Fall 2010 B233 Test Map

Exam 5

(45 multiple choice and 5 math)

Renal failure patients and medication dosage adjustment

DOSAGE MUST BE LOWERED – THE NORMAL DOSAGE RANGE COULD BE FATAL

Implications of protein in the urine

KIDNEYS ARE NOT FUNCTIONING CORRECTLY

Chlorothiazide
-common side effects of this medication
-relate side effects to mechanism of action
-when do you take this medication?
Furosemide
-loop diuretics
-know mechanism of action—be specific
It works by increasing the amount of salt and water that the kidneys remove from the blood. This extra
salt and water is then passed out through the urine. By increasing the amount of water removed from the
blood, furosemide causes a decrease in blood volume. Because of this effect, the drug can lower blood
pressure and help with water retention.

Spironolactone
-dietary restrictions—what kind of foods to avoid
AVOID USE OF POTASSIUM BASED SALT SUBSTITUES, DO NOT EAT EXCESS AMOUNTS OF
FOOS HIGH IN POTASSIUM

Hypokalemia
-physical signs and symptoms
OCCURS WHEN SERUM POTASSIUM LEVEL FALLS BELOW 3.5 AND CAUSES MUSCLE
WEAKNESS, LETHARGY, ANOREXIA, DYSRHYTHMIAS, AND CARDIAC ARREST

Implications of Hypertonic versus hypotonic crystalloid solutions

-what if the wrong one is hung?

Low sodium
-what kind of fluid to hang?
HYPERTONIC SOLUTION IS HUNG

Hyperkalemia
-standard protocol…why does it work?
LOWER THE DOSE OF POTASSIUM SPARING DIURETIC, GLUCOSE OR INSULIN CAN BE
ADMINISTERED BECAUSE IT CAUSES POTASSIUM TO LEAVE THE EXTRACELLULAR FLUID
AND ENTER CELLS. CALCIUM GLUCONATE OR CALCIUM CHLORIDE MAY BE ADMINISTERED
TO COUNTERACT POTASSIUM TOXICITY TO THE HEART. SOCIDUM BICARBONATE IS
SOMETIMES INFUSED TO CORRECT ACIDSOSIS CONCURRENT WITH THE HYPERKALEMIA
(POLYSTERRENE SULFONATE CAN BE GIVEN ORALLY OR RECTALLY)
Potassium chloride
-implications for patient if given IV bolus versus IV drip
-what must be done to liquid form prior to administration
MUST DILUTE THE LIQUID PRIOR AND MUST GIVE THE IV BOLUS SLOWLY

Serum albumin
-what are you watching for in your patient when giving this?
Symptomatic relief and supportive treatment in management of shock, burns, hypoprothrombinemia, adult
respiratory distress syndrome, cardiopulmonary bypass, acute liver failure, acute nephrosis, sequestration of
protein-rich fluids, erythrocyte resuspension, hypotension or shock during renal dialysis, hyperbilirubinemia
and erythroblastosis fetalis.
Hypotension after rapid infusion (above 10 mL/min) or intra-arterial administration to patients undergoing
cardiopulmonary bypass; rapid administration may cause vascular overload, dyspnea or pulmonary edema.
Exercise and fluid replacement
Acetaminophen
-dosage form for children versus infants
*CHILDREN LESS THAN ONE YEAR NEED “INFANT DROPS” RATHER THAN CHILDREN’S
LIQUID TO DECREASE THE AMOUNT OF FLUID TO BE CONSUMED
-prevention of overdose in children and adults
-drug to drug interactions
*ACETAMINOPHEN INHIBITS WARFARIN METABOLISM CAUSING THE ANTICOAGULANT
TO ACCUMLATE TO TOXIC LEVELS, WHICH MAY RESULT IN ELEVATED WARFARIN LEVELS
AND BLEEDING. ALSO HEPATOXIC DRUGS AND BARBITUARES ARE NOT RECOMMENDED
BECAUSE IT MAY RESULT IN LIVER FAILURE FROM HEPATIC NEVROSIS.

