Preop Nursing Exam Study Guide PDF

**[UNIT 2 EXAM STUDY GUIDE]** **[PREOP NURSING]** Preop nurse is a patient educator, advocator and admissions nurse It is crucial for the preop nurse to identify any needs the patient may have while in their care. - Full medical History (including prescription and over the counter medicati...

**[UNIT 2 EXAM STUDY GUIDE]** **[PREOP NURSING]** Preop nurse is a patient educator, advocator and admissions nurse It is crucial for the preop nurse to identify any needs the patient may have while in their care. - Full medical History (including prescription and over the counter medication, herbal and alternative therapies) - Assessment of patient's health status - Collection of information and paperwork necessary for intraoperative and postoperative care - Completion of preoperative orders (IV antibiotics, thromboembolic-deterrent (TED) hose, etc.) - Patient education regarding entire surgical process - Verifying that the patient and a witness signed the informed consent - The initial time-out when the patient verifies the following: 1. All information on the identification band is correct---full name and one other identifier 2. The name of the surgeon 3. The procedure that will be completed by the surgeon 4. The correct side of the body on which the surgery will occur if this is a unilateral procedure - Make sure the surgical consent is signed - Witnessing the consent - Make sure anesthesia consent is signed - Make sure the POA or DPA/DNR is in the file (advanced directives) Informed consent---when the patient autonomously and cognitively grants permission to a provider to perform a surgical procedure after considering all alternatives, benefits, and risks of the procedure. It is the nurses responsibility to make sure the patient has all the information needed to make an informed decision about the procedure being offered. - Components of a consent include the following: - Consent for the procedure itself - Name of surgery, type of surgery, and reason for the surgery - Name of the surgeon to perform the surgery - Reason that intervention will benefit patient - All alternative options to surgery - Potential outcomes if surgery is not performed Consent for anesthesia Consent for blood products to be given---the nurse must be aware of cultural and religious obligations that prevent the patient from consenting to receive blood products. Inability to consent---special consideration occur when the patient is not able to consent for care. These situations include: - Patients who are unable to sign their name, - A patient who is deaf - A patient who speaks another language - A minor - Emergency situations Patient Assessment: - Medical history - Social history - Surgical history Questions to ask the patient: - Age - Allergies - Current meds/OTC, vitamins/herbal supplements - Medical history - Surgical history - Previous anesthesia and/or complications - Last oral intake - Medical implants or devices - Piercings - Dental implants - Family history - Social history, drinking, smoking, illicit drugs - Support system - Advanced directives Physical Assessment: - Height - Weight - Vital signs - Pain scale Head to Toe Assessment: - Peripheral pulses - Color of skin - Skin turgor - Cap refill - Temperature - Edema - Auscultate heart and lungs - Breathing, rate/depth/rhythm/breath sounds - Pulse ox - General cognition, understands commands - Movement, strength, sensation in extremities - Skin integrity - Skin hygiene - Bowel sounds - Urine output/ catheter/ color/ smell/ look Lab Assessment: - Blood type - Metabolic panel (renal/liver) - Coagulation - CBC - WBC Radiological Assessment: - MRI - CT Scan - Cat Scan - X-ray - EKG/ECG Prep for surgery: - Patient teaching - Guidance - Recovery - Dvt's - Mobility - Prevention of pneumonia Physical Prep: - IV - Bowel / bladder elimination - Skin - Medications/antibiotics Patient Transfer: (The last thing for the preop nurse to do). **ALL MUST BE DOCUMENTED IN CHART UPON HANDOFF TO OR** - Pt ID - Physical prep - Confirm NPO - Medical history - Admission vitals - Lab work - Allergy bracelet - Initial time out - Copies of documentation - Pt education with verbalized return info - Pt and family questions answered **[Intraoperative care]** Surgical Team: **Sterile team members** - Surgeon - Surgical assistant - Scrub nurse/surgical technician/ OR technician - Anesthesia - Circulating nurse - UAP - OR Director/Coordinator/Manager Surgical Settings: - Inpatient more than 24 hours - Ambulatory or outpatient less than 24 hours - Elective - Urgent Surgical Time Out: - Correct patient - Correct procedure - Correct position - Correct equipment - Correct imaging - Correct site/ side/ location - Does patient have an implant - Does patient have a pacemaker - Does patient need antibiotics - Fire risk assessment Surgical Scrub: Nails are short and clean, jewelry removed, wash hands thoroughly was with disposable antimicrobial sponge for 3- 5 minutes. Instead of prewashing hands you can use a waterless alcohol-based prep. Surgical Attire: Scrubs, sterile gown, mask, hair cap, booties, sterile gloves, protective eyewear, sturdy footwear. **[Types