Pharm Exam 2 Panopto (Updated) PDF

Mild to moderate Pain Can use: - Aspirin - NSAID - Acetaminophen (Tylenol) + If someone is bleeding - Don't give NSAID because it can cause further bleeding +...

Mild to moderate Pain Can use: - Aspirin - NSAID - Acetaminophen (Tylenol) + If someone is bleeding - Don't give NSAID because it can cause further bleeding + If someone has liver problems - Don’t give acetaminophen because it can cause further liver damage Aspirin + If you give too much aspirin - cause salicylism + Long term use - cause tinnitus + Don’t give to children because it causes Reyes Syndrome > Exceptions - Juvenile Rheumatoid Arthritis - Rheumatic Heart Fever - Kawasaki *make sure they don’t have viral infection because it can cause Reyes Syndrome Moderate to Severe Pain (need something stronger) Can use opioids such as : - Morphine - Vicodin - Oxycodone - Fentanyl + Monitor for Respiratory Failure - Monitor respirations + Antidote for Respiratory Failure - Narcan/Naloxone  Hospice Patients - Comfort measures are PRIORITY + Still check vital signs - Even when respiration are below normal range, pain medication is still given because the priority to provide comfort measures to the patient Side/Adverse Effects + Constipation - Listen to bowel sounds - Don’t paralytic ileus + Drowsiness/Sleepy + Orthostatic Hypotension - Make use they get up slowly from bed and slowly when they stand up - Prevent falls For severe pain + If have pancreatitis or cholecystitis pain is due the area being close to sphincter oddi - Can cause spasm if give morphine cause more pain (DON'T GIVE MORPHINE) - Give Demerol/meperidine + Sickle Cell Crisis - Very painful due to abnormal blood cell shape accumulating at the branch of blood vessel - DON’T GIVE DEMEROL > adds to accumulative effect and can cause seizures - Give Morphine Assessment for Pain + PQRST - Provoke > what cause the pain - Quality/Quantity - Region >where is the pain; does it radiate - Severe - Time > when is it start + Once you give them pain medication - Go back and check there pain level - Patients have the right to be without pain or at least a 3/10 pain level in order to be able to do their ADLs + PAIN IS WHATEVER THE PATIENT SAYS - No matter their age - Whatever causes the pain in adults can also be the cause of children's pain Different Types of Vaccines + Newborne - Hep B > Received before going home + When two months - Hep B (second dose) - DTap - Rota (for diarrhea) - IPV - Hib (prevent epiglottitis) - PVC (for Pneumonia) > If have fever, send home and tell them to go back when they don’t have fever > Normal to have pain on injection site  + More than 12 months - Able to receive live vaccine > MMR > Chicken Pox > OPV + MMR - Next schedules dose would be at 4 to 6 yrs old - Don’t give this vaccine to pregnant women > can cross placenta barrier causing defect to baby - Don’t give if allergic to > egg > neomycin > sorbitol > gelatin - Don’t give if WBC low - Don’t give to infants + Flu Vaccine - Don’t give if allergic to eggs - Not live vaccine Antigen + Viral + Can be - Bacteria - Foreign body - Fungal + Go inside body - B cell makes antibody and try to bind antigen to prevent problems + Can be hypersensitive - Can be a problem Vaccine Can be active or passive + Active - Give vaccine and have to wait for body to make antibodies + Passive - Give something that already has the antibodies so they don’t have to wait for the body to make those antibodies Toxoids - Take from the toxin - make the toxin weak so it will not cause a problem PPD (Purified Protein Derivative) Test for TB + Give in forearm + 10 degree intradermal + See bebel + Check after 48 to 72 hr Positive tests + If more than 10 mm induration + If WBC low and more than 5 mm + For remote area more than 15 mm > If positive = they were exposed to TB > If test is positive, next step would be x-ray > If positive with x-ray, TB would be confirmed with sputum - Has to be positive 3x consecutively to say patient has active TB - To confirm that it is negative, it has to be narrative 3x consecutively Immunity + Organ - Spleen - Lymph nodes - WBC Natural vs Artificial + Natural - Get sick and already have your antibodies - Babies get it from mom + Artificial - Something that is given - Such as vaccines Cellular Immunity + CD4 + T Lymphocyte Humoral Immunity + B Cell - Produce antibodies + Plasma cell Spiderman Droplet Precautions - Sepsis - Pertussis - Influenza - Diferi - Epiglottitis - Rubella - Meningitis - Adenovirus - N + Stand 3 to 6 feet + Use mask + Don't let them sneeze or cough on your face MTV Airborne precautions - Measles - Tuberculosis - Varicella + N95 mask + Negative air room + Close door + HEPA MRSWEE Contact precautions - MRSA - Respiratory Infection (RSV - Skin infection (scabies) - Wound Infection - Eye infection (pink eye) - Enteri (C.Diff) + Wash hands + Use gloves + Don't put belonging on their bed Hepatitis A and E + Contact precaution + Don't share utensils B, C, D, G + Transmitted via blood and sex + No