When caring for a client prescribed an antiviral medication to treat herpes viruses, nursing considerations include performing a baseline assessment, as well as monitoring for side effects and evaluating for the desired therapeutic effects. Client education is focused on safe self- administration, as well as learning to recognize side effects, and when to notify the healthcare provider. *****2.side effects of valacyclovir Potential side effects include headache and nausea, as well as more serious side effects such as nephrotoxicity, thrombotic thrombocytopenic purpura and hemolytic uremic syndrome. **osmosis video** Acyclovir and valacyclovir should also be used cautiously when there’s an electrolyte imbalance or dehydration. In addition, acyclovir should not be used in combination with zidovudine, as it increases the level of zidovudine and the risk of neurologic side effects; aminoglycosides combined with acyclovir increase the risk of nephrotoxicity. Acyclovir and valacyclovir can cause neurological side effects, including agitation, tremors, confusion, and myoclonus; more rarely, clients can develop hallucinations, and even encephalopathy or seizures. Acyclovir and valacyclovir can also lead to thrombotic thrombocytopenic purpura, and hemolytic uremic syndrome. The most common side effects of valacyclovir include headache, nausea, vomiting, diarrhea, and abdominal pain. Less common side effects may include dizziness, fatigue, rash, and increased liver enzymes. Valacyclovir is generally well-tolerated, but dehydration and kidney problems are potential serious side effects that require monitoring. As with other antiviral medications, there is a risk of developing resistance with long-term use. Proper dosing and staying well-hydrated can help minimize side effects. ****3.Sites safe for IV insertion. (IV Therapy PPT) The most common and safe sites for IV insertion are the veins on the inner aspect of the forearm. Other potential sites include the antecubital fossa (front of the elbow), back of the hand, and foot veins in children. — Avoid using hand veins in older adults or ambulatory patients due to increased risk of complications. Proper site assessment is crucial - avoid areas with signs of infection, infiltration, thrombosis, vascular grafts/fistulas, or on the same side as a mastectomy. — Visible veins on the chest, breast, abdomen, or trunk should not be used. Proper site selection, vein assessment, and technique are crucial for successful IV insertion and preventing complications. - Vascular visualization technology can aid in locating suitable veins for patients with difficult IV access. **Avoid the fragile dorsal veins of the older adult client. These veins have a greater risk for tissue damage and developing an infiltration or thrombophlebitis. When selecting a vein: (fund p1083 a. Avoid vein selection in: - Area of joint flexion (e.g., wrist, antecubital fossa) - Area with pain on palpation - Site distal to previous venipuncture site, sclerosed or hardened veins. previous infiltrations or extravasations, areas of venous valves, or phlebitic vessels - Compromised skin and sites distal to these areas (e.g., areas with open wounds, extremities with an infection) - Location that interferes with planned procedures - Veins that are compromised (upper extremity on side of breast surgery with axillary node dissection or lymphedema or after radiation, arteriovenous (AV/ fistulas/grafts, or affected extremity from cerebrovascular accident (CA)) - Fragile dorsal veins in older adults b. Choose site that will not interfere with patient's activities of daily living (ADLs), use of assist devices, or planned procedures. Select a venous site most likely to last the full length of the prescribed therapy (Gorski et al., 2021) (see Fig. 42.15). Discuss the preference for VAD site selection with the patient. Option: Use vascular visualization technology. Veins on dorsal and ventral surfaces of arms (e.g., metacarpal, cephalic, basilic, or median) are preferred in adults. a. Use most distal site in nondominant arm if possible. ***4.Clinical findings of cellulitis (IV Therapy PPT) - Localized area of erythema (redness) and edema (swelling) - Warmth and tenderness over the affected area - Spreading redness with indistinct borders - Possible drainage or oozing if skin is broken - Fever and chills may be present if systemic infection - Lymphangitis (red streaks tracking along lymph vessels) and lymphadenopathy (swollen lymph nodes) Cellulitis typically starts as a localized skin infection that can spread rapidly if untreated. It requires prompt antibiotic treatment to prevent progression to systemic infection or complications like abscess formation or sepsis. — Careful monitoring of the affected area's size, color, and associated symptoms guides management. Cellulitis typically starts as a localized skin infection that can spread rapidly through the lymphatic system. It must be differentiated from the more severe necrotizing fasciitis which involves necrosis of the deeper fascia and muscles. Prompt antibiotic treatment is crucial for cellulitis to prevent complications. Cellulitis (ATI FUND P.297) — Pain, warmth, edema, induration, red streaking, fever, chills, malaise TREATMENT Discontinue the infusion and remove the catheter. Elevate the extremity. Apply warm compresses 3 to 4 times/day. Obtain a specimen for culture at the site and prepare the catheter for culture if drainage is present. Administer the following: Antibiotics Analgesics Antipyretics PREVENTION Rotate sites at least every 72 hr. Avoid inserting an IV into the lower extremities. Use hand hygiene. Use surgical aseptic technique. ***5.Reasons why IV meds are administered (IV Therapy PPT) There are several reasons why medications may be administered intravenously (IV): 1. Rapid onset of action - IV route allows medications to directly enter the bloodstream for faster systemic effects compared to oral or other routes. 2. Reliable absorption - Bypassing the gastrointestinal tract ensures complete and consistent absorption, unlike oral medications affected by factors like food intake. 3. Ability to titrate dosing - IV infusions allow precise titration and adjustment of medication doses based on patient response. 4. Inability to take oral medications - Patients who are unconscious, nauseated, or have gastrointestinal issues may require IV medications. 5. Fluid resuscitation - IV fluids and electrolyte replacements are crucial for hydration, fluid balance, and correcting electrolyte imbalances. 6. Emergency situations - Rapid IV access is vital for administering life-saving medications, blood products, or other critical therapies. 7. Continuous infusions - Certain medications like antibiotics, anticoagulants, or chemotherapeutics require continuous IV infusion for optimal therapeutic effects. The IV route allows precise control, rapid action, and reliable delivery of medications and fluids, making it essential in various clinical situations. ****6.Antidotes for drugs reviewed in class. There are many different antidotes used for various drug overdoses and toxicities. Naloxone - Reverses effects of opioid overdose by blocking opioid receptors. Flumazenil - Reverses effects of benzodiazepine overdose by blocking benzodiazepine receptors. N-acetylcysteine - Antidote for acetaminophen overdose, prevents formation of toxic metabolites. Fomepizole - Antidote for toxic alcohol poisoning like methanol and ethylene glycol. Digoxin immune fab - Binds and neutralizes digoxin in digoxin toxicity. Deferoxamine - Chelating agent used for iron poisoning and iron overload. Hydroxocobalamin - Binds cyanide and used as an antidote for cyanide poisoning. Protamine sulfate - Reverses effects of heparin by binding to it. The choice of antidote depends on the specific drug involved and the clinical scenario. Prompt administration of the appropriate antidote can be life-saving in cases of drug overdose or toxicity. 7.hypotonic intravenous (IV) fluid A hypotonic IV fluid is one that has a lower osmolarity or concentration than normal body fluids. When infused, the hypotonic solution causes fluid to shift from the vascular space into the cells due to osmosis. This results in cellular swelling and a decrease in plasma volume. Hypotonic fluids like 0.45% saline solution are used carefully in clinical settings to avoid complications from fluid shifts. Proper monitoring of fluid balance is crucial when administering hypotonic IV fluids. The purpose of using hypotonic intravenous (IV) fluids is to decrease the osmolality or tonicity of the body's fluids. Hypotonic solutions have a lower concentration of solutes compared to normal body fluids. When infused, they help dilute the extracellular fluid and allow water to move from the IV fluid into the cells, rehydrating them. —> Hypotonic IV fluids are used to treat conditions like hypernatremia (excess sodium) or increased osmolality, where cells are dehydrated. Examples include 0.45% sodium chloride solution. However, care must be taken as rapid infusion of hypotonic fluids can lead to complications like fluid overload or electrolyte imbalances. 