of surgeries:]** - Emergency surgery---surgery must be done immediately to save a patient's life, limb, or ability to function - Urgent Surgery---surgery must be done within 24 to 48 hours to prevent permanent injury to the patient or death - Elective surgery---surgery that may be necessary but can be planned around the patients and surgeon's schedule - Ambulatory/Outpatient surgery---surgery usually performed in 1 day with the patient being admitted to the ambulatory surgical center in the morning and discharged after recovery criteria is met - Exploratory surgery---surgery performed to obtain a diagnosis and possible resolution - Ablative surgery---surgery to remove tissue from an organ or area of the body - Palliative Surgery---surgery performed to decrease pain or symptoms in patients suffering from incurable illnesses - Reconstructive Surgery---surgery to restore function or a defect in an area of the body - Cosmetic---Surgery to change or revise an area or structure of the body - Minimally Invasive Surgery---Surgery performed through very small openings in the skin, using instruments through which the surgeon can visualize the area such as a laparoscope - Telesurgery or robotic surgery---surgery performed from a location other than the surgical sit, by use of robotic equipment. **[Types of Anesthesia]** General: Reversible unconscious state/ this requires ventilatory support. - Can be alone or in combination with the following a. Volatile agents (inhalation of gas) b. IV agents c. Muscle relaxants - Hypoxia - Respiratory and cardiovascular disfunction - Hypo/hypertension - Fluid/ electrolyte imbalance - Residual muscle paralysis - Neurological problems, dementia, prolonged awakening - Malignant Hyperthermia MH (Malignant Hyperthermia)---volatile gas and or succinylcholine, sustained muscle contractions related to increased intracellular calcium ion concentration. Signs of MH: - Acidosis - Tachycardia - Glycolysis - Hypoxia - Hyperthermia MH is life threatening and must be treated immediately or the patient will die. Antidote: Dantrolene Cool patient quickly Educate family of patient of MH and that it can be inherited Regional Anesthesia: - Spinal (spinal column) - Spinal headaches - Lay patient flat on back head flat, pt may need a blood patch - Epidural (epidural space) - Caudal (regional sacrum) - Nerve blocks Local Anesthesia: Amides---vasoconstriction increased catecholamine release - Lidocaine - Bupivacaine - Increase hypertension - Tachycardia MAC (Monitored Anesthesia Care) Anesthesia without unconsciousness Patient can maintain own airway Responds to verbal commands Responds to physical stimulation **Objectives for MAC:** - Maintenance of Consciousness - Elevate of Pain threshold - Enhanced cooperation - Some degree of amnesia - Minimal variations of vital signs - Quick and safe return to daily living activity **[Airway management:]** - Protecting and insuring proper oxygenation and ventilation - Laryngospasm - Bronchial intubation - Tracheal intubation - Aspiration **[Common patient positions during surgery:]** - Supine---face up - Prone---face down - Lateral---side lying - Low lithotomy---supine legs apart and raised in leg rests **[Positioning Devices:]** - OR Bed - Head rest - Arm boards - Arm restraints - Padding - Blankets - Pillows - Safety straps - Sandbags - Beanbags - Towels - Foam pads - Gel devices Complications: - Pressure injuries Nursing Assessment: Nursing Diagnosis to be conscious of: - Risk for impairment tissue & skin integrity - Risk for infection - Risk for injury - Risk for knowledge deficit - Risk for potential unplanned hypothermia - Risk for potential thrombus Nursing Management: - Ensure OR consent is signed - Ensure correct patient positioning - Monitor donning of OR attire - Ensure supplies are available - Check fluid and instruments for temperature - Confirm flashed instruments are cool Action: - Preform time-out - Preform equipment safety check - Utilize sterile technique - Assist anesthesia with intubation - Properly ground the pt as indicated - Keep patient safety belt in place - Apply support hose and sequential compression devices - Keep patient warm - Maintain sterile field - Accurately record number of sponges and sharps - Accurately measure irrigation fluid - Keep OR closed - Keep hallways free of equipment Teaching: - Explain to patient what to expect - Keep family updated **Post Operative Care Nursing** **PACU (Post Anesthesia Care Unit)** Postoperative care begins immediately after surgery Close Observation (GOALS) - Wake up and resume normal body function - Control pain - Prevent complications Post Anesthesia Phases: - Phase I---Immediate post anesthesia period - Phase II---Prepare for discharge - Phase III---Extended Observation (criteria not met for discharge) PACU Settings: - Inpatient PACU - ICU - Outpatient PACU - Procedure Areas Patient care in PACU Setting: - Assessment and monitor - Timely intervention - Evaluate interventions - Reassess pt. condition - Evaluation Priority Assessment: - Airway - Respirations - Vital signs - Neuro function - Temperature - Pain - Dressings - Incisions - Patency of IV - Hydration Diagnostics: - Labs - Chest x-ray - ECG Pain Management: - PCA pump---only patient can administer medication, not family or HCP, if patient cannot administer patient is not a candidate PONV: (Post operative nausea and vomiting Complications PONV: - Increase length of stay - Decrease ability to perform activities - Delayed return to work - Increased ED visits PACU Risks: Requires frequent assessment - Respiratory depression - Bleeding from surgical site Older Adult Considerations: - Respiratory - Cardiac - Renal - Skin - Delirium - Immobility - Nutrition Nursing Management: - Vitals - Neurological - Peripheral pulses - Temperature - Color of skin - Urine output - Pain - Surgical incision Actions: - Connect ECG - Start assessment - Document vital signs - Hand off report from OR - Continuous monitoring - Medicate as ordered Teaching: - Family member (non-sedated person) - Communicate plan of care - Inform family when pt is in PACU - Allow visiting - Provide discharge instructions Postoperative Complications: - Atelectasis - Pneumonia - Pulmonary embolism - Hypoxemia - Hypoxia - Fluid and electrolyte imbalance - Tachycardia - Vasoconstriction - Dehydration - Surgical blood loss - Clot formation - Delirium - Postoperative ileus - Urinary retention - Surgical site infection (dehiscence) - Evisceration Nursing Care for inpatient: - Respiratory - Vitals - Peripheral profusion - Neurological - GI genitourinary - Skin/drains - Pain - Fluid and electrolyte volume Actions: - Respiratory - Fluid Management - Mobility - DVT prophylaxis - Diet Management - Surgical wound site/wound management - Pressure injury - Fall prevention - Managing constipation - Remove Folley Teaching: - Unit education - Safety topics - Discharge instructions **[PHARMACOLOGY]** **[GENERAL ANESTHESIA]** **[MEDICATIONS THAT MAY CAUSE ADVERSE REACTIONS WITH ANESTHESIA]** **[Medication Classification Mechanism of Action Exemplars Nursing Implications ]** 1. **[Antiarrhythmics\--]**Affect tolerance of anesthesia and potentiate neuromuscular blockers; depress cardiac function, output, and pulse Amiodarone (Cordarone) Sotalol (Betapace) Ibutilide (Covert) Dofetilide (Tikosyn) Dronedarone (Multaq) **Obtain baseline:** Electrocardiogram Vital signs **Monitor:** Vital signs during the procedure **Communicate:** All medications to anesthesia team 2. **[Antihypertensives\--]**Alter response to muscle relaxants and opioids. May cause hypotensive crisis during and after the procedure Captopril (Capoten) Clonidine HCl (Catapres) Metoprolol (Lopressor, Toprol XL) Atenolol (Tenormin) Losartan (Cozaar) Olmesartan (Benicar) Telmisartan (Micardis) Valsartan (Diovan, Entresto) **Monitor:** Blood pressures **Communicate:** All medications to anesthesia team 3. **[Corticosteroids\--]**Increase need for higher doses of steroids used for replacement therapy. May increase healing time because of blockage of collagen formation. Increase risk of hemorrhage and may mask signs of infection Dexamethasone (Decadron) Hydrocortisone (Cortef) Prednisone **Assess for:** Hyperglycemia Infection Bleeding Wound healing Splint incisions to promote healing Continue therapy during the procedure 4. **[Anticoagulants\--]**Inhibit clot formation through interaction in different stages of the coagulation cascade. Increase risk of hemorrhage Enoxaparin (Lovenox) Heparin Rivaroxaban (Xarelto) Warfarin (Coumadin) **Obtain:** Baseline coagulation studies Taper medication at least 48 hours before the procedure Have vitamin K (Coumadin) and protamine sulfate (heparin) available as antidotes if excessive bleeding occurs during the procedure 5. **[Antiplatelet agents\--]**Inhibit platelet aggregation to prevent clot development Aspirin (Bayer aspirin, Ecotin) Clopidogrel (Plavix) Inform physicians if the medication has not been withheld before surgery Monitor for excessive bleeding Nonsteroidal anti-inflammatory drugs (NSAIDs) May prolong bleeding time and may cause intraoperative or postoperative bleeding Ibuprofen (Motrin, Advil) Naproxen (Aleve, Naprosyn, Anaprox**[)]** Inform physicians if the medication has not been withheld before surgery 6. **[Anticonvulsants\--]**May alter the metabolism of anesthesia Phenobarbital (Nembutal) Phenytoin (Dilantin) Be alert for the potential of seizures, which can cause injury during a procedure Maintain medication schedule Have suction and oral airway available 7. **[Insulin\--]**Decreased need for insulin during the preoperative period due to decreased oral intake Increased need postoperatively due to the stress of the surgery increasing glucose release Needs may fluctuate postoperatively because of decreased oral intake. Closely monitor blood glucose levels preoperatively, intraoperatively, and postoperatively. NOTE: Antihypertensives---cause hypotension Beta Blockers---increase myocardial depression Anesthetics: Drugs that reduce or eliminate pain by depressing nerve function in the CNS &PNS. General Anesthetics: - Given by Anesthesiologist - CRNA - Anesthesia assistant They produce varying degrees of: - Pain relief - Depression consciousness - Skeletal muscle relaxation - Reflex reduction Inhalation Anesthetics: - Volatile liquids or gases