Histamine
-role in seasonal allergies
*HISTAMINE IS A KEY CHEMICAL MEDIATOR OF INFLAMMATION THAT IS STORED
PRIMARILY WITHIN MAST CELLS. MAST CELLS DETECT FOR INJURY AND RELEASE
HISTAMINE WHICH WHEN IT REACHES ITS RECEPTORS IT CAUSES ITCHING, INCRSED MUCUS
SECRETION, AND RUNNY NOSE. IN SEVERE CASES IT MAY CAUSE BRONCHOCONSTRICTION,
EDEMA, HYPOTENSION. RECEPTROS RESPONSIBLE ARE H1.

Prednisone
-taken long term, why or why not?
LONG THERAPY IS NOT RECOMMENDED BECAUSE IT CAUSES THE ADRENAL GLAND TO
NOT FUNCTION CORRECTULY, AND CUSHING SYNDROM MAY BE DEVELOPED. SOMETIMES
CLIENTS WILL TAKE MEDICATION EVERY OTHER DAY TO HELP THE ADRENAL GLAND
FUNCTION
Ibuprofen
-max daily amount
*MAX IS 3200 MG PER DAY
NSAIDs
 -side effect; what you want your patients to not experience with NSAID therapy
NSAIDS CAN CAUSE GASTRIC UPSET, NAUSEA, VOMITING, ULCERATION, EPIGASTRIC PAIN,
HEARTBURN AND BLEEDING MUST BE MONITORED BECAUSE NSAIDS HAVE AN
ANTICOAGULANT EFFECT.
= MAKE SURE PATIENTS HAVE NO LIVER PROBLEMS, AND THAT THEY DO NOT HAVE
STOMACH PAIN

Antibiotics
-some slow growth, what does this mean in terms of what the body does?
ANTIBIOTICS EXERT SELECTIVE TOXICITY ON BACTERIAL CELLS BY TARGETING THESE
UNIQUE DIFFERENCES BETWEEN BACTERIAL AND HUMAN CELLS.

Multiple Antibiotics
-common side effect when on multiple antibiotics
RESISTANCE ISCOMMON WHEN USING MORE THAN ONE. EFFICACY OF EACH DRUG IS OFTEN
REDUCED (ANTAGONISM)

Resistance
-how does this happen? What is the most common way this happens?
KILLING POPULATIONS OF BACTERIA THAT ARE SENSITIVE TO THE DRUG LEAVES BEHIND
THOSE MICROBES THAT POSSESS MUTATIONS THAT MADE THEM INSENSITIVE TO THE
EFFECTS OF THE ANTIBIOTIC. PERSRIBING ANTIBIODICS WHEN NOT NEEDED, AND NOT
FINISHED A PRESCRIPTION CAN CAUSE THIS.

Blood Cultures
-when do you obtain these? Are there special parameters?
LABORATORY TESTS SHOULD BE CONDUCTED TO IDENTIFY THE SPECIFIC PATHOGEN PRIOR
TO BEGINNING ANTI-INFECTIVE THERAPY. WHEN MILD INFECTIONS ARE PRESENT
SOMETIMES LABORATORY IDENTIFCATION IS NOT NECESSARY.

Gentamycin
-common adverse effect
OTOTOXICITY CAN PRODUCE A LOSS OF HEARING OR BALANCE, WHICH MAY BECOME
PERMANENT. IMMEDIATELY REPORT TINNITUS, HIGH-FREQUENCY HEARING LOSS,
PERSISTENT HEADACHE, NAUSEA OR VERTIGO

Multiple drugs for Tuberculosis

-why?
THE MYCOBACTERIA GROW SLOWLY, AND RESISTANCE IS COMMON SO USING MULTIPLE
DRUGS LOWERS THE POTENTIAL FOR RESISTANCE AND INCREASES THE SUCCESS OF THE
THERAPY. FIRST LINE ARE USED FIRST AND ARE LESS TOXIC AND MORE EFFECTIVE, AND
SECOND LINE IS USED WHEN A RESISTANCE DEVELOPS. THOSE WITH COMPROMISED
IMMUNE SYSTEMS MAY ALSO RECEIVE DRUGS TO PREVENT TB. THERAPY IS LONG AND MAY
TAKE SEVERAL MEDICATIONS
Penicillin G
-IV; protocol
DO NOT MIX PENICILLIN AND AMINOGLYCOSDES IN THE SAME INTRAVENOUS SOLUTION
AND GIVE IV MEDICATIONS 1 HOUR APART TO PREVENT INTERACTIONS. MUST WEAR AN
ALERT BRACELET IF ALLERGIC TO PENICILLINS