8.RN interventions for IV potassium replacement When administering IV potassium replacement, key nursing interventions include: - Verify provider order for potassium dose, concentration, and rate. Double check calculations. - Assess patient's kidney function and urine output to ensure adequate excretion before giving potassium. - Never give potassium as an IV push or bolus due to risk of cardiac dysrhythmias. - Administer potassium via infusion pump or buretrol for controlled rate. Do not exceed 10 mEq/hr for non-monitored patients or 20 mEq/hr for monitored patients. - Monitor patient on cardiac monitor throughout infusion and watch for ECG changes. - Assess patient for signs of hyperkalemia like muscle weakness, paresthesias, or arrhythmias. - Provide thorough patient education on potassium's role, dietary sources, and importance of compliance. - Document potassium level, dose given, route, rate, patient response, and any adverse effects. Careful dosing, administration technique, and monitoring are crucial when replacing potassium intravenously to prevent life- threatening complications. *****9.crystalloid solutions adverse effect Crystalloid solutions can have the following adverse effects: - Edema (fluid buildup) anywhere in the body, including peripheral edema and pulmonary edema, since crystalloids can leak out of blood vessels into tissues. - Dilution of plasma proteins, further reducing colloid oncotic pressure that keeps fluid within blood vessels. - Fluid overload if large volumes are infused over a prolonged period. - Short-lived effects requiring repeated administration of large volumes. Careful monitoring of fluid status and judicious use based on the patient's condition is important to mitigate these potential adverse effects of crystalloid solutions. Crystalloid solutions are intravenous fluids that contain small molecules like electrolytes and glucose that can pass through semi- permeable membranes. They are isotonic, hypotonic, or hypertonic compared to blood plasma. Common crystalloids include normal saline, lactated Ringer's, and dextrose solutions. — Crystalloids are used to replace fluid losses, maintain hydration, and treat fluid and electrolyte imbalances. They are less expensive than colloids, have no risk of allergic reactions, and do not affect coagulation. However, they can cause edema as they readily leave the vascular space. — Crystalloids provide temporary volume expansion until they redistribute throughout the body's fluid compartments. ****10. patient cues the RN would expect to decrease intravenous therapy As a registered nurse, I would expect to decrease or discontinue intravenous (IV) therapy if the patient exhibits the following cues: - Improvement in the condition requiring IV fluids or medications, such as stabilized vital signs or resolution of dehydration. - Development of complications from IV therapy like phlebitis, infiltration, or fluid overload. - Ability to tolerate oral intake, allowing transition to oral medications. - Discharge orders or transfer to a lower level of care where IV access is no longer required. - Patient request or refusal to continue IV therapy, after education on risks/benefits. Continuously assessing the patient's response and ongoing need for IV therapy is crucial. Timely discontinuation when no longer necessary prevents complications and promotes patient comfort and mobility.  ****11. Treatment for genital herpes For genital herpes, antiviral medications like acyclovir, valacyclovir, and famciclovir are recommended treatments. They can be taken episodically at the first sign of an outbreak to reduce severity and duration, or suppressive daily therapy can prevent or reduce frequency of outbreaks. —Intravenous acyclovir may be used for severe cases. —Antiviral treatment does not cure herpes but manages symptoms and reduces transmission risk. — Counseling on prevention through safe sex practices is also important. Acyclovir is indicated for the treatment of genital herpes. ********* Acyclovir is the drug of choice to treat herpes simplex infections. (p637 Acyclovir inhibits viral DNA synthesis. It also inhibits the activity of HSV-1 HSV-2, and varicella zoster. Acyclovir is a synthetic purine nucleoside analog and is the drug of choice to treat infections caused by members of the herpesvirus family. Herpesviruses are very sensitive to acyclovir. The bioavailability of acyclovir is low due to the poor absorption from the gastrointestinal (GI) tract. In fact, the bioavailability decreases as doses are increased. If a high dose is needed to treat an infection, the preferred route of administration is intravenous (IV). There are at least eight types of herpesviruses that cause infection in people. Drugs that treat herpesviruses include acyclovir, cidofovir, famciclovir, foscarnet, ganciclovir, idoxuridine, penciclovir, and trifluridine, among others. Most of these antivirals are effective against both types of herpes simplex viruses (HSV-1 and HSV-2). Three topical antiviral drugs are effective in  treating herpes simplex viruses. These drugs are idoxuridine, penciclovir, and trifluridine. Idoxuridine and trifluridine are limited to topical ophthalmic. Cidofovir, foscarnet, and ganciclovir are also effective against cytomegalovirus (CMV). Acyclovir, cidofovir, foscarnet, and penciclovir are used to treat herpesvirus and Epstein-Barr virus (EBV). The primary treatment for genital herpes involves antiviral medications like acyclovir, valacyclovir, or famciclovir. These drugs can help reduce the severity and duration of outbreaks if taken at the first sign of symptoms. — For initial outbreaks, antiviral therapy is recommended regardless of severity. Suppressive daily antiviral therapy can also be prescribed to prevent or reduce the frequency of recurrent outbreaks. — While not a cure, antivirals decrease viral shedding and transmission risk. Proper hygiene, stress management, and avoiding triggers like ultraviolet light exposure are also advised to prevent recurrences. — For severe cases with complications, hospitalization and intravenous antiviral therapy may be necessary. ****12.Administration of an intravenous bolus When administering an intravenous (IV) bolus medication, follow these key steps: — Verify the medication order, dosage, route, and patient identity. Prepare the medication following aseptic technique. Explain the procedure to the patient. — Assess patency of the IV line by flushing with normal saline. — Administer the bolus over 30-60 seconds by pushing the medication directly into the IV line. Flush the line again with normal saline to ensure full dose delivery. Monitor the patient closely for any adverse reactions. Document the medication administration accurately. An intravenous (IV) bolus refers to the administration of a medication or fluid directly into the venous circulation over a short period of time, usually 30 seconds to a few minutes. Key nursing interventions for IV bolus administration include: - Verify the medication order, dosage calculations, and compatibility. Double-check patient identification. - Explain the procedure and purpose to the patient. Ensure IV patency and secure access. - Administer the bolus at the recommended rate, usually by rapid IV push over 30-60 seconds. Do not exceed maximum safe infusion rates. - Flush the IV line with normal saline before and after the bolus to ensure complete delivery. - Monitor the patient closely for any adverse reactions or complications like infiltration or extravasation. - Reassess the patient's condition and response to the medication after administration. ATI FUNDAMENTALS: The provider prescribes the type of IV fluid, the volume to infuse, and either the rate at which to infuse the IV fluid or the total amount of time it should take to infuse the fluid. The nurse regulates the IV infusion, either with an IV pump or manually, to be sure to deliver the right amount. — Nurses administer large-volume IV infusions on a continuous basis (0.9% sodium chloride IV to infuse at 100 mL/hr), or intermittently (0.9% sodium chloride 500 mL to give IV over 3 hr). A fluid bolus is a large amount of IV fluid to give in a short time, usually less than 1 hr. A fluid bolus rapidly replaces fluid loss from dehydration, shock, hemorrhage, burns, or trauma. A large-gauge catheter (18-gauge or larger) is essential for maintaining the rapid rate necessary to administer a fluid bolus to an adult. — Nurses administer medications as an IV bolus, giving the medication in a small amount of solution, concentrated or diluted, and injecting it over a short time (1 to 2 min). Giving an IV bolus dose (ATI FUND P.293) - Inject the medications in small amounts of solution, concentrated or diluted, over a short time (1 to 2 min). - Administer medications directly into the peripheral IV or access port to achieve an immediate medication level in the bloodstream (with pain medication). - Prepare medications in the correct concentration and at a safe rate (amount of medication per minute). - Use extreme caution, and observe for adverse reactions or complications (redness, burning, or increasing pain). Accurate dosing, proper technique, and vigilant monitoring are crucial when giving IV bolus medications to prevent complications and ensure safe delivery of the intended therapeutic effect. An IV bolus involves introducing a concentrated dose of a medication directly into the systemic circulation. A piggyback is a small (25 to 250 mL) IV bag or bottle connected to a short tubing line that connects to the upper Y-port of a primary infusion line or to an intermittent venous access. An intermittent venous access (commonly called a saline lock) is an IV catheter capped off on the end with a small chamber covered by a rubber diaphragm or a specially designed cap. Volume- control administration (e.g., Buretrol) sets are small (150 mL) containers that attach just below the primary infusion bag or bottle. page 672 IV bolus medications require rapid delivery into the bloodstream, so it's crucial to administer them properly under sterile conditions and monitor the patient vigilantly. Rapid administration increases bioavailability but also potential side effects. 