that are vaporized in oxygen and inhaled. Parenteral Anesthetics: - Administered through IV Adjunct Anesthetics: - Drugs that enhances clinical therapy when used simultaneously with another drug. Contraindications of anesthesia: - Family history of MH - Allergy to anesthetic - Pregnancy - Narrow angle glaucoma - Acute porphyria Adverse Effects of Anesthesia: - Cardia issues - Peripheral circulation - Liver - Kidney - Respiratory tract - Myocardial depression - PONV - MH - Toxicity or overdose **[Drugs:]** Dexmedetomidine (Precedex) - Alpha 2---adrenergic receptor/agonist - Decreases anxiety without respiratory depression - Procedural sedation with short surgeries - Short ½ life - Awakens quickly - Used in ICU sedation of a patient on a mechanical ventilator Ketamine: - IV, general or MAC - IM - Rapid onset - Decreased incidence of reduction of cardiovascular respiratory and bowel functions Adverse Effects of Ketamine: Disturbing psychomimetic effects (Hallucinations) Nitrous Oxide: - Only inhaled gas used as general anesthesia - The weakest anesthetic - Used mostly in dental procedures - Supplement to general anesthesia - Used with children a lot Propofol (Diprivan) - Parental general anesthetic - Induction and maintenance of anesthesia - Sedation for mechanical ventilators - Decrease doses serves as a hypnotic affect - Monitor triglycerides - Some states prohibit nurse administration Sevoflurane (Ultane) - Fluorinate ether - Inhaled volatile gas - Rapid onset - Rapid elimination - Outpatient surgery setting - Nonirritating to airway - Induction of unconscious state - Used in pediatrics Moderate Sedation:\--MAC---may be used together or alone - IV benzodiazepine - Midazolam - Propofol - Fentanyl - Morphine These medications decrease pain, anxiety and they are hypnotic Local Anesthesia: - Topical - Parenteral Types of Local Anesthesia: - Spinal/ intraspinal, intrathecal or epidural - Infiltration - Nerve block - Topical - Peripheral nerve catheter Drugs that are Local Anesthetics: - Bupivacaine - Chloroprocaine - Mepivacaine - Prilocaine - Procaine - Propxycaine - Ripivacaine - Tetracaine Effects: - Autonomic activity lost - Pain and sensory functions - Motor skills Recovery: - Motor skills - Pain and Sensory - Autonomic Neuromuscular Blocking Drugs: - Prevent nerve transmission --Skeletal and Smooth muscles - Paralyzes - Used with anesthesia during surgery - Intubation - Do not cause sedation or pain relief - Paralyzes but patient is conscious - NMBD's (HAVE BLACK WARNING LABELS) Depolarizing Drugs: - Work with acetylcholine Nondepolarizing Drugs: - Block action of acetylcholine - Short acting - Intermediate acting - Long acting Contraindications: - MH - Adverse effects - Toxicity/ overdose Antidotes---Anticholinesterase Drugs: - Neostigmine - Pyridostigmine - Edenophonium Rocuronium (Zemuron) - Rapid intermediate acting - Adjunct to general anesthesia - Tracheal intubation - Skeletal muscle relaxation Implications: - Assess history of surgery and anesthesia - Ass past history of allergies and medications - Assess use of ETOH, illicit drugs, opioids - Assess vitals preop/intraop/postop - Monitor cardiovascular depression - Respiratory depression Complications of anesthesia: - Implement safety measures - Reorient pt to surroundings - Tech pt post op turn head and cough and deep breathing Table 15.1 Current Medications and Possible Implications Medication Classification Mechanism of Action Exemplars Nursing Implications +-----------------+-----------------+-----------------+-----------------+ | Antiarrhythmics | Affect | Amiodarone | Obtain | | | tolerance of | (Cordarone) | baseline: | | | anesthesia and | | | | | potentiate | Sotalol | | | | neuromuscular | (Betapace) | Electrocardiogr | | | blockers; | | am | | | depress cardiac | Ibutilide | | | | function, | (Covert) | Vital signs | | | output, and | | | | | pulse | Dofetilide | Monitor: | | | | (Tikosyn) | | | | | | Vital signs | | | | Dronedarone | during the | | | | (Multaq) | procedure | | | | | | | | | | Communicate: | | | | | | | | | | All | | | | | medications to | | | | | anesthesia team | +=================+=================+=================+=================+ | Antihypertensiv | Alter response | Captopril | Monitor: | | es | to muscle | (Capoten) | | | | relaxants and | | Blood | | | opioids | Clonidine HCl | pressures | | | | (Catapres) | | | | May cause | | Communicate: | | | hypotensive | Metoprolol | | | | crisis during | (Lopressor, | All | | | and after the | Toprol XL) | medications to | | | procedure | | anesthesia team | | | | Atenolol | | | | | (Tenormin) | | | | | | | | | | Losartan | | | | | (Cozaar) | | | | | | | | | | Olmesartan | | | | | (Benicar) | | | | | | | | | | Telmisartan | | | | | (Micardis) | | | | | | | | | | Valsartan | | | | | (Diovan, | | | | | Entresto) | | +-----------------+-----------------+-----------------+-----------------+ | Corticosteroids | Increase need | Dexamethasone | Assess for: | | | for higher | (Decadron) | | | | doses of | | Hyperglycemia | | | steroids used | | | | | for replacement | Hydrocortisone | Infection | | | therapy | (Cortef) | | | | | | Bleeding | | | May