sex or sharing needles Anesthetic Lidocaine - Used locally - Used to numb area before surgery Epidural - For women about to give birth - Cannot feel the pain but can still move Spinal Block - Given deeper than epidural - Not able to move and don't feel pain General Anesthetic - For major surgery CLASS NOTES FOR PAIN MANAGEMENT Mild Pain - Give NSAID - Moniot for bleeding If bleeding - Give acetaminophen Live problem - No acetaminophen - Use NSAID Morphine (Opioids) - Monitor respiration (PRIORITY) - Respiration 12 to 20 - If respiration at 12 report + Respiratory Failure - Give Narcan/ Naloxone (antidote for Opioids) + Can have - Constipation (increase fiber and fluids) - Risk for fall - Orthostatic hypotension - Paralytic ileus Pancreatitis and Cholecystitis - Morphine will cause spasm to Sphincter Oddie - Give demerol/meperidine Sickle Cell Crisis - Give morphine - If give demerol = cumulative (adding on) and cause seizure Pain Assessment - PQRST (Provoke, Quality/ Quantity, Region, Severe, Time) - Wong Baker Scale/FLACC Breakthrough - Pain for in the middle - Waiting for next dose Pain - Vital sign increase Aspirin - Not for children - Exception - Kawasaki - RHF - Juvenile RA - Can cause Reye syndrome - Before surgery or go to dentist - Stop aspirin Non Pharmacological Intervention First TEN - Stimulate nerves - Mild to moderate pain PCA - Only press only when in pain - Family cannot control only patient can Acetaminophen - Every 6 hrs - 4 grams for adults - 3 grams for children - Can damage liver - Antidote: acetylcysteine/ Mocomyst - Jaundice - Liver makes bile - Hyperbilirubinemia Adjuvant + Gabapentin/Neurontin - For phantom pain + Corticosteroids - Anti-inflammatory - Can indirectly relief pain Opioids + Morphine - For hospice (comfort measure) + Hydromorphone - 50 mg - Severe pain unrelieved by morphine + Overdose Opioid = pupils constrict + Withdrawal Opioid = pupils dilate + Overdose Stimulant = pupils dilate + Withdrawal Stimulants = pupils constrict + Interaction - Dilantin - Aspirin - Antacid - MAOI - Birth control - Herbal *Side rails up after giving sedating medication Anesthesia - Reduce pain + Lidocaine - Numb pain - Don't eat right away  + Epidural - Between L3, L4 - Sheath covering spina; cord = meninges - Med around meninges around dura mater - Don’t feel pain but feel pressure - Able to move + Spinal Block - Deeper in spinal cord - Not able to move + General Anesthetic - Put patient to sleep - ADR = decrease respiration CLASS NOTES FOR IMMUNIZATION Antigen - Foreign body Antibody - Produced by B cell - Sense foreign body - Inside plasma Antigen-Antibody Response - Specific antibody reacting specifically with that antigen Artificial - Make vaccine + Live vaccines - MMR - Chickenpox - OPV + Weakened Vaccine - Virus is weakened Natural - Has the disease and make antibody Vaccine Schedule Newborn - Give Hep B and RSV vaccine *RSV transmitted via droplet or contact and is contagious 2 months - Hep B second dose - DTaP - Hip 12 months or up - MMR 4 to 6 yr old - Check fo live vaccine 6 months - Influenza - After 6 months given annually Pertussis Vaccine - 2 months - 4 months - 6 months - 15 to 18 months - 4 to 6 yr old No MMR If pregnant If allergic to : - Gelatin - Egg - Sorbitol - Gelatin No Flu vaccine if allergic to - Egg No varicella vaccine if allergic to : - Neomycin - Sorbitol - Gelatin Vaccines + Attenuated = to make it weak + Inactive = killed virus Toxoid - Attenuated or weakened toxin + Tetanus - Every 10 yr - For nurses is every 5 yr - For rusty nail and burns give vaccine + Clostridium Tetani - DTaP prevents tetanus - Tetanus = tetani Purpose - For immunity, treatment, prevention Adverse Reaction - Allergic reaction - Arthralgia - LOC + Mild - Pain and swelling in injection site Interaction - Interact with other vaccine given at eh same time Implications and Teaching + Access for - Allergic to egg or feather - Presence of infection - Use of immunosuppressants - Pregnancy + Before going home after child birth - Check mom for immunity of MMR - If get vaccine don’t get pregnant for 3 months because vaccine can cause birth defects Complications of Mumps - Orchitis = inflammation of testicles - No receiving MMR = mumps = orchitis In vivo Diagnostic Biologic Agent TB - Intradermal - 10 degrees - Wheal + Positive = more than 10 mm induration > PPD positive = exposed to TB > X ray = see calcification = not confirming TB > Sputum - 3x positive consecutively = active TB - 3x negative consecutively = no active TB + WBC low - More than 5 mm induration = positive + Remote healthy areas - More than 15 mm induration = positive Antiproliferative - Prevents proliferation - Slows growth of lymphocytes responsible for autoimmune disease Immunomodulating Therapy + Side effects/ Adverse Reactions - Reduces immunity - Increase risk for infection / cancer] + Teaching - Inform of allergies HPV - 11 to 12 yr - Avoid cervical cancer Elderly - Shingles - Pneumonia - Influenza *make sure they are healthy before giving vaccine