13.Osmosis videos, Antibiotics – MOA of Cephalosporins & Side effects ** Mechanism of Action: Cephalosporins are bactericidal antibiotics that inhibit bacterial cell wall synthesis by binding to penicillin- binding proteins. This disrupts the formation of peptidoglycan cross-links in the cell wall, weakening the structural integrity and leading to cell lysis and death. **Common Side Effects: Gastrointestinal disturbances like nausea, vomiting, diarrhea. — Hypersensitivity reactions including rash, fever, anaphylaxis (cross-reactivity in penicillin-allergic patients). Nephrotoxicity and neurotoxicity with certain cephalosporins. — Superinfections like oral/vaginal candidiasis from disrupted normal flora. — Bone marrow suppression and bleeding problems are rare. from osmosis video: Common side effects associated with cephalosporins include headaches, dizziness, nausea, vomiting, and diarrhea. In addition, cephalosporins may disrupt the healthy intestinal flora, which can allow certain bacteria like Clostridioides difficile to survive and overgrow within the gastrointestinal tract, rarely but potentially leading to Clostridioides difficile infection or CDI for short. Cephalosporins are a large group of broad- spectrum antibiotics, which can be used to treat a wide variety of bacterial infections, including meningitis, pneumonia, urinary tract infections, and sepsis. These antibiotics get their name from Cephalosporium acremonium, a fungus from which they are derived. Now, cephalosporins belong to beta-lactam antibiotics, which means they have a beta- lactam ring in their core, and they mainly work by disrupting the synthesis of the peptidoglycan layer, a major component of bacterial cell walls. This weakens the bacterial cell wall, ultimately killing the bacteria. Now, cephalosporins are typically classified into five generations, each being used to treat certain types of bacterial infections. *****14.First generation cephalosporins used to treat? ***First-generation cephalosporins are typically used to treat: - Skin and soft tissue infections caused by Staphylococcus and Streptococcus species - Respiratory tract infections like bronchitis and pneumonia - Urinary tract infections - Bone and joint infections - Surgical prophylaxis for certain procedures They have good activity against gram-positive bacteria but limited coverage of gram-negative organisms. Examples include cefazolin, cephalexin, and cephradine. They are available in oral and parenteral formulations. ***osmosis video*** First-generation cephalosporins include cephalexin, which is administered orally; cefadroxil, which is administered orally and intravenously; and cefazolin, which is given intravenously and intramuscularly. —first-generation cephalosporins are effective against most gram-positive bacteria, such as Staphylococci and Streptococci spp; as well as some gram-negative bacteria like Escherichia coli, Proteus mirabilis, and Klebsiella pneumonia. first-generation cephalosporins are used to treat respiratory tract infections, urinary tract infections, some skin infections; and bone and joint infections. They can also be given as surgical antibiotic prophylaxis, to prevent infections from spreading to deeper tissues during surgical operations. *****15.Penicillin’s (Class) penicillins are further classified into four groups: basic penicillins, broad-spectrum or aminopenicillins, penicillinase-resistant or antistaphylococcal penicillins, and extended-spectrum or antipseudomonal penicillins. Penicillins are antibiotics that got their name from the Penicillium mold, from which they were originally extracted. They belong to the pharmacological group of beta-lactam antibiotics, because they have a beta-lactam ring in their structure. — Penicillins are used to treat a wide range of infections, including streptococcal infections, like pharyngitis, tonsillitis, scarlet fever, and endocarditis; pneumococcal infections; staphylococcal infections; diphtheria; anthrax; and syphilis. — to build their cell walls, bacteria need an enzyme called DD- transpeptidase, or penicillin binding protein, or PBP for short. Penicillins, like all beta lactam antibiotics, bind to this enzyme thanks to their beta-lactam ring, and prevent it from working. Now, some bacteria have developed resistance to beta lactam antibiotics. The most notable is Staphylococcus aureus, which has developed an enzyme called beta-lactamase or penicillinase, that breaks down the beta-lactam ring within the antibiotic, rendering it ineffective. — Basic penicillins include penicillin V, which is given orally, and penicillin G, which is administered intramuscularly or intravenously. In addition, there’s a specific penicillin G called penicillin G benzathine, which is a long acting penicillin that’s only administered intramuscularly. These are quite effective against common gram positive bacteria, so they’re used to treat upper respiratory infections, otitis media, pneumonia, rheumatic fever, erysipelas, skin and soft-tissue infections, and STIs like gonorrhea and syphilis. However, they don’t work well against most gram negative bacteria. — broad spectrum penicillins include amoxicillin, which is given orally, and ampicillin, which is administered orally, intramuscularly or intravenously. They’re effective against a wide variety of gram negative bacteria, so they’re useful to treat respiratory, gastrointestinal, genitourinary, and skin infections. Amoxicillin is also useful for gonorrhea, and ampicillin for more serious infections that require an intravenous administration, like meningitis, endocarditis, and septicemia. — penicillinase-resistant medications, or antistaphylococcal penicillins; these include dicloxacillin, which is given orally, as well as nafcillin and oxacillin, which are administered intramuscularly or intravenously. They were created to fight bacteria like Staphylococcus aureus, which often have the beta-lactamase enzyme making them resistant to other penicillins. — extended -spectrum penicillins like piperacillin, which is administered intravenously. These medications have more gram negative coverage. Most notably, they are effective against Pseudomonas aeruginosa. That’s why they’re also called antipseudomonal penicillins. Since these penicillins are still quite susceptible to beta lactamases, they’re often administered in combination with beta-lactamase inhibitors, such as tazobactam. They differ in their spectrum of activity against gram-positive and gram-negative bacteria, resistance to the penicillinase enzyme, and pharmacokinetic properties. The penicillinase- resistant and extended-spectrum classes have modifications to resist bacterial enzymes that break down penicillins. Penicillins are a class of beta-lactam antibiotics that inhibit bacterial cell wall synthesis. Their mechanism of action involves binding to and inactivating penicillin-binding proteins (PBPs), which are enzymes involved in the cross-linking of peptidoglycan strands in the bacterial cell wall. By disrupting this final stage of cell wall formation, penicillins prevent the bacteria from constructing a rigid, protective cell wall. This leads to osmotic instability, cell lysis, and death of the bacteria. — Penicillins are bactericidal, meaning they kill bacteria rather than just inhibiting their growth. ********16. Tetracyclines and Glycylcyclines side effects (Osmosisvideo) Tetracyclines can cause discoloration of permanent teeth and tooth enamel hypoplasia in fetuses and children. They may also retard fetal skeletal development if taken during pregnancy. Other side effects include photosensitivity, altered intestinal/vaginal flora leading to diarrhea or candidiasis, bulging fontanelles in neonates, blood dyscrasias like thrombocytopenia and hemolytic anemia, and exacerbation of lupus. Gastrointestinal upset, rash, and enterocolitis can also occur. For glycylcyclines like tigecycline, the most common adverse effects are nausea and vomiting in 20-30% of patients. Serious side effects may include bradycardia, severe diarrhea, hepatotoxicity, hyperglycemia, QTc prolongation, and potentially life- threatening interstitial lung disease or pneumonitis. **osmosis video ** Once administered, both tetracyclines and glycylcyclines work by entering the bacteria and completely shutting down their protein synthesis. This ultimately leads to a bacteriostatic effect, meaning they stop bacterial growth without killing the bacteria. Now, common side effects associated with both the tetracyclines and glycylcyclines include headache and dizziness, as well as abdominal pain, nausea, vomiting, esophageal irritation and diarrhea. In addition, they cause phototoxicity, so clients are much more likely to get sunburned. Some clients may also develop a skin rash or injection site reactions, as well as hypersensitivity reactions like exfoliative dermatitis, Stevens-Johnson syndrome, or anaphylaxis. Another important side effect is superinfection due to fungal overgrowth in the mouth, most commonly Candida; or bacterial overgrowth in the bowel, which can rarely, but potentially, cause a Clostridioides difficile infection or CDI for short. In addition, these medications can accumulate in teeth, causing permanent yellow or brown discoloration. — If taken during pregnancy after the fourth month of gestation, these medications can cause staining of the baby's deciduous teeth, but not their permanent teeth. On the other hand, if these medications are used in children younger than 8 years, they can cause discoloration of permanent teeth. — Additionally, these medications can accumulate in the bone, so children can have delayed bone growth. Lastly, the metabolic products of tetracycline can be nephrotoxic. Tetracyclines and glycylcyclines are antibiotics that stop bacterial growth by entering bacteria and inhibiting protein synthesis. They are used to treat infections of the respiratory, genitourinary, gastrointestinal, integumentary, and central nervous systems. Common side effects include gastrointestinal disturbances, headaches, dizziness, and photosensitivity; as well as more severe side effects like hypersensitivity reactions and superinfections. Other severe side effects include discoloration of teeth and delayed bone growth in children.  ****17. Patient assessment of itching When assessing a patient with itching (pruritus), gather the following information: - Location and distribution of the itching - Duration and pattern (constant or intermittent) - Severity and intensity of the itch - Presence of any visible skin lesions or rashes - Aggravating or relieving factors - Associated symptoms like redness, swelling, pain, fever - Recent illness, medications, or exposure to potential irritants - History of skin conditions, allergies, or systemic diseases Determine if the itch is generalized or localized. Ask about scratching behaviors that may be causing skin trauma. Assess the patient's mental status, as psychogenic itch can occur with certain psychiatric disorders. Evaluate for potential underlying causes like dry skin, infections, liver or kidney disease, malignancy, or neuropathy. A thorough assessment guides appropriate treatment of the itch and its root cause. *****18.Cefazolin Cefazolin (Ancef) is a first-generation cephalosporin antibiotic. — It is used for surgical prophylaxis and treatment of susceptible staphylococcal and streptococcal infections. Cefazolin provides excellent coverage against gram-positive bacteria but limited activity against gram- negative organisms. It is available only in parenteral formulations for intravenous or intramuscular administration. — As with other cephalosporins, common side effects include gastrointestinal upset, hypersensitivity reactions, and risk of superinfections like candidiasis. osmosis video: - first generation cephalosporins; given iv and IM - Alright, when caring for a client who has been prescribed a cephalosporin like cefazolin in order to prevent a surgical site infection, first perform a baseline assessment, including weight, vital signs, and noting the presence of fever, as well as fluid intake and output. Next, review their recent laboratory test results, including CBC, renal and hepatic function, and potassium levels. - Next, explain to your client how the medication will help to prevent an infection from developing in their surgical incision. Let them know that you will be administering the medication intravenously before their scheduled surgery, and that they will receive additional doses during and after surgery. Then, reassure your client that you will be monitoring them closely for side effects, keeping a close eye on their blood count, fluid and electrolyte balance, liver enzymes, as well as for the presence of gastrointestinal disturbances like diarrhea.. -Okay, when preparing to administer cefazolin intravenously, ensure your client is adequately hydrated, and that they have a patent IV and an indwelling urinary catheter in place. Then, confirm the ordered dosage and input the correct mL/hr to be administered by infusion pump. -While your client is receiving the medication, be sure to monitor the insertion site closely for signs of extravasation, such as redness, puffiness, or blanching. In addition, monitor their vital signs and urine output, as well as for signs of a hypersensitivity reaction, including an unusual rash or blister, throat tightness, difficulty swallowing, or shortness of breath. - Finally, after administration of cefazolin, continue to monitor their vital signs, CBC, electrolytes, and renal function postoperatively. Additionally, evaluate for the therapeutic response by assessing your client’s surgical site, looking for any signs of infection, like drainage, redness, warmth, swelling, or pain in the affected area; as well as approximation of the surgical wound. - In general, first-generation cephalosporins are effective against most gram-positive bacteria, such as Staphylococci and Streptococci spp; as well as some gram-negative bacteria like Escherichia coli, Proteus mirabilis, and Klebsiella pneumonia. first-generation cephalosporins are used to treat respiratory tract infections, urinary tract infections, some skin infections; and bone and joint infections. They can also be given as surgical antibiotic prophylaxis, to prevent infections from spreading to deeper tissues during surgical operations. Common side effects associated with cephalosporins include headaches, dizziness, nausea, vomiting, and diarrhea. In addition, cephalosporins may disrupt the healthy intestinal flora, which can allow certain bacteria like Clostridioides difficile to survive and overgrow within the gastrointestinal tract, rarely but potentially leading to Clostridioides difficile infection or CDI for short. Some clients may also develop a skin rash or injection site reactions, as well as hypersensitivity reactions like Stevens-Johnson syndrome or anaphylaxis. Finally, some cephalosporins may cause serious side effects, such as seizures, renal failure, and electrolyte abnormalities like hyperkalemia, and hematologic side effects like anemia, neutropenia, and thrombocytopenia. Now, cephalosporins are contraindicated in clients who are allergic to any beta-lactam antibiotic, as well as in infants younger than 1 month. Precautions should be taken during pregnancy and breastfeeding, as well as with elderly clients. In addition, these medications should be used with caution in clients with anemia or coagulation disorders. Finally, additional precautions should be taken when administering cephalosporins to clients with gastrointestinal diseases, as well as those with renal disease or on dialysis. ***19.Conditions  antihistamines treat Antihistamines are used to treat various conditions including: - Allergic rhinitis (hay fever) and nasal allergies - Urticaria (hives) and other allergic skin reactions - Symptoms of the common cold like sneezing, itchy/watery eyes - Allergic reactions to insect bites, foods, or medications - Motion sickness - Insomnia (some antihistamines have sedating effects) - Vertigo and symptoms of Parkinson's disease (due to anticholinergic effects) - Anaphylaxis (severe allergic reaction) - Angioedema (swelling under the skin) The newer non-sedating antihistamines like fexofenadine, loratadine, and cetirizine are preferred over older sedating ones like diphenhydramine for managing allergic conditions while avoiding excessive drowsiness. — They work by blocking the effects of histamine on histamine-1 (H1) receptors, thereby reducing symptoms like itching, sneezing, runny nose, watery eyes, hives, and swelling caused by histamine release during allergic reactions. Antihistamines provide symptomatic relief but do not treat the underlying cause of the allergic condition. ****20.malignant hyperthermia (MH) Malignant hyperthermia is a rare but life- threatening inherited disorder triggered by exposure to certain general anesthetics and the muscle relaxant succinylcholine. — It causes a rapid rise in body temperature, muscle rigidity, irregular heartbeat, and metabolic acidosis. — Prompt treatment with dantrolene, cooling measures, and supportive care is crucial. Patients at risk should be identified pre-operatively, and facilities must have dantrolene readily available during general anesthesia cases. Close monitoring during and after anesthesia is vital to recognize and manage this medical emergency. ATI MED-SURG— Malignant hyperthermia **MANIFESTATIONS - Acute life-threatening medical emergency - Inherited muscle disorder that anesthesia induces chemically - Hypermetabolic condition causing an alteration in calcium activity in muscle cells (muscle rigidity, hyperthermia, and damage to the CNS) - Triggering agents including inhalation anesthetic agents and succinylcholine - Increased carbon dioxide level, decreased oxygen saturation level, and tachycardia occur first, followed by dysrhythmias, muscle rigidity, hypotension, tachypnea, skin mottling, cyanosis, and muscle-cell protein in the urine (myoglobinuria) - Extremely elevated temperature a late manifestation: increasing as high as 41.7° C (107" F) **NURSING ACTIONS Assist with the termination of surgery. Administer IV dantrolene, a muscle relaxant. Administer 100% oxygen. Obtain specimens for ABGs to monitor for metabolic acidosis and blood tests to check for hyperkalemia. Infuse iced IV 0.9% sodium chloride. Apply a cooling blanket; ice to axillae, groin, neck, and head; and iced lavage. Insert an indwelling urinary catheter to monitor output and for myoglobinuria (due to muscle breakdown) Monitor cardiac rhythm and treat dysthythmias. Transfer client to intensive care. MED-SURG BOOK PAGE 161-162 Be certain to thoroughly assess all