increase | Prednisone | | | | healing time | | Wound healing | | | because of | | | | | blockage of | | Splint | | | collagen | | incisions to | | | formation | | promote healing | | | | | | | | Increase risk | | Continue | | | of hemorrhage | | therapy during | | | and may mask | | the procedure | | | signs of | | | | | infection | | | +-----------------+-----------------+-----------------+-----------------+ | Anticoagulants | Inhibit clot | Enoxaparin | Obtain: | | | formation | (Lovenox) | | | | through | | Baseline | | | interaction in | Heparin | coagulation | | | different | | studies | | | stages of the | Rivaroxaban | | | | coagulation | (Xarelto) | Taper | | | cascade | | medication at | | | | Warfarin | least 48 hours | | | Increase risk | (Coumadin) | before the | | | of hemorrhage | | procedure | | | | | | | | | | Have vitamin K | | | | | (Coumadin) and | | | | | protamine | | | | | sulfate | | | | | (heparin) | | | | | available as | | | | | antidotes if | | | | | excessive | | | | | bleeding occurs | | | | | during the | | | | | procedure | +-----------------+-----------------+-----------------+-----------------+ | Antiplatelet | Inhibit | Aspirin | Inform | | agents | platelet | (Bayer aspirin, | physicians if | | | aggregation to | Ecotin) | the medication | | | prevent clot | | has not been | | | development | Clopidogrel | withheld before | | | | (Plavix) | surgery | | | | | | | | | | Monitor for | | | | | excessive | | | | | bleeding | +-----------------+-----------------+-----------------+-----------------+ | Nonsteroidal | May prolong | Ibuprofen | Inform | | anti-inflammato | bleeding time | (Motrin, Advil) | physicians if | | ry | and may cause | | the medication | | drugs (NSAIDs) | intraoperative | Naproxen | has not been | | | or | (Aleve, | withheld before | | | postoperative | Naprosyn, | surgery | | | bleeding | Anaprox) | | +-----------------+-----------------+-----------------+-----------------+ | Anticonvulsants | May alter the | Phenobarbital | Be alert for | | | metabolism of | (Nembutal) | the potential | | | anesthesia | | of seizures, | | | | Phenytoin | which can cause | | | | (Dilantin) | injury during a | | | | | procedure | | | | | | | | | | Maintain | | | | | medication | | | | | schedule | | | | | | | | | | Have suction | | | | | and oral airway | | | | | available | +-----------------+-----------------+-----------------+-----------------+ | Insulin | | | Decreased need | | | | | for insulin | | | | | during the | | | | | preoperative | | | | | period due to | | | | | decreased oral | | | | | intake | | | | | | | | | | Increased need | | | | | postoperatively | | | | | due to the | | | | | stress of the | | | | | surgery | | | | | increasing | | | | | glucose release | | | | | | | | | | Needs may | | | | | fluctuate | | | | | postoperatively | | | | | because of | | | | | decreased oral | | | | | intake | +-----------------+-----------------+-----------------+-----------------+ **[Antibiotics:]** Gram (+) Gram (-) HAI (Healthcare associated infections: (MRSA)---Staphylococcus aureus - Hand washing - Antiseptics---applied to living tissue - Disinfectants---applied to surfaces Antibiotic Therapy: - Empiric Therapy- medical treatment based on clinical experience and probability rather than definitive diagnostic - Definitive Therapy- Treatment plan intended to provide a definitive cure or long term control of a disease or illness, after empirical therapy has failed. - Therapeutic Responses-shows decreased signs of infection - Subtherapeutic response-signs and symptoms do not improve Super infection: [C-DIFF---Common difficulties] - Secondary infection - Resistance - Food drug interactions - Host factors Allergic Reactions: Penicillin's/ Sulfonamides - Anaphylactic reactions - Decreased respirations - Rash - Hives - GI intolerance - OB related host factors - Anatomic site infection **CLASSES OF ANTIBIOTICS:** - **Sulfonamides** - **Penicillin's** - **Cephalosporins** - **Macrolides** - **Quinolones** - **Aminoglycosides** - **Tetracyclines** Sites of activity - Cell wall synthesis - DNA replication - RNA replication - Antimetabolites - Protein synthesis 30 s ribosome - Protein synthesis 50 s ribosome Mechanism of Actions: - Interferes with cell wall synthesis - Interferes protein synthesis - Interferes DNA replication - Metabolite Actions: - Bactericidal---kills bacteria - Bacteriostatic---inhibits growth **[Breaking antibiotics down by class:]** Sulfonamides: First group of antibiotics Combined with other antibiotics Action: - Bacteriostatic - Gram + - Gram -- - UTI's - Pneumonia - Upper respiratory tract infections - SMX-TMP - Hemolytic and aplastic anemia - Agranulocytes, thrombocytopenia - Photo sensitivity - Dermatitis - Steven Johnson's syndrome - Epidermal necrolysis - Nausea - Vomiting - Diarrhea - Pancreatitis - Hepatoxicity - Convulsions - Toxic nephrosis - Headache - Peripheral neuritis - Urticaria - Cough Beta-Lactam Antibiotics: - Penicillin's - Cephalosporins - Carbapenems - Monobactams - Penicillin G - Penicillin V - Nafcillin - Cloxacillin - Oxacillin - Dicloxacillin - Amoxicillin - Ampicillin - Carbenicillin - Piperacillin - Ticarcillin - Enter cell wall-get to bacteria - Binds to penicillin - Once bound---normal cell synthesis is disrupted - Bacteria dies from lysis - Gram + - Drug allergies. (zosyn, augmentin) - Allergic - Nausea - Vomiting - Diarrhea - Abdominal Pain - Many Interactions - Non-steroidal Anti-inflammatory drugs. Oral contraceptives, warfarin Cephalosporins: - Semisynthetic - Related to penicillins - Bactericidal - Broad spectrum - 2 groups - Gram + - Parenteral/ PO - Cefadroxil (Duricef, Ultracef) - Cephradine (Veloset - Cafazolin (anceft) - Cephlexin (Kelfex) Uses: - Surgery Prophylaxis - Gram + - Better with gram -- than first gen - IV, IM, PO - Cefaclor (Ceclor) - Cetprozil (Cefzil) - Cefoxitin (Mefoxin) - Cefuroxime (Zinacef) - Cefotetan (Cefotan) - Gram -- - Gram + - Ceftotaxime (Claforan) - Ceftazidime (Fortaz) - Cefdinir (Omnicef) - Ceftriaxone (Rocephin) IV IM, CNS Infections - Cefpodoxime - Ceftibuten (Cedax) - Cefiderocol (Fetroia) - Gram + - Broad spectrum - UTI - Cefepime (Maxipime) - Enhances Gram -- - Zerbaxa - Broader Spectrum - Telflaro\--MRSA Adverse Effects: Similar to pencillin Carbapenems: Indications: - Broadest spectrum antibiotic - Complicated body cavity connective tissue infections - Infuse over 60 minutes - Drug induced seizures Types of Carbapenems: - Imipenem/Cilastatin (Primaxin) - Bone Joint Skin Soft Tissue - Meropenem (Merrem) - Ertapenem (Invanz) - Doripenem (Doribax) Monobactams: - Aztreonam (Azactam)---E-Colli - Bactericidal - Parenteral Use only - Moderate to severe systemic UTI's Macrolides: - Erythromycin - Azythromycin - Clarithromycin - Fidaxomicin - Strep - Upper and Lower respiratory infections - Influenza - Syphilis - Lyme disease - Gonorrhea - Chlamydia - Mycoplasma Fidaxomicin: Newest Antibiotic Adverse Effects - N/V - GI Bleed - C-Diff - Minimal Absorption Tetracyclines: Wide Spectrum: Gram +, Gram - Natural and systemic, always obtain cultures before dosing patient, it is a bacteriostatic drug. Types of Tetracyclines: - Demeclocycline - Oxytetracycline - Tetracycline - Doxycycline - Minocycline - Tigecycline All products that decrease the absorption of Tetracyclines: - Dairy Products - Antacids - Iron - Salts Warning : Tetracyclines bind to calcium and will cause tooth discoloration in young children, babies - do not use children under 8 - Pregnant women - Lactating women/breast feeding Alters intestinal flora and causes the following - Superinfection (Candida Spp) - Diarrhea - Colitis - Yeast Infections - GI Upset - Entercolitis - Rash Things to check when patient is taking tetracylines: - Renal, liver, and cardiac functions - Health history - Drug interactions---what meds are they taking - Culture infected area before starting antibiotic - Take as prescribed - Assess for superinfection Sulfonamides: Take with 2000-3000mL of fluid in 24 hr period Assess RBC before therapy Take oral doses with food Cephalosporins: Assess penicillin allergy Give oral with food No alcohol Macrolides: Protein bound drugs (interactions) Absorption of erythromycin on empty stomach Need to take after a meal or snack Tetracyclines: Avoid milk products, iron, antacids Take with 6-8 ounces of water Photosensitivity **[IV Antibiotics]** For serious infections such as: MRSA ESBL CRO These patients are placed on contact isolation HAND WASHING IS ESSENTIAL MRSA---Hospital and Community VRE---Found in Urine ESBL---resistant to beta lactam---ineffective have to use carbapenems Aminoglycosides: TOXCICITIES OTOTOXCITY---EAR\--HEARING NEPHROTOXCICITY---KIDNEY---RENAL - Gentamicin - Neomycin - Tobramycin - Amikacin - Plazomicin - For nephrotoxic drug---use loop diuretics (antidote) - Reduces the amount of vitamin K - Do not use in Warfarin Patients - Do not use with neuromuscular blocking drugs QUINONES: End in floxacin Alters DNA killing bacteria BLACK BOX WARNING: Tendinitis, tendon rupture (increased ages), seizures, exacerbation of myasthenia gravis Clindamycin: - C-Diff - Vancomycin resistant enterococcus - MRSA - Serotonin Syndrome (SSRI's) - Anaerobic organisms - Acute alcohol intolerance - UTI's - Can cause fatal hepatoxicity - Measure TROUGH 10-20 mcg/mL - Can cause Ototoxicity - Can cause Nephrotoxicity - Neuromuscular Hypotension - Take other meds 1 hour prior to or after antibiotic - Slow infusion rate - Give Benadryl for reaction - Drug allergies - Hepatic, renal, cardiac complications - Labs - Health history - Immune status - Drug interactions - Obtain cultures before dosing - Give antibiotics - Assess for superinfections - Check name on med bank - Look alike sound alike drugs Ciprofloxacin: - Treats anthrax - Monitor therapeutic effects Aminoglycosides/ Vancomycin---MONITOR TROUGH LEVELS   Question 1 of 15  Report content error Which statement correctly describes the difference between the action of a spinal anesthesia and epidural anesthesia? - - Spinal anesthesia involves injection through the sacral hiatus, and epidural anesthesia involves injection into the epidural space. - **Correct** - Spinal anesthesia involves the injection into the subarachnoid space, and epidural anesthesia involves injection into the epidural space. - - Spinal anesthesia involves