Role of a nurse for a patient with infectious disease

-think about JCAHO’s major role for nursing
Fungal infection
-who is at risk?
THOSE AT RISK ARE HAVING PROLONGED THERAPY WITH CORTICOSTEROIDS,
EXPERIENCING EXTENSIVE BURNS, RECEIVING ANTINEOPLASTIC AGENTS, HAVING
INDWELLING VASCULAR CATHETERS OR RECENTLY RECEIVED ORGAN DRANSPLNATS
-what are the benefits of the new drugs?
THEY HAVE LESS NEPHROTOXIC PROPERTIES AND HAVE FEWER SERIOUS ADVERSE
EFFECTS(KIDNEY DAMAGAE) ALSO CAN BE ADMINISTERED ORALLY

Nystatin
-oral administration
CONTRADICTED IN PREGNANCY, MAY BE TOLD TO SWISH ONLY AND SPIT IF THERE ARE GI
PROBLEMS. FOR ORAL CANDIASIS THE DRUG SHOULD BE SWISHED FOR 2 MINUTES.

Amphortericin B
-most important lab value for patient on this med (SERIOUS FUNGAL)
CAUSES KIDNEY DAMAGE IN 80 PERCENT OF PEOPLE, SO CAREFULLY MONITOR INTAKE AND
OUTPUT, WEIGHT, OLIGURIA, HEMATURIA, ALSO OBTAIN BLOOD UREA NITROGE (BUN),
CREATININE, COMPLETE BLOOD COUNT, ELECTORYLYE AND LIVER TEST BEFORE
TREATMENT. WITHHOLD IF BUN ABOVE 40 MG OR SERUM CREATINE RISES ABOVE 3 MG

Metrodinazole
-patient education regarding administration guidelines (ANTI MALARIA)
PRACTICE RELIABLE CONTRACEPTION, AVOID DRINKING, RECOGNIZE THAT URINE MAY
TURN REDDISH BROWN, HAVE SEXUAL PARTNERS TREATED TO PREVENT REINFECTION,
IMMEDIATELY REPORT SEIZURES, NUMBNESS IN LIMBS, NAUSEA, HIVES, ITICHING, TAKE THE
DRUG WITH FOOD

Mebendazole
-side effects of this drug; what patients should expect for several days after med
SOME PARASITES WILL BE POOPED OUT, AND THE CLIENT SHOULD TAKE SHOWERS INSTEAD
OF BATH AND CHANGE UNDERGARMENTS, LINENS, AND TOWELS DAILY. SIDE EFFECTS ARE
ABDOMINAL PAIN, DISTENTION AND DIARHEA.

Malaria prevention drugs

-why do people become noncompliant with these drugs?
THEY GET SICK
AIDS virus
-what is the nature of viruses?
VIRUSES MUST ENTER A HOST AND THEN THEY USE HOST DNA TO MAKE THEIR RNA
-what is unique about the HIV virus?
ABLE TO MAKE DNA
-what lab is indicative of effectiveness of antiviral therapy?

-what drug is safe for pregnant women and reduces the transmission of AIDS from mother to baby?
Zidovudine
-lab value that indicates a side effect of this drug
LOW WHITE BLOOD CELL COUNT AND HEMOGLOBIN
Acyclovir
-priority assessment for patient on this
ASSESS IF LESIONS ARE GOING AWAY – NEUROTOXIC

AIDS antiviral therapy

-why is there high rates of noncompliance?
THERAPY IS EXPENSIVE AND COMPLICATED

HAART
-vital to the success of HAART