patients for a personal or family history of malignant hyperthermia (MH), an inherited muscle disorder, which is an acute, life-threatening complication of certain drugs used for general anesthesia. — It is characterized by many problems, including inadequate thermoregulation. The reaction begins in skeletal muscles exposed to the drugs, causing increased calcium levels in muscle cells and increased muscle metabolism. Serum calcium and potassium levels are increased, as is the metabolic rate, leading to acidosis, cardiac dysrhythmias, and a high body temperature. — If symptoms of MH develop while a patient is in surgery, it is an emergency. Intervention must take place immediately. MH may start immediately after anesthesia induction, several hours into the procedure, or after anesthesia is completed. Symptoms include tachycardia, dyarhythmias, muscle rigidity of the jaw and upper chest, hypotension, tachypnea, skin mot-tling, cyanosis, and myoglobinuria (muscle proteins in the urine due to rhabdomyolysis). — The most sensitive indication is an unexpected rise in the end-tidal carbon dioxide level with a decrease in oxygen saturation and tachycardia. Extremely elevated temperature, as high as 111.2°F (44°C), is a late sign of MH. — Survival depends on early diagnosis and the immediate actions of the entire surgical team. Dantrolene sodium, a skeletal muscle relaxant, is the only drug specifically approved for treatment of MH. ***21.statements is true about second-generation antihistamines —Second-generation antihistamines like loratadine, cetirizine, and fexofenadine are less sedating than first-generation antihistamines. They have a longer duration of action, allowing for once-daily dosing to improve adherence. These peripherally acting antihistamines do not readily cross the blood-brain barrier, resulting in fewer central nervous system side effects compared to older antihistamines. Second-generation or non-sedating antihistamines like loratadine, cetirizine, fexofenadine, and desloratadine were developed to avoid the sedating effects of older antihistamines. They work peripherally by blocking histamine receptors without readily crossing the blood-brain barrier. This results in fewer central nervous system side effects like drowsiness. Second-generation antihistamines also have a longer duration of action, allowing for once-daily dosing to improve adherence. While they are less sedating, higher doses can still cause some drowsiness. These newer antihistamines are available over-the- counter and have a favorable safety profile compared to first-generation agents. ****22.Macrolides osmosis video, name different of macrolides ***osmosis video: Macrolides are a class of antibiotics used to treat a wide range of infections caused by gram-positive and gram-negative bacteria. These medications include erythromycin, azithromycin, and clarithromycin. ——> All can be administered orally to treat mild to moderate bacterial infections of the respiratory, gastrointestinal, and genitourinary tracts; erythromycin can also be given intravenously, and azithromycin has an ophthalmic formulation to treat bacterial conjunctivitis. The different macrolide antibiotics include azithromycin, clarithromycin, erythromycin, and fidaxomicin. Azithromycin and clarithromycin have a longer duration of action compared to erythromycin, allowing less frequent dosing. Fidaxomicin is the newest macrolide, indicated specifically for treating Clostridioides difficile- associated diarrhea. ******23. macrolide antibiotics to their specific side effects. **osmosis video***regarding specific side effects, erythromycin can cause esophagitis, while azithromycin can rarely cause thrombocytopenia; while clarithromycin can cause abnormal taste and pancreatitis. Typically, macrolides are well tolerated, and rarely cause side effects. The most common ones can include headaches, a skin rash, and gastrointestinal disturbances like diarrhea, abdominal pain, nausea, and vomiting. (osmosis video). In addition, macrolides may disrupt the normal intestinal flora, which can allow certain bacteria like Clostridioides difficile to survive and overgrow within the gastrointestinal tract, rarely but potentially leading to Clostridioides difficile infection or CDI for short. Some clients on macrolides may also develop vaginitis and candidiasis, and if they’re used for a prolonged time, they can also lead to ototoxicity and hearing loss. Erythromycin: Gastrointestinal side effects like nausea, vomiting, and abdominal pain are common. Azithromycin and clarithromycin: Have fewer gastrointestinal side effects compared to erythromycin. However, clarithromycin carries a risk of QT prolongation and arrhythmias in patients with heart disease. Fidaxomicin: Used for C. difficile diarrhea. Common side effects include nausea, vomiting, and GI bleeding. Pregnancy category B drug. ***24.Common indications for a client who has TMP-SMX prescription Common indications for prescribing trimethoprim-sulfamethoxazole (TMP-SMX or co-trimoxazole) include: - Treatment of urinary tract infections caused by susceptible organisms - Prophylaxis and treatment of Pneumocystis jirovecii pneumonia in immunocompromised patients - Treatment of acute exacerbations of chronic bronchitis - Treatment of travelers' diarrhea caused by susceptible bacteria - Treatment of shigellosis and cholera - Prophylaxis for recurrent urinary tract infections TMP-SMX has a broad spectrum of antibacterial activity against many gram- positive and gram-negative organisms, as well as some protozoal infections like Pneumocystis jirovecii pneumonia. However, its use may be limited by allergies, drug interactions, and resistance patterns in certain geographic areas. ***25.Side effects of trimethoprim-sulfamethoxazole (TMP-SMX) Common side effects of trimethoprim- sulfamethoxazole (TMP-SMX) include nausea, vomiting, loss of appetite, rash, and photosensitivity. More serious adverse effects can include bone marrow suppression, nephrotoxicity, hepatotoxicity, and hypersensitivity reactions like Stevens-Johnson syndrome or toxic epidermal necrolysis. — Patients with sulfa allergies are at higher risk for hypersensitivity reactions and should avoid TMP-SMX. Adequate hydration and monitoring kidney function are important, especially in older adults or those with renal impairment. ****26.Contraindications for ondansetron The only listed contraindication for ondansetron is a known drug allergy. However, there is concern regarding the potential development of cleft palate in the fetus when ondansetron is used during the first trimester of pregnancy. Therefore, it should be used cautiously in pregnant women, especially during the first trimester.  On the other hand, serotonin antagonists, like ondansetron, block type 3 serotonin or 5-HT3 receptors centrally in the chemoreceptor trigger zone and peripherally, on the vagal nerve in the upper GI tract, leading to suppression of nausea and vomiting (osmosis video) Common side effects of ondansetron include headache, dizziness, and constipation, and it can prolong the QT interval, leading to dysrhythmias. It can also cause a life-threatening side effect called serotonin syndrome, which is caused by an accumulation of serotonin that results in overstimulation of the nervous system, characterized by skin flushing, tachycardia, and agitation. It can occur in patients treated with a combination of ondansetron and other medications that increase serotonin levels, such as antidepressants. As far as contraindications go, ondansetron should be used with caution in patients who have long QT syndrome, or who are taking other medications that prolong the QT interval, which could degenerate into torsades de pointes, a potentially life-threatening dysrhythmia. It also should be used with caution in patients at risk of dysrhythmias, such as those with electrolyte imbalances (osmosis video) *******27.MOA of promethazine Promethazine is a phenothiazine derivative that acts as a nonselective antagonist of multiple receptors including histamine H1, muscarinic acetylcholine, dopamine D2, and alpha-adrenergic receptors. Its main mechanisms of action are antihistaminic, anticholinergic, sedative, antiemetic, and anti-vertigo effects. The antihistaminic and anticholinergic properties contribute to its usefulness in treating nausea, vomiting, motion sickness, and allergic conditions. The sedative effects are due to its antagonism of H1 and D2 receptors in the brain. since promethazine blocks D2 receptors, it can cause extrapyramidal symptoms like muscle rigidity and a shuffling gait, restlessness, and facial grimacing; as well as neuroleptic malignant syndrome, an emergency condition which includes changes in mental status, hyperthermia, and muscle rigidity. Lastly, promethazine’s antihistamine effects can lead to dizziness and sedation.  