injection into the subdural space, and epidural anesthesia involves injection into the cerebrospinal fluid (CSF). - - Spinal anesthesia involves injection into the lower end of the spinal cord, and epidural anesthesia involves injection into the epidural space. Question 2 of 15  Report content error A patient is undergoing surgery and receiving a neuromuscular blocking agent, a short-acting barbiturate, and nitrous oxide. To achieve balanced anesthesia, which drug would be added to this drug regimen? - **Correct** - An opioid - - An additional dose of propofol - - An additional dose of nitrous oxide - - A benzodiazepine Question 3 of 15  Report content error Which drug diffuses rapidly in the arterial vascular system and crosses the blood-brain barrier to produce amnesia, skeletal muscle relaxation, and hypnosis? - - Propofol - - Diazepam - **Correct** - Isoflurane - - Thiopental sodium Question 4 of 15  Report content error The rate of absorption for topical lidocaine is determined by which factor? - - Amount of lidocaine applied - **Correct** - Blood flow to the area - - Frequency of lidocaine applied - - Tissue surrounding area of application Question 5 of 15  Report content error A nurse is getting ready to start a peripheral IV on a pediatric patient. Which form of lidocaine would be appropriate? - - Oral sedative - **Correct** - Topical preparation - - Subcutaneous injection - - Intramuscular injection Question 6 of 15  Report content error The health care provider has administered an appropriate dose of lidocaine for a local anesthetic. The patient still has sensation and mobility. Which statement describes what is happening? - - The drug is being absorbed rapidly. - - The drug is not being metabolized. - **Correct** - The drug is being absorbed more slowly than it is being metabolized. - - The drug is being absorbed much more rapidly than it is being metabolized. Question 7 of 15  Report content error A patient with poor perfusion to the right lower extremity is receiving topical lidocaine for a wound debridement. Which statement regarding the absorption of lidocaine in this patient is accurate? - **Correct** - Absorption will be slower than normal. - - Absorption will be faster than normal. - - Absorption rate is unknown and is dependent upon dosage. - - Absorption rate is unknown and is dependent upon frequency. Question 8 of 15  Report content error The nurse is caring for four patients who have all received lidocaine. Which patient symptom would the nurse assess first? - - Nausea - - Diarrhea - **Correct** - Rash and itching all over - - Pain increasing with movement Question 10 of 15  Report content error Which clinical manifestation indicates that a patient is exhibiting cardiac toxicity to lidocaine? - - Seizure - **Correct** - Bradycardia - - Bradypnea - - Tachypnea Question 11 of 15  Report content error A patient who is about to undergo surgery states, "My parents tell me I had a horrible response to anesthesia as a child." Which action would the nurse **most** likely anticipate? - - The surgery will be cancelled. - - A chest x-ray will be ordered. - - Nothing will be done because the patient does not know what actually happened. - **Correct** - The health care provider would discuss family history with the patient to get more information. Question 12 of 15  Report content error Which clinical manifestation indicates that a patient is exhibiting central nervous system (CNS) toxicity to lidocaine? - **Correct** - Seizure - - Heart block - - Tachypnea - - Hypertension Question 13 of 15  Report content error The nurse would educate the patient that which symptoms may occur with topical lidocaine? - - Redness - **Correct** - Burning - **Correct** - Stinging - - Swelling - **Correct** - Tenderness Question 14 of 15  Report content error Which statement is correct for patient teaching in preoperative preparation of receiving lidocaine for an epidural block? - **Correct** - "You will temporarily lose feeling and the ability to move below the waist." - - "You will temporarily lose feeling below the waist, but you'll still be able to move your legs." - - "We will only need to take vital signs to start but won't have to bother you once the epidural is in place." - - "We will need to take vital signs every 5 minutes while the epidural is in place." Question 15 of 15  Report content error The nurse teaches a patient prescribed a lidocaine patch that which symptom needs to be reported to the health care provider? - **Correct** - Drowsiness - - Hypertension - - Increased urine output - - Decreased sensation Question 9 of 15  Report content error Epinephrine is mixed with lidocaine for which purpose? - **Correct** - Prolong anesthesia - - Provide additional pain relief - **Incorrect** - Prevent thrombosis at injection site - - Decrease swelling at injection site Question 1 of 17  Report content error Which antibacterials are effective against *Pseudomonas aeruginosa*? - **Correct** - Piperacillin - **Correct** - Ceftriaxone - - Vancomycin - **Correct** - Cefepime - - Penicillin G (PCN G) Question 2 of 17  Report content error The nurse is preparing antibacterials for several