Promethazine shouldn’t be used in patients with hepatic impairment, bone marrow suppression, or conditions that could be affected by anticholinergic effects, like glaucoma and myasthenia gravis. Also, it should not be given to children with Reye syndrome, a serious condition that causes swelling in the brain and liver. Importantly, promethazine is considered a high-risk medication in pediatrics, older adults, and when given IV. In fact, it has two Black Box warnings including tissue necrosis with IV use and respiratory depression in children younger than 2 years old. (osmosis video) ****28.Surgical Care Improvement Project (SCIP) Surgical Care Improvement Project (MED- SURG P.158) The Surgical Care Improvement Project (SCIP), a set of core compliance measures, was initiated in 2006 to reduce surgical complications. — Focuses included administration of prophylactic antibiotics, the timing of discontinuation of urinary catheterization after surgery, and venous thromboembolism (VT) prophylaxis. These practices are now standard in surgical care. The Surgical Care Improvement Project (SCIP) was initiated in 2006 to reduce surgical complications. It focused on implementing core measures such as proper administration of prophylactic antibiotics, timely discontinuation of urinary catheters after surgery, and appropriate venous thromboembolism (VTE) prophylaxis. These practices aimed to improve patient safety and outcomes, and are now considered standard in surgical care. ATI MED-SURG The Joint Commission has implemented several National Patient Safety Goals to ensure quality and safety during surgical procedures. These goals include. — Marking of the client's surgical site — Pausing prior to a surgical procedure to ensure no errors are being made — Ensuring correct procedure is performed on the correct client at the correct body area Other actions to prevent harm include the Surgical Care Improvement Project (SCIP) which is aimed at preventing surgical complications. Team STEPPS can be used in the operative setting to increase communication, teamwork and collaboration. 29.National patient goals related to Safety and Preoperative Care of Perioperative Patients The National Patient Safety Goals related to preoperative care and safety of perioperative patients include: 1. Ensuring accurate patient identification using at least two identifiers. 2. Effective communication among the surgical team regarding critical elements of care, such as informed consent, pre- operative verification process, marking the procedure site, and completing a safe surgery checklist. 3. Administering appropriate prophylactic antibiotics within one hour before incision. 4. Implementing evidence-based practices to prevent healthcare-associated infections, such as proper hair removal, hand hygiene, and aseptic techniques. 5. Implementing policies and procedures to prevent surgical site infections, including discontinuing prophylactic antibiotics within 24 hours after surgery. 6. Implementing evidence-based practices to prevent venous thromboembolism, such as using appropriate prophylaxis and providing patient education. These goals aim to improve communication, prevent errors, and enhance patient safety throughout the perioperative period. ATI MED-SURG The Joint Commission has implemented several National Patient Safety Goals to ensure quality and safety during surgical procedures. These goals include. — Marking of the client's surgical site — Pausing prior to a surgical procedure to ensure no errors are being made — Ensuring correct procedure is performed on the correct client at the correct body area Other actions to prevent harm include the Surgical Care Improvement Project (SCIP) which is aimed at preventing surgical complications. Team STEPPS can be used in the operative setting to increase communication, teamwork and collaboration.  ******30.Purpose of Team Stepps The purpose of TeamSTEPPS is to facilitate effective communication, teamwork, and collaboration among healthcare professionals to enhance patient safety and quality of care. It provides strategies and tools to improve team performance, promote a culture of safety, and prevent medical errors. TeamSTEPPS aims to create a shared mental model among team members, foster mutual respect, and standardize communication techniques like SBAR for clear and structured information exchange. By optimizing teamwork and interprofessional coordination, TeamSTEPPS ultimately leads to better patient outcomes. TeamSTEPPS® is a system designed to facilitate communication between health care providers to enhance patient safety and quality of care. - Designed by the Department of Defense (DOD) and the Agency for Healthcare Research and Quality (AHRQ), TeamSTEPPS has been shown to be effective when used in the surgical environment (AHRQ, 2020). - This system promotes communication, safety, and interprofessional teamwork and colaboration, which has been shown by evidence to result in better patient outcomes and quality of care. (MED- SURG P159 ATI MED-SURG The Joint Commission has implemented several National Patient Safety Goals to ensure quality and safety during surgical procedures. These goals include. — Marking of the client's surgical site — Pausing prior to a surgical procedure to ensure no errors are being made — Ensuring correct procedure is performed on the correct client at the correct body area Other actions to prevent harm include the Surgical Care Improvement Project (SCIP) which is aimed at preventing surgical complications. Team STEPPS can be used in the operative setting to increase communication, teamwork and collaboration.  ****31.Safety concerns of epidural catheter There are several safety concerns associated with epidural catheters: 1. Infection risk - Strict aseptic technique is crucial during insertion and maintenance to prevent bacterial contamination leading to epidural abscess or meningitis. 2. Bleeding/hematoma - Coagulation status must be assessed, as epidural hematomas can cause neurological deficits if not promptly treated. 3. Catheter migration or shearing - Improper positioning or dislodgement of the catheter can result in ineffective analgesia or unintended intrathecal/intravascular injection. 4. Medication errors - Verifying the correct medication, concentration, and dosing is vital, as epidural administration of the wrong drug can have severe consequences. 5. Respiratory depression - Opioid medications given epidurally can cause respiratory depression, necessitating close monitoring. 6. Neurological injury - Trauma during insertion or injection into the wrong space can potentially damage nerves or the spinal cord. Diligent patient assessment, adhering to protocols, and maintaining sterility are essential to mitigate the risks associated with epidural catheter use. ****32.Spinal headache and blood patch — A spinal headache is a potential complication of spinal or epidural anesthesia, occurring in up to 70% of patients who experience inadvertent dural puncture. — It is often self-limiting and treated with bed rest, analgesics, and hydration. — In severe cases, an epidural blood patch may be performed, where the anesthesiologist injects 15-20 mL of the patient's own blood into the epidural space. This creates a clot that seals the dural puncture, relieving the headache in over 90% of cases. The blood patch is a safe and highly effective treatment for postdural puncture headaches that do not resolve with conservative measures. ****33.patient safety  strategy to prevent PE after surgery To prevent pulmonary embolism (PE) after surgery: 1. Early ambulation and leg exercises to promote blood flow and prevent stasis. 2. Pharmacological prophylaxis with anticoagulants like heparin, low molecular weight heparin, or direct oral anticoagulants in high-risk patients. 3. Mechanical prophylaxis with intermittent pneumatic compression devices or graduated compression stockings. 4. Risk assessment to identify patients needing extended prophylaxis post-discharge. 5. Patient education on recognizing signs/ symptoms of PE and importance of prophylaxis. A multimodal approach combining pharmacological, mechanical, and early ambulation provides optimal prevention of venous thromboembolism and PE in the postoperative period. ****34.how do street drugs affect the effects of anesthesia The use of street drugs can significantly impact the effects and safety of anesthesia. Substances like cocaine, amphetamines, and opioids can increase anesthesia requirements, leading to delayed emergence and respiratory depression. Marijuana use increases the risk of airway issues during intubation. Alcohol and benzodiazepine abuse may exacerbate sedation and respiratory depression from anesthetics. — It is crucial for patients to disclose any substance use to the anesthesia team to allow for appropriate dosing adjustments and monitoring during the perioperative period. Substance abuse can predispose patients to anesthetic-induced complications, so transparency about drug use history is vital for safe anesthesia management. *****35.dronabinol Dronabinol (Marinol) is a synthetic form of tetrahydrocannabinol (THC), the main psychoactive component in marijuana. — It is FDA-approved for treating nausea and vomiting associated with cancer chemotherapy when other antiemetics have failed. — Dronabinol can also stimulate appetite and promote weight gain in patients with AIDS or undergoing chemotherapy. — As a cannabinoid, it requires monitoring for potential side effects like dehydration, cognitive impairment, and respiratory depression. — Proper patient assessment and precautions are necessary when administering dronabinol. **********36.promethazine Promethazine is an antiemetic and sedative medication used to treat nausea, vomiting, and motion sickness. As an anti-dopaminergic drug, it requires careful assessment for dehydration, electrolyte imbalances, and adverse effects like orthostatic hypotension, tachycardia, and extrapyramidal symptoms. Proper dosing, monitoring vital signs, and checking for drug interactions are crucial safety measures when administering promethazine. Verifying the correct medication to prevent sound-alike errors, such as confusing it with prochlorperazine, is also important. ******37. MOA of Ondansetron Ondansetron is a selective 5-HT3 receptor antagonist that blocks serotonin at the 5-HT3 receptors in the chemoreceptor trigger zone and gastrointestinal tract. By inhibiting serotonin binding at these receptors, ondansetron prevents nausea and vomiting induced by chemotherapy, radiation therapy, and surgery. Its antiemetic mechanism of action makes it highly effective for preventing and treating nausea and vomiting associated with cancer treatments and anesthesia. ****38. Role of the RN during the 3 phases (pre op, intraop, and post op) sherpath lessons The role of the RN during the three phases of perioperative care is: Preoperative Phase: - Assess patient's health status and risk factors - Provide preoperative teaching and obtain informed consent - Ensure proper preoperative preparation (NPO status, skin prep, etc.) - Advocate for the patient and coordinate care Intraoperative Phase: - Act as the circulating nurse monitoring the patient, surgery, and environment - Manage patient positioning, medications, specimens, and surgical counts - Serve as a patient advocate ensuring safety and dignity Postoperative Phase: - Assess and monitor patient's recovery (vital signs, pain, surgical site, etc.) - Provide postoperative teaching on wound care, medications, and follow-up - Coordinate discharge planning and home care needs - Advocate for the patient's ongoing care requirements The perioperative RN plays a crucial role as the patient's advocate throughout the surgical experience, ensuring quality care, safety, and optimal outcomes. NURSING ROLES DURING SURGERY p. 1437 There are two traditional nursing roles in the OR: circulating nurse and scrub nurse (Fig. 50.5). The circulating nurse is an RN who does not scrub in and uses the nursing process in the management of patient care activities in the OR suite. The circulating nurse monitors the surgery closely and also manages patient positioning, antimicrobial skin prepa-ration, medications, implants, placement and function of IPC devices, specimens, warming devices, and surgical counts of instruments and dressings (AORN, 2020a). The circulating nurse does not wear an OR gown. The scrub nurse is either an RN or surgical technologist who is often certified (CST). Scrub nurses must have a thorough knowledge of each step of a surgical procedure because they work in the surgical field with the surgeon. The scrub nurse must be able to anticipate each instrument and supply item needed by the surgeons (Rothrock, 2019). A circulating nurse and scrub nurse partner together to ensure patient safety by minimizing risk of error. The team also works together to ensure cost-A efficient use of supplies. A new role in the OR includes the RN first assistant (RNFA). This is an expanded role that requires formal academic education (AORN, 2020b). The RNFA collaborates with the surgeon by handling and cutting tissue, using instruments and medical devices, providing exposure of the surgical area and hemostasis, and suturing (Rothrock, 2019). preoperative phase: sherpath the preoperative phase is the first phase of the perioperative period. During the preoperative phase, the patient collaborates with the surgeon to decide on the need for surgery, schedules the procedure, undergoes preoperative testing, and receives teaching and information about the surgery. The preoperative phase can be very short, as in emergency situations, or can last several months. Patient assessment for conditions that may contribute to surgical risk, such as gender, age, health conditions, and medication or substance use, is the key to minimizing the potential for complications from surgery or anesthesia. Informed consent is an important aspect of the preoperative phase of surgery. Consent must be obtained before pain medications or sedatives are administered. The surgeon provides a description of the surgical procedure, benefits, risks, potential complications, expected outcomes, and postoperative recovery before obtaining informed consent. The preoperative nurse witnesses the informed consent for surgery, but never obtains informed consent. If the nurse finds that the patient does not understand the procedure or is unsure about signing the consent, the surgeon is contacted to further discuss the consent with the patient. Preoperative teaching is best completed in multiple sessions to allow time for patients to comprehend and retain information. Family members should be included in patient teaching when available. Preoperative teaching is important for preparing patients for surgery and for facilitating postoperative care and recovery. Patients who are well-informed about their surgeries are more likely to have decreased fear and anxiety preoperatively and be better prepared for postoperative pain management, activities, and exercises. Preoperative nurses act as patient advocates throughout the preoperative phase of surgery by implementing preoperative surgical prescriptions, providing preoperative and postoperative teaching, witnessing informed consent, and reviewing the patient’s preoperative surgical checklist to ensure that all tests and activities have been completed and the patient is ready for transfer to the operating room. The preoperative phase of surgery starts when your patient’s time of surgery is confirmed and ends with the start of their surgery. When caring for your patient during this phase, you’ll promote patient safety by following the steps of the Clinical Judgment Measurement Model to make clinical decisions regarding patient care. as the preoperative nurse, you’ll ensure patient safety by recognizing important cues. These cues can be gathered from the patient or their family members during your assessment. Important cues may include your patient’s medical history such as medication allergies, previous response to anesthesia and pain medications, surgical history, prescription and over-the-counter medications; as well as underlying health conditions that could potentially lead to complications during the surgery and postoperative recovery like atherosclerosis, cardiac dysrhythmias, or diabetes mellitus. Other important cues can include results of preoperative tests, such as clotting factors or blood glucose. You’ll also ensure that consent for surgery has been signed. Also, evaluate your patient and their family members’ understanding of the surgical procedure and ensure their questions have been answered. Lastly, perform a psychosocial assessment to identify emotional support needs prior to surgery. Next, you'll analyze these cues by determining the relationship between the cues and linking them to your patient’s history and clinical presentation. For example, you'll determine if your patient’s elevated heart rate and respirations are related to anxiety about their upcoming procedure or if they’re related to an underlying cardiovascular condition. Next, you’ll determine a priority hypothesis related to the preoperative phase such as anxiety or risk for injury. You'll rank the hypotheses according to urgency or likelihood, as well as considering whether they’re potentially life-threatening, like a new onset cardiac dysrhythmia, or an immediate concern like anxiety about the upcoming surgery. Based on this information, you’ll address the most serious or relevant hypothesis first, and then generate solutions. So, if your patient is exhibiting signs and symptoms of anxiety, such as irritability, restlessness, and expressing concern about their surgical procedure, you would generate a solution like, my patient’s anxiety will be managed to an acceptable level within one hour of intervention. Okay, once the solutions have been generated, you’ll take action to implement the solutions. For patients with anxiety, you can provide time for them to discuss their feelings and fears surrounding the procedure, answer their questions, and provide reassurance. You may also collaborate with a counselor or spiritual advisor depending on your patient’s preferences, or administer preoperative anxiolytics, as prescribed. Now, if your patient is at risk for injury due to a pre-existing condition, like chronic pain, monitor their pain and symptoms and reposition them as needed. Be sure to inform the surgical team about the patient’s pre-existing condition to minimize the risk for injury intraoperatively or postoperatively. Lastly, you'll evaluate whether the expected outcomes have been met by reassessing your patient. For example, you'll monitor their anxiety level to determine whether their condition is improving, declining, or remaining unchanged. If their condition is declining or hasn’t changed, you’ll revise the plan of care, and take additional actions to address your patient’s condition. So, if you notice your patient is still experiencing moderate anxiety after intervening, you'll bring this to the attention of the surgical team. The preoperative phase of surgery starts when your patient’s surgery is confirmed and ends with the start of their surgery. When caring for your patient during this phase, you'll go through the steps of the Clinical Judgment Measurement Model to make clinical decisions about patient care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes. **sherpath: The intraoperative phase is the second phase of surgery. The surgical team consists of sterile, scrubbed personnel who work within the sterile field and nonsterile personnel who work outside the sterile