patients. For which type of infection would a patient receive oxacillin? - **Correct** - Cardiac infection with a staphylococcal species - - Severe urinary infection with *E. coli* - - *C. difficile* infection that is resistant to penicillin (PCN) - - Severe tonsillitis with streptococcal species Question 3 of 17  Report content error For which patient would the nurse seek clarification if amoxicillin was prescribed? - - Patient who is pregnant and has a urinary infection - - Patient who is a diabetic and has a skin infection - **Correct** - Patient who has asthma with a throat infection - - A child with a respiratory infection Question 4 of 17  Report content error A patient developed pseudomembranous colitis after being on oral antibiotics for 4 days. Which drug would the nurse anticipate administering? - - Oral gentamicin - **Correct** - Oral vancomycin - - Intravenous (IV) gentamicin - - IV vancomycin Question 5 of 17  Report content error Which cephalosporin would the nurse anticipate administering to a patient diagnosed with an infection that is resistant to methicillin (methicillin-resistant *Staphylococcus aureus* \[MRSA\])? - - Cefepime - - Ceftriaxone - - Cefoxitin - **Correct** - Ceftaroline Question 7 of 17  Report content error For which patient condition would the nurse seek clarification before administering clindamycin? - - Mild renal impairment - - Skin infection - - Irritable bowel syndrome (IBS) - **Correct** - Advanced liver disease Question 8 of 17  Report content error Sulfamethoxazole-Trimethoprim (SMX-TMP) has a half-life of 8 to 10 hours. Which dosing schedule would be appropriate for SMX-TMP? - - Every 6 hours - - Every 8 hours - **Correct** - Every 12 hours - - Every 24 hours Question 9 of 17  Report content error Which classes of antibacterials are effective against *E. coli*? - - Lincosamide - **Correct** - Sulfonamide - **Correct** - Aminoglycoside - - Tetracycline - **Correct** - Fluoroquinolone Question 10 of 17  Report content error Which statement is an accurate description of the pharmacokinetic action of tetracycline? - - Tetracycline is metabolized by the liver. - - Tetracycline is absorbed in the lower intestine. - - Tetracycline is primarily excreted in feces. - **Correct** - Tetracycline absorption decreases as the dose is increased. Question 11 of 17  Report content error For which patient condition would tetracycline be indicated as a first-line therapy? - - Urinary infection with *E. coli* - **Correct** - Gastric infection with *H. pylori* - - Pulmonary infection with *P. aeruginosa* - - Ear infection with *H. influenzae* Question 12 of 17  Report content error Which antibacterial drugs have protein binding of less than 40%? - - Erythromycin - **Correct** - Gentamicin - - SMX-TMP - - Tetracycline - **Correct** - Ciprofloxacin Question 13 of 17  Report content error For which prescription for ceftriaxone would the nurse seek clarification? - **Correct** - Ceftriaxone 1 g intravenous (IV) every 8 hours - - Ceftriaxone 1 g IV every 12 hours - - Ceftriaxone 1 g IV every 24 hours - - Ceftriaxone 1 g intramuscular (IM) daily Question 14 of 17  Report content error Which class of drugs can increase the risk for nephrotoxicity when coadministered with vancomycin? - - Oral contraceptives - **Correct** - Nonsteroidal antiinflammatory drugs (NSAIDs) - - Loop diuretics - - Anesthetics Question 15 of 17  Report content error Which antibacterial prescription would concern the nurse? - **Correct** - Vancomycin 1 g intravenous (IV) every 12 hours for *C. difficile* colitis - - Amoxicillin 500 mg by mouth every 8 hours for urinary tract infection (UTI) - - Cephalexin 500 mg by mouth every 12 hours for pharyngitis - - Clindamycin 600 mg IV every 8 hours for skin infection Question 16 of 17  Report content error A patient who takes a diuretic was prescribed erythromycin for bronchitis. Which teaching information would the nurse provide to the patient? - - "Be sure to take this drug every 12 hours with a full glass of water." - **Correct** - "Erythromycin can cause ringing in the ears. Notify your health care provider if you notice ringing in the ears." - **Correct** - "You may take the drug with food if the drug causes nausea." - - "You may have pain at the injection site because it is given in the muscle." - **Correct** - "You may need to increase your potassium supplement." Question 17 of 17  Report content error A patient was prescribed Sulfamethoxazole-Trimethoprim (SMX-TMP) for a skin infection. Which instructions would the nurse include in the discharge teaching? - **Correct** - "Use an alternate form of birth control." - **Correct** - "Avoid all alcohol products." - - "Notify your health care provider of any nausea." - **Correct** - "Be sure to apply sunscreen." - - "Be sure to take the medicine on an empty stomach." Question 6 of 17  Report content error For which reason is cilastatin administered with imipenem? - - Cilastatin prevents the elimination of imipenem. - **Correct** - Cilastatin prevents renal metabolism of imipenem. - **Incorrect** - Cilastatin prevents hepatic metabolism of imipenem. - - Cilastatin offers cardiac protection against imipenem.