field. All intraoperative team members work together to protect patient safety throughout the intraoperative experience. During the intraoperative phase, the patient is transferred to the operating room table. A time- out is initiated by the circulating nurse once the patient is safely situated on the operating room table to ensure that the right patient, right procedure, and right surgical site are verified before the patient is anesthetized. The patient is then anesthetized, positioned, prepped, and draped for surgery. The surgeon then completes the surgical procedure. The patient is continuously monitored throughout the surgery for complications related to surgery or anesthesia. The circulating nurse is the patient’s advocate who monitors for possible complications, positions the patient to avoid injury, documents all priorities of care and interventions, and communicates any concerns to the surgical team. The intraoperative phase of surgery ends when the patient is transferred to the PACU. (sherpath): Ongoing detailed assessments conducted by the PACU nurse include the following: General health and appearance Level of consciousness and neurologic status Vital signs and pain level Respiratory system: breath sounds, rate, rhythm, depth, use of accessory muscles, gag reflex Oxygenation saturation and capillary refill Skin color and temperature Patency of IV lines, IV fluids, and infusion rate Patency of drains Urinary output  Surgical site Dressing drainage (type, amount, and color) Drainage under the patient Ability to move all extremities Presence or lack of nausea and vomiting Laboratory results 39. prophylaxis against surgery-related VTE Prophylaxis against surgery-related venous thromboembolism (VTE) includes both pharmacological and mechanical interventions. Pharmacological options like low- molecular-weight heparin or other anticoagulants may be prescribed based on the patient's risk factors. Mechanical prophylaxis involves the use of intermittent pneumatic compression devices, graduated compression stockings, and early ambulation to promote venous return and prevent stasis. As a nurse, you play a vital role in assessing VTE risk, implementing prescribed prophylaxis measures, monitoring for adverse effects, and encouraging mobility. Effective VTE prophylaxis requires an interprofessional approach and adherence to evidence-based guidelines to ensure patient safety during the perioperative period. 40. complications associated with smoking tobacco and vaping Smoking tobacco and vaping are associated with numerous health complications: Tobacco smoking increases the risk of lung cancer, heart disease, stroke, COPD, and other respiratory diseases. It also raises the risk of cancers of the mouth, esophagus, liver, bladder, kidney, cervix, and myeloid leukemia. — Smoking during pregnancy can lead to low birth weight, preterm delivery, and reduced lung function in babies. Vaping and e-cigarette use have been linked to lung injuries like bronchiolitis obliterans ("popcorn lung"), worsening of existing lung conditions, and the 2019 outbreak of e- cigarette or vaping product use-associated lung injury (EVALI). The lithium batteries and toxic flavorings in vaping products pose additional risks like burns, explosions, and respiratory issues. Both tobacco and vaping expose users to nicotine, an addictive substance with cardiovascular effects. 41. pulmonary function test Pulmonary function tests (PFTs) are a group of tests that measure how well the lungs are working. They assess lung volumes, capacities, flow rates, and gas exchange. Common PFTs include spirometry to measure forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1), which help diagnose obstructive or restrictive lung diseases. Other tests evaluate diffusing capacity across the alveolar-capillary membrane, airway resistance, and distribution of ventilation. PFTs aid in diagnosing conditions like asthma, COPD, interstitial lung disease, and monitoring disease progression or response to treatment. Proper administration and interpretation by trained personnel are crucial for accurate results. 42. purpose of a blood type and crossmatch The purpose of a blood type and crossmatch is to ensure safe blood transfusion by determining compatibility between the donor's blood and the recipient's blood. The blood typing identifies the ABO and Rh groups, while the crossmatch detects any antibodies in the recipient's plasma that may react against the donor's red blood cells. This prevents potentially life-threatening hemolytic transfusion reactions caused by incompatible blood types. Proper blood typing and crossmatching are critical steps before any blood transfusion to maximize safety and minimize risks for the patient. Blood Groups and Types. Blood transfusions must be matched to each patient to avoid incompatibility. RBCs have antigens in their mem-branes; the plasma contains antibodies against specific RBC antigens. If incompatible blood is transfused (i.e., a patient's RBC antigens differ from those transfused), the patient's antibodies trigger RBC destruction in a potentially dangerous transfusion reaction (i.., an immune response to the transfused blood components). The most important grouping for transfusion purposes is the ABO system, which identifies A, B, O, and AB blood types. Determination of blood type is made on the basis of the presence or absence of A and B RBC antigens. Individuals with type A blood have A antigens on their RBCs and antit-B antibodies in their plasma. Individuals with type B blood have B antigens on their RBCs and anti-A antibodies in their plasma. A person who has type AB blood has both A and B antigens on the RBCs and no antibodies against either antigen in the plasma. A type O individual has neither A nor B antigens on RBCs but has both anti-A and anti-B antibodies in the plasma (Gorski, 2018). Table 42.14 shows the compatibilities between blood types of donors and recipi-ents. People with type O-negative blood are considered universal blood donors because they can donate packed RCs and platelets to people with any ABO blood type. People with type AB-positive blood are called universal blood recipients because they can receive packed RBCs and platelets of any ABO type. Another consideration when matching blood components for transfusions is the Rh factor, which refers to another antigen in RBC membranes. Most people have this antigen and are Rh positive; a person without it is Rh negative. People who are Rh negative receive only Rh-negative blood components. (chapter 42 page 1071 when caring for your patient who’s prescribed an antiemetic, begin by performing a baseline GI assessment, including bowel sounds, the onset and frequency of nausea and vomiting, as well as the amount and contents of the emesis. Then assess their vital signs and check their most recent laboratory test results, including electrolytes and urinalysis, as well as diagnostic tests like ECG, as needed. Also, review your patient’s medication list to determine if any medication interactions are present. During care, be sure an emesis basin is nearby, and provide mouth care to maintain good oral hygiene after episodes of vomiting. Monitor your patient closely for side effects and evaluate the effectiveness of antiemetic therapy. Now if your patient is being discharged home on an antiemetic, focus your teaching on safe self-administration. Teach them to take their medication exactly as prescribed. Encourage them to drink clear liquids as tolerated and explain that sipping small amounts of fluid every 15 to 20 minutes is often better tolerated than drinking large amounts of liquids less often. As their symptoms begin to decrease, let them know that they could try eating foods that contain a lot of liquid in them, such as gelatin or popsicles. Then, they can try eating foods that can help settle their stomach, such as crackers or dry toast. Advise them to avoid taking any over-the-counter medications during therapy and to avoid alcohol since it can worsen the sedative effects of antiemetics. Next, teach them to avoid driving motor vehicles or participating in any activities that require alertness until they are aware of how the medication affects them. Lastly, instruct your patient to contact their health care provider if their nausea does not resolve or if it gets worse. — If they're prescribed promethazine, advise them to report side effects such as restlessness, muscle rigidity, facial grimacing, changes in their mental status, or fever. — For patients prescribed ondansetron, advise them to report side effects like palpitations, flushing, or confusion. Alright, as a recap.... Antiemetics are used to treat nausea and vomiting. Dopamine antagonists, like promethazine, block D2 receptors in the chemoreceptor trigger zone, while serotonin antagonists, like ondansetron, block 5-HT3 receptors in the chemoreceptor trigger zone and the vagal nerve in the upper GI tract. Important side effects for promethazine include extrapyramidal symptoms and neuroleptic malignant syndrome. Promethazine also has two Black Box warnings including tissue necrosis with IV use and respiratory depression in children younger than 2 years old. For ondansetron, important side effects include QT prolongation and serotonin syndrome. Nursing considerations for antiemetic therapy include establishing a baseline assessment, monitoring for side effects, evaluating the effectiveness of therapy, and providing teaching for safe self- administration. (osmosis video)